Thursday, 21 October 2010

Good Old Copperfield!

"Life Is Not A Bed Of Roses"  or
"Living With Dementia".

Good Old Copperfield!  I love this blog in Pulse!  These two GPs always offer a wonderful insight into the joys and woes of their world.

Take a look at this weeks article "What, if not antipsychotics?"  It is pure truth and I love them for it!

The majority of people I am proud to care for have some form of dementia.  We are strange in our home for we regard the residents as our employers - we work for them!

Living with dementia is not a bed of roses; it is not two sweet little old ladies enjoying tea and scones and a confused chat - although it can be for a lucky few.  Some residents are lucky in that they are totally apathetic and appear to suffer no emotional harm.  But perhaps they do in the quiet strange place in which they dwell - I don't know.

Living with dementia is about existing in a frightening, alien world where even you closest family will eventually become strangers.  For some - it must be akin to being in a permanent drunken stupor where you touch, feel and attempt to understand and make sense of  all that is around you - but you can't.

It is about Annie, who, when waking in the morning finds herself in a strange room and she is frightened!  Strangers enter her room and talk to her - but she doesn't understand what they are saying.  They continue talking as they help her from her bed and begin to undress her and prepare her for her day.   But she screams "Police!  Police!" and kicks and bites and punches, for she fears she is being raped.

It is about Jim - who despite family fears that it would be harmful - has been told that he has dementia by his psychogeriatrician, for he believes that Jim has a right to know and it is in Jim's best interests.  What about Jim's right not to know?  Jim is angry, agitated, anxious and so very afraid.  He is tormented and his family can no longer cope with the stress that caring for Jim brings.

He has entered nursing care much earlier than would perhaps have been required if he had not known.  He is resentful and insulted by required, personal interventions and reacts with extreme violence.  He sleeps little and wanders the home, entering others bedrooms as he searches for his wife.  He requires 1-1 observations through the night as he is a danger to himself and others.

After other meds have been tried and have not alleviated his distress - he is prescribed antipsychotics and after a while he is calmer, but still a little troubled.  He now eats and joins in activities and sleeps.  His life has regained a certain quality.

It is about Betty who is a long term resident.  She has in her time, worked as a barmaid and a carer.  When she first arrived she would attempt  (as if driven by routine) to tidy the home - clearing away plates and cups before residents had finished their meals.  These residents reacted in anger and sometimes physical conflict ensued - for social inhibitions often fly away when you have dementia.  She attempted to 'go home' with staff - thinking she had finished her shift - and when she couldn't, would erupt into violent behaviour.  She was prescribed antipsychotics and calmed and regained a certain quality to her life.

They were taken away from her earlier this year, following the DOHs insistence that side effects outweighed benefits with regards to the elderly.  She is now again that poor, mad, tormented and very distressed soul; she wanders the home, interfering with others and invading their space.  They slap her and she slaps back.
We fill in Safeguarding Vulnerable Adults forms for all involved and send them off to the powers that be and all is tickety-boo!  But who is the vulnerable adult here?  Betty who is now permanently tormented to meet DOH directives or the poor souls whose space she persistently invades?

Given the choice - I would rather live five years of a drug-induced calm - where my life had a level of quality than seven years existing in a permanent, living hell on earth.

I agree with Copperfield in that it is socially unacceptable to allow the elderly to suffer in torment.  Why do we allow it?



Anonymous said...

Too true, it is easy for those in ivory towers to condemn antipsychotics. While they can be a chemical cosh, they can be the difference between a family coping and one not coping.

Your Betty sounds my now deceased grandmother, who had for a time run a hotel. She would often be firing the domestic staff for not being sharp enough with the cleaning. She also used to confuse the families of other residents by answering the phone, and telling them that they had the wrong number. This is the borchester hotel...

Sadly this amusing phase passed, when she could no longer recognise us it was just distressing.

Hypercryptical said...

Thanks for your comment Dr Phil.

There are very few residents in our home recieving antipsychotics - and they need them! Life is sadly pure torture for some of those with dementia.

Of course other residents and staff 'benefit' from a HAPPIER resident - but that is not the reason why they are prescribed. They are prescribed (not by GPs; not at the request of staff - but by a psychogeriatrician who feels they are needed) to allieviate distress.

I do wonder if this belief that antipsychotics are a 'chemical cosh' is grossly exagerated, for it is almost impossible for a resident to eat and drink in a drug induced, highly sedated state. Residents dying of malnutrition would surely be noticed! Generally drugs are titrated up (from the smallest dose) and not down!

Sad story about your grandmother Dr Phil. I can relate to this for my dear old mum followed a similar path.

When someone you love no longer recognises you, it is distressing; they become a stranger to you too; it as if the essence of them has died - but their body lives on as a constant reminder of what you have lost - you are in fact, bereaved.