Member of a comm/ corp 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 (Book 1: 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.

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).

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.

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 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

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

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

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)

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.

Dementia is accompanied by behavioural changes, which affect persons living with dementia and individuals around them. 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

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.

Source: Agency for Integrated Care

Causes of Behavioural 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 people 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 the person 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: The person living with dementia may be experiencing pain or discomfort, and may be suffering from other illnesses at the same time.

2. Psychological/Cognitive Needs: The person 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: The person may be feeling lonely, isolated, or bored.

4. Environmental/External Needs: The person may be in an overstimulating environment (e.g., with loud noises or busy environment), or experiencing a different and unfamiliar routine.

Management of Behavioural Changes

It is often the daily, non-pharmacological methods and techniques that turn out to be effective in delaying the development of the person’s dementia in the long-term. Thus, non-pharmacological measures such as psychosocial interventions (e.g., music therapy, cognitive stimulation therapy)  are usually the first-line approach before medication treatment is considered. Sometimes, a combination of both non-pharmacological and pharmacological managements may offer better outcomes too.

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

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

Caring for a person living with dementia involves many things. These include the use of both medications and psychosocial interventions (such as engagement and environmental changes to suit the person). Care plans should integrate both these kinds of treatments when addressing the factors that affect the condition of a person living with dementia. These include biological, psychological, and social factors.

Though non-drug measures are usually the first-line approach to address the symptoms of dementia, medications are still important in the treatment of dementia.

Presently, there is no cure for dementia. Although slight improvements or stabilisation of symptoms can at times be seen, these ultimately do not cure or prevent the disease or restore mental health. There are, however, drugs that may help improve mental function, mood or behaviour and slow down the symptomatic progression of the disease.

It is important to note that not every medication or combination of medications works for everyone. Each person responds differently to different types of medications. Doctors and pharmacists may need to adjust the course of medication based on the response of the person living with dementia and the feedback of caregivers.

Common Medications Prescribed for Dementia

The following are some medications used to relieve some symptoms of dementia:

Acetylcholinesterase Inhibitors

1. Helps maintain mental function
2. Donepezil (Aricept), Rivastigmine (Exelon*) and Galantamine (Reminyl)
3. Used primarily to treat mild to moderate stages of the disease although there is also evidence of effectiveness in advanced dementia
4. * Exelon is available in a patch form to be stuck onto the skin

N-methyl D-aspartate (NMDA) antagonists (which prevent cell damage from glutamate), such as Memantine

1. Alternative if patients cannot tolerate Acetylcholinesterase inhibitors
2. Can be used on its own or in combination with Acetylcholinesterase inhibitors

Antipsychotics, Antidepressants, Mood Stabilisers and Sedatives

1. Used to treat various challenging and disruptive symptoms such as anxiety, depression, aggression, agitation and sleep problems as a result of dementia

Side Effects

All medications have side effects. Consult your doctor or pharmacist on what they are. Do not make adjustments to the medication routine of a person living with dementia without seeking medical advice first.

Medication takes time to take their intended effect, and so it is important to follow the prescription even if effects are not seen for some time and if side effects are present. In addition, effects differ from person to person, so even if other persons respond differently, caregivers and the person taking it should not independently decide to change their dosage.

Generally, the medications listed above are well tolerated. Possible side effects include:

Acetylcholinesterase Inhibitors

1. Nausea, vomiting, diarrhoea

N-methyl D-aspartate (NMDA) antagonists (which prevent cell damage from glutamate), such as Memantine

1. Dizziness, headaches, fatigue, hallucinations, confusion

Antipsychotics

Antipsychotics must be used with caution and usually not for prolonged periods because they can:

1. Increase the risk of cardiovascular diseases, such as stroke or heart attack
2. Cause excessive drowsiness and impair alertness and communication
3. Cause slowness, rigidity, unsteady gait and falls

Hydration

Certain medications can also interfere with feelings of hydration and/ or thirst. Dehydration can be a serious health problem in older adults as it can be associated with other illnesses. Prevent dehydration by providing the 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 can’t drink independently.
• Offer barley, milk, soy milk, tea, coffee, juice, juicy fruits and soups for variety.

Medication Management General Tips

Missing Medications

If a person living with dementia forgets to take their medication, it should be administered as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped. The dose should not be doubled to make up for the missed dose. Caregivers and care professionals should take note of missed or irregular doses and share this information with the medical team working with the person living with dementia.

Being Transparent With the Medical Team About the Consumption of Medications or Other Products

Caregivers, care professionals, and the person living with dementia should be transparent with all doctor(s) and pharmacist(s) looking after the person living with dementia about whether the person is taking:

• Any medications or supplements that have been previously prescribed
• Those that have been prescribed by other doctors, including traditional medicines
• Herbal preparations, supplements, or nutritional products.

These include:

• Medications prescribed to address the person’s dementia and those for other purposes
• Medications prescribed in different forms, including pills, injections, inhalants, and topical medications and creams (those applied on the skin), etc.

There needs to be transparency between these teams to avoid harmful conflicts in medications. See the section below on the Patient’s Medication List for more information on keeping track of medications.

Pay Attention to and Follow Medication Administration Instructions

Pay attention to and follow special instructions given by the doctor or pharmacist who gives the medications. Examples of instructions include:

• The number of times a day to consume the medication, the dosage during each consumption, and how long the prescription lasts for
• Whether the person needs to consume the medication before or after food
• What food to avoid while taking the medication
• How to administer the medication

Look Out for Side Effects

Look out for any possible side effects of medications taken. The person living with dementia may have difficulty finding the words to alert others to side effects they are experiencing.

Drowsiness

Take note of medications that may cause drowsiness, as this may increase the risk of falling, especially in persons older in age.

Pay Attention to Special Storage Instructions

It is important to store medication in a cool and dry place, away from direct light and heat. Some medication may require refrigerated storage conditions. If a person living with dementia moves to different locations during the day, such as to a day care centre or for different community activities, arrangements will have to be made such that the medications are kept in suitable conditions.

Administer as per the Doctor’s Instruction

Do not stop using any medication without first consulting the doctor or pharmacist. If you have any doubts, contact the doctor or pharmacist for clarification. Follow the advice of medical professionals. Caregivers and persons living with dementia should not make decisions on their own about their medication prescription. Medication takes time to take effect, so it is important to follow the prescription even if effects are not seen for some time. In addition, effects differ from person to person, so even if other persons respond differently, caregivers and the person taking it should not independently decide to change their dosage.

Coordinating Medication Assistance

The person living with dementia may be cared for by different caregivers and care professionals, and may require medication reminders or assistance from these different persons. It is important that the caregivers and care professionals are all on the same page about what the person’s medication prescriptions are, and are prepared to provide assistance if needed.

Medication Records: The Patient’s Medication List

It is important to keep an updated list of all medications being taken. This list is called the Patient’s Medication List (PML).

dementia-hub-sg

This list facilitates communication between different healthcare professionals and contains vital information healthcare professionals can use when seeing persons living with dementia for the first time. It also helps to have one ready in the event of a serious drug interaction or overdose.

The PML should include:

• Two identifiers eg. name and NRIC number
• Chronic medical conditions
• Any drug or food allergies and a description of the allergic reaction
• The names of all medications/supplements/vitamins prescribed (brand name and active ingredient), strength, dosing instructions, and reason for use
• Date last updated

Bring the updated list for each visit to the clinic, hospital, or pharmacy, and show it to the healthcare professional. It also helps to add a picture of the medication and its bottle for easy identification to the list.

Remembering to Take Medications

Regularly forgetting to take dosages of medicine on time can lessen the medication’s effectiveness. It is important that caregivers and care professionals find ways to ensure that persons living with dementia take their medication in a timely and consistent manner.

Keeping track of the medication that needs to be taken at different times of day can be a struggle for both caregivers and persons living with dementia, especially when there is a mix of medicine that needs to be taken before and after meals throughout the day. This is even more challenging for a person living with dementia.

However, with some simple reminders and other medication management tools, medication can be managed effectively. Doing so can help people living with early-stage dementia continue to take their medication independently.

There are various methods that can be used to do this. Some of these methods allow the person living with dementia to maintain their independence in the early stages of dementia.

Use Pill Boxes

dementia-hub-sg

One of the simplest ways for keeping track of medication in pill form is the use of pill boxes. By placing each dose into a different compartment, it is easier for the person taking the medicine to identify and consume it at the correct times. By labelling each compartment, it also becomes easier to tell the time of day that each dose should be taken. This solution has the added benefit of making it easy to tell at a glance if a dosage has been missed.

Another solution is to use automatic pill dispensers. Such dispensers may have alarms that remind the user when it is time to take medications, and automatically dispenses medicine for that time of the day. There are a range of devices that offer slightly different functions at different price points that can be suited to the differing needs.

Set Reminders

If there are not too many different medicines to take, and if the person living with dementia needs only a simple reminder to take their medication at the correct time, using a phone to set alarms with simple descriptions can be an appropriate solution. Placing a daily schedule next to a digital clock can make it easier for the person living with dementia to tell which medications they should be taking.

Use a Timetable

Persons living with dementia and those caring for them can use a timetable to take note of when medications have to be taken. This is especially helpful if there are many types of medications to take. It can also be helpful when caregivers hand over caregiving duties to others when they are unavailable, or if the person living with dementia receives medication assistance services from home care personnel or centre-based care staff.

Medication Management Services

Some persons living with dementia and caregivers may require additional medication management services.

Some reasons for needing medication management services include:

Progressing dementia: In later stages, persons living with dementia may no longer be able to take their medication independently.
Living arrangements: Some persons living with dementia may live alone, or may not have family or caregivers around at certain times of the day when medication needs to be administered.
Type of medication: Some medications may be more difficult to administer independently, especially at later stages of dementia, such as injections, inhalers, nebulisers, etc.
Multiple medications and consumption timings: Having many medications to take at multiple times of the day may be difficult to coordinate.

There are medication-related services available for persons living with dementia by both public and private service providers. These services make it easier to manage medications. Services include:

• Medication packing
• Administering medication if clients and/or caregivers are unable to do so
• Medication supervision
• Medication reminders
• Monitoring of medication compliance and proper taking of medication
• Collection of medication from the pharmacy
• Other services: Some other services are listed in the “Additional Resources” section below.

How to Get Medication Management Services

Here are some ways to engage these services:

• Get a referral from a hospital, polyclinic or GP who is familiar with the conditions and needs of the person living with dementia.
• You can visit an AIC Link location near you for advice on care services and schemes.
• You may also use the online E-care locator to find service providers near you.

The average price of the service is about $20 per hour before means-test subsidy. If caregivers and persons living with dementia require financial assistance for the service, they may speak to a service provider or the medical social worker in the hospital or polyclinic.

Additional Resources

HealthHub services: Check medication prescriptions and request prescription refills online

The HealthHub website and mobile application allows patients to check their past medication prescriptions and request medication prescription refills online.

You will need to use SingPass to access these services on the HealthHub website or mobile application.

Download the Android app
Download the Apple app


PILBOX & MDS by SingHealth Polyclinic

SingHealth Polyclinics (SHP) Pharmacy provides both Prescription In Locker Box (PILBOX) and Medication Delivery Service (MDS).

PILBOX allows patients or their caregivers to collect prescription refills any time without queueing.

It is currently available at

1. SHP-Bedok
2. SHP-Marine Parade
3. SHP-Sengkang
4. SHP-Punggol
5. SHP-Tampines

The Medication Delivery Service (MDS) allows patients or their caregivers to have prescription refills delivered to their preferred address, without having to physically turn up at the polyclinic.

This delivery service is currently available in all SHP pharmacies.


ConviDose™ by National Healthcare Group

ConviDose™ is a multi-dose packaging compliance service by National Healthcare Group (NHG) that helps patients and caregivers arrange their medicines.

The right amount of medicines are packed into each sachet according to the time medications should be taken.

ConviDose™ is an easy-to-follow system which allows patients or caregivers to manage medicines easily and spot any missed doses.

Currently, ConviDose™ service is available from the following polyclinics.

1. Ang Mo Kio Polyclinic
2. Bukit Batok Polylinic
3. Choa Chu Kang Polyclinic
4. Clementi Polyclinic
5. Jurong Polyclinic
6. Hougang Polyclinic
7. Pioneer Polyclinic
8. Toa Payoh Polyclinic
9. Woodlands Polyclinic
10. Yishun Polyclinic


‘Ask-a-Pharmacist’ by National Healthcare Group

‘Ask-a-Pharmacist’ by National Healthcare Group (NHG) allows patients and caregivers to direct questions to a patient care pharmacist regarding their medications or any drug-related concerns or issues.

Patients and caregivers can post questions at their website.

If you need advice immediately, consult a Doctor, or call a NHGP Pharmacist via the NHGP contact centre at 6355 3000 or NUP contact centre at 6663 6847.


National Central Fill Pharmacy (NCFP)

From 2022, the National Central Fill Pharmacy (NCFP) will consolidate medications across multiple providers in a central location, from which the medications will be delivered directly to patients’ homes, secured post boxes or other convenient locations. This will improve access to pharmacy services.

This delivery model will be rolled out in phases. The first phase will be ready in early 2022 for polyclinic patients taking chronic disease medications. The following phases will include patients from public hospitals.1 2

This medication delivery service will be available in 2022. Read more about this initiative.

References

  1. Teo, J., & Tan, C. (2021, March 5). Budget debate: Central national pharmacy being set up to deliver medications to patients’ homes. The Straits Times. https://www.straitstimes.com/singapore/politics/budget-debate-central-national-pharmacy-being-set-up-to-deliver-medications-to.
  2. Speech By Dr Koh Poh Koon, Senior Minister Of State For Health, At The Ministry Of Health Committee Of Supply Debate 2021, On Friday 5 March 2021. Ministry of Health. (2021, March 5). https://www.moh.gov.sg/news-highlights/details/speech-by-dr-koh-poh-koon-senior-minister-of-state-for-health-at-the-ministry-of-health-committee-of-supply-debate-2021-on-friday-5-march-2021.

Smart Devices Available in Singapore

Many persons living with dementia feel the urge to walk about and in some cases leave their homes. Though this walking is sometimes termed as “wandering”, it is rarely ever aimless. Persons with dementia may simply not remember where they had set out to go, or what they had intended to do.

Wandering becomes a cause of concern when persons living with dementia encounter dangerous situations while wandering about the neighbourhood. For example, they often experience problems with orientation, which causes difficulties in finding their way back home. When the person with dementia is away from home for an unusually long time, or if the caregiver is unable to locate him/her, then wandering becomes a problem.

Another reason for concern is that there is a significant number of older persons living with dementia, whose primary caregivers are also seniors. For example, primary caregivers could be a spouse who is likely to be close in age. Seniors may be more vulnerable due to age-related reasons, such as an increased proneness to falls and fall-related injuries.

To address these issues, smart devices have been invented to improve the lives of persons living with dementia and seniors by allowing caregivers to keep an eye on their loved ones when they are out and about, and to help ensure their safety. Some of these devices include personal GPS trackers and personal alert buttons:

Personal GPS trackers can alert caregivers once the user leaves pre-set safe zones (for e.g., home), and track the user’s locations and movements in real time.

• When an older person falls, he/she may be alone or unable to shout for help. The situation can be worse if it is the caregiver who falls and no one else is taking care of the person with dementia. Personal alert buttons thus allow the user to quickly inform other family members (children and/or relatives) or care professionals when such emergency situations occur, by pressing an ‘SOS’ button.

There has been a growing number of devices that build in both of these features, allowing the user’s live location and movements to be tracked, and allowing him/her to press a ‘SOS’ or panic button to call for help during emergency situations (e.g  after a fall).

The table below lists down the personal GPS trackers and alert buttons that are available in Singapore.

Note: This list is not exhaustive or an endorsement of products. Information is accurate as of 5 September 2021. Please contact the respective sellers for more information.

Wearable Personal GPS Tracker
Tack GPS

Vendor/ Distributor: Tack GPS

Feature(s): Tack GPS offers a tiny and lightweight personal GPS tracker, which is highly recommended for persons living with dementia and seniors. This device uses multiple smart sensors and technologies to locate individuals, even when they are in the buildings.

Price Range(s) (with GST): USD$79

Contact: Visit Tack GPS.

Various devices

Vendor/ Distributor: OMG Solutions

Feature(s): OMG Solutions supplies a wide range of technological solutions, including:

1. Wearable Personal GPS Tracker & Alert Button
2. Fall Prevention & Emergency/Distress Alarms
3. Security Cameras

Price Range(s) (with GST): Most of the devices and technologies cost over SGD$100.

Contact: Visit OMG Solutions.

Various devices

Vendor/ Distributor: Available at popular eCommerce sites. E.g. Qoo10, Lazada, Shopee, Amazon, Ebay

Feature(s): Wearable products ranging from pendants, watches, keychains, armbands etc. Wearables will be tracked using a mobile app or website.

Price Range(s) (with GST): Prices can range from around $40 to $220 according to build quality, range distance, battery life and technical support etc.

Contact: Search for “personal GPS tracker” on the eCommerce sites.

Various apps

Vendor/ Distributor: Mobile phone apps.

Feature(s): There are several mobile phone apps that allow users to share their live location with others and is updated in real time as the user moves. Some examples include:

• Life360: Family Locator & GPS Tracker
• Family Locator – GPS Tracker & Find Your Phone App

Even many widely-used messaging apps, like Whatsapp, Telegram etc., comprise this feature. However, this may drain the battery life of the user’s mobile phone quickly.

Price Range(s) (with GST): Some apps are free.

Contact: Search for “personal GPS tracker” on App Store or Google Play.

There are many devices out there you can choose from, so do consider these factors before you decide to purchase one that suits your needs:

• Monthly fees: Many GPS trackers use cellular technology to pinpoint the user’s location and share this location information with his/her family. Thus, you will need to sign up for a monthly mobile plan for the tracking device at the same time. There are devices where monthly fees are not required, but they may be more limited in their tracking capabilities.

• GPS trackers’ capabilities – tracker connection range and battery life: The more expensive devices offer wider tracker connection range and longer battery life.

• Conspicuousness: If an inconspicuous device is preferred, you may want to choose a device that can be worn as a necklace, watch, or bracelet.

Assistive Equipment and Home Healthcare Items Available in Singapore

As mentioned in the articles under Changes in Care Needs as Dementia Progresses, persons living with dementia will require increasingly more assistance in their activities of daily living as their condition progresses. There are several types of equipment available that aid caregivers in supporting persons living with dementia, such as mobility aids (i.e., walkers, wheelchairs, etc.), and toilet and shower aids (portable commodes, grab bars, etc.)

The table below lists down some enterprises in Singapore which sell assistive equipment. This list is not exhaustive. This Dementia Portal disclaims any financial interest in any of these enterprises. Information is accurate as of 27 March 2021. Please contact the respective companies for more information about their products.

Some of these enterprises offer online shopping where you can purchase the items and products online and have them delivered right to your doorstep.

Click on the name of the company to be re-directed to its website. Alternatively, you could call the company with the numbers listed to the right of their names:

ADS Healthcare Products: 6873 7922
Alphamed Pte Ltd: 6776 0549
Assisted Living Pte Ltd: 6254 2916 / 6254 2927


DNR Wheels Pte Ltd: 6254 4070 / WhatsApp: 9128 3829
Easy Wheels Pte Ltd: 9155 7142
Fu Kang Healthcare Supply: 97288210


KCI Medical Asia Pte Ltd: 1800 742 9929 (24 hours)
Lifeline Corporation Pte Ltd: 6289 2062 / 6289 6096
Pharmex Healthcare: 6841 7494


Progress Healthcare Pte Ltd: 6297 5955
Rehab King (Singapore): 9724 0227
Rehab Mart Homecare

Balestier: 6352 4400 / 9814 3126 (WhatsApp Only)
Chinatown: 6324 7077 / 9814 3240 (WhatsApp Only)
Paya Lebar: 6455 1551 / 9814 3146 (WhatsApp Only)
Upper Thomson: 6250 0555 / 8114 7104 (WhatsApp Only)


Rainbow Care: 6223 0904 / 6931 7425
Wellink Healthcare: 6242 2088 / 9329 0166
Yeap Medical Supplies: 6848 1010

A Network of Care and Support

In Singapore, persons at risk or living with dementia can be supported by an integrated mental health network that aims to help them live well in the community. This support also extends to their caregivers.

The network brings together health, social, and community care providers who serve persons with mental health conditions and their families. Learn how a caregiver is being supported by this network:

Source: Dementia-Friendly Singapore Initiative

Integrated Northern Dementia Care System

In 2012, the CARITAS Network (then known as “TC-iCommunity@North” integrated network), comprising Community Outreach Teams (CREST) and Community Intervention Teams (COMIT) and the dementia multi-disciplinary team of Khoo Teck Puat Hospital (KTPH) was piloted to provide person-centred care to the community, clients and their caregivers in the north. Today, it has  expanded to include other partners, e.g. primary care providers, dementia day care partners and grassroots organisations, so that there is a continuum of care for their clients and caregivers.

Beyond building and integrating care services, a Dementia-Friendly Community is also set up in Yishun to build an inclusive environment where persons living with dementia and their caregivers will be able to get help and support, thus reducing caregiver stress and fatigue. Persons living with dementia can feel respected, valued, and confident with help within easy reach, and are able to continue to lead independent lives at home and in the community.

Both the CARITAS network and the Yishun Dementia-Friendly Community come together to provide integrated care and local community support for persons living with dementia and their caregivers.

dementia-hub-sg

Community Outreach Teams (CREST - Community Resource Engagement and Support Team)

Caregivers may not recognise the signs and symptoms of dementia and where they can seek help. The Community Resource, Engagement and Support Team (CREST) is a community outreach team that serves as a community safety network for people with and/at risk of depression, dementia and other mental health conditions. It supports their caregivers with resources they need to continue to care for their loved ones at home and in the community. In your neighbourhood, you can approach the Community Outreach Teams which are driven by the social service agencies.

Other than raising public awareness of dementia and mental wellness, the Community Outreach Teams (CREST) provide screening to promote the recognition of early signs and symptoms of dementia at individuals’ homes. If you need a listening ear for emotional support or need help to be linked up with other services, they will be able to support you.

Watch how Mdm Hasnah and her sister are being supported by CREST:

Source: Dementia-Friendly Singapore Initiative

Community Intervention Teams (COMIT)

In your neighbourhood, we also have the Community Intervention Teams which are driven by the social service agencies.

The Community Intervention Teams (COMIT) provide needs assessments, counselling and psychosocial therapy for clients and caregivers. An individualised care plan will also be developed for persons living with dementia in collaboration with other health and social care partners. Besides persons living with dementia, COMIT also supports their loved ones with in-depth information about the mental health condition and coping skills to support their caregiving journey.

Learn how Stella and her mother-in-law are being supported by COMIT and the CREST teams:

Source: Dementia-Friendly Singapore Initiative

There are many available care services available to support seniors who require supervision while their caregivers are at work or need assistance caring for them. These services aim to maintain and/or improve the general, physical and social well-being of seniors through therapy. These services also doubles as a place for seniors to socialise and take part in recreational activities.

Day Care Services

There are dementia day care services which provide full day care in a centre-based setting for persons living with dementia. The centres provide structured programmes to improve or maintain the mental and physical well-being of persons living with dementia.

Activities can include:

• Mind stimulating games
• Music therapy
• Reminiscence Therapy

There are many day care centres in Singapore providing General Dementia Day Care and Enhanced Dementia Day Care services. You can find them via the E-care Locator.

There is also another programme called “Family of Wisdom” which is provided by Dementia Singapore (DSG). It is a weekly three-hour enrichment programme conducted in a small group setting where persons living with dementia are grouped according to their stage of dementia, language, age and educational profile. Find out more.

Nursing Homes

Nursing homes provide long-term residential care support to seniors who need help in daily living and nursing care. There are nursing homes which provide specific dementia facilities catering to persons living with dementia. Find out the list of nursing homes near you.

Respite Care

Respite is important for caregivers. They may take respite by sending their loved ones living with dementia to a day care service or weekend-respite services. Home personal care also provides eldersitting service whereby the care professionals will engage the person living with dementia in activities while the caregiver takes a break.

Caregivers may need to access respite care unexpectedly. Planning ahead for respite care will help them to better care for themselves and their loved ones. Caregivers can pre-enrol for respite care ahead of time under the Go Respite pilot programme, to shorten the time required to access respite care when they need it. Learn more.

Caregivers may also join the Caregiver Support Network to focus on their own self-care, enjoy activities with other caregivers and share experiences. They may email ccmh@aic.sg if they are keen to join any Caregiver Support Network.

Caring for a person living with dementia requires careful financial planning, and may sometimes require the family of the person living with dementia to tap on financial resources. There are a number of government financial schemes available.

The tables below list down the financial resources in the following 5 areas:

• Mobility Assistance
• Daily Activities Assistance
• Caregiving Assistance
• Medical Fees Assistance
• For Low Income Individuals

List of Financial Resources

For Mobility Assistance

Assistive Technology Fund (ATF)

The ATF provides subsidies for persons with disabilities (PWDs) to purchase assistive technology devices to enable independent living.

Successful applicants qualify for a means-tested subsidy of up to 90% of the cost of the required equipment, subject to a lifetime cap of $40,000.

Find out more.

For Daily Activities Assistance

Seniors Mobility and Enabling Fund (SMF)

The SMF provides holistic support for seniors to age in place within the community by extending subsidies to Singaporean seniors:

• Requiring mobility and assistive devices for daily independent living and to remain ambulant in the community
• Receiving government funded home care and care within the community, needing home healthcare items for their care

Find out more.


Enhancement for Active Seniors (EASE)

The Housing and Development Board introduced EASE in 2012 to subsidise home modifications so that older residents can live at ease in their homes.

This is what can be installed in a flat through the EASE programme:

• Slip-resistant treatment to floor tiles in up to two bathrooms or toilets
• Grab bars in the flat (eight or 10 grab bars for the first toilet, and six grab bars for the second toilet)
• Up to five ramps in the flat, and/or at the main entrance – if it is doable

Find out more.


ElderShield

ElderShield is a basic long-term care insurance scheme designed to help Singaporeans meet expenses for severe disability, especially during old age.

The ElderShield scheme has been enhanced into the new CareShield Life scheme introduced from mid-2020.

• Until 2019, Singaporean Citizens and Permanent Residents with MediSave Accounts were automatically enrolled in the ElderShield scheme at 40 years of age, unless they opted out.
• From 2020 onwards, there were no new automatic enrolments into ElderShield at 40 years of age. Singapore Citizens and Permanent Residents born in 1980 and after are instead automatically covered by CareShield Life on 1 October 2020 or when they turn 30.

Depending on the plan the person has, ElderShield will pay a monthly cash benefit of $300 per month for up to 60 months, or $400 per month for up to 72 months if the person has a severe disability. The Ministry of Health has appointed three private insurers to administer ElderShield: Aviva, Great Eastern and NTUC Income.

Find out more from AIC and CareShield Life.


CareShield Life

CareShield Life is a long-term care insurance scheme for Singaporean Citizens and Permanent Residents launched on 1 October 2020 which provides basic financial protection should an individual become severely disabled, especially during old age, and need care for a prolonged duration.

CareShield Life policyholders who are/become severely disabled are eligible to make claims, and can receive payouts for as long as they remain severely disabled, and meet the terms and conditions needed to receive payouts. Payouts start at $600 cash per month in 2020, which increases annually until age 67 or when a successful claim is made, whichever is earlier.

Find out more from AIC and CareShield Life.


Interim Disability Assistance Programme for the Elderly (IDAPE)

The IDAPE is an assistance scheme that was set up in 2002 for a small group of seniors who were not eligible for ElderShield at the time, because they were too old or had pre-existing disabilities.

If these seniors develop severe disabilities, they can receive $150 or $250 monthly cash payout (depending on their financial circumstances) for up to 72 months. There is no restriction on how the payments should be used, as long as they are used for the care of the disabled IDAPE claimant.

For example, the payments can offset:

• Medical bills
• Nursing costs
• Hiring a foreign domestic worker (FDW) as a helper to care for the disabled IDAPE claimant

The senior may nominate himself/herself, a caregiver who is 21 years old and above, or a nursing home that the senior is residing in to receive the IDAPE payout.

Find out more.


ElderFund

ElderFund is a discretionary assistance scheme launched on 31 January 2020.

It is targeted at severely disabled lower-income Singapore Citizens aged 30 and older, who are not able to benefit from CareShield Life, ElderShield, and the Interim Disability Assistance Programme for the Elderly (IDAPE), and have low MediSave balances and inadequate personal savings to meet their long-term care needs.

Eligible Singapore Citizens can receive up to $250 cash per month for as long as they remain eligible, and meet the terms and conditions needed for receipt of payment.

Find out more.


MediSave Care

MediSave Care is a long-term care scheme that was launched on 1 October 2020. It allows Singapore Citizens or Permanent Residents aged 30 and above who are severely disabled to make monthly cash withdrawals up to a total of $200 per month from their own and/or their spouses MediSave Accounts for their long-term care needs.

Find out more from AIC and CareShield Life.

For Caregiving Assistance

Caregiving Training Grant (CTG)

The CTG is a $200 annual subsidy that lets caregivers attend approved courses to better care for their loved ones. The $200 subsidy is provided for each care recipient every financial year (from April to March the following year). If multiple caregivers of the same care recipient wish to attend training, the $200 would need to be shared among the family members.

Find out more.


Foreign Domestic Worker (FDW) Levy Concession for Persons with Disabilities

The FDW Levy Concession for Persons with Disabilities lets families pay the Foreign Domestic Worker levy at a concessionary rate of $60 a month, instead of $300. Each household is eligible for up to two FDW levy concessions, caring for two loved ones at any one time.

Find out more.


Home Caregiving Grant

The HCG is a $200 monthly cash payout to support loved ones with at least permanent moderate disability, i.e. always require some assistance to perform three or more Activities of Daily Living (ADLs).

This grant can be used to defray the costs of caregiving expenses, such as the costs of eldercare and caregiver support services in the community, or hiring of a Foreign Domestic Worker (FDW).

Find out more.

For Medical Fees Assistance

Community Health Assist Scheme (CHAS)

The CHAS enables all Singapore Citizens, including Pioneer Generation (PG) and Merdeka Generation (MG) cardholders, to receive subsidies for medical and/or dental care* at participating General Practitioner (GP) and dental clinics.

Visit CHAS for more information.

*Only for CHAS Blue/Orange, MG and PG cardholders


Medical Fee Exemption Card (MFEC)

The Medical Fee Exemption Card (MFEC) can cover expenses for standard medical and hospitalisation treatment at government or restructured hospitals, polyclinics, and approved intermediate and long-term care services for needy residents of MOH-funded nursing homes, or MSF-fundSed sheltered and disability homes.

Eligible applicants must have personal savings of $6000 or less, and a monthly per capita family income of $700 or less. They must be Singapore Citizens or Permanent Residents of Singapore, and either residents of MOH-funded nursing homes or MSF-funded sheltered and disability homes.

Find out more.


MediFund

The Medical Endowment Fund (MediFund) is an endowment fund set up by the Government. It is used to assist needy Singapore citizens who experience difficulties paying for remaining bills after receiving Government subsidies and other means of payment, which include MediShield Life, MediSave, and cash.

MediFund Silver, a scheme that is part of MediFund, provides assistance to persons aged 65 and older.

MediFund can be used to pay for restructured hospitals, national specialty centres, and intermediate and long-term care services.

Eligible applicants must be a Singapore citizen, a subsidised patient, have received or require treatment from a Medifund-approved institution, and be having difficulties with paying for their healthcare bills after Government subsidies and other means, including MediShield Life, MediSave, and cash.

Find out more from the Agency for Integrated Care and Ministry of Health.


MediShield Life

MediShield Life is medical insurance that provides life-time coverage for all Singaporeans. Unlike the previous scheme, MediShield, you cannot opt out of MediShield Life.

The premiums for MediShield Life can be paid using Medisave funds or cash. The Government has also provided subsidies for lower- and middle-income Singaporeans, as well as for Pioneer Generation members. There are also subsidies for the first four years of MediShield Life, as people move from MediShield to MediShield Life.

Find out more from the Agency for Integrated Care and Ministry of Health.

For Individuals with Low Incomes

Silver Support (SS) Scheme

The SS Scheme provides a quarterly cash supplement to seniors who had low incomes during their working years and now have less in their retirement.

There is no need to apply for the Silver Support (SS) Scheme. The CPF board automatically reviews eligibility for SS annually. Persons who qualify will receive a notification letter from CPF in December of the preceding year.

Find out more.


ComCare Schemes

The ComCare group of government financial schemes provide social assistance to low-income individuals and families, and is available at Social Service Offices (SSOs).

1. ComCare Interim Assistance

ComCare Interim Assistance may be provided to individuals and/or households that require urgent and immediate help of a duration of less than 3 months.

Find out more.

2. ComCare Short-to-Medium-Term Assistance

ComCare Short-To-Medium Assistance may be provided to individuals and/or households for persons or households that need temporary financial help due to an inability to find work for a period of time.

Find out more.

3. ComCare Long-Term Assistance (Public Assistance)

ComCare Long-Term Assistance may be provided to persons who are unable to work and need financial support.

Find out more.

Recipients of ComCare Public Assistance receive full subsidies for the treatment of conditions covered under CHAS. Find out more.


Workfare Income Supplement (WIS) Scheme

Introduced in 2007, the WIS Scheme is a broad-based measure for Singaporeans who meet certain requirements that tops up the salaries of our lower-income workers and helps them save for retirement. It supplements their income and retirement savings through cash payments and CPF contributions.

Find out more.

Click on the two images below to view tables that summarise the lists of financial resources above:

dementiahub
dementiahub

How to Access Services for Financial Schemes

eServices for Financing Schemes Application Portal

As part of the Agency for Integrated Care (AIC)’s efforts to streamline the application process for long-term care schemes, AIC has launched the eServices for Financing Schemes (eFASS) application portal on 1 October 2020. Patients and caregivers can submit applications to and manage their long-term care schemes online using the platform.

More information about eFASS.


AIC Link

Need advice on care services and schemes? Caring for a loved one and need training or assistance? AIC Link advises caregivers and their loved ones on getting the right care at the right place. Care Consultants at AIC Link provide information on care at home, assistance schemes, and caregiver support.

Visit AIC Link for more information and how to access financial assistance schemes and other support at these locations.


Social Service Offices (SSOs)

For more general financial assistance, you may approach your nearest Social Service Office find out more about what assistance schemes may be available for you and family members. You may also apply for financial assistance at SSOs.

Find the nearest SSO to your residential address.


Medical Social Services

Some hospitals and healthcare institutions have medical social services. Amongst other responsibilities, medical social workers and officers can provide information on financial assistance. They can help patients and their caregivers to find or be referred to resources in the community to address financial needs, amongst other needs.

If a person living with dementia currently receives services at a hospital or healthcare institution, they and/or their caregivers and family members may approach the medical social services department regarding the financial issues related to the person living with dementia.

Additional Resources

Agency for Integrated Care (AIC): Financial Assistance

Information on financial assistance schemes.

Information on care- and finance-related web tools and mobile apps.


LifeSG app

This one-stop mobile application, created by the Singapore government, features information on a list of schemes and other government programmes. Visit LifeSG and download the app from the links below.


SchemesSG

This website was created by a ground-up initiative as a platform for the public to easily search for financial schemes that fit specific sets of needs. Visit SchemesSG.

Source: Ministry of Social & Family Development

Watch the video in Chinese or Malay subtitles.

What Is the Lasting Power of Attorney?

As dementia progresses, persons with this condition will have increasing difficulty with judgment and problem solving. You may notice that they might be less able to make sound financial and healthcare decisions.

The Lasting Power of Attorney (LPA) is a legal document that allows a person (a donor) to appoint one or more persons as donee(s). Donees are persons who have the authority to make decisions and act on the donor’s behalf should this person lose their mental capacity. The donor must be at least 21 years of age and have the mental capacity to voluntarily make this appointment, should he/she lose the capacity to make his/her own decisions.

The person(s) who are appointed by the donor to act on this donor’s behalf upon the donor’s loss of mental capacity are known as the donee(s). Donors must be at least 21 years of age, and someone whom the donor trusts to make decisions on their behalf, in their best interests.

It is necessary for a certified issuer to sign the LPA as a witness and to certify that the donor is aware of the implications of making an LPA. A certificate issuer can be a psychiatrist, a practicing lawyer, or an accredited medical practitioner.

There are two types of LPA Forms:

Form 1: This is a standard version that individuals use to grant general powers with basic restrictions to their donee(s).

Form 2: This is for those who have non-standard requirements and wish to grant customised powers to their donee(s). It is typically chosen by those who have larger and more complicated assets.

If you are interested or feel that an LPA is important for yourself or someone you know, please visit the Office of the Public Guardian.

For more information, you may also call 1800-226-6222, or email enquiry@publicguardian.gov.sg.

How Should Donees Use the LPA?

Watch this video by the Ministry for Social and Family Development to find out about the roles and responsibilities of donees, how donees should use the LPA, and how the LPA could come in useful should a donor lose mental capacity.

Source: Ministry of Social & Family Development

How to Make a Lasting Power of Attorney

Visit the Office of the Public Guardian (OPG) for the steps on how to make a Lasting Power of Attorney (LPA).

What if an LPA Has Not Been Made When a Person Loses Mental Capacity?

A potential deputy has to go to Court to apply to be a deputy for the person who has lost mental capacity, and the Court has to appoint this person as deputy.

A deputy makes decisions on behalf of a person who lacks mental capacity when the person has not made a Lasting Power of Attorney (LPA) and has no donee to decide on their behalf in respect of those decisions.

Read more about deputies.

Professional Donees

The Professional Deputies and Donees (PDD) scheme allows for individuals who currently have mental capacity to make an LPA by appointing a professional donee. This scheme came into effect in September 2018.

Professional deputies and donees:

• Are paid for their services;
• Must not be related the person they are appointed to act for;
• Must submit annual reports to the Office of the Public Guardian to explain the decisions and expenses they made on the person’s behalf;
• Must be an eligible professional from a professional group specified by the Mental Capacity Act (lawyers, doctors, accountants, allied health professionals, nurses, social workers).

For more information on the Professional Deputies and Donees scheme, visit the Office of the Public Guardian.

Additional Resources

My Legacy

This is a Singapore government website which contains information on end-of-life planning. Find out more about making a LPA. This page is also available in Mandarin (中文), Malay (Melayu), and Tamil (தமிழ்).


Living with Dementia: A Resource Kit for Caregivers (Book 2: Planning Care)

This booklet by the Agency for Integrated Care (AIC) contains information on the LPA and other related legal matters.

Living With Dementia: A Resource Kit for Caregivers (Book 2: Planning Care)

 


Council for Third Age: Chinese-Language Article the LPA (持久授权书)

View the article.


Office of the Public Guardian: Chinese-Language Brochure on the LPA (持久授权书)

View the brochure.


Article by Channel NewsAsia: “New scheme for people to appoint professional proxies should they lose mental capacity in future”

View the article.


Chinese-Language Podcast on the LPA, 持久授权书 (LPA) 播客

Listen to the podcast.

Source: Vintage Radio SG

Ask the Experts – Planning Ahead: Finances & Legal

This video by AIC addresses some financial and legal concerns such as how to address frozen assets and how the LPA works.

Source: Agency for Integrated Care

Lianhe Wanbao Coffee Talkshow on the Lasting Power of Attorney (Full)

Source: Ministry of Social & Family Development

Channel 8 News Video:《有法说清楚》持久授权书究竟有多重要?

Source: MediaCorp Channel 8

A deputy is appointed by the Court to make decisions on behalf of a person who lacks mental capacity when the person has not made a Lasting Power of Attorney (LPA) and has no donee to decide on their behalf in respect of those decisions.

A deputy can be an individual or a licensed trust company under the Trust Companies Act (Cap.336), as prescribed by the Mental Capacity Regulations.

Deputies must submit annual reports to the Office of the Public Guardian (OPG) to explain the decisions and expenses they made on the person’s behalf.

Please see these resources for more information on deputyship:

The Office of the Public Guardian (OPG)
The Family Justice Courts (FJC)

Professional Deputies

The Professional Deputies and Donees (PDD) scheme aims to serve individuals who may not have family members or close friends to rely on to be their proxy decision makers. This scheme came into effect in September 2018.

In the case where a person has lost their mental capacity, has not appointed a donee, and others (such as next-of-kin) do not apply to appoint a deputy for the person, the Family Justice Courts can appoint a professional deputy for this person.

Professional deputies and donees:

• Are paid for their services;
• Must not be related the person they are appointed to act for;
• Must submit annual reports to the Office of the Public Guardian to explain the decisions and expenses they made on the person’s behalf;
• Must be an eligible professional from a professional group specified by the Mental Capacity Act (lawyers, doctors, accountants, allied health professionals, nurses, social workers).

For more information on the Professional Deputies and Donees scheme, visit this page by the Office of the Public Guardian.

Additional Resources

My Legacy

This is a Singapore government website which contains information on end-of-life planning. Find out more on making a LPA. This page is also available in Mandarin (中文), Malay (Melayu), and Tamil (தமிழ்).


Article by Channel NewsAsia: “New scheme for people to appoint professional proxies should they lose mental capacity in future”


Ask the Experts – Planning Ahead: Finances & Legal

This video by AIC addresses some financial and legal concerns such as how to address frozen assets and how the LPA works.

Source: Agency for Integrated Care

Webinar on Deputyship Duties

This webinar (duration: 50 minutes) is a guide on the duties of a deputy. This webinar includes information about the deputy’s roles and responsibilities towards the person they act for, how they should understand and comply with their court order, and how to fill in the deputy report form.

Source: Ministry of Social & Family Development

An Advance Medical Directive (AMD) is a legal document signed by a person in advance, informing their doctor that they do not want any extraordinary life-sustaining treatment to be used in the event that they become terminally ill and unconscious.

Making an AMD is a voluntary decision. As medical technology advances, there are increasingly many ways of extending a person’s life. This means that people can live longer even with a terminal illness. Extraordinary life-sustaining treatment is any medical treatment which serves only to prolong the lifespan of terminally ill patients but does not cure the illness. For example, a respirator connected to a patient to assist with breathing is not a treatment and does not bring about healing for the patient.

A person living with dementia may not be able to express their wishes to continue or stop treatment. Some people may prefer to pass away naturally in peace and not extend treatment. In the situation that a person living with dementia is not able to communicate their wishes to the doctor in the future, the doctor will be guided by their AMD.

How to Make an AMD

• Patients must be above the age of 21 and of sound mind.
• Three doctors (including the hospital doctor) must all certify that patients are terminally ill.* Two of the doctors must be specialists.
• Patients need to complete and sign the AMD form in the presence of two witnesses – the doctor in-charge and someone who is above 21. Both witnesses cannot stand to gain anything from the patient’s passing.

If there is a disagreement between the doctors:

• The doctor-in-charge will review the AMD
• If there is still no agreement, the Ministry of Health will appoint three additional specialists to review the patient’s case.
• If all the three appointed specialists are unable to certify that the patient is terminally ill, the AMD cannot take effect.

More information can be found on the Ministry of Health’s website.

An AMD can be cancelled at any time. The person who has made the AMD can do this by completing a form or writing a letter to the Registrar of AMDs, and having a witness who can testify to their cancellation. The caregiver themself may opt to be a witness.

If the person who has made the AMD is unable to write, they may communicate their wishes to cancel the AMD by speaking or using sign language. The witness will have to submit the notice and explain why they are unable to submit it themselves.

For more information on the Advance Medical Directive, please visit the Ministry of Health’s page on the AMD.

Additional Resources

Planning Ahead: Advance Directives in Singapore
This video provides information on how sharing your wishes and values in advance helps your loved ones understand what treatment decisions you would prefer in a medical crisis. In this talk, Dr Chua will explain the importance of Advance Care Planning (ACP), how it complements the Lasting Power of Attorney (LPA) and AMD and how you can get started on planning ahead.

Source: Council for Third Age (C3A)

Source: Agency for Integrated Care

Advance Care Planning (ACP) is the process of planning for one’s future health and personal care. Having ACP conversations will allow your loved one with dementia to:

• Share their personal values and beliefs with the family
• Explore how his/her values and beliefs influence their healthcare preferences in difficult medical situations
• Delegate a trusted member/relative to make healthcare decisions on their behalf, should he/she be unable to one day

Ideally, discussions about the person living with dementia should take place as early as possible, while your loved one with dementia still has the capacity to make informed choices and decisions.

Learn more about what ACP is. For more information, visit AIC.

Who Is Advance Care Planning For?

ACP is an important part of routine healthcare. Anyone can start their ACP today regardless of their age or health condition. Discussing and documenting healthcare preferences with loved ones and a healthcare team can give everyone peace of mind.

ACP is particularly important for people who have a chronic illness, an early cognitive impairment, frail, or are approaching the end of life.

Benefits of Advance Care Planning

Doing an ACP helps to promote more holistic healthcare:

• Patients receive healthcare that is tailored to their values and preferences. Many patients who have done their ACP avoided unnecessary or overly aggressive medical treatments.

• Families of people who have done their ACP experienced less anxiety, less stress, and were clearer about what decisions to make.

• The healthcare team has a better understanding of the quality of life you expect and can act in your best interests.

This video explores a scenario where a family together works out the care plan of their loved one who has dementia.

Source: Agency for Integrated Care

4 Simple Steps to Advance Care Planning

1. Think about it

Consider what your loved one needs to live meaningfully and what would be important to him/her at the end of life.
Understand the prognosis and treatment options.

2. Talk with loved ones and caregivers

Discuss wishes and goals for care with close family and friends to help them better understand the situation.
Your loved one with dementia may have one or two trusted loved ones who can be his/her voice.

3. Put wishes into a plan

Record and share decisions and wishes with appropriate persons.
Share and discuss these future healthcare choices with the attending doctor.

4. Review your preferences

Your loved one can always change his/her mind after the plans are made.
If that happens, be sure to update the ACP documents and make new copies for the trusted parties involved.

To start the Advance Care Planning process, you can download this workbook which will guide you and your loved ones through the process.

Where to Do an Advance Care Plan

Advance Care Planning (ACP) may be done at most hospitals, selected polyclinics, and community care providers:

• If you are a patient at a hospital or polyclinic, please ask your doctor for a referral.
• If you are generally in good health, you may make an appointment at ACP nodes.
• Some providers offer the option to do ACP over a video conferencing platform (TeleACP Providers).
• You may also apply for a Lasting Power of Attorney with selected service providers.

For information on TeleACP providers and selected services providers, visit the Agency for Integrated Care’s website.

Additional Resources

My Legacy

This is a Singapore government website which contains information on end-of-life planning. Their pages are available in English, Mandarin (中文), Malay (Melayu), and Tamil (தமிழ்).

• Find out more on making an Advance Care Plan.
• Find out more on planning ahead.


Our Grandfather Story: Are You Afraid of Dying?

In this video, interviewees share their journeys with their health conditions. They also discuss ACP and the Lasting Power of Attorney (LPA).

Source: Our Grandfather Story

Planning a will is important to carry on the wishes of a person after they pass on. The will should contain clear instructions about what one wants to do with their money and the assets they own. It will also ensure that their legacy and future generations are taken care of accordingly.

About a Will

A will takes effect after death. It is a legal document that describes a person’s estate, which includes their money, savings and assets. It also states how their estate will be distributed among their beneficiaries.

Wills differ from person to person. It can be a simple one-page document to a complex one, depending on the person’s estate. It also contains instructions about the care of young children, special needs children, gifts to charity, and so on.

A will normally enlists the following:

• A list of all of the person’s assets
• A list of all the person’s liabilities and debts, stating how the person wants to pay their debts off before assets are distributed to the beneficiaries
• The beneficiaries and guardians, and how much each one is to receive
• The executors carry out the person’s will. A beneficiary may also be the executor.
• The advisors (such as the person’s lawyers and accountants)
• A revocation clause: This is to cancel out any wills the person planned previously.
• A residuary clause: This gives the person a say in how they want to distribute the rest of their estate. For example, if a beneficiary dies before the person does, the intended assets will be a part of this remainder.

Why Make a Will?

If a person does not have a will, the Public Trustee, an office under the Ministry of Law, will decide who receives their property based on the law. This means that people to whom this person wants to pass on their money or belongings may not get them. If a person you know or care for has not made a will, help this person ensure that their money goes where they want it to go by planning a will.

They may appoint:

• An executor, someone trusted to make sure their wishes are carried out; or
• A guardian to take care of the property or money they are leaving for their children.

If you and/or a person you care for need legal advice, you may want to consider visiting a free legal clinic. Keep in mind free legal clinics are staffed by volunteer lawyers so not all of them may be experts in this area. You should call the clinic before you visit to make sure they can give you and/or the person you care for the necessary advice. Free legal clinics are also offered at some community clubs.

Additional Resources

My Legacy

A Singapore government website which contains information on end-of-life planning and writing a will.


MoneySense

A Singapore government website which contains information on estate planning.

End-of-life care, or palliative care, aims to support a person in the later stages of a life-limiting condition to live as well as possible until they pass on. It also aims to support family and caregivers during this time and after the person passes on. End-of-life care may last for weeks, months, or occasionally years. It is often difficult to know exactly when a person living with dementia is approaching the end of their life.

A person-centred care approach is an important aspect of palliative care as it is with dementia care in general. A person-centred approach, according to Professor Tom Kitwood, a major contributor in the field of dementia care: values a person who lives with dementia; treats the person as an individual; looks at the world through the person’s perspective; and addresses the effects of the social environment on the person living with dementia.1 These things are just as important for a person living with dementia as they live their final days.

Nearing the End of Life

There are symptoms in the later stages of dementia that can suggest the person is reaching the final stage of their illness, but this may be difficult to predict.

These include:

• Speech limited to single words or phrases that may not make sense
• Needing help with most everyday activities
• Eating less and having difficulties swallowing
• Bowel and bladder incontinence
• Being unable to walk or stand, problems sitting up and controlling the head, and becoming bed-bound.

A Good Death

For many people, a ‘good death’ means:

• Being treated with compassion and respect
• Being kept clean, comfortable and free from distressing symptoms
• Being in a familiar place surrounded by those close to them End of Life Care seeks to support all aspects of your loved one’s wellbeing, especially:

• Physical needs (including pain relief and management of other symptoms)
• Emotional health
• Social health – their relationships with others
• Spiritual beliefs

Professional Care

End-of-life care for a person living with dementia can involve a number of different professionals working together, including the doctor, nurses, social workers or care home staff. Palliative care professionals at a local hospice or hospital may give specialist input if this is needed. This team of professionals should keep you updated as the person’s condition changes and involve you in any decisions. The person should always have an up-to-date care plan that includes end of life plans and is shared with those involved in the person’s care. It is likely that a person living with dementia is nearing the end of their life if they have these symptoms, along with other problems such as frailty, infections that keep coming back, and pressure ulcers.

Additional Resources

My Legacy

This is a Singapore government website which contains information on end-of-life planning.


Challenge by Public Service Division: Is There Room For Dying Well In Singapore?

This 2014 article on a Singapore government Public Service Division blog discusses the quality of death in Singapore.


Singapore Hospice Council: Palliative Care

The Singapore Hospice Council’s website provides information on what palliative care is, and various aspects of palliative care such as why it is needed, how it can help, where it is provided, and how it can start.

References

  1. Brooker, D. (2004). What is person-centred care in dementia?. Reviews in clinical gerontology, 13(3), 215-222.

Our Hope for People Impacted by Dementia

We believe that a key outcome for persons living with dementia should not stop at dementia awareness or a dementia-friendly society, but the inclusion of persons living with dementia.

Dementia-Awareness, Dementia-Friendliness, and Dementia-Inclusiveness

A society can take steps towards dementia inclusion by first becoming aware of this condition and the issues surrounding it (dementia-awareness).

The society can take action to ensure that its physical and social environment is adjusted to suit the needs of persons impacted by dementia (dementia-friendliness).

Lastly, it can embrace persons who are affected by dementia to ensure that they are not left behind (dementia-inclusiveness).

Though dementia-awareness, dementia-friendliness, and dementia-inclusiveness can develop in a society in that sequence (awareness before friendliness, and friendliness before inclusiveness, as seen in the image below), they may not necessarily occur in this order. They can also develop at the same time.

dementiahub

Below provides more details and examples on the above concepts.

  • Dementia-Awareness

     

    Society is aware of what dementia is and the issues surrounding it.

  • Dementia-Friendliness

     

    People in society are respectful to persons living with dementia. Society, including businesses, organisations, and other institutions, adjust their facilities, infrastructure, and personnel to accommodate persons living with dementia.

  • Dementia-Inclusiveness

     

    Though discussions on how dementia inclusion is defined are still ongoing, some common features in these discussions over the goals of inclusion, in light of the many different kinds of needs are1-4:

    • Making changes such that persons living with cognitive impairments are able to lead meaningful and dignified lives

    • Matching the physical and social environment, including physical space, and social practices and norms, to the needs of persons living with disabilities

    • Equipping persons in society, including family members and care professionals, to support persons with disabilities

    • Having persons feel that they are part of society and building their confidence to participate actively in social and cultural activities

    • Diseases do not label or define the persons who have them

    • The society which claims inclusivity or aims towards it is held accountable to the standard of inclusivity

Dementia-Friendly Singapore (DFSG) and Dementia-Friendly Communities (DFCs)

One initiative that aims to build dementia-friendliness is the Dementia-Friendly Singapore (DFSG) initiative. DSFG is led by the Agency for Integrated Care (AIC), and aims to build a more caring and inclusive society for persons living with dementia and their caregivers.

As part of the DFSG initiative, certain districts in Singapore have been designated as Dementia-Friendly Communities (DFCs).

Click the logo below for more information:

dementiahub

References

  1. Chiu, M. Y., Lim, K. H., Chan, K., Evans, S., & Huxley, P. J. (2016). What does social inclusion mean to Singaporeans? A qualitative study of the concept of social inclusion. Asia Pacific Journal of Social Work and Development26(2-3), 64-76.
  2. Dementia Connections Canada. (2018, September). What’s the Difference Between “Dementia Friendly” and “Dementia Inclusive”. Dementia Connections. https://dementiaconnections.ca/2018-9-14-whats-the-difference-between-dementia-friendly-and-dementia-inclusive/
  3. National Council of Social Services. (2016, December). 3rd Enabling Masterplan. https://www.msf.gov.sg/media-room/Pages/MSF-to-study-and-consider-recommendations-made-by-EM-Steering-Comm.aspx
  4. Putnam, D., Wasserman, D., Blustein, J., & Asch, A. Disability and Justice (2019). In E.N. Zalta (Eds), The Stanford Encyclopedia of Philosophy (Winter 2019 Edition). Metaphysics Research Lab, Stanford University. https://plato.stanford.edu/archives/win2019/entries/disability-justice/

Dementia can be a socially alienating illness. Many who have the condition spend their time cooped up indoors or in a nursing home, no longer able to lead normal lives. This is a shame as many persons living with dementia can continue their daily routines if given a safe and inclusive environment to do so.

To create a more caring and inclusive society to support persons living with dementia and their families, the Dementia-Friendly Singapore (DFSG) initiative was launched by the Ministry of Health (MOH) and supported by the Agency for Integrated Care (AIC) and community partners.

How Can a Dementia-Inclusive Singapore Support Persons Living With Dementia and Their Loved Ones?

The DFSG initiative encourages persons living with dementia to continue living in their own homes and go about their usual routines in the community. This has to collectively involve the community’s members – who include but are not limited to neighbours, shopkeepers, coffee-shop drink sellers, and bank tellers – who can understand and help them.

In a dementia-inclusive Singapore, people, neighbours, shops, markets, and businesses are sensitised to the challenges of persons living with dementia and treat them with empathy and patience. In such an environment, persons living with dementia are empowered to live as independently and meaningfully as possible, with dignity.

What Is a Dementia-Friendly Community (DFC), and Why Is It Important?

Click here to watch a Mandarin version of the video.

A DFC is a community where:

• People are aware of dementia and its signs, and understand how to better support persons living with dementia and their caregivers;
• Environments are safe and easy for persons living with dementia to navigate and continue with activities and routines that they enjoy;
• Businesses’ and services’ staff are respectful and helpful towards persons living with dementia; and
• Resources are readily available to increase the public’s dementia awareness and provide better support for those with need.

In such a social environment, persons living with dementia and their caregivers will be encouraged to seek help and support. They will also feel included in their community, be more independent, and have more choice and control over their lives, while feeling:

dementiahub

At the same time, seniors can reduce their risk of developing dementia with readily accessible active ageing activities. Persons living with dementia can be identified early, and appropriate care and support will be provided.

This is a community that reaches out to its neighbours and seeks to support people affected by this condition in coping with their condition.

DFCs in Singapore

There are currently a number of DFCs in Singapore which include Yishun, MacPherson, Hong Kah North, Bedok, Queenstown, Fengshan, Bishan, and Kebun Baru. Yishun was the first DFC in Singapore, set up by Khoo Teck Puat Hospital (KTPH) and the Lien Foundation under the Forget Us Not initiative. Under this initiative, KTPH provided training to over 20,000 people to help them better identify and understand dementia.

In DFCs, people in the neighbourhood are aware of dementia and understand how to better support persons living with dementia and their caregivers. Businesses and services are encouraged to make adjustments that will have a positive impact on the lives of persons living with dementia and their caregivers. An example of a dementia-friendly business venue in a DFC is Kim San Leng Food Centre in Bishan. Some stallholders at this food centre have been given training on how to recognise signs of dementia. They also have checklists to display in their stalls on signs of dementia and pointers on how to interact with persons living with dementia.1

At the heart of any DFC are the volunteers known as Dementia Friends. This network of Dementia Friends is an essential building block in creating a DFC. These volunteers are trained with the knowledge and skills to help persons living with dementia continue living independently and help families of persons living with dementia keep an eye on their loved ones. Today, more than 130,000 individuals from over 120 groups, businesses and organisations are aware about dementia under Dementia-Friendly Singapore and Lien Foundation’s Forget Us Not initiative.

Having a community that supports persons living with dementia helps these persons, their caregivers, and the people around them feel welcomed and respected. This can improve their overall health and well-being and reduce the strain on long-term care services. An enhanced quality of life in turn lowers the cost of dementia care in Singapore.

The strength of DFCs depends on networks of Dementia Friends who keep a look out for persons living with dementia in neighbourhoods and extend a helping hand when needed. If you would like to play a part, sign up as a Dementia Friend today!

Framework to Set Up a DFC

dementia friend

Dementia-Friendly Singapore has implemented a Dementia-Friendly Community framework with strategies to Engage, Empower and Enable persons living with dementia including a Dementia Friends mobile app to seek community help for missing persons living with dementia.

ENGAGE

Community by raising dementia awareness to keep a lookout for people living with dementia through:

1. Outreach activities (residents, constituency offices, faith-based groups, corporates, service partners and schools)
2. Targeted screening (mood and memory screening)
3. Go-To Points

EMPOWER

Caregivers, clients and at-risk individuals with services and support that cater to their needs through:

1. Preventive activities
2. Caregiver support network
3. Services (service linkages, care coordination, intervention, case management)

ENABLE

Community and partners in adopting dementia-friendly designs so that people living with dementia can live well in the community through:

1. Environment enhancements (business and built environment)
2. Technology and innovation (dementia friends app, DFSG portal, DFSG Facebook, etc.)

Mental-Health

Find out how we can play a part and build a DFC:

Mental-Health
Mental-20Health

Building a Dementia-Inclusive Singapore: How Can You Play a Part?

dementiahub

If you would like to organise a Dementia Awareness Workshop at your workplace, school or any other community space, you may contact academy@dementia.org.sg.

Organisations That Have Helped Build DFCs in Singapore

Corporates

● Building: Centre for Liveable Cities, Town Councils
● Arts & Leisure: National Library Board, National Heritage Board
● Banking: HSBC, DBS, Hong Leong Finance
● Retail: Guardian, Pure and Well
● Transport: SMRT, Grab

Community Partners

● Dementia Singapore (DSG)
● AMKFSC Community Services
● Singapore Anglican Community Services
● AWWA
● Brahm Centre
● Caregivers Alliance Limited
● Care Corner Seniors Services
● Charis ACE
● Club HEAL
● Fei Yue Community Services
● FILOS Community Services
● Montfort Care
● NTUC Health
● O’Joy Care Services
● Peace-CONNECT Cluster Support
● REACH Community Services
● Singapore Silver Ribbon
● St Hilda’s Community Services
● The Salvation Army – Peacehaven Bedok Day Centre
● Thye Hua Kwan Moral Charities
● TOUCH Community Services
● TRANS Family Services
● Viriya Community Services

Additional Resources

In order to create an inclusive Dementia-Friendly Community (iDFC) in Kebun Baru (KB), a group of students from NUS Chua Thian Poh Community Leadership Centre (CTPCLC) partners with Dementia Singapore (formerly known as Alzheimer’s Disease Association) to conduct a ground-sensing study to:

• Understand KB residents’ knowledge of and attitudes toward dementia;
• Uncover what a DFC means to them; and
• Explore what can be done to make KB dementia friendly.


This guide by the Lee Kuan Yew Centre for Innovative Cities from the Singapore University of Technology and Design (SUTD) provides guidelines and recommendations for community partners to build DFCs across Singapore.

References

  1. Lin, Y. (2017, October 8). Singapore’s first dementia-friendly coffee shop. The Straits Times. https://www.straitstimes.com/singapore/health/singapores-first-dementia-friendly-coffee-shop

The Dementia-Friendly Singapore (DFSG) initiative aims to build a more caring and inclusive society for persons living with dementia and their caregivers. These Dementia-Friendly Communities (DFC) are in Yishun, Hong Kah North, Macpherson, Queenstown, Bedok, Fengshan, Bukit Batok East, Woodlands and more.

As part of the DFSG initiative, members of the public can sign up as a Dementia Friend to join the initiative in building a Dementia-Friendly Singapore by downloading the Dementia Friends Mobile App. Dementia Friends will learn about dementia and how to communicate with persons living with dementia. Through this, they can lend a helping hand and keep a lookout for persons living with dementia who may need support.

On the Dementia Friends Mobile App, users can:

• Get info, tips and resources on dementia
• Post cases of missing loved ones and help keep a lookout
• Receive updates on events and training

Hear What Others Have to Say About the Dementia Friends Mobile App:

Download The Dementia Friends Mobile App and Sign Up As A Dementia Friend Today!

To download, search for “Dementia Friends” on Google Play for Android users, or the App Store for Apple iOS users. You may also simply click the following buttons, or scan the QR codes below:

For Android Users:

GooglePlayButton
dementiahub

For iOS Users:

AppStoreButton
dementiahub
dementiahub
dementia-hub-sg

For more information on the Dementia Friends Mobile App, visit Dementia Friendly Singapore.

Why Is a Dementia-Inclusive Environment Important?

Researchers have predicted that the number of persons living with dementia around the globe is set to almost triple to more than 150 million by 2050.1

While dementia already presents a set of challenges for persons living with dementia and their families, stigma and discrimination worsen the psychological, social, emotional and financial impacts on them, such as social rejection, financial insecurity, internalized shame, and isolation.2 Similarly, with the rising prevalence of dementia in Singapore, where one in 10 people aged 60 and above is diagnosed with dementia, these ramifications are relevant and of growing concern for the nation with an aging population.

Dementia-inclusive environments are pertinent in mitigating the stigma and discrimination against those affected by dementia.2 Such environments enable them to continue living well and be involved meaningfully in the society for as long as possible, to enjoy a good quality of life.

Ensuring the inclusivity of different spaces to persons living with dementia and their families is a society-wide endeavour. Like anyone else, they can participate in many kinds of activities and have access to different spaces when the environment is designed to support their inclusion.

Physical and social environments can be continually designed and altered in dementia-inclusive ways. These environments include both places frequented most by persons living with dementia (e.g., their own homes, centre-based services, long-term care facilities) and the wider environment (e.g., public infrastructure, transport systems, arts and religious spaces, healthcare institutions, public offices).

Defining the Physical & Social Environments for Persons Living With Dementia

There are mainly two types of environments to consider when designing a dementia-inclusive environment for persons living with dementia – the physical environment and the social environment. It is also important to take into account the ways these two types of environments interact with each other.

The World Health Organization (WHO) defines the physical and social environments as such:

Physical Environment

Refers to the immediate physical surroundings and spaces, including built infrastructure and elements, and industrial and occupational structures2

Examples (but not limited to):

• Roads, pathways, etc.
• Outdoor spaces
• Spatial layout
• Safety features
• Visual cues to orientation
• Lighting

Social Environment

Refers to the social relationships and cultural contexts within which a person lives2


Examples (but not limited to):

• Social and economic processes
• Healthcare and community care programmes and services (Please refer to our article on Programmes & Services in the Community to find out more about the efforts to make Singapore’s social environment more dementia-inclusive.)
• Cultural practices
• Religious institutions and practices

Benefits of a Well-Designed & Supportive Physical Environment

As dementia causes changes in the brain, it affects one’s perception and experience of their environments, and consequently the way they interact with the environments and vice versa. Physical environments can thus either support persons living with dementia well, or create bigger problems for them.

Designing and building the physical environments to the experience, cognitive and functional abilities, sensory changes, needs and preferences, lifestyle patterns and life history of persons living with dementia can yield positive outcomes for them.

A well-designed supportive physical environment can have several benefits for persons living with dementia, such as:3

• Reduce behavioural changes, e.g., anxiety, agitation, disorientation, social withdrawal, etc.
• Support remaining cognitive and functional abilities (lower level of dependence in activities of daily living)
• Encourage positive behaviours, e.g., increased social contact
• Enable positive and meaningful engagement
• Provide a sense of comfort and continuity of care

Aspects of Physical Environments to Address for a Dementia-Inclusive Design

A physical environment has four types of elements: (1) Fixed, (2) Semi-fixed and (3) Non-fixed features, and (4) Sensory qualities:1,2

Fixed

Features which are not movable and rarely change

Examples: Building structure, Walls, Floors, Built-in cabinets, etc.

Semi-Fixed

Features/objects which are movable and changeable

Examples: Flooring material, Window and door materials, Pieces of furniture, etc.

Non-Fixed

Features/objects which are movable and changeable

Examples: Wall decorations, Pictures, Activity materials, etc.

Sensory Qualities

Attributes of an environment that interact with our five senses

Examples: Lighting, Sound, Smell, etc.

The four types of elements are further illustrated below:

dementiahub

References

  1. Fo, A. (2021, July 27). Dementia cases ‘set to almost triple worldwide to more than 150 million by 2050’. Yahoo! News. https://sg.news.yahoo.com/dementia-cases-set-almost-triple-140000242.html?guccounter=1
  2. World Health Organization. (2021). Towards a dementia inclusive society: WHO toolkit for dementia-friendly initiatives (DFIs). https://www.who.int/publications/i/item/9789240031531
  3. Chaudhury, H., & Cooke, H. (2014). Design matters in dementia care: The role of the physical environment in dementia care settings. In M. Downs & B. Bowers (Eds.), Excellence in dementia care: Research into practice (pp. 144-158). Open University Press.

In recent years, there has been a growing pool of dementia-inclusive design guiding principles developed by subject matter experts, intended for laypersons, caregivers, and care professionals to address and enhance the different aspects of the physical environments that persons with dementia live in.

A Dementia-Inclusive Design Process

To be in line with the delivery of person-centred dementia care, the design process should take into account the voices of persons living with dementia and their families, and the voices of the communities they are from, in a collaborative and consultative manner. Persons living with dementia and their communities can draw on their unique resources and identities to shape their environments. By including the ideas and opinions of persons living with dementia and those who live in the same environment, the design process may be more beneficial and personalized for them.

Common Features Across Various Dementia-Inclusive Design Principles

Across the various design guiding principles developed by experts all over the world, here are some common features that these guidelines have highlighted what a well-designed, supportive dementia-inclusive environment should comprise:3-6

Homely & Familiar Environment

“Home” symbolizes comfort, safety, and security for many individuals. A homely environment that is familiar to persons living with dementia can provide them with the feelings of security, comfort and warmth. A familiar environment can also help them to know where they are and find where they want to go, further promoting independence and supporting wayfinding. An environment should therefore be familiar to the person living with dementia and reflect the characteristics of a typical Singaporean home setting.

Safety

Dementia brings about changes to the brain that may impair risk assessment abilities and affect judgments. It is important to create a safe environment for persons living with dementia to move around, such as increasing visibility, reducing clutter, preventing falls and avoiding access to high-risk areas.

Supporting Cognitive & Functional Abilities

A well-designed supportive environment can compensate for the cognitive impairments and functional limitations that dementia causes. Some ways to support the remaining abilities of persons living with dementia include:

• Appropriate and adequate lighting help to reduce eyestrain and improve depth perception
• Strong colour contrasts between table tops and dinnerware help to improve differentiation
• Not too much patterns in walls and flooring help to prevent distraction

Appropriate Environmental/ Sensory Stimulation

Too many stimuli in the surroundings can overstimulate persons living with dementia, leading to negative behavioural changes (e.g., confusion, disorientation, agitation, anxiety, etc.). A calm and serene environment can alleviate distress and minimize behavioural changes.

Thus, to support persons living with dementia to interact positively with their surroundings, there should be a balance in the amount of stimuli that they are exposed to. Negative stimuli should be reduced and positive stimuli should be encouraged.

Avoid exposure to:

• Loud noises and continuous sound
• Drastic swings in temperatures
• Inadequate lighting
• Bright and confusing prints

Empowerment & Autonomy

A well-designed supportive environment should empower persons with dementia to live as independently and as autonomously as possible, such as moving around by themselves and managing their own choices. This can maximize their well-being and confidence levels.

Personal Space & Privacy

Physical spaces of different functions can be created for persons living with dementia. There should be a space for them to get some privacy and enjoy quiet moments by themselves.

In centre-based services and care facilities, physical spaces for operational functions, such as delivery of goods or rubbish collection, should be designed in a manner that they do not come into the view of persons living with dementia, to reduce interference and disturbance to them.

Activity Space & Meaningful Participation

There should be physical spaces and opportunities for persons living with dementia to engage in individual and group activities which are meaningful and purposeful to them, as activities can help to maintain their cognitive and functional abilities. Activities offered to persons living with dementia should be tailored to their preferences and interests during that period of time, and be culturally and age appropriate as well.

Opportunities for Social Interactions

In centre-based services and care facilities, furniture and seating can be arranged in a manner where groups of persons living with dementia can socialize and interact, promoting their well-being.

Accessibility

A dementia-inclusive community would offer persons living with dementia easy accessibility to essential services and amenities in the neighbourhood (e.g., post office, markets/supermarkets, banks, hospitals and clinics, etc.).

Resources on Dementia-Inclusive Design Principles

Checklists and audit tools are typically included along with dementia-inclusive design guiding principles, for laypersons, caregivers, and/or care professionals to assess and identify key areas for improvement in the physical environments to better support persons living with dementia. Most of these checklists and assessment/audit tools can be self-administered.

Some of these improvements can be as small as creating signages or changing the lightings at a low cost, while others may involve larger-scale renovations which will require a higher budget. No matter what these changes are, they can have a major impact in creating dementia-inclusive environments for persons living with dementia.

In the following sections, design guiding principles developed by subject matter experts all over the world, have been consolidated and classified according to the different settings they can be applied to. Resources which contain the abovementioned checklists and assessment/audit tools will be indicated in the tables below.

Please note that the following lists of resources of design guiding principles, and checklists and assessment/audit tools are not exhaustive. Additionally, there is no one perfect checklist or assessment/audit tool, users may select one or a combination of several tools that suit their needs.

Most importantly, one should understand and be thoroughly familiar with the guiding principles to design and create a dementia-inclusive and person-centred environment, before putting them into practice.

The section below lists resources on dementia-inclusive design for:

• Physical Environments of Various Settings
• Outdoor Environments

List of Resources on Physical Environments of Various Settings

Local Resources

“Looking to the Future” (2nd Edition) and Singaporean Environment Assessment Tool (SEAT)

The second edition of “Looking to the Future” serves as a guidebook to build dementia-friendly design in community care facilities in Singapore.

On top of detailing the six principles in designing dementia-friendly facilities and spaces, it provides recommendations and examples of how users may put these principles into practice in various physical spaces, including:

• Common Areas (lobby, lift lobbies, entrances and exits)
• Bedrooms
• Toilets and Showers
• Therapeutic Activity Spaces
• Sensory and Reminiscence Areas
• Quiet Spaces
• Dining Areas and Dry Pantries
• Therapeutic Gardens and Outdoor Spaces

The second part of the guidebook introduces the Singaporean Environment Assessment Tool (SEAT), which provides a systematic framework for reviewing environments for people living with dementia and identifying areas for improvement. The SEAT is designed to be used by a non-design professional and can be completed by a member of staff or a person visiting the facility with minimal knowledge of dementia care.


Elderly- and Dementia-Friendly Environment

This booklet by Nanyang Polytechnic, Dementia Singapore, and Agency for Integrated Care serves as a guidance and starting point for individuals who intend to build an inclusive, supportive, and sustainable environmental design in Housing and Development Board (HDB) flats/apartments where most Singaporeans reside, and in which most elderly and persons living with dementia are living with their families.

It offers recommendations on the therapeutic design of the physical environment, including both environments inside and outside (Residential Estate) of a HDB flat/ apartment.

The booklet also offers a 79-item checklist that reminds and recommends individuals the aspects to focus on when considering designing and building an elderly- and dementia-inclusive environment. This checklist focuses on the following areas:

• Spatial Environment
• Wayfinding
• Accessibility and Safety
• Lighting and Nature
• Colour Contrast
• Tranquil Environment
• Barriers or Challenges

Overseas Resources

Dementia Enabling Environment Virtual Information Centre

Alzheimer’s Western Australia’s Dementia Enabling Environment Virtual Information Centre provides design guiding principles, practical tips, and resources to make some physical environments more dementia enabling. These environments include:

• The home
• Care environments
• Gardens
• Public buildings
• Hospitals

This Virtual Information Centre also provides a pool of Environmental Assessment Tools and Design Audit Tools for use to assess dementia care environments.


Resources from the National Disability Authority in Ireland

The National Disability Authority in Ireland has published resources which provide useful pointers and discussion points on designing dementia-inclusive environments.

Research for “Dementia and Home Design in Ireland Looking at New Build and Retro-Fit Homes From a Universal Design Approach: Key Findings and Recommendations Report 2015

This 2015 report was written as part of a collaborative research study that was developed to underpin the development of Ireland’s national Guidelines used to inform future design of dwelling for persons living with dementia, and to retrofit existing dwellings using a Universal Design approach.

Universal Design Guidelines Dementia Friendly Dwellings for People With Dementia, Their Families and Carers Centre for Excellence in Universal Design

These guidelines were developed in response to the collaborative research study detailed in the 2015 report above.

List of Resources for Outdoor Environments Only

Local Resources

Six Principles of Dementia-Friendly Neighbourhood

The Agency for Integrated Care and Singapore University of Technology and Design have authored a document which outlines six guiding principles and features which are useful for designing dementia-friendly outdoor spaces and environments in Singapore. Good practices of dementia-friendly interventions are offered in this document for consideration as well.

Overseas Resources

Neighbourhoods for Life

Mitchell, Burton & Raman (2004) have created a checklist of recommendations to help housing associations/boards improve and design dementia-friendly outdoor environments. These recommendations are supported by findings of a three-year research project.

• Checklist of recommendations
• Evidence behind the checklist of recommendations

References

  1. Rapoport, A. (1990). The meaning of the built environment: A nonverbal communication approach. University of Arizona Press
  2. Chaudhury, H., & Cooke, H. (2014). Design matters in dementia care: The role of the physical environment in dementia care settings. In M. Downs & B. Bowers (Eds.), Excellence in dementia care: Research into practice (pp. 144-158). Open University Press.
  3. Agency for Integrated Care. (2021). Looking into the future (second edition): Inclusive design for people living with dementia. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/Looking%20to%20the%20Future.pdf
  4. Nanyang Polytechnic, & Alzheimer’s Disease Association. (2019). Elderly- and dementia-inclusive environment. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/AIC%20NYP%20Guidebook%20Eng.pdf
  5. Yuen, B., Bhuyan, M. R., Močnik, Š., & Yap, W. (2020). Six principles of dementia-friendly neighbourhood. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/SUTL%20Dementia%20Friendly%20Guidelines.pdf
  6. Chaudhury, H., Hung, L., & Badger, M. (2013). The Role of Physical Environment in Supporting Person-centered Dining in Long-Term Care. American Journal of Alzheimer’s Disease & Other Dementias, 28(5), 491–500. doi: 10.1177/1533317513488923

This article lists some examples of neighbourhoods in Singapore, where adjustments have been made to address the needs of persons impacted by dementia. These examples feature the adaptation of different aspects of the environment, including the physical and social environments, to aid wayfinding and support the wellbeing of persons living with dementia.

In addition, this guide by the Lee Kuan Yew Centre for Innovative Cities from the Singapore University of Technology and Design provides guidelines and recommendations for community partners to build Dementia-Friendly Communities (DFCs) across Singapore.

Kebun Baru, Singapore

To create an inclusive Dementia-Friendly Community (iDFC) in Kebun Baru (KB), a group of students from NUS Chua Thian Poh Community Leadership Centre partners with Dementia Singapore (formerly known as Alzheimer’s Disease Association) to conduct a ground-sensing study to:

• Understand KB residents’ knowledge of and attitudes toward dementia;
• Uncover what a DFC means to them; and
• Explore what can be done to make KB dementia friendly.


dementia-hub-sg

From late 2019 to March 2020, a collaborative project between Dementia Singapore, grassroots leaders, and community partners was conducted in the community of Kebun Baru, Ang Mo Kio. One of the initiatives in this project was the Wayfinding Project, which aimed to make wayfinding, that is, navigation of physical surroundings, easier for persons living with dementia in this community.

Discussions were held with two persons living with young-onset dementia, participants from Dementia Singapore’s Voices for Hope programme for persons living with dementia and their caregivers, and Mr Henry Kwek (Member of Parliament and Advisor for Kebun Baru Constituency). Following this, murals of familiar retro items were painted on strategically-located walls at void decks of HDB blocks in two Residents’ Committees. In effect, these murals can function as landmarks that differentiate buildings and corridors from each other, making it easier for person living with dementia to orientate themselves while moving through this vicinity.

Sources on Kebun Baru: Dementia Singapore1

Woodlands, Singapore

As part of the Dementia Friendly Singapore initiative spearheaded by the Ministry of Health and supported by the Agency for Integrated Care (AIC) and community partners, a DFC initiative was launched in Woodlands Estate in November 2019.

A key feature of Woodland’s DFC initiative is the Dementia Friends Mobilisation Team. The team is involved in engaging and educating various segments of the community, including young persons, residents, merchants, students, and hawkers, on what dementia is, how to befriend and engage persons living with dementia, and what to do if they encounter a person living with dementia.

Another feature of the DFC initiative is the creation of 15 Go-To Points in Woodlands, which are locations where lost person living with dementia can be brought to. At Go-To Points, trained staff can provide advice, calm persons living with dementia, and aid in identifying and contacting these persons’ next-of-kin. In addition, the public can access information about dementia and these locations. Some of these points currently include shops, medical and social care centres, and a community centre.

Sources on Woodlands DFC: The Straits Times2 and TODAYonline3

Yishun, Singapore

Yishun, like Woodlands, is also a neighbourhood in Singapore designated as a DFC. The government, private merchants, community organisations, and health and social care partners are involved in making the Yishun community more inclusive for persons living with dementia.

Like other DFCs, Yishun has dementia Go-To Points. One such point at the Sree Narayana Mission Nursing Home is a 24/7 Go-To Point, ensuring that there is round-the-clock support for persons living with dementia in Yishun.4

Notably, the now nationwide Forget Us Not collaborative campaign involving Lien Foundation, Khoo Teck Puat Hospital (KTPH) and Dementia Singapore, which first started as a ground-up initiative in 2016 at KTPH, has conducted education and training sessions for personnel both islandwide and in the Yishun vicinity, where KTPH is located. Amongst other initiatives that the campaign has seen, staff at KTPH’s call centre and Yishun Community Hospital, including more frequently front-facing staff such as security personnel and those stationed at public-facing areas of the hospitals, have undergone dementia training.5,6

The neighbourhood also features blocks repainted with distinctive colours and block numbers to help persons living with dementia differentiate between them, enhancing the ease with which they navigate the area. Murals of fishes, trees and pineapples reminiscent of Yishun’s history were also created to build a sense of the area’s identity amongst residents.

Yishun Integrated Transport Hub, which opened in 2019, is an example of how infrastructure can be designed with an eye on including persons living with dementia. It features a more elder- and dementia-inclusive physical environment, with larger and more easy-to-read directional signs, barrier-free bus boarding and alighting points, and a quiet room for commuters to access a quiet and calming environment. A dementia Go-To Point allows members of the public to guide persons living with dementia to a designated place where these persons can find assistance. Staff are also trained to identify and assist persons who display signs of dementia.7

dementia-hub-sg

Another group on board with efforts to care for persons living with dementia is the Yishun North Neighbourhood Police Centre’s Citizens-on-Patrol team. Members of the citizen volunteer team are trained to detect, respond, and assist persons living with dementia while on patrol.8

References

  1. Dementia Singapore. (2020, April 20). Building an inclusive, dementia-friendly Kebun Baru. https://dementia.org.sg/2020/04/20/building-an-inclusive-dementia-friendly-kebun-baru/
  2. Koh, F. (2019, November 24). Young people to play central role in making Woodlands dementia-friendly. The Straits Times. https://www.straitstimes.com/singapore/young-people-to-play-central-role-in-making-woodlands-dementia-friendly
  3. Tang, L. (2019, November 24). ‘Not an old-person problem’: Outreach team getting youth to help tackle dementia. TODAYonline. https://www.todayonline.com/singapore/not-old-person-problem-mobilisation-team-involving-youth-tackling-dementia
  4. Hong, J. (2017, September 10). First 24-hour dementia go-to point launched in Yishun. The Straits Times. https://www.straitstimes.com/singapore/first-24-hour-dementia-go-to-point-launched-in-yishun
  5. Lien Foundation. (2016, January 20). Yishun, Singapore’s first dementia-friendly estate follows the trend of leading dementia-friendly communities around the world. [Press release]. http://www.lienfoundation.org/sites/default/files/Forget%20Us%20Not%20Press%20Release%20Final%20Combined_0.pdf
  6. Lien Foundation. (n.d.). Forget Us Not. Retrieved February 22, 2021, from https://www.lienfoundation.org/project/forget-us-not
  7. Agency for Integrated Care. (2019, October 29). 5 Ways Yishun Integrated Transport Hub is Senior and Dementia Friendly. https://www.aic-blog.com/5-ways-yishun-integrated-transport-hub-senior-and-dementia-friendly
  8. Yap, E. (2016, January 20). Let’s not forget dementia. Ageless Online. https://www.agelessonline.net/lets-not-forget-dementia/

CARA Membership Replaces NCSS’ Safe Return Card

CARA replaces the existing Safe Return Card (SRC) initiative by the National Council of Social Service (NCSS) used by persons living with dementia. A pioneering membership programme by Dementia Singapore – formerly known as Alzheimer’s Disease Association (ADA) – the CARA membership will have the same safe return functions of the Safe Return Card, but with added features and benefits.

What Is CARA Membership?

dementia-hub-sg

Community | Assurance | Rewards | Acceptance

CARA is a lifestyle and community digital platform that provides easy access for persons living with dementia and caregivers to connect to an ecosystem of solutions via a mobile application. It serves as a key touchpoint for members, providing personalised support across the journey of living with and caring for dementia.

CARA is a catalyst for creating a Community of like-minded people to drive conversation and spark initiatives that will enable persons living with dementia and their caregivers to lead meaningful and purposeful lives.

With CARA, the Safe Return functionality has been enhanced through the provision of a unique QR code identifier for each member living with dementia. This provides Assurance that persons living with dementia can continue to move freely and independently within a safe community, giving caregivers a greater peace of mind.

All CARA members will get to enjoy tailored Rewards from our carefully selected partners who share our vision. CARA Advocates for inclusion and facilitates a dementia-ready future so that persons living with dementia and their caregivers feel respected, supported, and Accepted by society.

As part of Dementia Singapore, CARA will partner organisations, caregivers, and systems to strengthen the overall effectiveness of the dementia care ecosystem. We aim to enable the best care for our members, now and into the future.

CARA as Family Care Circle: Connecting Multiple Caregivers to a Loved One Living With Dementia

We know caring for a loved one living with dementia is a team effort. Members of a family all play different roles in the caregiving journey. A platform to communicate and connect easily with each other enhances the quality of dementia care. With CARA, multiple family members in the care circle can link their account to their loved one living with dementia and receive timely updates. Every member would be able to build their own profile within the CARA app, access safe return notifications, and enjoy the benefits of CARA.

dementia-hub-sg

Who Can Apply, and How?

A CARA membership is eligible to Singapore residents who are either a) living with dementia, or b) is a caregiver of a person living with dementia. Members living with dementia will receive the physical CARA card and e-card in the app. Caregivers will only receive the e-card.

To apply, download the CARA SG mobile application from Google Play for Android users or the App Store for Apple iOS users and you will be guided through the sign-up process.

Be a Dementia-Inclusive Business

In a significant step towards building a dementia-inclusive society, Dementia Singapore has launched Singapore’s first toolkit for businesses, offering a dementia-inclusive three-stage framework that can be easily integrated into their business practices.

STAGE 1: AWARENESS

 

At this stage, businesses are just becoming aware of dementia as an issue they need to address. There is an interest to learn more about dementia.

STAGE 2: FRIENDLINESS

 

As businesses take action to become dementia-friendly, they ensure the physical facilities and infrastructure of their stores are adjusted to the needs of customers with dementia. Employees are also trained to support and handle the needs of customers with dementia.

STAGE 3: INCLUSIVENESS

 

To become dementia-inclusive, businesses take steps to support not only customers, but also employees impacted by dementia. This includes hiring and retaining employees with dementia, and providing support to employees who are carers to persons with dementia. A truly inclusive business leaves no one behind.

The “Business Toolkit for a Dementia-Inclusive Singapore” contains a checklist, helping you to fulfil each stage as your business progresses to become dementia-inclusive.

The toolkit also includes personal experiences from persons living with dementia and their carers to help companies better understand their challenges. It also contains case studies of other organisations both locally and overseas that have successfully transitioned to become dementia-friendly and inclusive.

This toolkit is just as applicable to an individual as a 1,000 strong organisation. You can make a difference by starting a dementia-inclusive business initiative within a department and inspire others and the organisation to do the same.

Download the Business Toolkit now!