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Bringing the Montessori Methods for Dementia to the Hospital Emergency Room
The idea: Use Montessori Methods for Dementia™ to reduce anxiety and confusion associated with long waits in hospital emergency rooms.

Hi! My name is Judy Cohen and I'm the founder of L'chaim Retirement Homes and Dementia Support Seniors Day Center. I live and work in Toronto Canada. I have been working with individuals with dementia for past 11 years and continue to do so.

Understanding the anxiety and confusion associated with the long wait in an Hospital Emergency room, especially for elderly suffering from dementia, we decided to try and implement the Montessori Methods for Dementia™ and make the wait a less anxious and stressful experience.

As a first step, we donated a pile of Montessori activities to the emergency room. The staff are starting to be trained and we work together to better the long wait at the emergency room for the frail, frighten elderly with dementia. Slowly we get over challenges and the head nurse is writing a paper on the success stories and some problems we together are trying to overcome.

One of the many ideas brought to the waiting room at the hospital is the booklet we created with pictures and large writing, explaining what they are waiting for, where they are and what are the "actions" the nurse, technician or doctor will take with them -- for example -- a picture of a nurse taking blood, a picture of an X-ray room and an X-ray machine, and an explanation about what will happen there.

People with dementia cannot remember where they are, why they are there, and what are the normal procedures to expect. We need to bring the memory back to them.

GEM nurses and hospitals should think about implementing this idea. People at home that care for loved ones can use the Montessori Methods at home -- it works!

Contact Judy at the retirement home: or visit the website

Contact Judy at the day center information: or visit the day center website

Published on 29 January 2013



By Mary O’Hara

Tuesday 17 April 2012

Psychiatrist Suman Fernando warns that the government has walked away from the vital issue of race in mental health treatment

After decades of lobbying governments to address the disproportionately poor outcomes of people from black and minority ethnic groups (BME) in mental health services in Britain, psychiatrist Suman Fernando claims that under the coalition government there is a "huge" risk of race "falling under the radar altogether".

Fernando, 80, has this week launched his latest initiative, an informal inquiry into the effects on individuals of a diagnosis of schizophrenia – a serious condition applied to some groups more than others, and especially to black men. "When the label of schizophrenia is attached to people it can cause serious problems through increasing stigma and undermining the humanity of people," he explains.

Fernando wants also to draw attention to what is unfolding now within the NHS and the government, and says conditions are "going to get worse generally across the health service" for BME patients, because amid all the upheaval of NHS reforms the sidelining of "vital" issues around race and mental health provision is going unnoticed.

"They have walked away from it completely," he says of the coalition's attitude to addressing racial disparities in mental health diagnosis and treatment. "You can't mention equalities [within the Department of Health]. There is a sense that race is off the agenda. It's the idea of 'post-race'. That is what they are saying. [But] that's not the case, and it's very worrying." He reserves particular ire for the Liberal Democrats, who he says "were very supportive" of efforts to improve the system for BME groups before getting into government but now demonstrate "no interest" in reform.

Fernando, who grew up in Sri Lanka and trained and practised as a psychiatrist in Britain before focusing on academia and activism, claims that what was already a low priority will be marginalised further. "You get meetings now [in the health department] where there is no representation of BME issues on mental health," he says. "That wouldn't have happened 10 years ago. There was always a voice there."

"There is tokenism," he adds. "There are one or two brown-skinned people who always get to chair something but not to actually say anything, because as a chair you can't really say very much."

Racial stereotypes

Fernando has written extensively on the poor mental health outcomes of some ethnic groups and has suggested that the health service could be "institutionally racist", arguing that "inherited" ideas about racial stereotypes among mental health professionals – such as the "perceived dangerousness" of black men – has produced a skewed diagnostic and treatment system.

According to data from the Labour government's 2005 Count Me In census, which for the first time collated statistics on ethnic minorities in mental health services, black men and mixed race men are three or more times more likely than the general population to be admitted to a psychiatric unit. Women from the same groups are two or more times more likely to be admitted. Meanwhile, other research has found that despite there being no evidence to suggest that African Caribbean people are more likely to be aggressive than their white counterparts, staff in mental health hospitals are more likely to perceive people from this background as potentially dangerous.

Alongside other campaigners, Fernando has repeatedly called attention to these and other race-related data, such as the fact that black men in Britain are much more likely to be sectioned under the Mental Health Act and that once in a psychiatric institution they tend to be held for longer than their white counterparts. Add to this disparities in access to "talking therapies" and higher-than-average rates of supervised community treatment orders for some BME groups, and what emerges is "clear evidence" of a system in need of reform, Fernando says.

His determination to shine a light on the coalition's lack of action on race and mental health is a continuation of his role as a thorn in the side of policy-makers. Despite being on several mental health advisory boards over the years, including the Mental Health Act Commission, Fernando's career is marked by his refusal to accept that a few political initiatives are evidence of real change.

His role as an agitator is probably best exemplified by his public rejection of an OBE in 2007, in protest at proposed revisions under the previous Labour government's Mental Health Act – changes he and others argued would enable people "who were seen as dangerous" to be much more easily sectioned and "to be kept sectioned almost indefinitely".

As an advocate of "trans-cultural psychiatry" (an approach that questions the appropriateness of applying Western disorders to different cultures and ethnic groups) Fernando has long been at the forefront of calls for a rethink by mental health professionals about how they engage with service users from different ethnic and cultural backgrounds. When his first book on the subject, Mental Health, Race and Culture, was published in 1988, he recalls being shunned by some in his profession. "I think they thought I was accusing them. I said [to them], 'If you think I am criticising you I am also criticising me.'"

As one of very few "brown-skinned people" in psychiatry in Britain during the 1960s and 70s, he says he was well aware of his uniqueness and that perhaps because of this "the race thing" – and especially different rates of diagnosis for some conditions – struck him right away and quickly "became a mission".

Have there been any improvements since then?

"In the 90s there was recognition that things needed to be tackled," Fernando responds. He commends the last Labour administration for attempting to integrate issues to do with race into broader mental health strategies. "There were good intentions. There were many government schemes. But too often it ends up tokenistic," he adds sombrely. "Tokenism is counter-productive. It prevents change."

Can of worms

More contentious, he says politicians are afraid of doing anything too radical or directing too much attention to race: "This is where we keep coming back to racism. There is the fear [among politicians] that it is a can of worms and that the right will accuse them of pandering to [black people]".

What of the future?

The four-person schizophrenia inquiry, which includes a consultant psychiatrist, a service-user advocate and an activist service user, will hear from a range of people about their experiences of living with a diagnosis. This body of firsthand evidence will be presented in the autumn to professional bodies including the Royal College of Psychiatrists and the Department of Health.

Then, despite his advanced years, Fernando has no plans "to step back" from activism. A good first step for real reform of the mental health system, he says, would be a commission to examine the impact of race and culture on diagnosis and treatment. Crucial too, he adds, is that BME activists build closer ties with service users and revise their campaigning approach. "Maybe we should be making more alliances."

Curriculum vitae

Age 80.

Lives North London.

Family Married with one daughter and two grandchildren.

Education Secondary education in Colombo, Sri Lanka; BA in natural sciences, University of Cambridge; doctor of medicine, University of Cambridge; fellow, Royal College of Psychiatrists.

Career 2000-present: honorary professor in faculty of social sciences and humanities, London Metropolitan University; 2007-11: consultant to trauma and global health programme co-ordinated by McGill University, Montreal; 1998-11: senior lecturer in mental health, University of Kent; 1969-94: consultant psychiatrist, Chase Farm hospital; 1961-69: psychiatrist at various mental health hospitals in London.

Public life 2012: part of a group co-ordinating an inquiry into 'schizophrenia' label; 1988–2009: on various committees to advise on mental health services, including chair and member, Transcultural Psychiatry Society (UK); consultant, World Health Organisation mental health and substances dependence department; 1986-95: chair, Mental Health Act Commission's standing committee on race and culture.

New component found in coffee could help in the fight against Alzheimer's

ScienceDaily (June 28, 2011) — A yet unidentified component of coffee interacts with the beverage's caffeine, which could be a surprising reason why daily coffee intake protects against Alzheimer's disease.

A new Alzheimer's mouse study by researchers at the University of South Florida found that this interaction boosts blood levels of a critical growth factor that seems to fight off the Alzheimer's disease process.

The findings appear in the early online version of an article to be published June 28 in the Journal of Alzheimer's Disease. Using mice bred to develop symptoms mimicking Alzheimer's disease, the USF team presents the first evidence that caffeinated coffee offers protection against the memory-robbing disease that is not possible with other caffeine-containing drinks or decaffeinated coffee.

Previous observational studies in humans reported that daily coffee/caffeine intake during mid-life and in older age decreases the risk of Alzheimer's disease. The USF researchers' earlier studies in Alzheimer's mice indicated that caffeine was likely the ingredient in coffee that provides this protection because it decreases brain production of the abnormal protein beta-amyloid, which is thought to cause the disease.

The new study does not diminish the importance of caffeine to protect against Alzheimer's. Rather it shows that caffeinated coffee induces an increase in blood levels of a growth factor called GCSF (granulocyte colony stimulating factor). GCSF is a substance greatly decreased in patients with Alzheimer's disease and demonstrated to improve memory in Alzheimer's mice. A just-completed clinical trial at the USF Health Byrd Alzheimer's Institute is investigating GCSF treatment to prevent full-blown Alzheimer's in patients with mild cognitive impairment, a condition preceding the disease. The results of that trial are currently being evaluated and should be known soon.

"Caffeinated coffee provides a natural increase in blood GCSF levels," said USF neuroscientist Dr. Chuanhai Cao, lead author of the study. "The exact way that this occurs is not understood. There is a synergistic interaction between caffeine and some mystery component of coffee that provides this beneficial increase in blood GCSF levels."

The researchers would like to identify this yet unknown component so that coffee and other beverages could be enriched with it to provide long-term protection against Alzheimer's.

In their study, the researchers compared the effects of caffeinated and decaffeinated coffee to those of caffeine alone. In both Alzheimer's mice and normal mice, treatment with caffeinated coffee greatly increased blood levels of GCSF; neither caffeine alone or decaffeinated coffee provided this effect. The researchers caution that, since they used only "drip" coffee in their studies, they do not know whether "instant" caffeinated coffee would provide the same GCSF response.

The boost in GCSF levels is important, because the researchers also reported that long-term treatment with coffee (but not decaffeinated coffee) enhances memory in Alzheimer's mice. Higher blood GCSF levels due to coffee intake were associated with better memory. The researchers identified three ways that GCSF seems to improve memory performance in the Alzheimer's mice. First, GCSF recruits stem cells from bone marrow to enter the brain and remove the harmful beta-amyloid protein that initiates the disease. GCSF also creates new connections between brain cells and increases the birth of new neurons in the brain.

"All three mechanisms could complement caffeine's ability to suppress beta amyloid production in the brain" Dr. Cao said, "Together these actions appear to give coffee an amazing potential to protect against Alzheimer's -- but only if you drink moderate amounts of caffeinated coffee."

Although the present study was performed in Alzheimer's mice, the researchers indicated that they've gathered clinical evidence of caffeine/coffee's ability to protect humans against Alzheimer's and will soon publish those findings.

Coffee is safe for most Americans to consume in the moderate amounts (4 to 5 cups a day) that appear necessary to protect against Alzheimer's disease. The USF researchers previously reported this level of coffee/caffeine intake was needed to counteract the brain pathology and memory impairment in Alzheimer's mice. The average American drinks 1½ to 2 cups of coffee a day, considerably less than the amount the researchers believe protects against Alzheimer's.

"No synthetic drugs have yet been developed to treat the underlying Alzheimer's disease process" said Dr. Gary Arendash, the study's other lead author. "We see no reason why an inherently natural product such as coffee cannot be more beneficial and safer than medications, especially to protect against a disease that takes decades to become apparent after it starts in the brain."

The researchers believe that moderate daily coffee intake starting at least by middle age (30s -- 50s) is optimal for providing protection against Alzheimer's disease, although starting even in older age appears protective from their studies. "We are not saying that daily moderate coffee consumption will completely protect people from getting Alzheimer's disease," Dr. Cao said. "However, we do believe that moderate coffee consumption can appreciably reduce your risk of this dreaded disease or delay its onset."

The researchers conclude that coffee is the best source of caffeine to counteract the cognitive decline of Alzheimer's because its yet unidentified component synergizes with caffeine to increase blood GCSF levels. Other sources of caffeine, such as carbonated drinks, energy drinks, and tea, would not provide the same level of protection against Alzheimer's as coffee, they said.

Coffee also contains many ingredients other than caffeine that potentially offer cognitive benefits against Alzheimer's disease. "The average American gets most of their daily antioxidants intake through coffee," Dr. Cao said. "Coffee is high in anti-inflammatory compounds that also may provide protective benefits against Alzheimer's disease."

An increasing body of scientific literature indicates that moderate consumption of coffee decreases the risk of several diseases of aging, including Parkinson's disease, Type II diabetes and stroke. Just within the last few months, new studies have reported that drinking coffee in moderation may also significantly reduce the risk of breast and prostate cancers.

"Now is the time to aggressively pursue the protective benefits of coffee against Alzheimer's disease," Dr. Arendash said. "Hopefully, the coffee industry will soon become an active partner with Alzheimer's researchers to find the protective ingredient in coffee and concentrate it in dietary sources."

New Alzheimer's diagnostic guidelines, now encompassing the full continuum of the disease from no overt symptoms to mild impairment to clear cognitive decline, could double the number of Americans with some form of the disease to more than 10 million. With the baby-boomer generation entering older age, these numbers will climb even more unless an effective preventive measure is identified.

"Because Alzheimer's starts in the brain several decades before it is diagnosed, any protective therapy would obviously need to be taken for decades," Dr. Cao said. "We believe moderate daily consumption of caffeinated coffee is the best current option for long-term protection against Alzheimer's memory loss. Coffee is inexpensive, readily available, easily gets into the brain, appears to directly attack the disease process, and has few side-effects for most of us."

According to the researchers, no other Alzheimer's therapy being developed comes close to meeting all these criteria.

"Aside from coffee, two other lifestyle choices -- physical and cognitive activity -- appear to reduce the risk of dementia. Combining regular physical and mental exercise with moderate coffee consumption would seem to be an excellent multi-faceted approach to reducing risk or delaying Alzheimer's," Dr. Arendash said. "With pharmaceutical companies spending millions of dollars trying to develop drugs against Alzheimer's disease, there may very well be an effective preventive right under our noses every morning -- caffeinated coffee."

This USF study was funded by the NIH-designated Florida Alzheimer's Disease Research Center and the State of Florida.

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