Jasper Live Series: How to protect our seniors from covid 19

For those who didn't manage to catch us live, you can watch the whole interview here on FB. If you prefer to read my response instead, I have listed all my answers here. Hope it's useful information for everyone to learn how to protect their seniors from the deadly covid 19!

1. Please introduce yourself

1. Hi everyone. I am Dr Angel Ho. I am a specialist in internal medicine and will pursue further studies in geriatrics which is the care of the elderly. I am also one of the visiting specialist at Jasper Lodge-- which is a franchise of doctor-managed nursing homes, aiming to provide quality care to the residents. 

2. Besides being a fulltime doctor, I am also a partime blogger at www.dryingzangel.com . I enjoy sharing about healthy lifestyle tips with my readers. If you google @yingzangel, you will be able to have a look at my IG, FB page, blog as well as YouTube.

3. A little bit more information about myself. I am a mother to 2 active boys and wife to Dr Ryan, a wound care specialist. Both our parents are already more than 60 years old. So we are very much aware of how important it is to keep them safe and healthy nowadays. 

4. Besides that, I love talking and listening to people’s experience. And I absolutely love whipping up healthy nutritious meals for my family (which sometimes is disapproved because in my kitchen, every dish is low sugar, low salt and less oil)

5. I have shared today’s live series on my FB and IG as well. I hope you feel as excited as I feel right now! Do share the live video with your family and friends because we are going to discuss about a very important topic today-- which is how to protect our parents from covid 19.

1. Why did you choose to pursue the pathway of becoming a Geriatrician? And what exactly does a Geriatrician do?

1. When I was much younger, I thought I wanted to do something sexy, something more exciting like being a cardiothoracic surgeon. Perhaps I was fairly impressionable and was really inspired by Team Medical Dragon which was a popular Japanese drama series back then. 

2. As I gained more experience, I noticed that healthcare for older people in Malaysia really needs attention. I grew passion in caring for them. Even though it can be really difficult to get a concise and precise assessment when you are time pressed because most older people just have too much to tell! But sometimes all they need is just some therapeutic talking.

3. A geriatrician is trained to treat people older than 60 years old. Because as we age, the bodily functions change due to wear and tear. And we cannot treat older people the same way we do with other grown ups. A geriatrician is also sensitive to the multiple interactions between chronic illnesses, medications (you will be surprised at how many drugs a person takes both from various doctors and over the counter!) and other social as well as psychological factors that contribute towards the health of an elderly person. It can be extremely complicated and most of the time, requires a multidisciplinary team of healthcare professionals to tease out the issues. The study of geriatrics is about empowering our elderly population -- to improve quality of life and optimize social participation.

1. Give us an update on the COVID-19 situation in Malaysia, where do you think we are heading towards?

1. Malaysia is indeed quite lucky in the sense that local transmission of the disease has been managed to be controlled due to an effective MCO. We have diagnosed almost 8500 cases of covid 19 throughout the country with a recovery rate of 82% and death rate at only about 1%. Not surprisingly those who did not make it were mostly elderly with multiple medical illnesses. And this is precisely why we are having the discussion today-- about how to protect our loved ones who are the most vulnerable.The trend is definitely down going. We need to continue with our efforts to stop it from climbing back up again. 

2. The most important point here is only obtain your information from official portals. To get the latest accurate covid 19 statistics, please join the following telegram accounts : Majlis Keselamatan Negara and CPRC KEMENTERIAN Kesihatan Malaysia. ALternatively, download MySejahtera App to know hotspots around certain areas.

1. I understand that you are mainly working with elderly seniors. How do you think COVID-19 has impacted the lives of the senior population in Malaysia?

1. The aged, unfortunately, have suffered the most in this pandemic. Taking Italy as an example, most of the Covid 19 deaths occurred among the elderly with multiple medical problems such as diabetes, heart problems and not surprisingly with dementia. They are often the ones with weaker immunity and are much easier to get infected. Besides that complications from the infection such as kidney failure and the need to be on life support machine can often spell disaster in this age group of patients. 

2. For those who are relatively healthy, social distancing measures make people feel isolated. Many elderly people are restricted from their morning walks and grocery shopping. It can be extremely depressing when they are confined to their home for long periods of time. Sometimes, caregivers become stressed out as well, especially for those who care for older people with dementia. For example, Mr A has problems with wandering to nearby coffee shop which is not allowed during MCO. He gets argumentative when being stopped from going out. Usually his main caregiver who is his daughter gets some respite from visiting siblings from interstate once a week. But due to MCO, they are unable to travel interstate to care for their father. So you can imagine the stressful situation in the household. 

2. Many elderly have an assortment of medical conditions. What should we be more worried about? Managing their existing medical conditions or avoiding COVID-19? If so, what course of action should we be taking?

1. Both are equally important. That is why we have implemented a few contingency plans for this.

2. For elderly with other medical problems-- we usually delay their clinic appointments until later dates if their condition is stable. That is via reviewing their blood test results which may eliminate the need for the patient to have a face to face clinical consultation. This is because we have to implement social distancing measures in all outpatient clinics. And to make sure the patients we really need to review are seen fast with a short waiting time.

3. We are in the process of setting up virtual clinics. We will set up computer systems to have virtual consultations with patients whom we have determined to be able to self monitor to a certain degree. We do have to be very careful to select our patients because we are not able to perform clinical examination during virtual consultation. When in doubt, we may still need to call the patient back to see them in person. 

4. As for regular medication top ups, our pharmacy department is very helpful in terms of setting up drive through, locker as well as mailing systems to the nearest clinic or even to home. This has greatly reduced the queue and waiting period at the pharmacy.

3. The government is doing free PCR swab tests for all nursing homes, care centers and old folks home staff and residents in Malaysia. What about those staying in such facilities? How do you think we could protect them?

1. I really applaud the move to do PCR swab for people who stay in nursing care facilities. If you look at the situation in the US, they only detected covid 19 in their nursing facilities after a sudden surge of initially unexplained deaths. This is a painful lesson that we should learn because many older people simply present in an atypical manner-- many just become confused and refuse to eat. Rarely they will come to doctors with the typical fever, cough and shortness of breath. In other words, we tend to underdiagnose possible infections in the older population. By diagnosing more cases via free PCR , people become more vigilant towards suspecting possible infections. This will stop the infection from spreading like wild fire. 

2. In Malaysia, many nursing homes are overpopulated due to high demand. Not to mention that dementia is highly prevalent, under diagnosed and under managed. As I mentioned before this, people with dementia are at the highest risk of dying from covid 19 infection. Social distancing is also definitely a huge issue in these settings. We, in fact, will not be surprised if good respiratory etiquette and social distancing is not being practiced in many centers. People are just not aware of it. And it can be a real struggle to ask people with dementia to wear masks and wash their hands.

3. I strongly advise nursing homes to adhere strictly to the Malaysian Society of Geriatric Medicine guidelines. Please take hand hygiene and good respiratory etiquette very seriously. Visitation should be limited to only next of kin with screening of temperature upon entry. But this does not mean that residents are locked up. Because the centers should have daily social activities modified to less physical contact such as colouring and mental arithmetics so as to adhere to social distancing measures. Other means such as video calls between residents and their loved ones should also be arranged . Physically isolating the residents is the key to protect them.

1. Moving forward, how can we as a community protect our seniors? How should seniors protect themselves?

1. Our community needs to be aware that covid 19 is here to stay. Therefore, we have to adapt to the new normal. As there is a possibility of asymptomatic carriers, everyone has the responsibility to break the chain of transmission by- wearing masks, washing hands or using hand rubs, staying at home as much as possible especially when you have cold like symptoms. Remember young healthy people may have little or no symptoms but if the infection is passed onto the older age groups, it may mean life or death for them.

2. Similarly, our seniors need to be equally vigilant. Be aware and avoid sick contact. Even though they may miss their loved ones very much, they will need to practice social distancing as much as possible. We really have to learn from our Muslim friends, for example, for doing so well this Raya Season-- No open house and just BerRaya Di Rumah. 

2. What other advice would you be giving us to move forward after the COVID-19 pandemic? How should we and our senior population prepare ourselves in case of another outbreak or pandemic?

1. The virus is here to stay and we human, as a community, just have to live with it and make adaptations to our old practice. Reduce physical contact, but we can still communicate to each other frequently and effectively by using technology. There are so many free applications like WhatsApp, WeChat, Skype and Zoom that allow interactive virtual communications. As for shopping, there are so many platforms like Shopee and Lazada which make online purchase fast, secure and convenient.

2. Humans are blessed with brains so we can think and plan around unfortunate circumstances like this. This is for survival sake. And it is no joke. In the healthcare setting, we are also actively trying to adapt to the new normal while still providing the best quality of care to our patients. Now that daycare centers are opened and schools are to follow suit gradually, we really have to protect our children as well. It is really just the same sets of advice here- wash your hands, cover your mouth and your nose while sneezing and coughing, wear masks and stay at home as much as possible. 

3. These advice applies to many other infectious diseases and we as a community have to embrace the change for the better.