Monday, 20 January 2014

Hospitals gear up for spike in dementia cases

IMH to open homely wards with 'memory cubby holes' by bedside for patients
By Janice Tai, The Sunday Times, 19 Jan 2014

New facilities for dementia patients are being launched as hospitals and help agencies gear up for a surge in the number of people who seek earlier help for the disease.

Next month, the Institute of Mental Health (IMH) will open its wards specially for dementia patients.

Designed to create a homely environment, the wards lead to a garden. There will be "memory cubby holes" installed by the bedside for patients to place cherished items that may help trigger their memory.

The colours and materials of furniture in the wards are specially selected to provide a calming environment.

Alzheimer's Disease Association (ADA), one of the key voluntary welfare organisations here that champion dementia issues, is also launching a unique day-care centre in Tiong Bahru next month with a similar aim in mind.

Family members can help in the rehabilitation of their loved ones suffering from the disease by interacting with them in a mock-up apartment at the centre.

It comes complete with a living room and a pantry, where staff can train dementia clients and their caregivers in a realistic home environment.

The association has also created a similar mock-up apartment at its existing training centre in Bendemeer Road.

Toilets are fitted with a coin-lock system that enables a caregiver to open them using a coin from the outside should an elderly dementia patient find himself locked in.

Shared cupboards are designed such that one half with see-through panels is set aside for a person with dementia to allow him to pick out clothes easily. The other half, belonging to his caregiver, is painted white to blend with the walls.

The aim is to draw attention away from the caregiver's clothes and minimise confusion for the person with dementia.

The plans by IMH and ADA come amid a surge in the number of people who suffer from dementia in Singapore.

Around 28,000 Singaporeans aged 60 and above have dementia, and the number is projected to hit 80,000 by 2030.

Hospitals say more people are seeking help earlier, hoping to impede the progress of the disease. At Khoo Teck Puat Hospital, for example, the average age of patients who are diagnosed with dementia is about 70 to 75 years old now, compared with 75 to 80 years old a decade ago.

Half of the some 250 to 300 new patients that the hospital handles now are in the early stages of the disease compared with 20 to 30 per cent of the 150 new cases seen 10 years ago.

The National University Hospital (NUH) is also seeing a similar trend.

"Ten years ago, many families attributed memory problems as a normal consequence of ageing and would refuse further assessment," said Dr Reshma Merchant, a geriatrician at NUH.

Now, family members are consulting doctors earlier once their loved ones have "subtle memory issues", such as misplacing keys or repeating questions, she added.

Dr Philip Yap, senior consultant at the department of geriatric medicine at Khoo Teck Puat Hospital, said the focus now should be on taking better care of dementia patients once they have been diagnosed.

"As there is no cure on the horizon, we need to build better health and social care infrastructure to cope with the rising tide," he said.


28,000 - Number of Singaporeans aged 60 and above with dementia

80,000 -Projected number of such cases by 2030

No restraint for dementia patients at special ward
KTPH ward is homely and the nurses are specially trained
By Salma Khalik, The Straits Times, 21 Apr 2014

KHOO Teck Puat Hospital (KTPH) has gone a full year without having to restrain patients suffering from dementia who sometimes get agitated and become aggressive.

The secret is its specially designed dementia ward which it started just over a year ago when it noticed increasing numbers of patients with dementia needing normal medical treatment.

And the numbers will continue to grow, said Dr Philip Yeo, a senior consultant in geriatric medicine at KTPH.

Similar to other older persons, these people are susceptible to health problems including infections, heart failure and falls, he noted.

In fact, patients with dementia are more likely to suffer functional decline, confusion and have falls, said Dr Reshma Merchant, head of general medicine at the National University Hospital (NUH).

It is for these reasons that KTPH started its special dementia ward. The 10-bed ward, which is at the end of its geriatric ward, looks cheerful and homely, with areas where patients can sit in comfortable chairs away from their bed to watch television.

A glass wall provides a view of a garden, where patients are taken for strolls by nurses and therapists. There is also regular music therapy to bring cheer.

The design of the ward is such that patients are not tempted to leave. Doors in the ward are painted to look like bookshelves, so patients won't be tempted to walk out, or become angry when not allowed to.

But some become confused when they cannot take down one of the "books" to read, so staff quickly distract them. Patients are also encouraged to bring photos, and personal or religious items to make the place feel more like home.

The frail elderly often find a hospital environment disconcerting and stressful, said Dr Yeo. The situation gets worse when dementia is added to the equation.

He said: "A change in their daily routine, coupled with medication and tests, and the effects of the acute illness, increase confusion, anxiety and agitation. In such circumstances, they may act up and refuse medical treatment."

In KTPH's dementia ward - so far the only one in a public hospital - the nurses are specially trained to deal with such problems and to provide patients with activities that will keep them mentally and physically occupied.

They try to view unusual behaviour as an "expression of unmet physical or emotional needs", he said.

Dr Yeo said that unlike other wards, the patient's needs are given more importance than routine tasks. So nurses distributing medicine would stop their work should a patient need help to go to the toilet - instead of asking the patient to wait, or say it is fine as he has diapers on.

"Being patient-centred implies making the extra effort to help patients have a 'normal' toileting experience instead of passing urine in the diapers," he added.

And it appears to have worked. The family of one patient wrote to say: "We wanted to say 'Thank You' for the care, concern and compassion shown to our father Mr Ho S. L. during his stay. We wish we could list down the names of the individual nurses. It was comforting to know that we could go home and not worry because you proved to us that he was in good hands."

The success of KTPH has prompted NUH to also look into setting up a special area for patients with dementia, which should be ready by early next year.

Dr Merchant said they "use many other techniques and distraction therapies to avoid restraints", such as bandaging the drip site so they won't pull it out, or hiding urinary catheters in their pants.

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