Cultural Shifts in England/A Carer copes

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Chapter VIII: A Carer copes

Today’s society is changing. Those who are retired – the over sixty-fives, are living longer, fitter, healthier lives. They are taking a greater part in the life of the nation, stimulated by their television, radio, and music player; handling their latest wireless handheld gadget under the tutelage of their grandchildren. Unfortunately living longer gives debilitating illnesses time to take root and grow… especially fatty deposits that thicken the artery lining. One of these common illnesses is multi-infarct (number of small strokes) dementia, which damages the central nervous system (cerebral thrombosis). The present UK population is sixty-two and a half million… over sixteen percent are over sixty-five. It is believed that that will increase to twenty-three percent, by 2034. The disparity between the sexes - of those reaching one hundred, is closing. The figures for all dementia sufferers will rise proportionally - as the aging population grows. No paper on the subject can be devoid of medical terminology… any research exposes descriptions of steps, tests and effects, different, but meaning the same. I hope I have given a layman’s understanding in a way that helps interested readers, sufferers and carers.

Vascular dementia[edit]

This peripheral vascular disease – a disability described as short-term memory loss (impairment of cognitive ability), expresses itself as a mental problem. The illness is mainly age-related although can occur to younger adults. The patient experiences problems associated with: anxiety, depression, panic attacks, muscle-spasms, and convulsions. This paper is directed towards carers looking after aged citizens who have retired from work, and deals with a condition known as: 'multi-infarct' (circulatory matters) 'vascular' (blood related) 'dementia' (brain damaged). There are a number of other diseases and syndromes that can be confused with this complaint. However, a CT scan of the brain, and a number of suitable, clinical, diagnostic tests - day-to-day functionality tests, give signs and symptoms of the illness. The test results are a record of: time needed to make a decision; the concentration afforded to the task, the amount of study given, and the behaviour exhibited afterwards. These investigations give an indication as to which dementia it might be. However, it must be appreciated that early on there are no tests to make a definitive diagnosis - for other under-laying conditions may be present - only time points towards certainty. Changes in behaviour are often remarkably difficult to identify and in this instance the regression is slow.

The Problem[edit]

An individual can age, without being aware that they may be susceptible to vascular dementia. All individuals have inherent weaknesses that can lay dormant, be undetected, until old age degenerates, or the person falls seriously ill. Hereditary illnesses - weaknesses, and physical abnormalities, play a part in every person’s make-up. Some individuals never suffer from vascular dementia until very late in life, others not at all, and some have the problem in middle-age. The problems, when discussing this particular dementia, are the linings of the arteries - that feed blood to the brain. In other dementias the heart and legs are affected. The arteries become coated with fatty deposits (plaques)… which build up and thicken, narrowing the vessel… and over time… harden. The hardened cholesterol, plaque deposits, crack… blood cells (platelets) gather together, forming clots - around the cracks… bits drop off become lodged and the artery becomes choked. The one time free passage of blood is now prevented from feeding the cells with oxygen and nutriments. The progression of fatty build-up in other arteries continues, sufficient to starve more cells. It is believed by neuroscientists that some brain cells can grow new neurons although the growth occurs mostly when young – and then only when receiving the optimum oxygen and nutrients. Once damaged, by blood starvation, however momentary, they die. Aging and stress cause progressive deterioration and impairment, the damaged cell structure cannot reform nor be replaced and the cortex of the brain irreparably damaged.

Function of blood[edit]

Blood is the transporter of oxygen to the body’s tissue. It receives oxygen in the lungs which is the function of erythrocytes (red blood cells). Fifty-five percent of the blood is plasma (albumin, globulin and fibrinogen) - the protein, a yellowy coloured fluid… is the medium by which the blood cells are transported round the body - consisting of just over ninety percent water… which diffuses carbon dioxide. The other forty-five percent are the blood cells (electrolytes) - sodium chlorine, potassium, manganese, and carbon irons. The controlled movement of blood (homeostasis): controls body temperature, maintains the correct balance of alkalinity and electrolytes, and carries hormones around the body. The white blood cells are to do with producing anti-bodies, dealing with bacteria, worms, histamine, serotonin, heparin – releasing enzymes; detecting and defending the body’s tissue. It is the lymphocytes within the white cell structure which produce memory cells. As a simple explanation of body needs: food is its nutriments, the liver converts this into energy, bone marrow produces blood cells, the cells: transmit, insulate, protect and nourish; the lungs oxygenates the blood, that produces water… which releases energy; blood transports the cells around the body, the heart pumps the blood, and liver cleans it. It is clear from this simple explanation that anything which restricts the flow of blood is serious.

Restriction of blood[edit]

Any action or deficiency that restricts the normal flow of blood is serious… These are some illnesses, deficiencies and congenital problems that have a particular link to vascular dementia: heart problems, high blood pressure, irregular heart beats, high cholesterol levels, strokes, hemorrhagic lesions, diabetes (insulin resistance), and damage brain’s cells. Ageing, alcohol consumption, cancer, dietary matters, sedentary life-style, and stress - that reduces neutrophils – allows bacteria to grow, all play a part in the degeneration process. Preventing the free flow of blood exacerbates underlying conditions… many individuals who suffer from a restricted blood-flow eventually experience some form of dementia.

Psychological effects[edit]

If the flow of blood to the brain is seriously constrained the brain cells do not receive rejuvenating glucose and oxygen and start to die. This process cannot be prevented but can be slowed down. The unpreventable deterioration is observed by the persons: behavioural dysfunction, change of personality, intellectual deterioration, and memory loss. These changes are experienced by: feelings of insecurity, lacking confidence, of being unloved, threatened – not being cared for - being bypassed - left out, and not wanted. The patient lashes out verbally, accusing those nearest of being unfaithful and uncaring. The unhappy patient gives way to: sleeplessness, jealousy, becomes depressed, feels sad and lonely, starts to become disinterested in food - feels unchallenged and unrewarded… all these depressive feeling reduces self-worth; this further reduces confidence… leads to indecision… and eventually to loss of control.

Symptoms[edit]

There is a natural loss of memory as a normal process of aging. Dementia is one or a number of mental skills coming on top of the normal degeneration process – affecting short-term memory, concentration, speech, and logical progression. The degeneration, when is does occur, is more obvious when more difficult mental tasks are attempted. Stress, suffered from failure, further pushes the patient’s remaining confidence even lower. Lapses in memory and reasoning are followed by periods of stability… these give way to further lapses. The gradual downward spiral can be brought up short by a stroke – interruption of blood supply to specific parts of the brain, the results being sudden and permanent: paralysis, speech defect, or seizures. The damage to the vascular system is mainly due to hardening of the arteries… deposits of fatty deposits that restrict the flow of blood… an action that affects the heart (cardiovascular disease, which if blocked causes myocardial infarction - a heart attack); brain (cerebrovascular) disease, blocked arteries causes cerebral thrombosis, and legs (claudication) experience cramps, tingling, numbness, and swollen joints…

The Brain[edit]

Vascular Dementia is to do with a shortage of blood to some brain cells that damage the cortex. The cause is by fatty particles momentarily blocking tiny blood vessels, called the vascular system, carry oxygen and nutriments to the brain. Without the blood’s life giving properties, even for just a few seconds, the receptor cells in the brain die, never to be activated again… the cortex is that part of the brain associated with mental ability – memory, problem solving, control, alertness and behavioural changes. There is no set progression rate for speed of regression; it depends upon which cognitive effect, or effects, are being experienced. The cause of the constriction to the vascular system can be attributed to: a damaged heart, high cholesterol and diabetes. Which of these, and it could be more than one, needs identifying, for remedial help can slow the degeneration?

Diagnosis of vascular dementia[edit]

Recognising that you have a mental problem – difficulty managing day-to-day living, sorting out your financial matters, or remembering a sequence of events – is upsetting, disturbing, and notoriously difficult to evaluate. The onset of one or other of these may extend over a long period, to the extent that you may not notice a difference, perhaps you may think it’s just something to put up with – link it to old age, and compensate by being more organized. Your change in behaviour maybe recognised by someone close who can see the difference. Whatever route taken to recognise and accept your deterioration you must do something about it.

There are a number of very good reasons why you should make an effort to find out what the problem is. First, there are chemical procedures that will improve your mental state. These will not present a problem for you to take nor will they remove any other physiological function. There are support groups, and early diagnosis will allow you to make provision for housing, day-to-day living assistance, adapting your life-style and rectifying any bad habits.

Your first immediate action[edit]

Your mental health concerns will interest your doctor, who will give you a simple question and answer functionality test. His evaluation, if your fears are correct, will suggest a diagnostic screening to make certain of his diagnosis. First though, he will ask for a urine and blood test to check for mineral deficiencies and infections. He may well offer you a low dose of a named sedative for short term relief. The radiologist will carefully compare and observe the scans, checking for imperfections - giving title to your medical condition… this will confirm some, if not all, of your doctor’s opinions. The neurologist may then give you his opinion on the observations of the radiologist - about your nervous system; a geriatrician or psychologist will advise your doctor on the amount of mental impairment using a series of mini-mental state examinations and abbreviated mental tests… Based on these tests and their scores your doctor will confirm the diagnosis and prescribe a course of antidepressants to lower anxiety, this will slow down the degeneration process, taking away some of the stress and anxiety. A psychiatric nurse will visit on a weekly or fortnightly basis to afford security and well-being.

Long-term prognosis[edit]

There are two main types of vascular dementia: those caused by a stroke and a small vessel disease where the tiny arteries are partially or totally blocked. There are others where the patient has a combination of these two. Included are a number of other named types all to do with an interruption of blood to the brain. Starving blood to the brain can occur: slowly and evenly, over a relatively long period of time; in a series of intermittent step-by-step actions, or by a sudden heart attack. If the impairment has been caused by a blow to the head, the effect may not be progressive or fatal but prove to be a permanent disability. A caring sympathetic observation of the patient dressing, putting on and tying shoes, washing, flushing the toilet, and problems of incontinence, will indicate where outside help is eventually required. Evaluating these five daily tasks give The Barthel Index of a person’s functionality.

Treatment[edit]

All medicines can cause side effects. Taking a new treatment should be carefully monitored by the doctor but if at all possible by the patient and carer as well… noting changes in behavior and physical condition. It is essential that both the doctor and patient discuss the benefits against possible side-effects. The main treatments - tablets or/and drops, are prescribed for depression – feeling nervous, confused, lack of motivation and apathy… panic attacks - sweating – feelings of fear, anxiety, palpitations of the heart, trembling, pins and needles in arms or head, fast shallow breathing and unnecessary worry about feelings of insecurity and agitation. Talking therapy, is as important as chemicals – directed conversation by the carer refreshes memory - stimulates, distracts, and interests, the best daily prescription… Communication is essential to promote consciousness, awareness, and positive sensations. If possible try and encourage the sufferer to jot down daily thoughts, reminders, and feelings, without laying too much emphasis on what is written. Both talking and writing therapy is wearing on the carer for any negative remarks or doubtful disclosures cause depression and sets back any confidence built up. Doing jobs in company with the carer is very beneficial. It is clear that in time the patient has to be closely overseen and a referral sought to find a home to make their safety paramount. Relatives must not be overly worried if their loved one seeks and forms an attachment with another resident. It is the job of the care home to act as chaperon for their charges - to see that the attachment does not get out of hand. The Prime Minister sets out a proactive approach for Dementia Strategy to prevent a crisis. He wishes to push forward early diagnosis for suspected sufferers. The latest treatment Acetylcholinesterase Inhibitors (Achei's) have been produced to slow down the progressive decline principally for Alzheimers but also used in some vascula dementia sufferers. There are four brands which are on the market some in tablet and patch form one given in later stages but now being considered for early treatment in conjunction with other Achei's. Simon Lovestone's, Professor of Old Age Psychiatry, King's College, London, has two main interests: why amyloid plaques(protein associated with microtubules)contain tangles, perfecting diagnostic tests to predict which people will suffer from memory loss. Professor Lovestone believes within the next ten years there will be a possibility to slow down the progression of dementia.

Welcoming a good death[edit]

You might feel you shouldn’t think about death as that is considered morbid. There is nothing more natural than dying. How often do you hear the remark, “He died a good death.”? What is a good death, what does one have to do to bring that about? By death I mean irreversible brainstem dysfunction where the body cannot be resuscitated. Being in peaceful surroundings occupying a place of calm where you can maintain self respect and have your wishes respected is the basis of a good death. Leaving behind your personal effects in a tidy state that gives instructions what is to be done when you have departed goes a long way to setting your mind at rest. This preparation for death can be started now. You cannot possibly have everything in order but at least just thinking about it positively, will start the process off. Opening your mind to the possibility of death is recognition of where you are now and how you got there. Life is a journey along a path leading from your mother’s womb. You receive genes from both your parents that predetermine certain characteristics both mental and physical these continue to grow influenced by nutriments and stimulations peculiar to your time, place and parents, particularly those from your mother. Your upbringing, schooling, work and leisure shape you as an individual. Along the way you form prejudicial opinions, harm others and say unkind things. Whilst you are still alive there is always time to acknowledge these mistakes. Admitting these, even if its only to yourself, is beneficial, doing something about them by seeking forgiveness is by far the hardest part… but how rewarding when you do especially to achieve your goal of a good death. Writing a Will, appointing an Attorney, filling in an order for your funeral – arranging the sort of farewell service you would like, can be a rewarding experience - highlighting essentials and prioritizing your wishes. When accomplished this will put your mind at rest and may well remind you of happy times, long forgotten friends and mistakes that can be admitted. As the time approaches death try to arrange having a reliable caring friend close by that’ll attend and give notice to your needs. Make sure you acknowledge all your friends and close relatives by remembering their name in your Will mentioning them tells them they have been thought about and not forgotten. A new concept in caring is a Soul Midwife who will be with you to the end observing your needs, giving comfort and safety. An American counterpart is a Doula Midwife who performs a similar task. Their members give training, advice and guidance. As a pregnant woman during labour needs support so do those who are dying? You may move in and out of consciousness just before your death, before your brain ceases to function so don’t put off last minute wishes. To be able to breathe gently is not always possible so try to concentrate on breathing either by counting your breaths or visualizing blowing up a balloon. A good vibration copies the song’s lyrics. Atomic particle science and nanotechnology defines life through energy. Anything which keeps the body vibrating strongly – in tune with time and space will be beneficial. The carer should be confident, calmly responsive to the patient’s mood and condition. Life has an affinity to an infinite variety of electromagnetic waves. It is the lack of nutriments, light and air which results in energy loss. The physics of light colour and sound plays an essential part in life. It would seem clear from those who have been close to those dying a last minute effort is made by the body that is all consuming… this effort leads to a great tiredness that cannot be fought. Holding hands with a loved one, being stroked, kept warm and comfortable as life continues outside the open window… listening to gentle music, are all comforting. The carer may describe the day the music or what is happening outside in gentle tones… a prayer maybe said. As responses fall away a transition occurs which reduces energy, the person passes to peace and well-being, when the soul (a person’s being) is finally freed - given up.--78.147.159.202 (discuss) 12:47, 3 April 2014 (UTC)

Self help towards better aging[edit]

There are over fifty-three million people in England - life expectancy is about eighty; one per-cent of the population has a chance of reaching ninety, nearly a third of those will suffer from dementia. It is expected that, as early testing takes hold (Doctors have this as a new goal), the figures for those with dementia will rise and dementia to be shown developing earlier than previously thought. Dementia is caused by poor blood circulation, an accident to the head, a stroke, or fatty deposits in the blood - all can fluctuate, eventually to restrict blood flow - to block nutriments and oxygen feeding the brain. There is a relationship between the mind - the way you experience conscience thought, and brain to form judgments. The brain’s cells and neuron connections cause the body to react. Dementia sufferers have short term memory loss caused by these neuron connectors and cells becoming blocked. Some loss of both prevents: completing a sentence, making projections, forming judgments and coherent thoughts, giving focus, allowing perceptive thought – all necessary abilities for daily living. Long-term (varies from patient to patient – within perhaps three years from diagnosis) patients: cannot dress, need toilet supervision are incontinent, nervous, suffer from extremes of unhappiness, become agitated, over tired, conscience about security and worried about time keeping. Mental processes can be viewed as physical processes in the nervous system. Any blockage in the arteries has a detrimental affect. It is believed that eventually science will identify what the mind is and how it affects the body. There are touchable stimulations outside the body: minerals, flora, and fauna, also untouchable: gravity, light, solar and space, that cause the mind and body to react. These and other stimulations go towards building full human potential. Our minds’ move us from place to place… one thought leads to another and the brain’s assimilations change and adapt those thoughts… they are then recorded and stored, ready to alter future thinking. In dementia sufferers these processes all slowly fade away. To help ourselves fend off dementia we need to consider the following especially those who have a propensity to gain weight, have heart or lung problems, high cholesterol levels, incidences of dementia in the family or suffer from stress. All need to take regular exercise, improve sleep patterns, even if problems are related to genetic faults. Exercise improves heart and lung function which helps transport nutriments and oxygen to the brain. It is the build up of damaging free radicals which oxidize – which develop arterial plaques. Healthy aging can be facilitated. The object is to develop good habits. Doing things together, in a group, spurs people on: reading, playing, gardening, yoga, talking, viewing… promotes social interaction. Physical activity has many benefits including inducing Brain Derived Neurotrophic Factor (BDNF) a secreted protein encoded by the gene – a growth factor found in the brain and its periphery. Take in the sunshine and synthesize vitamin D, help lower your blood pressure. Take on new resolutions before the next year. Get to bed earlier, get in your eight hours by taking a good book, switch off your phone and computers, and listen to your favorite music. Change your diet, eat less meat and eat more vegetables and fruits, reduce your coffee intake, drink less alcohol, consider intermittent fasting and calorific restriction to induce the production of brain derived Neurotrophic factor. Keep an eye on what prescription drugs you are taking. If you are having treatment for diabetes, rheumatoid arthritis, or for poor thyroid function, check with your doctor. It is believed that high Homocysteine levels in the blood plasma cause cell damage – a key predictor of potential health – a low level risk factor for dementia sufferers, can be affected. This naturally occurring amino acid is part of the body’s process, must be balanced, and is highly dependant on vitamin derived cofactors, and deficiencies in vitamin B12, folic acid, zinc, B6, B2 and trimethylglcine. There are cognitive tests and training courses (Cognitive Gaming Platforms) set up on the web that can improve cognitive Aging. If you are going to watch the television make sure it’s a happy jolly program for laughing activates your brain. Leave aside violence, stressful and fearful encounters. Social interaction often assists relaxation, reduces stress, and forms new relationships all good social goals. Those who feel able can volunteer: to give help and purpose, encouragement and pleasure to others, and can satisfy a personal need as well as the need in others, start social networking you’ll feel so much better and may introduce you to a new language or taking up a musical instrument. Look at the letter page of your local newspaper and form an answer, even if you do not send it - the intent alone creates interest and association.--Terence Kearey (discusscontribs) 11:50, 1 September 2014 (UTC) The plight of a dementia carer.

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The plight of dementia carers[edit]

If you had said to me five years ago that I would be writing this I would have laughed you out of court, literally! But then: I was an ignorant, innocent, without a care in the world, busily writing and painting my next picture, planning my holiday trip – to sweep down the slopes of Zell-am-see… wondering if my boots would last anther season debating to myself whether I could keep up with the Germans in the top class? My wife concerned about her health lined up another day’s vitamin pills to beat Old Father Time whilst declaring to all and sundry her pills would be her salvation; if she didn’t have them with her in her coffin with her then it would be her duster… if the volume of pills were to be her judge they would win by a whisker. Being younger and brighter than I she planned for all eventualities particularly a long-life. At one stage in her career she had been referred to as ‘Super Woman’ by the Daily Mail’s Financial Editor, and lauded by her peers. It was twelve years ago when we bought our spanking new car ‘for our future’. We had expectations of balmy summer days spent visiting National Trust, houses and gardens, picnicking off the rear let-down space with chairs and table carefully tucked away - secured in their restraining straps. After paying over our hard earned money - to afford the latest and probable last vehicle we were to own, we gazed in awe at this superb conveyance. Now we were one of the retired hoards about to have a final fling together in comfort and style… gone were worries and concerns… we, like Kenneth Grahame’s Mr. Toad, were for the open road… However, it was not to be…: why was it so impossible for her to let go of a habit of a lifetime? She put down her pen filing the last client’s particulars. The back and stomach aches, that seemed to come from an old operation, continually nag her. Visiting the doctor became a monthly event then weekly - I began to loose count, this was becoming no flight of fancy but a worrying necessity. Her NH doctor gave up the unequal struggle - suggested a new surgery closer to home - the last consultant had, after another round of x-rays, the audacity to laugh…! Did he guess what was wrong? Time did nothing to help relieve the boredom - of not having to achieve goals. Being wanted, admired and made to feel important had been her driving force. Even though now, since retirement, there was time to read, to walk, and take-in the countryside. These past-times were no compensation for a feather-in- the- cap or pat-on-the-back. What price now the inflated bank balance and exciting anticipation of the share market; why did she have to start these recriminations, accusations and doubts? Perhaps taking up petit-point again may help to relieve her aching heart? The new doctor seemed to be able to see the situation clearer. Was he pre-warned - asking penetrating questions about: lifestyle, hobbies, friendships, leisure activities and personal anxieties, probing what was causing her paranoia? He arranged a visit from a healthcare visitor to see the home environment - just to get a feel for the situation. This prompted both a Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) brain scan, and a further home visit by her doctor – psychiatrist, who gave her a series of test combinations including a Mini Mental Status Exam (MMSE) and follow-up interview to complete the test procedure. The complaint was declared to be probably vascular dementia – one of the many brain disorders along with Alzheimer and Parkinson’s. Now at last there was a name for her condition and known future outlined. What on earth was dementia and how could someone so switched on as my wife get it? A period of study took over my life. Gone the writing, the past life of painting, the much enjoyed delving into history, now I had to learn to save my soul and help my wife. Thank goodness I was computer literate I could delve into and consult the latest medical discoveries and find out how others in my position were coping. Whilst I was doing this I was forced to take notice of my wife’s odd behaviour in the home and community! It was brought home to me very quickly how local people judge others - who are in distress. I was hugged and vilified, befriended and distrusted. There was no way I could educate those around me of my true feelings and what I was putting up with, I just had to get on with it. Fortunately my wife could rationally take in that her care was going to be of paramount importance. Thankfully I had been the person who stayed at home shopping, cooking and looking after the home - this home building was second nature. Maintaining the fabric of the home, planning extension and executing them had been a personal past-time over thirty years. I had the tools and the expertise. We decided early on to think about how my wife wanted to live her life. In cases where the patient is docile – amenable to taking instructions and easily amused, a series of expeditions - days out, holidays, and local events could be planned. In this instance it was the reverse, her anxieties, worries about security, impatience and confusion heralded each living day and night making everything stressful. Now what was wanted was a socially secure environment in pleasant comfortable surroundings with twenty-four hour help on hand. Where were we to find this? How much was this going to cost and how was it to be paid for? I had to find out what was available in the area – what was on offer and affordable. It soon became clear that to provide all she wanted would cost a thousand pounds a week. Finding £52, 000.00 every year was going to stretch the budget - we had less than that between us with a mortgage to pay. Obviously the main house would have to be sold and along with that the furniture and the rest of the contents which would not fit into a one bedroomed retirement bungalow, let-out and kept for just such an emergency - then the mortgage paid off. A secure home for dementia patients was finally agreed upon and a series of visits and stay-over’s arranged. It all went amazingly well. The care home was accommodating, the staff pleasant and helpful and the surroundings perfect. What was not expected by me was my wife’s speedy request to become a resident – she was both adamant and happy with her decision, choosing a room and the day to start. The house was put on the market. A value estimated and a completion time span given. I had to plan quickly for if completion was going to be that fast as believed what was I to do with the bulk of the furniture? The children asked what they wanted. Their choice did little to relieve the situation. An auctioneer was chosen and our precious highly polished furniture wrapped and consigned to the removal van. I will never see the likes again, a lifetime’s endeavour, a van of much dusted belongings including some of my paintings trundled out of the gate. At this juncture I thought it sensible to re-read my wife’s Will. What a shock; a closer look revealed everything in the Estate was in her name – in Trust. The more I thought about it the more I resolved to make sure I became in the end sufficiently independent with my own home and my own things about me. The County Council’s loan was to carry the period between selling the house and its completion - having to be paid back when the solicitor received the purchase price. There was no way, at my age, was I going to seek permission from anyone else to plan my salvation. A solicitor was needed, and fast, but would they see my case clearly and be sympathetic to my hopes for the future. Now that my wife was taken care of what would they advise and how long would it take, more importantly, how much would it all cost? --89.243.13.147 (discuss) 11:22, 14 October 2014 (UTC)

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Where there’s a Will[edit]

It is generally only in later life that an effort is made to write a will even though all solicitors point out the pitfalls of not doing so; appointing an attorney comes second - for putting your private life in order, and a guardian for your children a close third. This story gives an instance why it is so important to think carefully about what is yours to pass on, what is not, and why updating a will is so important. I would like to inject a further consideration, why not sit down and make your intentions clear to your nearest and dearest. If you cannot, because it would cause dissention, you know that either your intentions are wrong or you have badly explained your reasoning. In ancient times a person’s possessions were simply distributed to the family. Later the Greeks stipulated that a man’s belongings be given to whomsoever the possessor pleased given certain class conditions like citizenship. However, the Romans granted both, wanting to protect the family – to keep up family rites whilst ensuring that heirs and descendants had secured for them a legal minimum; the will, they asserted, having to be signed by the testator (person leaving a will) who lists the assets as an important addition. In Justinian times the family gave way to an heir liable for the debts arising from a list of assets, and by the time Augustus took office the will became operative from the time of making - not waiting for death. Constantine’s Christian England charged all lands and goods to a male heir although some rights of the wife and children could be recognized. This continued until the dissolution of the monasteries when all land could be owned absolutely and inherited, if given by will in writing - signed before a number of witnesses. In the middle of the eighteenth century there had to be a reliability of witnesses as long as they didn’t receive any gift. Any change in disposition of land, after the time of making the will, required a new one to be made. Regarding everything else, other than land, a man couldn’t dispose of personal property without considering his wife and children; in the case of a wife she got half, if there were children as well they all only received one third. The Wills Act of 1837, set out much of what we understand today. Gradually precedents gave direction - shaped decisions for the court. Rules of interpretation are many. Changes in circumstances such as divorce, marriage, children, and influx of new capital etc., require a carefully worded codicil or a new will. In the event of questioned mental capacity the existing will stands resolute. If there is an illegal entry, or other such bad entry, that doesn’t condemn the whole the good entries hold true. When the will is read it is important that any error be quickly recognized and noted for the sale of land, property and goods can go ahead before correct ownership revealed and respected. Over fifty percent of all those who die don’t leave behind a will nor appoint an attorney - to ensure their wishes properly taken care of. There should be four important considerations uppermost in a married couples mind: talking together about their hopes and fears (see: Cultural Shifts in England/Marriage), making their wills, both having their own attorneys, and providing a guardian for their children – all these should be put into place before some dreadful accident or failing mental health. Consider the following: A couple marry - the second time around for both - each having their own children. He retained custody of his under age children, she having lost custody of hers (now looked after by her ex-husband), moved into his furnished house taking over the household tasks whilst keeping up with her freelance work. After twenty years of happily married life the husband makes a will leaving everything in Trust for his children; itemizing every single item in the house - for insurance (replacement value) purposes. In the will (on first death) - the husband’s death, he passes his Estate onto his wife. Investing in a Portfolio Bond, written up in joint names, he provide his wife with a means to maintain her life-style and something to upkeep the Estate - to maintain its value. On last death (the eventual death of his wife), the Estate passes back to his children. If the wife wishes to make a major change she has to seek permission from the Trustees, their task being to administer the property as set out in the deed, his Executors appointed to execute his will. The family solicitor advised the wife to have an independent lawyer look at the husband’s will. The wife, respecting her husband’s financial and legal expertise, whilst sharing the same family solicitor, thought her interests would be attended to - refrained from questioning the will. On the face of it this will, as written by the family solicitor, covers the husband’s desire to look after his children and his wife. Unfortunately the will, upon his death, limits the wife from building up her own Estate and restricts certain freedoms. The husband, being prone to a heart condition, had a series of mini-strokes which may have caused vascular dementia. After diagnosis he immediately asked his wife to be his attorney for both finance and welfare. Social Services advised employing a solicitor to put into place Lasting Power of Attorney (LPA). Wanting to change his will, to include some missed out property, the husband found his mental incapacity preventing his solicitor from considering him fit - his existing will had to remain in place. The wife then interviewed by Social Services, who guided her through the likely course of her husband’s illness, including the difficulties she would experience when continuous care or confined care was going to be necessary. She asked whether dementia could result in her husband’s earlier death. She was told it was possible. Her adviser told her she should visit local care homes to see what was on offer and to ask what the costs were likely to be. By this time her husband was wandering, unable to rest or sit still, remaining awake at night - being plagued by anxieties. He started to accuse her of unfaithfulness and abuse her. Her delving into the availability of a residential home and their costs jolted her. A bill of a thousand pounds a week = fifty-two thousand pounds a year, would soon clear out both their savings, what then? The wife tried to remain apart from his terrifying accusations now knowing his illness would need confined care in a residential home where he felt happy'. The wife then began to visualize how her future life could be, if she did not plan ahead… made a point of visiting all the local care homes - to get a feeling what was in store for her husband and to give him a chance to become acclimatized to a new, safer future. There was a fine choice but one home in particular stood out and a day’s visit arranged. After an interview with the person in charge a one day’s visit succeeded to two - which progressed to weekend stays. These trials proved that here was a solution. Would he be happy as a permanent resident? She could see he looked forward to these secure, social surroundings, appreciating the outings and various entertainment schemes promoting group interaction. With this he certainly looked happier. After a period of time he declared that he wished to become a permanent resident. Within the month he became a resident. She now began to seriously consider herself. How was she going to cope with the bills, maintain the home – be on her own after sharing all her past life; what would happen if she wanted in later life to: share her home, rent part out, seek equity release, find a companion, perhaps remarry, move home against the trustees or executors advice, provide for her own care or leave something to her own children etc.? Having made a vow, ‘through sickness and in health’, was stricken by guilt. Her mind went round in circles, there were so many permutations. She hurried to her solicitor... In hushed, formal surroundings, she told her distressing story emphasizing how she wanted to be able to plan her own life now he no longer needed her. Her solicitor considered ‘a statuary will change’ on the understanding the husband, “lacked knowledge or approval of the contents of the will”. However, wiser expertise was sought from counsel who recommended either a straight forward divorce or judicial separation, both would result in Ancillary Relief splitting the estate. Judicial separation sounded morally easier to consider for it was difficult to divorce a loved husband who now needed specialized care. After facing questions from the other side, and from the court, she changed her plea to divorce to make the case simpler. The court asked the wife to discharge her Lasting Power of Attorney (LPA) giving the reason that it would be ‘a conflict of interest’. A litigation friend was sought from the family who elected the second attorney to replace the wife, who stepped down. The petition signed by the petitioner (the wife) sent to the court, and offered to the respondent (litigation friend standing in for the husband) was not contested. Filling in Form E - outlining financial particulars was requested by the court from both sides… to be returned to the court and exchanged between the petitioner and respondent to help form an agreement. During Financial Dispute Resolution hearings further resolutions were agreed and an application for nisi lodged which was later accepted. After a series of court meetings, both sides negotiated a draft agreement. A Final Dispute Resolution hearing was ordered by the judge during which both sides were asked to negotiate and refine the issues - after the petitioner had answered a questionnaire. Each party was asked to file and serve a position statement setting out the final order they seek and an analysis of other matters. Quickly an agreement was hammered out resulting in the wife being awarded the small cottage with a sum of money for maintenance. Conclusion: The husband had not kept his will up-to-date, nor had he considered he might suffer from dementia that would stop him updating it. Including his wife’s personal possessions in his list of contents was an unfortunate action. The husband and wife should have discussed how their wills worded: to allow them each to share the estate to celebrate their long and happy marriage and for both to to mention their own children. There should have been a consideration for the last survivor – to be able live in a furnished home, with enough capital to look after themselves and their property.--89.243.13.147 (discuss) 11:41, 14 October 2014 (UTC)

Acknowledgements[edit]

Dementia: Alzheimer’s and other Dementias at your fingertips (paperback) By Harry Cayton, Nori Graham, James Warner. Class Publishing: 3rd Edition. Hodkinson, H M (1972) “Evaluation of a mental test score for assessment of mental impairment in the elderly.” Office for National Statistics: Population Estimates. Revised 2002 – 2008 – 2010. Functional Evaluation, The Barthel Index. Florence I Mahoney MD and Dorothea W Barthel BA PT. Maryland State medical Journal 1965. The Dementia Centre provided by Personal Services Society UK. The Dementia Services Development Centre, University of Sterling. Alzheimer’s Society information UK – Progression of dementia. Baddeley A D (1986) Working Memory; Oxford University Press. The Structure and Functions of Blood – Vascular System <ivy-rose.co.uk> The Soul Midwives by Felicity Warner, pub. by Hay House 2013. Food for the brain, Alzheimer's report 2012.