SINGAPORE \u2013 When the 95-year-old patient who has moderate dementia was discharged from hospital, she became increasingly confused and agitated.<\/p>\n
Her daughters initially thought the change in her behaviour was related to her dementia \u2013 that it had worsened.<\/p>\n
\u201cIt was only during home monitoring by the Community Health Team that it was flagged that she had delirium due to a urinary tract infection (UTI). Before that, we had never heard of delirium. We just thought my mother\u2019s dementia was getting worse,\u201d said her daughter Wong, 68, who declined to give her full name.<\/p>\n
Delirium, a state of sudden confusion and a severe change in mental function that reduces the ability to focus, sustain or shift attention, often gets missed and is frequently mistaken for normal ageing or a worsening of dementia.<\/p>\n
\u201cIt is usually caused by underlying medical conditions, such as drugs, infections, electrolyte imbalances, constipation and UTI,\u201d said geriatrician Lim Jun Pei from Tan Tock Seng Hospital (TTSH).<\/p>\n
\u201cIt leads to adverse outcomes. Some of the patients would even describe it as a post-traumatic stress experience when they remember the episode they went through. There was a loss of dignity, well-being, independence, as well as pain and suffering,\u201d she added.<\/p>\n
To lessen the burden and strengthen delirium care in the community, Lim and her team developed a new pathway within TTSH@Home, TTSH\u2019s alternative hospital service that delivers inpatient-level medical care directly to a patient\u2019s home, enabling suitable patients to receive hospital-level care safely at home.<\/p>\n
It is supported by specialist oversight and home-based clinical support from a team of nurses, who also provide caregiver education that includes different phrases to help caregivers remember information.<\/p>\n
This pathway was implemented after the team visited the National Health Service of Greater Manchester in Britain, where they observed its community delirium programme demonstrating how suitable patients could be managed safely outside the hospital, between February and March 2025.<\/p>\n The team that helped Wong (centre) manage her elderly mother\u2019s delirium: (from left) geriatrician Lim Jun Pei, senior staff nurse Annie Ling, senior nurse clinician Joey Yeo and geriatrician Bao Minfang.<\/p>\n ST PHOTO: GIN TAY<\/p>\n<\/figcaption><\/figure>\n Lim said a study by the team at TTSH found that more than one in 10 patients (11 per cent) aged 65 and above experienced delirium while admitted to hospital for surgery, and this risk was three times higher in people with dementia.<\/p>\n A separate study in Britain found that about three in 10 patients (31 per cent) who experienced delirium developed dementia within five years of the onset of delirium.<\/p>\n Both studies, she said, demonstrated the need for timely intervention to address the underlying causes.<\/p>\n Lim added that the early results of the new pathway to recognise and manage delirium early within TTSH@Home \u201chave been encouraging\u201d.<\/p>\n The data from June to December 2025 found that three in 10 elderly patients (28.4 per cent) aged 85 and above who were cared for under the programme had a diagnosis of delirium.<\/p>\n Lim said that while they generally needed 1.25 more days of care on average, the rate of returning to hospital remained similarly low.<\/p>\n While there is no specific national figure for the total annual healthcare cost attributed only to delirium in Singapore, in the United States, it is higher than the costs of many other conditions common in the elderly.<\/p>\n The estimated annual national healthcare cost burden of delirium in the US is US$152 billion (S$194 billion), second only to cardiovascular disease, at US$258 billion, and higher than that of diabetes, at US$92 billion.<\/p>\n Beyond supporting patients at home, TTSH has also trained more than 130 people across 23 community partner organisations, including nursing homes, in delirium and dementia awareness.<\/p>\n Senior staff nurse Annie Ling teaching Wong how to use the word \u201cevade\u201d as a mnemonic to recognise signs of delirium in her elderly mother.<\/p>\n ST PHOTO: GIN TAY<\/p>\n<\/figcaption><\/figure>\n Lim said apart from medical factors, environmental factors can also contribute to delirium.<\/p>\n \u201cFor some patients, familiar home surroundings, supported by trained caregivers and structured clinical oversight, may help (them) remain calmer and more engaged in recovery,\u201d she said.<\/p>\n For Wong, the home-based care for her elderly mother \u201cmade a world of difference\u201d.<\/p>\n The coaching from the TTSH@Home nurses taught Wong to distinguish between delirium and dementia, and she now has the confidence to work with her domestic helpers to care for her mother.<\/p>\n \u201cLearning to recognise the signs gave me the confidence to support her recovery at home. The helper now takes the initiative to record her blood pressure, temperature and oxygen levels regularly,\u201d she said, adding that she is glad her mother has almost returned to her normal activities such as playing games like Swat The Fly.<\/p>\n<\/picture><\/div>
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