No restraint for dementia patients at special ward

Ms Jane Tan, a music therapist, performing for a dementia patient in a specially-designed dementia ward at Khoo Teck Puat Hospital. Regular music therapy is one of the features of the 10-bed ward.
PHOTO: No restraint for dementia patients at special ward

SINGAPORE - Khoo Teck Puat Hospital (KTPH) has gone a full year without having to restrain patients suffering from dementia who sometimes get agitated and become aggressive.

The secret is its specially designed dementia ward which it started just over a year ago when it noticed increasing numbers of patients with dementia needing normal medical treatment.

And the numbers will continue to grow, said Dr Philip Yeo, a senior consultant in geriatric medicine at KTPH.

Similar to other older persons, these people are susceptible to health problems including infections, heart failure and falls, he noted.

In fact, patients with dementia are more likely to suffer functional decline, confusion and have falls, said Dr Reshma Merchant, head of general medicine at the National University Hospital (NUH).

It is for these reasons that KTPH started its special dementia ward. The 10-bed ward, which is at the end of its geriatric ward, looks cheerful and homely, with areas where patients can sit in comfortable chairs away from their bed to watch television.

A glass wall provides a view of a garden, where patients are taken for strolls by nurses and therapists. There is also regular music therapy to bring cheer.

The design of the ward is such that patients are not tempted to leave. Doors in the ward are painted to look like bookshelves, so patients won't be tempted to walk out, or become angry when not allowed to.

But some become confused when they cannot take down one of the "books" to read, so staff quickly distract them. Patients are also encouraged to bring photos, and personal or religious items to make the place feel more like home.

The frail elderly often find a hospital environment disconcerting and stressful, said Dr Yeo. The situation gets worse when dementia is added to the equation.

He said: "A change in their daily routine, coupled with medication and tests, and the effects of the acute illness, increase confusion, anxiety and agitation. In such circumstances, they may act up and refuse medical treatment."

In KTPH's dementia ward - so far the only one in a public hospital - the nurses are specially trained to deal with such problems and to provide patients with activities that will keep them mentally and physically occupied.

They try to view unusual behaviour as an "expression of unmet physical or emotional needs", he said.

Dr Yeo said that unlike other wards, the patient's needs are given more importance than routine tasks. So nurses distributing medicine would stop their work should a patient need help to go to the toilet - instead of asking the patient to wait, or say it is fine as he has diapers on.

"Being patient-centred implies making the extra effort to help patients have a 'normal' toileting experience instead of passing urine in the diapers," he added.

And it appears to have worked. The family of one patient wrote to say: "We wanted to say 'Thank You' for the care, concern and compassion shown to our father Mr Ho S. L. during his stay. We wish we could list down the names of the individual nurses. It was comforting to know that we could go home and not worry because you proved to us that he was in good hands."

The success of KTPH has prompted NUH to also look into setting up a special area for patients with dementia, which should be ready by early next year.

Dr Merchant said they "use many other techniques and distraction therapies to avoid restraints", such as bandaging the drip site so they won't pull it out, or hiding urinary catheters in their pants.

This article was published on April 21 in The Straits Times.

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