PRAMA LEKHWANI

Abstract

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 (SNCF). The SNCF 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 I was involved in

The project that I was involved in aims to help seniors who are diagnosed with Dementia or Depression in both physical and legal aspects. The value of this project is that we learn more about diseases that affect the seniors and try to understand and help our ageing population. Many people from different departments were involved in this projects, such as doctors, nurses, lawyers , researchers as well as social workers/ volunteers. We mostly worked from school, or visited some elderly for interview purposes, as well as visit important places such as the Assisi Hospice and Silver Generation Office to understand more about what the elderly goes through.

As the project is an on-going 3 year long process, when we joined it was already in the process. A part of our attachment was to conduct the Montreal Cognitive Assessment (MoCA test) at Paya Lebar- Kovan CC. We also interviewed the Advisor to the Paya Lebar- Kovan CC, Mr Alex Yeo as well as an elderly woman, Ms Gina Williams, who is a patient of Dr Carol Tan's. The many interviews we conducted required us to have good communication skills with the elderly as well as professionals.

Elaboration on activities done

Activities done include:

• Talk on Pastoral Care with Ms Rose Goh

Ms Rose Goh is the head of pastoral care at Mount Alvernia Hospital. She told us more about how th hosptal aims to help patients spiritually alongside psychically. Here are my notes from the briefing:

Pastoral care is not about making peace, but about making them come to terms with their fate. It is about being non-judgemental and encouraging them to share stories and give support in any way meaningful to them

It is the;

- skilled ministry of the heart

- staying with patients ups and downs

- stepping into patients' world

- helping patients take control of situations

- praying with patients, when the need arises

- recognising that each of us are different

• MoCA Test training at Lundbeck Regional Office

This training was conducted by Dr Keira. She explained to us that Lundbeck and Dr Carol Tan were working together to try to find a solution for Dementia. One of the early processes of this is to screen for dementia, which can preliminary be done by the MoCA Test. She taught us how to conduct the MoCA Test and we practiced on one another.

• Write Up on Dementia or Depression , and MoCA test

Dr Carol Tan asked us to submit a write up on Dementia or Depression (one per person) based on a videos that we watched. This allowed us to better understand how Dementia is diagnosed and some prevention strategies. We also did some basic research on the MoCA test.

• MoCA Test screening at Paya Lebar Kovan CC

On a Saturday after TJC's Annual Go Green Day, we went to Paya Lebar Kovan CC to put the knowledge that we learnt at Lundbeck to the test. We met with many elderly people screening them for the MoCA Test. This was an enriching experience as we needed to better communicate with them as they may be sensitive to 'failing' the test. We were then asked to direct them to either Dr Carol Tan, the Silver Generation Office, or let them go home with a goodie bag if they had done well for the test.

• LPA Talk at Paya Lebar Kovan CC

We listened to a talk by Mr Alex Yeo about the benefits of having a Lasting Power of Attorney (LPA) should a patient lose mental capacity to make decisions for oneself. The LPA is a legal document where another person can be assigned to make financial ,or personal decisions, or both, for a patient who may have lost mental ability to make decisions. We also learnt that it is different from a will, as an LPA is only used when one is alive while a will comes into play after the death of the individual. Mr Alex Yeo had to carefully explain to the elderly what this was and patiently answer their questions. We were very impressed by his ability to do so.

• Tour of Assisi Hospice

We were fortunate to be able to get a peek into the Assisi hospice and also receive a talk on what goes on in the hospice. We were shown some of the wards for dementia and some recreational facilities.

A hospice is where terminally ill patients are kept for palliative care. Terminal illnesss include; cancer, HIV, dementia , organ failures etc. It is very painful for patients, and Assisi hospice aims to make life as easy as possible , manage family members and their anxiety. Assisi also aims for the patient to be able to have dignity in their last days which can last till 1 or 2 years. Palliative care is life affirming, so that the patients can live in comfort and dignity, while Assisi aims to provide a caring community for patients.

• Interview Ms Gina Williams

In the interview with Ms Gina Williams, we learnt that she is a very inspirational woman who has many achievements in her life.

Many elderly work very hard throughout their lives. However, after a certain age they are required to stop working. This causes a lot of free time that they do not know how to put to use. Hence, this may also cause some illnesses as well as depression due to lack of work to do. We learnt that it is important to keep one's mind engaged even after retirement as it allows us to keep our brain healthy.

• Interview Mr Alex Yeo

From the interview with Mr Yeo, we learnt more about his outreach programme in Paya Lebar Kovan CC. He is a 41 year old Lawyer by profession and he helps out at the CC to raise awareness about the LPA and also offers pro-bono LPA drafting for seniors in that area. We learnt that there is no appropriate age to apply, as

• loss of mental capacity can happen anytime
• dementia is very common, since seniors are more prone to it, it is highly encouraged for them to apply for LPA
• if you apply at a young age, you should change the donee when older

We also need to make seniors more aware of LPA so as to ensure that they can make an informed decision and choose the right people. There are also safety nets such as social workers and healthcare providers that have channels to allow for investigation in cases of misuse of LPA. For example, doctors are required to report any cases of misuse of LPA to the government without consultation of the donee.

A misconception that many old people have is that there is no need for a will after applying for LPA. This is false as an LPA is only used when the person is alive while a will is used when the person has passed on.

Some reasons why some elderly avoid applying for an LPA:

1. Do not want to confront the issue

• solution: raise awareness

1. Do not have the right person

• state can step in to help manage their affairs

On a National Level, pro-bono LPA applications in all constituencies such as the one in place at Paya Lebar Kovan CC requires organisation and connections, and is up to the individual community / constituency . It also depends on how mature the estate is, as a younger estate may not have an urgent need for such program.

• Visit to Silver Generation Office

We learnt a lot from our talk at the SGO office.

There is an established community network for seniors (CNS) with

— established active ageing in 1 in 2 RCs

— screened more than 45k seniors

— partner w SSAs

The objective of the CNS is to bring various community stakeholders together , keep an eye out for elderly, refer seniors to active ageing programmes, identify frail and lonely seniors for befriending and care & social services. The ministry of health, AIC and MSF also provide aged care services & care coordination to help vulnerable seniors

We were educated that there were 3 types of seniors, well seniors, lonely seniors and frail seniors. The methods that are used to ensure the well-being of these seniors are as followed.

Well seniors : keep well — provide facilities to keep well like HPB active ageing programme through functional screening

Lonely seniors : build baseline social support or safety net , so that every lonely senior has a friend, through Senior Activity Centres to provide support to seniors in studio / rental apartments and building up befriending providers and volunteer befrienders in every community , and connect lonely seniors to 24/7 befriending lines as baseline social net

Frail seniors : coordinate social and health support for seniors

community network for seniors allows seniors to age in place so they can grow older within community.

3 Content knowledge / skills learnt

1. Dementia information

Some symptoms of dementia are loss of memory, a change in behaviour, loss of basic abilities hence affecting daily activities, a change in behaviour and concentration problems. Additionally, Dementia can also be spotted in the elderly through signs like poor judgement, problems in communication and language, and withdrawal from their friends and family. This causes overall changes in the patient’s personality which can prove to be increasingly frustrating to friends and family. This disease is often caused by life challenges, an often occurrence in such a stage in one’s life where one may find that their life is changing too drastically once they retire.

Dementia also causes disease and chemical imbalances in the brain. For example, a progressive loss in brain cells causes a chemical imbalance in the brain, and hence may lead to dementia. In earl stags of the disease, the patient may be able to maintain an independent life. However, as the disease progresses, the patient may increasingly need a caretaker to oversee details like medication , financial situation, and household chores. In later stages of Dementia, one may need help with basic activities such as dressing and washing. At this point, it becomes necessary for the person to be cared for and given attention most of the time, for safety. This is often too much commitment for one close family or friend, hence more carers may be required.

2. MoCA test

What is MoCa? The Montreal Cognitive Assessment (MoCA) is a commonly used screening assessment to detect cognitive impairment. It was created in 1996 in Montreal, Quebec by Ziad Nasreddine, and has been clinically adopted in many other settings. The MoCA is useful for detecting MCI or early dementia in occupational health settings, especially as the workforce is ageing.

Mild Cognitive Impairment (MCI) is a syndrome defined as cognitive decline greater than expected for the age and educational level of an individual, but it does not significantly interfere much with daily life activities. MCI incidence ranges from 3 to 19 percent in population-based epidemiological studies in adults over 65 years of age and more than half advance to dementia in 5 years.

How does MoCA work? The MoCA test is a one-page 30-point examination conducted in about 10 minutes. The guidelines for testing and administration are available online to clinicians. The test comes in 46 languages and dialects and is even available for those who are visually impaired. The MoCA assesses several cognitive domains such as the short-term memory recall task and test of visuospatial abilities, Multiple aspects of executive functions, Attention, concentration, working memory, language, abstract reasoning and orientation to time and place

To ensure that other countries, even non-english speaking, can adapt to the test, linguistic and cultural changes are made. Multiple cultural and linguistic variables may affect the norms of the MoCA across different countries and languages.

3. Measures put in place to help elderly

Community Network for Seniors , where active ageing has been established in 1 in 2 RCs, and more than 45k seniors have been screened. The CNS also partners with SSAs to bring various community together, and keep an eye out for the elderly and refer them to active ageing programmes, as well as identify frail and lonely seniors for befriending and care and social services.

For well seniors, the plan is to encourage them to keep well by providing facilities to keep well like the active ageing population for functional screening

For lonely seniors, a baseline social support structure or safety net so every lonely senior has a friend. Senior Activity Centres are also available to provide support tp seniors in studio apartments and connect lonely seniors to 24/7 befriending lines.

Frail seniors are also taken care of through home and hospital care services and coordinated with to ensure social and health support. There are also establishments such as the Assisi hospice that can take care of the sick elderly nearing end of life (palliative care)

2 interesting aspects of learning

1. It was very rewarding to see how the elderly appreciated our help and were greatly benefited from what we did, as well as enjoyed the little things such as communicating with us and telling us little anecdotes about their life. For example, Ms Gina Williams looked very happy that she was talking to us and since we talked to a few elderly people , it gave us a chance to understand what they go through directly from their perspective rather than the one we are used to, of loved ones of those going through the diseases.This also allowed us to sympathise with them. We were intrigued to find out that they feel that they have little to do after retirement and how that takes a toll on their mental health.

2. I learned about pastoral care and the importance of spiritual healing alongside physical healing for patients. many patients’ mental health also suffer when they are admitted into the hospital as they adopt a ‘why me?’ resentful type of attitude. However, pastoral counsellors help patients to come to terms with their reality and help them to accept it. it was heartwarming to know that these counsellors really consider both the patients and their loved ones’ thoughts and feelings, and hence we became more sensitive in communication with the elderly, which a lot of people our age may struggle with. We understood how to talk to them such that they do not feel as though they are ‘sick’ and a burden on their loved ones. We had to do this when we were helping Dr Tan screen for dementia using the MoCA test. A lot of elderly considered that if they were made to go to Dr Tan they had ‘failed’ the test. However, through this we learnt how to phrase what we say so that we do not make the elderly worried.

1 takeaway for life

The sensitivity towards such subjects that I have gained is very precious to me, as I feel that it is very difficult to obtain without seeing these places first hand. Although we were aware of these diseases before we never considered how deeply they affect the elderly and their loved ones, also reminded me of my grandparents who are also ageing, which made me very emotional because it reminds us how little time we may have with them, and to live life moment by moment . the visit to the hospice put in perspective life and death, which is a concept many of us are uncomfortable with. I treasure the experiences that I have had and the memories I have made in my journey to helping the elderly.