Most of the developed world is faced with difficult decisions on how to care for the rapidly growing population of elderly people who can no longer care for themselves. In my own country, the UK, there are 800,000 dementia sufferers. Globally the figure is 35 million, projected to reach 115 million by 2050.
The most difficult ones to help are those who not only cannot help themselves but, through mental frailty are unable to ask what help they need or do not even know. I recently read in The Times (31 March, 2012, article by David Charter, p.46) of an imaginative new scheme to make the lives of severe dementia sufferers as normal as possible.
Hogeweg is a specially designed village near Amsterdam. It is a community of 152 living in 23 separate houses. To get to the shops, restaurant and hairdressers they have to go through open spaces, exposed to sun, rain and wind, not covered walkways. There is no traffic and although the whole perimeter is secure they can walk around in complete safety without feeling like prisoners, even though it could be argued that in fact they are prisoners. But such people need protection from a world full of hazards as well as to be within reach of medical or psychological help. The ethos is to allow them to live as normal a life as possible.
The design and interior of each house is based on detailed research of Dutch society and is on one of seven themes: Christian, Indonesian, urban, rustic, homely, cultural or upper class. There is an individual room for each person, a large shared sitting/dining room and a kitchen. The 6 residents meet for an evening meal cooked in their own kitchen.
Less medication is needed and residents are in general calmer than their counterparts in conventional nursing homes.
A natural question comes to mind. Is it ethical to deceive the residents into thinking they are free agents in the real world?
As an ordinary Christian layman I see it like this. If you believe in a loving Creator who wants to bring all people of all races, cultures and creeds together in peace and ultimately to eternal life and you want to help God do this your aim must be to serve God by serving his people, as commanded by Jesus Christ. A dementia patient is one of God’s children and one must help that person in any way within your power to feel less frightened, less anxious, more bold, more caring, more aware of God’s holy presence in all of life and death. What is more truthful? The act of loving care that goes into creating a reassuring environment and helping someone feel secure and comfortable inside their ailing mind-body system, someone whose essence is I believe beyond the mind-body system and is learning from the experiences of love and suffering. Or is it pumping them full of drugs and minimising all human contact because it is time consuming and expensive? Which is more true to God? And which causes the greater spiritual growth and learning in the carer?
Hogeweg, which will no doubt further improve with experience, should give carers, visitors, pastors, chaplains, psychologists and counsellors time to interact with the residents in a relaxed way and in a supportive environment.
There may be another strategem to make richer the lives of dementia sufferers: give them as much contact as possible with mainstream society. I know from experience that many older people failing in mind and body get great pleasure from seeing people go about their business the way they once did themselves, and interacting with young people, especially children, and being entertained in simple ways.
How this might be done? I think there is great scope for further innovation here. Here are some examples which come to mind for a place like Hogeweg.
- a cafe in the midst of the development open to the general public and to residents (clients from outside would be issued with a pass on entry for security purposes).
- a theatre for both residents and the public (again, passes would be issued for security).
- arrange with schools, colleges, drama groups, musicians and choirs to perform in the theatre.
- a race-track passing through an area where residents can see the contestants. It could be for people, bikes or horses subject to certain safety precautions.
Such measures would, I believe, enrich the lives of dementia sufferers in their last years while friends and relatives would find their visits more meaningful and enjoyable as they shared experiences with the residents and staff.
See also Reversing dementia in honybees