OTGV #52 - Eldercare 2

Broadcast Date: 08/03/04

Care for aged relatives.

The state can only do so much.

What the state and society can offer only compliments what the family itself can provide.

Hi, welcome to On the Grapevine with me Chong Ching Liang as I take another look at the issues surrounding eldercare.

At a recent SingHealth-organised national health conference, Minister of State for Health Balaji Sadasivan highlighted the importance of proper disease management.

"The challenges we face are to better prevent chronic diseases, detect such diseases early, prevent complications arising from disease conditions and ensure that every Singaporean has the means to provide integrated, holistic and seamless care. While much of the components and tools are already in place in the clusters, much still remains to be done in terms of developing disease management as a cost-effective and efficient model of delivery of care for patients with multiple medical conditions."

And the elderly are most likely to be the ones with multiple medical conditions.

Yet some elderly Singaporeans are bed-ridden and their family members have given up on taking them to a doctor for proper disease management.

You can't blame the relatives because it's gotten too tough for them both financially and psychologically.

This isn't a problem yet but Singapore, in a decade or more, will see its population of elders double or even tripled.

Head of Geriatric Medicine at the Singapore General Hospital, Carol Goh is looking over her shoulder at the looming problems.

"And they are getting quite scary. We are facing a situation [where] we are not growing as fast as a population but the percentage of elderly is growing extremely fast. And that's the worrying thing because all these elderly will need someone to take care of them."

As the public healthcare system strives to catch up with the demographic curve, relatives must step up to help with the care of the elderly.

The first thing they must do is to get rid of certain myths such as the one that the hospital is the answer to all their prayers.

Head of SGH's orthopaedic surgery Tan Seang Beng.

"When a person comes to hospital, automatically the relatives assume everything will be taken care of because they are at the hospital. But they forget that while the hospitals have increased their advancement in delivery of healthcare but we have gone very much into specialisation. So you may go into oncology ward and so on. So you have very highly trained doctors, very highly trained nurses in that particular field of speciality. So when you say you bring your mother in and automatically all the needs will be taken care of, that may not actually be the case."

The family or the patient can help plug in the gaps in disease management.

Discharging from the hospital means the onus of managing a patient has been passed on to the step-down healthcare institutions, neighbourhood clinics or the family members.

SGH's Senior Consultant in orthopaedic surgery, Wong Meng Koon says the family must be the one in control of the information.

"Every patient that is discharged from the hospital has a discharge summary. There's pretty comprehensive information on investigations and the surgeries and findings. I think you really need to encourage the public how to take ownership of your own information. I don't think it applies to you and our generation but certainly when my grandma goes to see her doctor, she says 'yeah I have some sort of allergies' and she has no idea what that was. So take ownership of your own information."

Greater awareness of what's happening to their aged relatives will help families.

Family members can be the best assistants any doctors of elderly patients can have.

For example, they can observe the effects or side-effects of any medication and pass this information on to the doctors.

Also, don't rush to the hospital all the time as some of the chronic conditions don’t require specialists says Dr Tan Seang Beng.

"Many of these diabetes, high blood pressure, heart disease etc you don't really need to have super-specialists. So by centralising it and partnering with the geriatrician, be it training our doctors and nurses, the level of care and standards is now much better. You don't have to call a cardiologist every time the blood pressure goes up."

It is inconvenient for families to bring their aged relatives to hospitals for follow-ups and home-base care for elderly patients isn't yet available on a large scale in Singapore.

So the family members may have to turn to GPs at the neighbourhood clinics for help.

But Dr Wong points out a stumbling block to GP making house calls.

"But if you go into a very successful business, that guy may not even resuscitate a person that'd just had an accident outside. The fact is that he has other commitment to a whole group of people in his clinic. We really can't make the call whether he did the right or wrong thing. There will be GPs that are hungry for business and they just come down. And once you formed that relationship where you grow old together, he's not going to say no. "

Ultimately, while the families of elderly patients need to have some faith in the doctors, they shouldn't just take their words wholesale.

After all, the attending doctors or specialists observe their patients only in the little ten minute slots each visit.

They are dependent on their elderly patients' relatives for information.

Research, understand, observe and report.

You'll be surprise how much your little involvement can turn up.

This is Chong Ching Liang for Newsradio 938.


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Related Links:

Newsradio 938 (now 938Live)
http://www.938live.sg/

Ministry of Health
http://www.moh.gov.sg/

Tan Tock Seng Hospital
www.ttsh.com.sg

Singapore General Hospital
www.sgh.com.sg

OTGV #51 - Eldercare 1

Broadcast Date: 01/03/04

The Singhealth group of healthcare institutions hopes to serve its aged patients better. Chong Ching Liang finds out why it is doing this now and what the changes involve.

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Everyone talks about Singapore becoming a graying society. Well, in less than thirty years' time, society may simply be white.

It is projected that two out of five Singaporeans will be over 65 years of age.

Hi Welcome to On the Grapevine with me Chong Ching Liang as I take a look at care for the elderly.

Singapore has one of the lowest fertility rates in the world, with a figure of just 1.37 live births per couple. The population isn't producing enough to replace itself.

Coupled with the aging statistics, it is a ticking time bomb.

Dr Carol Goh, Head of Geriatric Medicine at the Singapore General Hospital.

"The diseases that our population is facing are chronic diseases. We have a high incident of strokes and we all lead fairly sedentary lives. So we're all going to be facing a population that is going to have a lot of issues with regards to functional care. So we will have elderly who may be wheel chair bound or at least need help getting around. We are hoping that despite this, we are going to have a society where we support our elderly and promote their care and not have an elderly person left alone with no one to take care of him and no good quality of life."

Many of us already have or will have aged relatives. For superstition's sake or mere complacency, we often try not to think of bad things happening to our loved ones. So we never plan for what'll happen if our aged relatives have a nasty fall or illness that leaves them wheelchair bound.

When this happens, we panic.

There are stories of Singaporeans trying to "dump" their aged relatives onto the hospital system, or nursing homes. S-G-H's Orthopaedic Head, Tan Seang Beng describes an all too common scenario.

"All the things that we take for granted: Go to work and leave the old fogies managing by themselves. But when we have an injury suddenly is now magnified. You want to bring them home but when you find that when you physically have to do it, it is very difficult. So what do they do? They tell me, 'well, we still bring them home' and they manage the best that they can. But honestly, many of the times, most are not well managed. Because if your mother now is unable to walk well and the children or the family may be working, who's going to bring the mother to hospital?"

According to SingHealth statistics, one in three patients seeking orthopaedic treatment such as those for fractures and bone injuries are elderly.

For internal or respiratory medicines, the figure rises to nearly one in two.

And geriatric medicine, the branch of medicine looking after the ailments of the aged is terribly short-handed.

So Dr Carol Goh says it must innovate.

"For geriatrics for example, there are all of thirty in Singapore. And the number of geriatric trained nurses is very few. So if have a system that is dependent on any one specialty doing it all, then it is going to be very difficult. And that is where my orthopaedic surgeons have been most supportive. In the end this is part of what we called geriatrisation of services. You don't have to be only the geriatric trained or specialty services that manage the elderly. We are raising the awareness of the elderly in all specialities."

Singhealth plans to "geriatise" to all its institutions in two years time that is getting them to cater to the elderly. Part of this exercise is a discharge planning programme where aged patients are referred out to a community hospital for convalescence.

Taking them out of the acute-care hospitals like S-G-H, Alexandra or Tan Tock Seng hospitals will reduce their chance of catching nasty infections like pneumonia.

But there's also a social purpose explains Dr Goh.

"A lot of them are the referrals that we have diverted from nursing; this is not to say that a nursing home stay is wrong, but a lot of patients we want to give a chance when they were borderline cases. You know, the families were saying 'I am in a state of shock, my grandma fell down', 'she fractured her hip', 'I can't take care of her' and 'I don't have enough time' then the family will come to us and say, 'well, we want to put her in a nursing home.' And grandma may not want to go to a nursing home. She want to be given a chance to go back home. So they needed time. So for the grey cases especially, for those whose families were wavering, we wanted to send them to a place where they have more time, and more rehabilitation, and give her the chance."

But some of the elderly patients won't recover despite a lengthy stay. So inevitably, they will be discharged home from the community hospital. Ideally the next layer of care would be the neighbourhood doctors or GPs.

They help relatives manage their elderly relatives' chronic illnesses like diabetes or high blood pressure. But Dr Goh highlights some obstacles.

"We face two issues. Number one our GP simply don't have the time to go to patients' house because it takes a lot. But again we hope to expand and working with partners both for SGH patients as well as Ang Mo Kio as a continuum that have access to home medical. Home based service is really important. And working in partnership with Ang Mo Kio because they also have a home medical programme where they actually use a GP."

The day isn't here yet when GPs are willing to step up to this role where they take part in providing home care for the elderly.

Until that day, the public healthcare system has to pick up the slack.

One thing is for sure, if the family of aged patients feel they aren't supported enough to keep their parents home, they won't. And the ones who lose out the most will be the elders.

So this latest initiative by the Singhealth group and the Health Ministry is a breath of spring breeze for those heading into their autumn years.

This is Chong Ching Liang for Newsradio 938.

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Related Links:

Newsradio 938 (now 938Live)
http://www.938live.sg/

Ministry of Health
http://www.moh.gov.sg/

Tan Tock Seng Hospital
www.ttsh.com.sg

Singapore General Hospital
www.sgh.com.sg

Alexandra Hospital
www.alexhosp.com.sg