A recent study by researchers at Duke-NUS Medical School has found that almost all older adults in Singapore living at home with advanced dementia undergo at least one potentially burdensome medical intervention during their final year. The findings highlight the pressing need for improved end-of-life support, particularly for families who often must make difficult decisions with limited guidance. While dementia prevalence is rising sharply across the Asia–Pacific region, most existing knowledge about the last stages of the illness comes from Western studies, underscoring the importance of region-specific research such as this.
Published in the Journal of Gerontology: Medical Sciences, the study examined the experiences of older adults with advanced dementia over the last year of life and found that ninety-two per cent received interventions such as feeding tubes or physical restraints. Experts note that such measures rarely improve comfort or survival and may, in fact, increase distress. The researchers identified several factors shaping these outcomes, beginning with an overreliance on taxing medical treatments. Nearly half of the older adults received antibiotics, more than one in five were given intravenous fluids, and almost three-quarters were tube-fed or restrained, with tube feeding far more common than in Western contexts despite clinical recommendations for careful hand feeding.
Hospitalisations were also frequent. Almost half of the individuals studied spent at least one night in hospital during their final year, and more than a third died there. In Singapore, where long-term care facilities are less commonly used for end-of-life care than in many Western countries, reliance on hospitals often led to interventions that added discomfort without clear clinical benefit.
The study highlighted the significant burden placed on informal caregivers, who provide the bulk of hands-on support. 42% provided at least 60% of total care, and 30% left their jobs to look after their loved ones. On average, caregivers dedicated forty-two hours of care per week, a workload comparable to full-time employment, with an estimated annual value exceeding S$32,000. Despite their efforts, many felt poorly informed, with almost two-thirds reporting inadequate guidance when making care decisions and only a small minority being told about life expectancy. This lack of communication left families struggling to prepare for the end of life.
The findings draw on data from the PISCES cohort, a longitudinal study that surveyed caregivers every four months between 2018 and 2023. However, nearly all caregivers agreed that comfort should be a primary goal, about a third—mostly adult children—prioritised prolonging life, reflecting cultural values around filial responsibility. The study’s authors, including Dr Ellie Bostwick Andres and Associate Professor Chetna Malhotra, emphasised the need for culturally informed education and better home-based palliative approaches to reduce avoidable interventions.
The research is now informing new caregiver support tools, including CareBuddy, a mobile application promoting healthy ageing, and decision aids to help families navigate complex choices. As noted by Professor Patrick Tan, Duke-NUS’ Dean-designate, the findings reveal the profound emotional and practical challenges of dementia care and the need to build systems that support both older adults and the families who sustain them.
More information: Ellie Bostwick Andres et al, The final year for community-dwelling older adults with dementia in an Asian setting: admissions, interventions, and caregiver burden, The Journals of Gerontology Series A. DOI: 10.1093/gerona/glaf227
Journal information: The Journals of Gerontology Series A Provided by Duke-NUS Medical School
