You can listen to Episode S311 right here!
Lori Pinkerton-Rolet
Hello, and welcome to the Third Age Design podcast, sharing essential information on senior environments. I’m Lori Pinkerton-Rolet. And this month, we continue our review of the World Series of design, where we’ll be speaking with the head of medicine, and a specialist in neurodegenerative disorders, about a unique village in France, where every resident has dementia, and how they’ve used light and dark to maintain levels of independence seldom found elsewhere. In fact, this development is so innovative, that it’s both our key interview and our innovation spotlight rolled into one. Albert Einstein so beautifully portrayed by Tom Conti. In the recent film, Oppenheimer said, well, not in the film, mind you, but set Anyway, do not grow old, no matter how long you live, never cease to stand like curious children before the great mystery into which we are born. And so very much as a mystery. And the third age design and this podcast are here to provide you with research which unpicks new concepts and innovations that we can all use to improve senior living environments in our own countries. And if you haven’t already, why not go to our website at ThirdAge.Design and hit the Join Us button. You’ll automatically receive this quarters a TAD Extra exclusive information for our community members. And this quarter. It’s priceless. As we share an interview with the husband of a resident at the French village we’re about to feature on today’s episode. Let me just say you will be moved. Okay, let’s get started. According to the World Alzheimer’s report 2023 published by Alzheimer’s disease International. The World Health Organisation estimates that 1 billion people were over the age of 60 in 2020, and that this age category will double to 2.1 billion people by 2052 thirds of whom will be living in lower and middle income countries. Now the number of people living in dementia across the world is expected to rise from 55 million which was back in 2019 to 139 million by 2050. And remember, two thirds of these people will be living in lower and middle income countries, the current models of dementia care are really unlikely to be sufficient. So let’s look at a new model right now. Which took its starting point from the Hogewyck Village in the Netherlands, but then went in a totally new direction. My guest today is Gaëlle Marie-Bailleul, the aforementioned head of medicine at le village Landais, located in Dax in southwestern France, and this is the village where residents tend to the gardens they check on the donkeys there’s no cash or prices in the village supermarket and where staff walk among the residents without any clear identification, and where extensive research is underway. As to how living a life of, well, freedom in a safe environment is being tested against medication levels, depression and anxiety. Our interview today was assisted by translator Anita Herbert and former US public radio announcer, Valerie Adler, was integral to the interview and will be speaking Gaëlle’s answers for us in English. Just remember, the transcript is available in 13 languages on our website at www.Third Age Dot Design. Gaëlle, we understand that the creation of the village was inspired by Hovik village in the Netherlands. And it’s a project that very many people know about. But I read that you wanted to push the notion of autonomy even further and to examine your results with a very scientific approach. So could you expand on that for us?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
In fact, at the moment, there are only around 10 such villages in the world, but they are not all the same size and do not have the same number or type of residence, or even the same approach to care. And no one had really done research on this type of project. So when we talk about autonomy, it is really more around the notion of freedom of movement for residents who are at liberty to come and go at their own pace according to their needs and desires.
Lori Pinkerton-Rolet
And can you talk about what is most important to consider when you’re trying to find the balance between safety and autonomy?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
We think in terms of securing, rather than security. It’s a question of nuance. By this, I mean that it is necessary to keep people safe, but not to remove risk altogether, because there are always risks in performing activities that make us feel content, whether that is the risk of falling, cutting oneself, or eating something that is not okay to eat. Therefore, we try to give someone back his autonomy, the freedom to act as one wishes to the extent that one is able,
Lori Pinkerton-Rolet
I think it may be difficult to answer this, but how do you evaluate this? How do you correctly juggle between the two?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
All this will reveal itself as we look at our research, and we discuss what we see. The problem here is that the research time is different from the time of journalists or politicians, or even the time of caregivers, not everything comes at once and doing observational research takes time. By which I mean for two years, we will be watching the result of what we are doing, and then we will deliver our findings. And we’re not there yet.
Lori Pinkerton-Rolet
Thank you. And we do understand that the research is important part of what you do at the Village Landais, I found four things on your website that you are specifically studying as does the Landais Alzheimers village have a positive impact on people’s quality of life, their social participation and their health? Does it improve the quality of life at work for professionals that are working there? Is it based on a viable and reproducible model? And also, that the research programme also includes a medical economic study, which will evaluate the cost and effectiveness ratio of the project now, which to you is the most important bit of research that you’re carrying out at the moment?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
In fact, the village itself is the subject of research at the moment. And as much as there is an independent team, in fact, two independent teams who are observing our system, what is the village? What is our village? How do we work? There is a team from Inserm, from nearby Bordeaux and a second neuro psychology team. Professor Amieva has already done a lot of research on the elderly and other research in psycho sociology around caregiving. So all the questions you list are the questions that research will have to answer after at least two years of observation. So the positive impact or not on the quality of life, and on the four large groups of people who are observed….that is to say the villagers, the professionals, the volunteers and the family caregivers. So it’s quality of life, but also other things. That’s the main parameter, and the secondary parameters, mainly behavioural disorders and cognitive levels, and the socio economic survey, which will evaluate the cost effectiveness ratio.
Lori Pinkerton-Rolet
Thank you. And we understand that the village and its research are largely financed by public money. So in light of your results, so far, is the village considered a success by its funders? And are you confident that you’ll received continued funding?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
Village Landais is an experimental model? So we operate in this capacity, there is a five year renewal period. How will that work? The funds were given for the period of 2016 to 2021. And as we were only able to open in June 2020, we were renewed at that point with the same so called Experimental funds. And then in 2027, this period of experimentation will cease. And we will have to adopt a more typical model or create a new model for financing. So we are really waiting for results on the research since a priori it will be based on that, at least for the observational research, by which I mean how is this village this way of doing things where there are particular criteria for being a village actually reproducible? And for an organisation? Is it perhaps worth investing more initially, and maybe afterwards, we get other things out of it, even if the initial investment is more important in the short term. But maybe in the medium and long term, we land on our feet, as they say in France.
Lori Pinkerton-Rolet
Now, a specific objective at living large, long day is to reduce or even eliminate medications. How is that going?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
So we can say that this objective was established not so much by doctors, as by many people, perhaps by families because there was a great fear of psychotropic medications and also the possible overuse of this type of medication. I want to rectify that when we talk about reducing or eliminating medications. Firstly, people who have Alzheimer’s disease don’t just have Alzheimer’s disease. So I doubt that in the village, we will reduce blood pressure, diabetes or other pathologies, and these will always require the relevant types of medication. On the other hand, the fact that we always have physicians in the village – there are three – makes it possible to better prevent to be more quickly at the Add side of the villager, since we are always there, and therefore we can surely reduce the number of hospitalizations and reduce overmedication because of the expertise of the doctors who are here and through my specific psychogeriatric expertise to support the villagers and the team.
Lori Pinkerton-Rolet
So you’re moving towards the reduction of these psychotropic drugs while knowing that the rest must still be continued. So is that reduction actually happening? And with the reduction are behavioural problems of those affected more severe, are they more difficult to manage, in other words, in the absence of the psychotropic drugs, because those are after all a bit of a sedation?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
So when we talk about psychotropic medications, in fact, I’m speaking with my pure Doctor hat on, we use psychotropic medications in the face of behavioural disorders, which are very frequently added to with the pathology of Alzheimer’s disease. And so in fact, we use symptomatic medications, that is to say, in the face of a delusional idea, when it is too significant or when it has too great an intensity or frequency, we use these medications to reduce the impact that it has for both a villager and for those around him. So if we want to reduce these psychotropic medications, we have to prevent these behavioural disorders. So the whole idea is to say that with a different more humane system, we will be able to reduce these behavioural disorders and therefore manage to reduce the psychotropic medications. It’s an avalanche of things. In fact,
Lori Pinkerton-Rolet
yes, and of course, at Third Age design, that’s us. We’re interested in how your results can be linked to the principles of design and architecture, and also how a space is organised for things to work best for the residence. There are things that you already have in place for this, can you explain them.
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
So given the fact that it is a village established on five hectares, what is very important for me really is the freedom to come and go. These five hectares are wooded, with plants that already existed before and it is entirely secured by a barrier, but one which is almost completely hidden by plants. And so one has the feeling of freedom and of going where and when one wants. That is very important because it reduces constraints. When someone who already feels constrained and diminished, and prevented by their illness from being able to do this or that thing. Well, if we add more constraints, it will increase their behavioural problems. This park is for people in addition to the villagers who were used to being outside, because in the Lande, we’re often outside due to the weather. But also these are people, many of them from agricultural backgrounds, who were often outside and who had a relationship with nature, which is important for them. Regarding possible disorientation in the space. What we tell them is it doesn’t matter if they don’t find their way back because there’s always a human being on the path to take them home. Whether it’s a villager, a volunteer or a professional, they will always find someone in the park. Knowing that between each neighbourhood there is a path that is clearer which in general, they do not leave because it’s much lighter than the rest of the natural surrounding, which is green are lined with pine trees.
Lori Pinkerton-Rolet
On the website for Village Landais I saw, just for a second, a fences at the side of a lake, but really nothing else. It’s all just open space. And I could also see the use of different colours in different areas.
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
Indeed, the fence is much more visible when you cross the bridge, since you can cross from one side of the village to the other above the three small ponds. And so that’s really where it can be seen. It’s 1.8 metres high, even where it is in the green areas, we see it but when we traverse the park and we take the overall view, we hardly notice it. Now in relation to the colours of the neighbourhood, effectively, there are four districts and each district has a particular colour. It’s really more for those who still have the ability to remember their colour, the colour of their neighbourhood and to make a mnemonic device, but it’s not used so much by the villagers, as by their families.
Lori Pinkerton-Rolet
In the different neighbourhoods does the decor inside also differ.
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
So there are four neighbourhoods with four colours and in each neighbourhood there are four houses around a small square, and that makes a neighbourhood. The four houses each have a slightly different style of decoration, but which does not correspond to what was put forward and hug a bike in the Netherlands. It’s not based on differences in socio cultural level, it’s just a different decor.
Lori Pinkerton-Rolet
And do the residents learn their particular colours?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
This is the very principle of Alzheimer’s disease. It’s being unable to learn new things. So it’s difficult but for those who still have the capacity at the start, when they arrive, we put a small bracelet on them. We offer them a small bracelet the colour of their neighbourhood to help them remember to perhaps make a connection between the colour and where they live,
Lori Pinkerton-Rolet
How have dementia design principles been implemented in the planning of the village.
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
In fact, in conceptualising spaces, architects often avoid there being dark corners. Why? Because someone who has Alzheimer’s disease has difficulties not only with memory, but also at certain moments in the evolution of their disease disorders that we call visual spatial disorders. Black actually looks like emptiness like a void. But emptiness is scary. So if for example, there is a black square on the ground, because there was a hole and we filled it in with black, the person who has Alzheimer’s disease will try to walk around this black thing. There is something that is black or dark. So in fact, we use black or dark as a repellent. That is to say, in places where we don’t want people to go, we make them dark. In the village, you may have seen on the map that there is a central square called the bus deed. This is the name used in the lawn to refer to the Village Square. And there are arches, the arches are rather dark underneath, and so is the exit from the village. It’s more in the places where we want to avoid people finding their way and saying to themselves, I have to get out that way. So we use darkness to discourage them from going there. By contrast, we have to use light to attract people.
Lori Pinkerton-Rolet
So are there any specific facilities for visiting families on site? Is there a special room where people are received or where they could possibly spend the night
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
Families who come to see their loved ones have at their disposal nine studios, in which families who are from far away can, for a ridiculous price compared to a hotel, come for several days to visit. But in the village principle, we only welcome people with Alzheimer’s disease. It is not a place where we accommodate others. They can come visit sleep for a few nights, but they can’t live there.
Lori Pinkerton-Rolet
You also have a brasserie, grocery store, media library, a hairdresser, how did you decide which facilities to include?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
These places were designed for specific people, the media library and the auditorium or third party places. That is to say places where with two separate entrances, villagers will be able to go but also people from outside the village, they’ll be able to meet the health centres private and is within the village walls. The Brasserie and the hairdresser are places that can be open to both families and villagers. And on the other hand, the grocery store is a place that is only for villagers. Because it is not a real grocery store. There is no exchange of money. It’s more like a pantry where every day the villagers go shopping with their shopping list to find what is needed at home to be able to make the meal, but there is no exchange of money. So there is no one from outside coming to the grocery store.
Lori Pinkerton-Rolet
So you said that for the media library in the auditorium, the villagers can go there through a different entrance do they go alone.
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
For time in the media library, the villages are accompanied either by their family or by a facilitator. This will be for an activity that is taking place at a given time. As for the auditorium, we don’t go there unless there is a show a film screening. So there is always someone able to accompany them. The villagers that we welcome mostly have an illness that is moderate, moderately severe to severe. Here, there are very few who are at the beginning of their illness who could go completely on their own.
Lori Pinkerton-Rolet
I think I read that you intend to open the restaurant to the public has that already happened?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
Not yet, not totally. Currently, the brasserie is open mainly to families and all visitors who come and volunteers. But for the moment, there are no people from the city, for example, who come to eat here. This requires an amount of logistical organisation which is much larger than a simple retirement home would need to employ. So you have to imagine things differently.
Lori Pinkerton-Rolet
And what are the advantages of doing that?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
The main idea is to change the way people think about Alzheimer’s disease. So we open up and let people live together with the problems surrounding the opening of the village to the public is an ethical question. Because indeed, we must, must respect the private lives of the villagers and their families. It’s not a place where outsiders can come to just look. But we are trying to change the outlook of the entire population related to this disease, to give an understanding of what is needed in terms of support and environment.
Lori Pinkerton-Rolet
So the idea is less for the people living with Alzheimer’s and more for the people who aren’t…
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
Both. For this type of change, it’s for both, yes.
Lori Pinkerton-Rolet
Please can you tell our listeners how the resident’s spaces are furnished?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
People bring their own furniture all from home. In the room there is only the bed which is a so called Alzheimer’s bed, which goes to the lowest position designed especially for people who have Alzheimer’s disease. Otherwise everything else is brought by them…an armchair, a wardrobe. This creates the framework to build as much of a familiar environment as possible, and creates a sense of security.
Lori Pinkerton-Rolet
Finally, if we’re talking about the future of senior living environments for people with dementia, what do you think is the most important thing to remember?
GAËLLE MARIE-BAILLEUL (VOICEOVER VALERIE ADLER)
For me, the most important thing is the freedom to come and go as few constraints as possible. And this idea that we call this positive benevolence, that is to say creating a kind environment, one that empowers people to enjoy nature as they wish, without anguish, to have their world and our world interact in the best possible way.
Lori Pinkerton-Rolet
This has been so very interesting and helpful. Gaëlle, thank you so much for joining us on the podcast. And you’ll find links to the Village Landais and the world Alzheimer’s report 2023 on the podcast page for this episode at www.thirdage.design. We’ll be back to our usual format for next month, including the innovation spotlight, when we will look at a unique approach to senior loneliness from the United Kingdom. And of course, our review of the TAD international events calendar for 2024. Also, our World Series of design will continue as we examine the burning question, when is a cruise ship not a cruise ship? Well, when it’s a US based and landlocked, independent living and assisted living facility, Thank you to today’s special guest, Gaëlle Marie-Bailleul, of the Village Landais, to Anita Herbert for her input and translation skills, to Valerie Adler, of The Right Website, who recorded the English translation of Gail’s answers and to our producer Mike Scales, who had a lot more editing this month. And finally to you for joining us. I’m Lori Pinkerton-Rolet, and I do hope you’ll join me for the next one.