An expert's advice on ageing well

Singapore's has one of the fastest ageing populations in the world. By 2030, one in five residents will be aged 65 and above.

Dr Tan Thai Lian, a senior consultant in the field of geriatric medicine, tells YourHealth that the main concern of the elderly is losing their physical and mental faculties.

"Many older people, when asked, would agree that they are not afraid of death, but are more afraid of becoming a burden to their family," says Dr Tan Thai Lian, who has over 20 years of experience in the public healthcare sector and heads Tan Tock Seng Hospital's Department of Geriatric Medicine.

As a geriatric specialist, Dr Tan's focus is "preserving, as much as possible, the physical and mental faculties of older patients". Geriatric care deals with the functional, medical and psychosocial aspects of the frail elderly who may be facing physical or cognitive decline.

"It is important to remember an important maxim in medicine: 'To cure sometime, to relief often, to comfort always'," Dr Tan tells YourHealth. "Sometimes, the relentless attempt to cure may inflict more pain and suffering, without benefiting the person. So sending a patient home to die may actually be the more appropriate and humane thing to do," he says.

Dr Tan, who became the Clinical Director of Renci Hospital after its restructuring in 2009, shares with YourHealth some practical steps that people can take to help themselves age well.

The first step is to avoid speeding up the ageing process. "Smoking, excessive binging, excessive drinking… basically leading an unhealthy lifestyle speeds up the ageing process," says Dr Tan.

The second step is to "eat well and move well" by having good nutrition, staying active and exercising regularly.

One should also look after any chronic illnesses one might have, such as heart disease, high cholesterol levels, diabetes or arthritis. "Do not ignore illnesses - get appropriate health screenings and prevent deterioration of existing conditions", Dr Tan urges.

One should also maintain good psychosocial and mental health by being socially engaged and maintaining healthy relationships with one's family, friends and community. Dr Tan recommends volunteerism as a good way of staying active and involved.

One should also prevent accidents by avoiding high-risk activities, while modifying home settings to minimize slips and falls.

Dr Tan advises family and caregivers to watch out for changes in their elderly loved ones, particularly when such changes affect the person's normal activities. "This holds true for mood, and other functional issues such as memory and gait stability. Any abnormalities will need attention and evaluation."

"While medicine intends to prevent premature death, it is not the business of medicine to prevent all deaths," noted Dr Tan, who was a recipient of the Healthcare Humanity Award 2012.

"The art of medicine is knowing how to provide relief and comfort when cure is not a realistic goal."

What is geriatric care?

What is geriatric care?

"Geriatric care is patient-centred, goal oriented care tailored towards the characteristics of the individual patient," explains Dr Tan.

"For some, especially the healthy and active elderly, the goal is to treat all reversible diseases, prevent onset of diseases or control and minimise complication from any chronic diseases, and encourage active participation in life.

"For others, especially those with chronic medical conditions, the goal is ‘secondary prevention’, i.e. to prevent the deterioration of disease by constant monitoring and ensuring compliance to treatment," says the head of Tan Tock Seng Hospital's geriatric department.

"For yet another group where the diseases are advanced, the goal is 'tertiary prevention' – i.e. prevent complication from diseases, maximise function, assist in functional, psychosocial needs," he notes.

"In this group, discussion of end of life care needs to be done, and the focus is not about 'quantity' of life but 'quality' of life," he added.

ayxhy@sph.com.sg