The Boon Lay CC had collaborated with Alexandra Hospital and Jurong Medical Centre to provide a Nurse Educator service in the community. I was seconded to work there on Monday, Wednesday and Fridays to help the residents to stay healthy with promotion of positive health, health screening, education and advice on health issues.
We had a small open house last Friday and was attended by 60 participants. We had sponsors from Abbotts and Comfortkeepers and one minute hair dye company. Free gifts and milk samples were given out to the first 50 participants. They came to see me for their Blood pressure monitoring, vision test and finger prick for sugar and cholesterol. We also have residents coming in for simple dressings and caregivers coming in for advice and help.

The flowers in the garden, the plants by the aisle, the special places like the round staircase, the geriatric centre and the cafe - i gonna missed all these. As from February 2009, i was seconded to the Boon Lay Wellness Centre so i do not return to Alexandra Hospital except when i need to attend training courses or meet my bosses. I love the nature and the environment in the hospital.

Not sure if you read the article in the ST today about the story of Mr Cedric De Souza ’s blocked artery and how he managed to survive. He said - i did not know then that i was a walking time bomb, I allowed my work to take precedence over my health. So do take note that your body will give you signals - please do take heed and pay attention.
“Life is uncertain, I can drop dead tomorrow, so it is better to take things easy and enjoy living while i can,” he says. For people who are workaholics do remember to stop and think about your body if it is not well - do take a break!
My CEO always said that we do not maintain our body parts like we do for our car. Our car we will send to the workshop for maintenance but we forget to do that for our body.
Remember to check your health and make sure that it is functioning well otherwise it can breakdown too.

Caring for our seniors in Geriatric Medicine - we are always talking about the 5 Giants that affect our elderly ’s quality of life and functions. The Giants are Infection, Instability, Immobility, Incontinence and Impaired Cognition.
Infection can hit the older person harder than it does on the younger adult because they become more sick and frail. Some even succumb to the infection and die. The common infections are chest infection or pneumonia and the urinary tract infection. So when the elderly is confused the Geriatrician will conduct tests to exclude infections.
Instability means loss of balance, leading to frequent falls and there are many causes. Some of the factors are related to the ageing process like blurred vision due to cataracts leading to falls, weakness of the knees due to osteoarthritis, vertigo and neurological problems. The others can be due to the effects of medications, unsafe environment and diseases like strokes etc….
Immobility is one of the biggest problem because the elderly can become depressed when they cannot be independent and need help to move around. People who suffer from diseases like strokes, fractures and osteoporosis and neurological disorders like Parkinson’s disease and end stage dementia.
Incontinence is the involuntary leakage of urine which has a social and emotional impact on the person. Most of the time the elderly will try ways to cope with the incontinence until they are unable to because of their impaired mobility or impaired cognition then they get admitted into hospital and incidentally discovered. Incontinence can be improved if not cured so if elderly suffers from incontinence they can see a Continence specialist.
Impaired Cognition - The Geriatrician will exclude the 3Ds - delirium, depression and dementia. It means the person’s mental functions has deteriorated or changed.

Besides Dementia (as mentioned in the previous posting), the other two Ds are Depression and Delirium.
Depression is common among the senior people in Singapore. It is really not easy to diagnose depression. One of the objectives of the Wellness Programme is to encourage all senior people to get out of the flat /house and go and join activities in the community centres. By doing that, they will get engaged socially with friends and find new “kakis” for games like mahjong, chess, dancing class, Karaoke groups, exercise group etc….. In this way they will not be bored and lonely and the chances of getting depression will be reduced.
As for delirium - it is one of the atypical presenting symptoms when the elderly fall sick. They ususally become confused, then may present with delirium and fallen with injuries or incontinent and upon further investigations then the elderly is found to have an infection or a heart problem. If your elderly person is delirious, you must get him to see a Geriatrician urgently. We always said that when you are 70 the Geriatrician is your specialist.

Minister for ageing issues - Minister Lim Boon Heng said that there are 18,000 people suffering from dementia now in Singapore and the number will more than double by 2020. It is very frightening to know that many of the baby boomers will be age 70-85 by then and with the rapid ageing population more will suffer this mental degeneration. So how can we keep away from Dementia? We must continue to keep our mind active and stimulated. Be engaged in work, activities, planning and decision making. If you suffer from chronic diseases like diabetes, hypertension, high cholesterol, make sure you get treated and in control because poor control can affect the brain cells and functions. Keep yourself healthy - eat wisely and exercise regularly. Remember Dementia is a disease and not a normal part of ageing. We need to seek help early and drug treatment can only slow the progress of the disease but not cure. However we need support and care 24/7 if we suffer dementia.

In April 2003 Readers Digest issue there is a story about Dennis Turner who was 60 years old and when he first noticed a tremor in his right hand he went all out to get rid of the disease. He does not know why he developed Parkinson’s disease. the predisposing factors are germs, age, environmental poisons etc.. In Parkinson’s disease there is a decreasing level of brain chemical dopamine which can make you stiff, slow down your movements and long term sufferers said “can turn you into stone.” It is a debilitating disease! During that time there was much controversy over stem cells, however his neuro-surgeon tried a new method by using stem cells from Turner’s brain to create healthy new neurons. He took out a pea sized bit of brain tissue from Turners and sort out for the brain stem cells and grew them in the lab. for seven months. After that he transplanted millions of them into Turner’s brain. This had helped to ease 80% of the symptoms and after a year, no one can tell that Turner had Parkinson’s disease before because he could functioned like before.
This story reminded me of my 80 year old patient - a Chinese business man who had tried using embryonic fetal brain tissue implanted in his brain by Chinese doctors from China. He impressed me as a quiet, humble gentleman with a charming smile and a festinating gait. He was independent for about 6 years after the surgery then he became very stiff and succumbed to the symptoms of Parkinson’s disease. During the last 4 years of his life, he was kept well by his caregivers and his family because he was out of his house for regular therapy at our day care centre.
There is hope for Parkinson’s disease victims in the research dishes in the laboratory that stem cells research holds immense hope for them in the future.

My patient’s son was sharing with me about his mum who had fallen in the bathroom and sustained a fracture of the hip two years ago. She stood up to get the bath towel from the towel rail with one hand and the other hand was placed onto the folding door for support. As the door was not completely unfolded, it moves when she apply her weight onto it so she lost balance and fell, hitting her hip on the kerb.
She had undergone a hip operation, been to the community hospital for rehabilitation for 3months after that but she did not regained her confidence to walk then. Hence she had been attending the social day care centre for maintenance rehabilitation and socialisation. It took her almost two years to get up from the wheelchair to walk again with a walking frame and then a walking stick. He told me that he had spent a large sum of money after her mum’s fall. Luckily she is now recovering from the fall and had regained her confidence to walk again otherwise she can be wheelchair bound for life.
For some who may not be so lucky they may mot be able to fix back the broken bones with surgery and may be bedbound even. So remember to prevent falls we must keep our homes safe for our elderly folks. We must also help them build stronger bone density with calcium rich food and exercise.
Based on the OSTA chart, if you are 50 years old and above, your weight must not be lower than your age otherwise you are at a higher risk for Osteoporosis. So we must also maintain a good body mass index at just below 23 and not below 18. Apparently thin and frail elderly are prone to fractures when they fall because they do not have the cushion paddings for their bones.

As the Nurse Edcuator in Boon Lay Wellness Centre, i will contact residents who had their health screening done by AH Team in the community for follow up. During the follow ups, i discovered that a few of the residents had better BP readings, reduced BMI and reduced cholesterol levels after they had started on regular exercises. One example is this Malay lady in her mid 40s - she started to come to the gym for her exercises once or twice a week and she had improved tremendously over six months. Besides she also watched her diet now and has been taking less oily food with more fruits and vegetable intake.
The other person is a lady in her 60s who had very high cholesterol level, with daily morning exercises at the centre her cholesterol had dropped to a lower level and she is also encouraged to watch her diet so that her BMI can be reduced too. The other thing is when they socialised they improved with their moods and are more positive than before.

In Toyota’s history, key leaders have been found within the company at the right time to shape the next step in Toyota’s evolution. They have been there across the enterprise - in sales, product development, manufacturing and design. Toyota does not go around shopping for “successful” CEOs and Presidents because their leaders must live and thoroughly understand the Toyota culture day by day.
Since a critical element of the culture is genchi gembutsu, which means deeply observing the actual situation in detail, leaders must demonstrate this ability and understand how work gets done at the shop floor level within Toyota. Read more on the way the organisation works with regards to 5S, kanban, Jidoka, Heijunka, Andon , 14 principles of management and building a learning organisation on this website.
http://www.si.umich.edu/ICOS/Liker04.pdf
Or Read the book on The Toyota Way by Jeffrey K.Liker