Thursday, 16 September 2010


This week I've spent hours in meetings, mostly management meetings, striving to keep our service ticking along nicely through basically asking simply for us to be left alone. Investing time in meetings to do nothing and change nothing is necessary, to stop well meaning folk make unhelpful changes, but there's little joy to this. The endless hours can be a bit of a dark cloud on your working week.

I've a gentleman who's just had his 6 week review by his social worker, having been placed in a care home from intermediate care. He's staying in the care home since he's immobile, episodically confused and falling.

He's got severe osteoarthritis, with the wear and tear on his joints causing severe pain, limiting mobility striking. From being independent a year ago, he's no sedentary and almost immobile. When he does try and walk he's in pain and falls, often.

He's an older gentleman and has prostatism, drippling urine and having continence problems.

He was made known to me by the care home, rather than from medics in Primary or Secondary care, with concern that he'd developed pressure areas and was this causing infection making him more confused, causing him to shout out at night now? A fair question for a regular residential home to ask. I pulled medical notes from the acute Trust, spoke with the GP, pulled off his blood results and scans and found a different picture.

His poor gait and falls wasn't put down to arthritis and pain. His incontinence wasn't put down to prostatism. His episodic confusion and decline in function over a year wasn't put down to dementia. He'd been investigated and found to have normal pressure hydrocephalus and placed in permanent residential care to support his consequent deficits.

The care home simply sought sensible advice on whether there was a treatable cause for his new behaviour (of feeling anxious and shouting out at night) or whether as they phrased it, it was part of the progression of his swollen brain.


Good initial GP assessment, then good medical work up by a physician, then good neurosurgical assessment and then good care in a care home.

My dark cloud this week has a silver lining.

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