Older Mind Matters

Nottingham conference: stars and rocket science

In March I spent two days at the Faculty of Old Age Psychiatry residential conference in Nottingham - a great conference as usual and lots to think about.

Rob Howard was a star. He spoke about anti-psychotic drugs and made a number of important points:

· We should remind ourselves that antipsychotics work in dementia as antipsychotics.
· Even a great antipsychotic is useless without therapeutic engagement.

It's not rocket science.

Another star was John O'Brien. What struck me forcibly from his talk on NICE is this: he told us that there is a guideline on the diabetic foot. Alongside this we have a single guideline on dementia, the whole of dementia (currently being updated) - how broad is that? If this isn't an example of institutional ageism I don't know what is. (Would you get away with one guideline to cover the whole of cancer- I don't think so, do you?) But hey we’re old age psychiatrists – we’re used to being grateful for what we get (just like our patients!)

I went to two workshops on the first day. The first was on end of life care and dementia. This was practical and focused. With colleagues I was presenting a poster at the conference on a Living and Dying Well with Dementia app to which I made a small contribution (it's worth a look – see a promotional video if you’re interested at https://vimeo.com/114686591). The second was on couples living with dementia. I was interested to learn about an intervention being developed at the Tavistock Centre for Couple Relationships, particularly about their use of videotaping and grounding the intervention in everyday life (read about the Living together with Dementia intervention here). Two ideas that resonated with me were: 
1. The negative cycle – how we (family/ professionals/ public) unwittingly disempower people with dementia sometimes with the best of intentions by expecting less of them and maybe taking over from them things that they could still do,
2. Working with couples and people with dementia, instead of just carers – something that is close to my heart as a family and systemic psychotherapist.

The conference was buzzing with enthusiasm and ideas, and I was too!

PS read more about ageism here.

PPS I haven't mentioned James Warner the Chair of the Faculty of Old Age Psychiatry. He has provided a clear lead at a very difficult time for the specialty and he's another very bright star indeed.

1 comment (Add your own)

1. Dave Jolley wrote:
Thanks for this. It is good to read about the buzz and to know that Rob Howard and John O’Brien are still superstars and making powerful points. Good too to know you rate James Warner.
Well I didn’t go to Nottingham – part of my shift toward family-centred/local activities – but I am certainly interested to know what’s going on and who is saying what to what effect. I shall almost certainly attend the Dementia Congress in Brighton where there will probably be few Old Age Psychiatrists but lots of people who are devoted to the cause of people with dementia and their families.
Now colour me jaundiced.
Do we really want or need more guidance from NICE? It is lack of warmth and commitment which saddens me rather than lack of pages of references to what someone says, now, is best practice. ‘Best practice’ which is likely to be outside the realms of affordable reality even if you agree it is best practice.
I like the Dying with dementia app advert. I might like the app but I don’t do apps. I have devoted quite a lot of time and heart to developing and encouraging a positive approach to dying, especially dying with dementia. It is great to know that the approach has gained credence. I am not sure about dealing with such profound issues by mobile phone – for me or anyone of my generation
I love the Tavistock thing- Just imagine the Tavistock Clinic taking interest in the lives of people with dementia and their families! But hey! Do they know how many people are being diagnosed with this condition every year, month, week and day? And they all are part of families. Could you realistically apply this approach to all of those families or even a very small proportion? Beautiful good practice – but another way to bankrupt the nation – or to suck resources into a particular organisation for practice of ‘research’.
Families with difficulties may well benefit from such elegant help. Some of them may have dementia. Let’s do it that way.
It brings me back to wonder what advantage there is to the recent surge in diagnosis – As I have seen it, the risk of disadvantage by labelling is high for the individual and their family. There is an implication that, where they would have been seen as self-sufficient or mutually-sufficient, they are now in need of professional help and therapy for years to death. No one can afford it.
People are discharge from specialist services after an initial assessment, to cope with their extra knowledge as well as their essential difficulties. What’s that all about?

Fri, April 29, 2016 @ 7:37 AM

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