‘How can we ensure that ageing societies are more prosperous societies?’ That’s the question posed by the latest Charles Street Symposium, an essay competition run by the Legatum Institute (for which I’m an advisor).
My answer? I haven’t a clue. Especially now that I make regular visits to a private care home specialising in dementia. Before I got to know it, I had the idea that dementia was a sort of extreme version of absent-mindedness, with the odd harmless delusion that you’re the Queen of Holland – plus Alzheimer’s, which was scary and fortunately rare.
Now I know that Alzheimer’s may be scary but it isn’t rare: this study found that 10 per cent of a study group of 82 year-olds, none of whom had dementia, went on to develop it (and, interestingly, that they tended to be the ones who took the least exercise). But 82 isn’t really very old these days: take a group of 87 year-olds without dementia, and how many would go on to develop Alzheimer’s? I’ve been horrified how many of my mother’s friends, who seemed not have dementia in their mid-80s, went on to be diagnosed with it.
And there are other varieties of dementia, some of them pretty common – for example, the vascular dementia that afflicted Margaret Thatcher so badly in her last decade. And the horrific Lewy Body dementia, whose early onset almost certainly led Robin Williams to kill himself.
In the home I visit, I don’t know who has what, and in some cases there is no precise diagnosis — each person has his or her unique symptoms, and there is no definitive medical test for dementia. As this website explains, ‘it is not simply one disease but a syndrome. This means that it is a term that is used to describe a group of symptoms which could be caused by one or many different diseases.’ (That said, I think it’s fair enough to refer to dementia as a ‘disease’.)
So caring for dementia patients is a complicated business, requiring almost infinite patience from staff and making cruel demands on the psychological stamina of family members.
In this home there’s the sweetest old lady who, the first time I met her, greeted me with the words ‘Hello darling!’ and then, without pausing for breath, ‘you fucking tosser’.
Put simply, that second bit was the disease talking. I doubt that this lady ever used those words before she developed dementia — but she’d heard them, and now her brain reaches for them to express inchoate anger.
The staff don’t turn a hair when they’re greeted in this fashion. Every one of them, whatever their role, is trained to deal with dementia. Sudden hooting and shouting from residents doesn’t bother them, either, though they’re very good at calming them down, drawing on their specialist training.
Also, they don’t show a flicker of boredom when a well-spoken old lady tells them, in the civilised tones of a hostess pouring mulled wine for the local hunt, that her family hails from such-and-such a town and that her father was a magistrate. For the 50th time that day.
That lady is 93. She’ll tell you how old she is — again and again — in surprised tones which imply that she didn’t expect to live that long. I’m sure her relations didn’t expect it either.
I’m just guessing, but if she’d died ten years ago she would probably have gone to her grave with all her marbles. As it is, she’s one of the 850,000 people with dementia in the UK, a total that will pass one million by 2025 and two million by 2051. Perhaps more, if immigration continues at its current crazy rate.
But what I can’t find out is how many of those 850,000 are in specialist dementia care homes — or ordinary nursing homes that offer staff trained in dealing with dementia.
Not enough, I’m sure. This is an expensive illness — for the NHS and also for families who decide (not unreasonably) that the only way to ensure meticulous care for their troubled and demanding loved one is to go private.
Those families need to do their homework: there are plenty of cowboys out there. And once they’ve found the right place, they could be looking at a weekly bill of £1,000.
So, as I say, I’ve no idea how ageing societies can ensure that they’re prosperous. According to one dementia expert I talked to, we are decades away from drug treatments that will reverse, as opposed to mask, the symptoms of the major varieties of the disease. In a few years’ time, dementia homes will be absolutely full of old people — visiting their parents. Bang goes the retirement cruise.