Getting to know patients pays off at dementia unit

When an 80-year-old man with dementia was first admitted to Khoo Teck Puat Hospital last year, he refused to eat and drink because he feared the food was poisoned.

He was suspicious of everybody, including his daughter and domestic helper. No one could convince him to take his medication either.

"The most efficient and convenient way to deal with such a situation would usually be to restrain his arms and do tube-feeding, so that he gets the nutrition he needs," said Associate Professor Philip Yap, director of the geriatric centre at the hospital.

But the doctors and nurses at the hospital's Care for the Acute Mentally Infirm Elder (Camie) unit decided to win him over so that he would do willingly what was for his own good.

Said his daughter, Ms Florence Tay, 55, a retired nurse: "When he first came in, he just sat there and refused to change into hospital clothes. So they let him wear his own clothes. He was also allowed to be himself. If he wanted to lie on the bed or sit in front of the TV, they let him be."

One night, a nurse was assisting him to the toilet. In his disoriented state, he panicked and punched her in the chest. Yet the nurse remained patient and explained to him that he was in a hospital and she was there to help him.

When he did not want to drink water, a psychiatrist encouraged him to do so by modelling the desired behaviour for him. Each sip he took, she did the same.

FAMILIAR SURROUNDINGS

They also allowed familiar faces, such as the maid or my brother, to feed him so that he was more motivated to eat.

MS FLORENCE TAY, whose father was at Khoo Teck Puat Hospital's Care for the Acute Mentally Infirm Elder unit.

"They also allowed familiar faces, such as the maid or my brother, to feed him so that he was more motivated to eat," said Ms Tay. "My dad is the traditional, authoritative Chinese man and I know restraints would not have worked because he hates doing things that go against his will," she added.

Instead, the staff there knew he liked gardening and let him water the plants in the garden.

To keep up with the level of attention some patients like Mr Tay need, the Camie unit added one more nurse to its night shift.

Today, Mr Tay is back home and he eats three meals a day. He enjoys cake or oats for breakfast and blended rice or noodles for lunch and dinner.

Ms Yoga Nalini, 53, also saw a drastic change in behaviour in her mother-in-law when she was admitted to the Camie unit three years ago. Her mother-in-law, now 85 and with advanced dementia, had had a fall at home and hurt her back.

She was initially in another hospital for two weeks. "Except for her physiotherapy sessions, she was lying in bed all the time. The fear of the risk of falls took precedence over her quality of life," said Ms Nalini, an accountant.

"I saw her losing her cognitive ability as she began to forget to do things, and she lost mobility because her muscles were not being used," she added, tearing at the memory.

So the daughter-in-law decided to transfer her to the Camie unit for dementia monitoring and rehabilitation instead. The stay did not cost her more.

Nurses there encouraged her to do things herself. They cut her fruit up into smaller pieces and skewered them on toothpicks so she could feed herself. They found out that she was a former broadcaster of classical music and signed her up for music therapy.

Today, the 85-year-old woman lives independently in her apartment with her domestic helper. She goes to two dementia enrichment centres almost every day. Said Ms Nalini: "She is happy and I am glad we are helping her achieve some semblance of a normal life, instead of putting her in wheelchairs and commodes."

Janice Tai

A version of this article appeared in the print edition of The Sunday Times on August 13, 2017, with the headline 'Getting to know patients pays off at dementia unit'. Print Edition | Subscribe