A bit of background information about dementia specifics... and yes I do love my anatomy and physiology –
It’s a bit obvious but the brain needs to be looked after as it can’t be rewired when things go wrong.
Physically the weight of the human brain decreases by approximately 5% between 30 and 70 years, 10% at 80 years and 20% at 90 years of age. As we age, anatomically our brain structures change. Ventricles tend to enlarge, meninges being to thicken, there is a loss of nerve cells (which is minor and selective) and a general decline in quantity of nerve processes. The presence of senile plaques, neurofibrillary tangles and granulovacuolar degeneration, increase with age and are present in 80% of healthy individuals that are aged 70 years and above. There is also a biochemical decline of neurotransmitter systems and ischemic lesions are present in half of normal people over 65 years of age.
The problem lies within the relationship between post mortem histology and brain function in life. In general as we age, there is a general decline in functional capacity and adaptability as well as the increased occurrence of chronic degeneration conditions such as Parkinson’s and so forth. Currently half of general hospital beds are occupied by the ageing elderly and the management of this population is riddled with problems such as; increased sensitivity to the possible side effects of treatment, most patients tend to have more than one disorder present as well as social and psychiatric complications.
These psychiatric complications arise as the elderly often unwell and have sensory impairments and so it is difficult to determine what is normal ageing and what is not. Standard tests such as the mini mental state examination (MMSE) measure intellectual intelligence and the diagnostic significance of these scores increases as these test scores tend to decline from mid life onwards. Tests like the MMSE focus on learning new tasks but do not fairly represent the value of experience. Clearly the short term memory does deteriorate and decreased motor function (changes in central nervous system) may help to explain the impaired performance in tests due to the slow response speed. However changes in attitude (i.e. increased rigidity, caution) and personality (disengagement from society) also need to be taken into account.
Demographics of the elderly population are dependent on their societies (i.e. traditions and customs in asian countries such as China vary significantly from the normal practices in western countries such as England). On the whole, we are seeing an ageing population and so the social structure has also changed compared to previous years. Usual destinations include care homes, living alone or with their partners (a significant majority do do this now) and very few live with their children. Some have very little family to help and with many middle aged women working, this means that there are less people to visit. A disturbingly large proportion of the elderly population are living dangerously close to the official definition of poverty what with poor accommodation and lower incomes compared to the younger population, which I find very disturbing. You only have to glance at the newspapers during the coming winter to months to see what kind of issues the elderly in this country have to contend with i.e. unable to pay the increased heating bills etc.
Perhaps it is just my outlook on life and how I have been brought up, but the abandonment of the elderly does anger me. A lot. May be I am taking it too seriously, I mean it’s not like I am related to these people. In fact even familial ties do not hold a lot of water these days; they seem to have no importance as they did in previous times – a factor that is contributing to a ‘broken Britain’ as Cameron would say.
And yet I still feel a connection to these elderly people around me. I choose to care because I genuinely want to care for them and not because my intended profession asks me to do so; to care for all people equally regardless of age, creed or colour. When I assess these people and I take the time to sit and talk to them, I do it because I want to know more about them and how they got here and not use it as a method of impressing the senior clinicians or getting the best diagnosis – things that would further my career. I can’t say it is entirely altruistic because that would be untrue; I am put in those situations because I am here to do a job which will benefit me primarily in achieving my career aspirations – but at the same time I hope it benefits them personally as well as medically.
These people have worked hard in their lives, contributed to the society we live and yet when the time comes to reap the benefits they are cast aside like spare parts. I see their own family members short tempered and not willing to ‘waste their time’ with them. Often we hear familiar terms bandied about when discussing this section of society; ‘a dinosaur’, ‘stuck in the dark ages’, ‘not willing to adapt/ be flexible’, ‘reaching the end of their mortal coil’, ‘they’re not contributing to society so why waste precious resources on them?’ are just a few that I have heard. However I believe that is not true.
The elderly population that I see around me are a group of people, the majority of which did believe in working hard and providing for their families. Can we say the same for the current generation – those scrounging off benefits to the detriment of the hard working, tax-paying, law abiding citizens of society? I mean what sort of message is that sending to the younger generation? I may be a 20 something and I am aware of how this is making me sound but at the time how many of us can genuinely say that we take to the time to understand these people?
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