COVID-19 Impact in Community Care—A Perspective on Older Persons With Dementia in Singapore

To the Editor:

The health and care of our vulnerable older persons with dementia (PWDs) have been inadvertently compromised by general measures taken to protect our community. On April 3, 2020, the Singapore government enforced social distancing measures and compulsory mask-wearing.¹ The Silver Generation Office reinforced these measures to cognitively impaired older people with home visits.² An ongoing initiative, “Support for Persons Living With Dementia Over the COVID-19 Period (SPOC-19),” organized by the Alzheimer's Disease Association (ADA) and the Agency for Integrated Care, provides memos to appeal for waiver of monetary fines for PWDs who breach safe distancing rules.^{3 , 4}

Physical rehabilitation and dementia care centers have suspended operations temporarily.⁵ The burden of caregiving, having fallen squarely on families of PWDs, invariably increases caregiver stress.⁶ These center closures have also led to their physical and cognitive deconditioning.^{6 , 7} New online alternatives are made available to replace center-based exercise and dementia-care programs. These include exercise programs by the Singapore Health Promotion Board and SportsSG as well as dementia-care programs by ADA such as (1) “Stay Home Fun With ADA” comprising of karaoke, bingo, and cooking; (2) “Journey with the Arts and Dementia (JADE),” a reminiscence-based program; and (3) “ADA Memories Café,” a virtual sing-along session.⁸

Lack of access to technology, digital illiteracy, and sensory impairment, however, limit the use of online resources.⁶ Additional assistance is needed to set up digital devices and troubleshoot connectivity problems. This is challenging for households that are struggling with caregiving duties in addition to working-from-home and looking after young children.

Recognizing the above limitations, we can consider engaging mass media channels for our digitally challenged older persons with (1) dedicated television and radio channels to screen exercise and cognitive-stimulating programs and having (2) short exercise routines as filler television programs to periodically remind them to exercise. For comprehensive personalized care, we propose having (1) a dedicated resource helpline to help PWDs and their caregivers navigate the myriad of new resources and initiatives, and (2) where resources are available, for all PWDs to be recruited into a registry for tailored case management.