Those who care for people with dementia must be prepared to fight prejudice in the health and social services to get them proper care and treatment, according to a hospital consultant People with dementia are disadvantaged by ageism and by the high status given to the ability to think clearly, says Dr Desmond O'Neill, consultant in geriatric medicine and age-related health care in the Adelaide and Meath Hospitals in Dublin.
Too little emphasis is put on their ability to derive pleasure from relationships, activity and creativity, he writes in the Irish Journal of Psychological Medicine.
Survey findings reported in another article in the journal suggest that people over 75 are more optimistic about their future than those between 65 and 74. Dr O'Neill argues that to see a person with dementia as "only a shell of his former self" is "repugnant to a moral solidarity with those suffering from dementia".
Moreover, he says, it "contrasts with many carers' experience that people with dementia have great sensitivity to attitudes and behaviour of those around them". He is critical of how some doctors relate to people with dementia.
"It is not uncommon for patients with dementia and their care-givers to complain of insensitive assessment whereby the physician did not interview the patient alone and talked to the care-giver as if the patient was not in the room," he writes.
"It is a challenge to our humanity and professional skills to ensure that the patient feels that they are at the centre of a relationship where their fears and problems will be professionally and confidentially handled."
At the very least, he says, the patient should be interviewed alone before the doctor talks to the carers.
Too much emphasis is being put on the ability to think clearly and remember and too little on feelings and relationships, according to Dr O'Neill.
"In dementia, we need to convert the dictum `I think, therefore I am' to `I will, feel and relate while disconnected by forgetfulness from my former self, but still, I am,"' he writes.
People with dementia are vulnerable to being denied high-quality health care, he argues. This discrimination is due to ageism and to a prejudice - which he calls "cognitivism" - against those who can no longer think clearly or remember. "Those who care for patients with dementia need to understand the potency of ageism and cognitivism in health and social services, and assume a role of advocacy to ensure adequate assessment and care facilities for their patients," he writes.
A second article reports on a survey of nearly 1,000 older people in Dublin which found that people over 75 are more optimistic about the future than people aged 65 to 74.
While 8 per cent of people in the younger group described their future as bleak, only 4 per cent in the older age group shared that view.
Commenting on this finding, the authors write that "hopelessness and a wish to die do not appear to increase with age and cannot be regarded as an integral part of ageing".
Overall, about 16 per cent of people stated that life was "not worth living", but none had made plans to kill themselves or had tried to kill themselves.
About one in eight of those surveyed were assessed as depressed, and of that group 69 per cent reported having had at least one suicidal feeling in the previous month. The researchers were from St James's Hospital, Dublin, Mercer's Institute for Research on Ageing, the Jonathan Swift Clinic, and the Health Research Board.