Denis Eustace is the fifth generation of his family to work in the family business, but while the longevity of family involvement may not be unique, the business pretty much is.
The Eustace family owns the Highfield Healthcare group.
Its business is the care of the elderly and those requiring treatment for mental health. Denis is a consultant psychiatrist, specialising in “later life” care. Since the group was founded in Dublin by his ancestor John Eustace in 1825 there has been at least one psychiatrist in every generation of the family.
For over 30 years, Denis was the clinical director of the group, and today in his 70s he has stepped back, but not too far back.
He doesn’t like using the word tsunami, but he struggles to find another more appropriate in describing the problems with mental health among older people during the pandemic.
“We have seen a tsunami of cases, me and my colleagues, since this began, the kind of people that we might never have seen otherwise,” he says.
This is the hidden fall-out, the quiet suffering that is going on behind closed doors where older people are cocooning or simply isolating themselves to the best of their ability.
“I would not have seen people coming to me much previously with issues like sleep disturbance, but they are terrified of the virus,” he says.
“And then there is the loneliness. I believe that this has been a lost year. As we get that bit older the clock is ticking. Can you imagine an older person and here is a totally wasted year — they couldn’t do anything but stay at home and be minded.
"And older people don’t like to be minded. God knows what is going to happen in 2021.”
Denis’s experience is mirrored in a report out this week that showed one in five adults over 60 reported symptoms of depression since the arrival of Covid 19.
This is twice the level that would be expected in normal times.
The report, the latest publication from the Irish Longitudinal Study on Ageing, states that those most likely to experience depression were older people who lived alone and those with low levels of physical activity.
Denis sees the absence of socialisation as having a particularly serious impact on older people.
“Before they would go down to the local shops, chat in the newsagents, probably driving, go to retirement activities, that sort of thing. Now they have become totally isolated."
The pandemic has also brought to the fore some issues that might otherwise have remained hidden, such as mild cognitive impairment.
“Let’s say you have a couple living at home and the husband, or wife, goes to the GP and says there is something wrong with my wife, or vise versa. Their memory is not as good. Under normal circumstances, the husband might have been out playing golf or whatever and wouldn’t have spotted it.”
While mild cognitive impairment doesn’t necessarily develop into a serious condition, between 10% and 15% go on every year to suffer from dementia.
Those who already have pre-existing conditions are feeling a disproportionate effect from the strictures of the pandemic.
“People with any kind of dementia are deteriorating faster than they would otherwise,” he says.
There is a way back to full health for many older people who are feeling the effects of the pandemic on their mental health, but the psychiatrist worries that the uncertainty that exists about the short-term future is going to weigh heavily.
“I would like to think that when the vaccine settles down older people will return to normal, yes they can be rescued.
“The message is that if a family member has a concern about an older loved one, go to the GP to discuss the case and if necessary it will be passed on.
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“We are doing video conferencing now (for treatment), it’s not the same but the good news is, and without putting myself on a perch, I have managed to turn people around. When they see me they see an older man and they say, well obviously he knows what he’s talking about.”
The Eustace family’s involvement in mental health has tracked the evolution of that branch of medicine.
The family were originally Quakers from Cork and when John Eustace first studied in the area he was a proponent of what was then a new approach, known as “moral treatment”.
“The ethos in the Quaker view for looking after the mentally ill was to have holistic approach,” he says.
During his own time, he has seen a major transformation in the area of mental health, but he has also seen the limits despite the advances of medicine and science in general.
“We had the advent of anti-depressants which date from 1952 and although they were tweaked in the 1980s we are still using the same types of medicine today.
“I’m delighted that I have these tools in pharmacology but obviously empathy, talking therapies, that’s extremely important also.
“As for that lightbulb moment, I think we’re still a long way off.”
:: Denis Eustace is this week’s guest on the Mick Clifford Podcast