Dementia has become a pressing social and health issue, especially in developed economies like Hong Kong. Many NGOs in Hong Kong have provided centre based programs, which include physical exercises, recreational activities and cognitive training for dementia people, and also caring skills for the caregivers.
Early intervention of Dementia
One large scale intervention is the “Active Prevention and Early Detection of Cognitive Impairment Project” (APEC, 先知先覺® – 認知障礙預防計劃). This intervention is based on a study done by the Department of Psychiatry of CUHK from 2011 to 2013, to examine the effectiveness of structured physical and cognitive activities in enhancing brain functions of the elderly. With over 400 participants, this study indicated that “56% of the participants showed improvement in cognitive functioning, 37% maintained the same level and only 7% retrograded”. The lead researcher, Professor Linda Lam said, ‘In conclusion, structured physical and cognitive activities are effective in helping the elderly to improve their cognitive functions.” As an evidence based model. APEC had been rolled in four phases involving 26 NGOs, 83 service units and covering 17 districts in Hong Kong.
Centre based intervention is a structured program, which is relatively easy to roll out and replicated. The evidence on cognitive improvement could be substantiate. The question is whether the cognitive improvement could be generalized into everyday life. That is, could we help people to be more independent and socially engaged?
Home based intervention
Home based intervention is an alternative solution. It is based on numerous findings that physical activities could improve the brain functioning. Physical activities include physical exercises, going for a walk, dancing, simple household chores such as cooking, sweeping, vacuuming or folding laundry.
Since the caregivers will arrange daily routines for the dementia persons, they have a major role in determining whether the dementia persons could live an active, engaged and meaningful life. Because of the perceived danger, many caregivers will stop the dementia persons to get involve in cooking and other household chores, to have time alone inside or outside the house. However, without enough physical activities and sunshine at day time, dementia persons are prone to have depression, could not sleep well and night wandering is common.
An active, engaged and meaningful daily schedule
A successful home intervention requires a NGO to work with a family. The NGO worker will help the caregiver to design an active, engaged and meaningful daily schedule based on the capabilities and preferences of the dementia person. For example, if the dementia person is good in cooking before the onset of the dementia symptoms, then the cooking procedures could be broken down into smaller tasks. The dementia persons can still participate in cooking by doing some of the cooking tasks. Engagement is a way to show respect rather than over-protecting the dementia persons.
Smart home system
Smart home system is a network of connected sensors that can help the caregivers to monitor the activities of the dementia persons and prevent accidents in an unobtrusive manner. For example, a temperature sensor could alert the caregiver if the dementia person forgets to turn off the stove in the kitchen. If the dementia person has night wandering behavior, the motion sensor in the bedroom will alert the caregiver. The door sensor will trigger an alarm if dementia person goes out in the middle of the night.
Another useful smart technology is the wearable watch-liked activity tracker. It can keep track the day time activities and quality of sleep of the dementia person. Once the NGO worker has helped the caregivers to redesign the daily routines, and the smart home system is installed to ensure safety, the activity tracker will start to measure the amount of physical activities and quality of sleep.
Many studies using imaging technology have indicated that physical activities will change the structure the brain, and help to slow down the decline of the cognitive functions. It is time for NGOs to try home based intervention which could be equally effective as centre based intervention. And certainly home based intervention will help both the caregivers and the dementia persons. The caregivers will feel more relax, and the dementia will feel respected and empowered.