Monday 26 October 2015

Dementia-friendly society 'crucial for ageing well'

Minister stresses need to raise awareness, build suitable infrastructure and focus on research
By Linette Lai, The Straits Times, 24 Oct 2015

Tackling dementia on "a few fronts" is the key to helping Singaporeans age well, Health Minister Gan Kim Yong said yesterday.

This includes raising awareness about the condition, building infrastructure suited to people who have it, and focusing research on how to delay its onset.

"While it is important for us to focus on the 'hardware', it is even more important for us to foster stronger community support and create dementia-friendly communities," Mr Gan said.

He was speaking at the Alzheimer's Disease Association's (ADA) 25th anniversary symposium held at the Concorde Hotel .

In Singapore, dementia affects an estimated one in 10 people aged over 60. Alzheimer's disease is the most common type of dementia, affecting over 70 per cent of patients.

Yesterday, Mr Gan highlighted the example of Chong Pang, where the Agency for Integrated Care and Alexandra Health System have been working to pilot such a community.

Their task was to make sure everyone in the area - from retailers to primary school pupils - had a basic understanding of the condition and how to help those with it cope.

Chong Pang has around 50,000 residents, 20 per cent of whom are aged above 65. An estimated 1,000 of these seniors have dementia, and may run into problems when going about their daily chores.

For example, said Dr Philip Yap, senior consultant and director of Khoo Teck Puat Hospital's geriatric centre, they may often unintentionally shoplift or withdraw the same amount of money several times a day due to their failing memories. They also have a tendency to get lost on public transport.

His team has been working with security guards and bank staff to help them spot such warning signs.

"For example, if someone comes repeatedly to draw money, perhaps alarm bells should ring," Dr Yap said. "We teach (the staff) to be patient and to help calm them down."

He has also been working with primary schools, hoping pupils will share what they learn with their parents. "Many people have heard of dementia, but are not altogether familiar with the manifestations."

Yesterday, the ADA also shared findings of a focus group discussion it held to find out how many people think Singapore is dementia-friendly. Of the 91 surveyed, almost nine in 10 said they felt Singapore was not dementia-friendly at all, according to ADA chief executive Jason Foo.

One of the issues highlighted was the way that places and buildings change very quickly in Singapore.

Said Mr Foo: "As we advance, we change things and we forget that there's this group of people who cannot keep up."

Healthcare professionals pilot home-based care system for advanced dementia patients
116 patients are currently on Project Dignity, funded by Temasek Cares, the philanthropic arm of Temasek Holdings.
By Imelda Saad, Channel NewsAsia, 23 Oct 2015

A team of healthcare professionals is pioneering a home-based care system for persons with advanced end-stage dementia. 116 patients are currently on Project Dignity, which is being funded by Temasek Cares, the philanthropic arm of Temasek Holdings.

Mdm Hewa Rose Marlini Gardi's husband suffers from advanced end stage dementia. The 82-year-old former civil and structural engineer cannot move and cannot speak. Mdm Rose does not even know if he can recognise her anymore.

The 71-year-old said that at one point, she was crying every day, not knowing how to handle her husband. The frequent trips to the hospital also took its toll on both Mdm Rose and her husband.

"Prepare him, bathe him, we have to do everything early," said Mdm Rose. "We also have to feed him. He's (always) very tired. He groans very night because his body is in pain."

Over the past year though, Mdm Rose received help from a team of healthcare professionals. Led by a doctor, the team supports persons with dementia and their caregivers, with scheduled home visits. This cuts back on the stress of a hospital stay.

"We know that in the last year of our patient's life, with advanced dementia, the frequency of complications increases," said Dr Allyn Hum, senior consultant at Tan Tock Seng Hospital's Department of Palliative Medicine.

She added: "Many of our patients have infections that require them to come back to the hospital. The unfortunate reality is that in spite of coming back to the hospitals many of my patients do not do better than (than) when they first came in and in fact they may also have more suffering in the hospital because they are in an unfamiliar environment and may be cared for by caregivers who are not familiar to them."

Those on the pilot programme receive 24-hour access to a care-team.

Said Dr Hum: "(We can try) to determine what causes the distress ... it's the issue of pain and it hasn't been moved or if it's the issue of constipation and they haven't been able to move their bowels for several days.

"If they haven't seen a loved one whose voice comforts them, then they continue to be more distressed. But in their own homes, when we are able to address these issues, teach caregivers what to do and administer the medications in a manner that actually helps them, we don't need to restrain them."


Up till now, home-based care for dementia patients is unheard of. Dr Hum said such palliative care is traditionally associated with patients suffering from terminal illness like cancer or organ failure. She added that it is time to think of palliative care for dementia patients, as the population ages.

As of 2012, there are an estimated 28,000 people with dementia in Singapore. That number is expected to grow to 80,000 in 2030 and 180,000 by 2050.

"Palliative care is really about improving the quality of life and not only the last days," said Dr Hum. "It starts from the very time that we know that we are dealing with an illness that is not curable and we work together with the geriatric team, we work together with the primary team. We bring in our expertise, we combine it with the geriatricians and we do this together as a team, so the person who really benefits is the patient. We're talking about doing this not in the hospital, but in their homes." 

However, doing so requires hospitals to beef up on its resources. Dr Hum's team alone comprises six dedicated personnel, including a nurse, social worker and even a research associate.

Temasek Cares has set aside S$3 million over the next three years for the programme, which is expected to benefit 550 people with dementia and their care-givers.

The team of professionals hope to gather hard data on how home-based care benefits dementia patients. They want to forward this information to the Health Ministry with the aim of increasing capacity to eventually roll out this service, nationwide.

Quote of the Day: "What patients and their families don’t realize is that they are on their own." — Dr. Diane E. Meier,...
Posted by The New York Times on Tuesday, October 27, 2015

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