Over this festive period it may mean you you have your loved ones visiting you here in Singapore. If you’ve got family visiting, especially your parents, it is important not only to cherish these special weeks and months together, but also ensure their health is well looked during their stay in Singapore.
We believe that good clinical care is essential for our elderly patients. Here I discuss a few key topics that are of utmost importance for our elderly community.
COVID-19 and its implications
The importance of COVID-19 vaccines cannot be stressed enough, especially for the population greatest at risk of acquiring severe disease due to COVID-19, and one of the biggest groups in this are those aged 65 years or above.
It is essential for those 65 years old and above to be vaccinated against COVID-19. In Singapore, mRNA vaccines (Pfizer-BioNtech and Moderna) are available to all residents and long-term visitors aged 12 years and above. We at Osler Health International also offer Sinopharm, which is more like a traditional vaccine and uses an inactivated virus to help our immune system develop an immune response to fight against COVID-19.
As we are entering an endemic stage of COVID-19, we must ensure to keep up our protection against COVID-19. There is limited information about how often we may need boosters, but for now, it is recommended to take your COVID-19 vaccine booster if your last COVD-19 mRNA vaccine dose was 5 or more months ago.
On the topic of vaccines…
While we are discussing vaccines, it must be highlighted the elderly community is at a higher risk of severe disease from certain other illnesses.
The annual flu vaccine is important for older adults to build up immunity against influenza, especially as research shows, to avoid serious illness if one catches flu and COVID-19 together.
Two other vaccines that are important in the elderly to consider are the pneumococcal vaccine and the shingles vaccine.
The pneumococcal vaccine helps to protect against very serious and life-threatening pneumococcal infections. A type of this vaccine is also given to babies during their routine immunisations. There are 2 types of pneumococcal vaccines that are recommended for those above 65 years of age – the PCV13 (pneumococcal conjugate) and PPSV23 (pneumococcal polysaccharide). Both these vaccines cover different bacterial strains that cause pneumonia. Usually, the PCV13 is given first, followed by PPSV23.
The shingles vaccine is also recommended in the older population. Different countries have different guidelines on this. The US Centre for Disease Control (CDC) recommends adults 50 years or older for shingles vaccination, whereas, the UK’s NHS guidelines recommend this vaccine for those between 70 to 79 years. A doctor will discuss this vaccination with you and recommend the most suitable time for your elderly relative.
Looking after physical health
Ageing is a very individualized process and can mean different things for people of the same ‘age’. This is why as we get older, our health requires specialized care.
Diseases, such as diabetes, high blood pressure, heart disease, stroke, kidney disease, joint pains and aches, cancer, can take a toll on our overall quality of life. These diseases tend to often occur together as we age. A regular follow-up for these chronic conditions is essential. At these reviews, the doctor will evaluate and discuss the progress of these conditions, the goals of treatment for care, especially ensuring the elderly are on the appropriate medications, reviewing their side effects and interactions.
The doctor will also recommend screening for certain diseases, such as cancer screening at age-appropriate windows. Osler Health can help to coordinate with the primary care provider back home, ensuring a smooth transition while your relatives are in Singapore.
In addition to this, an assessment of other physical aspects is also important to ensure holistic well-being. Some important issues to discuss and assess with the healthcare provider are:
- nutrition (which includes your diet)
- activity levels
- smoking and alcohol intake
- eyesight and hearing
- bowel and urinary continence
Another important aspect of health as we get older is our mobility. Our muscles and bones undergo physiological changes as we age. This in turn has an impact on our mobility and balance, and lead to joint problems, age-related bone disease, mobility problems and falls.The doctor will carefully assess day-to-day functioning. Support from other allied health professionals, such as physiotherapists and occupational therapists, is often needed to provide the best management to optimize and maintain our functional ability.
Mental well-being is a core part of our health. This cannot be truer for older people, especially those who may have experienced social isolation during the pandemic, or those, who may have uprooted their lives and moved to a new city to live close-by or with their families. Recognising the impact of this is an important step towards providing a foundation of empathy and care for older age adults.
Two key themes that must be highlighted when we think about mental health for older patients are depression and dementia. Both these syndromes can manifest in multiple ways. They may occur independently of each other, or, often overlap. Older patients who may suffer from depression may not always complain of low mood. Often, they may experience change in their appetite, weight loss, anxiety with health and may show some decline in their memory.
Dementia, which affects memory and other higher functions of the brain, can present with decline in memory and also changes in one’s mood (e.g., anxiety, irritability and low mood). Some older adults may have some memory loss alone, but no other impact on their daily functioning. These individuals are often diagnosed with cognitive impairment, and not dementia per se.
Mental health in older adults can be complex and requires detailed and thorough evaluation with your doctor. A timely diagnosis can aid in helping patients and their families accessing medical treatment and support in the way that is most appropriate for them.
Several older individuals may not need any ‘medical’ therapy. Research has shown the benefits of ‘non-medicinal’ therapies to maintain cognition, independence and wellbeing of older adults. In Singapore, several such activities are available to older adults. This may range from meeting other likeminded individuals within our local communities (e.g., condominium groups, meetup groups for visiting or longterm staying older adults via Facebook or Whatsapp groups), getting involved in local charities and local groups, day care programs run by organisations focused for older adults, such as CareLibrary, Allium Healthcare to name a few. Singapore also boasts of equine therapy for older adults that helps with psychosocial and physical wellbeing.
Looking after you
The joy of family and caring for a loved one can create a new meaning in life for yourself. However, it can also bring about stress in forms of physical, psychological and financial burdens.
We recognize the significant impact caregiving brings about and we are here to support you through this. Please come and talk to us about how you are doing. Your mental and physical wellbeing is of utmost importance. We will also be able to help liaise and coordinate care between different parts of the healthcare system to help you and your family members achieve a smooth health journey.
Dr Trisha Upadhyaya is a British trained GP based at Osler’s Star Vista clinic. Dr Trisha is passionate about elderly care and can guide a treatment programme that is individualised to your family needs. T:6339 2727
- COVID-19 vaccination, Ministry of Health Singapore.
- COVID-19 vaccination, World Health Organisation.
- CDC Adult Immunization Schedule 2021.
- NHS Adult Vaccinations 2021.
- Welsh TJ, Gordon AL, Gladman JR. Comprehensive geriatric assessment–a guide for the non-specialist. Int J Clin Pract. 2014;68(3):290-293. doi:10.1111/ijcp.12313
- Hamilton W, Round J. Identifying frailty in primary care. BMJ 2017; 358: j4478 doi:10. 1136/bmj.j4478
- Tuttle CSL, Maier AB. Towards a biological geriatric assessment. Exp Gerontol. 2018 Jul 1;107:102-107. doi: 10.1016/j.exger.2017.09.017. Epub 2017 Sep 28. PMID: 28964828.
- Tazkarji B, Lam R, Lee S, Meiyappan S. Approach to preventive care in the elderly. Can Fam Physician. 2016 Sep;62(9):717-21. PMID: 27629666; PMCID: PMC5023341.
- Wilkinson P et al. Depression in older adults. BMJ 2018; 363 :k4922 doi: 10. 1136/bmj.k4922
- NICE guideline. Dementia: assessment, management and support for people living with dementia and their carers. Published 20th June 2018.
- Swartz K, Collins LG. Caregiver Care. Am Fam Physician. 2019 Jun 1;99(11):699-706. PMID: 31150177.