fbpx

As we speak, the concept of adopting a multi-disciplinary approach towards providing care in hospital settings as well as within the community has been growing. One might raise the question – why is there an urgent need for the healthcare system to implement such an approach? Well, let’s start by defining the term.  

What are Multi-Disciplinary Teams?

Multi-Disciplinary Teams (MDTs) refers to a team of professionals of different specialisations working together to develop and deliver an optimal healthcare plan as a concerted unit. In the era of healthcare delivery reform, MDT-based care delivery is an integral strategy to enhancing care quality, reducing treatment time, lowering costs, and improving client safety – raising the standards of care and professionalism for the client and practitioner respectively. 

Why do we need community based Multi-Disciplinary Teams?

Community MDT has been intentionally championed and is effectively shaped by teams that have consisted of occupational therapists (OTs) over many years. As compared to the institutional forms of MDT found in typical hospital settings, community-based MDT focuses on a more holistic approach that goes beyond the medical model of addressing mortality or the survival of a condition.

As part of a biopsychosocial model, the community based MDT works together to recommend and develop client-centred treatment and intervention plans that encompass all the environmental, occupational, physical, psychological, social, and cognitive aspects of life that are meaningful and important to a client.  Clients and their caregivers are enabled and empowered to be part of the decision making process in their rehabilitation journey and care. 

As a result, this process yields better outcomes and efforts can be sustained beyond what the team can achieve alone or in the clinic – all of which leads to a more positive and progressive form of healthcare.

Factors hindering rehabilitation, recovery and care

  1. Lack of collaborative flow within teams 

Traditionally, MDT teams in most institutions have largely been spearheaded by doctors. Recommendations by the team would often be overruled by the leading doctor when it comes to direction of treatments and making decisions for the client. While there is nothing fundamentally uncommon with this practice, a top-down hierarchy could disrupt the collaborative flow among the professionals in developing solutions that would have been more holistic for the client.

  1. Rehabilitation in simulated settings to prepare for discharge to home 

Hospital therapists would be working towards helping their clients gradually improve and be well enough to be discharged. When rehabilitation sessions take place in environments that is nothing like their homes, there lies the possibility that the client might not be able to perform the same skills at the same levels that they’ve perfected in the hospital once they are back in their home environment.  As clinics that try to simulate the home environment may not be able to fully replicate the client’s own home to its nuances, the performance of the client at home and at the hospital can differ by a noticeable margin. 

  1. So, when can we send this client home?

Even when allied health professionals – who are practitioners of the biopsychosocial model and client-centred practice – are part of MDTs in acute and primary care settings, the typical approach and mindset stems from a very different set of priorities when compared with practitioners in the community. This is because they are positioned to mainly get people stable and well enough to leave the hospitals. 

So, what happens after the client leaves the hospital? This brings us to our last point.

  1. Lack of continuity 

There is seldom the opportunity to work with clients once they return to the community. In other words, clinicians in hospitals might always be only “fighting fires instead of preventing them”. To simply rely on the hospital system that is heavily bogged down to provide the immediacy, and especially now post-pandemic, the lengthy down time in between discharge and their follow-up appointment has people wondering “What do I do now?”.

Continuous therapy provided by Community MDTs allows clients with chronic or new medical conditions that much needed healthcare support to learn to function with these fresh challenges. During the crucial rehabilitative stage when clients recover from hospitalisation, the end goal is to let them regain or maintain the functions that enable them to live as independently as possible or before they lose the ability to do so. Thus, it is of utmost importance that therapy should be done in a way that’s familiar to the most natural habitat after a long bout of hospital stay – in their homes.

This provides Community MDTs a golden opportunity to present the most effective and sometimes life-changing interventions to maximise post-discharge recovery and mitigate the development of factors that contribute to decreased recovery potential and other serious complications that delay recovery. People who have lost their abilities to perform activities of daily living and bedridden clients suffering from spasticity are prime examples of the population requiring immediate and continuous attention.  

An Enhanced Community MDT Approach

Lifeweavers has taken the Community MDT concept further with both the role of a case manager serving as the key liaison between clients, caregivers and the team, and the idea of social prescribing that seeks to optimise health holistically with the support of a more diverse team.

As part of the Community MDT, the case manager develops a comprehensive view of the needs of clients and caregivers to be that link between service evaluation and service planning, help to reduce fragmentation between services and allow the healthcare practitioners within the team to focus on clinical work and be relieved from case management duties.

With a focus on delivering value to all stakeholders involved, the case manager works towards maintaining the integrity of the therapy plan with a well-defined and organised pathway – keeping up with healthcare protocols, service standards, client goals and intended outcomes. This is accomplished through a framework that takes effect from the moment of new enquiry by helping to disseminate and collect key information to and from the client from the team, to systematically onboard the client, arranging for the initial assessments, formation of the therapy plan, managing the case and providing continuous reviews that is aligned to the identified plan and goals. 

Social prescribing is where complementary non-healthcare services like Yoga and Massage could be recommended alongside with mainstream Physiotherapy to enhance the rehabilitation process and extend client’s physical therapy goals.  As part of the goals of social prescription to enhance quality of life and yield better health outcomes, Occupational Therapists may recommend the exploration of new hobbies of interest with specialised classes to bring an added dimension of leisure and activity engagement to the client. This community based layer of collaboration that is part of social prescription, also opens up the next level of transition for the client from typical medical treatments to a more holistic suite of health based interventions that are more relatable to everyday living.  

The idea of enhancing the Community MDT is to attain quality of life for our clients, maintain high standards of healthcare yet truly harness the effectiveness and efficiency of continuous therapy services in the community without the restrictions typically presented by rigid institutions.

3 Steps To The Right Ramp

Ramps – a wonderful invention that has made the inaccessible accessible in recent years throughout the world. But is a ramp always the best solution? To answer this question, let’s first  consider the following:
 
Step 1 – Does the person need a ramp to get over that step? Ramps are meant for wheels. For some, walking up a ramp is more difficult than taking a step. If you are using a wheelchair for long distances outside only, you might not need a ramp at the front door. 
 
Step 2 – Is there enough clearance at the doorway? The standard recommended gradient is 1:12. If an off the shelf ramp is going to infringe on your neighbours space you may need to think about bespoke options.
 
Step 3 – Will it affect other people in the home?

A Slippery Slope?

Ramps, grab bars and non slip flooring are the trio that comes to mind for most when thinking about how to make a home eldery/ disability friendly.

Ramps however, can require a bit more thought and here’s why:

Walking up a ramp: the muscle strength, flexibility and balance required to mobilise up a ramp is different from a step. 

Some people find it more difficult to use a ramp, for these people falls risk can be increased, rather than reduced.

People with memory difficulties may forget the ramp is there and when expecting a step down, become unbalanced at the unexpected terrain.

So do consider the above factors BEFORE installing a ramp, it’s not a one-size-fits-all solution.

Benefits of Ramps

Ramps are best for wheels, wheelchairs and mobility scooters.

Ramps improve access and could increase a person’s engagement with their community and social circles. 

If one family member needs a ramp, but another does not, an alternative may be required i.e. a portable ramp. Portable ramps can be cost effective and come in a variety of sizes. 

Case Study – The Problem Of “One Size Fits All” Solutions

A client with Parkinson’s and dementia had a ramp installed by his family because they had bought him a wheelchair to use when going on family outings. He was able to step into and out of the flat independently and was determined to maintain his ability to do this. He would only agree to sit in his wheelchair once outside the front door. The ramp remained in place and the client had three falls mobilising on the ramp due to difficulties balancing caused by his Parkinson’s. He then developed a fear of leaving his home and of falling, leading to refusal to leave the flat. This had a knock on effect to how he socialised with his family and attended appointments. Therapy was required to regain his confidence and ability to leave the house, but the first thing we did was remove the biggest risk to his independence and safety – the ramp!

This is a real case of a family with the very best of intentions at heart, but without full knowledge of the risks. Though a ramp may be seen as a solution for someone with mobility problems, without fully taking into consideration a person’s needs and motivations, there is a risk of creating more issues. 

If you are considering a ramp for yourself or your family member, we recommend first reviewing  these statements:

1 The ramp is for a wheelchair or mobility scooter only.

2 The person is motivated to use the ramp/wheelchair as appropriate. 

3 The person does not have a cognitive issue/memory problems that may cause them to use the ramp in an unsafe way.

4 The ramp will not be disruptive/create risks for other family members. 

Can you tick all the statements above? If not, this should be a red flag when it comes to installing a ramp. If you cannot tick any of the statements at all, the choice of a ramp is very likely the wrong one. 

If you have identified any red flags, we recommend having an Assessment by an occupational therapist. This Assessment can help you explore the risks/benefits of a ramp fully, and ensure you are selecting the best solution for cost, independence and safety.

Suggested Read: "Already Old" Does Not Mean Frailty!

Aging is inevitable but frailty doesn’t have to be. It’s important to ask, why do some people become weak as they age and others don’t? Sometimes people who have had an amputation or past health conditions are actually stronger than those with no medical issues and good nutritional health.

SHARE THE ARTICLE WITH ANYONE ON THE PLATFORMS BELOW:

Around 1 in 3 Singaporeans over 50 suffer from falls every year. In 2006, injurious falls cost $6.8 billion in hospital admissions, this is not including the indirect costs such as out-patient appointments and families taking time off work. The statistics also tell us 50% of the elderly who have fallen will fall again the following year. These statistics are expected to rise with the increase in aging population and the reason why Falls Prevention is key with the elderly.

We all fall as we age, right? 

 

We often hear people say that falling is a “natural” part of aging, this is NOT the case. Falling in old age is not inevitable but there are many elderly who do not fall too. So, what’s the reason some people fall and others don’t? 

We are all individuals with varying needs and health status. Ill health and lifestyle factors can be big contributors to falls risk. Additionally, no falls are equal, some lead to more debilitating outcomes than others. A common outcome from falling is hip fracture. Studies in Singapore reveal the shocking statistic that in patients recovering from a hip fracture, only 25% percent made a full recovery and 40% ended up in a nursing home

Reasons for Falls can be Complex

The multifactorial nature of falls makes it difficult to give a one-stop shop, well rounded solution for prevention without a holistic overview of a person’s circumstances.

Recognized contributors to falls are:

  • Frailty
  • Balance issues
  • Reduced reaction time
  • Muscles weakness
  • Reduced vision
  • Medications such as Diuretics, sedatives or anti-hypertension medications
  • Poor footwear
  • Fatigue
  • Reduced nutritional intake
  • Loneliness
  • Environmental hazards / unsupportive environment

The majority of falls in Singapore happen at home and are often due to a combination of factors. The World Health Organisation (WHO) Global Report on Falls Prevention in Older Age highlights that there is good evidence that home assessment and intervention is effective in reducing falls in high risk populations. 

The MOH falls guidelines in Singapore recommend a home environment assessment to identify fall hazards and identify solutions for the people at risk. It is highlighted that this intervention is most effective when completed by an Occupational Therapist (OT) compared to other care providers because the OT looks at the different facet of a person from their environment to the lifestyle and various other meaningful area of living. 

The WHO also encourages self-management, rather than dependence on professionals, by giving older people an active role. Sometimes, getting back into a role may require some practice or a period of rehab but the long term benefits of this are seen both financially and in quality of life.

A multidisciplinary approach involving care provided by multiple professionals with different specialties will be the most effective to reduce falls risk. Physiotherapists are a natural partner with the OT, while practitioners of other disciplines will be deployed based on the individual needs of a person. There’s not a one size fit all solution.

 

Reducing Falls Risk: Where to get started

Intervening before a fall happens is best, although it’s never too late. First, you need a holistic assessment from an occupational therapist to identify a person’s falls risk. The initial assessment will assess the person’s physical, cognitive (thinking), emotional, environmental and social falls risk factors. The occupational therapist will then be able to prioritise the main problem areas and advise on who else needs to be involved, for example there may be need for a physiotherapist, occupational therapist and dietitian working together as a multidisciplinary team.

The initial assessment can be done at the same time as a home assessment. This means the therapist can also review the environment, help identify hazards and give on the spot solutions to begin reducing falls risks straight away.

The Occupational Therapist will also help a person get back into an active and meaningful role, safely taking into consideration any impairments or barriers the person may be facing.

It’s important to note however that falls intervention requires commitment from the patient and their caregivers/loved ones. Rarely is the problem solved with a quick solution but it is a great investment when considering the gains of prolonged health and reduced financial burden through falls prevention.

Lifeweavers are happy to help at any point of your journey, from signposting the way to working alongside you. We would also love to hear your success stories of falls interventions that have helped you!

But if you need help with someone who has fell recently or is becoming more weak, do drop us a line immediately. We will do an assessment and recommend next steps as soon as we can.

Don’t Netflix and Over Chill

Restricted access to physical environments is the biggest factor for most of us during the quarantine and social distancing of a pandemic outbreak. Activities we used to do outside the home need to be adapted, however some simply cannot be done at home, leaving a void. The initial excitement of being able to binge watch Netflix at home is a short lived solution to the deprivation because it’s a very passive activity and as humans we are driven to actively engage in something meaningful, not being able to do so can be very stressful.

By reading this article, you will be able to use a basic analysis, apply it to your individual circumstances to find solutions that are right for you. Some generalised advice will also be included along the way. 

 

Just to highlight: this guide is giving suggestions on maintaining well being through occupations. It is not relating to issues of loss of income.

 

Defining Occupational Deprivation

Occupational deprivation is the prolonged restriction from participation in necessary or meaningful activities due to circumstances outside one’s control. Just as we are faced with restricted movement in these days of quarantine, many people find that the hobbies and activities that maintain their well-being or are part of cultural norms are being limited. This is a topic that is at the core of occupational science and therapy.

Consequences and Solutions

This guide will show you how to identify and find solutions to problems you may face because you are unable to go about your daily activities as you did before the circuit breaker.  We are not sure how long the restrictions will remain or how long the after effects will last on us. There are steps we can take to foresee potential issues and structure solutions to offset these.

Consequence:

Social Isolation: The absence of social contact which can easily happen with the romoted distancing


Solutions:

Use instant messaging or ring people up.

Get updated news often.

Find topics that interest you and follow conversations on those topics, lots of uploads on YouTube, other online video platforms and websites.

Participate in virtual communities and projects you can be a part of remotely.

Consequence:

Restricted Movement with the Public Quarantine Orders can affect Fitness and Physical functions


Solutions:
 
Quantify how much physical activity you would normally do in a day (including walking between bus stops and walking to lunch), then schedule in the same amount or more for alternative physical activities.

Schedule ‘activity breaks’ throughout the day, for example, do 30 sit ups at 11am, 30 squats at 12pm, 15 push-ups at 3pm. Work all the main muscle groups. 

Think up activities that can be done outdoors and indoors.



Consequence:

Difficulties in Structuring Time in a Meaningful Way 


Solutions:

Keep your basic activities, such as showering, getting dressed, meal times and brushing teeth in a familiar routine. This ensures you have set time in between to schedule in other activities. If your weekend routine is different, then continue with having your weekend routine too. 

Wash and get dressed even if you’re not leaving the house. This might mean changing from one comfy pair of track pants to another but it will help symbolise a new phase of the routine.

If it helps, list out your current daily schedule.. Identify if anything’s missing that would make the day feel more meaningful and find an activity to fill that. You may be missing mental stimulation that gives you a sense of personal or professional growth. Look for activities that can fulfil these needs such as learning a language, do an online course or learn how to make something new.

Alternate between activities which need active engagement that involves learning and interacting; and passive engagements such as watching TV. Be aware of getting sucked into just doing passive activities such as watching TV all day. This often results in feeling unsatisfied or frustrated with our choices. 

Avoid the urge to ‘pass time’ with over eating and drinking. In fact, this could be a sign that you need to review how you’re structuring your day.



Consequence:
 
Capacity Atrophy: Decline in Function, both Physically and Mentally, from the Lack of Stimulating Activities


Solution:

Occupational therapists have a phrase ‘ If you don’t use it you lose it’. If there’s a particular skill you want, or need to keep, find a way to keep it going. This doesn’t necessarily mean doing the exact activity you did before, but finding something that has the same components. E.g fast reaction times, hand eye coordination, problem solving, dexterity, critical thinking. Activities might include online games, board games, sewing, painting, writing articles, blogs, learning a new topic.



Consequence:
 
Reduced Self Belief from Reduced Relational Support

Are there things you would not try alone, yet would consider doing if your friends were doing with you? Here’s some tips to build on your self belief from within. 


Solutions:
 
Acknowledge any negative internal dialogue you have regarding doing the particular activity. Replace it with something positive, reassuring or even a solution,  i.e, “There’s no point doing it alone as I wont be able to do it well” vs “I can try it for fun, if it doesn’t go well I can still learn from it”.

Come up with a list of your strengths and weaknesses pertaining to the activity. Focus on the strengths. Find solutions to offset the weaknesses. 

Plan out the activity and do it. If it’s a bigger task you may need to break it down into smaller components, but ‘the doing’ it is the most important bit!
Reflect on how your strengths and solutions helped you do the activity. 

Reflect on how you can learn from the experience to do it better next time.
Repeating the activity soon after the first time will help you consolidate your new learnings and your self belief in being able to guide yourself through a new activity/situation.

General Advice on Healthy Balanced Activities 

Factor in ‘screen breaks’ if you look at a screen a lot. This helps rest your eyes and break up a sedentary routine.  If you’re looking at a computer or phone screen after dark, apply a blue light filter (can usually be found under settings) so the blue light does not affect your ability to fall asleep later on,  consequently disrupting a healthy sleep wake cycle.

Feeling Stressed?

This is a whole topic on its own, but we’re keeping it brief here, stress is a sign of imbalance – ignore at your own peril.  If you’re feeling stressed, acknowledge it. Identify poor coping strategies you may be prone to.  Reflect on if stress is affecting you differently at different times during the day.

Fighting The Monotony Of Always Being At Home 

Try and do your scheduled activities in different environments so when you move onto a new task you get a change of view as well.  This might just mean moving to a different chair or table, or moving your chair to a different location. This will help break up the monotony of always feeling like you’re in the same place and  help give you the feeling that you’re getting a different perspective on things, which after all is what leaving the house helps us do.


Mindset

Perhaps the most important skill to learn is how to harness your internal environment.  Although our external environment plays an enormous role in how we feel, at the end of the day our subject experience comes from within and there’s lots we can do with it. Finding ways to filter out the things that frustrate us and focus on positives is a good start, there’s lots of mindfulness apps out there that can help you with this.  It’s a life skill that gets better with practise and will radiate out to other areas of our lives, wherever we may be.

About Lifeweavers 

Lifeweavers is a team of allied health professionals led by the knowledge that health and well being is influenced and maintained by the activities we choose to do. A loss of ability to do activities consequently can affect health and well being. Lifeweavers’ mission is to help people understand this link and how to promote health through activities even in the face of adversity. 

Email or whatsapp us for an urgent intervention or quick queries. 

 

SHARE THE ARTICLE WITH ANYONE ON THE PLATFORMS BELOW:

Aging is inevitable but frailty doesn’t have to be. It’s important to ask, why do some people become weak as they age and others don’t? Sometimes people who have had an amputation or past health conditions are actually stronger than those with no medical issues and good nutritional health.

The answer is simple. Movement. Less movement = weaker muscles and bones.

What are we doing when we’re moving?

An occupation, an activity. So the less activities we do the weaker we are likely to become.

‘But I’m not as young as I used to be’ my mother says and she’s right. As we get older we won’t be able to keep up with the pace and agility we had when we were younger, so that leads us on to our next question about expectations.

Realistic expectations are key to staying healthy through occupations as we age. Expectations may come from ourselves and others around us, such as family and friends. So it’s important to try and get everyone on the same page and understanding what is achievable.

Step 1. Use It or Lose It.

Don’t stop doing your routine activities. Even if someone offers to do it for you as an expression of love. Likewise don’t stop a person doing their routine activities (which they can safely do independently) because they are ‘getting old’ or because that’s the maid’s job now.

The less active an aging person is, the more likely they are going to become frail and a falls risk in the future. Going down this road comes with financial and logistic burdens which can be avoided. The more things a person can ‘do’ in a day, the more things they will be able to keep doing in the future.

Step 2: Reverse Frailty

Yes you read that correctly, there is evidence that frailty can be reversed. Dr Ken Rockwood and his team have done lots of good work in the area of frailty in the older adult population. They have developed the The Clinical Frailty Scale (CFS), an easy to use scale to track frailty, with examples of how each score may relate to an individual’s function. Through a comprehensive  geriatric assessment, correct nutrition, management of existing conditions and staying active in occupations, CFS scores can decrease. And when frailty decreases, overall health and quality of life tends to improve. It’s also worth pointing out that there’s no age brackets on this scale. That’s because frailty isn’t necessarily an age dependent issue.

copyright Dalhouse University

So next time you hear the phrase “old already” being used as a reason to stop doing an activity, take a look at the frail scale again and remember frailty can be accelerated, decreased and reversed.

Not sure how to keep doing your valued activities? Ask our occupational therapists, this is their expertise!

Reversing Frailty Levels in Primary Care Using the CARES Model.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95


SHARE THE ARTICLE WITH ANYONE ON THE PLATFORMS BELOW:

Many of you may have heard the phrase “Sitting Is The New Smoking”. It is a looming health risk to modern city dwellers like you and me.

Now most of us are working from home, and moving even lesser, the risk of ergonomic injury may be increasing. How can we offset this risk?

In 2014, it was stated poor ergonomics cost Singapore 3.5 billion dollars per year in sick days, medical bills, legal costs, etc.

Ergonomics in which “ergo” means work and “nomics” is to study, relates to studying the prevention of work contributed sickness or injury.

Here are some quick advice from an occupational therapy perspective –

Move about every 20 minutes, set an alarm to prompt you for a mini break,

  • Simply walking the length of the house will help offset stress accumulated from sitting too long
  • Do a downward dog for a good overall stretch
  • Shake out / stretch out tension in your joints
  • Gaze over a long distance to rest your eyes

Change Positions If You Can

  • See if there’s a way to set up a standing and sitting station, alternate between them too. They don’t need to be permanent set ups, you can set them up as you need, set up can be part of your mini break.

Experiment With Your Work Routine (this will depend on your work demands)

  • Some people prefer working during quiet times, at home this may be evenings and early mornings.
  • Break up your working day, for example 5-8am + 10am-12pm + 3-5pm. The rest of the time you can do what-ever you want!
  • Remember to adjust the blue light settings on your computer if you’re working at night. Blue light will trigger your biological ‘stay awake’ setting. Try and get an hour of screen free time before bed.

Best practice advice for sitting at the computer

  •   Back, thighs, hips and the bottom of the feet should be fully supported
  •   Think 90 degrees for elbows, hips, knees and ankles.
  •   Hands, wrists and forearm in-line parallel to the floor
  •   Elbows stay close to the body
  •    Knees and hips should be around the same height
  •   Top third of the monitor should be at eye level

Additionally, during the current quarantine / stay at home period

I don’t have a home office, nor did I bring any extra equipment home before the circuit breaker, so I got creative.

I sit in the firmest chair I can find (a soft sofa is generally not a good idea for working) and placed a pillow behind my back so I’m sitting upright and my feet can touch the floor.

Stacking up several think books or magazines, I’m able to position the laptop so that my screen is at eye level.

I used a wireless keyboard (fortunately, I have one) on top of a cookbook on my lap ( also stops my legs getting hot).

I placed a magazine next to my right side to use with my wireless mouse.

Your solution will differ depending on your environment and how thick your books are!

But remember no ergonomic position will stop injury if you don’t move.

Listen to what your body is telling you, if you’re feeling restless whilst reading this you’ve probably been sedentary too long. Get your heart rate up, do some jumping jacks, dust off the skipping rope, do 30 squats holding a watermelon, go for a walk with a backpack filled with rice.

This advice is generalized and although these principles can be applied to most, previous injuries or specific work demands may require an individual assessment. During these times of social distancing, Lifeweavers provides ergonomic consultations through a teleconferencing platform which ensures high standards of security and confidentiality. Book a session at www.lifeweavers.org

Article contributed by Elizabeth Piper

Elizabeth is the Principal Occupational Therapist at Lifeweavers, an allied health company that specializes in bringing therapy to people’s homes. Trained and worked in the UK, Europe and Singapore, she designs services and provides interventions for a range of musculoskeletal and neurological conditions in both institutional and community settings. She now leads a therapy team with a wide range of specialisations from stroke to dementia, working with adults to adolescent clients.

Suggested Read: Guide To Occupational Deprivation

The virus outbreak has kept many of us from going out. How do we cope with the lack of activity and missing the things we like to do?

 

SHARE THE ARTICLE WITH ANYONE ON THE PLATFORMS BELOW:

Aim: For readers to understand the totality of the holistic approach to manage a Person with Dementia (PwD).

Dementia as a progressive condition is likely to worsen over time. Often starting with memory issues then more physical symptoms. Abilities can also fluctuate daily depending on multiple factors. 

The key to managing dementia is in the environment, this is something that can be changed and adapted through the course of time. Environment refers to physical, social and cultural aspects, the way we interact with a person and how we manage our own expectations of that person.

Caregivers and loved ones are perhaps the biggest environmental factor which can help a person with dementia flourish and continue to enjoy the richness life has to offer. But the greatest emotional and physical strain is often on these people which is why it’s essential every dementia intervention includes the caregivers and loved ones well-being too. If the caregivers are not well and amply equipped, it is likely the person with dementia will struggle more too. 

Education is key in having good foundations for a dementia prosperous environment. Managing our own expectations and providing activities in such a way that the PwD feels comfortable and empowered to engage. We need good knowledge on the condition to be able to provide a range of activities to benefit the PwD and know how to make adaptations to suit the PwD’s abilities every single day. 

The effects of regular engagement in activities can maintain and/or improve function, reduce distress, improve self-efficacy, reduce caregivers stress, establishing a routine for the PwD, reduce isolation and loneliness, and many more!

If a PwD is already displaying signs of frequent distress and withdrawal from activities, the process of re-engagement and establishing routine usually takes more time, at times up to a year. Having continuous therapy will ensure all angles are covered and appropriate support is established. 

It’s also useful to develop a profile of the PwD’s distress triggers and reliefs. The occupational therapist will help you do this. This offers a snapshot of practical ways to minimise distress and manage it effectively for both the PwD and caregivers. The home environment may need some adaptations to provide more visual cues to help the PwD orientate themselves and identify environmental hazards.

Interventions can be tailored to any stage of dementia with the ultimate goal of establishing well-being. There are many things within our control that we can do to help the world of a PwD remain fulfilling and dignified. 

Lifeweavers has designed and provides a specialised dementia management program specific for the community.  It comprises of continuous therapy, family education, helpers/caregivers training, maintenance sessions, prescribing equipment and home modifications to improve engagement with the PwD and help set and achieve goals within and outside the home environment.

Reference: Home & Centre Based Care Services Outstrips Nursing Homes as the Main Form of Long Term Care in Singapore (Lien Foundation 2018) 

 

SHARE THE ARTICLE WITH ANYONE ON THE PLATFORMS BELOW:

Leisure activities are those we choose to participate in during our spare time, when we are not involved in work or self-care activities. These activities tend to be ones that engage our interests, we enjoy, and find meaningful (Majnemer, 2009). There is evidence that participating in leisure activities has a number of benefits:

  1. We feel happier
  2. It is good for our physical and mental wellbeing
  3. It leads to better social supports
  4. It helps us cope with life stress

So the question is, if it has so many benefits, why isn’t leisure time given as much attention as it should be?

Our Fast Paced Society

We exist in a culture that places great emphasis on high productivity, where we are constantly “busy”. If we are not busy, sometimes we even think we must LOOK busy. How many times has someone asked if you want to do something after work, or even take your full lunch break and you respond with “I don’t have the time”? Perhaps you have family responsibilities or chores you feel you must prioritise and social time is forgotten. Perhaps you feel it is “selfish” to take time for yourself and you should be prioritising other things. These attitudes certainly exist in Singapore, and Singaporeans have been reported to sleep the least and work some of the longest hours in the world (Todayonline). Constantly working longer hours means less time for leisure and social opportunities, and this equates to less time to rest, reflect, grow and adapt.

What we want to emphasise here is the negative impact of constantly being on the go and not taking time for our own interests. We understand this can be extremely challenging, but existing at such a pace is simply unsustainable in the long term.

What is most beneficial to a person is finding a form of “occupational balance”. This means finding the right balance between self care, productivity (including work) and leisure occupations that works for you. Neglecting to acknowledge an imbalance can lead to negative effects on our physical and mental health, some of which are below.

  1. Increased risk of stress
  2. Increased risk of depression and anxiety
  3. Increased risk of physical health problems
  4. Lack of meaningful social contact and relationships
  5. Increased likelihood of poor coping strategies e.g. use of alcohol, drugs and smoking
  6. Increased risk of heart problems
  7. Lack of physical exercise and weight gain
  8. Fatigue

That’s a big list right? And not only is this a big list, consider how these things will affect your productivity over time. A lack of balance is counterintuitive, which is why we really should be paying more attention to how we use our time in all areas of life if we want to maintain our health.

If you recognise that you have a lack of downtime and leisure in your life, you can do something about it. We at Lifeweavers specialise in analysis of activity and how a person is using their time. We can help you look at your daily routine and occupational demands to make things work better for you, so get in touch!

Leisure as an Essential Rehabilitation Tool

The focus on leisure is not just important to those of us who are able bodied, but also is essential for people with illnesses, injuries and disabilities. Evidence suggests that people with disabilities are much less likely to engage in meaningful activities in line with their interests. Choices of leisure activities for people with physical and intellectual disabilities can be extremely restricted.

Client centred practice is a core value here at Lifeweavers, and we therefore consider the whole individual and their needs during the rehabilitation process. Traditional approaches have focused mainly on impairments and functioning, however we feel it is necessary to go beyond this if we are taking a truly holistic approach by also exploring a person’s interests, leisure and social needs.

An example of this could be a person needing to improve self care skills such as washing and dressing following an injury or illness. Washing and dressing are everyday occupations which a person needs to engage in as part of their day, however if we only focus on the achievement of self care itself, we may come up against a problem – motivation. Why should this person get up and go through their self care routine when it is so hard/painful/just downright boring? However if we also consider a person’s interests including their leisure and social needs, the rehabilitation process may become less of a chore, and more of a means to achieving an important goal.

Let’s say you used to really love meeting with friends at your favourite café on a Wednesday afternoon, by aiming for this outcome as a client centred leisure goal you could achieve the following:

  1. Learning to manage your self care more independently
  2. Improve your stamina when washing and dressing
  3. Increase your confidence in visiting the community again
  4. Rekindle your social connections or build new ones
  5. Reduce the likelihood of depression and anxiety

…and this is just from one leisure focused goal! Leisure can be used as an agent of change for the individual, having positive effects mentally and physically.

If you have a disability (or care for someone who does) and feel you would like to increase your social connections and explore your interests, get in touch with us here at Lifeweavers and we can help you achieve your goals.

SHARE THE ARTICLE WITH ANYONE ON THE PLATFORMS BELOW:

Our healthcare systems tend to place a disproportionate emphasis on a reactive model of care, that is – we become unwell, and then in response to this we receive healthcare intervention. An alternative approach is prevention. Prevention means taking measures to prevent disease, rather than just treating diseases as they occur. A preventive model means stopping the development of disease before symptoms or life-threatening events happen.

When we are young and fit, we can be guilty of taking our health for granted. We think about the here and now, with little thought about the consequences in the future. Prevention does not mean living under restrictions and having no fun in life. By educating ourselves and understanding that we can have control over our health, will not only mean living life with increased awareness, but can be an empowering process.

Here’s some handy information and tips on how you can use a preventive approach in your life.

Risk Factors

Evidence suggests that certain people have a higher risk of disease. The problem is, a lot of people do not know they are at higher risk, and that making certain lifestyle choices can be very detrimental to their health.

Health Screening

The National Population Health Survey conducted in 2017 in Singapore has identified an increase in obesity, diabetes, hypertension and alcohol consumption. There has been no significant decrease in smoking behaviour since 2004.

Screen for Life is a preventative health program from the Health Promotion Board in Singapore. The program provides screening for cancer and chronic illness including high blood pressure, obesity, diabetes and high cholesterol that have risk factors in people aged 25 and up.

The earlier you are aware that you are at risk (or that something is developing) the earlier you can start making positive changes and informed decisions about your health. You can talk to your doctor about arranging health screening.

Frailty Prevention

In a survey by the Ministry of Health in 2017, nearly half of those aged 60 and above in Singapore were identified as frail or pre-frail. Frailty reduces quality of life and increases risk of falls. Falls can have a devastating effect on a person’s health. Help prevent frailty by:

  1. Asking your doctor for a fraily screen
  2. Maintaining an active lifestyle
  3. Eating a balanced nutritious diet
  4. Keeping the mind active and focusing on a positive attitude

Lifestyle Changes

We are all individuals, who lead different lives and have varying coping strategies. We all make choices every day, some good, some bad, and we have a right to make choices that others may consider unwise. However, if we really considered the health impacts of our choices and also the financial burden that ill health could bring in the future, would we not consider some simple changes? Read on to find out what can help you now.

Being Active

People who are more active are less likely to experience future health problems. Inactivity is linked with obesity, which can lead to increased risk of diabetes and high blood pressure. Studies on a sedentary lifestyle indicate increased chances of early death. Inactivity is also bad for our mental health. National guidelines recommend:

  1. Breaking up periods of inactivity that last 90 minutes or more with 5-10 mins of standing or moving around.
  2. 150 minutes of moderate intensity activity per week
  3. Inclusion of strength activities such as weight training, tai chi, yoga and pilates,

Reducing Alcohol Consumption

We all know this one, but we often neglect to take it seriously. High consumption of alcohol has been associated with obesity, cancer, cirrhosis of the liver, memory loss and male impotency. Moderation is the key, with recommendations in Singapore being to drink no more than 2 standard drinks a day for men, and 1 for women (1 standard = 1 330ml can of beer or 100ml of wine).

Eating a Balanced Diet

The National Health Survey 2010 identified that 1 in 9 Singaporeans is obese, a 57% increase since 2004. Obesity and poor nutrition can have significant health impacts.

National guidelines recommend:

  1. Aim to eat at least 2 servings of fruits and 2 servings of vegetables daily
  2. At least 1 serving or rice and alternatives should come from a whole grain source
  3. Aim to fill half your plate with vegetables, a quarter with whole grains, and a quarter with meat. See My Health Hub “My healthy plate” for more info.

Reducing Stress

we live in a culture of excess. We work too much, we sleep too little, we drink too much, we eat too much. We often engage in one negative behaviour, to cope with another. This is unsustainable, and inevitably takes its toll on our physical and mental health.

Evidence shows a link between stress and chronic conditions. An unbalanced lifestyle of all work and no play is bad for our health.

  1. Identify triggers – what is causing the stress?
  2. Identify negative coping strategies – are you using quick fixes such as alcohol, smoking or avoidance?
  3. Make time for fun and relaxation – e.g. deep breathing, spending time with friends, listening to music, writing in a journal.

Small Changes Make a Big Difference

Prevention can start with simple changes, but at Lifeweavers we understand that getting over the starting line is not always as easy as it seems.

It is always best to see your doctor if considering any lifestyle changes. At Lifeweavers, we can help you move forward with taking positive steps. As occupational therapists, we specialise in analysis of activity and how we use our time, we can help you find balance and make changes that could benefit your health for the future.

Lifeweavers helps companies maximise their human resources by preventing increase in sick leave and strategising on enhanced productivity on all kinds of industries by taking a preventive approach to work health. Our therapists are experts in urgent interventions to arrest a crisis or work with the management on long term corporate strategies, even holding regular clinical sessions right at your work place. It is best to assess and work with the staff at their immediate work environment for best effect. Get in touch.

SHARE THE ARTICLE WITH ANYONE ON THE PLATFORMS BELOW: