Helping the Aged
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Singapore is a rapidly ageing society. The number of seniors in Singapore aged 65 years and above is expected to rise from one in six in 2022 to one in four in 2030. According to local research (WISE Study, 2015), one in 10 of those aged 60 years and above have some form of dementia.
As we continue to live longer due to greater life expectancy, we are likely to see more elderly spending their golden years in poor health, coping with various conditions like dementia, chronic illnesses and frailty. There are a number of things which we are doing to help the aged cope better in their later years.
DEMENTIA
Dementia is characterised by progressive memory and cognitive decline leading to difficulties coping with everyday activities. Memory loss occurs gradually and worsens progressively, with
short-term memory loss occurring first. There is difficulty retaining new information, which can manifest as difficulty in recalling phone numbers that were just given, or reporting what was just said.
Persons living with dementia may also repeat what they have said in the same conversation or to the same person, and cannot keep track of a short list of things to buy or to do for the day.
They compensate by increasingly relying on making lists, marking the calendar, or depending on reminders from other people.
Other signs and symptoms of dementia include:
- Problems recognising familiar faces, places or items.
- Difficulties with expressive or receptive language, such as using vague expressions instead of explicit details (“you know what I mean” or “he/she/that person” rather than their roles or names), unable to recall names of close family or friends, problems finding words to express themselves, or difficulty understanding what is said to them.
- Difficulties performing previously familiar activities, such as using tools, driving a vehicle, navigating in familiar environments, or performing activities of daily living, such as dressing and using utensils during mealtime.
- Worsening of problem-solving abilities, and relying more on others to organise, plan or make decisions for them. They have difficulty multi-tasking or find it difficult to resume something they were doing before an interruption.
In addition, there may be changes to moods and behaviours, such as depression, anxiety, hallucinations, anxiety, paranoia and sleeping problems.
Dementia is not part of normal ageing. In normal ageing, we may expect a decline in our ability to remember new things or in our short-term memory. However, there should not be an impairment in our judgement, long-term memory, our ability to live independently, or social and occupational functions. In dementia, the cognitive deficits interfere with independence in everyday activities.
Dementia is not a single disease. There are different kinds of dementia based on different pathological changes to the brain: e.g., Alzheimer’s Disease (AD), vascular dementia, Lewy Body Dementia (LWD), Fronto-Temporal Dementia (FTD) and alcohol-related dementia.
LOWERING RISK OF DEMENTIA AND CHRONIC ILLNESS
People do not age the same way. What we do now and the lifestyles we choose affect how we age, and our quality of life in the future. A research paper (Daniel W. Belsky et al. 2015) which studied a cohort of individuals aged 38 years old found that while most individuals have a biological age (measured by a set of biomarkers) that roughly reflects their chronological age, some individuals seemed to have a much younger biological age, while others appeared to undergo an accelerated ageing process that made their bodies seem almost one decade older.
As the same cohort aged into their 40s, there were also wide differences in “brain-age”, with some experiencing accelerated cognitive decline, while others maintained their cognitive functions remarkably well.
Prevention is important. It enables us to lead the lives we want. Understanding the modifiable risk factors for dementia and the things we can do in response can help us to lower our risk
of developing dementia. For example, vascular dementia, the second most common cause of dementia after AD, often has symptoms that begin after a stroke or a series of small strokes
(“mini-strokes”) that often go unnoticed. Its risk factors include common chronic illnesses like hypertension, high cholesterol and diabetes.
We can prevent cognitive decline and reduce the risk of dementia with some good health habits. These include:
- Staying physically active.
- Having enough sleep.
- Not smoking and avoiding excessive alcohol consumption.
- Having a healthy diet.
- Having good social connections.
Also, we should ensure that chronic illnesses like hypertension, hypercholesterolemia or diabetes are optimally managed. This would involve early detection though health screening for chronic illnesses, lifestyle changes that include healthy eating and regular physical activity, avoiding risk factors like smoking and excessive alcohol use, and adhering to prescribed medications and medical follow-up.
EARLIER PREVENTION THROUGH COMMUNITIES OF CARE
Healthier SG is a government programme that allows Singapore residents to choose a dedicated General Practitioner (GP) to manage their health. This is supported by hospitals and social service agencies.
For example, TTSH’s (Tan Tock Seng Hospital) Community Health Teams (CHTs) serve as a bridge between the hospital and the community.
They build local networks with social service agencies, grassroots organisations, primary care doctors and community mental health providers, to meet the health and social needs of residents. These networks are essentially Communities of Care (CoCs) that help to coordinate care for those with complex needs through case discussions and joint care planning. The CHTs also run Community Health Posts where community nurses, health coaches and therapists attend to residents’ care needs, close to where they live.
As Healthier SG ramps up, CoCs can help GPs support residents in their health plans and improve care coordination. Through this collaboration, residents can easily access a suite of lifestyle programmes and social activities organised by healthcare and community partners by either signing up themselves or through referrals by their GPs.
The CHTs also partner social service agencies, grassroots organisations and the Silver Generation Office (SGO) to hold community health screening events to detect/assess chronic illnesses, daily function, and risk of falls and frailty. Residents found to have health issues in these screenings are then connected with GPs and suitable services for follow-up, or CHT health coaches will recommend or deliver suitable lifestyle interventions to them.
Community exercise programmes like “Healthy Ageing Promotion Programme for You” (HAPPY) have been shown to improve cognition, physical function and reduce isolation. Also, the “Live Well, Age Well” programme by the Health Promotion Board (HPB) and People’s Association (PA) has a suite of active ageing programmes to help seniors improve their physical, mental and social health. These are held at accessible locations like Community Centres, Residents’ Network Centres and Active Ageing Centres.
Hospitals and polyclinics also have structured programmes that target residents at risk of specific conditions. For example, TTSH’s “Make It Siew Dai” programme is a multiweek course where residents can learn tips on healthy eating, food preparation and understanding nutritional labelling in an interactive environment, with the intent of preventing diabetes. TTSH is also partnering with HPB to deliver a prefrailty programme called “Steady Lah!”, where participants are taught appropriate exercises for strength and balance, and given nutrition tips to delay muscle loss over several sessions.
LIVING WELL WITH DEMENTIA
Memory clinics in hospitals help in the early identification and diagnosis of dementia. They have been established in several polyclinics to facilitate access to diagnosis and care management in the community. Together with community partners, they form a network of providers where training, co-consult sessions and case discussions are held so that care can be delivered seamlessly.
One such network is TTSH’s Geriatric Integrated Network for Dementia (GerIND). There are also plans to form more Community Resource, Engagement & Support Teams (CREST), which serve to proactively identify seniors at risk of dementia, and refer them for further assessment.
Families of persons living with dementia can now access a wider range of resources. For example, DementiaHub.SG is a onestop online portal that provides useful resources for persons living with dementia and their caregivers. They can access information on risk factors and signs of dementia, where to go to get a diagnosis, services in the community, caregiver support, as well as tips and suggestions for living well with dementia and caring for persons with dementia. Caregivers can also access caregiver training and support provided by Caregivers Alliance and TTSH’s Carer Matters programme.
Planning ahead is important. Considerations should be made regarding the making of a will, Lasting Power of Attorney and Advance Care Planning (ACP). It should be noted that ACP helps one plan for his/her future health and personal care. ACP conversations allow persons living with dementia to share their personal values and beliefs with their family, so that their family can understand how these values and beliefs influence the persons’ healthcare preferences. A trusted family member can then be delegated to make healthcare decisions on the person’s behalf, in the event that he/ she is unable to.
Our rapidly ageing society would see many challenges in the future, with more people being diagnosed with dementia. Living well with dementia would require lifestyle changes and optimal illness management. However, this need not be a journey taken alone. CoCs could help to better support persons with dementia and their caregivers in the neighbourhoods they live in. We should not only add years to our lives; our lives should be lived with meaning and purpose in our golden years.
