Improving the Quality of Life of 

dementia
patients 
in Western Singapore
Donor: Council for the Third Age (C3A)
Duration: 5 years (Jan 2023 – July 2027)
Funding requested: SGD $1,723,074.31 
Total project budget: SGD $ 1,914,527.01

Group 4
Dexter Chan A0181031X, Eunice Tong A0146732E, Louisa Sun A0134410Y,
Jamie Kok A0242638B, Lee Long Yu A0218909U, Neo Jun Kai A0002556N
 Who we are
Established since 1990  Awarded NCSS Outstanding Voluntary Welfare
Previously known as Alzheimer’s
Disease Association (ADA) 
Singapore's leading Social Service Agency in
specialised dementia care for patients1 
Provides caregiver support, training,
consultancy, and advocacy1
Patron: Singapore’s
President, Halimah Yacob (since 2018)
Our achievements Current Partners3
Organization 2010-2012
Co-developed Dementia Clinical Practice Guidelines with
MOH 20132
Established dementia friendly communities (2019-2020)
in Kebun Baru and Yio Chu Kang3
Dementia Hub.Sg (2021) - one stop resource for
education on dementia. Partnership with Agency of
Integrated Care (AIC)2  Other Partners: GP mental health
network clinics (PCN), Ageing Planning
Collaborative research on Arts and Dance Therapy Office (APO), Senior Activities Centres
Programs (SACs), 
Community Centres (CCs)
Global and National Health Policies
• The US Preventive Services Task Force (UPSTF)4 and Singapore 2013 Clinical Practice
Guideline5 concluded that the current evidence is insufficient to assess the balance of benefits and
harms of screening for cognitive impairment in asymptomatic older adults 

• However, persons who report progressive cognitive or behavioural complaints suggestive of

dementia should receive early evaluation 
• This includes patients suspected to have cognitive impairment by their physicians or caregivers
despite absence of complaints

• Early detection and diagnosis of dementia is beneficial to patients, caregivers and society
• Diagnosis within the window to receive effective treatments that slow down the progression of
disease can 
• Prolong function in the community4,5
• Delay institutionalisation4,5
• Lower overall healthcare expenditure4,5
• Early planning of health matters including advanced care planning (ACP)5
Importance of Early Detection of Dementia
Patients
• Early intervention of dementia
proven to be more effective5
• Managing mild symptoms in
primary care decreases burden
on acute hospitals5
• Autonomy to initiate early
healthcare
planning discussions e.g.
advanced care planning (ACP) to
ensure alignment of future
treatment goals5,6
Caregivers
• Educate caregivers to detect
and manage behavioural
symptoms of mild dementia6,7
• Caregiver support and timely
interventions reduces stress
and burden (advanced/severe
dementia)6
• Access to early training
and appropriate planning
• Support group for
fellow caregivers
Healthcare Policy
Makers
• Forward planning in
healthcare resources
allocation8
• Cost effectiveness of right
siting of care to primary
care for patients with mild
dementia8
                          2020                                              2050
6-fold increase 
1 in 10  53,000 (1.4%)       187,000  (6.2%) 
in expenditure on dementia
Singaporeans >60yo has Current population: 3.52mil
Projected Projected population: 3.03mil
increase of dementia burden in Singapore by 205013:
dementia9
(citizens and permanent residents)10-12 $13.1 billion

• Dementia can affect adults of any age, but

is more common in those aged 65 and above9

• Globally
• ~5.2% adults >60 years old have dementia14 
• High prevalence of undetected dementia:
61.7% pooled rate15

• Alzheimer's Disease is one of the top 5 leading

causes of death in Singapore16 

IMHE, n.d.17
Situation Analysis on Dementia in Singapore
Risk Factors [higher risk]
Non-modifiable18
Age [Increased with older age]
Gender [Female]
Ethnicity [Malays and Indians]19
Family history [Positive]
Genetics [APOE4 variant]
Modifiable 18,20
Education level [Lower
education]
Working status [Unemployed]
History of chronic diseases i.e.
stroke, cardiovascular disease,
depression, diabetes  centers during circuit breaker
Social Interaction [Social
isolation]
Lifestyle
Alcohol use [Excessive]
Smoking Status [Smoker]
Physical Activity [Low]
Barriers
Knowledge
Symptom of memory loss often mistaken as
"normal" part of ageing21
Inaccurate understanding of dementia as not
preventable and part of the ageing process21
Attitudes
Fear of discrimination, personal avoidance, fear
of labeling, stigma22,23
COVID-19 resulted in the closure of the ADA
café which was set up to foster a more
dementia-friendly community24
Practices
COVID-19 caused suspension of dementia care
COVID-19 cause people to abstain from
"unnecessary" check-ups at
polyclinics/hospitals
Some SACs whilst elderly friendly may not be
dementia friendly
Catalysts
Launch of many dementia care initiatives like "Forget Us Not" and
"Dementia Friends" to increase awareness and provide resource
directory
- “Forget us not” trained close to 20,000 people in dealing with
seniors to spot symptoms, debunk myths, reduce stigma and
offer practical assistance to persons with dementia25
- “Dementia Friends” mobile app helped to locate an average of
10 missing persons per month and recruited almost 12,000
people to support its cause since its launch20
Recognition of dementia as one of the conditions claimable by
Medisave under Chronic Disease Management Programme27 and
Government Subsidies for treatment and management
Dementia (e.g. Community Health Assist Scheme (CHAS) and
Seniors' Mobility and Enabling Fund)
Proliferation of Dementia Friendly Communities (DFC)26,28:
- Colour zoning, lighting and signages labelling and signs, visible
agency staff nametags 
Location:  Yishun, Hong Kah North, Bukit Batok East, Woodlands,
Bedok, Fengshan.
Jurong West
• A mature estate in Singapore
• Large number (district with 4th greatest number of seniors in Singapore) and high proportion of
seniors29
• Projected to continue having high proportions of seniors in 2050 29
• High prevalence of diabetes mellitus (DM), acute myocardial infarction (AMI), and stroke 30
• Current limited activities targeting dementia screening within the region compared to other regions of
Singapore
• Able to leverage on New Horizon Centre to target the surrounding Jurong West area​31

Number of Singaporeans ≥60yo

Low High
 Proposed Fast-Tracked Referral Pathway
Trained personnel will
carry out simple medical
history assessment and
first-line screening tests
(MMSE)5 for patients to
Seniors with be referred for tele-
symptoms (memory or consult with specialist*
behavioural) suggestive
of dementia recruited
for screening at senior Not diagnosed with
dementia
activity centre (SAC) or
community centres Community nurse to
support tele-consult with
National University
Polyclinic (NUP) or NUHS
Geriatric doctor to perform
initial diagnosis of dementia
*Seniors who show signs of moderate/severe dementia or
display other signs unlikely related to dementia are referred
directly to the hospital for further evaluation
Fast-track referral to National
Investigations (blood University Polyclinics (NUP)/
tests and imaging) by Primary Care Network
geriatrician, if (GPs) / NUHS Geriatrics for
needed. Patient can continued medical treatment
have tests done at an and long-term follow-up
ambulatory centre
Not diagnosed with Non-dementia cause of memory
dementia loss or other diagnosis
For persons who are diagnosed with
dementia and their families/caregivers:
Dementia Singapore will offer and
provide 
- dementia education, 
- targeted ancillary services and support,
and 
- provide links and connections to other
relevant services
Key Partners
Key Collaborators for this project:
Theory of Change
Problem Statement Activities Mid-term changes Desired Long-term Changes
Increase subsidised screening program at Earlier detection and timely referral of
community setting/primary care/long- dementia for possible intervention5
term care facilities
Lower QoL and
Healthcare planning discussions5 (e.g.
high caregiver Teleconsults32 in SACs with aid of
ACP) conducted early with patients and
burden (Paid & community nurses resulting in
family  Improved quality of
unpaid burden) reduced travel to hospital, to allay COVID-
for dementia 19 fears life for dementia
↑ social interaction and maintained patients
patients Community education to increase mental wellbeing33 
amongst ageing dementia awareness including diagnosis
population in and management
↑ awareness on dementia symptoms and
Jurong West its available care/ support
due to late Senior Day Care/SAC activities
Improved Quality of
diagnosis of Dementia friendly re-designed SACs life for caregivers37
↓ discrimination on dementia​
dementia 
Online resources and care packages to
provide education, training, and financial ↑ utilisation of financial support
assistance to caregivers packages available for dementia care and
reduced out of pocket costs34,35
Dementia Care Training Workshops for
Foreign Domestic Workers Improved support and reduced burden on
caregivers36
Support groups, networks for caregivers 
Assumption:  • Dementia pathways are present- diagnosis to treatment are set in stone
• Awareness will change behaviour and attitudes • Seniors will be willing to go for screening
• Tech savvy + know how to use online resource • Seniors are willing to participate in activities at Senior Day Care/SAC
Logic Model
Impact Outcomes
At least 80% of patients with dementia At least 50% increase in the diagnosis of mild dementia in seniors above 60
maintained or showed improvement in years old by referral partners 
their scores on DEMQoL (Dementia Quality
of Life) Instrument after 5 years At least 90% of seniors that accept referral are seen within 4 weeks or
- To be completed by patient & caregiver less from screening to tele-consult 
(DEMQOL-Proxy)*
At least 80% of seniors with mild dementia would have reported completing
ACP within 1 year of diagnosis

At least 70% of mild dementia seniors reported feeling orientated and

comfortable in the SACs with the dementia friendly feature in our yearly
feedback survey 

At least 60% of seniors with mild dementia would have maintained or showed
improvement in LSNS-6** during yearly follow-ups

At least 70% of the Jurong West population would be able to list at least 2
Dementia symptoms and screening criteria 

* DEMQOL is a 28-item interview administered questionnaire. DEMQOL- Proxy 31 item interviewer administered questionnaire38
**Lubben Social Network Scale- 6 question, LSNS-6 score ranges between 0 and 30, with a higher score indicating more social engagement39
Logic Model
Outputs Process Inputs
Coverage Partnership Manpower 
- At least 60% of seniors above 60 years old would have - Partnerships would have been established with NUP, NUHS - Screeners (nurses /
reported seeing the outreach electronic/paper advertising Geriatrics and at Jurong West PCN to establish a coordinated trained personnel)
materials in the past week care network with community partners - IT developers for online
- At least 50% of Jurong West SAC have Dementia Screening by - Partnership with NUHS would be established to co-design resources
the end of 3rd Year  and enhance programs in SACs to be more dementia friendly - Program coordinator
-  At least 90% of SAC in Jurong West would be redesigned - Leadership
and equipped with dementia-friendly features according to Quality Assurance
MOH's recommendation - At least 95% personnel would have completed the MMSE Materials
training deemed competent in using the tool according to a - Brochures for outreach
Access competency checklist.
- Technological Touchpoint in at least 3 SACs would have set up - At least 95% personnel would have completed the Money
the teleconsult service within 2 years, to ensure continuity of teleconsult app training deemed competent in - Funding for
consults during COVID-19 troubleshooting the app according to a competency checklist screening program
- At least 6 Geriatricians would have participated in the - All community education messages would have been vetted
teleconsult by Year 2 by a team from Dementia Singapore and seniors in Jurong Technology
West for quality check at least 1 week before dissemination - Web for screening
Utilisation  registration & online
- At least 80% of seniors with mild dementia symptoms would resources
have enrolled in centre base social activity 3 times a week - NGEMR (Next Generation
according to the attendance logbook Electronic Medical Records)
- oneNUHS app 
Timeline
Project Budget (Singapore Dollars)

Year 1 Year 2 Year 3 Year 4 Year 5 Total

Personnel  $170,950.00   $233,616.50   $249,969.66   $267,467.53   $286,190.26   $1,208,193.94 
Benefits  $44,211.50   $59,685.31   $63,723.28   $68,043.91   $72,666.98   $308,330.97 
Travel/Transport  $3,000.00   $3,150.00   $3,307.50   $3,472.88   $3,278.18   $16,208.56 
Training  $2,500.00   $3,500.00   $3,500.00   $3,500.00   $3,500.00   $16,500.00 
Capital expenditure  $-     $-     $-     $-     $-     $-   

Operating Supplies &

Equipment  $19,330.00   $1,730.00   $1,730.00   $1,730.00   $1,730.00   $26,250.00 
Other  $8,000.00   $8,000.00   $8,000.00   $8,000.00   $6,000.00   $38,000.00 

Monitoring and
Evaluation  $27,862.67   $13,931.33   $41,794.00   $15,931.33   $29,862.67   $129,382.00 
Indirect Costs (10%)  $25,652.42   $32,188.31   $37,029.44   $36,641.56   $40,149.81   $171,661.55 
Total grant request  $271,355.93   $320,221.31   $368,148.49   $364,308.49   $399,040.10   $1,723,074.31 
Match (10%)  $30,150.66   $35,580.15   $40,905.39   $40,478.72   $44,337.79   $191,452.70 
GRAND TOTAL  $301,506.58   $355,801.45   $409,053.87   $404,787.21   $443,377.89   $1,914,527.01 
Sustainability Action Plan
 Component Objectives
Sustainability • 100% of our current partners (NUHS, SACs, PA ) commit
Action Plan to continue activities beyond the project
Year 4 onwards • To maintain sustained partnership and establish
new partnerships with other healthcare clusters
and SACs in other regions
• To engage NUHS to enhance technological process
of using one NUHS and consideration of NGEMR use for
a more integrated referral mechanism
Health • At least 90% of the population in
Outcomes Singapore would have awareness of
Year 6 onwards Dementia symptoms  • Singapore wide household surveys
• At least 95% take-up rate for screening for early
memory loss in target population
Health Systems • At least 60% of SACs, daycares nationwide would have
Strengthening implemented 3 or more meaningful activities to reduce
Year 3 onwards the progression of dementia  dementia  • Number of SAC/daycare centres prepared to
• At least 90% of SACs nationwide would be redesigned
and equipped with dementia-friendly features
according to MOH's recommendation.
Community • At least 70% of Community Centres (CCs) and SACs in
Systems Singapore take ownership and can organize
Strengthening independently the screening and organize
Year 6 onwards advertisement  encouraging screening as needed
among the elderly 
Enabling • At least 20% of the annual budget of this program will
Environment be funded by Ministry of Health in 6 year
Year 6 onwards  • At least 80% of Singapore redeveloped as Dementia
Friendly Communities including Jurong West
Activities
• Stakeholder Engagement
• Review Service Agreements
• Review Job Descriptions
• Creation of partnership with other health systems –
speaking with other geriatrician to champion the
cause 
• Information campaign on dementia and early
symptoms
to estimate Knowledge, Attitude and Practice
of Dementia Symptoms pre and post roll out 
• Having training and workshop for SAC/daycare to
newer activities that help reduce progression of
• Strengthen a cross-referral system between NUHS and
program in the SAC 
• Training and refresher courses provided to SAC/CC staff
to build capability.
• SACs/CCs are able to raise their own funds to organize
screening activity  Singapore
• Annual audit, monitoring and evaluation of processes
• Reports to be shared with MOH and AIC for potential
scaling to other clusters
• Lobbying and Consulting with member of parliament
• Participate in council debate
Indicators
• At least 1 stakeholder meeting a year with
100% attendance from representative of all
key stakeholders
• Number of service agreements with
Healthcare providers like SAC 
• Number and percent of people reported to
have awareness of Dementia symptoms
• Number of seniors reported early memory
loss who attend screening events.
• Number of SAC/daycare staff retaining and
workshops 
maintain the cross-referral systems with NUHS
• Number of Community Centres/SACs that are
able to organize the screening by themselves
with little or no help from Dementia
 
• Number of parliamentary members that
receive our report
• Number of meetings with Ministry Staff  to
encourage support for dementia programs 
• Number of DFCs in Singapore
Thank you and we will now take questions.
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