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A story from the “Seniors’ Journey: Past, Present and Future” publication from the National Council of Social Service, showing the time and effort and dedication to the family of that generation of Singaporeans.
From “Seniors’ Journey: Past, Present and Future”, 2014, National Council of Social Service
Chan Ngot You has dedicated her life to being a housewife and caring for her four children. The 78-year-old grandmother of four shared that she was introduced at the age of 18 to the craft of sarong cloth weaving. “It is really good exercise for the legs and hands!” However, she stopped doing weaving after two years and decided to be an amah.
As an amah, Ngot You had an unusual colleague. She worked side by side with her mother-in-law for the same employer, although they both had different roles. Her mother-in-law would do the cooking, while Ngot you washed, ironed and cleaned. “We got along well; there were no conflicts,” said Ngot You. She stopped work as an amah when she became pregnant with her first child, and decided to be a full-time housewife.
Ngot You took it upon herself not just to care for her children’s needs, but also to cook lunch for her husband and his workers at their garage. “My children are very well-behaved, so it was easy looking after them since birth,” she says, with a hint of pride. However, when the youngest daughter went to secondary school and there was “nothing for her to do at home”, she came out again to work at a steel factory in Aljunied from 1964 to 1968. The factory shifted to another location, and Ngot You stopped working for good to concentrate on her children and housework.
Care giving is a long term commitment that is very challenging and tiring both physically and emotionally. Some like me, do not really have a choice, being the eldest in the family. However it is a task that I take on gladly and if given a choice I would choose to do it, even knowing what I know and experience now. For example looking after my mum during the last days of her life when she had end stage kidney failure was a real blessing for me eventhough I had to leave my job to take her to dialysis 3 times a week. If I have missed this I am not sure if I could answer the question, “have I done enough ?” and will have to carry this throughout my life. Even so, we always ask, could I have done more?
We can lessen or even overcome the physical stress by deploying technology and state of the art equipment. My dad who is 84 and bedridden for almost 5 years now, we are able bring him to the toilet and shower him using a hoist. Most nights we do not have to change his diaper because we use a very absorbent diaper overnight diaper, and just need to check on him once to make sure all is well.
Little tips on relieving the physical stress and getting enough rest for the Caregivers and also the person being cared goes a long way towards peace and emotional wellbeing of all at home. Especially CareGivers need to make sure they get sufficient rest this will also help to lessen the emotional load. Physical stress from lack of sleep, will result in lethargic, irritable, short temperedness, which is one of the mina causes of emotional stress and depression, not only in the CareGivers but also the person cared for.
Overnight diapers because they are used for about 9-12 hours should be made of a non-Woven, Breathable material to ensure that the skin is not stressed with heat and urine vapours that are trapped under the diaper. This causes stress to the patient and potentially may increase the risk of itch and rashes, which could lead to infection and pressure sores. Therefore users should refrain from using Non-breathable Plastic diapers for prolonged overnight use.
One way to know if you diaper is a non-woven breathable material is to check the tapes used to secure the diaper. If the tapes are the normal sticky tapes, this means that the diapers are using non-breathable plastic, because sticky tapes will not be able to stick on Non-Woven, Breathable diapers. The Non-Woven Breathable diapers can only make use of Velcro tapes to secure the diapers because sticky tapes cannot stick on non-Woven, Breathable material.
Overnight diapers provide more peaceful and restful nights, this is just one effective way Care Givers can reduce the already challenging task, therefore care givers should look to using technology and the latest product to help ease the load and to protect their physical and consequently emotional wellbeing.
Check out BWGeneration’s range of Adult Diapers
This article was posted on before on other sites, but we think it is important to share this with the members here.
Seven practical tips to approaching your parents in a dignified way.
It’s not easy when roles are reversed. That’s true for you as a caregiver, as well as your dad or mum as they age. It’s also probably decades since any of you gave a second thought to incontinence.
What makes it all the more challenging is that way back then, the person agonising over nappy rash was your mum or dad over your cute little tush. But they had it easy, in a sense. Getting you into a nappy or diaper was a given. They never had to convince you to put one on – it was just the right thing to do.
Sure, it took effort to finally toilet train you and wean you off the nappy or diaper, but that’s where the ‘battle’ ended. Getting you off the diaper was likened to accomplishing a life goal. In fact, it was celebrated – seen as a milestone towards growing up.
Denial, dread, doom?
Dealing with your parents’ need for diapers, on the other hand, may feel counter-intuitive at times. All these years, you’ve experienced them as independent adults, in control, leading the family. Then, the reality sets in that they may not be able to manage even their bodily functions as well as before.
Some may experience incontinence, needing adult diapers all the time. For others, it’s just slowness getting to the toilet. There’s the urge to urinate, and awareness of the need to go to the toilet, but the speed is impaired.
With that comes an inevitable sense of loss – for you and your parent. There may also be fear or frustration. Some respond in denial, others in dread that it spells the beginning of the end, “Am I growing old and useless?” they ask.
Others may try to hide the problem by staying at home. Unfortunately, they lose the freedom to go about daily activities as before. Sometimes, this leaves the whole family puzzled about this change in behaviour.
All these are rather natural responses. It is important to recognise and address how everyone is feeling. Sometimes, all it takes is asking with empathy, “This is tough for you, isn’t it?”
Followed by a statement in the vein of: “It’s tough for me too. But there’s nothing to be ashamed of. We all change as we age, and we are here to help and care for you”.
There are ways to talk to your mum or dad about adult diapers and confident continence care, while maintaining their dignity. Here are seven practical tips:
- Get educated first: Before you speak to your mum or dad, understand the many possible reasons for incontinence. Sometimes incontinence is temporary or can be improved. Bring your parent to a doctor for some professional advice.
There’s no need to struggle with wet pants, stained furniture or embarrassing smells. It’s also unnecessary to be cooped up at home due to fear. Show your parent that he or she can go out of the house with confidence and continue to lead an active ageing lifestyle.
- Focus on independence: There’s a tendency to talk about all the things you cannot do when dealing with incontinence. In contrast, it may be more effective to talk about all the things you can do, if you manage incontinence effectively. That includes getting the right medical help and practising good habits.
Let them know there’s now a comprehensive range of continence care products, beginning with gathered inserts for people with light incontinence (minor leaks when coughing) to ultra absorbent adult diapers for those who need it to last through the night.
- Start with pull-ups: Many elderly feel adverse to wearing adult diapers because of its association with babies. Rather, they take well to using pull-up pants as it resembles their own underwear. Pull-ups are also easier to put on and take off than adult diapers with re-sealable tapes, allowing for greater control and autonomy for the user. This is a small but very important element for elderly who may be already experiencing other losses.
Just be aware that pull-up pants are suitable for ambulant elderly (able to stand and walk), while adult diapers (wrapped with re-sealable tapes) are for those who are wheelchair-bound, or mostly cared for in bed.
- Reward with incentives: After putting on the pull-ups or adult diapers, take your mum or dad on an outing. Or, bring him or her out for a restaurant meal. This encourages him or her and helps build confidence. Nothing makes mum or dad happier than to be seen with his or her children. There is a sense of pride for mum or dad that his or her children care for them.
- Appeal to community-living: There are two aspects in this matter. First, it is crucial that elderly stay active and engaged with their peers and family. Unfortunately, some become so embarrassed or overwhelmed with their problems with incontinence that they stay at home and become socially-isolated. Emphasise the need for your parent to stay in touch with what’s important to keep physically and mentally healthy.
Second, with most families living in HDB flats in Singapore, it is more bearable when the home smells clean and fresh. When someone at home experiences incontinence, other family members’ daily lives are affected too. For example, it takes time and effort to constantly clean up the place or wash soiled
clothes. To minimise such tension, many elderly cooperate and use continence care products when it’s needed.
- Let them choose: Even after showing them the options, mum or dad may not try on the pull-ups or adult diapers immediately. Simply have them easily available around the house so that your parent can give them a try when ready. You may be surprised to find that
he or she uses it when going out for a medical appointment, embarking on a long road trip or taking a plane.
- Get outside help: Don’t take it personally, but your parent may be more receptive at times if he or she hears it from a doctor, nurse, professional caregiver or even the neighbour who casually talks about the diapers he or
she is using. So, get someone to speak to your parent about how to better cope with his or her continence.
Identify your allies, and don’t get into WWW III about adult diapers with your parent.
If I had known then when I made the decision to come back to Singapore to care for my parents, to what I know and have learnt up till now about Care Giving, maybe I would take more time to consider the decision, to take the responsibility about caring for someone.
Having said that I would still take on this responsibility to care for my parents not because it is my duty but also I could not think of anyone who could care for them better than family members who love them.
Is it like going to war?
Not exactly but also not far from it. I used war as a comparison because it is a daily battle that does not really get better, in fact most situations will get from bad to worse. We need to be mindful that it is a battle that has no winners, also it is not a battle against anyone or any situation. It is a battle that to maintain the calling that we as care givers are doing the right thing no matter the odds and finally there will be peace and we will prevail until it our own season of ageing and needing care.
I have come across many cases where care giving has caused severe family situations, both for the care giver and the care recipient, I guess the best comparison is war to get attention and make people sit up that this task and commitment should not be taken lightly.
I have come across divorces caused by care giving, siblings disharmony, grandchildren leaving home, emotional breakdowns, financial instability to the point of needing seeking welfare, the list goes on hence care givers need to prepare, research and get trained.
Preparing and equipping the Care Giver.
This step is usually missed out, because usually Care Givers are thrust into the role or they wake up one day, almost suddenly, they have someone to care for.
There are some key facets of Care Giving that are important:
- Emotional preparedness
- Financial preparedness
- Time commitment preparedness
- Relationship preparedness
- Space preparedness
- Equipment preparedness
In this article, I like to start with the very basic 6) Equipment preparedness. This because in a recent focus group I found that almost all, about 90% of the care givers participating in the focus group, their care recipients had developed painful bed sores, some with permanent physical damage. Typically bed sores take many months to heal some as long as 6-9 months!
With the correct equipment and knowledge this condition is very preventable. Hence when we sent someone into war to do battle we provide the soldiers with the right equipment to fight and defend themselves. At the very minimum, we provide the soldiers with, helmets, rifles, ammunition and training how to use them.
At the very minimum care givers (for bedridden elderly), will require :
Minimum Essential Equipment to avoid Bed Sores:
- Hospital Beds
- Air Mattress
- Diapers, Ultra Absorbent, Breathable
- Barrier Cream
Optional but highly desired:
- Adult Wet Wipes
Hopefully with the minimum essentials, the painful and sometimes debilitating bedsores can be prevented.
There are avenues for free used equipment and also our Government provides huge subsidies for these equipment. The Care Giver just needs to apply for them.
Don’t use it, you will lose it.
The old adage in maintaining muscle: don’t use it you will lose it. The older you get, the more you have to work to maintain your muscles,
Between ages 40 and 70 years, muscle mass decreases by about 8% per decade; beyond 70 years, the rate of loss increases to about 15% per decade.
A study published in Medicine & Science in Sports & Exercise,
“Researchers report that men and women over the age of 60 have to lift weights more often than younger adults to maintain muscle mass and muscle size.”
“Our data are the first to suggest that older adults require greater weekly maintenance, than younger individuals to maintain resistance-training-induced increases in muscle mass,” study co-researcher and physiologist Marcas Bamman, PhD, of the University of Alabama, Birmingham, says in a press release.
In addition to exercise and keeping active older adults need to ensure that they have the relevant and sufficient nutrition in order for the body to have sufficient protein and also nutrition to build and maintain muscles.
Maintaining and building muscle mass in older adults is important to an Active Ageing lifestyle to ensure not only a longer lifer but a healthy and enjoyable life.
Some pictures of muscle loss from inactivy due being bed ridden. Also some great Active Ageing pictures and video from the recent 50 plus expo, with older adults practising active ageing.
While Popo (my maternal grandmother) was completely taking Ensure® for her nutritional needs, my mum was using it to supplement her meals. At one point in time, my whole family was extremely concerned about Mum as she was losing weight very quickly and visibly gaunt. She was also losing muscle tone fast. This made her weak and unable to walk properly. As a result she was prone to falls!
We brought her to the doctor and started looking more closely at what and how she ate. I realized that eating is a very social activity. As many older persons often eat alone, they may not find the food appetizing or began to develop habits that may lead to malnutrition. Therefore, I started having more meals with Mum, chatting with her and encouraging her to finish all that was on her plate.
On top of that, we gave Mum a cup of Ensure® between meals (as part of her morning and afternoon tea) to increase her calorie intake. As Mum was picky about what she ate, giving her Ensure also gave me peace of mind that she was getting the vitamins and minerals she needed.
At times, Mum even refused to take the Ensure®! My Helper and I mixed it into her Milo. That’s one of my tips to you as a Caregiver. Understand what your loved one likes to eat and use Ensure as an ingredient in the preparation process. Since then, I’ve discovered some recipes that use Ensure®. And, I would like to share this one with you that I found on abbottadult.com.sg
Ensure® Life Salad of Poached Tiger Prawns
- 300g tiger prawn – cooked and halved
- 2 green apples – cubed
- 1 stalk celery – cubed
- ½ white onion – chopped
- 1 tablespoon “Japanese baby” mayonnaise
- ½ lemon juice
- 2 tablespoon Ensure Life Vanilla Powder (diluted with a little water)
- 1 lettuce – cut into pieces
- salt and pepper to taste
- 6 cherry tomatoes
- 18 pieces semi dried tomato
- 18 pieces stuffed olives
- 50g walnut
- Mix prawn, apples, celery and onion in a bowl
- In another bowl, mix mayonnaise with lemon juice, Ensure Life powder, season to taste
- Pour dressing into salad bowl and toss well
- Arrange lettuce on the bottom of a nice salad bowl and pour prepared prawn salad over
- Garnish with walnuts, tomatoes and olives
As my mum got better, she needed less Ensure®. But, for a while, we kept a can in the cupboard for days when she had little appetite for food. Now, she does not need it anymore, but I’ve added Ensure® and Ensure® recipes into my caregiving repertoire and I will use them again when needed.
The Ministry of Health introduced new guidelines for home and day care services on Saturday 25 April 2015 that will enable service providers to work towards delivering quality care for the elderly.
The guidelines spell out the expected outcomes in four main areas: the provision of holistic care services that are coordinated and comprehensive; the safety and quality of care; “informed and enabling care” such that beneficiaries and caregivers have autonomy in making care decisions; and organisational excellence.
Such guidelines offer even more peace of mind to caregivers and improve the quality of life for the elderly.
Does your loved one attend a day care or use home care services? Or, do you know of somewone who may benefit from such services?
Share with us your thoughts.
For the full story, read: New Guidelines for Day Care and Home Care for the Elderly by Priscilla Goy in The Straits Times, retrieved 29 April 2015
For me Popo (my maternal grandmother) was the best cook in the whole wide world. In fact, her Cantonese cooking was so close to my heart that I included a Recipes page in my blog on taking care of her. One of the dishes that she was able to cook into her 90s was Century Egg Porridge.
Popo had a hearty appetite too. She continued to eat relatively well for the first two of the four years that she was bedridden. Yes, she enjoyed her chicken drumstick, ice-cream cones, as well as peanut butter and jelly sandwiches. It was only in the last year and a half of her life that her appetite waned.
Popo’s mind was very clear when she eventually told us that she did not want to eat anymore. She asked that we give her Ensure for her meals. So, we filled a small bottle with Ensure and placed it by her bed. She sipped on it throughout the day. Once finished, we replaced it with a new bottle.
Of course it was hard for me to come to terms with the changes. I enjoyed watching Popo enjoying her food. I felt the loss of no longer being able to buy yummy Lontong for her and bond over her favourite local dishes. But, I also knew that she was making sense. She understood the nutritional value of Ensure as I had explained it to her before.
Ensure can be a total meal replacement for someone who is not taking food. It’s also a good supplement or complement to those who are having meals, but not getting enough nourishment because of the food they choose.
So, I knew that Popo would be getting the calories and nutrients needed in a balanced meal by taking Ensure. With the help of the doctors and nurses, we calculated how much Ensure that Popo would need each day to maintain a healthy weight and her body immunity.
Everything worked out well. Ensure was her main sustenance until the end of her life. Of course, some stuff still whet her appetite from time to time, and we’d readily cook it for her or run down to buy it. I’m glad that I was inspired to get her a durian not long before she was down with Pneumonia and completely stopped taking in any food or drink by mouth. She passed away peacefully in her sleep at age 98.
I have lovely memories of Popo chomping chicken wings, sipping Ensure, slurping ice cream, and savouring durians. From time to time, when I think of Popo, I comfort myself with a bowl of Century Egg Porridge. The image you see in this picture depicts my Popo bringing me to school. I miss her!
How have mealtimes changed for you and your loved one? How are you coping with the changes? What are the things that you continue to enjoy together? Do share. I would love to hear from you.
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