TEDWomen 2018
Yvonne van Amerongen: The "dementia village" that's redefining elder care
Yvonne van Amerongen: 一个重新定义老年关怀的痴呆疗养院
Filmed:
Readability: 2.7
1,767,650 views
你希望自己的晚年如何度过？是在一个死气沉沉、像医院一样的地方，还是一个周围有超市、酒吧、剧院和公园的村落？现在看来答案似乎很明显，但当Yvonne van Amerongen在25年前帮助开发阿姆斯特丹首创的Hogeweyk痴呆症护理中心时，它被视为打破传统的一次冒险。和Yvonne van Amerongen一起到Hogeweyk，看一看这个基于自由，意义和社交生活的开创性的疗养院是什么样子吧。
Yvonne van Amerongen - Dementia-care visionary
Yvonne van Amerongen is an occupational therapist and a social worker. Full bio
Yvonne van Amerongen is an occupational therapist and a social worker. Full bio
Double-click the English transcript below to play the video.
00:12
This is the Hogeweyk.
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这是Hogeweyk。
00:14
It's a neighborhood in a small town
very near Amsterdam, in the Netherlands.
very near Amsterdam, in the Netherlands.
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它是位于荷兰阿姆斯特丹旁边的
一个小镇的一个社区。
一个小镇的一个社区。
00:19
There are 27 houses
for six, seven people each.
for six, seven people each.
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这儿有27所住户，每家有6，7个人，
00:23
There's a small mall with a restaurant,
a pub, a supermarket, a club room.
a pub, a supermarket, a club room.
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这儿有一个小商场，里面有一个餐厅，
一个酒吧，一个超市，和一个娱乐室。
一个酒吧，一个超市，和一个娱乐室。
00:28
There are streets, alleys,
there's a theater.
there's a theater.
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这儿有街道和小巷，
还有一个剧场。
还有一个剧场。
00:34
It actually is a nursing home.
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它其实是一个疗养院，
00:37
A nursing home for people
that live with an advanced dementia
that live with an advanced dementia
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为那些患有重度痴呆的人
提供24小时的护理和关怀。
00:42
and that need 24-7 care and support.
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00:47
Dementia is a terrible disease,
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痴呆是一个很可怕的疾病，
而且我们目前仍然没法治愈它。
00:50
and we still don't have any cure for it.
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00:54
It's getting to be
a major problem in the world,
a major problem in the world,
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它正在成为一个全世界的重大问题，
给人民，政治家 ，还有全世界
00:57
for the people, for the politicians,
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00:59
for the world -- it's getting
to be a big problem.
to be a big problem.
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都带来了很大的问题。
01:03
We see that we have waiting lists
in the nursing homes.
in the nursing homes.
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我们看到疗养院还有等候名单。
01:07
Most people that come to the nursing homes
with dementia are women.
with dementia are women.
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大部分来疗养院的痴呆患者都是女性，
01:11
And that's also because women
are used to taking care of people,
are used to taking care of people,
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这也是因为女性很习惯于照顾别人，
01:16
so they can manage to take care
of their husband with dementia,
of their husband with dementia,
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如果她们的丈夫患了痴呆，
她们就可以照顾他们，
她们就可以照顾他们，
但反过来对丈夫们就没有那么简单。
01:20
but the other way around
is not so easy for the gentlemen.
is not so easy for the gentlemen.
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01:26
Dementia is a disease
that affects the brain.
that affects the brain.
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痴呆是一种影响大脑的疾病。
患者的大脑变得十分混乱，
01:30
The brain is confused.
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01:33
People don't know anymore
what the time is,
what the time is,
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不知道几点了，
发生了什么事，也不认识人。
01:36
what's going on, who people are.
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他们变得非常糊涂，
01:39
They're very confused.
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还因此变得
01:40
And because of that confusion,
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焦虑，抑郁，和易怒。
01:43
they get to be anxious,
depressed, aggressive.
depressed, aggressive.
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01:50
This is a traditional nursing home.
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这是一个传统的疗养院，
我1992年的时候在那里工作，
01:53
I worked there in 1992.
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01:55
I was a care manager.
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我负责照料患者。
01:57
And we often spoke together about the fact
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我们经常会讨论，
如果我们的父母、朋友、
甚至是自己生病了，
甚至是自己生病了，
02:00
that what we were doing there
was not what we wanted for our parents,
was not what we wanted for our parents,
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我们不会想让他们来这里。
02:05
for our friends, for ourselves.
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02:09
And one day, we said,
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有一天，我们意识到，
我们只是一直这么说是没用的，
02:11
"When we keep on saying this,
nothing is going to change.
nothing is going to change.
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在这里我们做主，
02:14
We are in charge here.
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我们应该做点什么，
02:15
We should do something about this,
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让这里变成一个我们放心
自己父母来的地方。
自己父母来的地方。
02:18
so that we do want
to have our parents here."
to have our parents here."
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02:22
We talked about that,
and what we saw every day
and what we saw every day
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我们每天看到的是
住在这里的患者
02:25
was that the people
that lived in our nursing home
that lived in our nursing home
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对周边的环境感到迷茫，
02:29
were confused about their environment,
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因为他们看到的是像医院一样的环境，
02:31
because what they saw
was a hospital-like environment,
was a hospital-like environment,
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有医生、护士、穿着制服的护理人员，
02:35
with doctors and nurses
and paramedics in uniform,
and paramedics in uniform,
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而且他们住在病房里。
02:39
and they lived on a ward.
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02:42
And they didn't understand
why they lived there.
why they lived there.
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他们不明白为什么他们住在这里，
他们想尽快离开。
02:44
And they looked for the place to get away.
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02:48
They looked and hoped to find
the door to go home again.
the door to go home again.
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想要找到那个通往家的门。
02:54
And we said what we are doing
in this situation
in this situation
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我们发现，在这种情况下，
我们让这些本来就糊涂的人，
02:57
is offering these people
that already have a confused brain
that already have a confused brain
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变得更糊涂了。
03:02
some more confusion.
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我们在混乱之上增添混乱，
03:04
We were adding confusion to confusion.
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03:08
And that was not what these people needed.
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这反而是在帮倒忙。
03:11
These people wanted to have a life,
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这些人想要有一个生活，
还需要我们帮助他们来面对痴呆。
03:13
and the help, our help,
to deal with that dementia.
to deal with that dementia.
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03:17
These people wanted to live
in a normal house,
in a normal house,
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他们想生活在一个正常的房子里，
03:22
not in a ward.
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不是病房里。
03:24
They wanted to have a normal household,
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他们想要一个正常的家，
想闻到厨房里炉子上
飘出的晚饭的香气，
飘出的晚饭的香气，
03:27
where they would smell their dinner
on the stove in the kitchen.
on the stove in the kitchen.
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03:32
Or be free to go to the kitchen
and grab something to eat or drink.
and grab something to eat or drink.
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或是能自己走到厨房里，
拿点什么吃的喝的。
拿点什么吃的喝的。
03:37
That's what these people needed.
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这是他们所需要的，
也是我们应该给他们提供的。
03:39
And that's what we should
organize for them.
organize for them.
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03:43
And we said we should
organize this like at home,
organize this like at home,
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我们觉得，为了营造家的氛围，
不能让他们十几个或者几十个人
住在一起，像在病房一样，
住在一起，像在病房一样，
03:48
so they wouldn't live with a group
of 15 or 20 or 30, like in a ward.
of 15 or 20 or 30, like in a ward.
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03:53
No, a small group of people,
six or seven, family-like.
six or seven, family-like.
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他们以6-7个人为团体
住在一起，像家一样。
住在一起，像家一样。
03:59
Like living with friends.
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就好像和朋友住在一起。
04:02
And we should find a way to select people
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我们应该想办法
筛选出生活兴趣相同的人，
04:05
based on their ideas about life
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这样他们住在一起的时候
04:08
so that they did have
a good chance to become friends,
a good chance to become friends,
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能变成好朋友。
04:11
when they lived together.
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04:14
And we interviewed
all the families of the residents
all the families of the residents
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我们也采访了所有患者的家人，
问他们“你的爸爸重视什么？”
“你的妈妈重视什么？”
“你的妈妈重视什么？”
04:18
about "what is important for your father,"
"what's important for your mother,"
"what's important for your mother,"
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“他们的生活是什么样的？”
“他们想要什么？”
“他们想要什么？”
04:22
"what is their life like,"
"what do they want."
"what do they want."
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然后我们成立了7个小组，
叫做“生活方式小组”。
叫做“生活方式小组”。
04:24
And we found seven groups,
and we call them lifestyle groups.
and we call them lifestyle groups.
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04:29
And for instance,
we found this formal lifestyle.
we found this formal lifestyle.
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比如，有一个小组的生活方式很正式，
04:33
In this lifestyle,
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在这种生活方式下，
大家互相交往的方式都很正式，
04:35
people have a more formal way
of interacting with each other,
of interacting with each other,
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保持适当的距离。
04:38
a distant way.
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他们每天的生活开始得较晚，
04:39
Their daily rhythm
starts later in the day,
starts later in the day,
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结束得也较晚。
04:42
ends later in the day.
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这个小组的人比别的小组
04:43
Classical music is more heard
in this lifestyle group
in this lifestyle group
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更喜欢听经典音乐。
04:46
than in other lifestyle groups.
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他们更喜欢法国美食，
04:48
And their menu,
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04:50
well, is more French cuisine
than traditional Dutch.
than traditional Dutch.
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而不是传统的荷兰美食。
04:53
(Laughter)
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（笑）
另外一种“手艺人”的
生活方式则很不同。
生活方式则很不同。
04:55
In contrary to the craftsman lifestyle.
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这是一个很传统的生活方式，
04:59
That's a very traditional lifestyle,
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他们很早起床，很早睡觉，
05:01
and they get up early
in the morning, go to bed early,
in the morning, go to bed early,
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因为他们一生都在努力工作，
通常是用他们的双手为生，
通常是用他们的双手为生，
05:03
because they have worked hard
their whole life, mostly with their hands,
their whole life, mostly with their hands,
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他们通常有一个很小的家庭生意，
一个小农场，一个小商店。
一个小农场，一个小商店。
05:08
very often had a very small
family business, a small farm, a shop,
family business, a small farm, a shop,
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比如B先生，他曾是个农场工人。
05:12
or like Mr. B, he was a farmhand.
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05:17
And he told me that he would go
to his work every morning
to his work every morning
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他告诉我，他每天早上去工作，
包里装着午饭，
05:20
with a paper bag with his lunch
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05:24
and one cigar.
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还有一支雪茄。
05:26
That one cigar was the only luxury
he could afford for himself.
he could afford for himself.
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那一支雪茄就是他能
负担得起的唯一的奢侈品。
负担得起的唯一的奢侈品。
05:31
And after lunch,
he would have that one cigar.
he would have that one cigar.
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吃完午饭，他就抽那支雪茄。
05:35
And until the day he died in the Hogeweyk,
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一直到他在Hogeweyk去世的那一天，
05:38
he was in this little shed, every day,
after lunch, to smoke his cigar.
after lunch, to smoke his cigar.
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他每天午饭后都在
这个小棚子里抽雪茄。
这个小棚子里抽雪茄。
05:47
This is my mother.
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这是我的母亲，
她喜欢文艺的生活方式，
05:48
She's of the cultural lifestyle,
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05:50
she's been living
in the Hogeweyk six weeks now.
in the Hogeweyk six weeks now.
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她住在Hogeweyk六周了，
05:53
And that lifestyle is about traveling,
meeting other people, other cultures,
meeting other people, other cultures,
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这种生活方式包括旅行，
结识不同的人和不同的文化，
结识不同的人和不同的文化，
探索艺术和音乐。
05:58
interest in arts and music.
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06:02
There are more lifestyles.
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还有更多别的生活方式。
06:04
But that's what we talked about,
and that's what we did.
and that's what we did.
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这是我们设想的，也是我们最终做到的。
06:09
But that's not life in a house
with a group of people,
with a group of people,
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但是这并不是生活的全部
——在自己的房子里，
——在自己的房子里，
和一群志同道合的人在一起，
过自己的生活。
过自己的生活。
06:14
like-minded people, your own life,
your own household.
your own household.
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06:18
There's more in life,
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生活中还有别的，
每个人都要想要有乐趣的
生活和有意义的生活，
生活和有意义的生活，
06:19
everybody wants fun in life
and a meaningful life.
and a meaningful life.
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06:23
We are social animals --
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我们都是社会动物，
我们需要社交生活。
06:25
we need a social life.
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06:27
And that's what we started.
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而这就是我们所做的。
06:30
We want to go out of our house
and do some shopping,
and do some shopping,
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人们都想出门去，去购物，
认识不同的人，
06:34
and meet other people.
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06:36
Or go to the pub,
have a beer with friends.
have a beer with friends.
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或者去酒吧，和朋友一起喝酒。
06:40
Or like Mr. W -- he likes
to go out every day,
to go out every day,
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或者像W先生那样——他喜欢每天出门，
看看周围有没有漂亮的姑娘。
06:45
see if there are nice ladies around.
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（笑）
06:48
(Laughter)
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06:50
And he's very courteous to them,
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他对她们非常礼貌，
他想得到微笑，于是他得到了，
06:52
and he hopes for smiles and he gets them.
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06:54
And he dances with them in the pub.
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他每天都在酒吧里和她们跳舞，
06:58
It's a feast every day.
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每天都是一场盛宴。
还有的人更愿意和朋友去饭店，
06:59
There are people that would
rather go to the restaurant,
rather go to the restaurant,
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喝点红酒，
07:02
have a wine with friends,
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或者和朋友共进午餐
或晚餐，庆贺人生。
或晚餐，庆贺人生。
07:04
or lunch or dinner with friends
and celebrate life.
and celebrate life.
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我母亲喜欢在公园里走走，
07:08
And my mother,
she takes a walk in the park,
she takes a walk in the park,
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坐在长椅上晒晒太阳，
07:10
and sits on a bench in the sun,
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希望一个路人会过来坐在她身旁，
07:12
hoping that a passerby will come
and sit next to her
and sit next to her
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和她讨论人生，
07:15
and have a conversation about life
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或者讨论池塘里的鸭子。
07:18
or about the ducks in the pond.
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07:22
That social life is important.
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社交生活是很重要的，
07:24
It means that you're part
of society, that you belong.
of society, that you belong.
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它意味着你是社会的一份子，
07:29
And that's what we people need.
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人们需要这种归属感，
07:33
Even if you're living
with advanced dementia.
with advanced dementia.
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即使患有严重痴呆的人也需要。
07:37
This is what I see from my office window.
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这是从我的办公室窗户看出去的景色，
有一天，我看到一位女士从一边走过来，
07:40
And one day, I saw a lady
coming from one side,
coming from one side,
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另一位女士从另一边走过来，
她们在拐角处碰到了，
她们在拐角处碰到了，
07:44
and the other lady from the other side,
and they met at the corner.
and they met at the corner.
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我跟她们两个都很熟，
07:48
And I knew both ladies very well.
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07:50
I often saw them walking around outside.
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经常看到她们在外面散步。
07:54
And now and then, I tried
to have a conversation with them,
to have a conversation with them,
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我会时不时地和她们对话，
但是她们的对话——
07:59
but their conversation was ...
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08:02
rather hard to understand.
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很难理解。
08:05
But I saw them meeting,
and I saw them talking,
and I saw them talking,
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但我看到她们碰面、交谈，
我看到她们做手势，
08:09
and I saw them gesturing.
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她们在一起很开心，
08:11
And they had fun together.
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08:13
And then they said goodbye,
and each went their own way.
and each went their own way.
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然后她们互相道别，继续各自行路了。
08:17
And that's what you want in life,
meeting other people
meeting other people
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这就是你在生活中想要的，
结识不同的人，融入社会。
08:20
and being part of society.
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08:23
And that's what I saw happening.
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这也是我看到正在发生的，
08:26
The Hogeweyk has become a place
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Hogeweyk已经变成了一个
能让患有严重痴呆的人居住，
08:28
where people with very advanced
dementia can live,
dementia can live,
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并且感到自由和安全的地方。
08:31
have freedom and safety,
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因为这里的专业人员和志愿者
08:33
because the professionals working there
and the volunteers working there
and the volunteers working there
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知道如何应对痴呆，
08:38
know how to deal with dementia.
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08:41
And the professionals know
how to do their professional work
how to do their professional work
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这里的专业人员知道如何
既完成他们的工作，
既完成他们的工作，
08:44
in a way that it fits in a natural way
in the life of our residents.
in the life of our residents.
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又不影响患者的正常生活。
08:50
And that means that the management
has to provide everything
has to provide everything
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这意味着管理层需要为他们提供
他们工作中需要的一切。
08:55
those people need to do their work.
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08:58
It needs a management
that dares to do this.
that dares to do this.
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这需要一个敢于付诸行动的管理层，
敢于在一个传统的疗养院里，
09:02
To do things differently
than we always have done
than we always have done
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用不同寻常的方法做事。
09:05
in a traditional nursing home.
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09:10
We see that it works.
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我们看到了它是有效的，
09:14
We think this can be done everywhere,
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我们认为这在任何地方都能实现，
因为这不是只有富人才能享受的。
09:17
because this is not for the rich.
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09:19
We've been doing this with the same budget
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我们的预算
和我们国家每一个传统疗养院都一样，
09:24
as any traditional nursing home
has in our country.
has in our country.
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我们只有州政府的财政预算。
09:28
We work only with the state budget.
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09:32
(Applause)
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（鼓掌）
09:40
Because it has to do
with thinking different,
with thinking different,
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这需要的是改变思路，
看看你面前的人，
09:43
and looking at the person in front of you
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想想这个人现在需要什么。
09:46
and looking at what
does this person need now.
does this person need now.
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09:51
And it's about a smile,
it's about thinking different,
it's about thinking different,
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这需要的是一个微笑，
需要的是换一个方式思考，
需要的是换一个方式思考，
需要的是做出行动，
而这些都不需要花钱。
而这些都不需要花钱。
09:54
it's about how you act,
and that costs nothing.
and that costs nothing.
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09:59
And there's something else:
it's about making choices.
it's about making choices.
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还有一点，关乎如何做选择，
10:03
It's about making choices
what you spend your money on.
what you spend your money on.
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选择把钱花在什么地方。
10:08
I always say,
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我经常说，
10:11
"Red curtains are
as expensive as gray ones."
as expensive as gray ones."
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”红窗帘和灰色窗帘一样贵。“
（笑）
10:16
(Laughter)
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在任何地方，我们都能做到。
10:17
It's possible, everywhere.
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10:21
Thank you.
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谢谢！
（鼓掌）
10:22
(Applause)
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ABOUT THE SPEAKER
Yvonne van Amerongen - Dementia-care visionaryYvonne van Amerongen is an occupational therapist and a social worker.
Why you should listen
Before 1983, when Yvonne van Amerongen started working for the nursing home Hogewey, she worked in a hospital for psychiatric diseases and in a rehabilitation center. In 1992 she was the care manager of the traditional nursing home Hogewey when the management team started thinking about the vision of care for people living with severe dementia. In 1993, this vision was the basis for the development of what now is the neighborhood The Hogeweyk, with 27 houses for more than 170 seniors with severe dementia. Van Amerongen was the project leader and one of the founders of the vision for excellent care, living and well-being for people with severe dementia and of neighborhood The Hogeweyk.
Van Amerongen now works as a consultant for Be, supporting and advising healthcare organizations, governments, architects and project starters around the world to improve the quality of life of people living with dementia. Be is part of the Vivium Care group (non-profit), also the owner of The Hogeweyk.
Yvonne van Amerongen | Speaker | TED.com