Dementia rates on the rise as population ages: Study

More people here are developing dementia as the population ages, underscoring the need to beef up services for such patients.

One in 10 people aged 60 and above here has dementia, a three-year study on almost 5,000 patients and their caregivers by Institute of Mental Health (IMH) experts and other international investigators has found.

This finding of the $4.4 million Well-being of the Singapore Elderly study - funded by the Health Ministry and Singapore Millennium Foundation - was released yesterday. It points to the growing prevalence here of the progressive brain disorder, when compared to the findings of an older study done using a different method.

In the World Health Organisation ageing survey done in 1994 by Professor Kua Ee Heok, now a senior consultant at the National University Hospital (NUH), only 3 per cent of those aged 65 and older were diagnosed with dementia.

Most countries have a prevalence rate of 5 per cent to 8 per cent, but IMH researchers said these were measured using a less sensitive method - which excluded mild cases - than theirs.

Professor Chong Siow Ann, the vice-chairman of IMH's medical board (research), who led the new study, said: "This is the most comprehensive, most rigorous study that we have done to date of this nature in Singapore. The concern is how we can use it to assess if we have adequate resources to meet the challenges now and those that will emerge."

IMH experts attribute the rise in the prevalence of dementia to a rapidly ageing population and increasing rates of stroke, obesity, diabetes and high blood pressure - conditions that are risk factors for dementia.

Singapore has about 660,000 residents aged 60 and above, up from about 280,000 in 1994.

In 2012, about 28,000 people in this age group had dementia. The number is expected to soar to 80,000 by 2030.

Other factors such as education and employment were also associated with dementia.

People who were educated up to primary level are 3.6 times more likely to develop the disease than those with tertiary education, while the risk for housewives and retirees is at least 25 times higher than that for workers.

But the reasons are not known. People with dementia might be jobless because they have lost the ability to work, rather than unemployment being the cause of the disease, the researchers said.

Dementia patients may also have memory loss and difficulties in comprehension and expression.

Knowing its prevalence helps policymakers plan services, and raises awareness so people can recognise its symptoms and seek help early, IMH researchers said.

Dr Christopher Lien, director of community geriatrics at Changi General Hospital, said: "The numbers could have significant implications on the resources we put in to support such seniors, from ramping up facilities and training staff skilled in dementia care, to doing research that goes beyond the current alleviation of symptoms to prevention and cure."

Prof Kua said previous studies and data from NUH's memory clinic in the last 20 years show that only a fifth of all cases are detected. Many go undiagnosed as symptoms are often mistaken for poor memory or signs of old age.

Early diagnosis is important because it allows for treatment or intervention that may slow down the progression of the disease and reduce the burden on caregivers.

The preliminary results of a 10-year study tracking the mental health of 600 Jurong residents with dementia and depression found that regular therapeutic activities such as music, art and taiji maintained or slowed down such disorders, Prof Kua said.

IMH chief executive Chua Hong Choon said: "The more we learn about the problems that the elderly will face, the better prepared we can be."

Key findings

In Singapore, one in 10 people above 60 has dementia.

People are more likely to develop the condition the older they get.

Those aged 85 and older are 18.4 times more likely to have the condition compared to their peers who are aged between 60 and 74. The risk is 4.3 times for those aged 75 to 84.

Those who had a stroke before have a higher risk of developing the condition.

Individuals who are unemployed or have lower education levels tend to be associated with having dementia.

About 85 per cent of people with dementia needed care "some or much of the time".

Half of those with dementia are being cared for by paid help.

Caregivers of people with dementia reported significantly more distress and psychological problems than caregivers of people without the condition.

Caregivers of those with the condition 'more distressed'

Carers of people with dementia reported being three times more distressed than other caregivers, because these patients tend to have more needs than others.

The Well-being of the Singapore Elderly survey found that 86 per cent of dementia patients need care "some or much of the time". In contrast, elderly people who do not have dementia need attention only about 10 per cent of the time.

Possibly for this reason, dementia patients' family members and friends are more likely to require paid helpers such as domestic workers.

Of the more than 2,400 caregivers surveyed, half said they provide the care themselves while the rest turned to paid helpers. Fewer than a third of the caregivers of those without dementia hired help.

One of the researchers involved in the study, Dr Ng Li Ling, a senior consultant psychiatrist at Changi General Hospital, said: "People with dementia are very disabled and, therefore, will need help in their personal care, and they may have behaviour that causes stress to the caregivers.

"This study means that we really need to develop a whole range of services for caregivers, ranging from increasing awareness, having an early diagnosis and having appropriate interventions."

Caregivers themselves also need more support as they grow old.

Cabby L.C. Lim, 61, started taking care of his parents, who both have dementia, six years ago. Despite having the help of two domestic workers, he still found the situation "extremely tiring".

The taxi driver works from 4pm till midnight, and would spend six to seven hours in the day tending to his mother and father. His father is 97 while his mother, who died last month, was 94. Both their conditions went beyond mere forgetfulness.

"My father turned aggressive and would box and kick me, while my mother would scold and accuse us of stealing her things or poisoning her," he said.

His fatigue and anxiety over their condition meant that he suffered sleepless nights. But he is thankful for the occasional home visits he gets from a team from the Institute of Mental Health.

"They checked on my parents, gave advice to the domestic workers and brought comfort to me."

jantai@sph.com.sg

This article was first published on Mar 26, 2015.
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