SINGAPORE: The Republic is facing an ageing population and by 2030, the number of people with dementia here will double. What are some challenges faced by caregivers and what is being done to create a Singapore that supports them?
One case involves Mr Ong (not his real name), who was diagnosed with fronto-temporal dementia in 2012, at the age of 53. It is a condition that leads to memory loss and at times, aggressive behaviour.
"He was okay when the kids were young,” his wife, Judy said in Mandarin. “He'd take the kids out to the zoo when he wasn't working on Sundays."
There have not been many of such happy memories lately. "He started acting very weirdly,” Mr Ong’s daughter, Sarah, said.
Ms Ong added: “He would put timers on the refrigerator. He'd say, 'if I make the fridge turn on and off every three hours I will save my money’.
“That day, he started walking around in the house and shaking the window grilles of the living room. My mum was trying to hold him and calm him down but he just pushed her away. He went to the master bedroom and started shaking the window grilles."
Mr Ong was diagnosed with fronto-temporal dementia at the age of 53. (Photo: Kenneth Lim)
Over the years, Mr Ong's condition has taken a toll on his wife and children. "You don't know when he's going to act up,” Mrs Ong said. “I’m worried every morning, when I see him walk out the door, not knowing what might happen in the next minute. It's come to the point where I can't bear it any longer - it's driving me crazy."
“It always troubles me when my mum is alone with him because my mum will call or SMS me but I'll be at work,” said Ms Ong, wiping her eyes. “Then, I'll feel very frustrated and helpless. I'd wish I was there. I started to have panic attacks."
In August 2015, Mr Ong was arrested at his home on suspicion that he was involved in mischief and theft.
"When the police came, we immediately provided them with the relevant medical documents to prove that my dad had had dementia for the last three years,” said his son, Tom. “However, the police acted as if they had had no training in handling patients with dementia. Three to four police officers surrounded him, asking, 'Did you steal the item?'"
The rise of dementia in Singapore has led to calls for more awareness about the condition in society, especially since the signs and symptoms are not very obvious.
"If you encounter such a person for the first time, you'll never guess that this person has some mental illness,” the younger Mr Ong said.
“It's only through interactions that you will find out that this patient is actually a bit abnormal, compared to the rest of us. So, based on the first impression, I don't think the police will be able to judge whether he's lucid or not."
Police officers follow several procedures when dealing with suspects suffering from intellectual disabilities or mental disorders. One is known as the Appropriate Adults Scheme, where volunteers are present during police interviews, acting as a bridge between the police and the vulnerable suspect.
The officer also has to establish the suspect does have a mental condition and will check medical records, or if these are not available, make an assessment based on his behaviour.
The police have said they do not divulge details of investigations to those not involved in a case due to confidentiality. Channel NewsAsia understands Mr Ong's family did tell the police about his condition at the point of arrest. An Appropriate Adult was called in once the police confirmed his condition after further assessment.
No further action was taken against Mr Ong thereafter.
SOCIAL VS MEDICAL COST
Recently, the family decided to send Mr Ong to the Institute of Mental Health (IMH), which has a Dementia Friendly Ward and a team that helps similar families. “I would say it has been a huge burden off my mum's back,” said Mr Ong’s son.
According to a consultant at the IMH's Department of Geriatric Psychiatry, more families are turning to his team for help with dementia.
"People are so confused they cannot understand other people's perspective,” said Dr Richard Goves. Illustrating an example, he said a patient with dementia could think they are being threatened if a nurse wants to change his dirty diaper. “That can be replicated at home as well, where it can be met with retaliation,” he added.
The consultant also said such misunderstandings can be avoided by educating the caregivers, such as the maid or family members, on how to understand it from the patient's perspective. “Unfortunately, the person with dementia cannot change,” he said. “They do not know what they're doing."
Today, one in 10 people above the age of 60 years has dementia. A 2014 IMH study also found that the cost of care is about S$1.4 billion a year.
"The cost of dementia is significant - it is a lot more than many other physical conditions,” said Dr Mythily Subramaniam, who was one of the leading researchers involved in the study. "And what is kind of surprising is the social cost. The cost borne by the caregivers is actually much more than the medical costs."
Dr Subramaniam, however, added that there is a silver lining. According to another study that she did in October 2015, it showed that Singaporeans - especially younger citizens - are becoming more aware about dementia.
About 66 per cent of those polled recognise the signs and symptoms of the condition. “It is a stress on any country and across the world people are facing the same issues and nobody is completely prepared for it,” Dr Subramaniam said.
“But I think one of the amazing things I've seen in the last five years or so, even before the results of the study were announced, I saw that there was a gearing up, there were a lot of services which were kind of rolled out by various agencies, not just at early treatment and rehabilitation, but even prevention - active ageing and all that, quite a bit of emphasis, which is really important."
GENERATING AWARENESS FROM THE GROUND UP
One of these is the Dementia Friendly Singapore initiative, a nationwide effort that aims to raise awareness and support for those with the condition.
"It is very important for us to prepare society now to better support the growing number of seniors with dementia," said Senior Minister of State for Health Dr Amy Khor. "Over recent times, there has been more awareness, more talk about dementia, but we need to do more so that people will be more understanding, and provide them with the necessary care and support.”
"Dementia Friends" at the launch of the "Forget Us Not" campaign. (Photo: Chan Luo-er)
At the national level, Dr Khor said authorities are also increasing the capacity of long-term care services. For example, the number of daytime dementia care places will increase from 1,000 to 3,000 by 2020.
The Health Promotion Board also runs a dementia info-line and produces booklets and toolkits to help the general public better understand the condition.
Ground-up efforts have also surfaced in recent months. In January, the Lien Foundation and Khoo Teck Puat Hospital launched the first “dementia-friendly community” in Yishun through a campaign called "Forget Us Not".
About 9,000 people have been trained to look out for those with symptoms of dementia, and offer help. "There is a need and a thirst from the community to know more about this subject," said its project manager Gabriel Lim. "I think we certainly want to do more to capture and build on this momentum."
Mr Lim added that he hopes to work more with F&B outlets, banks and transport operators to raise awareness.
A group of Nanyang Polytechnic students go on regular walkabouts to share their knowledge on dementia with the public. (Photo: Kenneth Lim)
Schools are also looking to do their part. A group of Nanyang Polytechnic students go on regular walkabouts to share knowledge with the public, and plan talks and events for their peers. "I'm really interested to know more about dementia," said nursing student Zahrah Binte Ismail.
She added: "Sometimes, we see people get affected by dementia patients, who already have lost some of their memories. It's beyond control for them, so what I can do is just offer them help."
"In Singapore, we need to inject more compassion into society," another student Benjamin Woo said. "The youths are in a very important position, where they are able help out these people that are going to grow old in the future."
So far, three dementia-friendly communities have been launched, in Yishun, Hong Kah and MacPherson.
Features at these neighbourhoods include "community touch points" or community centres that act as go-to points for those who have lost their way. Volunteers at the centres will then help them return safely to their family and caregivers.
FOSTERING ACCEPTANCE WITHIN THE COMMUNITY
However, beyond just changing the physical environment, Mr Ong’s son said it is also about fostering acceptance within the community. "I don't really think putting up prominent road signs can help a dementia patient get home," he said.
"If you have a neighbour who knows that your family member has dementia and sees him wandering on the streets alone and he is able to go up to him and bring him home, then I think that is a very important thing,” he added. “This comes down to awareness rather than building physical features."
These days, Mr Ong's family is planning to place him in a nursing home after he is discharged from IMH. "I've reached my limit,” Ms Ong said. "I think it's beyond what I can do. I can only tell myself I gave it my all, but there's still no solution. I think it's better we leave it to the experts to take care of him. This is for the better - or else I don't know or what I'll have to go through."
The younger Mr Ong added: "For now, the nursing home will provide better care for my dad. It's not something that we really want to do. But we're concerned that if we don't do it, both my parents could be ending up under mental care."
Dr Amy Khor hopes everyone can help to create dementia friendly communities to better provide care and support for these seniors in Singapore. (Photo: Kenneth Lim)
Through the dementia-friendly community initiative, authorities are hoping to go one step further to provide support and care for families like Mr Ong's within the neighbourhood.
"We do not wish to see seniors being institutionalised just because they have dementia," Dr Khor said. "Therefore, we are rallying everyone to create dementia-friendly communities so that they can better provide care and support for these seniors to age at home, within the community, with confidence."
The dementia-friendly community effort will soon be expanded to areas like Bedok and Queenstown, and possible island-wide.