Pingxi bands together to create safe community for dementia patients
Pingxi bands together to create safe community for dementia patients
2024-01-28
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.
Lee Yu-tsung
Shopkeeper
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.
Lee Wen-chuan
Shopkeeper
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.
Lee Wen-chuan
Shopkeeper
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.
Lee Yu-tsung
Shopkeeper
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.
Lee Yu-tsung
Shopkeeper
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.
Lee Wen-chuan
Shopkeeper
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.
Lin Shu-hua
Shopkeeper
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.
Lin Shu-hua
Shopkeeper
“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.
Lin Tai-jen
Doctor
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.
Lin Tai-jen
Doctor
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.
Lin Tai-jen
Doctor
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.
Liu Ching-fang
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.
Lin Shu-hua
Shopkeeper
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.
Lee Yu-tsung
Shopkeeper
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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健忘村裡的阿嬤
2024-01-28
新北市平溪以天燈聞名，但其實這山區觀光勝地，在年輕人大量外移之下，有高達三分之一居民年齡都超過65歲，長者失智問題在這裡感受特別深刻。地方衛所特別花了近一年時間，進行平溪全區的失智普篩，協助轉診就醫，並且透過工作坊、共識營的方式，培訓老街店家，在平溪打造一個對失智者友善的聚落。
一大早，平溪的菁桐老街上，許多店家還沒開門，只有入口這間商店，忙碌的節奏聲已經響起。
由於平溪沒有傳統市場，商店老闆李溫泉每天半夜三點起床，到台北市替鄉親、餐廳店家買菜。
64歲的李溫泉經營商店三十餘載，當初從母親手中接下傳承四代的商店，見證了平溪的起落，也看著媽媽一路從女強人，變成困在地下室的老人。
李溫泉的老母親李林勸已高齡91歲，兒孫在顧店之餘，經常下樓陪伴。
李溫泉說，李家既賣雜貨、蔬菜水果，又經營瓦斯行，都是媽媽替兒孫打下的一片江山。
[[菁桐老街商家 李禹璁]]
“奶奶以前是很風光的人物，畢竟她當婦女會的理事長，當了二十年。在那個時候婦女會來講，在平溪鄉，它算三大會之一。蔣經國來的時候，沒多少人能靠近(蔣經國)，我阿嬤是其中一位。”
李林勸在70歲前叱吒商場，然而過了73歲，原本意氣風發的她，一點一滴在凋零。
[[菁桐老街商家 李温泉]]
“因為我媽會幫忙賣東西，會收錢，在找錢方面，我發現她不靈光了。我們發現這個狀況，你也不能跟她講她不好，她不會承認，她說偶爾算錯怎麼不會？誰都會(算錯)。
剛開始李溫泉以為，媽媽只是正常老化，反應變得遲鈍，直到某天早晨，媽媽煮飯煮到差點火燒屋，才驚覺不對勁。
[[菁桐老街商家 李温泉]]
“她有時候煮東西，她有關火，關小火，然後她忘了，就去睡覺了。結果我們睡到11點，哇，怎麼濃煙都起來，去看，忘記關(火)了。”
老人家在幾個月內，接連三次忘記關火，孫子認為，這應該不是阿嬤年紀大變糊塗，那麼簡單的情況而已。但他想帶阿嬤掛號看精神科卻遭拒。
[[菁桐老街商家 李禹璁]]
“我阿嬤對那個科別是有不好印象的，(她說)那是發瘋的人在看，現在我去看我是不是發瘋？我婦女會理事長，風光無限。”
動之以情說服好一陣子，阿嬤才願意卸下心防就醫。看診後被診斷是輕度失智，醫生開立延緩失智惡化的處方箋，但阿嬤不聽話，吞了幾次藥後就不吃，家人雖然苦惱，但也敵不過老人家的固執。
[[菁桐老街商家 李禹璁]]
“其實失智症，它不只失智、忘東忘西這麼簡單，它會伴隨著情緒控管不佳，她情緒不好的原因，有可能就來自於她忘東忘西。譬如說，你跟他說，你的東西放在哪，她說不是啦，我不是放在那邊，大家為了這種小事而爭執。在我看來，失智症，那是我家族的力量強大，不然，一個失智症絕對可以拖垮一家人。”
七年多前，阿嬤又因為一場車禍，身體每況愈下，不僅難以行走，連記憶也被抹去。
[[菁桐老街商家 李温泉]]
“她現在也認不得我了，應該講幾年前就認不得我，五年前，會叫錯名字，叫我的名字會叫我爸爸。”
被深愛的媽媽遺忘，是難以承受之痛，李溫泉與媽媽的故事，只是平溪這個高齡鄉鎮的縮影。
平溪天燈遠近馳名，然而觀光勝地的背後，面臨的是年輕人口外移，與超高齡化之現況。平溪總人口僅約4160人，是全新北市人數最少的一區，但65歲以上的長者就高達1368人，平均每三位就有一位是老人。
長輩多，最需要面對的課題之一，就是失智。依照衛福部估算，台灣65歲以上的長者，大約每十三人就有一位確診。失智症是一種認知退化症候群，它的症狀不單只有記憶力減退，還有語言、空間感、計算、判斷力等各方面的功能退化。在平溪就經常上演著老人失蹤，全村協尋的狀況。
[[菁桐老街商家 林淑華]]
“兒子一直很擔心他媽媽，發動全村的一直去找，後來調監視器，她是往小學那邊方向去，大家找到晚上十點，都還找不到，後來是她兒子那邊的河邊山溝裡找到。”
店家說，有的長輩還會跑進他們店裡，反覆詢問相同的問題。
[[菁桐老街商家 林淑華]]
“這個是不是要用垃圾袋？來問五次，她自己不知道。後來我們跟她家人反映，我就是踢到鐵板，她女兒說，不是這樣，我媽媽不會這樣。”
一旦家人不願相信長輩失智，恐怕就無法及早發現與預防。
幸好，2016年平溪衛生所，來了一位醫生，解決當地窘境。
他是平溪前衛生所主任林太仁，有感於該地老年人口眾多，他想要以自己神經科的專長，在地方對症下藥。
首先，林太仁趁著長輩平常到衛生所復健時，讓他們檢測AD-8極早期失智症篩檢量表，長者以為只是例行性的檢查，因此乖乖配合。至於平常不會到衛生所的長輩，林太仁則主動出擊。
[[醫師 林太仁]]
“我們就去拜訪他們，比如我們這裡有十二個里，我們就分四個組、四個地段，一個地段可能300多個(老)人，將近400個(老)人，我們有四位護理師，配合著我們計畫。
衛生所團隊花了近一年的時間，做完平溪全區的失智普篩，難題是，該請疑似失智的長者配合轉診到大醫院。
[[醫師 林太仁]]
“你要跟他講「你失智了」，有時候他對這個名詞會比較敏感，但是有時候我們就說，阿嬤妳的頭腦稍微怪怪，妳想事情都會打結，妳看，妳有沒有？她會說，有喔，我有打結，我就說，好啦，我帶妳去大醫院檢查一遍，把妳的頭腦看一看，讓妳比較聰明，讓妳比較不會出事，類似這樣的一個狀況，就帶老人家走，有時候連拐帶騙類似這樣子。”
衛生所與慈濟醫院合作，建立一條快速通道，讓老人家不用舟車勞頓，在醫院花一天時間完成所有檢查，最後找出失智確診個案。
[[醫師 林太仁]]
“實際上我們去做出來的(人數) 105到108(位)左右，這些人裡面，我們就會根據他的臨床失智評估量表，CDR量表，從CDR的0.5，一直到3，到4，到臥床。那有些比較嚴重的，CDR等於3的，就是臥床的，有32到35位，家屬就已經接到安養機構去，那實際上留在我們本地的，大概70多位。”
這七十位輕中度失智長者，林太仁希望他們能在地安老，然而照顧人力有限，子女也經常不在父母身邊。在平溪獨居的長者就有101位，因此失智症照護已經無法單靠家庭，還需要靠「社區」互助才能照應。
[[一粒麥子基金會新北中心主任 劉靜芳]]
“我們會安排一些課程，像上午的課會以運動為主。有時候外地的子女，他也還蠻依賴我們告訴他，最近老人家的狀況或是訊息。”
長輩不僅可以在長照據點上課，新北市衛生局更從三年前開始舉辦二十四堂工作坊、共識營，讓老街商家學習失智識能，透過專業培訓，打造出友善社區。
[[菁桐老街商家 林淑華]]
“我們有時候會看一下這個老人，看他今天有什麼不一樣，哪裡不對了，但是還是會告訴他的家人。”
就算遇到失智老人到商店重複購買，也能體諒。
[[菁桐老街商家 李禹璁]]
“因為我們是友善商店，所以我們其實有跟家屬說過，只要是那些罐頭類，不會腐敗的你都可以退，甚至蔥蒜，你三小時後來退，我們都可以接受。”
目前台灣失智人口已經超過30萬人，如果每個社區居民對失智有一定程度的理解，並且像平溪小鎮的店家一樣，學會接納與互助，每個住在健忘村裡的老人，或許都能重拾笑顏。
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