Macau Matters | Dementia in Macau

Richard Whitfield

A few years ago I had the very sad experience of not being recognized by an old family friend who had been institutionalized because of dementia. This larger than life man, whom I had admired from a young age for his charisma and intellect, was just a hallow shell who did not even recognize his own children and who could not safely live alone.

Dementia is the collective term used to describe neurological disorders that lead to progressively impaired brain function. Many disorders lead to dementia but the most well known is Alzheimer’s disease which involves the progressive degeneration and death of brain cells leading to declining thinking, behavioral and social skills that disrupts a person’s ability to function independently. The exact causes of Alzheimer’s disease aren’t fully understood, but at its core are abnormally functioning brain proteins that disrupt the work of brain cells (neurons) and unleash a series of toxic events. Neurons are damaged, lose connections to each other and eventually die. Generally, dementia is irreversible and largely non-treatable.

Most dementia is age related so that as people live longer they are more likely to have impaired brain function. 50+ years ago dementia was largely unheard of because people did not live long enough for it to surface, but it is now becoming more and more common. For example, around 250 people/day are being diagnosed with dementia in Australia and they project that this figure will rise to over 650/day by 2056. A recent Australian report also estimates that it will cost AU$37 billion/year to care for the estimated 1.1 million dementia sufferers in Australia in 2056.

Prorated for population, this suggests that 5+ cases of dementia are now being diagnosed daily in Macau and that we might have 25,000 cases here by 2050, and each might cost MOP200,000/year to care for. I do not believe that Macau is prepared at all for this emerging problem.

Modern demographic trends – people living longer, families fragmenting so that multiple generations no longer live close together, etc – mean that dementia will increasingly become a community problem in the future. People with mild dementia need a lot of supervision, like children, and so can place a heavy burden on families caring for them. Severe dementia suffers often do not have adequate brain function to live independently and are mostly put into residential care where their quality of life can often be compromised. Even now, over 50% of the people in elderly residential care in Australia suffer from dementia, and this proportion will rise in the future.

In The Netherlands they are experimenting to develop much better care facilities for dementia suffers based on what they call the Hogeweyk concept. Facilities following this concept mirror the wider community so that they look like villages with separate “houses” with rooms for 8-10 dementia suffers in each, and with a central square, a supermarket, local shops, cinema, etc so it seems to be a normal village. Moreover, the support staff dress in “street clothes” and act as helpful friends rather than as doctors and nurses. The idea is that the dementia suffers do not realize they are institutionalized and continue to live their “normal” lives. The cost of care is not much different, but the prison-like institutional feel is totally eliminated to dramatically improve the quality of life of the residents. This approach is starting to find favor in other countries (Australia included) to lift the quality of care.

Through my previous work I visited several residential care facilities in Macau for the mentally and physically disabled and the elderly. Generally, while the management and care staff in these facilities try their best, the facilities themselves are not well designed or thought out and they are largely unaware of world trends and best practices. No Hogeweyk villages in Macau, which needs to change!