SIR Terry Pratchett has said the Government makes sufferers from Alzheimer’s disease feel like malingerers, as if it believed that they did not suffer from a real disease. While i can well under- stand his frustration i do not think what he said is quite accurate.
Alzheimer’s disease is probably the most feared illness of old age for it seems to rob us of what is most essential about us: our capacity to live a self-directed life. The older someone is the more likely he or she is to have Alzheimer’s and it creeps up on you like a thief in the night, gradually and at first imperceptibly. You know something is wrong but not exactly what it is.
It can take a long time for anyone else to recognise it. Not realising that you are ill younger people may be impatient with your forgetfulness as if it were wilful. They ascribe blame where compassion would be more in order.
Even when the disease has been diagnosed many have difficulty in fully accepting that an old person’s behaviour or loss of memory is involuntary. With the best will in the world and a determination to be patient and understanding it is frustrating to be asked the very same question by someone several times an hour.
Surely we cannot help but think our aged relation could do better with a little more effort? Even when we know this to be nonsense we still think it and this is because we consider the person with Alzheimer’s not as he or she is now but as he or she once was, that is to say fully alert and in possession of his or her mental faculties. We do not make the allowances that we should, at least not all the time.
THESE are human failings, not govern- mental ones. Better knowledge and awareness of Alzheimer’s might help but they will not by themselves ensure that understanding will be extended to every patient who suffers from the disease.
Sir Terry makes another important point, however: that when patients with Alzheimer’s disease, through no fault of their own, need to be cared for in a home they are made to pay for it by the liquidation of their savings or the sale of their house. And since they have contributed taxes throughout their working lives this is unfair and discriminatory.
The promise of the welfare state was that in return for high taxation everyone would be looked after from cradle to grave but this has turned out to be like a worthless insurance policy that covers you for every- thing except that which actually does happen to you.
Strictly speaking people with Alzheimer’s disease are not discriminated against: the same financial conditions apply to every old person who is admitted to a home for what- ever reason. But there is no doubt that a promise that turned out to be false was issued by successive governments. People were given the distinct impression that they need not make provision for a personal catastrophe such as Alzheimer’s because everything would be taken care of by the state.
Indeed the high taxation throughout their lives prevented them from being able to make provision for such a catastrophe even if they had wanted to. They were left with the worst of both worlds, neither insurance nor the means to pay for their own care except with the one asset that it took them their whole lives to accumulate, namely their house. No wonder there is a sense of injustice.
When the cradle-to-grave promise was made the government had no idea that within a few decades people would be living as long as they now do and that there would be so many people, many of them with Alzheimer’s, in need of care.
The old age pension was started on the premise that most people would not live long enough to draw it and therefore a pay-as-you-go system might even be profitable to the government.
The cradle-to-grave promise was easy enough to make and keep when the grave was not as many years removed from the cradle as it is now. Where governments have been culpable is in continuing to pretend to keep old promises when they knew that they could not do so.
WE SHOULD not be too gloomy, however. Old age is not Alzheimer's and nothing else.
It is true that more people than ever are living to the age at which they are most at risk of developing Alzheimer’s and there are more patients with it than ever before. Treatment is not yet very effective and we don’t even know how to prevent it.
A recent paper in the British Medical Journal suggested that education, general knowledge and a diet richer in fruit and vegetables had reduced rates of Alzheimer’s but this does not mean that knowing more or eating more fruit actually prevents Alzheimer’s.
But as we live longer lives so we also live healthier ones. old people are more active than they used to be.
The average 70-year-old now is probably as energetic and fit as a 60-year-old was 20 or 30 years ago and he in turn was fitter than his predecessor. it is not only life that has been extended but a healthy life.
Furthermore it is still true that the majority of old people are looked after, when necessary, by their close relatives.
No doctor can fail to have been moved by the noble and indeed heroic attempts of many families to look after their elderly. like most glasses that are half-empty the glass of old age is half-full as well.
Originally published in the Daily Express.
Posted on 03/15/2012 7:46 AM by Theodore Dalrymple