Despite being a physician and a bioethicist, Tia Powell wasn’t prepared to address the challenges she faced when her grandmother, and then her mother, were diagnosed with dementia – not to mention confronting the hard truth that her own odds aren’t great.
In the U.S., 10,000 baby boomers turn 65 every day; by the time a person reaches 85, their chances of having dementia approach 50 percent. And the truth is, there is no cure, and none coming soon. Dr. Powell’s goal is to move the conversation away from an exclusive focus on cure to a genuine appreciation of care–what we can do for those who have dementia, and how to keep life meaningful and even joyful.
In Dementia Reimagined by demystifing dementia, Dr. Powell helps us understand it from the point of view of both physician and caregiver. Ultimately, she wants us all to know that dementia is not only about loss–it’s also about the preservation of dignity and hope.
“Essential reading for anyone who cares for or about a person with dementia, treats a person with dementia, or is concerned about their own risk of dementia....This book gives us a vision for what a meaningful life with dementia can look like.”—Carol Levine, Director, Families and Health Care Project, United Hospital Fund; author of Navigating Your Later Years for Dumm
Dr. Tia Powell is Director of the Montefiore Einstein Center for Bioethics and of the Einstein Cardozo Master of Science in Bioethics program. She is Professor of Epidemiology, Division of Bioethics, and Psychiatry. She has bioethics expertise in public policy, dementia, consultation, end of life care, decision-making capacity, bioethics education and the ethics of public health disasters. She is a board certified psychiatrist and Fellow of the New York Academy of Medicine, the American Psychiatric Association and The Hastings Center.
Why was it important to you to write this book?
After my mother’s diagnosis of dementia, I just was struck over and over again by how little I knew: even in the context of being a physician and a medical school professor. And I just kept thinking if we—six adult kids, everybody trying hard—if we’re having a hard time, how much harder must this be for lots of people who aren’t as medically savvy, or don’t have siblings or other family members that they can crowd-source the problem to? It made me feel like I wanted to collect the information I wish I’d known.
Given the fact that so many of us do have a personal connection, how does the stigma and misinformation surrounding dementia persist?
I’m also a psychiatrist, and this is a pervasive problem with mental health issues as well. There’s the burden of the actual disease, and then there’s the huge additional burden of the societal bias and prejudice. There are senior living facilities where the people who are living there don’t want to see anybody with dementia, they don't want that person coming to the dining room anymore, because they realize that could be them. And it’s so unempathetic. But there’s a long history of this. So many caregivers of people with dementia say, “We don’t actually get invited to dinner anymore; we’re not part of the community supper club.” But wouldn’t it be a better society if we were more inclusive of people with dementia? And people with other disabilities? Because many of us are going to cross that line. That’s going to be us!
For a while, my mother would say: “Please be patient with me, I have Alzheimer’s disease.”
Some people with dementia do preserve a kind of social genius and social skill and it’s very humbling. They often are able to do what we should have made much easier for them. And I’m not trying to paint a rosy picture, but I find incredible dignity in people with dementia. And we need to give them credit and work with that.
In Dementia Reimagined, you actually talk about planning ahead for your own dementia. I applaud you for writing this section in the first person, because it immediately made me realize that I too need to begin asking myself those questions.
I think it had to be an “I” voice. If I’m going to say, “Get over yourself, start planning for it, think about it”—I should step up. It’s very hollow to make virtuous recommendations for other people that you have no intention of following. It’s really not persuasive.
The other thing is, as a psychiatrist, I take the view that we have some difficult conversations because it’s much less difficult to have them than to avoid them. You may think you’re doing yourself a favor by not thinking about dementia, but if you don’t do it, somebody else will be forced to make those decisions for you. And there’s no way somebody’s going to perfectly intuit what you might have wanted.
And the general rule, in the US in particular, is directly contrary to what most people say they want. You ask most people what kind of care they would want with advanced dementia, and they say, “I want to focus on comfort.” But US law says, “Unless you tell me to quit, I have to keep throwing everything at you.” Which is directly contrary to what most people say.
In your book, you describe the history of how we have cared for people with dementia in this country not only in recent decades, but for the past few hundred years.
I wanted to understand why we are where we are and also to rid people of the notion that in some rosy earlier time, families always circled around their elders, Mom stayed home, everyone was happy, and that was a lovely, earlier time. Actually, not so much. It’s also a women’s issue. When people say the family provided care, it’s typically the women who drop everything and care for their grandma or their husband’s grandma. I’m not saying that’s wrong, it’s a beautiful choice, but that doesn’t mean it was a lovely rosy time.
It’s a tricky, complicated question. People in Asian cultures are really grappling with this. The long-held tradition of caring for elders in family is coming up against very high rates of education and more and more women working outside the home. So how are we doing that? How are we reckoning? Is it always wrong to have a nursing home? What more can we do to help keep frail elders at home?
Let’s talk about care versus cure. Why is it easier, in this country, to talk about research toward a dementia “cure” than it is to get the conversation going about improving dementia care?
This fits within some larger problems in the US health care system. We love to invest in acute care medicine, in advanced science and research, and that’s all to the good, there’ve been wonderful advances. But weirdly, our health care outcomes are worse than other nations with advanced economies. And why is that, when we spend so much more on acute care? There’s a book called The American Health Care Paradox (Public Affairs: 2013), by Elizabeth Bradley and Lauren Taylor, that explains why: it’s because we don’t spend nearly as much on social services. Things like meals on wheels, visiting nurses, helping people stay safely in their homes: those things have a huge impact on health outcomes.
We’re spending so much money on finding a cure. And I am confident it’s not coming for the baby boomers. It’s certainly not coming for anybody who has dementia today. And that message does not get out.
People with cognitive impairment need a team effort to look at: how do we support your overall health? In a way to maximize your joy in life, the number of days you’re going to have living the life you want? What services are available in your community, and when you might need them? Let’s make a plan for you. And let’s have a great social worker to put that together. We could fund ten geriatric social workers for the cost of a PET scanner.
By the way, the first adult day health program in the U.S. started in Chinatown in San Francisco. It basically was about people not wanting to put their elders in nursing homes, but instead to keep them safe during the day (while they went off to work). They could still live at home and have dinner with the family.
I do think it’s important to do research for our kids and their kids. At some point, it will be important to know exactly which type of dementia somebody has because there may be things we can do, and that will be the time for biomarkers.
But we have a lot of people with dementia in this country who aren’t getting enough to eat. And that’s unconscionable. I want to use some money for that. Let’s start there.
Ann Hedreen is a writer, filmmaker and teacher. Her memoir, Her Beautiful Brain, won a 2016 Next Generation Indie award. Ann’s writing can also be found in 3rdAct Magazine and other publications. She is just finishing a second memoir, The Observant Doubter.
Ann Hedreen's powerful memoir, Her Beautiful Brain, won a 2016 Next Generation Indie award. Ann’s writing can also be found in 3rd Act Magazine and other publications. She is just finishing a second memoir, The Observant Doubter.
In her moving memoir Her Beautiful Brain, author Ann Hedreen writes beautifully about the effect of her own mother's young-onset Alzheimer’s disease on her mother and her extended family.
Dr. Tia Powell explains why medical research won't be able to find a cure for dementia in time for the Baby Boomers, one of the many revelations in this discussion about her important new book Dementia Remagined.
Dr. Tia Powell discusses her mission to improve the options and care for people suffering from dementia in this inspiring video.
Dr. Tia Powell invites us to think how we can create better lives for those living with dementia. Check out this inspiring video.
CUSWF invited Ann Hedreen, a writer, filmmaker and teacher, to interview Tia Powell, MD, Director, Montefiore Einstein Center for Bioethics, about Tia's new book Dementia Reimagined: Building a Life of Joy and Dignity from Beginning to End.
In the following piece by Ann Hedreen, she and Tia share meaningful insights and further elucidate a challenging topic. We welcome feedback and personal stories from our readers.
Ten years from now, every single Baby Boomer in the United States will have turned 65, and we’ll account for 20 percent of the population, outnumbering children for the first time in U.S. history. China is aging even faster: the World Health organization estimates that in the next twenty years, the number of people 60 or older will more than double, reaching 28 percent. Many of us will be healthy and vibrant in our old age, even as we manage chronic conditions ranging from cranky knees to heart disease. Some of us will start to worry about our brains. Some of that worrisome short-term memory loss will turn out to be more serious. If we’re lucky enough to reach 85, our chance of living with dementia will likely be 50 percent. And the chance of scientists coming up with a magic pill by the time we need it—one that can prevent, stop or reverse any of the many types of dementia we might encounter—is close to nil.
That’s the bad news. But Dr. Tia Powell wants us to know that there is much we can do besides wring our hands as we face a future that could include a dementia diagnosis for ourselves or for someone we love. In Dementia Reimagined: Building a Life of Joy and Dignity from Beginning to End, Dr. Powell, a professor of psychiatry and bioethics, makes a powerful case for reimagining how we view dementia.
It’s a subject that’s personal for me. I watched my mother live with and eventually die from young-onset Alzheimer’s disease. Like Powell, I am one of six siblings who scrambled to keep up with the demands of our mother’s relentless illness. I wish we’d had Dementia Reimagined in our hands then. I’m glad it’s available now for other families like ours. (Read more)
Ann's memoir, Her Beautiful Brain, which documented her experience with a mother with early-onset Alzheimer's disease, won a 2016 Next Generation Indie award. Ann’s writing can also be found in and other publications. She is just finishing a second memoir, The Observant Doubter.
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