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Copyright © 2012, Emerald Group Publishing Limited
Cognitive Function and Wellbeing
Article Type: Editorial From: Quality in Ageing and Older Adults, Volume 13, Issue 3
In the current fiscal environment, we must be vigilant in ensuring that the provision of social protection, long-term care and access to public health for the elderly is not undermined. On this International Day of Older Persons, I call on governments and communities everywhere to provide more opportunities for their ageing populations (Ban Ki-moon, United Nations Secretary General, on International Day of Older Persons in 2011).
For a second year in succession, a conference and a public lecture were held in Cardiff to celebrate this special day. Both events were well attended. The topic this year was “Cognitive Function and Wellbeing”, and papers, together with poster displays, covered a wide range of issues. The first part of this issue of “Quality in Ageing in Older Adults” offers articles based on the papers delivered at this conference. The second part of the issue offers two additional papers that align well with this conference theme.
The opening paper is from Professor Alison Wray who spoke on a very practical and helpful level about barriers to meaningful communication with patients with dementia. Overuse of commonly used routine expressions, or empty “filler” phrases – “formulaic language” – can have a negative effect and can discourage a carer and friends from attempting to develop a conversation with an elderly person. This limitation needs to be recognised together with the need for occasional stimulating comments and questions to be included at intervals into the conversation. Alison illustrated all this in anecdotes from her experience with older subjects, and indicated some ways in which an enriching of conversation can be achieved.
Professor Julie Williams then told us about ten genes that are now known to contribute to the risk of developing Alzheimer’s disease. Work on these are increasing understanding of the actual processes that are going wrong during ageing and are contributing to the development of dementia. Processes now known to be relevant include the immune response within the brain and the way that lipids, including cholesterol are processed. These are involved in basic cellular processes within the brain, and some of them are beginning to be unravelled. The expectation is that understanding these processes, and the errors that occur in them, will lead to the development of new treatments.
Antony Bayer commenced by reassuring that none of us has a perfect memory, whatever our age. Difficulties with memory increase as we grow older, yet only a minority of us will develop dementia. Distinguishing pathological cognitive decline from everyday memory lapses is essential if the right people are to be selected and the right people receive the right treatment. Dementia has many causes, some of which are difficult to tell apart, and different treatments are likely to be appropriate. Timely and accurate diagnosis is therefore essential. There has been remarkable progress in the diagnosis, in the treatment and in the management of dementia, and in his talk, Tony drew on research conducted in Wales.
Advances in understanding of the basic psychological processes in coping with the adversities of ageing underlay the presentation by John Gallacher. John focused upon the concept of “resilience” – the ability to adapt positively to adversity. Resilience of character and of behaviour becomes of increasing importance as older people face increasing social and economic threats, together with failing health. Within a context of community infrastructure and supportive close relationships, self-esteem and self-efficacy are key positive factors enhancing resilience, while depression, anxiety and negative emotions operate to reduce the ability to cope with adversity.
The conference day itself ended with a wonderful “take home” message from Professor Bob Woods. It is often assumed that people with dementia “suffer” from their condition, and that their self-worth, their quality of life and their wellbeing are necessarily reduced. Evidence from a variety of sources suggests that whilst people with dementia are at increased risk of experiencing depression and anxiety, relative wellbeing is possible. Creative interventions, including involvement in music, visual arts and reminiscence may provide means for people with dementia to join those who proclaim that they are indeed living with dementia.
The two papers which conclude this issue build well on those from the UN Conference. Dr Helen Frost and colleagues, of the Scottish “Later Life Working Group”, present an overview of the evidence on interventions that prevent or delay disablement in later life. The development of systematic review procedures represents an enormous advance in the evaluation of medical and social interventions and in clinical practice. They have made great contributions to the growth of “evidence-based medicine”. Their value includes the identification of interventions for which evidence of benefit is inadequate or equivocal and, sadly, the judgement of these authors is that there are all too many interventions “of unknown effectiveness, partly due to unstandardised use of outcomes and poor experimental design”. The paper is a salutary read for all of us.
The paper, by Nicky Kime, a Senior Research Fellow for the “Getting Sorted” Self-management Programme in Leeds Metropolitan University, concerns telephone befriending services aimed at supporting lonely older people. While loneliness is difficult to define, there is little doubt that it is increasing and will continue to increase throughout an ageing society.
Dr Kime’s study evaluates only the organisation and management of a number of services. Eight services managed by voluntary or charitable organisations were self-evaluated by questionnaires and in group discussions. It would have been difficult and perhaps unacceptable, to impose an experimental design and define outcome measures for all eight services. A conclusion drawn by the authors was that telephone support services need to be flexible if they are to respond to their particular client base, but whether the flexibility is to satisfy the elderly clients needs, or to conform to the demands of the project organisers and their teams of voluntary workers, is a dilemma indicated in the title of the paper.
In fact, there have been a number of investigations of social isolation and loneliness and the report by Dr Frost and colleagues includes a systematic review of reports, some of which involved telephone and visiting interventions. The judgement on these is that there is “weak” evidence consistent with benefit – so good luck to Nicky Kime for her telephone befriending service.