Friday, 22 July 2016
Alzheimer’s Disease Foundation Malaysia (ADFM) will be conducting a one-day Training Workshop on “ESSENTIALS OF DEMENTIA CARE” for family caregivers / individuals who are involved in the care of people living with Alzheimer’s dementia.
Participants will benefit from this interactive video-aided training through experiential learning and role play; and equip with the essential knowledge and practical skills to understand and to effectively care for people affected by dementia.
Taking care of people or loved ones with dementia affects our lives in multiple ways. It is our objective and hope that this hands-on training will be attended by every caregiver who has to cope with the complex and unpredictable issues involved in caring for people affected by dementia.
Date: Saturday, 30 July 2016
Time: 8.45am to 5.30pm
Venue: No. 6, Lorong 11/8E, Seksyen 11, 46200 Petaling Jaya
Medium of Instruction: English
Group Size: not more than 25 participants
Morning Session: Facilitators will be Dr Khor Hui Min, Geriatrician from UMMC and Dr Elizabeth Chong from HKL.
1. Dementia and Alzheimer's Disease
2. Stages of Alzheimer's Disease
3. Communication Problems in Dementia
4. Behavioural Problems
5. Managing Disturbed and Aggressive Behaviour
6. Wandering and Care Management
Afternoon Session: Facilitators will be Nurse Educator, Ms Foo Sook Lee and Ms Tan Saw Cheang; Physiotherapist, Edwin Tay
1. Assisting with Mobility
2. Bathing/Grooming and Care management
3. Managing Meals and Care Management
4. Incontinence and Care Management
Certificate of Attendance: Will be issued to participants upon request.
Course Fee (includes course materials, certificate of attendance, refreshments and lunch):
(1) RM50 / participant for family caregivers; and
(2) RM60 / participant for other categories
Bank-in direct to ADFM Bank Account with CIMB Bank at Account No. 800 229 3277. If Cheque should be addressed to: ALZHEIMER’S DISEASE FOUNDATION.
Confirmation of Registration:
For clarifications, email: firstname.lastname@example.org OR WhatsApp/SMS Jenny at 016 608 2513.
Kindly register early to facilitate the logistic arrangements.
Posted by Jenny at 00:44
Tuesday, 24 May 2016
Doctors write millions of prescriptions a year for drugs to calm the behaviour of people with Alzheimer’s disease and other types of dementia. But non-drug approaches actually work better, and carry far fewer risks, experts conclude in a new report.
Non-drug approaches should be the first choice for treating dementia persons’ common symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions, say the researchers in a paper just published by the British Medical Journal.
Clinicians at the University of Michigan and Johns Hopkins have developed a strategy to minimize the use of potentially dangerous drugs for behaviour problems.
The approach is called DICE – for describe, investigate, create and evaluate – and is based on data collected from two decades of research studies. The strategy is intended to be collaboration among doctors, caregivers and, when possible, the person with Alzheimer’s disease and involves the following steps.
THE COMPONENTS OF THE DICE APPROACH ARE:
Describe - First, caregivers and AD persons should describe the “who, what, when, where and why” of specific behavioural problems that the person with Alzheimer’s disease might be dealing with, including times of day they may occur, circumstances or situations that trigger them, and the level of distress that they cause. If someone becomes agitated and tends to pace in the evenings after the TV set is turned on, for example, that information should be conveyed to the doctor.
Investigate - The doctor or other health care provider should examine the person with Alzheimer’s disease to look for any underlying medical or environmental causes that may be contributing to the problem. A variety of medications, for example, can cause problematic side effects or interfere with sleep. Similarly, a lack of daily routines, poor lighting in the home or excess clutter can be confusing for someone with dementia and increase anxiety.
Create - Working together, caregivers and health care professionals should develop a plan to respond to behavioural issues and prevent future problems. These might include establishing regular routines for the person with Alzheimer’s disease, and providing education and support for caregivers.
Evaluate - Finally, the doctor should assess whether the plan is working, and make adjustments as needed.
The DICE approach can be more effective and safer than prescription medications such as haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal), all of which significantly increase the risk of death, the authors say. They note that sometimes the use of such drugs is appropriate, for example, if someone with Alzheimer’s disease poses a risk to themselves or those around them. And antidepressants can be useful for treating someone with serious depression. But in many cases, a non-drug approach should be tried first, they say, and any drugs that are prescribed should be monitored and discontinued when possible.
For anyone with Alzheimer’s disease, it’s important to assess whether he or she might be suffering from physical problems that are exacerbating the difficult behaviour. Being hungry, thirsty or in pain can all lead to outbursts. Untreated medical problems, such as a urinary tract infection, a toothache or interactions between different drugs, can also contribute to problems. Poor vision or hearing can also be disorienting and contribute to behaviour problems. Treatment of the underlying medical problem can help to ease agitation.
In the home environment, over stimulation or lack of stimulation can also aggravate behavioural problems. A loud TV or radio can be unpleasant for someone with Alzheimer’s disease, and that person may not be able to communicate his frustration or make the mental connection to go and turn the noisy device off. Lack of activity or lack of routines can likewise lead to confusion and contribute to behaviour problems.
“The evidence for non-pharmaceutical approaches to the behaviour problems often seen in dementia is better than the evidence for antipsychotics, and far better than for other classes of medication,” said study author Dr. Helen C. Kales, Head of the University of Michigan Program for Positive Aging. “The issue and the challenge is that our health care system has not incentivized training in alternatives to drug use, and there is little to no reimbursement for caregiver-based methods.”
The best evidence among non-drug approaches is for those that focus on training caregivers - whether they are spouses, adult children or staff in nursing homes and assisted living facilities - to make behavioural and environmental interventions.
For caregivers, stress and depression can diminish coping skills. Caregivers need education about the disease and should be taught skills about communicating with a loved one with Alzheimer’s disease. Caregivers also need to have realistic expectations about the course of the disease, the lack of effective treatments, and challenges that may arise.
The authors describe five non-drug approaches to caregiving that have been shown to help reduce behaviour issues. They include:
1. Providing education for the caregiver;
2. Enhancing effective communication between the caregiver and the person with dementia;
3. Creating meaningful activities for the person with dementia;
4. Simplifying tasks and establishing structured routines; and
5. Ensuring safety and simplifying and enhancing the environment around the Alzheimer’s person, whether in the home or the nursing/assisted living setting.
Specific measures might include:
1. Removing clutter from the home;
2. Using calming music or simple activities that help to engage a person with dementia; or
3. Using a calm voice instead of being confrontational.
It’s also critical that caregivers get breaks from their responsibilities and take care of themselves, especially in the home, to help them avoid burnout and taking their frustration out on the persons living with Alzheimer’s.
“Behaviour-based strategies may take longer than prescriptions,” acknowledges Kales, a member of the U-M Institute for Healthcare Policy and Innovation. “But if you teach people the principles behind DICE, the approach becomes more natural and part of one’s routine. It can be very empowering for caregivers or nursing home staff.”
More research on both new drug options and the best ways to assess and address behavioural symptoms is needed, the authors conclude. But in the meantime, the evidence to date comes down in favour of non-drug approaches in most cases.
(Source: By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University. Helen C. Kales, Laura N. Gitlin, Constantine G Lyketsos: “State of the Art Review: Assessment and management of behavioural and psychological symptoms of dementia.” BMJ, March 2, 2015.)
If you take multiple prescription medications, you know their costs can add up. One way to save money is to ask your doctor if a generic is available - but are generic drugs as effective as more expensive brands? Yes, says the American College of Physicians, a doctors group that issued a statement in the January issue of Annals of Internal Medicine that advises all clinicians to prescribe generic drugs when possible.
“The biggest difference between brand-name medications and generics is cost,” says Claudene George, M.D., R.Ph., Assistant Professor of Clinical Medicine and Geriatrics at Albert Einstein College of Medicine in New York. “Companies that develop brand-name drugs invest in research, development and marketing - which drive up cost. Generic manufacturers can produce medications more cost-effectively.”
Here are five more facts to consider:
1. Generics have the same active ingredients as brand-name drugs.
New drugs have patents that protect them from being reproduced by other companies for typically 17 years. Once the patent expires, other manufacturers can sell the drug. The U.S. Food and Drug Administration approves only generics biologically equivalent to their brand-name counterparts, although inactive ingredients may differ. Generics may have a different shape, color or flavor. Rarely do these variations make a difference in effectiveness or side effects.
2. Studies have compared generics vs. brand-name drugs.
The research has largely found the effectiveness of both is the same and brand names offer no superiority.
3. The same pharmaceutical companies that produce brand-name drugs often manufacture generics.
Five of the top 10 generics manufacturers are brand-name pharmaceutical companies.
4. You’re more likely to take a generic drug as directed.
That’s partly because generics have lower out-of-pocket costs. The higher costs of brands have consistently been associated with lower adherence rates because patients may skip taking some doses or filling prescriptions altogether to save money.
5. Doctors report they’re influenced by patient requests.
In a recent survey, four in 10 doctors said they sometimes or often prescribe a brand name when a generic is available because the patient wants it. If your doctor prescribes a drug, ask whether a generic that works just as well is available.
If you switch from a brand name to a generic, be aware of any new changes in your medical condition or any side effects, says Dr. George. Although rare, it’s possible to experience minor differences when switching.
(Source: HealthAfter50, posted in Healthy Living on 24 May 2016)
Saturday, 7 May 2016
ADFM will be conducting a Two-Day Four Module "Living with Dementia" Training Workshop on:
Saturday, 14 May 16 (8.30am - 6.00pm)
Module One – Understanding of Dementia
Module Two – Behavioural Effects of Dementia
Sunday, 15 May 16 (8.30am to 6.00pm)
Module Three - Effective Communication Skills
Module Four – Activities for Living and Pleasure
Group Size: Limited to 20 – 25 participants only
This Training Workshop is designed to equip the caregivers with a deeper understanding of dementia on a person-centered approach to care, practical skills and strategies in responding to and handling the different challenges, and to make a difference to the life of a person with dementia.
It is designed to be an informative and interactive workshop with video-aided presentation, case study analysis and sharing, and group discussions.
The workshop focuses on:
· Understanding the nature of dementia.
· Understanding behaviour and person-centered care approaches to behavioural changes.
· Strategies to communicate and interact more effectively.
· Importance of creating an engaging physical environment with meaningful activities in a person-centered way in dementia care.
Workshop Facilitators: Geriatrician Dr Elizabeth Chong and Dr Khor Hui Min, Nurse Educator Ms Tan Saw Cheang and Ms Foo Sook Lee.
Target participants: Family caregivers and individuals caring for people with dementia.
Certificate of Attendance: Will be issued to healthcare providers.
(i) RM80 per participant for family caregivers
(ii) RM150 per participant for other individuals
Payment: Bank in direct to ADFM Bank Account with CIMB at Account No. 800 229 3277. If Cheque, should be crossed and addressed to "Alzheimer's Disease Foundation". Email copy of payment slip to email@example.com for confirmation of registration and accounting record.
More details, contact Jenny at 016 608 2513 / 03 7931 5850 or via above email.
Friday, 15 April 2016
Mild cognitive impairment (MCI) falls somewhere between age-associated memory impairment and early dementia. People with mild cognitive impairment are more forgetful than normal for their age, but they don’t experience other cognitive problems associated with dementia, such as disorientation or confusion about routine activities. Routine tasks such as paying bills, shopping and meal preparation may become challenging but can still be performed. People with MCI may take more time doing these activities and they may make more mistakes. They are generally able to live independently but may be less active socially.
About one in five older adults has some type of MCI. In a 2010 study of nearly 2,000 people, about 16 percent of dementia-free people over age 70 were suffering from MCI. Men were more likely to suffer than women, although women may simply experience dementia at a later age. In the study, risk factors included being a carrier of the APOE ε4 gene (a known risk factor for late-onset Alzheimer’s disease), never having married and having less than nine years of education. In a 2011 study of nearly 1,300 women age 85 and older, 23 percent were diagnosed with MCI. The researchers recommend that women this age should be screened for cognitive problems.
The National Institute on Aging/Alzheimer’s Association workgroup has come up with new diagnostic guidelines for MCI due to Alzheimer’s disease. With MCI, people experience gradual cognitive decline due to Alzheimer’s-related brain changes. A person is thought to suffer from MCI if he or she meets the following criteria:
• A friend, family member, doctor or the person in question is concerned about a change in his or her cognition compared to the previous level.
• The person is experiencing more difficulties in one or more cognitive areas such as memory, attention and language than would be expected for his or her age or educational background. Difficulty learning and retaining new information is most common in MCI patients who develop Alzheimer’s-related dementia.
• The person is having trouble performing complex tasks such as paying bills, preparing a meal or shopping. He or she may take more time, be less efficient and make more mistakes than in the past. Still, he or she maintains his or her independence with minimal assistance.
• There’s no evidence of significant impairment in social or occupational functioning.
• There should be objective evidence of progressive cognitive decline over time. Cognitive testing can assess the degree of impairment. Scores for people with MCI are usually 1 to 1.5 standard deviations below the mean for their age and education level. Some formal cognitive tests that assess both immediate and delayed recall can help identify MCI patients who are likely to progress to Alzheimer’s dementia within a few years. Other tests can determine impairment in problem-solving, reasoning and language. Doctors may also assess a person’s cognitive function using informal techniques, like asking a patient to learn a street address and then remember it after a delay.
• Vascular, traumatic and medical illnesses that could explain the decline in cognition must be ruled out. The goal is to increase the likelihood that the underlying cause of MCI is probably Alzheimer’s.
• If a person is known to carry a genetic defect, such as a mutation in APP, PS-1 or PS-2, he or she most likely has MCI due to Alzheimer’s disease. Most of these carriers develop Alzheimer’s before age 65. A person who meets the diagnostic criteria for MCI and carries a variant of the Apolipoprotein E (APOE) gene is more likely to progress to Alzheimer’s dementia within a few years than someone without it.
Researchers have discovered that activities such as exercise and computer use may prevent MCI. In a 2010 Mayo Clinic study, adults between ages 70 and 90 who participated in moderate physical exercise like brisk walking or biking and used a computer were less likely to develop MCI. Another Mayo Clinic study found that consuming more heart-healthy mono- and polyunsaturated fats reduced the risk of MCI among people age 70 and older. These fatty acids—which are found in olive oil, nuts, seafood and vegetable oils—appear to prevent inflammation and reduce the risk of blood clots, stroke and heart disease.
Many experts believe that MCI may be an early warning sign of memory disorders later in life. Studies show that up to 15 percent of people with MCI progress to Alzheimer’s disease each year, compared with a rate of 1 to 2 percent a year for the general older population.
(Source: Health After 50, 14 April 2016)
Friday, 1 April 2016
Please be advised that the above 30 minutes mandarin program will be aired on this Sunday, 3 April 2016 to promote greater awareness of Alzheimer’s disease/dementia in the country with BM sub-titles.
This 30 minutes program documented the life of 78-years old AD Patient, Madam Diong Swee Tin who on her motorbike without fail everyday insists on going to tab rubber at their family rubber estate, except rainy days although memory fade; interviews of her family members and Geriatrician, Assoc Prof Dr Tan Maw Pin of UMMC.
The program also covered the interviews of caregivers Mdm Lee Guat Im & Mdm Lim Tat Sim and Psycho-Geriatrician, Dr Teh Ewe Eow of Penang.
There will be a repeat on:
Date: Saturday, 2 April 2016
Air Time: 3.28pm – 3.30pm
Channel: NTV7 (Astro Channel 107)
Please do not miss the above 30 minutes Forget Me Not Program scheduled on this Sunday, 3 April 2016 at 6.00pm.
Friday, 18 March 2016
(Soruce: Alzheimer's Society, March 2016 Research Update)
On 10th March 2016, news outlets reported on a nutritional drink that claimed to "stop the brain from shrinking" and "slow the progression of Alzheimer's disease". We examine the science behind these headlines.
The story is based on clinical trial results that were presented at the Advances in Alzheimer's Therapy congress in Athens. This research team provided evidence that this drink may help to improve some aspects of memory in people who have mild cognitive impairment due to the very early stages of Alzheimer's disease. However, it is recommended that you speak to your GP before starting to take this drink or any other nutritional supplements or medication.
What is the drink?
Souvenaid is a nutritional drink containing an active ingredient called Fortasyn Connect. This is a combination of fatty acids, vitamins and other nutrients. It was developed with the aim of preventing the loss of important connections between brain cells that occurs in Alzheimer's disease. Whilst this effect on brain cells has been shown in animal studies, it has not yet been confirmed that the drink has the same effect in people.
Previous trials of the drink were not able to show any effect on its ability to slow or prevent cognitive decline but there was evidence that it may improve some kinds of memory in people in the early stages of Alzheimer's disease. Therefore, it is approved as a food for medical purposes for people in the earlier stages of the condition and is available over the counter at £3.50 for a daily dose.
What was this trial and what were the results?
The study involved 311 people who had mild cognitive impairment, which is a condition where someone has mild memory problems that are not severe enough for them to be diagnosed with dementia. The study participants had also had tests like brain scans or spinal taps to show that their memory problems were most likely due to the very early stages of Alzheimer's disease.
Half of the people on the trial took the drink containing Fortasyn Connect once a day for two years; the other half took a drink with the same calorie content but without the active ingredient. When the researchers analysed the results at the end of the trial, there was no difference in overall cognitive performance between the two groups.
However, when the researchers used more sensitive tests they found that the people who had taken the drink containing Fortasyn Connect had improvements in their episodic memory (memories of specific events and the time and place that they happened). Brain scans from the trial also showed that the people who took Souvenaid had less shrinkage in certain areas of their brain, including in the hippocampus, which is involved in memory.
There was no evidence presented that those who took Souvenaid were less likely to experience cognitive decline or to progress to full Alzheimer's disease. The research team are still analysing this data from the LipiDiDiet trial.
What do these results mean?
These trial results have not yet been published which means they have not yet been rigorously scrutinised by the scientific community. We need to wait for the trial results to be published to be able to get a detailed understanding of what they mean for people with early Alzheimer's disease.
Based on the results presented at the conference, we cannot say that the drink is able to prevent cognitive decline in those mild cognitive impairment due to the very early stages of Alzheimer's disease. The drink has no overall effect on cognition when it is taken for two years.
There is evidence that it can bring improvements in some aspects of memory after two years. This means it might be able to help people in the very early stages of Alzheimer's disease to manage some of the memory problems they commonly experience.
I'm worried about my memory - should I buy this drink?
If you are worried about your memory, or have a diagnosis of mild cognitive impairment, you should see your GP to discuss the options that are suitable for you.
This trial only looked at people with mild cognitive impairment due to the very early stages of Alzheimer's disease, but there are many other causes of mild cognitive impairment. There is no evidence that this drink would improve memory in everyone who has this condition so it is best to consult with your GP before beginning any nutritional supplement.
There is evidence that regular physical activity, avoiding smoking, eating a healthy, balanced diet and keeping your blood pressure in check are all ways to reduce your risk of developing dementia. This nutritional drink might improve memory in some people with mild memory problems but there is currently no evidence that it will slow cognitive decline or prevent dementia.
Several people find that having a bad night’s sleep can affect their memory and thinking abilities the next day. But does poor sleep have an effect on your memory in the longer term? This article explores the research into whether there is a link between sleep and dementia risk.
People affected by dementia often have several issues with getting a good night's sleep, and sometimes people report that their memory seems worse after a bad night. However, the evidence is unclear on whether poor sleep is a risk factor for dementia.
Sleep and dementia is a complicated topic. Different types of dementia are associated with different sleep problems. Researchers are also not yet sure which way the interaction goes - whether poor sleep causes or exacerbates dementia or if dementia leads to poor sleep. Some researchers believe that both of these theories could be true, and the relationship could be circular. On top of this, it is unclear what the mechanisms are that underlie these interactions.
It is clear that more research is needed to understand this relationship; in particular research that observes large groups of affected people for very long periods of time.
Light Sleep Disorders
Light sleep disorders are often called rapid eye movement sleep behaviour disorder (RBD), and cause people to act out their dreams through moving or talking in their sleep. Dementia with Lewy bodies and Parkinson's disease seem to be particularly associated with light sleep disorders and some studies have suggested that light sleep disorders are a very early indicator of these conditions, particularly in older men.
Some researchers believe that the part of the brain that is damaged with dementia with Lewy bodies or Parkinson's disease also plays a role in light sleep, explaining why people with these conditions are particularly affected by light sleep disorders.
Sleep-Wake Cycle Disorders
The sleep-wake cycle is the 24 hour cycle that the body goes through each day, normally ensuring that we are active during the day and sleepy at night. When this cycle is altered is causes many unusual and disruptive sleep patterns. These include wakefulness at night and problems falling asleep and staying asleep, as well as drowsiness and napping during the day.
These sorts of sleep disturbances are associated with many kinds of dementia, most notably Alzheimer's disease. They also affect people with Parkinson's disease.
It is thought by some researchers that the Alzheimer's hallmark protein amyloid may be behind the link between Alzheimer's disease and sleep-wake cycles. Increased amyloid in the brain is commonly seen in people with Alzheimer's and studies have shown that raised amyloid levels may be associated with poor sleep quality. The amyloid protein has also been linked to problems with storing memories whilst we sleep and other research indicates that poor sleep may affect the body's ability to clear the toxic amyloid protein from the brain.
This has led to the suggestion that improving sleep quality may have the potential to delay progression of Alzheimer's disease. However, it is also possible that the changes to the sleep-wake cycle are caused by other changes in the brain, and do not have an impact on risk of the condition. More research is needed to understand what the mechanisms linking sleep-wake cycles and Alzheimer's are.
Sleep Disordered Breathing
Sleep disordered breathing is when someone has difficulty breathing when they are asleep. This may be because of obstructions to the airway, making breathing harder work. Sleep disordered breathing is sometimes called sleep apnoea.
People of all ages can be affected by sleep disordered breathing, but it is most common in older people and people with obesity. Some research has suggested that people who are affected by sleep disordered breathing may be at higher risk of cognitive decline or impairment. This is because sleep disordered breathing may cause damage to the brain due to changes of levels of oxygen and carbon dioxide in the blood. It may also change flow of blood to the brain.
Treatments for Poor Sleep
Good quality sleep is linked to good health, including cognitive health. Researchers have also investigated whether there are effective treatments for poor sleep and whether these treatments can affect dementia risk. Some drug treatments for poor sleep, such as benzodiazepines, have been linked to an increased risk of dementia although the evidence behind this link is conflicting. Alzheimer's Society is funding a study into the effects these drugs could have on dementia risk.
Many treatments that have been suggested to improve quality of sleep involve lifestyle changes. Regular sleep regimes, eating schedules and diets, exercise, and ensuring exposure to bright light in the morning are all ways that you can improve your sleep quality. However more research is needed to indicate whether these activities have an effect on risk of dementia or disease progression. There is more information in treatment of sleep disorders on the NHS Choices website or you can speak to your GP.
A machine called continuous positive airway pressure (CPAP) has been shown to reduce the consequences of sleep apnoea by several studies. Before this treatment can be used, research is needed to indicate with more detail how to use it, for example how long the treatment should last and what lifestyle changes can be made to help.
There are also several drugs that have been trialled to improve sleep. Some doctors may prescribe melatonin, a hormone believed to be important in maintaining regular sleep-wake cycles. There is some evidence that this treatment does improve sleep quality in people with Alzheimer's disease and Parkinson's disease but so far evidence suggests melatonin does not affect risk of dementia or cognitive function.
Please consult your GP before making any decisions about taking sleep medication.
(Source: Alzheimer's Society, March 2016 Research Update)
Sunday, 13 March 2016
All Caregivers and Families,
All caregivers and their family members, and allied healthcare providers for AD persons, please do not miss this valuable monthly sharing session.
To register, forward the completed Registration Form to firstname.lastname@example.org or by email giving full name/s, mobile contacts and email address.
Should you require any further information, kindly contact Jenny at 016 608 2513 / 03 7931 5850.
Kindly be punctual as we will start at 2.00pm.
YOU REALLY SHOULD KNOW WHAT IT FEELS LIKE TO GROW OLD
|TREAT OLDER PEOPLE WITH EMPATHY AND KINDNESS|
Sharing with you the following extracts from the articles, Titled Aging in Agony on Elder Abuse and What does it feel like to grow old?, by S Indramalar in Star2 on 11 March 2016.
With his shoulders slumped, head hanging low and chin resting on his chest, Bernard Matthews is a shell of the man he used to be.
Up until a few years ago, the 82-year-old retired teacher used to read and write. A strapping man – he used to play hockey in his youth – Bernard would walk to the neighbourhood coffee shop to discuss current affairs and exchange “war stories” with his friends.
These days, he doesn’t say much. He shuffles and mumbles, and prefers to stay in his room.
He was recently diagnosed with depression and dementia, but his well-being deteriorated rapidly because he has been mistreated at home.
The verbal and emotional abuse started four years ago.
After Bernard lost his wife, his son and family moved in with him. Bernard thought their company would be good in his golden years.
He didn’t expect to be bullied.
It was his house but Bernard was made to feel like he was invading “their” space. He was yelled at for every little thing: forgetting to turn the TV off, not folding his towel or even watching “too much” television. He was accused of being a “burden” even though most of his pension went towards household expenses, called a “nuisance” and was constantly belittled.
All this began to eat away at Bernard. Bit by bit, he became withdrawn and depressed. He stopped going for his walks.
A concerned neighbour alerted the police and two officers came to check on him in his house in Labu, Johor. After assessing the situation, one of them discreetly advised Bernard to file a report of abuse.
For the first time, Bernard felt he could do something about his situation. He called his daughter who lived in Kuala Lumpur and they went to the police station where Bernard shared about the abuse he’d been suffering.
The police said they’d help him get a protection order from the courts. But at the last minute, Bernard backed down.
“He is my son. I don’t know why he is like this but he’s my son,” Bernard told his daughter. He also refused to move in with her because he didn’t want to leave his own house.
Elder abuse is a growing problem in Malaysia’s fast-ageing society but it is a crime that is grossly under-reported. Just like domestic violence, most view it as a “family matter” that is best dealt within the family.
Elder abuse, as defined by the World Health Organisation, is a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.
The country also needs to re-examine its laws to ensure the elderly are not vulnerable to abuse.
Thus far, the assumption is that the elderly will be well cared for in their golden years because filial piety is a trait most Malaysians are brought up with.
It is, however, not a value everyone subscribes to. The hard reality is that government health and social services must play their roles in protecting the elderly from abuse or mistreatment. Presently, there are no specific laws to ensure elderly care, what more protect the elderly from abuse. The welfare of elders comes under the purview of the Penal code and the Domestic Violence Act.
Doctors, social workers and other frontline responders now do not have clear guidelines on handling elder abuse.
“We found that most primary care doctors and nurses have had no training on handling elder abuse cases and rely on the guidelines that we have on child protection. Without any clear guidelines when it comes to elder abuse, most said they were just guessing and didn’t know what they should do,” says Universiti Malaya’s Department of Social and Preventive Medicine lecturer Assoc. Prof. Dr Noran Naqiah Hairi. She is leading an ongoing study – called the Prevent Elder Abuse and Neglect Initiative (Peace) – with her colleague Dr Clare Choo.
Consultant Geriatrician, Dr Rajbans Singh concurs, pointing out instances when social workers wanted to remove the elderly from an abusive environment but had nowhere to place them.
“So, what do doctors do? Do we call the police? We are not clear on the protocol related to elder abuse. When it comes to children, the SOPs are clear as we have the Child Act, but not so with elderly patients."
“At present, what we do is talk to the family members and try to counsel the caregivers and discuss problems they may face,” he says.
He stresses that while we may want to believe that as an Asian society we will look after our elderly, we need to accept our changing society and prepare for the future.
One of the contributing factors to elder abuse cases, says consultant geriatrician Dr Rajbans Singh, is a lack of awareness, knowledge and understanding about elderly care and support.
“In my 20 years as a geriatrician, I have come across many cases. A lot of the times, the abuse occurs not because the carers or family want to intentionally hurt or harm the older person but because they do not know how to care for the elderly."
“It’s different with children, where you are in charge and you can set the rules. With the elderly, they can make up their own minds. We have to remember that these older people were once ‘somebodies’ – they were the head of households, they were professionals or had jobs and were depended on for many things. But, the roles have now changed and that’s not an easy thing to deal with,” explains Dr Rajbans.
"Things get more challenging if the older person is no longer alert because of Alzheimer’s or dementia, diseases that correspond largely to ageing."
“Emotional and psychological abuse is very common especially if the patient (older person) has dementia. Many carers really don’t understand the nature of the disease and don’t know how to deal with someone with dementia,” says Dr Rajbans.
He shares his childhood experience of dealing with the elderly.
“My grandfather had dementia. At the time, I was quite young… I wasn’t a doctor yet. He would just walk out and talk about things that didn’t make sense to us. Sometimes, he would go to the road outside our house and take a leak. I remember my cousins would get very upset with him. They took his actions personally, as if the old man was out to make things difficult for them on purpose.
“What we didn’t understand at the time was that he was suffering from dementia. It was only years later when I became a doctor did I understand his behaviour at the time,” he shares.
"However, as important as it is for caregivers to empathise, it is also crucial for them to have a support system to lean on."
“Most families think about the welfare of the older person so much, they forget about the carer. In many families, the responsibility of caring for the older person falls on the shoulders of one child or one sibling."
“The others may contribute financially or occasionally, but the responsibility is largely on one person. It can take a heavy toll, especially if the elderly person is not well."
“The carer’s life now is centred around this older person. After some time, with no support or help, he or she may find it hard to cope and that is when the abuse starts – by taking out the stress on the elderly person,” says Dr Rajbans.
When it comes to caring for the elderly, families need to come together and support each other.
“If it gets too stressful, caregivers can hire private nursing help for a few hours every week just to allow them some time to do their own thing. Or, find suitable day-care facilities that are comfortable for the elder persons and allow them to meet and talk to their peers, while giving caregivers some time for themselves,” suggests Dr Rajbans
Presently, senior citizens (60 and above) make up 9% (2.77 million) of the country’s 30.49 million population. This figure is expected to shoot up to 15% by 2030.
The existing support services aren’t enough to cope with the current ageing population, let alone the surge in less than 15 years.
Something needs to be done, says Consultant Geriatrician, Dr Rajbans Singh.
“We currently have 20 geriatricians in the country. Singapore has a much smaller population and they have about 100. In many countries, geriatrics has become one of the largest (area of) specialisation as they know they are dealing with an aging population. We need to catch up,” he says.
“An ageing society is our reality. Everyone is busy with their careers or living abroad. We have to think of putting in place support services – community nursing homes and day-care centres, community nurses and so on. “It’s not too late, but we have to act quickly,” he says
(Full Text – email@example.com, 11 March 2016)