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Forget Nursing Homes – Ageing In Place Is Best Suited For Dementia

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Forget Nursing Homes – Ageing In Place Is Best Suited For Dementia
Many developed nations across the world are facing what is now known as the silver tsunami as life expectancies continue to grow as birth rates plummet.
Singapore is no exception. Come the end of the decade, and the proportion of people aged 65 and above here will grow from one in six to one in four.
Many of these silvers in super-aged Singapore might require extra medical care as age-related ailments set in – especially dementia, where ageing is the biggest risk factor.
At 65, only 1 in 10 people have dementia. By the time they reach 90, that number will have soared to more than half.
Is the nation adequately armed to tackle the issue? In the lead-up to World Alzheimer’s Day (21 September), SilverStreak speaks to Jason Foo, CEO of Dementia Singapore, a social service agency specialising in dementia care since its inception in 1990.
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More nursing homes help, but not the solution, says Dementia Singapore CEO
That figure is perilously close to the previously reported estimate of around 103,000 people with dementia by 2030, a little over six years before the deadline. More recent projections put us at around 152,000 people living with dementia by the end of the decade.
Jason provides two explanations for the ballooning of the estimate by more than 50%: “One reason is life expectancy, which is increasing not only in Singapore but around the world. Our senior population has grown significantly since the previous estimate was done.
“But another major reason is awareness. In the past, being forgetful was just seen as a part of getting old. But now there’s an understanding that forgetfulness, together with other symptoms like changes in behaviour and the ability to perform activities of daily living (ADL) like going to the toilet or changing, are indicative of something bigger.

"There is a much larger proportion of people who are getting diagnosed, which is pushing the number up. It might even be underestimated – what it really tells us is that this is a problem that is growing and is worth our attention."

Dementia is an umbrella term for several diseases that affect memory, thinking and the ability to perform ADLs. Its symptoms can only be treated, supported or managed – there is no cure for the ailment.
Therefore, people with dementia often require supervision or caregiver assistance, especially once it has progressed from early-stage dementia to a moderate or severe stage.
One solution is nursing homes. Singapore plans to double the capacity of nursing home beds from around 16,200 in 2022 to 31,000 over the next decade – far short of the current projection of 152,000 people with dementia by 2030.
“While it is a solution, I am glad that both Dementia Singapore and the government agree that it is not the first solution – it is in fact the last resort, as we’d much rather people age in place in their homes with support from the community and a network of eldercare centres.

"The reality is people with dementia in nursing homes hardly get any visitors. The relatives feel like they aren’t recognised anyway, so what’s the use? Whereas if these people with dementia were at home, they’d still have a chance to interact with their family members regularly."

Besides, the benefits for ageing in place are numerous, he explains. They include the prevention of social isolation, a greater sense of dignity, and better inclusion into society. By living in familiar places, people with dementia feel calmer, while being better able to recall happy memories.
Equipping the community to deal with dementia care
Forget Nursing Homes – Ageing In Place Is Best Suited For Dementia - Craft workshop
In that aspect, Singapore has come a long way since Dementia Singapore was incepted, says Jason. Back then, it was known as the Alzheimer’s Diseases Association.

“You have to understand that back then, not as much was known about dementia as compared to now. Many of these families were at their wits’ end and didn’t know how to find help or care for their relatives.”

The organisation was formed and Jason, an accountant by trade, was roped in to handle the books. He eventually took the helm full-time in 2012.
In its early years, the social service agency focused on creating and running centres with specialised dementia care services. They currently run four dementia daycare centres in Bukit Batok, Jurong Point, Tampines and Toa Payoh.
Since about six years ago, they’ve eased off the throttle on opening new centres on their own, in favour of working with daycare centres run by other faith-based and charitable organisations.

"There is also a lot more social interaction that can help stimulate them cognitively, as compared to leaving them alone at home. And research has shown that this social interaction is key to managing dementia."

Dementia Singapore also conducts training for caregivers – including relatives of people with dementia and foreign domestic workers – at times convenient for them in English, Malay and Burmese.
Worrying trend of persons with young-onset dementia
Nevertheless, Jason stresses that dementia is not an ailment reserved for the aged.

"It’s grown from about 50 cases a year to about 400 cases a year. The number of cases are growing, but we’re not sure why yet. Hospitals here are still in the midst of research."

What’s worse, while people with YOD exhibit similar symptoms to those with late-onset dementia, they often deteriorate faster. Researchers have not determined the exact reason, though one theory Jason mentions is the higher metabolic rate of younger folk, leading to quicker changes in the brain.
What they do know for sure is that, while numbers are comparatively small, the economic and emotional impact of young-onset dementia is often magnitudes greater.
The emotional impact of young-onset dementia is especially weighty, says Jason.

“People who get dementia early might get depressed. ‘Why did I get it? Doesn’t this only happen once I’m 70 or 80? Why now?’”

Novel medicines on the horizon, but no panacea yet for dementia
Forget Nursing Homes – Ageing In Place Is Best Suited For Dementia - [Dementia Singapore VR
In July, the US Food and Drug Administration approved lecanemab, the first drug to treat Alzheimer’s. The experimental drug was developed jointly by Japan’s Eisai and Biogen of the United States and can now be brought over to Singapore.
Jason of Dementia Singapore reminds us that this is not a cure-all.

"Clinical trials have been quite successful for a select group of people – about a quarter of the population. However, it should be stressed that this isn’t a cure. It can slow down the deterioration and keep it stable. It is also very expensive, costing around $35,000 a year."

For individuals looking to ward off the ailment, they’re better off engaging in the “heart-healthy activities”.
As part of their work, Dementia Singapore continues to experiment with novel management strategies – whether that be craft workshops, or innovative “Totsu-Totsu” dance sessions from Japan.
Forget Nursing Homes – Ageing In Place Is Best Suited For Dementia - Dementia Singapore Inclusive society
Dementia Singapore also works with government agencies to make hubs like bus interchanges and HDB void decks more accessible for those with dementia. In this case, coloured murals displaying nostalgic items can help people with dementia navigate the area.
In lieu of a cure to dementia that may never come, Jason hopes that their outreach can help shape the nation into a dementia-inclusive society.
“We’re always trying to educate the community to spot the signs. People with dementia walk into a shop to pick up something and walk out after forgetting to pay. They often get the police called on them, and especially for people with YOD, you might get a very nasty reaction. Learning how to spot the signs and handle the situation is key.

Find out more about Dementia Singapore and its workshops and training programmes here.

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