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Dementia is a chronic brain disorder that impairs memory, reasoning, communication, and daily function. It results from progressive brain damage, commonly from Alzheimer’s disease, vascular dementia, or Lewy body dementia. As dementia advances, individuals lose the ability to recognise people, manage tasks, and make sense of their surroundings.
Prevalence of dementia
Over 55 million people worldwide live with dementia, with 10 million new cases every year (World Health Organization, 2023). In Singapore, about one in ten seniors aged 60 and above has dementia. This number is expected to exceed 100,000 by 2030, making dementia one of the fastest-growing health concerns in the nation’s ageing population.
General concept of dementia care
Dementia care goes beyond medical management. It focuses on supporting the person’s remaining abilities, sense of identity, and emotional well-being. The key principle is person-centered care, i.e. understanding the individual’s history, preferences, and behaviours to guide daily support.
Effective dementia care emphasises:
Familiarity and routine
Familiar environments help preserve residual memory. Predictable routines reduce anxiety and confusion.Emotional safety
Caregivers provide reassurance through calm tone, touch, and patience. Emotional stability often matters more than cognitive performance.Validation instead of correction
Instead of challenging delusions or memory gaps, caregivers respond empathetically to the person’s feelings.Engagement in meaningful activities
Simple, repetitive tasks such as folding towels, watering plants, or singing familiar songs help maintain purpose and comfort.Continuity of care
Seeing the same caregivers daily helps residents build trust and reduces behavioural disturbances.
Good dementia care respects the person’s life story and prioritises stability over novelty. Change may stimulate the healthy brain, but in dementia, it causes distress.
What we should do in managing demented elderly?
Keep the environment familiar and calm.
Maintain consistent routines for meals, sleep, and activities.
Use visual cues such as name labels and photos to help orientation.
Encourage engagement in meaningful, simple activities.
Ensure caregivers and companions remain consistent to build trust.
Support communication with short, clear sentences and gentle tones.
These strategies reduce confusion, prevent agitation, and enhance the sense of security.
What we should not do?
We should avoid frequent changes to their environment, caregivers, or daily structure. Demented elderly rely on familiarity to stay oriented. Disrupting this pattern forces them to re-learn what their brain can no longer store effectively.
Examples of what not to do include:
Transferring them repeatedly between wards or rooms.
Changing caregivers too often, especially for personal care.
Rearranging their furniture or décor without clear reason.
Altering meal times or activity schedules abruptly.
Mixing social groups too often, especially when they have bonded with certain peers.
Each unfamiliar change chips away at their emotional security. They may become withdrawn, irritable, or aggressive. The mind, already struggling to connect past and present, collapses under new stimuli it cannot process.
What could happen if we keep changing their familiar surroundings?
Frequent changes cause disorientation and agitation. The person loses their sense of place and belonging. Studies show that relocation or staff turnover can trigger “transfer trauma”, leading to sleep disturbance, confusion, and loss of function. Over time, this may lead to depression or accelerated decline.
Simple consistency, such as seeing the same caregiver or eating the same breakfast daily, gives them structure and calm. It helps preserve their dignity and reduces behavioural symptoms.
Conclusion
Changing the environment and people around a demented elderly person is not advisable unless absolutely necessary, such as for safety or medical reasons. Familiarity anchors their fragile sense of reality. It preserves function, reduces stress, and supports emotional well-being. In dementia care, stability is not convenience, it is therapy. Nursing homes and families should protect this stability through consistent care routines, trusted staff, and an environment that feels like home.