Frank

It became obvious following his wife’s death that Frank had considerable memory problems that his wife had been covering up.

He has since been diagnosed with dementia and has great difficulty with dressing (frequently wearing inappropriate clothing for the weather or dressing in the wrong order, e.g. trying to put underwear over his trousers). He is a very proud man and became difficult or even aggressive when his daughter tried to help.

Despite being a generally well-groomed man he was also refusing to undress or wash, apparently unaware of any personal hygiene issues and resentful of any attempts to discuss this with him.

A care package was introduced to help him with personal care in the mornings and this has been successful for the most part, although he can refuse to co-operate at times.

Frank mostly stays in the house, in a small, dark living room, watching the television while his daughter goes to work during office hours.

He is able to make himself a cup of tea with biscuits but little else. He usually does not leave the house. However, as a precaution his daughter has begun locking him in while she goes to work. She has done this since an episode where he left the house during the day and was picked up by the police, in a very anxious and dishevelled state.

Otherwise Frank’s apparent interests in life are increasingly limited.

He very rarely initiates any conversations and usually gives only monosyllabic answers to questions. He does not express any wishes, hopes or desires, and time spent with his daughter is most often characterised by long periods of silence.

Frank’s behaviour and difficulties in managing suggest that he is in the early to middle stages of dementia, and that he is in difficulties.

His lifestyle is not good for him – a reducing set of options in his day-to-day routine. Living on biscuits, tea and television in a small dark room, barely conversing, unable to go out – it sounds like a prison sentence for the crime of being ill. It carries a strong sense of depression with it – and it is an all-too-familiar scenario.

Dementia is an illness where links with depression are increasingly acknowledged but still not fully explored and explained.

It is not the least surprising that some people diagnosed with dementia (or filled with dread at their own cognitive losses and increasing difficulties with managing the world) should often go through a period of depression. Figures for suicide in early stage dementia are appallingly high.

The relationship between depression and dementia, however, is not straightforward: it is easy to mistake severe and chronic, yet treatable, depression for dementia – and depression is much more common in old age than we used to acknowledge.

Carers need to be aware of this. But the link is more complex: depression may contribute to dementia. If you are apathetic and listless you give yourself little stimulation and it is easier to fall into problems – so depression and dementia may feed one another in complex ways.

While she was alive, Frank’s wife will have felt that she was helping him by covering for his memory losses and will have done so out of an understandable and loving instinct to help.

But it is horribly common after the death of a spouse to see other family members take over the lives of people living with the early stages of dementia, reducing that person to an unnecessary amount of dependence – a situation that often happens in residential and nursing care, too.

People living with dementia may well find some tasks frustrating and difficult and will be very grateful for help. But if you do everything for them, you take away their ability to do it for themselves, and if you cover up memory loss you compound a sense that it is something to be ashamed of and hidden away rather than a problem to be confronted and managed where possible.

It is vital that people are given as much control over their own lives as possible.

Many people with dementia and their partners manage to find humour in their day-to-day experience of dementia – and it is clear that this is an option that often helps people feel more dignified, human and strong.

There is clearly a place for putting yourself in their shoes here – for carers to think about what might help them under similar circumstances, to try to find meaning in confused or unhelpful behaviour.

More than anything else, Frank’s behaviour can be read as suggesting an underlying anxiety. He has withdrawn from the world and is too uncomfortable with his own position and with his relationship with the world to be able to respond positively to his daughter’s attempts to help him dress.