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Monday, 20 Mar, 2023

‘We should worry about the dementia epidemic,’ says CEO of St Luke’s Hospital for the elderly (Straits Times Premium)

SINGAPORE - It is not your usual hospital ward. For one thing, there is a courtyard filled with plants. There is also an activity corner, with shelves holding plastic baskets filled with toy fish and vegetables such as broccoli and eggplant. Framed pictures – mostly of trees and plants – line the walls.

In one bed, a woman rests, her bony hands cradling a baby doll clad in powder-blue rompers with the words Little Brother emblazoned across the chest. Around the corner, another woman, with snowy white hair, tells a nurse in a mixture of Mandarin and Hokkien that soya sauce is an essential ingredient for fried rice.

Welcome to Ward 1D at St Luke’s Hospital in Bukit Batok, the first community hospital in Singapore to set up a dementia ward more than 15 years ago because it recognises that people with dementia have special needs and require specialised care.

Dementia is the term for several diseases that affect memory, thinking and the ability to get on with daily life.

The ward prides itself on offering “holistic, coordinated and individualised” dementia care. Besides medical and nursing services, patients have access to many different types of therapy – physio, occupational, art, music and even doll therapy. In dementia care, therapeutic dolls are used to soothe and calm agitated patients.

Associate Professor Tan Boon Yeow, 55, is proud of the ward, not just because he is the chief executive of St Luke’s. He played a key role in setting up the ward when he was a young doctor in 2007, a few years after he returned from Australia where he received training in community geriatrics.

“Before that, we’d have patients just sitting outside (the wards) and they’d be screaming and shouting. So we decided to have a ward. And somehow, the air there is magical so once they walk into the ward, the patients just settle down,” he says. 

He adds that St Luke’s – working with the Agency for Integrated Care, which coordinates aged care services – also has a community intervention team comprising health workers in different disciplines who bring care to patients in their homes.

In more ways than one, Prof Tan’s life – both professional and personal – has been inextricably tied to St Luke’s, which opened in 1996 and is the first hospital in Singapore dedicated to the elderly sick.

“As a medical student, I remember buying a brick they were selling to raise funds to get this place built,” says the head honcho with an affectingly calm disposition.

When he was a trainee doctor in the late 1990s, he became a volunteer at the hospital. He remembers being cajoled by the hospital’s medical officer to help out one night even though he was reluctant to because his wife was then heavily pregnant with twins.

“At about 11pm, he sent me home, maybe because he felt guilty. That very night, my wife delivered. So my daughters, who are 26, are as old as the hospital,” says Prof Tan, whose wife is a surgeon. 

When he finished his postgraduate training in family medicine in 1999, the hospital offered him a job. He has been with St Luke’s since, rising up the ranks to become chief executive in 2016. Along the way, he also made a name for himself as a key proponent of dementia care in Singapore, and an outstanding clinician.

An adjunct associate professor at both the National University of Singapore (NUS) Yong Loo Lin School of Medicine and Duke-NUS Medical School, he has bagged several awards. These include the Ministry of Health’s National Outstanding Clinician Educator Award (2019); The Albert & Mary Lim Award (2019), described as the equivalent of the Cultural Medallion in family medicine; and the Distinguished Educators’ Award (2022) from the College of Family Physicians Singapore.

With a laugh, the elder of two sons of a second-hand car businessman and a primary school teacher lets on that he applied to study medicine at NUS for the wrong reason: to defer from national service.

“At the time, medicine offered a route to disrupt your national service,” he says sheepishly. “Because I went there for the wrong reasons, I wasn’t inspired to study. I was failing test after test, and had to see the dean in Year One. He said, ‘You sure you’re still interested? Because if you don’t buck up, you’re going to have to leave.’”

Assoc Prof Tan Boon Yeow (extreme left) with health workers and a patient at St Luke’s dementia ward.
Assoc Prof Tan Boon Yeow (extreme left) with health workers and a patient at St Luke’s dementia ward. The hospital became the first community hospital in Singapore to set up a dementia ward over 15 years ago. PHOTO: TAN BOON YEOW

Buck up he did. Resolving that he should live his life with purpose, he told himself: “Eh, maybe through medicine, I can help people.”

“Today, I always ask people, ‘Why do you want to do medicine?’ Because if their why is not strong, then they will likely leave (the profession).”

An attachment at St Luke’s – where there were many patients with multiple conditions – for his postgraduate training made him decide to specialise in family medicine. “I realised that there was a need. Not many doctors wanted to do this because it’s not glamorous. Patients who get admitted here need a period of time for rehab, or sub-acute care, where we make sure that they transit back home well. Being a generalist allows me to see that range of patients. In a sub-specialised field, you tend to wear only that hat that you’re trained in,” says Prof Tan.

Tending to sick seniors at St Luke’s also made him realise one thing: “As we grow as a nation, there’s a need for more doctors to invest in looking after the elderly.”

He decided to make a career of it. Two years after he joined St Luke’s in 1999, the hospital sent him to Melbourne, Australia, where he worked with Professor Emeritus Edmond Chiu, a leading expert in dementia care.

His time there afforded him not just a ringside seat to the illness, but also how it was treated and managed Down Under.

“A lot of their services were set up to support people at home... In Australia, unlike in Singapore, a lot of dementia patients live alone. So (the health service) will try its best to keep them as long as possible at home, before it shifts them into an institutional home. The whole posture was different. It was not just looking after them medically and clinically, but looking after them as a person.”

His experience convinced him more could be done for the older person in Singapore.

“So coming back, one of the first things I did was to start our ward for dementia patients,” says Prof Tan, who believes that training for healthcare workers in dementia care is very important. 

Together with several other doctors, he is part of a dementia network which exchanges ideas and discusses overseas training opportunities for doctors and nurses.

The conviction that he is answering a calling grew stronger over the years as he started treating patients and developing relationships with them and their carers.

“Realising that they are actually somebody’s father, mother, brother or sister makes the greatest impact because oftentimes it’s so easy to just say, ‘Eh, this patient, in Bed 16, is just really difficult.’ That insight gives a new desire of wanting to help them in a different way,” he says.

He adds: “We probably learn most and are most reflective when we ourselves or those close to us are affected.”

His mother-in-law is now living with the illness. Dementia also afflicted his father-in-law before he died a couple of years ago. 

Prof Tan with his mother-in-law, Madam Chor Poh Giok, in a photo taken in Christmas 2022
Prof Tan with his mother-in-law, Madam Chor Poh Giok, in a photo taken in Christmas 2022. She was diagnosed with dementia about a decade ago. PHOTO: TAN BOON YEOW

“I remember travelling with them to Hawaii when my sister-in-law got married some years ago. We spent two weeks there but it was a big struggle. One was dementing, the other one we didn’t know yet but was probably in the early stages. They were disoriented because it was cold and there was a big time zone difference,” says Prof Tan, adding that his father-in-law would urinate in inappropriate places as the disease progressed.

He noticed something was not quite right with his mother-in-law, 88, about 10 years ago. “One of the things that struck me was when she started getting rashes on her face. Then I realised she was using Dettol – the type you use to clean floors – to wash her face.”

He recalls the time one of his sisters-in-law flew back from the United States and stayed in the same room as her mother. “She flew back thousands of miles and my mother-in-law would wake up and say, ‘Who is this stranger lying beside me?’ 

“Once you go through that, then you realise the plight of a caregiver as well. I’m a healthcare provider, I’m informed and I know enough about the disease, but I still struggle, and say ‘Eh, how come like that? What am I to do?’, let alone someone who has no clue.”

Increasingly, dementia is a scenario many Singaporeans will have to grapple with. The Agency for Integrated Care estimates that 86,000, or one in 10, Singaporeans aged 60 and older may have dementia. The number is expected to go up to 130,000 by 2030.

“We are one of the fastest-ageing nations in the world, and we know that dementia is related to age. So at 65, after every five years, the number doubles. So we got to do the maths right... that silver tsunami or the dementia epidemic is something we should worry about.” 

Singapore has pockets of good care, but more can be done, he says. The way he sees it, the biggest challenge the society faces is caregiver burnout.

“Especially if a person is doing it all alone. No matter how understanding you are, you’re just tired. When you’re tired, there’s only this much of care you can give,” he says, adding that carers who do not understand the illness or make use of the resources available often succumb to angst, and worse, depression.

It is the reason, he stresses, why education and support are so important.

“People must understand that it’s the disease, not the person,” he says.

Last year, St Luke’s launched Always, Mother, an interactive charity film which highlights the personhood of a person living with dementia. Research has shown that the personhood – the sum total of values and life experiences – of someone with dementia does not change even as the disease progresses.

For instance, his mother-in-law, he says, has always been a generous person and her generosity – “she’s always sharing her food” – is intact even as her faculties are deteriorating.

The film also allows viewers to put themselves in the shoes of its caregiver character to influence choice and navigate care options for his mother who has dementia. 

“Caregiving,” says Prof Tan, “is where we learn about the self, and what our posture is towards all these things that are happening. I’ve seen caregivers who, in spite of everything going on, continue to live life to the fullest. I’ve got a caregiver, a son who stopped work just to look after his mum, and every year, he would do this big exercise to take her overseas because he wants to expose her (to the joys of travel). So they build their life around this. Then there are those who just lament and ask why life (is so difficult).”

“It’s about framing the mindset, it’s about acceptance,” he says, adding that it is important for carers to have conversations about what is happening to them and their loved ones.

Asked if he worries about getting dementia himself, Prof Tan smiles and says: “I don’t fret, but I guess one prayer I have is ‘God, if it’s possible don’t let me have it lah, you know?’ Largely, it’s because I don’t want to burden the people around me. I see a lot of my patients struggle with that.”

Originally posted in Straits Times (Premium):  ‘We should worry about the dementia epidemic,’ says CEO of St Luke’s Hospital for the elderly