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Hi. I'm Doctor Andrew Rochford.
I want to ask you a question: have you ever met someone whose life has been affected by dementia?
The odds are, you have.
There are more than two hundred new cases of dementia diagnosed in Australia every single day.
Right now it's actually the largest cause of disability in people over the age of sixty-five.
These days we're all living longer - which is great news - but an ageing population means we're more and more likely to meet someone with dementia in our daily lives.
Just because the risk of dementia increases with age, it's not a normal part of ageing.
It's a disease.
In fact, younger onset dementia can affect people in their fifties, forties, or even in their thirties.
And this can make it hard to recognise.
When you or I meet someone with an illness or a disability that makes life a challenge for them, we tend to adapt the way we work to try and help them out.
But if it's not obvious that a person has dementia, how are you going to know?
When we talk about dementia we're actually talking about a range of diseases that can affect the brain in different ways.
Some can make it hard for a person to make new memories. Others can make it hard to communicate, and can make even simple situations become confusing and aggravating.
The information in this resource will help you to recognise the signs of dementia. It'll also help you think about how you can minimise the impact of dementia in your own day-to-day life.
Public transport is important to the independence of older people, and to those affected by dementia.
But age is not always a warning sign of dementia - in fact, if you're not looking for them, the signs can be easy to miss.
With an ageing population, it is increasingly likely you'll encounter a passenger with dementia.
It may mean memory loss, physical difficulties or unintended changes in behaviour. It can make instructions hard to follow. Travelling from one place to another can become a challenge. But it's different for everyone - that's why dementia is so confusing.
An understanding of dementia can help you in your work - especially when a passenger's behaviour is unusual.
Listen to the audio version of the transcript (right click & save target as to download)
A bright, sunny day in a tree-lined suburb. As cars whoosh past, an older woman in a hat and scarf steps up to a bus stop and signals for it to stop. In one hand she pulls a shopping basket. Behind her, sitting on a bench, sits a bearded man in a suit and tie holding a bunch of flowers.
The bus pulls to the stop with a squeal, and the woman ambles on board, followed by the man in the suit. She drops her coins as she fumbles to put her ticket in the machine, and the man stoops to pick them up for her. The bus driver leans around to watch, as the machine rejects her ticket, and she turns it around to reinsert it, as the man offers her the coins. She takes them, and backs her way to the seat.
The driver asks "Ticket mate", and the male passenger responds "Oh, sorry." The older woman puts her purse back in her bag as the bus takes off down the road.
A pair of teenage boys sit midway up the bus, sharing their earphones, one of them putting a stick of gum in his mouth. A young woman looks up from her iPad, glancing sidelong at the older woman, who sits grimly with her hands on her shopping basket, the male passenger behind her. The bell sounds, and the "next stop" sign lights up. The driver indicates, brakes, and pushes the door release button. The doors open, and he glances in the mirror. Nobody gets up. He turns over his shoulder, to see the young woman glance around. The teenage boys laugh at each other. The driver turns back and indicates, driving away again. The other teenage boy sticks his gum under his seat. The bell sounds, and the "next stop" sign lights up again. The driver indicates, brakes, and glances in the mirror as the doors open again.
When no one gets up, he looks over his shoulder. The teenage boys stare out the windows. The young woman looks up from her iPad, and over her shoulder. The old woman stares straight at the driver, who asks, "Is this you?"
She shakes her head, and nods subtly over her shoulder at the man in the suit, who stares out the window, distracted. The driver asks, "Is this you mate?" The man looks over slowly, and shakes his head, saying, "No."
The driver turns back, the doors close, and as he drives on he glances in the mirror. The man in the suit pushes the button – to which the young woman reacts sharply, asking, "Hey, are you getting off this time? Are you getting off here?" The man asks back, "Are we nearly there darling?" She scoffs, saying "Don't call me darling," before returning to her iPad, shooting him an annoyed glance.
He lowers his eyes and says "Sorry."
The driver glances in the mirror, watching this. The old woman and the teenage boys stare at the man, and the driver stops the bus, standing to address him. "Are you OK there mate?"
The man nods, saying, "Ah, yes."
The young woman butts in, "He keeps ringing the bell!"
The driver holds up a hand calmly, saying "I know." He turns back to the man, asking, "Where are you getting off?"
The man replies "Not until the city."
The driver says "I'm not going to the city, mate, I'm going by the airport."
The man nods, and says "OK" as the young woman butts in again, saying "You're on the wrong bus!"
The driver holds up a hand, sighing, and says "Thanks." To the man he asks "Have you got somebody that can pick you up?"
The man glances around, uncomfortably, and says "I don't know."
The driver continues, "Maybe a family member can come and get you?"
The man glances around again, saying "I don't know."
Nodding, the driver calmly says "OK, you just sit tight there, alright?" They nod at each other.
The driver sits in his seat again, speaking into his radio as the man sits, uncomfortably. The driver says, "Depot, driver T1. I've got a gentleman who's a bit confused about where he's going."
On the radio, the depot operator responds, "OK T1."
The driver continues, "I'm not too happy about dropping him off at a stop, he seems a bit disoriented?"
The depot operator replies, "OK T1, stand by."
The driver says, "I'm trying to get a contact number from him, for maybe a family member?"
The depot operator says, "OK T1, if you get a number let us know and we'll try and get in contact with someone for you."
The driver says "Thanks," and hangs up the handset, turning back to the man to say, "Just sit tight there, OK mate?"
The man whispers back, "OK." The driver indicates and drives on, as the teenage boys put their earphones back in. The old woman stands, rings the bell, and says to the young woman "This is my stop. I am getting off." As she walks by, the young woman smirks to herself. The bus continues on down the road.
Listen to the audio version of the transcript (right click & save target as to download)
Passengers pour through the ticket gates of a bustling train station. A woman in her forties with a bag over her shoulder walks through a crowd. Nearby, a group of rowdy football fans push through the crowd.
The woman approaches a ticket machine, taps on the screen, and opens her purse. She drops her coins into the machine, and is distracted by the sound of a P.A. announcement. She checks her watch, and hurries away quickly. Behind her, the machine dispenses a ticket.
She walks through the crowd and on to the platform, pushing a button to open the doors before stepping on to a train. Up the platform, the rowdy football fans chant as they pour on to the train.
Inside the train a transit officer leans against the wall, ticket validation machine tucked under his arm. The football fans chant as they move up the aisle, disturbing the passengers – including the woman – before finding a seat up the end of the carriage. The transit officer smirks as he watches them.
The train rolls down the tracks and under a bridge.
The transit officer walks up the aisle to the football fans, asking, "Tickets? Good match?" He checks their tickets in the validator, then moves up the aisle to the woman, asking, "Ticket?"
She glances at him, smiling, shakes her head and says, "No," before looking out the window.
He asks, "You don't have one?" She replies, "I've already got one." The football fans roar suddenly, and the officer glances over at them, gesturing and asking, "Fellas, fellas, can you call half time? I'm trying to talk here." They jeer at him, but quieten down.
He turns back to the woman and asks, "Could you get your ticket out please?" She frowns and asks, "Do I need another one?" He replies, "No, I need to see your ticket." She opens her purse, saying, "I don't need one." He persists, asking, "Do you not have a ticket?" As the football fans grow louder, she pulls out a piece of paper and hands it to him, saying, "There."
The officer turns as one of the football fans pulls his friend's shirt over his head and tackles him. The officer calls out, "Could you keep the tackling down, I'm trying to talk." They quieten again, as the woman hands the paper to the officer and says, "There." He replies, "That's not a ticket." She unfolds it, confused, and says, "Yes." He asks, "Is there a reason you haven't got a ticket?" She shakes her head, worried, and says, "I don't know." He repeats, "You don't know? You're aware there's a fine for travelling without a ticket?" She looks up at him, worried, and reaches into her purse, pulling out the paper again and handing it to him. He says, "Yeah, I know, but that's not a ticket, I don't know what that is. You need to buy a ticket." She asks, worried, "Do I have to get off?" He asks, "Is the next stop your stop?" She shakes her head, confused, then nods. He frowns, "OK, are you travelling on your own today?" She replies, "Yes." He continues, "OK, is someone meeting you when you get off today?" She nods. He says, "OK, who's meeting you?" She answers, uncertainly, "My sister." He asks, "What's her name?" She replies, "Beth." He repeats, "Beth? OK, it's OK, just wait a moment, it's alright." He moves back down the aisle, as she looks in her purse, concerned, and he speaks into his phone, saying, "It's Ted on the south line, look I've got a passenger here without a ticket, but I think there might be more to the story, she's a bit confused, and I'm a bit wary of letting her wander off by herself at the next stop. She says she's meeting her sister, I was wondering if you could put a call out at the station for a Beth, and maybe let the transit officer know? I just want to make sure someone's meeting her. OK, thanks."
As the train pulls up to the station he moves up the aisle, passing the football fans. He says, "Final siren lads," and they roar, standing to get off the train.
Their chants fade as the train waits at the station.
Listen to the audio version of the transcript (right click & save target as to download)
An elderly woman with a walking stick stands outside a building bearing the sign "The Murray Clinic". A white taxi pulls up at the curb beside her. The driver nods as she climbs inside, and asks, "Going to Hillbrook?" She replies, "Yes." He fills in his register and checks his mirrors as he drives off. He pushes the "Fare" button on his taximeter, and drives. The woman asks, "Are you married?" He glances in the mirror, and replies, "I am." She says, "That's nice." He smiles, and says, "Yes." She asks, "Is your wife at home?" He shakes his head, saying, "She's recovering, in the hospital." She looks concerned, saying, "Oh dear." He checks his watch. "I'm supposed to go and see her, bit tight today. Visiting hours are almost over." She says, "Oh dear."
The driver asks, "Are you married?" The passenger stares out the window distractedly, replying, "Yes, are you?" The driver glances over his shoulder, confused, saying, "Yes, I said yes."
The taxi drives up the freeway. The passenger looks concerned. The driver adjusts his mirror. The passenger asks, worried, "Why are you taking the freeway?" The driver asks, "Sorry?" She shakes her head, saying, "You shouldn't be taking the freeway." The driver asks, "Why not?" She says firmly, "Turn around." The driver looks out the window, surprised, explaining, "I can't." She repeats, "Turn around, now, please." The driver points, trying to calm her, saying, "I'll take the next exit." She shakes her head, agitated, insisting, "You're going the wrong way! This isn't the way to my house!" The driver watches her, concerned, in the mirror, and glances at her over his shoulder as she looks around, distressed.
The taxi veers off an exit from the freeway, turning around a roundabout and pulling up outside a house.
The driver says, "And we're here, see?" She looks out the window, blankly, saying, "This isn't my house." He asks, "Where is your house?" She replies, "North Beach." He asks, "Whereabouts in North Beach?" She looks confused, and stammers. He points to her bag, asking, "Do you have it printed somewhere?" She checks in her bag and retrieves her purse, handing it to him. He opens it and glances inside, saying, "This says Hillbrook." She replies, "No." He points into the purse, persisting, "Yeah, this is here. See?" He hands her back the purse and points out the window. She stares, confused, and looks around, worried.
The driver turns, frustrated, as his watch alarm beeps. He turns it off, shaking his head, impatiently. The woman asks, worried, "Where have you taken me?" The driver holds up a hand, calmingly, saying, "It's OK, just give me a moment."
He pushes a button on his console, and a voice speaks over the radio, "Taxi 421, Amil, how can I help?" Amil speaks into the radio, squinting, "Yes I have a passenger here, a bit confused about her destination, there was a booking, but she's not sure where she's supposed to be?" The passenger watches him, concerned. The voice on the radio replies, "OK was this the pickup from North Park?" Amil replies, "Ah, yes, pickup from North Park, ah, I don't think I should leave her here, I can't tell whether she should be here or not." He looks over his shoulder to see the passenger looking worriedly out the window. He nods at her, saying, "It's OK, we'll just figure out where you're supposed to be."
The voice on the radio says, "OK, the contact number is the doctor's surgery." Amil says, "Yes, I think I'll take her back there." The voice on the radio replies, "OK Amil, thank you." He says, "Alright, thank you!"
He checks his watch and pushes a button on it again, turning to address the passenger, "We're going to take you back to the doctor's, OK?" The passenger smiles, and replies, "OK." As Amil starts the engine, she leans forward and says, "I hope your wife's alright." Amil glances at her, surprised, then smiles, and nods.
For people in the early stages of dementia, public transport can be a good alternative to driving.
As the condition progresses, though, it can become more challenging to remember and follow instructions.
A person with dementia may misunderstand the rules of public transport. They may be prone to linger, or to wander, without being aware of the risks to their own safety.
Schedules, fares, and even just the noise of public transport can cause confusion, resulting in anxiety or even embarrassment.
It's important to remember that the behaviour of a person with dementia is not always intentional. But with understanding, you may be able to help.
By the time I finish this sentence, someone else in the world will have been diagnosed with dementia.
That's one every seven seconds.
This means within thirty years there will be more than one hundred million people living on the planet with dementia - more than four times the population of Australia.
So if you don't know someone with dementia yet, you will soon.
Remember: not all forms of dementia are the same.
Some might make it hard for a person to remember something that just happened, even though they can remember things that happened years ago.
But in other forms of dementia, memory loss might be less noticeable than sudden changes in mood, dizziness and unsteadiness, or even hallucinations.
Think about it this way: have you ever had one of those dreams where no one could understand what you were saying, no matter how hard you tried? You wake up, confused, and realise that none of it made any sense - but it felt real to you at the time.
Sometimes that's how a person with dementia feels. Remember, what they're feeling makes sense to them, even if it doesn't to you.
Sounds confusing, doesn't it?
Now consider this person surrounded by noise and distraction: in a shopping centre, for instance, or a busy workplace. That's what I'd call a challenge.
But it's the challenge that a person with dementia faces every day.
So what can you do to make life a little bit more fulfilling?
When you find yourself faced with unusual behaviour - it might be confusion at simple instructions, or repetitive questions - ask yourself the question: could this be dementia?
A person with dementia will find it much easier to understand you if you speak calmly and in short sentences. It helps to maintain a friendly attitude, in your body language and your eye contact.
If possible, you could even help by moving the conversation away from any distractions or loud noises. If a person with dementia is older, maybe you could take them somewhere they can sit down: it can all help to make communication easier - for both you and them.
The main thing is to be patient. We all lead busy lives, and it's not always easy to consider the reasons behind someone's behaviour.
For more about communication, you can go to the "Additional Information" section on this resource.
No matter how independent a person with dementia is, they rely on the care of their friends, families and their communities. Everyone deserves the chance to get the most out of their lives, and with a little effort you can be a big contribution to that.
As the population ages, you're more and more likely to come face to face with dementia. It could be in your work, but it might also be in your everyday life. It might even be a friend or a family member.
If you feel the impact of dementia, how do you want your community to respond?
Understanding dementia won't just help you deal with situations in the workplace - it helps reduce the impact for everyone.
So next time you find yourself faced with unusual behaviour, why not ask yourself: could this be dementia?