DOCTORS from top hospitals are leading the charge to ensure that more older folk in Singapore are cared for in nursing homes, community hospitals and at home. This will ease the crunch on hospital beds and improve the care of the elderly. Take aged care physician David Yong, for instance.
In June, the senior aged care physician from Changi General Hospital (CGH) began a project to reduce pneumonia infections at Grace Lodge, a 72-bed nursing home in Punggol. His belief that prevention is better than cure has ensured that pneumonia cases have been slashed at the nursing home, averting costly hospital treatment. In the past year, about 45 residents at the home contracted pneumonia, with more than half ending up at CGH’s emergency department. The respiratory disease, caused by inflammation in the lungs, is one of the most common reasons for hospital admission among the elderly. But since June, Dr Yong’s project which aims to prevent the disease or spot and treat symptoms early has lowered the rates of hospital readmission.
Pneumonia is caused by viruses or bacteria. But among frail, bedridden nursing home patients, many of whom have difficulties swallowing and are tube-fed, pneumonia often results from food entering the lungs. This condition is known as aspiration pneumonia. In a bid to bring down instances of aspiration pneumonia, Dr Yong together with CGH speech therapist Yang Hui Lin has trained the nursing staff at Grace Lodge to ensure that food given to bedridden patients is of the right consistency.
“If it’s too thin, stroke or dementia patients may have difficulty swallowing,” says Ms Yang. “And they could choke.” Through a one-hour lecture, followed by a 90-minute bedside hands-on workshop, staff were shown how to mix each patient’s meal to the correct consistency. Staff members were also trained to detect signs of pneumonia early to prevent it from worsening. And rather than send patients to hospital, Dr Yong arranged for the requisite antibiotics to be administered within the nursing home.
Some patients sent to hospital for pneumonia treatment end up spending 10 days there on average, costing about $7,000. The programme costs $10,000 a year and has already lowered pneumonia rates by about a third. “As hospital doctors, we areforever looking for ways to reduce unnecessary admission rates,” says Dr Yong. “It’s amazing that this simple idea to prevent or treat early is working well.”