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Ageing for Beginners

Tuesday, 27 November 2018

Who were they? The now is not what they were. Look again.

Daily we meet new people. For many of the young, older people seem … just old.

This demands a special approach, talking loudly so they can hear, and then repeating messages, as they might not have understood the first time around, or the language of today differs increasingly from the way we spoke in the past.

“What’s cool dear? I find it rather warm.” After that it’s time to get back to the real world: “Nice to meet you,” a fast wave and they’re off.

But what the heck is this word old anyway?

I’m not old but they did not seem to see that while they were here.

But the older individuals weren't always like that.

Our judgements of others are commonly made in a few minutes meeting, and short but inconsequential conversations.

But what we see is often far from what the individual was, and certainly carries few concepts of past strengths, resilience, struggles, successes, and tragedies.

As we gain in years some of us maintain the essence of our personalities, good and bad.

But others, as a consequence of some of the traumas of ageing, are unavoidably transformed to a different being.

The onset of dementia can bring such an unravelling of persona.

My father died three weeks short of 100.

He had worked hard, became a very successful businessman, and travelled the world until his late 80s.

Despite his struggles following a stroke at 89, he maintained his effervescent personality, dealing to daily physical and memory struggles with courage and humour.

His interest in others, and powerful and consistent empathy, presented an interesting and fascinating individual to whom all ages could relate.

“Tell me about yourself,” he would encourage his young visitors.

And they came. He was lucky as were we for his personality remained unchecked and unaltered. He was who you met.

In contrast, one of my grandmothers, who died close to the age of 90, was to me as a kid a grumpy old woman.

She complained and moaned about things we kids did, though there were flashes of her past spirited individualism.

At first, we were bored with being told off.

But as we learned more, things began to change. We used to visit her on a farm she managed till the age of 80.

The toilet was still outside, and at weekly intervals a man would come at night and empty the toilet receptacle, so it was ready for a further week's offerings.

The telephone was a party line so the neighbours could listen in, and some did. Coming from the big city we were astounded as kids to save the midnight run to the loo, with a chamber pot under our beds, a topic of extreme entertainment for three small boys.

As we learned more about the grandmother’s history we slowly learned to admire her extraordinary courage and resilience that had carried through life.

Her husband, my grandfather, an immigrant from New Orleans USA, a highly educated escapee from something, and hopelessly impractical, died at the age of 47, leaving her with five children, and a completely unproductive farm at the end of the Coromandel Peninsula, a few hours from Auckland by occasional ferry.

She told me, with tears in her eyes, her memory from nearly 50 years before of trudging from the hospital with a small carry bag of her deceased husband’s possessions.

She walked the four kilometres to the ferry for the trip home to let the children know their father had died.

Over subsequent years she transferred her family to far more productive land outside of Paeroa where they eventually established three successful dairy farms, one for each of my two uncles, but with my grandmother's farm strategically sited between the two so she could supervise.

She became President of the Women's Division of the New Zealand Federated Farmers in the 1930s, a powerful political body in the country and one of the few that heralded the rights and opportunities of women.

She married a Boer War and Gallipoli veteran to help manage the farm. She became the driving force and spirit of the family, and of the local community.

With those experiences behind her, keeping three small boys in check was a breeze. As early dementia became manifest, her spirit began to submerge and what we saw was very far from what she had been.

The crabby old woman we first knew masked an individual of furious energy, persistence, reliability and drive carrying her family and then her community out from the trials and tragedies of their past.

Her huge breakthrough for me was to cook my first of every chocolate steam pudding at the farm. I was fixed and converted.

These two personal vignettes highlight for me that engaging in personal interactions with many senior citizens requires a little more attention and commitment than a casual introduction.

I'm finding a little more time exploring the past, commonly opens doors to well-lived lives of drama, imagination, commitment and entertainment.

The past may be the past, but most individuals usually retain their basic character, even when it's been battered by some disease or the ageing process.

Increasingly I find how much one can learn from one's fellow man where time might have drawn some curtains across lives that were magical in their own right.

Technology helps us moving on and adjusting to today's fast changing world; but for most of us that long training ground of decades of living, struggling and laughing, cannot be eliminated.

Memories are a wonderful literature to tap into, and to share, and cry and laugh and admire.

Get five people in their 80s together and you have five stories for novels. A village becomes a library.

The rules of engagement are simple:

Stop and talk and find out who they really are, where have they been, and what fascinates them now.

Sometimes a shared autobiography can break ice and reveal passionate common grounds to explore.

It’s not always young people struggling to find the real individual in their relatives or acquaintances older guise, but two seniors working to understand themselves.
It can be an exciting journey of discovery.


About the Author

Dr Doug Wilson has been an academic physician, and a pharmaceutical industry research executive and a medical scientist as well as a writer.

For the past 30 years he has monitored the scientific literature as it relates to ageing, and the conditions that may interrupt your enjoyment of that process. His background as a physician, a scientist, and a developer of new drugs, he's well placed to distil clear messages from the huge forests of data that exist and confuse.

Doug’s aim is to cut through the fads and fallacies to concentrate on the core issues and the physiological and psychological reasons behind them.

Armed with this information, we can plan for our older years to be golden years, not tarnished, confused or stressed years.


 

Tuesday, 20 November 2018

Forgetfulness: Normal Ageing or early Dementia?

Dr-Doug-WilsonA few months back I visited someone in Mangakino, a small New Zealand central North Island town, originally built for the workers who were constructing the huge hydro dam of the same name. I had visited there as a kid to see the massive building works. When I returned home, a drive of around 40 minutes, my wife enquired where I had been. I knew where I had been in crisp detail, but not the name of the town. Whakamaru was the next town and that I remembered well from my schoolboy visit over 60 years ago. But Mangakino had taken fright and raced away from my finely tuned neurones. “Come back,” I wanted to shout. But I could only bleat: “It’s slipped my mind. I’ll remember later.”

Simple solution: I’ll google it, or least the neighbouring dam: Whakamaru. Sure enough, there on the map nearby was Mangakino. Problem solved.

Nope. Not solved at all. After I closed the Google screen I called out to my wife: “It was XXXX?” The pesky word remained absent, absent without leave I might add, and the Google jog had gone with it. I began to think that I’d better check in to a dementia unit as I was losing it, and what did I need to take with me?

Common sense prevailed as I felt on top of stuff otherwise. So I wrote the word Mangakino on a card and placed it beside the phone and computer. It took three days for that pesky neurone either to wake up, or pass the name to an underworked neighbour. And it did, and now I am Mangakino educated and friendly.

I don’t have dementia!

So occasional, or even common trouble with memory recall is a feature of normal ageing. When dementia arrives, at first with isolated episodes of abnormal or even bizarre behaviour, sudden mood changes, or increasing patches of forgetfulness or lack of recognition of people they know well, or increasing confusion, then it is time for action. Daily skills begin to fade; individuals can struggle with conversation; judgment becomes unreliable; they may wander without knowing where they are, and their personality can alter materially. It is time for a proper medical assessment, to be sure that the issue is dementia, as in many instances it is something else. You don’t want to get it wrong! Self-diagnosis is a wobbly zone and can prematurely label a spouse or loved one with a disturbing diagnosis that it is not.

Sometimes the individual is reacting adversely to medication; drug doses for older subjects are commonly too high. Or their thyroid gland is out of kilter, or there are disturbances of their liver or kidney. Type II diabetes can induce changes suggestive of dementia, as can mini strokes. Too much alcohol in the elderly is a common disrupter of behaviour and memory. Depression and anxiety can over-run the governors of normal behaviour. A bladder, or even deep skin infection may tip behaviours off balance and individuals can appear confused. Low levels of vitamin B12 are a common cause of abnormal behaviour and personality in older people.

So find the disorders that are not dementia and get them treated. Missing a masquerading condition that is readily identified and treated is a major lost opportunity to discard the dementia label and return life to its rightful path. There are a range of tests for dementia that doctors and psychology professionals use to cement the diagnosis.

Although there are different forms of dementia, Alzheimer’s being the most common, there are many others, such as dementia with Lewy bodies, the affliction that targeted Robin Williams and triggered major behavioural crises and hallucinations. However, with a few differences, the long term course is rather common for all causes of dementia, with slow decline, as the individual becomes withdrawn and their very sense of self becomes dragged towards the dementia realm. Even watching themselves in a mirror many see a stranger looking back at them.

What to do? Is there a cure or a treatment? There has to be, as so many conditions, even cancer, are benefitting from new treatments these days. At present there is no treatment that addresses the underlying disease process. It is essential for families, partners and spouses, once the diagnosis is certain, that they learn to accept the predictable decline in the patient, and their inevitable loss of the individual they have known, as they are replaced by a slow moving and thinking stranger who occupies their body.

There are short term drugs: anticholinesterase drugs such as Aricept or Exelone which can restore some memory and initiative and decrease anxiety. But these benefits tend to fade over 12 months. At the present time, despite billons of dollars spent on massive research programs, nothing has appeared to arrest or reverse this condition. And nothing will for a few years. This also means that occasional trials of unique interventions delivered by very caring relatives, describing very positive outcomes, are unlikely to be transferable or to move the general treatment world of dementia very far or be sustainable.

Not all is depressing. Many people with dementia are surprisingly happy with their lot and have a jolly disposition. Perhaps in some primitive way they see themselves getting away with outrageous things, they might long have wished to do. A pattern of exercise is very helpful to reduce the rate of decline into frailty and disability. At the same time people’s susceptibility to infection and physical decline can be accelerated if their nutrition is ignored, and they benefit from positively monitored dietary guidance. There are wide differences in the rate of decline as the disease plods its path rapidly in some, and slowly over some years in others. Faster decline is more common in those where the disease asserted itself at a younger age. Interaction with family and carers will assist the patient's mood, and to some extent their rate of decline.


About the Author

Dr Doug Wilson has been an academic physician, and a pharmaceutical industry research executive and a medical scientist as well as a writer.

For the past 30 years he has monitored the scientific literature as it relates to ageing, and the conditions that may interrupt your enjoyment of that process. His background as a physician, a scientist, and a developer of new drugs, he's well placed to distil clear messages from the huge forests of data that exist and confuse.

Doug’s aim is to cut through the fads and fallacies to concentrate on the core issues and the physiological and psychological reasons behind them.

Armed with this information, we can plan for our older years to be golden years, not tarnished, confused or stressed years.

 

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