I once knew a kind old woman. Perhaps she wasn’t all that old. But old enough to have a married daughter. And certainly she was old enough to know better. But she didn’t have a clue what was going to happen if she wasn’t careful.
Ageism, like sexism, knows no boundaries. The health system is a prime example of ageism in action.
This week an article in the Medical Journal of Australia’s Insight online caught my eye. (‘Polypharmacy a shared duty’, by Charlotte Mitchell.)
The article quotes a recent study in Queensland and Victoria. Subjects were 1220 people over 70. They had been admitted to eleven acute hospitals in a five year period. On admission three quarters of these older patients took five or more drugs a day. More than a fifth were on ten or more.
Karen Hitchcock’s essay Dear Life: On Caring for the Elderly is compassionate, respectful and beautifully written. As a study of ageism in our society, it is also seriously scary.
The author is a physician who works in a major Melbourne hospital. Her patients are mostly elderly. She has a Doctor of Philosophy Degree in Writing and is the author of award-winning fiction.
There are many causes of dementia, including Alzheimer’s disease. In Australia, more than 332,000 people in Australia currently suffer from Alzheimer’s alone. As the population ages, the incidence of dementia also is expected to increase.
As a person’s symptoms of dementia increase, more and more short-term memory is lost. The person will live much more in the past. When the present time makes no sense, the past is the only place they can live. Sadly, even those memories are eventually lost as the disease advances.
Emma Healey’s new book, Elizabeth is Missing is a novel with dementia t its heart. The book examines issues related to dementia and it is also a dark psychological thriller.
Six of Elizabeth’s family members have been stricken with dementia. The book began from a chance remark from Elizabeth’s grandmother, who was suffering at the time from mild dementia. She told Emma and her family that her friend was missing. That was the trigger for an imagined story.
The book is written from the point of view of Maud, a woman who has dementia. The author has imagined herself into the mind of another, much older woman. She also said that she made use of notes of conversations she had with her grandmother. She used this experience to inform her book.
Many writers say they use snippets of overheard conversations in their work. Emma Healey admits to deliberately making notes. She recorded conversations with her afflicted grandmother to use in a novel. This takes the practice to an altogether different level!
People with dementia can remember selectively. They are frequently unreliable witnesses even to their own lives and experiences. Sometimes they remember events long past. They recount those events as if they are occurring in the present or recent past.
Caring for a person with dementia is arduous, often thankless, labour. Working with them can be likened to detective work. What are they trying to tell us? What exactly are we hearing from this person? What time of their life are they talking about? How can we connect with them? How can we continue to respect them and show that respect?
Because what they say can be undependable, it does not mean we can discount what they tell us. I once worked in a dementia-specific aged care facility. All of the residents were dementia sufferers. One of the residents complained loudly that someone was hurting her. The staff, used to working with these apparently unreliable witnesses, were inclined to disbelieve her. But one skilled registered nurse took the old woman seriously.
When the nurse examined the resident, she found multiple bruises on the old woman’s arms and torso. Her fragile skin had been broken by too-rough handling by a staff member. The bruising was new. The police were called. A staff member was stood down pending an enquiry. He was later charged and convicted of assault.
People with dementia are particularly vulnerable. They can be assaulted by strangers. Family members, also, can abuse them financially, physically, emotionally and sexually.
Returning to the novel Elizabeth is Missing. The protagonist is an unreliable narrator. Can the reader believe what she says? Which parts of the story are true? What should we question? What should we discard?
It is absolutely fine to write an unreliable narrator in fiction. We know the story is not true, so it does not matter whether the teller of the story can be trusted.
This is one of the major differences between fiction and life-writing. In memoir and autobiography, the writer is constrained to tell the truth as he or she knows it. The writer forms a contract with the readers that the story is the truth, and that it can be believed. It is particularly important that a life-writer tells the emotional truth.
According to Emma Healey, there is always a gap in writing that the reader must fill in. No writer can tell a complete story.
‘Elizabeth is Missing was fun to write,’ Emma Healey told a large audience at the Perth Writers Festival 2015. ‘Humour is important when dealing with difficult subjects.’
If you suspect someone, including you, is being abused by a family member, contact Adovcare’s Elder Abuse Help Line on 1300 724 679
For information about dementia contact Alzheimer’s Australia. The number of the National Alzheimer’s Helpline is 1800 100 500