Community of care: Supporting people with dementia in Singapore
Published on
26 Oct 2021
Published by
The Straits Times
SINGAPORE - As caregiver to a parent with dementia, Mr Yeo Seng Sit spends hours with his 83-year-old mother Chew Cheng Phong, encouraging her to do simple chores, mental exercises and colouring.
The everyday routine, which both of them enjoy, is a far cry from the scene at his home last year, when Madam Chew often became aggressive and had to be warded in an acute care hospital after she tried to attack her late husband one morning.
Mr Yeo and his family have been helped by pilot projects to support persons with dementia and their caregivers, run by St Luke's Hospital, which also works with the Agency for Integrated Care (AIC), the national agency which coordinates the delivery of aged care services.
AIC estimates that one in 10 Singaporeans aged 60 and older may have dementia - 86,000 in total, with the number projected to rise to 130,000 by 2030. Public, private and grassroots efforts are increasing to meet the needs of patients and caregivers and support them on multiple levels.
Dementia is caused by diseases that affect the brain and is not a normal part of ageing.
Symptoms include deteriorating cognitive abilities, including more difficulty remembering information, familiar faces or words. Personality changes are common. Alzheimer's disease is a type of dementia.
There is no single cause of dementia, but factors such as stress, a sedentary lifestyle or family history of dementia can increase one's risk of developing the disease.
Last month, in conjunction with World Alzheimer's Day on Sept 21, social service agency Dementia Singapore and AIC launched online portal DementiaHub.SG for patients and caregivers seeking help.
The portal hosts articles, medical research, infographics and other content, as well as a dementia helpline.
Last week saw the start of the Enabling Festival, a grassroots effort held every year since 2018 to increase awareness of dementia and what caregivers can do to bond with their loved ones.
It is organised by social enterprise Enable Asia, which was founded by two caregivers to people with dementia.
The projected increase in persons with dementia in Singapore has also prompted private healthcare institution Farrer Park Hospital to start a shared-care model for dementia treatment and management last month.
Prior to that, dementia cases were seen by specialists - such as neurologists, geriatricians and psychiatrists - who managed patients separately and did not necessarily share information, even though the specialists might be treating similar symptoms such as depression and sleeplessness.
The hospital's chief executive, Dr Peng Chung Mien, says that under the new model, primary care providers such as general practitioners refer patients to specialists for diagnosis and intervention. Once stabilised, patients are discharged back to primary care for regular monitoring.
He adds that the model allows patients and caregivers to be referred to Dementia Singapore for psycho-social support, activities to help with memory, training for caregivers and awareness programmes for those with early-onset dementia.
The hospital has also started offering artificial intelligenceassisted MRI screenings that could allow early detection of dementia through monitoring changes in the volume of the brain.
Dementia and its management has been a concern for Singapore for years. According to an AIC spokesman, in 2012, the agency and the Ministry of Health developed a Community Mental Health Masterplan which promotes early identification of dementia and mental health conditions; enables patients to seek early treatment nearer to their homes; and aims to ensure that patients are supported in the community.
St Luke's Hospital's community response team is a pilot project with AIC, in which healthcare professionals seek to provide timely intervention before a patient's condition deteriorates to the point where they need to be admitted into an acute care hospital.
Ms Cheung Siew Li, director, care and integration department, St Luke's Hospital, says patients are referred to the team via AIC's CareInMind service, mental health community partners, senior care centres, grassroots and also specialist outpatient clinics.
"The team intervenes through triage, diagnosis, assessment of needs, medical and behavioural interventions, support for caregivers, and referrals to appropriate community resources which can meet the longer-term needs of patients and their caregivers," she adds.
The hospital's home intervention programme is another community project in which a nurse and social worker provide support to seniors with dementia and their caregivers. It has served 582 persons to date.
Despite the availability of such resources, caregivers like Mr Yeo may still struggle to find help.
Mr Yeo, who is in his 50s, single, and works in technical administration, initially did not understand what was happening in his family.
The second of four brothers and the only one living with their parents, he thought his mother's aggression last year stemmed from the stress of the Covid-19 pandemic lockdown.
"I didn't think it was dementia. I thought she was frustrated and emotional," he says. "Initially, I struggled to find the correct service provider to help my mum. Finding the right doctor to treat her was also not easy."
He sought help by calling AIC. At first, he thought a volunteer befriending service might help his mum. Later, AIC sent down the community response team of healthcare professionals from St Luke's Hospital, who diagnosed Madam Chew's dementia.
She had to be warded for three weeks in an acute care hospital to manage her behavioural symptoms and was then discharged into the care of St Luke's.
The family was also put on the hospital's home intervention programme, in which the nursing care coordinator from St Luke's discussed various strategies with Mr Yeo that made the situation at home more bearable.
Mr Yeo organised his parents' schedules to minimise interaction between them and that helped his father feel safe at home until he died in August this year.
Mr Yeo finds various ways to engage with his mother. Her daily routine includes going down to the ground floor of their Housing Board block in Bukit Panjang with the domestic helper in the morning for simple exercises and to talk to the neighbours.
Mr Yeo encourages his mother to do simple chores, such as hanging her clothes to dry and sorting vegetables. She also enjoys colouring now.
"You have to be very patient and spend time with her," he says.
Music therapist Fontane Liang, who works with dementia patients at Jurong Community Hospital, suggests that making music together through banging pots and pans or clapping in rhythm can help caregivers and their charges bond and feel happier.
Her suggested at-home musical activities for caregivers and patients to do together are available online till Oct 28 as part of Arts&Health Festival organised by Ng Teng Fong General Hospital and Jurong Community Hospital.
Shared activities such as looking at old photos helped artist Danny Raven Tan bond with his mother, Madam Thian, who was diagnosed with dementia in 2015. Mr Tan, 54, co-founded social enterprise Enable Asia with fellow caregiver Daniel Lim, and runs the yearly Enabling Festival. He recalls a rocky learning journey after his mother's diagnosis.
He had to cope with her decreasing ability to converse and her increasing frailty. Now 89, she needs help with daily activities including bathing and going to the bathroom.
An informal caregiver's support network jointly initiated by Dementia Singapore, Lien Foundation and Tan Tock Seng Hospital provided a safe space for him to share his experiences with other caregivers. Before the pandemic, the group would meet in person, now they connect over video calls.
The group also shares tips on how to connect with and care for loved ones with dementia. Mr Tan helps his mother dye her hair, wear make-up and dress up for outings, even just being wheeled along the corridor of her HDB flat in central Singapore.
"It's important to engage people living with dementia and make sure that they feel they exist. Ask them for their opinions on various matters, whether or not it means anything to them. Help them dress up - if you look good, you feel good," he says.
The objective of his Enabling Festival is to raise awareness of dementia and share resources for caregivers and persons with dementia. This year, it focuses on the sense of taste and how families can bond over cooking and food.
"Five years ago, I didn't know anything about dementia and now, through this Enabling Festival, I'm enabling people to learn more and connect," he says. "Through this journey, I've also become more empathetic and patient when I see and interact with various people, especially people with dementia and their caregivers."
Community support is essential for caregivers, says Mr Yeo. Neighbours have been supportive of his family after he explained why loud noises might come from his flat sometimes. A neighbour whose mother-in-law has dementia has offered help, swapped stories and looks out for Madam Chew. He says: "As neighbours, we respect each other. No one complains."
Knowing that the number of people with dementia is on the rise in Singapore, he hopes for more communities to be prepared to support families like his.
"People's mindsets need to shift to support each other," he says.
Signs and symptoms of dementia
It can be difficult for most people to tell the difference between the behaviour characteristic of ageing and symptoms of dementia, says Dr Vina Doshi, consultant physician and specialist in geriatric medicine at AgeWell Seniors Clinic in Farrer Park Hospital.
Normal forgetfulness is when a person might suddenly forget where an item is, but later the information comes back quickly and is correct, she says.
Dementia, in contrast, is marked by patterns of repetition which occur due to poor short-term memory.
Dr Doshi adds: "It's not just memory loss and forgetting who came to visit yesterday. Dementia affects other aspects of day-to-day functioning. There are issues with language as well. The person can't find words to describe things and is forgetting names."
Dr Linus Chua, associate consultant at St Luke's Hospital, says the key difference between symptoms of dementia and normal ageing is "the loss of ability to function independently safely".
He adds that people with dementia often exhibit behaviour which causes stress to caregivers. They often repeat comments and questions, get agitated easily, may get confused in the evening and have trouble sleeping through the night.
Persons with dementia may become aggressive or accuse others of stealing their belongings.
Says Dr Chua: "They may start to wander in the community and get lost, forget to turn off the stove and forget to pay when buying things in shops.
"As dementia progresses, they may forget how to care for themselves, needing care in basic activities of daily living such as toileting, keeping clean and eating."
Dr Doshi says early intervention is key since dementia can be managed through medication and other therapies.
However, people often deny the onset of dementia in themselves or their loved ones.
She says: "People like to brush this away. People say: 'This is normal ageing, what do you expect?' But if a 60-year-old says they are becoming forgetful, alarm bells should start ringing."
Where to seek help
For dementia-related issues and community care options:
Agency for Integrated Care Hotline: 1800-650-6060
Dementia Helpline: 6377-0700
DementiaHub.SG: Go to DementiaHub's website
Institute of Mental Health's Mental Health Helpline: 6389-2222 (24 hours)
Samaritans of Singapore: 1800-221-4444 (24 hours) /1-767 (24 hours)
Care Corner Counselling Centre: 1800-353-5800
ComCare Hotline: 1800-222-0000 (24 hours)
Information provided by Dementia Singapore and the Agency for Integrated Care
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
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