Caregiving for a loved one with dementia can be challenging and demanding.

Besides experiencing physical strain and mental stress, caregivers may also have questions on how best to care for their loved one with dementia. Al these can lead to feelings of frustration, anger, guilt and anxiety setting in – also known as caregiver burnout.

In this month’s 'Ask the Specialist' forum, the Department of Post-Acute and Continuing Care (PACC) at Outram Community Hospital (OCH) answers your questions on ways to look after a loved one with dementia.

OCH is managed under SingHealth Community Hospitals (SCH), a member of the SingHealth group.

This As​k The Specialist forum has closed. Thank you for your interest and participation.

Check out this article on tips to prevent caregiver burnout and where to get help.

1. Question by g*******
Is it alright to let a dementia patient sleep most of the day? How / what can we do to make sure she gets the correct physical therapy in order to slow down deterioration of bones and joints?

Answered by  the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi g*******,
It would be best to limit daytime napping for someone with dementia so as to improve their sleep at night. 

It is good to continue strength training and a reasonable amount of physical activity for the elderly. Depending on the needs of your loved one, you might want to consider bringing her to an elderly friendly gym such as Gym Tonic ( or discuss with your family physician for a referral to a Day Rehabilitation Centre for physical therapy. You can refer to the ‘Living with Dementia’ resource kit for caregivers found on AIC website for more information.

2. Question by e*****
Hello Dr, my father recently exhibited some behavioural changes like mood swings especially in the evenings, staying awake at night past his usual bed hours and insisting to keep the main door open and sitting on the sofa. He also became agitated and stopped the helper who tried to close the main apartment door when she and my mother wanted to retire to their bedrooms for teh night. How can we find out what triggers these behaviour changes as he used to be docile and just forgetful as I would like to help my mother and the helper aswell as myself understand these changes and learn how to care for my father in his current phase of dementia. Thanks.

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi e*****,
This must be a stressful time for you and your family. Considering the new behavioural changes, I would suggest that your father consult a family physician who can assess his condition and advise you further. 
Thank you.

3. Question by R**
I am a 72 year old retired Pioneer citizen.
If I am struck by a stroke and become half or fully paralysed, where can I get professional medical care support and what would it cost me?
I am a self-funded retiree. I sustain my wife and myself on savings. Yes, I do have medilife insurance cover with ntuc income.
Please guide me as I am afraid of being afflicted by this debilitating illness that dementia brings or hit by an unexpected stroke causing paralysis.

Thank you for your guidance.

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
We have a robust medical system in Singapore that supports our elderly with medical conditions such as stroke and dementia as well as chronic diseases.

Elderly with underlying medical conditions can receive a range of treatment and services in their community, from the polyclinics to home-based medical care. There are also various support services such as Day Rehabilitation Centres, home help and home nursing services. 

As you are a Pioneer Citizen, medical fees incurred in public healthcare institutions are heavily subsidised while the fees for home care services will vary according to your household income.

We are glad to hear that both you and your wife have Medishield coverage, which can help to cover a portion of your inpatient bills.

Should you have further concerns on medical costs, you can discuss with your doctor to be referred to a medical social worker for further advice. 

4. Question by M*****
My friend's wife was diagnosed with Dementia. However, she denied that she has dementia and refused to see Doctor and take the medication prescribed by the Doctor. What should my friend do to make her take her medication? Thank you.

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi M*****,
It is common for a person with dementia to have poor awareness about their condition and refuse to take their prescribed medications. 
We would suggest for your friend to try and understand the underlying reasons why his wife has been refusing the medications. Some common reasons are the taste of the medications and having too many pills to take. If this is the reason, your friend can speak to the doctor and explore other forms of medications that are easier for consumption, such as liquid instead of pills. 
Thank you.

5. Question by B************
Hi Dr, 
How to convince an elderly to go for a dementia assessment? Mental health issues are often a stigma to the older generation.
What is being done in a dementia assessment? 
How to determine if an elderly has dementia or other mental health issues if she refuses to seek medical help?

How fast will the decline of the dementia be when the elderly is showing signs of declining mental health, exhibiting forgetfulness, changes in mood, lost of interest in going out or meeting people, repetition in speech, frustrations, hallucinations, delirium etc., even though she seems to be functioning fine most of the time.

Moving forward how to care for an elderly dementia patient who is living alone and cannot seem to get along well with family or friends? Also does not agree or listen to Doctors' advice most of the time? 

Thank you!

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi B************,
A comprehensive assessment is usually done for dementia evaluation. Besides taking a detailed history and doing a physical examination, the physician will advise on other investigative tests required. After the assessment, the family physician will advise the patient accordingly on the cause of the symptoms – whether the patient has dementia or mental health related conditions, or both.

The rate of decline of the dementia depends on the underlying cause and the presence of other underlying medical conditions.

It can be challenging to convince an elderly to go for a dementia assessment. Family members or members in the elderly’s social support network may need to assist him or her to see a doctor. Alternatively, family members can choose to consult the family physician who has been caring for the elderly, for an assessment first. 

Caring for an elderly with dementia who is socially isolated can be challenging. A primary concern is whether the elderly with dementia would be able to cope and live alone safely. 

Family members can consider approaching the Agency for Integrated Care (AIC) to seek assistance for referral to services relevant for elderly with dementia such as home help, home medical care and dementia daycare services. For more information, you can call the AIC hotline at 1800-650-6060.

Thank you.

6. Question by P*********
If I have an elderly relative whom the family suspects has dementia, but refuses to go to a clinic / hospital for evaluation, what are some options that we can explore?
Thank you!

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi P*********,
Thank you for your question.
There are various community outreach programmes available for the elderly, which are supported by institutions across different regions of Singapore. Alternatively, you may want to consider engaging a doctor to do a home visit for assessment. 

Here are some contacts for your consideration. You can approach them to seek more information.
◦Aged Psychiatry Community Assessment & Treatment Service (APCATS) [Central region]
Tel: 6389 2175, Email:
◦Community Psychogeriatric Programme (CPGP) [Eastern region]
Tel: 6426 7504 / 6426 7506, Email:
◦Geriatric Psychiatric Out-Reach Assessment Consultation and Enablement (G-RACE) [Western region],
Tel: 6872 4118, Email:
◦Assessment and Shared Care Team (ASCAT)@North
Tel: 6555 8828
Tel: 6355 3000 
◦ Community, Resource, Engagement and Support Team (CREST)

7. Question by K*********
Is it a must for patient who has been diagnosed as having mild Alzheimer disease to start taking dementia medication during the 1st 1 to 2 years?

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi K*********, 
This depends on the patient’s condition and his or her suitability of starting dementia medication. Patients and their caregivers can bring this up for discussion with the physician in charge. 

8. Question by s********
Hi Dr,
My father is taking 11 medications for his heart problem and high blood pressure besides other medication for his knee pains and skin problem. 

I had brought him to see a specialist at SGH for examination a few years ago, Doctor commented that his condition was not that bad and no medication was prescribed. I noted that he has been becoming more and more forgetfully such as location of his walking stick, grumpy such as complaining no one caring for him  and long winded, he has been quarrelling with my mother on small things. Is this sign of deteroriation? Is it necessary to take him to see a specialist for evaluation again?

As he is resistant to learn things to train his brain or exercise for his physical, is there any other ways to improve his mental and physical?

Thank you.

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi s********, 
Given your father’s change in mood and cognition, you might want to bring him to your family physician for an assessment. Your family physician will be able to further advise if a referral to a specialist is necessary. 

You can also read more about providing care and support to a loved one with dementia here.
Thank you. 

9. Question by J****
Hi Dr,
Just recently one morning when my mum woke up, she (aged 87 with severe dementia) said "I am no good, you are good. Old already, Die". This is the first time she talks about death. She told the maid in Malay but I heard it and she said the same thing to me. At that moment, I did not know how I should response to her, so I told her, "Mum you are strong, no die" 

Dr, would you like to suggest how I should response to my mum if she bring up about death again? How should one communicate to a person with severe dementia about death? I find this really hard.

Answered by the Department of Post-Acute and Continuing Care (PACC), Outram Community Hospital (OCH):
Hi J****, 
It is indeed challenging to have a discussion on death with our loved ones, especially one with severe dementia. 
There might be some underlying reasons that prompted your mother to make these statements. You might want to bring her to your family physician who can better assess her health condition. 
You can also try to find out if there is anything that worries her or if there is something that would give her some comfort and strength. 
Thank you.

Ref: L20