Excerpt
Dementia has crept up on us, rather like D.W. Winnicott’s idea of the unwelcome change that we dread in the future, not realizing that it has already happened. Our own ageing is something we only see when it has arrived, through a veil of denial, as the artist Lucien Freud found when he said that he looked in the mirror every morning, misinterpreted the information that he received, and that is where his troubles started. As we age our body demands our attention, as the ego, will and life forces on one hand, and our physical capacity on the other, are increasingly mismatched. The darker side of cognitive decline has moved from being the butt of jokes around a bit of “senile” memory loss, to being one of the major challenges of the new century: a downside of (mostly) welcomed greater collective longevity than ever before in human history, bringing with it, the sting in the tail, the “epidemic” of dementia. According to the World Health Organisation, more than 50 million people now live with dementia worldwide – nearly 60% of whom live in low and middle income countries – and every year there are nearly ten million new cases
1. Coming from nowhere in the charts of death causation, dementia is now either the leading contributory cause of death, or close to it. Far more than memory loss, it is actually a remorseless process of global physical and mental decline that can cause death in its own right.. Deaths due to dementia worldwide more than doubled between 2000 and 2016, making it the fifth leading cause of all global deaths in 2016 (compared to 14th in 2000) (World Health Organisation
2018). In some higher income countries it has become a leading cause of death. In Australia, for example, deaths from the leading cause, heart disease, have decreased over the past decade, while numbers of deaths from dementia, now the second leading cause of death, have increased by 68% (Australian Bureau of Statistics
2018). It is the leading cause of death for Australian women. Being played out over years, and often unrecognized for several in the early stages, dementia is making enormous demands on patients, families, carers, health systems, and entire societies (for good information, for example in the Australian context, see
https://www.utas.edu.au/wicking). The ceiling of future care demand is not known, but the ‘area under the curve’ of encounters with health services, resulting from dementia, is exploding all over the world. The needs for health and social care are already exceeding capacity everywhere. …
