Kathy’s story - Living with a learning disability and dementia

Imagine reaching your 40’s or 50’s having lived your whole life in the shadows of discrimination, exclusion, social stigma and poor treatment within many health and social care services... and then developing dementia. You’re younger than the majority of people who live with dementia and your dementia is likely (either through our perceptions or the circumstances of your health) to progress more rapidly. You are now part of one of the most seldom heard groups in society** - People living with a learning disability and dementia.

This is an issue close to my heart: My longest serving consultancy client of nearly 5 years are learning disability provider MacIntyre. I count many of the amazing people they support and their awesome staff as both colleagues and friends, but it wasn’t MacIntyre who originally introduced me to what life can be like when you’re a younger person with a learning disability and dementia.

On the day my dad moved into the care home that he would go on to spend over 8 years in, we met Kathy*. She was a bubbly, smiley, caring lady, clearly much younger than my dad and every other resident in the care home. She loved to ask questions and talk to anyone who would spend time with her.

Kathy wasn’t living with Down’s Syndrome, which is the learning disability most people associate with the development of Alzheimer’s Disease. Her only visitor was her sister, an older lady, devoted to her younger sibling and fiercely protective of her. Kathy’s sister was one of the most active and vocal contributors to resident’s meetings, making her a firm ally of ours. I’m sure she told me more about the disabilities and health issues that had dominated Kathy’s earlier life on one of our numerous chats over a cuppa, but I don’t recall the details.

Kathy’s room was in the corner at the end of the corridor, almost as if she was somehow set apart from the other residents - I never knew if that was deliberate or not. Kathy spent a lot of time in her room, making multiple clothing changes in a day and immersed with her toys and dolls. It was one of the most cosy rooms in the care home with every spare space filled, including having a bird feeder outside and plants on the windowsill that Kathy tended every day.

It’s been over 6 years since my dad died, but I still remember Kathy. She had a sparkle, but also a sadness. To be in a care home, surrounded by people significantly older than her, with staff who were mostly wonderful but without much time to spend with her (and the time they did spend with her was very much about tasks and functions) didn’t seem like the right environment for Kathy. She needed interaction, occupation (as did everyone!) and to socialise with her peers. 

Without her sister Kathy’s life would have been almost nondescript. Just another learning disability statistic, put into an aged care home that in the local area had a reputation for taking people other care homes wouldn’t take. Kathy’s sister was the person who had filled Kathy’s room with the things she loved, bought the clothes Kathy loved to keep changing into and the foodie treats that brightened up the long days.

Granted, the care home was better than Kathy living in one of the infamous long-stay hospitals, but that is a comparison that only looks favourable because long-stay hospitals really are the lowest dominator in terms of care and support provision for people with a learning disability. Back when my dad was alive I thought that was all Kathy could hope for, then in 2013 I began working with MacIntyre and was introduced to supported living, lifelong learning, person-centred approaches, Great Interactions, and the gold-standard of involving people in their care and support. The rest, as they say, is history.

I wish Kathy had known MacIntyre. I wish every person living with a learning disability, and especially people with LD who are developing dementia, could know MacIntyre. I’ll admit I’m bias; I’ve been heavily involved in their dementia work so of course I’m a huge supporter, but it really is groundbreaking as I wrote about here: ‘Watch And Learn: People With Learning Disabilities Leading The Way’ and here: ‘A Marriage Of Learning Disabilities And Dementia’.

But why does it matter you might wonder? Surely people like Kathy are few and far between? In fact, quite the opposite is true. People with a learning disability are living longer than ever before, but have a greater chance of developing dementia, with the link between Down’s Syndrome and Alzheimer’s Disease that I mentioned earlier being the biggest-known risk factor. Research and knowledge about LD and dementia remains patchy though, in common with so much about how as a society we view the importance of people with learning disabilities within our communities. 

Things are changing and heading in a more positive direction, but it shames us all that statistics like those calculated by the LeDeR (Learning Disabilities Mortality Review) programme tell us that a man with a learning disability dies 23 years younger than men in the general population, and that a woman with a learning disability dies 29 years younger than women in the general population. The median (when collecting data, this is the middle value, obtained from separating the higher half of the data sample from the lower half) age of death for a man with LD is 59 and for a woman is 56.

Those ages of course mean that if a person with a learning disability is going to develop dementia the majority will do so as a younger person, and in addition will likely face barriers in:

• Identifying their dementia (including diagnostic overshadowing, where a person’s dementia symptoms are written off as learning disability ‘behaviours’)
• Receiving a timely diagnosis (including difficulty accessing memory clinics and other specialist dementia services).
• Being offered treatments (including non-pharmacological interventions, like music therapy and life story work, which a person with a learning disability may never experience).
• Accessing age-appropriate, specialised care and support. 

I don’t know what happened to Kathy. My dad left the care home they shared on a cold March night by ambulance with an aspiration pneumonia that he never recovered from. He became a subject of safeguarding, and we went to clear his room shortly afterwards, the last time I saw Kathy. Her health, like my dad’s and everyone else’s, had deteriorated, she’d been hospitalised for bowel blockages and other stomach related issues, was immobile, and much of her spirit and communication abilities had become lost in the constant upheavals that characterised her life. The care home went on to be rated inadequate by CQC and has now closed.

Kathy had a life, but not the life she could or should have had, something far too many people with a learning disability experience. I’ve seen both sides of how we support people with a learning disability and dementia, and my appeal to anyone designing care and support services for our ageing learning disability population is to utalise best practice - it’s out there, shared by MacIntyre and others for all to learn from. It’s replicable, it’s achievable, and most of all it’s inspirational, because if we can get support for a person with a learning disability and dementia right, we can improve how everyone lives with dementia.

Until next time...

You can follow me on Twitter: @bethyb1886
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*Name changed to protect identity.

**September 2017 saw the launch of the Dementia Action Alliance's (DAA) 'From Seldom Heard to Seen and Heard' Campaign. The campaign focuses on people living with dementia and their families from six communities who are often marginalised from services and support: Lesbian, Gay, Bisexual and Transgender + (LGBT), Black, Asian and Minority Ethnic (BAME), Young onset dementia, The prison population, People living in rural communities and People with learning disabilities.

I'm a national member of the DAA, and proud to have worked with the team in developing this campaign, mostly by utilising my extensive knowledge and experience of working with people who have a learning disability and dementia. I wrote about BAME communities in my October 2017 blog, and people who are living in rural communities in my March 2018 blog.

Living with dementia as a younger person

In amongst the figures announced recently by the Alzheimer's Society on the scale and cost of dementia in the UK, the data on the numbers of younger people developing dementia was particularly notable. It is estimated that 42,325 people are now living with younger-onset (early-onset) dementia, a number considerably higher than previously thought. Given the problems younger people often have around obtaining a diagnosis it is probably safe to say that the actual figure could be even higher.

Dementia is traditionally associated with older people. That is the prevailing view amongst the general population, and in truth little has been done to dispel it. Occasionally there will be a newspaper or magazine article about an adult under 65 with dementia, and rarer still a child with dementia, but such coverage is often more sensationalist than really educational.

We know that dementia remains stigmatised generally, but if you are a younger person with dementia that stigma is likely to be far more significant. We know too that there aren't enough good quality, personalised and responsive post-diagnostic support services for people who are diagnosed with dementia - again, if you are a younger person that dearth of support is potentially even greater. 

It is well documented that carers of loved ones with dementia generally don't have anywhere near enough support to carry out their caring role. However, that situation can even more acute if your loved one is younger and your family is plunged into a completely different type of crisis around jobs, housing and the care of under-age children. It is also worth noting that dementia in younger people often progresses quicker than for older people. That isn't always the case, and many younger people live well with dementia for many years, but such wellbeing is usually in spite of rather than because of the level of support and care that they are offered from their local health and social care systems.

Issues around the progression of dementia are challenging enough, but adding in the potential requirement for residential care makes the picture even more complex. Many families find it difficult, if not impossible, to source a high quality care home that specialises in caring for younger people who are living with dementia. Mostly the only option is aged care, where a person in their 50's could be living with people in their 80's and 90's with very little in common in terms of hobbies and outlook.

Combine the factors of increased stigma, inadequate post-diagnostic support, challenges for family carers, likely progression of younger-onset dementia, and the lack of specialist residential care together and there is absolutely no doubt that if you are a younger person who is living with dementia you are facing numerous obstacles to living well. Even many of the therapeutic products that have been developed to help individuals who are living with dementia are based on reminiscence of eras that will mean little to younger people.

There are numerous societal pressures too. Because most individuals don't understand that younger people can develop dementia, if you are a younger person with dementia you face being disbelieved when you disclose your diagnosis. You may well become more isolated because friends of the same age cannot comprehend your diagnosis, and if you are working and find that your employment ends you can face huge financial pressures around paying your mortgage etc.

Your local services, if you have any, are generally aimed at older people (be they day centres, singing groups or dementia cafes), although there are some notable exceptions which I will cover at the end of this blog. Vital connections into peer support and international mentoring are often not made at the point of diagnosis, and so isolation is further compounded, added to by difficulties in travelling if your driving licence is taken away.

To say that the UK is badly failing younger people with dementia is something of an understatement. Why this group of people have been ignored for so long is, I suspect, due to that prevailing societal view that dementia only affects older people. If that is the case, then these latest figures should be a big wake-up call to our politicians and policy makers. Whilst specialist services may not be cheap, the cost of providing nothing is far greater, both for the health service and for every single family affected by younger-onset dementia.

Whilst the powers that be mull over that prospect, I couldn’t write a blog post about younger-onset dementia without mentioning some of the inspirational individuals and organisations who are leading the way for younger people with dementia. In their own way each challenges the stigma and discrimination faced by younger people with dementia, and together they form a powerful, collective voice. I hope that through them not only will society learn more about living with dementia generally, but that the particular needs of younger people living with dementia become better understood and more comprehensively addressed.

For anyone who is UK-based, there are a huge amount of resources on the Young Dementia UK website, including a regional breakdown of specialist support services for younger people who are living with dementia: http://www.youngdementiauk.org/support-across-uk. Young Dementia UK also have a list of blogs written by people who are living with younger-onset dementia, including Kate Swaffer and Chris Roberts, two very active campaigners for the rights of younger people who are living with dementia: http://www.youngdementiauk.org/blogs.

Although not exclusively working in the field of younger-onset dementia, I would also recommend checking out Dementia Alliance International, and the work of Norman McNamara, Innovations in Dementia and Dementia Mentors.

Until next time...

You can follow me on Twitter: @bethyb1886

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Talking about dementia... with your employee

Welcome to the sixth of my seven ‘mini’ blogs for UK Dementia Awareness Week 2014.

Concerns that a person is developing dementia aren't just restricted to that individual - they also affect those closest to them, bringing complex relationships into play. Over this Awareness Week I want to look at some of the emotions and reactions that underpin the difficult conversations thousands of people are having, or thinking of having, as they open up about dementia.

Day 6 - 'The understanding employer'

I would venture to suggest that most employers - when questioned about their approach to an employee developing dementia - would say that they can’t cope with employing an individual should they have an official diagnosis.

A greater hammer-blow to a person with early-onset (young-onset) dementia, who may still be in full-time employment and relying on that income, is hard to imagine. It arguably ranks alongside losing your driving license as one of the most pivotally disempowering moments for a person who has developed dementia. Yet looking at each person’s situation individually, and trying to make reasonable modifications to their workload or environment, could enable an employee to continue to work for as long as possible if they want to.

Given the myth that still proliferates that dementia is a disease of ageing, many employers would potentially not think of dementia even if an employee of working age is exhibiting dementia-related symptoms. Yet with the drive to boost diagnosis rates, understanding what dementia is, and how your business could help an employee developing dementia (or indeed an employee who is a carer for an individual with dementia) will become increasingly important.
 
Opening up to a person you know about your concerns that they may be developing dementia is a conversation most people dread and many seek to postpone for as long as possible. For help and advice on how to broach the topic of dementia, read my blog post 'Having THAT conversation'.

 

Next post on 24 May 2014.
Until then...

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The corners of your mind

I’m a bit of a fan of all things vintage, as you might have gathered given my love of our older generations. Music is no exception to this rule, hence the title of this blog post coming from a much loved song, ‘The way we were’.

 

 

I’ve always felt that the lyrics to this song are a rather poignant reminder of how life changes through the years. It also has important meanings in relation to our memories, the invisible library that lives within our brain and chronicles our lives. Should dementia ever set in, that library becomes muddled, and eventually toms of knowledge are like books that have been borrowed from the library and never returned. The person with dementia then becomes a bit like a frantic librarian, trying desperately to remember where they have stored the particular segment of knowledge that is required.

I wrote in 'Loving our elders and betters' about how, when an older person dies, "It is as if a library has burnt down." Many people would argue that dementia is like a slow burn, very gradually turning memories to cinders, often initially with little physical evidence of the ‘fire’ taking place. Given the choice I think some people facing such a future would rather experience a giant inferno that engulfs their lives with such rapidity that they have no idea that it has even happened, but dementia is rarely like that.

It teases the mind, allowing us to retain selected memories, often those going back many years, but not always the most useful ones. Those crucial practical memories of how to undertake and successfully complete tasks may go very early, as can memories of what we did or said a minute, hour, day or week ago. The precious memories of key life events, and key individuals in our lives, may also end up being filed under absent.

Being deprived of that last set of memories is particularly painful because they characterise our lives and us as individuals. They act as a safety blanket, giving us a place to meander into during those quiet moments of reflection, or provide thoughts of positivity and strength when we are feeling vulnerable or worried. We want to be able to remember people, places and things that are important to us, knowledge we have studied hard to acquire or experiences we want to be able to pass on, but dementia has other ideas.

Memory problems are something we generally – and wrongly - associate with ageing, as I wrote about here. Moreover, I think that throughout our lives many of us are guilty of taking our own memory for granted, and in our interactions with others we readily expect their mind to perform with seamless speed and accuracy. We don’t have time or patience for a hunt around someone else's personal library – we want our information instantly, and not being able to deliver that often leads to the belief that someone is unintelligent, useless, worthless or stupid.

However dementia, and the way in which it can affect our memories, can hit anyone and not just in old age. Having a previously brilliant brain is no guarantee that you won’t get dementia. I’ve met leading doctors, academics and businessmen who are living with dementia – all had hugely admired brains that have now been ravaged. My dad, whilst never a man of high academic standing, had a truly impressive mind – his knowledge of the countryside, farming and animals was second to none. His wisdom was a gift that as a child I never really appreciated. Now it’s gone, I miss it more than words can say.

The corners of our minds harbour things that we may think we will never need, but each memory has its place and importance and being without any of them will adversely affect our lives at some point. We talk a lot about memory ‘loss’ in dementia like it is something that can be found again. Sadly even for people who achieve respite or improvement from their symptoms through therapeutic interventions, they are still living with a terminal disease that is characterised by eventual decline.

What I admire most, however, is the way in which many people with dementia try to guard against this, always working to prevent dementia steeling more books from their memory library. I think as outsiders looking in, we often don’t realise just how hard people with dementia try in order to maintain normality and keep all of those important memories alive. For many, notebooks and post-it notes become their allies – the feeling being that what cannot be remembered must be written down.

Increasingly I think technology (smartphones, tablets and other handheld devices) will have a role to play, particularly for people who are diagnosed with younger onset dementia and are already used to leading very technological lives. However, I think nothing will ever really beat our loved ones for helping to keep memories alive and effectively providing a 'Back Up Brain'* for us all, regardless of whether we develop dementia or not.

Dementia has the power to literally re-write and remove our memories, twisting, confusing and manipulating those precious nuggets of understanding and experience that we build up over our lives. As the song tells us, "Memories may be beautiful and yet, what’s too painful to remember, we simply choose to forget." Having that choice is a wonderful thing that we should never take for granted. 

Until next time...

You can follow me on Twitter: @bethyb1886

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*Back Up Brain – BUB –  is a phrase borrowed from my inspirational friend Kate Swaffer, an Australian lady living with young-onset dementia for whom her husband is her primary BUB. I would recommend checking out Kate’s blog http://kateswaffer.com/daily-blog/.

Diagnosis – The day and the aftermath

Given that dementia is one of the most feared, if indeed not THE most feared disease in the UK and beyond, you could probably turn the moment of diagnosis (worldwide a new diagnosis of dementia is made every four seconds) into the basis of a horror story.

It is truly the news that no one wants to hear, and however much it can help to explain that which seemed unexplainable, it is for any individual and their family a life-changing moment. You may well feel angry, numb or very emotional. There may be tears, or it may be all about trying to maintain a stiff upper lip. In the hours, days, weeks and months ahead there will be questions, so many questions, and potentially a scarcity of answers. Of course some questions are unanswerable, the most notable being “Why me, why us?”

Then there will be the decisions, which you may be advised not to rush, and yet may feel you want to get out of the way just so that you don’t have to continually mull them over in your mind. How are you going to break the news to your family and friends? Do you even want to tell them? What about advanced care planning? Can you face making plans for a time when your dementia will be advanced and you aren’t able to participate in planning in the way that you can at the moment? Do you have a will and a Lasting Power of Attorney in place?

Add into that potential areas of conflict with your partner or those closest to you. Maybe they want to tell people about your dementia but you don’t want anyone to know. Maybe you don’t want to call what you’ve been diagnosed with ‘dementia’ through fear of stigma, but your partner does. Maybe your family want to access help and support services that you don’t feel ready to be a part of yet.

If coping with all of this wasn’t enough, crushing moments when you cannot hide from the truth can crop up unexpectedly and with alarming regularity. Handing in your driver’s licence. Visiting your GP. Having your ‘behaviour’ explained by your partner to people who have no idea about dementia, or a very stigmatised view. The sympathy that flows when people hear about your diagnosis – sympathy that you know is well-intentioned but makes you feel even more like a patient. Or the fact that friends and family stop talking to you and only talk to your partner. Even small things, like applying for travel insurance, can remind you of your diagnosed status.

Inside your head you may be thinking that you’ve let everyone down. You may feel as though you’ve been robbed of your future and the plans you had to enjoy your life. You may dread the thought of needing care, or of having to watch your partner caring for you. You may be wondering where you will live and how you will afford to pay your bills. Indeed, may just want to scream, cry and kick something (not the cat!).

For people who’ve been diagnosed with young-onset or early-onset dementia (dementia in someone under 65) there are often additional considerations. You may have to decide how to tell your employer. You may be facing losing your job and potentially not being able to pay your mortgage, and likewise for your partner if you need them to help care for you. You may still have dependent children who are relying on you, or ageing parents who need you to be caring for them in their mature years.

In short, a diagnosis of dementia has a ripple effect throughout every aspect of life that affects not just the person with dementia but everyone who knows and loves them. For most people, that life-changing moment of diagnosis will come during an appointment with a consultant specialising in dementia (an old-age psychiatrist), in potentially a very clinical setting, often with little offered in the way of help and support largely because the clinician hasn’t been given resources to signpost you to.

It may come after many months of waiting following your initial consultation with your GP, and will usually be as a result of extensive tests at your local Memory Clinic. It may not be a shock, or it may be the biggest shock you’ve ever had, but it’s important to remember that whilst so many aspects of your life may be set to change over time, fundamentally you walk out of that consultation room the same person who walked in.

A diagnosis should never mean that you go from being a vibrant, hopeful person to someone who cannot see a way out of the fog. Everything that you could do before you walked into that room you can still do when you come out of it, and if you are to live well with dementia you need to keep on doing as much as you possibly can for as long as you possibly can. It’s easy to get blogged down in the really tough stuff, most notably wondering how you may decline in the future, but if any disease should make you want to live for the moment, it’s dementia.

My dad astounded many a medic by living for 19 years with dementia, and having quality of life very late on. Back when my dad was diagnosed we didn’t have Memory Clinics, and due to the haphazard nature of how dad’s dementia was supported (or rather not supported) during the first ten years of his life with the disease, dad’s diagnosis came while he was an inpatient in the local hospital, with his ‘team’ diagnosing and us as his family simply being informed that he had been moved to an Elderly Mentally Infirm (EMI) Unit. When we asked why he had being moved, we were bluntly told, “He has dementia.” Only after demanding to see one of the consultant psychiatrists in charge of the unit did we understand a little more, but I can honestly say that pretty much we just had to ‘learn on the job’ , and we were still learning nine years later when he passed away.

In many respects, that is the nature of dementia. A few people have a very rapid progression into the advanced stages of the disease, and indeed pass away quite quickly afterwards. For most people, however, the decline is far slower, enabling a huge amount of occupation and enjoyment in life that provides priceless memories. My hope is that as we improve awareness, understanding, care and support that everyone’s experiences of diagnosis and the aftermath will be less of a horror story and more of an inspiring story.

Until next time...

You can follow me on Twitter: @bethyb1886

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A sense of achievement

One of the most pervasive beliefs about dementia is that people living with it cannot achieve anything. For many the onset of living with dementia can signal the end of aspects of their life that represent the very foundations of their existence, and the consequences of that can have a very negative effect on their health and wellbeing.

If you are a younger person who is still in active employment it can mean the end of that way of life, regardless of whether you wish to continue working in some capacity or not. For someone like my father, diagnosed much later in life after a crisis point, it can mean the end of living independently and an unavoidable move into a care home.

In both scenarios, loss of independence, purpose and the chance to achieve something every day can be devastating. If someone is able to remain involved in engaging, stimulating and worthwhile work, it can have a very positive therapeutic effect that will help to alleviate their dementia symptoms . The minute someone feels condemned to being no longer useful, and potentially just sits in front of a television all day, hardly moving, not needing to process information or problem solve, more rapid and extensive brain deterioration is highly likely. Daytime TV isn’t considered to be mind-numbing for no reason!

Likewise, being forced through your current symptoms to move into a care home, leaving behind the familiarity of your own home, your comforts and most of your possessions can again often bring about a significant deterioration. In my father’s case, his care home never offered him the chance to do meaningful and worthwhile tasks that could have improved his experience of care in those early years. Even something as simple as gardening could have made a world of difference to his quality of life and sense of achievement.

You could argue that an element of personal responsibility comes into play when looking at your own quality of life, but in the case of someone with dementia, the way in which the disease robs a person of that previously assumed ability to control their life complicates issues of personal responsibility immensely. In an ideal world we motivate ourselves and seek out opportunities, but that is often easier said than done when living with dementia means that doors are slammed in your face.

Unlike the support given to many disabled people, people with dementia do not routinely get offered help to enable them to remain in active employment for longer, or in some cases, even remain in their own home for longer. Yet we know that people with dementia do still want to achieve in everyday life, and most would much rather live in their own home than in a communal establishment.

Retaining independence is something most people guard fiercely. More often than not in the earlier stages of the disease, it isn’t the dementia itself that will rob someone of that independence, it is often the attitudes of society and the care and support systems we have (or don’t have!) that manage to do that.

For example, if employment becomes too problematic, or indeed someone is already retired, access to voluntary work can become a lifeline. For however long someone is able to do something, even if their support needs increase, they should be enabled to do that. Assistive technology, support workers or mentoring, memory triggers, flexibility and careful planning of each day can all help in supporting someone with dementia to continue to achieve and contribute to society.

Many of the things needed to enable someone to remain actively engaged in some form of work can also help to keep them living in their own home for longer too. Again the key here is support. Holistic family support is vital where a family are the main care providers, and where someone lives alone, a support package that focuses on keeping them as independent and safe as possible must be active and constantly reviewed.

It can be a very difficult juggling act, not least because much of the support that people with dementia and their families need relies on health and social care working together, which as we all know isn’t the norm. Often people find themselves at a crisis point, whereby either a carer can no longer cope or the person needing care has deteriorated to a point where they are admitted to hospital. If they cannot return to their own home for whatever reason, it is then vital that they have the chance to move into a care home that will support them as much as possible in a partnership of doing things WITH them, not just FOR them.

I want care providers to embrace seeing the people who come to live within their community as participants in the daily running of that community, not just as someone there to receive a service. What achievement means in practical terms for each resident in a care home can vary immensely, but here are some classic examples:

• Allowing a previously dedicated housewife to become actively involved in household tasks like folding washing, dusting or polishing cutlery.
• Helping an avid cook to make simple meals.
• Assisting the perfect hostess to serve tea and cakes to her guests or fellow residents.
• Providing a gardener with a piece of land, tools and plants to grow favourite food or flowers.
• Offering a retired secretary the chance to help with stuffing mailshots into envelopes or putting stamps onto letters.
• Helping a retired postman to distribute the mail around the home.
• Giving an animal lover pet grooming tasks.
• Offering a music or drama performer the chance to entertain everyone.

The list is endless and of course specific to an individual’s background and hobbies, but the point is that all of these tasks can give a person a sense of achievement. We must never lose sight of the need we all have to feel  that we have achieved something, and in the case of someone who is living with dementia, be mindful that achievement is a key component of living well with dementia.

Until next time...

You can follow me on Twitter: @bethyb1886

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In sickness and in health

Through my work I am very privileged to meet and chat with people whose day-to-day life revolves around caring for someone with dementia or living with it themselves. Why ‘privileged’ you might wonder? Simply because having walked this path with my father, I know how tough it can be, and I have the ultimate respect and appreciation for what living with dementia really means both for the person themselves but also for those who are closest to them.

A lady currently caring for her husband said to me last week that she feels like she is drowning, that bit by bit dementia is literally sucking the life out of her, her marriage, her greatest friendship, her home life and her future. She is realistic about what the years ahead hold; she notices every change, every deterioration in her husband and plans everything, such as she can, on ‘worst case scenario’. She says she sees nothing ahead of her except darkness and sadness.

Another lady contacted me to describe the great emptiness in her life. Due to her own health she could no longer continue to care for her husband of 50 years at home, and reluctantly had to take the decision to move him into a care home last year. Having been married at 22, and never spending more than a few nights apart in all those years, she felt as though the blow dementia had dealt her life was, in many ways, worse than the bereavement that comes when a loved one passes away. She described it as if the disease was taunting her, explaining that although she still visited her husband every day, he appeared utterly oblivious to her presence.

Dementia doesn’t just affect older people either. I still remember very vividly hearing the heart-breaking tale of a lady whose husband had been a high-flyer in London. He had been offered and taken early retirement at 51, and he and his wife had planned to enjoy what they hoped would be golden years of rest, relaxation, travel and doing all the things that they had never been able to do whilst he was working and she was bringing up their family. Within a year of his retirement, her husband had been diagnosed with early onset dementia and his symptoms were advancing at an alarming rate. She felt bereft and cried daily, expecting that her husband would possibly never see his 60^th birthday.

These are just three couples in amongst hundreds of thousands, in the UK alone, whose lives have been invaded by dementia. I write a lot about how having a parent with dementia affects your relationship with your mum or dad, but if anything the effect on a marriage or partnership can be even more profound partially due, I think, to the age demographics involved.

When you are part of the younger generation, you grow up to appreciate the fragility of life as beloved older relatives experience health problems and pass away. I vividly remember losing my much cherished grandmother when I was only 7. My grandfather had died when I was just a baby, and both my father’s parents passed away long before he even married my mother. If anything life as a youngster tries to prepare you for looking after your parents and coping with whatever their needs may be in the future, not that such preparation is ever enough.

In a marriage or long term relationship, where both partners are often of a similar age, having made a life-long commitment to each other and with expectations of growing old together as their children go off and live their own lives, the blow can be even more cruel. That life you thought you would always have together will never be as you expected it to be once dementia intervenes. One partner will often be faced with providing care and coping with changes in their spouse that leave them feeling completely empty , isolated and vulnerable. Moreover, as dementia is terminal, you face one day laying to rest someone who may be the only person in your world that you could truly rely on.

There are also additional considerations when a partner has dementia. I have heard people with dementia describe their sadness at being unable to share a bed with their husband or wife due to dementia giving them violent night terrors that puts their spouse at risk of being unintentionally hurt. Many couples also bravely talk very candidly about dementia wrecking the intimacy in their relationship. How their partner’s dementia means that they have lost the understanding of what intimacy is, and that they no longer reciprocate even a hug or a kiss.

Maybe as a society, with preconceptions that dementia is a disease of the old and that sex is the preserve of the young, some may feel that this is all a perfectly normal part of aging. But try telling that to the husband or wife who misses the warmth of their partner’s body next to them on a cold winter’s night, or the expression of love, reassurance, solidarity, tenderness and kindness that a kiss or a hug provides. Without those fundamental aspects of a loving relationship, loneliness, depression and the searing pain and sadness of what feels like a separation can be overwhelming.

To anyone who is on the dementia journey with their best friend, lover and life-partner, I send you my thoughts and hopes that you find strength amidst the struggle, and love within the despair. For you, ‘In sickness and in health’ has a meaning well beyond anything you ever thought it would.

Until next time...

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