Tackling the unique demands of dementia care

MEMORY loss, mood swings and deteriorating cognitive skills.

These were just some of the symptoms that Koo May Yeok noticed her then 77-year-old mother was exhibiting.

Being in the healthcare industry, Ms Koo knew that something was amiss, and her mum was diagnosed with dementia after seeking treatment at a hospital.

The syndrome is a growing issue in Singapore as the ageing population increases. Locally, according to the Well-being of the Singapore Elderly (WiSE) study led by the Institute of Mental Health in 2015, one in 10 people aged 60 and above may have dementia. This meant that in 2012, 28,000 Singaporeans above the age of 60 were affected, and the number is expected to rise to 80,000 by 2030.

On the Alzheimer's Disease Association's (ADA's) website, it states that a study on the monetary cost of family caregiving for people with dementia in Singapore showed an estimated S$2.8 billion was spent in 2015 locally and this figure is estimated to almost triple by 2030.

Ng Chong Jin, deputy head and senior consultant of the Department of Geriatric Medicine at Khoo Teck Puat Hospital, said that there are a few misconceptions with regard to the affliction which causes a decline in mental ability (see table for his points). And while dementia is more common in people over the age of 65, Dr Ng said that there is an increased number of Young-onset Dementia / Early-onset Dementia over the years.

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When asked what can be done to delay the onset of the disease, or slow the deterioration of the disease, Dr Ng said: "Increasing physical activity is an effective intervention to delay the cognitive symptoms of ageing and to reduce the risk of dementia. Several studies which looked at the effect of aerobic exercises in middle-aged or older adults have reported improvement in thinking and memory, and reduction in dementia rates. When dementia is diagnosed, doctors may start a medication to slow down its progression rate, and may recommend programmes such as enrolling in dementia day care centres to allow cognitive stimulating activities and social interaction."

Recognising this, OCBC spearheaded the OCBC Glowing Years programme in 2018 at the AWWA Dementia Day Care Centre.

The initiative arose from the bank volunteers' observation in 2018 that some of the seniors at AWWA were less inclined to participate in some of the physical and cognitive activities at the centre - these are two of the most effective ways to reduce the risk of dementia or, for those who have begun to show symptoms, to slow down the deterioration of the condition.

OCBC Bank said: "Our volunteers then decided to partner AWWA to design a holistic programme to tackle the silent disease. After a pilot roll-out in January 2018 involving 80 seniors from the AWWA Dementia Day Care Centre, more than half the number of participants showed marked improvement in mental alertness and social interaction after six months."

Combining a fun exercise regime with a compelling incentive scheme, the initiative motivates the seniors to improve their motor and cognitive skills. The objective is to especially help at-risk seniors who are socially withdrawn, physically inactive and lack social networks or family bonds. Points are awarded for taking part in keep-fit or mentally stimulating exercises; these can be used to redeem carefully-selected rewards like a massage, a pedicure, an outing or a hairdo refresh. These incentives are meant to encourage a more participative lifestyle. The types of rewards are in turn modified based on feedback from the seniors.

Sairam Azad, deputy director, Health and Senior Care at AWWA, said: "OCBC Glowing Years programme offered rewards to the seniors for their participation in the interventions offered by the centre. These rewards, in turn brought happiness and positive emotions that motivated the seniors and enhanced their participation in the programme. This was aligned with our centre's mission to delay the progression of dementia.

"Such a scheme also positively influenced the caregivers and encouraged them to send the clients more regularly (minimising absences) to the centre. This initiative brought about 20 per cent increase in client attendance to the centre that may have contributed towards positive outcomes in delaying the deterioration of dementia. The variety of rewards offered to the clients under the programme also enabled the centre to practise person centred care by offering choices to the clients based on their likes."

Arpita Srivastava, occupational therapist, Allied Health Professional Group, joined AWWA in February 2017 and was transferred to Dementia Day Care Centre Ang Mo Kio in 2019.

The occupational therapist said: "Since the implementation of the OCBC Glowing Years Programme in 2018, we have seen an increase in motivation in our dementia clients coming to our centres to participate in a variety of activities.

"These activities include physical exercises, mental/ cognitive exercises, therapies catering to different clients' enjoyment. OCBC's funding has also enabled us to provide a multi-sensory environment in one of our centres. We were able to install a Snoezelen Room which is a therapeutic environment that delivers high levels of stimuli to patients with dementia."

She added that overall, the OCBC Glowing Years programme has helped seniors' participation in various social, physical and cognitive activities and allowed them to live independently in the community.

Ms Koo also noticed a marked improvement in her mum's behaviour ever since enrolling her in the day care centre. "AWWA really did a good job. They asked what my mum's interests were and tried to incorporate it into her daily activities. For example, they knew she used to love gardening and would let her water the plants. She now looks forward to going there every day (except the weekends). It was tough during the circuit breaker period as she could not go to the centre physically, so I was glad when AWWA came up with telecommuting for her to have some interaction online."

When asked about what more can be done to help the caregivers, she added that clarity of process is very important.

"From my own experience, it took a while to get the proper diagnosis for my mum as she seemed 'normal'. If you are not close to the person, you wouldn't notice the sometimes subtle behavioural change. Hence even the healthcare professionals were initially doubtful. And after she was diagnosed, when I asked the doctor to refer her to ADA, he wrote a memo when the proper procedure was supposedly to do a referral with the Agency for Integrated Care. So I had to do my own legwork."

Mr Sairam from AWWA said that dementia care in Singapore has improved over the years but more can still be done.

"Persons with dementia are unique and so are their needs. Care for persons with dementia is onerous and demands resources. It is important that more companies like OCBC come forward to offer support and partner agencies like AWWA to help develop holistic programmes with elements to encourage motivation and participation of seniors. It will certainly help if each client's care is personalised and corporates go the extra mile through sponsoring various activities or programmes that can support our client's biological, psychological and social needs.

Although this process is resource intensive, this will offer better returns in the longer run to empower seniors to lead dignified lives."

• This article is part of a series on sustainability initiatives, supported by OCBC Bank