Hunt the Blame

I’m loathe to disagree with the great William Shakespeare and his description of the seven ages of man.¹ The helplessness of senility does have a superficial similarity to childhood, but I believe the differences are much more poignant. The dependency of childhood is a delightful stage, full of anticipation of progress and exciting hope for the future. The terrible dependency of dementia is a cruel, inexorable decline with any hope apparently disappearing. The grief can be magnified by the sense of loss as a once familiar personality often seems to disintegrate and disappear.

As with any deeply distressing condition the search for a dramatic cure can be desperate, and there has been a lot of focus recently on medical interventions such as screening and early use of medication. There is certainly a lot more to be done to improve the lives of people with dementia and their carers, but I think it should primarily be focused on social care and support rather than more specific medical intervention.

As well as help with the practical burden of caring for a dependent person, people need a great deal of emotional support and guidance to find hope in caring for a loved one. Finding that hope can seem impossible, but I was moved by a recent piece by the writer and commentator Alex Andreou in The Guardian.² He described how he had found consolation by fundamentally shifting the way he thought about his mother’s dementia. He started to accept her as she was, living in the present, and not dwelling on how things had been in a different past. I have also heard people describe how they have found keys in things such as music, pictures, and favourite food that can restore the humanity of what seems to be a disintegrating personality. Their relationships can become fulfilling again, not just a case of practical day-to-day survival. Finding the person that sometimes seems to have disappeared can seem daunting and relies on a shift in perspective. It needs patience and gentle encouragement. This is often impossible when the burden of daily care is overwhelming. Improving support with the practicalities is crucial to allow the deeper understanding to blossom.

So, although I am wary about disagreeing with Shakespeare’s assessment, I have no problems taking issue with Jeremy Hunt when he recently castigated GPs on our ignorance of dementia, and refusal to send patients for tests to diagnose it.³ This suggests that he believes we should be concentrating on the medical model of treating dementia rather than looking at its wider social and emotional context. Perhaps it wasn’t a coincidence that he made some of these comments while visiting a pharmaceutical industry research facility. Of course, developing effective drugs to prevent or treat dementia would be a huge advance but for the moment, the greatest help seems to be through caring and kindness. These solutions are not the dramatic miracle cures that make great headlines but I think they would have a great impact on the lives of those affected.

This is not an easy option and it does need investment in focused social care. So, if Jeremy Hunt is genuinely concerned about the inadequacy of dementia care he should look at funding and coordination in that area, and not leave it to the vagaries of an ill defined ‘Big Society’. Putting your own house in order is always more difficult though, than blaming someone else and grabbing a few headlines.