Today’s blog was written by Krysten Zator, Summer Law Student

According to the Alzheimer Society of Canada, 564,000 Canadians live with dementia, a number which is expected to rise to almost 1 million by the year 2031.[1] Globally, about 50 million individuals live with dementia, a number which is expected to triple by 2050.[2] There is no cure for the disease.[3] The World Health Organization (WHO) recently recognized dementia as a public health priority.[4] In keeping with this, the WHO released guidelines this week on how individuals can decrease their risk of developing dementia through practicing a healthy lifestyle.[5]

Individuals with more severe dementia likely need help with day to day tasks due to the behavioural and cognitive problems associated with the disease.[6] Understandably then, a substantial portion of individuals in Canada with dementia live in long-term care facilities or are cared for in hospitals.[7] In fact, Statistics Canada reported that in 2011 and 2012, almost half of individuals over the age of 45 years in long-term care facilities had been diagnosed with dementia.[8] However, these environments might not be the best place for care. For example,  individuals with dementia may be more likely to be restrained or inappropriately medicated in long-term care relative to other seniors.[9] Their care may also be limited to very little therapy or interaction with others.[10] This may lead to isolation and decreased quality of life. Stigma related to the disease may compound isolation, as others may focus on what the individual cannot do, instead of what they can do.[11]

Fortunately, some care facilities are innovating by instead applying alternative “person-centered” care. This approach focuses both on meeting the emotional and social needs of individuals with dementia as well as on their existing capabilities.[12] A “dementia village” is a unique example of the person-centered approach. As mentioned in Audrey Miller’s post on this blog in 2014,[13] one such village exists in the Netherlands. Here, residents with severe dementia live as freely and naturally as possible in a secure, enclosed community designed around their needs and safety.[14]

The village, De Hogeweyk, is located just outside of Amsterdam.[15] It was opened in 2009 and funded mainly by the Netherlands government.[16] The community is the realized vision of co-founder Yvonne van Amerongen and other staff of the original traditional nursing home that previously sat on the De Hogeweyk site.[17] They aimed to improve resident care after realizing that the existing hospital-like setting added to the confusion of the residents and that residents might better benefit from a home-like setting.[18] The aim was to instead provide a home-like environment where residents could live as ordinarily and freely as possible with others to promote social interaction, independence, fulfilment, and normalcy.[19]

De Hogeweyk achieved this vision by creating a safe community where 152 individuals with severe dementia live as independently as possible in 23 houses of up to 7 residents who have similar lifestyles and interests.[20] By grouping residents together this way, the creators hoped that co-habitating residents would become friends and feel at home in a familiar environment.[21] Each of the seven available “lifestyles” is decorated and designed to reflect the  specific theme. For example, the cozy “homely” environment has a larger kitchen and gardening tools.[22] On the other hand, the “craftsman” house embodies the lifestyle of someone who might have been a shop worker or farmhand, with the residents rising and going to bed early, as they might have in their earlier years.[23] The residents function with the assistance of regularly-clothed staff who are specifically trained to care for them and assist with day to day tasks as needed.[24] Monthly fees, which are several thousand dollars, are largely covered by the government under the national health insurance system.[25]

“That social life is important. It means that you’re part of society, that you belong. And that’s what we people need. Even if you’re living with advanced dementia.” – Yvonne von Amerongen at TEDWomen 2018[26]

The closed grounds contain a fully-functional community including a theatre, grocery store, café, market square, greenery, and general services.[27] Residents can roam freely and interact with others without safety concerns. This is in stark contrast to the reported under 2 minutes of outside time that residents of a typical Dutch nursing home receive.[28] There is no shortage of attention to detail and care in designing the amenities to achieve the project’s goals. De Hogeweyk provides several clubs the residents can join, social events they can attend, as well as a local pub, hair salon, and hardware store on the grounds.[29]  In her TED Talk, van Amerongen paints a picture of normalcy: residents may take walks through the park, resting on benches waiting for a passerby to strike up a conversation, or have dinner with friends over a bottle of wine at the local restaurant.[30] In addition to resident interaction, visitors can come in and enjoy the grounds and facilities,[31] meaning that residents interact with the outside community as well, but within the safety of De Hogeweyk.

Furthermore, the community promotes activities and interventions that have some scientific support for improvement of dementia symptoms and quality of life. For example, the closed community promotes an active lifestyle. A recent meta-analysis concluded that physical exercise may improve cognitive function in those with dementia.[32] The community also employs “reminiscence therapy”, a commonly-used intervention for dementia, which involves using items to prompt memories and conversation about an individual’s past.[33] One recent scientific review of reminiscence therapy and dementia found inconsistent results as to the effectiveness of reminiscence therapy.[34]  However, the researchers did find some small, but positive benefits of reminiscence therapy on cognition, mood, and general functioning, which were more likely to be found in studies conducted in a care facility.[35] Whether these effects are realized at De Hogeweyk is unclear. However, according to Beatrice Godwin, who visited the grounds, residents were calm and content, and the staff reported that residents required less medication.[36]

More information on the De Hogeweyk village can be found on the official website. To view the 2018 TED Talk by Yvonne van Amerongen (co-founder) on De Hogeweyk, please click here. To view a video of CNN’s coverage of De Hogeweyk, please click here.

More locally, a new enclosed community modeled after De Hogeweyk is set to open this coming summer in British Columbia for residents with dementia.[37] Like De Hogeweyk, “The Village” will be composed of distinct homes (six) and also have a community centre composed of various services such as a store, salon, café, and spa. The Village will house 78 residents, who will be cared for by 72 staff members.[38] More information on The Village can be found here.

Dementia villages seem to provide a promising novel approach to dementia treatment by promoting independence and social interaction while keeping residents safe within the village boundaries. As noted by Godwin, research is still needed to determine whether there are clear, direct positive effects of these dementia villages on cognition, behaviour, and quality of life.[39] However, there is some indication that the De Hogeweyk community facilitates activities that improve health and that the resident quality of life is good, at least colloquially, if not scientifically. Hopefully The Village is a sign of new developments to come in person-centred dementia care. In the words of van Amerongen, “it has to do with thinking different, and looking at the person in front of you and looking at what does this person need now… it’s about how you act, and that costs nothing… It’s possible, everywhere.”[40]

[1] Alzheimer Society of Canada, “Dementia numbers in Canada” (2019), online: Alzheimer Society of Canada <alzheimer.ca/en/Home/About-dementia/What-is-dementia/Dementia-numbers> [ASC].

[2] World Health Organization, “Dementia” (14 May 2019), online: World Health Organization <www.who.int/news-room/fact-sheets/detail/dementia>.

[3] Ibid.

[4] Ibid.

[5] World Health Organization, News Release, “Adopting a healthy lifestyle helps reduce the risk of dementia” (14 May 2019), online: World Health Organization <www.who.int/news-room/detail/14-05-2019-adopting-a-healthy-lifestyle-helps-reduce-the-risk-of-dementia>.

[6] Catharine Jenkins & Analisa Smythe, “Reflections on a visit to a dementia care village” (July 2013) 25:6 Nursing Older People 14.

[7] ASC, supra note 1; Suzy L Wong, Heather Gilmour & Pamela L Ramage-Morin, “Alzheimer’s disease and other dementias in Canada” (18 May 2016), online (pdf): Statistics Canada <www150.statcan.gc.ca/n1/pub/82-003-x/2016005/article/14613-eng.htm>; Canadian Institute for Health Information, “Most seniors with dementia in Canada live at home” (2019), online: Canadian Institute for Health Information <www.cihi.ca/en/dementia-in-canada/dementia-across-the-health-system/dementia-in-home-and-community-care>; Canadian Institute for Health Information, “Policy changes and educational supports help spur a decrease in inappropriate use of antipsychotics and restraints” (2019), online: Canadian Institute for Health Information <www.cihi.ca/en/dementia-in-canada/dementia-across-the-health-system/dementia-in-long-term-care> [CIHI].

[8] Wong et al, supra note 7.

[9] CIHI, supra note 7; Jenkins & Smythe, supra note 6.

[10] Jenkins & Smythe, supra note 6.

[11] Nicole L Batsch & Mary S Mittelman, “World Alzheimer Report 2012: Overcoming the stigma of dementia” (2012), online (pdf): Alzheimer’s Disease International <www.alz.co.uk/research/WorldAlzheimerReport2012.pdf>.

[12] Jenkins & Smythe, supra note 6; Alzheimer’s Society, “Person-centred care” (2019), online: Alzheimer’s Society <www.alzheimers.org.uk/about-dementia/treatments/person-centred-care>.

[13] Audrey Miller, “September is World Alzheimer’s Month” (22 September 2014), All About Estates, online (blog): All About Estates <www.allaboutestates.ca/september-is-world-alzheimers-month/>.

[14] See the official “Hogeweyk” site: Hogewey, “Hogeweyk” (2019), online: Hogewey <hogeweyk.dementiavillage.com/en/>.

[15] Josh Planos, “The Dutch Village Where Everyone Has Dementia”, The Atlantic (14 November 2014), online: <www.theatlantic.com/health/archive/2014/11/the-dutch-village-where-everyone-has-dementia/382195/>.

[16] Ibid.

[17] Ibid; TED, “TED Speaker: Yvonne van Amerongen” (2018), online: TED <www.ted.com/speakers/yvonne_van_amerongen_heijer>; TED, “The ‘dementia village’ that’s redefining elder care” (2018), online: TED <www.ted.com/talks/yvonne_van_amerongen_the_dementia_village_that_s_redefining_elder_care/transcript#t-248361> [TED Talk].

[18] TED Talk, supra note 17.

[19] Ibid; Hogewey, supra note 14; Planos, supra note 15.

[20] Hogewey, supra note 14.

[21] Jenkins & Smythe, supra note 6; TED Talk, supra note 17; Staff, “Dementia villages: A new way of caring for the vulnerable old”, The Economist (13 January 2018), online: <www.economist.com/europe/2018/01/13/a-new-way-of-caring-for-the-vulnerable-old> [The Economist].

[22] Jenkins & Smythe, supra note 6.

[23] TED Talk, supra note 17.

[24] Ibid; Hogewey, supra note 14.

[25] The Economist, supra note 21.

[26] TED Talk, supra note 17.

[27] Beatrice Godwin, “Hogewey: A ‘home from home’ in the Netherlands” (May 2015) 23:3 Journal of

Dementia Care 28; Planos, supra note 15.

[28] Planos, supra note 15.

[29] Chris Weller, “Inside the Dutch ‘dementia village’ that offers beer, bingo, and top-notch healthcare”, Business Insider (2 August 2017), online: <www.businessinsider.com/inside-hogewey-dementia-village-2017-7>; Hogewey, supra note 14.

supra note 12.

[30] TED Talk, supra note 17.

[31] Hogewey, supra note 14.

[32] C Groot et al, “The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials” (January 2016) 25 Ageing Research Reviews 13.

[33] B Woods et al, “Reminiscence therapy for dementia” (2005) 2 Cochrane Database of Systematic Reviews, Art No: CD0001120, online (pdf): The Cochrane Collaboration <discovery.ucl.ac.uk/1345239/1/Spector_Woods_et_al-2005-The_Cochrane_Library.pdf>.

[34] B Woods et al, “Reminiscence therapy for dementia” (1 March 2018) 3 Cochrane Database of Systematic Reviews, Art No: CD0001120, online (pdf): The Cochrane Collaboration <www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001120.pub3/epdf/full>.

[35] Ibid.

[36] Godwin, supra note 27.

[37] See “The Village” website, CANBRIT, “The Village”, online: CANBRIT <www.thevillagelangley.com/>.

[38] Kevin Griffin, “Canada’s first ‘dementia village’ is set to open its doors in Langley, B.C. next year”, National Post (28 February 2018), online: <nationalpost.com/news/canada/canadas-first-dementia-village-is-set-to-open-its-doors-in-langley-b-c-next-year>.

[39] Godwin, supra note 27.

[40] TED Talk, supra note 17.