(as published by Tristan Blythe, Group Editor, Thewealthnet)
Cognitive decline, such as Alzheimer’s or other forms of dementia, remains a somewhat taboo subject. It is, understandably, an area many find difficult to discuss.
However, the UK’s wealth management sector cannot afford to ignore it and the impact it has on a firm’s interaction with clients, according to David Durlacher, chief executive of Julius Baer in the UK and Ireland.
A news story this week about a man who shot his wife in a care home and was diagnosed with a mental illness called paraphrenia (http://www.bbc.co.uk/news/uk-england-essex-36865867) put me in mind of a patient I saw a few months ago.
My patient confidently told me that there were a group of little people (about 3 inches tall) on her garden fence who fire green arrows at her. She feels these arrows prick her skin and she is convinced they are loaded with poison which will kill her. The arrows penetrate brick so wherever she goes she is subject to a constant volley. Furthermore the little men read her thoughts, so she can never evade their clutches; they always know where she is. And they talk about her – commenting on Continue reading “Don’t forget the little people”
A few years ago the BBC wanted to film me because I was doing a clinical trial on Ginkgo biloba extract as a treatment for dementia. They turned up with a camera crew and demanded that I wear a white coat. I explained that as a psychiatrist this may not send the right message but they insisted as it would add credibility to the science I was discussing. Then, for additional visual effect, they asked I sit in front of a microscope. The last time I had done that was in the VI form! Still they insisted, so I asked my colleague and friend, a brain scientist, to borrow his microscope. It was HUGE! A massive piece of kit the size of a motorbike. Finally they asked that I look down the microscope at a slide of a person with dementia. My kind friend lent me a slide- one made by Alois Alzheimer himself with a slice of brain from his first patient, August Deter.
Why tell you that tale? When Alzheimer wrote about Auguste Deter Continue reading “Dementia: Looking beyond memory”
The term ‘design for the elderly’ has always annoyed me, partly because if feels vaguely discriminatory and partly because the term the elderly is so imprecise. It also annoys me because the key to all good design is to have an in-depth understanding of your customers and what they want from what you are designing.
So, who are ‘the elderly’?
A 45 year old man develops a neurological condition rendering him multiple physical health difficulties and depression. He has been married for five years. At an initial assessment from a health professional, he is asked about the impact these changes are having on his relationship with his wife, and whether he is interested in and still able to have a sexual relationship with her. When problems are detected, an open discussion takes place regarding what help he might benefit from, and whether it would be useful for him and his wife to receive help as a couple.
So why don’t we ask older people later in life about their sexual lives and sexual relationships? Why don’t we ask when we know that changes in physical and mental health often impact on sexual functioning? What are we afraid of?
The NHS needs to reverse its misguided practice of incorporating old age mental health services into generic “all age” services.
According to recent research in the British Journal of Psychiatry (http://bjp.rcpsych.org/content/207/5/440), older adults have better outcomes if cared for in mental health services specifically set up to meet their needs. The journal asked me to write the accompanying editorial (http://bjp.rcpsych.org/content/207/5/375), and in it I outlined the reasons why I believe the NHS has been wrong to move away from services catering specifically for the needs of older people.
Over the last few years, some NHS trusts have incorporated old age mental health services into generic “all age” services. In these services an 18 year old and 80 year old person would be treated by the same team. There are three main reasons for this trend to ageless services: cost saving, misunderstanding of the Equalities Act and ageism. There are also three main reasons why older people should have their own dedicated services:
It was reported in The Lancet medical journal last month[1] that the prevalence of dementia in the UK has fallen from around 850,000 to 670,000. This figure seems encouraging, but the risk is that it brings complacency to the world of dementia care.
Although it is impossible to say with certainty, there are probably two separate reasons for this reduction. Firstly, the often quoted higher figure was derived by consensus of opinion from experts rather than plain science. This was not an entirely inappropriate method of estimation, because Continue reading “Keeping dementia on the radar”
As a Consultant Clinical Psychologist who’s worked with older people in the NHS for many years, I’ve lost count of the number of times I’ve heard the following questions at a first appointment: Was I sure I could see them for psychological therapy as there must be people younger who really needed help instead? Was I sure there were enough resources within the NHS for them to be helped? Did I really believe change was possible at their age?
Continue reading “Psychological therapies for older people – why ageism is old hat”
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