HANNAH LUCIA VALENCIA ANASCO

Background information of the ORGANIZATION:

The Good Life Co-operative (TGLC) is a non profit social enterprise that aims to reach out to seniors 50 years and above and their families. As Singapore grapples with issues such as ageing population and rising healthcare costs, the launch of TGLC in 2014 was deemed a timely move. The Good Life’s mission is mainly to provide quality healthcare to members so they are able to live long, well and carefree. They do so by working together with reputed medical professionals to create programmes that make healthy living desirable, attainable and fun. The approach TGLC takes is more preventive in nature so as not to be over-dependent on public resources. As such, they focus more on educating the public on healthcare. Through which, they hope that the public can take greater responsibility for their own health and age gracefully.

TGLC is also one of the registered cooperatives in Singapore under the Singapore National Co-operative Federation (SCNF). The SCNF was established in 1980 as Singapore’s collective representation of the co-operative movement. These co-ops have a common goal of achieving social and economic end to benefit the community at large.

Background information of the projects / tasks which you were involved in.

My WOW group was attached to Dr Carol Tan to understand the intricacies of the healthcare sector and the ways that the community can come together to support the elderly and address the problems that the ageing population face. The major issues being tackled were dementia and depression, as well as issues with overall health and mental well-being. The Good Life Co-operative (TGLC), in collaboration with other organisations like Lundbeck and the Silver Generation Office (SGO) as well as Mr Alex Yeo in regards to a grassroots programme he has implemented, aims to launch initiatives to tackle these issues on a mass scale to help people around Singapore.

The project was launched last year in November. The grassroots programme by Mr Alex Yeo at the Paya Lebar Kovan CC was launched to spread awareness to the public about the Lasting Power of Attorney (LPA), its usefulness in legally providing a person to make decisions for someone who is no longer mentally capable of doing so themself, and the benefits to applying for one. His additional free-of-charge draftings of LPA and his pro-bono initiative has benefitted 510 residents and their families so far. Alongside this, free screenings of dementia and depression were offered to the elderly of the neighbourhood, and the services and the necessary support systems were provided to them from there, as shown by the support from Lundbeck, SGO and TGLC. Dr Carol Tan also has plans to further set up a mobile bus clinic with an AI healthcare system that would be able to diagnose a patient based on the symptoms they key in. In addition, the Lundbeck Office is conducting a research study to find out whether a new drug will be able to treat dementia thoroughly in its early stages. There are also plans for a fundraiser event in the future to raise money for the health and wellness programme that will be launching in the future.

This project is one of utmost importance in Singapore especially, with its ageing population continuing to face challenges and obstacles daily with little knowledge or preparation on how to tackle them effectively. It becomes exceptionally vital to spread awareness amongst the youth about the issues that the elderly face and what they can do about it, and even more so to offer available resources for the elderly to deal with the myriad of problems they face daily. With mental, psychological, and physical well-being on the line, ensuring that the elderly are well taken care of and properly supported with the right networks and systems in place is extremely crucial as the struggles they face (such as a lack of mobility, loneliness, mental and physical health issues) become more rampant.

When my WOW group joined, this project was already in motion and the extent of our involvement was to thoroughly grasp the way the healthcare sector involved a multi-faceted system that works behind the scenes to properly care for the elderly in Singapore, helping out and volunteering in the grassroots programme in particular as well as volunteering to help during the fundraiser event that will be happening soon. With much more to come in regards to the future of this project, my group was lucky enough to be a part of the programme picking up momentum as it gathered more support for the initiatives in place and the initiatives to come.

Elaboration / record of the activities done

The first step was to receive training. Before we could volunteer to help out with the grassroots programme at Paya Lebar Kovan CC to screen the elderly for dementia and depression, it was extremely important that we learnt two things:

1. What it means to have dementia and depression, meaning we had to have a good grasp on both mental illnesses in terms of our knowledge of its symptoms, its causes, its effects, and its treatments
2. How to screen people for both dementia and depression

For the first one, my group was made to watch two videos, one on dementia and one on depression, as well as watch a documentary about the struggles of old age, read brochures on each mental illness and conduct our own research. From these, we each wrote a 500 word report detailing everything we had learnt about dementia and depression. After becoming knowledgeable enough on the subjects, we received training at the Lundbeck Office for the second one. We used the screening tool called the MoCA test and we first learnt about the scoring system, and how to test people using it. We practised testing the MoCA test on one another before we were deemed ready to volunteer.

Then came the hands-on experience. At Paya Lebar Kovan CC, where we were to offer our help to screen people for the grassroots programme, we were given the task to screen the elderly of the neighbourhood for dementia using the MoCA test and direct them to the necessary support systems based on their score. It was a very good experience that I found enriching as it was extremely hands-on. It felt very meaningful to play an important role in such a vital programme that is meant to enhance community awareness and preparedness in the face of issues regarding old age. It made me realise how real the situation of ageing is — it felt more real than it would feel through the informational videos we would watch or the words we would read in our textbooks. The various people who took the test and reacted in very different ways showed the complexities of the situation that brought me back to reality violently. To actually see how your cognitive ability can slip away from people as they age during our time volunteering at the programme was very eye-opening.

Along the way, we were lucky enough to receive interviews with Mr Alex Yeo and Ms Gina Williams to understand the layers of this situation with more depth.

First, Mr Alex Yeo. Mr Alex Yeo is a litigation lawyer and is one of the People’s Action Party’s branch chairmen in Aljunied GRC. We interviewed him in regards to his launch of the grassroots programme at Paya Lebar Kovan CC and about the problems he felt were important to address in Singapore regarding the ageing population. He especially placed emphasis on the LPA, a legally binding document that appoints a trusted individual in charge of making important decisions for someone who has lost the mental capacity to do so. He has been helping residents draft their LPA without charging them as part of the first phase of his programme, and the following phases are in motion with free health screenings and educational talks to further spread awareness and tackle the health issues that the elderly are facing in the area. A problem that Mr Alex Yeo had identified was the issue of the residents being unwilling to apply for LPA because of their resistance to the fact that they are facing problems to begin with, and a key solution he has put forward was to continue education and advocacy to drill in and normalise the importance of such a legally binding document. In addition, he offered us an understanding of the challenges that the elderly often face (such as the lack of mobility, health problems regarding bone density, diabetes, or mental illnesses, lack of a strong social support system) and his means of solving them, one of the important ones of his health and wellness programme being reaching out. The accessibility of aid is important to get across to the residents, and that is why the idea of a mobile bus clinic and free screenings and free draftings of LPA are extremely important in providing a conducive environment to support the elderly.

Second, Ms Gina Williams. She is a patient of Dr Carol Tan, so we interviewed her about her life experiences. Ms Gina Williams led a very active life and she had accomplished much in her time. Having to grow up at a very young age due to tough circumstances in her childhood, she developed a very strong and resilient personality that carried her through countless projects in her life, such as helping to rebuild a school, ********. However, even so, as she continued growing older, certain policies restricted her from continuing to work at the same level as she used to, and she grew unable to stay as mentally active as she used to because of it. Ms Gina Williams’ story inspired me because of her pure grit and determination, and her life motto of seeing a problem and utterly having to fix it. She had led such a fulfilling life of accomplishment and success, and it made me realise that with each life that we are given, we can do so much more than we think we are capable of as long as we dedicate and commit enough of ourselves to the craft of hard work. However, as much as this is true, it also made me realise how nobody is invincible in the face of old age and it is inevitable that these struggles that we see others going through are not just their struggles but will also soon be our reality, and it becomes more important to prepare for the future through means such as staying active while we are young and doing our best to avoid all the risk factors that may lead to health problems in the future.

In addition, we were able to receive briefings and tours to help us understand more thoroughly the intricacies of the healthcare sectors that are not often talked about, specifically regarding our tour of Assisi Hospice and our briefing on pastoral care services, both touching on end-of-life care. It was extremely enriching to learn about this aspect of healthcare especially because it seems as though death has been made a taboo subject in society. However, learning about the facilities offered to those who are nearing the later stages of their life at the hospice and the support provided by the hospice (be it through nurses, medical care or emotional support through means ranging from community activities and therapy to pastoral care) allowed us to learn more about the facets of death that are not often talked about. The spiritual side of coming to terms with death, and the physical of dealing with the toll of the effects of nearing death, are both very real scenarios that are often unspoken of and both must be considered when taking care of those reaching the end of their life, especially when they are made aware of it.

Elaboration / record of results / deliverables / impact of work done

For our deliverable, we have decided to put together a video that encompasses all of our reflections and learning points together, and it will be used at the fundraiser event happening to raise money for the initiatives part of the health and wellness programme.

3 content knowledge / skills learnt

1. Firstly, the basics of dementia. First, a key aspect of dementia to unpack is its causes. There are five types of causes of dementia. The first is neurodegenerative causes, the leading cause of dementia, which involves the death of brain cells causing irreversible and gradual detrimental effects on cognitive abilities. The second is cerebrovascular causes, in which dementia arises as the result of a stroke, a heart disease, atherosclerosis, and anything that may cause disruption of the blood flow in the brain. The third is infection-related, where viruses, bacteria, or parasites begin to harm the brain cells to the point of causing dementia. The fourth is toxic and metabolic causes, where a chemical imbalance in the body is induced therefore leading to dementia. The last one is traumatic causes, where severe injuries to the head (such as concussions) could cause dementia as well. Overall, the causes of dementia could be summed up as the result of life challenges and other biological conditions like chemical imbalances in the body or diseases. Second, it is important to understand the scale of its impact. It is easy for younger generations to overlook the actual severity of the impact of dementia, because of the ignorance that we have to its exact nature. However, looking at the statistics, dementia affects 50 million people worldwide. In fact, it only grows more pressing with each year, 10 million new cases appearing annually. Even in Singapore alone, more than 80 000 Singaporeans have dementia. In fact, it is said to be one of the major causes of disability and dependency among older people worldwide. With how prevalent it is, it becomes extremely crucial to acknowledge the widespread nature of dementia and the scale of its impact. Third, I will be unpacking the physical effects of dementia on those who have it. As mentioned previously, dementia is described as the loss of brain functions. The degeneration of cognitive abilities results in a change of behaviour in those who have it. Namely, the symptoms of dementia include memory loss, poor judgement, behaviour changes, the inability to do everyday tasks, language problems, a lack of concentration, and withdrawal from people. Lastly, however, with the physical effects of dementia, it is equally if not more important to understand the emotional and psychological effects of dementia. Those with dementia often feel lost and confused, with difficulty to make sense of their surroundings. When this happens, they can feel angry and upset with themselves, reducing their self-confidence. Dementia and its physical effects take a toll on the psychological and emotional wellbeing of those who have it, and this cannot be overlooked.
2. Secondly, the solutions and treatments. First, what people with dementia can do. This refers to a more micro level of managing dementia, and it includes various activities to incorporate into their lifestyle to cope better with it. For instance, they can eat healthy and stay active to make sure they remain physically healthy and engaged. In addition, it is important for them to find friends so that they can build effective support systems around them to be able to talk about their experiences. However, while their lifestyle is important, it is also extremely important for them to seek professional help, in order to receive the proper treatment to help with their experience with dementia. Second, how others can support those with dementia. Emotional support is especially important, and it becomes vital to prioritise time for sharing advice and listening to problems that they may have. Understanding the symptoms of dementia and helping around with daily activities is important as well to maintain a stable and loving environment. Last, what society and the community we live in can do. At large, there are many things that society can do to better the experiences of those with dementia. For instance, in Singapore, they have introduced a grassroots programme in Paya Lebar to launch a new health and wellness programme. Initiatives like this being used to spread public awareness on a mass scale and offer means to access medical screenings and health talks are important in creating a cohesive society that values education and awareness above all. Community efforts to implement initiatives such as these must also be accompanied by the interest of the community to learn as well – with this, a system of support will be very much available to those with dementia.
3. Lastly, the MoCA test, or, the screening tool for dementia. The MoCa test is a one-page 30-point examination conducted in about 10 minutes, and it is often used to detect mild cognitive impairment or early dementia. There are a few cognitive domains that it tests: memory, visuospatial abilities, orientation to time and place, abstract reasoning, language, and concentration. With each domain, there is at least one question or activity on the test that will exercise this domain. For instance, to test for abstract reasoning, those taking the test will be asked to find a similarity or a common category between two items (i.e. both apples and bananas are fruits, both bicycles and cars are ways to transport and travel around). To test for visuospatial abilities, they must be able to draw a clock with the correct hands at a certain timing and to copy a three-dimensional cube perfectly. There are various other ways to test for the different domains. Generally, if they score from 20-26 out of 30, they are considered to have mild cognitive impairment. Anything below 20 out of 30 is already considered dementia.

2 interesting aspects of your learning

1. One of the takeaways that I got from this attachment is the ability to truly empathise with the struggles of old age. In school, we always talk about the aging population in Singapore and how it impacts society but this attachment gave me the ability to look at it from a much closer and fuller perspective. The hands-on experience showed me the true reality of what it can be like to grow older, and how it psychologically and emotionally affects the people who have it. The way dementia creates feelings of helplessness and loneliness, or the way old age brings about a lack of mobility that could hinder day-to-day life — there are so many things that I feel the youth does not really take into consideration as they look at society and the whole concept of "growing older" through rose-tinted glasses. Take those away, and you realise how real people are actually impacted in depth. It really puts things into perspective, especially considering the fact that growing up and growing old are inevitable. No one is infallible to these winds of change, as much as we like to believe we are strong and unstoppable when we are young.
2. On that same note, this attachment taught me the importance of living life to the fullest. We heard so many stories about the lives of so many different people, like Ms Gina Williams, Mr Alex Yeo, and Dr Carol Tan, and we learnt of all they have done with their lives. They led fulfilling lives filled with accomplishment, working together with others to help those around them. All of these life stories made me realise how cohesive society is to be able to provide a community for the people around them. Understanding how much work goes into doing so, and listening to these lives that are just filled with so much passion and drive and energy, made me realise how much importance lies in leading a life you are proud of and one filled with satisfaction.

1 takeaway for life

This attachment made me realise more clearly than ever the concept and the full gravity of death. Personally, death has always been a concept that was very far away or very abstract, something that was just a part of life and something everyone will have to go through eventually - but as we learnt more about the Assisi Hospice and the pastoral care services provided there, it became fully real to me, the concept of a whole human life filled with connections and loved ones and memories and skills and passions just ending like that. The stories that we were told, about people who were afraid of dying or people who were not ready to say goodbye to their loved ones, it made me realise the full gravity of the situation and the full weight of the situation. It got me thinking about how real and how daunting death is and, because of that fact, how important it is to never take for granted the people around us whom we love and the life that we are given, because it could all end just like that.