PLWD Archive - DementiaHub.SG

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.

Age-related Changes

Dementia

Problems with memory

Occasionally forgetting names or appointments and events, but being able to remember them later. Sometimes, completely forgetting what others have mentioned.

May have trouble remembering people or important dates and events, and/or ask for the same information over and over again to the point that this can affect their daily activities (e.g., getting around and making purchases).

Misplacing items

Occasionally misplacing items, but being able to retrace steps to find them.

Losing items and being unable to retrace steps to find them. Placing things in unusual places (e.g., placing a mobile phone in the refrigerator), and/or accusing others of stealing. These behaviours might occur more frequently over time.

Problems with visual perception

Age-related vision changes, such as cataracts or glaucoma, can result in poor vision.

Becoming unable to recognise objects and faces due to changes in the brain. Difficulty in identifying patterns, colours, distances and spaces (e.g., perceiving glare on the floor as a pool of water).

Problems with walking & mobility

Due to age-related health reasons, such as muscle weakness and joint problems, may experience pain and stiffness when walking, or have reduced tolerance to walk long distances or climb the stairs.

Gradually losing the ability to walk safely due to reduced balance and awareness of the environment. May require more support to sit, stand and move over time.

Changes in mood, behaviour & personality

Getting tired of work, family and social activities sometimes, and feeling a little down or anxious. Occasionally becoming irritable when familiar routines or specific ways of doing things are disrupted.

Having rapid mood swings for no apparent reason, withdrawing from social activities, becoming passive, and sleeping more than usual. Becoming a little insensitive towards others.

Confusion with time & places

Occasionally getting confused about the day of the week but able to figure it out later. Sometimes, going to a spot in the house and forgetting the reason of going there, but able to remember the reason again.

Being unable to tell the time, or experiencing confusion about meal times (e.g., asking for lunch at night). Being unable to recognise their location, even their own home, which leads to feelings of frustration in unfamiliar or noisy environments. Getting lost in familiar places they often go to.

Difficulties in communication

Experiencing a bit of difficulty finding the right word sometimes. Needing to concentrate harder to keep up with a conversation, but sometimes losing track of the conversation if distracted or if multiple people speak at the same time.

Struggling to express themselves, and having trouble finding the right word or naming objects. Having problems understanding what others are saying, and sometimes stopping conversations without knowing how to continue.

Judgement & social behaviour

Making a bad decision once in a while.

Not knowing if it is safe or correct to do certain things (e.g., giving large amounts of money to strangers, or shouting and taking off clothes in public).

Difficulties in planning, thinking & completing familiar tasks

Being a bit slower to react to things or think things through, and becoming less able to multitask, especially when distracted. Occasionally making a mistake, e.g. when planning the monthly household budget.

Having difficulty planning and carrying out familiar and daily tasks (e.g., organising a grocery list, managing the monthly household budget and paying bills, or remembering the rules of a favourite game). Paying less attention to grooming or hygiene. Having trouble concentrating and following instructions, and because of this, taking a much longer time to do things.

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

9 Differences Between Normal Aging & Dementia

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.

Read Next

Though these articles are written for caregivers, reading them may equip you with knowledge about how to live with your condition:

1. Designing A Daily Routine
2. Inspiring Stories

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 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 one with the perspective of a person living with dementia. Experience the challenges a person living with dementia faces in a typical apartment in Singapore, and consider how the environment can be modified 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

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

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

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

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

Statistics on Dementia on a Global Scale

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

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

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

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

Downloadable Resources

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

Click on the images below to download in English.

Forget Us Not: Building a Dementia Friendly Community

understanding-dementia

Understanding Dementia

References

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

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

Misconception: Dementia is a natural part of ageing.

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

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

In normal ageing, a person may:

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

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

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

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

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

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

Misconception: Persons living with dementia only experience memory loss.

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

Common symptoms of different types of dementia include:

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

Sometimes, other behavioural and psychological symptoms may also occur:

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

Misconception: Dementia only affects older people.

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

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

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

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

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

Misconception: Dementia can be completely prevented.

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

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

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

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

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

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

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

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

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

Find out more on Dementia-Inclusive Environments.

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

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

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

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

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

Misconception: Dementia is hereditary.

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

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

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

References

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

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

Dementia & Mild Cognitive Impairment (MCI)

Dementia and mild cognitive impairment are different conditions.

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

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

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

Adapted from: SingHealth1

Dementia & Depression

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

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

Some key differences between dementia and depression are:3

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

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

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

Dementia & Delirium

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

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

Adapted from: Changi General Hospital4 and HealthXchange.sg5

References

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

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

Alzheimer’s Disease (AD)

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

Vascular Dementia

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

Lewy Body Dementia (LBD)

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

Fronto-Temporal Dementia (FTD)

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

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

Alcohol-Related Dementia

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

Downloadable Resources

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

Click on the image below to download in English.

understanding-dementia

Understanding Dementia

References

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

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

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

dementia-hub-sg

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

There are many changes that come along with living independently with dementia.

If you are staying on your own and currently living with early-stage dementia or mild cognitive impairment (MCI), here are some tips to cope with the changes to maintain your independence for as long as possible.

Make Everyday Tasks Easier

Have a regular daily routine
Create a regular routine, which makes it easier for you to remember what to do in a day. You may consider different types of activities on some days, such as meeting a loved one and going out to have fun. These activities will help your days be more meaningful and engaging, and prevent from being mundane or boring.


Organise your day
Place a calendar or notebook at a place where you can see frequently such as on the door of your refrigerator. On this calendar, you can use it to keep track of your:

• To-do list for the day
• Appointments, such as medical appointments, meeting your family and friends, etc.
• Strike off tasks and appointments when you complete them. At the end of each day, cross out the date on your calendar, as this helps you to be certain of the date when you wake up the next day.
• You may also keep a diary to journal down your everyday activities.
• You can write a few sentences, stick photos and memos (meal receipts, grocery lists and receipts, movie tickets, etc.) to indicate what you have done. You can also write your feelings for the day.
• From time to time, you can look back at this diary to remind you what you did or felt previously.


Use labels and notes
You can stick labels on your cupboards to remind you of the items that are stored inside. You can also stick notes on your main door to remind you to bring your keys and wallet when you head out of the house.


How to remember to pay bills
To avoid missing payments, consider setting up GIRO arrangements to pay the bills from your billing organisations (utility providers, telecommunications companies, insurance companies, etc.). You can apply for GIRO arrangements through Internet Banking or by calling the billing organisations for their GIRO application forms.

If you are concerned that you may forget about the bank account and the GIRO standing instruction, you can ask a trusted person to remind you about it occasionally.

• You can write the bank’s hotline number at a place you usually look at every day in case you need to contact the bank.
• Alternatively, you may ask someone you trust to help you pay your bills. This person can also help to review your financial statements and inform you of any unusual activity.


How to manage medications
There are several products which you can use to help you organise and schedule medication dosages. These products include weekly pill boxes and electronic pill boxes with an alarm clock. You can buy these boxes at pharmacies or online stores. Alternatively, you can create reminders on your phone or computer to take your medications.

Ensure Your Home Is Safe

Making minor modifications to your home can help create a safer and simpler environment for you to continue living independently with dementia. For example:


Create more open spaces
Get rid of unused items such as clothing, appliances, and furniture that are taking up space in your home. Paths to common places, such as corridors leading to your kitchen and bathroom(s) should be direct and free of obstacles.


Remove items to minimise fall risk
Remove or tack down carpets and rugs to prevent slippage. Remove or ensure that electrical cords and wires are tied away (along the walls or at a corner) from pathways for walking to minimise the possibility of tripping over them. Falls can cause injury and disability and make living alone inconvenient or challenging.


Improve lighting
Install night lights in your living room, bedrooms, toilets, and/or along the hallways. Adequate lighting can help you to see better and move around safely at night. Another affordable but useful installation you can make is to make light switches easier to locate by applying glow-in-the-dark tape over them.


Use a stove which turns off automatically
Instead of using a gas stove, consider installing a time-controlled gas hob which has a digital timer that automatically cuts off the gas supply after a pre-set time is up. Read a news article by the Straits Times on gas hobs with safety features.

It is very dangerous should you forget to turn off your gas stove and leave it running. If the stove emits too much flammable gas to the environment after it is left running, a spark can easily set fire to the gas and cause a fire in the house.

Alternatively, consider using an electric stove or induction cooker which switches off automatically when it does not detect pots and pans on its surface.


Install a Home Fire Alarm Device (HFAD)
You can also install a Home Fire Alarm Device (HFAD) if your house does not already have one. The HFAD can detect an incipient fire or white smoke from unattended cooking or electrical fire within the house, and sound an alarm to alert the occupant. When one is alerted about the fire in the house, he/she can either attend to the small fire, or call 995 and escape. Find out more about HFAD.

Find the list of retailers who provide HFADs on SCDF’s website.


Install other safety devices
Other safety devices you may want to consider include GPS trackers, emergency alert buttons, and fall monitors. Ask a family or friend to help you buy the right device and set it up for you. Find out more about these devices.


The 360° Virtual Reality Dementia-Friendly HDB Home Design Guide
Visit the latest 360° Virtual Reality Dementia-Friendly HDB Home Design Guide to learn how best to modify your home based on your needs and preferences to continue living independently with dementia.

Carry Your CARA Membership Card

The CARA membership card is helpful in case you get lost or need help. It replaces the former National Council of Social Service (NCSS) Safe Return Card, which now comes with enhanced features. The CARA membership card contains a QR code unique to the registered person living with dementia. In the event that you are lost, members of the public can scan this QR code to raise an alert via form submission. Once the form is submitted, your family or friend tagged to your account will be informed and will be able to help you to safely return home.

Find out more about CARA.

Build Your Support System

Identify people whom you can trust
Identify family and friends whom you can trust and have them as your emergency contacts. Write their phone numbers on a piece of paper and stick it beside your home phone, or save their numbers in your mobile phone. Consider entering their numbers into your speed dial contacts.


Consider sharing your diagnosis with neighbours whom you can trust
Good neighbours can be like family, and they are people who live in the closest proximity to you. If they are aware of your dementia diagnosis, they can keep a lookout and support you when you appear lost or require help.


Go for your scheduled medical appointments
Do not skip the medical appointments with your doctor who oversees care for your dementia condition.

• Your doctor can keep track of the changes associated with your dementia, and both develop and track a care plan for you that has your best interests at heart.

• Your doctor can also provide you with recommendations if you require additional care services (such as medication management services, medical escort services, assistance with daily living activities), or if participating in some programmes in the community may benefit you.


Join support groups
Dementia Singapore has multiple services and programmes for persons living with dementia. You can call Dementia Singapore’s helpline at 6377 0700 or visit the website to find out more. Connecting with like-minded individuals and seeking emotional and social support from them may give you strength in knowing that you are not alone in your dementia journey.

Keep Your Mind & Body Healthy

Living independently with dementia also includes adopting a healthy lifestyle. Keeping physically active, eating a healthy and balanced diet, getting enough sleep, and engaging in social activities have shown to help slow down dementia progression.

Physical exercises
Healthy food recipes
• Sleep well – Try to get at least 7 to 8 hours of sleep every night.
• Social activities – Continue to stay connected with your family and friends, visit and chat with them regularly. You may also join a programme at Dementia Singapore.

As your dementia progresses to moderate and advanced stages, alternative living arrangements have to be made because it may no longer be safe for you to to live independently.

It is important to include your loved ones (family and/ or friends) in this discussion on alternative living arrangements so that they understand the way you prefer to be cared for. Ideally, you should start these discussions as early as you can in your dementia journey. Find out more about what you can discuss with your loved ones here: Financial and Legal Support

References

  1. National Institute on Aging. (2019, November 12). Tips for living alone with early-stage dementia. https://www.nia.nih.gov/health/tips-living-alone-early-stage-dementia
  2. Alzheimer’s Society. (n.d.). Staying independent. https://www.alzheimers.org.uk/get-support/staying-independent
  3. Alzheimer’s Society. (2017). The memory handbook: A practical guide to living with memory problems. https://www.alzheimers.org.uk/sites/default/files/pdf/the_memory_handbook.pdf

Driving can represent independence and freedom for a person. One of the first concerns caregivers have when a loved one is diagnosed with dementia, is whether or not he or she should drive. While it may seem like an easy and automatic activity for frequent drivers, safe driving is a complex task which requires a range of cognitive abilities,1-4 such as:

• Attention and concentration: To focus on and switch between different driving tasks while ‘reading’ the road;
Visuospatial skills: To keep to the right speed, distance and road position;
Problem-solving skills: To deal with any incidents and challenges on the road, such diversions or obstacles;
Judgement and decision-making: For example, to understand and prepare for the behaviours of other drivers;
Fast reaction time and skills: For example, to act quickly to avoid an accident; and
Memory: For example, to remember a route.3,4

When Should One With Dementia Stop Driving

A dementia diagnosis does not always mean a person has to stop driving immediately. Some individuals in the early stages or with mild cognitive impairment (MCI) still drive.5

However, as dementia is a progressive condition that affects a person’s cognitive function, it can gradually affect your ability to drive safely, compromising your own and others’ safety. Driving will no longer be an option and you must stop.

Signs of Unsafe Driving

1. Getting lost when on familiar routes to places you know well

2. Not staying in the lane (drift between lanes)

3. Confusing the brake and gas pedals

4. Failing to observe traffic signs

5. Making slow or poor decisions in traffic

6. Hitting curbs or rounding a bend

7. Road hogging or speeding

8. Becoming angry or confused easily and frequently while on the road

9. Being involved in minor accidents or near-misses

10. Getting more traffic fines

Deciding to stop driving is a difficult decision, but it does not mean the end of your independence and freedom.

For your own safety and that of others on the road, it is important for you to be honest and open about your condition to your doctor and loved ones. Do not withhold information from your doctor to keep your license since this may put both you and others at risk.1

Look for Alternative Transportation Options

Fortunately, Singapore’s public transport system is amongst the best in the world. You can easily get around Singapore by various modes of transport – by taxi, private-hire car, MRT, and/or bus.

To help with your transition, you can begin taking public transport more often while you are still capable of driving. For example, you can take the public transport to your neighbourhood to buy your groceries, to a community centre, or to the shopping centre.

References

  1. UBC eHealth Strategy Office. (2011). Getting to know dementia: A patient’s guide to diagnosis, treatment, and care. https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Topics/Mental-Health-Substance-Use/Getting_to_know_dementia_a_patient_guide_to_diagnosis_treatment_and_care.pdf?la=en&hash=11C5366B58CAB0628DC4979E9E91976F1EBBF615
  2. Dementia Australia. (n.d.). Dementia and driving. https://www.dementia.org.au/resources/dementia-and-driving
  3. Alzheimer’s Society. (n.d.). Driving and Dementia. https://www.alzheimers.org.uk/get-support/staying-independent/driving-dementia
  4. Alzheimer’s Society. (2020). Driving and dementia. https://www.alzheimers.org.uk/sites/default/files/2018-10/439LP%20Driving%20and%20dementia.pdf
  5. Alzheimer Scotland. (2016). Driving and dementia. https://www.eddn.org.uk/wp-content/uploads/2018/01/Driving-and-Dementia.pdf
  6. Mayo Clinic. (2019, July 3). Alzheimer’s and dementia: When to stop driving. https://newsnetwork.mayoclinic.org/discussion/alzheimers-and-dementia-when-to-stop-driving/.
  7. Alzheimer’s Association. (n.d.). Dementia and driving. https://www.alz.org/help-support/caregiving/safety/dementia-driving

Work plays a central role in our lives, providing us with a sense of fulfilment, personal development, and income. There are many decisions to make about employment for persons with young-onset dementia, including whether or not to tell your employer, what changes could be made to the workplace and how long to continue working.

The issues related to deciding whether or not to tell an employer about a diagnosis of young-onset dementia can be very complex. There are no set rules that will work for everyone. For many people it will depend on the extent to which symptoms affect their ability to do their job, the pace at which symptoms are progressing, and the support that may be required of (or that’s likely to be offered by) the employer.

There may be no impact on employment for persons with young-onset dementia at the early stages, although a person’s ability to do their work is likely to be affected over time. It is important for people with young-onset dementia to consider a number of options before making a decision about continuing with on-going employment and/ or informing their employer.

Assessing the Employment Situation

• Consider possible safety risks associated with dementia symptoms (for example, if operating machinery, being responsible for financial matters or driving work vehicles) and if there is a duty of care to inform an employer or clients receiving a service.

• Allow time to absorb the diagnosis and don’t rush into any decisions.

• Fully review all aspects of the situation before telling an employer.

• Talk to family, health professionals and where appropriate, a union representative or anti-discrimination advocate about working conditions and health issues.

• Before considering resignation from employment, seek consultation and advice about employee entitlements and rights.

It may be useful to consider:

• Job satisfaction or work performance in the current role.

• Access to staff counselling.

• Number of years of service to the company.

• Nature of the work you do, and whether changes associated with young onset dementia may affect others.

• Ability of the company to provide support.

• Relationships with peers and management.

• Whether it may be possible to change or reduce duties or put in place supports that may assist in carrying out the job.

• Available superannuation, death or disability insurance.

• Availability of an advocate when interacting with the employer.

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

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

A continued inability to accept a dementia diagnosis can pose problems if persons living with dementia refuse to accept help in the future, or continue activities like driving even when it has become unsafe to do so. The difficulty in acknowledging the experience of memory or cognitive difficulties could sometimes be due to fear, or a genuine inability to understand that there is a problem. If you find it difficult to accept a dementia diagnosis, it is important to identify the reason for this so that you know how to tackle the problem.

Anosognosia

In some cases, a struggle to acknowledge dementia does not stem from an active effort to deny the signs, but rather is due to an inability to understand that there is an impairment. Known as anosognosia, changes in the brain mean that individuals with dementia truly believe that there is nothing wrong with them. If others tell you that you have been showing signs of dementia, but what they say confuses you, this confusion may be due to brain changes. You may also feel frustrated or worried thinking about how you may experience anosognosia in the future. It is important that you acknowledge that this frustration is not your fault, or anyone’s fault, and accept it for what it is.

With anosognosia, no amount of evidence can convince a person with dementia to accept their diagnosis. Your caregiver(s) and care professionals will need to come up with caregiving strategies to work around this. As long as it does not pose a safety issue, it is okay to for them to allow you to keep helping out around the house.

If you or your loved ones suspect that you experience periods of anosognosia, it is important to consult a clinical psychologist or a psychiatrist to get a proper diagnosis. A medical professional will also be able to better advise you on how to proceed in such situations. Caregivers and care professionals may consult psychologists or care professionals in the future too should they believe that you have anosognosia.

Fear

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

Right after you receive your diagnosis, give yourself some time and space to think about it, and how you want to approach the situation or proceed. If you continue to find it difficult to accept your diagnosis, you can ask for support from caregivers, loved ones, and care professionals.

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

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

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.

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.

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.

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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:

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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:

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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?

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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
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For iOS Users:

AppStoreButton
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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:

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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 multiple 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 Only

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.

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