Older Mind Matters

International Psychogeriatric Association - Congress in Den Haag

I am writing this in the Hague whilst at the International Psychogeriatric Association (IPA) conference: this is the 15th International Congress of the Association and (as usual) the programme is packed.

Today (Wednesday September 7th) I started at 8am with a plenary session entitled The Future of Dementia. The take home message is:

  • The importance of nutrition, exercise, cognitive training and managing vascular risk factors in preventing dementia. A 10-25% reduction in seven lifestyle risk factors (including smoking, obesity, physical inactivity and cognitive inactivity) would prevent between 1.1 and 3 million people across the world from developing Alzheimer’s disease (Barnes and Yaffe, 2011)

I then went to a session on palliative care for people with dementia. I must confess to mixed feelings about the idea that people who are diagnosed with dementia should start to plan their end of life care. For me this doesn’t fit with the message of the National Dementia Strategy that people are living with dementia (as opposed to dying with dementia), although I am fully in favour of people being encouraged to plan their care with their families and the people who are supporting them.

Over lunchtime I attended a Clinical Leader Workshop on Elderly Abuse and followed this up with attending the ‘World Café’.  The World Café was a facilitated session where a small group of participants (perhaps 30-40) were challenged to think of a ‘wicked question’ related to the care of older people with mental health problems. After discussion, the question we agreed to spend time on was ‘Why bother?’ which led us to debate the ‘value’ of older people with dementia and other mental health problems. As professionals working in older people's mental health and IPA members we need to be able to articulate the reasons why we should bother – otherwise why should we expect the world to care? It is anticipated that these discussions will lead on to an action plan for the IPA.

So far the meeting has been thought provoking and stimulating. I sometimes wonder whether conferences have had their day and are now outmoded, given the new technologies at our disposal, but I have enjoyed meeting colleagues old and new from different countries around the world, talking with them informally, and learning from them, as well as from the programmed sessions.  The only disappointment has been the grey miserable weather – which makes me feel at home if I’m honest. 

Thursday Sept 8th

Today’s conference highlight for me was a film called Autumn Gold, described in the programme as a film which follows 5 senior athletes (all aged between 80 and 100 years old) as they prepare to take part in the track and field World Masters Championships.  I’ve found a trailer for it on youtube click HERE.

Watching the film made me reflect on the issue of ‘acting your age’ and accepting growing old. Dave Jolley, in his response to my June blog about resilience, referred to a “brittle determination to deny the consequences of time and experience” and contrasted this with “acceptance”. I continue to have concerns about this approach. If older adults try to keep fit and engage in sport are they trying to hang onto their youth at all costs, or are they giving us a model of how to be fit older adults? How can we be sure which side of the line dividing these two positions our efforts fall? To ‘act your age’ may be to give up and yield to the stereotype of an inactive uninteresting unproductive older person (sorry Dave I know I am extrapolating to extreme from what you said). Why is it that to try to maintain the activities important to oneself is seen as an attempt to deny age and cling to youth?  Perhaps it’s our ideas of old age that need to change. The athletes in the film push the boundaries of our expectations and I think we should applaud them – whilst accepting that we can’t all do the same.

3 comments (Add your own)

1. Aled wrote:
Our ideas of old age are unable to keep up with the improvements in life expectancy and the enormous differences between people at either end of the spectrum.

It strikes me that age has two components which can be considered separately: chronological age and, for want of a better term, ‘physical age’. The mistake is assuming the two are the same. The chronological age is just a number, but your physical age can be taken as a measure of what you’re safely capable of. The big difference is that we all have the ability, some of us more than others, to affect our physical age through our lifestyle choices.

The people in the clip demostrate the commendable attitude of constantly trying todiscover what their changing bodies are capable of. Being aware of your physical state is only sensible, being a slave to a number is pure foolishness.

Sat, September 10, 2011 @ 11:16 AM

2. Susan wrote:
Thanks Aled. I realise that my post above ended prematurely....

On the final day of the conference I went to a session entitled ‘What is value in dementia care?‘ This drew on the work of Michael Porter an American economist (see a Perspective article he wrote in the New England Journal of Medicine see http://www.nejm.org/doi/pdf/10.1056/NEJMp0904131 – he argues that ‘the central focus (in healthcare) must be on increasing value for patients’). Finances are hardly my strength but (if I understood it correctly) ’value’ would involve several initiatives including:
• Increasing the involvement of patients in their care
• Measuring outcomes across the whole of the care pathway – and these would be multi-source outcomes including the perspectives of patients and their families
• Integrating care around patients’ needs not service needs
I am particularly excited about the idea of outcome measures that matter – do we really know what people living with dementia value as outcomes of their care? It would be interesting (and probably challenging for services) to find out.

Mon, September 12, 2011 @ 8:55 PM

3. Dave J wrote:
Well yes - I am sure the greater value of such meetings is the meeting with others as human beings with interests or responsibilities near to our own. It is wonderful that these concerns (the mental health and well-being of older people) are now accepted as one of the world's BIG ISSUES of this century and beyond. This is a far cry from the time, within our working life-time, that people were shuffled away to large long-stay wards where they were thought to be not deserving of therapy of any sort.
I guess you can put together your own menu by choice from what is listed: life-style, abuse and palliative care followed by a shared pudding of wickedness might have been a bit heavy for some - but it indicates the drift.
There is a song I remember 'Who wants to live for ever?' It is a question of grace. Aled in his 20s is quite rightly busily pleased with the pleasures of his time. Chronological age and biological age remain fairly close in the early years but diverge as time passes. The divergence is certainly linked to social class and all the physical, mental as well as social, economic, educational and employment aspects encompassed within that concept. Should we mention the spiritual dimension? I think we should
We bother because we care for the plight of other human beings. We are so fortunate to have health and knowledge and abilities and maybe wisdom. It is the responsibility of those who have to share such waelth with others - for in this way they too can have more fun, more joy and less pain and sadness. This will mean they will probably live longer too (like us) - mostly because they get on and do things. I do agree that too much sitting about and anticipating what you might wish to do in circumstances which might happen sometime or never has little to recommend it. Yet I remain happy to walk, weed and wonder on my feet rather than cavort unnaturally on devices to catch the wind

Thu, September 15, 2011 @ 2:34 PM

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