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阿尔兹海默村,一个旧实验的新机会

阿尔兹海默村,一个旧实验的新机会

SOPHIE MELLOR 2021年10月11日
这个实验目前已经进行了一年,病人的行为出现了明显的变化。
对年轻人来说,新冠疫情导致的封锁意味着错过毕业典礼、空无一人的大学派对以及失去意义的度假机会。而对于老年人来说,后果则更加严重:身体缺乏活动、长时间的精神空虚,以及罹患阿尔茨海默症的威胁增加。

阿尔茨海默症协会(Alzheimer’s Association)的数据显示,自新冠疫情开始以来,美国死于痴呆症和阿尔茨海默氏症的人数增加了16%——这一趋势恰好与近期上映的以痴呆症为主题的大片《困在时间里的父亲》(the Father)和《超新星》(Supernova)相契合。随着人口老龄化,预计在新冠疫情得到控制后的很长一段时间内,这种趋势将进一步恶化。根据世界卫生组织(World Health Organization)的数据,2019年至2030年期间,痴呆症患者的人数预计将增加40%,至约7800万人;同期总花费增加近三分之一,至1.7万亿美元。

但在法国达克斯的一个小村庄,人们正在努力寻找更好的方法,来处理日益增加的痴呆症病例。作为此类最早的研究项目之一,这座小镇容纳了大约110名阿尔茨海默病早期至晚期患者。他们可以自由散步,光临村里的超市、理发店、餐厅、咖啡馆、图书馆和音乐厅。该项目每天的费用为65欧元(约合75美元),目的是让人们有更多的自主、自由和生活的意义,不至于立马面临经济困难的境地。该实验的发言人玛蒂尔德·卡龙-伯内尔说:“如果项目不是对每个人都适用,那么它就不会起作用。”

村庄

法国西南部的兰德斯·阿尔兹海默村(Landes Alzheimer’s Village)是在2020年疫情期间启动的一个实验项目。这一实验的灵感来自于荷兰的一家护理机构,实验的目的则是研究将阿尔茨海默症患者群体集中在一个微型村庄是否会减缓这种终末期疾病的传播。研究旨在提供更好的临终护理,并延长确诊之后的平均预后(目前为8年左右)。研究将于2025年结束,中期结果将于2022年公布。

乡村生活为患者们提供了一种更放松、压力更小的生活方式,至少与医院以及其他治疗机构的阿尔茨海默症护理相比,情况确实如此。患者们在与他人交流、洗澡和购物方面拥有更多自主权。“在这个村子里,我们希望老人们能过一种近乎正常的日常生活,但同时保证安全。”卡龙-伯内尔对《财富》杂志表示。美好的环境是有帮助的。

现年82岁的玛德琳·埃尔萨尔德是去年6月首批搬进这个村庄的人之一。她在世界经济论坛(World Economic Forum)上说,她喜欢周围的乡村和她租住的合租房子。“这就像在家里一样。”埃尔萨尔德说,她觉得自己得到了很好的照顾。

这个实验目前已经进行了一年,病人的行为出现了明显的变化。卡龙-伯内尔指出,村庄从来访的家庭成员那里已经获得了更多的积极反馈。此外,内部医生对老年痴呆症晚期患者经常出现的焦虑和抑郁等病症的治疗需求,也有了明显的减少。

允许居民自己去商店和理发店,让他们恢复了独立和能力自给自足感。“还给了他们做自己和做其他事情的能力,即使没有以前那么简单有效了。这让它们重获新生。”他说。

阿尔兹海默村的想法并不新奇,类似的村庄在德国、加拿大和新西兰等地也出现过。这个想法最初是荷兰的一家专注于痴呆症的养老院于1992年提出的,并于2009年投入使用。此后,加拿大健康药品和技术署(Canadian Agency for Drugs and Technologies in Health)开展的研究发现,来自荷兰村庄的新证据显示,包含户外和公共空间的家庭式环境的创建,有助于痴呆症患者。虽然一些研究人员对老年痴呆症村庄类似“楚门秀”(Truman Show)的本质提出了批评,但据报道,诸多家庭已经看到了这一模式的优越性。

《财富》杂志尝试联系荷兰霍格韦(Hogewey)医疗机构,但并未收到回复。

达克斯的实验

痴呆症目前在所有致死疾病中位列第七,也是老年人残疾、不得不依赖他人生活的主要原因。随着世界老龄化加剧,病例将会激增。2000年至2019年期间,心脏病等其他主要致死疾病的死亡人数下降了7.3%,但与此同时,阿尔茨海默症的死亡人数激增了145%。

世卫组织的一份报告显示,只有很小一部分国家制定了针对不断增长的痴呆症患者人口的计划。尽管许多计划需要大量财政投资,但很少有国家采取行动,以调动和分配资金。

与大多数健康问题一样,低收入家庭的老年人更容易罹患这种疾病。痴呆症的风险因素与贫穷高度相关,包括缺乏运动、不健康饮食、吸烟和酗酒,以及高血压、糖尿病和肥胖等。

根据阿尔茨海默症协会的数据,随着年龄的增长,黑人患阿尔茨海默症的几率是白人的两倍。这加剧了美国贫富差距的情形,因为照顾痴呆症患者一生总成本的70%由患者的家人自行承担,包括自付、长期护理费用以及无偿护理。

据阿尔茨海默症协会估计,在美国,痴呆症患者一生的护理费用高达373527美元。相比之下,兰德斯阿尔茨海默村每年的护理费用为23725欧元(约合27400美元)。目前,兰德斯阿尔茨海默村每年的运营成本为670万欧元,其中大约400万欧元由法国政府补贴。

波尔多人口健康研究中心(Bordeaux Population Health Research Center)研究员伊莲娜·阿米耶瓦也曾与这一村庄合作。她对《财富》杂志表示,“成本问题是关键”。虽然兰德斯阿尔茨海默村系统的投资和运营成本可以减少住院、门诊咨询以及痴呆症药物处方的数量,但关键将是如何让这个目前得到了大量补贴的系统,将来继续在经济上有价值。她指出,该项目的全部目的是找出成本效益比为几何。(财富中文网)

编译:杨二一

对年轻人来说,新冠疫情导致的封锁意味着错过毕业典礼、空无一人的大学派对以及失去意义的度假机会。而对于老年人来说,后果则更加严重:身体缺乏活动、长时间的精神空虚,以及罹患阿尔茨海默症的威胁增加。

阿尔茨海默症协会(Alzheimer’s Association)的数据显示,自新冠疫情开始以来,美国死于痴呆症和阿尔茨海默氏症的人数增加了16%——这一趋势恰好与近期上映的以痴呆症为主题的大片《困在时间里的父亲》(the Father)和《超新星》(Supernova)相契合。随着人口老龄化,预计在新冠疫情得到控制后的很长一段时间内,这种趋势将进一步恶化。根据世界卫生组织(World Health Organization)的数据,2019年至2030年期间,痴呆症患者的人数预计将增加40%,至约7800万人;同期总花费增加近三分之一,至1.7万亿美元。

但在法国达克斯的一个小村庄,人们正在努力寻找更好的方法,来处理日益增加的痴呆症病例。作为此类最早的研究项目之一,这座小镇容纳了大约110名阿尔茨海默病早期至晚期患者。他们可以自由散步,光临村里的超市、理发店、餐厅、咖啡馆、图书馆和音乐厅。该项目每天的费用为65欧元(约合75美元),目的是让人们有更多的自主、自由和生活的意义,不至于立马面临经济困难的境地。该实验的发言人玛蒂尔德·卡龙-伯内尔说:“如果项目不是对每个人都适用,那么它就不会起作用。”

村庄

法国西南部的兰德斯·阿尔兹海默村(Landes Alzheimer’s Village)是在2020年疫情期间启动的一个实验项目。这一实验的灵感来自于荷兰的一家护理机构,实验的目的则是研究将阿尔茨海默症患者群体集中在一个微型村庄是否会减缓这种终末期疾病的传播。研究旨在提供更好的临终护理,并延长确诊之后的平均预后(目前为8年左右)。研究将于2025年结束,中期结果将于2022年公布。

乡村生活为患者们提供了一种更放松、压力更小的生活方式,至少与医院以及其他治疗机构的阿尔茨海默症护理相比,情况确实如此。患者们在与他人交流、洗澡和购物方面拥有更多自主权。“在这个村子里,我们希望老人们能过一种近乎正常的日常生活,但同时保证安全。”卡龙-伯内尔对《财富》杂志表示。美好的环境是有帮助的。

现年82岁的玛德琳·埃尔萨尔德是去年6月首批搬进这个村庄的人之一。她在世界经济论坛(World Economic Forum)上说,她喜欢周围的乡村和她租住的合租房子。“这就像在家里一样。”埃尔萨尔德说,她觉得自己得到了很好的照顾。

这个实验目前已经进行了一年,病人的行为出现了明显的变化。卡龙-伯内尔指出,村庄从来访的家庭成员那里已经获得了更多的积极反馈。此外,内部医生对老年痴呆症晚期患者经常出现的焦虑和抑郁等病症的治疗需求,也有了明显的减少。

允许居民自己去商店和理发店,让他们恢复了独立和能力自给自足感。“还给了他们做自己和做其他事情的能力,即使没有以前那么简单有效了。这让它们重获新生。”他说。

阿尔兹海默村的想法并不新奇,类似的村庄在德国、加拿大和新西兰等地也出现过。这个想法最初是荷兰的一家专注于痴呆症的养老院于1992年提出的,并于2009年投入使用。此后,加拿大健康药品和技术署(Canadian Agency for Drugs and Technologies in Health)开展的研究发现,来自荷兰村庄的新证据显示,包含户外和公共空间的家庭式环境的创建,有助于痴呆症患者。虽然一些研究人员对老年痴呆症村庄类似“楚门秀”(Truman Show)的本质提出了批评,但据报道,诸多家庭已经看到了这一模式的优越性。

《财富》杂志尝试联系荷兰霍格韦(Hogewey)医疗机构,但并未收到回复。

达克斯的实验

痴呆症目前在所有致死疾病中位列第七,也是老年人残疾、不得不依赖他人生活的主要原因。随着世界老龄化加剧,病例将会激增。2000年至2019年期间,心脏病等其他主要致死疾病的死亡人数下降了7.3%,但与此同时,阿尔茨海默症的死亡人数激增了145%。

世卫组织的一份报告显示,只有很小一部分国家制定了针对不断增长的痴呆症患者人口的计划。尽管许多计划需要大量财政投资,但很少有国家采取行动,以调动和分配资金。

与大多数健康问题一样,低收入家庭的老年人更容易罹患这种疾病。痴呆症的风险因素与贫穷高度相关,包括缺乏运动、不健康饮食、吸烟和酗酒,以及高血压、糖尿病和肥胖等。

根据阿尔茨海默症协会的数据,随着年龄的增长,黑人患阿尔茨海默症的几率是白人的两倍。这加剧了美国贫富差距的情形,因为照顾痴呆症患者一生总成本的70%由患者的家人自行承担,包括自付、长期护理费用以及无偿护理。

据阿尔茨海默症协会估计,在美国,痴呆症患者一生的护理费用高达373527美元。相比之下,兰德斯阿尔茨海默村每年的护理费用为23725欧元(约合27400美元)。目前,兰德斯阿尔茨海默村每年的运营成本为670万欧元,其中大约400万欧元由法国政府补贴。

波尔多人口健康研究中心(Bordeaux Population Health Research Center)研究员伊莲娜·阿米耶瓦也曾与这一村庄合作。她对《财富》杂志表示,“成本问题是关键”。虽然兰德斯阿尔茨海默村系统的投资和运营成本可以减少住院、门诊咨询以及痴呆症药物处方的数量,但关键将是如何让这个目前得到了大量补贴的系统,将来继续在经济上有价值。她指出,该项目的全部目的是找出成本效益比为几何。(财富中文网)

编译:杨二一

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.

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