Confusion and dementia are on my mind

My family is dealing with my elderly mother who has slipped into a dramatic decline--frequent falls and intermittent confusion--her body and her mind have betrayed her. Much to her dismay, she can not live alone. These days, months, and this entire year is not what she hoped for--definitely not the golden years society promises. It is hard for her and hard for my sisters and I to watch. There are feelings of helplessness and hopelessness as she struggles bitter and resentful about her current state.

This week I am preparing a session on dementia for the 4th year Family Medicine residents here in Nablus. They have had lectures on this topic in the past, so my goal is to be interactive, give them tools and skills to use and to better understand how they address issues such as poly-pharmacy, competence assessment, and elder abuse. If these resources are not available, what are their responsibilities as community leaders to grapple with the needs of an aging population in the 21st century. When I observe them in their training clinics, seniors are often accompanied by an adult child who is caring for them. I am told families help each other with child care, and senior care much more here than in the US. More than half of the young family medicine doctors are women with children. Would they give up their careers to care for a parent as well as their children? Could they afford to financially?

On Thursday, I had a chance to see how Nablus is responding to their elderly residents. I watched six 6th-year medical students on their community health rotation talk about dementia at a local charitable organization for seniors. Nearly 100 seniors gathered in the center which was located in an older part of Nablus. Of course most were female, only four men, and only a few women didn't cover their heads with the hijab. In this region of white stone where the sun always shines, it is fashionable to wear your sunglasses on the top of your head when they aren't covering your eyes. The younger seniors did just that--sunglasses perched on top of the hijab like a crown. Judging from clothing choices, a range of socio-economic groups were present and a few spoke a little English. The most common greeting is "Welcome--Welcome to Palestine". Based on the number of wrinkles, many were born before the 1947-1949 war, known as the War of Independence for Israel and the Nakba, translated as the catastrophe, for Palestinians. At this time many Palestinians were forced from their homes and the UN eventually responded by creating refugee camps, initially tents, which are small cities in themselves some sixty years later. Nablus has an UNRWA camp in the heart of the city. I am guessing some of the attendees were from there, generally a poor population.

Before the session started, we stood and sang an upbeat and rousing song which a kind senior translated as: I love my country. I reflected on the many changes this group had lived through. As youth they knew a much less restricted Palestine. With the building of the wall, which began in 2000 life became more complicated with trips between cities six miles apart as the crow flies becoming journeys well over an hour (Bethlehem and Jerusalem). During the Intifadas in 1987 and 2000-2005, Nablus was a hot spot with tanks rolling through, citizens jailed or killed for unclear reasons, and curfews lasted for days at a time.

But none of those traumas or losses were evident on Thursday. They listened to the students, took notes, accepted plastic cups of water, then tiny paper cups of strong coffee, followed by candy--berry flavors in plastic wrappers. The hosts were gracious and the audience was engaged. When time came for questions many started talking, only a few raised their hands. The questions continued for twenty minutes and the host had to tell the audience the event was over. Several came up to ask the students more questions.

I thought of US audiences I've spoken to who are generally much less gregarious. Here, everyone talks with their hands. At home, there is often silence when it is time for questions and I usually plant a question or two to prime the pump.

The Family physician faculty who invited me was proud of his students. He told them that the pace of life was changing. Many families could not afford to have the wife stay home and take care of aging parents. The charitable organization also ran a 25 bed facility for elderly women. These young physicians would be addressing these changing needs.

While I didn't understand much of what was said, seniors asked about prevention: Vitamins and the medications available to slow the progression of dementia. They were vital and engaged, seeking knowledge and fellowship. As I watched and listened, I thought of our own struggle with my mother. Despite all the resources we have in the US, the process of aging and all the challenges it brings are still difficult. Needs are not fully addressed and emotions are raw. Perhaps it is the loss of control that is the most difficult. Or perhaps the poet Dylan Thomas is right: Do not go gentle into that good night, Old age should burn and rave at close of day; Rage, rage against the dying of the light.