ONEHealth Issue 5 by JurongHealth Campus

YO U R Q UA RT ER LY H EA LT H &WEL L N ES S J OU R N A L

2014ISSUE

ageing well with health & dignity

When Aches Nutrition memories Hard to &pains for the swallow fade golden years LEARN ABOUT DYSPHAGIA

SHOP WELL TO EAT WELL

STEMMING THE DEMENTIA TIDE

HELP FOR OLD -AGE PAIN

“ Ag e i n g i s n o t l o s t y o u t h , b u t a n e w s t ag e o f opportunity and strength.”

- Betty Friedan

At JurongHealth, our mission is to bring health to every home and for everyone at every age. In this instalment of ONEHealth, themed The Elderly Issue, we explore some of the implications of our rapidly ageing society. Singapore is one of the fastest ageing populations in the world. In 2009, 7.9 per cent of the population was aged 65 and above and by 2030, the proportion will hit 19 per cent – almost a fifth of the population. While this trend means we are living longer lives, it also means we will have some challenges to overcome. Apart from ensuring social services and physical infrastructure are more age-friendly, healthcare services also need to step up to address the rise in age-related illnesses. Our cover story looks at the impact of the ‘silver tsunami’, what it means to embrace active ageing and the factors that need to be addressed to ensure our elderly live their golden years with health, opportunities and dignity. This issue also highlights some of the common and significant diseases that affect the elderly community – and some of the ways these ailments can be treated and prevented. Read about how to respond in the event of stroke, spot the early signs of dementia and therapeutic options for swallowing difficulties. Learn also about treatment options for age-related aches and why dental care is particularly important in old age. In FOODforLIFE!, we offer tips on maintaining peak nutrition for seniors and demystify nutritional labels. Turn to HealthBUZZ to find out about the building progress of Ng Teng Fong General Hospital and take a sneak peek at some works-in-progress. For more behind-the-scenes insights, JurongHealth's supply and logistics team share what's in store for the new Logistics Hub.

The editorial team

ONEHEALTH

C NTENTS PUBLISHER JURONG HEALTH SERVICES PTE LTD EDITOR-IN-CHIEF CASEY CHANG DEPUTY EDITOR AARON LOH EDITORIAL ASSISTANT WU WANWEN CONTRIBUTING EXPERTS DR AFTAB AHMAD DR IRENE HII DR LEE JER EN DR LUKE LOW DR MUHD RAHIZAN ZAINULDIN DR NANDAKUMAR RAMASAMI DR NORHISHAM MAIN DR YAO CHAO SHU AILEEN KELLY CHARLES LEW SERENE TAY PUBLISHING CONSULTANT THINKFARM PTE LTD MANAGING DIRECTOR CHRISTOPHER TAY EDITORIAL & DESIGN SHERALYN TAY SHARON HO SHERING WEE MYCT BOON WRITING & PHOTOGRAPHY ADAM KOH BELLA LIM LOUISA FOO JUSTIN LOH CHERYL SIM ALVINN LIM CLIENT RELATIONSHIP JESSIE KEK

Taking shape!

HealthBUZZ 04 TAKING SHAPE! A look at the building progress of Ng Teng Fong General Hospital

The information in this publication is not meant to take the place of healthcare or services you may need. Please see your doctor or primary healthcare provider about any personal health concerns. All information is correct at time of print. ONEHEALTH IS PUBLISHED QUARTERLY BY JURONG HEALTH SERVICES PTE LTD. COPYRIGHT IS HELD BY THE PUBLISHER. REPRODUCTION IN PART OR WHOLE WITHOUT PERSMISSION IS PROHIBITED. ALL RIGHTS RESERVED. MCI (P) 090/06/2014 PRINTED BY KHL PRINTING CO PTE LTD.

For general enquiries, email

onehealth@juronghealth.com.sg

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HealthSense 08 ASK THE EXPERTS Health questions answered

WeCARE 10 SEEK & DELIVER Meet the team that keeps hospital supplies in stock

2014 • ISSUE 5

ageing well with health & dignity

12 EMBRACING THE GOLDEN AGE

FOODforLIFE! 32 NUTRITION FOR THE GOLDEN YEARS

The impact of an ageing society – and factors for ageing well

16 ACHES & PAINS Identify serious pain and when to seek help

19 WHEN MEMORIES FADE Spot the signs to seek early treatment for dementia

23 HARD TO SWALLOW Dysphagia: causes and therapies explained

The essential shopping list for seniors

READ IT RIGHT Nutritional labels deciphered

FRESH CATCH OF THE DAY Fish with lemongrass and orange

HealthBites 37 THE DIMENSIONS OF WELLNESS Six facets of active ageing

26 BLOW TO THE BRAIN Act F.A.S.T. when stroke strikes

29 LONG IN THE TOOTH The importance of dental care for the elderly

JurongHealth is a public healthcare cluster formed to integrate healthcare services and community care for the west. Managing Alexandra Hospital since August 2010, JurongHealth is growing in capacity and skills in preparation for the big move to Ng Teng Fong General Hospital in mid-2015 and Jurong Community Hospital later in the same year.

ONEHEALTH

HealthBUZZ

Taking shape! The JurongHealth team is pushing ahead with preparations to ensure a smooth opening of Ng Teng Fong General Hospital by mid-2015 Preparations for the move to Ng Teng Fong General Hospital (NTFGH) are well underway. JurongHealth â&#x20AC;&#x201C; which has been operating Alexandra Hospital (AH) for the last four years â&#x20AC;&#x201C; has been ramping up its manpower needs and information technology (IT) infrastructure for the new hospital to prepare for its opening. It has also been piloting new and improved processes to better serve the community in the west. Mr Foo Hee Jug, CEO, JurongHealth, expressed excitement about the progress. "As we get closer to the completion date, I'm even more excited to go to the site each time and see the steady progress as we push on." He added that the JurongHealth team is ready to take over and commission more areas of the hospital in the next few months. (Turn to page 6 for a list of areas already handed over).

ONEHEALTH

Work in progress The preparations are going well. Already, the JurongHealth team has gone on to test the various operational systems. In fact, electricity, water, air-conditioning and telecommunications systems were all switched on in mid-2014. To ensure back-of-house facilities are up and running smoothly, utilities and infrastructure are also going through test-runs. Meanwhile, JurongHealth has implemented new infrastructure and operational processes that aim to improve efficiency and healthcare delivery. New features include a 'one queue, one bill, one patient experience' system that will make visits to the hospital more convenient for patients. To help patients who need follow-up appointments, JurongHealth will also introduce Patient Service Coordinators who will be their key point of contact for answering general care plan queries and coordinating appointments. Making the most of the extra time before opening day, training and familiarisation exercises have also been stepped-up. Nurses and other healthcare staff have been attending training sessions to learn about and get familiar with the new equipment and skills. They have also taken part in full-dress rehearsals to ensure a smooth transition to NTFGH. It is really exciting to see the new and unique features of NTFGH coming to life.

Keeping Stock The new 500sqm state-ofthe-art Logistics Hub will feature driverless vehicles and a new stock arrangement system

Fire it up Over 3,000 nutritious meals will be prepared daily at the Central Kitchen by Food Services when NTFGH opens by mid-2015

New services coming your way... Room with a view NTFGH's unique fan-shaped wards maximise air flow, natural light and privacy

Ready to stock The inpatient pharmacy is starting to receive its store of medicines

Modular Specialist Outpatient Clinics (SOC) Synergy of specialties and services: The outpatient clinics will have specialist, allied health, pharmacy and diagnostic radiology services close at hand to improve convenience for patients Combined Intensive Care Unit (ICU) and High Dependency (HD) facilities One standard of care: Singapore’s first and only combined critical care facility merging the conventional surgical, medical, cardiac ICUs and HD units Data Centre

All systems go: The backbone of NTFGH’s IT systems has been commissioned and the team is hard at work to put seamless patient management systems and other IT processes in place Contact Centre

Call of duty: Ready to respond to queries and offer Point of care A preview of one of the nursing stations in the wards

help, the Contact Centre is one of JurongHealth’s many services to help patients find the resources they need ONEHEALTH

HealthBUZZ

Handing over As of November 2014, these areas have been commissioned and handed over to JurongHealth: • Data Centre • Contact Centre • Biomedical Engineering • Inpatient Pharmacy and store in basement 2 • Clinical Laboratoary • Kitchen • Maintenance Room • Cardiology, Clinical Diagnosis and General Medicine clinics • Security • Radiotherapy Department • Medical Records Office • Private and subsidised wards in Ward Tower, level 5 • Logistics Hub Admin • Central Sterile Supplies Department

Counting down and ramping up With the opening date expected in mid-2015, more and more areas of the new hospital are being spruced up and handed over each week. As of mid-November 2014, close to 20 areas have been commissioned, much to the excitement of the JurongHealth team. Other soon-to-be-ready areas include the podium of NTFGH's Ward Tower, and the crown of the Clinic Tower. Over at Jurong Community Hospital, construction is well underway with the structure reaching the roof at level 12. Works on the exterior of the hospital have also been making good progress.

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Connecting to the community In the wee hours of 30 September 2014, JurongHealth literally connected with our neighbours. Employing great engineering precision, two concrete beams – each measuring 41 metres and weighing 180 tonnes – were hoisted into position to create a new link bridge along Boon Lay Way to connect Ng Teng Fong General Hospital (NTFGH) with Westgate Mall. This key gateway connects the Hospitals to the Jurong East MRT station and bus interchange through Westgate Mall, bringing convenience and accessibility for our future patients, visitors and staff.

ONEHEALTH

HealthSense

Iâ&#x20AC;&#x2122;m trying to encourage my 68-year-old father to exercise. He is on medication for diabetes and hypertension. What types of exercise and physical activities can he do and which are those that he should avoid?

It is important to seek medical advice before embarking on an exercise programme, though barring any joint pain and serious cardiovascular issues, your father can do any exercise or physical activity at moderate intensity. This means he should be able to hold a conversation while exercising. Do opt for a mix of both aerobic and strength exercises. For example, brisk walking has been shown to control blood glucose level and blood pressure for persons with diabetes and hypertension. If your father is exercising for the first time or after a hiatus, he could walk at a moderate intensity for 10 minutes once or twice a week and increase exercise progressively if he feels able to. The target is to hit 30 minutes of walking three to five times weekly. For strengthening exercise, do squats; he can even do this while watching television. Remember, a physical activity can also include incidental activities such as household chores (sweeping, mopping, carrying groceries, etc.) provided these are done at moderate intensity. Do note that blood glucose level and blood pressure should be checked before and after exercising. Should your father feel unwell, he should not exercise for the day. If dizziness, excessive breathlessness, cold sweat, clammy hands or chest pain occurs, he should stop exercising and seek medical advice.

Dr Muhd Rahizan Zainuldin, SENIOR PHYSIOTHERAPIST

Q&A ONEHEALTH

Ask the expert! Have a burning health question? Send your question, name and contact number to onehealth@juronghealth.com.sg

I am planning to take probiotics as a supplement. What is the recommended dose, and are there any side effects?

While there is no consensus on the minimum amount of probiotics for beneficial effect, the typical dose used in studies is one billion to 20 billion live probiotics. Probiotics can be found in foods such as yoghurt, fermented dairy beverages, kimchi, sauerkraut, tempeh and some other fermented soy products. It is difficult to determine the amount of probiotics in these foods. As a general guide, include one to two servings of yoghurt (100g per serving) or a bottle of cultured milk drink (100ml per bottle) in your daily diet. If you are taking probiotics supplements for a medical condition, you should consult your doctor on the optimal dose. When introducing probiotics, start with a lower amount or dose. Probiotics are generally safe for consumption, though some side effects – flatulance, abdominal discomfort and/or bloating – can occur. Monitor your symptoms and gradually increase the amount as your tolerance improves.

Charles Lew, SENIOR DIETITIAN

I’m a 67-year-old female on long-term medication for high blood pressure and diabetes. There are occasions when I get dizzy spells and feel weak. When I check my blood pressure at home, the readings are quite low. Why does this happen and what should I do?

It is indeed possible to have hypertension (high blood pressure) with periods of low blood pressure causing dizziness. This is more common when you get older and especially in the presence of diabetes. The cause is usually multi-factorial, though common factors are poor diabetic control, medications and physical deconditioning because of limited physical activity. Diabetes itself affects blood pressure control because the nerves are affected by high blood sugar levels. Treatment could include a change in medication, altering the timing of medication, learning to avoid situations causing low blood pressure (eg, meals or drinks high in carbohydrates, getting up too quickly after sitting or lying down), or exercise. Do seek the opinion of your doctor for individualised treatment.

Dr Nandakumar Ramasami, CONSULTANT, DEPARTMENT OF MEDICINE

ONEHEALTH

WeCARE

Seek & Deliver JurongHealth's Materials Management Department (MMD) shares the exciting upcoming innovations at the new Logistics Hub that will serve to make patient care more efficient

What’s in store for the MMD with Ng Teng Fong General Hospital (NTFGH) opening in 2015? MMD will play a key role in the new Logistics Hub at NTFGH. The Hub will have a total operating area of 500 square metres and be able to maximise the storage capacity to 800 stock keeping units in a new mezzanine concept. This will allow us to cater to the demands of a bigger hospital and a larger patient load. The MMD Logistics team is working to integrate existing and new processes with technology to optimise the resources and raise productivity. We are excited for a few new innovations that will raise our productivity and efficiency. One is a Warehouse Management System to improve the accuracy of receiving, putting-away, picking up and issuing of items. Another is the Automatic Guided Vehicle (AGV), a driverless, programmable vehicle that does away with the manual labour of transporting supplies such as linens, pharmaceuticals and other hospital stocks. Each vehicle can carry up to 350kg in supplies, much more than a typical ‘human-powered’ trolley with a maximum capacity of 50kg. The effortless distribution of supplies to the service points will allow staff to do more value-added work and become more productive.

What keeps you motivated in your work? Even though we do not deal directly with patients, we know our work at the MMD will benefit them. By ensuring economies of scale for quality products and services, we transfer cost savings to our patients to ensure that they get quality care. We take pride in the timely delivery of supplies to the end user at the right time and place to support patient care.

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What does the MMD do? We source, stock and supply all manner of hospital items – from the gauze and sticky tape that hold your wounds together, to the high-tech medical equipment that makes your diagnosis and treatment possible. As the point of contact for all procurement of products and services required in the hospital, MMD’s job is to ensure that products and services are procured according to the right practices and procedures, at the best possible cost and are always at hand. Working together, the MMD team – comprising a procurement arm and a logistics one – acquires stocks to meet a wide range of needs, from basic tissue paper to occasional unusual items such as a tattoo machine, a bed with X-ray capabilities and fish food.

Team MMD Left to right: Abu Huzaifah Bin Masnin , Logistics Associate Ha n Hwe e Kwo n g, Logistics Associate Mu h ammad Al i Hus s ay ni, Associate Executive, Procurement Za kir Hussain Bi n M S Abdul Kader, Associate Executive, Logistics Sharon Ang , Senior Associate Executive, Procurement Cec i l i a Ta n, Executive, Procurement

ONEHEALTH

Leading an active and fulﬁlling life well into your twilight years is entirely possible. Here’s how to embrace active ageing to make the most of your golden years By Sheralyn Tay and Bella Lim

Embracing the Golden Age I N C O N S U LT A T ION WIT H DR IR EN E HII ,

R E S I D E N T P H YSIC IA N & DR LU KE LO W, F A M I L Y PH YSIC IA N (A SSOC IA T E

C O N S U L TANT ), LA K ESIDE F A MILY M E D I C I N E C LINIC

ONEHEALTH

The impact of the ‘silver tsunami’ Age creeps up on all of us, and while it poses some challenges, it is possible to live well even as the years catch on. In fact, the concept of active ageing is becoming more relevant today. Singapore, like many developed countries, is facing a rapidly ageing population. By 2030, one in ﬁve people will be 65 and older. Ensuring that this greying population (that will one day consist of you and I) live healthy, productive, enabled and digniﬁed lives is a challenge that involves individual effort, political will as well as community participation. We’ll all get older, but as the American comedian George Burns once said, “You can't help getting older, but you don't have to get old.”

The secret to healthy longevity One of the ways to live a healthy, active and fulﬁlling life in your senior years is to embrace the concept of active ageing. Active ageing (see page 37) is a holistic approach that helps a person to optimise their physical, mental and social health, be actively engaged in society and have the ﬁnancial security to lead a good quality of life. This concept starts not just when you ‘become old’ – but is a mindset that applies to anyone at any stage of life. From a healthcare perspective active ageing helps to promote healthy living, and hence extend life expectancy and quality of life for all people (including those who are frail, disabled and in need of care) as they age. Ageing with 'success' thus refers not only to the absence or avoidance of disease and risk factors for disease, but also to the maintenance of physical and mental functioning, good emotional health and active engagement with life. According to studies on successful ageing, genetics impacts only one-third of how well we age; two-thirds is based on what we can control: our personal lifestyle choices. In fact, attitude and lifestyle are the key factors for not only longevity but also quality of life. Research indicates that we can indeed help ourselves live longer, happier lives by maintaining good emotional health, engaging in a little mental stimulation, being active and participating in the world around us.

Some of the biggest challenges that result from an ageing population is the rise in age-related diseases. As Dr Irene Hii, Resident Physician, Lakeside Family Medicine Clinic, pointed out, the rate of long-term diseases will start to outweigh short-term infectious disease such as inﬂuenza or gastroenteritis. “Chronic disease becomes the leading cause of morbidity, disability and mortality and this is costly to individuals, families and the nation,” she said. Another challenge is that the support ratio (the number of people aged 15 to 64 per older person aged 65 or older) will fall. It was 6.4 in 2013 compared to 7.4 in 2010. “This means fewer people are available to care for the older people when they need assistance," said Dr Hii. To support the elderly and make up for the decreasing number of family caregivers, more social and health services such as hospitals, community hospitals, day care centres, nursing homes and related support services (homebased care, assistive devices, etc.) will be needed.

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And while all this means more spending on healthcare, Dr Hii emphasised that old age itself is not associated with increased medical spending. “Rather, it is disability and poor health – often associated with old age – that are costly,” she said, noting that age-related illnesses are not an inevitable part of ageing. “It has been shown that the origins of risk for chronic conditions (such as diabetes and heart disease), begin in early life.” Dr Luke Low, Family Physician (Associate Consultant), Lakeside Family Medicine Clinic, emphasised that ultimately, a healthy, active and productive population of seniors boils down to the prevention of so-called age-related conditions, starting in early adulthood and throughout one’s lifetime.

Because you’re happy Happiness is a boost to the immune system and alleviates stress, and reduces stress-related illnesses such as heart disease, obesity, diabetes, dementia and depression. Research shows that being involved with activities, people, and experiences that bring you joy boosts optimism and a positive attitude, which in turn are linked to longevity.

Train your brain Your brain likes new things and exercising your mental capacity is one way to extend your brain’s ﬁtness. Though the brain shrinks with age, learning new things and challenging the brain with games and new skills can build new neural connections. In fact, a regular ‘diet’ of new mental experiences – doing puzzles, learning a new language, or picking up an instrument – can develop creativity, open-mindedness and inquisitiveness, all traits linked to healthier ageing.

Love yourself

A positive attitude towards oneself and developing healthy self-esteem is important in ensuring you make positive life choices. Taking good care of yourself, accepting the way you are and being conﬁdent about your own attributes leads to making better lifestyle choices and taking better care of yourself.

Connect socially A growing body of research shows that people who participate in society live longer and have a lower risk of developing dementia and senility. People who have active social lives also tend to have overall better mental and physical well-being.

Move it or lose it The science is clear: activity is the linchpin to good health. People who exercise regularly have a lower risk of cardiovascular diseases, dementia, diabetes, depression, and osteoarthritis. Active people are less likely to be obese, a condition that is a risk factor for many diseases. Exercise need not even be running or intense sport, but simply moving about – taking walks, climbing stairs, carrying groceries in a basket instead of using a trolley.

ONEHEALTH

Social circle Social support and participation in one’s community is an important aspect of ageing well. Encouraging intergenerational interaction also develops social wellness and allows younger people to have more positive and realistic attitudes towards the older generation.

Health and social service systems In order

Ageing:

the bigger picture Other factors for healthy longevity include the larger societal and socio-economic landscape. According to Dr Hii, these include culture and gender; behaviour, biology and genetics; economics; one’s social circle; existing health and social service systems and the environment.

to promote active ageing, health systems need to focus on health promotion, disease prevention and maintaining access to quality primary healthcare and long-term care facilities.

Environment An age-friendly and accessible environment is important to support the changing physical needs of the elderly so that they can remain independent and active. Wide steps with gentle gradients, handrails, wheelchair accessible paths and doorways, accessible lifts and affordable public transportation services enable people of all ages and circumstances to participate in family or community life.

Culture and gender Culture inﬂuences many decisions. One of these is the expectation that the female in the family should be a caregiver to an ailing spouse or elderly parent. Caregiving responsibilities in turn affect a woman’s ﬁnancial independence and in the longer term, is linked to increased poverty and ill health in old age.

Behaviour, biology and genetics Lifestyle habits from a young age have been shown to impact longevity and one’s quality of life. So while a large part of ageing is genetically determined and cannot be changed, your state of health is also the result of genetics, environment, lifestyle and nutrition. This means the right lifestyle, behaviour and mindset can delay or prevent the onset of certain diseases.

Ultimately, it takes a proactive and holistic approach to achieve active and successful ageing. Education and awareness about age-related conditions are also important ways to empower yourself and make better lifestyle decisions. In the following pages, read about identifying serious old-age pain (page 16), spotting the signs of dementia (page 19), dysphagia (page 23), what to do if stroke strikes (page 26) and why dental care is even more important in old age (page 29).

Economics Income, opportunities for work and social protection impact ﬁnancial wellness in old age. Any form of work (formal, informal or voluntary) can increase social contact and psychological well-being and gives older people a sense of purpose and builds ﬁnancial security. ONEHEALTH

Aches and pains As one reaches the silver years, the ‘growing pains’ of adolescence become the ‘growing (older) pains’ of age. Learn how to identify serious causes of chronic pain so you can seek timely medical attention By Bella Lim I N C O NSULTAT ION WIT H DR L E E JE R E N , S EN IOR C ONSUL T AN T , GE R I AT R I C ME DI CI N E

ONEHEALTH

French poet Pierre-Jean de Béranger wrote:

“Old age doth in sharp pains abound”, a pithy description of the common aches felt in one’s senior years. According to Dr Lee Jer En, Senior Consultant, Geriatric Medicine, JurongHealth, chronic pain – or persistent pain that lasts at least three months – is a complaint that is common in the elderly. He noted that a 2009 survey on chronic pain in Singaporeans found that incidence of chronic pain in patients older than 65 years old was almost 20 per cent compared to about 9 per cent in the general population. Some aches and pains are part of the ageing process, but some are signs telling you to pay attention to your body and pace yourself.

Chronic age-related pain Chronic pain is more common in an older person for many reasons. There is greater wear and tear on muscles, making older adults more vulnerable to aches and pains. Stiffer muscles and joints also result in limited ﬂexibility and range of movement. This means even people who are more active in their senior years and participate in a variety of sports and exercise regularly can experience an occasional bout of muscle soreness. Being less limber also means bones, joints, ligaments and muscles are at greater risk of injury. Another reason for greater incidence of chronic pain in older people is the conditions that cause such pain which become more common as we age. These include:

•

Osteoporosis or brittle bone disease that can cause fractures in the spine, hips, ankles, wrist and elsewhere

•

Arthritis or joint inﬂammation that affects the knees, hands, elbows and other bony joints, making it hard to move. The pain is usually worse in the morning

•

Post-herpetic neuralgia, a painful, chronic condition that can occur after shingles. Typically, the site where the shingles occurred feels a burning, sharp and jabbing, or a deep and aching pain

•

Nerve damage due to poorly controlled diabetes (called diabetic neuropathy)

•

Trigeminal neuralgia or an intense pain in the face due to a disorder of the trigeminal nerve, which carries feeling from the face to the brain

Another reason for more reports of pain in old age is that progress in medicine has resulted in longer lifespans so the long-term complications of chronic conditions, including pain, are more prone to occur. Older people today are also more likely to undergo surgeries for age-related problems and suffer post-operative pain. In addition, older people feel pain differently. ”Physiological studies suggest that pain tolerance is reduced in an older person,” said Dr Lee, “And when the pain does set in, pain becomes less bearable in the older person.”

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SEEK HELP for the hurting While it is common for an older person to accept pain as part of normal ageing, chronic pain can be a sign of serious underlying medical problems and should not be neglected.

“There is a chance of missing serious underlying medical conditions if treatment is delayed,” said Dr Lee. If you or your loved one experiences any of these signs in addition to unexplained pain, do see a doctor:

• Unexplained weight loss or loss of appetite • Fever • Pain that is worse at rest • Pain that is associated with weakness and numbness • Inability to pass urine • A past history of cancer Even if there are no serious consequences, chronic pain can signiﬁcantly affect the quality of life. Any pain that results in conditions such as insomnia, depression or makes you or your loved one unable to carry out daily activities should be addressed. Ideally, the management of chronic pain should combine multi-disciplinary approaches. Apart from prescribed medication, do also consider adopting lifestyle changes and good habits. For instance, getting enough sleep, light exercise and a little weight loss can actually go a long way to ease chronic pain.

ONEHEALTH

Home remedies for pain Try some of these drug-free remedies to counteract pain if it strikes.

Deep breathing Deep breathing releases mood enhancing hormones called endorphins that block pain signals. Light exercise Gentle stretching of affected joints (through yoga or taichi) or light activity (walking) also release endorphins. In addition, these activities promote blood circulation and nourish damaged nerves. Heat it up or chill it down Both heat or cold therapy stimulate the body to heal. Heat dilates blood vessels, increases blood circulation and reduces muscle spasms. Cold compresses, on the other hand, reduce swelling by constricting blood vessels and can numb pain. Try heat or ice packs at least twice a day and see which one offers the best relief from pain and stiffness.

Distraction mode Take your mind off your pain by doing something else; read a book, do a puzzle or watch a movie.

Eat your cure Traditional herbal treatments may prove helpful in easing pain. Some foods known to alleviate pain include ginger, turmeric and mint. Brew a hot ginger or mint tea or add a little turmeric to your meals.

.................................................. Before you take a painkiller, seek medical advice, especially if you are on other medications. Be aware of taking health supplements such as glucosamine, vitamin D, vitamin B-complex or calcium without a doctor’s advice. There is no evidence that these supplements are effective in relieving chronic pain for those with a balanced diet and who are not vitamin-deﬁcient.

Before you pop a pill...

Like a thief, dementia robs a person of their treasured memories. Learn more about how early intervention can preserve the quality of life and extend the hold on precious life experiences By Cheryl Sim

When memories fade IN CO N S U L T AT IO N W IT H D R N OR H I SH AM MAI N, S EN IO R CO N S U L T AN T , GER IAT R IC M EDICIN E

ONEHEALTH

More than just typical forgetfulness, dementia is the loss of brain function that causes rapid memory loss, impaired cognition (thinking ability), intellectual and physical malfunction and personality change. According to Dr Norhisham Main, Senior Consultant, Geriatric Medicine, JurongHealth, the disease had a prevalence of 26.6 million worldwide in 2006 and has almost doubled in under a decade, to 44.4 million in 2013. Some estimates show that numbers are set to grow to 75.6 million in 2030. “In Singapore, some 30,000 were recorded to have dementia in 2010 and numbers may triple to 92,000 in 2030,” he said. While the disease is often associated with the elderly, it is also striking a younger population as well. The National Neuroscience Institute records show that 45 per cent of their patients with dementia are below 65 years. Dementia has a profound impact not only on the afflicted, but also on the lives of those around them. Patients have a high chance of deteriorating rapidly if they are undiagnosed. This is why awareness, early diagnosis and intervention are important to better manage the condition.

The root causes Dementia is not actually a disease in itself, but a collection of symptoms that are caused by several diseases. The most common form is Alzheimer’s disease, which makes up about 7 in 10 cases of dementia. Vascular dementia is another type that is caused by a series of small strokes. Other less common types of dementia includes fronto-temporal dementia and Lewy body dementia, which have the same effect of causing brain cells to die at a faster rate than is normal.

Diagnosing dementia Telling the difference between the normal forgetfulness of old age and dementia takes a comprehensive assessment by a medical doctor and sometimes, a psychologist. Blood tests may be used to look for underlying disease conditions or other abnormalities. Brain imaging tests may also be ordered to look for structural changes caused by tumours or stroke. A psychologist will also be able to confirm dementia using a series of questions that assess the different aspects of brain function.

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Stages of dementia Stage 1 No impairment Stage 2 Mild cognitive decline with mild memory lapses – forgetting familiar words or misplacing everyday objects Stage 3 Mild cognitive decline with detectable lapses in memory such as trouble remembering names of people one has just met or forgetting content that one has just read Stage 4 Moderate cognitive decline with more severe forgetfulness – inability to recall recent events; do challenging mental maths (eg, counting backwards in multiples of 7); manage personal finances or plan a dinner Stage 5 Moderate or mid-stage disease with noticeable gaps in memory such as being unable to recall one’s home address or telephone; confusion about where one is or what day it is Stage 6 Moderately severe or mid-stage disease with worsening memory, personality changes and inability to do daily activities. There may be a loss of awareness about surroundings or difficulty with remembering personal details or the name of a spouse or caregiver Stage 7 Severe cognitive decline and inability to hold a conversation, control movement or even swallow

Old age forgetfulness or dementia? Forgetfulness can occur in an older person without dementia. This is normal and a part of the ageing process. Typically, ‘normal’ forgetfulness is due to a distraction or if one is multi-tasking. Given enough time, a person will recall the forgotten item or event. In terms of learning, an older person will also be able to do a task or learn a skill just as well as a younger person if given enough time. In contrast, said Dr Main, dementia causes abnormal lapses in memory and behaviour.

“Persons with dementia are unable to recall or remember information that has been given even after prompting or when given time. They may behave inappropriately or perform tasks that are beyond reason like putting laundry in the refrigerator.”

Dementia warning signs More than simple forgetfulness, signs of dementia include:

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Memory loss, particularly of short-term events. Examples include not remembering what one just ate or why one entered a room. A person may also no longer recognise a familiar face or place

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Difficulty communicating simple thoughts or wants

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Mood changes, depression or shifts in personality

•

Loss of ability to do familiar tasks and chores

•

Confusion and disorientation. One may get lost in a familiar neighbourhood

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With the prevalence of dementia expected to rise, early diagnosis and intervention will help manage the challenges that a person with dementia faces and allow for advance care planning. Social support and community-based care are also essential to help caregivers cope.

Caring well for dementia To ensure that a person with dementia gets the best care that he or she prefers, early diagnosis, intervention and advance care planning are important. This is to put care plans in place while the individual can make his or her own decisions and before the loss of mental capacity. “The management of dementia involves a multi-disciplinary approach that uses both drug and non-drug measures,” explained Dr Main. Some drugs, collectively known as cognitive enhancers, may be useful in helping to maintain memory, thinking and speaking skills. These treatments should not be used in isolation but to complement other non-drug measures such as music therapy, art therapy, massage therapy, reminiscence therapy and structured exercise programmes to minimise the behavioural and psychological symptoms of dementia. One successful approach is ‘personcentred care’, Dr Main noted, an approach that places the person with dementia at the centre of care and acknowledges the important role of the caregivers.

Help for caregivers Dementia also takes its toll on caregivers, who may suffer from mental and physical exhaustion due to the demands of looking after a person with dementia. Taking care of caregivers – via respite care, day centres and other support services – is important. For instance, respite care allows caregivers to take time away and recharge.

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Preventative steps No one knows what causes Alzheimer’s disease, the most common type of dementia, but a ‘brain-healthy’ lifestyle may help delay or prevent the onset of the disease. This means regular exercise, eating a balanced diet, moderating alcohol consumption, light mental stimulation (doing crossword puzzles, playing chess or mahjong, learning a new language), social interaction and stress management.

Dysphagia is more than a swallowing disorder. It can lead to poor nutrition, increase the risk of pneumonia, affect quality of life and diminish the joy of eating. Learn about the signiďŹ cance of this dysfunction and how to read the signs By Bella Lim IN CO N S U L T AT IO N W IT H AI LE E N KE LLY, S P EECH T H ER AP IS T

Hard to swallow

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A growing concern Swallowing difficulties, a condition known as dysphagia, do more than take away the pleasure of eating – it can lead to malnutrition, increase the risk of choking and even lead to pneumonia. According to Aileen Kelly, Speech Therapist, JurongHealth, the condition is on the rise.

“Dysphagia is a growing health concern in an ageing population,” she said. “The incidence of dysphagia in the elderly is likely to have a signiﬁcant impact on the cost of healthcare as well as the quality of life.”

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Some studies indicate that about 15 per cent of the elderly population is affected by dysphagia. One reason is that as we age, the ‘mechanics’ of how we swallow change. Ms Kelly explained, “As with other muscles in our body, the muscles involved with swallowing also decrease in strength and mobility as we age. This can lead to difficulties chewing, moving the food around our mouths and transferring food to our stomach.” These changes often happen slowly, so there is usually time for healthy people to adapt and continue to swallow safely. However, over time the subtle but accumulative changes in swallowing function can contribute to an increased risk of food and fluids entering the ‘wrong pipe’ – into the airway instead of the food pipe or oesophagus. Dysphagia risk is also higher in those with diseases associated with old age, such as dementia, stroke and Parkinson’s disease as does being on multiple medications.

How you swallow Many muscles work together to prevent food or water from entering the nose or lungs when you eat or drink. When the muscles involved in swallowing become weak or uncoordinated, food or liquid can enter the wrong 'pipes' and cause choking. Soft palate blocks the nasal cavity

Bolus of food

Tongue blocks the oral cavity Upper oesophagus sphincter (UOS) closed

UOS opens Oesophagus

Epiglottis blocks the larynx

UOS re-closes

Signs of dysphagia • • • •

Difficulty constricting the throat to swallow food or liquids Feeling a ‘lump’ of food or liquid stuck in the throat or chest Choking or coughing when swallowing Food or ﬂuid ‘coming back up’ through the throat, mouth, or nose after swallowing • Pain when swallowing • Feeling pain or pressure in the chest when eating • Weight loss due to the inability to swallow

Therapy & treatment Management of swallowing impairment is a team effort with a speech therapist playing a central role.

“Intervention for swallowing difficulties can be either compensatory or be a more intense rehabilitation,” said Ms Kelly. Compensation techniques focus on the implementation of techniques which are meant to improve the safety and efficiency of a person’s swallow. These include changes to posture during feeding, positioning food differently in the mouth and diet and fluid modifications (eg, thickening fluids to make them easier to swallow). It may also include the use of alternative feeding such as a feeding tube to meet nutritional needs.

Rehabilitation techniques focus on improving the physiology that is impaired in the swallow. Most of these techniques involve a form of exercise which ‘trains’ the muscles to improve swallowing function and minimise or prevent dysphagia-related conditions. Getting treatment for dysphagia is important to prevent not only nutritional deﬁciencies but also stave off related conditions such as pneumonia (caused when food particles enter the lungs and cause infection), Ms Kelly emphasised. Early intervention to improve swallowing also goes beyond just functional beneﬁts – it improves patients’ enjoyment of food and life.

Dysphagia can diminish the joy of eating because of the fear of choking and the blandness of ‘mushy’ texturemodiﬁed food. To increase the appeal and nutritional quality of meals, serve a variety of brightly coloured foods that have been pureed, mashed, minced or thickened.

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Blow to the brain Also known as a ‘brain attack’, a stroke can cause serious damage to the delicate cells in the brain. Learn how to lower your risk and spot early warning signs By Adam Koh I N C O NSULTATI ON WIT H DR AFT AB AH M AD, C ON S U L T AN T , DE PAR T ME N T O F ME DI CI N E

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Types of stroke A stroke occurs when blood supply to the brain is interrupted or severely restricted. This disruption, explained Dr Aftab Ahmad, Consultant, Department of Medicine, JurongHealth, interrupts the ﬂow of oxygen- and nutrient-rich blood and prevents it from reaching the brain. Starved of oxygen, brain cells die or are impaired, causing temporary or permanent disabilities, the severity of which depends on how long the brain goes without blood and which part is affected. Stroke complications include:

Infections of the chest or urinary tract Shoulder pain in the affected upper limb Paralysis or muscle weakness, typically on one side of body Difficulty in talking or swallowing (dysphagia) Memory loss or cognitive difficulties Numbness, typically on one side of body Limb contractures and bed sores Increased sensitivity to temperature changes

Ischaemic When an artery connecting to the brain becomes blocked or narrowed, typically due to a clot, the blood ﬂow is severely reduced, causing a stroke. The blood clot is formed by blood cells or components and fatty deposits called plaque. About 8 in 10 strokes are ischaemic in nature.

Ischaemic Stroke Blocked blood vessels limit blood flow to the brain

Haemorrhagic A leaking or burst blood vessel in the brain spills blood into the surrounding tissues, putting pressure on and damaging brain cells. These ruptures can be caused by hypertension, trauma, bloodthinning medications and weakened blood vessel walls.

Haemorrhagic Stroke Blood vessels rupture, causing swelling and damage to brain cells

Transient ischaemic attack (TIA) This ‘warning stroke’ is a temporary interruption of blood ﬂow to one part of the brain due to a blood clot or plaque deposit. The clot usually dissolves on its own in a few minutes but can cause stroke-like symptoms. Though this type of stroke is transient and leaves no permanent damage, it is still a medical emergency. TIAs may indicate a high risk of a full-blown stroke in the future.

Silent stroke Unlike TIAs that do not cause permanent harm, silent strokes are actual strokes that cause no outward symptoms and can only be detected through brain imaging. Silent stroke causes brain damage and increases future risk of stroke and TIAs. It also can cause cognitive impairment and its risk increases with age.

Spot the signs The signs of stroke vary widely depending on which part of the brain is affected. Signs include: • Sudden loss of balance and coordination, stumbling, dizziness • Slurred speech or inability to explain what is happening • Paralysis or numbness on one side of the body • Sudden blurred, blackened or double vision • Sudden and severe headaches accompanied by pain or stiffness in the face, neck or head

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Prevention making its mark According to the Singapore National Stroke Association, over 10,000 people are admitted to Singapore hospitals annually for stroke, making it the fourth most common cause of death in Singapore after cancer, pneumonia and heart disease. It also contributes to the biggest proportion of long-term disability. The good news is that the incidence of stroke is coming down – the Ministry of Health reports that the rate of strokes fell about 10 per cent from 175 per 100,000 people in 2007 to 158 per 100,000 people in 2011. The number of people dying from strokes has also dropped. After adjusting for an older population, the rate fell from 39 per 100,000 people in 2007 to 34 per 100,000 people in 2011. “The management of ischaemic stroke has improved over the years and eligible patients who come to us within the ﬁrst four hours after the onset of symptoms can be treated with clot buster medicine,” Dr Aftab noted,

“[However] stroke is a signiﬁcant cause of disability and premature death. Early recognition of symptoms and seeking help and medical attention is key.” 28

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• Cardiovascular disease such as heart failure, a valvular defect, heart infection or abnormal heart rhythm • High levels of homocysteine (an amino acid) in the blood • Use of birth control pills or other hormone therapy • Chronic diseases such as high blood pressure, high cholesterol or diabetes • A personal or family history of stroke, heart attack or TIA • Being 55 years old or older • Smoking • Obesity

Are you at risk? FAST response According to Dr Aftab, stroke is a medical emergency and early treatment by injecting a tissue plasminogen activator can be helpful in some ischaemic stroke patients. This ‘clot buster’ enzyme returns the blood ﬂow to normal by dissolving the clot. “It has to be administered early after stroke onset and can help to reverse the effects of stroke in some patients,” he said. Therefore, speedy identiﬁcation of stroke is essential.

To spot stroke,

think F.A.S.T.

Facial weakness – One side of the face is drooping and hard to move Arm weakness – Difficulty or inability to raise the arm fully Speech disturbances – Difficulty in understanding or producing speech (slurred speech) Time – Speedy treatment is essential! Call 995 or head directly to the emergency department

Even if tooth loss has occurred, regular visits to the dentist are still an important part of maintaining wellness in one's senior years. In fact, dental problems in the elderly have a far greater impact on health and well-being than just tooth loss. Hereâ&#x20AC;&#x2122;s what you need to know about age-related dental issues By Adam Koh

Long in the tooth I N C ON SUL TATION WITH DR YAO CHAO SHU , VISITING CO N S U L T AN T , DEP AR T M EN T O F DEN IS T R Y

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The enamel that protects our teeth is the toughest tissue in the body – but years of chewing, gnawing and grinding can take its toll. According to Dr Yao Chao Shu, Visiting Consultant, Department of Dentistry, JurongHealth, time naturally exposes the teeth to more wear and tear, chemical and bacterial attacks. “Older adults also tend to have gum recession, exposing the roots of the teeth, which do not have the protective enamel layer and are thus more prone to caries (cavities caused by bacteria),” she added. Older adults are also more likely to have illnesses, limited hand dexterity or low vision that may limit adequate daily oral hygiene as well. Medications such as antihypertensive, diuretics, antihistamines, and opioids too may result in dry mouth increasing the risk of cavities. Dr Yao, who specialises in geriatric dentistry, also pointed out,

“Elders with decreased mobility may also not visit their dentist as routinely as before and this may delay the chance of preventing and treating dental caries and periodontal diseases.” An added challenge for seniors who wear dentures is that dentures add to a higher incidence of food accumulation in the mouth and physical friction to the soft tissues and gums.

Common age-related tooth problems Periodontal or gum diseases due to the accumulation of bacteria in dental plaque results in inflammation and infection of the supporting gums and bones Root caries or cavities formed by bacterial acid attack on the root surfaces of the teeth Build-up of dental plaque – a sticky film made up of salivary proteins, food debris and bacteria. When left on the teeth for prolonged periods, the bacteria multiplies and excretes acids that attack the tooth structure, supporting gum and ligaments. Sugar ‘feeds’ this bacteria, increasing the risk of erosion Tooth wear or the loss of tooth structure due to friction (from chewing, grinding or from excessive brushing or picking) or chemical erosion from acidic diets or gastric reflux Edentulism (tooth loss) due to decay, gum problems, or physical injury Xerostomia (dry mouth) caused by disorders of the salivary glands, a side effect of medications or from radiation treatment to the head and neck Stomatitis or the inflammation and infection of the soft tissues in the mouth, caused by friction from dentures, irritation from spicy or acidic food, allergic reactions to filling materials, or microbial infections Oral cancer or the growth of invasive tissues that destroy the normal oral structures. The cause is unknown, although risk factors include smoking, drinking and betel nut chewing

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‘CLIP ON’ TEETH

A combination of dentures and dental implants can make the wearing of dentures a more comfortable routine. This involves surgically placing dental implants – root-like titanium-alloy structures – into the jaw bone to replace a missing tooth. If there is a complete loss of teeth, two to four of these implants may be placed in each jaw to serve as pillars to support a denture. These implants will provide a clip-like structure so one can secure and remove the dentures with ease. The beneﬁt is that the dentures do not move around the oral tissues as much, preventing ulcers and adding security for more comfort in chewing.

Caring for older teeth Periodontal or gum diseases due to the accumulation of bacteria dental plaque results in inflammation and infection of the supporting gums and bones The basic tenets of keeping teeth plaque-free and getting regular dental visits are essential in stopping dental diseases in their tracks, Dr Yao said. For elderly who have difficulty carrying out self-maintenance, caregivers also play an important role to assist in daily oral care and ensure regular visits to the dental clinics to capture problems early. “The presence of loose teeth or a toothache can make chewing uncomfortable, and multiple missing teeth reduces the chewing efficiency,” Dr Yao pointed out. This may affect nutrition and cause further periodontal diseases or oral ulcers, creating a vicious cycle. Poor nutrition can also take a toll on a person’s general well-being and affect the quality of life. Regular checks not only prevent problems but identify soft-tissue lesions under denture-bearing surfaces, and more importantly, pick up oral cancer in its early stages. Regardless of whether one has all one’s teeth, some missing teeth or no teeth at all, dental hygiene is essential, said Dr Yao.

“Seniors may have the misconception that if they have no teeth, there is no need to visit dentists, or they wait until they need a new pair of dentures.” Regular dental visits are essential to prevent further dental complications as oral health and general well-being are interrelated.

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FOODforLIFE!

Nutrition for the golden years IN CONSULTATION WITH SERENE TAY , PRINCIPAL DIETITIAN

Age brings about many changes, including dietary needs. Find out how to overcome the challenge and meet evolving nutritional demands to stay strong, sharp and energised By Louisa Foo As we age, changes in our bodies and activity level mean nutritional needs change as well. In fact, caloric needs decrease with age and by 80, we require about 20 per cent fewer calories than we do when we are 30. According to Serene Tay, Principal Dietitian, JurongHealth, many age-related factors affect changes in nutritional intake. These include a less active lifestyle, poorer digestion, lower levels of sensory perception (taste, smell and sight), dental issues, discomfort due to dentures and swallowing problems. â&#x20AC;&#x153;These factors mean seniors are not able to take in the recommended serving sizes and thus fail to meet daily requirements of calorie, protein, fibre, vitamins and minerals,â&#x20AC;? she explained. Seniors are also at higher risk for dehydration because their thirst sensation is less acute. Despite lower appetite and calorie-needs, proper nutrition in the senior years is essential to keep the body healthy and the mind alert to provide sufficient energy to go about the day. Ms Tay said this means seniors should opt for nutrient-dense foods to ensure they get an adequate amount of essential nutrients even with smaller meals.

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The essential shopping list for a healthy diet for seniors: Fish Ensuring an adequate intake of good quality low-fat protein is important especially in seniors to address muscle loss and aid healing. Fish is an easy to digest protein and an excellent source of nutrition. Have two servings of fish a week and where possible, choose oily fish such as salmon, cod, tuna or sardines. Tinned sardines and salmon are good options as these have edible bones that provide a calcium boost.

Meat Avoid red and fatty meats as these are high in heart-clogging saturated fats. Instead, choose skinless chicken, lean red meats and lean cuts of pork. Eat meat sparingly and be mindful that a palm-sized cut of meat offers a single serving.

Dairy and calcium-rich foods As we age, it is important to ensure that we take in enough calcium to prevent osteoporosis or brittle bone disease. Low-fat dairy products such as milk, cheese and yoghurt are all good sources of calcium and vitamin D. Tofu and soya bean milk are also excellent choices for the lactose intolerant.

Wholemeal carbohydrates

Always opt for wholemeal varieties of rice, noodles, bread or crackers as they provide a good source of energy-giving B vitamins and dietary fibre. A diet high in fibre doesn’t just promote healthy bowel function, but also offers protection against cardiovascular disease.

Fresh fruit and vegetables Vitamins from whole foods is best and most easily absorbed – and nothing beats the vitamin- and antioxidant-packed goodness of fresh fruit and vegetables. Pick a colourful and varied ‘bouquet’ of fruit and vegetables each day as bright colours signal high antioxidant content and add a beautiful vibrancy to your meals.

Eating tips 1. Instead of three big meals, opt for five or six smaller meals thoughout the day 2. If chewing is a problem, have soups, stews and porridge with finelychopped meat and vegetables 3. Enhance flavours with spices and herbs instead of salt and sugar 4. Boost nutrition by adding ikan bilis to oat porridge, mashed sardines to sandwiches, and tofu to soups and stir-fries. Add additional milk or soy milk powder to hot beverages 5. Opt for snacks of steamed wholemeal bao, soft fruit (a banana or slice of papaya) and low-fat milk

Recommended daily servings

For those over 51 years of age, the Health Promotion Board recommends:

4–6

servings wholemeal starches (brown rice, wholemeal bread or noodles/pasta)

2 + 2servings fruit & vegetables

servings lean protein (fish, meat,eggs, seafood)

serving calciumrich foods

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FOODforLIFE! Eating better begins at the supermarket when we make our choices for the fridge, freezer and pantry. Reading nutritional labels correctly is the first step to make sure your kitchen is stocked with healthier alternatives. According to Serene Tay, Principal Dietitian, JurongHealth, some common obstacles when reading labels include poor eyesight, a complicated ingredients list or misinterpreting the numbers. “The nutrition information

is presented as ‘per serving’ and ‘per 100g’, which may be complicated to understand,” Ms Tay pointed out. “Manufacturers may also use less common names for ingredients such as salt (sodium chloride) and sugar (maltose or fructose), so people may think a certain ingredient is not in the ingredient list.” Some nutritional claims such as ‘low cholesterol’ or ‘no added sugar’ may also be misunderstood as a certain food being cholesterol- or sugar-free. Reading the nutrition labels is a good way to know the actual calorie, fat, sodium, sugar and cholesterol content.

Demystifying nutrition labels Make wiser food choices by knowing what to look for on nutritional labels By Louisa Foo I N CONSULT AT ION WITH SERENE TAY, PR I NCI PAL DI ETITIAN

Read it right ONEHEALTH

Servings per package The number of servings in a single container or packet. There could be more than one serving per package. Serving size This measure of a single serving is defined by the manufacturer and varies from product to product. Be aware that the single serving indicated may be less than what you would typically eat. A packet of potato chips may contain 160 calories per 30g serving and contain ten servings. This means if you eat the whole packet, you would have had a whopping 1,600 calories. Comparing values When choosing between items look at the ‘per 100g’ or ‘per 100ml’ information as it offers a similar base of comparison rather than serving size, which varies. Nutritional data Focus on the key nutrients that are important to you. If you are on a diet, look at the energy or calorie values. For high blood pressure, zoom in on the sodium or check the saturated fat and cholesterol amounts if you have high cholesterol. Be mindful of fat content; no more than 30 per cent of your daily calories should come from fat.

Ms Tay recommends that as an alternative to reading nutrition labels, it may be more convenient and less confusing to look out for the Health Promotion Board’s Healthier Choice Symbols. These healthier choice logos mean these items are healthier when compared to similar foods.

Reduce fat intake

“Be mindful that these logos only acts as a guide and foods endorsed with these logos should still be eaten in moderation,”

Opt for lean protein sources

Stock up on fresh fruit and veggies

she advised.

Wholemeal carbs are best!

look for the

‘healthy triangle’ 20%

whole grains

25%

calcium

sugar

sodium

saturated fat

less

Snacks lower in fat, saturated fat, sodium or sugar compared to regular products ONEHEALTH

FOODforLIFE!

Fresh catch of the day Enjoy this zesty-fresh fusion-style fish dish

CONTRIBUTED BY THE DEPARTMENT OF DIETETICS AND NUTRITION, JURONGHEALTH

Lemongrass and Citrus Poached Fish Ingredients 200g Skinless dory fillet (or any fish fillet of your choice), divided into two 200ml Low-sodium/home-made chicken stock 200ml Orange juice Â˝ Clove small onion, diced 1 clove Garlic, minced 1 stalk Lemongrass, chopped into chunks Â˝ tbsp Cornstarch Salt and pepper to taste Nutrition value (per serving) Calories 158 kcal Protein 22g Fat 2.9 g Carbohydrates 10.6g Sodium 387mg

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Preparation Time: 20min Serves: 2

Method 1. In a large saucepan, combine the chicken stock, orange juice, onion, garlic and lemongrass and bring to a boil for 5 minutes 2. Reduce heat to a gentle simmer and add the fish fillets into the poaching liquid. Cook for 5 to 8 minutes till the fish is flaky and tender 3. Remove the cooked fish and set aside on serving dish 4. Turn up the heat and reduce the poaching liquid until it thickens slightly, season to taste 5. To make the gravy, dissolve the cornstarch in a little water and add to the reduced poaching liquid To serve 1. Drizzle fish with gravy 2. Garnish with parsley, capsicum and citrus slices

HealthBites

finding meaning, value and your place in the world. Spirituality is not necessarily religion, but it can be. It is about developing a personal value system that guides decisions and helps you accept and overcome obstacles.

building and expanding the trove of knowledge and skills through mentally stimulating activities.

forming and maintaining healthy, harmonious and positive relationships with family, friends and the community.

achieving personal fulfilment and actualisation by doing something meaningful with your talents, skills, experience or interests. Work need not be formal, but can be informal or even voluntary.

maintaining physical fitnessÂ with any range of activity you enjoy. Old age, weakness or frailty is not what prevents you from exercising, but exercise prevents weakness and frailty.

developing a positive and resilient mindset that helps you overcome challenges, express how you feel, accept adversity and be upbeat about life.

THE DIMENSIONS OF Live an active & fulfilling life well into your senior years with this holistic approach ONEHEALTH

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