After the 5Cs, comes the sixth… Chronic disease

Hi everyone. Thank you for tuning in on this topic on After The Fiesies comes the six chronic diseases. I am Dr Roslyn. Chronic diseases are defined broadly as conditions that last for a year or more, not only requiring ongoing medical attention, but may also affect the activities of daily living. This might hold in campaigns to raise awareness for prevention. The number of reported cases of chronic diseases continue to rise in Singapore. The concern is not just the issue where people involved are getting younger in age, but also more people being diagnosed with more than one chronic diseases, especially our elderly. So with me today to discuss this topic is Dr Matthew Chen, a director from National University Hospital High Doctor Matthew. It is a pleasure to have the conversation with you to discuss this topic. Also with us today is Bernadine, a year for nursing students from our nursing schools from NUS. Hi, Bernadine. Hello. Right, so first question first, may I start with Dr Matthew to have a brief introduction of yourself? Thanks for having me on the podcast. My name is Matthew. I'm a consultant nutrition working in NIH. I am a clinician at heart, but I also have an interest in both education and research with some emphasis on health and cognition. I'm just really thankful for the opportunity to come and join this discussion today. Hello, I'm Bernadine. I'm a year for nursing student from NUS. I'm not much background. I'm just an interesting student. Thank you. Happy to have you here. So today we are glad to hear from your perspective and students on what you see on our older adults in our society at large, right? Yes. So maybe you'll just start with a very simple question. We all agree that our elderly is living longer, but do you agree that they are actually healthier? So that's a very good question and in fact, we do have data on this. So if we were to look at the trends for life expectancy as well as the years that older adults live in good health, both numbers are actually increasing for both men and women. For example, 1990, women can expect to live up to 77 years old and then for men it's about 73 and comparing that with data we have from 2016, which is just five years ago, women actually can expect to live to 85 and men to 80 years old. Now, if we were to look at then the data for the years that men and women are living in good health, this number is increasing as well. Yeah, so in 1990, women are actually living to every expecting 68 years of good health for the 77 years that they are expected to live and rest for men is about 65 years and this number actually increased in 2016. So as you can see that the numbers are are increasing for both sides and I would imagine that the main issue that is able to explain is of course our improvements in our public health, like hygiene, screening programs. And naturally, as a result, we are also picking up more and more people with chronic disease. So all in all, I will say that I guess the general outlook is that people are growing older and expecting to live more years in good health. But of course, I mean if you think about it, the conversation can also be said of the years that you live in poor health. Because if you were to take the numbers that I mentioned earlier, there is still quite a significant number of years that men and women are living in poor health. And this is probably not just because of a chronic disease. It's probably from a multitude of factors. It can be psychosocial factors. It can be from other medical problems that end up contributing to I guess this is a condition known as frailty, which also includes having to take more and more medications and be tend to also interact with one another. So the issue cannot just be bought down to just chronic disease alone. To me, it sounds like it's a good news to Asia. I will do the growing health here, based on the statistics that was provided. And that probably explains that our elderly actually put in more efforts to manage their health in terms of prevention and maintenance. Do you think that the education level, their exposure, their support from their community plays a part in improving their health behavior as well? That's actually also interesting because we do know that if we were to compare the older adults in terms of their education level, compared to 10 years ago, certainly the population is getting more and more educated. And if we were to look at that from even in a regular clinic, I do see quite a spread of older adults. So we have those who are old, right? They are maybe 75 years and above and compared to that of the older's old. There is quite a difference in terms of the educational levels. And that I guess also shapes their attitude towards looking after themselves. And if I were to then compare that with some of the public talks that have given in the past, right? They are all very motivated to want to get healthier, right? And they are finally always and means. The challenge sometimes I find is with the information that they are receiving, right? I'm not sure whether you've seen like some of the maybe messages in all that older folks are sending around like fireworks at that kind of thing, right? And sometimes, you know, I do see, in fact, even my parents, I'm not sure about yourself, I'm not sure whether Bernadine has any experience as well. But yeah, so I do see messages, you know, propagating some myths, you know, and sometimes it's important to then be able to discern right between what is really accurate news versus, you know, the top nowadays fake news, right? Yeah. And especially in this pandemic era, right? What have your experiences been? For myself, definitely what you talk about, the fake news is very rampant in my family as well. Like I mean, I mean, because I'm a health care professional as well. So of course, I could see how better it was true or not. And I could disclose if, because of course, they share all this because they're anxious, right? And now it's such an uncertain period as well, the COVID pandemic. And definitely it will impact other people as well, especially those with chronic diseases. As they do their regular checkup, then they start thinking, oh, should I even go for my counseling today because now that's the pandemic, I don't even want to go near the health care institute. Why if I get a COVID-19 when I go there? You know, of course, they raise all these concerns. So I think it's very important to help them and also increase their awareness regarding fake news. Not everything on Facebook is true. Especially Facebook for some reason. I do not know why, but yeah, definitely. Also, the, again, my input regarding like the mental health and awareness. I think the reason why they're not so isolated is because like they definitely have more better mental health and awareness through a lot of the programs that the government who out, especially there is like the befenders program that really helped reach out elderly who are isolated and lonely, which is actually quite a crucial bridge in raising greater awareness and also the negative effect of chronic disease. And like others, not such as like the Medaka, Pioneer, active aging audience really helps the elderly in coping in their health. I think that's why there's also an improvement. It looks like there is a more awareness among elderly to better manage that health. As opposed to the past, do you think that more elderly are actually having more than one chronic diseases? Well, that trend is evident. So in fact, this has been explored in a recent local study as well. And we do find that those with three or more chronic diseases are increasing. And while the study didn't really go into the details about trying to find out the reason behind this trend, there are some hypothesis that being put forward. And the main reason for this trend is also probably because of the awareness, you know, like that what Bernadine has mentioned, right, that there is more opportunities for health screening. So in all the the efforts you have really been put in, right, and of course, I think many people are stepping forward to take this up. And in fact, this is also seen, you know, as part of like since we're not talking about COVID-19, right? Yeah, people are also stepping forward, you know, to consider vaccination against COVID-19, right? And we do see quite the significant number of older adults getting vaccinated as well, right? Of course, there are some who has other reasons, you know, medical reasons, social reasons for declining vaccination, right? But I think this is really evident of how enthusiastic you know, people are towards caring for their own health. It's an interesting point that you brought it out that it's not that our elderly are not managing their health that leads to an increased number of chronic diseases. Rather, it's an active part from our healthcare and to provide the screening and preventive activities that leads us to have an early detection of their health condition. So in actual fact, it's actually a good thing, right? Because if we had not discovered earlier, it will leads to much more complications. Yeah, yeah, exactly. Because of course, you know, when you are picking up chronic diseases like hypertension, diabetes, right? And intervening early, you are actually delaying the complications of these diseases, right? And then complications will include things like heart attack, stroke, right? And to a certain extent, it is also trying to prevent cognitive decline, right? Which in fact, a lot of older adults that we see very concerned about. And so they do take an effort, right? And so we then need to be able to cut through the fake news, you know, and all that to make sure that they are on the right track. Yeah, you know, the thing about Facebook, I think just to add on to one of the points earlier, or any other social media platform is that these applications are driven by algorithms to keep your attention on them, right? And so they have employed different ways and means to do so. And one of them, right, is really making sure that, you know, you are in an echo chamber, right? You like a certain post? The system is like, correct? The decide that, yeah, this is the kind of thing that will keep your eyeballs on it. So they can be pushing very similar articles. Does that pose a challenge to you when older adults actually go and visit you in the clinics and try to challenge you with all this information and even wants to seek a clarification on your treatment plans? Do you often have this kind of confrontation from our older adults? I wouldn't call it a confrontation, though. In fact, I invite such conversations because it is a chance, you know, for education to occur, right? It is a chance for us to clarify any doubts they have. It is a chance for us to make sure that they are receiving, you know, the right sort of information. Of course, at the end of the day, you know, the advice that we dispense in the clinic session has to be individualized, has to be tailored to the older person, right? Because there are perhaps, you know, they have their own preferences, their own ideas about things, right? And so then this is how we need to also change mindsets and change hearts, in that sense. I like the way how you put this entire situation such that when elderly confronted you already, no, ask you about some of the information they received through the media and question you about how you do your treatment plans. You actually make use of this opportunity to educate them. It's actually a very good strategy to catch that tension, to even provide them with the right information. So rather than putting in special timeslot to provide the education relevant to their health issues, you actually created an opportunity to provide the information to them, which is good strategy. What do you think, Bernadine? You have a lot of patients that will often come to you and question you why you're doing based on what they have read online. Yeah, like a lot of them, they were like, I go go about this. Actually it was supposed to be. And then I will look at them like, oh, you go go about it. Okay, what did you find out? You can tell me if you can learn this to get them. That's good. You actually create a relationship with them to tell them that you're willing to listen from the point of view. And what was the outcome usually? It was quite funny because one of my patients that died, I mean because I was in a work-based setting, then she was quite concerned because she was newly diagnosed with diabetes. So I mean, it gets kind of scary when you go out and then the first thing you see is like complications, but you will lose your food and all that. So it gets very terrifying to her. So like when I was there, then the first thing she said was, oh, the doctor diagnosed you with diabetes. I'm like, okay, until she said, it's very scary. Do you see the images? And then she was like, when is my food going to turn like that? Then she showed me a picture of a Democratic food. Yeah, and then I was just looking at her and I wondered, and I wondered how she could go until it became that image. So then she said, I heard that, then she told me, oh, I heard that if I do this, I think it was some non, like it's not a medication or what. It was just some ointment or something. Then other than she told me, if I put this ointment, my blood circulation will be better and all this. She was just telling me all these things. Then me not knowing about what that medicated oil was about. I was like, I was like, what did you tell me the name of the medicated oil? Let's find out what does it do together because I also have no idea until I'm so sorry because it's quite a busy space kind of setting. They might, they might just stay at the patient and see why and it might be your source of frustration for some of the healthcare workers because they are like, when you're getting all this information from right, they are just wondering. So I think especially if the pandemic now, there's a lot of misinformation due to like everyone wanting to know more, especially with like vaccination as well. So I think that it's very important that we all redirect them to sources that are legitimate and accurate. I don't know how many times I repeated this because I was in the committee setting for one month, but because they always asked about COVID-19, I always tell them to go to the MOH website or the WHO, where the information is accurate. But I think that in, like I think instead of getting frustrated with all that information, I'm like, oh, if you want to find out more, you can go here and here. Then I think this will help dispel all these fake news, you know. Yeah. I think you bring out two important points. It's like the first one is really healthcare themselves needs to readjust their mindsets that when patients come to them all this information, they should be ever ready to provide them the information and not to take it personally. And the second point that you have raised is that if further emphasize that healthcare providers place a critical role in having all the information and resources ready for elderly to provide them information when they ask for it. And if we fail to have that knowledge equipping us, we will not be able to manage that situation well. And that will be the missed opportunity to allow our patients to better take care of their health. At the same time, also will not provide them the assurance that the condition is going to get better. So that was actually a very powerful experience that you got there. I also want to just acknowledge Bernadine's experience just now. And I I'm just so inspired and so impressed, you know, at that her exhibition of true wisdom because, yeah, yeah, because it is really true wisdom, right, where you acknowledge that there are gaps in your own knowledge, right, and then you did something about it, right. And in the way you approach that matter, right, was instead of being authoritative, it was, it became more of a consultative approach, right, you were collaborating with the patient, right. It was also about her condition, right, yeah, and dispelling me and order and pointing her towards the right direction. Of course, it can be challenging, right, in a walk-based scenario and given, you know, the time constraints and all. And so, other avenues, right, we'll be also looking for patient information leaflets, right, that's available in the world. Yeah, or in the internet, whatever, yeah, because there are certainly resources are hard for conditions, especially diabetes, I would have such materials as well that can provide them. And for some reason, you know, if the setting that you're working in does not have information, sounds like that, right, then that also is an opportunity for quality improvement. Or, you know, it's also an opportunity to come up with some resources, maybe just a list of websites that kind of thing, find them towards understanding the condition better, right. And it was really to this end that, you know, like last year, you know, when it was way early in the pandemic, you know, we also saw that there was an information gap for older people with regards to COVID-19. And then, within annual heat, we also came up with a set of resources, right, to point older people to how they can maintain their health during this period of time, right, maintaining their diet, kind of exercises that you can do at home, other information resources that they can reach out to, right. And then we actually published it in four different languages, right, to reach out to as many people as possible, right. And so then even the website itself has been accessed thousands of times and it has even been gone on to be published in the American Geographic Society, right, on an international platform. So this is not just a work of one person, but it's really a multi-disciplinary team effort. Yeah, so this is like an example of how we can move on to manage this issue about information and as well as about health literacy. In fact, it's really truly a patient-centered care where we don't expect patients to listen to us only, but we provide them with a listening year. And more importantly, we have built out relationships with mutual understanding and improve the candidates that truly required. So that was actually a very good move to go about it, respecting them, hear what they have to say, and we provide them with the information without bias and judgement. So it is a mentality that all healthcare providers should have. Yeah, and that is where the relationship then becomes a therapeutic relationship. And then they will be more open, right, if you are actually listening to them. So this is giving them the power to make these decisions themselves. It is empowering them with the ability, which I feel that it's, and some being a win-win situation for both sides. Something that takes charge of their health with much more control and they are actually given the responsibility of their own health as well. So which actually will yield higher compliance rate to their treatment plant? Yeah, and in fact, now these we are also moving away from talking about compliance, but to adherence instead. Yeah, because, you know, by the virtue of the word to say, hey, you know, you need to comply with this, right, becomes also very commanding, very repetitive, right, yeah. And really, I think that we are beginning to see that, you know, people do want to take charge, right, they do want to be involved or responsible for their own health, right. And so they need to be empowered, right, with the right amount of information so that they can make the right decisions for their own health, right. And decisions doesn't mean that if it's unwise, you know, then, you know, it is the wrong thing to do, right. We all make decisions and, you know, it's, I guess, maybe down the line that someone would then regard it as being a wise or unwise decision, but at the point in time, you know, if you are presented with X amount of information and then you end up deciding on a particular action, right, or in action. Then, then, gun, it's how you go from there. So, so this question is about whether our elderly holding the mentality that having a chronic diseases in your older age is a norm, what is your view on that. So, I think it also comes with quite a mixed back, you know, because I think it's tough to apply one label across the entire population because we know just as, just as, you know, we are all in the population, right, all our views can be quite varied as well. Right. So, in fact, I would say that, you know, the, how I approach things would be to really listen to them and understand what their view points are, you know, because this is where then the treatment plan, right, becomes individualized, right, rather than, you know, because, you know, you fit this particular phenotype, right, this particular set of chronic diseases. Therefore, you need all these treatment plans that are set up for you, right, we have to take them into account, right, as a person, right, person first and then patient second, right. So, to then craft out something that is, you know, amenable to them, right, something that is acceptable for them, right, yeah, some of them do have the mentality, you know, oh, you know, now I've got this, you know, yeah, might as well, you know, I'm old already. So, you know, it's, you know, if I had, I had one patient the other day who told me, you know, she's a fighter, and, and, you know, regardless of whatever people think, right, she has her own mindset about things, right, and she still wants to maintain control. And so, we cannot just stereotype them and say, you know, I, oh, people are like that one. Yeah, it's, it shouldn't be that way. And that we have explored this issue, we should actually correct that mindset immediately and tell them that could be prevented and your quality of life would actually be enhanced with good adherence to the treatment plan that the doctor has prescribed. And the last question that I would like to ask is, do you think that our elderly today, the quality of life would anyway be affected because of the chronic diseases that they're having with as opposed to those older adults without chronic diseases. So, quality of life is actually quite interesting because, in fact, we've also done a study on this, you know, and we do find that there is correlation between those who are frail, right, with multiple medical conditions. And poorer self perceived quality of life. Yeah, and that being said, right, I must say that it is also an opportunity, right, for intervention. Because as we see, feel this self as a construct, it is a dynamic state, meaning that for someone who is regarded as frail, it means that, you know, they are more vulnerable, you know, to poorer health outcomes when they are exposed to stresses. Ini adalah percaya untuk mereka jika mereka berdua. untuk menghantar kuali disease, menghantar kuali mental faculty, fisikok, fungsi, dan berikan dan berikan transid, untuk menjadi periksaan atau robot state. Mereka juga ada periksaan untuk mempunyai keputusan yang terbuka, jika mereka mempunyai keputusan yang terbuka. Mereka ada periksaan untuk mempunyai keputusan yang terbuka, jika mereka mempunyai keputusan yang terbuka, jika mereka mempunyai keputusan yang terbuka. Mereka mempunyai keputusan yang terbuka, jika mereka mempunyai keputusan yang terbuka, jika mereka mempunyai keputusan yang terbuka. Apa yang saya Like about when I was doing the, there was this health education session, like one of the nurses she was talking to one of the patients. And the patient was like, she was just educating the patient. That's just one of the normal checkups, just checking in. Then the patient was, he was, then he just said that, "Oh, I've been eating really healthy." Because he called the health promotion, the pyramid, that one, right? So he said, "I'm doing late, I'm doing late." Oh, yeah, yeah, that, that, she said, "I choose all my, I buy all my food, as long as it has that sticker." Then the nurse educator was like, "Yes, but that sticker got other types, it's less sugar or less salt, it might not be the sticker that is meant for you." She said, "You don't want stickers to look out for." Then the other list said, "Oh, is it? Then after that. " So I think it really depends on the other, the otherly mindset as well. I think that's one of the major factors besides like us doing a support, making sure there's committee resources available for them. And as what Dr Matthew has mentioned, we need to look at the patient first before their chronic condition. I feel like a holistic care is very important, so that they will get motivated. And if they feel like they have enough resources, enough support, they will definitely feel like taking charge of their health and definitely manage their chronic condition. So moving forward, do you think that what are the challenges that we have to face with these conditions and this mentality? I think from what we are seeing at the moment, I think education really forms the foundation for this, because they need to be equipped and powered with the right information, so that they can make an educated decision and inform the decision with regards to how they can improve their health. And so then this is already in place by a health promotion ball, MOH, and just a couple of years ago, we have really declared a war on diabetes, but really I think if we were to be honest about it, I think it should be really targeting at managing chronic disease. And really I think education here will be the main trust. So thank you Dr Matthew and Bernadine for your insights on this topic, so thank you so much for joining us today. So from this session, we understand that elderly does undergo a series of biological aging process, and they are still able to retain a relatively healthy physical and mental capacity to live a good quality of life. So the cruel fact is when the aging process gets complicated, when the body is burdened with disease and disorders leading to early deterioration of the aging process, we believe that this effects can actually be delayed or minimized if the elderly health literacy is improved. So to conclude, I believe that this session returate the seriousness of this issue and highlight the importance of reflecting own health related behavior and mentality of self-management to achieve and sustain a longer and better quality of life. So thank you everyone for listening, and once again, thank you Dr Matthew and Bernadine for joining us today. Thank you. Thank you.