This is an abridged version of Member of Parliament Poh Li San’s Adjournment Motion titled Prepare Ourselves Better Towards a Dementia-Friendly Society that was delivered in Parliament on October 20, 2022.
Singapore is ageing rapidly. By 2030, around one in four citizens will be aged 65 and above.
The downside is that with more older people, there will also be more people afflicted with dementia.
Amongst the seniors, one in 10 persons above the age of 60 have been diagnosed with dementia. The incidence rate will increase to one out of two for those above age 85.
At present, there are approximately 92,000 persons diagnosed with dementia and this number is projected to increase by 65% to 152,000 in the next eight years.
Need to Expedite Preparations
These staggering statistics are a wake-up call.
Is Singapore ready to cope with more People Living with Dementia? More importantly, can Singapore be a more dementia-friendly society as this disease becomes more prevalent in our rapidly ageing society?
Dementia is a terminal illness because people living with dementia or PLWDs in short, will not recover. Their condition will only deteriorate over time.
In the advanced stage, most PLWDs would require extensive caregiving. Caregiving for PLWDs is challenging and may require 24/7 attention.
Very often, family members will have to give up their work and some may even suffer from burnout. There will also be implications for the caregivers’ own financial security in old age.
The productivity of our labour force will also take a hit. The economic impact to the families and society at large cannot be underestimated.
We are racing against time, as there is a fast-closing window to get ready before the dementia emergency hits us. I urge the government to expedite the implementation of dementia-focused policies and the building of more dementia-friendly infrastructure and community programmes.
Future measures for dementia fall in three broad categories: Building Capacity which takes the longest lead time, Mitigation against challenges associated with dementia, and finally, Prevention.
Building Capacity
Medical Facilities & Expertise
Capacity building can be broadly discussed in two categories, namely, medical facilities and expertise, as well as community facilities and programmes.
Over the years, the government has been building up its capacity in the provision of primary care. By 2030, there will be 32 polyclinics island wide. I look forward to Mental Health and Memory clinics being available in all polyclinics so that PLWDs can access these facilities quite conveniently.
I urge the Ministry to consider including dementia detection as an option for seniors undergoing regular health screening. Early diagnostics and detection are critical to help patients slow down the progress of dementia. It is very important to catch this disease early because there is only a small window to intervene effectively, through a beneficial combination of medication, exercise, brain stimulation, and socialisation.
In terms of trained medical personnel, I also hope that MOH has been increasing the number of geriatricians and psychologists. I would like to know what will be the projected ratio of geriatricians versus senior citizens by 2030. How will MOH build up this pipeline of medical specialists over the next 8 years?
Dementia Day Care Centres, Senior Centres & Nursing Homes
In the community, the number of places in dementia day care centres, senior centres and nursing homes have been increasing.
However, I am concerned that the rate of increase may not keep up with the needs of the growing number of PLWDs. I understand that the current waiting time for nursing homes is 9 months to a year. While I am heartened to note that in the next 10 years, our nursing home bed capacity will go up by close to another 100%, to more than 31,000, I am worried if this is even enough, especially for elderly with issues like dementia.
I hope the Minister would share the progress on the infrastructure build-up plans and strategies to recruit staff and train them. Also, how will we ramp up caregiver support and training? Would the Ministry elaborate on how these options will be financed, the government subsidies available, and the estimated range that a family is expected to pay?
Other than nursing homes, having a range of care and accommodation options is key to supporting families who are struggling with family members with dementia. While some PLWDs may need 24/7 full-time care, some others will be able to manage a range of independent living with varying levels of support or supervision.
Hence, it is important to provide alternative models of care in the community for PLWDs, other than nursing homes and senior day care centres, such as the Wellness Kampung community facilities, where they can participate in social activities while their caregivers get some respite.
Dementia-Friendly Estates
As our nation enters into an ageing demographic phase, it is crucial to review the design of our estates. Our estates will have to be more dementia-friendly.
I would like to ask the government to expedite the building of such community infrastructure, such as in new HDB estates and the Neighbourhood Renewal Programme for existing estates, to be dementia-friendly.
I would encourage fellow MPs and their town councils to consider adopting dementia-friendly designs for their repainting works. Distinctive colours and landmarks can be created to help PLWDs to better recognise their surroundings in case they lose their bearings and are unable to find their way home.
Another idea is to proliferate assisted living arrangements which allow seniors to remain independent and socially connected. This would also address the issue of many elderly living alone after their children get married and move out. One such example is the Red Crown social enterprise which arranges for several seniors to live together, provide companionship and help to take care of one another.
Some degree of government involvement and grants can help to scale up this nascent industry and to ensure that operators meet minimum service standards.
Dementia-friendly Social Programmes
VWOs play a key role in assisting PLWDs and their caregivers. They have well-trained social workers and volunteers to engage PLWDs in social activities that will slow down their decline and calm their moods. They also assist caregivers with counselling services so as to manage their stress and deal with burnout.
Unfortunately, many families with PLWDs are not aware of the services provided by these VWOs. Hence, the community network plays an important role in connecting the VWOs with residents who may need assistance.
I would like to share that in Sembawang West constituency, we started a Dementia Caregivers Support Network, to help residents access the services provided by the VWOs. The caregivers can also give each other’s mutual support and share their experiences and useful tips on caregiving.
However, many of such VWOs are only partially funded by the government and will need to raise their own funds, competing with other VWOs for the charity dollar. After all, funds are required for these VWOs to scale up their services and outreach so that more PLWDs and families can benefit.
I hope that MOH can review the funding model for such VWOs supporting dementia-friendly programmes so that they can focus their energies and resources on their programmes and services instead of organising fundraising activities.
Mitigation
Diagnosis
The second thrust is to mitigate the challenges faced by PLWDs, especially for those in the early and moderate stages, for them to live more independently.
To this end, a robust policy framework and adequate social infrastructure and services are essential for PLWDs to carry on with the basic functions to work, live and travel.
Legal Arrangements
To protect the interests of PLWDs, we need to increase awareness of Lasting Power of Attorney (LPA), Advance Care Planning (ACP) and Advance Medical Directive (AMD). I urge the Ministry to consider increasing the visibility of LPAs, ACPs and AMDs at GPs, polyclinics, as well as public and private hospitals.
People should be more aware of the role of social workers and professional donees registered with the Office of the Public Guardian, and agencies such as the Special Needs Trust Company – a non-profit agency which helps vulnerable people set up care plans using their insurance or assets.
To create more awareness, we need more talks and seminars at the community level, as well as coverage on our free-to-air TV channels and government social media, on dementia and what to do in preparation. For instance, the media coverage on several high-profile cases related to vulnerable PLWDs being swindled by ill-intent relatives or friends had actually spurred people to set up LPAs and wills.
Private Sector Involvement
Beyond the government and local communities, I would also like to suggest more involvement of the private sector. The public sector can collaborate with private entities to sponsor programmes within their companies and in the community to be dementia-friendly.
Our transportation system, airport, malls and public building owners can incorporate features to make their spaces and customer interactions more dementia-friendly. For instance, SMRT is taking the lead to provide 98 of its train stations across Singapore with Go-To-Points by the end of 2022. These Go-To-Points will allow disoriented commuters to calm down and wait in a comfortable space for their family members to bring them home safely.
Similarly, service providers, particularly banks, need to consider how they can better serve these customers while protecting their interests. It would be ideal if businesses can initiate these improvements. Notwithstanding, I hope the government would consider expediting these changes with guidelines and, if necessary, legislation for specific sectors.
Employment
To promote inclusiveness, I would like to request more support for people with Young Onset Dementia (YOD).
How can people with YOD remain employed for as long as possible?
How can employers be incentivised to redesign job roles, offer micro jobs and shape a more dementia-friendly work environment?
Also, how can employers be more understanding and supportive towards employed caregivers who are supporting loved ones with dementia?
I hope a more compassionate and inclusive workplace culture would develop over time, especially as the retirement age is progressively extended to 70 years old.
Prevention
The age-old saying prevention is better than cure rings true.
I am heartened to note the launch of the Lee Kong Chian School of Medicine Dementia Research Centre in April 2022. The Centre will conduct research to understand more about this disease.
Evidence from various international studies show that dementia can be prevented or delayed through the adoption of healthy lifestyle habits, including having regular physical activity, maintaining a balanced diet, not having excessive alcohol intake, and not smoking.
A recent study published in the International Journal of Epidemiology suggests that obesity may be associated with an increased risk for developing dementia.
While all of the above preventive actions are individual choices, the outcomes will have a profound impact on our families, our community and our nation. Thus, we must all make a greater concerted effort to help one another make good choices for our health and to persist in them.
In addition to the initiatives in Healthier SG, the government should consider investing more resources into public education and campaigns, and to redesign policies and systems to nudge our people to take greater responsibility for their own health and self-care.
It will save individuals and the healthcare system a whole lot of money from medical bills and expenses in the future.
For example, our hawker centres and food courts are still serving mostly high-carbohydrate, meaty dishes with little vegetables. We will need more healthy choices for our national canteens and encourage people to consume more greens, on top of less oil, less salt and less sugar.
It has also been found in a recent Harvard Medical School study that the lack of sleep in middle-age persons may increase dementia risk. Many of us, including my parliamentary colleagues, sacrifice sleep to get more work done or to complete other tasks. One tell-tale sign of sleep deprivation is when members occasionally nod off involuntarily in these chambers. Let us set a good example and get at least 6 to 8 hours of sleep daily.
Conclusion
Dementia can happen to any one of us and our families will be adversely affected. As a nation, we need to recognise that dementia is a fast-growing issue. In the next decade, a lot more work needs to be done to increase our capacity, to mitigate the challenges associated with dementia and to take preventive lifestyle changes.
While MOH expedites capacity building, we can all do our part to spread awareness about dementia, improve our community facilities and programmes and take better care of ourselves while we are still young.
Let’s not burden our future generations with the challenges of caregiving. Most importantly, let’s work towards a more compassionate, caring and inclusive society to help people living with dementia live with meaning and dignity.
Cover photo credit: Nguyen Thu Hoai on Unsplash, MCI Singapore/YouTube
