Are Msian Elderly Getting Enough?

when we first embarked upon the journey of a thousand miles looking for a suitable research topic to focus on for the coming AMSC 2010 themed Geriatric healthcare last march when the guidelines were out, all we knew about geriatric healthcare was (at least what I knew was hehe) palliative care for chronically ill elderly, elderly care in nursing homes or old folks homes and the fact that everyone knows it is best to care for ur parents urself when they age, not send them to nursing homes.

little did i noe that geriatric healthcare comprises of a whole broad range of aspects, from physical health to social support to socio economic security to problems like polypharmacy (taking multiple doses of the same drugs from diff clinics thus experiencing horrible side effects from them), the lack of specialised healthcare for elderly bcz of lack of geriatricians in the country, the rising need to attend to the concerns of the elderly esp their emotional well being bcz they're prone to depression due to their loss of active lifestyle and loneliness.

we consulted Prof Rahmah from the public health dept and she gave us input on carrying out a research. a questionnaire dubbed SF-36 was used to assess the QUALITY of LIFE of elderly. it has 36 questions that fit into 8 domains of quality of life: and the answers are subjective to what the elderly feels based on a Likert scale (1 to 4 or 1 to 6)

the 8 domains

1. General health perception : do u feel healthy?

2. Physical functioning: can u walk 500m, do vigorous activities etc.

3. Role limitation due to physical problems: do u need more time to achieve doing sth due to physical problems? etc.

4. Role limitation due to emotional problems: do u need more time / effort do do sth due to emotional problems?

5. Bodily pain: how often/ severity of bodily pain.

6. Social functioning: do you face problems that limit ur interaction w others?

7. Vitality: how often do u feel tired, worn out, full of energy etc

8. Mental health: how often do u feel happy / sad / down in dumps etc.

we carried out the survey in two gov old folks homes and in the Sabah community.

we compared the quality of life score for every domain in terms of

a) place of living : nursing home vs. community

Result: Quality of life is better in the community

Social functioning is worst in the community.

Vitality is worst in the old folks homes.

b) Gender:

Result: male elderly are more affected by physical problems, females more affected by emotional problems.

this suggest diff intervention methods in addressing the needs of male / female elderly. phps for males, creating opportunities for them to involve themselves in more physical based activities to decrease the sense of depression bcz of the drop in active lifestyle compared to their young age bcz of physical limitations. for females, phps more support grps to address emotional distress.

c) married elderly have better quality of life.

are we suppose to encourage elderly ppl to get married then? hehe.

phps more attention can be paid to those who are single / divorced / widowed.

d) Quality of life increases with higher education level.

e) Physical health correlates with emotional health.

despite our country having 15 gov nursing homes to care for the elderly etc, thr is still lack of workforce in these homes. the elderly to carer ratio is extremely high and the needs of the elderly cannot be met ideally. there are currently only 9 geriatricians for the 1.4 million elderly in the country.

any1 interested to specialize in geriatric healthcare? :P

as u walk around the wards in hospitals, u can gauge that 70% of the patients are elderly ppl. many express their wish to just perish bcz they cannot take the suffering from the illnesses they have any longer, they feel uncared for, they are depressed and feel they have no hope for recovery. it bcums normal that u will fall sick n suffer when u're old.

as much as the country advocates for the rights of the elderly thru the policies and NGOs like the NACSCOM and GeM and USIAMAS helping in uplifting the elderly in the country, the emphasis on elderly well being is still not enough. there is not enough awareness being pumped into the minds of the community, esp rural areas on active healthy lifestyle for the elderly, the importance of seeking treatment bcz illness is NOT a must in aging, and most importantly, dealing with the change in trend of more women working and a career centric society that cause the family support for elderly to drop tremendously.

in the end we find that the pool of elderly in the country are chucked into nursing homes or are mostly sick suffering depressed individuals.

with the advancement of medical technology leading to higher life expectancy and a growing aging population, the challenge in ensuring the well being of elderly in the country increases.

but as the challenge grows, it isnt a reason to back off. thr's more of a reason to look into the issue critically. bcz 1 day as well, we're going to be part of that aging community.

how can u play ur part? start understanding and show love to the elderly ppl ard you. :)

*a huge beam dedicated to Pei Sun for leading the AMSA academic team in completing and presenting this ppr in the conference and winning 3rd place. thank you Kevin Tan, Seng Wee, Grace, Chia Ying, Kevin Chin and everyone else who were directly or indirectly involved for making this achievement a success. :P huge thanks to Mr. Jaya Raman from the Jabatan Perancangan Pembangunan Negara for graciously helping us to speed up our proposal approval and the insight into the country's old folks homes given, all staff of Rumah seri Kenangan Cheng Melaka and N/Sembilan and everyone who helped us in the survey, and the support from the RC Hau wei, Chin Kimg. and the public health team for organizing an awesome geriatric health promotion. Yay! :D

extension of this morn's Ischemic Limb seminar

Found a pretty good powerpoint on Acute Limb Ischemia.

Google:

clinical features to assess severity of ischemia

and hit the 1st link on the search results. :)

This page offers good stuffs. Bookmark it :P

http://www.medicaleducationonline.org/index.php?option=com_docman

err

i find myself spiralling along the course of extreme emotions these few days. its pretty freaky.

its a mixture of hvg self confidence but thinking you're not good enough, standing tough but also being scared, filtering influences of emotions from those around you. its enough to make you go from being very happy to anxious to being lost to getting your senses stabilized again.

maybe its the whole stereotype painted picture by seniors or friends, all well meant to let u noe what u're getting into or what to expect. but it creates this destabilization and at some point you wonder whr your own opinion stand or should stand or how u shud be. lol.

i'm in my 6th wk of Surgery posting. its dubbed most easy going compared to the other 2. although i'm less blur, more confident, hv more knowledge compared to like 1st wk lol, i feel like i'm stil so inadequately equipped. stil lack of so much knowledge n skill, stil so incompetent. n probably not hardworking enough. am i hardworking enough? do i have a definition or std to compare myself to? i nvr reli savoured the thought of comparing myself w others. bt then again without a benchmark u can get lost. i dont have a schedule or target or i dunno, sth along that line. i woke up this morning feeling reli alarmed. just a sudden shock n feeling of fear that i'm in week 6 bt stil so far from being prepared to leave the posting soon. and fear, is not a nice feeling at all.

swinging along the lane. i've starved myself of feelings i don't even know what to feel right now.

its not entirely negative. its just, so swing-ish that u're knocked into a different spectrum b4 u know it.

its probably exam jitters thats affecting ev1's mood. the medicine n O&G ppl have short/long cases coming up n the nervousness is sucking into me as well.

lalallalalallalla

it started as an Obligation. thereafter,

when Jesus looked upon the crowd of thousands who had gathered in front of him to listen to his teachings for days, his heart was filled with compassion for the hungry people. and through the breaking of loaves and fish, he performed a miracle that fed all of them and additionally filled up 12 baskets of the fish and loaves from an original 5 loaves and 2 fishes.

now. compassion. love. obligation.

when we look at our purpose in doing things, some are done based on obligation. some based on compassion and love. some based on obligation at first, but as time passed, you developed compassion twds it.

sth simple for instance. u enter this new school as a stranger. u obey the rules, u dun throw rubbish ard its compounds, u greet the sch officers bcz its ur obligation as a student to do so. but after 3 years, u've come to become so familiar with the sch that u noe ur teacher's favourite parking spot, the menu at the canteen everyday, the distinct off-pitched keys of the piano played drg assembly and without realising it, u have grown to be so fond of ur sch. u no longer pick up rubbish bcz its an obligation but bcz u love ur sch and simply cannot stand the sight of some1 littering or abusing its facilities.

some institutions use community service as a way to penalize their members for failure to abide to the rules n regulations of the institution. whoever started this system is a genius. the punishment becomes a contribution. and from this form of retribution comes err what's the word.. repentance? not exactly repentance but the 'turning over a new leaf' with changed life perspective that sort of thing.

bcz the individual starts off by say, washing the sch toilet very very grudgingly (bcz no1 likes washing the toilet) and he is embarrassed by the fact that he is subjected to this form of punishment. the 'pain' is thr (the agony of a bunch of cute guys walking past n seeing this girl washing the sch longkang - no that has nvr happened to me hehe) n at the same time, the cleaning is done, and when this so called 'horrifying' job has been done a tad too often, the person hvg been in that institution for some time would probably be doing it voluntarily. maybe not washing clogged drains, maybe beautifying the environment, or some form of community service like helping out in old folks or charity homes etc.

i used to enter hospital wards thinking 'okay, so today i will clerk 1 patient at least and do physical examination on 1 patient at the wards'. i want it to be convenient and fast and i hoped for patients to give their cooperation. i complained to friends when patients say they're tired / sleeping / wave me away. a day with mostly unhappy tired sleeping patients would be a 'not so good' day.

1 day someone's words struck me. 'if i see any medical student taking history from a patient in a hurried manner, doing it for the sake of taking history and not being genuinely concerned for the patient, i'll fail that student.'

whoops.

that kinda stuck in my brain even days after.

last week i happened to have a so called very free morning, waiting for teaching in the ward or sth, and i sat down to take history from a patient. not reli to take history, but just chat with the aunty (cz dunno y i was so free that time). and as i let her talk about different aspects of her life, telling me her job, her life, concerns etc, i found out more about her background and stuff pertaining to her current conditions in a way that i definitely wouldnt be able to understand if i were to skip to short questions like 'what did u used to work as b4 this? *answer* 'where're u staying now?' *answer* etc. and after the long chat, in subsequent days, i felt not to say compelled, but genuinely interested to find out how she was doing and feeling. and she opened up to let me ask anything at all about her condition. and when she was going to be discharged, i felt very happy for her.

in reality it is of course not possible for doctors to build rapport to this level with every patient they hav in hospitals or else they would be treating just 5-10 patients a day with 50 more waiting in line.

but i captured a little essence in caring for a patient not bcz it was mere obligation but out of compassion.

yes it might make a difference in her life, but also importantly, it makes a difference in your life when you do so. the wards bcome more alive, in a way. =)

i got that person to thank for his words. lol.

Patience

Is patience congenital or acquired?

there're many people of whom i simply marvel at their level of patience. patience in tolerating madness. the madness of traffic, people's attributes, annoying flies, longggg menial work, long hours of listening, practicing something to perfection, learning and trying until getting it, the list goes on.

somehow patience is linked to the amount of passion you have for something, or someone. the threshold level you have for different things and people differs.

the amount of time you would spend teaching your younger brother, the hours you would spend listening to your best friend complaining and offering words of comfort or just a listening ear, the lengths you would go to make sure your mother gets the best medical treatment, even if you had to travel miles and journey hours long to get something done, you would do it because your heart is in it.

the amount of time a doctor spends to listen to medical students present cases, correct them nicely, listen attentively and give constructive feedback, even though he noes he could be better off doing something else at that time and he wasnt reli obligated to guide and teach them anw. despite their lack of presentation skills and knowledge that equal to nothingness in comparison to the perhaps 10 years of experience down the medical line of his, he takes in all questions, drills and explains concepts even with tired watering eyes.

at that point i was wondering if this doctor had the patience to do all that because of an inborn strike (not error :P) of patience or bcz he had the passion to teach or sth along that line.

its a remarkable trait that truly inspires students. sometimes a part of the reason that you are motivated is bcz u dun want all that patience and time invested to go to waste. and it also challenges you, to give back that kind of patience to society, acquantainces, ppl you hardly or dont noe and to do things that you dont like doing.

Unintentional harm

Ppl were born with the natural instinct to do wrong. If u realized, we weren't taught to carry out actions that are by society's standards or universally accepted as immoral i.e. lying, hurting others but these were inherent, as if a human nature. No one taught the 3 year old child to lie but he did so to save himself from perhaps punishment or repercussions of his actions. Sensing danger, he by all means tries to run away. Another illustration. The 4 year old boy refuses to admit he scribbled the wall because he was afraid of being scolded. Obviously no one taught him 'to lie to get away' prior to that. He did it by human instinct. You get what I mean. (if u beg to differ u're welcome to share ur opinion of course) but that isn't my main point here today anw.

 

When we do something that has unintentionally hurt others, we hope to clarify things, clear doubts and make amends to the person, to let him/her know that it was unintentional and we're sorry. Of course this doesn't give us the right to continue being ignorant n to hope for mercy each time we unintentionally hurt others. Bcz when it happens too often and repeatedly, ppl get tired of it and you know sth isn't right (with the way u're handling things). Whnever we're given the benefit of the doubt or are spared of our mistakes (or not), we take a lesson out of it, make a mental note and continue to mature and learn to be more and more tactful. In that process, we continue to salvage on open and forgiving hearts of ppl ard us to look past our misgivings.

 

Becz the point here is: None of us (well most of us anw) inherently wish to hurt others.

In whatever aspects and by whatever way.

 

So that brings me to the main point lol. Sorry for being sooo long winded.

Ppl around us (our friends / associates / family mbrs) who have caused hurt to us / our loved 1s / our friends / others could have done it unintentionally. Certain actions that we think are unacceptable by Our standards, may be acceptable by another person's standards. It differs bcz we were brought up in diff fam backgrds, a layout of society with diff expectations n needs and diff levels of tolerance.

 

The individual, did not realize he/she has caused hurt to another fella bcz:

1. If he/she were to be placed in that situation / commented w the use of certain words, he/she feels its alright n wouldn't be offended bcz he/she has a higher threshold level in accepting criticism.
   
2. He/she feels it's alright to be messy / borrow things without permission / leave things around etc. bcz he/she wouldn't mind for others to do likewise to his/her room or things.
   
3. There was a communication breakdown whr sth said meant a different thing/ Is interpreted differently by two diff individuals.
   
4. His/her standards of 'normal' differs from everyone else in our clique.
   

Brain jam. There are a 101 reasons that can be listed out.

 

Therefore, before we start judging / condemning / labeling a person for an action we disapprove of, we need to remind ourselves that:

1. No1 likes hurting others. (the definition of none is of course not absolute, well you know what I mean cz I'm lazy to list out exclusion criterias lol) It could most likely be unintentional.
   
2. Humans inherently have a tendency to do wrong, but as we mature and bcum educated, the norms of society/our surroundings and our conscience determines to what extent we inhibit sinful tendencies and do the 'right' things.
   

 

In order to evaluate that person, we have to rightfully

• Clarify matters, find out reason he/she did that blah
  
• Find out if it was intentional or otherwise
  
• Let the person know how and why his/her actions were hurtful or deemed to be wrong by others.
  
• And of course doing all the above in a very very tactful manner at a correct time.
  

 

If I had hurt sum1 unintentionally and did not realize it even til much later, I would appreciate it very much for ppl to tell me that and how was I wrong by the 'standards'. Not to be spoken of behind my back and deemed to be horrible by everyone else.

 

Well yeah, most ppl in society however prefer to take the shortcut and skip right to spreading juicy gossips about others. I dun deny this shortcut is easy and tempting to take (by inherently sinful nature hehe).

 

I therefore stil need to continuously remind myself to walk the longer road, take that extra mile of reflection and at the same time, try reduce unintentional harms towards others. J

 

We don't just need communication. we need effective communication.

 

*this post was written by random thought and is not linked to any specific personal encounter/experience.