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Editorial Write-Up
Letting Go
The year is coming to a close and 2021 has been a difficult year for many, especially with the pandemic still swirling around us and the rollercoaster up and down social restrictions. In short it was a messy year.
As is usual for this time of the year, I get into the habit to declutter my office and home so that whatever I don’t need can be ‘upcycled’ or ‘recycled’. It is a way to literally make space for what is to come. But as I get into the actual work, I find it is not as easy as just sorting, packing and removing. Even simple things like giving away clothes gives me cause to pause and defer some clothing pieces because of sentimental reasons even though physically I have outgrown them (that’s a nice way of saying I have grown fatter and can’t fit into it).
What is holding me back? The hesitancy to let go is driven by emotional attachment, but the more I hold onto it, the more clutter accumulates and eventually there is little space to take on more.
What is the relevance of this to caregiving you ask, it reflects about us as a person and regardless whether we are the caregiver or the one being cared for, we all have to let go some things in life so that we can make space for change, embrace new things and experiences.
Letting go to move ahead
To all the caregivers who may read this, there is only so much time and space in your life to juggle multiple responsibilities. If we keep adding more work, pressures build up and very soon it spills over, no different from the earlier example of decluttering a wardrobe. The hardest part is deciding what to let go and what to keep. Everyone has different priorities in life, and home situations are different so the intention here is not to prescribe what to do, but rather what steps we can do to move forward.
Letting go of physical barriers
This is probably an easier objective to assess and make changes, if the daily caregiving tasks are physically strenuous because the chair or bed transfer requires heavy lifting, perhaps its time to let go of old furniture and have it replaced with more ergonomic appliances. There is an inherent stubbornness in all of us to grow attach to our favourite sofa, but just as some of my elderly family members realized they needed help to get up, it took considerable persuasion for them to accept that a high chair is what was needed to enable a more comfortable sitting position and best of all they did not have to rely on someone to help them get up from the chair. I consider this a small victory, but every little bit helps.
Letting go of guilt
All too often I hear the repeated excuses that caregivers give that they feel obligated to sacrifice their own happiness because of the guilt they feel leaving their loved ones behind.
This is a mindset that needs reframing, your respite from caregiving duties does not equate to abandonment of your loved ones. Let go of the personal guilt, free yourself of this and one will find more space and capacity to go further on this caregiving journey. The pandemic has exacerbated the isolation for many people and this has caused friction and fractured family relationships.
Individual self-care is even more important right now and we cannot emphasize the benefits of just saying ‘I need my time and space, I still love you and my world involves both of us, but right now this time it is about me’. How many of us are prepared to say this without guilt, if you can, you have taken the first step to empty out the inner guilt and you are ready take on the next tasks with renewed energy.
Letting go of the past
The reason why all of us suffer from some degree of hoarding is that we are unable to let go of the past. There are some items that should be retained and that is what we need to discern, but holding onto too many items makes our lives messy. We need to do periodic spring cleaning and re-organisation, so as to increase our memory space, and these memories become richer in the longer term and are more easily retrievable.
Eventually the day will come when caregiving responsibilities end because the ones we were looking after have passed on. That day should be the transition to begin the next chapter of life and we have to let go of the past to move forward.
The analogy is like taking a long nature walk, the path is uneven, there will be obstacles to climb over, the journey is long, but along the way if you stop and silence your inner thoughts, you will hear the wind rustling the leaves, see the birds flying from tree to tree. When you look back you will have seen how far you have gone and as you look ahead at the trail you do not know what to expect, it will be uncertain and the natural tendency is for us to continue walking forward not backwards.
I have gone through my own personal journeys and key criteria is always travel light if you are embarking on a long travel, the more baggage we bring along, the harder the journey will be. As the new year dawns on us, my wish for everyone is let go of negative emotions, tidy up your physical environment, it takes both physical and mental housekeeping to prepare you for the caregiving journey ahead.
Happy New Year
Dr Daniel Tan
Board Member and
Editorial Sub-Committee: Editor-in-Chief
Caregiving Welfare Association
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CWA Caregivers' Week 2021 - 'Finding Resilience in Caregiving'
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A very warm welcome to CWA Annual Caregivers’ Week 2021!
Despite the current challenging COVID-19 situation, our efforts and indomitable spirits have enabled us to push forward and persevere in our mission in advocating support for caregivers.
This year is our 6th year holding Caregivers’ Week, which will be held from 1 to 7 November 2021 with the theme 'Finding Resilience in Caregiving'. CWA believes in the potential mental ability that caregivers have in them to adapt and overcome difficult situations that would help to manage their emotional stress better throughout their caregiving journey.
The campaign’s objective is also to raise public visibility on caregiving through our webinar series: 'Dedicating to Self-Care', where our invited guest speakers will share useful tips and resources, as well as interactive virtual workshops to be held over the week-long campaign that will help caregivers to look after themselves while taking care of their loved ones. In organising these activities, we hope to achieve greater public awareness on the important role caregivers play in helping their loved ones to lead a fulfilling life.
When we look around us, there may be some of us caring for someone or vice versa; it could be an ageing parent who needs a little more help, or someone who has illness that needs to be taken care of. Therefore, caregivers are everywhere in our community - be it our family members, friends, and neighbours.
With an ageing population, we will be depending even more on family caregivers to provide care for our loved ones. The enormous pressures and risks that come along with caregiving - burnout, emotional stress, and depletion of financial resources - are a reality of daily life for family caregivers. These pose an immense strain on them, many of whom are struggling to balance between work and family responsibilities. Therefore, it is important to understand the need to promote the awareness of caregiving – for caregivers to also better understand themselves.
Through this initiative, I hope that the community can come together and be part of CWA Annual Caregivers’ Week 2021 and celebrate the spirit of caregiving to show that caregivers are being valued and recognised. Together, we will forge a new path of positive change of caregiving in our community and I sincerely hope that all of you will benefit from the various activities organised specially for you.
Finally, allow me to extend my sincere appreciation to each and every one of you, who in one way or another has contributed to our CWA Annual Caregivers’ Week 2021.
Thank you and stay safe!
Dr Tan Hong Yee
President
Caregiving Welfare Association
5 Sleep Mistakes You Don’t Know You’re Making and How to Fix Them!
Sleep has been overlooked for many years ever since the invention of the artificial light by Thomas Edison. Modern day society tends to prioritise work, leisure and travel rather than sleep. Most recently, Singapore made the world’s headlines by being the most fatigued country in the world. So, what are we doing wrong when it comes to sleep? For starters, these are the most common sleep mistakes.
Not to worry, we have included sleep hacks that you can implement right away if you are guilty of making these mistakes.
1. Using your gadgets before bed
At least 95 percent of people use some kind of electronic device — TV, a computer, a phone or a tablet — within an hour of bedtime, according to the National Sleep Foundation. However, these gadgets emit blue light which will inhibit the production of melatonin, the sleepy hormone to help you fall asleep and stay asleep.
Solution: Make sure you have a power down hour. Try to avoid using your gadgets at least 1 hour or 30 mins before bedtime.
2. Drinking caffeine and having midnight snacks
Caffeine is a stimulant and it can affect your sleep. It has a half-life of 6-8 hours. So, make sure you try to avoid caffeine-consumption after 2pm so it doesn’t disrupt your sleep at night.
Refined sugars and processed food can stress the organs in charge of hormone regulation - causing you to wake in the night as your levels fluctuate.
Solution: Snack on foods that contains tryptophan. This amino acid is needed by the body to produce serotonin, which in turn makes melatonin.
3. Sleeping at odd hours
A lot of people often sleep at irregular hours but studies have shown that the timing of sleep matters, and it’s best to sleep as much as possible during hours of darkness.
Sleeping at night helps align the body’s circadian rhythm or internal clock, with its environment. Proper circadian timing is critical for sleep quality and affects mental health, cardiovascular function, metabolism, and other key elements of overall health. If you always sleep at different hours, you are severely disrupting your body clock and that’s not a good thing in the long run.
Solution: Go to bed at the same time and wake up at a fixed time whenever is possible. It will anchor your sleep and improve the quantity and quality of your sleep. The reason is that deep within your brain, you have a master 24-hour clock. It expects regularity and works best under conditions of regularity and controls your sleep/wake schedule.
4. Sleeping too hot
Part of the body’s process of falling asleep is reducing its temperature. So, if the room is too hot, you will find it uncomfortable and will have a hard time falling asleep.
Solution: Keep the room cool and well ventilated. Your brain and body needs to drop the temperature by 1 degree Celsius to fall asleep and stay asleep. It’s easier to sleep in a room that’s too cold than too hot. About 18 degree Celsius is what the experts recommend, but if you find it too cold, anything between 20-25 degree Celsius is also acceptable.
5. Stop saying you can't sleep!
If you don’t think you are a great sleeper, then you won’t be one. It’s just how it is. If you keep stressing about sleep, then you are just reinforcing that mantra in your head and turning it into a reality when bedtime comes.
The more you stress and worry about having just the right sleep routine or following the rules so exactly, the tougher it is for your body to relax, which is what triggers all the internal chemical processes in the brain and the rest of the body that initiate sleep.
Solution: Relax, meditate and pray. Jump into a better relationship with sleep. Listen to your body and have a positive loving relationship with sleep.
Author: Zoe Chu
Founder of Your Sleep BFF
References
https://ph.news.yahoo.com/singapore-listed-most-fatigue-country-in-the-world-survey-033247000.html
https://www.sleepfoundation.org/professionals/sleep-americar-polls/2011-poll-technology-and-sleep
https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx
https://www.healthline.com/health/sleep/best-temperature-to-sleep
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Behavioural Strategies To Manage Pain
We may experience aches and pain in our body from time to time when we overwork or overtax ourselves. We may also experience pain due to an injury or a medical condition. And as caregivers we may also experience pain when we overstrain ourselves while helping our loved ones.Managing pain is important. Pain can be physically and mentally draining, contributing to becoming burnt out from caregiving. Pain can also affect our attention and concentration, and consequently our ability to care for our loved ones.
Our first response to pain is to try to eliminate it. We rest or seek medical treatment for it. However, at times, the aches and pain returns. And unfortunately for some of us, the pain may be consistently there.
You probably have tried different ways to manage the pain e.g., Acupuncture, Traditional Chinese Medicine, Physiotherapy etc. Did you know that psychological methods can be added to your bag of tools to manage pain? While psychological methods do not help to cure or eliminate pain, they can help you to cope better with pain, improve your quality of life and functioning.
When we have pain, we naturally avoid certain action and activities that aggravate the pain. We may find ourselves limiting other actions outside of caregiving, e.g., avoiding bending over if we have back pain. At times, we may even have negative thoughts about how the pain will worsen and how our health and life will turn out. These behavioural and cognitive impacts of pain on us, can be better managed through behavioural strategies from psychology.
Here are some behavioural strategies from psychology to help you cope with pain.
Please continue to seek medical help for your pain, especially if it is acute pain.
1. Reframe Pain
Reframe pain as an experience that can benefit from self-management. Pain is frequently seen as debilitating and this will only make us more helpless. Pain can be effectively managed and this has been backed by research. While it may take a while for you to manage your pain effectively, it is within reach.
It is perfectly normal for you to avoid certain activities to not aggravate your pain. However, in the long run, avoiding activities may lead to muscle wastages and contribute to further inactivity. Build your activities up gradually rather than rush into them or push yourself beyond your limits. For example, if you can only stand for 10 minutes to cook now without aggravating the pain, slowly build it up, and take brief breaks, rather than forcing yourself to stand for 30 minutes.
We often experience a conflict within us when we have pain. We struggle between pursuing activities and reducing engagement in them. Such conflicts can be overcome when we break down the activities into small personal projects that can be realistically executed. For example, instead of cleaning the whole room in a day, it may be more realistic to just clean the cabinet. Instead of showering your loved ones all by yourself, you could ask others to help.
4. Pair Your New Activity With An Existing Activity
The chances and willingness of you doing something is higher if it is incorporated into your routine and part of your caregiving. For example, if you like to build up your capacity to perform the activity of taking a walk and have some hesitation to do so, you may want to plan to do it after an existing activity. I will go for a walk with my loved one who is wheelchair bound, after I have fed my loved one dinner.
5. Overcome Pain-Related Fear Through Evaluation
Our fear of pain frequently limits us from engaging in activities. One way to manage this fear is to evaluate our thoughts after we try out these activities. Most of the time, we will find that the thoughts may not be that true.
Caregiving is challenging. Managing pain is not easy either. You are not alone and the journey can definitely be better. I hope these behavioural strategies from psychology can help you in one way or another.
Lew Yuen Foong, Henry
Counselling Psychologist
M A (Applied Psychology)
Registered Psychologist and Clinical Supervisor of Singapore Psychological Society
References
de Moraisa, D., Terassia, M., Inouyea, K., Luchesia, B. M., & Pavarinia, S. C. I. (2016). Chronic pain in elderly caregivers at different levels of frailty. Rev Gaúcha Enferm, 37(4), e60700.
Sharpe, L., Jones, E., Ashton‐James, C. E., Nicholas, M. K., & Refshauge, K. (2020). Necessary components of psychological treatment in pain management programs: A Delphi study. European Journal of Pain, 24(6), 1160-1168.
Terassi, M., Montoya, P., Pavarini, S. C. I., & Hortense, P. (2021). Influence of chronic pain on cognitive performance in elderly caregivers: a longitudinal study. Revista brasileira de enfermagem, 74(suppl 2), e20200412.
Terassi, M., Ottaviani, A. C., SOUZA, É. N. D., Fraga, F. J., Montoya, P., Pavarini, S. C. I., & Hortense, P. (2021). Cognition and chronic pain: an analysis on community-dwelling elderly caregivers and non-caregivers. Arquivos de Neuro-Psiquiatria, 79, 201-208.
Vlaeyen, J. W., & Crombez, G. (2020). Behavioral conceptualization and treatment of chronic pain. Annual review of clinical psychology, 16, 187-212.
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5 Vegetables to Avoid for Better Sleep in TCM
Sleep is an inherent part of healthy living but an activity that is much deprived for many in society today. Getting into sleep and staying asleep seems to be almost unachievable by many people as they struggle to even get through the night in peace. This is especially so for caregivers who may have to break their sleep to serve the person they are caring for during the wee hours of the night. In Traditional Chinese Medicine, poor sleep is seen when organs such as the Heart and Kidney are out of balance. The reasons for sleep problems can be multiple and diverse, having mostly been built up over time and thus resulting in an imbalance.
Lifestyle habits are one of the factors that we can start to reevaluate and improve to bring about positive changes to sleep quality and pattern. One of which is dietary.
In some ancient traditions, it is advocated that there are certain vegetables or herbs that should be avoided in diets as they can cause overstimulation to the mind and disturb meditative cultivation. From a Traditional Chinese Medicine point of view, it can be seen that these vegetables have properties such as “Warming” or “Hot” and “Pungent” in flavor that can increase the Heart fire and direct energy outwards and upwards. This means that they can result in agitation or excitement to the person and the nervous system. To have good quality sleep, TCM advocates for energy to be consolidated inwards rather than dispersed. Hence to have a better-quality sleep, it is encouraged to avoid, if not cut down, these vegetables in one’s diet (especially at dinner) to keep the nerves and mind peaceful and overall energy grounded.
Here are five of them and their individual properties that may result in the person being more stimulated, which may be brought over into the evening and affect sleep quality.
1. Onions
Temperature: Warm
Flavor: Pungent
Properties: circulates qi, circulates blood, disperses cold, clears dampness, resolves phlegm
2. Garlic
Temperature: Hot
Flavor: Pungent, sweet, salty
Properties: circulates qi, clears dampness, eliminates toxins, disperses wind, resolves phlegm
3. Chives
Temperature: Warm
Flavor: Pungent
Properties: circulates qi, circulates blood
4. Scallion (Green onions)
Temperature: Warm
Flavor: Pungent
Properties: disperses cold, eliminates toxins, disperses wind, reduces swelling
5. Leeks
Temperature: Warm
Flavor: Pungent, sweet, sour
Properties: circulates qi, circulates blood, disperses cold
Dr Lim Xiang Jun
Senior Consultant TCM Physician
PhD. Acupuncture/Chinese Medicine
Founder of Dr Xiang Jun, The Modern Traditional Doctor
To find out more about the various services offered by Dr Lim Xiang Jun, please click HERE
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Nutrition and Immunity
Adequate nutrients and water are vital for the functioning of all your organs, and it is a huge part of keeping your immune system functioning at an optimal level. Think of your immune system as your “personal bodyguards”, protecting you against infections and other harmful elements. As we age, our immune system becomes less effective at tackling infections and protecting us against harmful elements as its responses slow down. At the same time, the ageing immune system sometimes fail to resolve an inflammatory process, causing an ongoing, low-grade systemic inflammation. These changes in immune function may contribute to the greater susceptibility of seniors to some infections and inflammatory diseases like cardiovascular, cancer, dementia, and even Type 2 diabetes.
The good news is that adopting the right diet, with moderate physical activities, may help a person maintain healthy immunity into older age.
An optimal immune system is a well-balanced immune system. It is not overactive or underactive. Immune overactivity can result in health conditions like allergies, sensitivities/intolerances, and autoimmune disorders. An underactive immune system is “overwhelmed”, “weakened”, and unable to protect the body from invading pathogens and leaves people vulnerable to infections.
Healthy ways to keep a balanced immune system
Your best line of defense is a healthy lifestyle, and this includes adequate nutrients, hydration, and sleep. A healthy immune system needs good, regular nourishment. It has been long recognised that people who live in poverty and are malnourished are more vulnerable to infectious diseases.
Here are seven (7) dietary considerations to a healthier immune system
1. Take steps to avoid infections
Wash your hands regularly. Wash your hands before handling food and eating.
2. Eat a diet that is high in fresh, minimally processed food
Most foods that we eat today has gone through some degree of processing. Processing can be minimal like freezing freshly caught fish and seafoods, frozen vegetables, fruits and berries, and bottled/canned whole vegetables without added salt, sugar, and flavourings. These are all good.
Some foods have gone through a high degree of processing – ultra-processed foods. These ultra-processed foods tend to be high in sugar, salt, trans fats and artificial flavourings. Examples of ultra-processed foods are crackers and chips, instant cereals, instant noodles, instant soups, packaged bread and buns, processed cheese slices, flavoured yogurt drinks, processed meat products like “hot dogs”, nuggets and processed ham slices.
As much as possible, avoid these ultra-processed foods and choose the less processed options. The more processed a food is, the less micronutrients the food will contain. Micronutrients are vitamins and minerals. Micronutrient deficiencies like Vitamin B6, Vitamin C and Zinc often result in a suppressed immune system and increased susceptibility to infections.
3. Minimise consumption of ultra-processed foods
Not only do ultra-processed foods contain less nutrients, they also contain high amount of food additives, artificial flavourings and colourings too. Long term, constant exposure to these food chemicals can result in chronic inflammation, overactive or underactive immune system.
4. Limit intake of foods and beverages that are high in sugar
Limit intake of foods and beverages that are high in sugar like soft drinks, cakes, cookies, ice creams, yogurt drinks and others. Studies have linked high blood sugar levels to an impaired immune response in people with and without diabetes. (1,2)5. If you drink alcohol
Drink in moderation, which is about 1 glass of wine, 1 can of 330ml beer or 1 shot of spirits for women. For men, the amount is about 2 glasses of wine, 660ml beer or 2 shots of spirits. Moderate consumption of alcohol has no effect on the immune system of healthy individuals, but overconsumption weakens both the innate and adaptive immune system, and increases susceptibility to infections. (3,4)
6. Eat adequate protein
Protein malnutrition has been known to impair immune function and increase the susceptibility of animals and humans to infectious disease. It is recommended to consume about 1g of protein (or more for active individuals) for every kg of body weight. (5,6). High protein foods include eggs, seafoods, chicken, all types of red and white meat. For vegetarians, legumes, beans and bean-based products like tofu and tempeh are good sources of protein.
7. Make hydration a priority!
Water carries nutrients and other important components to the immune system and helps to remove metabolic waste from our organs daily. If not flushed out, these metabolic wastes have the potential to become toxic and weaken the immune system. It is recommended to have at least 1.5 litres of fluid daily. Fluid intake can be plain water, herbal tea, vegetable juices or from water-rich foods like watermelon and broth. Dehydration is common among seniors. Scheduling frequent small drinks and incorporating water-rich foods into their snacks, can help to improve overall fluid intake.
Ms Katherine Khoo
Nutritional Therapist
Aman Wellness Pte Ltd
References
1. Acute hyperglycemia impairs IL‐6 expression in humans. Immun Inflamm Dis. 2016 Mar; 4(1): 91–97. Published online 2016 Jan 19. doi: 10.1002/iid3.97.
2. Type 2 Diabetes and its Impact on the Immune System. Curr Diabetes Rev 2020;16(5):442-449. doi: 10.2174/1573399815666191024085838.
3. Influence of alcohol consumption on immunological status: a review. Eur J Clin Nutr. 2002 Aug;56 Suppl 3:S50-3. doi: 10.1038/sj.ejcn.1601486.
4. Alcohol and the Immune System. Alcohol Res. 2015; 37(2): 153–155. PMCID: PMC4590612.
5. Amino acids and immune function. Br J Nutr. 2007 Aug;98(2):237-52. doi: 10.1017/S000711450769936X. Epub 2007 Apr 3
6. Effect of dietary protein and amino acids on immune function. Crit Care Med. 1990 Feb;18(2 Suppl):S86-93.
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
To find out more about the various services offered by Rehab & Beyond Pte Ltd please click HERE
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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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