Understanding Dementia and How To Care for Loved Ones

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. Imagine being someone who is beginning to experience the onset of dementia. You start forgetting your house keys, and a few months down the road, you can’t remember what you had for breakfast.

“I’m just forgetful lately,” you assure your family.

Remembering the time of day becomes more difficult, and you start getting frustrated with yourself. Lashing out at loved ones becomes a common occurrence as they notice changes in your behaviour. Simple forgetfulness has now turned into something bigger.

Can you imagine it? This is just one way a person might begin to feel the effects of dementia.

So what is dementia?

Dementia is a chronic and progressive illness that affects the brain. It is a general term for symptoms like a decline in memory, reasoning and other cognitive skills. Sometimes, it can even lead to decline in intellectual function, personality changes, or it may be severe enough to prevent a person from functioning as well as they used to. Dementia is caused by damage to the brain and its cells. This disease can happen to anyone but is mostly known to affect the elderly aged 60 and above.

There are various causes of dementia, but two of the most common causes are Alzheimer’s Disease and vascular dementia.

Alzheimer’s Disease is a specific brain disease that accounts for 60 – 80% of dementia cases. Alzheimer’s Disease is associated with the accumulation of brain deposits, destroyed nerve cells and shrinkage of the brain.

Another cause of dementia is vascular dementia. When blood flow to the brain is reduced or blocked, brain cells are deprived of oxygen and nutrients. This may occur after a major stroke, depending on how the blood vessels around the brain are affected. Other health conditions like high blood pressure, diabetes, high cholesterol and heart problems are also contributing factors.

There is no cure for dementia. However, there are current treatments to manage behavioural symptoms and delay the progression of the disease.

What are the different stages of dementia?

There are 3 stages in the progression of dementia.

A person with mild dementia may need assistance in instrumental activities such as managing finances, paying bills, grocery shopping and operating complex appliances. They may lose track of time and events.

In the moderate stage, he/she may need assistance with basic day-to-day activities such as showering, toileting, personal hygiene and grooming. Occasionally, they may experience urine and bowel incontinence. Some behavioural changes may happen, such as becoming withdrawn, irritable, agitated or even losing their way.

In the severe stage, a person with dementia may be totally dependent on their caregiver to provide personal care for activities like showering, using the toilet and eating. He or she may be talking less, eventually leading to the inability to speak.

How is dementia diagnosed?

You may be noticing your loved one becoming more forgetful, misplacing things and getting lost in familiar environments. These may be signs to get him or her evaluated by a medical professional. Accurate diagnosis for dementia is important as other factors like depression, hypothyroidism and vitamin deficiencies also exhibit similar symptoms to dementia.

Diagnosing dementia may include:

• A case history analysis and history-taking verified by a family member. This allows the professional to distinguish the significant changes in your loved one’s functioning levels.
• A basic blood test to rule out any treatable medical conditions such as thyroid problems and vitamin deficiencies.
• Brain imaging such as CT and MRI scans to determine the structural pattern of brain shrinkage and to see if there are signs associated with stroke diseases.
• Cognitive tests such as Mini-Mental State Examination (MMSE) and Abbreviated Mental Test (AMT). These test the memory, attention span and concentration levels. They help to determine the severity of memory and cognitive deficits. Your physician may refer your loved one for neuropsychological assessment which provides details and a standardised assessment across a wide range of cognitive domains in the brain.
• A complete physical examination and psychiatric evaluation to rule out any possible sign of stroke, treatable depression and other mental health disorders.

Early detection and diagnosis enables you to better manage the functional decline due to dementia. A diagnosis also helps you to better understand and react to challenging behavioural changes like agitation and withdrawal. Finally, your family will be able to plan ahead for the future; including your finances, future health choices and medical care for your loved one.

Client Profile: Home Personal Care Client with Dementia

Mr Tan*, age 73, has been an NTUC Health Home Care client for 3+ years. He suffers from late stage dementia and has difficulty talking, standing and swallowing. He lives in a landed property in Kranji with his wife, son, daughter and domestic helper. Our Care Associate, Ruben, visits him twice a week for 3 hours:

• Companionship: Ruben keeps Mr Tan company from 8 to 11AM twice weekly. They play classical music and do colouring exercises
• Cognitive Exercises: Ruben will also stimulate Mr Tan’s memory by sharing stories from the past
• Showering: Ruben helps to shower Mr Tan and change his diapers
• Physical Exercises: Ruben takes Mr Tan for walks in the neighbourhood and practices stretches at home.

Client Profile: Home Physiotherapy Client with Dementia

Mrs Lai*, age 76, suffers from dementia. Like many dementia patients, she struggles with inertia. Physiotherapist Christina explains to her and her family the importance of moving and developing a routine. Mrs Lai sees Christina twice a week for 4 – 5 months. When Christina first saw her, she would only shower once a month. After therapy, she would shower every other day.

• Day Rehabilitation: Mrs Lai was initially referred for rehabilitation at our centres before being referred to Home Therapy.
• Functional Exercises: Dementia clients usually find it challenging to focus on typical strength training exercises like wall push ups and lifting dumbbells, so Christina uses functional exercises like walking down corridors or stairs.
• Exercise via Games: Christina plays card games (e.g. Snap) with Mrs Lai, getting her to stand up and play for as long as she can. This improves balance and standing tolerance.
• Cognitive Therapy: Christina asks Mrs Lai to write down “promises” to herself in her diary (e.g. to shower every other day). Mrs Lai can recognise her own handwriting, which helps her to recollect past thoughts.

*These are case examples of how we support clients with dementia.

Caregivers of Seniors with Dementia: How to protect your loved ones during COVID-19

With the COVID-19 pandemic still under way, seniors are encouraged to stay in due to their vulnerability to complications from an infection. Seniors with dementia may face difficulty understanding the need to stay home, as the ‘new normal’ disrupts their routines and can become disorienting for them.

Caring for people with dementia can also become tricky for caregivers if they do not have a care plan in place. How can we best help them and ourselves tide over difficult times? To make things easier, here are some guidelines for caregivers to follow:

Share what COVID-19 is about

1. Explain COVID-19 simply by using visual aids such as posters with informative pictures, or even videos in a language they are familiar with.
2. Try not to overload them with information. Ask questions, and take the time to listen to their concerns.
3. Reassure them that you are there to support them.

Guide them to a new normal

1. Help with creating new routines by engaging them in other activities at home.
2. Here are some caregiver activities for seniors in our Resources section.
3. Engaging in activities can help to distract them from all the changes, and keep their mind stimulated.
4. Write out a new schedule on a whiteboard to plan the days and help your loved ones keep track of the new routines.

Keep a clean and well-ventilated environment for them

1. Cleaning and disinfecting common surfaces helps to keep seniors feeling clean and comfortable.
2. Increased ventilation within your home can reduce the chances of COVID-19 infection. Open your windows and turn on the fan to promote good fresh air circulation.

Check in on them

1. Observe your loved ones for signs of stress as they may not be able to articulate their feelings or needs well.
2. Reassure them often and chat with them about their feelings.
3. Monitor them for any symptoms of COVID-19 by taking temperatures twice daily and remind them to wash their hands.

What happens if you or other caregivers in the home fall sick or need to be away for an extended period of time? Preparation is key to avoid last-minute scrambling during an emergency. Here is a checklist to help you get started on creating a backup plan.

Seeking help from others is a completely viable option for caregivers, especially as it becomes more challenging to adapt to caregiving through a “new normal”. In times of need, do not be afraid to reach out to your loved ones or neighbours for help.

There are also many organisations and services that can provide support. The Alzheimer’s Disease Association is an excellent place to learn more about how to care for seniors living with dementia, especially during this period.

You can also apply for SPOC-19 to better support yourself and your senior. With SPOC-19, the public and ground enforcement authorities will be able to recognise that your senior has dementia, and can offer appropriate assistance for them.

Hang in there, and remember that you are not alone during this period!