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The Growing Challenge of Dementia Caregiving in Singapore: A Cultural Perspective

Dementia is one of the most significant health challenges of our time. According to the World Health Organization, over 35 million people were diagnosed with dementia in 2012, and these numbers are expected to soar in the coming decades. In Asia, and particularly in Singapore, the rise in dementia cases is a consequence of an increasingly aging population. The unique cultural fabric of Singapore, deeply influenced by Confucian and Taoist principles, molds the caregiving experience in ways that differ from Western societies.


Understanding Dementia and Its Impact on Caregivers

The approach to dementia care has evolved over the years. Pioneers like Kitwood have emphasized the importance of a person-focused perspective, which seeks to understand individuals with dementia within the context of their personal history and family dynamics. However, this shift in perspective does not alleviate the fact that caregivers face a higher risk of psychological morbidity, such as depression and anxiety. The relentless progression of dementia subjects’ caregivers to chronic stress as they struggle to adapt to the deteriorating condition of their loved ones.


Caregivers need support to take care of dementia patients
Dementia is a terminal disease for person with servere dementia

The Cultural Lens of Caregiving in Asia

Culture profoundly influences how we perceive ourselves and our responsibilities. In Asia, despite the diversity, certain shared values have a significant impact on caregiving. Concepts of self-construal, as proposed by Markus and Kitayama, suggest that Asians are more likely to have an interdependent view of self, which emphasizes the importance of social relationships over individual desires.


Confucian, Taoist ideals and major world religions such as Islam play a pivotal role in shaping caregiving attitudes. These philosophies and values stress family responsibility and the acceptance of one's fate, which in turn affects the willingness to seek help and utilize available caregiving resources. In Singapore, where the population is predominantly Chinese, these cultural norms are evident in the caregiving practices and the reluctance to rely on external support.


The Singaporean Context: A Microcosm of Asian Caregiving

In Singapore, the rapid increase in dementia cases has prompted the government to formulate strategies to address this issue, including early identification, caregiver support, and community services. Despite these measures, Singaporean caregivers, bound by cultural expectations, often face the caregiving journey with a sense of duty and resignation.


The traditional hierarchy within Chinese families typically dictates the order of caregiving responsibility, with spouses, particularly wives, being the primary caregivers. This role comes with a unique set of challenges, including a loss of identity and self-esteem as caregivers try to juggle their duties towards their spouse and children.


The Dual Nature of Caregiving: Acceptance and Empowerment

Singaporean caregivers often express a sense of destiny when it comes to their role. Yet, despite a passive acceptance of their situation, many also exhibit a sense of control and empowerment as they adapt to their new roles. This dual nature of caregiving reflects the complexity of the experience, where passive acceptance coexists with active coping strategies.


The shift in the caregiver's identity, from a partner to a caretaker, can lead to a redefinition of the marital relationship. Some caregivers find solace in reimagining the relationship with their spouse, transitioning from a husband-wife dynamic to a parent-child one. This coping mechanism can be a form of active adaptation that preserves the emotional bond despite the change in roles.


Coping with Caregiving: The Singaporean Experience

The study of Singaporean caregivers reveals various coping strategies employed to deal with the burdens of caregiving. There is an increasing openness to seeking formal help, which may indicate a cultural shift towards acceptance of mental health support. Caregivers also rely on informal support networks and engage in activities such as faith practices or hobbies to manage the stress associated with caregiving.


Navigating the Influence of Culture and Gender on Caregiving

Cultural values, particularly those rooted in Confucianism, influence the self-perception of Singaporean caregivers. The conflict between fulfilling their roles and coping with the demands of caregiving can affect their self-esteem and sense of mastery. Gender roles compound this effect, as women are often expected to prioritize familial relationships, making the caregiving role especially challenging when those relationships are altered by dementia.


Supporting Caregivers: Tailoring Interventions to Cultural Needs

It is clear that caregiving interventions in Singapore need to be culturally sensitive. Discussions around the challenges of caregiving, the loss of previous relationships, and the empowerment that can come from taking control are crucial. Helping caregivers shift from a mindset of resignation to one of active coping can significantly improve their quality of life.


Coping with Caregiving: Strategies and Support

The caregivers in Singapore employ various coping strategies to deal with the stress and challenges associated with caregiving. Informal support from friends and family is often helpful. Interestingly, unlike in other Asian cultures, Singaporean caregivers are open to seeking formal help, signaling a possible shift in perceptions towards mental health issues in Singapore.


Religion, work, and physical exercise also serve as coping mechanisms for some caregivers. This diversity in coping strategies underscores the need for personalized interventions that take into account each caregiver's unique situation and preferences.


The Role of Brain Training in Dementia Caregiving

One underexplored but promising modality to support caregivers is brain training. NeurOptimal® is a type of brain training that teaches the brain to be a better learner and better at regulating itself. It works by alerting the brain to pay attention to its moment-to-moment choices, allowing the brain to notice its habitual patterns and make corrections.


This kind of training can potentially help caregivers cope with the stress and challenges associated with their role. It can also help them develop greater resilience and improve their overall well-being.


Need to take care of Caregivers

As dementia cases continue to rise in Singapore, understanding the cultural context of caregiving becomes increasingly important. While caregivers in Singapore face unique challenges, they also demonstrate resilience and adaptability. By acknowledging the cultural and gender-specific influences on caregiving, we can create more effective support systems that respect and empower those who undertake this critical role.


Reference: Tuomola, J., Soon, J., Fisher, P. et al. Lived Experience of Caregivers of Persons with Dementia and the Impact on their Sense of Self: A Qualitative Study in Singapore. J Cross Cult Gerontol 31, 157–172 (2016).

 

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