Take different view of dementia beyond illness

A lady with dementia performing a cognitive activity at The Care Library facilitated by a centre employee.
A lady with dementia performing a cognitive activity at The Care Library facilitated by a centre employee.PHOTO: ST FILE

The Sembawang "dementia village" site tender expands our housing and care options for persons with dementia (PWD) (First dementia care village to be built in Sembawang, July 17). Such villages are designed for residents to pursue their own lives despite declining functional abilities.

However, in land-scarce Singapore, its affordability has been questioned (5 hard questions to ask about the 'dementia village' plan in Sembawang, July 25).

A national survey found that three in four PWD feel rejected, and more than half of the public feel uncomfortable interacting with PWD (3 in 4 with dementia feel lonely, rejected: Survey, April 30).

This, in part, has to do with our perception of dementia. The common public health approach to old age is to manage disease and deficits. Recently, the World Health Organisation defined healthy ageing as a "process of developing and maintaining the functional ability that enables well-being in older age".

Functional ability is the total of one's intrinsic physical and mental capacities plus the environment, and their interactions.

This intrinsic capacity-environment approach points towards optimising capacity together with cultivating an empowering environment for ageing in place.

Dementia has been a term which describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily life. This definition focuses on the nature and cause of the disease and its deficits.

Another view of dementia is as a shift in the way an individual experiences the environment. Functional decline means one's life is not what it used to be and one gradually accepts a "new normal". Such a view encourages us to look beyond managing deficits towards optimising potential and well-being.

Being well in this "new normal" goes beyond looking at the extent of disabilities and illness, and looking towards growth, autonomy, connectedness, meaning, and joy. People with dementia, while experiencing functional decline, can continue to socialise, connect, learn cognitive and motor skills and mentor/teach pre-school children under the appropriate environments and conditions.

These can be made possible in a variety of housing and care settings but require intentionality and creativity. Some institutionalised care approaches can be restrictive when they put PWD in living environments and situations where they cannot succeed and then medicate or further restrict the (predictable) result.

With the growing number of PWD, we have a definite way to go towards understanding, identifying and co-creating a friendly and empowering environment for everyone.

Wee Shiou Liang (Dr)

A version of this article appeared in the print edition of The Straits Times on July 29, 2019, with the headline 'Take different view of dementia beyond illness'. Print Edition | Subscribe