The Division of Geriatric Medicine in Changi General Hospital is one of three accredited advanced specialty training centers for Geriatric Medicine in Singapore.

The division utilizes an age-defined, needs-related admissions criteria for A & E admissions. Inter-discipline referrals further contribute to the unit’s work. Our philosophy aims to restore frail multi-pathology elderly patients to optimal functional independence whenever possible.

Currently there are two dedicated geriatric medicine wards staffed by geriatric-trained nurses and multi-disciplinary teams. There is a fully functioning day-hospital to support early hospital discharges and facilitate outpatient multidisciplinary assessment. Other outpatient services include the assessment of elderly memory, incontinence, feeding and nutrition, mobility problems and falls. The division maintains close working relationship with psycho-geriatricians in the CGH Psychological Medicine Division.

The unit is also committed to the principle of “geritisation of health services”. This initiative aim to incorporate basic principles of geriatric care and discharge planning into hospital services across multiple disciplines. As part of the integrated framework for care of elderly patients, our division is committed to promote the smooth transition of patients from acute medical care (hospitals) to step-down facilities (community hospital and nursing homes).

In addition to strategies to refine processes, the division also maintains a partnership with St Andrew’s Community Hospital, Lion’s Nursing Home and Grace Lodge Nursing Home to offer professional and training support to staff in these facilities.

TRAINING PROGRAMME

BASIC SPECIALITY TRAINING

• Knowledge of a wide spectrum of conditions and problems in elderly patients.
• An understanding of the atypical presentation of disease in older patients (e.g. immobility, impaired cognition, incontinence and impaired feeding).
• The experience and skills necessary to assess and manage the multiple pathology in frail elderly patients (including functional and social issues).
• An understanding of effective multi-disciplinary teamwork for a holistic approach to patients.
• Familiarity with the various geriatric support services available in the community.
• An understanding of the issues related to health maintenance of older patients in the community.
• An appreciation of the role of the Geriatric Day Hospital in facilitating early discharge, in maintaining elderly patients in the community, and in preventing admissions. These objectives are accomplished through daily ward rounds, grand ward rounds, core lectures, small group tutorials and journal clubs. Visits to various step-down care facilities, community hospitals, nursing homes, day care centers and Senior Citizen Health Care Centers are also encouraged.

ADVANCED SPECIALITY TRAINING

Training objectives for advanced trainees (registrars) are similar to that for medical officers, but are at a higher skill level. Additional components of the advanced training curriculum include:

• Gerontology - particularly medical and social perspectives
• Geriatric Assessment (eg: the various assessment tools/ instruments and their validity) and the place of rehabilitation
• Health promotion and preventative health in the elderly.
• Pharmacology of old age and interventions for polypharmacy.
• Geriatric Syndromes and their related clinical implications
• End of life care
• Bio-ethical and medico-legal issues

Advanced trainees will also be expected to acquire skills for:

• Leading the multidisciplinary team
• Ambulatory (outpatient) Care and the management of older patients in Geriatric Day Hospital
• Management of patients in step-down care facilities, including community hospitals, long term care (e.g. nursing homes), and community support services.
• Collaboration with other disciplines such as psychogeriatrics (e.g. Dementia Care), orthopaedics (orthogeriatrics and falls), urology, rehabilitative medicine, etc.
• Teaching of junior medical staff, medical students, nursing staff and allied health professionals.
• Participation in audit, research and journal reviews.
• Leadership in the planning and development of services.
• Trainees generally have supervised ward based responsibilities during which they will lead ward rounds and multidisciplinary meetings, run their own outpatient clinics, and have patients in Geriatric Day Hospital. Inter-disciplinary consultations (e.g. blue letters) are discussed with Consultants wherever appropriate and guidance is also given for consultative visits to step-down care facilities (e.g. community hospital and nursing homes).

Advanced trainees in geriatric medicine are also expected to maintain an ongoing competence and confidence in acute medicine and are rostered to cover general medicine calls. Specialist Training Committee also requires trainees to spend at least 3 months in a general medicine rotation and one month in medical ICU.

Training in continence management includes continence clinics, urodynamic studies and other continence strategies. Orthopaedics in old age is an emerging collaboration between the geriatric unit and the department of orthopaedic surgery and will receive increasing training emphasis. Registrars are also rotated to related disciplines in rehabilitation medicine, psychogeriatrics, palliative medicine and domicillary care.

Advanced trainees are encouraged to develop a sub-specialty interest while training in the many facets of geriatric medicine.

AREAS OF RESEARCH AND COLLABORATION

There is an active research interest in the unit and at present, studies on dysphagia, thyroid dysfunction, incontinence, stroke and prescribing in the elderly are underway. A number of conference community regard initiatives are also in progress.

WELFARE & FACILITIES FOR JUNIOR DOCTORS
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