LCQ6: Care services for dementia patients
27.3.2024

Following is a question by the Hon Doreen Kong and a reply by the Secretary for Labour and Welfare, Mr Chris Sun, in the Legislative Council today (March 27): Question: According to the statistics of the Hospital Authority (HA), there were around 79 400 patients with dementia in Hong Kong receiving treatment in HA in 2020. In addition, according to the forecast of a study, in 2039, among persons aged 60 and above, 333 000 will suffer from dementia. In this connection, will the Government inform this Council: (1) of the latest number of persons diagnosed with dementia, together with a breakdown and percentage by the channel where the diagnosis was confirmed (i.e. private and public healthcare systems), age and gender; (2) whether it has compiled statistics and evaluated the effectiveness in respect of the demand of dementia patients for care services and resource allocation; if so, whether it will plan and improve the relevant services on the basis of the evaluation outcomes, such as formulating long-term support policies and plans for care services for patients at the early, intermediate and late stages of dementia, as well as re-launching territory-wide awareness campaigns on dementia; and (3) as it is learnt that currently, many residential care homes (RCHs) adopt a "restraint" approach to restrict the activities of elderly persons with dementia, whether the authorities have put in place measures to reduce the adoption of such care approach by RCHs, and whether the authorities have plans to promote to RCHs the "restraint-free" care concept for elderly persons and to assist RCHs in improving their facilities to facilitate the implementation of such care concept? Reply: President, In consultation with the Health Bureau (HHB), I reply to the Member's question as follows: (1) The number of patients diagnosed with dementia and receiving treatment in the Hospital Authority (HA) in 2022, with a breakdown by age and sex, is at Annex I. The HA does not keep the number of patients who obtained diagnosis in the private healthcare system. (2) Dementia is a disease caused by a decline in brain functions due to neurological changes. At present, there is no cure for dementia. Patients can slow down the degenerative process of the brain and alleviate the symptoms with medical and non-medical support (e.g. reminiscence, multi-sensory and cognitive training, etc). Except for dementia patients at a severe stage or those requiring medical care due to serious complications, patients in general can continue living at home and receive different community care and support services according to their needs, so as to maintain their quality of life and alleviate their carers' burden. Dementia patients commonly suffer from multiple chronic diseases such as hypertension, diabetes mellitus, cardiovascular diseases, etc, as well as physical deterioration (such as memory loss, falls and continence). To flexibly deploy resources, the HA will refer patients to different specialist out-patient clinics of the HA, including medicine, geriatric, psychogeriatric and memory clinic according to their needs, allowing patients to receive joint consultation and treatment. For example, the geriatric team provides services to dementia patients suffering from other geriatric conditions, while the psychogeriatric team is responsible for supporting dementia patients experiencing severe comorbid emotional or behavioural symptoms. As dementia patients often require services from different specialist out-patient clinics, the health expenditure arising from the provision of treatment and care services to dementia patients cannot be separately quantified, or to conduct statistical and effectiveness evaluation on resources allocation. The cost incurred for the medical services provided by the HA to patients aged 65 or above in the past three years is at Annex II. In addition to the above medical services, the Government implements different measures to support patients with dementia: Supporting elderly persons with dementia The HHB (formerly the Food and Health Bureau) and the Social Welfare Department (SWD) implemented the Dementia Community Support Scheme as a pilot scheme in February 2017, to provide cross-sectoral and multi-disciplinary support services to elderly persons with mild or moderate dementia and their carers. The HA is responsible for identifying and referring suitable patients with dementia to District Elderly Community Centres (DECCs), as well as designing and reviewing in collaboration with DECCs individual care plans (ICPs) for the patients concerned. DECCs arrange activities and services for participants based on their needs according to the agreed ICPs, with a view to improving their cognitive ability, knowledge of home safety, self-care ability, physical functioning and social skills, etc. The Scheme has been made permanent since February 2019 and expanded to all seven HA clusters and 41 DECCs in the territory, and can serve over 2 000 elderly persons each year. The SWD provides the Dementia Supplement to eligible elderly service units to strengthen their care of and support for elderly persons with dementia, such as employing additional professional staff (including occupational therapists, nurses and social workers, etc) or purchasing relevant professional services, and organising training programmes for them. Public education The SWD launched a territory-wide public education programme titled the Dementia Friendly Community Campaign (the Campaign) from September 2018 to March 2023 to enhance the public's understanding of dementia and encourage members of the public to support and care about persons with dementia and their carers. The Campaign received positive feedback and support from different sectors of the community during the period. Relevant service units will continue to promote messages of caring for dementia and organise activities supporting dementia patients and their carers. The SWD will review the need for organising a similar territory-wide public education campaign in a timely manner. In addition, the Department of Health (DH) has been providing the latest health information on dementia through various channels, including the Elderly Health Service website, the Elderly Health Information Hotline, education kit for elderly carers, online videos, media interviews, the Elderly Health Service Newsletter and health talks to enhance public understanding of the disease and provide family members and carers of dementia patients with practical skills and insights to manage the disease. Furthermore, the HA has been implementing various health promotion activities, including organising educational talks and publishing pamphlets, etc. to raise community awareness of dementia. Harnessing gerontechnology Through the Innovation and Technology Fund for Application in Elderly and Rehabilitation Care, the Government subsidises eligible elderly and rehabilitation service units to procure, rent and trial technology products. Products covered under the Fund include technology products aiding the improvement of users' cognitive ability, such as smart projectors with interactive games which can improve users' cognitive and responsive abilities, delaying the deterioration of dementia symptoms. The Government will inject additional $1 billion into the Fund this financial year, and expand its scope to cover gerontechnology products suitable for household use. (3) The Code of Practice for Residential Care Homes (Elderly Persons) (the Code of Practice) provides guidelines on the use of restraint and care for dementia elderly persons. The Code of Practice stipulates that residential care homes for the elderly (RCHEs) should avoid using restraint. The use of restraint should only be considered when all other alternative attempts are ineffective or in case of emergency and when the well-being of the resident and/or other residents is imperilled. RCHEs should consult healthcare professionals and relevant professional practitioners and take appropriate measures in providing needed care to dementia residents. The SWD regularly organises workshops on care knowledge for RCHE staff. Topics include understanding dementia, providing care to dementia elderly persons and the use of restraint, etc.