We’re all very white!

We’re all very white!

And straight.

And pretty much middle class…

I’ve been in a number of discussions recently about inclusion, ethnicity and gender identity.

Because we who advocate and campaign for better dementia support and care are largely white, straight and middle class.

Of course, as we know, non white British people don’t get dementia. Just indigenous us. The majority. So we can ignore the rest.

Who are we anyway? Angles, Saxons, Jutes, Flemish…Germanic then.

Who rules Britannia? Yep. We Germanics. We straights?

Hang on, I cannot keep this up. It has to stop.

Surrounded by stereotypes as we are, none more so than the historic images of demented madmen in straitjackets and locked up, images that are perpetuated in much of the media, we must break free from them.

What are the proportions of ethnic minorities in Britain?

How many people identify as LGBTQ?

“An estimated 1.4 million people aged 16 and over in the UK identified as lesbian, gay or bisexual (LGB) in 2019 – a statistically significant increase from 1.2 million in 2018 – continuing the trend we have seen over recent years.”

(HMGovt)

There are a lot of people in Britain who do not conform to the white British stereotype. Why don’t we see many of them in research, and advocacy, and dementia cafes…?

Why are most campaigners white? And straight?

Perhaps because others live fearful lives, fearful of the reactions they are too used to getting from us whitey straights?

Perhaps because they have known persecution ever since coming out, and probably before.

Perhaps because their experience of health and care has been of assumptions, prejudice and even hatred? (fear?)

Come on, let’s get it out there…there’s plenty of this around. Much of it indirect and unconscious, which needs real effort to redress.

So what is going on?

Language and culture can prevent openness about, or even recognition of, dementia. And those used to prejudice, direct or indirect, tend not to go where prejudice is expected. Health care. Social care. Society. Shops. Jobs.

The LGBTQ community often lives separate parallel life, keeping within their groups and communities where they feel safe. Why would they not?

Are ethnic and gender identity groups ‘hard to reach’? God, I’ve heard that so often for so many years. These people are not hard to reach, but it does take a bit of effort and an open mind. They are indeed seldom heard, and seldom given the empathic understanding they deserve.

Minorities are often (though history) blamed for the ills of societies. They are easy targets when those in government or in the social majority face hardship and challenges which they really do not want to acknowledge as their own responsibility.

LGBTQ people living with dementia in care often hide their sexuality in order to avoid aggression and/or being told to leave. Think about this. Your memory and cognition falters and you have to remember to not say or do anything that might reveal who you are. You cannot have photos of your loved ones on display. You have to join in the banter directed against your own kind.

Or your family refuses to accept your dementia, and may be too proud to let anyone outside the home find out. You are stuck, imprisoned, without help or understanding.

We don’t do anything to change this horrid situation by continuing to just be white middle class advocates and groups and researchers. We don’t change anything when we specify that those who take part in research must speak fluent English.

Perhaps in my Shropshire bubble we are the exception? Perhaps in writing this I am demonstrating my own unconscious prejudice? (I hope not.)

My experience on Zoom over two and a bit years, and in my ‘work’ in earlier years, suggests that I am not wrong.

Sleep in Dementia?

Sleep well last night? asks my wife.

Nope. Kept waking up. Every hour. Almost to the minute.

Nightmare dreams. Still unsure about reality.

And I feel groggy, foggy and soggy.

Perhaps you ought to tell the doctor?

Er, well, what could they do?

Dunno, but…

I can understand why further research is so needed into sleep in dementia. A quick search throws up of lot of articles from pre 2012 but precious few more recently.

And the meta analysis carried out by a UCL team in 2017 found no evidence based reliable treatments.

(Source: Current Opinion in Psychiatry, Volume 30, Number 6, November 2017, pp. 491-497(7))

What might we try?

Drugs? No strong evidence in favour, and plenty against. Plus side effect horrors.

Activity? Of course. But if, like me, you have a few co-morbidities that limit your movement or stamina/endurance, you may be unable to increase exercise significantly.

Daylight? The natural world? Trees? There is evidence that seeing trees increases wellbeing…

Sunshine.. Lovely, but not always available. Being outside, I believe, is good though.

Foot bath ‘therapy’? Yes, someone mentioned that recently. Not so silly if you have painful feet at night.

Aromatherapy? Becoming widely accepted, but is there evidence?

Preventing daytime napping? Could cause considerable behavioural difficulties in late afternoon.

And so on…

One abstract I read spoke of the need to analyse a person’s sleep patterns before attempting treatment. Bit like doing an xray before replacing a hip?

Durr!

I wonder how often doctors in general practice order sleep studies? And if they are available in sufficient quantity?

I wonder if sleep specialists are available to all who could benefit?

And if there is no consensus on evidence based treatments, is a specialist just guessing too?

What do GPs think when I say I am having problems sleeping?

Do they have that heart sink? Another thing they have no real idea how to treat?

I had sleep apnoea for several years before I told the GP, (when I was still a healthy weight!), had a sleep study, and was given a cpap machine. About 15 years ago. And before that, in 2003 I had a coronary bypass. Did oxygen reduction at night cause my dementia?

Possibly irrelevant now. But my sleep now is interrupted by waking frequently. I often see the same time plus 60 minutes on the clock. I have vivid, often unpleasant, dreams.

And when, like today, I wake after a better sleep I feel wonderful.

That says to me that sleep is a wonderful thing.

I am really pleased and inspired to have become a member of the TiMeS sleep study project team.

In five years’ time, let’s hope we find some treatments or approaches that are proven to work.

You can follow @TrialTimes on Twitter, as we develop the work.

Sleep well last night? asks my wife.

Nope. Kept waking up. Every hour. Almost to the minute.

Nightmare dreams. Still unsure about reality.

And I feel groggy, foggy and soggy.

Perhaps you ought to tell the doctor?

Er, well, what could they do?

Dunno, but…

I can understand why further research is so needed into sleep in dementia. A quick search throws up of lot of articles from pre 2012 but precious few more recently.

And the meta analysis carried out by this UCL team in 2017 found no evidence based reliable treatments.

(Source: Current Opinion in Psychiatry, Volume 30, Number 6, November 2017, pp. 491-497(7))

What might we try?

Drugs? No strong evidence in favour, and plenty against. Plus side effect horrors.

Activity? Of course. But if, like me, you have a few co-morbidities that limit your movement or stamina/endurance, you may be unable to increase exercise significantly.

Daylight? The natural world? Trees? There is evidence that seeing trees increases wellbeing…

Sunshine.. Lovely, but not always available. Being outside, I believe, is good though.

Foot bath ‘therapy’? Yes, someone mentioned that recently. Not so silly if you have painful feet at night.

Aromatherapy? Becoming widely accepted, but is there evidence?

Preventing daytime napping? Could cause considerable behavioural difficulties in late afternoon.

And so on…

One abstract I read spoke of the need to analyse a person’s sleep patterns before attempting treatment. Bit like doing an xray before replacing a hip?

Durr!

I wonder how often doctors in general practice order sleep studies? And if they are available in sufficient quantity?

I wonder if sleep specialists are available to all who could benefit?

And if there is no consensus on evidence based treatments, is a specialist just guessing too?

What do GPs think when I say I am having problems sleeping?

Do they have that heart sink? Another thing they have no real idea how to treat?

I had sleep apnoea for several years before I told the GP, (when I was still a healthy weight!), had a sleep study, and was given a cpap machine. About 15 years ago. And before that, in 2003 I had a coronary bypass. Did oxygen reduction at night cause my dementia?

Possibly irrelevant now. But my sleep now is interrupted by waking frequently. I often see the same time plus 60 minutes on the clock. I have vivid, often unpleasant, dreams.

And when, like today, I wake after a better sleep I feel wonderful.

That says to me that sleep is a wonderful thing.

I am really pleased and inspired to have become a member of the TiMeS sleep study project team.

In five years’ time, let’s hope we find some treatments or approaches that are proven to work.

You can follow @TrialTimes on Twitter, as we develop the work.