This article was originally published in the New York Times on November 25th 2010, “The Vanishing Mind” is part of a series in which the New York Times examines the worldwide struggle to find answers about Alzheimer’s disease. This story is about the South Korean Experience. To go to the New York Times Website, please click here.
SEONGNAM, South Korea — They were stooped, hobbled, disoriented, fumbling around the house. They got confused in the bathtub and struggled up stairs that seemed to swim before them.
“Oh, it hurts,” said Noh Hyun-ho, sinking to the ground. “I thought I was going to die,” said Yook Seo-hyun.
There was surprisingly little giggling, considering that Hyun-ho, Seo-hyun and the others were actually perfectly healthy 11- to 13-year-old children. But they had strapped on splints, weighted harnesses and fogged-up glasses, and were given tasks like “Doorknob Experience” and “Bathroom Experience,” all to help them feel what it was like to be old, frail or demented.
Keywords: seniors, mental impairment, healthcare
“Even though they are smiling for us, every day, 24 hours, is difficult for them,” Jeong Jae-hee, 12, said she learned. “They lose their memory and go back to childhood.”
It is part of a remarkable South Korean campaign to cope with an exploding problem: Alzheimer’s disease and other dementias. As one of the world’s fastest-aging countries, with nearly 9 percent of its population over 65 already afflicted, South Korea has opened a “War on Dementia,” spending money and shining floodlights on a disease that is, here as in many places, riddled with shame and fear.
South Korea is training thousands of people, including children, as “dementia supporters,” to recognize symptoms and care for patients. The 11- to 13-year-olds, for instance, were in the government’s “Aging-Friendly Comprehensive Experience Hall” outside Seoul. Besides the aging simulation exercise, they viewed a PowerPoint presentation defining dementia and were trained, in the hall’s Dementia Experience Center, to perform hand massage in nursing homes.
“ ‘What did I do with my phone? It’s in the refrigerator,’ ” said one instructor, explaining memory loss. “Have you seen someone like that? They may go missing and die on the street.”
In another striking move, South Korea is also pushing to make diagnoses early, despite there being scant treatment.
“This used to be hidden” and “there is still stigma and bias,” said Kim Hye-jin, director of senior policy for the Health and Welfare Ministry. But “we want to get them out of their shells, out of their homes and diagnosed” to help families adjust and give patients “a higher chance of being taken care of at home.”
Hundreds of neighborhood dementia diagnostic centers have been created. Nursing homes have nearly tripled since 2008. Other dementia programs, providing day care and home care, have increased fivefold since 2008, to nearly 20,000. Care is heavily subsidized.
And a government dementia database allows families to register relatives and receive iron-on identification numbers. Citizens encountering wanderers with dementia report their numbers to officials, who contact families. To finance this, South Korea created a long-term-care insurance system, paid for with 6.6 percent increases in people’s national health insurance premiums. In 2009, about $1 billion of government and public insurance money was spent on dementia patients. Still, with the over-65 population jumping from 7 percent in 2000 to 14 percent in 2018 to 20 percent in 2026, dementia is straining the country, socially and economically.
“At least one family member has to give up work” to provide caregiving, said Kwak Young-soon, social welfare director for Mapo District, one of Seoul’s 25 geographic districts. Because South Korea encourages people to work well past retirement age, families may also lose dementia sufferers’ incomes.
Most families no longer have generations living together to help with caregiving, and some facilities have long waiting lists, but “we can’t keep building nursing homes,” Mr. Kwak said. “We call it a ghost. It’s basically eating up the whole house.”
South Korea is at the forefront of a worldwide eruption of dementia, from about 30 million estimated cases now to an estimated 100 million in 2050. And while South Korea’s approach is unusually extensive, even in the United States, the National Alzheimer’s Project Act was introduced this year to establish a separate Alzheimer’s office to create “an integrated national plan to overcome Alzheimer’s.” Supporters of the bill, currently in committee, include Sandra Day O’Connor, whose late husband had Alzheimer’s.
South Korea also worries that dementia, previously stigmatized as “ghost-seeing” or “one’s second childhood” could “dilute respect for elders,” Mr. Kwak said. “There’s a saying that even the most filial son or daughter will not be filial if they look after a parent for more than three years.” So the authorities promote the notion that filial piety implies doing everything possible for elders with dementia, a condition now called chimae (pronounced chee-may): disease of knowledge and the brain which makes adults become babies. But South Korea’s low birth rate will make family caregiving tougher.
“I feel as if a tsunami’s coming,” said Lee Sung-hee, the South Korean Alzheimer’s Association president, who trains nursing home staff members, but also thousands who regularly interact with the elderly: bus drivers, tellers, hairstylists, postal workers. “Sometimes I think I want to run away,” she said. “But even the highest mountain, just worrying does not move anything, but if you choose one area and move stone by stone, you pave a way to move the whole mountain.”
South Korea is even trying to turn a crisis into a business opportunity. The Aging-Friendly hall, financed by the Ministry of Knowledge Economy, encourages businesses to enter “silver industries,” producing items for feeble elderly people, from chopsticks that are easier to pick up to automated harnesses that hoist people from bed, sliding along a ceiling track, and deposit them onto toilets or living room couches.