Michael Gordon MD, MSc, FRCPC is a geriatrician working at Baycrest Health Science System. He is medical program director of the palliative care program, co-head of the clinical ethics program and a professor of Medicine at the University of Toronto. He is the author of Late Stage Dementia, Promoting Compassion, Comfort and Care; Moments that Matter: Cases in Ethical Eldercare and Brooklyn Beginnings: A Geriatrician's Odyssey. For more information see drmichaelgordon.com
Every once in a while, a family member of a patient who is experiencing the progression of their dementia starts the conversations with the words, “Surely, with all the current medical science and money being spent on it, there is something more we can do to halt the decline in my mother (or father or other loved one). At times there is a sense of accompanying aggressiveness, anger and for sure frustration, as if I, in my role as a geriatrician might be reluctant to try something novel or worst of all be ignorant of a new discovery. Not infrequently the challenges is accompanied by print-outs of internet-based articles on “new or experimental” treatments for dementia ranging from megavitamins or some “secret” concoction with a mysterious ingredient that “doctors won’t talk about” being “of course” in cahoots with the pharmaceutical industry. The most recent “curative” product provided to me was accompanied by a You-tube video clip attesting to the miraculous attributes of coconut oil.
The recent death of Margaret Thatcher, former prime minister of Britain, reminded me of the film I saw about her life, The Iron Lady. The public’s response to her death ranged from outpourings of vilification to expressions especially by world leaders of admiration and a lauding of her place in history. The film which preceded her death by two years and was highly acclaimed in the world of cinema, recounts her personal history and political life form the vantage point of her early and later stages of dementia and its impact on her behaviour and memory. There were a number of very poignant and vivid mixtures of past recollections and current experiences. It reflected fairly accurately the observations of those working the field that we recognize in our patients which we must explain family members to help them deal with behaviours. Family often remark with a tone of frustration and early on scepticism, “She can remember in great detail first job as a seamstress in that over-crowded New York factory, but cannot remember what she had for breakfast today”.
In many of those living with dementia, especially during the later stages of the condition, the intrusion of significant past experiences cause great agitation and behavioural outbursts. At other times, that vivid recall can lead to warm and sometimes tearful recollections about loved ones that they think are still alive and are distraught to find that they have died. Such occurrences were elegantly illustrated in the Thatcher movie when Thatcher’s daughter has to remind her mother of her late husband’s death as she struggles with emptying his clothes closet and donating his belongings that bring back strong associations and vivid memories of him that enter and leave her consciousness as she struggles to recall the present and separate it from the past.
It was of special interest to those of us who lived through Thatcher’s period in public life and the major challenges faced by Britain during this period to witness the degree of animosity and venom that was brought forth to those numerous members of the British public who suffered directly as a result of Thatcher’s economic austerity measures. The last years of her life, in which she was severely affected by dementia did not seem to dampen or cause any diminution of the animosity felt towards her because of her policies that erupted at the news of her death. The movie with the role of Thatcher played stunningly by the incomparable Meryl Streep stirred a sense I have had previously as I observed some of the greatest or best known minds or public figures in the world afflicted by the usually devastating effects of dementia, most often of the Alzheimer type. This has helped me explain to the family members of my own patients that ask the “surely there is something more to do” question that some of the most important, famous and wealthiest people in the world when living with dementia, suffer in the same way as their loved one. This is despite, presumably, having access to the greatest medical experts available in the field. Besides Thatcher, her best political ally, the late President Ronald Reagan was also afflicted with the dementia which many in the field thought he already showed evidence of while he was still in office. Other well-known individuals who also succumbed to dementia include Iris Murdoch whose rich life was the subject the film Iris (2001), which was based on Bayley's memories of his wife as she developed Alzheimer's disease. Rita Hayworth and Charlton Heston were internationally known and recognized film personalities with the latter becoming the president of the National Rifle Association (1998 until he resigned in 2003), an organization that currently more than five years after his death is front and center in the recent re-kindled controversy of gun control in the United States. Aaron Copeland, the great American composer, experienced Alzheimer’s disease and died from complications of it in 1990. His musical legacy is legend.
For those health care professionals, especially the physicians who practice geriatrics and geriatric psychiatry how we respond to those family members who interject the “surely” statement, we should be able to draw on our collective personal and professional experience to provide an acceptable response to the questioner. To be able to recount the lives of the rich and famous and even “infamous” if you have that perspective on Margaret Thatcher, she be off assistance in illustrating the limits of modern medicine. By being able to give such examples, it allows physicians to demonstrate and affirm that we will endeavor to do the best within the confines of contemporary medical practice to help and support their loved one who is living with dementia.
