Care Professional Archives - DementiaHub.SG https://www.dementiahub.sg/care-professional-category/care-professional/ Singapore’s One-Stop Resource Portal on Dementia Fri, 24 Jul 2026 04:33:18 +0000 en-US hourly 1 https://www.dementiahub.sg/wp-content/uploads/2022/06/fav.png Care Professional Archives - DementiaHub.SG https://www.dementiahub.sg/care-professional-category/care-professional/ 32 32 Expressive Arts Therapy: An Introduction https://www.dementiahub.sg/dementia-practice/expressive-arts-therapy-an-introduction/ Tue, 16 Dec 2025 02:38:03 +0000 https://www.dementiahub.sg/?post_type=dementia&p=76788 Expressive Arts Therapy or EXAT is a form of psychotherapy that integrates multiple art forms—such as visual art, music, dance/movement, drama, and writing—within a therapeutic process. Find out how persons living with dementia can benefit from this therapy.

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Rather than focusing on artistic skill, Expressive Arts Therapy emphasises the process of creating as a way to explore feelings, experiences, and inner conflicts that may be difficult to express verbally.

Guided by a trained therapist, persons living with dementia use multiple art forms to access insight, reduce stress, build resilience, and foster integration of mind, body, and emotions in a safe, supportive environment.

What Expressive Arts Therapy Is  

Expressive Arts Therapy or EXAT is a form of psychotherapy that integrates multiple art forms—such as visual art, music, dance/movement, drama, and writing—within a therapeutic process. It is grounded in person-centred and humanistic theories; and based on models like the Expressive Therapies Continuum (ETC) and principles of intermodal arts integration. 

EXAT differs from traditional, single-modality art therapies, for example art therapy or music therapy, by intentionally combining diverse artistic forms to support emotional expression, self-exploration, cognitive stimulation, and psychological healing. It provides a non-verbal, sensory-rich pathway of communication for persons living with dementia, as verbal communication often becomes more challenging as dementia progresses.

The table below shows how different art forms can be used in EXAT with a specific intention: 

Art Form

Examples of Use

Intention

Music

Listen to music, singing, or playing instruments.

To reduce agitation and anxiety; moderate mood; and support non-verbal communication.

Drama

Use movement, role-play, puppetry, mirroring, or improvisational storytelling.

To externalise inner conflicts and gain new perspectives in a safe and supported environment.

Dance/

Movement  

Use body movements and gestures to express emotions, opinons, thoughts, and identity.

To promote mind-body sensitivity and awareness, emotional release and expression.

Poetry/

Storytelling

Journal down poetry, narrative storytelling, free writing.

Bridges the gap between visuals and feelings, allowing one to articulate unspoken thoughts, gain insights and construct meanings.

Visual Art

Create or engage with images through painting, drawing, sculpting or art appreciation.

To access, process and communicate complex emotions, thoughts, and trauma.

Differentiate Expressive Arts Therapy from Expressive Arts Programmes

EXAT is often misunderstood as or confused with Expressive Arts Programme. It is, therefore, essential to know the differences between these two approaches.

What Expressive Arts Therapy (EXAT) Is

What Expressive Arts Programme Is

A psychotherapy approach delivered by a trained mental health professional that integrates multiple art modalities within a therapeutic framework.

Recreational, educational, or social activities involving art, music, dance, or other creative forms without a formal therapeutic process.

Grounded in psychological and art-based theories, it aims to explore emotions, identity, cognitive stimulation, and psychological healing.

Focuses on enjoyment, reminiscence, cultural engagement, entertainment, or sensory stimulation.

Facilitated by trained expressive arts therapists.  

Facilitated by activity staff, volunteers, or artists without clinical training.

Between the two, only EXAT is designed to cater for psychological and emotional needs through a structured therapeutic process.

Benefits of Expressive Arts Therapy (EXAT)

EXAT provides a safe, supportive, and flexible space for participants—including persons living with dementia and caregivers—who seek emotional and/or psychological support.  

Benefits for Persons Living with Dementia

  • Bypasses verbal limitations by offering sensory, emotional, and embodied ways to express themselves.
  • Reconnects individuals to their sense of identity and life story.
  • Addresses unmet emotional and sensory needs, contributing to reduced agitation, anxiety, and wandering.
  • Enhances mood, confidence, and a sense of self-worth.

 

Benefits for Caregivers

  • Provides a safe space to process emotional stress and grief.
  • Strengthens self-awareness and reconnects caregivers to their own identity beyond the caregiving role.
  • Offers creative tools for stress relief and emotional release.
  • Builds resilience and emotional regulation skills to cope with daily challenges.

Getting Started

You may wish to consider any of these simple activities to help you get started:

Additional Tips

  • #1
    Create space by clearing clutter and arranging chairs in a circle.
  • #2
    Be a part of the activity to set the tone that you are not there to teach the activity.
  • #3
    Use prompts that invite exploration, play and curiosity, such as: “Let’s see what happens if we do this,” rather than giving direct instructions.
  • #4
    Be warm and supportive without slipping into “child-like” language.
  • #5
    Speak with respect, using clear and simple phrasing while preserving the dignity of each person.
  • #6
    Give participants some breathing space. There is no need to fill every minute with tasks. It is all right to experience moments of silence. If someone chooses not to take part in the activity, let him be — he may simply need more time to feel safe. Some participants may take a few sessions to settle in, so allow the pace to unfold naturally.

Conclusion

The use of diverse art modalities creates a relaxed, playful and engaging environment where participants can express their feelings and experiences.

For persons living with dementia, EXAT can help bypass cognitive limitations by tapping into sensorial, emotional, and embodied forms of communication. For caregivers, EXAT provides a safe outlet to express emotions, manage stress, reconnect with their inner selves, and improves overall well-being.

It nurtures curiosity, invites play, and supports a sense of identity and self-worth by offering opportunities for meaningful self-expression despite the changes dementia brings.

Author's Bio

Rachel Lim is a registered expressive arts therapist with ANZACATA and currently leads the development of Expressive Arts Therapy services at Dementia Singapore Ltd. With a master’s degree in Expressive Arts Therapy from the University of Hong Kong and a background in psychology, Rachel specialises in supporting persons living with dementia and their caregivers through creative, sensory-based approaches.

References

Lusebrink, V. B. (2010). Assessment and therapeutic application of the expressive therapies continuum: Implications for brain structures and functions. Art Therapy, 27(4), 168-177.

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]]> Music Therapy – a Symptomatic Treatment of Dementia https://www.dementiahub.sg/dementia-practice/music-therapy-a-symptomatic-treatment-of-dementia/ Mon, 25 Aug 2025 07:27:39 +0000 https://www.dementiahub.sg/?post_type=dementia&p=72339 Let's explore the use of music therapy as a non-pharmacological intervention to improve cognitive and behavioural symptoms in persons living with dementia, the possible effects and benefits, and how music therapy is used in Singapore to enhance the quality of life of those living with dementia.

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Music is a complex composition of melody, harmony, rhythm, timbre, tempo, dynamics, form, texture, and words or lyrics. These elements, when put together, have a profound effect on the listener’s emotions, behaviour, and memory. When used appropriately, music can be a useful and effective tool to optimise the quality of life for persons living with dementia.

With these unique qualities, music has been widely used as a potentially beneficial intervention to improve moods, cognitive function, memory, and communication. This is commonly known as music therapy. Music therapy can also provide opportunities for socialisation and connection between individuals with dementia and people around them in both personal sphere and group setting.  

In this article, we explore the use of music therapy as a non-pharmacological intervention to improve cognitive and behavioural symptoms in persons living with dementia, the possible effects and benefits of music therapy, and how music therapy is used in Singapore to better or enhance the quality of life of those living with dementia.

Benefits of Music Therapy for Persons Living with Dementia

Non-pharmacological approaches like music-based interventions are regarded as low-risk, accessible and inclusive as an approach to managing behavioural psychological symptoms of dementia or BPSDs, compared to pharmacological interventions.

Based on recent studies, music therapy has gained worldwide popularity in managing symptoms of dementia over the years. It is found that musical training can help mitigate effects of cognitive impairments and increase the capacity of persons to remember music.

In a study on persons living with Alzheimer’s Disease (AD), researchers found that persons with AD showed improvement in word fluency, biographical memory, and memory of the lyrics after participating in music therapy sessions.

Here are some of the benefits music therapy can have on persons living with dementia, as supported by several studies:  

 

Potential Benefits of Music Therapy for Persons Living with Dementia

1.

Improves mood and reduces agitation

Music can evoke positive emotions and memories. This can help alleviate depressive symptoms and other negative emotions such as anxiety and agitation which are common behavioural and psychological symptoms of dementia.  

2.

Enhances cognitive function

Music can improve certain cognitive and executive functions such as verbal fluency, recollection of lyrics/memories, and assists in Activities of Daily Living (ADLs).  

3.

Enhances communication

Music can serve as a non-verbal communication tool that helps persons living with dementia to express their thoughts.   

4.

Improves socialisation and connection with people

Group music activities can eliminate isolation and loneliness.

5.

Improves quality of life

All the benefits can lead to improved quality of life. It is especially beneficial to those who are battling with emotional symptoms, such as anxiety.

Supported Evidence of Music Therapy

The use of customised music playlist in medical setting has been proven effective in combating (disinhibited) behavioural symptoms of people living with dementia. Studies reported a rise in positive results in recent years.

Here are some evidence-based statistics that support the effectiveness of music therapy in managing BPSDs or behavioural and psychological symptoms of dementia, including agitation, aggression depression, anxiety and apathy, particularly in moderate stage of dementia:

  • A meta-analysis of 17 randomised controlled trials (RCTs) by Zhang et al. (2017) found out that music therapy significantly reduced disruptive behaviours of persons living with dementia.
  • An RCT conducted by Raglio et. al. (2010) revealed that individualised music therapy had a 30 per cent reduction in disruptive behaviours compared to control group.
  • A Cochrane review (2018) that analysed 22 trials with over 1,097 participants saw music-based intervention resulted in significant reduction in depressive symptoms.

“Music Therapy is a person-centered, non-pharmacological approach that supports emotional well-being, cognitive function, and social interaction. It also provides opportunities for caregiver participation, strengthening emotional bonds and offering shared joyful experiences. The structured yet flexible format makes it accessible and highly beneficial for persons with dementia, including those in moderate stages. It is also listed as a recommended intervention for BPSD as part of the clinical guidelines for dementia by Singapore’s Ministry of Health.”

R. S. Chandraajothi, Senior Centre Manager, Care Services - New Horizon Centre Bukit Batok & Jurong Point, Dementia Singapore

Music has the power to evoke emotions and help persons living with dementia recall and share their life stories with their caregivers and vice versa. Furthermore, music therapy activities can easily and effectively be incorporated into other forms of therapy such as reminiscence therapy and art therapy.

Here are some practical, meaningful, and evidenced-based activities (and their benefits) you can incorporate into the lives of persons living with dementia:

  • Create a personalised playlist that includes your loved one’s favourite songs from his youth/era or culture. This can trigger fond memories and facilitate conversation.
  • Encourage your loved ones to sway along or clap to the rhythm and tempo of the music. This can improve movements and functional abilities.
  • Play soothing and familiar music to help your loved one manage emotions, moods, and relieve anxiety and pain.
  • Encourage your loved one with dementia to sing along to his favourite songs. This will improve speech articulation and fluency over time.
  • Combine music with visual art such as painting to encourage self-expression and enhance creativity.

Conclusion

As research continues to validate the effectiveness and benefits of music therapy, integrating music therapy into dementia care not only honours the personhood of persons living with dementia, but it is also an accessible and meaningful way to connect them with their loved ones. In the gentle rhythm of familiar melodies, many find joy, comfort and more importantly a renewed sense of identity and dignity that enhance their quality of life.  

References
  1. Bleibel, M., El Cheikh, A., Sadier, N.S. et al. The effect of music therapy on cognitive functions in patients with Alzheimer’s disease: a systematic review of randomized controlled trials. Alz Res Therapy 15, 65 (2023). https://doi.org/10.1186/s13195-023-01214-9
  2. Shirsat A, Jha RK, Verma P. Music Therapy in the Treatment of Dementia: A Review Article. Cureus. 2023 Mar 31;15(3):e36954. doi: 10.7759/cureus.36954. PMID: 37139292; PMCID: PMC10151115. 
  3. Zhang, Y., Cai, J., An, L., Hui, F., Ren, T., Ma, H., Zhao, Q. (2017). Does music therapy enhance behavioural and cognitive function in elderly dementia patients? A systematic review and meta-analysis. Ageing Research Reviews, 35, 1–11. DOI: 10.1016/j.arr.2016.12.003 
  4. Van der Steen, J. T., Smaling, H. J. A., van der Wouden, J. C., Bruinsma, M. S., Scholten, R. J. P. M., & Vink, A. C. (2018). Music-based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews, 2018(7), CD003477. DOI: 10.1002/14651858.CD003477.pub4 
  5. Raglio, A., Bellelli, G., Traficante, D., Gianotti, M., Ubezio, M. C., Gentile, S., Villani, D., & Trabucchi, M. (2010). Efficacy of music therapy treatment based on cycles of sessions: A randomised controlled trial. Ageing & Mental Health, 14(8), 900–904.  

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]]> Recognising and Responding to Abuse in Dementia Care https://www.dementiahub.sg/dementia-practice/recognising-and-responding-to-abuse-in-dementia-care/ Tue, 18 Feb 2025 15:59:59 +0000 https://www.dementiahub.sg/?post_type=dementia&p=65469 Listen Min Read Elder abuse is a growing concern in Singapore, with cases continuing to rise in recent years. In 2022, 370 elder abuse cases were reported, up from 338 in 2021 and 283 in 2020.1 One key factor is the overwhelming stress caregivers face, especially those caring for elderly persons with complex needs who depend […]

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Elder abuse is a growing concern in Singapore, with cases continuing to rise in recent years. In 2022, 370 elder abuse cases were reported, up from 338 in 2021 and 283 in 2020.1 One key factor is the overwhelming stress caregivers face, especially those caring for elderly persons with complex needs who depend on them for care.

As caregiving demands increase, caregivers may become physically and emotionally exhausted, which can sometimes lead to unintentional harm. Understanding the signs of abuse and knowing how to respond are crucial to protecting vulnerable groups such as persons living with dementia.

Read on to learn more about the types of abuse, how to recognise the signs, and what to do if you suspect abuse.

Types of Abuse

Abuse in dementia care refers to harm or mistreatment of persons living with dementia, and can take various forms:  

1. Physical Abuse

This can include hitting, pushing, or restraining the person living with dementia. 

2. Emotional Abuse

This can include verbal aggression, threats, intimidation, or isolating the person living with dementia from others, which can harm their emotional well–being.

3. Neglect and Self-Neglect

This can include failing to provide basic needs such as food, clothing, or medical care. 

4. Financial Abuse

This can include stealing money or assets, coercing the person with dementia to sign over their assets or power of attorney.

5. Sexual Abuse

This can include unwanted touching or sexual acts. 

Recognising Abuse in Dementia Care

Why Is It Crucial to Recognise Abuse?

Recognising and responding to abuse in dementia care is essential, as persons living with dementia are often unable to report abuse themselves. This is due to several factors: 

Inability to Recognise Abuse

Cognitive decline can make it difficult for persons living with dementia to recognise mistreatment. They may not have the awareness to identify abusive behaviour or might mistake it for part of their normal care routine.

Difficulty Expressing Concerns

Even if they are aware that something is wrong, persons living with dementia may struggle to communicate their feelings. Loss of language skills and cognitive challenges can prevent them from expressing their distress or seeking help.

Signs and Symptoms of Abuse

The following are common signs and symptoms that may indicate abuse: 

Note: This section was adapted from HelpGuide: Elder Abuse and Neglect. 

Risk Factors for Abuse in Dementia Care

Abuse can occur in any caregiving situation, but certain factors can increase the risk. Common risk factors include:

Caregiver Stress

Dementia caregiving is demanding, and the stress can lead to frustration and, sometimes, abusive behaviours. 

Isolation

Caregivers and their loved ones may be isolated, with little support or outside help.

Caregiver Mental Health Issues

Pre-existing mental health conditions, such as depression or other diagnoses, can impact a caregiver’s ability to cope with stress, potentially contributing to abusive behaviours.

Behavioural Changes in Dementia

As dementia progresses, a person living with dementia may experience changes in behaviour, such as increased agitation or disinhibition. These changes can be challenging for caregivers, who may feel stressed or overwhelmed.

History of Domestic Violence

A history of domestic violence in the home increases the likelihood of abuse.

Responding to Abuse

If you suspect abuse, immediate action is essential to protect the person living with dementia. Here are a few steps you can take: 

Ensure Immediate Safety

If the person living with dementia is in immediate danger, take steps to remove them from the situation and ensure their safety. If there is no immediate risk, monitor the situation closely and consult with relevant professionals, such as social workers or healthcare providers, to determine the best course of action.

Document and Gather Evidence

Document any signs of abuse, including physical injuries, changes in behaviour, or verbal reports. Keep detailed records of any incidents, as this will be important for reporting.

Report the Abuse

Report suspected abuse to the relevant authorities. In Singapore, contact the National Anti-Violence and Sexual Harassment (NAVH) Helpline at 1800-777-0000. This 24-hour helpline provides support and triages cases to the appropriate services. For non-life-threatening emergencies, you can also report abuse online via the NAVH Reporting Form on FormSG. You can also approach the Office of the Public Guardian (OPG), which provides support for safeguarding vulnerable adults at risk of abuse or exploitation.  

If the situation presents an immediate danger to life or safety, contact the police immediately by dialling 999.

Follow-up and Support

Ensure the person living with dementia continues to receive appropriate care and support. Work with social workers, healthcare providers, or other professionals to address the situation and ensure their ongoing safety.

For more information on protecting vulnerable individuals under the law, you can refer to the Vulnerable Adult Act.

Conclusion

Abuse in dementia care affects more than just older adults. It can impact anyone experiencing cognitive decline, regardless of age. Persons living with dementia are particularly vulnerable, and any form of abuse can have devastating consequences on their physical and emotional well–being. 

It is essential for professionals, caregivers, and the community to remain alert. By recognising the signs of abuse early, taking prompt action, and providing necessary support, we can help prevent abuse. In doing so, we can ensure that those living with dementia are treated with the respect, care, and protection they deserve. 

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References

  1. Straits Times. (2023, May 31). Slight rise in elder abuse cases; caregiver stress is a common factor behind abuse. The Straits Times. Retrieved from https://www.straitstimes.com/singapore/slight-rise-in-elder-abuse-cases-caregiver-stress-is-a-common-factor-behind-abuse
  2. HelpGuide. (n.d.). Elder abuse and neglect: Recognising and responding to elder abuse. HelpGuide.org. Retrieved from https://www.helpguide.org/aging/healthy-aging/elder-abuse-and-neglect
  3. Ministry of Social and Family Development. (n.d.). Protecting the vulnerable. Office of Public Guardian. Retrieved from https://www.msf.gov.sg/what-we-do/opg/safeguards/protecting-the-vulnerable 

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]]> Understanding the Four Pillars of Humanitude https://www.dementiahub.sg/living-well-with-dementia/understanding-the-four-pillars-of-humanitude/ Sat, 07 Sep 2024 03:02:42 +0000 https://www.dementiahub.sg/?post_type=dementia&p=56679 Listen Min Read As dementia progresses, the needs of those living with the condition evolve, requiring caregivers to adapt and find new ways to

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As dementia progresses, the needs of those living with the condition evolve, requiring caregivers to adapt and find new ways to connect and support their loved ones. This journey can be challenging but also rewarding, as it offers an opportunity to enhance the quality of life through caregiving. The Humanitude methodology provides a structured approach, based on four key pillars—Gaze, Speech, Touch, and Verticality—to address these changing needs effectively.

This article will explore the four pillars of Humanitude and provide practical tips on incorporating these pillars into your caregiving practices.

What is Humanitude™?

Humanitude is a care methodology developed by Yves Gineste and Rosette Marescotti, specifically designed to improve the quality of life for persons living with dementia. It combines a philosophy of care with practical techniques that emphasize respect, empathy, and connection. The four pillars of Humanitude—Gaze, Speech, Touch, and Verticality—are central to this approach. Each pillar represents a fundamental aspect of human interaction, helping caregivers foster positive relationships and support the emotional and physical needs of those in their care.

Benefits of Humanitude

Scientific research and outcomes have highlighted several key benefits of Humanitude care for persons living with dementia, delirium, and cognitive impairments:

  • Improved ability to perform activities of daily living (ADL).
  • Greater participation in daily activities.
  • Enhanced physical movement and independence.
  • Overall improvement in well-being.
  • Decreased ill-being.

For caregivers working in healthcare, practicing Humanitude has been associated with:

  • Reduced burnout
  • Increased empathy
  • Improved attitudes

Applying the Four Pillars of Humanitude: Do's and Don'ts

1. Humanitude Gaze

Gaze is a fundamental non-verbal pillar of Humanitude, essential for building emotional connections. It stimulates oxytocin, the hormone associated with love and bonding. The Humanitude Gaze is characterised by being axial, long, near, and horizontal. However, it is important to personalise this technique to suit the individual needs and preferences of each person. 

Do's

  • Horizontal: Establish eye contact at the same eye level as the person
  • Front: Approach the person from where they are looking
  • Long: Maintain eye contact for a longer duration
  • Near: Stay close, ideally within 25 cm

Don'ts

  • Vertical: Avoid looking down from above. 
  • Sideways: Refrain from glancing sideways, as it can be perceived as disinterest. 
  • Brief: Don’t make eye contact fleeting.
  • Distant: Avoid looking from more than an arm’s length away.
2. Humanitude Speech

Speech is a vital pillar of Humanitude, marked by a low, soothing tone, calm melodic intonation, and positive reinforcement. These elements work together to create a reassuring and validating environment, making interactions more comforting and supportive. 

Do's

  • Low Tone: Use a low tone of voice
  • Melodic Intonation: Speak with a gentle, rhythmic tone
  • Calm and Soothing Delivery: Keep your speech slow and composed. 
  • Positive Reinforcement: Use encouraging language

Don'ts

  • Harsh or Loud Tone: Avoid raising your voice or using a harsh tone
  • Dismissive Phrases: Refrain from using short, dismissive phrases like “what!”
  • Negative Words: Avoid negative language, such as criticising someone for being “slow”.
3. Humanitude Touch

Touch is a non-verbal method to communicate care and comfort, described in Humanitude with characteristics such as wide, soft, slow, frequent, caressing, and embracing. 

Do's

  • Wide: Use a relaxed, open palm to make contact, slightly wide apart, creating a feeling of warmth and embrace. 
  • Soft: Touch should feel like caressing a baby—gentle and reassuring. 
  • Slow: Move your hand slowly to convey patience and care, akin to pacifying a baby.
  • Start on Accepted Areas: Begin with socially accepted areas like the hands, shoulders, or forearms.

Don'ts

  • Claw: Avoid gripping with fingers
  • Fast: Don’t rush your touch; quick movements can be startling. 
  • Small Surface: Avoid using only fingertips or pointy surfaces, which can feel sharp or uncomfortable. 
  • Scarce: Don’t shy away from or avoid touch; consistent, gentle contact is important. 
4. Verticality

Verticality is a key pillar of Humanitude, vital for maintaining a person’s self-esteem and physical health. Since we naturally walk on two feet, staying upright helps foster a sense of confidence, health, and freedom. It reduces bedridden rates and promotes overall wellbeing. 

Do's

  • Upright Care: Whenever possible, provide care while the person is standing or sitting up, rather than lying down. 
  • Encourage Movement: Aim for the person to stand or walk for at least 20 minutes a day, even if in short sessions.

Don'ts

  • Avoid Unnecessary Lying Down: Refrain from providing care while the person is lying down if they can sit up or stand with assistance.

To see these principles in action, watch the video below.

The Four Pillars of Humanitude: Gaze, Speech, Touch and Verticality
Source: Humanitude Singapore

Watch Rosette Marescotti guide a caregiver in using Humanitude techniques to encourage a woman living with dementia to go for a walk. This video showcases the transformative impact of the four pillars.

Watch video

Conclusion ​​

Humanitude provides a structured approach to dementia care in Singapore, ensuring that caregivers are equipped with the tools and knowledge to create these meaningful connections. The four pillars of Humanitude can significantly enhance caregiving experiences for both yourself and the person in your care. These techniques are not just about providing care; they are about creating moments of connection, understanding, and compassion. 

In your journey as a caregiver, remember that every interaction is an opportunity to affirm the dignity and humanity of your loved one living with dementia. With the right approach, you can turn challenges into opportunities for connection and growth, ensuring that your loved one feels valued and supported at every stage of their journey.

To learn more about Humanitude™, visit the Humanitude™ Singapore website to explore a variety of resources, including videos and insights into Humanitude care. If you are a healthcare professional, you may consider signing up for the Humanitude™ Care Action-Training course to discover a relationship-centred approach to caring for persons living with dementia. For caregivers, you may consider signing up for the Humanitude™ Caregivers Training courses.   

AUTHOR BIO

HUMANITUDE SINGAPORE

Humanitude Singapore is part of Humanitude International Network of providers for training programmes on Humanitude Care Methodology. Since 2019, Humanitude Singapore has been providing Humanitude training for a thousand of healthcare professionals in Singapore, from various care settings, including acute hospitals, community hospitals, nursing homes and day care centres. Through various collaborations in the healthcare communities, Humanitude Singapore has become a trusted partner with a shared vision of enhancing the well-being of caregivers and vulnerable care recipients, including persons living with dementia.

Website

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]]> Responding to Behaviour Changes using the ABC approach https://www.dementiahub.sg/dementia-practice/responding-to-behaviour-changes-using-the-abc-approach/ Mon, 22 Jul 2024 11:57:33 +0000 https://www.dementiahub.sg/?post_type=dementia&p=54285 Listen Min Read Behavioural and Psychological Symptoms of Dementia (BPSD) often present significant challenges, impacting both the person with dementia and those providing care.

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Behavioural and Psychological Symptoms of Dementia (BPSD) often present significant challenges, impacting both the person with dementia and those providing care. This article delves into common manifestations of BPSD and introduces the ABC approach—a structured method to analyse and manage these symptoms effectively.

Persons living with dementia may experience behavioural and psychological symptoms of dementia (BPSD) which can include symptoms of disturbed perception, thought content, mood, or behaviour. Here are some examples of BPSD that are commonly seen in persons living with dementia:

One of the ways to manage and reduce the occurrence of BPSD is to utilise the ABC approach.

What is the ABC approach?

The ABC approach is a simple and effective method for understanding and managing behaviour changes by analysing the triggers, actions or responses, and outcomes associated with those behaviours:

A = Antecedents
B = Behaviour
C = Consequences

It allows for the observation of events leading up to a change in behaviour, as well as the immediate and long-term effects of that behaviour.  

By breaking down behavioural events into these components, caregivers can gain insights into why these behaviours occur and develop targeted strategies to support persons living with dementia to reduce the impact and frequency of BPSD. 

Let’s dive deeper into each of the steps of the ABC approach.  

Antecedents

Antecedents are events or factors that precede the behaviour change and contribute to its occurrence. Antecedents are also called “triggers” because they “set off” behaviours. When reviewing these events, it is important to take note of the following points:

1. When and where did the behaviour occur?
2. What was the person living with dementia doing right before the behaviour occurred?
3. What was happening around the person living with dementia at that time?
4. Consider environmental factors that might influence their behaviour.
  • Does the environment provide a safe place for the person living with dementia to walk around? 
  • Does it encourage independence, dignity and mobility? 
  • Does it accommodate their personal cultural and lifestyle habits? 
  • Other factors include:   
    • Noise 
    • Clutter  
    • Bright lights/glare on the floor 
    • Mirrors 
    • Temperature 
    • Recent changes to the environment 
5. Consider the following physical factors: 
  • Basic needs:  
    • Hunger, fatigue, constipation/faecal impaction 
  • Recent change in medical condition:  
    • Metabolic: Hyper/hypo thyroidism, hypercalcemia, hyponatremia 
    • Infection: Urinary tract infection, pneumonia, septicaemia 
    • Traumatic: Chronic pain, head trauma, fractures  
    • Systemic: Hypoglycaemia, Vitamin B12 deficiency, folate deficiency  
  • Medication:  
    • Sedatives, antihistamines, polypharmacy 
6. Consider the following psychological factors: 
  • History of psychiatric illness e.g. schizophrenia
  • Recent loss or accumulation of losses
  • Response to delusions or hallucinations

CAUSEd is a problem-solving tool developed by Dementia Australia to enable caregivers and care professionals to identify possible triggers of behaviour changes. Find out more about CAUSEd here. 

Behaviour

“Behaviour” in the ABC Approach refers to the specific behaviour change that needs to be addressed. Those behaviours that are of immediate concern would be those that risk harm to the person living with dementia or others or have a negative impact on the quality of life of the person living with dementia and/or their caregivers. Look at one behaviour at a time in the problem-solving process.

1. What was the behaviour of the person living with dementia?

Be as specific as possible. For example, if the person living with dementia is displaying signs of aggression, be specific to describe the presenting behaviour. Examples of specific presenting behaviours include, using the umbrella to hit the caregiver, shouting vulgarities, throwing a cup at the caregiver.

2. It is also critical to identify the frequency, scope, and duration of such behaviours.

Consequences

These refer to the events that happen immediately after the behaviour occurs. It also includes all the reactions and responses to the person living with dementia, including those by the caregiver, other family members, staff or visitors.

1. How did others respond to the change in behaviour?
  • Ignored the person living with dementia 
  • Reprimanded the person living with dementia  
  • Tried to correct the person living with dementia 
  • Restrained the person living with dementia 
  • Sedated the person living with dementia 
2. What was the response of the person living with dementia to the reactions of others?
  • Annoyed 
  • Upset 
  • Angry  
  • Offended  

We must remember that persons living with dementia are unable to control and/or prevent these behaviours on their own.  So, what we can do or respond is to change or adjust what happens before (antecedents) or after (consequences) the behaviours. And it is recommended to change one antecedent or consequence at a time so that we can evaluate what is working and what is not. It is also important to note that the condition of the person living with dementia may deteriorate with time, therefore the same strategies may not always work. Modifying the environment (physical and social) over time might be necessary. 

Keeping a Behaviour Log

When dealing with behaviour changes, we can observe or reflect on the behavioural patterns of the person living with dementia during these stressful situations. One of the things that you can do is to monitor changes in behaviour with a behaviour log. By keeping a behaviour log, we may be able to find out what works to prevent or de-escalate the behaviour. Apply Person-Centred Care (PCC) to identify the unmet needs which may exacerbate the behaviour of concern, and make adjustments to the antecedents or consequence in order to address possible unmet needs related to attachment, comfort, occupation, identity and inclusion. 

Here is an example of an ABC Behaviour Log that can be used to help you observe and record these behaviours efficiently: 

Table 1. Extract from Mary’s ABC chart (Sample)
Date & Time

A = Antecedent (Triggers)

What happened immediately before the change in behaviour?
– Who was involved?
– What activity was going on?
– When did the behaviour occur?
– Where did the behaviour occur?
– How (in what way or manner?)
(Consider any potential unmet needs)

B = Behaviour

What was the behaviour you would like to change?
– Describe the behaviour observed i.e. yelling, kicking, swearing.
– What happened?
– How long did it last?
(Do not try to guess emotions)

C = Consequences (Responses)

What happened after the behaviour occurred?
– How did the person living with dementia respond?
– How did others around the person respond?
– Who else was involved?

1/7/2024, 5pmMary was playing mahjong with other residents and seemed very engrossed in the session. As it was dinner time, staff nurse Peter abruptly stopped the mahjong session. Mary was visibly upset and started scolding vulgarities at Peter. She said, “I was about to win and you cleared all the tiles! You are so bad!”When her dinner plate was served to her, Mary said firmly that she did not want to eat. When the staff tried to persuade her by scooping food for her and bringing to her mouth, Mary threw her dinner plate onto the floor and continued to spew vulgarities towards the staff.Mary tried to walk out of the dining area but was stopped by Peter. Another staff, Maryanne, came over to assist and both of them eventually brought her to her bed and gave her a radio to listen to. Mary was observed to have calmed down a little but was still visibly upset.
1/7/2024, 8pmStaff nurse Peter told Mary that it is time to go to the toilet and to change her diaper. However, Mary shouted, “No, I am not in the mood today. Do not bother me. You better get stay out of my sight!”Mary refused to go to the toilet for her diaper change. She scolded Peter when he attempted to assist her from her bed to the toilet.Mary kept shaking her head vigorously and tried to hit Peter multiple times. She was eventually physically restrained by two staff to the bed. Diaper change was done on the hospital bed.

Download the ABC Behaviour Log here.

Conclusion

The ABC approach can enable caregivers to monitor behaviour changes and their associated factors over time, so that strategies can be applied to address unmet needs which may perpetuate the occurrence of behaviours of concern. Responding to behaviour changes in a Person-Centred way can help to alleviate the burden of care and improve the quality of life of the person living with dementia and their caregivers.

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]]> Vascular Dementia https://www.dementiahub.sg/what-is-dementia/vascular-dementia/ Thu, 14 Dec 2023 04:41:02 +0000 https://www.dementiahub.sg/?post_type=dementia&p=43124 Vascular dementia is a type of dementia that happens when problems in blood flow to the brain damage the brain tissues.

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Vascular dementia is one of the most common types of dementia in Singapore. In fact, 45.5% or almost half of those with dementia in Singapore have this condition. 1 Read on to find out more about what it is, its symptoms and risk factors, and how to reduce the risk of developing this type of dementia. 

What is Vascular Dementia?

Vascular dementia is a type of dementia caused by blood-flow-related brain damage. The word ‘vascular’ refers to blood vessels. 

How Common is Vascular Dementia?

In many parts of the world including Singapore, vascular dementia is the second most common type of dementia after Alzheimer’s disease. According to the National Neuroscience Institute (NNI), 16% of the patients seen at NNI from 2013-2017 who developed dementia when they were above 65 years of age had vascular dementia, while those who had developed dementia below 65 years of age seen at NNI in the same period accounted for 19% of cases. 2

Main Symptoms of Vascular Dementia

The symptoms of vascular dementia are similar to those experienced in other types of dementia. Typical symptoms include: 

  • Slow thought 
  • Difficulty with planning 
  • Trouble understanding 
  • Issues with concentration 
  • Mood and/or behaviour changes 
  • Memory and language issues 
  • Problems with movement and/or balance 

 

The symptoms experienced depend on the specific brain areas that have been damaged. For example, if brain areas that are needed to understand language are damaged, a person with this kind of brain damage may have trouble understanding what they hear others saying, or what they read. 

Read more about causes of vascular dementia in the sections below for more information of more specific groups of symptoms that can occur. 

How quickly do symptoms develop?

The speed of symptom development depends on the cause, type, and severity of the vascular dementia. 

Symptoms of vascular dementia can develop slowly over time, which typically happens when the dementia is caused by chronic, slow-developing blood vessel damage. 

On the other hand, symptoms can appear or worsen suddenly after a stroke: after both the first stroke and any subsequent strokes. 

Do symptoms differ from symptoms of other types of dementia, such as Alzheimer’s disease?

Symptoms of vascular dementia tend to be characterised more by speed of thought and problem-solving ability. 
Some symptoms, like memory loss and language issues, tend to be more prominent in dementia caused by Alzheimer’s disease than in vascular dementia, although persons living with vascular dementia may experience them too. 

The differences between the symptoms of vascular dementia and those of other kinds of dementia may be more obvious at the milder stages of dementia. As dementia progresses, the kinds of symptoms experienced may broaden in scope, and the differences between the symptoms of vascular dementia and other kinds of dementia may become less apparent.  

Mixed dementia: More than one type of dementia

A person can also develop mixed dementia, which happens when a person has more than one type of dementia. Most cases of mixed dementia happen with Alzheimer’s and vascular dementia since they are the two most common types of dementia. Persons with mixed dementia will show signs of both types of dementia, with one type of dementia often being predominant. 

Causes

Blood carries nutrients and oxygen that our body’s cells need to work and be alive. When blood cannot reach certain brain tissues because of problems with blood flow, these tissues cannot receive the oxygen and nutrients they need and become damaged. If this lack of blood flow happens for too long, these tissues can die, causing irreversible damage. 

Some of the more common vascular issues that can cause vascular dementia include: 

Ischemic stroke

The word ‘ischemia’ means ‘lack of blood flow’. An ischemic stroke is a blockage in a blood vessel in the brain. A single ischemic stroke or multiple strokes can prevent blood from reaching brain tissues. 

Haemorrhagic stroke

The word ‘haemorrhage’ means bleeding. Haemorrhaging in the brain, or a haemorrhagic stroke, can happen in the brain’s blood vessels, and it is life-threatening when this happens. There are many possible causes of bleeding in the brain, including head trauma, high blood pressure that weakens blood vessels’ walls, and aneurysms (abnormal bulging in the walls of blood vessels). 

Chronic blood vessel damage

Chronic blood vessel damage means damage to blood vessels that continues for a long time. 

Damage to blood vessels, such as the narrowing of blood vessels, can, when it is severe, obstruct blood from flowing to brain tissues. Over time, this obstruction can develop into vascular dementia. 

Types of Vascular Dementia

The symptoms of vascular dementia, and their order of development as dementia progresses, depend on the type of vascular dementia a person develops. The types of dementia are defined by different causes. 

Below are the main types of vascular dementia:  

Subcortical vascular dementia
  • Subcortical vascular dementia happens when tiny blood vessels deep inside the brain become damaged. 
  • Most tissues damaged in this type of dementia happen in an area deep within the brain called the subcortex. 
Stroke-related dementia

Stroke-related dementia happens when a stroke or multiple strokes happen in the brain. A stroke prevents blood from reaching brain tissues, leading to tissue death. The place where there is dead tissue due to low blood supply is called an ‘infarct’. 

  • Strategic-infarct dementia 
    • Strategic-infarct dementia happens when dementia is caused by one large stroke
    • In this kind of dementia, there is a sudden and drastic change in thinking and behaviour, although with appropriate support, symptoms can be stabilised. 
  • Multi-infarct dementia 
    • Multi-infarct dementia happens when dementia is caused by a series of strokes which progressively damages brain tissue. 
    • Some strokes can be small and have minor symptoms. They can even happen without noticeable symptoms, in which case they are called ‘silent’ strokes. 
    • Smaller strokes are also called ministrokes or transient ischemic attacks (TIAs). 
    • Ministrokes can last for a few minutes each, and their more obvious symptoms can last for an hour to a day. 
    • As more strokes happen over time, symptoms of dementia can develop and worsen. The worsening of symptoms may be more noticeable immediately after each small stroke, after which the symptoms may tend to stabilise.

Stroke Syndromes

For both strategic-infarct and multi-infarct dementia, the parts of the brain that the stroke damages affects the syndrome (a group of symptoms) that a person experiences will differ. Knowing what stroke syndromes you or your loved one with vascular dementia may have can help you to better manage the symptoms of vascular dementia and get the appropriate support. 

Many strokes will occur with hallmark stroke symptoms: 

  • Facial drooping of one side of the face 
  • Hemiparesis: weakness on one side of the body 
  • Numbness, usually on one side of the body 
  • Dysarthria: difficulty with speaking and/or slurred speech 
  • Dysphasia, or language impairment: an impaired ability to understand spoken and written language 
  • Confusion: trouble speaking and understanding speech 
  • Sight issues in either or both eyes 
  • Movement issues: trouble with walking; dizziness; difficulties with balance and coordination  
  • Severe headache without a known cause 

These hallmark symptoms may not always happen in a stroke, or may happen with other syndromes depending on the type of stroke. The type of stroke itself depends on the area of the brain affected, including the side of the brain (right or left). 

Some symptoms happen immediately when the stroke first happens, while others may develop after some time. In addition, some symptoms are long-lasting, while some symptoms involving the loss of abilities (for example. speech, sight) can sometimes be partially recovered. 

More information about stroke syndromes can be found in the section Additional Information: Stroke Syndromes at the end of the article. 

Treatment and Support

As vascular dementia is highly linked to vascular health issues, persons living with vascular dementia may be advised to take steps to improve their overall cardiovascular health, such as by improving their diet and level of physical activity. 

Treating and supporting dementia-related health conditions

Treatment and support after the diagnosis of vascular dementia may be done alongside treatment of health conditions that caused the dementia. For example, if a person has had a stroke that has led to the development of vascular dementia, this person may take medications for post-stroke treatment while undergoing rehabilitation therapies, such as physical therapy, speech therapy, and occupational therapy, to work on post-stroke issues.  

Practical, psychosocial, and emotional support

Experiencing and adapting to vascular dementia are not easy for both the person experiencing the condition and their family and friends. It is, therefore, important to get support. Apart from the support from your community, support services are also available. For example, there are post-diagnostic support programmes that help to guide persons diagnosed with dementia and family caregivers through a period of time after diagnosis. 

For more information on the support services available, contact a Community Outreach Team (CREST). 

Risks

The risk of developing vascular dementia is closely linked to what affects one’s vascular health. Some risk factors for developing vascular dementia include: 

  • High blood pressure 
  • High blood cholesterol 
  • Diabetes 
  • Obesity 
  • Smoking 
  • Older age 

How can I reduce my risk of developing vascular dementia?

In general, keeping one’s vascular system healthy and maintaining a healthy lifestyle helps to reduce the risk of developing vascular dementia. 

Ways to keep one’s vascular system healthy: 

Have a balanced diet
  • Moderate salt, sugar, and fat intake 
  • Eat sufficient fruits and vegetables 
  • Consume more wholegrain instead of refined carbohydrates like white rice or white bread 
  • Consume more protein-rich foods with healthy fats such as fish meat and beans over red meats 
Stay physically active
  • It is recommended to have 150 minutes of moderate-intensity physical activity per week 
  • Do a good mix of aerobic exercise (exercise that speeds up your heart rate and breathing), strength-training exercise (exercise that maintains and builds muscle mass), stretching, and balance exercises 
Get enough sleep
  • In general, getting enough sleep lowers the risk for serious health problems 
Manage stress
  • Managing stress, especially long-term stress can improve heart health and mood, which in turn lowers the risk of developing vascular dementia 
Avoid or reduce smoking
  • Smoking damages blood vessels, which may make developing vascular dementia more likely 
Stay socially engaged and connected
  • Staying connected with others helps to regulate stress levels, which is good for vascular health 
  • Some ways you could keep connected could include: visiting Active Ageing Centres, volunteering in your community with others, organising occasions to eat together, or asking friends and/or family to do leisure activities together 
Stay mentally active

Keep yourself engaged in activities that challenge yourself mentally. For example: 

  • Doing things that exercise your creativity (art activities, gardening, etc.) 
  • Learning new skills 
  • Playing games 
  • Having discussions with others 

Watch this video by the Health Promotion Board to learn more about reducing the risk of developing vascular dementia. 

Find out more about reducing the risk of developing dementia here. 

How to get help: 
If you or someone you know may have vascular dementia and need support or information, contact a Community Outreach Team (CREST) to find out more about getting support, or call Dementia Singapore’s helpline at 6377 0700. 

Additional Information: Stroke Syndromes

A stroke syndrome is a group of symptoms that happens because of a stroke.  

Cerebellar Stroke Syndrome
  • Cerebellar strokes happen when blood vessel blockage or bleeding prevents blood flow to a part of the cerebellum.
  • Cerebellar strokes are rare, and make up less than 10% of strokes.3
  • Cerebellar stroke symptoms include:
    • Dizziness and vertigo, with a feeling of falling to one side (occurs in 75% of cases of cerebellar stroke)4
    • Nausea and vomiting (occurs in 50% of cases) 4
    • Difficulty with walking
    • Difficulties with coordination
    • Tremors
    • Headache
    • Slurred speech
    • Trouble with speech
    • Double vision
Pontine Stroke Syndrome
  • A pontine stroke happens when blood vessel blockage or bleeding prevents blood flow to a part of the brain stem called the pons.
  • Pontine strokes are common, accounting for about 7% of strokes.5
  • Pons and brain stem stroke symptoms may differ from the hallmark stroke symptoms, and may include:
    • Dizziness, vertigo, and severe balance issues
    • Double vision
    • Slurred speech
    • Swallowing difficulties
    • Reduced alertness
    • Motor and/or sensory impairment
    • Hemiparesis: weakness and clumsiness in the face, arms, and legs on one side of the body
Frontal Lobe Stroke Syndrome
  • A frontal lobe stroke happens when blood vessel blockage or bleeding prevents blood flow to the frontal lobes of the brain’s cerebral cortex. 
  • Frontal stroke symptoms include: 
    • Hemiparesis 
    • Speech issues 
    • Swallowing difficulties 
    • Incontinence
    • Difficulties with spatial reasoning 
    • Changes in behaviour and personality 
    • Difficulties with executive functioning skills, such as reasoning, judgement, decision making, and problem solving 
Temporal Lobe Stroke Syndrome
  • A temporal lobe stroke happens when blood vessel blockage or bleeding prevents blood flow to the temporal lobes of the brain’s cerebral cortex. 
  • Temporal lobe stroke symptoms include: 
    • Speech issues 
      • Wernicke’s aphasia: a condition where a person is unable to understand the meaning of language spoken to them, or to produce meaningful language 
    • Hearing issues 
      • Hearing impairment may range from mild hearing loss to complete loss of hearing, which is rare 
      • Difficulties with processing sounds 
      • Auditory hallucinations
    • Emotional changes such as fits of anger or aggression, or a lack of interest 
    • Difficulties with memory 
Parietal Lobe Stroke Syndrome
  • A parietal lobe stroke happens when blood vessel blockage or bleeding prevents blood flow to the parietal lobes of the brain’s cerebral cortex. 
  • The symptoms of a parietal lobe stroke depend on whether the left or right parietal lobe is affected, and which side of the individual’s brain is more dominant for certain functions (e.g. language, mental calculations). 
  • In most cases, a right-sided parietal lobe stroke leads to: 
    • Paresthesia, or abnormal sensations, on the left side of the body 
    • Weakness on the left side of the body 
    • Hemispatial neglect: a decreased awareness of the left side of the body and the environment on the left side 
    • Impaired spatial awareness of the environment on the left side of the body 
    • Difficulties with copying drawings 
    • Difficulties with sense of direction, and for visual and spatial memory 
    • Anosognosia: A lack of awareness of stroke symptoms, or that the stroke has even occurred 
  • In most cases, a left-sided parietal lobe stroke leads to: 
    • Paresthesia, weakness, hemispatial neglect, and/or impaired spatial awareness on the left side of the body 
    • Right-left confusion: difficulty with orientating the self to the left or right sides of one’s body or environment 
    • Agnosia: difficulties with recognising objects 
    • Acalculia: difficulty with counting 
    • Aphasia: speech and language issues; parietal lobe damage may also result in the inability to repeat others’ speech 
    • Agraphia: difficulty with writing 
Occipital Lobe Stroke Syndrome
  • An occipital lobe stroke happens when blood vessel blockage or bleeding prevents blood flow to the occipital lobes of the brain’s cerebral cortex. 
  • Occipital lobe strokes happen less often than strokes in the other cerebral lobes (temporal, parietal, and frontal lobes). 
  • Because the occipital lobes serve important functions in a person’s ability to perceive, process, and remember visual and spatial information, strokes that affect this brain area may strongly affect these abilities 
    • Occipital lobe stroke symptoms include: 
    • Vision loss: 
      • Heianopia: blindness on one side of the person’s field of vision 
        • A stroke that affects one side of the occipital lobe will affect the field of vision opposite to the affected brain area; for example damage to the left occipital lobe causes vision loss in the right half of the field of vision. 
      • Quadrantanopia: blindness in one quadrant of the person’s field of vision 
      • Central vision loss: loss of sight in the centre (middle) of your field of vision 
      • Complete cortical blindness: Cortical blindness means total loss of sight due to damage in the brain’s cortex; this sight loss is not due to changes to the eyes. 
        • Anton syndrome: In some rare cases, persons with cortical blindness may be unaware that they are blind despite being shown evidence that that is the case 
    • Visual agnosia: an ability to recognise objects by sight 
    • Prosopagnosia, or face blindness: an ability to recognise the faces of people 
      • Word blindness: some people may be able to recognise letters and spell words, but not recognise words 
    • Visual hallucinations: though rare, persons may see images that do not originate from actual visual stimuli in their environment like sparks and lights 
    • Alexia without agraphia: an inability to read without difficulties with writing ability 
    • Difficulty with eye movement 
      • Nystagmus: Uncontrollable, constant, and rapid eye movements 
      • Control of eye movements: the nerves controlling the muscles that manage movements of different eye parts may be affected, which may cause eye misalignment and double vision, difficulties in tracking objects, difficulties with adapting to changes in light intensity, and eyelid drooping. 

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References

  1. Health Promotion Board. (n.d.). Let’s talk about Vascular Dementia. HealthHub. https://www.healthhub.sg/programmes/mindsg/vascular-dementia  
  2. Chiew, H. J. (2021, July 5). Young-onset dementia: Improving outcomes with early recognition at Primary Care. SingHealth. https://www.singhealth.com.sg/news/defining-med/Young-Onset-Dementia  
  3. Ng, Z. X., Yang, W. R. E., Seet, E., Koh, K. M., Teo, K. J., Low, S. W., Chou, N., Yeo, T. T., & Venketasubramanian, N. (2015). Cerebellar strokes: A clinical outcome review of 79 cases. Singapore Medical Journal, 56(03), 145–149. https://doi.org/10.11622/smedj.2014195  
  4. Ioannides K, Tadi P, Naqvi IA. Cerebellar Infarct. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470416/  
  5. Huang, J., Qiu, Z., Zhou, P., Li, J., Chen, Y., Huang, R., Li, C., Ouyang, X., Feng, H., Xu, H., Liu, D., Dai, Z., Zhu, J., Liu, X., Chen, H., & Jiang, Y. (2019). Topographic location of unisolated pontine infarction. BMC Neurology, 19(1), 1-6. https://doi.org/10.1186/s12883-019-1411-6  

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]]> Creating a Life Story for Persons with Dementia https://www.dementiahub.sg/living-well-with-dementia/creating-a-life-story-for-persons-with-dementia/ Thu, 20 Jun 2024 13:03:20 +0000 https://www.dementiahub.sg/?post_type=dementia&p=52654 Listen Min Read Discover the powerful impact of life story work in dementia care. This article explores how gathering and reflecting on personal narratives

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Discover the powerful impact of life story work in dementia care. This article explores how gathering and reflecting on personal narratives enriches identity, deepens empathy, and fosters meaningful connections for persons living with dementia and caregivers alike.

What is a Life Story?

Everyone has their own, unique life story. Our life experiences, beliefs, likes and dislikes, shape us as individuals. Life story work is an activity in which a person living with dementia is facilitated by family members and/or healthcare professionals to gather and review their past. The process of engaging in life story work helps the person to share their stories and enhance their sense of identity1.

Persons Living with Dementia and their Life Story

As dementia progresses, persons living with dementia can experience problems with communication and memory loss. Incorporating personal narratives and biographical knowledge while caring for a person living with dementia has been shown to increase caregiver’s empathy and uphold person-centred care2.

What is the Purpose of a Life Story Resource?

  • Provide a guide for family members and/or care staffs to discover the person;
  • Celebrate life achievements, special events, holidays, and other occasions that have been historically important to the person; 
  • Promote and support mental stimulation; 
  • Provide emotional comfort and pleasure; 
  • Help engage the person in meaningful conversations about the past where memories are more vibrant and clearer; 
  • Encourage social interactions between the person living with dementia, family members, and caregivers; 
  • Provide meaningful interaction to calm the person living with dementia if overwhelmed by other people, events, and noises in the environment; 
  • Use as a refocusing tool to support the person living with dementia in new and unfamiliar surroundings (e.g. hospital, moving to nursing home, changing rooms, etc.)3.  

Making a Life Story Resource

Information Gathering

Gather information about the person living with dementia from family members, care staff, case files, or directly from the person living with dementia themselves.

Preparation of Materials

Prepare materials to create a life story, including old photographs, keepsakes, thick files, colored papers, decorative items, colored pencils, paint, glue, scissors, and clear plastic folders.

Topic Selection

Suggested topics to include in a life story: 

  1. About me – personal bio
  2. Favourite food  
  3. Occupation
  4. Home 
  5. Childhood
  6. Favourite Idols
  7. Travel
  8. Retirement
  9. Relationships – Significant relationship with family and friends
  10. Legacy 

If the person living with dementia  has experienced sad or traumatic events that would cause great distress, you may want to avoid revisiting these life events. However, it may be helpful to explain these on a separate document that can be given to family members or other caregivers so that they can identify whether changes in behaviours are related to a specific events that have happened in the past.  

What Does a Life Story Look Like?

When developing a life story with a person living with dementia, one of the following formats, or a combination of formats, can be considered:  

  • Book 
  • Collage 
  • Video recording 
  • Memory box 
  • Personal profile document 
  • Mobile phone application 

The life story can be designed in any way that is meaningful to the person living with dementia. Those who prefer to do this virtually can do so using CARA, a lifestyle and community digital platform that provides easy access for persons living with dementia and caregivers to connect to an ecosystem of solutions via a mobile application. CARA has introduced a Care Circle feature, which allows family caregivers to collaborate on shared notes and create Memories, honouring and celebrating the life of their loved one with dementia. These Memory records can be used as personalised content, making every interaction throughout the dementia journey a meaningful one. Find out more about Care Circle here.

However, if you are looking for a more structured template, you can refer to the following resources:

dementia-uk-my-life-story-template_page-0001 (1)

Life Story Template
Source: Dementia UK

Dementia UK’s Life Story template is a practical tool for capturing personal histories, particularly for those with dementia. It offers customisable sections and a straightforward approach for easy documentation. Get started on your story today.

Download Template
this_is_me_1553_page-0001 (1)

This is Me Template
Source: Alzheimer Society

This is me serves as a tool for life story work, helping caregivers record important details about the background, preferences, and significant life events of the person living with dementia. By using This is me,  health and social care professionals can provide more personalised and attentive care based on a deeper understanding of the person living with dementia. 

Download Template

How Do You Engage Persons Living with Dementia in Creating a Life Story Resource?

Involving the person living with dementia as much as possible makes the life story more likely to reflect the person’s wishes and preferences and encourages a sense of ownership. The person living with dementia may also have very different views about the purpose of their life story resource. Respect their wishes about what goes into the life story and who will see it, now and in the future.  

Engage and  help them where needed, and write or type the information gathered so that they can see the story forming, with you. Try not to overload them with questions. It may be easier to start the conversations with open-ended questions. For example, you might say, “Can you share more about where you grew up?”.  

Learn more about effective communication with persons living with dementia here.

Creating  the life story may take days, weeks, or even months.  Remember that you can always add more information to it later and check in with other family members and friends to provide key information if needed. Remember to also be sensitive as reflecting on one’s life can be emotional.  

Conclusion

A life story resource does not stop here. It is retold and remains unfinished. It is also more likely to be successful if life story work is initiated early in the dementia journey. Do continue to add on to the stories and information as conversations with persons living with dementia continues.   

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References

  1. Thompson,R. (2011). Using life story work to enhance care. Nurs Older People. 23(8): 16-21. doi: 10.7748/nop2011.10.23.8/16.c8713.
  2. Doran, C., Noonan, M., Doody, O. (2019). Life-story work in long-term care facilities for older people: An integrative review. J Clin Nurs. 28(7-8):1070-1084. doi: 10.1111/jocn.14718. 

  3. Dementia UK, (n.d). Creating a ‘Life Story’ Caring for someone with dementia (n.d.). Retrieved from: https://www.dementiauk.org/wp-content/uploads/dementia-uk-creating-a-life-story.pdf  

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]]> Vocally Disruptive Behaviour https://www.dementiahub.sg/care-professional-category/care-professional/behaviours-of-concern/vocally-disruptive-behaviour/ Wed, 15 Jul 2026 00:51:31 +0000 https://www.dementiahub.sg/?post_type=dementia&p=86575 Vocally Disruptive Behaviour (VDB) covers a range of vocalisation (both verbal and non-verbal) that may cause distress to others.

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Vocally Disruptive Behaviour (VDB) covers a range of vocalisation (both verbal and non-verbal) that may cause distress to others (Ahmed et al., 2021).

Some examples of VDB are (Dementia Collaborative Research Centre, 2012):

  • Noises that seem purposeless and preservative
  • Noises as a response to surroundings
  • Noises intended to provoke a response from others

 

VDB tends to become more prevalent as Dementia progresses (McMinn & Draper, 2005). 

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References

  1. Ahmed, S. B., Obieta, A., Santos, T., Ahmad, S., & Ibrahim, J. E. (2021). Effects of nonpharmacological interventions on disruptive vocalisation in nursing home patients with Dementia—A Systematic Review. Frontiers in Rehabilitation Sciences, 2. https://doi.org/10.3389/fresc.2021.718302
  2. Andersen, E. M., Kristiansen, E. D., & Rasmussen, G. (2019). Routines of “sitting” and “enjoying ourselves” in the common room of a Dementia unit. Logopedics Phoniatrics Vocology, 44(1), 23–30. https://doi.org/10.1080/14015439.2019.1554854
  3. DementiaHub. (2024, September 10). Namaste care programme. https://www.Dementiahub.sg/Dementia-practice/namaste-care-programme/
  4. Dementia Collaborative Research Centre. (2012). Behaviour Management – A guide to good practice Retrieved November 1, 2024 from https://www.Dementiaresearch.org.au/wp-content/uploads/2020/07/DCRC_BPSD_Guide_2012.pdf
  5. Khan, Z., Da Silva, M. V., Nunez, K., Kalafatis, C., Nowicki, S., Walker, Z., Testad, I., Francis, P., & Ballard, C. (2021). Investigating the effects of impairment in non‐verbal communication on neuropsychiatric symptoms and quality of life of people living with Dementia. Alzheimer S & Dementia Translational Research & Clinical Interventions, 7(1). https://doi.org/10.1002/trc2.12172
  6. Lorusso, L. N., & Bosch, S. J. (2017). Impact of multisensory environments on Behavior for people with Dementia: a systematic literature review. The Gerontologist, 58(3), e168–e179. https://doi.org/10.1093/geront/gnw168
  7. Matteau, E., Landreville, P., Laplante, L., & Laplante, C. (2003). Disruptive vocalizations: A means to communicate in Dementia? American Journal of Alzheimer S Disease & Other Dementias®, 18(3), 147-53.https://doi.org/10.1177/153331750301800 307 
  8. McMinn, B., & Draper, B. (2005). Vocally disruptive behaviour in Dementia: Development of an evidence based practice guideline. Aging & Mental Health, 9(1), 16–24. https://doi.org/10.1080/13607860512331334068 
  9. Nwogbunyama, C., Kelly, B. D., & Cooney, C. (2020). Vocally disruptive behaviour in nursing home residents in Ireland: a descriptive study. Irish Journal of Psychological Medicine, 40(2), 217–227. https://doi.org/10.1017/ipm.2020.124
  10. Randall, E. W., & Clissett, P. C. (2015). What are the relative merits of interventions used to reduce the occurrences of disruptive vocalisation in persons with Dementia? – a systematic review. International Journal of Older People Nursing, 11(1), 4–17. https://doi.org/10.1111/opn.12083
  11. Roberto, K. A., McCann, B. R., Savla, J., & Blieszner, R. (2024). Family caregivers’ management of behavioral expressions of Dementia. The Gerontologist, 64(6). https://doi.org/10.1093/geront/gnae020
  12. Salvi, S., Preston, N., Cornally, N., Walshe, C., Brady, N., Fitzgerald, S., Hartigan, I., Pocknell, C. E., Timmons, S., Loučka, M., Hlávka, J., Albanesi, B., Gonella, S., Di Giulio, P., Olagnero, J. M., Van Der Steen, J., Van Den Broek, B., Kaasalainen, S., Chambers, T., . . . O’Neill, R. (2025). Implementing Namaste Care in nursing care homes for people with advanced Dementia: a systematically constructed review with framework synthesis. BMC Geriatrics, 25(1). https://doi.org/10.1186/s12877-024-05636-4
  13. Sefcik, J. S., Ersek, M., Hartnett, S. C., & Cacchione, P. Z. (2018). Integrative review: Persistent vocalizations among nursing home residents with Dementia. International Psychogeriatrics, 31(5), 667–683. https://doi.org/10.1017/s1041610218001205
  14. Telenius, E. W., Tangen, G. G., Eriksen, S., & Rokstad, A. M. M. (2022). Fun and a meaningful routine: the experience of physical activity in people with Dementia. BMC Geriatrics, 22(1). https://doi.org/10.1186/s12877-022-03149-6
  15. Von Gunten, A., Alnawaqil, A. M., Abderhalden, C., Needham, I., & Schupbach, B. (2008). Vocally disruptive behavior in the elderly: a systematic review. International Psychogeriatrics, 20(4), 653–672. https://doi.org/10.1017/s1041610208006728 

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]]> Programmes and Services https://www.dementiahub.sg/dementia/programmes-and-services/ Thu, 09 Apr 2026 02:45:47 +0000 https://www.dementiahub.sg/?post_type=dementia&p=41934 Persons living with dementia and caregivers are supported by an integrated mental health network to help them live well in the community.

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There are numerous programmes and services available in the community, owing to the Integrated Mental Health Network. This network brings together health, social, and community care providers who serve various clients, including persons living with dementia and their care partners.  
 
If you are just starting out on your journey with dementia and don’t quite know where to start, this article is for you. Read on to find out about the various programmes and services available, how they can help you, and requirements you might need to take note of before applying. 

CARE & SUPPORT SERVICES

Care & Support services involve the provision of practical (i.e., support with daily activities, linking clients up to relevant care services), emotional and financial support for persons living with dementia and their caregivers. These services may be rendered at home, a day care centre, or a nursing home for clients who require care and support that cannot be provided at home.

SOCIAL ACTIVITIES/PROGRAMMES

Social activities and programmes create opportunities for interaction with others in the community, which is especially pertinent for persons living with dementia who may become more withdrawn over time as they socialise or communicate less. These activities and programmes are aimed at slowing down the progress of dementia, providing a structured schedule, and improving the mood of persons living with dementia.

MEDICAL AND HEALTHCARE SERVICES

Medical and healthcare services for persons living with dementia may include medical assessments, rehabilitation care, prescription of medications to aid with behaviour, memory and mood, as well as nutritional assessments. These services may be rendered in various settings, including the care recipient’s home, centres, hospitals or nursing homes.

ADDITIONAL RESOURCE

Directory Listing of Dementia Support and Services

This resource details a comprehensive list of the various programmes and services in the community, divided by the 4 main regions in Singapore so you can easily find a service provider near you.

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References

  1. Retrieved on 23 November 2023 from https://supportgowhere.life.gov.sg/.
  2. Introduction to Community Care Services. Retrieved on 23 November 2023 from https://www.aic.sg/care-services 

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