Monday, 30 April 2012

COMMON DUST


By Georgia Douglas Johnson


And who shall separate the dust
What later we shall be:
Whose keen discerning eye will scan
And solve the mystery?

The high, the low, the rich, the poor, 

The black, the white, the red, 

And all the chromatique between, 

Of whom shall it be said:

Here lies the dust of Africa; 

Here are the sons of Rome; 

Here lies the one unlabelled, 

The world at large his home!

Can one then separate the dust? 

Will mankind lie apart, 

When life has settled back again 

The same as from the start?

Sunday, 29 April 2012

DEAD

Most people think life sucks, and then you die. Not me. I beg to differ. I think life sucks, then you get cancer, then your dog dies, your wife leaves you, the cancer goes into remission, you get a new dog, you get remarried, you owe ten million dollars in medical bills but you work hard for thirty five years and you pay it back and then one day you have a massive stroke, your whole right side is paralyzed, you have to limp along the streets and speak out of the left side of your mouth and drool but you go into rehabilitation and regain the power to walk and the power to talk and then one day you step off a curb at Sixty-seventh Street, and BANG you get hit by a city bus and then you die. Maybe.
The final hour when we cease to exist does not itself bring death; it merely of itself completes the death-process. We reach death at that moment, but we have been a long time on the way.

TWISTERRR. A free trial to flee.

Betty Botter had some butter, "But," she said, "this butter's bitter. If I bake this bitter butter, it would make my batter bitter. But a bit of better butter-that would make my batter better." So she bought a bit of butter, better than her bitter butter, and she baked it in her batter, and the batter was not bitter. So 'twas better Betty Botter bought a bit of better butter. Then I saw Peter Piper picked a peck of pickled peppers. Did Peter Piper pick a peck of pickled peppers? If Peter Piper picked a peck of pickled peppers, where's the peck of pickled peppers Peter Piper picked? But I slit the sheet, the sheet I slit, and on the slitted sheet I sit as She sells sea shells by the sea shore. The shells she sells are surely seashells. So if she sells shells on the seashore, I'm sure she sells seashore shells. Then I tweeted a Tudor who tooted a flute tried to tutor two tooters to toot. Said the two to their tutor, "Is it harder to toot or to tutor two tooters to toot?"
You might wonder who me be, twist erring, I am not the pheasant plucker, I'm the pheasant plucker's mate. I am only plucking pheasants 'cause the pheasant plucker's running late, I saw a flea and a fly flew up in a flue. Said the flea, "Let us fly!" Said the fly, "Let us flee!" So they flew through a flaw in the flue. Suddenly a bitter biting bittern Bit a better brother bittern, And the bitter better bittern Bit the bitter biter back. And the bitter bittern, bitten, By the better bitten bittern, Said: "I'm a bitter biter bit, alack!" but I believe Mr. See owned a saw. And Mr. Soar owned a seesaw. Now See's saw sawed Soar's seesaw before Soar saw See, which made Soar sore.
Had Soar seen See's saw before See sawed Soar's seesaw, See's saw would not have sawed Soar's seesaw.
So See's saw sawed Soar's seesaw. But it was sad to see Soar so sore just because See's saw sawed Soar's seesaw!
Let me tell a tale, a tree toad loved a she-toad who lived up in a tree.
He was a two-toed tree toad but a three-toed toad was she.
The two-toed tree toad tried to win the three-toed she-toad's heart, for the two-toed tree toad loved the ground that the three-toed tree toad trod.
But the two-toed tree toad tried in vain. He couldn't please her whim.
From her tree toad bower with her three-toed power tThe she-toad vetoed him.
Then here I stand looking across here was a young fisher named Fischer who fished for a fish in a fissure. The fish with a grin, pulled the fisherman in; Now they're fishing the fissure for Fischer. Surely a pleasant place to place a plaice is a place where a plaice is pleased to be placed.

DEATH AWAITS

You; you told me to accept the things to which binds me, you want me to love the person with whom fate brings me and to do so you prefer with all my heart. Why, then lies you still, love me and the world would still be mine. Tell you the truth, your song has been about the faith and beauty of this world; but on top of all these memories is love and I propose no more aches and suffering. You were made absolutely to be loved, eternally.
I see no bravery in your eyes but a huge sadness as death approaches. I pray my love to thee, a love not only for what you are but for what I am when I'm with you. They say if you love someone, let them go, how? When I am you that suffers with morphine hopelessly dripping into your blood. For a heaven on earth I lived by wooing thee, now thou lay motionless drifting away. Spent most of my days with you and shared my nights in your beautiful firm arms.
Tales on your youth tells it all, lots of charm and might on every stage you trod, you were but mighty, your wasted muscles confirm the chants received from your foes and pals, listen to my song, a story to outlast eternity. Sweetheart be mine, stay in my open arms to fill my entire heart. You reached your peak swiftly, hastily, you commanded the world to virtually bow to your bark and call, which wittingly hit me to be, and since, I vowed to be by your graceful side.
Truly I remained by you, though this sudden end bestowed on our fusion brings fort our separation, splits my heart and worst upon my misery, time and time again I must await your last breath which endlessly loses it's breadth by the mirth of life. I drunk, in my flooding tears, as it sinks my fears. I see me in you, share your pain because I feel the trauma that ends your life. I stand next to you and feels not your pulse, but your shallowed breath as I await your death. For on the other side you will be me, you are the dreamer and me the part of you they won't take away when your dream ends.
So many around you but they see me not, happy, for that makes it easy to travel away from that which is mortal, into a painless haven, a nowhere that I claim my freedom with your apparition, I am but just you casting off worn out bodies and putting on new ones. For it is better to conquer yourself than to win a thousand battles. Then the victory is mine. It can not be taking from me, not by angels or by demons, neither by heaven nor hell.

Thursday, 26 April 2012

HIGH CHOLESTEROL

About 25% of Americans ages 45 and older took a statin drug in the years 2005-08. That's up from just 2% in 1988-94. These numbers come from the National Center for Health Statistics.

There are roughly 127 million Americans over age 45. So that means there are almost 32 million statin users. That's equal to the entire populations of Florida and Georgia combined.

Are too many people taking a statin or not enough? Before we tackle that thorny question, here's the good news. Just over 13% of Americans have high total cholesterol levels. This is much better than the government's 17%. The results are based on a survey done in 2009 and 2010 by the U.S. Centers for Disease Control and Prevention (CDC).

The CDC defined high total cholesterol as 240 milligrams per deciliter (mg/dL) or greater.

The CDC did not find out why cholesterol levels continue to fall. It would be great to attribute this to healthier eating and more exercise. But the more likely reason is the huge increase in the number of people taking statins or other drugs to lower cholesterol.

Let's go back to the question of too much or too little statin use. People who would say "too much" believe that many of those who take statins for slightly high cholesterol are at low risk of heart disease and stroke. They therefore are not really getting any benefits.

The main reason for taking a statin is to reduce risk. Simply lowering a number does not make you feel better, have better health or live longer. So, this group says, why take a medicine that might have side effects?

Those in the "too little" camp say that what we call a normal cholesterol level is really much too high. They say a normal cholesterol level should be under 150 mg/dL. And they say high cholesterol is not just a number. Coronary artery disease, stroke and other blood vessel diseases are the No. 1 U.S. cause of death. Many people who develop these conditions have cholesterol levels well within the so-called normal range.

What Changes Can I Make Now?

You should be on a statin if you have:

Coronary artery disease
Chronic (long-term) kidney disease
A prior heart attack or stroke
Statin treatment also is usually needed if you have a high LDL cholesterol level and diabetes or other factors that increase your risk of heart attack or stroke. An extremely high LDL almost always requires a statin or other drug to lower cholesterol.

Otherwise, diet and exercise are the best treatment to try first.

Different foods lower cholesterol in various ways. Some deliver soluble fiber. This type of fiber binds cholesterol in the digestive system and drags it out of the body before it can get into circulation. Some foods give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols. They help to block the body from absorbing cholesterol.

Here are 10 specific foods you can eat to lower your cholesterol level.

Oats -- Start your day with a bowl of oatmeal or a cold, oat-based cereal such as Cheerios for breakfast.
Barley and other whole grains -- Like oats and oat bran, barley and other whole grains can help lower the risk of heart disease. They do this mainly by supplying soluble fiber.
Beans are especially rich in soluble fiber. They also take a while for the body to digest. You feel full longer after a meal. That can help you lose weight.
Eggplant and okra -- These two low-calorie vegetables are good sources of soluble fiber.
Nuts -- Almonds, walnuts, peanuts and other nuts lower LDL. They have additional nutrients that protect the heart in other ways.
Vegetable oils -- Use liquid vegetable oils such as olive, canola, sunflower, safflower and others. Using these oils in place of butter, lard or shortening helps lower LDL.
Apples, grapes, strawberries and citrus fruits -- These fruits are rich in pectin, a type of soluble fiber that lowers LDL.
Foods fortified with sterols and stanols The foods include margarines and some others. Sterols and stanols extracted from plants gum up the body's ability to absorb cholesterol from food.
Soy -- Eating soybeans and foods made from them, such as tofu and soy milk, can lower LDL by 5% to 6%.
Fatty fish -- Eating fish two or three times a week can lower LDL in two ways. Fish replaces meat, which has LDL-boosting saturated fats. It also provides omega-3 fats that help to lower LDL.
While exercise won't lower LDL, it will raise your HDL (the good cholesterol). Even if these numbers don't change, exercise reduces your risk of heart attack and stroke later in life.

HAPPINESS

If happiness is the meaning and purpose of life as the great philosopher Aristotle supposed, then we must be happy for all that comes into our life, for even misfortune blesses us if it builds our character and strengthens our faith in pursuing that which is good and noble. Motivational speakers will tell you there are a number of good habits that you can implement to aid in your pursuit of happiness. Start by establishing new habits and then expanding the number to even more. These successful habits might include: Learn to manage your time and not waste it. Be curious and have a desire to always be learning. Practice self-discipline because your motivation and work ethic depend upon it. Always follow through and complete what you start. Be of service to others. Do the right thing; show your integrity. Keep your word. Cultivate a sense of enthusiasm and joy, then notice how you are suddenly attracting exactly the kind of people —helpers, mentors, investors, and guides — you need for happiness and the size of your happiness depends on the depth of your desire. Your ideas are like diamonds.. .without the refining process, they are just dirty rocks, but by cutting away the impurities, they become priceless. One way to spread happiness is to keep your promises. Just as you see someone who is faithful to his word as trustworthy, so your friends, family, and business colleagues will also trust you when you hold to the truth. In this age of spin, when facts get altered in ways to deliberately mislead people and to further ideological agendas, let your truth be absolute. It isn't always easy to align your feelings, thoughts, beliefs, and spoken words so that no one questions your truthfulness or integrity. Gandhi used truth as his nonviolent weapon against adversaries. No one questioned his truthfulness or whether he could keep his promises to others. Imagine the happiness of millions of Indians when his Quit India movement secured their freedom from the British. Courage is facing your fears, Stupidity is fearing nothing at all. Happiness is nothing but winning, winning is not a "sometime"thing. You don't win once in a awhile, you don't do things right once in awhile, you do them right all of the time. Winning is a habit, unfortunately, so is losing.

Secured safety

People with dementia can be particularly vulnerable to abuse and mistreatment for many reasons. Dementia can also make it harder to detect when abuse is taking place and moreover impossible in many situations when cross checking for evidence. One way or the other we all grew up reading or guided or influenced by a Holy book from the variety of respected religion in our havens. Fundamentally non of the teachings around us would condone the act of hitting the aged, we just can't smack or slap the elderly, even some say don't strike a man when he is down. We can't just mishandle people with dementia, thou shalt not pull, push or pinch the disable. The elderly, frail, prone to accidents and instabilities think of the wisdom in their vulnerable realm but otherwise to maltreat or mishandle them is out of any sort of sanity. Incredibly a child is deed rebellious by just standing and adamantly taking on punishment from parents or teachers, we all as kids had to run, make our parents or teachers to feel their unchallenged superiorities and naturally we always surrender to do wrong again. We never meant to retaliate even to people in their prime and had enough strength to punish us as kids, all because we had to respect them.
When they grow old and frail it's then our duty to surrender to them that unconditional security. Then I find it appalling to hear of the vulnerable adult being punched or maltreated in any sense, compare that not to pontius Pilate but the soldier who nailed inches of iron through the palms of Jesus.
If thou had been compelled to commit such atrocities of inhumanity, hold on and let he who without sin to cast the biggest stone at thou but better still regroup your loving nurture and do no evil to the dear vulnerable adult

Wednesday, 25 April 2012

EPILOGUE

EPILOGUE

By Robert Browning


At the midnight in the silence of the sleep-time,
When you set your fancies free,
Will they pass to where—by death, fools think, imprisoned—
Low he lies who once so loved you, whom you loved so,
—Pity me?

Oh to love so, be so loved, yet so mistaken!
What had I on earth to do
With the slothful, with the mawkish, the unmanly?
Like the aimless, helpless, hopeless, did I drivel
—Being—who?

One who never turned his back but marched breast forward,
Never doubted clouds would break,
Never dreamed, though right were worsted, wrong would triumph,
Held we fall to rise, are baffled to fight better,
Sleep to wake.

No, at noonday in the bustle of man's work-time
Greet the unseen with a cheer!
Bid him forward, breast and back as either should be,
"Strive and thrive!" cry "Speed,—fight on, fare ever
There as here!"

Tuesday, 24 April 2012

How she rose to a sweet mum.


The evil men do, drives afar angels and the good remains hard to find. To me every young mother has nothing but bravery, so be it and stronger I pray they mature. A rose is a rose, She is but the glorious sun at day and shines at night to tenderly bring up her heroes. She will always be a sweet scented rose not only in beauty but the touch of care she radiates. The apple, pear and the plum could never be a rose, she remains none but a perfect simple rose to her touched family.

If I have the chance I will send her a single flower, from the deeps of my pure heart where I could speak the language of a fragile leave flower. One perfect sweet scented therapeutic rose, for she deserves none but a rose. Look deep into your lovers soul and deny her not a rose, for you to be a butterfly, sweeping through with secured breeze of ecstasy, just to land on her rose. Embrace her love, become but one with her and call her an angel. Amen.

Monday, 23 April 2012

TABOO

Taboo generally describes that which is unmentionable because, on a hierarchical scale, it is either ineffably sacred, like the name of God, or unspeakably vile, like cannibalism or incest. Freud reminds us, in Totem and Taboo (originally published 1912–1913) that “Taboo is a Polynesian word, the translation of which provides difficulties for us because we no longer possess the idea which it connotes” (1950, 18). Historically, taboos have tended to move from religious to secular, especially sexual to racial, topics, but they can manifest themselves in relation to a wide variety of things, creatures, human experiences, conditions, deeds, and words. The term is now used somewhat loosely of any social indiscretion that ought to be avoided, since strictly speaking, a taboo action should not be performed nor referred to, and a taboo word should never be uttered. Although the word itself is Tongan in origin, having been brought into English by the explorer Captain James Cook in his Voyage to the Pacific Ocean (1777), the broader notion of prohibition is fundamental and found in all societies. Originally spelled tabu in the Melanesian languages, the word had a complex social and anthropological meaning: the adjectival use referred to physical locales that were sacred, set apart for a gods, kings, priests, or chiefs, and therefore prohibited for general use. Cook noted in his account that “the word has a very comprehensive meaning; but, in general, signifies that a thing is forbidden” (II vii). Itcould also be used as a verb: Cook records that a man had “been discovered with a woman who was taboo’d.” (Cook’s description conforms to the taboos of his own time by not referring explicitly to sexual activity.) Linguistically taboo is rooted in word magic, especially in the belief that certain forces and creatures cannot or must not be named. These have come to include a great range such as the name of God, the Devil, death, damnation, disease, madness, being crippled, the varieties of excretion, and copulation, and in some societies, being fired, being poor, being fat, having a humble occupation, or references to underclothes. Taboos can present themselves in unexpected forms. One of the strangest is that the Germanic ancestors of theEnglish regarded the bear as a creature of such totemistic force that it was referred to only indirectly as “the brown one” or via such metaphors as “the honey wolf.” In several religions, such as Brahmanism, Judaism, and Islam, direct reference to the name of God is taboo. This is not the case with Christianity, although there are biblical injunctions, such as the Third Commandment, against “taking the Lord’s name in vain” (Exodus 20:7). Absolute taboos are rare and impractical, since they obviously impede communication and cannot be enforced in an increasingly secular and multicultural world. Consequently, the relationship between taboo and euphemism is symbiotic. As the entry for euphemisms shows, some euphemisms are time-honored, such as those for the name of God, while others are comparatively recent, such as those relating to fatness. Historically, there are few areas of continuous taboo. In medieval times, contrary to expectation, the name of God was used very freely in ways that now seem blasphemous, while “four-letter” words were used incertain literary genres and even in medical textbooks. In the Victorian era virtually all the categories listed in the previous paragraph were taboo. The exception was fatness, admired in the male embonpoint or paunch. Today taboo increasingly refers to prohibitions against socially unacceptable words, expressions, and topics, especially of a sexual and racist nature. They are also governed by context and medium, being most strictly observed in the press, the printed word, and broadcasting, but less so in oral usage, especially in male-to-male talk. A reminder of the earlier force of taboos occurs in this passage: “If a man had been able to say to you when you were young and in love: ‘An’ if tha —, an’ if tha —, I’d be glad.’” This is from Aldous Huxley’s edition of The Letters of D.H. Lawrence (1932, 773), quoting a famous passage from Lady Chatterley’s Lover, from which Huxley had to excise pisses and shits. Yet both these words figure in proverbs listed in M.P. Tilley’s major collection, A Dictionary of theProverbs in England in the Sixteenth and Seventeenth Centuries (1950). There are also biographical and individual factors governing taboos, especially that of age. Louis MacNeice explores this theme in “The Blasphemies,” a poem tracing changing sensitivity through decades of personal maturation. It begins with the child’s speculation:“The sin against the Holy . . . though what / He wondered was it?” “Cold in his bed,” he is terrified at the prospect that “I shall be damned through thinking Damn.” But ten years later he is “Preening himself as a gay blasphemer.” “Rising thirty, he had decided / God was a mere expletive, a cheap one.” Between forty and fifty “He grew to feel the issue irrelevant.”The poem ends with the taboo broken, but the question remaining: “The sin /Against the Holy Ghost—What is it?”In recent decades the notion of linguistic taboo has shifted from being actual to mythical. Revealingly, in the first linguistic instance given in the Oxford English Dictionary, LeonardBloomfield wrote in his classic study Language (1933): “In America knocked up is a tabu form for ‘rendered pregnant’” (xx ii), thereby breaking the supposed taboo in an example that now seems rather quaint. (In Victorian times even the word pregnant was taboo.) A double standard is particularly apparent in modern dictionaries, which commonly employ the usage label “taboo” of sexual and racist terms, even though these words are acknowledged to be incommon use. The modern use of corpora, or large bodies of evidence of actual usage, both spoken and written, has enabled lexicographers to make meaningful assessments of word frequency. These clearly show that the notion of “taboo” is a misnomer. Thus the LongmanDictionary of Contemporary English (3rd edition, 1995) is based on both the Longman Corpus and the British National Corpus to establish the 3,000 most frequently used words in spoken and written English. Although fuck is marked as “taboo,” its usage is rated as S3, one of 3,000 most frequently spoken words—while fucking is rated even higher as S1, one of the1,000 most frequently spoken words. Bastard, bugger, and bloody are rated as S3, while shit and ass are rated as S2. (None of these words achieves so high a rating in written usage, and the first three are far more common in British than in American English.) Furthermore, it should be noted that usage labels in modern dictionaries tend to be remarkable in their inconsistency. The increasing use of taboo to mean simply “offensive” or “grossly impolite” rather than“strictly forbidden” is also apparent in recent publications actually using the term in their titles. These include A Dictionary of Obscenity, Taboo and Euphemism (1988) by James McDonaldand Forbidden American English (1990) by Richard A. Spears. The latter often rates somewords (e.g., fuck) as “taboo in all senses,” but others (e.g., cunt) as merely “very vulgar.”However, the work gives quite elaborate caution notes. In recent decades, as taboos have moved from sexual to racial terms, the lexicographical accommodation of ethnic slurs has attracted much controversy. The Oxford UniversityPress was subjected to protests and eventually a lawsuit in 1972 over the inclusion of opprobrious senses of the word Jew. Two years previously the editor in chief of Webster’s NewWorld Dictionary pointedly omitted what were termed in the Preface “those true obscenities, the terms of racial or ethnic opprobrium.” Today, former taboos against religious exclamations are less stringently observed, while gross sexual terms are increasingly current. The category that now most conforms to genuine taboo is that of race.

Natural High Blood Pressure Remedies

Natural High Blood Pressure Remedies. Depending on how extreme your blood pressure problem is, you may be completely successful with home remedies. However, if you are overweight, smoke, drink, have high stress levels or don’t exercise, you may need to correct one of these problems in order to cure your high blood pressure. Although reducing stress or losing weight may be the key to your high blood pressure problem, there may be other, less drastic approaches you can take to remedy your high blood pressure. You may need more calcium, magnesium, or potassium in your diet to help bring down your blood pressure. Milk and dairy products are excellent sources of calcium, and many fruits and vegetables are also very high in potassium. Magnesium can be found in halibut, nuts and spinach. You may be able to remedy your high blood pressure by avoiding a few simple things. Licorice, Ginseng, Rosemary and ephedra are all known to raise blood pressure and should be consumed with care.

Foods and Stimulants

The main reason certain foods boost sex drive is because they contain specific vital nutrients needed by your brain and body to function optimally, not because they contain some magical ingredient that your body has never encountered. It’s as simple as that. When your body, and brain, are getting all these nutrients in abundant supply, vigorous sexual health is a natural end result. The following is a list of some of the sexiest foods around, along with the explanations as to why they work so well, i.e. which nutrients in them make these foods so potent and sex-friendly…First, here are the top commonly-used foods that can also boost sex drive:
Celery: This food is a good source of Riboflavin, Vitamin B6, PantothenicAcid, Phosphorus, and a very good source of Dietary Fiber, Vitamin A,Vitamin C, Vitamin K, Folate, Potassium and Manganese. Avocados: Aside from being very low in Cholesterol and Sodium, this food is a good source of Dietary Fiber, Vitamin B-Complex, Vitamin C, VitaminK, Folate, lots of minerals and amino acids… and it’s a great source of protein. Almonds: Low in Cholesterol, and a good source of Magnesium. They're also a very good source of Vitamin E, Potassium, Protein, and Phosphorus.(Most nuts are great sources of nutrients that promote sexual health, and often containing phosphorus and zinc as well.) Sunflower seeds: This food is a good source of Pantothenic Acid,Phosphorus, Copper, Manganese and Selenium, and Vitamin E. It’s also low in Cholesterol. Tomatoes: This food is a good source of Vitamin E, Thiamin, Niacin,Vitamin B6, Folate, Magnesium, Phosphorus and Copper… and a very good source of Dietary Fiber, Vitamin A, Vitamin C, Vitamin K, Potassium and Manganese. Whole Grains: This food is a good source of Thiamin, Folate, Selenium,and Manganese. Bananas: This food is a good source of Dietary Fiber, Vitamin C,Potassium and Manganese, and a very good source of Vitamin B-Complex. Bananas are great for increasing sexual energy! Oysters: Zinc and Phosphorus (two of the sexiest minerals around) are what make this food a winner. It’s also a good source of Vitamin C, Riboflavin, Niacin and a very good source of Protein, Vitamin B12, Iron, Copper, Manganese and Selenium. Lamb Liver (and Beef Liver) are also highly-potent foods containing some of the usual suspects (including B vitamins.) Honey: This food is one of the fastest to provide your body with sexual energy because it is very easily digested. This is also why atheletes are a fan of honey, right before intense physical activity. Combine a few spoonfuls of honey with a glass of milk, and a handful of nuts, and you'll give yourself lots of explosive power. Notice that the above foods have some common, repetitive nutrients that make those foods great sexual boosters. (Pay special attention to the italicised nutrients in the above items, as well as those listed next.) Chili peppers, garlic, onions, ginger, asparagus, and other such pungent foods are also great, mainly because they contain Sulfur and Phosphorus (a potent combination) among other sex nutrients, like B-Vitamins.The Lesser-Known Sex Foods & StimulantsIn addition to the above commonly known foods, here are more super potent sex foods that are not so commonly used or known: Bee Pollen: Hard to believe but this is one of the best quality of protein out there. It has been said to offer greater sexual endurance and nourishes the neuro-genital reflex since it’s packed with natural enzymes, amino acids hormones, vitamins and minerals. Brewer's Yeast: Brewer's yeast is another one of those substances that's called a "complete food." While it has a very potent taste and smell, it's packed with lots of 'sexy' nutrients: It contains all the essential amino acids, a great source of protein and B-complex vitamins, as well as Chromium, Zinc, Iron, Phosphorus, and Selenium. In short, it's a powerhouse. Torula yeast is also used in similar ways. Caviar: This is another food that is abundant in nutrients needed for optimum sexual performance, including Zinc. It’s also one of the best sources of phosphorus. This food also provides nutrients that help with muscle contraction i.e. more frequent and intense orgasms. (Most other seafoods are also great sources of sexual nutrients.) Lecithin: Aside from being very low in Cholesterol and Sodium, this food is a very good source of Vitamin K, and yes, Phosphorus. It helps with sexual excitement and proper blood flow, which is important to sexual arousal as well as stronger orgasms. Royal Jelly: This food is a great source of protein, vitamins, and pantothenic acid which makes for easier absorption, which in turn provides lots of energy as well as stress relief… a great combination. Wheat Germ: Very low in Cholesterol and Sodium, this food is a good source of Dietary Fiber, Protein, Vitamin B6, Folate, Magnesium and copper, and a very good source of Thiamin, Phosphorus, Zinc, Manganese and Selenium. (Another powerhouse that you should use often.) Wheat germ oil and wheat bran are also good. Finally, foods such as Kelp, Acerola fruit, and Seaweed are also high in nutrients which promote sexual health. All of the above foods are available at most health food stores. Of course, if you need stronger doses of the nutrients found in the above foods (which often produce better results,) you can always take supplements that contain Zinc, Phosphorus, Vitamin E, B-Complexvitamins (Niacin, Biotin, Choline, Riboflavin, B-12, etc) and so on. (See above for other nutrients listed.) And now for the extremely…Rare, Little-Known Sex Foods & Stimulants Muira Puama Extract: Muira puama has been long-known by a select few as the miracle from the rain forests. Countries like Brazil praise it for it's erectile function and libido enhancing properties. It is also used to combat impotency. Aside from being a sexual stimulant, it's also known for helping with a large number of other problems, including central nervous system disorders, depression, digestive problems, gastrointestinal disorders, heart problems, menstrual cramps, menopause, nerve problems, neuromuscular problems,nervous exhaustion, and even rheumatism, stress, trauma, and muscle weakness. Aloe Vera: Yes, Aloe Vera, the stuff that’s used for skin therapy is also known for it’s many other powerful health benefits. One of them happens to be sexual health. This plant is packed with nutrients that have sexually stimulating qualities. However, to get maximum sexual benefits, it has to be consumed in pure form, specifically the clear gel contained in the central portion of the leaf. Spirulina: Much like bee pollen, Spirulina is one of the world’s most perfectfoods. It contains all the best of what your body needs, and none of what it doesn't (i.e. no cholesterol or extra calories.) And much like bee pollen, Spirulina is great for increasing sexual vigor. Avena Sativa: Avena sativa is the scientific name for the grass commonly known as oats (or green oats.) While it has been used medicinally for a long time, some experts also praise it as a sex booster. Yet, others consider it to be a mild and gentle sexual enhancer, which seems to work much better when used in combination with other, stronger sex herbs. Here's a list of some of these other sex herbs, listed in alphabetical order: Ashwagandha (also known as Indian ginseng,) Catuaba, Dong Quai, GotuKola, Horny Goat Weed, Maca, Passion flower, Rhodiola rosea (Rose root),Tongkat Ali, Tribulus Terrestris, and Yohimbe.And of course, one of the more commonly-known ones to add to this list would be Ginseng (Chinese.) Important: As always, please consult with your physician (and perhaps even a qualified herbalist) before taking any of these herbs.

Voodoo

NOTIONS SUCH AS CURSES, black magic, pin dolls and skeleton-painted priests are inextricably linked with the popular perception of Voodoo. Acombination of Hollywood movies, fictional novels and comic book story lines have helped instil the idea that Voodoo is amysterious, evil religion, stemming from darkest Africa. Many people believe it has been used to bring about the early deaths of unwelcome researchers and to resurrect the zombified bodies of dead believers. However, those who practise Voodoo say these rumours and myths have been borne out of ignorance and misplaced fear. Voodoo, they say, is actually a peaceful religion very similar in emphasis to the Catholic faith. They say it should cause no feeling of trepidation in anybody. Voodoo, also known as Vodun, Vodoun,Voudou or Sevi Lua, originated in the west African countries of Nigeria, Benin and Togo.‘Voodoo’ is an ancient African word for‘Great Spirit’, and the religion itself is believed to stretch back many millennia. The first the developed world knew of it was when slave traders started capturing African workers in the sixteenth century, and deporting them to the West Indies. On arriving in the islands, the slaves were forcibly invested in the Catholic faith, but as there were few facilities for them to actually practise this new religion, many slipped back into their native traditions.Their religion was founded on the idea of one supreme God – an unknowable but almighty force. Under Him there lies a network of ‘Loa’ or spirits, which are broadly equivalent to the Christian idea of patron saints. Each Loa represents a different area of life and has certain qualities. For example, if a farmer was worried about his crops he would focus his worship on the Loa known as ‘Zaka’, the spirit of agriculture. Despite the similarity between these African faiths, and their own, the French and Spanish conquerors refused to accept that these enslaved savages could have their own indigenous religion. Fearing that they were actually worshipping the devil, Voodoo was banned, and slave leaders and priests were beaten into confessing that their rituals were evil. However, the Voodoo faith was continued in secret, particularly in Haiti. Over time it even adopted some aspects of the Catholic religion, as descendants of the original slaves spread throughout across the Caribbean. The belief of West Indian workers mixed with voodoo practices of slaves taken to the American south-lands and a centre for the faith was soon created in New Orleans with its fertile blend of French, Spanish and African cultures. Today, 15% of New Orleans citizens, and 60 million people worldwide, practise Voodoo. In 1996 it was also made the official faith of Benin. Despite this official recognition, there is still a great deal of mystery and fear attached to Voodoo rituals. The Voodoo temple is called a Hounfour, and the leader of the ceremony is a male priest called a Houngan, or a female priest called a Mambo. At the centre of the temple there is a post used to contact spirits, and a highly decorated altar. There is a feast before the ceremony, and a particular pattern relating to the Loa being worshipped isoutlined on the temple floor. Dancing and chanting accompanied by beats from rattles and religious drums called Tamboulas begin. One of the dancers is said to be possessed by the Loa, enters a trance and behaves just as the Loa would. An animal, normally a chicken, goat, sheep or dog, is sacrificed and their blood is collected. This is used to sate the hunger of the Loa. Although these rites and rituals are used for good purposes – asking for guidance and help – there are some less wholesome practices. Voodoo black magic is performed by Caplatas or Bokors who place curses, and stick pins in Voodoo dolls to cause people pain and suffering. However, this use of voodoo is very rare, and the faith is promoted by its followers as being a wonderful way to understand the human condition and the world around us. Even though some of the practices seem a little strange, are they really much different from evangelist rituals or even archaic Catholicrites? As with many of Humanity's mysteries, a little tolerance and understanding goes a long way to revealing the truth.

THE LITTLE WHITE HEARSE

THE LITTLE WHITE HEARSE

By Ella Wheeler Wilcox


Somebody’s baby was buried to-day—
The empty white hearse from the grave rumbled back,
And the morning somehow seemed less smiling and gay
As I paused on the walk while it crossed on its way,
And a shadow seemed drawn o’er the sun’s golden track.

Somebody’s baby was laid out to rest,
White as a snowdrop, and fair to behold,
And the soft little hands were crossed over the breast,
And those hands and the lips and the eyelids were pressed
With kisses as hot as the eyelids were cold.

Somebody saw it go out of her sight,
Under the coffin lid—out through the door;
Somebody finds only darkness and blight
All through the glory of summer-sun light;
Somebody’s baby will waken no more.

Somebody’s sorrow is making me weep:
I know not her name, but I echo her cry,
For the dearly bought baby she longed so to keep,
The baby that rode to its long-lasting sleep
In the little white hearse that went rumbling by.

I know not her name, but her sorrow I know;
While I paused on the crossing I lived it once more,
And back to my heart surged that river of woe
That but in the breast of a mother can flow;
For the little white hearse has been, too, at my door.

Sunday, 22 April 2012

ELDERLY SUICIDE.

If you judge by the media and the public education programs, you might be inclined to think that teenagers and young adults (aged 15 to 24) are the age group most likely to kill themselves.Actually, they have the second-lowest rate of suicide. (The absolute lowest rate is among kids aged 5 to 14; children younger than that are apparently deemed incapable of consciously choosing to end their lives.) It is the elderly, by far, who have the highest rate of suicide.In the US, of every 100,000 people aged 75 to 79, 16.5 kill themselves. For those 80 and over,the rate is 19.43. This compares to a rate of 8.15 per 100,000 for people between the ages 15 and19, and 12.84 for people aged 20 to 24.As with every age group, men are far more likely to kill themselves, but among the elderly this trend reaches extreme proportions. Of people 65 and older, men comprise a staggering 84percent of suicides.Because men commit the vast majority of hara-kiri among old people, looking at these male suicide rates makes for extremely depressing reading. For guys aged 75 to 79, the suicide rate is34.26 per 100,000. In the 80 to 84 group, men's suicide rate is 44.12. When you look at men 85and older, the suicide rate is a heart-breaking 54.52. Compare this to the suicide rate for dudes in their mid to late teens: 13.22 per 100,000.It is true that suicide ranks as the second or third most common cause of death in young people (depending on age group), while it is number 15 and under for various groups of the elderly. Still, the suicide rate among the young is equal to their proportion of the population, while the elderly are way over represented as a group. And old people are cut down by a great many diseases and disorders virtually unknown to the young, which naturally pushes suicide down inthe rankings.The reasons why this suicide epidemic is ignored are highly speculative and would be too lengthy to get into here. However, we can rule out one seemingly likely explanation — suicide among the aged is invisible because they usually O.D. on prescription drugs or kill themselves inother ways that could easily be mistaken for natural death in someone of advanced years. This doesn't wash, primarily because guns are the most common method of dispatch. Of suicides over65, men used a gun 79.5 percent of the time, while women shot themselves 37 percent of thetime. It's hard to mistake that for natural causes.The sky-high suicide rate among the elderly applies to the entire world, not just the US. Plottedin a graph, suicide rates by age group around the globe gently curve upward as age increases. When the graph reaches the final age group, the line suddenly spikes, especially for men. Worldwide, men 75 and over have a suicide rate of 55.7 per 100,000, while women in the same age group have a rate of 18.8. This rate for old men is almost three times the global rate for guys aged 15 to 24, while the rate for old women is well over three times the rate for young gals in that age group.

WORK KILLS MORE PEOPLE THAN WAR

WORK KILLS MORE PEOPLE THAN WAR The United Nations' International Labor Organization has revealed some horrifying stats:The ILO estimates that approximately two million workers lose their lives annually due to occupational injuries and illnesses, with accidents causing at least 350,000 deaths a year. For every fatal accident, there are an estimated 1,000 non-fatal injuries, many of which result in lost earnings, permanent disability and poverty. The death toll at work, much of which is attributable to unsafe working practices, is the equivalent of 5,000 workers dying each day, three persons every minute.This is more than double the figure for deaths from warfare (650,000 death* per year). According to the ILO's SafeWork programme, work kills more people than alcohol and drugs together and the resulting loss in Gross Domestic Product is 20 times greater than allofficial development assistance to the developing countries. Each year, 6,570 US workers die because of injuries at work, while 60,225 meet their maker dueto occupational diseases. (Meanwhile, 13.2 million get hurt, and 1.1 million develop illnessesthat don't kill them.) On an average day, two or three workers are fatally shot, two fall to their deaths, one is killed after being smashed by a vehicle, and one is electrocuted. Each year, around 30 workers die of heat stroke, and another 30 expire from carbon monoxide. Although blue collar workers face a lot of the most obvious dangers, those slaving in offices or stores must contend with toxic air, workplace violence, driving accidents, and (especially for the health-care workers) transmissible diseases. The Occupational Safety and Health Administration warns that poisonous indoor air in nonindustrial workplaces causes "thousands of heart disease deaths [and] hundreds of lung cancer deaths" each year. But hey, everybody has to go sometime, right? And since we spend so much of our lives in the workplace, it's only logical that a lot of deaths happen — or at least are set into motion — on the job. This explanation certainly is true to an extent, but it doesn't excuse all such deaths. The international Labor Organization says that half of workplace fatalities are avoidable. In A Job toDie For, Lisa Cullen writes: In the workplace, few real accidents occur because the surroundings and operations are known; therefore, hazards can be identified. When harm from those hazards can be foreseen, accidents can be prevented....Most jobs have expected, known hazards. Working in and near excavations, for example, poses the obvious risks of death or injury from cave-in.... When trenches or excavations collapse because soil was piled right up to the edge, there is little room to claim it was an accident.

“Can a person be scared to death?”

Strong positive or negative emotions— ecstasy,grief, excitement—can lead to sudden cardiac death via ventricular fibrillation (irregular heartbeat), as in the case ofpeople who have died during sexual intercourse or when frightened. Or when frightened during sexual intercourse,which happens more often than you might think.
Coco Ballantyne, Scientific American, January 30, 2009.

VALIDATE

To validate means to confirm, affirm, acknowledge, value. To validate the experience of another is to accept the reality and the power of that experience. All experience is meaningful to the person having the experience, even if we do not understand what it means. Validation therapy is an approach developed by Naomi Feil in order to communicate well with people with moderate or severe dementia.
Recognising painful feelings such as grief, fear or anger will help reduce the pain of these feelings for the person with dementia. Instead of confronting older people with poor memory, we try to share their concerns and feelings. It means acknowledging the reality of a person's emotions and feelings and gives a response on the feeling level.
Practically we need to:
Draw closer to the other person.
Building trust with them.
Using eye contact and other non verbal skills to show to show the person you are listening to them.
Help them to see you empathise by mirroring their body movements, voice.
Stop judging the person and start accepting.
Try to summarise their feelings in words.
The aims are to ease the person's distress and aid life review.
Validation involves a high level of empathy attempting to understand the other person's frame of reference even if they are confused, paranoid, hallucinating.
When we are validated we feel more alive, more valued and accepted, more real.
The same is true for people with dementia.
The good thing about validation is we can apply it in daily living with partners, children and disorientated people at a particular time.

Friday, 20 April 2012

Maintaining everyday skills

It is easy to assume that adults with dementia will inevitably lose everyday skills and become dependent on others. With time, dementia can affect a person's skills; however the degree of impairment will vary from person to person. It is important for people with dementia to remain as active as possible. Being active helps people with dementia to feel good about themselves.People with dementia need to continue carrying out as many of their previous activities as independently as possible, in order to retain their skills. Doing things for themselves will enhance their physical, social and emotional well-being, through the preservation of their dignity, confidence and self-esteem. If you spend time with someone with dementia, you need to support and encourage them to do whatever they can for themselves, and to offer only as much help as they need. This is not always easy - not least because it may be frustrating watching something being done slowly when you could do it more quickly and easily yourself. But even if the person is struggling with a task, try to avoid the temptation to take over. If you do, they may lose confidence and are likely to cope less well.Tips: helping out. If you do need to offer help, try to do things with, rather than for, the person. This will helpthem feel more involved.. Always try to focus on what the person can do rather than what they can't.. Remember that they may have a short attention span and may find it hard to remember or concentrate on things.. Try to be patient, and allow plenty of time and rest breaks in between tasks.. Give plenty of praise and encouragement.If you feel yourself becoming irritated or frustrated, think how the person might also be feeling. Take time out to give yourself, and the person, some time alone. If you feel that you both need some time apart, make sure that the person is safe, and then go into another room for a few minutes. Remember, it is important to look after yourself. You do not have to do this alone; there is support available, including the Alzheimer's Society Helpline.Offer help sensitivelyAs the dementia progresses, the person may find certain tasks increasingly difficult, while others may remain manageable for much longer. By helping sensitively, you can offer support while enabling them to do what they can for themselves. You will need to adjust the level of help you offer, so that they can continue to make the best use of their remaining skills.Tips. Try breaking the task down into sections. For example, the person may find it easier to continue dressing themselves if you put the clothes out for them in the order that they need to put them on. Or you could pass the next garment to the person, holding it out ready for them to grasp at the right place, or encourage them to put their vest on over their head before you straighten it down for them.. Even if the person can't complete a full task, carrying out one or two steps of it - particularly the final step - can give them a sense of achievement.. Make sure that any reminders or instructions are simple. Use short sentences, with gestures and body language to add meaning.. Be tactful. Try to imagine that you are the person receiving help, and speak in a way that you would find helpful if you were in their position.. Try doing things together, such as folding clothes or drying dishes.. Try integrating opportunities to do things into the daily routine.. Make sure that the person doesn't feel that they are being supervised or criticised in any way. This means checking your tone of voice as well as the words that you use.. When the dementia is at a more advanced stage, try pointing, demonstrating, or guiding an action rather than giving a verbal explanation. For example, the person may be able to brush their own hair if you hand them the brush and start by gently guiding their hand. Use your voice to make reassuring and encouraging sounds rather than using actual words.Make sure the person feels safeFeeling safe is essential for our sense of well-being, but for a person with dementia the world may feel like an unsafe place for much of the time. Most of us can only imagine how frightening it must be to experience the world in this way.Tips. Respond to how the person is feeling at that very moment.. Be reassuring, and avoid confronting them with distressing reminders or tasks.. Remember, the more you can help the person not to feel anxious and stressed, the more likely they are to be able to use their skills to the best advantage.Make sure they have things to doWe all need to feel useful. This is as true for people with dementia as it is for anyone else. Encouraging the person to carry out activities around the home or garden is a way of enabling them to feel needed while maintaining their everyday skills. In the home, they may like to carry out simple tasks, such as dusting, polishing, folding clothes, laying and clearing tables, drying dishes and sorting cutlery. Work in the garden might include digging, watering, raking or sweeping leaves. Leisure activities are equally important. Try to help the person maintain skills related to their past interests and habits. For example, if they used to enjoy carpentry, they may get satisfaction from sanding a piece of wood. If they enjoyed cooking, they may be able to advise you on a recipe or help prepare a particular dish by peeling the vegetables. Encourage the person to go outdoors and possibly on accompanied outings to the shops, garden centre and other public places. Sitting and chatting,watching others and listening to music all count as 'activities'. Opportunities to engage with children and animals can bring lots of pleasure too.Tips. Make sure the person has things to do. Aim for a balance between active and passiveactivities, depending on what is important to the individual and their energy levels.. Remember that it's more important that the person feels useful than that they complete the task perfectly.. If you do have to redo a task that they have done, be very tactful, or try to do it without their noticing.. Always thank the person for their help.Use memory aidsYou can use memory aids and other reminders to help the person use their skills for longer. These may be of most help in the early to moderate stages of dementia when the person is better able to understand the message and to act upon it.Ideas include:. labelling cupboards and drawers, perhaps using pictures rather than words - for example, a photo of a cup and jar of coffee. a large calendar showing the day, month and year. a noticeboard for messages. notes stuck by the front door.There are assistive technology aids designed to help people with memory problems, however theseshould be considered carefully to determine if the equipment would benefit the person with dementia primarily, and if the person wants to trial it. Help the person relaxThere are plenty of things you can do to help the person feel calm and secure.Tips. Ensure that the person is as close as possible to people and things that they recognise, and that they enjoy being with.. Make sure the atmosphere is relaxed and uncritical.. Try to ensure familiar surroundings and a regular routine, as this will be reassuring.. Try to avoid too many conflicting sounds or large numbers of people, as this can add to a person's confusion. If possible, turn off the radio or the television. If the person needs to concentrate on something in particular, take them to a quiet place.. If the person becomes upset or embarrassed by their declining abilities or clumsiness, give them plenty of reassurance, and when things do go wrong, be tactful and encouraging. Having a good laugh about it together often helps.Consider seeking professional adviceIf the person with dementia finds it particularly hard to cope with certain activities, either because of the dementia or because of other disabilities, there may be some recognised solutions out there. An occupational therapist can assess the difficulties and can make recommendations to maximise independence, safety and confidence when undertaking activities. This may be by adapting the task; by doing things using a different approach or by using assistive technology. You can contact an occupational therapist through:. social services (look in the phone book under your local council). your GP. your local memory service (ask your local hospital for details). the College of Occupational Therapists.If the occupational therapist recommends any changes, try to make them as soon as possible, to give the person the best chance of absorbing new information. The earlier you contact an occupational therapist, the more effective their solutions will be.

‘Dementia brain tour’

Introduction to the brain. The human brain is incredibly complex. It controls everything our body does,from coordinating our movements and our speech, keeping our heart beatingand storing our memories.Despite all this there is still a lot we don’t know about the inner workings of thebrain.Imaging technologies can give us an idea of what is going on inside the brain.The human brain weighs around 1.5 kilos.It is fed by a network of blood vessels that deliver oxygen and nutrients to thecells.The brain can be divided into four main sections, the cerebral hemispheres,the limbic system, the cerebellum and the brain stemThe bulk of the brain is made up of the cerebral hemispheres.This is made up of the grey matter, the processing centre and the whitematter which is like the wiring.The cerebral hemispheres can be split into four different lobes which eachhave different functions.The frontal lobe is responsible for our behaviour.The parietal lobe helps us with tasks like calculation and spelling and itcontrols our complex movements.The temporal lobe is important for language, emotion and memory.And the occipital lobe is responsible for our vision.At the centre of the brain is the limbic system.This area controls a number of functions but importantly it controls learningand memory particularly in the hippocampus.The cerebellum or little brain controls movement, posture and balance,The brain stem is thought to be the oldest part of the brain it controls our vitalliving functions such as breathing, heart beat and blood pressure)Research is vital in the fight against dementia. Alzheimer’s Society fundsscientists to carry out research into the cause, cure, care and prevention ofdementia. Brain cellsThe brain is made up of billions of nerve cells.Nerve cells are specially designed for their function. They are elongated withmany tentacle-like projections called dendrites that make connections with thecells around them.Dendrites form an intricate network between cells and the white matter. Thepoint where two cells meet is called a synapse.Messages are passed along and between cells through tiny electricalimpulses and chemical messages.This is the basis for how the brain works. This is how the brain controls ourmovements, our thoughts, our memories. If something stops the cell fromdoing its job, this can result in dementia.Nerve cells are like any other cell in the body. They need oxygen nutrients tostay alive. They also rely on close contact with their neighbouring cells. If anerve cell is starved on oxygen or nutrients or becomes isolated from itsneighbouring cells it will die.Research is vital in the fight against dementia. Alzheimer’s Society fundsscientists to carry out research into the cause, cure, care and prevention ofdementia. What is dementia?Dementia affects over 750,000 people in the UK. It is not a disease in its ownright and it is not a natural part of ageing. It is an umbrella term that describesa group of symptoms that are caused by many diseases that affect the brainfor example, Alzheimer’s disease.Dementia is caused by loss of nerve cells in the brain. Most dementias areprogressive which mean they gradually get worse. This is because when anerve cell dies it usually cannot be replaced. As more and more nerve cellsdie the brain starts to shrink.This is known as brain atrophy which can often be seen in the brain scan of aperson with dementia.Common symptoms of dementia include memory loss, impaired cognition andlack of physical coordination. However their symptoms do depend on thearea of the brain that is affected.For example if cells in the temporal lobe start to die then that person mightstart to experience difficulties with their language.Or if someone’s occipital lobe is affected this can cause problems with vision.There is currently no cure for dementia and many of the diseases that cause itare terminal.Research is vital in the fight against dementia. Alzheimer’s Society fundsscientists to carry out research into the cause, cure, care and prevention ofdementia. Alzheimer’s diseaseAlzheimer’s disease affects over 400,000 people in the UK. It is the mostcommon cause of dementia and it is also the best understood.Alzheimer’s most commonly develops in the hippocampus which is why it isoften linked to memory loss.The hallmark of Alzheimer’s disease is the development of amyloid plaquesand tau tangles in nerve cells.Amyloid is produced when a much larger protein, the amyloid precursorprotein is broken down. This amyloid then accumulates as plaques on theoutside of nerve cells.Many scientists believe amyloid is toxic and causes cells to die.The second hallmark of Alzheimer’s disease is tangles in a protein called tau.Tau is produced by normal healthy nerve cells however during Alzheimer’sdisease an abnormal version is caused which doesn’t function correctly. Itcauses tangles within the cells and effectively strangles the cells which thendie.Current treatments for Alzheimer’s disease are designed to improvecommunication between cells. However these treatments can only slow theprogression of the symptoms of the disease. Scientists hope in the futuredrugs will target amyloid and tau and hopefully stop the disease altogether.Research is vital in the fight against dementia. Alzheimer’s Society fundsscientists to carry out research into the cause, cure, care and prevention ofdementia. Posterior cortical atrophyPosterior cortical atrophy or PCA is a specific type of Alzheimer’s disease thataffects the back of the brain, the occipital lobe. This is the type of Alzheimer’sthat the author Terry Pratchett has been diagnosed with.The symptoms of PCA are very specific. Since this part of the brain isresponsible for visual processing people with PCA lose the ability to recognisecolours and shapes, to recognise faces, they lose the ability to read.Often the classic symptoms of Alzheimer’s disease such as memory lossdon’t develop till much later on in PCA. This means that PCA is oftenmisdiagnosed or only picked up at the later stages.It is likely that PCA is actually more common that we think as it is oftendismissed as problems with eyesight associated with old age.Alzheimer’s Society funds research into the cause, cure, care and preventionof dementia, including PCA. One of our current research projects is lookinginto whether a brain scanning technology could be developed to helpdiagnose PCA. Vascular dementiaVascular dementia is the second most common type of dementia although itcan also occur it combination with Alzheimer’s disease in a condition calledmixed dementia.Vascular dementia is associated with problems in the blood supply to thebrain. Interruption of the blood supply for example through a blockage or aleak can cause a stroke. A stroke can cause significant damage to the area ofthe brain that is starved of its blood supply.Sometimes a single stroke can be enough to cause the symptoms ofdementia. In other cases a person may experience a series of smaller strokesof many years that gradually causes damage.Vascular dementia can also be caused by small vessel disease which is dueto damage to the tiny blood vessels deep inside the brain.Prevention of vascular dementia is closely linked to maintaining a healthyblood supply. People with higher blood pressure are at a much higher risk ofdementia.The risk can be reduced by stopping smoking, maintaining a healthy weightand regular exercise.Research is vital in the fight against dementia. Alzheimer’s Society fundsscientists to carry out research into the cause, cure, care and prevention ofdementia. Dementia with lewy bodiesDementia with lewy bodies affects about 4% of people with dementia. It isclosely related to Alzheimer’s disease and also to Parkinson’s disease.Lewy bodies are tiny spherical deposits of protein that develop inside nervecells.They prevent the cells from communicating properly by disrupting the tinychemical messages between cells. As yet we have no idea why Lewy bodiesform.Lewy body dementia can affect many different parts of the brain leading tomany different types of symptoms.This type of dementia shares many symptoms with Alzheimer’s diseasehowever people with lewy body dementia often experience hallucinations orproblems with paying attention.They can frequently experience problems with their movement as well in asimilar way to people with Parkinson’s disease.Research is vital in the fight against dementia. Alzheimer’s Society fundsscientists to carry out research into the cause, cure, care and prevention ofdementia. Fronto-temporal dementiaFronto-temporal dementia covers a range of conditions that affect the frontaland temporal lobes.People with damage to their frontal lobes will often experience changes intheir behaviour for example becoming more disinhibited whereas people withdamage to their temporal lobe will often struggle with language.People who experience damage to both of these areas might experience amixture of these symptoms. This is a fairly rare form of dementia and it oftenaffects younger people.Unlike other forms of dementia there maybe a strong family link with frontotemporaldementia. Scientists have identified some genes that are linked tofronto-temporal dementia but our understanding of them is still limited.One of the diseases that causes fronto-temporal dementia is Pick’s disease.Proteins accumulate inside nerve cells causing dementia. As yet we have noidea why certain parts of the brain are far more vulnerable to this disease thanothers.Research is vital in the fight for a cure against dementia. Alzheimer’s Societyfunds scientists to carry out research into the cause, cure, care andprevention of dementia. Rarer causes of dementiaThere are a number of rarer diseases and conditions that cause dementia.People with Down’s syndrome are particularly at risk of developing dementia,and they are more likely to develop Alzheimer’s disease early in life.This is because the gene that has been linked to Alzheimer’s disease is foundon chromosome 21. People with Down’s syndrome have an extra copy of thischromosome and therefore an extra copy of the Alzheimer’s gene. Dementia can also be caused by HIV, Huntingdon’s disease, Prion diseaseslike CJD and also excessive alcohol consumption. The biology of thesedementias is still poorly understood and in most cases treatments are verylimited.Research is vital in the fight for a cure against dementia. Alzheimer’s Societyfunds scientists to carry out research into the cause, cure, care andprevention of dementia.

Burden of disease

Dementia is one of the main causes of disability in later life. In a wide consensus consultation for the World Health Organization’s Global Burden of Disease report, disability from dementia was accorded a higher weight than that for almost any other condition, with the exception of spinal cord injury and terminal cancer. Of course, older people are particularly likely to have multiple health conditions – chronic physical diseases affecting different organ systems, coexisting with mental and cognitive disorders. Dementia, however, has a disproportionate impact on capacity for independent living. Still its global public health significance continues to be under-appreciated and misunderstood. According to the 2003 World Health Report Global Burden of Disease estimates, dementia contributed 11.2% of all years lived with disability among people aged 60 and over; more than stroke (9.5%), musculoskeletal disorders (8.9%), cardiovascular disease (5.0%) and all forms of cancer (2.4%).We estimate that there are now 683,597 people with dementia in the UK. This represents one person in every 88 (1.1%) of the entire UK population. This is probably a very slight underestimate as it may not comprehensively include people with learning disabilities or people with dementia in NHS continuing care facilities.The total number of people with dementia in the UK is forecast to increase to 940,110 by 2021 and 1,735,087 by 2051, an increase of 38% over the next 15 years and 154% over the next 45 years.• Early onset dementia is comparatively rare, accounting for 2.2% of all people withdementia in the UK. We estimate that there are now at least 15,034 people with earlyonset dementia (onset before the age of 65 years) in the UK and 668,563 people withlate onset dementia (onset after the age of 65 years). However, given that data on the numbers of early onset cases are based on referrals to services, this number is likely to be an underestimate. The true figure may be up to three times higher.• The numbers of people with late onset dementia continue to rise for each five-yearage band up to the age of 80–84, and decline thereafter. Despite this, two-thirds(68%) of all people with dementia are aged 80 and over, and one sixth (17%) aged90 or over.• Overall we estimate that 222,925 men and 445,641 women have late onset dementia,approximately two women for every man affected. Both the higher mortality amongmen and the higher age-specific dementia prevalence in women contribute to the preponderanceof women among the ‘oldest-old’ with dementia.Dementia subtypes• We estimate that 416,967 people with dementia (62%) have Alzheimer’s disease (AD),the most common form of dementia. The next most common subtypes are vasculardementia (VaD) and mixed dementia, accounting for nearly one third (27%) of allcases.• The distribution of subtypes is different in men and women. Alzheimer’s disease ismore common in women (67% in women compared with 55% in men), while vasculardementia and mixed dementias account for 31% of all cases in men and just 25% inwomen. Severity of dementia• Among those with late onset dementia, 370,283 (55.4%) have mild dementia, 214,638(32.1%) have moderate dementia and 83,801 (12.5%) have severe dementia.• The proportion considered to have severe dementia increases with increasing age, from 6.3% for those aged 65 to 69 years to 23.3% for those aged 95 years and over. Institutional care• We estimate that 424,378 people with late onset dementia (63.5%) live in privatehouseholds (the community), whereas 244,185 (36.5%) live in care homes.• The proportion of those with dementia living in care homes rises steadily with age, from 26.6% of those aged 65–74, to 60.8% of those aged 90 and over. Historically, a lack of attention from policy makers and service commissioners to the needs of people with dementia has led to dementia care being delivered piecemeal and in an inefficient fashion. More investment accompanied by careful planning will be needed in the years ahead in order to ensure that not only do we maximise quality of life for people with dementia and their families, but also that we do so in an efficient way with the resources available.

DEMENTIA AND AHEAD

When someone voices fears about becoming forgetful or confused, peopleoften reassure them that this is a normal part of ageing. But are they right?It is true that dementia is more common among over-65s, and some of usdo become more forgetful as we get older, or during times of stress or illness.But dementia is a different sort of forgetfulness. Many of us may momentarilyforget a friend’s name. But if you have dementia, you may forget that youhave ever met them before. Your memory loss will be more noticeable, andmay be accompanied by mood changes and confusion.Forgetfulness and confusion are not always signs of dementia, but it is veryimportant to ask the doctor to check them out. Drugs are available that canhelp people with certain forms of dementia. Other medication can help withsymptoms that often accompany dementia, like anxiety or insomnia. So if youaren’t diagnosed, you could be missing out. And if you don’t have dementia,your forgetfulness may indicate another condition – such as depression –that needs to be treated.After I came to the UK, my brain was not working properly. I used to go walkingand not come back, and when my wife asked me to go shopping, instead ofbuying eggs I would buy tea. I was very worried. The doctors examined meand gave me medicine. Since then it’s been much better. I still forget things –I wouldn’t say I’m 100 per cent – but I’m probably 70 per cent.I like reading, and we often go for three mile walks in the park. Sometimeswe visit the neighbours or we go to the temple, or shopping with the children.I used to grow a lot of vegetables in the garden – aubergine, cabbages andsweet potato – which we cooked in curry with rice.Our family is very close. We live with our son’s family, and I am never alone –there are always people around us. They understand that I have memoryproblems, but they don’t worry about these things. Our grandchildren arewonderful. In the early days, I used to carry them to kindergarten. Now theyare growing up.I am happy. I have had a really good life. My philosophy is to be happy withthe family – the future is good for us.Dementia is the name for a collection of symptoms that include memoryloss, mood changes and problems with communication and reasoning.These symptoms are brought about by a number of diseases that causechanges in the brain.The most common of these is Alzheimer’s disease. Alzheimer’s changes thechemistry and structure of the brain, causing the brain cells to die off. Thefirst sign is usually short-term memory loss. Other types of dementia includevascular dementia, dementia with Lewy bodies and Pick’s disease.Each of these diseases affects the brain in slightly different ways. For example,Alzheimer’s disease tends to progress gradually at first, while vascular dementiatends to progress in a stepped way.But a person’s experience of dementia will depend on other things too –the people around them, their personal circumstances, and the environmentthey live in. Dementia progresses in a way that is unique to each individual.People often think of dementia as a form of memory loss. And usually it doesstart by affecting people’s short-term memory. But it’s more than that: it canalso affect the way people think, speak and do things.Dementia makes it harder to do things because it makes it difficult to plan andlearn new activities, and interferes with structured tasks like writing. Dementiacan also make it harder to communicate. For example, the person might havetrouble remembering the right word or recognising who someone is.Dementia also affects people’s mood and motivation levels. This may happenif the disease affects the part of your brain that controls emotions. But evenwhere this does not happen, people with dementia can feel sad, frightened,frustrated or angry about what’s happening to them.Dementia can’t be cured, but there is much that can be done to help. Everyyear we understand more about dementia, and develop new strategies thatcan help to boost someone’s confidence and maintain their independencefor as long as possible.Dementia – that’s what they told me I have. I’m very forgetful, and I don’tsleep much. At first, I just put it down to working too hard or something. I getso frustrated. You go somewhere and you can’t even remember what you wantto buy. You just stand there in space, looking, wondering, ‘Is this the right place?’I have to write things down. Sometimes, even if I write them down I don’tremember them. But I tell my family where I’m going and things, sosomebody will ring me up and tell me what is happening. And my friendgave me a board to stick everything on.I go to a dementia café once a week. I think there is a stigma around dementia.I think people look down on you and say, ‘That’s a mad woman,’ or something.At the café it doesn’t matter who you are – everybody’s on the same level.The social side is very good and the staff are fantastic.I love singing – it lifts you. And if I feel down, I pray and talk to God. I askhim, ‘Why? Why am I like this?’ And then a scripture will come into my heador something, maybe one of the psalms. It is very, very comforting.Most of us have some image in our mind of what life with dementia lookslike. That image is often very bleak. So it can be surprising to learn that manypeople with dementia continue to drive, socialise and hold down satisfyingjobs. Even as dementia progresses, many people lead active, healthy lives,continue their hobbies, and enjoy loving friendships and relationships.Someone with dementia will probably have difficulty remembering thingsand organising themselves. They may forget an appointment or tell you thesame joke twice. But this may not stop them from doing the things thatmatter most to them.Medication may help people with some kinds of dementia. This is why it’simportant to go to the doctor as soon as you suspect there may be a problem.It’s a difficult step to take, but a diagnosis can open up many opportunitiesto help overcome problems and find better ways of coping.Of course, dementia does make it harder to do certain things. But with theright support and know-how, it is possible for someone with dementia to getthe very best out of life.Most mornings I have breakfast with my partner, Tony, then he goes offto work and I decide what to do with my day. I do miss work, but when Istarted my last job I just couldn’t manage it. I went to see the GP and wasdiagnosed with Alzheimer’s.Twice a week I go walking and I’m in an a cappella choir. I’m still driving,so I’m not housebound by any means. I make sure I keep using my brain.I read three or four chapters a day. I try not to watch daytime television,but I do like Radio 4. And if it’s a miserable rainy day I’ll always put on Sexand the City to make me laugh.We have systems so I don’t forget something. We have a whiteboard withreminders. When we’ve done a task, we stick a little spot next to it. Tonywill often phone and remind me to do things. I’m functioning very well,but everything is controlled. If I was suddenly thrown into Trafalgar Square,I wouldn’t know what to do.I’m certainly not in denial – I’d rather I didn’t have it. But I don’t dwellon it. To be able to drive, sing, use a computer quite happily – it’s not theend of the world. That’s been the most surprising thing about dementia.I’m still carrying on the way I always was. I’m just leading my life.A talented gospel singer, a loving family man, a keen walker and self-confessedRadio 4 addict… Clarice, Poopal and Caroline, who we meet in these pages,are living proof that people with dementia can live rich, varied lives.Clarice is a warm, outgoing woman who teases her daughters affectionatelyas they describe how they adapt family life to support Clarice’s dementia dayby day. Poopal is a quietly spoken, dignified man who is surrounded by a lovingfamily. He takes great pride in their successes in their journey from Sri Lankato London. Caroline is an engaging woman, with a wicked sense of humour,whose days are packed with social events. She enjoys close friendships and astrong, supportive relationship with her partner Tony.Sometimes, dementia can overshadow the other aspects of the person – thebits that really matter. Poopal, Caroline and Clarice remind us of the personbehind the dementia. They are three very different people, with just one thingin common: all three are living with dementia. But each is doing it in theirown way, and on their own terms.

Carers’ health

Caring for a person with dementia can be a long-term commitment and many familycarers reported many years of caring for their relative 17. If a person with dementiaenters long-term care this may be due to the exhaustion of the carer and their healthmay have been adversely affected. As others have noted, it was often the case thatthe caring role did not cease once the person with dementia had entered long-termcare and this was especially so due to issues surrounding the provision of food.Where food provision was inadequate a carer may continue to provide food for theperson with dementia and regularly come to the home or hospital to provide helpwith eating. While this is to be encouraged where the carer is willing it can also beviewed as a failure of the care system in homes or hospitals if carers cannot leavethe person with dementia with confidence that they will receive an adequate diet.These data illustrate the sheer work involved in supporting many people withdementia to eat and drink. The work extends beyond providing nutrition ormaintaining hygiene. It can be very much part of total support for a person withdementia: maintaining their dignity, responding to their preferences and includingthem in ordinary life. For many carers this involves extraordinary commitments oftime and infinite patience. Most do not appear to see this as out of the ordinary –and are modest about this work. It is work, however, and help with food and drink isoften needed throughout the day and evening and sometimes at night Carers painted a variety of pictures about the impact of caring on their own health and some mentioned the effects on their own eating. For example, one wife observed: I do feel a little less like eating sometimes after preparing and dishing up a meal, and then having to cut up a plateful of food for my husband.Others reported more difficulty, such as heightened anxiety at meals:His inability to cope and irritability at meal times made me lose appetite andenjoyment of food. Meal times because stressful instead of the social affairwe had formerly enjoyed.For some, the stress was more pervasive: It is very wearing having to monitor my mother’s eating habits as she tries to catch me out, hiding food before throwing it away.Finally, a small number reported significant problems not so much with theirrelatives’ eating but other behaviours which affected carers’ own health and diet:I nursed my husband for about 15 months before he was admitted to anursing home due to violence. Towards the end I had to cut my visits down17 Briggs K & Askham J (1999) The needs of people with dementia and those who care for them: a review of the literature Alzheimer’s Society, London 16 to four or five days a week because I was very poorly, lost over 2 stone, stress and very depressed.

PROBLEM SOLVING

Many carers reported that their relative with dementia had died and had lost significant weight in the process. However, while the end of life must be an issue for many, very few reported it. As previously mentioned, professional carers were more concerned with the ethical aspects of feeding or withdrawing food. We highlight this as an issue which is conspicuous by its absence and this may indicate a lack ofdiscussion between professionals, who appear to be concerned and relatives,who may not have the opportunity to discuss this.Carers’ feelings about eating and drinking at their relative’s end of life were mixed. Strong views were held by some about staff ‘interfering’ with a person who wasdying. For example:My father, when dying, was frequently disturbed to be given food, which I felthe didn’t want.Other carers reported that they wished more had been done:…my father (with cancer of the colon was) put in a single bed ward where, although food and drink were placed before him little attempt was made tosee it was consumed. He wasted over some 3 weeks and finally died.Very few carers reported medical intervention through tube-feeding (which isuncommon with people with dementia in the UK), most saw their role and that ofstaff was to maintain comfort such as giving sips of water. When this seemed to belacking in some settings, again hospitals were most frequently criticised; carerswere saddened if death had not been easy, comfortable or dignified.TipsAs this research also shows, carers develop skills in problem solving. These areuseful for other carers to learn but also for paid staff. Problem solving seemed torelate to a confidence to try different ways of doing things. Most carers say theydevelop this through trial and error – very few were able to report constructive helpfrom support services in managing difficulties at home. For some this ability toproblem solve successfully seemed to be linked to their knowledge of their relative’s particular problems and a sense that helping with eating and drinking were important. One daughter’s experience illustrated this: I have to be careful not to serve her (my mother) first because if I do she will push the plate away and give it to me or my husband because she thinks we haven’t anything to eat. She will insist we have hers – she went without during the war in order to feed us. If I serve her last this doesn’t happen.For others, making life easier generally was a way in which carers continued tocare. Getting more help in the kitchen or with shopping, or using convenience food,were strategies that some carers used to reduce stress or work: For example: I have recently bought a microwave oven with the idea of re-heating the occasional frozen meal if I did not feel like cooking. Other carers reported that a positive attitude helped them in the task of caring and in managing unfamiliar tasks: For most of our married life I never had to worry about where my next meal was coming from; now I have to do it all myself, by following the instructions on the packet, but she has never refused what I’ve given her so I can’t be too bad! This terrible experience has, if anything, brought us closer together. Others said that they managed through having a sense of humour: A very time consuming business being a sole carer, but we have our laughs as well!These accounts also highlight that while much work involved in supporting a personto eat and drink may be seen as personal care, or even nursing tasks, otherelements involve tasks such as co-ordinating services or keeping an eye on things.For example, one friend reported: A hot meal and sandwiches/cake are delivered daily. Originally my friend paid daily for the meals but then cancelled the service without informing me. The service is now paid for by cheque (by myself as attorney) a month in advance.Specific tips included:?? the use of finger foods, different sized plates (some reported using small platesto convince the person with dementia that they were getting large enoughportions and other reported using larger plates for the opposite reason)?? laying the table using non-patterned tablecloths in order that the person withdementia would not become confused between food on a plate and the patterns on the tablecloth?? presenting the person with dementia with only one type of food at a time?? eating in a quiet atmosphere.These suggestions are included in professional literature and self-help material.What is interesting here is the variety of approaches and the need to try different,even opposite, strategies.

FEED DEMENTIA

Co-morbidity. Dementia is largely a condition of older people and significant co-morbidity exists.Co-morbid conditions include heart disease, Parkinson’s disease or different formsof cancer, any of which make the task of supporting the person with dementia moredifficult. In particular, difficulties arise which are compounded when supporting aperson with dementia to eat or drink if the person has other pre-existing healthproblems or develops other illnesses. Some diseases interact more with dementiathan others, especially if there is a nutritional aspect to the disease. As such,diabetes was commonly reported as a co-morbid condition where problems arose indementia and this may be due to a link between the two conditions. There wereseveral reasons for this including over-eating, a preference for sweet foods andunder-eating all of which made the maintenance of blood sugar levels problematic.There were no significant 'tips' in this regard but this is an area where professionaladvice is much needed from doctors, dietitians and specialist nurses, not particularlyto carers who displayed accurate and well-informed knowledge in their responses,but to staff including hospital nurses, day care and residential staff.One daughter reported:My mother spent some time in hospital after a stroke. She had already beensuffering with dementia. Despite the CPN and myself explaining her needs,Mum was often given food difficult for her to eat.A group of carers who were supporting a person with dementia who had diabetes,observed that the co-morbidity was adversely affected in several ways especiallywhen the person with dementia developed a sweet tooth. Carers reported, forexample, that it was difficult to persuade people that they cannot eat what others areeating, especially in formal care settings. Others found the problems to be moregeneral:My father has diabetes as well as multi-infarct dementia, therefore it isessential that he eats appropriate food at specific times.Combinations of physical health problems with dementia seemed not always to beunderstood by staff and this troubled carers:(my father) has been given chips and fatty food despite me explaining he hasno gallbladder. There are too many different staff on to ensure they know.In addition to physical health problems, if the person appeared to have depressionthis sometimes seemed to magnify problems with eating, such as lack of motivation,having a limited appetite or lack of enjoyment of food.Social issuesA striking feature of the data and one which some family carers were keen to report,was how it was possible to eat out with their relative with dementia. Theexperiences were not universally positive. However, finding the right restaurant wasimportant and making some special provision for the person with dementia such asan isolated table or one near the toilet was reported as possibly helpful to others.Keeping the environment quiet, at home especially, seemed to contribute as thisminimised distraction for the person with dementia. The issue of dignity: for theperson with dementia, the carer and other diners was raised. Generally, thosecarers who had decided not to worry what others thought were able to continueeating out. Others gave up at a very early stage. This is an area which could beexplored further as there was also a commonly reported concept that eating out,eating with others and keeping up some routine in socialising eating were positivefactors which encouraged the person with dementia to eat.The data provide many examples of helping people to eat in a social context. Whilemany carers provide support at home, there were examples of families continuing toenjoy going out. One daughter described this as a matter of her caring routine:I work full time but visit mum straight from work on a Tuesday and Thursdaynight and from lunch on Saturday. We always go out for a drink in apub/restaurant, shopping, visiting friends or for a ride in the car before goingout for a meal in the evening. Mum can’t make a decision about what tochoose from the menu, sometimes she will order a meal and then when itcomes she’ll say ‘I’ll never eat all that, why did you let me order it?’ Mosttimes I order for her and she eats what she can and enjoys it.Some carers reported that they found some people and places more welcomingthan others. For example, one wife commented:Where they knew him eating out was OK, but where they didn’t I feltunwelcome.Another wife found that her husband had not always been welcome:When out in a restaurant my husband would order a meal for his friend aswell, who was not there. Some restaurants would understand, but a lot wouldtreat him bad.One common thread was whether carers felt that the behaviour of the person withdementia in a public setting was manageable or embarrassing. As an example ofbehaviour that seemed a little inappropriate to the family but did not interfere toomuch with their enjoyment one daughter reported:She (my mother) eats very well when taken out for a meal but if the food isportable, such as chicken pieces or steak, she wants to wrap it up and take ithome.Other carers reported that in their experience the benefits of going out for a mealbecame outweighed by the proble ms. For example, one daughter admitted:I cannot relax enough to make it worthwhile eating out with my mother.Another carer acknowledged, as did others, that it was the family’s feelings thatwere affected:When we took (my husband) out for meals I think it upsets my family and memore than it upsets him as he makes a mess sometimes.Weight change, food supplements, dehydration and eliminationWeight change - increase and loss of weight - was frequently reported. Weight gainwas related to over-eating due apparently to forgetting that a meal had been eatenand also to a constant search for food. Some carers handled this by providingadditional meals and snacks but it was also reported that food had to be hidden andlocked away. Eventual loss of weight was one of the most commonly reportedproblems and negative aspects of dementia and this was often related to careprovision, which forms a theme below. Many carers sought explanations for weightloss as this daughter reported:When my mother first had Alzheimer’s we noticed a severe loss of weight.She normally weighed between 9.5 and 10 stone. She went down to 6.5stone. Our GP was not alarmed and didn’t seem to want to explain.Many of the 'tips' which we report separately are concerned with helping people withdementia to eat and this includes the use of food supplements which are, generally,favourably mentioned. The source of such supplements is not always reported butmany brand names are mentioned. The supplements are either fortified drinks orpowders which can be added to whatever food the person with dementia will eat.Only a few carers reported contact with a dietitian: food supplements had eitherbeen prescribed by a GP, or carers purchased them themselves. Someresidential/nursing homes also provided them. For those providing support to aperson who could not longer eat or who were thought to have insufficient nutrition,food supplements provided some assistance. As one person indicated, they werecommonly used in residential or nursing home care:In the nursing home my mother was given only ‘Build up’ liquid food whichshe drank when I was present to help her. When the nurses said she couldeat no solids I found she was able to eat bananas and seedless grapes ifcarefully administered.Carers also reported a variety of ways in which they tried to make such supplementsas pleasant as possible for the person with dementia. Some had not found it easy toget the level of help they thought they needed with such products:After pleading with the GP I managed to get him to prescribe Ensure Pluswhich I used plain and heated with chocolate.Reduced eating was also associated with reduced drinking and this appearedespecially distressing for family carers as the person with dementia rapidly becamedehydrated. This was a notable problem in institutional care, particularly in hospitaland many negative experiences were reported. The solutions to under-eating anddrinking were quite simple: small frequent portions and gentle encouragement andreminding to eat and drink. Such care appeared to be poorly addressed in hospitalsdespite advice and enquiry by carers about preferences and strategies to encouragefood and fluid intake. Many carers reported vigilance was necessary to monitor thecare of people with dementia in hospital. Problems with drinking were mentioned ina number of replies. Many carers felt that their relative did not receive sufficientfluid, especially water, in formal care settings. There were a number of reports offamily members trying to make sure that people were given sufficient drinks, andthat when drinks were supplied the person with dementia could manage to hold thecup or straw, or that it was within reach or at the right temperature. Hospital wardswere singled out as places where family members felt that such help with drinkingwas inadequate. One wife reported:I feel that not enough liquids seem to be given in hospitals/nursing homes.(My husband) was used to drinking many pints of water/squash and a coupleof weak beers a day but they only seem to give tea at meal times. He wasn’tup to finding drinks of water by himself. I used to take him in cans of softdrinks.Closely related to the issue of drinking was elimination. There were reports ofconstipation and urinary tract infections associated with poor diets and low fluidintake. Often, these had been resolved when the person moved to a home orreturned home and a better pattern of eating and drinking was established. A groupof carers drew atte ntion to the links between eating and drinking and their relatives’problems with going to the toilet. Many thought that the person with dementia didnot drink enough, particularly in the evening, to avoid visiting the toilet. Others feltthat drinking was not encouraged by care staff to avoid problems with continence orbecause staff lacked knowledge about the benefits of drinking. For example:When my late wife, who was believed to have Lewy Body Dementia, was inresidential care, she developed a problem with drinking fluids. At one stageshe became dehydrated and required urgent hospital treatment. I have longsuspected that this could have arisen as a result of a lack of training in staff.They were notably kind but it is obvious that these qualities are not enough.Some noted that their support of their relative included help with continence andlinked this to their supervision over what their relative was eating or drinking. This,too, added to carers’ work as one daughter illustrated:Mum suffers constipation quite often but can also go the opposite and get ina mess.Mouth problemsMouth problems were attributed in some instances to poor fluid intake and as noted,this was connected by many carers to poor quality care. For some they wereresolved by better fluid intake. However, problems with dentures were also seen togive rise to mouth problems and a range of other difficulties. Carers described how,in people with dementia who were losing weight, their relatives’ dentures became illfitting leading to a sore mouth or dispensing with the use of dentures altogether.Where carers had been able to maintain the use of dentures it was reported bysome that these were either lost in hospital, not cleaned properly or simply left bythe bed. Where community dentists visited people at home this was warmlywelcomed. However, some people with dementia became very reluctant to permitothers, including dentists, to remove dentures or carry out oral procedures. Othercarers noted that it was difficult to persuade their relatives to clean their teeth andthey had devised various ways, either on their own or with the support of others, tohelp maintain oral hygiene. One wife recalled:….there were great difficulties with my husband’s gums – bleeding andinflamed. I found an excellent dentist who very patiently and sensitivelycleared up the problem and saw him every 2 or 3 weeks to clean his teeth ashe was no longer able to do this properly himself, he wouldn’t let me help,saying ‘I’m a man, I can do this myself!’.Those care providers who seemed to appreciate the importance of teeth anddentures both for eating but also for comfort and dignity were appreciated. Onedaughter reported:The Home was very helpful in getting mum new dentures. She had flushedhers down the toilet when she coughed.However, such care was not always forthcoming:In the residential home my mother is in, the staff appear not to recognise aproblem until it is pointed out to them, i.e. my mother not cleaning her teeth,she got a fungal infection in her gums.Food beliefs, preferences and changes in tasteFood beliefs, preferences and changes in taste are related because food beliefsmay dictate preferences. However, it was frequently reported that some individualswith dementia had undergone profound changes in food preference. Thesechanges in preference challenged the notions of the carers about such issues as'healthy eating' and social norms regarding 'three square meals' and the overt use ofconvenience foods.Accounts from carers in this study confirm that many people with dementia developa sweet tooth, but they also provide evidence that some people begin to eat ordrink things that they would not have done previously. Equally, sweets, chocolateand biscuits were commonly reported as items which people increasingly enjoyed,at times in great quantity. For some carers it was a relief that the person they weresupporting would at least eat something. For example, one daughter reported:Chocolate has been a big favourite – this seems to keep her going on a noneatingday.Other carers said that they felt it necessary to keep an eye on what was beingbought. One daughter recalled finding numerous sweet items secreted away by herfather:He could still go to the local shops to buy sweets and biscuits which he hid inhis bedroom.Others found that their relative might eat sweet items non stop and so theyrestricted what was available or on view:I have to limit the number of biscuits she has to two when we have ourmorning drink otherwise she will eat the whole packet.However, not everyone preferred sweet things, as one husband reported:Before Alzheimer’s drank no milk in tea or coffee etc. and only used dryskimmed milk in cooking. She has gone off sweet things.Other carers also noted their relatives’ changed preferences:My husband who was diagnosed with Alzheimer’s Disease has changed hiseating habits. He now drinks coffee several times a day – before his illnesshe drank only tea. He now dislikes cold meats – previously he often atethem.Such changes need also to be put in the context of people’s food habits and beliefsabout diet, nutrition and cultural practices. A small number of carers reportedfirmly held beliefs about what a good diet meant to them and how they wanted tomaintain this:My husband’s diagnosis was only 7 months ago and therefore we havecontinued with our usual diet which is high fibre, including fresh fruit andvegetables, poultry, fish and very little red meat, together with a one day acesupplement.Other carers felt concerned that their relative with dementia, or themselves, werenot having ‘proper meals’. For some this seemed linked with long-standing foodhabits and new ways of shopping, cooking or new types of food could cause someanxiety. One daughter reported:I am concerned at the amount of processed food my father eats but I do notwant to restrict his liberty while he is still capable of shopping and cooking forhimself.Other carers reported great adaptability and indicate that they had tried numerous ofpresenting food and drink to make eating more pleasurable, to maintain a person’sindependence and to tempt those with limited appetites.Care provision and transitions in careIt was overwhelmingly the case that carers reported general hospital care of peoplewith dementia very negatively. Lack of staff, lack of time and poor attitudes andtraining were all cited. There is evidence that specialist units and homes (nursingand social work) provided better care and this was noticed through transitions incare. A typical pattern would be admission to hospital due to some emergency,sometimes associated with not eating or being dehydrated, where the condition ofthe person with dementia would deteriorate. The episode would highlight the needfor a longer term solution to the care of the person with dementia and, once in ahome, their general care and nutrition would improve. We wish to highlight the careof people with dementia in hospital as an area of major concern and one thaturgently needs to be addressed.Regardless of the type of setting, however, essentially, the provision andpresentation of food was seen as a barometer of care. Some carers felt that theirrelative was not treated well in formal care settings. This applied to lack of careover food intake but also more generally. For example, concern was expressedabout people being left in dirty clothes with food spillages down them. When arelative has always taken a pride in their appearance, to see them in food-stainedclothes can be upsetting as one carer illustrated:In the residential home staff did not change clothing when she had drippedfood down herself which caused us distress as, before advanced dementiashe had been most meticulous about her clothing.Experiences differed and there were examples of good and poor care from allsettings, locations and services. One common theme identified was that ofresidential home staff being over-stretched and under-trained. As one carerreported from her experience:Homes very tremendously. Some have highly skilled staff; however, manylack basic training and seem unable to treat the resident as an adult. Thiscan be most obvious at mealtimes when staff seem incapable of assisting ina non-intrusive way allowing maximum independence and dignity.Generally, carers did not see problems as deliberate neglect but wereunderstanding of pressures:As with everything in Alzheimer’s what is really required is time, patience andempathy, sometimes easier said than done.Those carers who had found high quality care considered themselves veryfortunate. Many seemed to feel that taking trouble with food and drink indicated agood caring environment:I am very pleased with the residential home in which my mother lives, thefood is always well presented, cooked expertly and smells appetising.Carers’ accounts provide evidence that some services are inadequate, in somecases unacceptable. Others, which might have been helpful early on, do not alwaysrespond to the changing needs of the person with dementia. For example, whilemeals on wheels services could be helpful, many of those carers whose relative hadreceived them for a while reported that their relative no longer benefited from theseif meals were simply delivered and left:Meals on wheels were of very little help. They were delivered early(11.30am) when she was not hungry. She would put the meal in the fridge(whilst still hot) saying she would eat it late. She would then forget about it.In a very few instances, help with delivered meals was provided and this seemedeffective. In other cases, help was provided with preparing food and then eating itand this was seen to maintain independence and to provide valuable company atmeal times.The most trenchant criticisms, however, were made about hospital staff. Staff weresaid by many carers to take no account of the person with dementia’s needs. Forexample:When admitted to the hospital very little notice of what my husband ate ordrank was taken by the staff. No suitable diet was produced. He was unableto swallow and was given a disgusting concoction of what other patients weregiven but put together in a blender which he was quite unable to eat…Foodand medication were just left on his locker.Relatives reported their frustrations at telling staff about the effects of dementia andseeing this ignored:On one occasion we visited my mother in hospital, her lips were swollen andblistered because she had drunk something too hot. We did tell the hospitalnot to give her hot drinks unless supervised, which seemed to have beenignored.Many commented critically on the routines within the hospital ward when food wasdelivered and the person with dementia was overlooked:Hospital staff could not cope with her (my mother’s) confusion, food wasplaced in front of her and left.Carers repeatedly expressed great anxiety at times about leaving their relative inhospital:In a general hospital where my father had to go for a broken wrist he wasconstantly given good care but no assistance was given to him to help himeat…. Sometimes I was told he was not hungry – but unless you fed myfather he would not eat. It was all rather worrying.Some carers reported frequently going into hospital to ensure that their relative wasbeing looked after. For example, one wife said:Unfortunately he has now had a stroke and has problems with chewing andswallowing so things will be more difficult when he is eventually dischargedfrom hospital…At present I go in at one of the meal times daily in the hospitalto help the staff by feeding my husband myself.RiskCarers reported managing risk as a major concern. Danger to the person withdementia was evident in a number of ways, which ranged from the storage andconsumption of out of date food, inappropriate storage of food and problems withcooking. It was evident that many older people with dementia became unsafe ifunsupervised, in the kitchen due to practices such as using gas or electricity atmaximum settings, forgetting that things had been left on the stove and puttingelectrical appliances such as kettle on the stove to heat. Supervision in thepreparation of food or involvement in the preparation of food often helped but forthose people living alone the disconnection of the relevant gas and electricalappliances and the organisation of alternative meal provision, sometime usingmeals on wheels, provided a solution. Some carers reported that the microwaveoven was a 'godsend' in such situations. Very few reported professional help inadvise about assistive technology.Some carers reported anxiety over their relative’s behaviour around eating. In asmall number of instances people with dementia placed themselves in danger byeating non-edible substances:My brother bought unsuitable food if he went out alone – he tried to eat thelittle squares for cleaning the sink.Other relatives reported that some symptoms of dementia were difficult to manage ifthey occurred at unpredictable or difficult times:Mum became restless and confused at night and would get up, stating shewas hungry…. I could not leave her up and about at night – she insisted oncooking chips!Many carers tried to balance their relative’s independence with keeping an eye opento risks in the home, particularly the kitchen:Mum uses a toaster and is safe doing this and I think it is also very good thatshe does this for herself.A small number reported that a person with dementia might be at risk over alcohol,but most appeared not to want to restrict this pleasure entirely:She (my mother) was drinking too much sherry – partly because she was depressed, partly because she forgot how much she had had – occasionally she was drunk.