Over the past week, a number of key matters relevant to rural dementia have been highlighted in the media. These include; the Lancet paper about dementia risks, the work of the National Parks, changing childhoods and the announcement about local NHS provision in the Peak Park. On the face of it you may be wondering what links these matters. In short they are all happening in the Peak Park. Since I’ve been asked to give my opinion on these matters I thought I’d try to write a blog.
Firstly, we had one of those headliners which attracts so much attention. The team at University College London, published a paper in the renowned Lancet. The Lancet is a highly regarded academic journal which many academics can only aspire to. However, the experts, headed by Professor Gill Livingstone, have identified 9 factors which contribute to the risk of dementia. The team spent many months examining and assessing mountains of evidence to identify the key factors which can contribute towards a higher risk of dementia. A risk of dementia is not the same as getting dementia; you can have all these risks and not get dementia at all. Some of these risks are to do with past and present lifestyles. Some are possible to change if you wanted to whilst others are more indicators. As with lots of dementia research it is complicated stuff but nonetheless helps discussions around dementia. I am not going to go into the whole paper but suffice to say the media presented both stretched and not so stretched versions depending on the source. However the factors include; health issues such as having type 2 diabetes, high blood pressure, obesity, mid life hearing loss, smoking and a history of not seeking help for depression at the early stages. These are all health conditions which can be managed and possibly mitigated by the NHS. The other factors are less easy to manage and include social isolation, lack of physical exercise. Lastly but significantly is the level of educational attainment, which generally means the higher the level, the lower the risk of dementia. Educational attainment is more tricky as clearly educational attainment is a much about opportunities in childhood. As a family carer pointed out to me, whilst it is interesting to know, it is often very difficult to change habits and especially when older and stressed with caring. I agree but all is not lost.
We can’t do much to change educational attainment and clearly opportunities for continuing education were very different if you were born in the 1940’s than say the 1970’s. Gaining a place in a grammar school and possible university level education was an exception, particularly in rural areas. However, adult education thrived in these communities with evening classes in many subjects, some of which led to formal qualifications and others were pursued for pleasure of being with others sharing same interests. Although the landscape of adult education has changed and indeed contracted, the interests of those who attended continues, often as dedicated interest groups. In the Peak Park we have historical interest, community choirs, classical language, poetry, miniature modelling and dance groups. Many of these thrive as not only places of lifelong learning but also as places to build lifelong friendships. And we could consider each of these risks but really they don’t work in isolation but neither do the preventives. Indeed on balance the preventives may be dismantling more than one risk!
In many ways dementia is about trying to adopt a proactive approach. This can be done by enjoying getting out in the outdoors, maintaining connections with others and generally following all the usual healthy lifestyle advice. It is also about the community and organisations supporting these healthy lifestyles by supporting dementia friendly walking groups, considering accessible paths and stiles which creaky bones can skim over, providing running buddies, enhancing the trails so that a person with dementia can walk with independence. This week is National Parks Week. National Parks are both places of outstanding beauty but also working landscapes. The stretched park rangers strive to manage the landscape and the people who live, work and visit. National Parks attract many visitors who wish to experience the great outdoors on hot(ish) summer days. Whilst they are busy places, the parks can also be places of great isolation and harsh chilling loneliness. We know that many older people feel especially isolated when they can no longer go out to their places of connection and so independence is so important to maintain.
One of the striking lifestyle factors which I had underestimated is just how physically fit many rural older people are. It isn’t uncommon for retirees to walk 6 miles every day across uneven terrain and indeed many continue to do so even in very advanced years. Likewise, the number of fell runners and cyclists who in their younger years of retirement were still competing in events is significant. Old habits die hard and many of these wonderful older people with dementia still desire to have a short run or a cycle down the trail. These old habits, especially among those living with dementia, can be interpreted as “escaping” or “wandering” when really they are simply strong desires to get into the outside and to enjoy exercise.
Another aspect of living in a rural area are childhood experiences; another report which did provoke interesting conversations this week identified the changing nature of childhood activities in the outdoors. This report didn’t hit many of the headlines but is a contribution by the National Trust. Mud pie making, birding and den building have been pushed to one side to make way for computer games. It seems that climbing trees, once the core remit of every kudos seeking 6 year old is no more and often deemed too risky by adults. Memories of being in nature are one of the most enduring and positive stories which people with dementia tell me about; the joy of learning to be outdoors, to avoid being caught by an adult for doing some risky thing, the joy of hiding in a smelly muddy den and discovering wildlife. Do we really want to deny our children such lovely memories? Perhaps grandparents need to encourage such risk taking. Perhaps we need to enable all children to experience such activities, in the absence of an adult eye, to foster such enduring memories.
On a more serious note, over past year, the Peak Park community has been involved in a consultation process to decide the future of NHS community care, especially for those with dementia and/or in need of rehabilitation following illness. The outcome decisions were announced earlier this week and include an overhaul from community hospital bedded care to individual care in own home. This care will be along the lines of an intensive period of rehabilitation and support by a team of community experts. Many people in the community responded to the consultation with over 22,000 signatories from among a total local population of 37,000. Fears, anger and disappointment have compounded into a sense of abandonment among the most rural dwellers, many of whom do not have the resources to undertake complicated journeys to centres of excellence for their care. I am worried not so much about the decision to support own home care, which is evidence based but about the consequences for the future accessibility among the most remote dwellers. We know rural care is very expensive to deliver but infrastructure issues about living in a remote region seem to have remained marginalised throughout the consultation. Yet not addressing these very issues could see the failure of what can be a very good step towards exemplary rural care.
This brings me full circle to the particular nature of living and working in the Peak Park. The population as a whole is static and declining because there are more deaths than births. Already the proportion of older people is much higher than the UK average of 17% with an average of 28% in the Park. In some parishes, the number of people over 65 years stands at 39% of the total parish population. By 2028 the overall figure of over 65 year olds will be 48% (ONS, 2015). That is really worrying. Now is the time to consider the genuine future needs of the communities and to consider preventing the decline in younger families and subsequent workforce. Without a secure workforce then the future needs of families affected by dementia will be reliant upon the goodwill of ageing family members. This is a real concern and unique in such rural areas.
So that’s my round up of the week; one of positives and also some less than positives. We can build on the positives so that living with dementia in a rural area is one of well being.