The Savages
'is it like Alzheimer's?'

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I’ve never been to Buffalo, New York but I’m guessing it’s not as dreary and as bland as it is depicted in the movie, “The Savages”.

The movie revolves around Mr Lenny Savage (Philip Bosco) who has dementia and is moved back to Buffalo to be near his estranged children, Wendy (Laura Linney) and Jon (Philip Seymour Hoffman), when his elderly girlfriend suddenly dies whilst having her nails done in a beauty parlour.

The movie begins with the sound of harps and a troop of older ladies in sparkling blue leotards performing a dance routine (I assume as part of a regular exercise group or similar) under a beautiful blue sky in Sun City, Arizona. This is a plush retirement complex where Lenny is living. He resides with his elderly ‘girlfriend’ who herself is significantly more demented than Lenny and needs the assistance of a ‘home healthcare professional’. The home carer, whose uniform is theatre scrubs, makes it clear he’s there only for the girlfriend and this grates on Lenny. An incident ensues whereby Lenny has failed to flush the toilet and is lambasted by the carer for his forgetfulness. In a fit of pique Lenny is involved in a ‘handling faecal matter’ incident which he uses to write an obscenity on the wall about the carer. This acute episode of BPSD then triggers off calls to Lenny’s children. Soon after, his girlfriend dies and it becomes a social problem as Lenny is taken into hospital.

The son and daughter arrive, carrying the “baggage” of their own respective relationship problems, including the myriad unresolved issues from their relatively loveless and repressed upbringing,. added to which is now the dilemma of having to deal with, and make decisions for, their estranged father. On their arrival at the hospital, their father is lying pitifully on a bed, immobilised by wrist restraints attached to the bedsides (thankfully having an IVI and been catheterised). The nurse explains the restraints are necessary to manage Lenny’s difficult and probably delirious behaviour.

The family meet a physician who fumbles through the possible diagnoses whilst flashing head scans at them. He mentions a possible diagnosis of ‘vascular dementia or multi infarct dementia’ upon which the daughter asks (as often happens in my experience) ‘is it like Alzheimer’s?’ and is relieved when it isn’t (again often the case in my experience. Alzheimer’s is unfortunately misperceived as being a much worse disease). The physician also proposes a diagnosis of Parkinson’s disease. Soon after the son and daughter are seen in a bar reading educative books about dementia and Parkinson’s disease.

Prior to seeing their father in hospital they meet the family of Lenny’s deceased girlfriend where it is made clear that the flat where Lenny and his girlfriend lived, was owned by his girlfriend and is now to be sold. The upshot is that their father is homeless and in hospital.

Predictably there is tension between the son and daughter as to what the best course of action is for their father; the usual tension between trying to keep an older person at home, or considering assisted living (sheltered accommodation) or the inevitable placement in a care home. The son is pragmatic and clearly thinks a care home is the only viable option but the daughter, more guilt-ridden, wants to consider him living independently or in an assisted living environment. Again this reflects a process seen in many families who find themselves in this predicament whereby the needs and wishes of the individual have to be balanced against those of family and friends.

Discussion between the son and daughter leads to the inevitable conclusion that their father needs a ‘facility for older people’ which the son translates bluntly for his sister as ‘it’s a nursing home’. He finds a quaintly named care home in Buffalo called the Valley View Rehabilitation Centre. The father is discharged from hospital with the mandatory poly-pharmacy of several bottles containing tablets (and a pile of incontinence pads), but needs a plane ride to Buffalo with his daughter escorting him. He is unceremoniously put on the plane in the busy middle section. During the flight he suddenly wants to use the toilet and becomes agitated. His daughter struggles to assist him walk to the toilet whereupon his trousers sink to his ankles (the daughter had removed them because they “aged” him). There is poignant shot of him from behind - standing helpless in the aisle with his trousers around his ankles sporting a drooping, presumably sodden incontinence pad.

They arrive late at night and there is a rather funereal drive to the care home which resembles an industrial building and is probably without a valley view! To keep up the small quota of elderly stereotypes in the movie (interestingly seemingly the same the world over) the nurse on his arrival at the care home greets him with ‘…you like bingo, Mr Savage?’ He is shown into his drab soulless shared room with little or no potential for individuality and his privacy guarded only by a wafer-thin curtain around his bed.

The following day the family meet the care home manager where the reality and inevitability of the situation is further highlighted when she asks them to discuss their father’s advance directive for future healthcare and to ask their father about his wishes for his funeral. The son and daughter take their father to a café/diner where these issues are uncomfortably discussed with him and he becomes somewhat distraught.

The daughter still feeling ‘horrible and guilty’ at the Valley View placement, decides to view some promotional videos of plusher care homes and they end up having an ‘interview’ for admission into the Greenhill Manor nursing home (Valley View and Greenhill – contrasting with the tree-themed names of care homes in the UK!). During the interview Lenny undergoes an MMSE and struggles despite the daughter trying to silently mouth him the answers for which she gets berated by the interviewing nurse! This visit heightens the discord between the son and daughter as the son feels he can see beyond the ‘wellness propaganda and landscaping’ which he feels is more to entice the carers and family and covers up the bleak fact that it’s a place for old people to die in. The son and daughter also have a discussion as to who has the more ‘portable life’ to be the main carer for their father.

The son and daughter also attend a dementia support group where the lady leading the session expounds her views of the carer’s bible – ‘eldercare for dummies’ (which actually exists - author Rachelle Zukerman, 2003; and there’s also the book ‘Alzheimer’s for dummies’ which can easily be found on Google).

Towards the end of the movie Lenny begins to fail to recognise his daughter and becomes nicely spatially disorientated, thinking he is in a hotel. The inevitable terminal decline occurs, preceded by the ‘curling toes sign’ (noted by the carer to occur shortly before death), and Lenny dies peacefully (in hospital) attended by his son and daughter. The end of the movie did unfortunately descend into the obligatory uplifting and schmaltzy finale, characteristic of American movies. The daughter rescues her lover’s dog (the lover is one of her father’s carers) that was due to be put down because of arthritic hips and in the last scene we see her jogging along (in the sun for once!) followed by the dog padding along behind her with the use of a wheeled contraption (maybe a doggy zimmerframe!) attached to its hind legs.

The movie has received much critical acclaim, and whilst it is a little one-paced, it has some humorous moments; but creates a sombre and gloomy atmosphere throughout. I’m not sure the Lenny character really conveyed the essence of a dementia patient when compared to the compelling and probably benchmark portrayal of dementia by Dame Judie Dench in ‘Iris’. If anything, the short portrayal in the movie of Lenny’s girlfriend was much more convincing. Equally however, the behavioural problems were not so horrendous as to further propagate the negative stereotype in dementia sufferers.

The strength of the movie was really in following the emotions and dynamics between the son and daughter, rather than the depiction of dementia. Oftentimes the death of an older person can crystallise longstanding rifts and dynamics between family members as they each try to deal with issues in their own individual way. This movie touches upon the issue of the ‘emotional duty’ of estranged families faced with caring for someone they’ve long since ceased to love or respect. I think carers of dementia patients may well identify with the various aspects of the care of a dementia sufferer, and in particular the agonising and emotive issues surrounding that wrenching decision to place someone in care.

A mainstream movie with dementia as a core element has got to be good in raising the overall profile of the disease and all the issues of care it engenders. Encouragingly another current movie, ‘Away From Her’ starring Julie Christie is based on the main character developing Alzheimer’s disease, and is in the running to win various awards.

Martin Curtice
Consultant in old age psychiatry
QEPH
Birmingham

BGS Newsletter, March 2008
Issue 15 ISSN 1748-6343 15