BEYOND DENTISTRY AND STOPPING DEMENTIA

August seems to be a popular month for seminars. I attended three, and had to skip two as they clashed with other commitments. Some of the information I picked up from each of these seminars is of relevance to seniors. I am sharing these slides and images below in the hope that our blog readers will benefit from the information given by the distinguished speakers.

Sat 15 August - Seminar on "Beyond Dentistry: More Than Teeth" presented by Channel News Asia and Specialist Dental Group of Singapore

Who would want to pay S$10 and spend Saturday afternoon listening to a group of dental and medical specialists talk about tooth decay, gum disease, etcetera? The answer: 500 people! Dental talks can be most boring, but the six specialists certainly knew how to inform, impress and entertain the audience with their lively presentation of the latest advances in dental care. 

A packed ballroom at the dental seminar. (Image from Specialist Dental Group blog)

While every one of the six speakers had good advice to offer on how to maintain dental health and ensure our teeth last a lifetime, the talk that resonated most with me as a senior citizen was 'Better Teeth, Better Years' delivered by prosthodontist Dr Neo Tee Khin. 

Remember how we dreaded going to the dentist during our childhood days in the 1950s and 60s? Qualified dentists were a rare breed then, especially in the small towns. Those we had were men in white who had learned their trade from other men in white before them through a period of apprenticeship. The fastest remedy for a persistent toothache in those days was an immediate extraction. That's how many ended up losing good teeth and having them replaced with ill-fitting dentures.

Thank goodness dentistry today has gone far beyond those dark days of terror in the dentist's chair. Dentists, like doctors, are sworn to save our teeth. Extraction is always the last resort. If you have a choice and if you can afford it, go for implants rather than dentures. They fit better, function and look like natural teeth, and last a lifetime if you practise dental hygiene diligently.

The speakers. Very impressive qualifications and credentials.  Click here for their biodata. 

Poor dental hygiene can lead to health problems like diabetes, hypertension, heart disease/stroke, lung infections, stomach ulcers, cancer and even erectile dysfunction. To maintain strong teeth and healthy gums, visit your dentist every six months, brush your teeth twice a day (also after meals if you can), and FLOSS, FLOSS, FLOSS!

For more about each of the talks and the speakers, click here.

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Thurs 13 August - Symposium on "Ageing in Malaysia: From Molecules to Community" organized jointly by Universiti Kebangsaan Malaysia (UKM), Universiti Teknologi Mara (UiTM) and Universiti Putra Malaysia (UPM)

Sat 22 August - Seminar on "The Rising Tide - Dementia - Can we stop it?" organized by the Gerontological Society, Singapore

Both seminars focused on dementia and shared similar findings from the research studies done although the racial demographics differed. Some images of slides taken from the talks:

Both Malaysia and Singapore will have an ageing population by 2050. This will see a rise in the number of people with dementia. 

As the population ages, we are seeing a dramatic rise in cases of dementia among the elderly. What are the signs of dementia? Is it preventable? Curable? Inheritable? How can caregivers deal with the stress of looking after a dementia patient 24/7? What are the costs involved in dementia care? These were some of the questions that the three speakers addressed.

A/Prof Dr Rathi Mahendran reported on the Jurong Ageing Study (JAS), conducted to find out how interventions of mindfulness, art, tai chi and music reminiscence can help the elderly with mental health problems. Click here to view a video of Prof Kua Ee Heok taking about the study.

Pay heed to the risk factors. 

Immediate Past President of the Gerontological Society of Singapore, A/Prof Goh Lee Gan shared on the Dementia Prevention Program. He called for volunteers to be trained to assist with conducting the program. Click here to view related video of Prof Kua Ee Heok explaining the program.

A briefing session for volunteers on the components of the program. Interested? Please contact Ms Chan Hui Yu at chan_hui_yu@nuhs.edu.sg

The Health component of the program in detail

The same advice for both Malaysians and Singaporeans on how to reduce the risks of getting dementia

With Prof Kua Ee Heok. We hail from the same hometown of Batu Pahat, and share a common interest in dementia. An Oxford-Harvard graduate in psychiatry, Prof Kua has written many books on the subject and is a much sought after speaker on ageing and mental health issues. 

HOGEWEY - A PLACE LIKE HOME FOR THOSE WITH DEMENTIA

Thanks to an unexpected birthday gift of a return air ticket to Amsterdam, I had the opportunity to visit Hogewey Village. It has been on my wish list since I first read about the place two years ago, and watched CNN's Dr Sanjay Gupta's insightful documentary 'Dementia Village'. Now I can happily strike Hogewey off my wish list.

The prime mover behind this innovative concept is co-founder and former nurse Yvonne van Amerongen. I had emailed her earlier requesting permission to visit the facility with Marianne Abbink Lankhorst, my Dutch friend. She wrote back to say we were both welcomed to visit anytime. Excellent!

So there we were at Hogewey on a warm Thursday afternoon of 29 July 2015. Visitors enter and exit via the sliding door which is controlled by the receptionist. The door remains closed to the residents. They are not allowed out of the facility on their own.

We were given a map showing the layout of the place, and several information sheets about Hogewey. We had the freedom to move around and explore but were reminded to respect the privacy of the residents. In other words, no peering into their living quarters or taking their photos without their permission. But we were welcome to use the information and images provided on the Vivium website.

Front view of Hogewey

The homes and the courtyards. So much greenery and flowering shrubs, and benches everywhere.

The Indonesian lifestyle corner. Indonesia was once a Dutch colony.

As we had no access to the homes, this composite image is taken from internet sources. It gives you an idea of the different lifestyle settings. Residents are housed in groups according to the lifestyle they are familiar with. 

Hogewey is the world's first village built specifically for people in the advanced stage of dementia. The concept for it is based on the belief that dementia patients can still enjoy a relatively normal life if they live together with like-minded people in an environment that is familiar to them.

Residents share a common dining room and living room (Images: Daily Mail)

There are currently 152 residents at Hogewey, with six to seven housed in each of the 23 homes. grouped into seven distinct lifestyle settings: urban, homely, cultural, traditional, Gooi (well-to-do), Indonesian and Christian. Residents have their own bedrooms but share a common living room, dining room and kitchen. Each home has one or two staff to look after the residents and do the cooking.

Another view of the homes. 

The staff at Hogewey outnumber the residents 4:1. You will see them as housekeepers, shop assistants and minders, but you won't find them in staff uniform. Volunteers are identified by a nondescript badge they wear. Hogewey takes great pains to avoid any resemblance to a hospital or a nursing home. Instead, it strives to make Hogewey as close as possible to a small gated neighbourhood complete with its own supermarket, cafe, restaurant, beauty salon and theatre. There is a large central square and smaller ones or courtyards with benches and chairs where residents can sit and soak in the sunshine, weather permitting.

(When we were there, there was intermittent rain. That explains why you don't see any residents outdoors in the photos.)

Join me as I take you on a tour of Hogewey.

The main boulevard, with shops flanking both sides.

The cafe is the first outlet you see on your left as you walk along the boulevard.

This is probably where the residents go to work their muscles and limbs.

There's even a repair shop in case anything needs fixing.

Inside the beauty salon. We didn't get to enter so this image is taken from the Daily Mail.

This is The Passage - a spacious hall where the residents gather to enjoy group activities. There is always music playing in the background as the elderly love music from the old days. Expect to see some of them dancing too. We did.

That's Marianne at the door of the Rembrandt Room. This is where the residents enjoy art and craft activities.

The supermarket at Hogewey is well-stocked. Every item carries a price tag. The cashier issues a receipt for purchases but no cash changes hands. All transactions are covered in the residents' payment scheme.

There are no locks anywhere. Doors and elevators open and close as you step on the weight-sensitive floor panel. Residents have the freedom to move around and participate in the daily programme of activities if they wish to. The objective is to make life in Hogewey as normal as possible, and as close to what they are accustomed to.

No need to press any button or turn any door knob. Doors open when you step on the floor panel in front of it.

According to Yvonne in the CNN interview, the concept works. Residents do not need as much medication, they seem happier and are living longer. The Hogewey model has been replicated in Canada, Switzerland and the UK, and that's evidence of its success, aside from the awards it has won since 2010. Apparently those on the waiting list have to wait at least a year before there is a vacancy. That only happens when a resident has passed on. Hogewey is where those with severe dementia come to live out their remaining years in peace and with dignity.



The residents I met while strolling around Hogewey gave me friendly smiles and nods. Except for one resident in a wheelchair cuddling a doll, visitors would not know that the elderly folk enjoying activities in The Passage have Alzheimer's. A group was happily playing a board game, another was setting up pins for bowling.

To the outsider, Hogewey is a microcosm of a make-believe world. But to the residents, it is a reality that is a continuation of life as they know it, in a setting that they are familiar with.

Programme of activities in Dutch, of course.

The burning question readers might want to ask is: How much are the fees? Around USD3600 per resident per month. It's heavily subsidized by the Dutch government, otherwise it would cost upwards from USD8000 a month. At such figures, only the super rich with dementia in Malaysia and Singapore can afford to live out their final days in this utopia.

OPPORTUNITIES TO SUPPLEMENT YOUR PENSION

For many of us retirees, tightening our belts has become part and parcel of daily living. We think twice before purchasing non-essential items. Even when shopping for necessities, we have taken to comparing prices first before making a decision. Getting value for money is our shopping credo now.

It's not that we can't afford to spend, but with the implementation of GST, the weakening ringgit, and the escalating rise in the cost of living, we have to keep a careful eye on our spending. Unless we have shares that pay decent dividends, or own a small business that generates some income, we are depleting our savings as we spend. How long will our retirement funds last? Will our nest egg be sufficient to see us through the next 20 years? All it takes is just one major health crisis or a financial setback to wipe out a big chunk of our savings.

Falling back on our children for financial support is no longer an option. They have their own family and financial commitments to take care of. Consider ourselves fortunate if they don't seek support from us!

Award-winning occupational therapist Lim Hwee Er is founder of Goshen Consultancy Services

So this leaves us with no choice but to work for as long as we are able, or invest wisely to generate some extra income for rainy days and old age.

I'll leave the financial experts to advise on investments. With age working against us in the employment market, the most feasible option is probably to start a small home-based business. Below are some suggestions that require minimal start-up capital, and virtually no overheads to worry about if you operate from your home. What you must have are determination, resilience and commitment to deliver your best.

If you live in a residential neighbourhood e.g. Taman Megah, or in a condo complex e.g. Mont Kiara, you already have a pool of potential customers for the following services:

Home Tutoring and Classes

• Home tuition - especially recommended for retired teachers. So convenient for parents looking for an experienced home tutor to coach their children in English/Bahasa, Maths and Music. There is also demand to teach Conversational English to expat wives and other adults who have a desire to improve their English.
• Cooking classes - easy enough to conduct cooking or baking classes in your home. Or rent a multi-purpose function room in your condo block to conduct your classes.
• Computer classes - you will be surprised how many seniors are eager to learn how to use the internet and social media. You can conduct classes for interested seniors. They bring their own laptops or tablets. 

Consider teaching seniors how to use social media either on a personal tutor basis or in a class.

Personalized services

Home Physiotherapy (Image: AsiaOne.com)

• Physiotherapy, massage, pedicure, manicure, facials, etc. Make use of your experience in these fields. If you don't have the experience but have an interest to learn, go get the training required.
• One of my friends conducts swim classes for seniors in their condo pool. They can choose to have one-to-one instruction, or in a group of three. 
• Confinement ladies are earning very good money, often commanding RM8000 and above for their services for just one month of post-delivery cooking and caring for the newborn baby. In Singapore, the going rate can be as high as SGD3000!

Confinement ladies can make good money especially in Singapore (Image from The Ant Daily)

Small home-based businesses

Just as there ia a huge demand for services targeting parents with little children e.g. home child-minding, daycare centres, tuition centres, there is an even greater and more urgent demand to provide similar services for the elderly.

Start small within your condo or neighbourhood community. If you satisfy your customers, they will promote your services by word of mouth. Maintain quality control and prompt service, and you can be assured of a viable business that will contribute towards your nest egg. I know of friends who are doing splendidly operating from their home kitchen, taking orders for cakes, jams and roasted nuts.

With global ageing comes a wide and varied range of services that cater to the needs of the elderly. Opportunities are excellent for those interested in targeting this niche market:

• Daycare centres for the elderly, There is a HUGE demand for such a service. Statistics are not available, but the number of elderly parents left alone at home is on the rise. Adult children with elderly parents would welcome such centres. Start small by taking in not more than five elderly who required minimal assistance with feeding and mobility.
• Meal delivery to the elderly. The elderly have special dietary needs. Meal delivery would appeal to them, especially to those who find it a hassle to cook.
• Transport-on-call. Provides an essential service for the elderly living alone who need to see the doctor or do grocery shopping. The service comes with extras, like keeping the elderly company at the hospital, or helping with the groceries.

Meal delivery at your door-step for senior citizens (Image: Internet)

If you are seeking paper qualifications or skills training for any of the above, check out what courses are offered at baking schools, IT centres, Centres for Continuing Education at local universities. MCA Wanita as well as Women's Institute of Malaysia (WIM) regularly conduct courses to equip women with skills to enable them to earn an income.

There are also free online courses that you can sign up for. All it takes is just a Google search to find out what's available, where, and when.

A baking class in session at MCA Wanita's training course for confinement nannies (Image from MCA website)

As long as you have the drive and the determination to succeed, you are never too old for an encore career, or be your own boss. Not only does working keep you mentally, physically and socially active, it helps to supplement your retirement funds. The key is to find a vocation or a business that drives you. Then it is no longer work but a passion.

SHALL WE SEND MOM TO A PRIVATE HOSPITAL OR A GOVT HOSPITAL?

When an elderly parent has a bad fall and requires immediate medical attention, what do you do?

Call for an ambulance.

"Which hospital to send her?"

You have little time to think of comparative costs, hospital's reputation, doctors on your contact list. etcetera. There is even less time to consult family members.

So if you have an elderly parent living with you, it's advisable to do some homework and be prepared in the event she has to be admitted to the hospital immediately. Here are some factors that will help you decide where to send her, namely;

• costs - how much can you pay? What's your max?
• location - is the hospital close enough for daily visits?
• reputation - what have you heard about the medical expertise and nursing care?
• services - how efficient and integrated are the services?
• facilities - do the facilities meet your expectations of comfort, care and convenience?

Still applicable by and large for public hospitals, but for private hospitals, the fees have skyrocketed. (Sourced from Astro Awani)

Surgery and hospital stay at a private hospital can swallow up a sizable portion of your retirement savings. If your elderly parents are in their 80s and 90s, they probably have no medical insurance. If you can afford it, or if your siblings are prepared to share the hefty bill, then by all means, opt for a private hospital.

Otherwise, go with a government hospital. Whether they work in a private hospital or a government one, all medical doctors are commited to the Hippocratic Oath to treat, mend and heal patients entrusted to their care. Even in teaching hospitals, senior surgeons and professors are there to supervise and step in when the situation calls for their intervention. So there is really no need for concern in this aspect.

The modern version still maintains the essence of the original

If there is any difference, it is arguably in the quality of nursing care. Private hospital nurses are at your beck and call. They cater to your every need or demand. They have better bedside manners, are more gentle and patient, and make an attempt to get to know you as an individual. But it will cost you. Nothing is complimentary. Every service or item, no matter how small, is chargeable.

Contrast that with the nurses in government hospitals, or at least in the one where my mom was admitted. The nurses behaved as if they were doing my mom a favour rather than providing a service. A couple of times my mom was busy with visitors and missed the diaper change when the nurses made their rounds. She had to wait till the next round which was hours away. When I asked for her diaper to be changed, the nurses showed their annoyance. On one occasion when I approached the nurse to change the bedsheet as my mom had wet it, she handed me a fresh bedsheet, expecting me to do it all by myself!

These are 2009 prices. Expect to pay much more now with GST. See below for current fees.

Government hospitals are heavily subsidized, so charges are a whole lot lower. For comparison, in March 2011, when my mom was discharged after 15 days in a private hospital for hip surgery and angioplasty, the bill came to a whopping RM45,532.90. This excludes the charges for rehabilitation and medicine. The itemised bill came to several pages!

Compare this with the costs incurred for my mom's recent 9-day stay in the orthopedic ward of a government teaching hospital. Irrespective of room-type, patients were charged RM70 a day. This covered breakfast, lunch, tea-time and dinner. You could select your meal from the daily menu. X-rays cost RM85 each, physiotherapy sessions RM20 each and doctor's (intern) consultation was Rm15. Add RM2120 for the PFNA device, and another couple of hundred for diapers, medicine, rubber gloves and other essential items, the grand total came to just under RM5000.

An amendment to the 13th Schedule of the Private Healthcare Facilities and Services Act 1998 passed in Dec 2013 allows doctors in private clinics and hospitals to raise their fees. But as the official receipt above shows, some specialists can charge as much as RM340 or more for consultation and medicine.

The majority of middle income wage earners can't afford the high cost of sending a loved one to a private hospital. They will have to opt for a public hospital and bear with the less than satisfactory nursing care, basic facilities, and long queues for consultation and for medicine.

(On a separate note, if you are unable to stay in the hospital ward with your loved one for the entire period, you can hire the services of a part-time nurse. Charges are RM12 an hour at the hospital, and RM15 an hour for home care. The minimum is 12 hours to make it worth their while.)

Some conclusions:

• Invest in medical insurance for yourself and your family if you haven't done so yet. Pensioners and their spouse enjoy free medical treatment and hospitalization, or pay only a nominal fee.
• When you do your retirement planning, remember to factor in medical expenses for your elderly parents. Most financial planners don't mention this crucial allocation.
• How much you can afford to pay is more important than showing how filial you are. Filial piety is not measured in monetary terms. Your mom will recover from hip surgery whether it is done in a private hospital or a government hospital.
• Find out what you have to do to prevent falls in the elderly. My mom fell not once but several times, including two falls that required surgery and hospitalization. The first time she slipped and fell outside the bathroom. The second time she fell from her bed. Just bear in mind that despite the closest supervision and best preventive measures, accidents can and do happen. We can only reduce the risks.
• Take care of your health. Keep fit. Eat sensibly. No awareness campaign is as powerful as the harsh reality of seeing patients in ICU with tubes inserted in their body after heart surgery. Equally heartbreaking is to hear the cries and moans of the patients in the orthopedic ward after amputation. An elderly patient in the room next to my mom's lost both legs and an arm because of diabetes. The government's anti-smoking campaign requiring all cigarette packs to carry images of lung cancer has met with limited success. To quit, smokers need to face harsh reality, not 2D images, campaigns or exhortations.

For a list of private hospitals, click on this link: http://new.medicine.com.my/private/hospitals/

For a list of government hospitals, click on this link: http://new.medicine.com.my/government/hospitals/

OH NO! MOM FELL - AGAIN...

Mom before she was
admitted to UMMC

The call came early on Saturday 20 June, at 7.27am to be precise. "Mom fell and fractured her left leg." Oh no, not again! The last time I received a similar call was in March 2011 when she slipped and fell at home. She broke her hip then, and had major surgery followed by months of rehabilitation. It was a traumatic experience both for her and for me as her primary caregiver. I had prayed that we would never have to go through the painful ordeal again. ("Mom Fell And Broke Her Right Hip")

Alas, with that phone call from my brother, it was deja vu all over again.

I cancelled all my appointments in Singapore for the following week, and took the earliest available flight back to Kuala Lumpur. It was straight from KLIA2 to UMMC (Universiti Malaya Medical Centre) with my luggage and all.

Before surgery - Mom's left leg all wrapped up and weighted down to keep it straight and raised. Even so, she was able to kick away the pillow and roll over on her left side. Surely that must have hurt?

The PFNA Asia (also known as PFNA II)

Mom had been rushed to emergency at UMMC, and subsequently admitted to the orthopedic ward. X-rays showed she had sustained a fracture to the femur near the hip joint. She had fallen from her bed to the floor in the nursing home. Due to her age (mom is 89), that minor fall was enough to cause a fracture. The doctors said she would require surgery, and gave me a number to contact to order (and pay in advance) a device called 'proximal femoral nail antirotation' or PFNA.

Surgery was scheduled for the afternoon of Monday 22 June. Unfortunately, just before she was wheeled into the operating theatre (OT) final tests showed her blood pressure was way too high to risk going ahead with the surgery. The doctors decided to postpone it to the morning of Wednesday 24 June.

During the intervening days, the nurses administered medicine to lower mom's BP to an acceptable level for surgery to proceed on Wednesday. When mom was wheeled out hours later from the OT, her eyes were wide open and she was alert. I noticed she wasn't on a drip. The instant she saw me, she called my name and insisted I accompany her back to the ward.

The surgery was a success. Post-surgery, however, was an entirely different story.

The two incisions where the PFNA device was inserted.

Caring for an elderly with dementia is vastly different from caring for one without. Dementia patients especially those recovering from surgery require supervision 24/7. My mom has dementia and this complicated matters tremendously. Her inability to understand and remember instructions made her most uncooperative to the point of being unintentionally rebellious. She couldn't fathom the need to have tubes, needles and bandages on her body, and was in the habit of removing them repeatedly, much to the frustration of the nurses and doctors. 

She kept demanding help to get up and use the toilet. When reminded that she had diapers on, she insisted she didn't want to soil her pants. This was what upset her most - the loss of dignity and privacy at having to rely on others to change her diapers. She would scream, curse and swear at anyone, including the nurses, who didn't give in to her demands. 

Before surgery (left) and after (right)

She couldn't recall that she had just had lunch or dinner, and demanded to be fed again. It was a challenge watching over her 24/7 to make sure she didn't try and get up, or remove the bandages/plasters/diapers. I had to resort to the services of a private nurse to relieve me on three occasions so I could get some rest. I was also lucky to have my sister-in-law come by on Saturday 27 June, so I could attend a workshop on 'Essentials of Dementia Care' organized by Alzheimer's Disease Foundation Malaysia (ADFM).

On Sunday 28 June at 4pm, Mom was discharged from UMMC. That day was also my birthday. Indeed it was the second time I was spending my birthday in hospital,  Only this time I was not the patient.

Mom with my bro Henry at her new nursing home in PJ

Right now Mom seems to have settled in nicely at this nursing home in Petaling Jaya, one of the very few that accept post-surgery admissions.

This is only the beginning of the road to recovery for Mom. She is one tough cookie. I am sure she will bounce back and be on her feet in no time.

(This post was written to share with family members and also with carers who may be going through a similar experience with their loved ones. More posts to follow...)