Sunday 25 February 2018

Rude health: The dementia train

There are sober warnings from Japan's experience of old age, says Maurice Gueret, as 90 becomes the new 80

(Stock photo)
(Stock photo)
Dr Maurice Gueret.

We are now living longer than the pension-scheme bean counters might like. Cast an eye over the deaths column of any newspaper. Phrases like "in her hundredth year" and "at the tender age of 96" feature regularly. Sometimes there are three or four nonagenarians on a single day.

Figures from Census 2011 suggested that the typical Irish man lived to 78 years and the average woman got four-and-a-half years' peace afterwards. I'll be interested to see what advance is made when numbers get crunched from last month's census. I don't believe the hype about our children and grandchildren living to be centenarians, but society needs to get used to the idea that, for the next generation and beyond, 90 could well be the new 80.

The Economist magazine isn't on my weekly reading digest, but I made it my business to check out a recent widely-praised article on Japan - a land of rising dementia levels. Last year, 10,000 dementia sufferers went missing in Japan. Many weren't found. Others met with tragic ends, courtesy of the nation's fondness for high-speed transport. One man lost his father when his dad walked into the path of a train. The son received an itemised bill for €58,000 from the railway company. The small print warned of interest accrual for late payment. In one year alone, 28 Japanese dementia patients were involved in train accidents; 22 of them died. Forecasters suggest that by 2060 the number of citizens with dementia could approach one in 10. A think-tank floated the idea of moving older people out of the capital, to beef up declining rural communities. The government liked the idea, but the minister for rural revitalisation had to deny that politicians were reinventing ubasute, the legendary custom of abandoning infirm relatives to die on mountainsides. Japan has other issues. Murder of Alzheimer's patients is rising. Staff turnover in care settings is huge. Nurses in the sector are poorly paid. Immigrants do much of the care. But Japan's biggest problem, one we are fast mirroring in Europe, is that it simply doesn't have enough grandchildren.

History books in 100 years from now could have difficulty explaining to schoolchildren why their ancestors worked themselves into such a lather about paying for clean water and draining its waste. Not long ago, doctors on these islands voted the piped-water 'sanitary revolution' as the most important medical milestone of the last 200 years. Household water beat off very fierce competition from anaesthetics, antibiotics, vaccines and the establishment of the HSE. Yet it has become the defining political issue of our time, only because half the country's politicians have forged careers on opposing its metering. Irish people were never renowned for their reluctance in paying for liquids. Despite having the best tap water in Europe, we became the biggest bottled water drinkers in the EU when the Ballygowan craze started up in the 1980s. Long before somebody thought of charging for fizzed-up well water, there were spas all over Ireland with queues long and wide. One of the best known was the Fionn-Uisge Spa, just above Dublin's zoological gardens. All manner of cures were claimed from its iron-rich waters, and it became as fashionable as any swanky clinic in the 19th Century. It was patronised by dukes and lords, and the hoi polloi followed suit, paying a penny for a tumbler of water and five shillings for free water for a season. Our State made one glaring mistake in the formation of Irish Water. It should have been called Irish Spa.

Speaking of swanky clinics, Dublin and Cork are exceedingly lucky to have three VHI Swiftcare Clinics between them. Every weekend, umpteen members of the worried wealthy thank their stars for such a service. My own family doesn't exactly beat a path through the doors, but when you need a limb X-rayed, an emergency dentist, an urgent opinion, or suturing, the service is excellent. There were political calls recently for a minister for primary care. I'd rather that the country decides what sort of non-hospital care it wants before going down that path. This country and its doctors are investing millions in primary-care centres up and down the country. Many of them remain closed in the evenings and weekends. Most have no X-ray facilities available on site. Out-of-hours GP services are all very well, but everyone knows that the biggest handicap all Irish GPs face is an inability to access tests. Surely this is what primary care needs - swanky consultation rooms without access to laboratory and radiology services are not the future. The world is moving on. Just as doctors demand it for their own families, patients are going to seek out one-stop healthcare. If I was minister, I wouldn't allow another penny to be spent on another primary-care centre that didn't offer the same level of staffing, availability and diagnostic facilities as a VHI Swiftcare clinic.

I was thinking out loud about retirement recently, and mentioned a tip-off about a nursing home right by the wild Atlantic sea. Well, the manager of same has been in touch, and can meet many of my stipulated requirements. There are plenty of currachs nearby and Peacockes of Maam Cross (a short bus trip away) regularly hosts 1980s-themed discos. The only spanner in the works for Carna Nursing and Retirement Home is the absence of high-speed internet. But Mr Flaherty, the general manager, hopes that it will be in place on my admission in 2043.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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