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Editorial Write-Up
Physiotherapy Management of Osteoporosis
Osteoporosis is a condition where the internal bone structure changes and reduces in density. It can result in patients succumbing to low-impact, fragility fractures.
Osteoporotic fractures may lead to poorer health, more disability, and a significant reduction in quality of life. Patients with osteoporosis need calcium as well as vitamin D for better bone health, and vitamin D is synthesised in the skin by exposure to sunlight. However, many seniors remain at home, and thus may be deprived of sunlight and exercise, putting them at risk of osteoporosis.
Other Causes
There are many contributing factors associated with osteoporosis. These include:
• Decline in bone mass with ageing
• Sedentary lifestyle with little or no physical activities
• Impaired hormone production (such as oestrogen deficiency)
• Prolonged use of medications.
• Low calcium intake or absorption. Excessive alcohol consumption can decrease the body's ability to absorb calcium.
Tips to Prevent Osteoporosis
Other than taking medication, it is also important to include good nutrition (including adequate amounts of vitamin D and calcium), limit alcohol intake, smoking cessation, and daily exercise prescribed by a physiotherapist.
Physiotherapy management of individuals with osteoporosis and osteopenia (osteopenia is when your bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis) should include:
1. Weight-bearing exercises
Bone responds to the load applied to it by strengthening its structure. Physically active individuals typically have higher bone density than those who have a sedentary lifestyle.
Exercises such as walking, skipping, or hopping, has been shown to maintain or improve bone density in this population.
For individuals with low bone mass, it may be safer to begin exercise training by walking and hopping in a swimming pool with the water at chest or shoulder level. The buoyancy of the water helps with cushioning the impact of these exercises on the bone.
2. Strengthening exercises
Resistance training or strengthening using body weight, free weights, or resistance bands, have also been shown to maintain or improve bone density around the body parts that are being exercised. Lifting your legs against gravity or moving your limbs against water resistance also helps with strengthening the limbs and have positive effects on bone density. Strengthening exercises are also important to prevent or reduce back pain.
3. Balance exercises and Functional exercises (Flexibility and strengthening through whole body movements)
Fall prevention is important as falls often result in fractures in individuals with low bone density. Exercises that improve balance and postural control are therefore important to reduce the risk of falls.
Functional exercises such as Tai Chi and Pilates can help improve the individual's overall physical function and postural control.
4. Postural exercises
Exercises can help to improve posture and prevent postural changes such as thoracic kyphosis (hunchback). These exercises also reduce joint stiffness and strengthen muscles that help the individual maintain good posture.
Individuals with a risk of spinal fracture should avoid high impact or repetitive forward bending and/or twisting exercises as they place high amounts of pressure on the spine.
Alternatively, the focus can be on strengthening of the muscles at the back of the body. Some examples include neck exercises like chin tucks, upper back extensions, shoulder blade squeezes, and hip extensions.
5. Education and Awareness
Individuals with osteoporosis or osteopenia should:
• Avoid falls by
- Getting their eyesight checked regularly
- Having good lighting on stairs
- Removing cluttered furniture or rugs that can cause trips and falls
- Wearing well-fitted shoes to prevent falls
• Follow a healthy diet that includes enough calcium and Vitamin D
• Avoid heavy lifting – enlist the help of others or consider home delivery grocery shopping.
Osteoporosis can be diagnosed and prevented with effective treatments before fractures occur. The prevention, detection, and treatment of osteoporosis is important. Seek help from a healthcare professional to receive appropriate care.
Jaden Lim
Principal Physiotherapist &
ACSM Certified Clinical Exercise Physiologist
Rehab & Beyond Pte Ltd
Source: https://www.webmd.com/osteoporosis/guide/osteopenia-early-signs-of-bone-loss
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CWA 17th Anniversary - 'OF CHANGE & HOPE'
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This month marks the 17th Anniversary since the Caregiving Welfare Association (CWA) has been set up, so that we can recognise, support and empower caregivers of the silver generation. Change is inevitable in life, and over the years, the climate of caregiving and even CWA has evolved. I would like to take this moment to revisit the importance of caring for our caregivers and the elderly, and reflect on the role that all of us have to play in caregiving despite a climate of change.
What are some of these many changes? Over the years, families have gradually become smaller, and so have living spaces. The responsibility of care naturally becomes distributed amongst less people, and it is increasingly more difficult to expect the family unit to be the sole source of support for both caregivers and the elderly. The elderly also often live alone or with a domestic worker, which can further worsen problems of isolation. More resources also need to be put in to maintain environmental safety and monitoring. Over the years, we have become increasingly digitized, which is a double-edged sword - for some, having to deal with technology can be bewildering and upsetting. On the other hand, technology is already increasingly being used to help with aspects of safety monitoring of the elderly, timely access to medical care, medication reminders and keeping socially connected, among many others.
Challenges that Caregivers face
The rigours of life sometimes put us in a place where we compartmentalize ourselves in terms of work, personal commitments and family. For a caregiver however, the role of caregiving remains overarching amidst all the other duties and daily activities such as juggling with jobs, children and social activities. Unsurprisingly, this often leads to tremendous difficulties in many areas for the caregiver. It is important therefore that caregivers should have the necessary support systems in place, so that they do not need to feel like they are alone in this labour of love.
Caregiver burnout is not uncommon, and can lead to difficult emotions such as anger, resentment and guilt over our loved ones. It is very often a lonely undertaking, and many are unaware of the vast breadth of resources and help that are available. Left unaddressed, these difficult emotions can negatively impact the emotional health of caregivers, predisposing them to conditions such as anxiety, depression and physical health problems.
Caregiving is also physically taxing for families. Many of our seniors have mobility problems, and require assistance in transfers, walking, showering and even eating. These can be further complicated by medical issues, such as frequent toileting in the middle of the night or day-night reversal symptoms in dementia. Caregivers often find themselves physically exhausted and lacking even basic sleep, and many end up having to forgo self-care and their own social interactions as a result. Unfortunately, these further add on and perpetuate a vicious cycle leading to worsening caregiver stress and burnout.
Finally, caregiving can lead to significant financial strain. In addition to regular expenses such as medications and doctors' visits, there can be other unexpected financial expenditures such as medical emergencies. Some of the elderly also require physical modifications or mobility aids, or even dedicated transport services. These add up to significant amounts over time.
Changing to better support our Caregivers
CWA as an organisation has also evolved over time. CWA was formed many years ago (initially known as Caregiving Counselling Welfare Association before our name change in 2010) in order to be a focal resource to support caregivers and provide them with resources and knowledge. In that same year, the Caregiver Support Group was set up so that caregivers can come together to share and learn how other caregivers have coped with similar difficulties.
Over the years, CWA has expanded the scope of our services to direct eldercare services to help them age better, as maintaining the independence of seniors is another important aspect of alleviating the stress on caregivers. In addition, avoiding premature or unnecessary institutionalisation often provides a higher quality of life and medical outcomes for the seniors.
One key challenge many caregivers face is having the practical help they need at home, and therefore the CWA Home Nursing Care and the Eldersitter Program were initiated in 2013 and 2015 respectively. These programs were later consolidated under CWA's Home Personal Care service in order to provide comprehensive and personalised care that fits the needs of the elderly and their families. Under the Home Personal Care service, CWA has focused on training local Community Caregivers who are able to communicate effectively with the seniors that they help to care for. Currently, the Home Personal Care service covers a wide range of services including assistance with basic care and toileting, companionship and social engagement, and accompanying them for appointments. In short, these are tasks that our Community Caregivers and volunteers take over from time to time, so that the family caregivers can have periods of respite to focus on other things that matter as well.
We have also focused on public education and raising public awareness through forums such as the Annual Caregivers' Week since its inauguration in 2016. In addition to talks, the Caregivers' Week also consists of workshops that help caregivers alleviate stress and frustration. We have also launched the Community Outreach Program where our volunteers conduct home visits to identify isolated and vulnerable seniors and encourage them to be
socially engaged through the activities provided at CWA Centre. In Nov 2017, CWA launched the Caregivers' Sanctuary located at the National University Hospital Medical Centreto bridge the transition from hospital care to home care.
Unexpected Changes and Changes of the future
In the last year or so, one significant aspect of change was brought about by the COVID-19 pandemic. Our generous supporters and donors have helped us tremendously in raising funds that keep our programs running, via different means such as online donation platforms. Our staff and volunteers have also tapped on available resources such as making periodic calls to seniors under our care, to keep in touch and to ensure that any emergent needs are met. For Caregivers’ Week 2020, we adapted to the times by bringing the event online instead. One aspect that the pandemic has highlighted is the importance of this human touch and connectedness. In the course of my clinical work, I have seen unfortunate seniors that have suffered and deteriorated as a result of reduced physical contact and social activities. This really brings to light a magic beyond what we do in science and medicine - the importance of having caregivers and services as a part of their lives.
It is my hope that CWA’s services will continue to evolve for the better, even as things around us change over time. But at the same time, we need to preserve the core of why we do what we do, and from time to time revisit our mission to address the needs of both caregivers and seniors. Despite any changes that happen down the road, we will still strive to meet their unmet needs, tap judiciously on new and emerging resources such as technology, while maintaining the core essence of a human connection to let caregivers and seniors know that they are not alone in this journey.
Dr Tan Hong Yee
President
Caregiving Welfare Association
WHY SHOULD WE LOVE OUR SLEEP?
“Human beings today are making demands on their bodies and their minds that are in conflict with their biological nature.” ~From Sleep Thieves, by Stanley Coren
We live in a go, go, go society. Energy drinks, coffee, and pastries have become the answer to sleepiness these days. We do not listen to our bodies when they tell us that we need to slow down and to relax. Our views on sleep have changed since the Industrial Revolution and especially with the invention of the lightbulb.
Now, we have all kinds of sunscreen and lotions that suppress the body’s natural production of melatonin. As a result, contributing to the body producing insufficient melatonin that is supposed to facilitate the transition to sleep. Our social lifestyle has evolved with the times with too many options when it comes to entertainment and the types of caffeinated drinks on the menu. Hence, being too active does contributes to how we choose to spend too much time staying up late and thus losing much of our sleep. With all these that are happening, it seems like we do not make sleep as a priority anymore.
Sleep is like the holy grail of all. Every single night it turns back the clock of time on us. Through sleep, it helps to repair our damaged cells and it rebalances our body’s hormones (Peterson & Werneburg, 2018). If all these are not occurring, without the natural process of healing to take place through sufficient sleep, we will be aging much faster because of all the damages that the body is undergoing.
The other thing sleep does for us, is to make us smarter. It cleans out our brain every night from toxins so when we wake up, our brain is on full steam ahead and it can serve us at its best. If these bad toxins are not cleaned out, it may lead to dementia and Alzheimer’s disease (Hamilton, 2013).
Sleep does not just keep us from being cranky, moody, and grumpy but it helps us to cope with stress and what life is hurling at us. Most of us, we are being thrown a great deal of things, it might be the challenges which we face at work, and even back home with our loved ones. It could also be some personal struggles which we may need to tackle from time to time. For some of us especially now during the Covid19 pandemic, the news that we read or hear every day could be quite depressing or even stressful.
With sleep, when we dream in our REM (rapid eye movement) sleep (Cleveland Clinic, 2020; Macmillan, 2017), we have a safe zone - our dreams are like a playground for our mind to throw out everything that we could not cope with (Suni, 2020), or did not digest during the day because maybe we are just too busy, or perhaps it was uncomfortable thinking about it. So when we dream, we have our mind digesting all those things. It is similar to cells being repaired; our mind is also being repaired through sleep (Eugene & Masiak, 2015). This helps us to be more resilient, to keep us going and to make us happy.
If we do not have sufficient sleep, we can become not just grumpy, but more depressed and anxious about how we view our life situation or how we take on challenges overtime (Harvard Health Publishing, 2009). If these sounds quite familiar to us, then we may want to consider the consequences of having insufficient sleep. Like how we spend time in building up a good relationship with others, having sufficient sleep also requires deliberate effort and time being set aside to establish a good relationship.
Here are three things which we could do to love our sleep more.
FOCUS ON OUR SLEEP
Managing our stressors throughout the day is important and not just in the morning or at night as this can affect our sleep. Journal your thoughts when we have something on our mind instead of compiling them until night time, before dumping it all out and expecting it to take care of itself.
Alternatively, penning down our thoughts can be an example of how we symbolically put our worries/ stresses down on paper (Davidson, 2015), so that we do not need to keep thinking about it when it is time for us to sleep. We could always address it in the morning or when the time comes.
LISTEN TO OUR SLEEP
Just like our car dashboard, when we see the light flashing, we will take our car to the mechanics right away. Hence, if we are not sleeping well, please listen to what our body is trying to hint to us and then try to find out what is the real problem. Understand the reason(s) why we may not be sleeping properly.
COMMUNICATE WITH OUR SLEEP
Most of the time we love our sleep, but we can be very frustrated with it and we can get angry with it. Write a letter to sleep. It might sound crazy, but first we can write a complaint letter to sleep. Telling sleep that we are so angry with it because it is never there for us when we need it (i.e. when we struggle to fall asleep). Our complaint could also be that sleep wakes us up early when we are still tired. If this is happening to us, then just tell sleep that we are frustrated about it.
We could also try to write a love letter. Telling sleep how much we miss it. How much we love that feeling when we get enough of it when we wake up the next morning. We could also share with sleep that it has been there for us throughout the night, and it is because of sleep, we now feel fantastic like a superman/ superwoman. Telling sleep how much we look better and able to think smarter just because of it and we will miss it when it is not there. It might seem silly, but it is an exercise that is amazing to do.
All in all, when we learn how to improve our relationship with sleep, our body, mind, and health will benefit from it.
Thank you for having a great relationship with sleep.
Author: Zoe Chu
Founder of Your Sleep BFF
Reading articles:
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep-the-foundation-for-healthy-habits/art-20270117
https://www.npr.org/sections/health-shots/2013/10/18/236211811/brains-sweep-themselves-clean-of-toxins-during-sleep
https://my.clevelandclinic.org/health/articles/12148-sleep-basics
https://time.com/4970767/rem-sleep-dreams-health/
https://www.sleepfoundation.org/dreams
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651462/
https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health
https://www.theglobeandmail.com/life/health-and-fitness/health-advisor/thoughts-keeping-you-up-5-ways-to-settle-yourself-to-sleep/article22799705/
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Music Listening for Health and Well-Being
Every year on 1st March, we celebrate World Music Therapy Day, உலக இசை சிகிச்சை நாள், Hari Terapi Muzik Sedunia, and/or 世界音乐治疗日 to honor music therapists worldwide and highlight how music can make life better and more fulfilling.
I would like to take this opportunity to thank the Caregiving Welfare Association for allowing me to share about music therapy and how music can promote health and well-being.
The Association for Music Therapy (Singapore) defines music therapy as the “scientific use of music interventions within a therapeutic relationship towards observable or measurable functional, educational, rehabilitative or well-being outcomes by a credentialed professional.” Music therapy is administered by a trained professional and may include singing, listening to music, creating music, moving to music, and playing instruments. Research has shown that music therapy is effective in promoting movement, increasing motivation, and providing emotional support. As a board-certified music therapist, I am passionate about music and its ability to help individuals express their emotions, learn more about themselves, and enhance their quality of life.
Music for health and well-being is broad and encompasses many different aspects (Skånland, 2013). On one end of the spectrum, there is music therapy, an established healthcare profession whereby a trained professional delivers specially designed music interventions to work on specific target goal areas. For example, a music therapist may design a music and movement program targeted at promoting physical activity. On the other end of the spectrum, there are everyday uses of music for health whereby anyone may use music in their day-to-day lives. Common examples include listening to music to get oneself pumped up while exercising at the gym or to simply pass the time while commuting to work.
Research has shown that music listening has many health benefits. Listening to music can improve sleep, increase memory skills, elevate mood, help cope with daily stressors, and enhance overall quality of life and well-being (Batt-Rawden et al., 2005; Chan et al., 2009, 2012; Finlay & Rogers, 2015; Lai & Good, 2006; Mammarella et al., 2007; Sung et al., 2010). As an example, one participant shared that by dividing her large collection of CDs into playlists, she could use music to manage her emotions and overcome grief after having lost her husband (Ruud, 2013).
Ageing is commonly associated with a wide range of health issues, including decreasing memory skills, increasing loneliness, and declining physical and emotional health (Cornwell & Waite, 2009; Depp et al., 2010; Fiori et al., 2006). In Singapore, older adults reported feeling lonely and more depressed (Ge et al., 2019; Li et al., 2015; Subramaniam et al., 2016). Caregivers of older adults also face similar challenges (Malhotra et al., 2012). Thus, music can be a resource to improve physical health and quality of life (Coffman, 2002).
Listening to Music Mindfully
Now that we know that music can benefit us tremendously, allow me to share a music listening strategy – listening to music mindfully. In addition to simply listening to music, we will incorporate mindfulness elements. Mindfulness includes focusing on the immediate experience with curiosity, openness, and acceptance (Bishop et al., 2004).
Step 1: Pick a Song
Pick a song that you may like but have not heard for too many times. For example, pick a song from your favorite artist but not one that you are overly familiar with. Some additional suggestions include a song that is not too fast or too slow, and/or instrumentation that is not overwhelming.
Step 2: Set Up the Experience
Use a suitable device and app to play the song. Program it to stop right after the selected song is played. Use noise-cancelling headphones or high-quality speakers, if possible. Sit comfortably in a chair with both feet on the ground, or lie down on a yoga mat or bed.
Step 3: Play the Song
Just before you press play, take a few breaths in and out, drawing your attention to your breathing. Once ready, press play and bring your full attention to the experience of listening.
Step 4: Return to the Present
Once the song ends, allow yourself a minute to reflect on what you have just heard. Reflect on what your body felt, the emotions you experienced, and the thoughts that it evoked. Then bring your focus back to your breathing and return to the present moment.
You can also refer to this link for instructions on how to listen to music mindfully: https://www.instagram.com/p/CKoFMZBs6Yd/?utm_source=ig_web_copy_link
Whether you are an older adult or a caregiver, I hope that this simple music listening strategy will help you to relieve stress, reconnect with yourself, and live life to the fullest. As civil rights activist Maya Angelou (1928 – 2014) wrote, “Music was my refuge. I could crawl into the space between the notes and curl my back to loneliness.”
Mr Jonathan Tang
Music Therapist - Board
Certified MA, MT-BC
Extraordinary People Limited
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Caregiver's Gift of Love
Life is a journey of many different phases. We start off as infants, totally dependent on our parents for all our needs, and as we become adults, the circle of life puts us in the reverse role as caregivers be it to our children or our aging relatives.
Very much like the seasonality of weather, for which we are blessed with dry hot or cold wet, it is how we adapt to the changing seasons that best prepares us for what is to come.
For the new parents to be, the excitement and trepidation that comes just before the arrival of the new born, be it baby shower parties, shopping for baby accessories, prams, clothes makes the anticipation of their new caregiving responsibilities a joyous and in many ways a celebration of life.
Conversely when a loved one is about to be discharged home from hospital, the process of welcoming home our family member is often greeted with anxiety. The major difference is time and preparation. For many of us, such situations are jolts that shakes up our daily routine with little or no warning and together with the loss of what to do next, compounds the fear and anxiety of what is to come.
Caregiving is stressful when we are ill equipped with the understanding as to how to cope with the care needs of our loved ones. Expectant mothers have the luxury of time to prepare their homes, schedules, attend ante-natal classes and have themselves mentally and emotionally well prepared before their big day arrives.
Whereas for those caregivers who are thrust into a situation of dealing with a loved one who was previously independent and mobile, and now has dependency needs for daily living and mobility issues, is often cited as a great source of stress.
It is Okay not to be Okay
This is the first step of acknowledgement that is probably the most overlooked or denied. How often have we asked our relatives or friends in such situations if they are okay and the answer has been i am fine. We have to recognise that for those that depend on us, we are their world, and if anything happens to their caregivers, their world changes far more dramatically. They will want for us as their caregiver to be available in mind, body and spirit for them. This does not necessarily mean we have to be at their disposable 24/7, but instead we offer them our reassurance that they will be well looked after.
Ask for help
Caregiving can take a toil on one's physical, mental, emotional, financial resources. It is not uncommon to hear of caregiver's burnout which in its most tragic form can lead to physical harm either to the caregiver or recipient. It does not have to lead to this. What can we do about it, here are some suggestions.
a. Get help
It sounds simple enough and intuitive but sadly this is often the last resort. In fact it should be the very first thing any caregiver should do especially when they are starting their caregiving journey. Don't be shy, caregiving affects every family unit equally regardless of social status, ethnicity, education background. Do seek out support groups for information or referrals that can direct you to the resource help that benefits you most.
Granted that in Singapore our social service schemes are many and can be difficult to navigate, but one does not have to do it by yourself. There are many social agencies including the Caregiving Welfare Association that can be your guide through this.
b. Give yourself a caregiver time out
We all need a break whether we are studying, working, exercising, the human body is not designed to work continuously. Learning to let go and entrust the care of your loved ones to someone else or a respite facility should not invite feelings of guilt or inadequacy. It is true that the care recipient may develop a dependency syndrome on the caregiver, one advise to avoid this is through socialisation.
c. Join a support group
Social isolation is real in caregiving, studies have shown that recipients do feel isolated despite being around family members as they lose the human connection of their social circles. The same holds true for caregivers. Support groups are a tremendous source of solace and reassurance especially speaking to more experienced caregivers with similar situations.
d. Take time to treat yourself
A simple break such as a meal at your favourite food stall, shopping for yourself, a simple leisurely activity that helps you distract from the daily routine are all good small breaks, in simpler terms just carve out some 'me' time for yourself.
e. Have faith
If you have a religious faith, it is well recognised that keeping your spiritual well being does help recenter your thoughts and caregivers of faith generally cope better. An alternative to faith is meditation as a means to calm both mind and spirit to further pacify a caregiver's inner peace.
Caregiving can be difficult, it will stress and test our boundaries of patience, resilience, but despite this there are also many examples and positive stories from caregivers that their time spent with their loved ones were the most treasured and fulfilling periods of their lives. It starts with the caregiver taking time to love themself in equal measure as the ones they are looking after. As the saying goes, it takes a village to raise a child, likewise for the elderly, it takes that same village and some good drivers to help you navigate the caregiving route.
Dr Daniel Tan
Board Member and
Editorial Sub-Committee: Editor-in-Chief
Caregiving Welfare Association
Share your caregiver's story
If you wish to contribute to the caregiving community for seniors, you may share your stories on this page. Please email your article to us at contact@cwa.org.sg .
Kindly note that your article should not be more than 800 words. Prior to us sharing your article on this page, the CWA editorial team will need to approve your contribution first.
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