Caregiver Archive - DementiaHub.SG

Have you or your loved one been living with memory loss for some time? Have you been concerned about whether you or your loved one has dementia? A diagnosis may help address these concerns and reduce any anxiety you may have regarding these symptoms your loved one is experiencing.

Facing Dementia: Do I Have Dementia? (Ep 1)
Source: Channel News Asia

Documentary tracks individuals who have noticed differences and changes to their minds and want to find out why, and shows the process of undergoing tests for dementia.

Getting a diagnosis is an important first step for both your loved one living with dementia and yourself. It not only provides an explanation to the symptoms your loved one has been experiencing, but can accelerate the process of treatment, seeking professional support and care, and planning for the future 

Gain access to pharmacological and non-pharmacological treatment options

While there are no available treatments that can reverse the cognitive decline that comes with dementia, there are still a variety of medications and psychosocial interventions that can help slow down the decline and help your loved one maintain their quality of life for as long as possible.  

Research has also shown that treatments tend to be most effective in the early stages of dementia.1

Begin seeking out support services and financial schemes that are suitable for your loved one living with dementia and yourself

There are a variety of programmes available for both persons living with dementia as well as caregivers: 

  • A Network of Care and Support 
  • Community Outreach Teams (CREST – Community Resource Engagement and Support Team) 
  • Community Intervention Teams (COMIT) 
  • Day Care Services 
  • Nursing Homes 
  • Respite Care 

 Find out more.
 

Additionally, caring for persons living with dementia may incur significant medical care costs. Fortunately, there are several financial schemes you may look into to help ease the financial burden and aid you in your financial planning: 

  • Seniors Mobility and Enabling Fund (SMF) 
  • Enhancement for Active Seniors (EASE) 
  • ElderShield 
  • CareShield Life 
  • Interim Disability Assistance Programme for the Elderly (IDAPE) 
  • ElderFund 
  • MediSave Care 
  • Caregiving Training Grant (CTG)
     

Find out more about financial schemes here. 

It is important to note that the eligibility criteria for these services and subsidies often include being formally diagnosed, amongst other factors. This is to ensure that these aids are provided to those who are in need of them. It is also ideal to include your loved one in making these decisions when they still have the capacity to make informed decisions. 

Help your loved one make the necessary lifestyle adjustments that will enable them to live well with their dementia

If your loved one is still working, they may have to think about potentially reducing their work hours, reviewing their current responsibilities, or speaking with their employer about making other reasonable adjustments at the workplace. In some cases, major career adjustments, such as changing jobs or stopping work completely, may have to be made.

The both of you can also discuss potential safety issues, such as driving or wandering, ahead of time.

Plan for the future of both your loved one and yourself

Following the diagnosis, it is important to review current legal, financial, and care plans, among other important matters while your loved one still has the capacity to make decisions for themselves. It is important to empower your loved one to, through discussions with family and care professionals, determine what arrangements they would prefer during each stage of their dementia. Doing this will also give both you and your loved one peace of mind and prevent future disagreements within the family.

Learn more about advance care planning here.

Loved ones will be better able to support the person living with dementia

Before a clear diagnosis is made, it is likely that you and your loved one may find it difficult to make sense of instances of memory lapses, communication problems and personality changes, which had not been common occurrences before. This lack of understanding often results in frustration and confusion, as both parties may not know how to deal with these changes. 

However, a clear diagnosis allows for the realisation that these incidents are, in fact, symptoms of dementia. This makes it easier for your loved one, friends and family, to better understand your loved one’s condition as well as the challenges that come with it. 

Learn more about the needs of persons living with dementia here. 

Read on to find out about where to get a diagnosis, and how to start a conversation about getting a diagnosis. 

Additional Resources

#Expert

Ask the Expert: Do I Have Dementia? Where to Seek Support?
In this video by the Agency of Integrated Care, watch Emily Ong, Dementia Advocate, share her story on the motivations of getting a diagnosis.

References

  1. Prince, M., Bryce, R., Ferri, C., World Alzheimer report 2011: the benefits of early diagnosis and intervention. Alzheimer’s Disease International (2011). https://www.alzint.org/u/WorldAlzheimerReport2011.pdf

Young-onset dementia refers to any type of dementia that develops in persons below the age of 65. Symptoms of dementia may present themselves differently in a younger person, as compared to dementia in older adults.

Source: Channel NewsAsia

It is a myth that dementia affects only older adults. Over 50 million people worldwide live with dementia in 2020, and this number is expected to increase to 82 million in 2030 and 152 million in 2050.1 Approximately 5% to 6% of the number is young-onset dementia, amounting to around 3.9 million people living with young-onset dementia as of 2021.2

In the past few years, the number of younger Singaporeans being diagnosed with dementia is increasing at an alarming rate. More than 100 individuals are diagnosed with young-onset dementia at the National Neuroscience Institute every year.3

Varied Symptoms in Young-onset Dementia

Not only do the symptoms manifest differently in younger persons, the condition has a greater impact on a younger person’s life, immediate family and the society as compared to older adults living with dementia.2,4

Some symptoms include:2,4
• Persons living with young-onset dementia are more likely to experience problems with their motor skills, including movement and coordination.
• Dementia affecting the frontotemporal brain regions are more common in younger persons, affecting planning and executive functions.

Impact of Dementia on Younger People

Compared with older adults, younger persons are at different life stages, and have different responsibilities, stages in relationships, and social activities. These make their experience of dementia uniquely different from older people. Some of these situations might include:2,4

• Younger persons are more likely to be in employment and possibly at higher points in their career with more responsibilities, upon the onset of dementia. The symptoms of their dementia may become apparent at work, causing them to lose their jobs. This can further result in loss of financial well-being for their families.
• A younger person is more likely to be a parent with younger children. Thus, they will face more challenges and lose parental responsibilities as they may gradually be unable to care for their younger children.

At the same time, most existing dementia care services and programmes in Singapore are designed for older adults and may not be suitable for younger persons, given the difference in experience. There are very limited services and programmes which are effective and age-appropriate for this group of individuals.5

George's Story

When George found out he had dementia, he was only 46 years old. As an ex-chemistry teacher, a published author of chemistry textbooks, and an active runner who always kept in good health, it was a shock to him, his wife and their three children. Learn more about the journey George and his family have undergone upon receiving his dementia diagnosis.

Watch how George’s family copes with his diagnosis:

Source: CNA Insider

If you or someone you know is experiencing symptoms of dementia, consult a family doctor or polyclinic doctor who can guide a person through the process of tests and diagnosis.

References

  1. Dementia statistics. (n.d.). Alzheimer’s Disease International. Retrieved 24 March, 2021, from https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/
  2. Hendriks, S., Peetoom, K., Bakker, C., van der Flier, W. M., Papma, J. M., Koopmans, R., Verhey, F., de Vugt, M., Köhler, S., Young-Onset Dementia Epidemiology Study Group, Withall, A., Parlevliet, J. L., Uysal-Bozkir, Ö., Gibson, R. C., Neita, S. M., Nielsen, T. R., Salem, L. C., Nyberg, J., Lopes, M. A., Dominguez, J. C., … Ruano, L. (2021). Global prevalence of young-onset dementia: A Systematic Review and Meta-analysis. JAMA Neurology, 78(9), 1080–1090. https://doi.org/10.1001/jamaneurol.2021.2161 
  3. 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 
  4. Alzheimer Society of Calgary. (n.d.). Young-onset dementia. Retrieved 5 March, 2020, from https://www.alzheimercalgary.ca/learn/types-of-dementia/young-onset-dementia
  5. Siew, W. J. W. (2021). Support programmes for people with young-onset dementia. Lee Kuan Yew Centre for Innovative Cities. https://lkycic.sutd.edu.sg/wp-content/uploads/sites/7/2021/10/LKYCIC-LLMAU-Webpost-Oct-2021-Support-Programmes-for-PYOD-Final.pdf   

Dementia can affect the entire brain. Learn how the brain works and understand how changes in specific brain regions can affect the ways dementia symptoms manifest.

Overview of the Brain

The brain can be divided into three main regions:

1. Cerebrum (contains the cerebral cortex and other deeper brain structures)
2. Cerebellum
3. Brain stem

The sections below provide simple explanations of how the brain works and the functions associated with the three brain regions. It also explains how changes to each brain region can affect the way a person functions in specific ways.

1. The Cerebrum and Its Associated Functions

Cerebral cortex: Contains the frontal lobes, parietal lobes, occipital lobes, and temporal lobes.

Frontal Lobes

• The outer layer of the brain located at the front of the head (closer to the face).
• The site of executive functions, including working memory, reasoning, judgment, decision-making, selective attention, and behavioural inhibition.
• Contains Broca’s area, which is involved in language production. Damage to this area can cause Broca’s aphasia, where a person cannot speak fluently.
• In frontotemporal dementia, the frontal and temporal regions of the brain shrink. The associated functions of these areas decline.

Parietal Lobes

• The outer layer of the brain located at the top of the head.
• This region processes and integrates sensory information (e.g. sight, space, awareness of the position and movement of body parts, touch, taste, smell, and temperature).
• Damage to this can cause issues in perceiving, visualising, and planning space and movement.

Occipital Lobes

• The outer layer of the brain located at the back of the head.
• This region receives and processes visual information from the eyes.
• It is involved in perceiving shape, colour, and movement.
• Damage to this lobe can cause issues with perceiving and recognising visual information.

Temporal Lobes

• The outer layer of the brain located closer to the bottom and sides of a person’s head, near the ears.
• The temporal region processes hearing, memory encoding, and emotions
• It is also a site for language processing, and the learning and recall of non-verbal information.
• A brain region called Wernicke’s area, which processes the meaning of language, is part of the temporal cortex.
• Damage to this area results in Wernicke’s aphasia, a condition where a person can speak fluently but whose speech and writing do not make sense, and has difficulties understanding others’ language.
• In frontotemporal dementia, the frontal and temporal regions of the brain shrink. The associated functions of these areas decline.

Deeper brain structures: Includes the hippocampus, hypothalamus, thalamus, basal ganglia, amygdala, and ventricles

Hippocampus

• Located just under the temporal cortex.
• It is needed for the formation of memories, especially for memories of life events.

Hypothalamus

• The hypothalamus is critical for the regulation of the body: for body temperature, hydration, eating, sleep-wake cycles, and other functions.
• Changes to the hypothalamus and its interactions with other parts of the brain and body can affect the body’s regulation systems.

Thalamus

• The thalamus is a brain region that receives, processes, and sends sensory information to the cerebral cortex.

Basal Ganglia

• Located next to the thalamus.
• The basal ganglia are involved in processing the control of movement, and the formation and recall of habits and skills.
• Damage to the basal ganglia happens in conditions such as Parkinson’s disease and Huntington’s disease. Persons with these conditions have impairments to their movement. While having either of these conditions, people can develop dementia.

Amygdala

• Located in front of the hippocampus.
• This region is important for emotional processing.

Ventricles

• The ventricles are spaces in the brain where the fluid in the human nervous system (cerebrospinal fluid) is found.
• Cerebrospinal fluid protects and nourishes the brain, provides an immune response (from pathogens like viruses), and removes waste products from the brain.
• A condition called hydrocephalus, where there is too much fluid in the ventricles, can cause dementia-like symptoms like memory problems, amongst other issues.

2. The Cerebellum and Its Associated Functions

The cerebellum is located below the cerebrum and next to the brain stem. It controls functions including movement, balance, and posture. This region is involved in some cognitive processes.

3. The Brain Stem and Its Associated Functions

The brain stem is located just above the spinal cord, and connects the rest of the brain above to the spinal cord.

It controls very basic and automatic functions, such as control of the heart rate, automatic responses, breathing, blood pressure, levels of consciousness, and some aspects of pleasure and pain processing.

Watch neurologist Tim Rittman explains how the brain works.

Source: Alzheimer’s Research UK

The Brain Is A Complex Organ

The information above paints a simple picture of how the brain works. In reality, the brain is a very interconnected and complex organ. Brain functions require the activity of several areas.

Brain functions, especially the more complex ones, need other functions to work for themselves to work. This means that damage to one area can cause a domino effect on other functions.

As the brain sciences are a rapidly growing area, what we know about the brain and its effects on our health is changing by the day. Stay tuned to developments to find out how we can apply advances in the brain sciences to better the lives of persons living with dementia.

Knowing how dementia changes the brain, which affects dementia symptoms, helps us to understand why persons living with dementia behave the way they do.

The human brain is an organ of the nervous system that controls the body’s activities, processes information received by the body, and controls psychological functions such as cognition and emotion. Changes in the condition of brain regions can cause temporary or long-lasting impairment.

Some of the more common types of dementia are neurocognitive conditions such as Alzheimer’s dementia, vascular dementia, Lewy body dementia, and frontotemporal dementia.

Many of these symptoms associated with these neurocognitive conditions overlap. This is why people with different kinds of dementia have similar symptoms.

At the same time, each neurocognitive condition is caused by a different pattern of physical and chemical changes in the brain. This results in some differences in the pattern of symptom development, otherwise known as the condition’s “presentation” (how the person’s condition is “presented”).

How Changes In The Brain Affect Dementia Symptoms

While the presentation of dementia is largely dependent on the changes in the brain, the signs and symptoms are also influenced by environmental factors, such as a person’s physical environment (e.g. noise, temperature) and social environment (e.g. whether the person is made to feel included and respected).

How do brain changes affect the person?

Where the change happens in the brain

• Different areas in the brain are closely related to brain functions.
• Damage to an area can disrupt functions associated with this brain area.

Types of brain changes

• The way symptoms develop depends on the type of brain changes that happen, such as:

  • build-up of abnormal proteins
  • disruption of blood flow to the brain
  • too much cerebrospinal fluid in the brain’s ventricles
  • traumatic brain injury
  • abnormal signals in the brain

• Whether brain changes are temporary or long-lasting affects the person’s presentation of symptoms.

• Other health conditions a person experiences can also affect what happens in the brain, which can affect the person’s mental state.

For example, an infection can cause a person to experience delirium, which is an abrupt change in the brain which causes mental confusion.

Each person’s unique differences

• Each person has a unique body, brain, and history which shapes the way a condition develops in their brain.

The video below shows how Alzheimer’s disease, which is one kind of dementia, changes the brain.

Source: National Institute of Aging

Read on to learn more about how the brain works.

Although symptoms of dementia vary between individuals, there are some common warning signs.

Source: Agency for Integrated Care

“When you see a person living with dementia, you have seen just one.”

Every person living with dementia is unique and does not present the same symptoms. The needs and manifestations vary between individuals although there are some common symptoms.

Signs and symptoms of dementia include (but not limited to):

• Memory loss (forgetfulness) that occurs gradually, and worsens progressively with time. Immediate and short-term memory loss occurs first.
• Difficulty in communication.
• Problems recognising familiar faces, places, or items.
• Worsening of problem-solving abilities and increasing disorganisation.
• Problems with daily activities such as dressing and using utensils during mealtimes.

In addition, changes to moods and behaviours may also occur, such as:

• Depression
• Agitation
• Hallucinations
• Anxiety
• Paranoia
• Sleep problems

Christel & Her Grandparents

Christel shares how having been exposed to the condition with her grandfather taught her family to spot the signs in the case of her grandmother and take action.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital and Dementia Singapore

If you or someone you know is experiencing symptoms of dementia, consult a family doctor or polyclinic doctor who can guide a person through the process of tests and diagnosis.

Downloadable Resources

The following resource contain bite-sized information on Signs & Symptoms that you may download and/ or print:

Click on the image below to download in English.

Forget Us Not: Building a Dementia Friendly Community

References

  1. Alzheimer Society of Calgary. (n.d.). Young-Onset Dementia. Retrieved 5 March, 2020, fromhttps://www.alzheimercalgary.ca/learn/types-of-dementia/young-onset-dementia

Forgetfulness is not the only warning sign of dementia. Instead, it might be a result of normal ageing and not dementia. Learn how dementia is different from normal ageing.

As we age, some of us may get more forgetful and require a bit more time to recall things, or even struggle to multitask. It can get a little worrying that these might be early signs of dementia. However, these can be a result of normal ageing and not dementia.

The table below compares the 9 differences between signs of normal ageing and symptoms of dementia.

[wptb id=8351]

Content in table is adapted from Alzheimer’s Association and Alzheimer’s Society.

DO NOT: Use the above list to self-diagnose or diagnose someone with dementia.

DO: If you or someone you know is experiencing symptoms of dementia, consult a family doctor or polyclinic doctor who can guide a person through the process of tests and diagnosis.

Downloadable Resources

The following resources contain bite-sized information that you may download and/ or print:

Click on the images below to download in English or select another language.

Living with Dementia: A Resource Kit for Caregivers - Knowing Dementia

Forget Us Not: Building a Dementia Friendly Community

References

  1. Alzheimer Society of Calgary. (n.d.). Young-Onset Dementia. Retrieved 5 March, 2020, from https://www.alzheimercalgary.ca/learn/types-of-dementia/young-onset-dementia

Person-centred dementia care aims to enhance the wellbeing of persons living with dementia by meeting their psychological needs, which maintains personhood.

What is PCC?

Person-centred care (PCC) is a way of thinking about a person living with dementia and how to support them to enhance their quality of life.

When caring for a person living with dementia, it is sometimes difficult to understand why a person behaves in the way they do, or make decisions related to the activities they should engage in.

PCC focuses on:

  • Seeing each person living with dementia as a person who
    • Is valuable
    • Has their unique history, routines, personal preferences, and needs
    • Experiences the world in their own way
    • Sees the social relationships that the person has as important for their wellbeing
  • Improving and taking care of the person’s level of wellbeing by taking care of these things.

This is different from the medical model of care, which:

  • Sees the person living with dementia as only a medical patient who requires treatment from healthcare professionals;
  • Focuses on keeping the person clean and safe from injury and harm;
  • Does not consider the person’s unique history, routines, personal preferences; 
  • Ignores the psychological needs of the person.

What is the goal of PCC?

To maintain personhood in the face of a person’s declining mental powers.

How is this goal achieved?

By meeting the 5 areas of psychological need that each person experiences.

Tom Kitwood’s Flower of Psychological Needs shows the needs that each person, including persons living with dementia, has. These needs are: Comfort, Attachment, Inclusion, Occupation, Identity, and Love.

While caring for persons living with dementia, we can aim to meet these needs.

What happens as these needs are met?

  • The person feels loved.
  • The person’s entire sense of self-worth will be enhanced.
  • The person will be more likely to experience a sense of personal control and empowerment.
  • There will be an improvement in the physical and psychological wellbeing of the person.

10 Key Principles of PCC according to Tom Kitwood

  1. A non-judgemental acceptance of the uniqueness of each person.
  2. Respect for the past experiences and learning of each person.
  3. Recognising the whole person as having emotional, social, physical and spiritual needs.
  4. Staying in communication requires flexibility, lateral thinking, and acceptance of other viewpoints.
  5. Nourishing attachments means ensuring people feel welcome and included.
  6. Creating a feeling of community gives us a sense of belonging, of where we fit in and what is expected of us.
  7. Maximising freedom for people to contribute to their care and eliminating unnecessary controls.
  8. Allowing ourselves to receive from others and valuing what they give (in other words, allowing the person with dementia to contribute in some way to the care environment, as far as they are able).
  9. Building and maintaining an environment of trust – protect from bullying, exploitation and other abuses of power.
  10. Focusing on positives – on people’s abilities and what they can do.

Person-Centred Care in Dementia by Alzheimer’s WA

Read on to find out how to apply the person-centred care approach in everyday life with persons living with dementia.

References

1. Kitwood, T. M. (1997). Dementia Reconsidered: The Person Comes First. Open University Press.

As a person living with dementia increasingly faces challenges in communication as their condition advances, what can help us to better communicate and engage them in daily activities at home? Namaste Care might just be the answer to support them in everyday care.

How did Namaste Care begin?

Namaste Care was introduced by Joyce Simard in 2003. A social worker by training, Simard has many years of experience working in long-term care homes in the USA.

She is passionate about meeting the social, emotional and psychological needs of persons living with advanced dementia through non-medical approaches.

Inspired by the meaning of the Hindu term, “Namaste”, which is “to honour the spirit within”, she coined her work as Namaste Care.1

Essence of Namaste Care

Namaste care is a multi-approach care programme that incorporates sensory, psycho-social and spiritual elements to enhance the quality of life of persons living with advanced dementia.

Originally intended for groups of persons with advanced dementia living in long-term care facilities, Namaste Care has been adapted and implemented in other settings, including at day care centres and in an individual’s home.

It adopts a Person-Centered Care approach, where care is tailored to the unique needs and preferences of a person living with dementia.

Namaste Care programme seeks “to honour the spirit within” the person living with advanced dementia. Two principles which define the practice of Namaste Care are:

[wptb id=8415]

These principles can be applied in both group and individual programmes.

Benefits of Namaste Care

Finally, here are some benefits of Namaste Care on persons living with dementia and those around them, as shown by research:

person-living-with-dementia

Benefits for Persons Living with Advanced Dementia

  1. Better quality of life, along with reduced responsive behaviours, pain and interruptions to one’s meaningful engagement;
  2. Greater awareness and interaction with the environment;
  3. Took lesser medications; and
  4. More interaction with families.6-8
caring-for-a-loved-one-with-dementia

Benefits for Families and Relatives

Closer relationships with loved ones living with dementia.8-10

Providing Namaste Care At Home

This Namaste Care Package provides you with tips on how to implement effective Namaste Care for a person with dementia at home.

Be as creative as you can be, when you design and personalize a Namaste Care session to the person’s unique needs and preferences!

Enjoy the whole process of connecting with the person living with dementia!

In collaboration with the Agency for Integrated Care (AIC), Apex Harmony Lodge (AHL) has developed a Namaste Care training video to empower caregivers, like yourself, to adopt the therapeutic care approach. In doing so, it is hoped that more persons living with moderate to advanced dementia can benefit from it.

This video demonstrates an example of an ideal Namaste room, a list of equipment essential for Namaste Care, and a step-by-step guide on using appropriate touch, like hand massage, that enables you to connect and provide “tender, loving care” to the person living with dementia.

Source: Agency for Integrated Care & Apex Harmony Lodge

For more information on Namaste Care, visit namastecare.com.

Acknowledgment

Some content was adapted from the training notes compiled by Institute of Geriatrics and Active Ageing for Namaste Care Workshop by Dr Noorhazlina Bte Ali on 16 and 23 November 2019.

References

1. Jacobson-Wright, N., Latham, I., & Frost, F. (2019). Guidance for Care Homes-Implementing Namaste. University of Worcester: Association for Dementia Studies. https://www.worcester.ac.uk/documents/Guidance-for-Care-Homes-V3-updated.pdf

2. Tanner, L. (2017). Embracing touch in dementia care: A person-centred approach to touch and relationships. Jessica Kingsley Publishers.

3. Kendall, N. (2019). Namaste care for people living with advanced dementia: A practical guide for carers and professionals. Jessica Kingsley Publishers.

4. Goldschmidt, B., & van Meines, N. (2011). Comforting touch in dementia and end of life care: Take my hand. Singing Dragon.

5. Roberts, K., & Campbell, H. (2011). Using the M technique as therapy for patients at the end of life: Two case studies. International Journal of Palliative Nursing, 17(3), 114-118. doi: 10.12968/ijpn.2011.17.3.114

6. Stacpoole, M., Hockley, J., Thompsell, A., Simard, J., & Volicer, L. (2015). The Namaste Care programme can reduce behavioural symptoms in care home residents with advanced dementia. International Journal of Geriatric Psychiatry30(7), 702-709. doi: 10.1002/gps.4211.

7. Simard, J., & Volicer, L. (2010). Effects of Namaste Care on residents who do not benefit from usual activities. American Journal of Alzheimer’s Disease & Other Dementias25(1), 46-50. doi: 10.1177/1533317509333258.

8. Thompsell, A., Stacpoole, M., & Hockley, J. (2014). Namaste care: The benefits and the challenges. Journal of Dementia Care22(2), 28-30.

9. Stacpoole, M., Hockley, J., Thompsell, A., Simard, J., & Volicer, L. (2017). Implementing the Namaste Care Program for residents with advanced dementia: Exploring the perceptions of families and staff in UK care homes. Annals of Palliative Medicine6(4), 327-339. doi: 10.21037/apm.2017.06.26.

10. Manzar, B., & Volicer, L. (2015). Effects of namaste care: pilot study. American Journal of Alzheimer’s Disease2(1), 24-37. doi: 10.7726/ajad.2015.1003.

The CAUSEd problem-solving tool is designed to encourage caregivers and care professionals to understand the behaviours of persons living with dementia as a form of communication with their social and physical environments. In turn, caregivers and care professionals can identify the possible triggers for the behaviours, and minimize the impact of behaviours by developing and implementing support strategies.

What Is CAUSEd?

CAUSEd is a problem-solving tool developed by Dementia Australia, to enable caregivers and care professionals to understand the changes in behaviour of persons living with dementia. Using an easy-to-remember acronym, CAUSEd (see list below for elaboration) guides users to see behaviour changes as responses to changes in the brain, and consider various factors that can be addressed in response to the behaviour.

Communication
Activity
Unwell/Unmet needs
Story
Environment
dementia

The tool provides a systematic approach to:
• Identify the modifiable triggers for behaviour changes.
• Understand the unmet needs that persons living with dementia are communicating through their behaviours.
• Develop and implement support strategies to respond and meet the needs communicated, and minimize the impact of the behaviours.

Why Use CAUSEd?

As dementia progresses, it may become increasingly difficult for persons living with dementia to recognize and express their needs.

More often than not, the triggers for behavioural changes are often external to persons living with dementia, rather than an inevitable consequence of their dementia progression. These external triggers include problems in the social and physical environments that can be addressed and changed.

Despite limited evidence on effectiveness and significant evidence for potential adverse effects in older adults3, pharmacological treatments are often used.2 However, best-practice guidelines internationally recommend non-pharmacological approaches as first-line treatments for behaviours and symptoms related to dementia (BPSD).4,5

The CAUSEd problem-solving tool is a non-pharmacological approach that guides you to see beyond the behaviours and think about the causes in the following six aspects.6 The corresponding guiding questions also reflect that most of the triggers for the person’s behaviours can be addressed and modified using non-pharmacological strategies. Communication, Activity, Unwell/ Unmet Needs, Story, and Environment are factors that can be addressed or modified. While the dementia (with a lowercase d) cannot change, we can attempt to understand the person’s behaviour based on the dementia-related brain changes.

Putting CAUSEd into Practice: An Example

Madam Tan is a 78-year-old woman living with dementia, who has been recently admitted to the ward of the nursing home that you are working in. She uses a wheelchair and requires minimum to moderate assistance in her activities of daily living (ADLs).

On Madam Tan’s first morning at the home, you and your colleague have been assigned with the responsibility to assist Madam Tan in her showering. However, upon entering the bathroom, Madam Tan refused both of you to assist with her showering (behaviour: resistance to care). When you and your colleague attempted to continue with her care, she became increasingly agitated and eventually burst into tears (behaviour: emotional lability). She also began to push both of you away (behaviour: aggression) and thus immediately stopped with her care.

Using the CAUSEd approach to problem solve why Madam Tan was becoming distressed and not responding well to support with showering, here are some plausible areas of concern that may have triggered Madam Tan’s behaviour changes:

Communication: Madam Tan usually wears a hearing aid and glasses, and was having difficulty hearing and understanding what was being asked of her.
Activity: Madam Tan usually showers at night before going to bed, because this helps her to sleep better.
Environment: Madam Tan is unfamiliar with the new environment (nursing home) and has never met you and your colleague before today, which caused her to feel very anxious.

 

After identifying the triggers using the CAUSEd approach, you can introduce helpful strategies to support a more positive experience for Madam Tan during showering. These strategies include:

• Ensuring Madam Tan is wearing her hearing aid and glasses before communicating with her.
• Changing the time of her shower to the evenings.
• Inviting Madam Tan to the shower and offering some choice. E.g., “Would you like to have your shower at 7pm or 8pm?”.
• Providing visual cues such as asking Madam Tan to hold her toiletries.
• Ensuring Madam Tan has an opportunity to develop rapport with you and your colleague before her shower. E.g., participate together in activities that Madam Tan enjoys, have meals together with her, and frequently make small talk with her.
• Providing support at an appropriate pace for Madam Tan.

Learn More About The Application of CAUSEd

If you would like to learn more about the CAUSEd problem-solving tool, you can go online, or attend the Foundations of Person-Centred Dementia Care course by Dementia Singapore, which provides more information on Behavioural Communication.

This course offered by Dementia Singapore is intended for front-line care staff and volunteers who would like to be equipped with a basic understanding of how to care for people living with dementia in a variety of settings. These settings include the family home, centre-based services, and residential care facilities.

Acknowledgement

Many thanks to Dementia Australia for granting the permission to adapt and reproduce this article on the CAUSEd problem-solving tool. The tool is developed by Alzheimer’s Australia Vic educators, Di Fitzgerald and Marina Cavill.

Caregivers of persons living with dementia face unique challenges. Dementia progression can take several years and the caregiving needs vary as their loved ones transit through the stages of dementia. The good news is, no one caregiver is alone. There are several initiatives in Singapore to help support caregivers, specifically those caring for loved ones living with dementia. Read on to learn more about them!

Caregiver Support Groups

Caregiver Support Groups (CSGs) offer a private and safe environment for caregivers to share their thoughts, challenges and learnings with one another as they go through similar experiences. Such insights allow caregivers to share their knowledge through practical caregiving and self-care tips.

CSGs also help caregivers understand that they are not alone in their caregiving journey allowing the group to emotionally support each other.

Finding A Caregiver Support Group

Caregiver Support Groups exist in hospitals, in the community, and even online. One can speak to a social worker or ask fellow caregivers to learn more about support groups for caregivers and loved ones living with dementia.

The following is a comprehensive list of support groups one can explore:

In Hospitals & Specialist Centres

Khoo Teck Puat Hospital (KTPH)

Dementia Support Group sessions at KTPH are free and open to all. The group meets on the last Saturday of odd months, from 1pm to 3pm.

Tel.: 6555 8000
Email: ktph.memorycare@alexandrahealth.com.sg


National Neuroscience Institute (NNI)

Dementia Support Group sessions at NNI are organised by CARe (Cognitive Assessment & Rehabilitation) team. It is intended for NNI patients living with young-onset or atypical dementia and their caregivers. The sessions are conducted on Wednesday mornings and Thursday afternoons.

Tel.: 9656 8078
Email: mei_mei_nyu@nni.com.sg

In The Community

Dementia Singapore (DSG)

Caregiver Support Groups run by DSG are available in English, Mandarin and Malay. English groups are conducted at various locations on weekdays and Saturdays, while Mandarin groups are also available on Saturdays. Support Groups are strictly for family caregivers looking after for persons living with dementia.

Tel.: 6377 0700
Email any enquiry here.
Register directly online.


Caregivers Alliance Limited (CAL)

Support Groups are available to graduates of the caregivers-to-caregivers training programme.

Tel.: 6460 4400


Caregiving Welfare Association (CWA)

Support Groups at CWA are open to all family caregivers, and are conducted two times a month, around specific themes.

Tel.: 6466 7957 / 6466 7996/ 6734 2991
Email: contact@cwa.org.sg


Club Heal

Support Groups at Club Heal are offered on the first Fridays of the month at the three Mental Wellness Centres located in different areas.

Tel.: 6899 3463
Email to register: info@clubheal.org.sg


Filos Community Services

Organises Caregivers’ Cove Conversations where caregivers come together to share and learn common dementia related concerns.

Online Support Groups

Many private community groups are active on social media sites like Facebook.

These groups can take the form of:

• Online support groups wherein caregivers interact with fellow caregivers (e.g., Dementia-Friendly Singapore Facebook, TOUCH Caregivers Support Facebook)
• Interest groups in which caregivers and the interested public join to acquire relevant information
• Community Networking Projects (e.g., Project We Forgot Community Network)

Caregiver Support Network

The Caregiver Support Network (CSN) was formed as part of efforts under the Dementia-Friendly Singapore (DFSG) initiative to support and connect with caregivers taking care of persons living with dementia, and to address mental health or physical health conditions amongst caregivers. The goal of CSN is to empower caregivers through Peer Support Network focusing on self-care, mindset change and recognition.

The table below lists the Caregiver Support Networks offered by different service providers across Singapore. To make an enquiry about a CSN in a particular region, please call them at their corresponding contact numbers included in the table. To find out more about CSNs, you may contact Agency for Integrated Care at ccmh@aic.sg.

dementiahub
Central Region

MacPherson: Brahm Centre Ltd. (Tel.: 6741 1131)

Toa Payoh East: Care Corner (Tel.: 6258 6601)

Teck Ghee: AMKFSC Community Services Ltd. (Tel.: 9116 4790)

Yio Chu Kang: AWWA Ltd. (Tel.: 9621 7856)

East Region

Bedok: GoodLife! @ Bedok by Montfort Care (Tel.: 6312 3988)

North Region

Nee Soon South: Goodlife! @ Yishun by Montfort Care (Tel.: 6484 8040)

Woodlands: AWWA CREST Silver Station (Tel.: 9784 9247)

South Region

Queenstown: Fei Yue Community Services (Tel.: 6471 0012)

West Region

Hong Kah North: REACH Community Services (Tel.: 6801 0878 / 6801 0876)

Taman Jurong: NTUC Health (Tel.: 8223 1135)

Islandwide

Dementia Singapore Ltd (Tel.: 6377 0700)

Learn more about Dementia Singapore’s Caregiver Support Network offering: Interest-based Activities for Caregivers.

Other Forms of Caregiver Support

Dementia Helpline

Dementia Singapore also provides helpline counselling services for caregivers looking after persons living with dementia. Be assured that all information is kept strictly private and confidential.

If you are caring for a loved one with dementia and require help or assistance on what is suitable for you, call the Dementia Helpline at 6377 0700 or send an online enquiry.

The Dementia Helpline is open:
Mon to Fri: 9am to 6pm
Sat: 9am to 1pm
(Closed on Sundays & public holidays)

Additional Resources

Caregiver Support Network Toolkit
Caregiver Support Network Toolkit

Designed by the Agency for Integrated Care, this toolkit offers a step-by-step guide to empower individuals in setting up a Caregiver Support Network that emphasises self-care, peer support and recognising caregivers’ well-being in the community.

What is in a Day of a Person Living With Dementia?

Step into the shoes of persons living with dementia using the Virtual Reality (VR) application Experience Dementia in Singapore (EDIS).

Dementia is a degenerative condition where symptoms worsen over time. By creating an enabling environment and adopting a person-centred approach in managing the condition, the lived experience of a person living with dementia can be greatly improved.

EDIS presents the following scenarios to illustrate the challenges of a person living with dementia, and suggests how you, families, and communities can support their enablement.

In a HDB Home

Experience the world through the eyes of Auntie Lucy, a person living with dementia and find out what her anxieties and frustrations are at home. While understanding her perspective, find out how the living environment and a supportive relationship helps in enabling her to be independent.

At the Day Care Centre

Aunty Alice feels bored and restless at a dementia day care centre. She finds herself often being ignored, and feels that the activities offered are not to her preference. Learn how a care professional can use a person-centred care approach to enable a person living with dementia to feel respected and have an increased sense of belonging.

Heading to the Supermarket

It can be a daunting experience for a person living with dementia to navigate an MRT station that has multiple exits. Journey with Uncle James as he tries to find his way out of a station and complete his grocery shopping at a supermarket.

To enjoy a smooth experience, you are advised to:
• Reduce the number of applications running in the background of your device; and
• Ensure you are using the latest version of your browser with a good internet connection of at least 1 Mbps.

Register here to access the EDIS 360 web application. The link to the application’s VR scenarios will be made available upon completion and submission of the registration form.

Learn how a home can be modified to create a dementia-friendly environment that is more accessible, comfortable, and safe for persons living with dementia.

This VR application was developed by Dementia Singapore, supported by The Majurity Trust, Agency for Integrated Care and Singapore Institute of Technology (SIT).

Additional Resources

EDIS Virtual Reality
Dementia Care Training Using VR

Read about what others have learnt through the VR simulated immersive Dementia Care training. Report from Singapore Institute of Technology (SIT).

Persons living with dementia may face challenges navigating the physical environment, due to loss of orientation, sensory acuity, visual-spatial awareness, and mobility. Changes in their sensory system may reduce their tolerance towards environmental stimuli, such as sound levels, lighting, activity and people. For some persons living with dementia, the lack of sensory stimulation and occupational deprivation results in ill-being, leading to loss of self-worth and self-identity.

Experience Dementia in Singapore is a Virtual Reality (VR) application which provides you with the perspective of a person living with dementia. Step into the shoes of the person living with dementia to experience the challenges faced in a typical apartment in Singapore, and consider how we can modify the environment to support the well-being of the person living with dementia at home.

A dementia-friendly home aims to enable persons living with dementia to maintain their independence in performing everyday activities such as eating, going to the toilet, bathing, and continuing their hobbies in a meaningful way. Where possible the person living with dementia should be supported to engage in activities outdoors.

List of Resources for the Homes of Persons Living with Dementia

Local Resources

360° Virtual Reality Dementia-Friendly HDB Home Design Guide

The 360° Virtual Reality Dementia-Friendly HDB Home Design Guide is a resource developed by Agency for Integrated Care and Dementia Singapore, for persons living with dementia and their families, and care professionals in Singapore. It provides a range of proposed modifications to create a dementia-friendly home that is more accessible, comfortable and safer for persons living with dementia.

For the best viewing and user experience on this virtual reality guide, it is recommended to access it using a desktop.


HACK CARE

HACK CARE by LIEN Foundation is a catalogue of more than 240 pages of ideas to make a home a friendlier environment for persons living with dementia and their families. It assembles practical hacks, surprising ideas, and simple tips and tricks to simplify a caregiver’s life as they cope with the daily challenges of caregiving, while transforming them into meaningful and enriching moments.

Qanvast Dementia Friendly Home
HOW TO DESIGN A DEMENTIA-FRIENDLY HOME, AS TOLD BY AN EXPERT

Find practical tips on how to design a home that is safe and Dementia-Friendly from this feature story on Qanvast.

Overseas Resources

Making Your Home Dementia-Friendly

The Alzheimer’s Society in the United Kingdom has developed a booklet which describes some of the ways to create a more dementia-inclusive home, to support persons living with dementia and their families.

The booklet comprises multiple sections, where each section covers a different aspect of living at home. Some of the tips offered by this booklet, may require help and support from care professionals as well. The sections include:

• Lighting
• Furniture and furnishings
• Flooring
• Eating and drinking
• Using the bathroom
• Knowing where things are
• Keeping things in order
• Keeping safe

The booklet contains a checklist that recommends some changes individuals can implement to make their homes more dementia-inclusive.


Safety In and Around the Home

This resource by Dementia Australia contains tips on how friends, family, and caregivers of persons living with dementia, can improve the safety of the physical environment in and around the home.

The page comprises a simple safety checklist for individuals to assess their homes for any safety hazards.


Guidelines on Dementia-Friendly Environments

These resources by the Social Care Institute for Excellence in the United Kingdom, contain information on how the physical environments of various aspects in and around a home can be designed to be more dementia-inclusive, such as:

• Kitchen and dining areas
• Bedrooms
• Toilets and bathrooms
• Gardens
• Lighting
• Assistive technology
• Noise levels

There is no single cause of dementia. Rather, a combination of multiple factors is associated with the development of dementia. Family history and lifestyle factors, such as exercise patterns, dietary habits, and stress levels, are examples of risk factors that may contribute to the onset of dementia.

Risk factors are characteristics which increase the likelihood of developing a disease. Their presence does not guarantee the development of the disease in question. For example, not everyone who smokes develops heart disease and not everyone with heart disease has been a smoker. However, a person who smokes is more likely to develop heart disease.

Some risk factors can be modified. For example, being physically active reduces the risk of developing dementia. Other risk factors cannot be modified, however. Non-modifiable risk factors include age, genetics, gender, and ethnicity.

dementia-hub-sg

Some content is reproduced with permission from Alzheimer’s Disease International’s article on Risk Factors and Risk Reduction.

References

  1. Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. N., Ogunniyi, A., Ortega, V., Ritchie, K., Rockwood, K., Sampson, E. L., Samus, Q., Schneider, L. S., Selbæk, G., Teri, L., Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet Commissions, 396(10248), 413-446. https://doi.org/10.1016/S0140-6736(20)30367-6

Here are four common non-modifiable risk factors of disease that have been associated to the development of dementia:

Age

The greatest risk factor for dementia is age. Although age increases risk, dementia is not a normal part of ageing, and ageing is not itself a cause of dementia.

dementia-hub-sg

Genetics

Watch Dr Joshua Kua, a Geriatric Psychiatrist, answer whether dementia runs in the family:

Source: Agency for Integrated Care

dementia-hub-sg

There are more than 20 genes which affect a person’s risk of developing dementia. The gene APOE was the first known to increase a person’s risk of developing Alzheimer’s disease, which is the most common cause of dementia, and it is currently still the strongest risk gene known. There are also genes which directly cause dementia, but these deterministic genes (genes that guarantee the development of a condition) are rare – they are estimated to account for less than 1% of dementia cases, and cause young-onset forms in which symptoms usually develop before the age of 60.

Gender

Women are more likely to develop Alzheimer’s disease than men, even when the fact that women’s lifespans are on average longer than men’s is accounted for. The reasons for this are unclear.

dementia-hub-sg

Ethnicity

In a 2008 study investigating the prevalence of dementia in Singapore, Malays were found to have twice the risk of developing Alzheimer’s Disease than Chinese, while Indians had more than twice the risk of developing Alzheimer’s Disease and Vascular Dementia than Chinese. The reasons for this ethnic difference require further investigation.1

dementia-hub-sg

Some content is reproduced with permission from Alzheimer’s Disease International’s article on Risk Factors and Risk Reduction.

References

  1. Sahadevan, S., Saw, S. M., Gao, W., Tan, L. C., Chin, J. J., Hong, C. Y., & Venketasubramanian, N. (2008). Ethnic differences in Singapore’s dementia prevalence: The stroke, Parkinson’s disease, epilepsy, and dementia in Singapore study. Journal of the American Geriatrics Society, 56(11), 2061-2068. doi: 10.1111/j.1532-5415.2008.01992.x.

Although factors such as genes, gender, race, and age are not within control, there are things that can be done to reduce the risk of developing dementia.

Individuals can make lifestyle changes to reduce their risks of developing dementia, and systemic societal changes can be made to reduce the incidence of dementia in a community.

There is growing research evidence that supports the link between 12 factors, which are written about later in this article, and the risk of developing dementia. Though these risk factors are not direct causes of dementia, addressing all of them may potentially prevent or delay up to 40% of potential cases of the development of dementia cases.

dementia

Many of these 12 risk factors are also linked to other health conditions, such as cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, some of which, such as cardiovascular diseases, are themselves risk factors for dementia. Modifying the relevant health behaviours that prevent these health conditions may thus reduce the risk of many health issues simultaneously, leading to both better overall wellbeing and a reduced risk of developing dementia.

12 Modifiable Risk Factors of Dementia

Physical Inactivity

Regular physical activity is one of the best ways to reduce the risk of dementia. It is good for the heart, blood circulation, weight management and overall mental wellbeing. It can also help to lower cholesterol levels and maintain blood pressure at a healthy level, decreasing the risk of developing vascular dementia.

A year-long study by researchers at the University of Pittsburgh, involving 120 people aged between 60 and 80, found that walking briskly for 30 to 40 minutes a day three times a week was sufficient for re-growing the structures of the brain linked with cognitive decline in later life. Scans later revealed that the parts of the brain that shrink with age actually grew in volume after moderate but regular exercise.1

It is recommended that adults aim for either 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity each week, in order to maintain an activity level that raises the heart rate. This means simply brisk-walking for 30 minutes a day, five times a week, or jogging for 25 minutes a day, three times a week.

Though these are prescribed levels of physical activity for the general population, it is best if people pay attention to their own physical condition, which they know best. In addition, what matters is that they simply start trying. Every small step counts!

Smoking

Smoking greatly increases the risk of developing dementia in addition to creating complications for the lungs and heart, while increasing the risk of other conditions, including type 2 diabetes, stroke, lung cancer, and other cancers.

The World Health Organization (WHO) and Alzheimer’s Disease International (ADI) found a correlation between smoking and the risk of dementia: smokers have a 45% higher risk of developing dementia than non-smokers.2 WHO’s recently released guidelines for dementia risk reduction in 2019 listed tobacco dependence as the leading cause of preventable death globally, and associated it with other disorders and age-related conditions such as frailty and work ability in order people.3

These pieces of research and guidelines made based on evidence highlight the importance of not smoking for lowering the risk of dementia and cognitive decline. It is also better late than never when it comes to stopping the smoking habit, as stopping later in life also reduces the risk of dementia.

Excessive Alcohol Consumption

An excessive consumption of alcohol of more than 21 units per week significantly increases the risk of developing dementia, in addition to it being a causal factor in more than 200 disease and injury conditions, a range of mental and behavioural disorders, and other noncommunicable diseases.

Consuming moderate amounts of alcohol is recommended for reducing the above risks, and for maintaining overall wellbeing.

Air Pollution

A growing amount of research evidence suggests that air pollution increases the risk of developing dementia. It is recommended for policymakers to expedite improvements in air quality, particularly in areas with high air pollution.

Head Injury

Head injuries increase the risk of developing dementia. They are most commonly caused by car, motorcycle, and bicycle accidents; military exposures; boxing, football, hockey and other sports; firearms and violent assaults; and falls. Policymakers could use public health and other policy measures to reduce head injuries. In addition, individuals can exercise a reasonable level of precaution when participating in activities, such as wearing helmets during some sports activities, and observing workplace safety measures.

Infrequent Social Contact

Of all the ways to reduce the risk of dementia, engaging in frequent social activity may be the most enjoyable. It is well established that social interaction may delay the onset of dementia.

Though the research literature on which specific types of social activity reduce dementia risk is still developing, some theories suggest that social engagement may benefit brain health via brain stimulation, staving off dementia and depression in the process.

A study published in the American Journal of Public Health showed that women with larger social networks were 26% less likely to develop dementia than those with smaller social networks. In addition, women who had daily contact with friends and family cut their risk of developing dementia by almost half.4

The potential benefits of social contact on cutting dementia risk adds more reason to common experience of how social activity enriches lives. Some ways of engaging in activity include: joining a club or neighbourhood social activity, meeting friends for a meal, or volunteering.

The potential benefits of social contact on cutting dementia risk adds more reason to common experience of how social activity enriches lives. Some ways of engaging in activity include: joining a club or neighbourhood social activity, meeting friends for a meal, or volunteering.

Lower Levels of Educational Attainment

A low level of educational attainment in early life is one of the most significant risk factors for dementia. It is recommended that policy prioritises childhood education for all.

Mid-Life Obesity

Obesity is associated with an increased risk of dementia, especially in mid-life. It is also associated with other non-communicable diseases, and can generally be addressed through lifestyle changes such as diet and exercise.

Hypertension (High Blood Pressure)

Hypertension (high blood pressure) in mid-life increases a person’s risk of dementia, amongst other health problems. To reduce this risk, monitoring and keeping blood pressure at a healthy range is advised. This healthy blood pressure range can be worked towards and maintained through lifestyle changes, such as through exercise, a balanced diet, and stress management, and if necessary, medication for hypertension if prescribed by medical professionals.

Diabetes

Type 2 diabetes is a risk factor for the future development of dementia. Persons who have type 2 diabetes are advised to monitor their blood glucose level, and to manage it with dietary measures, regular exercise, other lifestyle measures, and medication, should this be prescribed by a doctor.

Depression, Loneliness and Social Isolation

Depression is associated with dementia incidence. It is currently not clear whether and to what extent dementia may be caused by depression or vice versa.

In any case, it is important to manage and treat depression because it is associated with increased disability, physical illnesses and other negative outcomes which themselves may complicate care for a person with dementia.

Hearing Impairment

People with hearing loss have a significantly increased risk of dementia, though using hearing aids seems to reduce this risk. As hearing loss is one of the risk factors which affects the most people, it may be a particularly strategic factor to address in reducing the incidence of dementia.

Watch and Learn the A, B, C, Ds to preventing Dementia today!

Source: Agency for Integrated Care

Additional Ways to Lower Dementia Risk

Mindful Mind Food

There is truth in the saying that you are what you eat, especially when it comes to reducing dementia risk. Maintaining a healthy and balanced diet not only makes one feel well, but also helps to reduce dementia risk, amongst other health issues like diabetes and heart disease. A diet rich in fruits, vegetables, unrefined cereals, grains, omega-3 fatty acids (commonly found in oily fish and nuts), and with less red meat may promote overall health and offset or delay the development of dementia. When in doubt, however, approach your doctor for more advice on making healthier dietary choices for a healthier brain.

lifestyle-beautiful-girl-during-yoga-exercise

Keep Your Mind Active – Brain Games

Just as exercise is highly beneficial for physical health, cognitive activities are also good for brain function and reduce the risk of developing dementia. According to Alzheimer’s Disease International (ADI), experiments conducted on both animals and humans showed that mentally stimulating activities are related to measurable improvements in brain vascular health, and in both brain structure and function.5 Another research report from the Rush Memory and Aging Project reports that cognitive stimulating activities (including reading and writing) in a group of 300 cognitively healthy men and women were associated with a slower cognitive decline in the six years prior to  death.6 The above evidence suggests that engaging in mentally stimulating activities, such as reading, playing bridge or chess, or doing puzzles (Sudoku, crosswords, etc.) may offset or delay the development of dementia.

pieces-white-jigsaw-wood

Heart Truths

There is evidence that a healthy heart benefits a healthy brain.

According to Meharvan Singh, Ph.D., Associate Professor of Pharmacology & Neuroscience, the brain receives approximately 15% of cardiac output, meaning that compromised cardiovascular function would reduce supply of blood (and thus oxygen) to the brain. Other research has shown that an increased risk of heart attacks and strokes can increase the chances of developing dementia.

A 2016 study by the University of Southern California found that statins, which are a kind of medication designed to help those with heart conditions, may play an additional role in protecting the brain from dementia.

teenager-woman-hand-with-cross-bible-praying-hands-folded-prayer_2379-1772

Adopting a healthy lifestyle by keeping active, eating a healthy and balanced diet, avoiding smoking and excessive alcohol consumption, and engaging in social activities, together promote good brain health, and can keep dementia as well as other diseases like stroke and heart attack at bay.

In light of the above, regular health checks, such as annual full-body check-ups which include cognitive screenings are encouraged. It is never too early to begin.

Some content is reproduced with permission from Alzheimer’s Disease International’s article on Risk Factors and Risk Reduction.

Downloadable Resources

The following resources contain bite-sized information on Modifiable Risk Factors & Lowering Risk that you may download and/ or print:

Click on the images below to download in English.

5 Ways to Reduce Your Risk of Dementia

Forget Us Not: Building a Dementia Friendly Community

understanding-dementia

Understanding Dementia

References

  1. Ahlskog, J. E., Geda, Y. E., Graff-Radford, N. R., & Petersen, R. C. (2011). Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clinic proceedings, 86(9), 876–884. https://doi.org/10.4065/mcp.2011.0252
  2. Alzheimer’s Disease International. (2014, July 9). Smoking increases risk of dementia. https://www.alzint.org/news/smoking-increases-risk-of-dementia/
  3. Geneva: World Health Organization. (2019). Risk reduction of cognitive decline and dementia: WHO guidelines. https://apps.who.int/iris/bitstream/handle/10665/312180/9789241550543-eng.pdf?ua=1
  4. Crooks, V. C., Lubben, J., Petitti, D. B., Little, D., & Chiu, V. (2008). Social network, cognitive function, and dementia incidence among elderly women. American journal of public health, 98(7), 1221–1227. https://doi.org/10.2105/AJPH.2007.115923
  5. Albanese, E., Guerchet, M., Prince, M., & Prina, M. (2014). World Alzheimer report 2014: Dementia and risk reduction: An analysis of protective and modifiable factors. Alzheimer’s Disease International. https://www.alzint.org/u/WorldAlzheimerReport2014.pdf
  6. Bennett, D. A., Schneider, J. A., Buchman, A. S., Barnes, L. L., Boyle, P. A., & Wilson, R. S. (2012). Overview and findings from the rush Memory and Aging Project. Current Alzheimer research, 9(6), 646–663. https://doi.org/10.2174/156720512801322663

Dementia is a collection of different symptoms characterised by a progressive worsening of memory and intellect (cognitive abilities), orientation, or personality, that is caused by the diseases that affect the brain. It is not a natural part of ageing.

Persons living with dementia eventually lose the ability to do things to a level that affects their daily functioning, such as working, performing daily activities, or social interaction.1 They may gradually find the following abilities challenging:

• Thinking and reasoning
• Problem-solving and making judgements
• Remembering new information or recalling recent events
• Learning new information and skills
• Recognising familiar faces and items
• Finding the right words to communicate

Dementia can affect adults of any age, but it is more common in those aged 65 and above.

Statistics on Dementia on a Global Scale

According to the Alzheimer’s Disease International (ADI),2 someone in the world develops dementia every 3 seconds. There are over 50 million people worldwide living with dementia in 2020. This number will almost double every 20 years, reaching 82 million in 2030 and 152 million in 2050. Much of the increase will be in developing countries. Already 60% of people with dementia live in low and middle income countries, but by 2050 this will rise to 71%. The fastest growth in the elderly population is taking place in China, India, and their south Asian and western Pacific neighbours.

Demographic ageing is a worldwide process that shows the successes of improved health care over the last century. Many are now living longer and healthier lives and so the world population has a greater proportion of older people. Dementia mainly affects older people, although there is a growing awareness of cases that start before the age of 65.

There are over 9.9 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds.

According to the Well-being of the Singapore Elderly (WiSE) nationwide study spearheaded by the Institute of Mental Health (IMH), 1 in every 10 people aged 60 years and above has dementia, with the condition affecting those above the age of 85.3 This translates into approximately 82,000 people in 2018, and more than 100,000 in the following few years. This number is expected to increase to 152,000 by 2030.4

Downloadable Resources

The following resources contain bite-sized information on What Is Dementia? that you may download and/ or print:

Click on the images below to download in English.

Forget Us Not: Building a Dementia Friendly Community

understanding-dementia

Understanding Dementia

References

  1. Your guide to understanding dementia. (2019, December 9). HealthHub. Retrieved on 24 March, 2021, from https://www.healthhub.sg/live-healthy/679/yourguidetounderstandingdementia_pdf
  2. Dementia statistics. (n.d.). Alzheimer’s Disease International. Retrieved 24 March, 2021, from https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/
  3. Subramaniam, M., Chong, S. A., Vaingankar, J. A., Abdin, E., Chua, B. Y., Chua, H. C., Eng, G. K., Heng, D., Hia, S. B., Huang, W., Jeyagurunathana, A., Kua, J., Lee, S. P., Mahendran, R., Magadi, H. Malladi, S., McCrone, P., Pang, S., Picco, L., . . . Prince, M. (2015). Prevalence of dementia in people aged 60 years and above: Results from the WiSE study. Journal of Alzheimer’s Disease, 45(4), 1127–1138. doi: 10.3233/jad-142769.
  4. Let’s talk about vascular dementia. (n.d.). HealthHub. Retrieved September 11, 2021, from https://www.healthhub.sg/programmes/74/understanding-dementia/

There are many myths surrounding dementia. Here are some common myths that have often exacerbated the stigma of dementia and perpetuated negative stereotypes about the condition.

Misconception: Dementia is a natural part of ageing.

Dementia is an illness that affects the brain and is not a natural part of ageing.

It is a condition that affects the brain, leading to progressive memory loss, decline in cognitive abilities, and personality changes.

In normal ageing, a person may:

• Still be able to pursue daily activities and function independently, despite occasional memory lapses.
• Require some time to remember directions and/or navigate new places.
• Still be capable of judgment and decision-making.
• Be able to recall and describe significant events.
• Have difficulty finding the right word to communicate but has no problem in holding a conversation.

Misconception: Dementia is the same as Alzheimer’s Disease.

There are different types of dementia, each with different causes and symptoms. What is common across causes of dementia is changes in the brain.

The causes of dementia include: Irreversible causes such as Alzheimer’s Disease, Vascular Dementia, Stroke, Parkinson’s Disease, Lewy Body conditions, and Fronto-temporal causes of dementia; and potentially reversible causes such as Hypothyroidism, Vitamin B12 Deficiency, and Alcohol-related syndromes.

Misconception: Memory loss means a person has or is going to have dementia.

Some memory lapses and the slowing of processing speed, such as with finding the right word, occurs with ageing.

Misconception: Persons living with dementia only experience memory loss.

Memory loss (forgetfulness) is one of the symptoms experienced by persons living with dementia. It is not the only symptom.

Common symptoms of different types of dementia include:

• Memory loss (forgetfulness) that occurs gradually, and worsens progressively with time. Immediate and short-term memory loss occurs first.
• Difficulty in communication.
• Problems recognising familiar faces or items.
• Worsening of general problem-solving, decision-making, judgment abilities and becoming more disorganised.
• Problems with daily activities such as buttoning of shirt, dressing and using utensils during mealtimes.

Sometimes, other behavioural and psychological symptoms may also occur:

• Depression
• Agitation
• Hallucinations
• Anxiety
• Paranoia
• Sleep problems

Misconception: Dementia only affects older people.

Dementia can also occur to younger persons. Dementia in persons below age 65 is known as young-onset dementia.

There is a rising trend in young-onset dementia cases in Singapore, as it is in some other countries. This may be due to a few reasons, including greater awareness of the condition and better screening methods.

The top two causes for young-onset dementia are currently Alzheimer’s disease, which is the most common cause, and vascular dementia.

Vascular dementia, where a series of mini-strokes occurs in the brain, is related to lifestyle diseases such as diabetes and high blood pressure. The rising trend in lifestyle diseases could be contributing to the rising rate of dementia diagnosis in younger persons.

How dementia looks like in a younger adult may be different from how it looks like in an older adult. Younger persons living with dementia tend to have more problems with language, problem-solving, planning, and object recognition. They may also show more behavioural changes.1,2

Misconception: Dementia can be completely prevented.

Dementia cannot be completely prevented with absolute certainty.3 However, there are ways to lower the risk of developing dementia.

Some risk factors of dementia, such as age, genes, or a lower level of educational attainment, are difficult or impossible to change.

However, the following can be done to lower the risk of dementia, or to delay the onset of dementia:

• Be physically active and exercise regularly
• Keep blood pressure at a healthy level
• Monitor blood glucose if you have diabetes
• Eat a balanced diet
• Quit smoking
• Go for regular health screening
• Refrain from heavy alcohol intake
• Be socially engaged

Misconception: Life is over for a person and the people around them when they develop dementia.

Developing dementia is not a death sentence. A person living with dementia can continue to adapt to life with their condition and can still live a meaningful life.

The person living with dementia and the people around them can still experience personal growth, relational growth, and enjoy meaningful experiences amidst the grief and loss that occurs with the progression of dementia.

Because dementia develops in a progressive way, and the loss of capabilities does not happen all at once, persons living with dementia continue to be able to do things for some time.

Depending on where they live, there may be support for persons living with dementia to continue to be included in meaningful social life. For example, in Singapore, there is growing awareness of dementia. There are also dementia-inclusive initiatives being carried out by different sectors and partners in the community to design the environment in a way that enables persons living with dementia and their caregivers to participate in community life.

Find out more on Dementia-Inclusive Environments.

Misconception: There is no use of treating dementia because there is no cure.

Although there is no cure for dementia, there are both pharmacological and psychosocial methods to manage the conditions of persons with dementia.

• Reversible causes and risk factors can be treated.
• Medications to slow the progression of dementia can be taken.
• Medications to improve the cognitive symptoms in Alzheimer’s Disease can be taken.
• Behavioural and Psychological Symptoms of Dementia (BPSD) can be managed through non-medication measures and with medication.

Misconception: Persons living with dementia are unable to make decisions, are unable to do things, cannot communicate, or are not aware of their surroundings.

Dementia develops gradually. During the earlier stages, persons living with dementia will still have some level of ability to make decisions, perform different actions, communicate, and be aware of themselves and their surroundings. Even during the later stages of dementia, persons living with dementia do have preferences, abilities, ways to communicate and awareness, which are expressed in their own way.

Misconception: Dementia is hereditary.

Something is hereditary if it is passed from parents to offspring through genes. In the majority of cases, dementia is not strictly inherited.

• Firstly, the development of dementia happens because of a combination of genetic and environmental factors. These factors work together to increase or decrease a person’s risk of developing dementia. A person with a biological parent or relative who has developed dementia will not necessarily develop dementia. However, this person’s risk of developing dementia will be increased.
• Secondly, the type of dementia a biological parent or relative has will affect the risk of a person developing dementia. Some types dementia, such as frontotemporal dementia, have a stronger genetic link compared to other types of dementia.

Watch ONE FM 91.3 radio hosts have a conversation with Dementia Singapore CEO Jason Foo about some myths about dementia.

References

  1. Gan, E. (2017, June 14). Dementia affecting more people under the age of 65. TODAYOnline. https://www.todayonline.com/singapore/dementia-affecting-more-people-under-age-65
  2. Teo, J. (2020, 21 June). More here diagnosed with young onset dementia, says NNI. SingHealth. https://www.singhealth.com.sg/news/tomorrows-medicine/more-here-diagnosed-with-young-onset-dementia-says-nni
  3. National Health Service. (n.d.). Can dementia be prevented? Retrieved 4 March, 2021, from https://www.nhs.uk/conditions/dementia/dementia-prevention/

Some conditions share symptoms with dementia. Here is a comparison between dementia, mild cognitive impairment, depression, and delirium:

Dementia & Mild Cognitive Impairment (MCI)

Dementia and mild cognitive impairment are different conditions.

Mild Cognitive Impairment (MCI) is a disorder with a modest but noticeable and measurable decline in cognitive abilities including memory and thinking skills.

A person with MCI is still able to function at his/her usual level but is at an increased risk of developing dementia.

Unlike dementia, MCI does not impair a person’s ability to carry out simple routine tasks or lead a normal life.

Adapted from: SingHealth1

Dementia & Depression

As both depression and dementia can share very similar symptoms such as isolation, a declining interest in hobbies, social withdrawal, and detachment, the two conditions can be easily confused. Severe depression can also sometimes cause a group of cognitive impairment symptoms known as pseudodementia, making it harder for one to articulate their feelings associated with depression.

Though research on the link between dementia and depression is still developing, many sources suggest that having symptoms of dementia in mid- or late life is associated with a higher risk of developing dementia.2 However, persons living with depression do not necessarily develop dementia.

Some key differences between dementia and depression are:3

• Onset, duration, and course: The onset of dementia is slow and insidious, with a progressive and irreversible deterioration; depressive episodes consist of mood changes that can last from two weeks to years, but are reversible.

• Mood: A depressed mood may be, but is not definitely present in early dementia; a depressed mood is definitely present in a person who experiences dementia.

• Thinking: With dementia, there is often difficulty with word-finding and abstraction, but in dementia, thinking is often intact, though the content of thought often has themes of helplessness and hopelessness.

Dementia & Delirium

Delirium refers to an abrupt change in the brain that is characterised by a fluctuation in the person’s level of consciousness, psychomotor disturbances, memory impairments, emotional changes, and altered cognition or perception, that occurs over hours or days. Risk factors include the development of a physical illness, sensory impairments, recent surgeries, and use of drugs or substances (either prescribed or illicit). Delirium is usually reversible.

Delirium does not necessarily occur with dementia, and persons without dementia can encounter delirium too. Unlike delirium, dementia slowly progresses over years, does not disturb levels of consciousness, is permanent, and has fairly consistent signs and symptoms. The behaviour of persons living with dementia is also fairly consistent on a day-to-day basis.

Adapted from: Changi General Hospital4 and HealthXchange.sg5

References

  1. SingHealth. (n.d.) Mild Cognitive Impairment (MCI): Signs and Symptoms. HealthXchange.sg. Retrieved on 5 March, 2021, from https://www.healthxchange.sg/seniors/ageing-concerns/mild-cognitive-impairment-signs-symptoms
  2. Barnes, D. E., Yaffe, K., Byers, A. L., McCormick, M., Schaefer, C., & Whitmer, R. A. (2012). Midlife vs late-life depressive symptoms and risk of dementia: Differential effects for Alzheimer disease and vascular dementia. Archives of general psychiatry, 69(5), 493-498.
  3. Victoria State Government. (n.d.). Differential diagnosis – depression, delirium and dementia. health.vic. Retrieved April 28, 2021, from https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/cognition/diff-diagnosis
  4. Changi General Hospital. (2019, January 10). Delirium: Symptoms and Management. HealthHub. https://www.healthhub.sg/a-z/diseases-and-conditions/627/delirium
  5. Lim, S. C. (n.d.). Dementia and Delirium: Know the Difference. HealthXchange.sg. Retrieved on 24 March, 2021, from 1. https://www.healthxchange.sg/head-neck/brain-nervous-system/dementia-delirium-difference

Dementia is not a single disease but a collection of symptoms. There are different kinds of dementia that occur caused by different changes in the brain.

Alzheimer’s Disease (AD)

Alzhemer’s disease is the most common type of dementia. It is caused by the build-up of certain kinds of proteins in and around brain cells. It has an insidious (slow) onset and is a progressive disease whereby symptoms gradually worsen over a number of years. AD is irreversible, slowly impairs memory and thinking skills, and may eventually affect the ability to carry out simple tasks such as eating. Currently, there is no cure for this disease but treatment can help manage symptoms of AD.

Vascular Dementia

Vascular dementia is a type of dementia that is caused by a disease or injury to blood vessels in the brain, mostly in the form of strokes. The onset of this kind of dementia may be abrupt, and symptoms depend on the location and impact of the stroke. A person with vascular dementia may also show evidence of silent strokes on brain scans. While vascular dementia is not reversible, it is important to treat its risk factors. Controlling risk factors such as high blood pressure, diabetes mellitus, high cholesterol, and smoking may slow the disease’s progression and reduce stroke recurrence.

Lewy Body Dementia (LBD)

Lewy body dementia is a type of dementia that occurs when there is an abnormal build-up of structures called Lewy bodies inside brain cells. This causes changes in movement, thinking and behaviour. Symptoms of LBD can sometimes also happen due to Parkinson’s disease – these symptoms include slowness, tremors, rigid muscles and vivid visual hallucinations. Other prominent symptoms include problems with attention, organisation, problem solving, and planning. People with LBD have higher risks for falls in view of their increased rigidity, instability and slow gait.1

Fronto-Temporal Dementia (FTD)

Fronto-temporal dementia is a type of dementia that is characterised by marked personality changes and in some cases, language difficulties. It is caused by progressive damage to the frontal and/or temporal regions of the brain. FTD can lead to reduced intellectual abilities and changes in personality, emotion and behaviour, which are related to the function of the brain’s frontal lobe. FTD can also cause difficulty in recognising objects, understanding, or language expression, which are related to the function of the brain’s temporal lobes.

Due to these symptoms, FTD can be mistaken for Alzheimer’s disease, Parkinson’s disease or a psychiatric disorder like depression, obsessive-compulsive disorder or schizophrenia. There is no treatment or cure yet but medications and lifestyle changes can help to relieve the symptoms. Most people affected by FTD are younger, between 40-70 years of age.

Alcohol-Related Dementia

Alcohol-related dementia is a cognitive disorder caused by alcohol-related brain damage. Some parts of the brain may be damaged through vitamin deficiencies, especially severe vitamin B-1 deficiency, since alcohol prevents this vitamin’s absorption and use. A risk factor for alcohol-related dementia is regular drinking of large volumes of alcohol.2

Downloadable Resources

The following resource contains bite-sized information on Different Types of Dementia that you may download and/ or print:

Click on the image below to download in English.

understanding-dementia

Understanding Dementia

References

Through this online course, you will get to learn the following and receive a certificate upon completion of the evaluation form and module.

• What is Dementia, its types, and risk factors
• ABCD Signs and Symptoms of Dementia
• Interacting & communicating with people living with dementia
• Ways to reduce the risk of getting dementia
• Dementia-Friendly Communities

Find out more or scan the QR code below to learn more about dementia now!

dementia-hub-sg

Screening vs Diagnosis

Screening persons for dementia and a diagnosis of dementia are two different things.

Screening for dementia with tools like the Abbreviated Mental Test (AMT) and Mini Mental State Examination (MMSE) cannot be used to diagnose a person with dementia. They are instead used to spot some obvious symptoms of dementia in persons being screened, after which persons who have been identified with dementia symptoms may be encouraged to consult a doctor for further testing.

Persons who have been identified as having dementia symptoms during screening do not necessarily have dementia, and vice versa: there is some chance that some persons who have not been identified as having dementia symptoms may have dementia.

Dementia screenings are helpful, but are not as thorough as a medically qualified professional’s evaluation and diagnosis.

If someone you know shows signs of dementia, please consult a doctor for testing and diagnosis.

Diagnosis

In Singapore, only medically qualified professionals, i.e. doctors, can diagnose dementia. A family doctor can be consulted for an initial assessment. If necessary, the doctor may refer the case to specialists (geriatricians, psychogeriatricians, neurologists and psychiatrists) for an official diagnosis.

Qualified professionals who can conduct dementia diagnoses are found at healthcare institutions such as family clinics and hospitals, and certified general practitioners’ clinics.

Source: Agency for Integrated Care (AIC)

Diagnosis can be conducted at several places including the hospitals listed below and certified general practitioners’ clinics.

You may obtain a professional diagnosis by approaching the places below:

Memory Clinics

You may contact any of the memory clinics in Singapore below.

Tan Tock Seng Hospital

Geriatric Medicine Clinic [Basement 1]
11 Jalan Tan Tock Seng Singapore 308433
Tel: 6359 6100
Fax: 6359 6101


Institute of Mental Health

Psychogeriatric Clinic
10 Buangkok View
Singapore 539747
Tel: 6389 2200
Fax: 6385 1075
*See ‘Downloadable Resources’ below


National University Hospital

Neuroscience Clinic
5b Lower Kent Ridge Road
Singapore 119074
Tel: 6779 5555
Fax: 6779 5678


Changi General Hospital

Geriatric Clinic
2 Simei Street 3
Singapore 529889
Tel: 6850 3510
Fax: 6787 2141

Ng Teng Fong Hospital

Geriatric Medicine 1
Jurong East Street 21
Singapore 609606
Tel: 6716 2000 (24 hours)  |  6716 2222 (appointment)


Singapore General Hospital

Department of Neurology
Outram Road
Singapore 169036
Tel: 6321 4377
Fax: 6220 3321
Email: appointments@sgh.com.sg


NNI @ TTSH Campus

Neuroscience Clinic, Level 1
National Neuroscience Institute
11 Jalan Tan Tock Seng
Singapore 308433
Tel: 6357 7095
Fax: 6357 7103
Email: appointments@nni.com.sg

General Practitioners

You can approach local General practitioners (GPs) who are certified to support and provide mental health assessments and diagnosis.

A recommended list of certified GPs can be found at Pg. 83 to 86 in ‘A Resource Kit for Caregivers’ by AIC.

Helplines

You can call the following helplines for more information.

a) Dementia Helpline by Dementia Singapore: 6377 0700
b) Agency for Integrated Care Hotline: 1800-650-6060
c) HealthLine by Health Promotion Board (HPB): 1800-223-1313

Downloadable Resources

The following resources contain bite-sized information on the IMH Memory Clinic that you may download and/ or print:

Click on the images below to download in English or select another language.

IMH Memory Clinic

If you suspect your loved one is displaying the signs and symptoms of dementia, you should encourage him or her to get properly diagnosed and treated. However, starting a conversation with someone on this sensitive issue may not be easy.

This article will first provide a short guide to how to start a conversation with a person living with dementia about getting a diagnosis, and then detail some guiding points about how to navigate these conversations.

A Short Guide to Starting a Conversation About Getting a Diagnosis

To encourage someone to talk when you’re worried about how their memory loss has affected them, you can:

1. Have the conversation in a familiar and relaxing place.
2. Cite examples of their behaviour to initiate awareness.
3. Have a frank conversation to discuss their needs and issues.

You do not need to get the person to agree to visit a doctor for a diagnosis in just one session. This is a difficult development to process, so it may take some time for the person to accept it.

Here are some questions that you may use to start the conversation:

• You seem worried; how can I help?
• You don’t seem yourself today, how are you feeling?
• Are you ok? You seem to be concerned about something.

Being diagnosed with dementia may come as a surprise to someone at first. However, with a clear diagnosis, persons living with dementia can get the information, treatment, management, and support needed to manage the symptoms.

Depending on the person’s comfort level, sharing concerns with family members early in the conversation can:

• Coax the person to obtain a diagnosis and seek support.
• Prepare family members early for the caregiving role.
• Help both the person and caregiver(s) to plan for the future.

The First Hurdle

Our first reactions upon receiving bad news are often to feel worried or helpless, or to lapse into denial. The mild and progressive nature of dementia also makes it convenient for people to brush off the symptoms as either a natural byproduct of ageing or a minor inconvenience. Any talk of it being a sign of something ominous or as a possible symptom of dementia is dismissed or explained away. Frequently misplacing things around the house may spark the response “I’m so forgetful”, and an older person’s mood swings may appear to some as them simply being unreasonable or seeking attention.

Rather than wait for a ‘defining incident’ to give dementia significance, put the truth gently to them. Cease making excuses for them and trivialising the signs. Without pointing out all the signs and symptoms you observe, try to help them connect the dots. With the intention to guide them towards early detection and diagnosis, subtly provide information on the symptoms of dementia that may gradually reveal to them what they might be trying to deny.

Seize The Opportunity

Often, the person’s reluctance to see a doctor is a result of fear, denial, or a desire to hold on to their decision-making abilities for as long as they are able to do so. Acknowledge their emotions and fears. Give them the room to embrace their true emotions but make use of opportunities to bring them to the doctor. For example, if they have been expressing concerns about cognitive symptoms or other health symptoms they acknowledge, you could take these opportunities to encourage them to go for a doctor’s consultation where dementia-related symptoms could be raised.

Reframe Your Approach

Knowing the barriers holding your loved one back from getting an early diagnosis is not sufficient. Ease their concerns by exploring these barriers with them and try to empathise with their emotions while providing reassurance. Share that seeing a doctor is the best course forward for them.

Instead of repeatedly emphasising the importance of early diagnosis, try asking them for a favour. Sometimes, loved ones will do something for others that they would not do for themselves. Making a doctor’s appointment a favour they can do for you may prove to be a good strategy. Reframing the purpose of the visit will help to provide clarity and make things less intimidating for your loved ones with dementia.

According to Diana Kerwin, MD, chief of geriatrics at Texas Health Presbyterian Hospital Dallas and the director of Texas Alzheimer’s and Memory Disorders, it helps for family members of persons who may have dementia to treat a doctor’s appointment as another preventive medicine visit like a colonoscopy or bone density testing. This appointment could also be described as a brain check-up.2

No one wants to see a loved one diagnosed with dementia or Alzheimer’s Disease. But the sooner they get it checked, the earlier care and support can be rendered. On the flip side, it can be even more comforting should the check-up show nothing out of order. What is certain is that one never loses out by getting themselves checked – and it all begins with a trip to the doctor.

If you are experiencing difficulty getting your loved one, who is suspected of dementia, to get a diagnosis, watch Dr Joshua Kua’s advice on how to encourage him/her to seek help:

Source: Agency for Integrated Care

References

  1. Agency for Integrated Care. (n.d.). Living with Dementia, A Resource Kit for Caregivers, Knowing Dementia. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/4%20Books/Book%201%20-%20KNOWING%20DEMENTIA.pdf
  2. Johnson, L. (April 18, 2019). Dementia Care: Navigating a Doctor’s Visit with Your Loved One. Retrieved May 4, 2021, from https://www.healthline.com/health/dementia-care-visiting-the-doctor-with-your-loved-one
  3. Dementia Singapore. (2017, October 24). Dealing with Dementia: The First Step. https://dementia.org.sg/2017/10/24/dealing-with-dementia-the-first-step/

All types of dementia are progressive. This means that while symptoms may at first be mild, they deteriorate with time. As dementia progresses, a person with this condition will need increasingly more help and support with daily living. Dementia affects every individual differently. This includes their experience of the symptoms, the rate at which the condition progresses (which itself varies across the different types of dementia), and the type and level of support required.

There are several stages of dementia. In all types of dementia, memory problems are the early signs. The deterioration in cognitive skills is gradual and in later stages, daily activities will become increasingly challenging without assistance.

Dementia progression can generally be classified into three stages – the mild, moderate, and advanced stages. These stages are a simplified explanation on how dementia symptoms change over time, and can be used as a guide to help persons living with dementia and their loved ones prepare for the future. It may be difficult to place a person’s condition in a specific stage as symptoms may appear in a different order and stages may overlap.1 However, understanding the stages as such helps us see how dementia progresses in general.

The following provides an overall idea of how the symptoms affect a person living with dementia and change across the three stages:

Activities of Daily Living

  • Mild Dementia

    • Still able to care for self in basic activities of daily living, i.e. personal hygiene, dressing
    • May have some difficulty with:

    ⇒ Taking public transportation
    ⇒ Money management

    • May have difficulty planning and managing household tasks such as cleaning and cooking
    • May have difficulty initiating activities

  • Moderate Dementia

    • Needs regular reminders and prompts in daily tasks
    • Requires assistance with dressing, personal hygiene, going to the toilet, eating, and some other daily activities.
    • High risk of falling

  • Advanced Dementia

    • Unable to care for self. Total dependence in taking care of own hygiene, eating, going to the toilet, and taking a shower
    • Problems with balance, coordination, resulting in instability and falls
    • Likely to have mobility issues, could be bed-bound
    • Eating and swallowing problems
    • Loss of bladder and bowel control

Behaviours

  • Mild Dementia

    • Apathy; lack of interest in activities they used to engage in
    • May become socially withdrawn
    • Rapid mood changes or have low mood

  • Moderate Dementia

    • Wandering
    • Repetitive actions/ questions
    • Sleep reversal
    • Frustration at not being able to communicate well
    • May appear depressed, and more easily upset, frustrated, agitated, and suspicious

  • Advanced Dementia

    • Crying, shouting or repetitive vocalisation as a means to communicate needs
    • Refusing care due to confusion
    • Passive/ withdrawn

Cognitive Decline

Memory

  • Mild Dementia

    • Forgetfulness (Difficulty with short-term memory)
    • Impaired judgement
    • Impaired abstract thinking
    • Misplacement of items

  • Moderate Dementia

    • Difficulty with short- and long-term memory
    • May begin to forget or be unable to recognise certain family members
    • May begin to be unable to remember own address or phone number

  • Advanced Dementia

    • No apparent awareness of past or present
    • Inability to recognise current self
    • Inability to recognise common objects

Language & Communication

  • Mild Dementia

    • Difficulty in following storylines and conversations
    • Difficulty finding the right words or remembering names

  • Moderate Dementia

    • Difficulty in communication due to repetitive speech or inability to understand contexts
    • Difficulty in expressing emotions and making needs known

  • Advanced Dementia

    • Unable to communicate through language
    • Unable to engage in meaningful conversations
    • May not be able to communicate or may be unresponsive at times
    • Incoherent speech
    • May express needs by yelling

Calculation

  • Mild Dementia

    • Problems with handling finances

  • Moderate Dementia

    • May have problems performing simple calculations

  • Advanced Dementia

    • Unable to perform any calculation

Disorientation

  • Mild Dementia

    • May occasionally feel disoriented, but may be able to navigate frequently visited places
    • May get lost in less familiar places

  • Moderate Dementia

    • May experience confusion in general; may have poor orientation to day, date and/or time
    • May get lost outdoors, even in familiar places

  • Advanced Dementia

    • Unable to differentiate day and night
    • May get lost at home

Downloadable Resources

The following resources contain bite-sized information on The ABCDs of Dementia Progression that you may download and/ or print:

Click on the images below to download in English.

Forget Us Not: Building a Dementia Friendly Community

understanding-dementia

Understanding Dementia

References

Your role as a caregiver changes with the progression of your loved one’s condition. Below summarises the caregiving experience through the different stages of dementia:1-3

Early-Stage Caregiving

What you may experience as a caregiver

Your loved one has recently been diagnosed with dementia, and you may feel that you are suddenly performing a new, unfamiliar role as a caregiver. You may be overwhelmed with emotions. This is normal.

You may experience or feel:

• Denial about the diagnosis;

• Lost about where to search for information and professional help related to dementia;

• Stress and Anxiety due to the uncertainty about the future as the condition progresses;

• Fear and worry about your ability to support your loved one living with dementia; and

• Anger or Frustration with the loss of control over the future.

What you can do as a caregiver

If your loved one is diagnosed with mild dementia, they can most likely be independent in most daily living activities, such as eating, showering and dressing, etc. They may still be able to drive and work.

However, they may require cues and reminders to help with memory to:

• Plan and organise matters
• Remember names
• Remember medical appointments
• Manage medications
• Manage finances

As a caregiver, you can:

• Support your loved one in maximising their independence in daily living activities for as long as possible. You can discuss and find a balance between interdependence and independence with your loved one. This can increase their confidence as well.

• Discuss and understand your loved one’s and your emotions together. Denial and fear are common in both caregivers and persons living with dementia.

• Continue to help your loved one live well. Though they are diagnosed with dementia, they will want to live well for as long as possible. Encourage them to remain physically and mentally healthy through exercises and balanced diets, and socially active and connected.

• Plan for the future together on financial and legal matters, and long-term care arrangements. A discussion with the rest of the family can be very helpful. Doing this can also help reduce your anxieties and worries regarding these matters.

• Take care of yourself. Caregiving for persons living with dementia is a long journey filled with ups and downs. It is important to first maintain your health and wellbeing in order to provide quality care to your loved one.

• Be empowered with information and resources. DementiaHub.SG provides resources and information that you may tap on to deepen your understanding of both dementia and of how to care for persons living with dementia. Take your time to explore this portal and visit it whenever the need arises.

Middle-Stage Caregiving

What you may experience as a caregiver

It is likely that you are a seasoned caregiver with a few years of experience.

As your loved one living with moderate dementia requires increasing support in their daily living activities, exhibits changes in his behaviours and/or emotions, and experiences difficulties with communication, you will take on more responsibilities to support their well-being. This involves making decisions for them and providing physical care.

Dementia may gradually change the personality of your loved one to the point that you may start questioning if this is the same person you know and love. This could be difficult to accept, especially if you have had a special bond with them. At this point, remember that your loved one is still the same person despite all the challenges they now have in communicating and expressing themselves.

Though there will be challenging and tiring days, there will also be good days. Though it may or may not happen, there is a chance that your relationship with your loved one may improve and you might enjoy some parts of your caregiving journey.

What you can do as a caregiver

As your loved one becomes more dependent on you for support and assistance, it becomes necessary for you to establish a structure and develop daily routines. At the same time, it is good to remain flexible and adjust these routines as their dementia continues to progress. Embrace your creativity as you generate and modify various strategies and ways to care for your loved one.

Caregiving responsibilities will grow more physically and/or emotionally demanding, so it is important that you focus on taking care of yourself too.

Late-Stage Caregiving

What you may experience as a caregiver

As your loved one’s dementia progresses to a more advanced stage, they will be totally dependent on you for their daily living activities. Additionally, they may be more vulnerable to infections, especially skin ulcers and pneumonia for having spent long hours in a wheelchair or bed.

Your loved one will require more intensive physical care around the clock, and you may require additional support and assistance at home.

Your loved one is approaching the end of his/her life. Dealing with loss is part of life. It is okay to feel sad when your loved one passes on. At the same time, while grief is a universal reaction to any form of loss, responses to it vary from person to person.

What you can do as a caregiver

Although your loved one may spend a lot of time in bed or a wheelchair, and have difficulties communicating and expressing themself, they still have the ability to experience the world through their senses (sight, hearing, smell, taste and touch). You may engage them in activities which stimulate the senses. An example of one such activity is the Namaste Care programme.

You may also gather with family members and caregivers to discuss alternative care arrangements for your loved one to ensure they get the appropriate care that they needs.

If your grief continues for years and starts to interfere with your daily life, do not hesitate to see your doctor or visit a counsellor.

Below provides an overview of activities you may engage your loved one with at each stage of dementia, and the available resources and support one can tap on to ease the caregiving role:

Mild Stage of Dementia

  • Examples of recreational activities

    • Life story work, e.g. writing a memoir, creating a photograph or video collection
    • Photo Reminiscing
    • Arts & Crafts
    • Hobbies
    • Games

  • Services to ease caregiving role

    • Emergency numbers
    • Helpline
    • Hospitals
    • Caregiver Training
    • Counselling
    • Respite Care
    • Senior Activity Centres
    • Senior Care Centres

  • Schemes to reduce the financial stress when providing care

    • Caregiver Training Grant (CTG)
    • Community Health Assist Scheme (CHAS)

Moderate Stage of Dementia

  • Examples of recreational activities

    • Photo-reminiscing
    • Arts & Crafts
    • Hobbies
    • Games

  • Services to ease caregiving role

    • Emergency numbers
    • Helpline
    • Government Hospitals
    • Community Hospitals
    • Caregiver Training
    • Caregiver Support Group
    • Counselling
    • Respite Care
    • Home Care
    • Senior Activity Centres
    • Senior Care Centres
    • Nursing Homes

  • Schemes to reduce the financial stress when providing care

    • CareShield Life
    • ElderShield
    • ElderFund
    • Enhancement for Active Seniors (EASE)
    • Foreign Domestic Worker Levy Concession
    • Home Caregiving Grant (HCG)
    • Interim Disability Assistance for the Elderly (IDAPE)
    • Pioneer Disability Assistance Scheme (PG-DAS)
    • Seniors’ Mobility and Enabling Fund (SMF)
    • ComCare Interim Assistance, Short-to-Medium-Term Assistance, and Long Term Assistance schemes

Advanced Stage of Dementia

  • Examples of recreational activities

    • Arts & Crafts
    • Hobbies
    • Games

  • Services to ease caregiving role

    • Emergency numbers
    • Helpline
    • Government Hospitals
    • Community Hospitals
    • Caregiver Training
    • Caregiver Support Group
    • Counselling
    • Respite Care
    • Home Care
    • Senior Activity Centres
    • Senior Care Centres
    • Nursing Homes

  • Schemes to reduce the financial stress when providing care

    • CareShield Life
    • ElderShield
    • ElderFund
    • Enhancement for Active Seniors (EASE)
    • Foreign Domestic Worker Levy Concession
    • Home Caregiving Grant (HCG)
    • Interim Disability Assistance for the Elderly (IDAPE)
    • Pioneer Disability Assistance Scheme (PG-DAS)
    • Seniors’ Mobility and Enabling Fund (SMF)
    • ComCare Interim Assistance, Short-to-Medium-Term Assistance, and Long Term Assistance schemes

Find out about services for your loved one.
Find out about services for caregivers.
Find more information on the abovementioned financial schemes.

References

  1. Alzheimer’s Association. (n.d.). Early-stage caregiving. https://www.alz.org/help-support/caregiving/stages-behaviors/early-stage
  2. Alzheimer’s Association. (n.d.). Middle-stage caregiving. https://www.alz.org/help-support/caregiving/stages-behaviors/middle-stage
  3. Alzheimer’s Association. (n.d.). Late-stage caregiving. https://www.alz.org/help-support/caregiving/stages-behaviors/late-stage

The worsening of the cognition of a person living with dementia may interfere with their activities of daily living and result in changes to their behaviours and emotions. The person’s personality may appear to have changed and become “very different from their ‘old self’”.

The main objectives of managing dementia symptoms are typically to:

• Improve the quality of life of persons living with dementia;
• Maximise or maintain their functional independence;
• Minimise any behavioural and/or emotional changes; and
• Minimise family caregivers’ stress.1

When it comes to dealing with almost any kind of illness or disease, medical intervention, especially in the form of drugs and medicines, are what we often turn to first. It is no different for dementia. A person diagnosed with dementia may ask questions like “Is there any medicine I can take to get better?” While there is currently no medicine that can completely cure dementia, there are treatments to help alleviate some of the symptoms that occur with dementia.

It has been suggested that for persons living with dementia, non-pharmacological interventions should be the first course of action as they work better and carry less risk when it comes to treating common symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy, and delusions. Some examples of non-pharmacological approaches include regular structured routine, good sleep hygiene, and reminiscence.1

In conclusion, effective and holistic intervention plans for persons living with dementia often require an integration of pharmacological and non-pharmacological (also termed as “psychosocial”) approaches.

In the following video, Dr. Chen Shiling of Khoo Teck Puat Hospital shares about why there is more to dementia treatment than just drugs. She raises three aspects of treatment and shares her past experiences that helped her understand how to care for a loved one living with dementia.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital and Dementia Singapore

References

  1. Poon, N. Y., Ooi, C. H., How, C. H. & Yoon, P. S. (2018). Dementia management: A brief overview for primary care clinicians. Singapore Medical Journal, 59(6), 295-299. https://doi.org/10.11622/smedj.2018070

Source: Dementia-Friendly Singapore Initiative

There are many scenarios where persons living with dementia may face difficulties and require assistance.

The K.I.N.D Gesture and C.A.R.E Approach can help us to remember what to do and be more confident when interacting and assisting persons living with dementia, especially in situations where they may appear to be lost.

The K.I.N.D Gesture

When you come across someone who is alone and appears anxious, be K.I.N.D

K

dementia-hub-sg

Keep a lookout for people who show the ABCD signs of dementia. They may also appear unkempt, and/or ask for food or money. The ABCD signs of dementia are:

• Activities of daily living: Difficulty performing daily activities or tasks such as cooking or dressing.
• Behaviour: May be socially withdrawn, more easily upset and frustrated.
• Cognition: Difficulty remembering things, problems with language and performing calculations.
• Disorientation: The person may lose his/her way in less familiar places, have poor orientation of day, date, and/or time.

I

dementia-hub-sg

Interact with patience.

• Ask one question at a time, for e.g., “Can I help?”. Be patient when waiting for a response.
• Talk and communicate slowly.
• Jog their memory by giving them the names of the nearby landmarks or the name of the current location.

N

dementia-hub-sg

Notice their needs and offer help.

• Bring them to a place to sit and rest. You may also offer a drink or some food.
• Ask for the next-of-kin’s whereabouts or contact number, or if they can recall their home telephone number.
• Check if they have some form of identification or look for an identification sticker with next-of-kin’s details e.g. EZ-link Card.

The identification sticker may look like this:

in-case-of-emergency-iced

Check the Dementia Friends app for updates of missing persons. Find out more about the Dementia Friends app, and how to be a Dementia Friend.

D

dementia-hub-sg

Dial for help.

• Call the next-of-kin.
• Alert security if found lost in buildings.
• Bring the person to the nearest Go-To Point that can provide assistance.
• Please call the police at 999 as the last resort.
• Continue to chat with them to provide reassurance until help arrives.

The C.A.R.E Approach

It is important that you communicate with C.A.R.E to someone who may have dementia

dementia-hub-sg
Clear, Simple & Patient When Talking to A Person Living with Dementia

• Use short and simple sentences
• Maintain a calming and comforting tone
• Speak clearly at a slower pace

dementia-hub-sg
Acknowledge His/ Her Concerns

• Smile
• Maintain eye contact
• Put the person at ease
• Be attentive when listening to him/her
• Be prepared to spend more time with him/her

dementia-hub-sg
Respectful & Reassuring

• Bring the person to a quieter location
• Give him/her time to think and respond
• Use a friendly and caring tone
• Show him/her care, concern and encouragement

dementia-hub-sg
Engage to Provide Comfort & Build Trust

• Be friendly
• Create and maintain a comforting presence when talking to the person
• Build a trusting relationship with him/her

⇒ Introduce yourself
⇒ Assure the person you are there to help him or her

• Ask appropriate questions in their preferred language, to help him/her regain self-awareness

⇒ “Who did you come with?”
⇒ “Where are you going?”
⇒ “What would you like me to do?”
⇒ “How would you like me to help you?”
⇒ “Do you want us to give _____ a call”

Downloadable Resources

The following resources provide bite-sized information on the K.I.N.D Gesture & C.A.R.E Approach that you may download and/ or print:

Click on the images below to download in English or select another language.

dementia-friendly-community-living-with-people-with-dementia

Happy Mind, Healthy life! Dementia-Friendly Singapore

We may encounter persons living with dementia in different situations depending on our social or work roles.

Watch this prize-winning video produced by Vinn Bay and Tee Boon Leng as part of the Alzheimer’s Disease International (ADI) conference in March 2009. As you watch, take note of how some members of the public interact with the person living with dementia who is lost in her neighbourhood, and how she feels because of these interactions.

Source: Health Promotion Board

Here are resources on how to apply the K.I.N.D Gesture and C.A.R.E Approach if you meet them in some scenarios listed below.

Though some of these resources are made for persons in specific social roles such as caregivers or service staff, they are also useful videos for the general public to watch since they may be similar to other scenarios encountered by anyone.

Understanding how people interact with persons living with dementia in different capacities also allows us to understand how we as a community can work together to build a more inclusive community.

In Retail & F&B Settings

Retail Settings

This video shows how the K.I.N.D Gesture and C.A.R.E Approach of interacting with persons living with dementia can be applied in retail settings.

Source: Dementia-Friendly Singapore Initiative

These are some scenarios where retail staff may encounter persons living with dementia:

Scenario 1: Someone has difficulty handling money at the point of purchase

What to do


Approach them in a friendly manner

Offer your help

If they are paying by cash, offer to help them count the right amount.

If they are paying by a card or mobile application that requires a Personal Identification Number (PIN) which they may have forgotten, politely suggest that they pay by cash instead.

You can also offer to keep their items first so they can return to purchase them when they have enough cash or recalled their PIN.

What not to do


Rush the person during payment.

Show signs of annoyance or impatience with gestures, facial expressions, or voice, such as folding arms, frowning, or raising your voice.

Scenario 2: Someone has forgotten to pay for their items before exiting the store

What to do


Approach them with a smile.

Ask politely if they may have forgotten to make a payment for the item.

If they are unable to pay, help to contact their family members for assistance.

Alternatively, retain the item and let them go.

Maintain a calm and polite demeanour.

What not to do


Raise your voice at them.

Scold and accuse them of stealing as this will cause them distress.

Scenario 3: Someone looks confused and unsure of the items which they wish to buy

What to do


Approach in a friendly manner

Assist them to identify the items by using visual cues such as the store’s specials and advertisements as appropriate.

If the store stocks the item, bring them to the specific area at which it is displayed.

If the item is not available in store, let them know that it is not available.

Suggest alternative products if appropriate.

What not to do


Ignore or brush them off.

Ridicule or embarrass them.

Scenario 4: Someone repeatedly purchases the same item(s) within a short span of time (e.g. a few times on the same day)

What to do


Politely remind them that they have bought the same items before.

If they realise that they do not need the items, help them return the items to the shelves.

If this is a recurrent issue (e.g., if the person comes back over many days), politely request for their family members’ contact details to inform them.

Note: Only request for them, with their consent, to present you with any identification that they may have. Do not physically search them without their consent.

What not to do


Question them about why they are buying the same items repeatedly.

Attempt to correct them if they insist they had not made those purchases.

Food & Beverage (F&B) Settings

This video shows how the K.I.N.D Gesture and C.A.R.E Approach of interacting with persons living with dementia can be applied in F&B settings.

Source: Dementia-Friendly Singapore Initiative

These are some scenarios where F&B staff may encounter persons living with dementia:

Scenario 1: Someone requests for an item that is not on the menu

What to do


Explain that the item is not available.

Show them the menu again and offer options that are similar to their requests.

It could be helpful to write the order down on paper to verify the order with them.

If the customer looks unable to decide or is confused, offer a seat where they can wait and calm down and take some time to decide.

What not to do


Show signs of impatience such as folding arms, raising your voice, or frowning when taking orders.

Scenario 2: Someone claims that their order is wrong when it is being correctly served to them

What to do


Politely show them a record of the order, such as the order chit.

What not to do


Argue or insist that they are wrong.

Scenario 3: Someone has trouble articulating or deciding their orders

What to do


Let them take their time.

Show them that you have their full attention by listening attentively, e.g. by repeating their order back to them.

You may try to assist if they have problems finding the right words for their orders.

You can cue them by using the menu and have them point to the item.

What not to do


Rush them to order their food.

Show annoyance, impatience, or a condescending attitude.

Public & Private Transport Settings

These are some scenarios where staff working in transport settings may encounter persons living with dementia:

Scenario 1: Someone gives an address that does not exist
Scenario 2: Someone does not disembark at the terminal or looks disorientated

What to do


Stay calm and patient.

Ask the person where they would like to go, and if possible, ask them to describe their destination.

If the address they provide does not exist, inform them politely.

If the address they provide is valid, guide them to the appropriate train/bus/taxi service. You may try to work with your transport teams to guide the person living with dementia safely back home, especially if the person’s route may involve multiple instructions and require coordination between personnel at different stations.

If they are unable to decide and look confused, offer help by asking them for the contact details of their family members.

If their address is available, offer to bring them home.

If no address can be found, stay calm and contact the police for help.

Note that you may only request for them to present you with any identification they may have. Do not physically search them without their consent.

What not to do


Ask them to get off the vehicle.

Leave them on their own without helping them.

Show annoyance or impatience such as frowning or raising your voice.

Scenario 3: Someone has insufficient balance on their fare cards and are confused about what to do

What to do


Bus captains may suggest that they pay by cash and help them to count the correct fare.

MRT station staff may direct them to the top-up machines and guide them.

If the person is not carrying money or fare cards, contact the nearest passenger service. centre/interchange for help.

Request for the person’s identification (e.g. I.C., EZ-Link card, NCSS card, or other cards) to contact their family members and get help.

If no one is available, remain calm and contact the police.

What not to do


Rush the person to pay up.

Show annoyance or impatience such as frowning or raising your voice.

Scenario 4: Eating and drinking on public transport

What to do


Politely show them the relevant signs in the bus or train for them to better understand what you are trying to tell them.

Politely remind them that they are on public transport.

If they continue to eat or drink, ask for help from HQ or supervisors.

What not to do


Scold them or confiscate their food and/or drink.

Ask them to get off the vehicle and leave them on their own without helping them.

For Bus Operators

This video shows how bus operators can interact with persons living with dementia.

Source: Dementia-Friendly Singapore Initiative

For Train Operators

This video shows how train operators can interact with persons living with dementia.

Source: Dementia-Friendly Singapore Initiative

For Private-Hire Vehicle Operators

This video shows how private-hire vehicle operators can interact with persons living with dementia.

Source: Dementia-Friendly Singapore Initiative

Bank Settings

These are some scenarios where staff working in bank settings may encounter persons living with dementia:

Scenario 1: The person forgets their Personal Identification Number (PIN) and/or signature

What to do


If the person forgets their PIN, politely ask if they would like to sign instead.

If they are unable to sign (as per bank records) or appear confused, request for their family members’ contact details or search the bank’s records to inform the family and request for their help.

Allow the person time to enter their PIN or sign.

What not to do


Rush them to make a decision.

Show annoyance or impatience such as frowning or raising your voice.

Scenario 2: Someone has trouble articulating their requests

What to do


Let the person take their time to think.

Politely ask if they would like to make a deposit, withdrawal, or a transfer.

Ask for their identification document, and check their transaction history to be able to guide them.

Use bank pamphlets as a way to cue them and find out about their requests.

What not to do


Rush the person while they try to articulate their request.

Show annoyance or impatience such as frowning or raising your voice.

Scenario 3: Someone comes in repeatedly within a short span of time (e.g. a few days) to withdraw substantial amounts of money

What to do


Politely inform them that they have made similar withdrawals earlier.

If they cannot recall having done so, show them their transaction records.

If necessary, consider showing them the CCTV footage of their recent visits.

What not to do


Create the impression that they are being stopped from withdrawing money.

Attempt to correct them if they insist that they had not visited the bank earlier.

Scenario 4: Someone mistakes the bank for another bank, or one that they used to go to in the past

What to do


Politely inform the person of your bank’s name and provide directions to their bank.

In the event that the bank is unfamiliar or is no longer in existence, bring them to a quiet area and contact their family members for help.

Ask for help from a supervisor if needed.

What not to do


Brush the person off or ignore them.

Ridicule the person.

Places of Worship

These are some scenarios where people in places of worship may encounter persons living with dementia:

Scenario 1: Someone performs prayers or rituals incorrectly or repeatedly
Scenario 2: Someone repeatedly visits places of worship or loiters around the premises looking lost

What to do


Start a casual conversation to find out whether they stay nearby.

If necessary, assist by bringing them back and make a note of this to the full-time staff in case this happens again.

If you notice that they continue to appear distressed or disorientated, try to find out the contact details of their family members and offer help.

You may need to contact the police if family members cannot be contacted.

Note that you may only request for their identification; do not physically search them without their consent.

What not to do


Attempt to correct them even if they have performed the rituals wrongly.

Make them feel that they are not welcome.

Question their rationale for coming to the place of worship.

One Day of Navigating Community Spaces as a Person Living With Dementia

Persons living with dementia participate in community spaces just as other community members do.

The following video shows an example of how one such person may navigate community spaces while living with their condition. It shows both positive and negative examples of how others may respond after recognising the ABCDs of Dementia Progression.

As you watch the video, place yourself in the shoes of the community members encountering this person living with dementia, and see the differences simple actions can make to these persons living with dementia.

Source: Dementia-Friendly Singapore Initiative

How Communication Can Be Affected at Different Stages of Dementia

As the condition of a person living with dementia progresses, the way in which others communicate and interact with them should also change in order to tailor the interaction to their needs, and to make the most of each conversation or interaction.

  • Early Stage

     

    The person living with dementia

    ⇒ Is able to follow and maintain meaningful conversations with difficulty in articulating certain words

    ⇒ May display some difficulties in giving/receiving instructions and understanding difficult ideas

    ⇒ May ask questions to confirm information frequently or repeat conversations

    ⇒ Able to communicate in brief social interactions with difficulty functioning in prolonged social settings

    ⇒ Difficulty with following lengthy conversations

    ⇒ May follow what is said, but forget it after a brief period

    ⇒ Jokes and sarcastic remarks can be confusing, and may provoke sensitive feelings towards context

    ⇒ May feel overwhelmed by excessive stimulation

  • Moderate Stage

     

    The person living with dementia

    ⇒ May be able to follow simple one-step instructions

    ⇒ May start to show more difficulty in following and maintaining conversations

    ⇒ May understand written information in a word-by-word process

    ⇒ May have decreased use of words for conversations

    ⇒ May repeatedly ask questions

    ⇒ May withdraw from the interaction if interaction is demanding

    ⇒ May experience personality and behavioural changes; E.g. suspiciousness and delusions which may hinder meaningful conversations

  • Advanced Stage

     

    The person living with dementia

    ⇒ May not be able to articulate meaningful statements

    ⇒ May start to repeat after the person in the conversation

    ⇒ May experience difficulty with verbal communication as ability to recall vocabulary may be reduced

    ⇒ May not be able to understand simple words being spoken to them

    ⇒ May express themselves verbally in patches or strings of words and sounds

    ⇒ Conversations may be disconnected

    ⇒ May not be aware of conversations directed to them, and may not be able to talk with others at all

    ⇒ May rely more heavily on visual cues, context, tone of voice, and touch to understand what others are communicating to them; use of non-verbal communication methods is recommended

    ⇒ May lapse into a familiar language used in their native country or their mother tongue

Adapted from: Communication Skills with Persons with Dementia by Khoo Teck Puat Hospital and Living with Dementia: A Resource Kit for Caregivers (Providing Care) by Agency for Integrated Care

How to Communicate With Persons Living With Dementia

For Caregivers

Interacting with the CARE approach

Source: Dementia-Friendly Singapore Initiative

Find out more about the K.I.N.D Gesture and C.A.R.E Approach.

Speaking with persons living with dementia

This video provides some suggestions on how caregivers can speak with persons living with dementia.

Source: ForgetUsNot Project by LIEN Foundation

Caregiving in public spaces

A caregiver’s sharing of a past experience where she and her mother, who lives with dementia, were interacting with members of the public.

Source: ForgetUsNot Project by LIEN Foundation

General Tips for Interaction With Persons Living With Dementia

1. Do not test the memory of persons living with dementia by asking them what they did recently.
Because of the disease, they are not able to remember many things. You will frustrate them by asking, “Don’t you remember?” Use memory aids like diaries, clocks or calendars to help them know what they have done and will be doing later.

2. Simplify activities and communication.
Break an activity down into simple, step-by-step tasks. The person will be able to focus on one step at a time and complete the activity. Keep sentences short and simple.

3. Offer reassurance and praise.
This will increase the person’s self-esteem and reinforce positive behaviour.

4. Do not argue with the person living with dementia.
What they see, hear or recall may not be the same as what you saw, heard or know.

5. Identify and remove triggers to unhelpful behaviour.
For example, if the person wants to go out of the house each time he sees shoes by the door, keep the shoes out of sight.

6. Identify underlying reasons for behaviour changes.
Try to establish if they have any underlying needs that they cannot express. For example, they could be showing these behaviour changes because they feel too warm or tired. They might also need a drink or use the toilet. If they seem uncomfortable, it could be a medical problem.

7. Keep up with social activities.
Most persons with dementia would benefit from physical or social activities regardless of the severity of their condition. Social activities ensure that they remain in contact with other people and offer a sense of well-being. Those at mild to moderate stages of dementia would enjoy being with family and friends in small gatherings as they would still be able to converse.

Recreational activities such as card games or hobbies could be enjoyable to them too. However, persons at a more advanced stage of dementia would more likely prefer a one-to-one interaction as they would need more visual and verbal cues.

8. Enjoy safe, outdoor activities.
Care needs to be taken to prevent falls when the person with dementia is walking in public spaces — steps, stairs, roads and crowded shopping malls — especially if they have osteoarthritis, heart problems or had a stroke previously.

Public spaces where there are even footpaths and seats available for rest would be ideal for them to visit. Some activities they could participate in include visits to neighbourhood parks and community gardens, tai chi/qigong with a community group, or the Memories Cafe or the Family of Wisdom programme organised by Dementia Singapore (formerly known as Alzheimer’s Disease Association).

Adapted from: HealthHub.sg

Tips for Conversations With Persons Living With Dementia

Face to face interaction

Approach the person from the front.

Attract the person’s attention.

Maintain eye contact.

Tone and volume of voice

Speak slowly and clearly.

Use a tone of voice that is gentle, calm, and reassuring.

Use positive and good-natured humour to lighten the mood.

Avoid using at a higher pitch and loud voice.

If the person living with dementia has hearing difficulties, consider encouraging them to use hearing aids, and use pictures/diagrams to help facilitate the conversation.

Conversation topics and activities

If you are having a chat with a person living with dementia, these are some suggestions for what you can do:

Talk about shared experiences: You can recount your experience about a certain event or memory. This may trigger memories in the person living with dementia.

Look at photographs together: You can look at photos from books and newspapers to get a conversation going.

Look at memorable items together: If the person living with dementia has items that are especially precious to them, you can look at them and talk about them.

Read together: If the person is able to read, you can ask them whether they would like to read a favourite book of theirs. You can also read their books to them and share your thoughts about them.

Listen to music together: You can play popular music or music that is special to them from an earlier period in their life, and talk about this music with them, mentioning the names of the musicians and the pieces of music. You can also sing or move to the music together.

Phrasing of sentences

Keep sentences simple, short, and direct.

Avoid lengthy conversations that require complex thinking. Break down tasks with clear, step-by-step instructions.

Use simple words that the person living with dementia can understand.

Ask questions one at a time as multiple questions can be overwhelming.

Ask close-ended questions answerable with a “yes” or “no.”

Ask, “Would you like some coffee?”

Avoid asking, “What would you like to drink?”

When providing the person choices, limit the number of choices to two.

Be patient

Allow the person living with dementia adequate time to respond. Do not interrupt or finish sentences unless they ask for help to complete a sentence.

If they do not respond, repeat yourself in a gentle, calm, and reassuring manner.

Take time to listen to what the person living with dementia feels, thinks, or needs.

Be supportive

Offering comfort and reassurance can encourage them to share their thoughts to you.

Sometimes, the emotions expressed are more important than what they say. Look for the intentions behind words or sounds. Observe their body language.

It is okay if you do not know what to do or say; your presence is the most important indication of support to the person living with dementia.

Treat the person living with dementia with dignity and respect

Avoid talking down or facing away as if they are not there.

Keep eye contact as much as possible and acknowledge your understanding of their expression and words.

Do not exclude them from conversations with others.

Adapted from: Communication Skills with Persons with Dementia by Khoo Teck Puat Hospital and Living with Dementia: A Resource Kit for Caregivers (Providing Care) by Agency for Integrated Care

Communicating with Persons Living with Dementia in End-of-Life Stages

Tips for interaction

⇒ Maintain eye contact as much as possible with the person living with dementia.

⇒ Talk about things of interest to them or reminisce about things from the past, even if you do not think they can follow what you are saying. They may respond to the tone of your voice and feel a level of connection with you even if they may not understand what you are saying.

⇒ Use appropriate physical contact such as holding hands or a hug to reassure them that you are there for them.

⇒ Take your time and look for non-verbal signals.

⇒ Non-verbal communication – gestures, body language, facial expression and touch – can help facilitate communication.

Visiting Relatives and Friends Who Live With Dementia

Understand Dementia
Understanding how dementia develops will allow you to better understand what your loved one is going through. It will help you to understand some of the behaviours or feelings your loved one is experiencing.

Always Introduce Yourself
Greet your loved one by introducing your name and how you are connected to them. Sometimes your loved one may have forgotten, and they may develop anxiety from trying to recall who you are.

Make the Visit Fun!
Make the visit fun by taking something with you: an old photo, a memento from a past trip together, or an item from olden days. Reading from a magazine or newspaper also helps to engage your loved one and gives both of you something to do together. Use music to lift your loved one’s mood. Music can create an atmosphere of relaxation or fun whether it is played from a CD or on an instrument. It can help your loved one recall past memories, or simply to have a good time!

Acknowledge Your Loved One’s Feelings
Have an open mind and be flexible: Your visit may not go according to how you have planned, but that is all right. Have an open mind on how your visit with your loved one goes, adapting to your loved one’s energy levels, mood, etc. Dementia can cause your loved one to experience feelings of anxiety, anger and agitation. Acknowledge how your loved one feels to provide some assurance.

Adapt Your Communication Style
Explore other methods of communication other than talking. Hold your loved one’s hand, give him/her a hug, a shoulder rub or hand massage to complement or replace conversation.

Communicate clearly by asking closed ended questions instead of open ended questions. Listen patiently and allow him/her time to respond. With dementia, your loved one’s ability to express himself/herself may be affected. Try not to finish his or her sentence. Instead, listen patiently as he/she speaks and searches for the right words.

Keep in Touch
Often, it is assumed that with memory loss, interaction with loved ones and friends holds little or no purpose. However, offering your loved one your time and presence helps to sustain their emotional wellbeing! Be comfortable with silence as it is not a bad thing. Savour each other’s presence and your time with each other.

How Not to Interact With Persons Living With Dementia

The following short film contains a skit with examples of how members of the public should not interact with a person living with dementia who appears to be lost in public.

Source: Health Promotion Board

The following video contains negative examples of how members of the public interact with a person who appears to have dementia and is lost when in different settings. It also provides alternative examples of how members of the public can help in the same situations by recognising the ABCDs of Dementia Progression.

Source: Dementia-Friendly Singapore

References

  1. Khoo Teck Puat Hospital. (2010). Communication Skills with Persons with Dementia. Retrieved November 21, 2019.
  2. Health Promotion Board (n.d.). How to Communicate With a Loved One With Dementia. HealthHub.sg. Retrieved May 3, 2021, from https://www.healthhub.sg/live-healthy/994/how-to-communicate-with-a-loved-one-with-dementia
  3. Agency for Integrated Care. (2018). Living with Dementia – A Resource Kit for Caregivers, Providing Care. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/4%20Books/Book%203%20-%20PROVIDING%20CARE.pdf
  4. Agency for Integrated Care. (2018). Living with Dementia – A Resource Kit for Caregivers, Planning Care. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/4%20Books/Book%202%20-%20PLANNING%20CARE.pdf

Tips for Festive Cheer

Festivities are typically a time for joy and celebration across all cultures. However, it might present as a stressful time for both caregivers and persons with dementia due to a disruption in their usual routine. Here are some practical tips on how you can make the time an enjoyable one for all family members.

1. Consider the food

Food is often a highlight in family get-togethers. Ensure that the food being served can also be savoured by your loved one. Try to serve softer food in smaller portion sizes for easier swallowing and digestion.

2. Planning the day

Try to keep to your loved one’s usual routine as much as possible. Schedule in some rest time for your loved one if an entire day of bustle might be overwhelming. Stagger the timings for visiting if you have many relatives coming as it might be overwhelming for your loved one.

3. Preparing for the festivities

What are the usual routines you do with your loved one during the festivities? Try to involve them with simple activities, such as rolling the dough when baking festive goodies, or folding paper decorations. The preparation process can also help to orientate your loved one and get them excited for the upcoming celebrations.

4. Communicate with your relatives

Try to get your relatives to spend some one-on-one time with your loved one with dementia.

5. Prepare some reminiscence materials

Get your relatives involved by putting together a scrapbook with old photos and mementos from the past. This will serve as a conversation starter between your relatives and your loved ones with dementia.

6. Enjoy the festivities too!

Get a relative to help out with your caregiving duties so that you will have some time off for yourself to enjoy the festivities and celebrations too!

It can be difficult to accept a dementia diagnosis, and understanding the reason behind the denial is important to coming up with strategies to help your loved one.

Receiving a dementia diagnosis can be harrowing—it’s normal for the person who has been diagnosed to feel a range of negative emotions, from sadness to frustration, or even outright denial.

Continued denial can pose problems when your loved one refuses to accept help in future, or continues activities like driving even when it has become unsafe for them to do so. The refusal to acknowledge that they are experiencing memory or cognitive difficulties could sometimes be due to fear, or a genuine inability to understand that there is a problem. It is important to identify the reason why your loved one is denying that they have dementia so that you know how to tackle the problem.

Anosognosia

In some cases, your loved one’s struggle to acknowledge their condition does not stem from an active effort to deny the signs, but rather is due to an inability to understand that there is an impairment. Known as anosognosia, changes in the brain mean that the individual truly believes that there is nothing wrong with them. This can be frustrating to deal with as a caregiver, but it is important that you acknowledge that this is not your loved one’s or anyone’s fault, and accept it for what it is.

With anosognosia, no amount of evidence will convince your loved one to accept their diagnosis. Instead, you will need to come up with caregiving strategies working around this. As long as it does not pose a safety issue, it is okay to let them keep helping out around the house.

If you believe that your loved one has anosognosia, it is important to consult a clinical psychologist or a psychiatrist in order to get a proper diagnosis. A medical professional will also be able to better advise you on how to proceed in such situations.

Fear

Denial of a dementia diagnosis often stems from fear—there’s just something about accepting the condition that makes it seem more real.

Right after your loved one has received their diagnosis, give them some time and space to think about it and how they want to approach the situation or proceed. During this time, they may also want to speak to you or other loved ones. However, if they continue to deny their diagnosis, please be patient and continue to support them.

One of the things you can do is to find out more about the dementia support groups or therapies run by Dementia Singapore or other organisations. Attending these sessions with other caregivers or people with dementia and seeing how they are still capable of living meaningful lives and having fun can be helpful in assuaging fears they have, and allow them to come to terms with their diagnosis.

It is also important to stay calm and supportive. Persons with dementia can live full and fulfilling lives with your support. Check out the stories of dementia advocates from Dementia Singapore’s Voices For Hope programme, and other inspiring persons with dementia like Kate Swaffer and George Chong, who are embodiments of the fact that life does not come to and end because of a dementia diagnosis; rather, it is a new adventure.

How Can I Encourage Someone to Seek Help for a Dementia Diagnosis?

Source: Dementia-Friendly Singapore

Undernutrition and weight loss are prevalent issues worldwide amongst persons living with dementia, often worsening as dementia progresses. 20 to 45% of persons living with dementia living in the community (outside institutions such as nursing homes) experience significant weight loss over a one-year period, while up to 50% of those residing in care homes have inadequate food intake.1 Consequences accompanying undernutrition and weight loss problems typically include frailty, poor skin health, increased rates of falls, hospitalisations, and mortality.1

The underlying reasons for undernutrition and weight loss in dementia are complex, multifactorial, and remain unclear. Declining cognitive function, changes in the brain’s central regulation of appetite, behaviour changes, and distractions in the environment may all play a role in reduced appetite, forgetting how to chew and swallow, and/or disrupted eating behaviour.1

Caregivers and care professionals supporting a person living with dementia should look into curbing undernutrition and weight loss issues, which can be avoided. Some examples of interventions include making improvements to the eating environment, tableware and utensils, and providing an adequate variety of food.

References

  1. Maëlenn, G., Martin, P., & Prina, M. (2014, February 11). Nutrition and dementia. Alzheimer’s Disease International. https://www.alzint.org/u/nutrition-and-dementia.pdf

As dementia progresses, a person may lose weight and suffer from undernutrition due to reduced appetite, declining cognitive function and behavioural changes.

Eating a balanced diet and drinking sufficient fluids are important to maintain physical and mental well-being. Any physical illness can make a difference to a person’s ability to cope. It may also make them confused or forgetful.

Healthy Eating

Source: Agency for Integrated Care

Today, there has been no clear and consistent information on dietary factors that may increase or decrease the risk for the onset of dementia. However, adopting a Mediterranean diet may lower the risk of cognitive decline and dementia. This means eating higher proportions of grains, fruits, fish and vegetables.

Eating Well

Eating a well-balanced nutritious diet is important for overall health.

The key to the ideal meal for seniors or persons living with dementia is not necessarily providing a special diet, but providing variety, balance and moderation. As they tend to eat less, they will require more vitamins and minerals to support their diets.

The Ideal Meal

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How Much to Eat?

The Ideal Plate

Drinking Enough Fluid

The fluid requirements for seniors are similar to younger adults’. Seniors, however, tend to drink less than what their bodies need for a number of reasons:

• With age, the body loses its ability to detect thirst.
• Some seniors also suffer from poor memory, immobility, or illness — all of which can result in decreased fluid intake.
• In addition, certain medications can also interfere with feelings of hydration and/or the thirst mechanism.

Dehydration can be a serious health problem in seniors as it can be associated with other illnesses. It is associated with increased risk of falls, urinary tract infections, dental disease, bronchopulmonary disorders (i.e. respiratory disorders), kidney stones, cancer, constipation, and impaired cognitive function.

Prevent dehydration by providing a person living with dementia with adequate fluids throughout the day.

Tips to increase fluid intake:

• Offer water frequently throughout the day and at mealtimes.
• Offer help to those who cannot drink independently.
• Offer barley, milk, soy milk, tea, coffee, juice, juicy fruits and soups for variety.

Downloadable Resources

The following resources contain bite-sized information on Nutrition & Hydration that you may download and/ or print:

Click on the images below to download in English or select another language.

Living Well with Dementia: A Resource Kit for Caregivers (Book 3: Providing Care)

How Can You Improve the Eating Environment?

While it is essential to pay attention to the nutritional aspects of a meal by providing regular, healthy and balanced meals, another important aspect of meals for persons living with dementia is the eating environment. As eating is a social activity, creating a comfortable dining atmosphere can help boost the appetite of a person living with dementia.

Some tips on creating a comfortable eating environment:

• Provide opportunities to eat together with others, but be mindful of group size. Too large a group can get noisy and distracting.
• Reduce unnecessary distractions (e.g. TV, household chores) unrelated to eating.
• Ensure that there is a selection of various foods.
• The colours of the food, plate, and table should be different and contrasting.
• Avoid the use of patterned plates to prevent confusion.

How Can You Improve the Appetite of a Person Living With Dementia?

We are aware of all the good and nutritious foods like walnuts and green leafy vegetables that persons living with dementia need to keep their brain health in the best possible condition. However, what if persons living with dementia refuse to eat? For most people without the condition, eating and having our meals promptly happens most naturally.

Singaporeans are known to live to eat, some going beyond the recommended three square meals a day with ease. For persons living with dementia, mealtimes are not so straightforward.

Due to problems with chewing, swallowing or digesting, eating sometimes becomes a difficult chore. With their diminished sense of taste and smell, food that was once delicious may also lose their allure, leading to some seniors losing interest in eating. Often, the effects of memory loss may also confuse them into thinking they have already eaten, resulting in them eating less. If a person living with dementia is on medication, some prescriptions can also affect appetite and increase the likelihood of constipation, making their eating and digesting process more difficult.

In the process of caring for someone living with dementia, it can get frustrating when getting them to tuck in to a meal. These are some tips that may ease the process:

• Let them choose what they want to eat.
• Provide regular snacks or small meals rather than setting designated mealtimes.
• Make the look and smell of the food appealing and appetising.
• Do not overload the plate with too much food. Small and regular portions work best.
• Use brightly-coloured plates to help make eating interesting and distinguish food better.
• Encourage the person living with dementia to get involved with mealtimes, such as asking them to help in preparing the food or laying the table.
• Maintain eye contact with them during mealtimes, and continuously guide them back their to eating when they pause.
• Invite familiar people to join the meal and provide company. However, minimise conversations during mealtimes, as they may be too over-stimulated or distracted to finish their meal.

Downloadable Resources

The following resource contains bite-sized information on Improving Eating Environment & Appetite that you may download and/ or print:

Click on the images below to download in English.

Information on Dementia, and How It Affects Eating and Drinking

Food for Thought: Live Well, Eat Well, Think Well

Recipe cards were developed in collaboration between the Agency for Integrated Care (AIC) and the dieticians from Khoo Teck Puat Hospital to encourage seniors to adopt a diet that promotes brain health and healthy living.

These recipes have been adapted from diets which have been researched upon, such as the Mediterranean and Okinawan diets. The recipes were further localised by running focus group sessions with seniors to discover their food preferences.

The guiding principles for the recipe cards are to find suitable, local ingredients, and to create healthy recipes that are also tasty and easy to prepare. Every recipe has eight ingredients or fewer, and have at most eight preparatory steps.

Downloadable Resources

The following resources contain bite-sized information on Food Recipes that you may download and/ or print:

Click on the images below to download in English or select another language.

Food for Thought – Eat Well, Live Well, Think Well Recipes (Set 1)

Food for Thought – Eat Well, Live Well, Think Well Recipes (Set 2)

Institutions and organisations around the world have developed booklets and guides to support care partners of persons living with dementia, by addressing matters related to eating, diets and nutrition. Here are some of these booklets and guides:

1. The Alzheimer’s Disease International published a report in 2014 titled Nutrition and Dementia , which investigated how a healthy diet and the right nutrition can improve the lives of persons living with dementia. The publication features:

• Dietary factors across the life course that might increase or decrease the risk of onset of dementia in later life;
• Relationship between dietary nutrients and dementia prevention;
• Recommendations on the actions to take in order to improve the nutrition of persons living with dementia; and
• The need for more research on nutrition and dementia.

2. The Alzheimer Society of Ireland developed a booklet titled Eating Well with Dementia which provides information to support family caregivers in:

• Understanding how dementia can affect a person’s appetite and experience with food;
• Meeting the nutritional needs of a person with dementia;
• Encouraging a person with dementia to enjoy and be involved in meal preparation and mealtimes; and
• Dealing with weight loss, weight gain and other issues that can emerge.

3. The Ministry of Health of Israel has also created a guide titled Eating and Living With Dignity for care professionals and family caregivers of persons with dementia. This guide provides information, tips, and recommendations addressing the following in persons with dementia, such as:

• Difficulties with eating and choosing food;
• Constipation problems;
• Changes in eating and swallowing as dementia progresses; and
• Maintaining health nutrition.

What Are Recreational Activities?

Recreational activities are activities that people participate in for leisure. These are activities that are meant to engage persons living with dementia and are not specifically intended to meet therapeutic outcomes.1

Recreational activities differ from activities done for the purpose of therapeutic outcomes, such as activities done as therapeutic activities or psychosocial interventions. These non-recreational activities aim to meet therapeutic goals, such as the improvement of cognitive or emotional conditions, and tend to be more structured.

Recreational activities, therapeutic activities, and psychosocial interventions complement each other in improving and maintaining the wellbeing of a person living with dementia.

Types of Recreational Activities

There are many kinds of recreational activities. One list of recreational activities by the International Classification of Functioning, Disability and Health (ICF) by the World Health Organisation (WHO)2 is as follows:

Play

Engaging in games with rules or unstructured or unorganized games and spontaneous recreation, such as playing chess or cards or children’s play.

Sports

Engaging in competitive and informally or formally organised games or athletic events, performed alone or in a group, such as bowling, gymnastics or soccer.

Arts & Culture

Engaging in, or appreciating fine arts or cultural events. Examples include going to the theatre, cinema, museum or art gallery, or acting in a play, reading, being read to, dancing, singing or playing a musical instrument for enjoyment.

Crafts

Engaging in handicrafts, such as pottery or knitting.

Hobbies

Engaging in pastimes such as stamp collecting and antique appreciation.

Socialising

Engaging in informal or casual gatherings with others, such as visiting friends or relatives or meeting informally in public places.

Other recreation and leisure

Other recreational activities

There are many other possible ways of categorising recreational activities as well which may not fall into the categories above.

Factors to Consider When Choosing Activities

Factors to consider when choosing activities for persons living with dementia include, amongst other things:

• Individual differences
• Type of dementia
• Age
• Personnel who need to be involved such as family caregivers, therapists, attendants, and the level of skill needed to facilitate these activities
• Mobility
• Past injuries
• Health conditions
• The stage of dementia
• The environment in which activities are conducted
• A schedule for persons with dementia and their caregivers that they find workable.

Personal Preferences
The preferences of the person taking part in the activity must also be considered. Activity facilitators and planners are encouraged to ask the persons taking part in the activity about what activities they would like to take part in from a choice of activities. They can also be asked whether the activity that they are being currently offered is something they would like to participate in.

Variety
Having a variety of activities is also highly encouraged. Having different activities will allow the participants to enjoy themselves and be engaged.

Here is a video by the Agency for Integrated Care about how persons living with dementia can be guided by caregivers and persons around them in daily activities. The video’s tips apply to a wide range of activities, including recreational activities.

Source: Agency for Integrated Care

Benefits of Activities

All persons, including persons living with dementia, have various needs, including psychological needs. Some of these psychological needs include attachment, comfort, identity, inclusion, and occupation. These needs are more likely to be met when these persons participate in recreational activities.3

There is evidence that participating in recreational activities improves the overall well-being of persons living with dementia. Amongst other benefits, evidence suggests that recreational activities promote, depending on the kind of activity4-6:

• Physical activity.
• Social and mental well-being.
• Cognitive function.
• Self-perceived health status.
• Functional ability.
• A sense of meaning through: feelings of pleasure and enjoyment experienced through involvement, a sense of connection and belonging, and a sense of autonomy and personal identity.

Facilitating Activities

If you are a caregiver, care professional, or anyone engaging a person living with dementia, here are some tips from the Agency for Integrated Care on how you can engage persons living with dementia through an activity:

• Choose activities that are similar to what they have always enjoyed.
• Emphasise their strengths. Focus on what the person living with dementia can do and not on what they cannot do.
• Communicate with them verbally and non-verbally. Always allow time for response and minimise options to reduce the likelihood of confusion or distress.
• Make sure the area is comfortable and conducive – provide adequate lighting, allow ample space to move around, and minimise background noise
• Keep an eye for signs of fatigue or being overwhelmed – frequently check if the person needs to rest

Examples of Recreational Activities

Sing A Song | Connecting Caregiver Tips by Forget Us Not

This video shows how a family has karaoke sessions together with Mr Peter Lim, a family member who lives with dementia.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

I Made A Card Game For Seniors | Connecting Caregiver Tips by Forget Us Not

Christel Goh is the creator of Hua Hee, a card game for seniors. She cares for her grandmother who is showing signs of dementia. She believes that games and constant engagement can delay the onset of dementia.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Hinghwa Methodist Church’s Silver Buddies programme

The Hinghwa Methodist Church Singapore runs Silver Buddies, bringing the community (including nearby residents) together to care for their mental, physical and social well-being. This is an example of a community recreational activity initiative. Community groups can conduct similar activities for different groups of people, including persons living with dementia.

Additional Resources

Here are some local and overseas resources and documents on activities and tips for planning activities for persons living with dementia. These resources can be used in different settings, including homes, nursing homes, and centre-based daycare programmes. They can also be used by organisations or groups intending to engage persons living with dementia.

Local Resources

Agency for Integrated Care (AIC)


1
. AIC Wellness Programme

The AIC Wellness Programme engages seniors through the provision of meaningful activities to enhance their wellbeing and quality of life. Many of these activities can also be performed by persons living with dementia.

Visit the AIC Wellness Programme page for more resources on recreational activities.

Dementia Singapore


1. Activities To Keep Your Loved Ones With Dementia Engaged During Covid-19

This article by Dementia Singapore is written for caregivers and those who want to care for persons with dementia during COVID-19 pandemic, which has been characterised by more time being spent at home, changes to social interaction patterns, and multiple other life routine changes.

Find out tips and resources on activities that persons living with dementia can still engage in while under pandemic restrictions.


2. Memories Café

Memories Café is a programme for persons living with dementia and their caregivers, conducted at external partner cafés and restaurants. The programme provides a normalised café setting for participants to interact through activities and conversations in a safe, supportive and conducive environment.

Due to the COVID-19 situation, Memories Café has ceased all physical sessions and has gone virtual. Check out Dementia Singapore’s YouTube to watch the recordings of Memories Café virtual sessions!

Find out how to join Memories Café sessions and for more information on the programme.

Overseas Resources

National Health Service (NHS), U.K.

This webpage details some activities that persons living with dementia can participate in.


Better Health Channel, Australia

This webpage by The Better Health Channel, written for carers of persons living with dementia, describes tips on planning activities for persons living with dementia.


Alzheimer’s Association, U.S.

This webpage by the Alzheimer’s Association in the United States contains a list of 50 activities that family members and friends can do together with persons living with dementia.

References

  1. Cambridge University Press. (2021). Recreation. In Cambridge Dictionary. In https://dictionary.cambridge.org/dictionary/english/recreation
  2. Recreation and Leisure. (2017). In International Classification of Functioning, Disability, and Health (ICF) online browser. https://apps.who.int/classifications/icfbrowser/
  3. Kitwood, T. (1997) Dementia Reconsidered: The Person Comes First. Open University Press, Buckingham.
  4. Innes, A., Page, S. J., & Cutler, C. (2016). Barriers to leisure participation for people with dementia and their carers: An exploratory analysis of carer and people with dementia’s experiences. Dementia15(6), 1643-1665. – https://uhra.herts.ac.uk/bitstream/handle/2299/20100/Innes_Page_and_Cutler_barriers_to_leisure_Accepted_Manuscript.pdf?sequence=2
  5. Fernández-Mayoralas, G., Rojo-Pérez, F., Martínez-Martín, P., Prieto-Flores, M. E., Rodríguez-Blázquez, C., Martín-García, S., Rojo-Abuín, J., & Forjaz, M. J. (2015). Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia. Aging & mental health19(11), 1031-1041. – https://digital.csic.es/bitstream/10261/109537/1/Aging %26 Mental Health_2015_13607863.2014.996734.pdf
  6. Phinney, A., Chaudhury, H., & O’connor, D. L. (2007). Doing as much as I can do: The meaning of activity for people with dementia. Aging and Mental Health11(4), 384-393. – https://www.tandfonline.com/doi/abs/10.1080/13607860601086470
  7. Innes, A., Page, S. J., & Cutler, C. (2016). Barriers to leisure participation for people with dementia and their carers: An exploratory analysis of carer and people with dementia’s experiences. Dementia15(6), 1643-1665. – https://uhra.herts.ac.uk/bitstream/handle/2299/20100/Innes_Page_and_Cutler_barriers_to_leisure_Accepted_Manuscript.pdf?sequence=2

Physical exercise has positive effects on the wellbeing of persons living with dementia, whether the exercise is done for recreation or as therapy. It can be done as the main focus of an activity, or as part of other activities that involve a heightened level of physical movement, such as gardening or dance.

Benefits of Physical Exercises

Physical activity is positively linked to overall health in general. Though research on the link between exercise and the wellbeing of persons living with dementia is still developing, current research has shown that exercise is linked to the improvement of physical functioning in persons living with dementia.1 It also has positive correlations with improvements in cognition, mood, agitation, and functional ability for persons living with dementia in some settings.2

“Aim for 150 minutes of moderate to vigorous every week for a healthier you.”
As recommended by the Health Promotion Board.

Tips For You!

In the two videos below, hear from Andrew Yeo, an exercise therapist who works with elderly living with dementia at the Salvation Army (Peacehaven Nursing Home), about the benefits of keeping our bodies on the move, especially as we get older, and how to make exercising fun and less daunting for the elderly by taking simple walks

Why Exercise?

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Get Moving!

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Considerations When Choosing and Adapting Physical Exercises

As with any other activity that persons living with dementia participate in, it is important to know certain details about the person with dementia when choosing and adapting the activity for them. These details include the person’s preferences, interests, age, history, and stage of dementia. Read more about factors to consider when choosing appropriate activities on Recreational Activities.

Safety

While taking part in physical exercises, it is important for these persons and their care team to be mindful of their risks to a reasonable degree when selecting physical activities to do. For example, since a higher proportion of persons living with dementia are older in age, they may have a higher fall risk. The activity should be modified such that risk is reduced to a reasonable level.

Attention should also be paid to the environment where persons living with dementia do their physical exercises in order to ensure both their safety and the conduciveness of their environment to their experience of the exercise. Find out more from our articles on Dementia-Inclusive Environments.

Follow These Guided Exercises!

Here are some videos on guided exercise routines that care professionals and caregivers can use to guide persons living with dementia.

Videos from Dementia Singapore

These are videos by the New Horizon Centres (NHCs) of Dementia Singapore (formerly known as Alzheimer’s Disease Association) showing simple exercise routines. Persons living with dementia can continue to participate in physical exercises at home by watching and following the following videos!

 

Stay Home Workouts with NHC Bukit Batok

Workout Song – “Rasa Sayang”

Workout Song – “Ai De Ni Ya He Chu Xun”

Workout Song – “Gao Shan Qing”

Workout Song – “Wang Chun Feng”

Stay Home Workouts with NHC Tampines

Group 1

Sitting 1

Sitting 3

Tara Band 1

Stay Home Workouts with NHC Toa Payoh

Group 1

Group 2

Videos from Dementia-Friendly Singapore

These are videos produced by the Dementia-Friendly Singapore movement on exercise routines for persons living with dementia.

Standing Psychomotoric Exercise

Seated Psychomotoric Exercises

References

  1. Pitkälä, K., Savikko, N., Poysti, M., Strandberg, T., Laakkonen, M. (2013). Efficacy of physical exercise intervention on mobility and physical functioning in older people with dementia: A systematic review. Experimental Gerontology, 48(1), 85-93. https://doi.org/10.1016/j.exger.2012.08.008
  2. Brett, L., Traynor, V., Stapley, P. J. (2016). Effects of physical exercise on health and well-being of individuals living with a dementia in nursing homes: a systematic review. Journal of the American Medical Directors Association, 17(2), 104-116.

The progression of dementia comes along with changes in your loved one’s:

• Abilities in Activities of Daily Living (ADLs)
• Behaviours
• Cognitive Function
• Orientation to People, Places and Time

Dementia progression and its corresponding behaviour changes require the appropriate response from caregivers.

With the necessary information and resources at hand, you will be better equipped to respond to these changes while providing care for your loved one.

Dementia Progression

Enable Your Loved One to Perform Their Daily Activities

In the fourth episode of the 6-part series “All About Dementia – Ask the Experts”, Ms Low Mui Lang answers questions related to managing the daily activities for persons living with dementia.

By watching this video, you can learn some helpful tips on how you can enable your loved one living with dementia to perform his/her daily activities, such as supporting him/her to continue what he/she loves to do, or assisting him/her in showering and respecting his/her privacy at the same time.

The following articles offer general tips which may help you to manage the progression of your loved one’s dementia.

Sharing Caregiving Responsibilities: Gathering the Family 
Designing A Daily Routine
Supporting Activities of Daily Living
Helping You Loved One Who Lives Alone
Taking Public Transportation

Behaviour Changes

It is important to understand how dementia may cause your loved one to behave differently, and how to address these changes constructively.

In addition, it is important to note that persons living with dementia present symptoms and behaviour differently. These symptoms and behaviours also differ across different types of dementia, and change as a person progresses through different stages of dementia.

However, there are many common behaviour changes observed in persons living with dementia. The information provided below and in the linked pages include tips on how to address such changes.

Behaviour Changes at Mild and Moderate Stages of Dementia

The articles below include information on some behaviours commonly exhibited in the mild and moderate stages of dementia.

Why Do Behavioural Changes Happen?
Managing Agitation & Aggression
Managing Mealtime Behaviours
Managing Sundowning
Managing Wandering Behaviour
Additional Resources for Other Behaviour Changes

Behavioural Changes in Advanced Stage Dementia

Some common behaviours in the advanced stage of dementia include:

• Losing mobility and ability to perform daily tasks
• Losing ability to communicate
Food refusal
Swallowing problems

Read the following articles about managing some of these behaviours in the advanced stage of dementia:

Swallowing Difficulties & Soft Diets
Managing Constipation
Managing Urinary Incontinence

A family discussion on sharing caregiving responsibilities can be very helpful when your loved one has been diagnosed with dementia. Some families may think it is taboo to discuss concerns revolving around dementia, but it is important for family members to be clear that the family discussion is about honouring your loved one’s preferences and wishes.

Different family members will cope with the diagnosis differently and communicate their thoughts and emotions in their own ways. Sometimes, this might lead to unintentional friction within the family. Some disagreements that may arise from caregiving may be about:

• The type of care given
• Financial responsibilities
• Role of each family member in sharing caregiving responsibilities
• Struggles with managing work, personal responsibilities and caring for loved one
• Emotions that come with the caregiving journey
• Underlying family or relational concerns

It is important that these issues are identified and managed efficiently. Preparing for them can reduce the stresses and strains from caregiving, and in the process, enhance and strengthen family relationships and dynamics.

Set some ground rules to help you and your family members have fruitful discussions on caregiving concerns:

• Keep your loved one’s needs and wants at the centre of the discussion. To have a clearer picture of what their preferences and wishes are, you can consider doing Advance Care Planning (ACP) as early as possible. Read more about ACP.

• Set aside time for regular meetings and discussions regarding your loved one’s care and the various caregiving responsibilities. Care needs can and will change with time.

• Have a roundtable discussion so that everyone will have a turn to speak and raise their concerns.

• Respect each other’s views and needs. Try to see things from all perspectives. Everyone has personal responsibilities that they need to consider – e.g. children, work, spouse, finances, etc.

• Focus on one issue at a time before moving onto the next.

• Consider which method you can use to come to a family consensus – e.g. through majority voting, seeking doctor’s opinion, etc.

• Be open to discuss and possibly adapt your point of view to the priorities at hand.

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Who Should Attend the Meeting?

If you have a big family, there may be instances in which certain members will be unable to attend. In such a case, it is important that family members who are in a position to finalise key decisions are present as much as possible, whether or not certain members are able to attend. This may not necessarily mean the eldest relative or the person paying the bills.

Whether your loved one with dementia should be part of the meeting depends on the following:

1. Is your loved one adequately able to think clearly and express his/ her wishes?

2. Do you think he/ she would be comfortable to be present at the discussion?

3. Can the family have a frank discussion if your loved one is present?

Setting an Agenda

In a meeting that reflects deep feelings and opinions from every individual, putting the situation in perspective helps the family focus on the main issue. This can be done by:

• Explaining the condition so that everyone understands what is happening. If you have been talking to the doctor or healthcare professional all this time, then you may be the best person to explain what you know.

• Laying out the possible healthcare options and costs involved with each choice.

• Making someone in the family the decision-maker on behalf of the person living with dementia.

• If your loved one already has a caregiver, or has a foreign domestic worker providing care, the family must assess if the caregiver has the ability to take care of your loved one’s new and developing needs.

Deciding Who Does What

The best way to choose the decision maker is to ask your loved one to choose a person while he/ she is able to make decisions on their own. If a decision maker has not been appointed, the family will need to nominate a decision maker everyone is comfortable with.

The meeting is also a good time for everyone to figure out the part they can play in sharing caregiving responsibilities. Some of the key roles we suggest include:

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Main caregiver

This should be the person who has been living with and taking care of the person living with dementia the most.

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Finances

Someone in the family may bear care costs, while the rest of the family chips in however they can.

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Transport

Family members who own vehicles may help to ferry the person to and back from appointments; if the family does not have a car or prefers not to use one, a family member could be in charge of arranging for transport for the person living with dementia.

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Support for main caregiver

When the main caregiver needs a break or extra help, or has to leave the country for a period, some family members may volunteer to step in to provide ongoing care.

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Liaison with healthcare professionals

Someone who can communicate and relay important healthcare information, if the main caregiver is unable to.

Should the Family Meeting Be Done In a Healthcare Setting?

Some families may prefer to hold the meeting in a hospital as they prefer to consult healthcare professionals directly when questions arise. Care professionals such as counsellors and medical social workers are also trained to help guide a family towards making decisions that benefit their loved one.

Every family has its own circumstances. You may ask a medical social worker or healthcare professional at your institution of choice to provide more advice on holding the discussion. Outside the healthcare setting, you may also approach a Family Service Centre.

Learn tips on holding a family meeting.

Keep the Family Involved

After the discussion, the family should stay in touch with one another. Social media makes it easy for people to contact one another quickly, and messaging apps like WhatsApp are very useful for families to send timely updates on the loved one’s condition. This can also be a good way for members of the family to show their support for the main caregiver.

Giving the caregiver emotional support can be just as powerful as lending a hand with everyday duties.

Learn tips on holding a family meeting.

Being well-prepared for a doctor’s visit will be beneficial to you and your loved one living with dementia.

Keep a symptom diary for your loved one

A diary helps you keep track of signs and symptoms experienced by your loved one. Record the symptoms or behaviours exhibited – when and how they started and how frequently they happen – and use these records to communicate any concerns you may have when it comes to caring for your loved one. This will also help the doctor in keeping track and administering a more tailored treatment plan.

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Maintain an appointment log of your loved one’s medical appointments

This will help you keep track of your loved one’s medical appointments, especially if they have several doctors. Get the most from a doctor’s visit by having a clear objective or by preparing questions.

Each entry into the appointment log records the discussion such as the treatment options recommended and any other notes from your doctor. This will also be helpful when caregiving arrangements are shared among family members, ensuring continuity of care for your loved one.

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Plan for the actual trip to the doctor

Most public transportation officers are trained to support persons with mobility issues. Private hires like Grab Assist can also help with your loved one’s trip to the doctor. Choose the most comfortable schedule for you and your loved one, keeping the time around your scheduled trip free from appointments to ensure a comfortable travel. They may also experience stress and anxiety from being in an unfamiliar environment, so always prepare for emergencies by bringing:

• A change of clothes
• Toiletries
• Towels
• Mobility aids
• Snacks and water

Persons living with dementia often feel confused and disoriented, especially when their memories begin to blur and their functions start to deteriorate. Your loved one living with dementia may have difficulties in performing his/ her usual tasks as their condition progresses. Designing a daily routine is a good way to provide them with some structure. Planning activities they enjoy can be helpful in reducing agitation and improving their mood.

Household Chores

Mealtimes

Personal Care

Creative Activities

Physical Activities

Mealtimes

Social Activities

Spiritual Activities

Before designing a daily routine, considering the following about your loved one will help in customising a routine for them:

• Their likes, dislikes, strengths, abilities and interests
• How they used to plan their days
• Times of the day when they feel more alert
• Having ample time for meals, bathing, and dressing
• Ensuring that they maintain a good sleep cycle by waking them up and letting them go to bed at regular timings

Daily Routine Example Suitable for Early- to Moderate-Stage Dementia

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Setting A Routine Keeps Things on Track

Anita’s mother lived with dementia and anxieties. Anita’s journey with her mother showed her how comforting certainty can be, and how a structured routine can also be beneficial for the caregivers around her.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

As the condition of persons living with dementia progresses, their abilities to perform Activities of Daily Living (ADLs) deteriorate as well. ADLs refer to routine activities which most persons have learned to perform from young and usually do on a daily basis without any assistance.1 However, due to dementia, individuals gradually become unable to perform these daily routines.2

The six ADLs include:

1. Personal Hygiene (Bathing/Showering, Oral Hygiene, etc.)
2. Dressing
3. Toileting
4. Mobility
5. Transferring
6. Eating and Drinking

As a caregiver, you play an important role in supporting your loved one living with dementia. Instead of completely doing ADLs for your loved one, you can provide proper assistance by making these activities easier for them to perform, or finding ways for them to do these activities by themselves via other methods. This helps to prolong their independence, empowering them to do whatever they can for as long as possible.

Listen to the sharing of May Chng, a nurse educator, on her belief in providing care that empowers her mother, Leow Yan Cheng. Despite her mother’s dementia diagnosis, May lets her mother perform the simple daily tasks, instead of taking over them. She even continues to involve her mother in cooking by getting her help with the smaller tasks. Speaking from both her professional and personal experience, May shares with us how complimenting her mother and others living with dementia is vital, and improves their sense of worth.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Cutlery Hacks

Watch how caregivers, Daniel and Danny, modified cutleries like cups, spoons and chopsticks, to enable their parent living with dementia to eat and drink independently!

Enabling Dad to Eat on His Own | Daniel Lim

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

My Dementia Cup Hack | Danny Raven Tan

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

The ABCs of Caregiving Course

This course covers the essential skills needed to care for your loved one’s daily needs based on his/her mobility condition (conditions include: ambulant [can walk], wheelchair-enabled, or bed-bound). Some of these essential skills are:

• Monitoring of vital signs (temperature, blood pressure, pulse rate) and managing emergencies
• Infection control (including hand hygiene and simple wound care) and basic skincare
• Serving oral medication (including reading of medication labels)
• Nutrition and Hydration

In addition to these more basic skills, you will learn how to support your loved one in their daily activities as well, mainly on:

• Assistance with eating
• Toileting
• Personal hygiene
• Mobility

If your loved one needs more specialised care, you can “top-up” your training course with additional electives, which include:

• Bed bath
• Transferring, Positioning and Mobility (Wheelchair)
• Care of Urinary Catheter
• Stoma Care

This course is suitable for you, who are looking after a loved one living with dementia everyday, and your foreign domestic helper (if you have hired one at home).

Find out more and sign up for the ABCs of Caregiving Course.

You may also download this brochure which contains bite-sized information about the ABCs of Caregiving Course.

Downloadable Resources

The following resources contain bite-sized information on Supporting Your Loved One’s ADLs that you may download and/ or print:

Click on the images below to download in English or select another language.

Activities of Daily Living by AIC
.

Body Mechanics: Positioning, Moving and Transfers by AIC

Assisting People with Dementia with their Personal Care: Ideas and Tips for Carers by Dr. Tamara Backhouse et. al, with University of East Anglia and Alzheimer’s Society, UK

References

  1. Grey, H. (n.d.). A complete guide to activities of daily living (ADL) in Singapore. https://www.homage.sg/resources/activities-of-daily-living-adl/
  2. Changi General Hospital. (2019, April 12). Dementia and activities of daily living (ADL). https://www.healthhub.sg/a-z/diseases-and-conditions/518/managing-activities-of-daily-livings-CGH

Persons living with dementia, especially in the earlier stages of dementia, may choose to live alone to maintain their independence for as long as possible, or to remain in a familiar neighbourhood. As the dementia progresses to moderate and advanced stages, it is likely that alternate living arrangements have to be made.

Here are some tips for you, as a caregiver, on how you can offer care to your loved one with dementia who lives alone.

  • Make your loved one’s self-care easier

     

    Your loved one may forget to shower, change their clothes and have their meals. They may also forget to perform housekeeping duties, or to feed pets, amongst other tasks.

    ●        Arrange for meal delivery services and housekeeping services.

    ●        Write reminders and stick them on places they will look at (fridge, bedroom, living room, etc.). For example, you could write notes that read “Feed the pets”, “Remember to turn off the stove”, “Sweep the floor”, etc.

    ●        Large and easy-to-read clocks and calendars will help your loved one to orient themselves to the time and date.

  • Improve safety in your loved one’s home

     

    Your loved one may lack judgment in dangerous situations such as those involving hazardous electrical appliances and slippery floors.

    ●        Install non-slip mats and grab bars in the bathroom.

    ●        Remove hazards from the house such as faulty kitchen appliances, clutter, fire hazards and broken furniture.

    ●        Use technology in the form of monitoring systems to help track your loved one’s mobility in the house.

  • Involve others in your loved one’s care

     

    A person living with dementia may exhibit behaviour that is hard to understand or accept. This may lead to unfriendliness or trouble with the neighbours, the police, and the community.

    ●        Involve other family members in caregiving and take turns to visit your loved one regularly. If regular visiting is not possible, communicate regularly with your loved one via phone call or text.

    ●        Explain your loved one’s situation to neighbours and local shopkeepers so that they can help keep an eye out for your loved one in the community.

Downloadable Resources

The following resources contain bite-sized information on some tips to Help Your Loved One Who Lives Alone that you may download and/ or print:

Click on the images below to download in English or select another language.

Living Well with Dementia: A Resource Kit for Caregivers (Book 2: Planning Care)

Public transportation is a common mode of transport for people in Singapore. This does not change even with the onset of dementia. Having an easily accessible transportation system enables persons living with dementia to stay connected to their friends, families, and community. It also provides access to healthcare service locations, such as the hospital.

Challenges Faced by Persons Living With Dementia

Dementia can make it challenging for people to access transport. Some reasons are:

• An inability to remember transport routes
• Disorientation to time and place
• Misplacing items whilst travelling (for e.g., ezlink card, bag)
• Decreased judgement and difficulty planning and organising transport
• Difficulty in communicating to transport operators where they want to go
• Changes in mood or behaviour whilst using public transport

A person living with dementia should be aided by a caregiver as they may not feel comfortable travelling alone. Not allowing a person living with dementia to go out may make them socially isolated and put them at risk of feeling depressed.

Tips for Travelling on Public Transport With Your Loved One

1. Plan the route before you make the journey

2. Allow enough time for travel

3. Take note of any situations that may make your loved one with dementia feel uncomfortable

4. Bring along a friend or relative for extra support if needed

Initiatives by Local Transport Providers

GrabAssist

Grab has launched its GrabAssist and GrabAssist Plus services, where drivers are trained in helping out passengers with different accessibility needs. On top of wheelchair transfer and handling of mobility devices, these drivers know the basic signs and symptoms of dementia and basic communication skills.

Go-To SMRT

Source: SMRT

In April 2021, the transport operator SMRT launched its Go-To SMRT initiative which will be rolled out throughout its network over two years. This initiative aims to make the SMRT network’s premises places that provide assistance in wayfinding, first aid, locating missing children or the elderly, and other forms of assistance.

As part of this initiative, 17 MRT stations and 5 bus interchanges have been designated as Dementia Go-To Points (GTPs), which serve as ‘safe return’ places where the public can bring persons living with dementia who are lost to. GTPs also serve as places where people can access information and resources about dementia, and link people to dementia-related services.

First aid rooms and WeCare rooms at SMRT stations and interchanges have also been refreshed. WeCare rooms are places where commuters in distress can rest and calm down.

Front-line SMRT staff have also been trained to handle situations involving persons from certain groups, including seniors, those with disabilities, and persons living with dementia.

References

  1. (2021, April 26). SMRT Media Release – SMRT demonstrates firm commitment to serve community through Go-To SMRT initiative. SMRT. https://www.smrt.com.sg/Announcements/articleid/1321.
  2. Yong, C. (2021, April 26). Smrt Mrt stations and bus interchanges to be turned into care centres. The Straits Times. https://www.straitstimes.com/singapore/smrt-to-train-staff-so-mrt-stations-and-bus-interchanges-can-be-first-place-of-call-for.

Dementia is accompanied by behavioural changes, which affect your loved one living with dementia and all of you around him/her. Behavioural changes can be one of the aspects of dementia that are most difficult to address. Persons living with dementia who experience behavioural changes are often described as having a “completely different personality” from their “old self”. Different behaviour changes occur at different points in mild and moderate stages of dementia, and vary between people and across different types of dementia.

These are some common behaviours exhibited by persons in the mild, moderate, and advanced stages of dementia that vary from person to person:

  • Mild Dementia

    ⇒ Forgetting things
    ⇒ Occasionally repeating themselves
    ⇒ Isolating themselves from others
    ⇒ Feeling tired all the time
    ⇒ Being easily irritated

  • Moderate Dementia

    ⇒ Getting lost in familiar places
    ⇒ Repeating things said
    ⇒ Problems with communication
    ⇒ Neglecting personal hygiene and self-care
    ⇒ Losing track of time & events
    ⇒ Misplacing items more frequently
    ⇒ Behavioural disturbances
    ⇒ Forgetting the names of common objects and familiar people
    ⇒ Forgetting important events, e.g. birthdays of their children
    ⇒ Being confused about timings and places
    ⇒ Poor or decreased judgement
    ⇒ Problems with abstract thinking
    ⇒ Swallowing problems

  • Advanced Dementia

    ⇒ Losing mobility and ability to perform daily tasks
    ⇒ Losing ability to communicate
    ⇒ Food refusal
    ⇒ Swallowing problems

Sometimes, behavioural changes during mild and moderate stages of dementia can cause concern. Some examples of behaviours of concern that are commonly seen include:

Aggression
Agitation
Being easily upset
Being easily irritable
Being prone to argue
Inappropriate screaming, crying, disruptive sounds
Refusal to shower, bathe or be groomed
Running away from home
Anxiety or excessive worry
Apathy or indifference
Delusions and/or hallucinations
Depression

Disinhibition
Sexually inappropriate behaviour
Socially inappropriate behaviour
Hoarding
Irregular Night-time Activity
Getting up at night
Repetitive Behaviours
Resistance to Activities of Daily Living (ADLs)
Sundowning
Wandering behaviours

Personal Stories

What My Grandmother Was Trying To Say

In this video, Dr. Chen Shiling, who cared for her late grandmother living with dementia, tells us how she has learnt to understand what her grandmother was trying to communicate through many trying episodes and her grandmother’s behavioural changes, which included her making wrongful accusations, wandering behaviour, and depression.

Dr. Chen Shiling is a Resident Physician at Khoo Teck Puat hospital. She was raised by her grandmother who had dementia.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Where Is My Money?

Episodes involving accusations, arguments, and tension are trying and stressful for family members. Unfortunately, these situations are common in households with persons living with dementia. In this video, Lily tells us her secret to always being able to ‘find’ missing money that has been misplaced by her mother-in-law.

Lily Phang is a caregiver and co-founder of Homage, a caregiving service. She helps her family to cope with the symptoms and behavioural changes that her mother-in-law, Tan Mui Hua faces.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Causes of Behaviour Changes

Every individual has needs that need to be met. However, as dementia affects the brain which controls all mental functions and voluntary behaviours including thoughts, emotions, and speech, the progression of dementia may cause your loved one to be increasingly less able to recognise their needs, know how to meet them, or communicate them. In addition to this, behaviour changes also occur due to changes in the brain. The type of behaviour change exhibited depends on the areas of the brain affected by the condition causing the person’s dementia as well.

It is also crucial to understand these behaviours from the perspective of your loved one living with dementia. They may present with these behaviours as a result of their needs not being met, their attempt to meet a need, or an attempt to communicate to individuals around them.

Unmet needs underlying behaviour changes can be generally categorised into the following four factors:

1. Physical Needs: Your loved one living with dementia may be experiencing pain or discomfort, and may be suffering from other illnesses at the same time.

2. Psychological/Cognitive Needs: Your loved one may be depressed or may have other mental health issues. They could also be feeling confused or threatened in an environment that does not seem right or familiar.

3. Social Needs: Your loved one may be feeling lonely, isolated, or bored.

4. Environmental/External Needs: Your loved one may be in an overstimulating environment (e.g., with loud noises or busy environment), or experiencing a different and unfamiliar routine.

Management of Behaviour Changes

When managing your loved one’s behaviours, it is important for you, as a caregiver, to ascertain some factors that may cause certain behaviours to happen. For example:

• What triggers the behaviour: Consider commonly unmet needs, such as constipation, pain, and toileting needs, or environmental triggers such as sounds, smells, and temperature.

• Whether the behaviour is causing distress to the person: If so, prompt treatment may be necessary.

• Whether the safety of the person is compromised: If so, some modifications to the home setting may need to be made to ensure that the environment is safe.

For every behaviour change, it is always good to share the above information you have collected and consult the doctor (geriatrician or psycho-geriatrician) who is seeing your loved one with dementia to rule out any physical health problems (for example, infections, medication side effects) that may be causing it. After ruling these problems out, non-pharmacological approaches should be first attempted to meet your loved one’s unmet needs and minimise or prevent their behaviour changes, before considering pharmacological management.

It is often the daily, non-pharmacological methods and techniques that turn out to be effective in the long-term. Non-pharmacological measures such as psychosocial interventions (e.g., music therapy, art therapy) are usually the first-line approach before medication treatment is considered. Below are some examples of simple, non-pharmacological techniques to consider as well:

1. Revise your approach. The task on hand may be too difficult that it needs to be simplified, or your loved one living with dementia may need some help with it. Help them to focus on their abilities, rather than on their inabilities.

2. Validate your loved one feels. Acknowledge your loved one’s feelings and experience, and patiently communicate this acknowledgement to them by your words and actions. Do not confront or argue – it is not necessary to always correct the person when they are in the wrong.

3. Direct their attention elsewhere. Identify the cause behind the behaviour and address it through engaging your loved one in meaningful activities.

Sometimes, a combination of both non-pharmacological and pharmacological managements may offer better outcomes too. Read further about the Pharmacological Management of dementia and behaviour changes.

Some Tips to Manage Behaviour Changes

In the fifth episode of a 6-part series “All About Dementia – Ask the Experts”, Dr Ng Wai Chong explains why persons living with dementia have changes in their behaviours. He also answers questions related to strategies in managing these behaviour changes, such as wandering behaviour, repetitive behaviour, refusal to take medications, and refusal to eat.

Source: Agency for Integrated Care

The Alzheimer’s Society from the United Kingdom provides general tips to family caregivers on ways to support persons living with dementia to meet their needs and reduce their behaviour changes using a non-pharmacological approach. It also lists a five-step strategy to manage behaviour changes. Read further about Alzheimer’s Society’s tips and strategies.

Finally, it is not easy managing the behaviour change(s) your loved one living with dementia is exhibiting. It is thus equally important that you take good care of yourself by seeking support from family, friends, counsellors or support groups, in order to better cope with your caregiving journey. Learn more about tips and resources on how to look after yourself.

At some point, your loved one living with dementia may behave aggressively, display an outburst of emotions, or act angrily towards individuals around them.

Defining Agitation & Aggression

Agitation

A set of behaviours that involve a person living with dementia experiencing verbal or motor anxiety.1

Aggression

A further level of agitation in which the behaviours can be expressed through verbal abuse, threats, damaging property, physical violence towards another person or over-reacting to minor setback or criticism.1

Possible Causes of Agitation & Aggression

Sometimes, your loved one may display agitation or behave aggressively as a result of an unmet need, which is causing them discomfort. Managing their agitation and aggressive behaviour is not easy. However, it is always useful to identify the cause/unmet need that triggers the agitation and/or aggressive behaviour, and find effective ways to manage them.1

The table below lists down some possible unmet needs that your loved one may be experiencing:

Biological

Progression of dementia causing loss of control over behaviours

Physical discomfort, such as pain, fever, illness, or constipation

Adverse reaction to medications

Fatigue/ sleep deprivation

Misunderstandings due to poor eyesight/ hearing

Hallucinations and delusions

Social

Lack of social contact and loneliness

Boredom, inactivity and sensory absence

Changing of established routine

Psychological

Frustrations at not being able to complete tasks

Possibility of depression

Perception that personal space is invaded

Perception that independence and freedom are threatened

Feeling ignored

Fear of surroundings or people as he/she can no longer recognise them

Some Ways to Manage Agitation & Aggression

Communication and Interaction Style

• Try to stay calm and take a deep breath. Avoid potential confrontations. Any expression of fear, alarm, anxiety or anger may make the situation worse.

• Be patient and listen to what they are saying.

• Approach your loved one slowly, maintain eye contact and try to encourage communication.

• Validate your loved one’s feelings – reassure them and acknowledge how they are feeling.

• If your loved one gets agitated/aggressive when you are caring for him/her, explain your actions in short, simple sentences such as “I am going to help you remove your shirt” or “We are here to help you”.

• Ask yourself if what you are doing for your loved one really needs to be done at that moment.

• Give them some time and space, and return in a while to try again gently.

• If your loved one living with dementia gets physically abusive

• Make some space between you and the person (at least one arm-length) to prevent yourself from getting physically injured.

• Do not try to restrain or restrict the outburst of anger unless they are causing harm to themselves or others.

• Call for help if needed.

• Ensure the environment is safe by keeping away dangerous items, such as scissors, knives, or any sharp objects.

• Identify and be aware of signs or behaviour indicating agitation or aggression. Redirect your loved one’s attention to focus elsewhere early with appropriate activities, before their outburst.

• Ensure your loved one’s basic needs are met, such as hunger, thirst, and sufficient sleep.

• Try to maintain consistency in your loved one’s daily routines, environment and carers.

• Ensure your loved one’s medical conditions and medications are reviewed regularly by the doctor.

Adapted from: Changi General Hospital

Galen's Mother: A Journey Into Dementia Documented Over The Years

Galen Yeo documents the drastic changes in his mother over the years, since she was diagnosed with dementia.

She was the sociable hostess whom friends loved to be around. And then one day, she started losing her memories. Frustrated at losing who she was, she’d have moments of violent temper. Being around her became a draining ordeal. These are the challenges of #facingdementia.

Source: CNA Insider

References

  1. Changi General Hospital. (2020, October 5). Managing agitation and aggression in dementia. https://www.healthhub.sg/live-healthy/843/managing-agitaton-and-aggression-in-dementia

Persons living with dementia may sometimes refuse to eat. They may become angry, agitated, or challenging to feed during mealtimes. This can happen for a variety of reasons:

• Disliking the food
• Feeling rushed
• Feeling uncomfortable with people or the environment
• Feeling frustrated with the difficulties they are having

It can be challenging to identify what the actual problem is, particularly if they have difficulties communicating. It is important to remember that these reactions are not deliberate.

Try not to rush your loved one or pressure them to eat and drink quickly. Instead, look for non-verbal cues such as body language and eye contact as a means of communication. Wait until they are calm and less anxious before proceeding with the meal.

What You May Observe & Suggested Strategies to Prevent This
Refusing feeding attempts/ spitting out food

• Check their mouths for ulcers or poor dental health as these can be painful
• Encourage independence when eating or drinking; gently place your hand over theirs to guide the cutlery to their mouth if they are unable to self-feed
• Offer familiar or favourite food and drinks
• Make the food look and smell appealing — prepare food with different tastes, colours and aromas
• Use familiar utensils
• Ensure that the temperature of the food served is appropriate

Eating very quickly

• Supervise the meal and use verbal and non-verbal prompts, e.g. prompt them to chew before swallowing
• Gently place your hand over theirs to control their feeding rate
• Cut up their food into smaller pieces to reduce the risk of choking

Distracted during mealtimes/ not attentive to eating

• Have a minimalistic table set-up
• Ensure that there are minimal distractions, e.g. quiet and calm environment, or fewer people
• Play calm and soothing music in the background during mealtimes
• Ensure appropriate and adequate lighting

What Is Sundowning?

Your loved one living with dementia may display behaviour changes particularly in the evening which include agitation, aggression, confusion and restlessness. This is known as sundowning and often occurs in the moderate to severe stages of dementia.

There is now a Night Respite service available for caregivers of persons living with dementia who have sundowning behaviour. Learn More.

Possible Causes of Sundowning

• Changes in the physical brain may affect the sleep cycle and cause wakefulness in the evening and at night.
• Your loved one may have previously been occupied and busy at a particular time of the day.
• Little or disturbed sleep that may cause restlessness or napping during the day time.
• Side effects of medication that can cause confusion, agitation or wear off during the evening time.
• Environments that cause discomfort may precipitate sundowning, for e.g., shadows that occur around evening time.

Some Ways to Manage Sundowning

Sundowning may cause some distress to caregivers. Here are some tips which may be helpful in reducing sundowning symptoms in your loved one.

1. Implement a daily schedule.
2. Occupy your loved one with a familiar activity that will bring them comfort, such as listening to their favourite music and looking at old photographs.
3. Reduce sources of discomfort from the environment such as loud noises and bright lights.

Content adapted from Alzheimer’s Society.

How Exercise Helped My Wife with Sleep

John Chin explains to us how evening walks have helped to prevent sundowning in his wife by keeping her engaged.

John Chin used to live in Miami with his wife Kwan. With the help of Kwan’s family, he now shuttles between the US and Singapore to take care of his wife who now lives here.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Downloadable Resources

The following resources contain bite-sized information on Managing Sundowning that you may download and/ or print:

Click on the images below to download in English or select another language.

Is Your Loved One Experiencing Sundowning?

Many persons living with dementia feel the urge to walk about and in some cases leave their homes. Though it is sometimes termed as “wandering”, it is rarely ever aimless. Persons living with dementia may simply not remember where they had set out to go, or what they had intended to do.

It is all right for persons living with dementia to walk around in a secure environment (for e.g., in their own homes or at day care centres), with supervision from others. However, wandering becomes a cause of concern when persons living with dementia meet with dangerous situations while wandering outside, about the neighbourhood alone. For example, they often experience problems with orientation, which causes difficulties in finding their way back home (getting lost). When the person living with dementia is away from home for an unusually long time, or when the caregiver is unable to locate him/her, then wandering becomes a problem.

Moreover, there is a significant number of older persons living with dementia, whose primary caregivers are seniors (for e.g., their spouse) as well. These seniors are more prone to falling and more susceptible to sustain fall-related injuries.

Possible Causes of Wandering Behaviours

Wandering behaviour can be caused by various factors including the following:

Boredom

Someone who is lacking in mental and physical stimulation may go out walking because they are simply looking for something to do.

Restlessness or a need to burn up energy

If your loved one used to have an active life and is suddenly stuck at home, they may simply have the urge to get out and about.

Memory problems and confusion

Your loved one may set off to a place and forget where he/she is going or why. Sometimes your loved one may tend to wander and forget how he/she got into that room in the first place. This can happen a lot more often in persons living with dementia. Your loved one may be trying to ‘retrace’ their steps. Likewise, if they do not remember an area, they may wander off until they find something familiar.

Confusing night with day

​Your loved one may suffer from sleep problems, or wake in the early hours and become disoriented. He/she may think it is daytime and decide to go for a walk.

Looking for familiar persons / items / places

Your loved one may wander off in search of someone, something, or a place relating to their past when he/she becomes confused.​​ Wandering may occur because they suddenly decide they need to find an old friend they have not seen for a long time. They could also be wondering where they parked their car, even if they have not driven for quite some time. Confusion about time and place is one of the symptoms of dementia.

Continuing with a habit or routine. 

If your loved one had a very specific routine or habit that they used to follow, they may want to carry on with it. Your loved one who is used to walking long distances may simply wish to continue doing so. They may also head out to attempt to go shopping or back to their old workplaces if this was something they used to do in the past.

An attempt to get away from something

If the situation or place they are currently in is stressful or unpleasant in any way, they may simply walk off to get away. Likewise, if the environment is noisy, they may walk off to find somewhere more quiet and peaceful.

Change of environment​

​Your loved one may feel uncertain and/or disoriented in a new environment such as a new home environment or daycare centre.

Physical discomfort or pain​

Your loved one may walk to ease discomfort that is caused by uncomfortable clothes, excessive heat or the need to go to the toilet.

Night Wandering

Always be aware that wandering can happen at any time, including the middle of the night. If a person who lives with dementia gets easily confused with what time of the day it is, you may find them wandering at 2 a.m. because they think they have to be somewhere and do not understand that they are supposed to be asleep.

Some Ways to Manage Wandering Behaviours

The tendency to wander is common amongst persons living with dementia. Depending on your loved one’s personality, how well they can cope, their reason(s) for wandering and the safety of the surrounding environment, you may use the following strategies to manage your loved one’s wandering behaviour:

Carry out daily activities

Having a routine can provide structure. Try to create a daily routine for your loved one with dementia.

Install locks out of the line of sight

Install either high or low exterior doors and consider placing slide bolts at the top or bottom.

Identify the most likely times of day or situations that wandering may occur

Identify your loved one’s wandering behaviour patterns by keeping records or a diary. Plan activities at that time. Activities and exercise can reduce anxiety, agitation and restlessness.

Use devices that signal when a door or window is opened

Use devices that signal when doors or windows are opened. For example, doors can be placed over bells, and electronic home alarms can be used.

Reassure the person if they feel lost, abandoned or disoriented

If your loved one wants to leave to “go home” or “go to work”, use communication focused on exploration and validation, and refrain from correcting them.

Provide supervision

Do not leave someone living with dementia unsupervised in new or changed surroundings. Never lock them at home or leave them in a car alone.

Keep car keys out of sight

If the person is no longer driving, remove access to car keys — a person living with dementia may try to drive. If the person is still able to drive, consider using a GPS device to guide them if they get lost.

Redirect attention elsewhere with activities

​Engage your loved one through a simple and quiet activity that is familiar to them from their earlier days.

Ensure all basic needs are met, and that your loved one is not experiencing any illness, pain or discomfort

Has your loved one gone to the bathroom? Is he or she thirsty or hungry? Go for his/her regular physical check-ups, which help to identify the presence of any illness, pain or discomfort.

Avoid busy places that are confusing and can cause disorientation

Shopping malls, grocery stores or other busy venues.

Remove objects that may encourage wandering

​Objects that may prompt wandering, such as handbags or keys, can be removed from sight.

Remove any obstacles to allow your loved one to wander about safely – ensure supervision is available and he/she has steady gait at all times.

Carry identification

Have your loved one carry ​identification such as the CARA Membership Card (which replaces the Safe Return Card). This can be helpful when he/she is found by others or the police. Find out more about the CARA Membership Programme.

Hear what care specialist Lily Teh from Homage has to say about helping the community and persons living with dementia find their way home:

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

When Your Loved One Goes Missing, You Should:

1. Remain calm.
2. Make a thorough search of the house and familiar places.
3. Try to remember what he/she was wearing.
4. Walk or drive around the vicinity and/or to any places he/she may visit regularly. Have someone stay at home in case he/she returns home, or to answer any phone calls.
5. Contact the police if immediate searches yield no result. Tell them the person has dementia and any concerns you have for their safety.​

Use the Dementia Friends App to request for help using the “Finding My Loved One” function.

When your loved one returns home:

1. ​​Notify the police immediately.
2. Do not scold them or show anxiety as this may confuse or frighten them.
3. Provide reassurance and get back into their regular routines as quickly as possible.

William’s Story

At first, William’s dementia symptoms included forgetfulness and confusion, but then the wandering and getting lost began. William’s dementia makes him sneak out to go wandering in the middle of the night. He even found a way out after the family padlocked the gate.

Watch how Bethany (William’s granddaughter) and her mother, Geraldine (William’s daughter and main caregiver), did what they could, but finally realized they need help:

Source: CNA Insider

Downloadable Resources

The following resources contain bite-sized information on  Managing Wandering Behaviour that you may download and/ or print:

Click on the images below to download in English or select another language.

Caregiver’s Guide: Supporting Persons With Dementia Who Wander

References

  1. Changi General Hospital. (2020, October 5). Managing agitation and aggression in dementia. HealthHub. https://www.healthhub.sg/live-healthy/843/managing-agitaton-and-aggression-in-dementia

1. Talking Point | CNA Insider

Looking after a loved one living with dementia can be frustrating. In this episode of Talking Point, it provides you with some tips on what to do when you face the following 3 scenarios – when your loved one living with dementia:

1. Refuses to bathe
2. Forgets that he/ she has eaten and keeps demanding for food
3. Accuses you or others of stealing

Source: CNA Insider

2. UCLA Alzheimer’s and Dementia Care Video series

The Multicampus Programs in Geriatric Medicine and Gerontology (MPGMG) at the David Geffen School of Medicine at UCLA created a series of videos on understanding and managing behaviours associated with dementia.

Every video scenario shows:

• The common response that family caregivers give in order to manage the behaviour change exhibited by their loved ones living with dementia;

• An expert’s explanation about the behaviour change, with tips to identify and minimise the triggers and suggestions for redirection; and

•  The recommended response (incorporating the tips) that family caregivers can show instead to better manage the behaviour change.

This site also provides a Take Action worksheet that allows caregivers and care professionals to record what they can do to minimise the triggers of the behaviour changes.

Watch the UCLA Alzheimer’s and Dementia Care Video series now.

3. Fact Sheets Developed by Overseas Dementia Associations

There are other behaviour changes that a person living with dementia may exhibit. For each of the following list of behaviour changes, there are overseas resources which:

• Define each behaviour change;
• Detail their possible causes and underlying unmet needs; and
• Suggest some plausible strategies to manage them at the time and when the behaviours have passed (to prevent the behaviours in future).

Please note that this is not an exhaustive list of resources. Click on the logos to access the fact sheets and websites for further reading.

Anxious Behaviours

alzheimers association
alzheimers Socitey
dementia Australia
UCLA Health
alzheimerswa

Refer to Pg. 8

DCRC

Refer to Pg. 94-105

Apathy

alzheimers Socitey
alzheimerswa

Refer to Pg. 6

DCRC

Refer to Pg. 106-117

UCLA Health

Depression

alzheimers association
alzheimers Socitey
dementia Australia
UCLA Health
dementiauk
alzheimerswa

Refer to Pg. 7

DCRC

Refer to Pg. 118-129

Disinhibited Behaviours

alzheimers Socitey
dementia Australia
UCLA Health
Verywell Health
alzheimerswa

Refer to Pg. 8

DCRC

Refer to Pg. 130-141

Hallucinations & Delusions

dementiauk
BENDIGO HEALTH
Verywell Health
dementia Australia