Friday 4 May 2012

Treat the elderly as elderly, not sick and fearsome

By Andy Ho, The Straits Times, 3 May 2012

SOME residents of Toh Yi Drive and others in Woodlands Street 83 recently petitioned against plans to build elder-friendly facilities near their homes.

One excuse was that the plans would mean more deaths around them. This is of course a ludicrous excuse. For if the mere presence of the elderly reminded one of death, would we not have to ship out our own aged parents too?

More honest residents might have admitted that they dislike living close to a concentration of slobbering, forgetful old people who are entirely dependent on their caregivers for all their needs.

It is common these days to hear people stigmatising senility - a failing memory and cognitive decline in the aged. While the elderly used to be respected, old age with cognitive decline is now feared. Elderly people who are dependent on others are seen as loathsome and disgusting.

This odious attitude is unacceptable. Perhaps the frequent portrayals of Alzheimer's disease in print and broadcast media as 'the mind robber' has effectively demonised cognitive decline in the aged. These images of the elderly as empty shells with disintegrated selves have transformed them into a group others fear to become.

Ironically, it may be ageing activists who have helped demonise the senile. In 2002, the World Health Organisation released its Active Ageing: A Policy Framework, to push nations into adopting 'active ageing' as part of their health policies. Active ageing aimed at promoting an active life after career and family responsibilities are fulfilled. It was targeted at improving the image of retirement and one's later years by emphasising the need to remain physically active and mentally engaged in a community.

But such an emphasis may itself stigmatise the last segment of life marked by decline and dependency. Once seen as a natural part of ageing that families dealt with, mental decline or senility has been medicalised into a disorder.

Because there are now supposedly neurobiological ways of understanding thought, emotion and behaviour, conditions like Alzheimer's are now largely seen as a biomedical problem.

In this model, patient behaviour is driven by neurochemistry problems, which calls for a pharmaceutical response. Thus, it is neurobiological research and drug development that will advance 'active ageing'. The triumphalist hope held out now is to technologically delay or even cure or prevent cognitive impairment.

Yet, science cannot even explain how consciousness, awareness and memory can emerge from nerves and neurotransmitters. That is, scientists do not even know what the mind is.

Thus, despite much effort, there are still no useful biomarkers of Alzheimer's available for clinical use. Drug development also has seen no dramatic success. Case Western Reserve University neurologist Peter Whitehouse even makes the case in The Myth Of Alzheimer's (2008): If this cognitive decline is an inevitable part of ageing, then labelling it with a medical diagnosis is a mistake.

With so much hope invested into a magic potion, society does not think enough about how best to deal with Alzheimer's if there is no remedy.

Instead, books, articles and TV shows offer commercial products and cultural pursuits as viable brain tonics. These include Gingko biloba, brain training with the Nintendo Wii, crossword puzzles and sudoku, or 'lifelong learning' programmes at the neighbourhood community centre.

While some of these things may help the bored, what they show is how cognitive capacity is overvalued in our culture, with its unrealistic images and expectations about staving off cognitive ageing.

A 2011 report by the Royal Society, called Brain Waves, expressed worries about the unrealistic promissory notes of imaginary futures that acolytes of the neuroscience revolution may be handing out.

In the past, fewer people lived to a very old age, so there were fewer instances of cognitive decline to see. Now, more people live very much longer, so we logically will see more of them around.

An inevitable process that unfolds naturally over time - ageing and decline - is now said to be a problem begging for a pharmaceutical solution. Unfortunately, this re-visioning of senility as a neurobiological disorder downplays the social contexts in which cognitive decline manifests.

After labelling them as ill, we infantilise and disenfranchise them socially. The stigma even spreads to their families and we look askance at the slobbering old men and women in wheelchairs, and also at their caregivers.

People with Alzheimer's die a social death at our hands before they leave this world. Their contributions, their past, their stories, are wiped out and we view them through the lens of fear and disgust. It is as if, in their mental and physical decline, they have no more dignity that calls forth our acceptance.

Instead, they are viewed simply as a st(r)ain on 'our' void deck. 'They' threaten 'our' social order, it seems.

This is wrong. Regardless of what today's science wants to claim, these old folks in our midst do not have a disease. The living must age and the ageing will decline cognitively, so we must embrace this and treat cognitively impaired elderly persons kindly. They are not ill, just old.


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