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December 9, 2019

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Where flawed old minds meet loving care

AS the population of the aged grows, Shanghai is faced with the challenge of caring for senior citizens who suffer learning, memory and perception disabilities — known collectively as cognitive disorders and broadly including forms of dementia.

An estimated 200,000 seniors in the city suffer from some sort of cognitive disorder, and the figure is rising, the Shanghai Civil Affairs Bureau says.

The Shanghai Yinkang Senior Care Home in Hongkou District is home to 350 seniors and about 60 percent of them have cognitive disorders. It created an exclusive area for them in 2015.

According to Tang Yuanqiu, director of the home, the exclusive area for elderly suffering from cognitive disorders is called “memory town.”

These residents often show abnormal emotional behavior, harbor illusions, wander off or exhibit violent tendencies. They may be incontinent or unable to get to the toilet by themselves. They may not know when to eat or how much to eat.

“Such abnormal behavior is difficult to tackle,” Tang said. “Although they can seem to act normally, they need 24-hour care and monitoring.”

The average age in the home is 85, with the oldest resident 103. “When the home was opened in 2012, such disorders were not widely recognized by society,” she said. “Families couldn’t cope and found that many community-based facilities refused to take their relatives. But we never give up on them.”

The home’s “memory town” was the first of its kind in the city.

The area is decorated with memorabilia from the past that might resonate with older people whose long-term memory is much sharper than short-term memory. “We collected old photos from their families and old magazines from the 1960s and 70s. We wanted to create a homely and nostalgic atmosphere for them. It has worked well so far,” Tang revealed.

The home also has an activity area where calligraphy, traditional opera, painting, movies, music, exercises and other activities are organized.

“They like group activities such as singing old songs,” said Tang.

Through the years, the home has developed its own care system and trained a professional nursing team adept at providing specialized care. “The services span everything from bathing to eating. Communication skills are the key to success. Not only verbal communication but also communication through body language, eye contact and gestures.”

Many residents come here from hospitals or their own homes, where care, if provided at all, was not geared to their cognitive disorders. That led to a deterioration in their conditions, Tang said.

The home’s staff assess their conditions and tailor care to individual needs. The cognitive disorders may not go into remission, but the patients’ conditions are stabilized.

Nursing staff must have loving hearts, patience, a sense of responsibility and powers of keen observation, Tang said.

Hou Haohao, who majored in care for the elderly, has been working at the home for one year. His duty mainly involves getting the residents into activities.

“I keep chatting with them,” he said. “For me, they are not old people. They are my friends. Caring for seniors with cognitive disorders is very demanding. Different ways of communication are important because many can’t express themselves well. We need to guess what they want by careful observation of their facial expressions and behavior.”

There are many moving stories encapsulated in the home.

One visiting spouse broke into tears when his 82-year-old wife suddenly recognized him after years of non-awareness.

A male patient became nervous and upset when a favorite care worker took annual leave. He cried and hugged her upon her return.

A blind male resident who was unsociable and refused to talk when he first came to the home was gradually pulled from his shell by patient care workers. After he underwent surgery to restore his eyesight, he returned to the home and gleefully put faces to the voices he recognized.

Nurse Chen Guangrong has been taking care of seniors with cognitive disorder for 13 years. “At first, I was scared by their behavior, but gradually I came to understand them,” she said. “I treat them like my family and that makes a difference. Every senior’s disorder is different, but they are all the same in responding to warmth and loving care.”

Chen has developed her own ways of soothing seniors.

For the former businessman who complained about everything and frequently lost his temper, she took him for walks.

For the former engineer who was always crying, she sat down with him to watch television.

A woman with a cognitive disorder hugs Chen every day.

“If I don’t hug her, she will feel sad,” Chen said. “The methods you employ for one senior won’t necessarily work on another. We cannot understand the worlds of their minds, but we can tell if something is upsetting them.”

Tang summed it up. “We can’t turn them into their former selves, but we can create a safe, stable and high-quality living environment for them,” she said.

Other elderly care homes in Shanghai are also exploring new avenues of caring for seniors with cognitive disorders.

The Heyun Senior Home in Hangtou Town of Pudong plans to redecorate two floors for them in a style harking back 30 years or more to surround them with happy, nostalgic memories.

“Living in a familiar environment offers spiritual comfort for seniors with cognitive disorders and is good for their health,” said Fei Anling, director of the home. “They may forget things that happened three minutes ago, but they do remember things that happened 30 years ago.”

The home has 52 residents, with about 40 percent suffering from cognitive disorders. “Ridiculous things happen in our home every day,” said Fei. “But every member of staff takes cognitive disorders seriously.”

Shanghai also has begun trials of “friendly communities” for seniors with cognitive disorders.

Subdistricts of Huangpu, Jing’an and Pudong were among the first to take part, according to the civil affairs bureau.

Participating communities will provide risk evaluation and early intervention into nursing care. They will also provide psychological counseling and respite services for families.

“Care of seniors with cognitive disorders is a new challenge and it is important to create friendly communities for them,” said Jiang Rui, deputy director of the bureau.

By the end of last year, Shanghai’s senior population had surged to about 5 million, or about a third of permanent residents. Among them, 817,000 were 80 years or older.

A thousand new beds for seniors with cognitive disorders have been provided at elderly care homes, and areas exclusively for those with cognitive disorders are being established. The target is to provide 8,000 beds by 2022.

“We will also establish a database and conduct staff training to ensure better services are delivered,” said Jiang.


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