Thursday, Dec 14th

Last updateWed, 11 Nov 2015 11am

Sunday, 19 March 2017 00:00

Aging Population, Disease Prevention and Rehabilitation

Written by  Lim Wen Xin / KL & Selangor

Professor Dr Nazirah binti Hasnan (1st right), Consultant Rehabilitation Physician-cum-Deputy Clinical Director of Universiti Malaya Medical Centre, shared on “Social Support along the Journey of Rehabilitation”. It was testified by her patient, Yap Kim Soon (on wheelchair) and Tzu Chi volunteers, Connie Teng (2nd right) and Lee Vun Jieh. [Photograph by Chua Teck Ching]

The breakout session on the topic of “Body” on the last day of the 2017 TIMA Conference focused on aging population, disease prevention and rehabilitation.


The session opened with Dr Lee Fatt Soon, Head of Geriatric Services of Hospital Kuala Lumpur, sharing on “Aging Seniors – the Overlooked and Underserved”. Dr Lee is Head of Geriatric Services of Hospital Kuala Lumpur and a lecturer, specializing in the care for the elderly. He highlighted how lonely and helpless the elderly actually are, and reminded the audience on how we have overlooked and underserved this rapidly booming group of aging seniors.

“Stigma,” he pointed out, “is the biggest issue.” External and internal stigma, if mishandled, may lead to depression and worsen the elderly’s situation. Insufficient or unresponsive programmes and consultations that often require long waiting time and complex procedures discourage them from getting proper treatment. The senior citizens also have to be moved between departments due to poor coordination and poorly coordinated appointment times. The supply and demand mismatch in the health insurance market meant that those who are insured (the young and healthy ones) do not need it while those who need it most, that is, the elderly, are not covered. Hence, he stressed the importance of having an “accessible, affordable and culturally acceptable healthcare system” in serving the aging population more effectively.

Dr Lee gently warned the audience that the elderly might show a typical presentation, co-morbidity and confusion of presentation of illness. They might not mean what they said; they might have countless complaints of pains in multiple areas; they might even have a psychiatric illness that looked like a physical one, and vice versa. Instead of being impatient, find out what has exactly gone wrong so we would not overlook the underlying problem. He shared, “Diseases aren’t hard to treat, social and home problems are,” and emphasized that if we were empathic, we could serve the underserved elderly better.

Neglected oral health

The second speaker, Professor Dr Rahimah Abdul Kadir is the Founding Dean of the Faculty of Dentistry at Lincoln University College, Malaysia. Despite the fact that everything that enters one’s body first goes through the mouth, oral health is highly neglected. She used the longevity of the Japanese as an exemplary achievement of taking good care of one’s oral health.

“What happens in the mouth is often what happens to your body.” She explained that since bacteria in the mouth could be transferred to the lungs, oral health and pneumonia are related; and since diabetic patients are more susceptible to bacterial infection, their ability to battle periodontal diseases is reduced.

As an example, she pointed out that nowadays, dentists are trained to always ask patients if they are diabetic before moving on with any dental procedures. Patients are unaware of the relation between the two so they would not bother informing the dentists about it. She shared that no matter how small is the procedure, even something as minor as a tooth extraction, it means an open wound, which involves wound healing, and that is a problem for diabetic patients. If the dentist had operated without the patient being informed, issues that could have been easily overcome would arise and complicate the surgery.

For those who have experienced it, dental issues can be excruciatingly painful. It disrupts regular sleeping patterns, reduces appetite, and affects the enjoyment of dining and the company of others. If left untreated, patients with dental problems may become anti-social and even face depression. This will lead to the patient’s poor quality of life. Current undergoing research is trying to identify possible relationship between dental health and domestic violence. As evidence shows that when the pain becomes unbearable, patients turn aggressive and are easily annoyed.

Oral cancer is ranked between the fifth to the eighth most common cancer in Malaysia. To encourage prevention and early intervention when required, Dr Rahimah showed the audience a video highlighting the importance of checking for oral cancer, as pain is not a good indicator for oral cancer. The video encouraged the public to ensure their upper and lower gums are healthy pink and not bleeding. If there was any prolonged recovery of an open wound in the mouth, consult a dentist. She ended her session with a gentle but firm reminder: “Reduce frequency of sugar intake and remove plague from teeth daily.”

Nutritional concerns for the aging population

The former Director of Allied Health Sciences Division of the Ministry of Health, Dato’ Tan Yoke Hwa aimed to promote healthy aging across the lifespan, and consequently reduce functional decline and risk of both communicable and non-communicable diseases.

Based on the Body Mass Index (BMI), Dato’ Tan explained that it is uncommon for an elderly to stay within the normal range. If they were underweight, be aware of the chances of being malnourished. As the elderly tend to move around and exercise less, it is acceptable for them to be slightly overweight. If they were severely overweight, however, their diet has to be supervised to avoid being obese; sugar, oil and fat intake have to be controlled.

She hinted that protein, carbohydrate and fat provide calories, and encouraged the public to reduce meat consumption. An older person would not eat a lot, so she emphasized the importance of preparing small portions with a higher and better quality nutritional value. For example, instead of having white bread for breakfast, opt for wholemeal hi-fibre bread because it contains more vitamins. Her advice to those in charge of the elderly’s meals was to be creative and innovative; mix colours and varieties of multiple vegetables and fruits so they would not get bored and uninterested.

“If babies can survive only on milk, it means milk itself is a sufficient meal.” Calcium, which comes from dairy and dairy product, is much needed for the aged. One could include milk in daily cooking by pouring some into scramble egg or pasta sauce. However, it should not be cooked on high temperature to prevent the destruction of the vitamins. Thanks to the creation of blenders, liquid meals could be easily prepared for the elderly with dental or chewing issues. Having said that, she echoed the challenge of promoting healthy diet to the elderly, and thus, repeatedly reminded throughout the session, “Enjoy but eat in moderation.”

Early diagnosis and treatment of heart disease – TCM perspective

“Coronary heart disease and stroke are the top killers in Malaysia; in Taiwan, it’s cancer.” Dr Shen Yi-Ying, Chief of Department of Chinese Medicine, Guanshan Tzu Chi General Hospital, Taiwan, revealed in a humorous, yet serious manner, the terrifying truth that the average age of Malaysians suffering a heart attack is 58.5 years, much younger than the world’s average.

Dr Shen attributed the reason to having greasy meals, dining and hence sleeping late, sitting more, and exercising less. In order to treat it, Dr Shen recommended the Meridian system that acts as a connecting and transporting system of the blood vessels.

Early diagnosis can be done through a few visual examinations. She informed the audience, “If the centre of your forehead (the “Yintang”) has a hanging needle pattern, or you have a crease at your earlobe, also known as the Frank’s sign, you might have heart problems. To check the blood circulation of the fingertip, gently squeeze the tip of your finger; the deeper the colour of your fingertip, the more serious is your heart disease. If you feel stiffness at your left shoulder and left chest, and have difficulty breathing, consult a doctor immediately.”

She explained that cupping, bloodletting and acupuncture can all be used to treat heart disease effectively. Cupping and bloodletting help improve blood circulation while acupuncture is used to relieve pain and stiffness around different parts of the arm and chest so patients feel less tired. She concluded by reminding the audience to look out for these visual symptoms of heart disease and get early intervention.

Social support along the journey of rehabilitation

The final speaker for the session was Professor Dr Nazirah binti Hasnan, Consultant Rehabilitation Physician-cum-Deputy Clinical Director of Universiti Malaya Medical Centre. That day, she brought with her, Yap Kim Soon, a patient paralysed from the neck downwards.

“Spinal cord injury is catastrophic and life changing,” affirmed Dr Nazirah. Patients suffer from limited activity, which in turn affects community participation and long-term health. When they cannot move around freely, they stop working or attending school and eventually become anti-social, thus affecting their mental health. “Cure is just around the corner,” she said, “but we don’t know which corner.” Therefore, the job of a physician is to maintain patient’s health so when cure is ready, patients can be cured.

Rehabilitation aims to maintain and improve patients’ medical conditions; prevent, minimize and reverse complications; reduce disability; help patients acquire new skills (essentially reducing the impact of disability); and alter the environment to promote eventual community participation. All these approaches require teamwork; the patient himself or herself is involved with decision-making and goal settings that are regularly reviewed to reflect achievability and reality.

For example, when Kim Soon first came to her, he could not sit up and felt dizzy the moment he was up because he had been lying down on bed for too long. The rehab team first trained him to sit upright because sitting up was important for grooming, toileting and dining. In an effort to make rehab less boring, the rehab team included play, recreational activities, and most importantly, community reintegration programmes in the recovery plan.

Dr Nazirah related that social support groups, such as, Tzu Chi contributed to the success of rehabilitation. As transportation could be a huge problem for patients, Tzu Chi volunteers who help send patients to and from the hospitals for follow-up sessions and other community reintegration programmes are vital. She quoted Sir Ludwig Guttman, the Founder of Spinal Cord Injury and the Paralympic Games, “Spinal paralysis is not the end of life, but the beginning of a new life.”

Yap Kim Soon’s story

Kim Soon was referred to Dr Nazirah through Tzu Chi in 2013, when he was 29 years old. An accident nine years ago left him paralysed, and being bedridden had left him with long-standing pressure ulcers and regular spasticity. The young man was in pain, but because he was paralysed, he could not pinpoint where the pain was. He was poorly equipped and had poor bathing and showering conditions. Although his parents worked at a hawker stall and his grandmother was old and sick, he had, albeit limited, social support. The big-hearted doctor highlighted that the social support received was not poor, but rather challenging, because of the social-economic issues.

A short video of him retelling his story was screened. Kim Soon was originally reluctant and discouraged, but the news on the missing MAS Flight MH370 changed his mind. He said in the interview that “You must seize the present and cherish people around you.” Compared to the passengers on the flight, he at least was alive and kicking. The transformation in him was remarkable: from someone who was entirely bedridden and dependent, he could now sit up, move around on a wheelchair, study and earn a living!

When he was invited to go on stage for a sharing session, the crowd was deeply moved. Even though he was still struggling, he urged himself to: “Try my best to live one day at a time… worrying about the future is a waste of time.” He thanked Dr Nazirah and the rehab team because, “They not only cured my body, but have also given me a new life.” The group motivated him by encouraging him to continue his dream of studying.

Along the path of his recovery, he was deeply discouraged. The Yaps had been going to a family doctor whose clinic was only five minutes away from their place since young. After the incident, they requested the doctor to visit Kim Soon as it was inconvenient for him to leave the house. But, the doctor rejected and instead asked the mother to send him to the clinic. After becoming a Tzu Chi care recipient, a TIMA doctor would regularly drive one hour from Old Klang Road all the way to his place for follow-up. He was extremely grateful, and shared that the TIMA doctor would patiently explain his condition and situation to him so much so that he felt better even without having any medication.

Every morning before they leave for work, Tzu Chi volunteers would move Kim Soon from the bed to the wheelchair so that he could start working. When needed, the volunteers would drive him to and from hospitals for check-ups or collect medicine for him from the hospitals. Volunteers Connie Teng and Lee Vun Jieh informed that they had learnt a lot from Kim Soon. Connie said that he is their teacher; although he is physically-challenged, he could achieve so much and aspire to live life to the fullest, as opposed to other people these days who are physically-able but refuse to do anything. Vun Jieh shared that while helping Kim Soon to relieve the latter’s worries and suffering, he could relieve his own worries and felt happier being able to help another person.

“I owe her a lot,” Kim Soon was thankful and also felt guilty towards his mother. The latter not only has to work, she also has to take care of Kim Soon and his aged grandmother. She would get up at 4 am and sleep at 9 pm every day. On top of that, she would wake up briefly at 1 am to move Kim Soon and to walk his grandmother to the washroom. He hoped that one day he could lessen his mother’s burden, to which the host answered encouragingly that he has managed to do so by working and contributing to society and family’s earnings.

In summation, he voiced his most sincere gratitude to his boss, Thomas, for giving him and other disabled people a chance at work. He also gave a piece of advice to the doctors present, “Don’t be too comfortable, do some volunteer work,” urging them to take some time off to travel to the patients as it would be of immense help to the patients.

“Heal the world, make it a better place, for you and for me and the entire human race…” With that, Kim Soon’s enlightening session came to an end.

 

Lee Fatt Soon, Head of Geriatric Services of Hospital Kuala Lumpur, gave a good insight into issues faced by the elderly people. [Photograph by Lim Su Nguan]   Professor Dr Rahimah Abdul Kadir from Lincoln University College reminded the audience to pay attention to oral health, as it is inter-related with one’s overall health. [Photograph by Lim Su Nguan]

Lee Fatt Soon, Head of Geriatric Services of Hospital Kuala Lumpur, gave a good insight into issues faced by the elderly people. [Photograph by Lim Su Nguan]
 
Professor Dr Rahimah Abdul Kadir from Lincoln University College reminded the audience to pay attention to oral health, as it is inter-related with one’s overall health. [Photograph by Lim Su Nguan]
 
Dato’ Tan Yoke Hwa, former Director of Allied Health Sciences Division of the Ministry of Health, mentioned that the elderly should choose their food wisely to ensure a healthy and balanced diet. [Photograph by Lim Su Nguan]   Dr Shen Yi-Ying, Chief of Department of Chinese Medicine, Guanshan Tzu Chi General Hospital, Taiwan, shared with the audience some visual symptoms of heart disease and its treatment. [Photograph by Chua Teck Ching]

Dato’ Tan Yoke Hwa, former Director of Allied Health Sciences Division of the Ministry of Health, mentioned that the elderly should choose their food wisely to ensure a healthy and balanced diet. [Photograph by Lim Su Nguan]
 
 
Dr Shen Yi-Ying, Chief of Department of Chinese Medicine, Guanshan Tzu Chi General Hospital, Taiwan, shared with the audience some visual symptoms of heart disease and its treatment. [Photograph by Chua Teck Ching]
 
There were open discussions on the topic shared. [Photograph by Lim Su Nguan]  

There were open discussions on the topic shared. [Photograph by Lim Su Nguan]