Forgetfulness is common in older people and is not always a cause for concern.
Early intervention can help to identify patients with mild cognitive impairment (MCI), which has been shown to have an annual conversion rate of 10 to 15% to dementia.
More serious and progressive forgetfulness may be caused by a disease of the brain, such as dementia. The more common causes of dementia are Alzheimer's Disease and vascular dementia. Although not reversible, early detection will enable treatment to be started, and this can help improve the patient's symptoms and quality of life as well as reduce the stress on those providing care for the patients.
We are one of the largest referral unit in Singapore for patients with cognitive and memory difficulties. Our multidisciplinary programme covers caring for patients with memory and cognitive difficulties through the different stages of diseases.
Our expertise is in early diagnosis of dementia and management of complications of dementia in its various stages, using a holistic approach (in line with the geriatric principles of looking at the various interactions of medical, functional and social factors impacting dementia diagnosis) to help patients and caregivers cope with the illness.
There are two main parts to our approach:
||The early stage of dementia can be difficult to distinguish from age-related memory loss or even depression. A systematic approach is adopted and it involves the following steps:
- Comprehensive clinical assessment by the geriatric physician, with detailed background history obtained from the family or caregivers.
- Assessment of the behavioural, functional and social effects of the illness, including caregiver stress, by the nurse clinician.
- Some standard psychometric tests may be conducted to assess the patient's mental functions.
- Radio-imaging of the brain and some blood tests may also be conducted.
||Upon diagnosis, a team of healthcare professionals will discuss and propose a treatment plan for the patient and his/her family members:
- Medication(s) to slow down the decline in mental functions and reduce the severity and frequency of the behaviour problems.
- The nurse clinician will explain what dementia is and teach caregivers the necessary coping skills and practical tips for frequently encountered problems, including home safety matters. Information on suitable community services will be provided and, if needed, referrals to these services will be made.
Where necessary and appropriate, we may refer patients for:
- Cognitive re-training programme with psychologists
- Assessment of home safety by the occupational therapist for patients who are staying alone at home or are alone at home for most part of the day.
- Assessment of driving safety by the occupational therapist as part of the Driving Assessment and Rehabilitation Programme (DARP) for early dementia patients who are still driving.
- Referral to the Medical Social Worker will be made if there are functional or safety issues with regards to the patient's ability to live at home safely. Patients and families with care or financial issues identified will also be seen by the medical social worker who will try to provide aid where appropriate. Patients' family members or caregivers who experience significant caregiver stress or burnout will also be referred to the medical social worker for counseling and help.
- Referral to the Physiotherapist would be made if the patient is assessed to have unsteady gait or increased risk of falls. Appropriate exercises and rehabilitation would be prescribed by the physiotherapist.
- Referral to the Dietician would be made if the patient is assessed to have decreased nutrition or poor feeding. Evaluation of patient's dietary habits and appropriate nutrition advice will be given.
- The Cognition Nurse Clinician will continue to follow-up on specific cases where there is significant caregiver stress or behavioural issues in the patients. They will be available in some cases to provide phone counseling and advice.
For patients with cognitive or memory difficulties who are non-ambulant, they will be assessed by the Geriatric Assessment Clinic in the Department of Geriatric Medicine, Tan Tock Seng Hospital for a comprehensive geriatric assessment of their geriatric syndromes and functional difficulties.
In view of the comprehensive and detailed nature of the cognitive assessment, the Memory Clinic will only be able to address the cognitive and memory difficulties of the individual. The other concomitant medical problems are best addressed by the patient's attending doctor or family physician.
We offer evaluation and treatment of older persons (aged 65 and above) with urinary incontinence.
Urinary incontinence is the involuntary leakage of urine. It occurs more frequently among older persons. However, it is never a consequence of the normal ageing process. Rather, it is usually caused by medical illnesses, medications, or impairment of function. Some of these causes are reversible with appropriate treatment.
Therefore, it is important to undergo an evaluation to identify the reason for the incontinence, and then to explore treatment options. Some may be cured of the incontinence, others may have their condition improved, and almost all can be helped to better cope with this condition should it be persistent.
- The patient is usually assessed by a nurse clinician who has special training in dealing with urinary incontinence
- A doctor then evaluates the patient through interview and physical examination.
- Urine tests are often performed
- Other tests are arranged if necessary
- There may be a need to keep a record of the urinary habit of the patient through filling out a bladder chart
- The cause and severity of the urinary incontinence is determined and treatment options are considered and discussed
- Treatment methods include modification of drinking habits, toileting scheduling, medications, as well as aids and appliances
Chronic non-malignant pain is a common problem in the elderly.
Older people may have several sources of pain as they commonly have multiple medical problems.
As a result of the pain, they may develop depression, mood disorders and have decreased physical activities.
We assess and treat older persons with chronic non-malignant pain.
- Help patients to control pain better through adjustment of medications
- Achieve an appropriate functional goal
- Enhance a patient’s quality of life
- Assessing and evaluating patients with chronic pain.
- Recommending the appropriate investigations which may include blood investigations and radiological investigations
- Prescribing appropriate medications to treat the chronic pain. We do not perform interventional procedures for pain relief
- Recommending appropriate therapy which includes physiotherapy and occupational therapy
- Appropriate review of patients with further adjustment in treatment if necessary
Approximately 30% of elderly aged 65 years and above experience a fall every year.
Half of those who fell will fall again.
Falls can result in serious consequences such as head injuries, fractures and reduced activity due to fear of falling.
This self imposed inactivity can result in functional decline.
There are many reasons why a person falls. It may be due to muscle weakness, poor balance, poor eyesight or an underlying medical condition. The fall may also be accidental or associated with high risk activity. It is hence important to accurately assess the causes of the fall so that appropriate measures can be taken to prevent further falls. It is also important to break the cycle of fall to prevent functional decline and reduce fear of falling.
We evaluate ambulant patients, aged 65 years and above, who have a history of fall or difficulty in walking. The aim is to identify the causes of falls in the individual patient and develop a care plan to help prevent further falls.
- The visit may take up to 2 hours.
- The patient is advised to wear loose, comfortable clothing and proper shoes.
- The patient will be seen by our nurse clinician who will obtain background information on his/her previous falls, functional status and assess the vision, hearing and fear of falling.
- A geriatrician will then perform a comprehensive clinical assessment of the patient’s falls. This will include a review of his/her medical history and medications, a physical examination and gait assessment. If necessary, radiological or blood tests may be ordered for the patient.
- He/She will also undergo an assessment by the physiotherapist who will look at his/her general fitness, balance and walking ability.
- the risk factors for falls and strategies to prevent further falls will be explained to the patient. This may include treatment of underlying medical problems, medication adjustment and physical therapy.
- A home visit by our occupational therapist may be arranged to assess patient’s home environment. Home modification may be recommended to improve patient safety at home.
- The geriatrician will review the patient in six weeks time and another review at six months unless there is a need for the patient to be seen earlier.
- The physiotherapist will enroll the patient in an exercise programme. This programme will be reviewed and adjusted as the patient improves.
Download Falls and Balance Clinic brochure
Older adults may have multiple, complex medical problems resulting in decreased ability to perform their day-to-day activities.
Some of these problems are potentially reversible Early interventions can prevent further disabilities
We conduct assessments to detect such problems and provide geriatric rehabilitation services to improve the elderly’s functions
We provide the following:
- Evaluate and identify the medical, functional and social disabilities of the older adult
- Provide interventions aimed to prevent further disabilities
- Help the older adult and his / her family to identify areas of needs and develop an individualised care plan so that the older adult can continue to live at home with his / her loved ones
At the first visit:
- The first visit may take up to 2 hours
- The patient will be assessed initially by a nurse clinician, followed by a geriatrician
- The geriatrician may require blood investigations or special investigations, such as X-rays, to be done
- The patient may be referred to other healthcare professionals such as the physiotherapist, occupational therapist and speech therapist
- Patients are required to bring all their medications (if any) during the first visit
- It is important for a family member or caregiver to be involved in the care of the patient and to accompany the patient to help identify areas of needs and develop an individualised care plan
- The geriatrician will communicate the clinical findings, diagnosis and recommended plan of management to the patient and his / her family
- The nurse clinician or therapist(s) may counsel, educate and train the family members or caregivers on strategies to care for the patient These may include advice on patient safety, nutrition and coping with difficult behaviours
- Referrals to community services such as day care centres may be initiated
Download Geriatric Assessment Clinic brochure
What is geriatric rehabilitation?
Geriatric Rehabilitation is a process to improve an older person’s function and to increase their ability to lead an active life in the community.
It aims to:
- Prevent disability and reduce impairment through exercises, so that the older adult can perform his / her daily activities
- Help older adults maintain their independence in the community through the use of correct aids and appliances
- Help older adults and their caregivers identify community services that may be of assistance to them
What happens at the rehabilitation session?
The physiotherapist or occupational therapist will enquire about the patient’s condition before proceeding to do a physical assessment on his / her ability to walk and perform self-care activities. He/ She will then plan and prescribe treatment according to the patient’s needs.
|Type of Therapy
||The sessions involved
- Balance training
- Walking re-training
- Endurance exercises
- Strengthening exercises for upper and lower extremities
- Self-care and caregiver training
- Falls precautions advice
- Advice on home modification and prescription of equipment
- Home visit and assessment
||A referral letter from a doctor or healthcare professional is required. Please call our hotline at 6357 8013 and indicate your request so that an appointment can be made.
- Geriatric Rehabilitation sessions are strictly by appointments only.
- Cancellation – If you urgently need to change or cancel your appointment, please inform us at 6357 8013 at least three days in advance.
- Attire: Please wear comfortable clothes and shoes.
|Duration of treatment session
||Duration of treatment ranges from once or twice a week to once a month. Each rehabilitation session would last from 30 to 60 minutes.
||Please be on time for your appointment. Latecomers will be seen at the physiotherapist or occupational therapist’s discretion or we may have to reschedule your appointment.
|The Geriatric Rehabilitation team includes:
- Geriatricians (specialised doctors)
- Occupational therapist
- Other allied healthcare personnel