Caregiver interventions have been shown to reduce caregiver depression, the burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers need caring too. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic helpers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from dealing with behavioural problems can lessen as the burden from coping with physical and functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to create a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community. The role of the GP in supporting the caregiver is more important than ever amid the current COVID-19 pandemic.

INTRODUCTION: The integration of advance care planning (ACP) as part of the comprehensive geriatric assessment (CGA) of hospitalised frail elderly patients, together with the clinical and demographic factors that determine successful ACP discussion, has not been previously explored. METHODS: A cross-sectional study on patients and family caregivers admitted under the geriatric medicine department of a tertiary hospital was conducted from October 2015 to December 2016. RESULTS: Among 311 eligible patients, 116 (37.3%) patients completed ACP discussion while 166 (53.4%) patients declined, with 62 (37.3%) of the decliners providing reasons for refusal. Univariate logistic regression analysis showed that older age, higher Charlson Comorbidity Index, poorer functional status and cognitive impairment had statistically significant associations with agreeing to ACP discussion (p < 0.05). On multivariate logistic regression analysis, only poorer functional status was significantly associated (odds ratio 2.22 [95% confidence interval 1.27-3.87]; p = 0.005). Among those who completed ACP discussion, a majority declined cardiopulmonary resuscitation (79.3%), preferred limited medical intervention or comfort care (82.8%), and opted for blood transfusion (62.9%), antibiotics (73.3%) and intravenous fluid (74.1%) but declined haemodialysis (50.9%). Decision-making was divided for enteral feeding. Among decliners, the main reasons for refusal were 'not keen' (33.9%), 'deferring to doctors' decision' (11.3%) and 'lack of ACP awareness' (11.3%). CONCLUSION The feasibility and utility of integrating ACP as part of CGA has been demonstrated. Poorer functional status is significantly associated with successful ACP discussion. Greater public education on end-of-life care choices (besides cardiopulmonary resuscitation) and follow-up with decliners are recommended.

Caregiver interventions have been shown to reduce caregiver depression, burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers too, need care. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic workers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from having to deal with behavioural problems can lessen as the burden from coping with functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to work towards creating a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community

General Practitioners (GPs) play an important role in early detection and initiation of the diagnostic process of dementia. A consideration of barriers and enablers of this process can aid the diagnostic process. Early referral for Specialist evaluation is an important step. The GP can also provide additional advice and support to the patient and caregiver during diagnosis.

Caregiver interventions have been shown to reduce caregiver depression, burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers too need care. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic helpers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from having to deal with behavioural problems can lessen as the burden from coping with functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to work towards creating a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community.