• What shall we say? 05 March 2018 | View comments

  • 5th March 2018 | By David Jolley

    Time to look forward to the Dementia UK Congress in Brighton in November. It is good that the congress has moved around the country during these 12 years but, even though the series started in Bournemouth, Brighton has become its natural home. I’ll not forget my first Brighton Congress – walking down the hill from the station past relaxed pairs who were playing chess on the pavement. Playing chess on the pavement! It is a message which we can all take as our own: whatever the mad, mad, wicked world is up to – I will find time and a place to do life well.

    What I am wanting to do is to celebrate good things which have developed in recent years – and prospects for even better – but also to pay respect to where we came from and how improvements have been achieved. Learning from the past gives sound direction for the future.

    It is difficult to remember that, before Martin Roth performed his careful description of the clinical characteristics and outcomes of older people admitted to Graylingwell Mental Hospital, all serious mental disorders of late life were commonly pooled under the label ‘senile psychosis’. From then on we have known that depressive states in later life are usually recoverable with the use of ECT or antidepressants which were introduced during the 1950s, delirium may end in death but otherwise usually resolves, but dementia persists and progresses to an early death.

    Roth M. (1955) The natural history of mental disorder in old age. Journal of Mental Science, 101, 281–291

    There were few studies of the prevalence and incidence of dementia. Those that were known included Roth’s classical series in Newcastle upon Tyne:

    Kay DW, Beamish P and Roth M (1964) Old age mental disorders in Newcastle upon Tyne: 1 – A study of prevalence. British Journal of Psychiatry 110: 146-158

    There were at least five people living with dementia in ordinary housing for every one in any sort of institutional care: institutional care at that time would be a long stay hospital or local authority home. There were very few care homes or nursing homes within the independent sector. There were no major charities devoted to dementia. The legislation of the time made scarce reference to issue of capacity amongst the rising number of older people affected by dementia. Life expectation for someone with a diagnosis of dementia and entering care was short with hardly any surviving for more than two years.

    Our understanding of the biology of mood disorders and dementia has advanced considerably during the past 50 years. The pattern of care offered to people with dementia is radically different now from that of the 1960s – a shift determined in part by response to exposure of the scandalous regimes practised in some institutions, but also by issues of economy and political perspective. The funding of care has become complex and contestable, legislation has changed and will change further.

    Perhaps a reflection on these changes which have occurred during a working lifetime will be of interest and give thought for plans for the future.

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