LIM YING SEE, CHERYL

Executive Summary/Abstract

Through this programme attached to The Good Life Co-op, we were given the oppportunity to visit many places such as the Assisi Hospice, Mt Alvernia Hospital, Lundbeck, Payar Lebar Kovan CC. Through this experience, we got to learn much more in depth into dementia/depression, as well as their screening tools. We also got a greater insight on how the Assisi hospice and Mt Alvernia Hospital runs, as well as how clinical pastoral care can be used to aid the patients in their spiritual healing and/or road to recovery.

Background Information Of The Projects / Tasks which you were involved in

The project we were working on aims to improve the health and quality of life of elderly. As Singapore is becoming more of an ageing population, we must be more cautious about the increase in people having dementia/depression as they age. As we work with Dr Carol Tan, a geriatrician at the Good Life Co-op, we hope to spread awareness on this issue as well as ensure that the elderly, and everyone else, is better prepared.

Elaboration / Record of the activities done

Researched on Depression and Dementia (Before WOW!)

To start off our attachment, our external mentor Dr Carol Tan gave us some videos on depression and dementia to watch so as to have a greater insight and knowledge on those two topics as we will be touching on them for the rest of the month. This included Toggle’s Turn Back The Time, where we learnt more about reminiscence therapy. We also did our own further research on them, specifically the screening tools for dementia and depression.

Sharing with Ms Rose Goh on Clinical Pastoral Care (06/01)

The first time we went over to Mt Alvernia Hospital, we had the opportunity to attend a sharing by Ms Rose Goh on clinical pastoral care. From this sharing, we were able to learn more about the importance of pastoral care in the hospital and hospice and how it can help patients and/or their families cope with the challenges they are faced with. By providing them with the emotional, spiritual, and religious needs, this will help them achieve a sense of purpose, self-worth, and for patients that are reaching the end of life, to pass on with a sense of dignity.

Learning how to conduct MoCA at Lundbeck (09/01)

At Lundbeck, Dr Keira taught us what each of the questions in the MoCA is about and how to conduct the assessment (calculating the score, how to judge their answer(s) etc). On top of that, she also taught us how to conduct the test on the elderly in the right manner, for example, how we should be patient towards the elderly so as to not stress them out in the test, and the speed at which we should talk at to ensure that the elderly understands our questions clearly.

Conducting MoCA at Payar Lebar Kovan CC (11/01)

After learning more about how MoCA (Montreal Cognitive Assessment) can be a way to screen for dementia and how to conduct it, we could apply what we had learnt by conducting this test on the elderly at Payar Lebar Kovan CC. This was really an eye opening experience as while some of the elderly were able to do well for the MoCA, others could not. We could see the worried expressions of the family members of the elderly that unfortunately, were unable to answer the questions accurately, and some elderly that were disappointed in themselves after the test. Although it was sometimes heartbreaking to watch, this let us see the reality of the situation.

However, we are glad that quite a number of elderly came down to do the MoCA screening, and that we were able to help out as much as we can.

Mr Alex Yeo’s talk on LPA and dementia (11/01)

At Payar Lebar Kovan CC, Mr Alex Yeo gave a talk on LPA and dementia to some of the elderlies and their families in the Kovan residential area. As most of us were not familiar with what LPA is, this gave us a greater insight on what LPA really is and why it is important to have one. On top of explaining it in detail and making sure everyone clearly understood him, Mr Alex Yeo also spoke in both English, and then repeated his points in Chinese in order to cater to the elderly that could only understand English/Chinese. After the talk, he answered any queries that the residents had.

Discussion on what we learnt from the places we visited (15/01)

Halfway through our attachment, we had already visited a number of places including Lundbeck, Mt Alvernia and Payar Lebar Kovan CC, but we never really took some time to reflect and talk about what we gained from these experiences. We finally sat down as a group and had a small discussion and sharing on what we learnt so far, as well as how this can help us produce our final deliverable and work on future projects.

Tour of Assisi Hospice (20/01)

Most of us have never visited a hospice and know little about it, but from this experience, we learnt that the hospice is for patients who have terminal illnesses, and the majority of them are cancer patients, though there are still patients with dementia, HIV, etc. We also learnt about palliative care, which helps to manage the quality of life of the patients by a multi professional team. This is done through different kinds of therapy and activities (art, music, sports etc) that are provided within the hospice to engage patients so they can cope better in the situations they are in.

The hospice offers 3 kinds of services for the patients: Home care, day care, and inpatient care. Home care patients, which are patients that are more stable and are taken care of at home, will only be visited on a need-to basis. Day care patients will be brought from their house to the hospice in the day (where they will participate in the various activities) and back by the staff. Meanwhile, inpatient care patients, most of them bed ridden, stay at the hospice overnight and usually have 3 months or less to the end of life.

Through this experience at the Assisi Hospice, we learnt a lot about what the Assisi hospice does and how patients are treated in the hospice to make them feel the most at ease and comfortable, so as to manage their pain, as it is often a painful process physically as well as mentally towards the end of their lives.

Planning & filming of our final deliverable (22/01, 23/01)

For our final deliverable, we had planned to make a video on dementia and LPA, so as to raise more awareness about dementia and the importance of having an LPA. However, after further consideration, our initial idea to deliver it in the form of stop motion seemed ineffective and very time consuming, since our target audience was ultimately the elderly. Thus, we decided to change it to more of an informative video, as seen in the picture below.

After discussions with our teacher and external mentors, we finally decided to on our third and final idea, which is to film a video where we reflect on what we had learnt through this whole attachment with The Good Life Co-op. We figured that this is the best option as we think that our final deliverable should reflect our entire experience, rather than specifically on dementia and LPA.

We then proceeded to film each of our own reflections at different areas of the school. We also had a mix of languages (English, Chinese, Malay, Hindi) in order to appeal to people of different races and languages. However, we decided that we would edit English subtitles when we compile the video.

Silver Generation Office (29/01)

We went to the Silver Generation Office where Ms Shirley gave us a talk on what the SGO does. We learnt that the SGO reaches out to seniors 60 years old and above to share with them the latest news/development such as the outbreak of the recent Wuhan coronavirus, and give them further help if needed, like if the senior is ill.

She also gave us a brief description of the different kinds of seniors: well seniors, lonely seniors and frail seniors. Well seniors are advised to keep active through the AAPs (Active Ageing Programmes), and to undergo functional screening to check their sight, hearing etc. Seniors whose spouse has passed on, children that have left home or physical disabilities that restricts their day to day activities might become lonely after a period of time, Thus, SACs (Senior Activity Centres) are there to give these seniors support. Frail seniors, on the other hand, are less abled and some have a fall risk. This is when the SGO will help to provide handrails in the houses for the seniors’ safety.

With the help of the SGO, the seniors will be able to “age in place”, which is to stay healthy while staying in the environment that they are comfortable in, rather that a nursing home etc.

3 Content Knowledge / Skills Learnt

1. What the MoCA is and how to use it to screen for signs of dementia

We had the opportunity to go over to the Lundbeck office to learn how to conduct the MoCA from Dr Keira. Afterwards, we conducted the test on elderly at Payar Lebar Kovan CC.

The Montreal Cognitive Assessment (MoCA) is a commonly used screening assessment to detect cognitive impairment. It is useful for detecting Mild Cognitive Impairment (MCI) or early dementia in occupational health settings, especially with the ageing population.

MoCA is a one-page 30-point examination conducted in about 10 minutes. The test comes in 46 languages and dialects and is even available for those who are visually impaired.

MoCA assesses several cognitive domains:

• The short-term memory recall task involves two learning trials of five nouns and delayed recall after approximately five minutes.
• Visuospatial abilities are assessed using a clock-drawing task and a three-dimensional cube copy. The subject is asked to draw a clock with the hours and showing the time 2:30. Successive results show a deterioration of pattern processing ability in a subject as they progress from MCI to severe Alzheimer's disease (AD).
• Multiple aspects of executive functions are assessed using an alternation task adapted from the trail-making B task, a phonemic fluency task, and a two-item verbal abstraction task.
• Attention, concentration, and working memory are evaluated using a sustained attention task (target detection using tapping), a serial subtraction task, and digits forward and backward.
• Language is assessed using a three-item confrontation naming task with low-familiarity animals.
• Abstract reasoning is assessed using a “ describe the similarity” task
  • lion, camel, rhinoceros
  • repetition of two syntactically complex sentences, and the aforementioned fluency task
• Orientation to time and place asking the subject for the date and the city in which the test is occurring.

However, while effective to a certain extent, MoCA should not be viewed as a substitute for a more in-depth neuropsychological assessment when domain-specific information is required.

2. Spiritual healing and pastoral care

From the sharing with Ms Rose Goh, I learnt that the clinical pastoral care at Mt Alvernia Hospital provides emotional, social and spiritual support to patients, their loved ones, as well as the staff in the hospital regardless of their race/religion. Pastoral care helps them to accept themselves and come to terms with reality, which is especially important when one is experiencing spiritual or emotional pain.

Spiritual healing is about finding a connection to something greater than yourself, be it friendship, community, a sense of virtue or meaning, God, a higher power or some sense of higher truth, beauty, nature or sacredness in life. In times when one is feeling helplessness, anger, despair or guilt, spiritual healing, which can be done through pastoral care, will give them a sense of fulfillment, purpose and self worth.

3. What LPA really is and its importance

We also got the chance to go to Payar Lebar Kovan CC not only to conduct the MoCA test on the elderly there, but also listen to Mr Alex Yeo talk about the LPA.

The Lasting Power of Attorney (LPA) is a legal document that allows a person to plan the management of his affairs in the event of a loss of mental capacity. In the LPA, the person making the LPA (the donor) appoints one or more persons (the donee) to act and make decisions on his/her behalf. A donee should be someone you trust who is reliable and competent to act on your behalf. The LPA is especially important if one is a sole breadwinner for the family, or if one frequently has to deal with health problems.

An LPA avoids the hassle of getting a court order, which can be both time-consuming and expensive. Additionally, where a deputy is appointed, you do not get a say in who is appointed to act for you, unlike an LPA.

A common misconception about the LPA is that it is similar to having a will. However, it is important to note that while the LPA takes effect when one loses the mental capacity to make his/her own decisions, the will will only take effect when one passes on.

2 Interesting Aspects Of My Learning

1. Conducting an interview

We don’t always get the chance to conduct interviews, but this programme allowed us to have the opportunity to conduct two interviews, one with Mr Alex Yeo and the other with Mrs Gina Williams. Prior to the interviews, we had to come up with interview questions.

Especially for Mr Alex Yeo who is one of the People’s Action Party’s branch chairman in Aljunied GRC, we researched more about him and what he does before crafting the interview questions. We then had to think of interview questions, by looking at the situation of Singapore’s ageing population and LPA from different perspectives, and how it will affect individuals, or society as a whole.

For Mrs Gina Williams on the other hand, we discussed with Dr Carol Tan as well as Mrs Williams’ daughter beforehand to find out Mrs Williams’ medical health, and to ensure that both parties agree on the topic of discussion for the interview, which is regarding her lifestyle. While coming up with the interview questions, we also had to ensure that we do not include questions that may be too sensitive or ones that cross the line.

Although both the interviews turned out to be not too formal and rather lighthearted, from this experience, I learnt that preparing for an interview takes a lot more time and effort than most imagine it to be, and the importance of doing research beforehand so the interview can go smoothly.

2. Elderly are different from what we think

Contrary to what most believe, many elderly are actually still very active when they get older.

From interacting with Mrs Gina Williams, who is 75 years of age, we realized how important it is to stay active. Even past her 70s, Mrs Williams is almost as healthy, if not healthier, and independent as someone half her age. She is very active and involved in things she finds interest in, and although her age restricts her from participating in many activities, she does not let it stop her from staying active. Furthermore, she also maintains a healthy lifestyle. She goes for walks often and is well aware of the importance of healthy living.

When we visited the Assisi Hospice, we also saw many elderly in the day care participating in activities so as to keep themselves physically active and healthy. While we were only there for a short while, we learnt that besides the activities to maintain their physical health, there were also events like karaoke and lessons for the elderly to explore their interests and find new hobbies. Furthermore, we realized that most of the elderly there were rather friendly and welcoming towards us, which was very different from what we expected from a hospice.

This taught us that age is just a number, and that we should not let it stop us from living life to the fullest and staying active mentally and physically.

1 Takeaway For Life

1. Importance of living life to the fullest

This programme allowed us to listen to the stories of many people, including that of our external mentor Dr Carol Tan, and her patient Mrs Gina Williams. After hearing about Dr Tan and Mrs Williams fulfilling lives filled with accomplishments over the years and at the same time, their willingness to help everyone around them, I was very inspired by their enthusiasm and initiative to do so. They taught us to do things with passion and drive, and to always strive to achieve great things, while trying to help others as much as possible.

At the Assisi Hospice and Mt Alvernia Hospital, we heard stories about patients and their families. This made me realize that life is short, and that although death may seem very far away and a foreign concept to many of us right now, it is a part of life and inevitable. We heard stories about patients who were afraid of dying or not ready to leave their families behind, and as daunting as it may sound, the pastoral care services provided in the hospital as well as the hospice’s support gave me more assurance on the situation.

Hence, I learnt that while we cannot escape the reality of death, it is important to always live our lives to the fullest, and to never take our lives as well as the people around us for granted.