[100-Year Brain Health⑨] Sweden: Queen Builds Dementia Facility and Government Publishes Guidelines

Royal Dementia Center 'Silvia Hemmet'
Increasing Demand for Education and Certification Overseas
Health and Welfare Agency Publishes National Dementia Guidelines

On August 25th (local time), the day care facility space at the Silviahemmet, the Swedish Royal Dementia Center. The sunlight comes in so much that it is bright even without turning on the lights.
Photo by Kim Youngwon

[Asia Economy Stockholm (Sweden) = Reporter Kim Young-won] On the 25th of last month (local time), Drottningholm Palace, the royal residence located about 30 minutes from the center of Stockholm, Sweden. From this tourist-filled place, it takes about 15 minutes on foot to reach Silviahemmet, the Royal Dementia Center. Situated among quiet houses and lush greenery, the interior of Silviahemmet was brightened by sunlight even without turning on the lights. The sunlight pouring through the large windows in the ceiling, designed to maintain a bright atmosphere even in winter, illuminated puzzles, paints, and canvases used by dementia patients.

The Queen Creates a Dementia Center

Silviahemmet is a facility operated by the Swedish royal family, established in 1996. King and Queen Silvia, who became interested in dementia after Queen Silvia’s mother suffered from it, founded Silviahemmet. Currently, Queen Silvia, the founder, also serves as its representative. Wilhelmina Hoffman, Chairperson of Silviahemmet and Director of the Swedish Dementia Center, said, "The Queen sometimes rides her bicycle from the palace to preside over meetings," adding, "Usually, people do not openly disclose that their parents have dementia, but the Queen officially revealed this to the media, which is special."

Silviahemmet provides education for medical and caregiving staff related to dementia and operates a day care facility. Ten dementia patients stay here daily from 9 a.m. to 3 p.m. The daily schedule of the day care facility varies flexibly depending on the weather. On nice days, patients enjoy swimming outdoors or go on picnics. Patients who dislike outdoor activities can paint inside. They also communicate with birds through the many large windows characteristic of the facility.

While various European countries operate day care facilities for dementia patients, Silviahemmet uniquely focuses on younger dementia patients. The youngest patient is 48 years old, and the average age ranges from 55 to 64 years. This is below the age of 65, which is generally classified as ‘elderly.’ Chairperson Hoffman explained, "There are many facilities for elderly patients, but these younger dementia patients do not belong anywhere."

Inside the restroom of the weekly care facility, the toilet and switches were painted in vivid colors to help dementia patients who have difficulty distinguishing colors. A curtain is hung on the mirror.
Photo by Kim Youngwon

Although the patients are younger than those in other facilities, consideration for patients is reflected throughout the facility. Inside the bathroom, the toilet and light switches are distinguished by vivid colors so that dementia patients can easily identify and use them independently. The toilet is blue, and the switch is red. The mirror, which is usually the first thing one sees upon entering a bathroom, is covered with a floral curtain. This is because dementia patients might be startled when seeing their reflection, as they may not realize they are aging.

"We Want to Receive Silvia Certification" Overseas as Well

Above all, Silviahemmet focuses on dementia-related education. Nurses, doctors, and caregivers currently working can receive 'Silvia Certification' through the education program here. Certified personnel receive titles such as Silvia Nurse or Silvia Caregiver and are given a red badge. On the day the reporter visited Silviahemmet, 16 caregivers from V?rmd?, a local government in Sweden, were undergoing training. Two Silvia nurses were in charge of the education. Chairperson Hoffman said, "People who receive this training often return to their institutions and act as representatives to teach what they have learned to their colleagues."

Not only individuals but entire caregiving institutions can receive Silvia certification. However, the process is relatively strict, requiring more than 70% of all staff, including caregivers and front desk employees, to complete Silvia training to obtain institutional certification. The certification is valid for three years, after which re-evaluation determines whether to extend it. Currently, 160 institutions have received Silvia certification, and institutions overseas, such as in Germany and Brazil, have also obtained it. Recently, demand for Silviahemmet’s education from foreign countries has increased, and online courses in various languages are being prepared. Education is already offered in English, Lithuanian, German, Spanish, and Chinese courses will soon begin.

Wilhelmina Hoffmann, Chairperson of Silviahemmet and Director of the Swedish Dementia Centre. Photo by Kim Young-won

Sweden also strives to improve dementia awareness among the general public, not just dementia-related workers. Since the dementia center was established in 2008, it has provided 15 free online courses and materials. Various topics such as sexual life with dementia, dementia and music, and dementia and art are available on the website, with about 500,000 users. Additionally, training is provided for personnel who might seem unrelated to dementia at first glance, such as police officers and security guards. Chairperson Hoffman explained, "Many dementia patients in Sweden live at home, so they might get lost when going outside or be mistaken for shoplifters due to their behavior," adding, "Police and security guards need to understand the characteristics of dementia patients to respond appropriately in real situations."

Delicate Response Through National Guidelines

The Swedish welfare authorities consider dementia a disease requiring major attention and published national dementia guidelines in 2010. Sweden issues national guidelines for serious chronic diseases or those with high social costs, and dementia is one of the 18 guidelines created so far. Stefan Brene, in charge of the national dementia guidelines at the Swedish Health and Welfare Agency, explained, "The guidelines include how to allocate resources for treatment and support, which policymakers can utilize."

From the left, Frida Nobel and Stefan Brene, in charge of the National Dementia Guidelines at the Swedish Public Health Agency. Photo by Kim Youngwon

The guidelines categorize dementia management recommendations into priorities from 1 to 10. Each item includes scientific evidence and points to avoid. Care facilities can use these recommendations in their operations. Frida Nobel, in charge, said, "For example, teamwork among medical institutions, caregivers, and family in dementia patient management is priority 1, the most strongly recommended, while prescribing antidepressants for dementia patients is priority 8, recommended only after trying other measures." She added, "Although the guidelines are not mandatory, on-site caregivers consider them important and respond positively."

The current guidelines were revised in 2017 after a follow-up evaluation in 2014. According to the person in charge, the revision emphasized the 'national leadership' aspect more than before. Although guideline revisions are not regularly scheduled, important areas like teamwork are evaluated annually. Nobel stated, "I think further improvements are needed in staff education and family support for dementia patients."