Oasis of calm for patients with delirium

Madam Liew Tim in NUH's Silver Unit this month with her son Wong Weng Yoi, daughter Brenda Wong (at right) and maid Juliana Abes Barang. Another son, Mr Wong Wing Chow, said of the Silver Unit: "It's a better environment - you don't have noise like i
Madam Liew Tim in NUH's Silver Unit this month with her son Wong Weng Yoi, daughter Brenda Wong (at right) and maid Juliana Abes Barang. Another son, Mr Wong Wing Chow, said of the Silver Unit: "It's a better environment - you don't have noise like in the outside wards, or people walking here and there."ST PHOTO: SEAH KWANG PENG

In the bustle of National University Hospital's (NUH) various wards, the Silver Unit is an oasis of calm. Set up to cater to elderly patients with delirium, the six-bed unit's closed doors and attached activity room set it apart from the rest of the hospital.

Its staff pride themselves on not using restraints as far as possible, which is not always easy as such patients can be confused and easily agitated. "In the past, some of the patients were restrained, or they would try to abscond (from the ward)," said Associate Professor Reshma Merchant, head of NUH's geriatric medicine division. "It was a conscious effort to say: 'What can we do to not use restraints?'"

Apart from the peaceful environment, one of the secrets of the Silver Unit's success is making sure that night and day are clearly defined for patients.

Many such patients experience sleep-wake reversal, which means that they sleep during the day but become active at night, Prof Merchant explained. "In the past, we had to use sleeping medications or take patients out to the nurses' station so that they wouldn't disturb other patients," she said.

These days, the ward staff make an effort to keep patients engaged during the day in the activity room next to the ward. Special panels mimicking the daytime sky have been installed above each bed.

And unlike in other wards, most nursing activities are done before 10pm so that patients can get a good rest. "We try to encourage peaceful sleep," said Prof Merchant.

The Silver Unit - officially called the specialised innovative longevity elderly recovery unit - was set up in April this year.

A similar five-bed Geriatric Monitoring Unit - also for the elderly with delirium - was established at Tan Tock Seng Hospital in 2010.

One of the Silver Unit's former patients is Madam Liew Tim, 100, who was there recently for more than 20 days following a bad fall.

Although most patients stay for only four or five days, Madam Liew stayed longer because of a recurrent infection and the availability of spare beds. Her son Wong Wing Chow, 70, said: "It's a better environment - you don't have noise like in the outside wards, or people walking here and there. She slept much more peacefully here."

A version of this article appeared in the print edition of The Straits Times on October 19, 2017, with the headline 'Oasis of calm for patients with delirium'. Print Edition | Subscribe