Death and dying, life and living in long-term care facilities in Singapore

Building a dignified system where Singaporeans can choose how we want to live and how we want to say goodbye

The loss of freedom, dignity and respect in places with 11 to 25 bedded wards, lacking in privacy, with staff being paid SGD$350 a month without food and accommodation were reported in a Channel NewsAsia program known as Talking Point. In addition, it was also mentioned by author and research Ms Radha Basu one staff member can be observed responsible for 20 to 32 residents in the night, and residents live with bare necessities such as a toothbrush, bed and a cabinet. The lifestyle was found to be highly regimented with the journalist sharing that there are were only 2 options for times for showers at 6 am or 7 am.  “it was like a hospital for the rest of your life” stated television host Anita Kapoor. She also states that “it’s not a criticism of the facilities themselves, it’s a criticism of the system. You cannot approach eldercare the way you approach hospital visits. It can’t just be a means to an end need. It is a life. You have to think in terms of life and end of life.”

I was really exhausted by the environment  

– television host, Anita Kapoor, 45 years of age.

I applaud Ms Kapoor for taking a stand and putting herself in the resident’s place, experiencing the environment literally for a fortnight first hand, living as residents lived.

Like my previous article about Singapore nursing homes, our story of the wooden bowl? I questioned how we want to care for our older adults, our parents, our grandparents, given the state of the nursing homes in Singapore. How do we care for our loved ones in Singapore with dementia without dementia enabling built environments?

My thoughts have constantly been being echoed in this programme. Pushing for better environments for people with dementia. I dare to say that I can dream for a day when Singapore will be able to have facilities that advocate for independence, dignity and respect for residents. Seeing an assisted living facility in the heart of Bukit Timah, it’s heartwarming and inspiring to see the St Bernadette Lifestyle village, assisted living facility that is just like a home.

It is with a flicker of hope that one day we can have facilities like intergenerational nursing homes inspired from our HDB designs (Taking a leaf from HDB flats for Pocket Gardens & Intergenerational Nursing Homes) which we call home.

In the meantime, I will keep working on a dementia enabling environmental audit tool for Singapore in the hope that we will be able to create dementia enabling long-term care facilities that Singaporeans can call home.

Watch the full episode here http://video.toggle.sg/en/series/talking-point-2016/ep24/458260

Probiotics and Alzheimer’s Disease

Good news for a lot of us in Asia whose probiotics drinking habits may be a daily run of the mill affair. From a young age, my parents would bottle me up with a small bottle of Yakult or Vitagen. These days if you walk into any 7-Eleven in Singapore, Korea, Japan or Taiwan you should be able to find a yoghurt drink rich with probiotics or just a probiotic supplement. Most of us in Asia would at least have heard of Lactobacillus acidophilus from our Yakult ads on television growing up.

New research published in the renown journal, Frontiers in Aging Neuroscience have shown that our daily dose of probiotics may have a positive impact on cognition. More research has to be carried out of course given this study is relatively new. The research, a randomised, double-blind controlled study conducted with 60 people living with dementia within a 12 week period. According to the study the participants consumed 200ml of probiotic milk daily containing Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum, and Lactobacillus fermentum.

Below is an infographic from the Internation Association for Probiotics and Prebiotics.

Looks like our recommended daily dose of probiotics may be doing us more good after all.

Reference:

Elmira Akbari, Zatollah Asemi, Reza Daneshvar Kakhaki, Fereshteh Bahmani, Ebrahim Kouchaki, Omid Reza Tamtaji, Gholam Ali Hamidi, Mahmoud Salami. Effect of Probiotic Supplementation on Cognitive Function and Metabolic Status in Alzheimer’s Disease: A Randomized, Double-Blind and Controlled Trial. Frontiers in Aging Neuroscience, 2016; 8 DOI: 10.3389/fnagi.2016.00256

http://journal.frontiersin.org/article/10.3389/fnagi.2016.00256/pdf

Poem: Do not ask me to remember

do-not-ask-me-to-remember

Brain Health is the new Heart Health

A great video that touches on the importance of brain health and how it’s really the new heart health of today.

The video also provides some tips on improving brain health such as

  • Sleep
  • Reduce Stress and Anxiety
  • Improve Diet and Nutrition
  • Improve Physical Exercise
  • Improve Cognitive Exercise

brain-health

 

People with Dementia cope worse in Hospitals, so why are our nursing homes in Asia designed to look like hospitals?

Hospital2.pngBelow is a great a great piece by Prof June Andrews republished free, online or in print, under Creative Commons licence.

 

Why hospitals are dangerous for people with dementia – and why it’s up to families to help

June Andrews, University of Stirling

People with dementia go into emergency hospitals more often than the rest of the population even though these hospitals are run as if every patient has perfect intellectual function. An acute hospital is like a meat grinder for people with dementia – it chews them up and spits them out – so it is worth both avoiding admission in the first place, and learning how to support someone if admission is really necessary.

Your local hospital might be prepared to welcome people with dementia but you can’t be sure. Its management would be wise to do so, as up to 50% of patients, on top of their illness or injury, may be elderly and frail and affected by either dementia or delirium. Delirium is a reversible state of confusion caused by stress and infection. If staff work to reduce delirium, it almost certainly also helps reduce problems associated with dementia.

Slippery slope

How we regard hospitals has developed over time. What was a costly amenity for our great-grandparents is now understood as a regular service. A building that was once viewed with dread because so many people died there is now seen as a desirable place to get treated. People battle against local hospital closures. They attend accident and emergency (A&E) in preference to going to see the GP, as if the hospital was superior.

But if old people with dementia can stay out of hospital, it’s much better. Of course, some things can’t be managed outside a hospital but for many, getting admitted is the top of a slippery slope. They may have been managing perfectly well at home, but during their hospital stay things happen that mean they never go home again.

Dementia patients are twice as likely to suffer preventable complications such as pressure ulcers and pneumonia in hospital. Patients with dementia and a fractured hip tend not to be given as much pain relief as other patients with fractured hip. Uncontrolled pain in dementia gives rise to delirium that is often undiagnosed and untreated in hospitals. As a result, half of these patients who develop delirium die in six months.

Patients with dementia may get missed by accident at mealtimes and have problems eating and drinking which are made worse in hospital. Some hospitals provide guidance but bad stories are more common.

Coping worse in hospital

Research shows that if you have dementia you will stay in hospital longer than other people with the same clinical problem. People frequently say that after admission it was discovered that they had not been coping at home. But in fact, it may be the opposite. A person who does not get enough to eat in hospital may have been eating adequately at home. The person coping on their own with washing and going to the toilet in a familiar home environment may not be able to negotiate the confusion of the ward and start to wet themselves and be unable to keep themselves clean.

Someone who managed to be happy and live quietly at home, sleeping at night and entertaining themselves by day, will be kept awake by noise and light at night, and bored rigid in the daytime, never even seeing daylight. Getting the lighting right can prevent major dementia symptoms such as mood swings, sleep problems, and behavioural issues.

Then when they become noisy and irritable they may be given dangerous anti-psychotic medication in the first instance to quieten them down. It is not unusual after this to have a fall or a fracture, causing a longer period in hospital during which patients can then develop depression and delirium, leading to early death.

This is a terrible human story. And it’s terrible financially too. Staying longer in hospital than others with the same condition makes for a greater tax burden and causes waiting lists. Social services are under pressure now to find care home places for people, when what they had before was a semi-independent person who mainly looked after themselves with a bit of home care. The family, if there is one, and the estate of the person now face the probability of having their assets stripped to pay for a situation that may have been avoidable or at least delayed for months and years.

Families can do more

Logically families should take more responsibility for care of elderly relatives while in a hospital. Be there to help them eat, and to help them with washing, keeping them company and making sure that they swallow their medication.

But hospital staff resist it. For political reasons the NHS has difficulty accepting a situation like this for fear of accusations that the system is failing. Just recommending help from families has in the past been misrepresented in the media or by politicians as an attack on the NHS.

This is because we have been led to believe an unreal fantasy of what hospitals can do. Recommending that families help is not a criticism but a practical response. If families support the frail person in hospital, it helps the nurses, reduces delayed discharges, saves money and maintains the dignity of the patient. Everyone wins. We must all do it out of enlightened self-interest to allow the system to focus on patients who have no-one and nothing.

The alternative is that we assume hospitals can do everything we expect for an ageing and increasingly frail patient group. That in itself is enough to lead to system failure, because we ask too much of them.

The Conversation

June Andrews, Professor of Dementia Studies, University of Stirling

This article was originally published on The Conversation. Read the original article.

June Andrews: A Revolution for Dementia Treatment

Prof June Andrews argues for a revolution in the approach to dealing with dementia.

I always learn something new when I listen to Prof June Andrews. The first time I saw Prof Andrews was at a dementia care conference in 2012. I sat in for one of the sessions as part of the conference and was blown away by the simple, logical and straight up manner in which she talked about dementia.

Like seriously, how many talks have you gone for or conferences that clinicians have thrown at you bombastic latin sounding terminology that sounds kind of confusing or cool but seriously you walk out of the talk feeling like you think you might have learnt something that you paid money for but … not really? Or drone on for ages about their research methods when really they know we are all here for the outcome and really their findings. We trust that you know your methodology, now tell us what the evidence is.

If you could spare a couple of minutes listen to Prof Andrews get straight to the issue at hand as she talks about revolutionising treatment for dementia.

Source: BBC Radio 4 – Four Thought, Series 3, June Andrews: A Revolution for Dementia Treatment

 

Travelling with your loved one with dementia

travel