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Thursday, 29 October 2015

Old age (Γηρατειά)

Can anything stop us from losing our mind?
"Eating a Mediterranean diet rich in fish and vegetables may help prevent your brain shrinking for as long as five years, new research suggests."  http://www.theguardian.com/lifeandstyle/2015/oct/21/mediterranean-diet-may-slow-the-ageing-process-by-five-years
We are seriously wondering about this in our house, as we watched the terrifying consequences of the developments of our 91-year-old yiayia's senile dementia. Up until two months ago, she was cooking her own meals and cleaning her house. She watched TV and read the Saturday local paper. She also pottered around the garden, and kept the front yard immaculately clean.

It was around this time when she also started telling us about the living dead: so-and-so died, she'd say, proceeding to tell us the gory details of their death. As far as we knew, these people were still alive. Sometimes old people confuse things, we'd tell the children. But we got worried, and hired help, a neighbor who was looking for this kind of work, and had experiencing in looking after old people. But imagine what this feels like for someone who had always tried to live independently. The relationship didn't quite work out.

There was also that time when she kept waking up at night and phoning us, to ask why we hadn't woken up yet, because it was time to go to work (it was often in the middle of the night). Checking her kitchen clock, we wondered if perhaps she had simply confused the time: the clock was indeed showing the wrong time. So we set it correctly, and changed the battery just in case. But the clock still kept changing time. So we removed the button that did this, to make sure that the time-changing gremlins didn't strike again. Yiayia then removed the alarm button and popped it onto the pin that had been left on the time-setting button. So we were back to square one. When we removed that button too, yiayia chucked the clock in the bin. "It's broken," she told us. "No, look yiayia," we said, holding it to her ear, "it's still ticking." But she wasn't convinced: "Only barely," she replied. It's just old age, we'd tell the children. But we were worried, so we called in a doctor.

"She's probably suffered a myriad of tiny strokes that were barely noticeable," he told us, and recommended donepezil and some sleeping tablets. It seemed to work, at least when she took it, that is. Yiayia had spent her life not just independently but also without taking any kind of medication whatsoever. All she ever took occasionally was paracetamol for a headache or other minor ailment. It was a shock to her that the doctor was suggesting that she take pills to live. "But there is noting wrong with me!" she kept saying. And she was right. Her blood tests showed no signs of illness. Normal reds, normal whites, normal cholesterol, normal heartbeat: in fact, normal everything. "She's really healthy," we told the kids, but we knew that there was something that was not really right.

She began moving the furniture around the house. She threw things out. We had to go through her rubbish every day: a cup, a plate, a bowl, even the remote control for the TV. And of course, food. "They've all been poisoned," she told us, howling with horror when we showed her what she was throwing out. "Get it out of this house immediately!" she'd cry, hitting her walking frame up and down on the floor. She was having psychoses. "It's a normal part of senile dementia," the doctor explained. "But she needs psychiatric help." At 91, I doubted that she would ever be able to receive help for her condition, not because the Greek health care system is broken, but because she would be unwilling to receive it. By this time, she had stopped taking all the medication she had been prescribed (we were giving it to her). She did not want our own help; how would she accept a change in environment and caregivers?

None of this terrified me personally as much as what was about to ensue, during her last week at home. Believing that we were poisoning all the food brought into the house, she stopped eating. She literally ate nothing all day. I checked her cupboards: apart from a few rusks, some olive oil, sugar, flour, rice and lentils, there was no other food. She had thrown everything else out, and refused to take anything we gave her. When she stopped eating our home-made meals, we brought in all sorts of other store-bought delicacies: she threw those out too, believing that the wrapping they came in was poisonous.

After three days, I insisted that we should take her to the hospital. Knowing that she wouldn't allow anyone to take her out of the house, I asked some big burly black-shirt-wearing relatives to help us coax her out. "You need to disarm her," I told them. "Take away the walking frame."  She had been using it like a deadly weapon, hitting anyone she had stopped trusting when they tried to approach her.

The doctors were very sympathetic. "There doesn't seem to be anything wrong with her", they said to us. "She's just senile." The A&E doctors called the resident psychiatrist who tried to give her some sedatives. But she refused to drink the water that had been laced with drops, nor did she accept to have anything injected in her. "We can't make her do anything," the doctors and nurses said, and we understood them to the tee: we couldn't make her do anything either. Yiayia went home, and continued her diet. For the last week of her life at home, she didn't take one bite of food.

How long can a person live without food before they faint, fall and create bigger problems than what they already have? It was either that, or residential care. State old-age care does exist, but it requires a lot of paperwork. For a start, the person entering state care needs to have thorough medical checkups before being admitted. Yiayia's issues did not allow us to go through this procedure. Private care differs not just in cost but also in terms of what kinds of cases they take on. We eventually chose a unit that is run by someone who has 40 years experience in geriatric care, 35 of which was spent caring for old people in state care.

Apparently, she's eating and has now started taking medication. But she's still not the yiayia we knew. I'm not sure if she will ever be again. The Mediterranean diet no doubt aided in her longevity. But it didn't stop her from the eventual decline that we all go through when we get old.

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