Tuesday, 3 May 2016

Dementia costs Singapore $1.4 billion a year

Study highlights urgency of need to tackle problem as nation ages
By Samantha Boh, The Straits Times, 2 May 2016

Dementia and its accompanying woes cost the country $1.4 billion every year, making it among the biggest drains on the healthcare system here.

This alarming figure, uncovered for the first time by local and international researchers, underscores the need to prevent the debilitating disease from taking hold in greying Singapore, say experts.

"Part of trying to define the scale of the problem is finding out dementia's economic cost," said Professor Chong Siow Ann, vice-chairman of the Institute of Mental Health's medical board (research), who was involved in the study.

"That then gives us an idea where we might want to intervene."

He and 13 others, from IMH, Changi General Hospital, the Ministry of Health and King's College London analysed the social care costs - such as care provided by family members and maids - and healthcare costs of 2,565 people, the majority of them aged 60 to 74. About one in 10 of them had dementia - consistent with the national average.

What the researchers found: For every person with dementia, he, his family and society paid $10,245 more in health and social care costs in 2013 than those without the condition.

As a country, Singapore shouldered the burden of $532 million that year, to care for people with the brain disease marked by memory disorders, personality changes and impaired reasoning. Taking into account social factors and other health problems dementia patients tend to suffer from such as depression and hypertension, the cost triples to $27,331 per person.

The study offers an important benchmark for the illness, said the researchers, who are calling in particular for more help for caregivers.

Said Dr Chia Shi-Lu, who chairs the Government Parliamentary Committee for Health: "Such studies do provide grist to the policy mill and are useful to either start or bookend discussions about resource allocations for specific medical issues, in this case dementia."

Last month, the Government declared war on diabetes, which cost more than $1 billion in 2010 - a figure expected to soar beyond $2.5 billion by 2050. The estimated cost per working-age person due to diabetes was $7,678 in 2010, and is expected to go up to $10,596 by 2050.

As at 2013, the annual cost of dementia, at $10,245 per patient, already closes in on the 2050 mark for diabetes, experts pointed out.

The price tag is expected to grow exponentially as the country ages. There were about 40,000 dementia patients here last year and this is projected to reach 53,000 by 2020, and 187,000 by 2050.

Notably, the study found that over three-quarters of the money spent on dementia patients comprises social care such as income lost when caregivers take time off work, while the rest is due to healthcare costs, including hospital admissions and doctor visits.

Associate Professor Phua Kai Hong of the Lee Kuan Yew School of Public Policy at the National University of Singapore said there is still a lack of professional outpatient care here such as rehabilitation services or care for a patient's daily needs.

"If you look at Singapore, most care is absorbed by the family or at most shows up as the cost of hiring a maid," Prof Phua said. Placing the burden squarely on these two groups would result in poor care for Singapore's elderly and heavy stress on caregivers, he warned.

Dr Jeremy Lim, a partner in global consulting firm Oliver Wyman, said there is a need to be creative in finding solutions. This includes changing the subsidy model to recognise the high social costs and give more subsidies not just for medicine and institutional care, but also in areas such as transport and elderly-friendly infrastructure for homes, for instance. "More of the same, meaning more of today's care model, will doom us to failure," he said.

'More help needed for dementia caregivers'
Training, financial support and wages for professionals must be improved: Experts
By Samantha Boh, The Straits Times, 2 May 2016

Dementia-specific training for maids, stronger financial support and better wages for home care professionals are needed to ensure that dementia patients here are properly cared for, say experts.

Providing their views on the back of a study that puts the cost of dementia care here at $532 million a year - and triple that amount if social factors and accompanying conditions such as depression and hypertension are taken into account - they stressed that dementia patients need better help both at home and in the community.

The Government, recognising the serious and growing problem of dementia in Singapore's ageing population, is tackling it on all fronts - by developing dementia-friendly towns, increasing the number of daycare places and nursing home beds and researching new ways to care for patients.

Nonetheless, researchers from the Institute of Mental Health found that the biggest burden falls squarely on caregivers, who account for over three-quarters of the costs incurred, such as time spent and wages lost.

So help has to start in the home.

Dr Philip Yap, senior consultant and director of Khoo Teck Puat Hospital's geriatric centre, said the burden is especially heavy for adults with children of their own who act as caregivers for their parents.

While applauding the Government's initiatives, he believes Singapore needs to "intensify and fortify support in the form of practical assistance", such as through better financial help for families.

Associate Professor Phua Kai Hong of the Lee Kuan Yew School of Public Policy at the National University of Singapore stressed the need for better training for maids. The Government could license and provide dementia care courses, and make it a requirement for maids caring for such people, he suggested.

"You cannot just throw a young maid into the deep end," he said.

While families can also turn to professional caregivers, there are far too few of them. And this will remain a problem until they are paid better and the profession is seen as more desirable, said Mr Jason Foo, chief executive officer of the Alzheimer's Disease Association of Singapore.

"There is the stigma that it is a dead-end job, that the pay is low and there is no progression. It's a struggle to attract young people," he explained.

This is a far cry from countries like Australia and Canada, where fresh graduates consider a job in the eldercare sector attractive, he added.

Said Ms Yorelle Kalika, chief executive of Active Global Caregivers, which offers professional caregiving help: "People in the service industry earn the least. On top of that, the job can get really messy and frustrating, so it takes a lot for anybody to want to be a caregiver."

Dr Ng Wai Chong, medical director of the Hua Mei Centre for Successful Ageing at Tsao Foundation, said that current community initiatives such as building dementia-friendly communities are a good start. For instance, staff at some McDonald's fast-food outlets have been trained to spot people with dementia and to interact with and help them.

But that is just scratching the surface, said experts.

"You need a proper care system in place. Not just many services," Dr Ng pointed out.

"A structure that allows you to stratify cases, identify the services required and escalate or de-escalate cases such that they get the most appropriate services at the most appropriate cost, in an organised manner."

The primary care sector - general practitioners and polyclinics - would need to take on a bigger role, he added, with support from nurses, social workers and therapists.

This would make care more accessible and reduce the burden on hospitals.

"Constantly referring cases to hospital specialists is a waste of effort, time and money," he said.

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