James Ashwell reveals why cultural and generational differences have made racism a 'ticking time bomb' in dementia care.

We live in a multi-cultural society where racism, quite rightly, is a dirty word, and racist remarks are thankfully no longer tolerated. For younger people this is a clear and simple message, one we've grown up with and find very easy to accept. I grew up in London, where most of my friendship group was made up of people of different races and nationalities and it was just a normal part of life. For older people who may have grown up in a world which was far less tolerant, including my parents who grew up in rural Birmingham, the message is one that had to be learnt later in life.

So what happens when those older people – the vast majority of whom have learnt to embrace cultural diversity – are diagnosed with dementia and start to lose social awareness? Add to this the tendency to live more vividly in the past, forgetting perhaps the cultural norms of the present, and it's quite possible they will start to make remarks which, in 2016, have the potential to cause deep offence and even outrage.

Of course dementia causes people to say embarrassing things; they no longer ‘self-edit' or consider the consequences of a comment before blurting it out – and it's not their fault. Families and loved ones quickly grow accustomed to this and learn to cope. However, racist comments are more difficult to simply ignore, brush off with a bit of humour – or forget. It's no wonder then that family carers become incredibly stressed about what the person with dementia 'might say' and to whom. In fact, it can become a ticking time bomb.

'Mum had a lovely team of carers but she kept saying that she didn't like the black woman with the fat bum, it was so awful,' says Alice. 'Mum had always been such a kind, considerate person and the carer herself took it on the chin but I was horrified and so worried about what she might say next. Besides, it was upsetting to hear her being so rude and – well – racist.’

Let's also remember that many professional carers – who do an incredibly tough, low-paid job – are not British nationals. Rightly or wrongly this can cause practical problems for some elderly people, whether they have dementia or not.

Kate found herself frustrated when trying to find a suitable care home for her father. ‘We found a lovely care home, but most of the carers didn’t speak English as their first language,’ she says. ‘Dad, who’s 92, was confused enough without having to deal with accents he just couldn’t understand, so eventually we had to turn it down.’ Kate admits she was too embarrassed to be honest with care home staff about this, worrying that if she did she might also be considered racist.

Of course some people with dementia may well be racist – we can't blame everything on dementia – but I'd hazard a guess that many aren't, so it's important that we all try to recognise the difference, and accept that whilst racist remarks may happen, they don't necessarily mean that the person with dementia is a racist.

Perhaps what matters most is how we, as a multi-cultural generation, learn to deal with these undoubtedly difficult and potentially divisive by-products of dementia. Silently squirming or seething when a person with dementia makes a derogatory racist comment won't change anything, but an honest and open debate just might. It could also stop everyone from feeling awkward by exposing another one of dementia’s dirty secrets.