Duke-NUS study: Over 90% of older adults with dementia undergo burdensome interventions in their final year

(Press-News.org) Singapore, 17 November 2025—A new study by researchers from Duke-NUS Medical School has revealed that almost all community-dwelling older adults with advanced dementia in Singapore experience at least one potentially burdensome intervention in their last year of life. The findings highlight an urgent need for new strategies to support families and reduce unnecessary interventions at the end of life.

Although the number of individuals living with dementia in the Asia-Pacific region is projected to rise to 71 million by 2050[1], current understanding of the last year of life with dementia is mostly informed by studies conducted in western contexts.

Published in the Journal of Gerontology: Medical Sciences, the study, examining individuals with dementia’s care experience in their last year of life in Singapore, found that 92 per cent of older adults with advanced dementia experienced burdensome interventions such as feeding tubes or restraints—approaches that experts say may not improve comfort or survival.

From surveys, the researchers found that the below key issues affected the quality of end-of-life care experienced by older adults with dementia living at home:

Overreliance on burdensome medical interventions: Nearly all older adults experienced taxing interventions in their final year of life, including antibiotics (49 per cent), IV fluids (22 per cent), and feeding tubes, restraints or both (74 per cent). The proportion of tube-fed older adults was significantly higher than in western contexts, and tube feeding often triggers the use of physical restraints to prevent tube removal. Clinical guidelines recommend careful hand feeding instead of tube feeding. High hospitalisation rate: Almost half (48 per cent) of older adults were hospitalised for at least a night in their final year, and 35 per cent died in hospital—proportions notably higher than in western studies where long-term care facilities such as nursing homes are the primary place of death. Such increased hospitalisation can expose patients to taxing and costly care experiences with limited clinical benefit. Heavy burden on informal caregivers: Family members bore the brunt of care, with 42 per cent providing at least 60 per cent of total care for their loved ones with dementia, and 30 per cent quitting their jobs to do so. Caregivers provided an average of 42 hours of care per week—more than a full-time job--equivalent to an annual wage of S$32,125. Insufficient caregiving support: A majority of caregivers (62 per cent) reported receiving inadequate information when making care or treatment decisions, and only 15 per cent were told how much longer their loved ones might live. The findings highlight critical gaps in caregiver communication and end-of-life preparedness. The data was culled from a longitudinal cohort, titled Panel study Investigating Status of Cognitively impaired Elderly in Singapore (PISCES), in which the researchers surveyed family caregivers of individuals with advanced dementia every four months, between 2018 and 2023.

Caregivers also generally agreed (98 per cent) comfort was a primary care goal, however, close to a third (31 per cent) of caregivers—mostly children of the older adults—considered prolonging life a priority.

Dr Ellie Bostwick Andres, first author of the paper and a senior research fellow from the Lien Centre for Palliative Care at Duke-NUS, said:

“Our study highlights a mismatch between caregivers’ stated values and the reality of older adults’ experience in their last year of life. Frequent hospitalisations and the widespread use of interventions generally deemed ‘low-value’ among older adults living at home highlights the need to adopt a palliative approach at home to alleviate symptoms and minimise burden on older adults and their caregivers.”

Dr Andres also said that as reliance on family caregivers increases in an ageing society like Singapore, more needs to be done to support and equip family caregivers to provide compassionate care for their loved ones at home.

Senior author Associate Professor Chetna Malhotra and Research Director at the Duke-NUS’ Lien Centre for Palliative Care, added:

“In Asia, cultural values shape approaches towards caring for end-of-life individuals with dementia living at home. For instance, children with strong filial values may be more inclined to try to help their parents live longer instead of opting for a palliative approach. This means that strategies to promote palliative care need to be driven by caregiver education and tailored to the region.”

Insights from the team’s study are now being used to curate tools that support caregivers—including CareBuddy, a mobile application that promotes healthy and graceful ageing, and decision aids that help them make informed care decisions for their loved ones.

Professor Patrick Tan, Duke-NUS’ Dean-designate and Senior Vice-Dean for Research, said:

“These findings reveal the human reality of dementia care in Asia—one defined by love, sacrifice, and difficult choices. As more older adults spend their final days at home, it’s critical that we build systems of care that show compassion not only to patients, but also their caregivers who sustain them.”

This research, which was supported by the Singapore Ministry of Health through the National Medical Research Council (NMRC) Office, MOH Holdings Pte Ltd, under the NMRC Health Services Research Grant (NMRC/HSRG/0081/2017) and COVID19TUG21 (MOH-000786), is part of Duke-NUS’ ongoing efforts to improve care for individuals with serious illnesses and their caregivers through groundbreaking discoveries and education. 

 

About Duke-NUS Medical School

Duke-NUS is Singapore’s flagship graduate entry medical school, established in 2005 with a strategic, government-led partnership between two world-class institutions: Duke University School of Medicine and the National University of Singapore (NUS). Through an innovative curriculum, students at Duke-NUS are nurtured to become multi-faceted ‘Clinicians Plus’ poised to steer the healthcare and biomedical ecosystem in Singapore and beyond. A leader in ground-breaking research and translational innovation, Duke-NUS has gained international renown through its five Signature Research Programmes and ten Centres. The enduring impact of its discoveries is amplified by its successful Academic Medicine partnership with Singapore Health Services (SingHealth), Singapore’s largest healthcare group. This strategic alliance has led to the creation of 15 Academic Clinical Programmes, which harness multi-disciplinary research and education to transform medicine and improve lives.   

For more information, please visit www.duke-nus.edu.sg 

 

About the National Medical Research Council (NMRC)
The NMRC was established in 1994 to oversee research funding from the Ministry of Health (MOH) and support the development and advancement of biomedical research in Singapore, particularly in the public healthcare clusters and medical schools. NMRC engages in research strategy and planning, provides funding to support competitive research grants and core research enablers, and is responsible for the development of clinician scientists through awards and fellowships. The council’s work is supported by the NMRC Office which is part of MOH Holdings Pte Ltd. Through its management of the various funding initiatives, NMRC promotes healthcare research in Singapore, for better health and economic outcomes.

[1] Alzheimer's Disease International DA. Dementia in the Asia Pacific Region. 2014. https://www.alzint.org/resource/dementia-in-the-asia-pacific-region/

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