Source: Agency for Integrated Care
Advance Care Planning
Advance Care Planning (ACP) is the process of planning for one’s future health and personal care. Having ACP conversations will allow a person living with dementia to:
• Share their personal values and beliefs with the family
• Explore how his/her values and beliefs influence their healthcare preferences in difficult medical situations
• Delegate a trusted member/relative to make healthcare decisions on their behalf, should he/she be unable to one day
Ideally, discussions about the person living with dementia should take place as early as possible, while he/she still has the capacity to make informed choices and decisions.
ACP is an important part of routine healthcare. Anyone can start their ACP today regardless of their age or health condition. Discussing and documenting healthcare preferences with loved ones and a healthcare team can give everyone peace of mind.
ACP is particularly important for people who have a chronic illness, an early cognitive impairment, frail, or are approaching the end of life.
Doing an ACP helps to promote more holistic healthcare:
• Patients receive healthcare that is tailored to their values and preferences. Many patients who have done their ACP avoided unnecessary or overly aggressive medical treatments.
• Families of people who have done their ACP experienced less anxiety, less stress, and were clearer about what decisions to make.
• The healthcare team has a better understanding of the quality of life you expect and can act in your best interests.
This video explores a scenario where a family together works out the care plan of their loved one who has dementia.
Source: Agency for Integrated Care
1. Think about it
Consider what a person with dementia needs to live meaningfully and what would be important to him/her at the end of life.
Understand the prognosis and treatment options.
2. Talk with loved ones and caregivers
Discuss wishes and goals for care with close family and friends to help them better understand the situation.
A person living with dementia may have one or two trusted loved ones who can be his/her voice.
3. Put wishes into a plan
Record and share decisions and wishes with appropriate persons.
Share and discuss these future healthcare choices with the attending doctor.
4. Review your preferences
A person living with dementia can always change his/her mind after the plans are made.
If that happens, be sure to update the ACP documents and make new copies for the trusted parties involved.
To start the Advance Care Planning process, you can download this workbook which will guide you and your loved ones through the process.
Advance Care Planning (ACP) may be done at most hospitals, selected polyclinics, and community care providers:
• If one is a patient at a hospital or polyclinic, they can ask their doctor for a referral.
• If one is generally in good health, they may make an appointment at ACP nodes.
• Some providers offer the option to do ACP over a video conferencing platform (TeleACP Providers).
• One may also apply for a Lasting Power of Attorney with selected service providers.
For information on TeleACP providers and selected services providers, visit the Agency for Integrated Care’s website.
This is a Singapore government website which contains information on end-of-life planning. Their pages are available in English, Mandarin (中文), Malay (Melayu), and Tamil (தமிழ்).
Our Grandfather Story: Are You Afraid of Dying?
In this video, interviewees share their journeys with their health conditions. They also discuss ACP and the Lasting Power of Attorney (LPA).
Source: Our Grandfather Story
1. Menon, Kars, Malhotra, Campbell & van Delden (2018) discussed the different perspectives of ACP use in the local Singaporean context, and about how involvement of a family network can facilitate acceptance of ACP’s use locally. It recommended seeking patients’ consent for family involvement in decision-making at regular intervals to encourage ACP use.
2. Dening, Sampson & De Vries (2019) listed out recommendations for discussing ACP for persons living with dementia including communication models and resources for reference, as well as a guide for ACP conversations.
3. An exploratory qualitative study by de Vries & Drury-Ruddlesden (2019) on 26 family members who had provided care for female persons living with dementia in New Zealand emphasised the importance of ACP and recommended three areas to prepare CG:
• Knowing the person and belief in “doing the right thing”
• Importance of Will and LPA
• Negotiating unexpected encounters