Our acute geriatric ward features a SILVER Unit (Specialized Innovative LongeVity and Elderly Recovery), specifically designed to care for older adults experiencing confusion and admitted for delirium. The staff in this unit receive specialised training and implement a comprehensive, multidisciplinary patient care programme that ensures the early resolution of delirium and prevents functional decline. Emphasising a restraint-free environment, the unit prioritises individualised and person-centred care, actively involving and educating families in the care process. Patients benefit from daily activities, orientation sessions, and music therapy, and are encouraged to dine and socialise in a communal area. The unit also includes an en-suite activity room, complete with a reminiscence corner, catering specifically to patients with memory issues.

The unit was honoured to host Mdm President Halimah Yacob during her official visit to the hospital on 19 September 2017. For more details about the President's visit and her interaction with our patients, click here.

For more information about our SILVER Unit, please click here.

Our team actively provides support and consultation to the NUHS Regional Health System's Community Care Team - Hospital to Home programme, which provides continued care for homebound patients discharged from the hospital, ensuring a smooth transition to home. It encompasses clinical, nursing, rehabilitation and psychosocial support for patients, their family members and caregivers.

Our doctors also work closely with community partners to facilitate ageing in place for older adults.

• Are aged 75 years and above
• Experience complex health problems and atypical symptoms, such as functional decline, memory loss, weight loss, urinary incontinence and overall decline in personal well-being

 During the initial visit:

• A comprehensive geriatric assessment, considered the gold standard in older adult care, will be conducted
• If necessary, the Geriatrician may request further investigations and/or refer patients to relevant allied health professionals for additional management
• The Geriatric team will provide advice and counselling on healthy ageing, including recommended vaccinations for flu and pneumonia.
  

Subsequent visits will be tailored based on the nature and complexity of the individual's problems.

For information on our outpatient services, including contact details, operating hours and directions to 13b Medicine Clinic, click here.

Geriatric Oncology (GOLDEN)

Geriatric oncology, a sub-specialty dedicated to providing of appropriate cancer treatment for older patients, comprises a specialised multidisciplinary team including doctors, nurses, therapists, pharmacists and social workers. The team delivers individualised and holistic cancer management plan and interventions, supporting older adults throughout their cancer journey.

The clinic is located at Level 8 and 10 of the Cancer Centre. Click here to learn more.

Rapid Access Care for Elders (RACE) clinic

The RACE clinic offers a fast-track service for early medical review of stable older adults who seek medical attention at the Emergency Department. Patients deemed stable enough for outpatient treatment may be referred by emergency doctors to the RACE clinic, with the aim of reducing unnecessary ward admissions.  

Successful Ageing and Fitness Evaluation (SAFE) Clinic

The SAFE clinic, catering to adults aged 75 years and above, specialises in preventing frailty, falls, and sarcopenia. Our multidisciplinary and multi-specialty team, including physiotherapists, occupational therapists, dietitians and geriatricians, focuses on strengthening patients and reducing their risk of falls and frailty.

The team provides comprehensive and personalised assessments, optimises chronic medical conditions, offers individualised nutrition advice and works to enhance patients' physical and functional abilities. Click here to learn more.

We are committed to the education of future doctors, ensuring that medical students receive comprehensive training in geriatric medicine during both their pre-clinical and clinical years.

Students from the Yong Loo Lin School of Medicine, National University of Singapore, participate in a Foundation module in Geriatric Medicine at the end of their second year. This includes the Clinical Skills Foundation Programme (CSFP), bridging the transition from basic science lectures to clinical learning. Through experiential learning, students begin to understand the basics of geriatric assessment, a skill they continue to develop throughout their medical education.

Over their five-year medical programme, students' learning objectives and exposure to Geriatric Medicine are reinforced in various postings, including Medicine, Psychiatry, Family Medicine and Surgery. In their final year, students undertake a three-week structured internship in geriatric medicine. This experience covers inpatient and outpatient geriatric care, as well as sub-acute, rehabilitation and community care in a community hospital. They develop core competencies in comprehensive geriatric assessment, differential diagnosis for older patients and creating patient-centred management plans for geriatric syndromes. They also gain experience in counselling patients and families on geriatric issues, initiating advanced care planning and end-of-life discussions, collaborating with interdisciplinary teams and ensuring safe transitions of care into the community.

The NUHS Geriatric Medicine Senior Residency Programme, spanning three years (two years ACGME-I accredited and one year Residency Advisory Committee approved), is designed for motivated and driven Internal Medicine residents.

The programme offers diverse clinical experiences in both acute and community care settings, a comprehensive didactic curriculum and career development programmes in medical education, research and/or hospital administration, supported by our dedicated faculty.

This integrated programme provides rotational clinical blocks and longitudinal clinical care across several sites in the country. Senior Residents develop their skills through supervised clinical experiences and formal national didactic teaching. Beyond essential medical knowledge, they develop leadership and teaching skills, professional attitudes and practical experience to deliver evidence-based, patient-centred care to older patients in various settings.

Learn more about our Senior Residency Programme here.

APNs in Geriatric care play a crucial role in the healthcare community, sharing their knowledge and expertise with junior nurses and APN interns. Focusing on the care of older patients, we address the unique challenges and needs they face in healthcare settings. Our specialised education and hands-on experience aim to equip nurses with the skills and compassion necessary to provide exceptional care to this vulnerable population.

Our commitment to evidence-based teaching and presentations ensures that we share the latest advancements in nursing care and treatment modalities. By staying abreast of current research and best practices, we empower our nursing peers to deliver high-quality care and make informed decisions in their clinical practice.

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• memory loss
  
• mood changes
  
• communication difficulties
  
• reasoning problems
  
• challenges in completing day-to-day tasks
  
  

These symptoms may occur individually or in combination. Initially, memory loss and cognitive difficulties can be troubling for the senior with dementia. They may become apathetic or lose interest in usual activities, face challenges in social situations and show emotional control issues. Some individuals may develop agitation, disruptive behaviour and hallucinations.

Often, seniors with dementia may not be aware of these issues as they gradually lose the ability to remember events or fully comprehend their environment.

Dementia can result from various conditions, including:

• Alzheimer's dementia

The most common form, accounting for 60– 80% of cases. It is caused by changes in brain chemistry and structure, leading to cell death. Short-term memory issues are often the first sign.

• Vascular dementia

Arises from inadequate blood and oxygen supply to the brain, leading to cell death. It can occur post-stroke or due to damaged brain arteries. 

• Dementia with Lewy bodies (DLB)

Named after the abnormal structures, Lewy bodies, that build up in brain nerve cells. It affects brain tissue function, causing symptoms like falls, confusion, hallucinations, reasoning difficulties and memory impairment. DLB shares similar characteristics with Parkinson's disease dementia but with a different trajectory.

• Fronto-temporal dementia 

Often affects younger individuals and results from damage to the brain's frontal part, leading to personality and behavior changes.

• Mixed dementia

Common in advanced age (85+), it's often a combination of Alzheimer's disease and vascular damage.  

• Other causes of dementia

Includes cumulative brain damage from chronic alcoholism or repeated head injuries (e.g. former professional boxers or football players).

Delirium is a medical condition characterized by sudden confusion. Individuals with delirium may struggle with attention, recognition of their surroundings and memory. Symptoms can vary throughout the day and often intensify in the evenings.

If you suspect a loved one is experiencing delirium, prompt evaluation by a doctor is vital to identify and treat the underlying causes. Alert your healthcare provider immediately.

Delirium in seniors can be triggered by various factors, including: 

• Infections (senior may not always exhibit a fever but rather a change in mental status)
• Medications, especially those with a high anticholinergic load
• Pain 
• Dehydration
• Constipation

Certain factors can predispose seniors to delirium: 

• Environmental changes, such as hospitalisation
• Use of multiple medications 
• Existing underlying dementia
• Poor eyesight or hearing 
  

Treatment for delirium involves:

• Addressing the underlying cause. Alongside acute treatment, we support patients by maintaining a calm environment, orienting them to their surroundings and explaining the reason for their hospital stay
• Alleviating pain and minimising discomfort
• Encouraging a regular sleep-wake cycle when possible
• Making hearing aids and eyeglasses available if the patient uses them at home
• Removing barriers and restraints, including urinary catheters, where possible
• Promoting mobility and cognitive activities

Family presence can be beneficial for patients with delirium. Familiar faces and support from loved ones can be comforting and helpful during their hospital stay.

The risk of falling increases with age due to factors like:

• Balance problems and muscle weakness 
• Poor vision
• Impaired sensation or foot pain 
• Long-term health conditions, such as heart disease, dementia or low blood pressure
• Vitamin D deficiency 
• Medications affecting attention (e.g. opioid analgesics, antianxiety drugs, and some anti-depressant drugs) or lowering blood pressure (e.g. antihypertensive, diuretic, and some heart drugs), including some over-the-counter medicines
• Poor safety awareness 

Falls can also be caused by physical conditions that impair mobility or balance, hazards in the environment, or potentially hazardous situations. A fall is also more likely to happen when:

• the floor is wet or has been recently polished, such as in the bathroom
• the lighting in the room is dim
• rugs or carpets aren't properly secured
• the person is reaching for storage areas, such as a cupboard, or is going down stairs
• the person is rushing to get to the toilet
  
• there are electrical or extension cords or objects that are in the way of walking
• there are uneven sidewalks and broken curbs
• the person is unfamiliar with his/her surroundings

Most falls occur when several causes interact. For example, people with Parkinson's disease and impaired vision (physical conditions) may trip on an extension cord (an environmental hazard) while rushing to answer the telephone (a potentially hazardous situation). The more risk factors a person has, the greater their chances of falling.

Falls can cause broken bones, like wrist, arm, ankle, and hip fractures. These injuries can make it hard for a person to get around, do everyday activities, or live on their own.

Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (e.g. blood thinners). An older person who falls and hits his/her head should see a doctor right away to make sure they don't have a brain injury.

Some falls can be serious and result in death. 

The effects of a fall may last a long time. Many people who fall, even if they're not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling.

It is vitally important for people to tell their doctor if they have fallen, even if the doctor has not asked, so that the doctor can uncover treatable reasons behind the fall. People who have fallen may be reluctant to tell their doctor because they think falling is just part of getting older, especially if they have not been injured. Even people who have been seriously injured during a fall and have been treated in an emergency department may be reluctant to admit they have fallen. 

Some older people may be reluctant to seek help and advice from their GP and other support services about preventing falls, because they believe their concerns won't be taken seriously. However, all healthcare professionals take falls in older people very seriously because of the significant impact they can have on a person's health.

Initial treatment focuses on injuries, such as head injuries, fractures, sprained ligaments and strained muscles.

Subsequently, addressing underlying disorders and improving walking and balance through physical and occupational therapy is essential. These therapies also build confidence and suggest preventive measures.

To reduce the risk of falls:

• Discuss fall risks and medication reviews with your doctor.
• Engage in strength and balance exercises.
  
• Ensure appropriate clothing and footwear.
• Regularly check your eyesight and update eyeglasses.
• Make your home safer with grab bars, non-slip mats, good lighting and removing tripping hazards.
• Limit alcohol consumption to avoid coordination and balance issues.

• Talk to your doctor to 
• evaluate your risk for falling and talk with them about specific things you can do
• review your medicines to see if any might make you dizzy or sleepy. This should include prescription medicines and over-the-counter medicines. Your doctor may recommend alternative medication or lower doses if they feel the side effects increase your chances of having a fall. In some cases, it may be possible for the medication to be stopped.
  
• Do strength and balance exercises
• Do exercises that make your legs stronger and improve your balance. This can take the form of simple activities such as walking and dancing, or training programmes. Tai Chi is a good example of such an exercise.
• Have proper clothes and footwear
• Avoid loose-fitting, trailing clothes that might trip you
• Wear well-fitting shoes that are in good condition and support the ankle
• Take care of your feet by trimming your toenails regularly and seeing a doctor about any foot problems

• Have your eyes checked

Have your eyes checked by an eye doctor at least once a year, and be sure to update your eyeglasses if needed. If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are. Not all visual problems can be treated. However, some problems, such as cataracts, can be surgically removed with surgery.

• Make your home safer
• Add grab bars inside and outside your bathroom 
• Use non-slip mats in the bathroom
• Mop up spills to prevent wet, slippery floors
• Get help lifting or moving items that are heavy or difficult to lift
• Remove clutter that you could trip over 
• Ensure all areas of the home are well lit 

• Avoid alcohol

Drinking alcohol can lead to loss of co-ordination and exaggerate the effects of some medicines. This can significantly increase the risk of falls, particularly in older people. Avoiding alcohol or reducing the amount you drink can reduce your fall risk. Excessive drinking can also contribute to the development of osteoporosis.

If you've fallen in the past, making changes to reduce your chances of falling can also help you overcome any fear of falling.

• What is Functional Decline?
  

Functional decline can manifest in various forms, with common signs including: 

• Reduced appetite
• Increased sleepiness, loss of interest and withdrawal
• Decreased communication with family
• Reduced mobility
• Urinary incontinence 
  

What causes Functional Decline?

Functional decline can be triggered by many factors, such as:

• Medical conditions such as infections, strokes or heart attacks.
• Reduced food and fluid intake, leading to decreased energy.
• Feelings of sadness or withdrawal, reducing motivation.
• Delirium due to environmental changes or infections.
• Impaired vision or hearing.
• Lack of sleep.
• Changes in social circumstances, such as new housing or caregivers
  

• What does it mean for my loved ones?
  

Support is crucial for family members experiencing functional decline. It's important not to attribute these changes solely to ageing. Seeking a consultation with a geriatrician or physician specialising in geriatric care is advisable. The presence and support of loved ones can be incredibly comforting and motivating for older adults.

A CGA conducted by geriatricians and a trained team can help identify the causes of functional decline, focus on the patient's strengths and find solutions to enhance their quality of life. Treatment may involve addressing acute medical conditions, improving function, memory, environment and/or mood.