The Scope of SAFE Planning

 

In the legal context, a dementia patient is a "Mentally Incapacitated Person" (MIP). A MIP cannot sign legal documents, e.g. documents governing one's own medical and financial arrangements. Planning must therefore be completed in a "period of validity" before dementia sets in. The scope of SAFE planning is as follows.

 

1 

Risk assessment

2 

Non-medical activities to prevent and delay degradation

3 

Advance Care Planning-Dementia (ACP-D)

4 

Legal, financial and medical arrangements

5 

Skills for communication with elderly parents

 

In case dementia is diagnosed, advice should be sought from doctors, social workers and relevant non-profit organizations with regard to specialized community service and support, such as community day care center.

 


 

1  Risk Assessment

 

Early signs of dementia is often overlooked, as there is a common misconception that memory loss is merely a part of normal ageing. At the same time, accurate diagnosis of dementia is a daunting process involving many specialist examinations. And with our low level of public awareness on this subject matter, dementia symptoms have often been ignored. An easy first step is to use the simple SAFE™ questionnaire to assess one's risk. Answering a questionnaire minimizes stress on the elderly person, and spares everyone tedious visits to one doctor after another.

SAFE™ is a preliminary tool which uses a progressive questionnaire to assess the risk of dementia development. Specialist and psychologist consultations can follow if necessary, depending on the questionnaire results.

1

Age

 0-45  46-50
51-55   56-60
61-65  66-70
71-75  76-80
81-85  96-90

2

Have you been sleeping well recently?

Very Good
Normal
Poor

3

Hypertension

Yes
No

4

Suffered one-time head injury that resulted in loss of consciousness

Yes
No

5

Participating in cognitively stimulatin activities (e.g. reading 26 newspapers, playing games like checkers, chess, cards, or crossword puzzles)
Yes
No

6

Doing vigorous leisure time physical activity every other day of at least 45 min

Yes
No

7

Do you have subjective memory problem?

Yes
No

 


 

2  Activities to Prevent and Delay Degradation without the use of medication

 

As we age, we experience changes in body function, physical condition, mood and sense of value. What are the things we must accept as reality? What are the things that can still be turned around?

The Good 7 Series is an interactive, evidence-based workshop designed by an experienced psychologist. It helps participants to better know their physical and psychological state, and to improve their habits without the use of medication. Simple psychological adjustment exercises and brain-stimulating activities are taught. When practiced regularly and persistently, they help build a stable state of light-heartedness, sound brain and restful sleep, and prevent as well as delay degradation. All of these are essential to a relaxed, enjoyable golden age.


 

Good 7 Series

 

Learn to adjust moods by means of positive psychology

Try new ways to do old things, to keep the brain flexible

Special exericses before sleep to ensure sleep quality and quality

 

Do exercises to build muscle and improve balance

Choose anti-inflammatory foods

Safeguard heart and brain, as a healthy heart is essential to a healthy brain

Maintain social contacts and interaction with friends and family

 


 

3  Advance Care Planning (ACP) for treatment and care

 

ACP in general is made by an individual while he is still capable of decision-making, after communicating with family and medical personnel with regard to one's own values and wishes. ACP-D is for potential dementia patients. It is made in a "validity period" before dementia sets in, by discussing with family and medical personnel what kind of treatment and care one wishes to receive after one loses decision-making capacity.

Drawing up the plan involves many important factors. Under current Hong Kong law, what protection is a dementia patient entitled to? What choices does he and his family members have? What special considerations should he take if one has children, if one is single, if one has different gender preference, or if his family members do not live in Hong Kong? How should one choose a "spokesperson" to speak for him when he is no longer capable? These are but some of the many questions that should be addressed. In essence, the patient should start planning if one wants to be cared for as one wishes, and to protect one's beloved family members from making difficult decisions for him.

 


 

4  Legal and Financial Arrangements

 

People seldom have need to consult a lawyer or read legal document. Many people see no sense in squandering money on legal service when their assets are limited and their family in harmony. However, once a person has dementia, one becomes a Mentally Incapacitated Person (MIP) with no right to sign medical, financial or legal documents. Without these documents, his family will not only have a hard time making medical and health care decisions for him, but may actually be plunged into financial difficulty for lack of access to the patient's assets. Stories of ugly disputes between family members are not uncommon. Many are due to the absence of valid documents signed in advance, and end up in costly law suits. Therefore, regardless of the size of assets, it is sensible to make an Enduring Power of Attorney and a Will while it is still possible. It will bring peace of mind to all, and make things easy for the family.

 


 

5  How to Communicate with and How to Treat Elderly Parents

 

Most elderly people prefer a dignified life over excessive dependence on others. Many of them also have trouble telling their own future plan to their children. At the same time, their children often make decisions for them, as though they were children. The care-giving children may find this an easier way to care for their parent, and think of it as an act of love. But depriving the elderly parent's freedom of decision may instead give the parents added stress, anxiety, helplessness and unhappiness. As a result, the two generations each has a plan in mind that is never discussed between them. Successful SAFE planning takes effort from both generations. The elderly parent can adjust his thinking and feelings; the adult children can learn to communicate with him. Frank and open discussion is the key.

 
  • Understand the state of mind of aging parents
  • Strike a balance between the parent's autonomy and his need for care
  • Recognize the parent's feelings
  • Pay attention to parent's mood and expression capability