Ageing society

Dementia care requires more than a nursing home approach, expert says, as Hong Kong faces rapidly ageing society

Dutch specialist says care centres are ‘dangerous’ and represent the opposite of what dementia patients need, which is to stay physically active

PUBLISHED : Saturday, 05 May, 2018, 4:01pm
UPDATED : Saturday, 05 May, 2018, 10:22pm

The deceptively ordinary Hogeweyk in the Netherlands has broken ground for those living with dementia, drawing praise from many in Hong Kong who hope their family members afflicted with the condition can live with dignity in a place that looks little like a nursing home.

Instead of being told what they cannot do, the residents live a normal life by doing grocery shopping within the village as carers watch over them to ensure their safety.

But in the eyes of Freek Gillissen, a Dutch expert on dementia at the Vrije Universiteit Amsterdam Alzheimer Centre, the concept is now “old-fashioned” as it essentially remains “a big nursing home”.

“It is a village concentrated with people only with dementia,” Gillessen explained during a recent visit to Hong Kong. “The attitude of the nurses did not change, and [they] still work in a white coat.”

Gillissen described the idea of nursing homes as “dangerous”. He claimed they represented the opposite of what society wanted for dementia patients, which is to stay physically active.

Instead, the best practice should allow those afflicted to “stay at home as long as possible” and be looked after by others in the community where everybody is well aware of the disease, he said.

This is precisely the direction the Netherlands is moving towards, and the lessons are growing ever more applicable to Hong Kong.

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The city’s population is rapidly greying, with the number of those aged over 80 peaking after 2050. Of this group, at least a third are expected to suffer dementia, according to official projections.

A Post study earlier found that at least five dementia patients – among 18 who reportedly went missing – were later found dead in 2017, sparking concerns over whether Hong Kong can adequately take care of them.

But Gillissen, a psychiatric nurse, said that was hardly a problem in Amsterdam. In his recollection, the Dutch metropolis only had one incident in which a dementia patient went missing and was later found dead over the past 20 years.

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He attributed Amsterdam’s success not to the rise of technology but to the awareness of its residents.

People are encouraged to immediately notify their neighbours if their family members are diagnosed with dementia, Gillissen said. And the readiness extends far beyond loved ones. For example, staff at the country’s largest supermarket chain, Albert Heijn, are adept at identifying those with dementia.

We all are interested in everything except the other person living next door. And that is a big problem
Freek Gillissen, dementia expert

“When people with dementia come for the tenth time in a day to buy another piece of bread, [staff] would tell her or him: ‘Sorry, but you have already been here’,” he said. “Everybody is trained.”

Efforts have picked up across Dutch society to boost awareness of and sensitivity towards those suffering from dementia-related ailments. Some 200 Alzheimer’s cafes and about 26 odensehuis – community centres for dementia patients, their carers and others to gather freely – now operate in the Netherlands. The cafes serve as a focal point to boost awareness of Alzheimer’s and foster information exchange.

“We give them the place and they organise everything,” Gillissen said. “They have a garden. They have small holidays where people with dementia will travel with five or six people to go outside Amsterdam so that their carers may also have a holiday.”

The expert acknowledged differences existed between Amsterdam and Hong Kong. But he believed the introduction of a case management system, alongside greater social awareness, would help improve the situation.

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Local social workers have been pushing for such a mechanism. They want a dedicated case manager to assess the needs of individual senior citizens on a continuous basis and line up the services they need most, ranging from day care to nursing services.

Raising awareness takes time, Gillissen said, noting it was the one thing “we don’t have in this area”.

“We all are interested in everything except the other person living next door,” he added. “And that is a big problem.”