Caring for your loved ones made easy

Taking care of an aged father was not easy for Ms Elina Chong. The need to juggle between her own business and family made it more difficult for her to visit her father at the nursing home.

Ms Chong said, “Although my siblings and I took turns to visit our father, it was not easy because we were all very busy, yet we really want to give the best care to him. Actually, we sent him to a nursing home with hopes that he would receive better care. However, he was not well taken care of during his two-month stay at the nursing home. This added stress with us constantly thinking how we could provide better care to our father.”

Such a scenario is not uncommon. Medical social workers at Alexandra Hospital (AH) are seeing a rising trend in caregiver stress. Ms Tan Ching Yee, Head of the Department of Medical Social Service at AH, said, “Those of us who have been involved in taking care of our own family members know how much mental, physical and emotional energy it requires, and the sacrifices we need to make when we take up such a responsibility. It is the same with the caregivers we encounter during the course of work.”

“Supporting caregivers should be a part of our total care plan. The burden and mental stress faced by caregivers are very real. They often have this misconception that talking about their struggles signifies failure,” she added.

Dr Terence Tang, a Consultant at the Department of Geriatric Medicine, added, “Often, the issues of caring for the elderly begins after the patient is discharged. We need to train caregivers to manage the patient.”

Geriatric Medicine team provides comprehensive care to the elderly
Geriatritians at AH believe caring for the elderly does not stop in the hospital. “The elderly have 60 to 70 years of history behind each of them. Nature would have taken its toll on every aspect of their being – physically, emotionally, socially and/or psychologically. Their needs are varied and complex,” said Dr James Low, a Senior Consultant and Head of the Department of Geriatric Medicine.

Each elderly person has a unique and interesting story to tell, for behind every disease is a human being. We must never forget that these elderly folks were once young and resplendent, full of life and vigour. We must make the path smooth for them and take good care of them. Above all, what our elderly need are kindness and compassion,” he added.

Empowering caregivers with skills and tools
The Geriatric Medicine team at AH, consisting of doctors, nurses, speech therapists and pharmacists, has introduced an initiative where caregivers are able to easily administer nasogastric (NG) tube feeding to patients who have swallowing difficulties.

Caregivers receive training from nurses until they are competent to administer NG tube feeding on their own. An NG tube feeding SMART kit with an easy-to-follow manual and tools needed for the feeding are also provided so that they tube feeding can be administered by the caregivers at home.

Every two weeks, when the tube is about to be changed, a nurse will call the caregiver to follow up and provide advice accordingly.

Initiative well received
The initiative has been well received by caregivers, and the Geriatric Ward has been getting fewer phone queries on the NG tube feeding. “Caregivers are more confident in taking care of their

loved ones once they have gone through the whole programme,” said Nurse Manager at the Geriatric Ward, Ms Sujata Rajaram.

Ms Chong is glad that her domestic helper has picked up the skills of NG tube feeding and will be able to administer it upon her father’s discharge: “The training and the kit are useful. My maid has been undergoing training for the last two days and did the feeding herself today. Now my father can return and be cared for in the comfort of our own home.”

Seeing the benefits of being able to care for their father personally, Ms Chong said she and her siblings are determined to pick up the tube feeding skills soon.

Improving the initiative
In addition to the training programme and SMART kit, the Geriatric  Medicine team also has a training DVD in the pipeline. “The DVD is a step forward from the existing training and kit we are providing. If a certain step is forgotten, caregivers and family can always refer to the DVD for reference,” said Ms Sujata.

At the end of the day, all these efforts are meant to serve elderly patients more effectively so that they can be treated with dignity even when they are old and frail.

The Nasogastric (NG) Tube Feeding SMART Kit
This is a tool kit caregivers can use to do their own NG tube feeding for the patient in the comforts of the home. The SMART (Simple, Maintenance, Aesthetics, Reusable and Transparent) kit comprises:

• A simple and easy-to-follow instructions
• Easy-to-maintain items for caregivers to perform the NG tube feeding
• Step-by-step pictorial guide on how to perform NG tube feeding
• Reusable items such as the 20ml syringe, 60ml syringe, pH indicator strips and a roll of hypoallergenic tape. These come with a manual containing a list of frequently-asked questions and a checklist to guide caregivers.

When a patient needs NG Tube Feeding
Tube feeding is usually administered to patients whose swallowing difficulties put them at higher risk of food entering the windpipe instead of the foodpipe. It is also meant for those who are not able to receive adequate nutrition or hydration when feeding through the mouth alone, possibly due to cognitive impairments. A speech therapist attending to the patient will be able to recommend the most suitable feeding method.

Senior Speech Therapist Ms Johncy Concepcion shared, “NG tube feeding is recommended for the interim. For example, it is for patients who have suffered from an acute stroke while participating in a swallowing rehabilitation programme.Another group of patients who would need NG tube feeding would be the elderly. Some of them may be too frail and may have a high risk of pneumonia caused by food and liquid getting into their lungs.”

To find out more about the initiative by the Geriatric Medicine team, please contact 6476 8828.

Source: http://www.alexhosp.com.sg/system/application/views/pdf/AHA_JunAug09.zip

Resizing Success

Alexandra Hospital’s Weight Management Programme helps patients find a new lease of life

Weighing 108kg with a Body Mass Index (BMI) of 40.2 – that washow heavy Ms Corinne Doong was at her peak in 2006. That puther at risk of getting chronic diseases such as heart complications,stroke, high cholesterol and diabetes. Now standing healthy at 58kg, Ms Corinne Doong recounts her story.

“I was of normal weight from young until JC (Junior College) Year 2. I only started putting on weight then, after I stopped all physical activities to concentrate on my ‘A’ Levels,” Ms Doong said.

The 39-year-old church administrative officer continued to put on weight when she went to Perth for further education.

“As an overseas student, eating fast food was more convenient as I had no time to cook proper meals. When I started working, I had a deskbound job and didn’t exercise,” she continued.

It was not a positive time for Ms Doong: “I felt depressed, tired easily and fell ill often. I avoided social events, had difficulty buying clothes and climbing stairs and needed a lot of sleep.”

Things changed after Ms Doong read about Alexandra Hospital’s (AH) bariatric surgery in the newspaper. She said, “When I read about the lap band surgery at AH, my first thought was ‘That is exactly what I need to help me lose weight!’”

Since 2000, AH’s Weight Management Programme has seen about 7,000 patients and about 345 patients have undergone lap band surgery since 2001. However, patients have to go through a stringent assessment before the most suitable treatment is recommended.

In Ms Doong’s case, lap band surgery was not the immediate solution. “I went through a six-month programme by the Weight Management team consisting of doctors, nurses, dietitians, physiotherapists, occupational therapists and psychologists. The doctor gave me the option of surgery only when I was still unable to lose weight,” she said.

Now with a healthy BMI of 21.6, Ms Doong is happy she sought help for her weight problem: “The surgery helped me to eat less as my small (stomach) pouch filled up with just a little food, causing me to feel full faster. Weight loss came naturally as what I ate was much less than what I burned.”

After the surgery, Ms Doong, who hardly passed her fitness tests in school, started wakeboarding lessons and participated in endurance races. She will be participating in the Tri-Factor Series 09 triathlon in September this year.

To find out more about the Weight Management Programme at the AH Health For Life Centre, please contact 6476 8828.

Source: http://www.alexhosp.com.sg/system/application/views/pdf/AHA_JunAug09.zip

 

Voicing your concerns

Six enriching perspectives at the Voice For Life forum

Held on 18 April this year at the Health Promotion Board auditorium, the Voice For Life forum provided informative and insightful perspectives on voice care to more than 150 participants.

Many of those who attended the forum were teachers with voice problems caused by shouting.

Dr Paul Mok, Head of the Department of Otolaryngology or ENT (Ear, Nose Throat), shared: “People don’t realise that our vocal folds can vibrate many times in a single second. The more we shout, strain or abuse the voice, the faster the vocal cords will slam against each other, resulting in a swollen and inflamed throat.”

Mr Samuel Tay, who loves to sing, has learnt a lot from the forum and he is adjusting his lifestyle so as to take care of his voice: “I’ve learnt to shout or scream less and I now know what kinds of food cause more harm and reflux.”

Tips to protect your voice
Speech Therapist Ms Kristen Linnermeyer shares 6 factors to prevent voice damage.

1. Do not smoke
2. Drink 8 to 10 glasses of water per day
3. Limit or avoid caffeine intake
4. Avoid talking, shouting or yelling over loud background noises
5. Consult a doctor if your voice and/or throat has been unwell hoarseness, throat phlegm, throat clearing, significant vocal fatigue or pain) for more than 2 weeks
6. Rest and treat your voice with care when you are tired or having an upper respiratory tract infection

To find out more about our Voice services at the ENT Clinic, please contact 6476 8828.

Source: http://www.alexhosp.com.sg/system/application/views/pdf/AHA_MarMay09.zip