An insight into dementia villages

A dementia village in Berlin

A new report gives an encouraging insight into the benefits of residential villages specially designed for those with Alzheimer’s and other forms of dementia, benefits that outweigh those of traditional nursing homes.

The report follows the recent positive news about trials into a drug capable of slowing cognitive decline. Now comes information from the Bloomberg Media Company describing much better community environments for dementia patients. It’s all good news at a time when developing better ideas is imperative as the number of people suffering various types of cognitive disease are predicted to triple over the next 30 years. That would mean an increase to 150 thousand in Portugal and 150 million worldwide.

The residential villages are small, enclosed and safe with public spaces to allow those with dementia, their families and friends, professional workers and volunteers to mix freely and enjoy a relatively high quality of life. Such villages have been built in parts of Europe and as far afield as Japan and New Zealand.

“The concept is resonating as societies grapple with aging populations, with rising fundamental questions about what care for Alzheimer’s and other degenerative disorders should look like, and whether the traditional nursing home model is outdated,” according to the Bloomberg report.

It quotes Jannette Spiering, one of the founders of the village idea first convened in the Netherlands: “We said, what do we have to change to make this more of a home? How could we create a community where you can go on with your own life?”  

The Netherlands project, located in Amsterdam, has about 160 inhabitants divided into various groups housed in 23 personalised residences.

In Japan, elderly people already make up almost a third of the population, compared to almost a quarter in Portugal. Japan has been working to ensure those with dementia can stay at home for as long as possible by training more social workers and others to personally engage with those with the disease, but the village concept takes that further by recreating the real world within safely enclosed spaces.

Those living in small village communities may be able to join together in pairs or small groups in doing some everyday things. In New Zealand, for example, the six or seven residents sharing individual rooms in a house can, with help if necessary, make shopping lists, wash clothes, go for walks, do a little gardening or just sit quietly chatting in the village square.

Research is being conducted in a village in the south of France into which safe but open liberties can lessen some dementia symptoms and, if so, how. If researchers succeed in showing that the holistic approach can slow cognitive decline, it could lead to a different approach for dementia care at a time when much of the medical profession and many members of the public have pinned their hopes  - and financial investments – on new but so far moderately effective medication.

People in the French pilot project, launched in the middle of the COVID pandemic, can stroll or be pushed in wheelchairs down walkways and under vaulted arches, stopping to chat with other residents or welcome visitors outside a supermarket, play scrabble outside a cafe, engage in an exercise class on park benches or have a haircut in the local salon.

“Here you are making people better, not by giving them medication, but simply because the environment is nicer,” says Paola Barbarino, CEO of Alzheimer’s Disease International, an umbrella organisation with no financial ties to any of the villages. 

Not everyone is happy with the village concept. The main criticism is that residents are trapped in a make-believe environment. Nor are the villages cheap to build, but proponents say they are less expensive to operate than nursing homes.

A French village with 120 residents could cost nearly €30 million to construct.  Building a nursing home in the same region with a similar number of beds would cost €10 million less. The maximum amount for village residents without any state or regional aid is about €2,000 a month. With subsidies it can be as low as €250 a month. A private room in a nursing home meanwhile would be about €9,000 a month, according to the international Alzheimer’s association.  

Alzheimer’s: reason for hope

Reports of a breakthrough in the treatment of Alzheimer’s have given hope to countless people close to the estimated 50 thousand people in Portugal and 50 million worldwide suffering from this disease.

There is still no cure for Alzheimer’s, the most common form of dementia. The latest reports refer to positive results from trials conducted on a drug that can slow the early stages of the disease. It is being described as the first drug to provide a real treatment option for Alzheimer’s patients.

The scientific committee of the organisation Alzheimer’s Portugal immediately issued a statement saying, “this news encourages us, and all of those on the side of Alzheimer’s patients, because it is a positive step in the fight against the disease.”

The statement went on to summarise the trials and results so far as reported in the New England Journal of Medicine.

A drug called lecanemab has been shown to reduce patients’ overall mental decline by 27% over 18 months. This may seem modest after more than 20 years of research by many specialists to fund significant remedies, but the new therapy is already being hailed as “momentous” and the start of a new era of Alzheimer’s treatment.

“While the clinical benefits seem somewhat limited, it can be expected they will become more apparent over time," says Dr Bart De Strooper, director of the UK Dementia Research Institute at  University College London. “it’s such a win for our field,” says Dr Liana Apostolova, a neurologist at the Indiana University School of Medicine in Indianapolis.

“Quite promising” is among the less enthusiastic comments from some researchers who feel more analysis is required as lecanemab has been associated with bleeding and swelling in the brain. The drug has yet to be approved by regulatory authorities.

Alzheimer’s is increasingly common, mainly among the elderly. It is a major cause of death in some countries. Many patients die within seven years of contracting the disease.

 Memory loss is the most common early indication of Alzheimer’s. This is followed in time with confusion about familiar places and people, struggling with making sensible decisions and carrying out simple tasks. Family and friends have to step in to help as early as possible.

Alzheimer’s Portugal, founded in 1988, is a member of the Alzheimer’s Europe non-governmental organisation dedicated specifically to promoting the quality of life of people with dementia along with their families and carers. Their well-qualified volunteers are continually giving advice and practical help.

The scientific committee of Alzheimer’s Portugal concluded their statement by saying: “It is not yet the solution that will solve the problem of curing the disease, but it is a small and important step in that direction.” 

Meanwhile, on a much grander scale, specialist scientists are predicting that within the next few decades there could be a second cognitive revolution that could radically change the internal mental processes that drive human behaviour. The astonishing predictions include the notion that human brains will evolve in such a way that they may be able to hugely expand their power of thinking, producing “super humans” with a much extended and perhaps indefinite lifespan.

More on this later perhaps. For now let’s keep our feet on the ground and wish Alzheimer’s and other dementia patients well.

What next for Isabel dos Santos?

The enigmatic Isabel dos Santos, arguably the most famous and infamous person in modern Portuguese history, has certainly had her ups and downs. Life for her now seems to be at an all time low and it is difficult to see what she can do about it.

The incumbent government in her homeland, the former Portuguese colony of Angola, which was returned to power in the general election in August this year, wants to finally put her behind bars for alleged corruption on a grand scale. As in Angola, the Portuguese authorities have frozen all her assets in major companies here. The Netherlands has done the same. Her reputation in the United States is such that she has been banned from entering the country.

Things became all the more serious last week when Interpol issued a red notice asking global law enforcement agencies to locate and provisionally arrest her pending extradition, surrender or similar legal actions.

This 49-year-old widow with three children is believed to be living in exile in the United Arab Emirates, though sometimes making visits to Lisbon and London. She had managed the stakes in her Lisbon companies for 12 years before immediately closing all operations when her assets were frozen in June 2020.

It is claimed she is now hiding from justice. She insists she is not and points out that she has always turned up on time when requested for questioning by the government’s investigative lawyers in Lisbon. She believes she is being politically persecuted, the victim of  false conspiracy assertions.

Despite this, she declared she would consider running for president in Angola’s general election in August. “I want to serve my country,” she said from an undisclosed location in a video interview with the German news organisation Deutsche Welle. That was a strange statement as Angola is the one place above all others she needs to steer clear of as she would be arrested on arrival for allegedly causing vast losses for the oil producing yet economically struggling nation.

With dual citizenship in Angola and Russia, it might be possible for Isabel dos Santos to go to Russia as a last ditch place to live in exile and avoid arrest, trial and likely long-term imprisonment.

Born in the former Soviet Republic of Azerbaijan, Isabel was educated in England, opened a restaurant in Angola in her early twenties and went on to create a business empire as an investment entrepreneur, thus becoming Africa’s wealthiest woman with assets worth billions of dollars.

Her life was complicated at an early age when her father, former Angolan President José Eduardo dos Santos, divorced her Russian mother, Tatiana, in 2002. Her mother took Isobel to England to attend an all-girls school in Kent and later to complete an electrical engineering degree at King’s College, London. Her mother died in 2020.  Her father, who had met Tatiana while he was studying as a young man in Azerbaijan, went on to become Angola’s president and dictator from 1978 to 2017. He married again at least twice and Isobel was the eldest of his 10 children. Her husband died in the United Arab Emirates in 2020. Her father died in Spain in July this year.

She has repeatedly denied allegations of embezzlement and money laundering, including charges in 2020 that she and her husband had stashed a billion dollars worth of Angolan state funds into their own companies while her father was president. She claims this is all false information, conspiracy lies invented by and on behalf of her father’s successor, Joao Lourenco, who has served as president since 2017.

Much of Isobel dos Santos’ alleged criminal behaviour has been exposed by the International Consortium of Investigative Journalists (ICIJ) in their ‘Luanda Leaks’ and subsequent ‘Pandora Papers’ documents.

The total value of her frozen assets is not clear. Nor is how much she has left to live on. One thing is clear, however: money does not always buy happiness.

 

Climate crisis: who really cares?

Public opinion in Portugal is one small but very positive part of the extraordinary divergence of thinking around the world on the subject of climate change, which is complicating what the overwhelming majority of climate scientists regard as a looming crisis that could become calamitous.

A high percentage of people in Portugal – higher than in the big majority of other countries – believe the scientific evidence that global warming is due to human activity and that it is ‘very’ or ‘extremely’ worrying.

Opinions vary greatly in the United States, the world’s second biggest polluter of greenhouse gasses. A huge number of people in the U.S. don’t care about global warming and many don’t believe it’s a problem or even happening. A lot of this hinges on political ideology and the Christian religion, according to recent studies.

The Pew Research Centre, a think-tank based in Washington D.C., this month published the results of a comprehensive survey showing that a majority of Americans “appear sceptical” of climate scientists. No more than a third of the American public give climate scientists high marks for their understanding of climate change. Even fewer say climate scientists understand the best ways to address climate change.

Almost a quarter of all American Christians, including 38% of Protestant Evangelicals, do not think climate change is a serious problem or a problem at all, according to the PEW study.

Evangelicals are estimated to number about 100 million, not that far short of a third of the entire US population. Most are said to favour the conservative Republican policies.

A poll last year put the number of Catholic adults at 21% of the total U.S. population, but politically they are split evenly between Republicans and Democrats. They are also roughly split 50-50 on whether global warming is due to human activity, and if it is a serious problem or not. 

Non-religious Americans tend to support the liberal Democrats. Only 4% of atheists and 11% of Agnostics consider climate change an insignificant problem.

Overall, there are relatively few climate change doubters or deniers in Portugal, a largely Socialist country where the predominant religion, Catholicism, is declining a lot. The Portuguese are all too familiar with severe heat waves, wildfires, droughts and rising sea levels. So no wonder they accept the scientific evidence that global warming is happening long before the critical deadline limits of 2%C, if not 1.5%C, hoped for by 2050. 

The young in Portugal are among the least confused and most concerned groups in Europe, in part because of this country’s well-understood vulnerability. They have little or no truck with the misinformation being put about by religious groups and large fossil fuel entities whose profits are endangered by the scientific truth.

The London School of Economics and Science reports that the UK’s main club for climate change deniers, the Global Warming Policy Foundation, has continued to spread misinformation this year about the impacts of rising levels of greenhouse gasses in the atmosphere.

A scholarly analysis has concluded that climate scepticism in Germany is underreported and that denial percentages are actually as high as in the USA.

A number of other international studies have found a surprising spread of attitudes in different countries. For example, a survey conducted across G20 countries revealed that more than 90% of people in India, the third largest polluter after China and the USA, wanted to do more to protect nature and stymie the effects of climate change.

 Another study conducted this April showed that 21% of French respondents aged between 35 and 49 were climate sceptics, while 47% thought it “too late to reverse global warming.”

It emerged from a European Union survey this year that Norwegians are very sceptical and that only one in four believe global warming is caused by humans. This compares with eight in ten Italians who do believe humans are responsible.

The latest European Social Survey, an academically driven study conducted across Europe every two years, reports that there has been a particularly large increase in those who are seriously concerned about climate change in Sweden and Hungary. Italy and Spain rank very highly in this regard, but only in Portugal are more than 50% of people “very” or “extremely” worried, according to this survey.

World populations coming and going

 

The global population as of last Tuesday, according to the United Nations, reached 8 billion and is still rising. On the same day, Portugal’s population was said to have been 10,126,454 and falling.

 

United Nations statistics show that in 1950 the global population was only 2.6 billion.  In 2011 it had risen to 7 billion. It is predicted to reach 9.7 billion in 2050 and 11 billion in 2100, catastrophic climate change and wars permitting.

 

For now, 61% of the global population live in Asia, 17% in Africa, 10% in Europe, over 5% in South America and under 5% in North America.

 

China is the country with the largest population (1.4 billion), but India is expected to overtake it next year. Far behind are the United States, (332 million) Indonesia (276.5 million) and Brazil (214 million).

 

The former Portuguese colony of Angola in south-western Africa, with 34 million inhabitants, has the third fastest growing population in the world with 3.4% per year.

 

Germany is the most populated of the European Union’s 27 member states with well over 83 million. Portugal is by no means among the lowest in the EU and has numbers close to those in Sweden.

 

 Portugal’s population has shrunk by 2% in the last decade and it continues to decline because of the low birth rate and the high number of young people emigrating to other European and North American countries.

 

In 2020 the birth rate in Portugal was 1.40 per woman. So the birth rate has indeed been low and it has been low and declining in many other places too. The reasons are said to include women’s empowerment in education and the workforce, lower child mortality and the increased cost of raising children.

 

People are on the move, both inside and outside their country of birth. The number of people leaving Portugal of late has been about 80,000 a year. Most have been seeking further education or better economic opportunities. Similar reasons across the world have pushed people into moving from rural areas into cities. It is expected that 70% of the world’s population will live in cities by 2045.

 

They are plenty of advantages in living in large urban areas such as Lisbon and Porto with populations of 518,000 and 250,000 respectively, or in mega-cities such as New York with more than 8 million  inhabitants and London, with more than 9 million. One of the big disadvantages of many large urban areas is poor air quality and its impact on health.

 

Climate change, conflict and political instability are expected to cause much more international migration in the coming years.  The flood of refugees from Ukraine is likely to be replicated from African nations if they are made almost uninhabitable by extreme heat, drought and resulting desertification.

 

The relatively well-off foreigners who have moved to reside in Portugal have done so mainly because they are made welcome by friendly people in a peaceful and beautiful country with a Mediterranean climate featuring mild winters.

 

Expatriate residents here account for 6.4% of the total population with about 184,000 Brazilians and 46,000 British. Many foreigners in the last two years have come from a number of other EU countries as well as from Ukraine.

 

The percentage of people aged 65 and over in Portugal has been increasing and last year reached more than 23%. The elderly are becoming more numerous is in many countries as life expectancy rises. Life expectancy in Portugal has risen from about 60 in the mid-1950s to a little over 82 nowadays. This trend may continue globally, but it depends very much on overall human behaviour.

 

Because of such factors as man-made greenhouse gas emissions and violent conflicts, about 700 million people or 9% of the global population are estimated to be living in extreme poverty, that’s to say on less that €2 a day.

 

One of the worst affected places is the large island state of Madagascar situated off the east coast of Africa. People there have long been experiencing desperate hardship because of poor administration, droughts, insufficient irrigation and drinking water, crop failures and criminal gangs stealing cattle and commodities.

 

According to the UN’s World Food Programme, as of the middle of last month 8.8 million people across Madagascar (about 33% of the entire population) are suffering from acute food shortages. That’s one million more than just three months ago. Further deterioration is expected between next month and March next year when two million more people are likely to be going hungry.

 

In his book Origins, a deeply detailed account of the evolution of all species of life from geological, paleontological and biological perspectives, Frank H.T. Rhodes concludes “A single species – ours - now has the capacity to influence or disrupt not only the natural rhythm, distribution and future patterns of life on Earth, but even its survival. In the billions of years on the planet that is a unique and sobering capacity.”

 

As far back as 1929, between the First and Second World Wars, the neurologist and founder of psychoanalysis, Sigmund Freud, wrote at the end of his book Civilisation and its Discontents: “The fateful question for the human species seems to me to be whether and to what extent their cultural development will succeed in mastering the disturbance in their communal life by the human instinct of aggression and self destruction.... Men have gained control over the forces of nature to such an extent that with their help they would have no difficulty in exterminating one another to the last man.”

 

That is as true now as it was then.  

 

 

 

The Lord Lucan mystery deepens

Almost half a century after the mysterious disappearance of John Bingham, the 7^th Earl of Lucan, best known as Lord Lucan, two new pieces of intriguing information have emerged about his presence in the Algarve.

He is said to have vanished without trace in November 1974, the day after he allegedly killed his children’s nanny and brutally attacked his estranged wife with an iron bar in his home in Belgravia, central London.

The crimes were investigated by London’s Metropolitan Police who then held a cold case review in 2004, the findings of which had never been made public until some details were published last week by the Daily Mail.

The Met had apparently tracked down and interviewed a woman who claimed she had seen Lord Lucan at a party in the Algarve just weeks after his disappearance.

If indeed Lord Lucan was in the Algarve in late 1974, this would have been the first and only sighting of him anywhere after his alleged crimes against the nanny, Sandra Rivett and his estranged wife, Veronica.

What we know for sure, as we revealed in 2017, is that Lord Lucan made a very private visit to the Algarve with his three children the summer before the violence in his Belgravia home.

The 1973 visit was confirmed by Lord Lucan’s wife, who believed he had committed suicide after the attacks. Lady Lucan, then officially entitled the Dowager Countess of Lucan, told me: “My late husband visited the Algarve with our three children, but I know nothing more about the visit.”

Lord Lucan’s presence in 1973 was confirmed in some detail by the person who arranged his visit, Liz Brewer, the former debutante who, after starting her business career in the Algarve in the 1960s, became an internationally renowned organiser of social events involving famous personalities.  She arranged Lord Lucan’s visit with the London-based Algarve Agency run by her then partner Neville Roberts. Lord Lucan, known to friends as ‘Lucky’, used to frequently walk past the agency’s office on his way to the Claremont Club, a top gambling venue owned by one of his best friends, John Aspinall.  

Very few people had known of Lord Lucan’s visit in 1973 until Liz Brewer revealed in 2017 that he had stayed for a few weeks with another of his best friends, Bill Shand-Kydd, Bill’s wife Christina and their two children, in their large holiday home located between Albufeira and Quinta do Saudade.

Liz Brewer said she spent much time showing Lord Lucan around Algarve beauty spots, including some of its loveliest beaches. She found him a very personable man.

Just recently, Liz Brewer recalled that another very famous person stayed with the Shand-Kydds at the same time as Lord Lucan. It was Diana Spencer, a distant relative of Christina who was a sister of Veronica. Diana, who came to the Algarve with her younger brother, turned 12 that summer. It was eight years before she married Prince Charles, now King Charles lll.

Lord Lucan’s visit was said to have been a special birthday visit, but it is not clear whose birthday was being celebrated. Diana’s birthday was on July 1. Christina’s was on August 3. Perhaps the celebratory visit was for both.

That aside, Liz Brewer was not surprised by the claim that a woman, who has not been named, saw Lucan at a party in the Algarve in 1974.  She rejects the allegation that he killed the nanny and battered his wife. She does not believe the popular theory that he committed suicide by jumping off a ferry into the English Channel. She thinks it quite plausible that with the help of some of his many wealthy friends and his knowledge of the Algarve, he came here and then made his way to Africa. Portugal and its former African colony, Angola, were in turmoil in 1974, the year of the ‘Carnation Revolution’.

Liz Brewer and others, including Lord Lucan’s younger brother, Hugh Bingham, said it might have been relatively easy for Lord Lucan to move to Morocco and then head south to live a new life, perhaps in one of the homes in South Africa owned by friends. 

Hugh Bingham, who died in South Africa in 2018, believed his brother probably first fled to Portugal because he had little chance of a fair trial in England. 

Unsubstantiated sightings of Lord Lucan have been reported from as far apart as Ireland, Australia and New Zealand. The latest claim that at the age of 98 he is still living in Australia as a Buddhist monk seems unlikely. While one facial recognition expert has little doubt, most analysts reject the notion.  

So the Lord Lucan mystery, like that of Madeleine McCann, remains unsolved, at least until a sure sighting or other evidence emerges.   

 

 

 

Brazil to help with the climate crisis

Brazilians in Portugal, the largest expatriate population here, may still have mixed feelings about the narrow victory in the presidential election back home, but Portuguese Prime Minister Antonio Costa and most of the delegates now in Egypt for the United Nations COP 27 climate summit are pleased at the outcome.

President-elect Luiz Inacio Lula da Silva, popularly known as Lula, has promised to help save the Amazon rainforest, which the far-right incumbent President Jair Bolsonaro has allowed to badly deteriorate. Almost a million square kilometres of the rainforest have gone. That’s about a fifth of its original forested area.

Apart from providing home to a vast number of different species of life, the trees of the Amazon help stabilise the climate by releasing 20 billion tonnes of water into the atmosphere each day. This plays a key role in carbon and oxygen cycles.

Brazil has an outsized influence on the climate in that degradation of the rainforest means that it is liable to release huge amounts of carbon dioxide, the primary greenhouse gas emitted. The Amazon stores enough carbon, which, if fully released, would be equivalent to an estimated 730 billion metric tonnes of carbon dioxide. That’s enough to account for 20-years of global emissions at current rates.

“Brazil is ready to resume its leading role in the fight against the climate crisis, protecting all our biodiversity, especially the Amazon forest,” the centre-left Lula, has said.

Bloomberg Green, a leading journalistic outlet on climate change, notes that Bolsonaro has significantly undermined environmental regulations and accelerated the destruction of the Amazon in large part by allowing illegal deforestation for cattle ranching, mining and other business purposes. Greenhouse gas emissions have risen in tandem

It remains to be seen what Lula will be able to accomplish when he officially takes up the presidency on 1^st January, but climate advocates certainly see his election as a move in a better direction.

“This election was huge for the future of the planet and for the future of the Amazon. No question,” said Samantha Gross, director of the Energy Security and Climate Initiative at the non-profit Brookings Institution based in Washington D.C.

If the planet gets too hot, the world largest rainforest in the Amazon will be an extraordinary tipping point, vulnerable to unstoppable conversion from forest to savannah through a process called ‘dieback’, ‘according to a recent paper in the journal Science.

Accelerated deforestation could trigger sooner rather than later a tipping point that releases countless and calamitous quantities of that stored carbon.

Lula is about to update his country’s intended contribution to the formal climate pledges made during the landmark COP 21 Paris Agreement signed by 196 countries in 2015.

President Joe Biden and 17 other top-level United States officials are attending COP 27, a clear indication that the world’s biggest greenhouse gas emitter is going to do more this time than simply make pledges it fails to honour.

United Nations Secretary-General and former Portuguese Prime Minister Antonio Guterres has said that rich nations must sign an “historic pact” with poor countries over the consequences of global warming or “we will be doomed”.

Meanwhile, the 40,000 heads of state, government ministers, executives, scientists and activists in deep discussions in Sharm El Sheik will be engulfed in feelings ranging all the way from fatalism to guarded optimism.