SINGAPORE — Step into Tan Tock Seng Hospital’s (TTSH) new geriatric unit and one will see senior patients playing with Barbie dolls, enjoying a game of mahjong, or huddling around a table looking at old photos of Singapore.

As they enjoy a massage, or try their hand at painting, an oldie tune from songstress Teresa Teng plays softly in the background.

This is all part of the hospital’s Namaste programme, an innovative form of therapy for patients with dementia or delirium, conducted at its six-bed subacute geriatric monitoring unit.

First developed by specialists in the United States, the programme helps patients with advanced dementia by invoking comfort and pleasure through sensory stimulation, particularly with the use of touch.

TTSH’s doctors have also adapted the structured therapy programme for its local patients. For example, instead of playing a game using poker cards, doctors and nurses engage dementia patients with a game of mahjong instead.

Conducted twice a week, the programme also introduces patients to familiar fragrances, music, flashcards of places and items from the past to trigger memories.

TTSH’s subacute geriatric monitoring unit was started in November 2017 to help elderly patients suffering from dementia and delirium. Delirium is a state of mental confusion due to an illness where a person may see or hear things that are not there and become very agitated or sleepy.

The unit caters to patients who are recovering from medical illness and related symptoms, but may display significant behavioural issues and require a higher level of monitoring.

It is modelled after the hospital’s geriatric monitoring unit, which was set up in 2010 to manage elderly patients hospitalised with signs of delirium.

Besides the Namaste programme, patients also undergo weekly group occupational therapy sessions, where they engage in group activities such as throwing hoops and team games.

While other hospitals such as Khoo Teck Puat Hospital and the National University Hospital also have geriatric units, TTSH is the first here to have a subacute geriatric monitoring unit.

Dr Lim Jun Pei, associate consultant at the TTSH’s geriatric medicine department, said that the unit allows healthcare givers to try out novel approaches and also counsel caregivers on best care methods.

Prior to this, TTSH did not have “specialised” and “patient centred care” as there was no dementia ward, added Dr Lim.

“We also have nurses of different abilities; if we talk about dementia centred care, that is not provided at the general ward,” she said.

“For patients who have behavioural issues, the nurses who manage them are very stressed, because they don’t have the technical know-how.”

Most of the patients at TTSH’s subacute geriatric monitoring unit are aged 85 and above, and they are first assessed by the geriatric medicine team’s doctors before admission. Other than clinical assessments, the doctors also interview family members to get a better understanding of the patient.

Staffed by three doctors and 10 nurses who work in shifts, the unit has seen 81 patients to date, of which 70 per cent suffered from dementia. There is also a psychogeriatrician, who deals with the study, prevention and treatment of mental disorders in seniors.

The nurses have to undergo two to three weeks of training to learn to better identify symptoms of dementia and delirium.

The average length of stay at the subacute unit is between two and three weeks. Upon discharge, doctors and nurses will also counsel caregivers and share caregiving techniques tailored to the individual patient.

Caregivers are also encouraged to complete a life history activity book and engage with patients about their likes and dislikes, as well as help evoke old memories and histories in order to provide meaningful and tailored care for them.

POSITIVE OUTCOMES

According to TTSH, the geriatric monitoring unit’s specially designed ward with a team of geriatric doctors and nurses have resulted in shorter lengths of stay for delirium patients.

Since setting up the subacute unit, the Namaste Programme has also been shown to improve sleep, reduce behavioural symptoms and decrease agitation among patients, said Dr Lim.

After undergoing the programme and other therapies, the 81 patients between November 2017 and October last year generally reported positive outcomes, as they saw improved function in daily activities such as feeding and bathing themselves. Caregivers of these patients also reported that their burdens had lessened.

Using the Modified Barthel Index, which measures the patient’s function in activities of daily living, patients in the subacute care unit displayed better functional abilities upon discharge and up to six months after, compared with patients in the acute geriatric monitoring unit.

While the unit only caters to female patients at the moment, Dr Lim hopes to set up a second six-bed unit for male patients at the hospital.