Knowledge to Practice Series: Dementia Care across the Continuum – Multi-dimensional Peek into the Unknown (24 Nov 2023)
8 December 2023
As efforts to build a dementia-ready Singapore gather steam, GERI brought together researchers, clinicians, community care partners and policymakers for a critical and expansive stock-take of the gaps and opportunities in dementia management and care, as part of the Institute’s Knowledge to Practice Series (KPS).
Organised in collaboration with the Ministry of Health (MOH), Chapter of Geriatricians and Society for Geriatric Medicine, the KPS webinar drew over 500 participants from policy divisions as well as primary, acute and community care sectors. Topics covered included dementia screening, person-centered long-term care, end-of-life prognostication and caregiver support. Click here [PDF, 327 KB] for the full programme. A synopsis of each presentation can also be found in our KPS Webinar Brief: click here [PDF, 186 KB].
In his opening remarks, Associate Professor Dan Yock Young, Deputy Director-General of Health, Health Services Group, MOH, laid out the Ministry’s three-prong approach in supporting the overall well-being of persons living with dementia (PLWDs): First, strengthening prevention and early detection of dementia; next, building up the capacity of community and long-term care services; and third, enhancing support for caregivers of PLWDs.
“It is important that even as we embark on many of these initiatives, we would need to work more closely with our research community, to develop innovative solutions (so as) to improve dementia prevention, detection, diagnosis and management,” said Associate Professor Dan.
Informing dementia policy through evidence-based research
GERI’s evidence-based contributions towards Singapore’s dementia strategy was highlighted in the presentation “A Rapid Review of Brief Diagnostic Tools to Identify Possible Dementia among Community-Dwelling Older Adults in Singapore”, delivered by Dr Lim Jun Pei, Consultant, Geriatric Medicine and Tan Tock Seng Hospital and Translation Lead, Institute of Geriatrics and Active Ageing.
The rapid review synthesised available evidence in Singapore to determine which brief screening tools could be used to identify potential dementia at the community level, as well as ascertain their diagnostic performance. Rapid reviews, Dr Lim explained, effectively answer urgent and emergent health issues in a manner that is relevant and useful for knowledge users, such as policymakers.
The study team comprised of domain experts – including GERI faculty – from all three healthcare clusters, as well as methodology experts from the Singapore Clinical Research Institute. GERI researchers supported the review team in conducting the evidence synthesis. The findings will serve to inform evidence-based decision-making by the MOH dementia policy workgroup, on Singapore’s strategy for dementia identification in the community.
Gaps and opportunities: Experts weigh in
Working upstream to address dementia and supporting carers emerged as key themes during the hour-long expert panel discussion, moderated by Associate Professor Philip Yap, GERI Adjunct Faculty, and Senior Consultant, Geriatric Medicine, Khoo Teck Puat Hospital.
Speaking during the panel discussion, Associate Professor Reshma Merchant, GERI Adjunct Faculty and also the Head of Division and Senior Consultant, Geriatric Medicine at the National University Hospital, observed that efforts to address dementia often take place “in the CPR mode” in the face of advanced disease, with medicine serving as “a small silver bullet”.
Instead, she identified more possible points for upstream intervention: diversifying settings for early detection of cognitive impairment; paying closer attention to environmental design and taking a generational approach to relationship-building between PLWDs and their communities, such as by integrating dementia education into the school curriculum.
Associate Professor Merchant also pointed to the potential of the WHO Integrated Care of Older Persons framework, which offers easy-to-execute tests to assess older adults’ hearing, vision and mobility, thereby helping to identify those at risk of cognitive decline at a much earlier stage.
On acting earlier to address dementia, Mr Jason Foo, Chief Executive Officer of Dementia Singapore, observed that older adults are often reluctant to visit hospitals for a diagnosis and appointments at memory clinics often take time to secure. Getting more primary care providers on board could boost timely diagnosis and enable interventions to be applied as soon as possible, said Mr Foo.
The panellists also called for the systematic and holistic support of caregivers and care providers of PLWDs. Ms See Yen Theng, Chief of the Caregiving and Community Mental Health Division at the Agency for Integrated Care (AIC), identified capability building of community care partners as a key focus. This entailed equipping them with the necessary skillsets, whilst also creating platforms for them to cross-share best practices and learn from one another.
Beyond shoring up caregiving skillsets, Dr Chan Ee Yuee, GERI Adjunct Faculty and Deputy Director of Nursing at Tan Tock Seng Hospital, also highlighted the need to help carers to build up their mental and psychological reserves, so that they would be able to sustain long-term caregiving.
Dementia: A cross-cutting challenge
Against the backdrop of dementia’s growing prevalence, as well as its social and economic implications, Associate Professor Ding Yew Yoong, Executive Director, GERI, noted that the stakes are high. For GERI’s part, it would continue to engage in relevant knowledge creation on dementia, conducting collaborative research with partners, and bridging research evidence into targeted spheres of policy and practice in a timely way.
Concluding the webinar, Associate Professor Ding said, “Dementia is one cross-cutting health and social challenge, and so we need players from all diverse sectors and disciplines to come together to the table for meaningful dialogue, collaboration and finally, action.”
For more information about the presentations, please email us at enquiry@geri.com.sg.