• D for Disease or Disability? 05 December 2016 | View comments

  • 5th December 2016 | By David Jolley

    I found myself alone at our regular Friday lunchtime study and discussion hour. This does not happen often but it gave me time to read again the paper from Jill Manthorpe and Steve Iliffe (J of Dementia Care November December 24 6 p 14 and 15] which challenges recent thinking about dementia. ‘The Dementia Strategy, time to change course’.

    Now that sounds pretty brave and thoughtful, but there is more to this than dementia. This fearful combination of professors of social work and general practice gives light to two earlier papers which question the orthodox view that the accumulation of older people in our world is an expensive embarrassment. Not so say R.G Evans and colleagues in ‘Apocalypse No’ Canadian Journal on Ageing (2001] S1 160 to 191. This R G is not Grimley, Geratologist from Oxford, but a professor of economics from British Columbia. The view explored is that the changes associated with ageing are not as great as hyped, but that added expense comes from the way that we are responding to them. ‘We’ equates to professionals and to older people and families, all wanting better standards of care and the development and application of new ‘therapies’. A similar conclusion is considered by a team from the Netherlands writing in the Journal of the Royal Statistical Society this year. ‘Gheorghe et al. Health losses at the end of life, a Bayesian mixed beta regression approach’. In essence, they say, the fact that more individuals survive into later life does not imply inevitably greater costs overall if, as is the situation, their period of ill-health and dependency is relatively short, concentrated in the weeks before death.

    Well hurrah for that. The logic is that we, society and especially the healthcare industry, should apply a curative model when cure of single pathologies is realistic, and a palliative or rehabilitation approach when living with, or dying with a condition or combination of conditions is the reality.

    Manthorpe and Iliffe criticise the current Dementia Strategy in being wrongheaded in continuing to encourage belief in an illness, curative model for dementia and related disorders. This has misdirected money and other resources to early identification of problems for which there is no effective treatment, raising anxieties and fears and syphoning away resources. These should be better focussed on helping individuals and families where there is real need and where the exhibition of informed care is known to be useful in reducing adverse symptoms and stress. This requires a palliative or rehabilitative mind-set, which is not alien to most clinicians who will be happy to continue to play their part in helping individuals and families alongside other professionals and voluntary agents.

    I am not at one with all which is said in this article but there is enough already to mean we should share it, discuss the ideas, and look forward to other papers in the series which is promised.

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