New Taipei’s Pingxi District is famous for its sky lantern festival. Less well-known is the crisis of its aging community. A third of Pingxi’s residents is 65 and older, and dozens of them struggle with dementia. In response, local health authorities spent nearly a year providing comprehensive dementia screening, to get residents the help they need. Not only that, the town has responded with health initiatives and workshops, to create a safe and happy environment for the cognitive impaired. We visit this model community in our Sunday special report.
It’s bright and early, and most shops here at Pingxi’s Jingtong Old Street have yet to open. But at this store near the entrance, you can already hear the rhythmic sounds of work getting done.
Pingxi does not have a traditional market. Shopkeeper Lee Wen-chuan gets up at 3 a.m. to visit Taipei, to buy goods for his neighbors and ingredients for restaurants.
Now 64, Lee Wen-chuan has been running the family business for more than 30 years. He inherited the shop from his mother, making him the fourth-generation owner. Lee has witnessed the rise and fall of Pingxi. He’s also seen his mother go from a powerful business woman to a basement shut-in.
Lee’s mother, Lee Lin-chuan, is 91 years old. When her family isn’t minding the shop upstairs, you’ll often find them keeping her company down below.
The family business sells groceries, vegetables, fruit, and even gas for cooking. The Lees say the business was built on their matriarch’s hard work.
Grandma used to be a very well-known figure. She was the head of the women’s association for 20 years. Back then, the women’s association was one of the three biggest associations in Pingxi. When Chiang Ching-kuo came, few could approach him. But grandma was one of the ones who could.
Before her 70s, Lee Lin-chuan was the queen of commerce. But after she hit 73, her energy began wane.
She would help with sales and ring customers up. But then I realized she was having trouble giving change. When we discovered that, we also couldn’t just tell her she was doing it wrong. She wouldn’t admit it. She would say, “A slip-up every now and then is normal, everyone makes mistakes!”
At the beginning, Lee Wen-chuan thought his mother’s behavior was simply a sign of old age. He only realized something was up when she nearly set the house on fire.
She was cooking something and she had turned down the fire to low heat. She forgot about it and went to sleep. We were all sleeping, and then at 11, there was smoke everywhere. We went to look and it turned out she’d forgotten to turn off the stove.
Similar incidents happened three times within just a few months, forcing her family to realize that the problem was beyond old age. Her grandson tried to take her to see a psychiatrist, but she refused.
She had a negative impression of psychiatrists. She’d say, “That’s where crazy people go! Do you think I’ve gone mad? I’m the head of the women’s association, I’m as good as can be.”
After much persuasion, Lee Lin-chuan finally gave in and went to see a doctor, who diagnosed her with mild dementia and prescribed medication to slow down its symptoms. But she wouldn’t have it. She took the medicine only a few times before stopping altogether. Despite best efforts, her family was unable to change her mind.
Dementia is not just about forgetting things here and there. It also has an impact on your emotional management. Forgetting things would put her in a bad mood. For example, you’d ask her where she put something, and she’d say she didn’t put it there. Then everyone would get into an argument over this unimportant thing. I think we can deal with dementia because we’re a strong family. If we weren’t, dementia would’ve absolutely torn us apart.
About seven years ago, Lee Lin-chuan got into a traffic accident that worsened her condition. Walking became difficult and her memory suffered.
Now she doesn’t recognize me. In fact it’s been several years since she’s stopped recognizing me. She calls me the wrong name. Or she calls me dad.
Being forgotten by his own beloved mother caused Lee Wen-chuan unbearable pain. Their story is just one of many like it in Pingxi.
Pingxi is famed for its sky lanterns, which attract visitors from far and wide. But when it’s not hosting the lantern festival, it is a town abandoned by young people, a super-aged community. Pingxi has 4,160 residents, making it the least populated district in New Taipei. The number of residents aged 65 and up is 1,368 – that is, about 1 in 3 people.
With so many older adults, dealing with dementia is a top priority. According to estimates from the Ministry of Health and Welfare, about 1 in 30 people aged 65 and up suffers from dementia. This cognitive disorder is not limited to memory loss. Patients experience a deterioration of language skills, spatial awareness, and the ability to perform calculations and make judgments. In Pingxi, older adults often go missing. When that happens, the whole town forms a big search party.
There was a man who was worried about his mother. So the whole town got together to look for her. They checked surveillance camera footage, and saw she had gone in the direction of the school over there. Everyone was looking for her until 10 p.m., but we still couldn’t find her. In the end, her son found her sitting near a stream.
The shopkeeper says that seniors sometimes wander in to ask the same questions, over and over.
“Do you need to use a garbage bag for this?” She asked me the same thing five times. She really didn’t know. Later I told her family, but I was dismissed. Her daughter said, “It’s not like that, my mother isn’t like that.”
When family members refuse to acknowledge signs of dementia, patients can miss out on early diagnosis and prevention.
But in 2016, Pingxi’s Public Health Center brought in a doctor to service the aging community.
This was Dr. Lin Tai-jen, who used his expertise in neurology to provide proactive dementia care.
The public health center offered rehab sessions to older adults. Lin used the sessions to screen patients for dementia, using the AD8 questionnaire. Participants saw it just one more step in their routine checkups and were happy to cooperate. For people who did not attend the rehab sessions, Lin adopted a different strategy.
We went out to them. We cover 20 boroughs, so we split into four teams, each one assigned to a different area. Each area had more than 300, nearly 400 older adults. We got four nurses to work with us on this project.
It took the health center almost an entire year to screen everyone in Pingxi for dementia. After the screening, they encountered an even tougher challenge, that of getting potential dementia patients to go to a hospital for a diagnosis.
You may want to tell them they have dementia, but they might feel a bit sensitive about the word. So instead we might tell them, “Hey, there could be something funny going on up there. Things can be confusing, right? Do you feel that?” Then they might say, “Yes, I do get confused.” So then I tell them, “It’s fine, let’s go to the hospital for a checkup, to take a look at your head. It can smarten you up, and make it less likely that you get into trouble.” We say things like that so that we can bring them over. We kind of have to deceive them sometimes.
The health center works with the Tzu Chi Hospital to offer a fast-track checkup process that can be completed in one day, saving patients multiple trips to the doctor. The process ends with a diagnosis.
We found between 105 and 108 patients with varying levels of severity on the Clinical Dementia Rating Scale. We had mild patients, who are a 0.5 on the CDR scale, all the way up to 3 or 4, which is when they have to stay in bed. We had about 32 to 35 patients with severe dementia. That’s patients who are a 3 or more on the scale and who are bedridden. In those cases, their families had them transferred to institutional care. Then there’s about 70 or more patients who have stayed at home.
Lin’s goal was for 70 patients with mild and moderate dementia to remain in the community. With caregiver numbers limited and many adult children working elsewhere, there were 101 older adults in Pingxi living alone. With no family to help out with dementia care, the community had to get involved in supporting patients.
A Kernel of Wheat Foundation
We arrange courses for them. So for example, in the morning, we mostly offer exercise classes. Sometimes, adult children who don’t live with their aging parents rely on us to keep them updated on their parents’ condition.
Pingxi offers more than exercise classes at the long-term care center. Over the last three years now, New Taipei’s Department of Health has offered 24 workshops and team-building events, to teach local businesses about dementia. The training courses have created a community that’s accommodating to dementia patients.
Sometimes we can tell if an older adult is behaving a little differently. Or if something odd is up. If so, we tell their families.
When dementia patients pop in to make the same purchase multiple times, shopkeepers are sympathetic.
We are a dementia-friendly business. So I tell their families that they can return all non-perishable goods, like canned food. We even let them return things like spring onions and garlic as long as it’s within three hours. We’re fine with all of that.
Across the nation, more than 300,000 people live with dementia. But not every community is as accommodating as Pingxi. The mountain town has become an example of how acceptance and caring for your neighbors can help dementia patients remember to smile, even when other memories fade away.
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