Reflections on ageing
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3395 (Published 01 June 2011) Cite this as: BMJ 2011;342:d3395
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I was concerned to read O'Neill's comment about the "unhelpful
depiction of dementia as a marker of dehumanisation rather than a series
of impairments ...". This sounds suspiciously like some of the more
Pollyanna-like statements to be found in the literature produced by some
dementia charities, suggesting as they do that life with dementia can be
perfectly fine and even fun. Of course it can, in the early stages, but
by the time the disease has become a practical problem to the patient and
his/her carers there are usually effects on personality. To put it
another way, the point at which others recognise the change from
forgetfulness to frank dementia is usually the stage at which the sufferer
changes from saying: "Oh, dear, I've forgotten where I live" to saying
"this isn't my house - you are lying to me". Once suspicion and paranoia
sets in the sufferer's personality changes, almost always for the worse,
with increasing development of fear, anger, distress manifested as verbal
abuse and sometimes actual physical violence. To pretend that these
things don't happen is wrong - it does nothing to prepare the person's
relatives and friends for the enormous difficulties which lie ahead.
Competing interests: No competing interests
Dementia, dehumanisation and lessons from Polyanna
Dr Fisken's reference to Pollyanna is perhaps less pejorative than he
might think. As readers of the novels will know, there is much to be
learned about responses to illness from the adventures of the heroine,
particularly after she loses the use of her legs in a car accident.
In any event, far from romanticizing dementia, Agronin does cover the
downsides and carer distress as well but his theme of maintained quality
of life is backed up by the peer-reviewed research of Bannerjee and
others.
Even more cogent witness come from the businessman Gerry Robinson in
the heart-breaking BBC documentary 'Can Gerry Robinson fix dementia
care?'. In it he showed how perceptive and attentive communication at the
pace of the older person with dementia can break down barriers and re-
assert personhood - if only his skills could be more widely disseminated
to those providing care to those with dementia and their families!
Competing interests: No competing interests