The Economist - USA (2020-08-29)

8 Special reportDementia The EconomistAugust 29th 2020

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mentia (nearly one-fifth of the total) were in residential care. In

Britain around 312,000 are in care homes, a number expected to

rise to 417,000 by 2025 and 667,000 by 2040. So severe is the short-

age of appropriate residential care that, before the covid-19 pan-

demic, a quarter of beds in National Health Service hospitals were

said to be occupied by people with dementia.

Many care homes are gruesome places, in which sedated resi-

dents sit or lie vacantly while overworked staff struggle to fulfil

routines for administering medicine, food and exercise, and a tele-

vision blares in a crowded living room. Efforts are being made to

improve such homes, with more emphasis placed on treating resi-

dents as individuals. “Reminiscence therapy”, in which people are

helped to remember events, people and places through sight,

touch, taste, smell or sound can have remarkable results. Music

seems especially potent. After caring for her mother and writing

her book on dementia, Sally Magnusson

founded a charity called “Playlist for Life”,

devoted to producing musical life-sound-

tracks for people. So dementia care need

not be grim.

In a much-praised example in the Neth-

erlands, Hogeweyk, a “dementia village” in

Weesp near Amsterdam, earlier this year

housed 169 people with advanced dementia

in 27 separate houses in one compound.

Residents choose between four “life-

styles”—traditional, urban, formal and

cosmopolitan—with decor, cuisine and activities adapted accord-

ingly. It has its own grocery shop and a restaurant that is open to

the public. Eloy van Hal, a founder of the centre, describes it as a

shift from a medical and institutional model to a “social-relation-

al, non-institutional” one. It is on the site of a conventional care

home, and no bigger. Operating costs are no higher and can be cov-

ered by the Dutch long-term-care insurance scheme. Mr van Hal

says the aim is that nothing should identify it as a “care home”. But

it still has a flag outside advertising itself as such, and residents

cannot go out at will.

In the Netherlands and elsewhere, much is done to help people

with dementia stay at home for as long as possible. This is what

they and their families often prefer. It also usually costs less than

residential care. The average stay in Hogeweyk is just over two

years, partly thanks to the support available to people in their own

homes until they suffer serious impairment. Yet care at home can

still place strain on caregivers. According to the oecd, the preva-

lence of mental-health problems among carers is 20% higher than

among non-carers. In Japan there has been alarm over a series of

“nursing murders”, in which caregivers have killed their charges.

The stresses of tending for an invalid at home are also cited as a

factor in many suicides.

Some places in Japan are bolstering care at home not just with

visits from professional carers but by making daily life more “de-

mentia-friendly”. According to the government, 12m people across

the country have been given rudimentary training as “dementia

supporters”. In Matsudo, a suburb of Tokyo, the local government

and volunteers organise “dementia cafés”, weekly get-togethers

for those with relatively mild dementia, for whom day-care facil-

ities are not yet suitable. A volunteer at one describes how some

people have been coming for two years and show no obvious signs

of mental deterioration. The municipality is also trying to make

the world outside safer. “Orange Patrols”, groups of five or six

mostly elderly volunteers in hi-vis jackets, keep a lookout for en-

dangered schoolchildren and disoriented old people.

People with dementia are also encouraged to carry a qrcode on

them, perhaps stuck to a walking-stick or hat, or on a lanyard. If

somebody finds them looking lost (and, thanks to a vigorous pub-

lic-information campaign, knows what to do) a smartphone scan

of the code will reveal details about them. Takeuchi Wataro, of

Mapple, a map and guidebook firm that sells codes on stickers at

¥1,800 ($17) for ten, says he was inspired by coming across a con-

fused old man walking blithely across a six-lane highway.

Home improvements

Looking after someone at home may not be possible for 24 hours a

day. In Britain a surge in the number of dementia cases ending up

in hospital seems linked to the closure of day-care centres, which

offered both a social outlet that helps slow cognitive decline, and a

much-needed respite for carers at home. Even better, some places

offer overnight stays when needed.

Another way to keep people at home longer is through technol-

ogy. In some public-housing blocks in Singapore, neighbours or

family members of the vulnerable elderly will be alerted if, say, a

tap in a washbasin has not been used for a while. Researchers at the

ukDementia Research Institute’s Care Research & Technology

Centre, based at Imperial College London, are experimenting with

taking this further. Infra-red and radar sensors installed in the

homes of those with dementia, devices worn by them as watches,

or hearing-aid type brain-scanners can all provide data giving ear-

ly warning of signs of trouble. They might pick up indications of

worsening dementia or a sickness. For example, blood-pressure

and temperature measurements and frequent visits to the lavatory

might indicate a urinary-tract infection (a common reason for

people with dementia to end up in hospital, because they can be

slow to respond to the symptoms).

There are also, inevitably, apps for dementia. “Refresh player”

and “Refresh studio”, from a tech firm called “How do I?” offer “per-

sonalised memory support”, including videos on how to perform

day-to-day tasks, such as run a bath or boil a kettle, which appear

when a smartphone taps a code on a sticker on a once-familiar but

now sometimes baffling object. They can also jog memories with

videos or photos supplied by family and friends. Japan is pioneer-

ing the use of robotics in caring for the elderly. Toys such as Paro, a

furry seal used as a “therapy animal”, and Pepper, a humanoid ro-

bot deployed in hundreds of care homes to play games, talk and

demonstrate exercise moves, can help.

Nobody pretends that these can be a substitute for human

care, especially for the bewildered. But they are at least a partial

answer to the question that will determine the future of demen-

tia care: who is going to do it? There are wonderful examples of

“people-centred” care for dementia sufferers. But most are ex-

tremely labour-intensive (see box on next page). And as the num-

ber of cases rises inexorably, in most countries it will be hard to

As the numbers

with the condi-

tion rise, in most

countries it will

be hard to find

enough carers

Golden oldies

Population aged 65 and over as % of total population

Source:UnitedNations

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0

21009080706050403020102000

Low-income countries

High-income countries Middle-income countries

World

FORECAST