Cities without memory
The medical term “dementia” refers to a complex variety of common cognitive disorders.
More than a hundred different types of diseases fall into this category, which counted almost 50 million patients in 2017, according to the estimates of the Alzheimer's Disease International (the international federation of associations for Alzheimer all over the world).
These diseases cause more or less severe deficits of cerebral functions such as thought, orientation, memory, and language, mostly affecting individuals aged above 65 who already present other pathologies such as diabetes and hypertension.
In this broad spectrum of diseases, Alzheimer is definitely the most known: a complex pathology for patients, but also for those who take care of them.
In the first phases of the disease, most individuals can remain home with the aid of their family, friends, or domestic care services. This, however, often becomes impossible as Alzheimer progresses.
Alzheimer’s patients (and their families) watch the rapid worsening of those cognitive abilities and competences needed to carry out the most elementary daily activities. There is more to it than the loss of memory: eating, washing, walking, and communicating are normal habits that can swiftly become unfeasible without the help of a caregiver. Often, the inability of carrying out such basic tasks brings about nervous states, anxiety, and aggression as a reaction to the psychological distress of the loss of autonomy. It is very complicated to manage the situation at home without a specific training and with one’s own personal life. For this reason, people suffering from the disease are admitted, often ahead of time, to nursing homes or geriatric hospitals with professionals who can take care of them daily.
The problem, however, is that Alzheimer’s patients admitted to these facilities do not always need hospitalisation; often, they still possess residual abilities that could be maintained.
OECD has emphasised how "the vast majority of long-term care facilities remain poorly designed for people with dementia". According to the Parisian group, staff are poorly trained and cannot handle such a complex pathology. This can lead to an excessive recourse to antipsychotic medications to treat behavioural and psychological symptoms of dementia.
Moreover, most care facilities resemble the architectural design of hospitals, and not a place where it is possible to spend the rest of one’s life peacefully. Sometimes patients’ potentialities fade away in nursing homes, especially those individuals who are losing their memory, recollections, affections.
In an attempt to oppose this fate, “villages” were founded to offer a better hospitality in a friendlier environment to the growing number of patients with Alzheimer and dementia.
Built exactly like small towns, Alzheimer villages are very different from traditional care facilities. Restaurants, bars, hairdressers, and other echoes of neighbourhood and city life can be found inside these villages. The idea at the basis is to soften the transition from the patients’ past life, thanks to a familiar and inclusive architecture that goes beyond its guests’ abilities and disabilities. Nurses and professionals (providing 24/7 assistance) do not wear white coats but normal clothing, making them characters in a setting or background actors on a film set – but with a specific training to respond to the symptoms and challenges of the illness.
To preserve their guests’ autonomy, Alzheimer villages focus on the specific needs and problems of dementia; women and men are welcomed into a safe and attentive therapeutic community, in a recognisable and healthy environment where they can feel at home.
Specialised design and architectural studios are behind the planning of these spaces. They base their work on a deep understanding of the needs and behaviours of the users, which are then translated into spatial functions and relations. Indeed, in the field of healthcare planning the nature of a building is pivotal to infuse familiarity into the patients and create a peaceful atmosphere inside nursing homes.
Villages carry these principles to extremes, because they must not be identified by patients as care facilities, but rather as an actual community: a small-scale reproduction of daily life, where patients can maintain their past habits in the present of the illness.
The first Alzheimer village was founded in Weesp, near Amsterdam.
Before its transformation, the “De Hogewyek” centre was a traditional nursing home. In 1993, the managers of the structure started to introduce some changes – a kitchen, communal spaces. Sixteen years later, in 2009, the centre was redesigned in its entirety with semi-detached housing units and provided with the services of a small village. The founders had asked themselves a simple question over time: "What is important in this phase of life? Being seated all day waiting for a doctor or doing the things you like?”. The answer was pretty obvious.
Today, “De Hogewyek” counts 27 housing spaces (based on seven different Dutch lifestyles) and a square, a supermarket, a hairdresser, a theatre, a bar, and a restaurant.
The over 150 residents choose their own daily schedule for meals and activities. The shopping is done at the village’s supermarket and meals are prepared together in each house. Alternatively, residents can choose to dine at the village’s restaurant, perhaps with their loved ones who are visiting. To encourage interactions, patients are allocated the different housing units according to their background and shared interests, in order to enhance the socialising moments.
Guests cannot leave the village alone, obviously. Unlike traditional care facilities, however, there are no concealed exits, dead ends, or locked doors that can confuse and frustrate individuals affected by dementia (except for the village’s main entrance). Safe and circular paths are lit by night, and so are the seating areas, water games, and gardens, which encourage residents to be active and to spend their time outdoors surrounded by nature.
Be it a coffee at the bar, some chats in one of the structure’s squares, or a walk through the village streets, the guests spend their day in complete freedom, followed by the attentive eye of the “plain-clothes” staff. This model has worked for eleven years. As a result, it is increasingly spreading across Europe
In Dax, a small town of 20.000 inhabitants in South-West France, these is a centre of excellence based on the same concept. The structure, inspired by the local architectural style, counts 16 houses for 120 patients and hosts a series of activities around a big central square. The main building, called the Bastide, is the hub of the structure with offices, medical practices, but also provisional housing for the guests’ families. Other facilities include a pharmacy, a restaurant, an auditorium, a multimedia library, a gym, a hairdresser, and a supermarket. All around, there is a big park with a shared kitchen garden and a small farm with animals for pet-therapy.
Two villages exist in Italy: “Il paese ritrovato” in Monza and “Villaggio Emanuele” in Rome. Both follow the structure of other European villages with bars, kitchen gardens, cinemas, a hairdresser, a few shops, and a lot of green. They resemble two real-life villages, where patients can move safely and comfortably with the aid of nursing and medical staff.
“Il paese ritrovato” extends on an area of 13.500 sqm and cost almost 10 million euros, raised thanks to private donations from wealthy families and organisations. The village is highly technological: the 8 flats (each of 420 square meters) are provided with small computers that control heating and lights; TVs have cameras that can monitor the residents’ feelings and that will soon be transmitting video messages from their relatives; several courtesy lights are positioned on the floor to ease orientation at night; movements are monitored through multifunctional electronic tags, which allow guests to pay and open doors.
In the Italian village, some benefits have already been measured scientifically.
Together with broad-spectrum results such as the increase in physical activity and the reduction of drugs and of episodes of aggression, other positive numbers have resulted from a closer monitoring.
Active time, for instance, measured through ISE (Index of Social Engagement), has increased from 4,19 to 4,65. Mood and socialisation have improved as well according to the Cornell Scale. The analysis of the NPI scale (Neuropsychiatric Inventory), which evaluates behaviour disorders, has recorded an improvement of behavioural dynamics, and thus the average value has changed from 19,2 to 13,8.
Even though initial data are promising, some criticise the fiction of Alzheimer villages, and several newspapers compared them to the movie “The Truman Show”.
The substantial difference is that relationships are authentic inside the villages. The same can be said for the various elements of the structure, which are carefully planned not to deceive guests, but to help them. Instead of expecting people with dementia to adapt to the surrounding world, in the villages it is the physical and social environment that adapts to their needs.
The betterment of the quality of life of people affected by dementia demands multidimensional changes in the philosophy of residential care and in the provision of healthcare itself.
Inside these villages, those suffering from cognitive disorders can rediscover the social and communal dignity usually denied by the disease and its stigma. There is no claim to cure the neurological deficit behind this revolutionary method, but only the respect for the person in his/her entirety, personality, and uniqueness; the idea is to keep on giving these people a meaning to their existence, even if they do not have any memory of it.