SINGAPORE – Mrs Angela Cheong was at a loss as to what to do when her father, who has had dementia for 10 years, started displaying bizarre behaviours daily from about late afternoon to 9pm in early 2020.
The 75-year-old man would pace around the house and repeatedly demand to be brought home, even though he was at home. When family members cajoled him, he would scold them, said Mrs Cheong.
On one occasion, he even ran away from their current home in Chinatown and went back to the family’s old place in Tanjong Pagar.
“It made me very scared and stressed at home, because you would not know what would trigger him. A method of coaxing him today might not work tomorrow. So it’s like I had to tiptoe while at home,” said Mrs Cheong, adding that she would have to rush home from her work at a lighting manufacturer to take care of her father.
It turned out that her father was suffering from sundowning syndrome. That is when those with dementia slip into a state of confusion in the late afternoon, often lasting into the night.
Some symptoms include restlessness, agitation, suspicion and disorientation. These behaviours are due to changes in one’s biological clock, leading to confused sleep-wake cycles.
Mr Cheong’s condition tapered off in the beginning of 2022, after his doctor prescribed medication to help him cope with sundowning.
A night respite programme has been piloted to give caregivers like Mrs Cheong some respite if their loved ones experience difficulties sleeping at night, especially if they display sundowning behaviours.
Three care homes – Vanguard Woodlands, Peacehaven Nursing Home and St Joseph’s Home – provide the overnight service from 7pm to 7am on weekdays.
The initiative has benefited more than 10 clients since it began in December 2019. The pilot was temporarily suspended in early 2020 due to Covid-19, but resumed in phases from late 2021 and has been fully operational since October 2022.
The Agency for Integrated Care (AIC), which runs the pilot, said trained care staff provide meaningful engagement and companionship for the dementia patients.
Depending on the care homes, geriatric chairs or beds are available for the clients to sleep on when they feel tired and sleepy. Staff may also work with the caregivers on reversing the clients’ body clock to normalise their lifestyles, added AIC.
The caregivers can decide when and how frequently they want to send their loved ones to the programme, depending on the families’ needs. Transport is also provided if needed.
Vanguard Senior Care centre manager Angeline Gan said specific goals for dementia patients are discussed with the caregiver during the intake assessment.
“Our care staff engage clients with light exercises and meaningful activities. The engagement allows clients to sleep more easily due to fatigue. In addition, the centre’s lights will be dimmed and soft music played to create a comfortable sleep environment,” said Ms Gan.
Activities include cognitive, sensory and reminiscence experiences, such as colouring, puzzles and games. Care staff will tailor activities according to clients’ interests, which can include mahjong or singing.
Ms Gan said most of the centre’s clients are able to sleep about 4½ to six hours a night due to the ambience created.
Some took a few sessions to get used to the centre’s environment and night respite routines. Those who are unable to sleep will be entertained with activities such as exercises, bingo games, or listening to oldies.
As the pilot does not operate on weekends and public holidays, Mrs Gan said caregivers are advised to keep a structured daily routine for those with dementia, and to avoid letting them have caffeinated drinks after 3pm or long naps in the day to help them cope with sundowning.
The pilot will end in mid-2023, and recommendations to improve the service will be proposed after a review.
