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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.
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:
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Diagnosis | 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.
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Treatment | 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.
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Where necessary and appropriate, we may refer patients for:
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Cognitive re-training programme conducted by a multidisciplinary team and led by
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 nutritional 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.
Download Memory Clinic brochure (255 kb, PDF)
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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 timely and appropriate treatment.
Therefore, it is important to undergo an evaluation to identify possible reasons for one's incontinence, and to explore potential 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.
We offer the following services:
- A continence specialist will evaluate the patient through history taking and physical examination.
- Urine tests are often performed.
- Other tests are arranged if necessary, which may include bladder scans, blood tests, or detailed scans.
- There may be a need to keep a record of the patient's urinary habit through self-completion of a bladder chart.
- The cause and severity of the urinary incontinence is determined and treatment options are considered and discussed.
- Treatment methods may include lifestyle advice, toileting scheduling, pelvic floor exercises, medications, as well as aids and appliances.
- Should surgical options be considered, a referral to the Urologist will be offered
Download Continence Clinic brochure (507 kb, PDF)
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Falls can result in serious consequences in the elderly such as injuries, decline in function as well as reduced activity due to fear of falling.
Falls in an elderly person may be related to muscle weakness, poor balance, or other underlying medical conditions. Hence, it is important to assess the causes of the fall so that appropriate measures can be taken to prevent further falls.
At our Falls and Balance Clinic, we evaluate ambulant patients, aged 65 years and above, who have frequent falls or difficulty in walking. We identify the causes of falls in the patient and develop a care plan to help prevent further falls.
The evaluation will include a review of the circumstances surrounding the falls and a comprehensive geriatric assessment by a doctor and our nurse specialist. Our physiotherapist will assess the physical function and prescribe individualized exercise for the patient or recommend an exercise class. When indicated, we will recommend a home safety assessment by our Occupational therapist. We also review the need to evaluate for and treat osteoporosis.
A follow up visit will be arranged to review the results of any investigations and the patient's progress.
Download Falls and Balance Clinic brochure (321 kb, PDF)
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Older adults may have multiple,
complex medical and functional problems in the context of social needs, resulting in decreased ability to perform their day-to-day activities.
Some of these problems are potentially reversible and early interventions can reduce further disabilities.
We conduct assessments to detect such problems, provide a care plan for managing these problems, and provide geriatric rehabilitation services to improve the elderly's functions.
We offer the following services:
- Evaluation and identification of the medical, functional and social needs of the patient
- Person-centered interventions aimed to reduce further disabilities
- Development of an individualized care plan together with the patient and his/her family so that the patient can continue to live at home with his/her loved ones
Download Geriatric Assessment Clinic brochure (258 kb, PDF)
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What is geriatric rehabilitation?
Geriatric Rehabilitation is a process to improve an older person's function, nutritional status, 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 patients can perform his/her daily activities
- Help patients maintain their independence in the community through the use of correct aids and appliances
- Help patients and their caregivers identify community services that may be of assistance to them
- Prevent or manage malnutrition through advising adequate nutrition so that rehabilitation effect can be optimised
We offer the following allied health services:
Strategically located within the Centre for Geriatric Medicine, the geriatric physiotherapy service allows convenient access for older adults to meet their rehabilitative needs. Through thorough assessments and examination, the geriatric rehabilitation physiotherapist will tailor treatment to each individual's needs.
The type of specialized geriatric rehabilitation for older patients may include:
- Assessment of function, gait and balance
- Functional mobility training
- Strength, balance and coordination training
- Prescription and education on use of walking aids
- Fall prevention education and advice
- Caregiver training to family member/carer on patient care, home management and home exercise programme.
Occupational Therapists (OTs) often work with older adults with chronic conditions such as problems with memory, frequent falls or functional decline. OTs help these older adults to achieve their health goals, through engagement in meaningful activities. This includes facilitating individuals to gain skills and confidence in their activities of daily living (ADLs), or train their caregivers to assist them.
The range of services include:
- Home safety assessment and recommend modifications
- Caregiver education and training
- Assessment and re-training of self care activities
- Cognitive assessment and training
- Prescription and use of adaptive equipment to aid in ADLs
A Speech Therapist provides assessments and interventions to patients who have communication and swallowing difficulties. He/She also provides training to care-givers and patients to educate them on how to swallow safely and to communicate effectively.
The types of services include:
- Swallowing assessment
- Clinical bedside assessment
- Instrumental assessment such as Videofluoroscopy (VFS) and Fiber-endoscopic evaluation of swallowing (FEES)
- Swallowing intervention such as:
- Diet/fluid modifications
- Strategies
- Therapy
- Communication assessment and intervention
- Caregiver training such as:
- Advice on supervised feeding, diet modification and medication taking
- Advice on communication strategies for more effective communication with patients with dementia
Having a good nutritional status can prevent malnutrition and frailty in older adults. Chronic diseases (e.g. diabetes and kidney disease) can also be prevented or managed with a nutrition conscious diet.
The types of dietetic interventions include:
- Individualised nutrition support advice for those with unintentional weight loss, loss of appetite and swallowing impairment
- Individualised dietary counselling to manage chronic diseases (e.g. diabetes and kidney disease)
You will expect the dietitian to conduct a nutritional assessment on patient's condition, dietary requirements, intake and weight changes, and advise on a nutrition care plan and provide intervention according to patient's needs.
Download Geriatric Rehabilitation Services brochure (276 kb, PDF)
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MasterMind is a structured group therapy programme designed by a collaborative team of healthcare professionals to empower patients diagnosed with Mild Cognitive Impairment and their caregivers with the skills to combat cognitive and physical frailty via multi-domain interventions.
MasterMind aims to enhance cognitive well-being, promote physical health and provide a supportive environment for personal growth and development.
Structure of Programme
Pre-assessment Session (1 hour)
At this initial session, participants will set personal goals and complete pre-programme questionnaires. A comprehensive review will be conducted by a team of professionals including a physiotherapist, occupational therapist, and psychologist to tailor the programme to individual needs.
Participants will receive guidance on how to download a
cognitive app on their smart devices. Please note that a separate subscription fee is required for the full version of the application.
Pre-Assessment Session will be conducted on 13 March 2024 and 18 September 2024.
Group Therapy Sessions (6 sessions, 3 hours each)
MasterMind comprises six group therapy sessions, each lasting 3 hours including short breaks.
Participants will engage in various therapeutic activities including cognitive training and exercises tailored to their individual needs and goals.
Group Therapy Session (Weekly Core Sessions x 5 and 1 Booster Session) would be conducted from 4 April 2024 to 30 May 2024 and 26 September 2024 to 21 November 2024.
Benefits of the Programme
Cognitive Skills
Acquire valuable memory strategies and cognitive skills that can be applied in daily life.
Physical Health
Combat frailty through regular physical activity routines, contributing to improved health, mobility, and strength.
Emotional Well-being
Pick up mindfulness techniques that can help improve attention, reduce anxiety and enhance emotional well-being.
Supportive Network
Foster a sense of support. Connect and create a valuable support network beyond the programme.
Self-confidence
Experience a boost in self-confidence and a sense of accomplishment by acquiring new cognitive and physical skills.
Long-term Benefits
Learn to apply skills in daily life, maximising the long-term benefits for cognitive, physical and emotional health.
Attire
Wear comfortable exercise attire and non-slip exercise shoes.
Accompanying Persons
One caregiver can accompany the patient during the group therapy sessions. This individual should be someone familiar with the patient's needs and preferences to provide support as necessary.
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