阿爾茨海默癥協(xié)會(huì)(Alzheimer’s Association)的數(shù)據(jù)顯示,自新冠疫情開始以來(lái),美國(guó)死于癡呆癥和阿爾茨海默氏癥的人數(shù)增加了16%——這一趨勢(shì)恰好與近期上映的以癡呆癥為主題的大片《困在時(shí)間里的父親》(the Father)和《超新星》(Supernova)相契合。隨著人口老齡化,預(yù)計(jì)在新冠疫情得到控制后的很長(zhǎng)一段時(shí)間內(nèi),這種趨勢(shì)將進(jìn)一步惡化。根據(jù)世界衛(wèi)生組織(World Health Organization)的數(shù)據(jù),2019年至2030年期間,癡呆癥患者的人數(shù)預(yù)計(jì)將增加40%,至約7800萬(wàn)人;同期總花費(fèi)增加近三分之一,至1.7萬(wàn)億美元。
但在法國(guó)達(dá)克斯的一個(gè)小村莊,人們正在努力尋找更好的方法,來(lái)處理日益增加的癡呆癥病例。作為此類最早的研究項(xiàng)目之一,這座小鎮(zhèn)容納了大約110名阿爾茨海默病早期至晚期患者。他們可以自由散步,光臨村里的超市、理發(fā)店、餐廳、咖啡館、圖書館和音樂廳。該項(xiàng)目每天的費(fèi)用為65歐元(約合75美元),目的是讓人們有更多的自主、自由和生活的意義,不至于立馬面臨經(jīng)濟(jì)困難的境地。該實(shí)驗(yàn)的發(fā)言人瑪?shù)贍柕隆た?伯內(nèi)爾說(shuō):“如果項(xiàng)目不是對(duì)每個(gè)人都適用,那么它就不會(huì)起作用。”
村莊
法國(guó)西南部的蘭德斯·阿爾茲海默村(Landes Alzheimer’s Village)是在2020年疫情期間啟動(dòng)的一個(gè)實(shí)驗(yàn)項(xiàng)目。這一實(shí)驗(yàn)的靈感來(lái)自于荷蘭的一家護(hù)理機(jī)構(gòu),實(shí)驗(yàn)的目的則是研究將阿爾茨海默癥患者群體集中在一個(gè)微型村莊是否會(huì)減緩這種終末期疾病的傳播。研究旨在提供更好的臨終護(hù)理,并延長(zhǎng)確診之后的平均預(yù)后(目前為8年左右)。研究將于2025年結(jié)束,中期結(jié)果將于2022年公布。
鄉(xiāng)村生活為患者們提供了一種更放松、壓力更小的生活方式,至少與醫(yī)院以及其他治療機(jī)構(gòu)的阿爾茨海默癥護(hù)理相比,情況確實(shí)如此。患者們?cè)谂c他人交流、洗澡和購(gòu)物方面擁有更多自主權(quán)。“在這個(gè)村子里,我們希望老人們能過一種近乎正常的日常生活,但同時(shí)保證安全。”卡龍-伯內(nèi)爾對(duì)《財(cái)富》雜志表示。美好的環(huán)境是有幫助的。
現(xiàn)年82歲的瑪?shù)铝铡ぐ査_爾德是去年6月首批搬進(jìn)這個(gè)村莊的人之一。她在世界經(jīng)濟(jì)論壇(World Economic Forum)上說(shuō),她喜歡周圍的鄉(xiāng)村和她租住的合租房子。“這就像在家里一樣。”埃爾薩爾德說(shuō),她覺得自己得到了很好的照顧。
這個(gè)實(shí)驗(yàn)?zāi)壳耙呀?jīng)進(jìn)行了一年,病人的行為出現(xiàn)了明顯的變化。卡龍-伯內(nèi)爾指出,村莊從來(lái)訪的家庭成員那里已經(jīng)獲得了更多的積極反饋。此外,內(nèi)部醫(yī)生對(duì)老年癡呆癥晚期患者經(jīng)常出現(xiàn)的焦慮和抑郁等病癥的治療需求,也有了明顯的減少。
允許居民自己去商店和理發(fā)店,讓他們恢復(fù)了獨(dú)立和能力自給自足感。“還給了他們做自己和做其他事情的能力,即使沒有以前那么簡(jiǎn)單有效了。這讓它們重獲新生。”他說(shuō)。
阿爾茲海默村的想法并不新奇,類似的村莊在德國(guó)、加拿大和新西蘭等地也出現(xiàn)過。這個(gè)想法最初是荷蘭的一家專注于癡呆癥的養(yǎng)老院于1992年提出的,并于2009年投入使用。此后,加拿大健康藥品和技術(shù)署(Canadian Agency for Drugs and Technologies in Health)開展的研究發(fā)現(xiàn),來(lái)自荷蘭村莊的新證據(jù)顯示,包含戶外和公共空間的家庭式環(huán)境的創(chuàng)建,有助于癡呆癥患者。雖然一些研究人員對(duì)老年癡呆癥村莊類似“楚門秀”(Truman Show)的本質(zhì)提出了批評(píng),但據(jù)報(bào)道,諸多家庭已經(jīng)看到了這一模式的優(yōu)越性。
《財(cái)富》雜志嘗試聯(lián)系荷蘭霍格韋(Hogewey)醫(yī)療機(jī)構(gòu),但并未收到回復(fù)。
達(dá)克斯的實(shí)驗(yàn)
癡呆癥目前在所有致死疾病中位列第七,也是老年人殘疾、不得不依賴他人生活的主要原因。隨著世界老齡化加劇,病例將會(huì)激增。2000年至2019年期間,心臟病等其他主要致死疾病的死亡人數(shù)下降了7.3%,但與此同時(shí),阿爾茨海默癥的死亡人數(shù)激增了145%。
世衛(wèi)組織的一份報(bào)告顯示,只有很小一部分國(guó)家制定了針對(duì)不斷增長(zhǎng)的癡呆癥患者人口的計(jì)劃。盡管許多計(jì)劃需要大量財(cái)政投資,但很少有國(guó)家采取行動(dòng),以調(diào)動(dòng)和分配資金。
與大多數(shù)健康問題一樣,低收入家庭的老年人更容易罹患這種疾病。癡呆癥的風(fēng)險(xiǎn)因素與貧窮高度相關(guān),包括缺乏運(yùn)動(dòng)、不健康飲食、吸煙和酗酒,以及高血壓、糖尿病和肥胖等。
根據(jù)阿爾茨海默癥協(xié)會(huì)的數(shù)據(jù),隨著年齡的增長(zhǎng),黑人患阿爾茨海默癥的幾率是白人的兩倍。這加劇了美國(guó)貧富差距的情形,因?yàn)檎疹櫚V呆癥患者一生總成本的70%由患者的家人自行承擔(dān),包括自付、長(zhǎng)期護(hù)理費(fèi)用以及無(wú)償護(hù)理。
據(jù)阿爾茨海默癥協(xié)會(huì)估計(jì),在美國(guó),癡呆癥患者一生的護(hù)理費(fèi)用高達(dá)373527美元。相比之下,蘭德斯阿爾茨海默村每年的護(hù)理費(fèi)用為23725歐元(約合27400美元)。目前,蘭德斯阿爾茨海默村每年的運(yùn)營(yíng)成本為670萬(wàn)歐元,其中大約400萬(wàn)歐元由法國(guó)政府補(bǔ)貼。
波爾多人口健康研究中心(Bordeaux Population Health Research Center)研究員伊蓮娜·阿米耶瓦也曾與這一村莊合作。她對(duì)《財(cái)富》雜志表示,“成本問題是關(guān)鍵”。雖然蘭德斯阿爾茨海默村系統(tǒng)的投資和運(yùn)營(yíng)成本可以減少住院、門診咨詢以及癡呆癥藥物處方的數(shù)量,但關(guān)鍵將是如何讓這個(gè)目前得到了大量補(bǔ)貼的系統(tǒng),將來(lái)繼續(xù)在經(jīng)濟(jì)上有價(jià)值。她指出,該項(xiàng)目的全部目的是找出成本效益比為幾何。(財(cái)富中文網(wǎng))
編譯:楊二一
對(duì)年輕人來(lái)說(shuō),新冠疫情導(dǎo)致的封鎖意味著錯(cuò)過畢業(yè)典禮、空無(wú)一人的大學(xué)派對(duì)以及失去意義的度假機(jī)會(huì)。而對(duì)于老年人來(lái)說(shuō),后果則更加嚴(yán)重:身體缺乏活動(dòng)、長(zhǎng)時(shí)間的精神空虛,以及罹患阿爾茨海默癥的威脅增加。
阿爾茨海默癥協(xié)會(huì)(Alzheimer’s Association)的數(shù)據(jù)顯示,自新冠疫情開始以來(lái),美國(guó)死于癡呆癥和阿爾茨海默氏癥的人數(shù)增加了16%——這一趨勢(shì)恰好與近期上映的以癡呆癥為主題的大片《困在時(shí)間里的父親》(the Father)和《超新星》(Supernova)相契合。隨著人口老齡化,預(yù)計(jì)在新冠疫情得到控制后的很長(zhǎng)一段時(shí)間內(nèi),這種趨勢(shì)將進(jìn)一步惡化。根據(jù)世界衛(wèi)生組織(World Health Organization)的數(shù)據(jù),2019年至2030年期間,癡呆癥患者的人數(shù)預(yù)計(jì)將增加40%,至約7800萬(wàn)人;同期總花費(fèi)增加近三分之一,至1.7萬(wàn)億美元。
但在法國(guó)達(dá)克斯的一個(gè)小村莊,人們正在努力尋找更好的方法,來(lái)處理日益增加的癡呆癥病例。作為此類最早的研究項(xiàng)目之一,這座小鎮(zhèn)容納了大約110名阿爾茨海默病早期至晚期患者。他們可以自由散步,光臨村里的超市、理發(fā)店、餐廳、咖啡館、圖書館和音樂廳。該項(xiàng)目每天的費(fèi)用為65歐元(約合75美元),目的是讓人們有更多的自主、自由和生活的意義,不至于立馬面臨經(jīng)濟(jì)困難的境地。該實(shí)驗(yàn)的發(fā)言人瑪?shù)贍柕隆た?伯內(nèi)爾說(shuō):“如果項(xiàng)目不是對(duì)每個(gè)人都適用,那么它就不會(huì)起作用。”
村莊
法國(guó)西南部的蘭德斯·阿爾茲海默村(Landes Alzheimer’s Village)是在2020年疫情期間啟動(dòng)的一個(gè)實(shí)驗(yàn)項(xiàng)目。這一實(shí)驗(yàn)的靈感來(lái)自于荷蘭的一家護(hù)理機(jī)構(gòu),實(shí)驗(yàn)的目的則是研究將阿爾茨海默癥患者群體集中在一個(gè)微型村莊是否會(huì)減緩這種終末期疾病的傳播。研究旨在提供更好的臨終護(hù)理,并延長(zhǎng)確診之后的平均預(yù)后(目前為8年左右)。研究將于2025年結(jié)束,中期結(jié)果將于2022年公布。
鄉(xiāng)村生活為患者們提供了一種更放松、壓力更小的生活方式,至少與醫(yī)院以及其他治療機(jī)構(gòu)的阿爾茨海默癥護(hù)理相比,情況確實(shí)如此。患者們?cè)谂c他人交流、洗澡和購(gòu)物方面擁有更多自主權(quán)。“在這個(gè)村子里,我們希望老人們能過一種近乎正常的日常生活,但同時(shí)保證安全。”卡龍-伯內(nèi)爾對(duì)《財(cái)富》雜志表示。美好的環(huán)境是有幫助的。
現(xiàn)年82歲的瑪?shù)铝铡ぐ査_爾德是去年6月首批搬進(jìn)這個(gè)村莊的人之一。她在世界經(jīng)濟(jì)論壇(World Economic Forum)上說(shuō),她喜歡周圍的鄉(xiāng)村和她租住的合租房子。“這就像在家里一樣。”埃爾薩爾德說(shuō),她覺得自己得到了很好的照顧。
這個(gè)實(shí)驗(yàn)?zāi)壳耙呀?jīng)進(jìn)行了一年,病人的行為出現(xiàn)了明顯的變化。卡龍-伯內(nèi)爾指出,村莊從來(lái)訪的家庭成員那里已經(jīng)獲得了更多的積極反饋。此外,內(nèi)部醫(yī)生對(duì)老年癡呆癥晚期患者經(jīng)常出現(xiàn)的焦慮和抑郁等病癥的治療需求,也有了明顯的減少。
允許居民自己去商店和理發(fā)店,讓他們恢復(fù)了獨(dú)立和能力自給自足感。“還給了他們做自己和做其他事情的能力,即使沒有以前那么簡(jiǎn)單有效了。這讓它們重獲新生。”他說(shuō)。
阿爾茲海默村的想法并不新奇,類似的村莊在德國(guó)、加拿大和新西蘭等地也出現(xiàn)過。這個(gè)想法最初是荷蘭的一家專注于癡呆癥的養(yǎng)老院于1992年提出的,并于2009年投入使用。此后,加拿大健康藥品和技術(shù)署(Canadian Agency for Drugs and Technologies in Health)開展的研究發(fā)現(xiàn),來(lái)自荷蘭村莊的新證據(jù)顯示,包含戶外和公共空間的家庭式環(huán)境的創(chuàng)建,有助于癡呆癥患者。雖然一些研究人員對(duì)老年癡呆癥村莊類似“楚門秀”(Truman Show)的本質(zhì)提出了批評(píng),但據(jù)報(bào)道,諸多家庭已經(jīng)看到了這一模式的優(yōu)越性。
《財(cái)富》雜志嘗試聯(lián)系荷蘭霍格韋(Hogewey)醫(yī)療機(jī)構(gòu),但并未收到回復(fù)。
達(dá)克斯的實(shí)驗(yàn)
癡呆癥目前在所有致死疾病中位列第七,也是老年人殘疾、不得不依賴他人生活的主要原因。隨著世界老齡化加劇,病例將會(huì)激增。2000年至2019年期間,心臟病等其他主要致死疾病的死亡人數(shù)下降了7.3%,但與此同時(shí),阿爾茨海默癥的死亡人數(shù)激增了145%。
世衛(wèi)組織的一份報(bào)告顯示,只有很小一部分國(guó)家制定了針對(duì)不斷增長(zhǎng)的癡呆癥患者人口的計(jì)劃。盡管許多計(jì)劃需要大量財(cái)政投資,但很少有國(guó)家采取行動(dòng),以調(diào)動(dòng)和分配資金。
與大多數(shù)健康問題一樣,低收入家庭的老年人更容易罹患這種疾病。癡呆癥的風(fēng)險(xiǎn)因素與貧窮高度相關(guān),包括缺乏運(yùn)動(dòng)、不健康飲食、吸煙和酗酒,以及高血壓、糖尿病和肥胖等。
根據(jù)阿爾茨海默癥協(xié)會(huì)的數(shù)據(jù),隨著年齡的增長(zhǎng),黑人患阿爾茨海默癥的幾率是白人的兩倍。這加劇了美國(guó)貧富差距的情形,因?yàn)檎疹櫚V呆癥患者一生總成本的70%由患者的家人自行承擔(dān),包括自付、長(zhǎng)期護(hù)理費(fèi)用以及無(wú)償護(hù)理。
據(jù)阿爾茨海默癥協(xié)會(huì)估計(jì),在美國(guó),癡呆癥患者一生的護(hù)理費(fèi)用高達(dá)373527美元。相比之下,蘭德斯阿爾茨海默村每年的護(hù)理費(fèi)用為23725歐元(約合27400美元)。目前,蘭德斯阿爾茨海默村每年的運(yùn)營(yíng)成本為670萬(wàn)歐元,其中大約400萬(wàn)歐元由法國(guó)政府補(bǔ)貼。
波爾多人口健康研究中心(Bordeaux Population Health Research Center)研究員伊蓮娜·阿米耶瓦也曾與這一村莊合作。她對(duì)《財(cái)富》雜志表示,“成本問題是關(guān)鍵”。雖然蘭德斯阿爾茨海默村系統(tǒng)的投資和運(yùn)營(yíng)成本可以減少住院、門診咨詢以及癡呆癥藥物處方的數(shù)量,但關(guān)鍵將是如何讓這個(gè)目前得到了大量補(bǔ)貼的系統(tǒng),將來(lái)繼續(xù)在經(jīng)濟(jì)上有價(jià)值。她指出,該項(xiàng)目的全部目的是找出成本效益比為幾何。(財(cái)富中文網(wǎng))
編譯:楊二一
For young people, COVID lockdowns meant missed graduations, empty college parties, and no much-needed getaways. For the elderly, the consequences were much more pernicious: physical inactivity, long days of mental monotony—and an increased threat of Alzheimer’s disease.
Deaths from dementia and Alzheimer’s in the U.S. increased by 16% since the start of pandemic, according to the Alzheimer’s Association, a trend that happened to coincide with recent blockbuster dementia-themed movies such as The Father and Supernova. That trend is expected to worsen long after COVID is under control as the population ages. The number of people living with dementia is expected to increase by 40% between 2019 and 2030, to around 78 million, according to the World Health Organization, with the overall cost increasing almost a third over the same period, to $1.7 trillion.
But a small village in Dax, France, is working to find a better way to handle the increasing caseload. In one of the first research projects of its kind, the small town houses around 110 people with early- to late-stage Alzheimer’s who are free to roam and visit the village’s supermarket, hairdresser, restaurant, café, library, and music hall. With a daily cost of €65 ($75), the program aims to allow people to exist with greater autonomy, purpose, and freedom without facing immediate financial hardship. “If it is not for everyone, it doesn’t work,” said Mathilde Charon-Burnel, a spokesperson for the experiment.
The village
The Village Landais Alzheimer (Landes Alzheimer’s Village), in southwest France, is an experiment launched in 2020, in the middle of the pandemic. Taking inspiration from a care facility in the Netherlands, the experiment set out to study whether grouping populations of Alzheimer’s patients together in a micro-village would slow the spread of the terminal disease. The study, which concludes in 2025, seeks to provide better end-of-life care and lengthen the average prognosis after a diagnosis, which is currently around eight years. Interim results are set to be published in 2022.
Village life affords the patients a more relaxed, low-stress schedule, at least compared with what is often enforced in Alzheimer’s care in hospitals or other treatment facilities. Patients have more autonomy to interact with others, shower, or shop when they please. “The idea here in the village is to have a nearly normal everyday life, but a safe one,” Charon-Burnel told Fortune. It helps that the surroundings are beautiful.
Madeleine Elissalde, an 82-year-old who was among the first to move into the village in June, told the World Economic Forum she likes the surrounding countryside and the shared house she lives in. “It’s like being at home,” Elissalde said, noting she felt well looked after.
It has been a year since the experiment was first launched, and there are already marked changes in patient behavior. Charon-Burnel notes that so far the village has recorded more positive feedback from visiting family members. And in-house doctors are prescribing less medication to treat disorders such as anxiety and depression that often accompany later-stage Alzheimer’s patients.
Allowing residents to go to the shops and hairdressers on their own restores their sense of independence and self-sufficiency. “It gives them back the ability to be themselves and to do things, even if it’s not as easy or efficient as before. It gives them their life back,” Charon-Burnel said.
The idea of a dementia village isn’t novel, with similar villages cropping up in places like Germany, Canada, and New Zealand. The idea was first conceived at a dementia-focused nursing home in the Netherlands in 1992 and opened in 2009. Since then, studies conducted by the Canadian Agency for Drugs and Technologies in Health, found that based on emerging evidence from the Dutch village, creating homelike environments with access to outdoor and common spaces helped patients with dementia. And while some researchers critique the Truman Show–like nature of Alzheimer’s villages, families are reported to have seen improvements from inhabitants.
Fortune reached out to the Dutch Hogewey care facility and did not receive a response.
A lesson from Dax
Dementia is currently the seventh leading cause of death among all diseases, and it is a major cause of disability and dependency among older people. As the world ages, cases are set to explode. And unlike other major killers like heart disease, deaths from which have decreased by 7.3% between 2000 and 2019, deaths from Alzheimer’s have increased 145%.
Few countries have a plan in place for the growing population of people with dementia, and despite many of these plans requiring big financial investment, few countries are going so far as to mobilize and allocate funding, according to a WHO report.
As is the case for most health problems, lower-income households are more vulnerable to the disease. Risk factors of dementia are all highly correlated with poverty, and include physical inactivity, unhealthy diets, use of tobacco and harmful amounts of alcohol, as well as hypertension, diabetes, and obesity.
According to the Alzheimer’s Association, Black Americans are twice as likely as white Americans to suffer from Alzheimer’s as they grow older. This exacerbates America’s wealth gap, as 70% of the total lifetime cost of caring for someone with dementia lands on the shoulders of their families, via out-of-pocket and long-term-care expenses and unpaid care.
The Alzheimer’s Association estimates the total lifetime cost of care for someone with dementia reaches $373,527 in the U.S. Compare that with the Landes Alzheimer’s Village, which carries a rate of €23,725 ($27,400) a year. About €4 million of the €6.7 million annual cost of running the Landes Alzheimer’s Village is currently subsidized by the French government.
Hélène Amieva, a researcher at the Bordeaux Population Health Research Center who also worked with the Dax village, told Fortune that “the question of cost is central.” While the investment and operating costs at the Landes Alzheimer’s Village system could reduce the amount of hospitalizations, outpatient consultations, and dementia drug prescriptions, the key will be to make the system, now heavily subsidized, economically worthwhile. The whole purpose of the project, she noted, is to find the cost/benefit ratio.