Articles

The Recipe for Healthy Ageing

 November 4, 2019

As you age, your metabolism starts to slow down and you will require less energy from food. It is important, therefore, to pack nutrient-dense foods into your everyday meals.

The recipe for healthy ageing starts with maintaining a healthy, balanced diet. Learn to get more from life with these easy-to-follow nutrition tips.

 

 

 

The silent heart attack you didn’t know you had – and how it could kill you

 October 29, 2019

When my Aunt Gert suffered a heart attack in her mid-70s, the examining doctor told her that it was not her first. Tests done to assess the damage to her heart revealed a section of dead muscle from a previous unrecognized heart attack. Sometime in the past, she had had what doctors call a “silent myocardial infarction,” or SMI, silent in that any symptoms she might have had at the time did not register as related to her heart and were not brought to medical attention.

My aunt was lucky. She survived her second heart attack and, by keeping cardiac risk factors under control, lived another two decades without further heart-related problems.

Aerial view of a pedestrian crossing

(Photo: Unsplash/Ryoji Iwata)

There are millions of people walking around in this country who, like my aunt, are oblivious to the fact that they have had an SMI and face an increased risk of having another, more obvious one that could cause severe heart damage and possibly death.

READ: Heart patients may benefit more from exercise than healthy people: Study

You might think a silent heart attack is better than a recognized one: “What you don’t know can’t hurt you.” Unfortunately, it can. Although knowing you’re at risk of a heart attack can be emotionally distressing, not knowing can have much more serious consequences, prompting you to continue living in ways that endanger the health of your heart and your life.

Although knowing you’re at risk of a heart attack can be emotionally distressing, not knowing can have much more serious consequences.

A recognised heart attack is a wake-up call to adopt medical and lifestyle measures that can minimise cardiac risk, like normalizing blood pressure and cholesterol levels, quitting smoking, losing weight if you’re overweight, getting regular exercise and controlling Type 2 diabetes. If diet and exercise are not sufficiently protective, there are now many medications that can help nature along.

Even without medication, if everyone at increased coronary risk adhered to a heart-healthy lifestyle, “the incidence of heart disease would be reduced by 80 per cent,” Dr Rekha Mankad, cardiologist and director of the Women’s Heart Center at the Mayo Clinic in Rochester, Minnesota, told me.

READ: Not too late to start again: What your exercise habits might say about how long you’ll live

Recent studies conducted in Iceland and Finland, which maintain excellent medical records on all citizens, have helped to determine how often SMIs occur and the long-term consequences associated with them. The findings, published in JAMA Cardiology last October, highlight the critical importance of not waiting until your heart sends a clear message that its life-sustaining ability has been compromised; instead, acknowledge the presence of coronary risk factors and take preventive measures to bring them under control before it’s too late.

Perhaps most revealing was the very thorough study conducted in Iceland among 935 men and women initially aged 67 to 93 who were followed for up to more than 13 years. When they enrolled in the study, each participant underwent a noninvasive test called cardiac magnetic resonance imaging that can most reliably show whether a silent heart attack had already occurred. Initially, 17 per cent were found to have had an SMI and 10 per cent had had a recognised attack.

After the first three years of follow-up, there was no difference in death rates between those who had an SMI and those who did not. The death rate in both groups was 3 per cent, significantly lower than the 9 per cent mortality rate among participants who had a recognized heart attack.

But as time went on, those with an SMI fared increasingly worse. By 10 years after their enrollment, half the participants with silent heart attacks had died, a death rate no different from that of men and women who entered the study with a history of a recognized heart attack.

Man dangling from a heart

(Photo: Unsplash/Nick Fewings)

While death was the most serious result following an SMI, there was also an elevated risk of developing congestive heart failure, which compromises the pumping ability of the heart. It leaves people increasingly short of breath and excessively fatigued. Legs swell, fluid collects around the heart, exercise tolerance is greatly reduced and patients are ultimately dependent on supplemental oxygen. Half of those who develop congestive heart failure die within five years of diagnosis, a death rate similar to some cancers.

The second recent study, published in JAMA Cardiology in July, involved autopsy findings among 5,869 men and women, average age 65, who had died suddenly in Northern Finland, where autopsies of such deaths are done automatically. Evidence of an SMI was apparent in 1,322 individuals who had no prior history of coronary artery disease. Furthermore, those who succumbed to sudden cardiac death during physical activity were more frequently found to have enlarged hearts, a sign of abnormal strain when hearts struggle to meet the body’s needs for oxygen and nutrients.

A silent heart attack is not always so silent, but its symptoms – mild chest discomfort, heartburn, nausea, shortness of breath – happen to lots of people and are typically attributed to other causes and not brought to medical attention

An enlarged heart by itself is a risk factor for sudden cardiac death, the authors noted, but when combined with heart muscle scars from a prior SMI, the prognosis is worse.

“Individuals with SMI were unaware of their disease and presumably did not limit their physical exertion when unrecognised symptoms occurred,” the authors from the University of Oulu in Finland and University of Miami Miller School of Medicine wrote. They suggested that a previously scarred heart can trigger abnormal heart rhythms and result in sudden death during exercise.

woman chilling on a gym ball

(Photo: Unsplash/Mr Lee)

“A silent heart attack is not always so silent, but its symptoms – mild chest discomfort, heartburn, nausea, shortness of breath – happen to lots of people and are typically attributed to other causes and not brought to medical attention,” Dr Robert O. Bonow, a cardiologist at Northwestern University Feinberg School of Medicine, told me. Women, whose symptoms are often vague, are especially unlikely to realise they are having a heart attack.

Screening large groups of people for evidence of an SMI is not economically or practically feasible at this time. Although an electrocardiogram, often done before surgery and sometimes by one’s personal physician, can show heart scarring in some people, “it is not as sensitive as a cardiac MRI that was used in the Iceland study,” Bonow said.

“While screening with cardiac MRI is not recommended, identification of risk factors certainly is,” he wrote in an editorial accompanying the Iceland study.

“It’s important for doctors to recognise people at risk and prescribe appropriate treatments to reduce that risk,” he said in an interview. “Although it’s human nature to ignore certain things until you have an event, adherence to preventive treatment can be lifesaving. In the United States, a heart attack is the leading cause of sudden death in people 65 and older.”

For people at high risk or who are suspected of having had a silent heart attack, doctors may recommend an imaging test, like a resting echocardiogram, nuclear stress test or, for people capable of exercise, an echocardiogram with a stress test, Mankad suggested. Intermittent testing of people with Type 2 diabetes, for example, might be advisable, she said.

People who feel younger are healthier than those who feel older, say experts

 

Not long ago, Stephanie Heller, a New Jersey realtor, was leaving her gym after a workout when she noticed a woman in the parking lot struggling to bend down. “I don’t know if she dropped something and had to pick it up, or if her shoe was untied,” Heller said, but she eagerly bounded over to help. The woman blamed old age for her incapacity, explaining that she was 70. But Heller was 71.

“This woman felt every bit her age,” she recalled. “I don’t let age stop me. I think it’s a mindset, really.”

Each of us has a chronological age, the number we commemorate on birthdays. But some 50-, 60- and 70-year-olds look and feel youthful, while others do not. Scientists can measure these differences by looking at age-related biomarkers – things like skin elasticity, blood pressure, lung capacity and grip strength. People with a healthy lifestyle and living conditions and a fortunate genetic inheritance tend to score “younger” on these assessments and are said to have a lower “biological age.”

An older lady

(Photo: Unsplash/BBH)

But there’s a much easier way to determine the shape people are in. It’s called “subjective age.”

Scientists are finding that people who feel younger than their chronological age are typically healthier and more psychologically resilient than those who feel older.

When scientists ask: “How old do you feel, most of the time?” the answer tends to reflect the state of people’s physical and mental health. “This simple question seems to be particularly powerful,” says Antonio Terracciano, a professor of geriatrics at Florida State University College of Medicine in Tallahassee.

READ: Stroke can happen at any age – how to recognise the signs and what to do

Scientists are finding that people who feel younger than their chronological age are typically healthier and more psychologically resilient than those who feel older. They perform better on memory tasks and are at lower risk of cognitive decline. In a study published in 2018, a team of South Korean researchers scanned the brains of 68 healthy older adults and found that those who felt younger than their age had thicker brain matter and had endured less age-related deterioration. By contrast, people who feel older than their chronological age are more at risk for hospitalization, dementia and death.

“We have found many, many predictive associations,” says Yannick Stephan, an assistant professor of health and aging psychology at the University of Montpellier in France who has been at the forefront of subjective age research.

If you’re over 40, chances are you feel younger than your driver’s license suggests. Some 80 per cent of people do, according to Stephan. A small fraction of people – fewer than 10 per cent – feel older. The discrepancy between felt and actual age increases with the years, Terracciano said. At age 50, people may feel about five years, or 10 per cent, younger, but by the time they’re 70 they may feel 15 per cent or even 20 per cent younger.

Most of the research on subjective age is based on associations between how old people feel and their health status, so it cannot establish cause and effect. It’s not clear, for example, whether feeling younger actually makes people healthier, or whether people who are already healthy tend to feel younger. But by simply asking people how old they feel, Stephan says, doctors might be able to identify who is most at risk for health problems.

A youthful frame of mind can have a powerful effect.

For Francisca Mercado-Ruiz of South Plainfield, New Jersey, getting healthier transformed her internal sense of age. In the months leading up to her 49th birthday last December, she fulfilled her goal of losing 49 pounds. Before the weight loss, she had back and hip pain and felt like she was 65. Now she’s off her blood pressure medication, full of energy, has few aches and says she feels 35.

An old lady who looks young

(Photo: Unsplash/Paul Stickman)

A few intriguing studies suggest that a youthful frame of mind can have a powerful effect. When scientists trick older people into feeling younger, most tend to instantly become more capable. In a 2013 experiment by Stephan and colleagues, for example, people’s grip strength significantly improved after they were told that they were stronger than most people their age. A Chinese study published last November in the journal Aging & Mental Health found that people performed better on a memory task after being told they were sharper than others their age.

READ: Got an older dog? Here’s how to keep it vibrant, happy and healthy

Whether these findings translate into real-world situations, however, is uncertain. In a 2018 German study, investigators asked people in their 60s, 70s and early 80s how old they felt, then measured their walking speed in two settings. Participants walked 20 feet in the laboratory while being observed and timed. They also wore belts containing an accelerometer while out and about in their daily lives. Those who reported feeling younger tended to walk faster during the lab assessment. But feeling younger had no impact on their walking speed in real life. Instead, the researchers found, the ones who walked faster were those who walked the most.

Close up on NUMBERS

(Photo: Unsplash/Nick Hillier)

What makes subjective age such a powerful predictor? Stephan believes that people possess intuitive information about their physical abilities, mental sharpness and emotional stability, all of which gets distilled into a single meaningful number.

In cultures where elders are respected for their wisdom and experience, people don’t even understand the concept of subjective age.

But critics assert that for many, subjective age simply reflects cultural obsessions with youth. People cultivate a younger identity to fend off stereotypes of frailty and senility, said David Weiss, a life span psychologist at the University of Leipzig. “If old age weren’t negatively valued, you wouldn’t have the need to say that you feel younger,” he said.

Indeed, in cultures where elders are respected for their wisdom and experience, people don’t even understand the concept of subjective age, he said. When a graduate student of Weiss’s did research in Jordan, the people he spoke with “would say, ‘I’m 80. I don’t know what you mean by ‘How old do I feel?’”

Close up of an OLD WOMAN

(Photo: Unsplash/Ursula Spaulding)

Paradoxically, older people may hold warm feelings for their generation even as they feel distaste for people their age. In a 2012 experiment, Weiss and a colleague divided 104 people aged 65 to 88 into two groups. Everyone had to complete five sentences, but one group was asked to describe people their age, while the other was asked about their generation.

The first group wrote things like “People of my age are afraid and worry about the future” and “People of my age often talk about their illnesses.” The generation-oriented group displayed a stronger sense of empowerment and meaning. They wrote things like “People of my generation were the 68ers who founded a more civil society,” a reference to the student protest movements of the late 1960s, and “People of my generation should pass on their life experience to the youth.” One way to combat internalized ageism, Weiss suggests, is to identify with one’s generation.

A similar feeling of shared purpose and belonging is what keeps Thomas W. Dortch Jr., 69, an Atlanta businessman and philanthropist, vibrant. People take him for being in his early 50s when they first meet him, and he says he feels like he’s in his early 40s.

“All my young staff and volunteers ask, where do you get all your energy?” Dortch said. He was mentored by African-American luminaries like the former United Nations Ambassador Andrew Young and the former Atlanta mayor, Maynard Jackson, Jr. Today, as national chairman of the organization 100 Black Men of America, he nurtures the next generation of black leaders. “I’ve been focused all my life on being engaged and working to make sure that life is better for future generations,” he said. “I can never be too tired to make a difference.”

Whatever their stance on subjective age, experts agree that everyone ages differently and that people do have some control. Healthy habits, including eating well and exercising, can keep age-related deterioration at bay. Just as important is keeping a positive attitude. Internalized ageism can worsen not just people’s outlook but their health. Experts urge that people recognize not just the losses associated with ageing but also the gains, which are significant.

As we age, we tend to become generally happier and more satisfied, said Dr. Tracey Gendron, a gerontologist at Virginia Commonwealth University who questions the whole notion of subjective age research. Let’s say someone who is 60 says they feel 45, Gendron said. What does that actually mean? Clearly, they don’t feel how they did 15 years earlier, because people constantly mature and change. So whose 45 do they feel?

In 2017, Gendron published a paper suggesting that the study of subjective age may be inherently unethical. “I think we have to ask ourselves the question, are we feeding the larger narrative of aging as decline by asking that question?” she said. “Older age is a time that we can actually look forward to. People really just enjoy themselves more and are at peace with who they are. I would love for everyone to say their age at every year and celebrate it.”

Extracted from CNA lifestyle

How salty food, work stress and soft drinks can lead to a broken hip

 October 23, 2019

Osteoporosis Awareness Month isn’t just for the older folk – doctors are seeing more young people with osteoporosis, thanks to unhealthy lifestyle choices. Here’s how you can minimise the risk.

Salty food can affect the way your body uses calcium to build strong bones. (Photo: Unsplash / Fabio Alves)


If you’re in your 30s or 40s, you probably think the chances of breaking your bones are low because osteoporosis only comes later in life, when you’re starting to become incontinent and frail with age.

And the good news – for you at least – is that you’re right.

According to Dr Chionh Siok Bee, senior consultant with National University Hospital’s Division of Endocrinology, the risks pick up for those in their 50s – a one-in-three lifetime risk of a fragility fracture for women, and one in five for men.

Photo of handicap sign painted on the road

The osteoporosis rate keeps climbing with age for both genders. (Photo: Pixabay)

The bad news? You’re not immune to osteoporosis. “We are seeing younger patients with osteoporosis due to a generally more sedentary lifestyle and higher frequency of partially lifestyle-linked diseases like diabetes, breast cancer and other cancers,” said Dr Chionh, who’s also president of the Osteoporosis Society (Singapore).

READ: How to reduce the risk of a recurrence after recovering from a hip fracture

She added that younger men and women may also have brittle bones if they have rheumatoid arthritis or hyperthyroidism. “Some common medications, such as the anti-gastric omeprazole, can also contribute to bone loss.”

Roughly beyond the age of 30, bone mass gradually decreases.

What’s even more worrying is that many people aren’t even aware they may have it – because there are no symptoms until one actually sustains a fracture, said Dr Ramesh Subramaniam, an orthopaedic surgeon at Mount Elizabeth Hospital.

Rubber bone

Your bones are a living structure and continue to be broken down and rebuilt bit by bit throughout your life. (Photo: Unsplash)

So when should one start to think about osteoporosis and bone health? The sooner, the better.

According to Dr Subramaniam, your body reaches peak bone mass – the maximum amount of bone you’ll have in your lifetime – in your early 20s if you’re female, and late 20s if you’re male. “After that, or roughly beyond the age of 30, bone mass gradually decreases,” he said.

READ: Knuckle cracking: It’s annoying to others but can it also cause arthritis?

Dr Chionh added: “If there is inadequate exercise or a period of immobility caused by illness, substantial amounts of bone can be lost. If there is a gross inadequate intake or absorption of calcium, the body will actually take calcium out from the bones to keep the blood calcium level normal.” Calcium in the blood is necessary for our well-being and also helps with functions such as clotting.

We are seeing younger patients with osteoporosis due to a generally more sedentary lifestyle and higher frequency of partially lifestyle-linked diseases like diabetes, breast cancer and other cancers.

If there’s at least one thing many of us know about osteoporosis, it’s that one’s calcium intake is very important. The catch is that some of our everyday activities have an effect on the amount of calcium in our body, which might make you prone to osteoporosis later on. Are you guilty of these scenarios?

  • YOU ACCOMPANY EACH MEAL WITH A SOFT DRINK

They’re not only sugar bombs, drinking a lot of soft drinks has also been attributed to lower bone mineral density at the hip joint in some studies, pointed out Dr Subramaniam. The bone-robbing factor is phosphorus, which is found in high amounts in some soft drinks. “This leads to an imbalance between phosphorus and calcium levels in the body. Many cola beverages also contain caffeine, which is known to contribute to increased calcium excretion.”

Bottled soft drinks

You’re less likely to drink milk if you drink soft drinks, provided you’re not avoiding milk because you are lactose intolerant. (Photo: Unsplash)

Furthermore, studies on fluid consumption trends have found that you’re less likely to drink milk if you drink soft drinks – provided you’re not avoiding milk because you are lactose intolerant.

  • YOU DRINK ALCOHOL – SOMETIMES A LITTLE TOO MUCH

Alcohol interferes with your body’s absorption of calcium and the action of Vitamin D, said Dr Chionh. “It’s a toxic substance that kills osteoblasts (bone formation cells). It also damages the nerves that control balance and prevents a person from falling. It disrupts hormones, particularly oestrogen, that control bone health, too.”

Glasses with white wine toasting

Alcohol is toxic to osteoblasts, which are bone formation cells. (Photo: Unsplash)

Not only that, Dr Subramaniam said that women with “chronic alcohol intake can trigger irregular menstrual cycles, a factor that reduces oestrogen levels and increases the risk for osteoporosis”. Men who drink excessively may produce less testosterone, a hormone linked to the production of osteoblasts.

READ: Can low-impact sports like cycling put your bones at risk?

So, how much alcohol is too much? For the sake of your bone health, keep it to not more than 2 units of alcohol per day for an adult male, said Dr Subramaniam. One unit of alcohol translates to a half pint of beer, one standard pour of hard liquor, or half a glass of wine.

  • YOU REALLY LIKE SALTY FOOD

You love to give your sashimi a good dunking in soya sauce. You won’t say no to bacon or a cold cut platter. And you sure won’t turn down a supper of Teochew porridge and its accompanying dishes of salted and preserved food.

Man holding a tray of sushi and soy sauce

A high intake of sodium is correlated with the mobilisation of calcium stores from the bones. (Photo: Unsplash)

But you might want to hold back. “Sodium directly or indirectly influences renal re-absorption of calcium, and results in increased calcium excretion,” said Dr Subramaniam. “This is correlated with the mobilisation of calcium stores from the bones.”

It is recommended not to exceed sodium intake of 2.3g per day, which is about one teaspoon of salt. “The American Heart Association is moving towards recommending an ideal limit of 1.5g per day,” said Dr Subramaniam.

  • YOU’RE A SMOKER

Nicotine and other toxic substances in cigarettes can damage bones in many ways, said Dr Subramaniam. Among them, smoking can reduce the blood supply to bones, slow the production of osteoblasts, decrease the absorption of calcium from your diet, and in women, break down bone-essential oestrogen in the body, he said.

This major risk factor of osteoporosis has no safe minimum, said Dr Chionh. “It is estimated that smoking contributes to one eighth of all hip fractures.”

A no-smoking sign in the city

Smoking can reduce the blood supply to bones, slow the production of osteoblasts, and decrease the absorption of calcium from your diet. (Photo: Unsplash)
  • YOU’RE STRESSED

Cortisol, the hormone produced by your body when you’re stressed, is known to decrease bone formation and increase bone breakdown. When you’re rushing to finish a report at work, for instance, your body’s hypothalamic-pituitary-adrenal (HPA) axis and the sympathomedullary (SAM) pathways are activated by cortisol.

“In chronic stress, the HPA-axis becomes dysregulated and results in suppressing the secretion of gonadal hormones and growth hormones,” said Dr Subramaniam. This increases inflammation levels in the body, which inhibit bone formation and eventually lead to bone loss.

Extracted from CNN

 

To have a long life, the 10 years from 70 to 79 years are crucial!!

 

Israeli scholars have found that there are around two health problems per month for people between the ages of 70 and 79. Surprisingly, the health status of the elderly aged 80-89 is as stable as the 60-69 age group!

70-79 years is a dangerous period. During this period, various organs decline rapidly. It is a frequent period of various geriatric diseases, and it is often prone to hyperlipemia, arteriosclerosis, hypertension, and diabetes.

After entering the age of 80, these diseases will decline, and the mental and physical health may return to the level of 60-69 years olds!

Thus, the age of 70 to 79 years old is called the “dangerous age group”. As people grow older many people want to have a good healthy life. They realise that “Health is Wealth”.

The 10-year health care of 70 to 79 years olds is crucial.

Here are some simple steps called
“Doing ten ones every day”

This will help you to navigate more smoothly through the “dangerous age group” stage of your life.

When the elderly are 70 to 79 years old, they may wish to do these “ten ones” every day. Here are the 10 tips:

 1.    a pot of water

Water is “the best and cheapest health drink”.
You must drink a glass of water during the following  three times/occasions each day:

First cup:
After getting out of bed, you can drink a glass of water on an empty stomach.

Because of our invisible sweating and urine secretion during sleep, we lose a lot of water. Even if we don’t feel thirsty after getting up, the body liquids will still be thick due to lack of water. Therefore, after getting out of bed, you must slowly add water as soon as possible.

Second cup:
A glass of water after exercise

The right amount of exercise is one of the cornerstones of longevity, especially for the elderly, and more attention should be paid to effective and reasonable exercise. However, after exercise, special attention should be paid to replenishing water. During exercise, sweat takes away electrolytes and consumes more energy. If you don’t pay attention, it is prone to hypoglycemia after exercise, and even cause syncope. Therefore, after the exercise, it is recommended that the old people drink water to which a small pinch of salt and sugar can be added and dissolved if you wish.

Third cup:
a glass of water before going to bed….

When people are asleep, sweat glands are still draining water. When the body’s water is reduced too much, the blood viscosity is increased. A cup of water before going to bed can effectively reduce the blood viscosity and may even slow down the appearance of aging. Helps against Angina, myocardial infarction and other diseases.

2.   a bowl of porridge

If you feel sick, drink a bowl of porridge! Wang Shixiong, a famous medical scientist in the Qing Dynasty, called porridge “the first complement of the world” in his book.

China Daily Online published a 14-year study conducted by Harvard University on 100,000 people. It found that a bowl of about 28 grams of whole grain cereal porridge per day can reduce mortality by 9% and reduce the chance of getting cardiovascular diseases.

Each volunteer was in good physical condition when he participated in the study in 1984, but in the 2010 feedback survey, more than 26,000 volunteers had passed away.

It was found that those volunteers who regularly ate whole grains such as porridge, brown rice, corn and buckwheat seem to have avoided most diseases, especially heart diseases.

3.   a cup of milk

Milk is known as “white blood” and it is so to the human body. Its nutritional value is well known with a lot of calcium, fat and protein .

The recommended daily intake of milk and dairy products is 300 grams.

4.   an egg

Eggs can be said to be the most suitable food for human consumption. The body’s absorption rate of egg protein can be as high as 98%.!!

5.   an apple

Modern research believes that apples have the effects of lowering cholesterol, losing weight, preventing cancer, preventing aging, enhancing memory, and making the skin smooth and soft.

The health benefits of different colored apples are different:

Red apples have the effect of lowering blood lipids and softening blood vessels

Green apple has the effect of nourishing liver and detoxifying, and can fight depression, so it is more suitable for young people to eat.

Yellow apples have a good effect on protecting vision.

6.    an onion

The Onion has a very high nutritional value and has many functions, including helping to lower blood sugar, lowering cholesterol, preventing cancer, protecting cardiovascular and cerebrovascular diseases, and also anti- bacteria, preventing colds, and supplementing calcium and bones. Eat onions at least three or four times a week.

 7.   a piece of fish

Chinese Nutritionists have warned that “eating “four legs” is worse  than eating “two legs”, eating “two legs” is worse than eating “no legs.”

“Four legs” mainly refers to pigs, cattle, and mutton. Eating too much of these meats is not conducive to weight loss and lowering blood fat;

“Two legs” mainly refers to poultry such as chicken, duck, goose, etc., which are good meat foods;

“No legs” mainly refers to fish and various vegetables. The protein contained in fish is easily digested and absorbed. The amount of unsaturated fatty acids in the fat, especially polyunsaturated fatty acids, is relatively good for the body.

8.    Gentle walking

This has a magical anti-aging effect.  When adults walk (about 1 kilometre or less) regularly for more than 12 weeks, they will achieve the effect of correct posture and waist circumference, and the body becomes strong and not easily tired.

In addition, walking exercise is also beneficial to treat headache, back pain, shoulder pain, etc., and can promote sleep.

Experts believe that a 30-minute walk a day can get rid of the danger of “adult disease”. People who take 10,000 steps a day will have a lower chance of developing cardiovascular and cerebrovascular disease.

9.   a hobby

Having a hobby, whether it is raising flowers, raising birds, collecting stamps, fishing, or painting, singing, playing chess, and traveling, can help the elderly to maintain extensive contact with society and nature. This broadens the horizons of interest of the elderly. They will love and cherish life.

10.   good mood

Old people should maintain good emotions as these are extremely important to their health. Common chronic diseases which affect the elderly are closely related to the negative emotions of the elderly:

Many patients with coronary heart disease have angina and myocardial infarction due to stimulation of adverse emotions, resulting in sudden death;

“Bad” temper leads to high blood pressure. In prolonged and severe cases, this can cause stroke, heart failure, sudden death, etc.;

Negative Emotions such as anger, anxiety, and grief can cause blood sugar levels to rise, causing metabolic disorders in the body.

This shows how important it is to have a good mood!

Physical aging is a natural phenomenon, and it is the most sensible choice to fully devote yourself to life and to live the best every day!

MOH to grow aged care services to meet rising demand

 October 11, 2019

 

Singapore has sufficient capacity currently to meet demand for aged care, the Ministry of Health (MOH) said in a statement yesterday. But it will continue to grow services to cater to a greying nation.

In response to a Lien Foundation report which said the Government has not provided enough facilities or subsidies for the rapidly ageing population, the MOH said it is “on track to meeting our targets of 6,200 daycare places, 10,000 home care places and 17,000 nursing home beds by 2020”.

The report, released yesterday, gave the example of how referrals for daycare at one centre outnumbered the capacity nationwide. It also cited how the median waiting time for general daycare was about 20 days, while that for dementia care was about 35 days.

The study also found that more seniors are being cared for outside of hospitals and nursing homes – 14,000 people used subsidised home and centre-based services last year, up from 12,000 in 2016.

In contrast, the number of residents in subsidised nursing homes had remained stable at around 10,000 in the past two years, signalling a shift in the main mode of long-term care for seniors.

The Lien report stressed the importance of preventive care, citing how a rapidly greying Singapore could see the number of people aged 65 years and older doubling to a million by 2030.

  • Key findings of Lien Foundation’s aged care study

  • The Lien Foundation released a report yesterday on home and community care for seniors in Singapore. The study was based on responses from 103 individuals, including interviews with 50 non-profit and private-care provider representatives, government representatives, experts on ageing and caregivers.In it, the authors highlighted several areas the sector could focus on as more elderly folk opt to age at home rather than in hospitals and nursing homes.INCREASING CAPACITY The Ministry of Health (MOH) is expected to hit its target of 6,200 daycare places, 10,000 home care places and 17,000 nursing home beds by 2020. But even as MOH continues to grow capacity, question marks remain over whether the numbers will be sufficient.For example, the number of referrals by the Agency for Integrated Care was already at 7,800 for daycare services in 2015. Last year, the number of daycare places was reportedly 5,000.REDUCING COSTS Home care for a severely disabled person can cost as much as $3,100, while the median cost to stay in a voluntary welfare organisation nursing home is $2,100. Households which have a per capita monthly income of $2,601 and above do not qualify for subsidies. The study called for more help to lower costs and a cap on the fundraising burden for non-profit providers.

    Separately, the study found that MOH’s spending on long-term care rose significantly in recent years, hitting $800 million in 2016, which is $200 million more than in 2015. But the $800 million was only 8 per cent of the healthcare budget and 0.19 per cent of Singapore’s gross domestic product for the year. In comparison, developed nations in the Organisation for Economic Cooperation and Development spent an average of 1.4 per cent of their GDP on long-term care in 2014.

    MORE EXPERTISE

    There are currently about 11,000 workers in long-term care. The report, while taking into account MOH’s $24 million investment to attract talent, highlighted how Singapore needs to increase that number by at least 45 per cent, with the biggest demand for direct-care workers.

    MORE REGULATION IN ELDERCARE

    There are around 60 private providers, but only two are regulated. Unlike nursing homes and childcare centres, home and centre-based care is not licensed in Singapore. All providers that receive government funding are subject to certain mandatory service requirements stipulated by MOH.

It also cited key focus areas such as funding, capacity, affordability, manpower and regulation that the Government could look at to upgrade Singapore’s home and centre-based care services.

In its statement, MOH said the Community Networks for Seniors (CNS), which involve government bodies, voluntary welfare organisations and volunteers teaming up to visit seniors, were set up to help seniors age in place.

Silver Generation Ambassadors also reach out to seniors, linking them up with befriending services as well as social and healthcare support for the frail.

Under the umbrella of CNS, more than 360 neighbourhoods hold weekly active ageing programmes.

By the end of April this year, more than 7,000 seniors had had their eyes, teeth and hearing checked.

MOH said: “Going forward, we are reaching out to more community partners to make active ageing programmes and functional screening more accessible to seniors in the community.”

It said the ministry recognises the important role played by caregivers, and offers respite options from weekend care at 11 eldercare centres, to longer-term care from several days to a month at more than 40 nursing homes.

But it agrees that more can be done to help caregivers, and is working on more options and better support.

The Lien study also found that cost is a concern, pointing out that while the majority of people want to age and be cared for in the comfort of their own homes, rather than in institutions, the costs of community care can be considerable.

MOH replied that there is up to 80 per cent subsidy for seniors who qualify, and for those who still cannot afford such care, Medifund will step in. The Government has already increased its spending on the eldercare sector, from $1.3 billion in the four years from 2007 to $5.1 billion in the four years from 2012.

It has also committed $2 billion to support the proposed CareShield Life scheme, in premium subsidies for the long-term care insurance which pays at least $600 a month for those who are severely disabled.

MOH said it welcomed the Lien report and will study the views and ideas raised.

An author of the study, National University of Singapore (NUS) Associate Professor Elaine Ho, hopes that action can be taken sooner rather than later.

She co-authored the study with fellow NUS Associate Professor Shirlena Huang. Both are from the Geography Department and Social Service Research Centre.

She said: “If we want to be sustainable as an ageing society and age healthily and happily, we actually need to put in the steps now rather than wait for the demographic explosion to take place.”

Extracted from Straits times

Types of urinary incontinence

 October 4, 2019

Elderly Incontinence Care

For many people, taking a trip to the bathroom is an activity that they can easily delay. However, for the 13 million Americans suffering from urinary incontinence, holding it isn’t an option. Incontinence can occur at any age but is common in older adults. The National Association for Continence recently stated that one in every five Americans over 40 years old suffers from urgency, overactive bladder or frequency symptoms. In nursing homes, over 50 percent of the elderly residents have urinary incontinence. Incontinence is common especially when aging, but it’s not normal. Because it is common, people tend to accept it and keep quiet. In a recent research, it was discovered that more than half the total population of incontinent people don’t visit a health care provider. In case you or a loved one is suffering from incontinence, don’t feel embarrassed, you’re not alone. And it’s worth talking about with a professional because of how it can interfere with enjoying life, from travel and exercise to romance and social outings.

Treatment and Management

Treatment for elderly incontinence can include medications, behavioral therapy, medical devices, and surgery. Treatments can include scheduled bathroom trips, bladder training, pads, fluid and diet management, and pelvic floor muscles exercises (Kegels).

Get Help

In some cases, there may be physical impediments to taking care of a loved one with incontinence. A person with certain health conditions may require a home attendant to assist during some hours. Keep in mind that an incontinent loved one may not always remain at home and alternative living can sometimes be the best solution.

 

Urinary Incontinence in Older Adults

 

Urinary incontinence means a person leaks urine by accident. While it may happen to anyone, urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled. Talk to your healthcare provider about what you can do.

What happens in the body to cause bladder control problems? The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning.

Causes of Urinary Incontinence

Incontinence can happen for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation. Some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

  • Weak bladder muscles
  • Overactive bladder muscles
  • Weak pelvic floor muscles
  • Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease
  • Blockage from an enlarged prostate in men
  • Diseases such as arthritis that may make it difficult to get to the bath­room in time
  • Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.

Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:

  • Prostatitis—a painful inflammation of the prostate gland
  • Injury, or damage to nerves or muscles from surgery
  • An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia (BPH), a condition where the prostate grows as men age.

Diagnosis of Urinary Incontinence

The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:

  • Urine and blood tests
  • Tests that measure how well you empty your bladder

In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your family doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.

Types of Urinary Incontinence

There are different types of incontinence:

  • Stress incontinence occurs when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. It’s the most common type of bladder control problem in younger and middle-age women. It may begin around the time of menopause.
  • Urge incontinence happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
  • Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
  • Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

Treatment for Urinary Incontinence

Today, there are more treatments for urinary incontinence than ever be­fore. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.

Bladder control training may help you get better control of your bladder. Your doctor may suggest you try the following:

  • Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer. Learn more about pelvic floor exercises and how to do them.
  • Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
  • Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
  • Lifestyle changes may help with incontinence. Losing weight, quitting smoking, saying “no” to alcohol, drinking less caffeine (found in coffee, tea, and many sodas), preventing constipation and avoiding lifting heavy objects may help with incontinence. Choosing water instead of other drinks and limiting drinks before bedtime may also help.

Incontinence and Alzheimer’s Disease

People in the later stages of Alzheimer’s disease often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, or not being able to find the toilet. To minimize the chance of accidents, the caregiver can:

  • Avoid giving drinks like caffeinated coffee, tea, and sodas, which may increase urination. But don’t limit water.
  • Keep pathways clear and the bathroom clutter-free, with a light on at all times.
  • Make sure you provide regular bathroom breaks.
  • Supply underwear that is easy to get on and off.
  • Use absorbent underclothes for trips away from home.

For more ways to deal with incontinence and other common medical problems in someone with Alzheimer’s, visit Alzheimer’s Disease: Common Medical Problems.

Managing Urinary Incontinence

Besides bladder control training, you may want to talk with your doctor about other ways to help manage incontinence:

  • Medicines can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage.
  • Some women find that using an estrogen vaginal cream may help relieve stress or urge incontinence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.
  • A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This can reduce stress incontinence in women. This treatment may need to be repeated.
  • Some women may be able to use a medical device, such as a urethral insert, a small disposable device inserted into the urethra. A pessary, a stiff ring inserted into the vagina, may help prevent leaking if you have a prolapsed bladder or vagina.
  • Nerve stimulation, which sends mild electric current to the nerves around the bladder that help control urination, may be another option.
  • Surgery can sometimes improve or cure incontinence if it’s caused by a change in the position of the bladder or blockage due to an enlarged prostate.

Even after treatment, some people still leak urine from time to time. There are bladder control products and other solutions, including adult diapers, furniture pads, urine deodorizing pills, and special skin cleansers that may make leaking urine bother you a little less.

Extracted from National institute of aging

Staying active and healthy in the later years

 

If Singaporeans expect to live to 100, can they still afford to retire in their 60s?

The question was posed by Mr Wilf Blackburn, chief executive of Prudential Singapore, at the discussion on ageing: Who can afford to fund four decades of retirement?

The answer is, not many – but allowing people to work as long as they are able would help.

Last October, Prudential Singapore began letting their employees work beyond the age of 62 on their existing contracts.

“We recognise many people want to work in their 60s, 70s and 80s, and are able to perform,” he said.

According to the Ministry of Manpower, about one in four workers last year was aged 55 and older.

In this year’s National Day Rally last month, Prime Minister Lee Hsien Loong announced that the retirement age will be raised from 62 now, to 63 in 2022, and eventually to 65 by 2030. Meanwhile, the re-employment age will also be raised from 67 now, to 68 in 2022 and to 70 by 2030.

Older workers will also get help in building up their retirement funds, with their Central Provident Fund contribution rates set to rise.

But income is just one side of the coin. Most people are also concerned about their expenditure in their retirement years, especially on health care.

This includes insurance premiums, which are likely to go up when people use more healthcare services and make more claims with age.

To encourage prudent use of healthcare services, Mr Blackburn said claims-based pricing was adopted by Prudential a few years ago.

Under this pricing strategy, premiums for the Integrated Shield plan rider for private hospitals are lower for those who do not make claims.

He added that more than 80 per cent of Prudential Singapore’s clients now benefit from a discount of 20 per cent because of this pricing method, which he said was similar to the no-claim discount approach for motor insurance.

In response to the joke that one can afford to die but not afford to be sick in Singapore, Senior Minister of State for Health Amy Khor said the Health Ministry has “worked very hard” to change this perception.

The Pioneer Generation and Merdeka Generation packages, which offer healthcare subsidies to Singaporeans born in 1949 or earlier and between 1950 and 1959 respectively, were put together to lift the burden of healthcare costs for older Singaporeans and give them the peace of mind that they will be able to afford medical care.

Dr Khor said many other programmes are being run in the community to help older people stay healthy.

“But at the end of the day, we have increased subsidies so that if they need to see the doctor, they will not be denied care because they cannot afford to see the doctor,” she said.

“Therefore, please don’t think that you cannot afford to fall sick. You can. But we hope that you will not fall sick.”

 

Extracted from Straits times

Turning silver into gold as Singaporeans live longer

 September 30, 2019

https://www.straitstimes.com/singapore/turning-silver-into-gold-as-singaporeans-live-longer

Singapore now has the world’s longest-living population, stealing the crown from long-reigning champion Japan. While the coveted spot is testament to the rising standards of living and healthcare here, longevity comes with its own issues, such as the need for more retirement savings, and rising medical costs.

In the Healthy For 100 roundtable discussion presented by Prudential Singapore, The Straits Times tackles the following questions with the help of guest panellists: Should people continue working past retirement age? Will insurance premiums skyrocket as healthcare costs rise? What must be done so that we do not only live long, but live well too?

IS SILVER THE NEW GOLD?

Ageing should be looked on as “silver dividends to be reaped” instead of a “silver tsunami to be feared”, noted Senior Minister of State for Health Amy Khor as she opened the discussion, although she agreed that the picture was not all rosy.

“We need to acknowledge that there are challenges to ageing… If not, some people would not have referred to it as a silver tsunami,” she said.

On the bright side, older people are a “very precious resource” to be tapped, in employment, volunteering and caregiving, said Associate Professor Lim Wee Shiong, senior geriatric consultant at Tan Tock Seng Hospital.

“In a workforce, we need the vibrance, the energy and the creativity of young people, but having older ones around with experience, perspective and their mentoring is also important,” he said.

He cited a US-based literacy programme where volunteers aged 50 and above tutored vulnerable children who were struggling in school. The schools that ran this programme became popular because of its success.

The panellists also sought to turn the definition of “old” on its head.

Prof Lim pointed out that until recently, demographic data grouped by age bands would categorise everyone in five-year bands, but those above 65 were lumped into the same band. Now, there is greater segmentation of older people into further sub-groups.

“I think we’re increasingly recognising there are many segments: People in their 60s have different needs from people in their 90s,” he noted. “Sometimes it’s just the simple things like remembering to break down the data and not lump everybody together. That will start to change attitudes.”

Ms Rachel Ngo, deputy director of the healthy ageing division at the Health Promotion Board, said what is important is not so much age, but that one should be well enough to “continue to do what you want to do for as long as you can”. “It’s not just about when you can start drawing down from CPF, or when you can start getting your ez-link card for senior concession,” she said.

WORKING INTO THE GOLDEN YEARS

As Singaporeans live longer, many will need to keep working to finance a retirement that could stretch to four decades.

But employment brings other benefits besides income, such as a sense of fulfilment, a boost to self-esteem and the chance to contribute to society, noted Dr Khor.

Prof Lim noted that work helps people to stay meaningfully engaged, which may in turn help to fend off neuro-degenerative diseases common among the elderly, such as dementia. Other ways include volunteering and taking on caregiving roles, he noted.

The Silver Volunteer Fund was launched in 2015 as part of the Government’s plans to encourage active ageing. The fund is used to support voluntary welfare organisations that develop programmes providing volunteering opportunities and training to seniors.

Dr Khor said that as of last month, more than 6,900 new senior recruits had benefited from the fund.

INCREASED SUBSIDIES

Over the years, we have actually provided many programmes in the community to try and get them (older people) to be healthy. But at the end of the day, we have increased subsidies so that if they need to see the doctor, they will not be denied care because they cannot afford to see the doctor. Therefore, please don’t think that you cannot afford to fall sick. You can. But we hope that you will not fall sick. 

DR AMY KHOR, Senior Minister of State for Health.

MANAGING TRANSITIONS

One of the key things that we will need to look into and think about as a society is really about managing transitions. Important transitions include retirement, stepping into the caregiving role, bereavement. This is not something that we often want to think about or do something about. We’re often thrust into that role. 

ASSOCIATE PROFESSOR LIM WEE SHIONG, senior geriatric consultant at Tan Tock Seng Hospital.

BEING AN ATTRACTIVE EMPLOYER

People don’t stop being able to do their jobs well just because they hit their 62nd or 65th birthday. So for us, being attractive for people and encouraging people to stay with us makes a lot of sense… It’s an obvious thing to do, particularly as the population ages, to make ourselves attractive as an employer to more senior people. 

MR WILF BLACKBURN, chief executive of Prudential Singapore.

TAKING PERSONAL RESPONSIBILITY TOO

Ageing is inevitable. But how we age in part is by choice. At the end of the day, as governments, as a community, as private entities, we can do as much as possible to create the ecosystem to support ageing in place. But it’s down to personal responsibility. And that really comes down to planning early and acting on it. 

MS RACHEL NGO, deputy director of the healthy ageing division at the Health Promotion Board.

AGEING WORKFORCE INEVITABLE

An older workforce is inevitable, given the country’s low total fertility rates. By 2030, one in four people will be 65 and above.

“Allowing older workers who wish to work and are able to do so really does help our employers address some of these manpower challenges,” said Dr Khor.

Last year, 43.8 per cent of people here between 65 and 69 were employed, compared with 25.7 per cent in 2007, according to figures from the Ministry of Manpower.

Over 90 per cent of eligible private sector employees who wished to continue working were offered re-employment at age 62, and two-thirds of them were able to continue on their existing contracts, without a specific end date.

In October last year, Prudential Singapore became one of the companies that allow their employees to continue working beyond age 62 with no change to their terms.

The oldest employee at Prudential Singapore is 64.

Prudential Singapore chief executive Wilf Blackburn said the move made commercial sense in an intensely competitive labour market like Singapore. “Because people don’t stop being able to do their jobs well just because they hit their 62nd or 65th birthday,” he noted. “For me, it’s an obvious thing to do, particularly as the population ages, to make ourselves attractive as an employer to more senior people.”

MAKING WAY FOR YOUNGER EMPLOYEES

Mr Blackburn offered assurances to younger employees who fear they may not move up the ladder if older staff members remain in their positions.

He said many of Prudential’s older employees want to keep working but not always at the same level of responsibility.

Some senior Prudential employees have stepped down from their management roles to be part of the team, while others took on alternative roles within the organisation.

Dr Khor agreed that many seniors might prefer to work on a part-time or ad-hoc basis or take on alternative roles as mentor or consultant to junior employees.

With “clever and conscientious” job redesign, Dr Khor said, employers can continue tapping their strengths, while younger employees do not have to worry about their chances of progression.

Mr Blackburn added that a work environment that offers flexibility and no symbols of status will also help senior workers to be comfortable in reduced roles.

“In an environment where nobody has an office and everyone has the same facilities, nobody feels bad if they take on a lower level of responsibility, and I think everyone feels more comfortable in that situation,” he noted.

AGEING WELL AND LIVING WELL

But an optimistic outlook for ageing can be very quickly reversed by poor health, and a study out earlier this year showed that while Singaporeans are living longer, they also spend correspondingly more years in disability and illness.

The average person has a life expectancy of 84.8 years, but despite enjoying the longest healthspan of 74.2 years in the world, he will spend 10.6 years in ill health and grapple with chronic conditions such as diabetes and dementia.

The prevalence rate of chronic conditions such as diabetes for Singaporeans aged 18 to 69 years old increased by 4 per cent between 2010 and 2017, while the rate for hypertension rose 14 per cent.

Figures from the Ministry of Health showed that about two-thirds of Singapore residents between 65 and 74, and 70 per cent of those aged 75 years and above were reported to have at least one known chronic condition – diabetes, high blood pressure or high blood cholesterol – last year.

Prof Lim noted that the healthcare system, while having done a “very good job for the past 30 or 40 years”, was designed largely for episodic care, or acute illnesses, in younger people.

With more older patients suffering from multiple interacting diseases, there is a need to review the system so that it adapts to changing needs, he added.

INVESTING IN A HEALTHY LIFESTYLE EARLY

Dr Khor said if chronic conditions were not properly managed, serious conditions will follow that will impact quality of life.

Ms Ngo noted, however, that it is possible to continue to function and be productive at work if chronic conditions are managed well. She urged people to plan to age in good health and act on it as early as possible, adopting habits such as exercise, a good diet and regular check-ups before health problems start surfacing.

The paradox is that people who are well tend to take good health for granted, even though they would “reap the biggest dividends” if they were to invest in a healthier lifestyle, said Prof Lim. “Exercise is king. Nutrition is queen. Together they make a kingdom,” he added.

HAPPY PEOPLE TEND TO LIVE HEALTHIER

Another crucial factor in physical health is psychological well-being, said Prof Lim, citing a study of nonagenarians which found that psychological factors such as resilience, optimism and neuroticism played a part in determining whether seniors aged well or not.

He added that society needs to look at properly managing major life transitions – such as retirement, stepping into a caregiving role and bereavement – as these events have an impact on mental well-being.

 

Extracted from Straits Times

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