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*Based on a speech delivered at Annual Scientific Symposium of the Hong Kong Psychogeriatric Association on 8 Nov 2008

Like many advanced economies, Hong Kong is facing the challenge of an ageing population. At present, one out of every eight people is aged 65 or above. The latest population projection tells us that the ratio will increase to 1:4 by 2033. By then, some if not most of us will have joined the “silver hair troop”. At the same time, the prevalence of dementia is also on a rising trend. How to take better care of the frail elders, including those suffering from dementia, and enhance the capability of families in looking after their elderly members has become an increasingly pressing issue for governments around the world to consider and Hong Kong is no exception.

What then are the challenges for Dementia? I would like therefore to bring you through my thoughts on 3 areas. First, can we somehow prevent dementia from setting in; secondly, perhaps more practical, is can we arrest or decrease the rate of deterioration of dementia, and finally what can we do to improve the life of those with dementia and those who look after them.

Dementia is a growing phenomenon worldwide. A recent study conducted by the Department of Health and the Chinese University of Hong Kong revealed that the prevalence rate of dementia among people aged 60 and above increased with age and doubled for every five years. The percentage of elders aged 60 to 64 suffering from dementia was 1.2% and increases to 32% for elders aged 85 or above. The overall prevalence rate of dementia among Hong Kong community elders aged 70 or above is estimated to be 9.3%, with 15.3% for female and 8.9% for male. In short dementia in an ageing population is inevitable. Furthermore, the growth in the population of demented elders will inevitably lead to an increase in service demand on the part of elders and their carers.

As a medical doctor by profession, I believe prevention is better than cure. To this end, the Elderly Commission (EC) and the Government have been promoting active ageing and healthy lifestyle. All elderly centres throughout the territory provide a wide range of recreational activities and volunteering opportunities for elders to develop social life and their potential. We believe that, through maintaining a social life, the deterioration rate of elders’ physical and mental health can be reduced. At the same time, the Department of Health has done a lot in raising the community’s awareness on dementia, such as the risk factors, the proper lifestyle, the importance of early medical consultation, and the know-how in caring for the demented. It is critical that family members can seek early medical consultation for elders who have symptoms of dementia. This will not only help demented elders maintain their self-care ability through timely cure, but also enhance their carers’ psychological preparedness in handling the emotional and behavioural changes of the demented elders.

Elders with dementia will experience an irreversible decline in intellectual, physical and social functioning, leading to their gradual deterioration in memory, thinking, judgement, and self-care ability. Understandably, they will be more reliant on others in their daily living. When their care needs are becoming too complicated and difficult to be handled by their families, admission to residential care homes may be considered as an alternative. I must emphasise, however, that it is not a must that demented elders should be taken care of at residential care homes. With family’s support, coupled with adequate community care services, demented elders can continue to enjoy lives at their own home. In fact, most of our elders prefer living in the community because living in a familiar neighbourhood means better access to the support of family, friends and neighbours. It will also instill in them a sense of belonging. With this in mind, EC and the Government have been advocating “ageing in the community”. By the same token, we also promote an integrated approach in taking care of demented elders, like services for other frail elders, so that they can continue to benefit from the interaction with other elders in a normal setting.

Over the years, the Government has devoted a lot of resources to the provision of care and support services at the community level for the elderly. Frail elders, including those suffering from dementia, may receive care and support services at home or in day care centres. These services include personal care, rehabilitation, escort, meal service and home cleaning, etc.

As a start, a glimpse of the HK health care system would enable us to understand the problems better.

We fully understand that carers face tremendous stress in looking after demented elders. To help carers enhance their care skills and knowledge, EC and the Government launched the District-based Trial Scheme on Carer Training (the Scheme) in three districts in October 2007. Under the Scheme, funding was provided to 11 District Elderly Community Centres (DECCs) to provide elder-care training programmes, including modules on care know-how for demented elders. Temporary stand-in services have also been organised to provide relief to carers. I am pleased to tell you that as of end September 2008, 730 individuals have been trained and many of them have become temporary helpers to carers, or volunteers in elderly centres. The number of elders served exceeded 4 300. It is heartening to learn that the Scheme has received such an encouraging response. To continue the momentum, we will extend the Scheme to cover all DECCs in the territory by December 2008 to train an additional 1 500 individuals in a year’s time. I hope that more and more carers can benefit from the Scheme either through skill enhancement or receiving temporary relief from taking care of demented elders.

As I said, some demented elders may no longer receive adequate care at home for various reasons and require residential care services at some stage of life. Indeed, residential care homes play a pivotal role in taking care of many elders suffering from dementia. I am glad that the Chief Executive has announced in his Policy Address that the Government will provide additional funding to subvented residential care homes so that they can strengthen their manpower to take care of demented elders.

As the Chairman of EC, I have the opportunity to visit many residential care homes. Many homes, including private homes, are providing specialised therapies to demented elders, e.g. reminiscence therapy, multi-sensory therapy and pet therapy, to cater for elders’ special needs. Some have also installed anti-wandering systems to prevent demented elders from leaving the premises alone. In view of the genuine need in enhancing these facilities so as to provide better care for demented elders, the Government has sought funding to upgrade the facilities and equipment of subvented residential care homes and day care centres for the elderly for installing anti-wandering systems, bed monitoring systems and to purchase equipment for conducting multi-sensory therapies.

Apart from the hardware, it is of paramount importance that elderly care staff are equipped with the necessary knowledge and skill sets to identify traits of dementia and provide timely intervention. The Government has been providing training to staff working in both subsidised and non-subsidised elderly service units since 2002. Specialised training courses, educational talks as well as on-site training, including those relating to dementia care, are provided regularly and where necessary. So far these efforts have shown their effectiveness and its will be up to all of us to ensure that Government’s efforts on this front will continue.

Who then should be responsible for taking care of our elders? In face of an ageing population and a rising prevalence of dementia, I believe that every individuals, their families and the society should share the responsibility, with services provided by the Government as a backup and a safety net. EC will continue to work with the Government in enhancing the quality of life of elders, whether they are suffering from dementia or other illnesses.

Policy decisions made today will have profound effects on the realities of tomorrow. Today's Symposium provides a good opportunity for experts and professionals in the field of elderly and mental health carer like you to exchange views on this important issue. Thank you.