• Network 09 January 2017 | View comments

  • 9th January 2017 | By David Jolley

    We had our first meeting of the Dementia Network at Willow Wood Hospice for this year on Wednesday. It is a wonderful group with people coming from the general hospital, primary care, care homes, a community care organisation, public health and the mental health (Memory] service to join the hospice based hosts. The network has been running for more than two years and looks fit to survive and continue to thrive and be influential. I still believe it would gain strengths and potentially have even more influence if it were opened to include family carers and people with dementia.

    This is a most significant time. The failure of medications which have been produced from the model of the Amyloid Hypothesis, to achieve any clinical benefits, should draw a line under that particular endeavour. Funds and energy will be better spent elsewhere. The November Dementia Congress at Brighton was another wonderful congregation of many who are driving forward efforts to improve understanding and care. We took time to check through some of the topics covered and views expressed.

    The debate had asked ‘Should we welcome a future of robots, avatars and digital technology in dementia care? ‘Avatars’ had defeated our 1999 edition of Chamber’s Dictionary, which knew it only as ‘manifestation of a Hindu god’. A generous electronic Christmas book token proved sufficient to bring us the 13th edition, published 2014, which includes the addition of ‘a movable image used to represent someone in cyberspace.’ So there we are.

    Our Willow Wood debate and discussion were mature and balanced. Some had seen the film of the name Avatar and had found it interesting. Using technology is fine but we must use it to strengthen and support human activities and not to have us become servants to the technology. I was banging on again about the self-service tills in M&S and many supermarkets, reducing us to objects on a conveyor belt. The modelling of general hospitals on such a system is the basis of their failure to be seen as caring and to make best and most economic use of people and knowledge.

    This predicted a similar commentary on Arlene Astell’s Tom Kitwood Memorial Lecture, which used a series of demonstrations where a computer programme acted as a transitional object between an individual with dementia and their professional carer. Two’s company and three can be a crowd unless the third knows and accepts its place as a facilitator rather than competitor. A worrying muse was, what the future will be like for our younger generations when they become old and frail. They seem to relate preferentially to machines and apps (Chamber’s allows this!]. Maybe they will be more at ease with cold steel than the warm hearts we look for.

    But how wonderful it is to be involved in discussion such as this with colleagues. We were happy with the range of topics covered in Brighton. At every one there was something to be said and much to be learned from each other. Contributions from DEEP, Sube Banerjee’s continued fascination with comorbidity (for Geriatric Medicine from the 1940s ‘multiple morbidity’] is welcomed, David Mowat’s absence and representation by a video giving one side of a story but avoiding discussion (Avatar?] are certainly not welcome. We remembered Normal Lamb who came and listened. We hope that Mrs May will require the same of her ministers.

    There was much more. The emphasis on the therapeutic power of the arts is strongly supported in Tameside and Glossop who have pioneered work of their own. Positive approaches to life in care homes were eagerly accepted. Homes in T and G, some in particular, bring in every good idea that they hear of.

    Alistair Burn’s anticipation of a biochemical breakthrough in his keynote address was badly holed by the announcement just days later that Solanezumab had failed, again, in a trial designed to demonstrate any clinical benefits.

    It is OK. We will carry on caring. Carol Brayne had much that is encouraging to bring from her studies of epidemiology and the evidence that incidence and prevalence can and do fall in response to better conditions for life and life style. And Jill Manthorpe and Steve Iliffe’s series in the JDC which counsels greater appreciation of the natural history of age-related illnesses and death in our times.

    All this feels quite at home in our hospice base.

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