To be crude about it, care homes are where we hide the evidence of our quest for youth
EARLIER this year I went dog-sledding with French-speaking huskies in Newfoundland. This had long been an ambition since I read Jack London's Call of the Wild at school. I don't know if they read Call of the Wild anymore in primary schools. Probably
they read "relevant" stuff about being a ten-year-old in contemporary Scotland and coping with the stress of one's computer game being last season's.
Anyway, there I am with my team of six huskies weaving through the snow-covered forest. I quickly discover this dog-sledding lark is not for the faint-hearted. For a start, you don't just meander across some flat expanse of snow. We are bounding up and down 1:1 inclines and shooting through narrow gaps in the trees at God knows what speed. You don't steer – that's the job of my lead dog. He has a black eye patch and occasionally looks at me balefully as I try to remember my droit from my gauche when shouting commands.
Later I discover that I am not the only ageing baby boomer who has decided to risk breaking their neck driving a dog sled through the Newfoundland wilderness in a bout of middle-aged insanity. It seems that the majority of folk who sign up for this extreme sport are well on their way to getting their bus pass, if not already using one. The lady who trains the huskies explains it is quite normal to have couples in their seventies going on dog-sledding expeditions.
I recount this tale because it says everything about the psychology of those of us born in the immediate aftermath of the Second World War. Naively, we are addicted to the notion not just that we will live for ever but that we will be young for ever. It is a view I have shared for decades – until recently. For suddenly, I begin to suspect that our unique cultural emphasis on eternal youth is ignoring dangerous unintended consequences.
It is easy to write the headline "60 is the new 40". And it is wonderful that folk of my generation can go dog-sledding in Newfoundland when in their seventies. Yet there is a downside to this quest for eternal life.
Yesterday, a group of British medical specialists voiced what many of us have suspected for a long time: that an ever-ageing population must eventually mean a rise in the occurrence of dementia to the point where it will overwhelm the ability of the NHS to cope with it. These experts predict that the burden of dementia on the UK will double to £35 billion a year within perhaps two decades.
Dementia is an umbrella term for a wide spectrum of diseases which are associated with (though not confined to) old age. The main types are Alzheimer's disease, which accounts for nearly two thirds of dementia in the UK; and vascular dementia, which is caused by problems with the supply of oxygen to the brain following a stroke. Dementia is not pretty at close range. Sufferers don't necessarily just sit in their armchairs like placid dolls, gazing at the television. They can be extremely violent or, in moments of lucidity, spiteful.
Even if dementia is not solely related to ageing, the risk factor shoots up as we grow older. It affects 6 per cent of those aged between 75 and 79; 12 per cent of those aged 80-84, and fully a quarter of those aged 85 and above.
The number of people with dementia in Britain is projected to increase by well over 30 per cent in the next 15 years. Please note: these figures could be only the tip of the iceberg as – notoriously – very many dementia cases go unreported.
Dementia accounts directly for 3 per cent of all deaths, though four times as many people may die with the disease. The real burden is the loss of dignity, the pain and effort imposed on families, and the burgeoning economic bill.
Last year, the National Audit Office – the public sector financial watchdog – published a report which calculated the current annual economic burden of late-onset dementia in the UK comes to £17 billion.That is more than the cost of stroke, heart disease and cancer combined. Predictably, the report received little publicity. After all, dementia is not sexy, while the minority of 70-year-olds who go dog-sledding definitely are.
The rising cost of dementia has nothing to do with hi-tech medicine. In fact, the proportion of spending on hospital treatment for the extreme elderly is not rising in relative terms. Certainly, more elderly people means more broken hips to be repaired. But improved lifestyles and healthy living into old age have actually offset the increasing cost of drugs and hi-tech medical advances.
The real financial burden is that those suffering from dementia can't look after themselves. As a result, over 60 per cent of folk placed in residential care homes have dementia to one degree or another. To be crude about it, care homes are where we hide the evidence of our quest for youth. Even then, two thirds of all those with dementia are looked after at home – usually until their relatives can't cope any longer.
This is not a plea for assisted dying. But equally, I am not convinced that science is going to come along with a magical cure for dementia. It is true that a tiny 3 per cent of the NHS research budget is devoted to this problem and that amount should be drastically increased.
Yet short of radical developments in bioengineering, the rest of the 21st century is going to be about managing dementia, not eradicating it. That is why we should heed this latest warning from the medical profession and start taking dementia seriously as an issue.
Dementia is not like other diseases. Calls for new NHS delivery targets will not make the rising tide of dementia dissipate. Instead, we need to begin by making old age respectable once more. Instead of pretending that eternal youth is possible, we should restore some dignity and cultural respect to the process of growing old.
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