TAN YU WEI

ABSTRACT

We were attached to Dr Carol Tan, a geriatrician, who is also the chairman of The Good Life Co-operative. Through this attachment, we learnt how to interact with seniors and understand them. We also focused on the mental well-being of seniors, looking out for seniors who have or might have depression or dementia. Through this attachment, we will help screen for seniors who are prone to dementia/depression, and also spread awareness about the importance of one's mental well-being.

Background information of the organisation

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-operations have a common goal of achieving social and economic end to benefit the community at large.

Background information of project

We were involved in this project which aims to care for the senior's mental well-being.

The project we were involved in with Dr Carol Tan, is to help prevent the elderly from developing dementia/depression as they age. Dr Carol has always believed that prevention is better than cure, and aims to help prevent the elderly from developing those mental disorders as listed above.

This project started last year November, and it also involved a lawyer Mr Alex Yeo. Mr Yeo is involved in encouraging seniors to do a Lasting Power of Attorney (LPA). It is where they choose someone they trust to manage their wealth, and it becomes active once the elderly becomes mentally incapable to manage their own wealth.

This whole project aims to help the seniors age healthily and with peace, with future facilities to do so too. Dr Carol is launching a mobile bus clinic, using the new AI babylon healthcare system, which allows the computer system to determine the elderly's illness/disorder just by keying in symptoms described by the elderly. The launching of the mobile bus clinic brings healthcare services closer to the elderly, and thus helping them age better.

Elaboration of activities done

We did outreach programmes such as helping to screen the elderly for dementia/depression, and also being able to talk to them and interact with them.

Besides that, we also read further into depression/dementia, researching how these mental disorders happen to someone and how it can affect someone.

Furthermore, we also decided to spread awareness on dementia and depression, by making a video as our final deliverable. Through this video, we hope that more people are aware that mental disorders should be treated, and more people will also start caring and looking out for people around them. Through this video, we hope the public understands the importance of one's mental well-being.

Evidence of work done

For our final deliverable, to help spread awareness on the importance of one's mental well-being to the public, we have made a video. In this video, we talked about the importance of one's mental well-being and also what we have learnt from the attachment at TGLC for our WOW! The Video is uploaded on the main page of TGLC.

3 Learning Points

The MoCA test.

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.

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:

1. The short-term memory recall task (5 points) involves two learning trials of five nouns and delayed recall after approximately five minutes.
2. Visuospatial abilities are assessed using a clock-drawing task (3 points) and a three-dimensional cube copy (1 point).

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).

3. Multiple aspects of executive functions are assessed using an alternation task adapted from the trail-making B task (1 point), a phonemic fluency task (1 point), and a two-item verbal abstraction task (2 points).

4. Attention, concentration, and working memory are evaluated using a sustained attention task (target detection using tapping; 1 point), a serial subtraction task (3 points), and digits forward and backward (1 point each).

5. Language is assessed using a three-item confrontation naming task with low-familiarity animals

6. Abstract reasoning is assessed using a “ describe the similarity” task

1. lion, camel, rhinoceros; 3 points
2. repetition of two syntactically complex sentences (2 points), and the aforementioned fluency task. 2 points

7. Orientation to time and place asking the subject for the date and the city in which the test is occurring (6 points).

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.

For other uses of the MoCA test:

As the MoCA assesses multiple cognitive domains, it may be a useful cognitive screening tool for several other neurological diseases that affect younger populations, such as Parkinson's disease, vascular cognitive impairment, Huntington's disease, brain metastasis, sleep behaviour disorder, primary brain tumours, multiple sclerosis and other conditions such as traumatic brain injury, depression, schizophrenia and heart failure. The test is also carried out in hospitals to determine whether patients should be allowed to live independently or with a home aide.

PHQ-2 and PHQ-9

Patient Health Questionnaire-2 (PHQ-2) inquires about the frequency of depressed mood and anhedonia over the past two weeks. The purpose of this is to screen for depression as a first-step approach, with the following questions asked:

1. Have you been bothered by little interest or pleasure in doing things?
2. Have you been feeling down, depressed, or hopeless in the last month?

• If patients respond positively to the above two questions, they should be further evaluated with a PHQ-9 test to determine if they meet the criteria for depression.

• PHQ-9 is used as a tool for screening, monitoring, diagnosing and determines the severity of depression.

• PHQ-9 questions include:

1. Little interest or pleasure in doing things
2. Feeling down, depressed or hopeless
3. Trouble falling asleep, staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself - or that you’re a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed. Or, the opposite - being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way

• For each question, there are 4 options -- not at all, several days, more than half the days and nearly everyday, with scores assigned to each option. PHQ-9 score obtained by adding score for each question (total points) -- Total scores of 5, 10, 15, and 20 represent cut points for mild, moderate, moderately severe and severe depression, respectively

• After patients take the test, treatment will be advised accordingly depending on their scores.

Spiritual and pastoral care

I learnt that it is empathising with someone, and really providing someone with a listening ear that can really help someone. We had the opportunity to listen to Ms Rose Goh, and she shared her experiences of her and her past patients. When patients have contracted terminal illness and their days are numbered, they will spend the rest of their time in an Assisi hospice. More than often at the assisi hospice, the patients will complain about the unfair treatment of god to them, as they have contracted the terminal illness. Ms Rose Goh is a therapist, and she will lend a listening ear to the patients, also praying for them if they require. Ms Rose Goh being there is to ensure that every patient does not die alone, and make sure that their last days will be happier and better.

2 interesting aspects of my learning

Impotance of mental health

In a fast pace society today, stress gets to us easily. In a world today, it is easy to get lonely and depressed from all the pressure on us and the high expectations from us. Thus, it is important to take note of our mental well-being, and we should treat it seriously. We should seek help immediately if we figure that these mental disorders are getting to us, and we should look out for others who might be suffering from mental disorders. We must learn to care for others, and accompany them, preventing them from feeling that they are all by themselves.

Who is involved in the project

Secondly, I found out that this project to help the elderly age better involves so many different people from different industries to ensure the positive and desired end result. A common goal to help the elderly, a kind heart and the willingness to help others live better brought together people from different industries. Although so far the project is successful, I would like to suggest a change in which it could help the elderly live better. That would be to increase the age of retirement to 75, if the elderly are healthy enough. Although I heard that this law has been put into place, it is not actively used by companies. For the case of Ms Gina Williams, she was forced to leave her job at 70 and it led to her mental health going on a nose dive after. Maybe we cannot change the age at which company retires their staff, but maybe we can come up with more activities for the elderly who are at home with nothing to do, after their retirement. Such would include board games and origami session, or yoga and news sharing sessions at the community centres. The people to host the games and interact with the elderly can be acquired through getting people to volunteer, such example would be through the website giving.sg. All these activities will help the elderly stay active and thus age healthier.

1 takeaway for life

Through this attachment, i learnt that we really need to empathise with someone or care for them. Besides that, we should really understand the situation someone is going through before passing a judgement. For example, throughout the attachment we learnt that most of the elderly have dementia not because they are lazy at home, but rather because there may not be enough facilities for them to use to stay active. At the Silver Generation Office, we heard about the different stories at which elderly faced different problems. Some elderly feel lonely, while others have physical mobility issues. For example before judging why an elderly house is so dirty, we should first find out why has this happened. Do they have a mobility issue, are they staying alone and don't have the physical ability to clean the house? Instead of passing judgement instantly, we should take a step back and understand the situation, empathise with the elderly and from there on help them overcome their difficulty. Only then, can we live in a more caring and loving society.