Ed i to r ia l

Health and well being – the cared and the carers

Often, when assessing the health and well being of

the older group of the population, there is a failure

to address the issues associated with those that

spend considerable time caring for these people. It

is difficult to arrive at an overall figure for the

number of carers in the UK, but it is estimated that

they number around 1.75 million. It is interesting

to note that the profile of carers varies, depending

who is being cared for. In an analysis of carers of

elderly parents or parents-in-law, most were

between the ages of 45 and 65 years, the majority

were female and they were providing more inten-

sive forms of care, this being associated with a

greater likelihood of the older person being men-

tally impaired. Care of people with dementia was

found to be particularly stressful for the carer.

However in the case regarding spouse carers, 70%

were over 65 years, 21% were over 75 years and

90% were retired. The division between men and

women was about equal. With many of these

carers being elderly themselves, it has been repor-

ted that more than half of older carers suffer a long

standing illness or disability, one-third provide

50 hours of care per week and one in five struggles

to pay essential bills. In addition, it was revealed

that the majority of older people who live with the

person they care for receive no regular visits from

health, social services or home care agencies, but

were also less likely to ask for help in the first

instance and one-third of them had never had a

break. Also 27% of carers had a depressive illness

and many were at risk of psychological ill-health.

Another key factor that is often ignored is the

impact of the financial costs on the carer and this

does not just apply to loss of earnings or pension

provision. Consideration has to be given to costs

arising from the carer’s lack of time, such as pur-

chase of convenience foods or greater use of a car

or taxi for shopping, and the cleaning and

replacement of clothes. To meet these extra costs,

many of the carers used savings or credit, delayed

paying bills, reduced savings and cashed in insur-

ance policies or borrowed money. As it is consid-

ered desirable for older people to be cared for in

their own homes instead of in residential care,

there is a significant price to be paid by carers if

adequate support is not put in place.

A recent study carried out by a leading charity in

Scotland, Help the Aged, raised the issue regarding

suicides among older people and suggested that

older people were not receiving sufficient support

and were poorly targeted for help as they were not

identified as a priority group. It was found that

people over the age of 55 years were 10 times more

likely to take their own lives than be killed in an

assault and that men were twice as likely to commit

suicide as women of the same age. Putting this into

context, there were 117 suicides in this group in

2003 or one every three days, accounting for a fifth

of all suicides in Scotland. It was also stated that in

health and academic circles, one of the most com-

mon conditions associated with suicide in older

adults is depression and this is also a widely under-

recognised and under-treated medical condition. It

was stressed that there was a need for an

improvement in the care system to recognise

depression in older people and treat it more quickly

by addressing the risk factors and be able to

respond to any immediate crisis to provide hope

and recovery. This issue is almost certainly not

restricted to Scotland but does indicate the vul-

nerable situation in which many older people find

themselves.

As already stated, one of most stressful situations

for a carer is to be responsible for someone who

suffers from senile dementia, particularly if this

person is a spouse or very close relative. As we age,

some degree of memory loss is natural, but when

memory loss and impaired thought processes affect

daily life and activities, severe problems can arise.

Senile dementia can affect a person’s ability to

learn, and concentrate on new tasks. There may

also be sudden mood and personality changes,

which are often difficult to deal with. Dementia

symptoms can be seen in 40% of people over the

age of 80 years and as the world population ages

the figures start to become very significant. It is

estimated in the United States that 4 million people

and more than half a million in the UK live with

some degree of dementia. It is estimated that 50%

to 70% of senile dementia cases are attributable to

Alzheimer’s disease. This disease is linked to the

gradual formation of plaques within the brain,

particularly in the hippocampus and adjoining

centres, and is irreversible. It is thought that the

disease either disrupts the production of an

important neurotransmitter or stimulates the

overproduction of an enzyme that destroys it and

so reduces the ability of brain cells to communicate

with each other. This leads to one or more cogni-

tive disturbances including aphasia, apraxia,

agnosia and/or executive functioning. It is estima-

� 2005 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2005; 22: 63–64 63

ted that 2–5% of people over 65 years and up to

20% of those over 85 years suffer from the disease.

There is no clear diagnostic test and the rate of

decline varies from patient to patient with the

course of the disease running between three and

twenty years.

A variety of drug treatments have been shown to

be beneficial and these include cholinesterase

inhibitors, antioxidants, oestrogen, and nonsteroi-

dal anti-inflammatory drugs (NSAIDS). The

National Institute for Clinical Excellence (NICE)

has recommended that cholinesterase inhibitors

should be made available in the UK for anyone

with a diagnosis of the disease and who would

benefit from the treatment. More recently, another

drug which blocks the chemical messenger, glu-

tamate, has become available. When brain cells are

damaged by Alzheimer’s disease they release glu-

tamate which triggers further damage, so blocking

its production could be helpful. Unfortunately, the

drugs only seem to delay the progress of the disease

by a few months and their side effects of nausea

and fatigue can be quite severe, so affecting the

sufferer’s quality of life even further.

After Alzheimer’s disease, vascular dementia is

the second leading cause of senile dementia. Vas-

cular dementia results from multiple small strokes

which change the blood supply to parts of the brain

resulting in irreversible brain tissue depth. Often

this form of dementia can cause the greatest anxi-

ety and stress in a carer as there is sudden and

significant change in personality or ability of the

individual to function with some independence

following a period of stability. Following a minor

stroke, these individuals may become totally

incontinent and be unable to deal with simple

everyday tasks. Such a situation significantly raises

the profile of the carer and can easily lead to con-

flicts where the cared for person still has some

cognisance of their personal condition and situ-

ation.

So what is our role in these situations? It is clear

that the dental team must try and assist in main-

taining the quality of life so that they are free of

infection, can enjoy eating, maintain communica-

tion for as long as possible and work closely with

other health care professionals in achieving this.

This not only applies to the dementia sufferers but

also to their carers who carry the increasing burden

of responsibility.

‘I hope I die before science makes me live to 150’

Tom Kirkwood, The End of Age, The Reith Lec-

tures, 2001.

James P. Newton

Editor

� 2005 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2005; 22: 63–64

64 Editorial