Serene village in China's Xi'an offers new approach to Alzheimer's care
Instead of confining sufferers behind locked doors or restricting them to rigid routines, the village offers an environment that meets them where they are. ST PHOTO: GAVIN FOO
SINGAPORE/XI'AN – Nestled amid the verdant forest parks and mountain springs of the Zhouzhi Louguan eco-cultural tourism resort zone in Xi'an, China, is a one-of-its-kind village for seniors.
Here, mornings are unhurried. In the centre of the village, a man-made lake mirrors the daylight, with the sound of water gently lapping against stone. A short stroll along the lakeside brings seniors to a bright, spacious dining hall, where breakfast is served.
There is quiet chatter – even laughter – as friends greet one another, some for the third or fourth time that morning.
Afterwards, a few residents go for a light workout in a tree-lined gazebo, while others head to a calligraphy or music class.
If the place looks like a typical quaint Chinese village, that is because it was designed to mimic one as much as possible.
Clues like a post office that does not send or receive actual mail, a convenience store that uses fake currency, and bus routes that loop endlessly around the tiny compound give away the nature of the village.
Spanning over 43,000 sq m, or about the size of six football fields , the compound is an Alzheimer's disease village – a first for China. It is run by real-estate-turned-healthcare company Perennial Holdings.
A mock post office and florist at the Perennial Alzheimer's Care Village Xi'an.
ST PHOTO: GAVIN FOO
Earlier in June, the Singapore-based company took journalists to tour the compound along with its healthcare facilities in other Chinese cities.
The innovative care model in the Perennial Alzheimer's Care Village Xi'an is designed for those living with a disease that progressively robs them of their memory, thinking and reasoning.
The illness is the most common disease that causes dementia, an umbrella term for symptoms ranging from confusion to changes in behaviour, to problems with language.
Instead of confining sufferers behind locked doors or restricting them to rigid routines, as in traditional eldercare facilities, the village offers an environment that meets them where they are – one built on safety, dignity and choice.
Residents can move about freely and interact with one other. Staff such as doctors, nurses and physiotherapists also aim to be part of the residents' lives, engaging with them like friends or family members on top of being medical professionals.
The care model was first popularised by the Hogeweyk dementia village in the Netherlands in 2009. More than a decade later, similar villages offering inclusive and small-scale communities for dementia patients have been set up in countries like France, Canada, Norway and Switzerland.
When setting up the Xi'an project, the Perennial team visited some of these villages to learn from their experiences.
Today, the Xi'an village comprises a dementia care home with about 450 beds, a nursing care hospital, a rehabilitation hospital and an international eldercare research institute.
Since it opened progressively from March 2024, the village has hosted over 50 residents, with 26 still residing there currently.
Staff aim to be part of the residents' lives, engaging with them like friends or family members on top of being medical professionals.
ST PHOTO: GAVIN FOO
Dr Song Xiangying, dean of the village, said the majority of the patients, who have medium to severe symptoms, have become less agitated, happier and calmer since they were admitted to the facility.
She cited the example of a man who, during his first few days after admission, would insist on going home after his meals.
Instead of trying to convince him to stay, she waited with the man at one of the 'bus stops' in the compound.
'We chatted about how long it would take for him to go home and even walked to another bus stop when we had waited too long,' said Dr Song, adding that going along with the man's version of reality helped to calm him. After a few days, he stopped wanting to go home.
One of the 'bus stops' in the compound.
ST PHOTO: GAVIN FOO
Dr Song also said no resident has wandered out of the compound. Such behaviour, known as elopement, is common because patients may be disorientated or have a desire to fulfil former obligations or unmet needs.
While the patient and understanding staff play a key role in its success, the facility is also equipped with high-tech security measures to prevent residents from wandering off.
'We use facial and video recognition to monitor the residents' whereabouts, so they do not need to put on wearable devices like bracelets,' said Dr Song.
All staff, including security guards and cleaners, know residents by name and keep a watchful eye on them, she added.
Residents can move about freely and interact with one another.
ST PHOTO: GAVIN FOO
Among the residents is Madam Wang Lai Fei, 76. While she had displayed early signs of Alzheimer's disease since 2023, her condition deteriorated in January after her husband died.
Her daughter-in-law Lu Jing said the elderly woman had wandered out on her own and got lost twice. Ms Lu then decided to admit Madam Wang to the facility as she was stressed from caregiving.
'Now, her condition is stable and she has even gained weight. She is very comfortable here, with a group of friends she can chit-chat with every day ,' said Ms Lu.
(From left) Dr Song Xiangying, dean of the village, with Madam Wang Lai Fei and Madam Wang's daughter-in-law Lu Jing.
ST PHOTO: GAVIN FOO
Assistant Professor Saima Hilal, from NUS' Saw Swee Hock School of Public Health, said that since dementia is a progressive condition with no known cure, the success of dementia villages should be measured not only by clinical outcomes like slowing of decline, but also, more importantly, by indicators of well-being and quality of life.
Some useful benchmarks include engagement in daily activities; reduced reliance on antipsychotic medication, physical restraints or hospital admissions; and cost-effectiveness over time, especially when factoring in fewer emergency admissions or complications.
Singapore tried to pilot its own dementia care village in 2020 in Buangkok Green, but the project attracted only one bid – a joint one by Perennial Holdings subsidiary Pre 11 and nursing and personal care operator Orpea.
Ultimately, the project was shelved because the Government found the bid of $15 million to be too low.
Perennial chief executive Pua Seck Guan said that if Singapore were to revive the project, the company would be 'happy to explore' opportunities, but he also cited high land costs as a challenge.
The Perennial Alzheimer's Care Village Xi'an spans over 43,000 sq m, about the size of six football fields.
ST PHOTO: GAVIN FOO
Prof Hilal noted that besides land costs, operational costs for such care models would also be higher due to the need for trained staff and low resident-to-staff ratios. Another challenge is the limited public-private investment, as the business model is not yet fully proven in South-east Asia.
Therefore, instead of replicating large-scale dementia villages, hybrid models could be more feasible in Singapore, she said.
These include embedding dementia-friendly design features in HDB estates and active ageing centres, setting up smaller cluster-living homes using under-utilised community spaces, and training neighbourhood volunteers and caregivers to support dementia-inclusive communities.
'These steps are more scalable and culturally appropriate for Singapore's high-density environment, and can deliver many of the same benefits as full-fledged dementia villages,' said Prof Hilal.
Join ST's WhatsApp Channel and get the latest news and must-reads.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
CNA
7 hours ago
- CNA
In China's first dementia village, residents live with dignity in a safe space
XI'AN: Nestled amidst lush greenery, tranquil lakes and the breathtaking Qinling Mountains in Xi'an, the capital of China's Shaanxi province, lies a village designed to offer specialised care to patients with Alzheimer's and other forms of dementia. It is China's first dedicated Alzheimer's care facility, built by Singapore real estate and healthcare firm Perennial Holdings. The Perennial Alzheimer's Care Village Xi'an is also the sixth such facility worldwide, with the first one set up in the Netherlands 20 years ago. FAMILIAR ROUTINES PROVIDE COMFORT The aim of these dementia villages is to blur the lines between home-like comfort and high-quality care, offering residents a dignified and fulfilling living environment, according to Perennial. The 43,000 sq m facility – roughly the size of six football fields – features spaces that replicate familiar settings like a bus stop, an activity centre, a post office, a hair salon and shops. This design allows residents to move about freely, while being monitored for their safety by cameras and facial recognition technology. Trained staff role-play as post office workers or neighbours to offer a sense of community. A supermarket-like space is designed for residents to shop with play money, giving them a sense of independence. One resident who has benefited from this environment is Madam Wang Lai Fei, who suffers from moderate Alzheimer's disease. The 76-year-old used to stay at home after her diagnosis. But her family struggled with her care, including incidents where she got lost. Her daughter-in-law Lu Jing told CNA: 'We had a nanny at home before, but she was unable to watch her all the time. We couldn't manage either and she got lost twice.' Looking for alternatives, Ms Lu and her husband decided to move Mdm Wang to the Perennial facility, which is conveniently located near their home. The senior is now taking music lessons, going for acupuncture and quick strolls at the park - activities that seemed impossible just six months ago. Despite costing more than the US$1,000 a month that Mdm Wang's son Mr Lu would have paid to hire a nanny, the family thinks it is a good decision. "Here, she eats and sleeps well, and her mental state is great. She's like a completely different, more energetic elderly lady. I think it's good,' said Ms Lu. Fees range from about US$1,200 to US$1,800 per month, depending on room type and level of care required for each resident. There are 700 beds across its eldercare complex, including at its nursing and rehabilitation hospitals. Perennial said it hopes to attract more Alzheimer's sufferers to live in the facility and aims to have about 100 residents by year-end. In the meantime, it is renting out rooms to tourists and visitors at US$60 a night, saying that it allows for positive interaction with its patients as it keeps them in touch with the outside world. "Our ramp-up and operations may take a little longer. There's a process of market cultivation, and we also need to identify our target customers,' added Dr Song Xiang Ying, vice dean of Perennial Alzheimer's Care Village Xi'an. Although experts say the effectiveness of such open-concept care facilities requires further research, the approach is still a step in the right direction. Dr Philip Yap, a senior consultant at Singapore's Khoo Teck Puat Hospital, noted that patients may experience agitation, restlessness, and a poor quality of life in an institutional and more healthcare-like medical care facility. "We want to then create spaces that would accommodate their routines and habits,' added Dr Yap, who is also chairman of social services agency Dementia Singapore. DEMAND FOR MORE CARE FACILITIES China has the world's highest number of Alzheimer's patients. Local media reported that nearly 17 million people suffer from dementia, including Alzheimer's disease - the most common type. Over 15 million of them are aged 60 and above. Early this year, authorities rolled out a national action plan to tackle this issue by increasing dedicated care services. By 2030, half of all eldercare facilities in China with more than 100 beds are expected to have dedicated dementia care units. Authorities also hope to train 15 million caregivers to work in the sector. Dr Song noted that the care village received incentives from the local government. 'At present there are two options. If we build a new facility, it's 10,000 yuan (US$1,400) per bed; for renovating an existing one, it's 5,000 yuan per bed,' she said. Dr Song added that the operating subsidy comes with certain conditions. 'We need to operate for a specified period and reach a certain occupancy rate in order to be eligible for it,' she said.
CNA
14 hours ago
- CNA
Menopause in the workplace: Is your company doing enough to support you through this transition?
If you've been struggling with menopause symptoms while at work, you're not alone. A recent study found that, in Singapore, 74 per cent of female employees (aged 45 years and older) experiencing at least two menopause-related symptoms reported that it interfered with their ability to do their job and diminished their quality of life. The results of the study were released in a White Paper by the NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE) at the National University of Singapore's Yong Loo Lin School of Medicine, and HeyVenus Integrated Healthscience, a women's health technology company. It is the first regional White Paper on menopause at work, with more than 1,700 participants from five countries – Japan, Australia, Vietnam, Indonesia and Singapore. The findings, presented in April, reveal the impact that menopause has on women's work and careers in the Asia-Pacific region. In Singapore, 66 per cent of women said that social stigma prevents them from openly discussing menopause symptoms – and seeking support in the workplace. One respondent said: 'I would like to talk about it. At the moment, it is not even acknowledged', while another hoped 'for managers to be understanding and considerate to those experiencing severe symptoms and help with timetable adjustments'. The White Paper also found that, locally, 71 per cent of female employees and 68 per cent of people managers say a menopause-friendly policy would benefit the organisation. However, only 31 per cent of companies have such policies in place. Christina Ang, founder and CEO of HeyVenus Integrated Healthscience, said that when unmanaged, menopause symptoms like fatigue, brain fog and anxiety can undermine performance, confidence and career progression. 'According to our APAC White Paper, over 50 per cent of women in Singapore who report that menopause symptoms affect their quality of life and work are in middle to senior leadership roles,' she told CNA Women. 'Yet most women don't speak up – 63 per cent report productivity loss due to symptoms but few seek support due to stigma or fear of being misunderstood.' This silent strain widens the gender gap in leadership by increasing absenteeism, contributing to talent attrition and disrupting succession planning, she added. In an ageing workforce, this is no longer just a women's issue – it's a structural leadership challenge. A SHIFT IN HEALTH CONVERSATIONS AT WORK In 2019, KK Women's and Children's Hospital (KKH) co-authored a local qualitative study involving perimenopausal women aged between 47 and 54 years, seen at the hospital, with the aim to increase the understanding of the experiences and needs of perimenopausal women with symptoms. 'Some women shared that they received good support from their employers, while others felt constricted by the nature of their work due to the gender bias placed against them,' said Associate Professor Rukshini Puvanendran, head and senior consultant, Family Medicine Service, KKH. 'While women hoped for better support, they did not expect it given the nature of Singapore's busy lifestyle.' Assoc Prof Rukshini, who is also co-director of KK Menopause Centre, said that, with more women in the workplace and rising retirement age, menopause-related health information in the workplace deserves more attention. Audrey Neo, senior partner at Page Executive, which specialises in human resources and consumer executive search, spoke with clients and industry leaders to gather views on the impact of menopause on the workplace. Menopause has long been a taboo subject in many cultures, including Singapore, and is not commonly discussed in the professional setting, she said. It can also be awkward to be singled out that one is going through menopause. 'However, as we move forward from the pandemic, there has been a noticeable shift in how we approach conversations around health and well-being at work,' said Neo. 'Singapore is becoming increasingly progressive in addressing topics once considered off-limits.' She cited the fact that Singapore's median age is rising. In 2000, the median age was around 34 years. In 2023, it was 42.7 years and is expected to hit 53years by 2050. 'Organisations will need to recognise the needs of employees in their forties and fifties, and hormonal shifts will be a health and wellness consideration and starting point,' said Neo. 'In the broader scheme of things, hormonal shifts affect men too, albeit differently, making this a conversation for everyone to empathise and participate in a safe environment. 'Additionally, framed within the broader context of diversity and inclusion, what kind of wellness practices that organisations incorporate to support employees going through hormonal shifts could be a good starting point to raise awareness on this front.' WORKPLACE MENOPAUSE SUPPPORT IS SMART BUSINESS Two women CNA Women spoke to shared how menopause symptoms affected them at work. Juanita Mega, 54, recalled two occasions in her previous job two years ago when she suddenly had heavy menstrual flow while in the office, resulting in her skirt being badly stained. Two of her colleagues saw what had happened and even though they were supportive, Mega felt embarrassed. 'Luckily, I had a shawl to cover up but I had to rush home to change, cancel face-to-face meetings and give an excuse about a family emergency,' she said. Mega also had other perimenopause symptoms – heart palpitations, night sweats and sleepless nights – and often had to rely on caffeine to perk her up in the mornings. Hazleen Ahmad, 53, experienced menopause symptoms such as brain fog, hot flashes and night sweats. It was while going through menopause that she was also diagnosed with attention deficit hyperactivity disorder (ADHD). Hazleen, who is deputy CEO of the Institute of Neurodiversity Global and president/chair of the Institute of Neurodiversity Singapore, said that 'the workplace of tomorrow must recognise that neuro developmental differences like ADHD and menopause aren't just medical issues – they're part of the rich tapestry of human experience'. Some companies in Singapore do offer menopause support. Standard Chartered expanded its medical coverage in 2023 to include treatment for menopause-related symptoms. It also has menopause toolkits, offers counselling support and organises talks for staff. HSBC Singapore also offers coverage for medical consultation and treatment of menopause. At S&P Global, a ratings and financial information provider, employees going through menopause can access an on-demand online education resource, a spokesperson told CNA Women. A Managing Menopause Toolkit is available to all employees and flexible work arrangements are on offer, including adjusted working hours and work-from-home options. There are also colleague-led support communities, to get together virtually or in person to share experiences and advice in a safe and supportive space. Dr Claudine Hyatt, a clinical psychologist and traumatologist, and a partner at mental wellbeing agency Cognitive Approach to Life Management (CALM) International, revealed that companies supporting women through menopause are not only compassionate – it's smart business. 'Midlife women are often at the peak of their professional expertise; failure to support them risks losing key institutional knowledge and leadership potential,' she said. 'Addressing menopause bridges a critical gap in gender-inclusive workplace policy – just as how maternity leave became standard, menopause support is the next frontier in fair workplace design,' she added. Dr Hyatt said that companies that prioritise women's health signal that they are forward-thinking and inclusive. And employees who feel seen and supported are more loyal, engaged and motivated. 'A workplace that supports women through menopause is a workplace that values longevity, equity and wellbeing. It's not just good ethics – it's good economics,' she said.
Straits Times
3 days ago
- Straits Times
Allergic reaction aboard SIA flight: What major airlines do to guard against triggering allergies
SINGAPORE – A Singapore Airlines flight was forced to make an emergency landing in October 2024 after a passenger suffered a severe shellfish allergy on board and had to be rushed to hospital. Dr Doreen Benary, 41, a resident of Manhattan, was flying from Frankfurt to New York City when she 'fell violently ill' after allegedly being served a meal containing shrimp. The plane was diverted to Paris, France. Dr Benary, a paediatrician, was rushed to hospital and then a second medical facility, where she underwent 'painful emergency treatment', according to court documents. She is suing the airline for negligence, claiming that she had warned flight attendants about the severity of her allergy – specifically, to shrimp. The incident, she said, caused her 'great pain, agony and mental anguish'. This is not SIA's first incident with an allergy mid-air. In 2017, a toddler went into anaphylactic shock and started vomiting when too many passengers around him started eating in-flight peanut snacks. The drug epinephrine is the first-line treatment in cases of anaphylaxis or severe allergic reactions. However, under United States Federal Aviation Administration requirements, for instance, easy-to-use auto-injector EpiPens are not required in on-board first aid kits. Some airlines carry epinephrine, but a trained medical professional is required to administer the correct dosage. Most airlines declare that allergen-free environments on board cannot be guaranteed, but several accommodations for passengers with dietary restrictions are offered. The Straits Times rounds up the practices of several major full-service airlines to guard against food allergies: 1. Singapore Airlines Since the 2017 incident, SIA no longer serves peanuts as snacks on flights. It still, however, serves other nuts like cashews and almonds, and signature local meals, like nasi lemak and satay, still contain peanuts. SIA recommends passengers refer to the in-flight menu page, which can be viewed up to eight days before the flight, although not all ingredients and allergens are listed. Alternatively, specific special meals, such as gluten-intolerant (no wheat, rye, barley, and bran in any form), seafood-free or a general allergen-free meal, can be selected at least 24 to 56 hours before flight departure, depending on the destination. 2. Cathay Pacific Hong Kong-based Cathay Pacific offers complimentary nut packets as a snack on flights. Passengers with nut allergies can request nut-free snacks, subject to availability, by submitting a physician's statement declaring their nut allergy via a form on its website. Although special dietary meals can be requested up to 24 hours before flying, Cathay Pacific does not offer meals suitable for certain common allergies such as gluten and dairy, and offer only 'gluten-intolerant' and 'low-lactose' meals respectively. Cathay Pacific suggests that passengers with severe allergies bring their own meals on board, wear a medical alert bracelet and carry an EpiPen that can be administered by their travel companion. Additionally, for added safety, they may request for priority boarding to wipe down their seat before the flight. 3. ANA For international flights, Japan's All Nippon Airways (ANA) is one of the few airlines that offer both an 'eight allergen-free meal' and a '28 allergen-free meal'. The eight allergen-free option excludes eight major allergens such as shellfish, eggs and tree nuts, as defined by Japanese food safety guidelines. The 28 allergen-free option goes a step further by excluding 20 additional allergens such as specific fruits, other meats, and gelatin. These meals are prepared in separate facilities to minimise the risk of cross-contamination, and must be requested 24 hours to eight days in advance before departure. ANA also offers an allergy buffer zone, or a designated area created around the passenger to minimise the risk of exposure to severe allergens. This must be requested, by phone, at least 48 hours before departure. 4. Qantas Australian carrier Qantas says it no longer offers peanuts as bar snacks on both flights and lounges and is minimising the use of peanut-based products in their meals. Other nut products are still served. It offers a gluten- and lactose-intolerant special meal service that can be requested up to 24 hours before departure. However, following 2024 changes to the in-flight menu, only the gluten-intolerant option is nut-free; Qantas does not offer allergy-specific meal options such as nut-free, dairy-free, or seafood-free meals. Travellers who bring their own meals cannot store or reheat them on board due to contamination concerns. 5. Emirates Emirates serves nuts on all flights, either as a meal ingredient or as an accompaniment to drinks. Special meals like gluten-friendly and low-lactose options can be requested at least 24 hours before departure. However, Emirates does not offer allergy-specific meals such as 'nut-free', 'dairy-free', or 'seafood-free' options. Those with severe allergies are encouraged to bring their own meals on board. That said, Emirates does not provide refrigeration or reheating. The airline advises passengers to bring their own medications, such as EpiPens, and to consult a doctor before flying. 6. Qatar Airways Doha-based Qatar Airways does not offer nut-free meals, and serves both peanuts and tree nuts on board. Those with severe allergies must submit a medical form at least 48 hours and no more than seven days before departure. Approved requests may result in a general announcement or seating accommodations, but these are not guaranteed. Customers who do not submit the form to disclose their allergies and instead declare it at check-in or on board the flight may be denied boarding due to safety considerations. These passengers will be required to sign a waiver before boarding. Qatar offers gluten-free and non-lactose special meals, which need to be requested at least 24 hours before departure. However, passengers with severe allergies are advised to bring their own food and necessary medication. While seafood-free meals are not explicitly offered, several vegetarian options can be chosen instead. 7. British Airways British Airways asks that passengers notify staff about any food allergy so they can inform passengers of any allergens contained in meals. In some instances, this information may also be available on the meal packaging. Its in-flight meals do not contain peanuts or peanut products, but may contain other nuts. Passengers with nut allergies can request the cabin crew to make an announcement, asking nearby passengers to refrain from eating nuts. BA offers a range of special meals, such as gluten-free, low-lactose and vegetarian for those sensitive to seafood. These need to be booked at least 48 hours in advance, or 24 hours if departing from London's Heathrow Airport – its main base. While there is no formal buffer zone or cleaning protocol, passengers with allergies are welcome to board early to wipe down their seating area. Carrying an EpiPen and bringing one's own food is strongly advised, though BA will not reheat personal meals. 8. Lufthansa German airline Lufthansa does not typically serve peanuts on its flights. It offers several special meal options, such as gluten- and lactose-intolerant, as well as vegetarian for those allergic to seafood. These special meals need to be requested at least 24 hours before departure and are generally offered only on longer-haul flights. In the event of severe allergic reactions during a flight, the airline states that its trained cabin crew are always equipped to provide emergency medical care. 9. Delta Airlines Delta from the US offers a formal allergy accommodation process through its Accessibility Service Request form. Although the cabin is not completely nut-free, if notified of a peanut allergy, the crew will refrain from serving peanut products during the flight. For food, animal or other allergies, passengers can board early to wipe down their seat area, or request a seat change. Other special meals, like gluten-free and diabetic-friendly meals, can be ordered at least 24 hours before departure, but allergy-specific meals are not available. Travellers are encouraged to bring their own food and carry necessary medication, including EpiPens. 10. United Airlines United does not serve peanuts in its meals or snacks. Passengers with severe food allergies are advised to notify a flight attendant, who can then ask nearby passengers to avoid consuming foods that may contain allergens. Special meals include vegan, gluten-friendly, kosher (food that adheres to Jewish dietary laws) and Asian vegetarian. They can be requested up to 24 hours before departure but are limited and not guaranteed on every flight. Passengers may also request to board early and wipe down their seat. Join ST's WhatsApp Channel and get the latest news and must-reads.
