One in 10 people in Singapore aged 60 years and above has dementia. Characterised by a progressive worsening of memory and intellect (cognitive abilities), orientation, or personality that is caused by diseases that affect the brain, this results in impaired daily functioning in PWDs.
While everyone experiences slight changes in cognitive abilities with age, dementia occurs when these changes become severe enough to interfere with day-to-day functioning. Several factors increase the risk of dementia.
Diagnosing and managing dementia
At CGH, the diagnosis of dementia is made through a battery of assessments. These include obtaining an understanding of the patients’ family history; assessing the loss of memory and cognitive function; and tests on cognition, mood, behavioural and psychological symptoms. “Physical examinations identify features of neurological issues which may indicate the cause of dementia. Blood tests and brain scans of the size of the hippocampus — the part of the brain responsible for memory storage — also play a part in diagnosing dementia,” says Dr Peter Chow, Consultant, Department of Geriatric Medicine, CGH.
While there is presently no cure for dementia, its behavioural symptoms can be alleviated and progression can be slowed through treatment options. There are medications that help regulate chemical activity in brain function — this may delay the cognitive decline in certain types of dementia. Other medications may also help to manage a person’s behavioural symptoms.
Caring for both caregivers and PWDs
The experience of Ms Rebecca Chang and her mother is one of over 3,600 patient experiences at CGH. Caring for PWDs can be a long, stressful and emotional journey. To optimise health outcomes, CGH’s geriatric care team recognises the importance of safeguarding the well-being of caregivers as well.
In March 2021, the Geriatric Day Hospital (GDH) Engage programme was launched, catering to PWDs and their caregivers and families. Led by a multi-disciplinary CGH team of doctors, nurses, psychologists, allied health professionals and medical social workers experienced in dementia care, the programme offers weekly cognitive stimulation therapy (CST). This is a psychological intervention that helps improve the patients’ cognition and well-being through structured physical and cognitive group activities. Caregivers and families of CGH PWDs also receive weekly educational sessions on managing various aspects of dementia care.
“This holistic programme imparts comprehensive knowledge for caregivers to discover the strategies of managing behavioural symptoms of dementia and understand the reasons for these changes, as well as what can be done about it,” shares CGH Senior Nurse Manager Chitra Pandiaya, one of the leads of the Engage programme. “The programme also provides caregivers with the know-how to empower a loved one with dementia to engage in activities that he/she values, and optimise nutrition to reduce the risk of cognitive decline, among other tips.”
Building mutual support
At some point of their caregiving journey, loved ones and family members may experience sadness, anxiety, loneliness and exhaustion. Being able to seek help and support along the way is crucial. The CGH care team runs a monthly support group at CGH’s Memory Café, where caregivers of PWDs get to know one another and build mutual support, exchange tips on managing day-to-day concerns arising at home, and share valuable experiences on their journey with dementia.
Caregivers at CGH’s monthly support group build mutual support and share experiences with one another.
Caring for patients in the hospital
PWDs in CGH’s dementia ward receive specially-curated person-centred care that focuses on their well-being. The care team creates a positive social and safe home-like environment for patients to move around in.
The environment is designed to be comfortable and familiar, with interior elements such as photographs of fruits and landscapes, pleasant colour schemes, safe corridors and communal dining spaces. Together with the patients’ involvement in meaningful activities, these reduce the risk of confusion. The care plan for each patient is tailored based on the individual’s preferences, interests and needs so as to better manage them physically, emotionally and socially.
To help patients experiencing confusion and reduce their discomfort, CGH has a comprehensive purple tag care bundle that ensures patients have good quality sleep, their pain is optimally managed, their bowels and bladder are emptied regularly, and their nutrition and hydration needs are met.
CGH’s care team engages PWDs in activities that help to reduce cognitive decline.
Dementia may affect a person with dementia’s (PWD) ability to do basic things, such as feeding and grooming themselves, and activities that they used to enjoy. Changi General Hospital (CGH) Senior Occupational Therapist Chew Xiaojia says, “PWDs may have certain behaviours that their family may have difficulty managing. However, these ‘behaviours’ are usually the unmet needs of the PWDs.” These patients are referred for the rehabilitation and management of their moods and behaviours.
At CGH, occupational therapists provide rehabilitation for PWDs through enjoyable and familiar activities. For PWDs with behavioural symptoms, the occupational therapists identify modifiable triggers and develop strategies to manage them better.
Occupational therapists also advise caregivers on how to plan and facilitate activities that PWDs enjoy, how to effectively assist PWDs in their activities of daily living, and recommendations on home modification and assistive equipment.
A CGH occupational therapist assists a patient with making a cup of coffee.
Dementia can cause a decline in physical and cognitive functions. Combined with lower activity levels and ageing, this decline raises the risk of falls, and may cause a loss of independence for PWDs.
Physiotherapists contribute to the holistic management of dementia care by optimising how each person can engage in fun, meaningful exercises to stay active, safe and healthy. This is done through specifically-targeted strength, flexibility and balance exercises. “These include exercises to ensure that the PWDs can get out of bed, or are able to walk about outside safely,” says CGH Physiotherapist Dermot Brady.
Keeping active also helps PWDs with their sleep quality and quality of life. In addition, physiotherapists empower caregivers with skills and techniques to assist the PWDs at home.
A CGH physiotherapist works with a patient on rehabilitation exercises.
PWDs often experience progressive communication and swallowing difficulties. “Communication difficulties may include reduced memory and attention, difficulty with understanding, and communicating with others. Swallowing difficulties may include coughing or choking, needing assistance and prompting with feeding, food refusal, or displaying behavioural symptoms during feeding,” says CGH Principal Speech Therapist Lee Yan Qing.
In the early stages of dementia, language therapy may be prescribed if appropriate. In later stages, speech therapists may suggest strategies such as speaking slowly and clearly by using simple sentences, and allowing enough time for PWDs to respond. For PWDs with swallowing difficulties, safe feeding strategies include modified diets and fluid consistencies for adequate nutrition.
A CGH speech therapist monitors a patient’s swallowing abilities as he drinks from the dysphagia cup.
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