The mild-to-moderate dementia suffered by Mr Saravanamuthu Marimuthu, 71, means he cannot remember to brush his teeth or have a bath in the morning, much less take the eight tablets he needs every day for his chronic illnesses.
If there was no one to give him a change of clothes after his shower, he would keep wearing the same things.
Yet Mr Saravanamuthu has managed to live alone in his one-room rental flat in Ang Mo Kio for more than a decade, with dementia his closest "companion" since he was diagnosed with it in 2016.
"I know I have a little bit (of dementia). I can't remember my own name sometimes," said Mr Saravanamuthu, fondly known as "Roy" to his neighbours and staff from the Awwa dementia day care centre situated at the bottom of his block.
As Singapore's population ages, he is one of a growing group of seniors who not only live alone or have dementia, but are also faced with the potentially terrifying prospect of both, battling the scourge alone.
Still, as his case demonstrates, it may be possible for seniors to continue living alone, at least for a while, with the help of social service organisations such as Awwa.
Every morning, a home care associate knocks on Mr Saravanamuthu's door to wake him up. When he opens the door, she reminds him to brush his teeth, shave and take a bath. She also hands him a fresh set of clothes and stands by to watch as he takes his medication.
Then she takes him downstairs to the Awwa dementia day care centre. Once a week, she helps him do his laundry or clean his house.
For the weekends, she will put out his tablets in two small cups - one for Saturday and one for Sunday.
"Sometimes, he will take them but he may forget. Sometimes, I come on Monday and he is wearing the same clothes and I don't know if he had taken any showers over the weekend," said Ms Devi Nair, 39, a home care associate with Awwa.
"But his dementia seems not to have gotten worse. I think it's because we let him do things for himself that he does not forget life skills. He is also meaningfully engaged with eating, activities and friends at the centre downstairs."
The number of people with dementia who endure the "frightening isolation" of living alone will double to nearly a quarter of a million in Britain over the next 20 years, an Alzheimer's charity there predicted this month.
There is no national data on the number of people with dementia who live alone in Singapore, though figures for those who live alone as well as those who have dementia have both surged over the years.
One in 10 people 60 years and above has dementia now, and the proportion rises to one in two among those aged 85 and older. An estimated 103,000 people will have dementia by 2030.
The number of seniors living alone was 41,000 in 2016 and is expected to rise to 92,000 by 2030.
Associate Professor Philip Yap, director of the Geriatric Centre at Khoo Teck Puat Hospital, said: "Since the prevalence of dementia is said to be 10 per cent in seniors, by extrapolating these figures, we can expect more than 4,000 seniors with dementia living alone today and there will be more than 9,000 of them in 2030."
Hospitals and charities such as Alexandra Hospital, the Alzheimer's Disease Association (ADA) and Awwa also confirm they are seeing more seniors with dementia living on their own.
"Many of them are single or childless without any living relatives. Some may have estranged relationships with their children or relatives. They are generally lowly educated, have little savings and do not know where to turn to for help," said Mr Kavin Seow, senior director of the elderly group at Touch Community Services.
THE RIGHT TO LIVE AT HOME
Generally, as society evolves and home care options expand, there will be more who choose to grow old in their own home, and the same goes for people living with dementia.
"Their home and a familiar environment, such as the local hawker centres and shops, are a form of security; similarly, they'll know how to work the washing machine and cooker because they've been doing it for decades," said Associate Professor Reshma Merchant, head of the division of Geriatric Medicine at National University Hospital.
"Suddenly uprooting them and moving them to live with their children can cause distress, create insecurity and accelerate functional and cognitive decline. People living with dementia have the right to live on their own if they want to."
This right should be called into question, and possibly withdrawn, said Prof Reshma, only if there is evidence to suggest that they are a danger to themselves or to others.
In the meantime, a growing army of community organisations is available to lend support to solitary seniors by offering household help, meal delivery, or befriending and nursing services.
ADA said seniors with dementia who live alone may be especially lonely if they isolate themselves further. Some may be ashamed to reveal their condition to others in the community.
There are other unique challenges for this group of people.
"The progressive nature of the disease may mean that though the seniors may have adjusted to certain changes in their lives, such as receiving services or allowing for home modifications, they can decline further, and then more services have to be brought in and this can be very difficult for the seniors to accept," said Dr Chen Shi Ling, a physician at Hua Mei Clinic at ComSA Whampoa Centre. ComSA stands for Community for Successful Ageing.
END UP IN NURSING HOMES?
Some people with dementia will also find themselves in the quandary of not being ill enough to have to go to a nursing home and yet not being able to live alone safely, said Dr Tan Li Feng, associate consultant of the healthy ageing programme at Alexandra Hospital.
"Many eventually end up in nursing homes. Often social workers in the community who keep an eye on them discover them in increasingly unkempt and unsafe states and will often call for an ambulance or the police to take them to hospital and they will end up in the care of the state," said Dr Tan.
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
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