Tag Archive - elderly care

Quality of life is more important than extension of life

Patrick Cheung, right, shares his perspectives during the Modern Aging launch.

At the Modern Aging launch, I heard Patrick Cheung, founder and honorary executive director of The Jade Club, a social enterprise based in Hong Kong that is tackling elderly care challenges in Greater China, touch on the importance of quality of life.

He shared this with me in an e-mail after the event: “Quality of life is more important than extension of life. Most governments use majority of their budget in saving life at hospitals rather than improving quality of life at old age. Hong Kong specifically needs to focus on this area and look at ageing-in-place. Being able to die at home surrounded with your loved one is much better than dying in the hospital.

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A GEM of an idea

The Tan Tock Seng Hospital (TTSH) in Singapore first started a Geriatric Emergency Medicine (GEM) in 2006. Since that time, the hospital has introduced several initiatives with the aim of improving the delivery of care to elderly patients in the Emergency Department (ED) including risk stratification, geriatric screening, falls evaluation and bladder control. TTSH currently has four GEM subspecialist doctors, and have trained more than 50 GEM nurses in its ED. TTSH remains the only hospital with geriatric services in the ED.

Ageless Voice finds out more about GEM from Dr Foo Chik Loon from the TTSH Emergency Dept:

What’s GEM about? How did you become involved in this field of emergency medicine?

In 2006, when at a lull in my career, my head of department pulled me into her office and asked me to start a geriatric emergency service. I had no interest in the elderly then, but later came to be in awe of every geriatrician I’d met. Today, with the help of an amazing team of doctors and nurses, slowly but surely, we’ve helped a lot of ED elders.

GEM is about improving the delivery of care to the elderly patients presenting to the emergency department. Its three pillars are:

a) Education – Majority of ED doctors and nurses received minimal training in geriatric care in medical/nursing school. It is important to raise their knowledge of the unique characteristics of the elderly, such as atypical presentations, polypharmacy, cognitive impairment, chronic diseases, and psychosocial dysfunction.

b) Target & screening – The ED traditional model of care is to ‘see and dispose’, i.e. to manage the patient’s primary complaint and either admit or discharge. However, the elderly patient is far more complex than their younger counterparts. Apart from the primary complaint, there are often multiple biopsychosocial issues that are hidden, that may have contributed to the presenting complaint, and that would result in further adverse events if unaddressed. The role of GEM is to screen for and unravel these unmet needs.

c) Networking – If clinically possible, elderly patients should be kept away from hospitalisation as far as possible. Admission comes with risks of deconditioning, nosocomial infections, medication errors, etc. To provide alternatives to admission, it is necessary for ED to establish direct workflows and links social, community and stepdown services. This is currently lacking in most EDs, resulting in inadequate transition of care upon discharge from ED.

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Community-based health and aged care in China

The population of China is currently 1.34 billion, which represents almost one-fifth of the world’s population. Over the period 2010 to 2065, it is estimated the proportion of people aged 65 years and over will increase from nine percent to 30 percent. In order to improve equity and financial sustainability, China is undergoing rapid health and aged care system reforms in response to its ageing population and rapid increases in the number of people with chronic diseases.


Innovative programme

Health system reforms include establishing a stronger primary healthcare system that incorporates patient-centred care and chronic disease self-management principles. A recent innovative programme has been introduced in Beijing, China, to help older people with diabetes to manage their illness. Called the “Happy Life Club”, it utilises health coaches trained in behavioural change and counselling principles to address the management of diabetes in older people in primary care settings in China. These coaches support participants to improve modifiable risk factors and adhere to effective self-management treatments associated with diabetes. This type of approach is popular with both health practitioners and older people.

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Elderly care in Hong Kong – the challenges & opportunities

Can you imagine, if you intend to have a bed at a residential home for elderly in Hong Kong, you would have to wait for around 39 months? And, if you wish to apply for elderly care services, you would probably have to visit several offices of different Government departments before you are offered the services? 

Hong Kong has the highest rate of institutionalised elderly (of around eight percent), when compared with other countries like USA and UK who are around three percent to four percent. So why do elderly in Hong Kong love to be institutionalised?

According to the Census projection in Hong Kong, it is expected in about 25 years, the percentage of the elderly population here would increase to 25 percent to 28 percent, meaning about one fourth of the total population would be elderly in Hong Kong at 2033.


Challenges of elderly care

As a Chinese society, filial piety has been a long belief that can foster quality care to the elderly. However, the following challenges are faced by elderly care in Hong Kong:

  1. Busy working lives – Even as they age, the spouse and children of the elderly have to work long hours before they can go home to take care of the elderly.
  2. Limited residential space – This prevents the elderly from being properly cared in their own homes. Worse still, their homes cannot accommodate a wheelchair.
  3. Intention of not to bother family members by the elderly – Elderly in Hong Kong are very considerate that they do not want to bother their families, choosing instead to live by themselves.
  4. Increasingly frail elderly population – Around 15 percent of the elderly suffer from chronic illness, whilst eight percent of those aged 80 suffer from dementia. These figures are set to increase as the population continues to age.
  5. Shortage of para-professionals (such as occupational therapists and physiotherapists) and nurses – Elderly institutions are not granted license if they lack sufficient para-medical staff. This means an added pressure to existing elderly institutions with their waiting lists for the elderly continuing to grow and the wait becomes longer. 

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