Envisioning tomorrow’s memory lane

People are living longer than ever. During the past half century, life expectancy has risen by 15 years, to an average of 73 years. Couple this with a global population-growth rate of less than 1%, and the percentage of aged people is growing disproportionately. By 2100, a third of all people are projected to be over 60.

A larger aged population requires health and social systems that can handle various challenges, including an increasing number of people with dementia. One in three people over the age of 85 presents with dementia. Hollywood actor Bruce Willis, former First Lady Rosalyn Carter, and Bafana Bafana coach Clive Barker have made headlines of late for being afflicted by the condition.

Dementia is a collective term for loss of memory and cognitive functions severe enough to adversely affect daily life. Up to 80% of dementia is underpinned by Alzheimer’s disease.

There is no cure for dementia. Genetic predisposition plays a role in contracting the illness but it is not an inevitable outcome of ageing.

Global impact

The average age of all countries’ populations is not the same. In general, high-income, developed countries have older populations. Counter-intuitively, over 60% of dementia sufferers live in low- and middle-income countries (LMIC). However, two-thirds of the costs of the disease occur in high-income countries, serving only 40% of global patients.

Low- or middle-income countries (LMIC) – including South Africa – face the considerable challenge of developing a long-term care infrastructure with limited healthcare resources. At present, lifestyle interventions are the best prevention for dementia. Hypertension, diabetes, obesity, smoking, alcohol use, and inactivity are some of the top risk factors for contracting the disease.

Recent developments

• Early research links viral infections like flu and herpes simplex to the development of dementia.
• Flavonol supplements (found in, among others, apples, berries, and cocoa beans) could improve memory in adults with poor diets.
• One out of ten cases can be prevented with adequate management of hearing loss. Entry-level hearing aids are over R30 000 and need replacement every few years.
• Clinical trials with the weight-loss drug Semaglutide are showing promising results in preventing and treating dementia. The minimum dose starts at around R1 500 per month.
• Adherence to the Mediterranean diet is statistically proven to lower risk.
• Social isolation (often caused by hearing loss) and loneliness could lead to or worsen Alzheimer’s related dementia.

A novel treatment approach: Dementia Villages

As an alternative to standard institutionalisation, the globe’s first ‘Dementia Village’ has been in operation in the Netherlands since 2009. Mirroring a typical neighbourhood, residents live in private rooms and can freely visit the grocery store, pub, movie theatre, restaurants or hairdresser.

Business staff all have some dementia training, and doctors and nurses blend into the environment seamlessly: no white coats anywhere. The focus is on deinstitutionalisation, independence and increased social interaction, collectively creating a sense of normalcy for patients. A similar village exists in Canada, and plans are in place in the United Kingdom to follow suit.

The future of dementia is influenced by several bigger, global factors:

• Inequitable access and inequality: We can expect more investment in dementia research leading to new scientific and technological advances. The purchase price of new products is high, therefore mostly benefitting those in high-income countries. In addition, healthcare workers are moving from LMIC to high-income countries, meaning that a projected 10 million healthcare worker shortage by 2030 will likely be skewed towards LMIC.
• Prevention: An integrated healthcare system that focuses on preventing disease, including dementia, through education, legislation and lifestyle change has a better chance of creating an impact than a system that aims to treat the ill.
• Governance: We are left with the question of whether governments of especially LMIC can create economies that can sustainably create jobs and drive growth, thereby creating funds to address overarching concerns.

The ageing population of the world is a new and unique phenomenon. There is a case to be made for reimagining the care model of not only dementia patients but of the elderly in general. The world should also change how it feels about the aged for the better. From dementia villages, we learn that anyone with basic training could fulfil a secondary role as a healthcare worker and that the aged and the ill can still meaningfully contribute to society. Imagine cities with fully integrated old-age communities that foster and leverage the abilities of the elderly. If we are not yet the aged of today, we most likely will be the aged of tomorrow. We could build a better world today, for ourselves tomorrow.