Posted on Wed 18 Jun 2008, 14:48 in NHS

Me, my dad and my daughter
When my dad was in his '60s and watching his mother slowly disintegrate through dementia, he would tell us we should shoot him if he “ever went like that”.
Now he’s in his 80s and clinging to a life he would have despised.
The reality of the government’s sudden enthusiasm for the question of ‘What Do We Do About Dementia?’ is that around 700,000 people in the UK currently have dementia, with two-thirds of them being cared for at home, their families carrying most of the cost of that care – financially and emotionally.
By 2021, that figure will be close to a million people and will top 1.7m by 2051, according to London School of Economics and Institute of Psychiatry research. That means one-in-three voters will be affected by dementia either as a sufferer, carer or relative.
Which includes most of my dad’s 24 immediate family members. Multiply that figure by all the dementia victims in the UK today and the government’s decision to start work on a National Dementia Strategy, and this week’s launch of a dementia strategy consultation, makes sense - even if it means nothing new until at least 2009.
My dad’s mum ended her life in a just-about-okay nursing home. Confused, no longer recognising her sons, and sedated. Assuming my dad lives long enough, the likelihood is that he will end his life the same way.
For now he’s living at home and, as in the majority of cases, the burden of coping with his mood swings, aggression, confusion and increasing personal care falls to his wife, my seventy-year-old mother. As long as his family can still see enough of his spirit to hang onto, we try to nurture the spark with memory books, simple conversations and changing strategies for coping with the loss of his personality and dignity.
But I’m not sure what else we would expect the government’s rush of enthusiasm for dementia strategies to deliver. My dad has had a posse of assessors and paid experts turn up over the last six months trying to help. But the drugs haven’t worked, and anything that involves his wife not being in the room with him – like going to a day centre – sets him off. In reality, the strategy is about waiting for the family to get to the point where they give up and put him in a home.
Maybe we should have pushed him to go to day centres and respite care much, much earlier – while he was still able to understand and respond postively to change, then we’d have been in the position of continuing a routine rather than trying to introduce something too new and too late.
But everyone talks about ‘memory loss’ in the early days, like it’s something you’ll find if only you take another look under the sofa cushions. No-one wants to hear about dementia or be told what they can realistically expect over time. And there’s no-one out there picking up the signs early enough for you to ask for help before you desperately need it.
Perhaps that’s something that should be in the new dementia strategy – a requirement for everyone over 70 to have annual mental health checks – to watch for early signs of dementia and give the patient non-drug ways of maintaining brain health?
The hardest thing for any family coping with dementia is knowing that you can’t look forward, because what are you looking forward to? Putting them in that home? Their death?
With my dad it’s also difficult to look back. We have to take a big leap back 20 years to the point before his health started to collapse. The dementia is only the latest illness. What came first was the regime of drug cocktails to deal with circulatory problems, then with stroke prevention, then the memory loss and mood swings.
Most of the time we never knew what he was being given or why and it was only recently that we found out some of his drugs where not meant to be given together or, like Risperadal and Largactil, should not have been to him given at all.
Maybe that’s the second thing that should be in the new National Dementia Strategy – a requirement for patients to have their medication independently reviewed every six months so they don’t get caught in patterns of prescribing that do more harm than good? It’s time we started viewing doctors and their assessments with the same level of cynicism we give to mechanics and plumbers.
It’s also time we stopped believing that with old age automatically comes long-term illness and degenerative disease and that we can’t do anything about it.
Or believing that it’s somehow okay for people in their 60s or 70s to die in hospital because that seems old enough to most people.
We’re meant to wear out, not be counted out by indifferent care and a belief that every pill is magic.
So, I’m telling my family now that if (or perhaps it should be when?) I get like my dad, don’t shoot me but don't let the doctors give me drugs. Whatever it is – even if it’s meant to keep my heart beating or stop my cancer spreading because, like my dad in his '60s, I don't believe that just staying alive is enough.
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