What became known as Covid-19, or the coronavirus, started in late 2019 as a cluster of pneumonia cases with an unknown cause. The cause of the pneumonia was found to be a new virus – severe acute respiratory syndrome coronavirus 2, or Sars-CoV-2. The illness caused by the virus is Covid-19.
Now declared as a pandemic by the World Health Organisation (WHO), the majority of people who contract Covid-19 suffer only mild, cold-like symptoms.
WHO says about 80% of people with Covid-19 recover without needing any specialist treatment. Only about one person in six becomes seriously ill “and develops difficulty breathing”.
So how can Covid-19 develop into a more serious illness featuring pneumonia, and what does that do to our lungs and the rest of our body?
How is the virus affecting people?
Guardian Australia spoke with Prof John Wilson, president-elect of the Royal Australasian College of Physicians and a respiratory physician.
He says almost all serious consequences of Covid-19 feature pneumonia.
Wilson says people who catch Covid-19 can be placed into four broad categories.
The least serious are those people who are “sub-clinical” and who have the virus but have no symptoms.
Next are those who get an infection in the upper respiratory tract, which, Wilson says, “means a person has a fever and a cough and maybe milder symptoms like headache or conjunctivitis”.
He says: “Those people with minor symptoms are still able to transmit the virus but may not be aware of it.”
The largest group of those who would be positive for Covid-19, and the people most likely to present to hospitals and surgeries, are those who develop the same flu-like symptoms that would usually keep them off work.
A fourth group, Wilson says, will develop severe illness that features pneumonia.
He says: “In Wuhan, it worked out that from those who had tested positive and had sought medical help, roughly 6% had a severe illness.”
The WHO says the elderly and people with underlying problems like high blood pressure, heart and lung problems or diabetes, are more likely to develop serious illness.
How does the pneumonia develop?
When people with Covid-19 develop a cough and fever, Wilson says this is a result of the infection reaching the respiratory tree – the air passages that conduct air between the lungs and the outside.
He says: “The lining of the respiratory tree becomes injured, causing inflammation. This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough.
“But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages.
“If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.”
If the air sacs then become inflamed, Wilson says this causes an “outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia.”
He says lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the body’s ability to take on oxygen and get rid of carbon dioxide.
“That’s the usual cause of death with severe pneumonia,” he says.
How can the pneumonia be treated?
Prof Christine Jenkins, chair of Lung Foundation Australia and a leading respiratory physician, told Guardian Australia: “Unfortunately, so far we don’t have anything that can stop people getting Covid-19 pneumonia.
“People are already trialling all sorts of medications and we’re hopeful that we might discover that there are various combinations of viral and anti-viral medications that could be effective. At the moment there isn’t any established treatment apart from supportive treatment, which is what we give people in intensive care.
“We ventilate them and maintain high oxygen levels until their lungs are able to function in a normal way again as they recover.”
Wilson says patients with viral pneumonia are also at risk of developing secondary infections, so they would also be treated with anti-viral medication and antibiotics.
“In some situations that isn’t enough,” he says of the current outbreak. “The pneumonia went unabated and the patients did not survive.”
Is Covid-19 pneumonia different?
Jenkins says Covid-19 pneumonia is different from the most common cases that people are admitted to hospitals for.
“Most types of pneumonia that we know of and that we admit people to hospital for are bacterial and they respond to an antibiotic.
Wilson says there is evidence that pneumonia caused by Covid-19 may be particularly severe. Wilson says cases of coronavirus pneumonia tend to affect all of the lungs, instead of just small parts.
He says: “Once we have an infection in the lung and, if it involves the air sacs, then the body’s response is first to try and destroy [the virus] and limit its replication.”
But Wilson says this “first responder mechanism” can be impaired in some groups, including people with underlying heart and lung conditions, diabetes and the elderly.
Jenkins says that, generally, people aged 65 and over are at risk of getting pneumonia, as well as people with medical conditions such as diabetes, cancer or a chronic disease affecting the lungs, heart, kidney or liver, smokers, Indigenous Australians, and infants aged 12 months and under.
“Age is the major predictor of risk of death from pneumonia. Pneumonia is always serious for an older person and in fact it used to be one of the main causes of death in the elderly. Now we have very good treatments for pneumonia.
“It’s important to remember that no matter how healthy and active you are, your risk for getting pneumonia increases with age. This is because our immune system naturally weakens with age, making it harder for our bodies to fight off infections and diseases.”
Extracted from The Guardian
What is the virus causing the illness in Wuhan?
It is a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city, which also sold live and newly slaughtered animals.
Have there been other coronaviruses?
New and troubling viruses usually originate in animal hosts. Ebola and flu are other examples, and severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. In 2002, Sars spread virtually unchecked to 37 countries, causing global panic, infecting more than 8,000 people and killing more than 750. Mers appears to be less easily passed from human to human, but has greater lethality, killing 35% of about 2,500 people who have been infected.
What are the symptoms caused by the Wuhan coronavirus?
The virus causes pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were already in poor health.
Is the virus being transmitted from one person to another?
China’s national health commission has confirmed human-to-human transmission, and there have been such transmissions elsewhere. As of 9 February, there have been at least 800 deaths from the virus worldwide. Infections inside China stand at almost 37,200 and global infections have passed 280 in 28 countries. The mortality rate is 2%.
Two members of one family have been confirmed to have the virus in the UK, a third person was diagnosed with it in Brighton, and a fourth is being treated in London, after more than 400 were tested and found negative. The Foreign Office has urged UK citizens to leave China if they can. Five new cases in France are British nationals, and British nationals are also among the 64 cases on a cruise liner off Japan.
The number of people to have contracted the virus could be far higher, as people with mild symptoms may not have been detected. Modelling by World Health Organization (WHO) experts at Imperial College London suggests there could be as many as 100,000 cases, with uncertainty putting the margins between 30,000 and 200,000.
Why is this worse than normal influenza, and how worried are the experts?
We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2%. However, this is likely to be an overestimate since many more people are likely to have been infected by the virus but not suffered severe enough symptoms to attend hospital, and so have not been counted. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.
Another key unknown, of which scientists should get a clearer idea in the coming weeks, is how contagious the coronavirus is. A crucial difference is that unlike flu, there is no vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the population – elderly people or those with existing respiratory or immune problems – to protect themselves. Hand-washing and avoiding other people if you feel unwell are important. One sensible step is to get the flu vaccine, which will reduce the burden on health services if the outbreak turns into a wider epidemic.
Should I go to the doctor if I have a cough?
Anyone who has travelled to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last two weeks and is experiencing cough or fever or shortness of breath should stay indoors and call NHS 111, even if symptoms are mild, the NHS advises.
Is the outbreak a pandemic?
Health experts are starting to say it could become a pandemic, but right now it falls short of what the WHO would consider to be one. A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed in about 25 countries outside China, but by no means in all 195 on the WHO’s list. It is also not spreading within those countries at the moment, except in a very few cases. By far the majority are travellers who picked up the virus in China.
Should we panic?
No. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern, and says there is a “window of opportunity” to halt the spread of the disease. The key issues are how transmissible this new coronavirus is between people and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact.
Healthcare workers could be at risk if they unexpectedly came across someone with respiratory symptoms who had travelled to an affected region. Generally, the coronavirus appears to be hitting older people hardest, with few cases in children.
A new coronavirus outbreak, which originated in the Chinese city of Wuhan and has spread throughout Asia and globally, has prompted people around the world to buy medical face masks in hopes of preventing infection.
Retailers in the U.S. and across the Internet are running out of antiviral face masks as the number of confirmed cases of the coronavirus (2019-nCoV) now exceeds 9,700 globally. More than 200 people have died from the virus in China, where the majority of the 2019-nCoV cases have been detected. The World Health Organization declared a global health emergency on Thursday as the outbreak continues to spread. As of Friday morning, the United Kingdom and Russia had both confirmed their first cases of the viral infection.
Local government officials in Wuhan have required that people wear face masks when they go out in public places to prevent the spread of infection. Health experts tell TIME that such a move is probably effective in the city, where a person is more likely to come in contact with someone who is infected than in other parts of the world.
But in the U.S., where just six cases of the coronavirus have so far been detected, wearing face masks will not be that effective, experts say. That’s largely because, according to public health workers, there is no sustained person-to-person transmission of the new coronavirus in the U.S., making face masks not yet necessary.
“People believe wearing masks will protect them against a novel organism they’re scared about,” says Saskia Popescu, a senior infection prevention epidemiologist at a private healthcare system in Phoenix, Ariz. “I understand the fear, but the U.S. is at a very low risk for this right now.”
Here’s what to know about using face masks in connection with the new coronavirus.
What does the CDC say about using face masks?
The Centers for Disease Control and Prevention (CDC) does not currently recommend that people in the U.S. wear face masks in public to prevent infection. Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, told reporters during a press call on Thursday that the best preventative measures include washing hands and covering coughs.
The CDC has issued guidelines on two different kinds of face masks — surgical masks and N95 respirators — which are commonly worn by health care professionals and those who are already sick.
Typical surgical masks usually found at pharmacies (and which were sold out on Amazon and other e-tailers as of Friday) are approved by the U.S. Food and Drug Administration to protect the wearer against large droplets or splashes of bodily and infected fluids from others, according to the CDC.
Wearing surgical masks does not prevent a person from inhaling smaller airborne particles; they are not considered respiratory protection by the CDC. Surgical masks are also loose fitting, and when the wearer inhales, there is potential for particles to leak in or out of the sides.
Extracted from: https://time.com/5774521/coronavirus-face-mask-prevention/
As China’s epidemic continues to spread, things may seem scary. Here are ten simple precautions that can protect you from contracting the coronavirus.
1. When you leave your home, wear gloves—winter mittens or outdoor gloves—and keep them on in subways, buses, and public spaces.
2. If you are in a social situation where you should remove your gloves, perhaps to shake hands or dine, do not touch your face or eyes, no matter how much something itches. Keep your hands away from contact with your face. And before you put your gloves back on, wash your hands thoroughly with soap and warm water, scrubbing the fingers. Put your gloves on.
3. Change gloves daily, washing them thoroughly, and avoid wearing damp gloves.
4. Masks are useless when worn outdoors and may not be very helpful even indoors. Most masks deteriorate after one or two wearings. Using the same mask day after day is worse than useless—it’s disgusting, as the contents of your mouth and nose eventually coat the inside of the mask with a smelly veneer that is attractive to bacteria. I rarely wear a face mask in an epidemic, and I have been in more than 30 outbreaks. Instead, I stay away from crowds, and I keep my distance from individual people—a half meter, about 1.5 feet, is a good standard. If someone is coughing or sneezing, I ask them to put on a mask—to protect me from their potentially contaminated fluids. If they decline, I step a meter (about 3 feet) away from them, or I leave. Don’t shake hands or hug people—politely beg off, saying it’s better for both of you not to come in close contact during an epidemic.
5. Inside your household, remove all of the towels from your bathrooms and kitchen immediately, and replace them with clean towels that have the names of each family member on them. Instruct everybody in your home to only use their own towels and never touch another family member’s. Wash all towels twice a week. Damp towels provide terrific homes for viruses, like common colds, flus, and, yes, coronaviruses.
6. Be careful with doorknobs. If it’s possible to open and close doors using your elbows or shoulders, do so. Wear gloves to turn a doorknob—or wash your hands after touching it. If anybody in your home takes sick, wash your doorknobs regularly. Similarly, be cautious with stairway banisters, desktops, cell phones, toys, laptops—any objects that are hand-held. As long as you handle only your own personal objects, you will be ok—but if you need to pick up someone else’s cell phone or cooking tools or use someone else’s computer keyboard, be mindful of not touching your face and wash your hands immediately after touching the object.
7. If you share meals, do not use your personal chopsticks and utensils to remove food from a serving bowl or plate and, of course, tell your children to never drink out of anybody else’s cups or from a container of shared fluid. It is customary in China to prepare several dishes for a meal and then allow everybody at the table to use their personal chopsticks to pull food from the common dishes: Don’t do this until the epidemic is over. Place serving spoons in each dish and instruct everybody at the table to scoop what they want from the serving dishes onto their personal plates or bowls, return the serving spoon to the main dish, and then use their personal chopsticks only to pick food from their personal plate or bowl into their mouth. Wash all food and kitchenware thoroughly between meals and avoid restaurants that have poor hygiene practices.
8. Absolutely do not buy, slaughter, or consume any live animal or fish until it is known what species was the source of the virus.
9. When the weather allows, open your windows at home or work, letting your space air out. The virus cannot linger in a well-ventilated space. But of course, if it is cold or the weather is inclement, keep warm and close those windows.
10. Finally, if you are caring for a friend or family member who is running a fever, always wear a tight-fitting mask when you are near them, and place one on the ailing person (unless they are nauseated). When you replace an old, dirty mask from the face of your friend or loved one be very, very careful—assume, for the sake of your protection, that it is covered in viruses, and handle it while wearing latex gloves, place it inside of a disposable container, seal it, and then put it in the trash. While wearing those latex gloves, gently wash the patient’s face with warm soap and water, using a disposable paper towel or cotton swab, and seal it after use in a container or plastic bag before placing it in your household trash. Wear long-sleeved shirts and clothing that covers your body when you are caring for your ailing friend or relative. Clean everything your patient wears or touches very thoroughly in hot soapy water, including sheets, towels, and utensils. If you have space, isolate the sick person in your household in a room, or a corner of a room, where they are comfortable, but separated from the rest of the household. If the weather is tolerable, open a window that is on the opposite side of the room, so that air gently blows past the patient’s face and then outdoors. Of course, don’t do this if it is very cold, as your friend or loved one will be made sicker if uncomfortably cold.
The Chinese government will take very drastic actions over the next few weeks, and this will be a time of hardship for the Chinese people. As the virus spreads in other countries, similarly draconian measures may be invoked to slow the epidemic. But with these simple precautions, if taken by everybody in your household, building, office, and school, you will dramatically reduce the spread of the virus and bring the outbreak to its knees.
Be safe. Do not panic. Take common sense precautions. As frightening as this time is, you will get through it.
Extracted from FP, author : Laurie Garrett
Drinking tea at least three times a week could reduce the risk of dying from cardiovascular disease and is linked with a longer and healthier life, at least in China, a new study suggests.
Black vs. green
LOOKING AFTER YOURSELF
|Take Care of Your Health
|Do Things You Enjoy
|Take a Break from Caregiving
|Remain Socially Connected
|Practise Mindfulness and Meditation
|Seek Professional Help
When caregivers are consumed in their role, they find it difficult to spare time or effort for other matters. Some caregivers may feel that it is easier to stay at home or that they are unable to leave their loved ones. Spending time away from home is only for running of errands or attending doctor’s appointment. There might be lack of understanding from friends and family on what caregivers like you are going through. Over time, you may withdraw from socialising with others, resulting in an isolating and lonely experience.
There are people in similar situations experiencing and feeling the same way as you do. Support groups offer a safe and comfortable platform for you to meet such people and share your experiences. You will get to learn new caregiving tips and know useful resources. Not only will you be getting help, but you will also be able to help others. Such interaction can provide emotional suppot, allow better stress management and reduce sense of frustration and isolation in caregivers. The support groups are usually facilitated by professionals such as social workers or counsellors, though there are some peer-led groups as well.
Support Groups by Hospital and Specialist Centre
- Khoo Teck Phuat Hospital
- Changi General Hospital
- National University Hospital
- Singapore General Hospital
- National Neroscience Institute (NNI)
- National Cancer Centre Singapore
- Institute of Mental Health
Support groups in the Community
- Alzheimer’s Disease Association
- Caregiving Welfare Association
- Caregiver Alliance Limited
- Club Heal
- Singapore Cancer Society (SCS)
- Singapore Heart Foundation
- Singapore National Stroke Association
- Heath Hub
Online Support Groups
Support groups can exist in virtual forms as well, such as online forums and social media platforms. Such platforms allow you to be part of a network of fellow caregivers, locally or internationally, without having to go down to a physical location. If you do not have the time, feel unwell, or prefer to maintain a degree of privacy when sharing your personal thoughts and feelings, online support groups may benefit you.
You can search online for such support group or ask other fellow caregivers to introduce you to some groups. Alternatively, below are some online communities you can check out on Facebook:
- AWWA Caregiver Connect
- Caregiver and the Elderly
- Chronic Obstructive Pulmonary Disease Association (Singapore)
- Diabetic Society of Singapore
- Life after stroke in Singapore
- PH Singapore (for pulmonary hypertension patients and caregivers)
- Singapore Association for Mental Health
- Singapore Liver Cancer Support Group
- Society for Continence (Singapore)
If you would like to address your challenges on a more personal level, you can seek counselling support from professionals. They can help you to understand and deal with your issues and emotions better.
Extracted from AIC Singapore
Linda Loh remembers a time when her 85-year-old mother used to be a “very nice person”.
As the tantrums began, at first the family put this down to Mdm Lee Sui Yee’s old age – but then, nothing seemed acceptable to her. “I’d talk to her, but she’d say that I never listen to her,” said her daughter.
“I’d try to cool myself down … just walk into the kitchen and stay away from her. But she’d also scold me for not staying and talking to her.”
An irritable Mdm Lee would especially be worked up about noise, such as a child crying or anybody talking loudly.
When she had a fall and was admitted to hospital in July 2016, the family found out the truth.
After she shouted at the nurses, struggled with them and, at one stage, talked about committing suicide – which she nearly did by trying to strangle herself – she was diagnosed with an episode of Major Depressive Disorder.
And her recovery has been slow. She would rather lie around at home, quietly and listlessly, than move about to improve her mood and blood circulation.
“Last time, she liked to listen to music – her operas. Now she never even asks me to turn on the TV for her,” sighed her daughter.
One in five elderly persons in Singapore aged 75 and above show signs of depression, according to the Singapore Longitudinal Ageing Study in 2012 by the National University of Singapore’s Yong Loo Lin School of Medicine.
And depression among the elderly has its own set of challenges, as seen in the documentary Facing Depression.
In cases like Mdm Lee’s, depressive mood swings are related to other health issues, like limited mobility and senile dementia, as well as loneliness and financial anxiety.
FROM PSYCHOLOGICAL TO PHYSICAL
Among the elderly with dementia, it is “very common” for depressive features to be present, said Dr Chris Tsoi, a consultant at the National University Hospital’s Department of Psychological Medicine. “The other way round is also true,” he added.
“All the brain functions are somewhat linked … Emotion will affect memory; memory itself will affect emotion. So when the memory function isn’t that good or tends to remember sad things, (the elderly) tend to be sadder.”
Mdm Lee was diagnosed with dementia in 2016, before her depressive episode. Previously she was “quite independent”, but that changed after she had a stroke and subsequent loss .
After she was discharged from hospital following her fall, she stayed with granddaughter Brenda Loh. But she got more confused, and even wanted to chase Ms Loh out of her own home.
With a change in environment, a patient like Mdm Lee would not have the “usual cues” needed to keep her brain “functioning normally”, Dr Tsoi explained. “The degeneration would be much faster, and the depression can hardly be treated.”
There can be a physical impact too. Said Dr Tsoi:
We have sufficient data to show that depression also could lead to heart disease and other physical problems, even stroke.
In the case of 70-year-old Stanley Seah, depression was diagnosed after he discovered that he had multiple medical conditions, namely high blood pressure, high cholesterol and diabetes.
But that was only the start: His depression worsened when his wife was diagnosed with a terminal illness.
FROM LOSS TO LONELINESS
The first sign of her failing health was jaundice. It turned out to be a symptom of pancreatic cancer, which eventually spread to her stomach and lungs. Soon after, she required hospice care.
Dover Park Hospice senior medical social worker Sally Gui, who worked with the couple, recalled that Mr Seah looked “quite down most of the time because of the wife’s condition”.
His already vulnerable mind was in a state of confusion. “I couldn’t concentrate on anything,” he shared. “Sometimes it was very hard to fall asleep. I kept rolling in bed until two or three o’clock before I could sleep.”
His wife of 30 years died last July. And he could not stop thinking of her.
I once cried for three days. The pain feels like a knife poking my heart. It hurts a lot.
Dr Tsoi said such a loss is “the most devastating” for elderly patients who had been married for a long time.
He added: “For them, it would be much more stressful than for a younger age group to adapt, both emotionally and socially.”
The NUS’ Singapore Longitudinal Ageing Study in 2004 found that widowed or divorced persons above 65 were more likely to experience depression (22 per cent) than widowed or divorced persons between the ages of 55 and 65 (13 per cent).
This series of studies also found that seniors living alone were twice as likely as their peers to develop depressive symptoms.
And their numbers are rising: The Department of Statistics estimates that 83,000 elderly persons will be living alone by 2030, compared with the 47,000 seniors aged 65 and above in 2016.
Mr Seah, who has no children, is now one of them. Mdm Lee, too, was living alone before she fell ill, since her husband died 14 years ago. Initially, however, she could count on her large family.
“At that time, I had another aunty, also about the same age as her,” said Mdm Loh, one of six children. “They’d go to find good food and go shopping together. After my aunty passed away, she felt lonelier.”
With the rest of the family having their own commitments, “they didn’t have much time for her”, admitted Mdm Loh. “She’d feel sad, but she never spoke out.”
TIP OF THE ICEBERG
As loneliness and physical illness gnawed away at Mdm Lee, her depression was compounded by worry that her hospital and medical bills would be a burden on her children.
Her daughter thinks this became the main issue. “She was full of fears. She felt that she was so helpless and hopeless.”
Concern for a family member is weighing on Mr Seah too, even as he tries to get over his wife’s death. His sister is mentally unstable and also lives alone. He calls her daily to check on her.
Whenever I call her, she’d say the words ‘I want to commit suicide’. That makes me worried.
The warning signs of suicide in the depressed elderly include unrelenting low mood; anxiety and psychic pain; loss of interest; and sleep problems, among others.
Mr Seah himself was referred to community counsellors when Dover Park Hospice predicted that there might be “some difficult bereavement issues”, said Ms Gui. It hoped to prevent a difficult situation from arising after his wife’s death.
As the widower put it – and others could see – the couple were “very close”. It still shows, from the way he dusts their photo frames lovingly and from the tears that flow when he looks at their photo albums.
“When she was sick, I looked after her. When I was sick, she looked after me. But I did the cooking because her legs were weak,” said Mr Seah, who spent the final two months with her in the hospice.
Recalling her last days, he said forlornly:
I stayed (by her side) four days and four nights. She didn’t pass away. I went out for two hours. She passed away. I was heartbroken.
While he has been getting the help he needs, that may not be so for the majority of depressed seniors.
In the Yong Loo Lin School of Medicine’s Community-based Early Psychiatric Intervention Strategy (2008), about 12 per cent of seniors who had depressive symptoms sought professional help, while 75 per cent did not see themselves as having a mental disorder.
Dr Tsoi is now seeing more cases of depressed seniors, roughly an increase of 5 per cent a year. But he believes this is still an underestimation.
“The reason is depression is such a taboo (subject) in the population,” he said. “Despite the increase, what we’re seeing now is just the tip of the iceberg.”
ALL HAVE VITAL ROLES TO PLAY
The consequences of depression are felt not only by the elderly but also their loved ones – for example 61-year-old Mdm Loh, who quit her job as a kitchen assistant in 2016 to be her mother’s main carer.
She felt “so helpless” in the beginning. “I didn’t even know how to comfort her,” she said. “My heart was aching.”
And then there is her mother’s full schedule of check-ups. “She doesn’t like to wait in the clinic for too long. It’s quite stressful for me, but I don’t really show it,” Mdm Loh said. “I just take it easy.”
When she could not cope, however, the family had to engage a domestic helper. But things did not get easier, as her mother was unhappy with the help.
“Everything the maid did … wasn’t up to her standard,” Mdm Loh explained, citing her mother’s expectations for cooking in particular. “I had to juggle my mum and the maid. It was so tiring for me.”
But she knows she must be positive and try her best. As Dr Tsoi noted, her role is vital to her mother getting back to her usual self.
“If the caregiver can’t tolerate the stress of going through difficulty, most likely the patient will end up in an old folks’ home,” he said.
To help these families, the NUH has the Geriatric Psychiatry Out-Reach Assessment, Consultation and Enablement (G-Race) programme, which provides home visit services for elderly patients with mobility issues.
An occupational therapist checks on Mdm Lee once every quarter – her mood, cognition and functional abilities – and engages her in various activities, such as flipping through a pack of cards showing various pictures.
“We’d like an activity that lets someone like Mdm Lee use her hands and coordination, but at the same time be happy that she has done something. And the mood will improve,” said principal occupational therapist Eng Jia Yen.
Mr Seah’s counsellor Berlinda Tan from Sage Counselling Centre also visits him in his three-room flat, once every three weeks.
“We believe that everyone has strengths, and so does Stanley,” she said. “When we affirm the strengths he has, it’ll change the way he perceives himself.”
Dr Tsoi noted that depression in old age is not inevitable, precisely because “it’s very much down to how a person perceives things – how their own experience can help them”.
Besides professional intervention, what he recommends to his elderly patients is to “engage with friends, go out more and talk to people more”.
All these help them to develop a lifestyle that’s against depression and memory loss.
At senior care centres, for example, with people available to help the elderly, there is “social pressure” to follow the activities, which they would not otherwise do at home.
NOT GIVING UP
But the first step is always the hardest. It took much persuading by Mr Seah’s counsellor before he agreed to join in the activities at one centre. Other agencies also proposed some activities, but he was not keen.
Even when his wife was alive, he saw himself as “somewhat like a lone ranger”. But Ms Tan would remind him that “there are always people around him who care for him, and community resources if he needs any help”.
Her efforts have paid off: After grieving alone for five months, he became more active, taking a liking especially to Carrom.
“It relieves some tension. I have to concentrate to shoot and all that,” said Mr Seah, who feels more happiness and “freedom” when he goes out nowadays.
He must stay on antidepressants, which help him to sleep. And he still does one other thing: Visit Dover Park Hospice. When he sees room 112, it reminds him of his wife. “It somewhat keeps her memory alive,” he said.
Knowing that grief manifests itself differently over time, Ms Gui said hopefully: “When he can cope with his grief and is feeling better, I suppose he won’t come back to this place so often.”
Mdm Lee, too, has made progress in the course of treatment. Ms Loh, one of her 16 grandchildren, observed: “She’s now calmer, and her mood is slightly better. She doesn’t throw her tantrums or scold people anyhow.”
She has also got used to the maid, recognising the value of her help in moving around. Mdm Lee herself may not speak much, but what she does say is indicative of her improvement.
“I’m too old to think too much. I don’t have to worry about money, so long as there’s a meal for another day,” she said in Cantonese to Dr Tsoi during one of her check-ups.
With her family’s constant encouragement, she is willing to be brought in her wheelchair to the neighbourhood park more often. And she can laugh at photos of her younger self.
Back in the day, she was a kitchen helper in a restaurant, and her daughter recalls how she worked hard for the family, “from morning till night”.
Etched in Mdm Loh’s memory is the difficult period in 1992 when her eldest daughter had leukaemia, and her mother took care of her family.
“She was so worried about me then. She helped to do the cooking, everything, for me, especially as my kids were quite young at that time,” Mdm Loh said gratefully.
“I never think of giving up on her, because I don’t want her to put up in an old folks’ home or nursing home. It’s my duty as a daughter, and also a way to repay her kindness.”
And she remembers the promise the family made to their father before he died: That they would “always take good care of mother”. She said: “I hope that my mum will stay healthy, to live a bit longer and happier.”
Where to find help:
Institute of Mental Health’s Helpline: 6389 2222
Samaritans of Singapore Hotline: 1800 221 4444
Singapore Association of Mental Health Helpline: 1800 283 7019
extracted from CNA