Max Winters
I attended a conference recently where a panel of senior living CEOs were discussing the future of residential memory care. To no one's surprise, the question of affordability came up very quickly, and the consensus was that residential memory care has become a luxury that few people will ever be able to afford. One of the panelists elaborated on the effects of this disparity by giving the example of how premium status with their credit card company guarantees them a live person when calling customer service, rather than an automated system. Then, they went on to make one of the most alarming statements I have heard in my professional life: 'In the future, memory care will be like this. Human interaction will be a luxury, and those who can't afford it will have to settle for automated or virtual interactions.' While their prediction may be more correct than we are willing to admit, we have a responsibility to those around us living with dementia (now and in the future) to make sure we do not go gentle into that automated night.
Now more than ever, we know how much social connection benefits our health. In fact, the U.S. Surgeon General recently declared we are living through an “epidemic of loneliness”, highlighting how social isolation increases our risk for developing dementia by 50 percent1 . In her book, The Village Effect, psychologist Susan Pinker built the case for 'social integration' as crucial to the wellbeing of older adults. Gerontologists and other sociologists define social integration as the number, type, and frequency of social contacts a particular person has. This is not the ability to call your best friend in Florida and have a two-hour conversation with them; it is the moments of basic human connection like thanking the person who makes your fancy coffee drink, or waving at your neighbor when they take out their trash. Pinker's work collects a significant body of evidence correlating higher levels of social integration with increased longevity in addition to lowering the risk for dementia2.
Unfortunately, stigma and misunderstanding often lead us to dehumanize those living with dementia3, which stops them from enjoying every day social connections. Yet here lies the paradox: we need social connections to both prevent and alleviate the symptoms of dementia. This is why creating a dementia-friendly Pennsylvania is absolutely critical: we have the opportunity to resolve this paradox and re-build bridges between a group of people desperately in need of social integration and the towns, neighborhoods, and cities where they should be able to find it in abundance, regardless of how much money they have.
To restore these connections, significant progress needs to be made in both our social and physical environments. From a social standpoint, developing empathy about the realities of dementia is crucial, and becoming a Dementia Friend or engaging in other educational opportunities that hear directly from people living with dementia (and their loved ones) is a great first step. Senior housing and other environments specifically for older adults need to focus on integrating those living with dementia, rather than segregating them in name of risk mitigation. Our cities, towns, and neighborhoods need to take seriously the tents of universal design, not just to allow people living with dementia to continue to thrive in the places where they already live; but because good design for people living with dementia turns out to be good design for everyone else too.
In a moment of increasingly virtual and automated interactions, the extent to which we can create change in our social and physical environments is the extent to which we can make the life-giving resource of human interaction free and accessible to every Pennsylvanian at risk for, or living with, dementia.
1 https://www.npr.org/2023/05/02/1173418268/loneliness-connection-mental-health-dementia-surgeon-general
2 Wang, Shanshan, et al. “Association between social integration and risk of dementia: A systematic review and meta‐analysis of longitudinal studies.” Journal of the American Geriatrics Society, vol. 71, no. 2, 2022, pp. 632–645
3 Behuniak, S. (2011). The living dead? The construction of people with Alzheimer's disease as zombies. Ageing & Society, 31(1), 70-92. doi:10.1017/S0144686X10000693