Controversy and Caring: An Update on Current Issues in Dementia

Article excerpt

Over the past decade, Americans have become increasingly familiar with the terms Alzheimer's disease and dementia. Although not fully understanding them, most Americans are aware and fearful of such conditions and frustrated by the slow progress in, or lack of, treatment for them. The public is overwhelmed by marketing and media efforts to portray scientists as close to a cure and able to manage the disease with current medications-despite almost no evidence to support this assertion. Furthermore, being diagnosed with Alzheimer's disease brings messages of hopelessness associated with the progressive nature of the disease. As the pendulum swings from promises of "miracle cures" to abject hopelessness, we miss the treatment forest for the trees, neglecting a critical integrated-care approach that must emphasize both nonpharmacological as well as pharmacological treatment approaches.

This special issue is intended to provide a balanced exploration of new trends and challenges in age-related dementia, including medical and nonmedical approaches to this disorder. In this introduction, I will review the information behind the fears about Alzheimer's disease and the increasing frustration about the messages surrounding dementia and will lay out the contents of this issue of Generations.

Fears of Aging and Alzheimer's Disease

The fears related to growing older, and the growth of ageism in our country, go hand in hand with the fears about getting dementiamost particularly, Alzheimer's disease. Emphasizing the growing numbers and frequent health challenges facing the older segment of our population, the American Psychological tion (APA, 2002) included age as an aspect of diversity and multiculturalism. This document utilizes Gordon Allport's Social Categorization Theory in understanding how older adults may become an "out group," facing significant discrimination. Allport used his social categorization theory to describe the basic tenets of discrimination through the creation of an "in group" and an "out group" (Allport, 1954). In this framework, then, people make sense of their world by creating categories and separate these categories into people like themselves or unlike themselves. The relevance for multicultural diversity issues includes the following common outcomes of categorizing: an exaggeration of the differences between groups, an exaggeration of the similarities within groups, the favoring of one's own group, and the unconscious process of discrimination toward the out group.

Allport's categorization theory lends itself to understanding older individuals as an out group. Essentially, the nondominant out group (older adults in this case) is viewed as homogeneous and portrayed as having a variety of negative characteristics. Older adults are viewed stereotypically as alike: alone and lonely, sick, frail and dependent, depressed, rigid, and unable to cope (Hinrichsen, 2006). This pervasive view portrays all older adults in a negative light and ignores the incredible heterogeneity of the aging experience and the strengths and positive attributes of older adults. Palmore (1990) estimated that 58 percent to 80 percent of older adults experience ageism, whether as the butt of the joke or as one assumed to be mentally or physically incapable. Ageism becomes most prominent when visible signs of disability or deterioration are evident. Within the medical community, this phenomenon frequently plays itself out as healthcare professionals speak to family members, often ignoring the older adult seeking treatment. Indeed, once diagnosed with Alzheimer's disease, people with dementia are often excluded from all aspects of active decision-making about their own treatment and personal care.

In his book, The Myth of Alzheimer's, Whitehouse (2008) described the sensationalism surrounding the course of Alzheimer's disease, with the medical community, dementia groups like the Alzheimer's Association, and the lay community emphasizing the total destruction of the "personhood" of the individual with dementia. …