Global Approaches to Dementia Care

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Wednesday, April 3, 2013

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A Place for Mom

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According to a report by Alzheimer’s Disease International (ADI), 35.6 million people worldwide have Alzheimer’s disease. Unless a cure is found, ADI projects this number will increase to 115 million people by the year 2050. As more countries are recognizing Alzheimer’s disease and other dementias as a public health crisis, we looked at how several countries approach dementia care and how they’re preparing for a growing population of people who have age-related cognitive impairment

Seeing Alzheimer’s and Dementia Differently

Sociologist Cathy Greenbiat, who photographed people living with Alzheimer’s in seven different countries and published them in her book, Love, Loss and Laughter: Seeing Alzheimer’s Differently, has an uplifting perspective on dementia care: “Everywhere I went, the same things were important: Music, art, smiles, loving care, [and] a lot of touch.” Cathy’s images capture not only the unique characteristics of Alzheimer’s care in diverse cultures, but also the raw humanity that binds Alzheimer’s caregivers.

United Kingdom: An Empathetic Approach

Dementia Friends is a government funded national initiative run by the British Alzheimer’s Society that aims to educate the public about what it’s like to live with dementia. The Prime Minister admitted that general awareness about Alzheimer’s is “shockingly low,” so according to the organization, “Dementia Friends aims to make everyday life better for people with dementia by changing the way the nation thinks, talks and acts.” Community awareness and education, and then turning this education into action is the overall goal of this Initiative. “We want there to be a million dementia friends by 2015 with the ‘know-how’ to feel understood and included in their community.”

Bristol England’s Grove Care in Winterbourne provides innovative dementia care that takes a “person-centered care with a holistic approach – taking into account a person’s physical and mental health needs as well as respecting and supporting their emotional, spiritual and cultural beliefs.” Reminiscence therapy is built on the idea that people with Alzheimer’s and dementia retain good long term memories, so they will relate strongly to anything that’s evocative of their youth and life decades ago. Grove Care’s “Memory Lane” neighborhood has an old fashion post office, grocer, and pub, with every detail of the 1950s era painstakingly recreated – so much so that it could serve as a set for a British remake Back to the Future.

Belgium: Dementia Friendly Cities

One interesting effort is taking place in the Belgian city of Bruges where a number of measures have been put in place to make the city safe and welcoming for people with dementia. The  BBC reports that Bruges is turning itself into a dementia-friendly city by making citywide changes such as adding special signs to shop windows indicating that they are safe places for people with dementia who are lost or need help (similar to the safe-place signs used for children in some parts of the U.S.). The city also maintains a database of people at risk of wandering so that they can be located quickly should they become lost. The database includes the location of places that registered wanderers used to live and work, as these are often the location they will seek during their confused misadventures.

Netherlands: Cutting Edge Dementia Care Innovators

The Netherlands is specifically focused on progressive dementia treatments, according to their National Dementia Programme. One of the most well-known dementia care communities in the world is located outside of Amsterdam.  The memory care community Hogewey, dubbed “Dementiaville,” has received a lot of international press for designing a community that allows residents to live without locks, with minimal medication, in their own apartments, and doing daily things they love—including shopping, cooking, going to movies and visiting the barber or hairdresser. Basically, the patients are encouraged to do the “same things they loved before their illness took hold.” This dementia community has been part of a 20-year experiment where residents are described as being “happy” and “full of life.” Because of Dementiaville’s success, a much larger version of this community is currently being built in Switzerland and is scheduled to open in 2017. The Independent reports: “To reinforce an atmosphere of normality, the caregivers will dress as gardeners, hairdressers, and shop assistants.”

Japan: Preserving Memory Through Learning Therapy

A low birthrate combined with extraordinary longevity has made Japan one of the oldest countries on Earth. So, naturally, Alzheimer’s and dementia is a major public health concern. One of Japan’s main contributions to memory care is known as “learning therapy”—a deceptively simple dementia therapy created by Ryuta Kawashima. During learning therapy, dementia patients are asked to do simple arithmetic problems as well as read aloud from books and stories each day. Evidence suggests that it can improve that quality of lives and potentially slow cognitive decline. “Learning Therapy” at first glance seems like it could be a lo-fi version of the electronic “brain game” systems, but the element of human-to-human interaction in these therapies is missing from solitary brain-game playing, and could be part of the reason that these trials have shown promise.

China: Memory Care Community Building Boom

China adopted many Western customs during its transition to a more open society and market-oriented economy, including caring for dementia sufferers in therapeutic memory care facilities. For Alzheimer’s and dementia advocates in China, as well as patients themselves, this transformation represented significant progress. Until as recently as the 1990′s, Alzheimer’s and dementia was heavily stigmatized, with sufferers often placed in psychiatric wards. A 2011 New York Times article describes how the recognition that hospitals are not suitable homes for dementia sufferers has led to a building boom in memory care communities. The Times article quoted Zhang Fan, noting that in Shanghai alone they will need 5,000 additional memory care beds a year to meet demand. But contrary to what you’d expect in a “socialist worker’s paradise,” the state does not pay for long-term care in China. The article explains China has “dismantled is old ‘iron rice bowl’ system of cradle-to-grave financial support from the state,” and elderly citizens in China must increasingly rely on their family members to pay for their senior care.

The United States: Improving Quality of Life

The United States government is on a mission to cure Alzheimer’s by 2025. Many memory care communities are focusing on new dementia treatment techniques to improve the quality of life for residents. Technologies such as the iPad offers puzzles to exercise resident’s minds, activities that improve dexterity and even apps that help them remember to take their medicine. Light therapy, music therapy, art therapy and storytelling are also fascinating techniques being used to help soothe and enhance the lives of dementia sufferers.

Memory care providers in the U.S. also emphasize what’s often called “person centered care,” which respects each persons background and individuality. We asked Rita Altman, Vice President of Memory Care and Programming at Sunrise Senior Living (a nationwide assisted living provider) about the challenges of caring for a such a diverse clientele. Altman said it starts with getting to know the resident, “We value all of the information that the resident and their family and friends share with us about [the new resident's] lifestyle and culture.” She explained that Sunrise is prepared to accommodate residents from all backgrounds, “There are many ways that we can accommodate each resident’s needs such as using language cards that enable caregivers to communicate with residents about their activities of daily living. We also encourage family members to bring in photos, tapestries, music, books and other mementos from the resident’s home and design their rooms to look and feel familiar, give them a sense of security and identity by reflecting their culture.”

With baby boomers reaching the age of 65 in record numbers, memory care is the fastest growing segment of senior care in country, with niche communities cropping up around the nation. For example there are even memory communities catering to retired NFL players.

Australia: A Global Leader in Care

A December of 2012 U.S. Senate Special Committee on Aging released a report analyzed how five developed countries are dealing with Alzheimer’s and dementia. Included in the report were the U.S., Australia, Great Britain, Japan and France. The report found seniors with Alzheimer’s and dementia are receiving the most care in Australia, although interestingly, the report also noted that Australia has the lowest incidence of dementia of the five nations analyzed. It could be that a lower incidence of dementia allows caregivers and agencies to concentrate their resources on a smaller group, making efforts more affective and allowing patients to receive more care. Another difference between Australia and the other nations is that, according to the report, “Australia’s federal government has primary responsibility for planning and funding long term care for the aged… Aged care services are finances through taxes.” In most other nations, including the United States, the government’s contribution to long term care for Alzheimer’s patients is more limited.

Australia’s National Quality Dementia Care Initiative specifically focuses on improving the quality of dementia care in Australia by enabling people with dementia and their caregivers to get involved in dementia research and care. In fact, one of the main goals of the initiative is to enable people with dementia and their caregivers to actually set priorities for dementia research and research knowledge translation.

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