Alzheimer’s villages could be the answer to the rising cases—and cost—of dementia

October 8, 2021, 4:47 PM UTC

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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