Local authority has duty of care to the elderly
IN reference to the article 'Elder abuse: spot the warning signs' by Dr Tay Hui Sian (The Star, June 18), and the proposed Senior Citizens Bill aimed at enhancing protection for Malaysia's ageing population, I would like to share my experience as a caregiver to my 80-year-old mother.
I have been my mother's sole carer since she was diagnosed with Alzheimer's disease five years ago. My sibling does not provide any financial or moral support.
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The Star
9 hours ago
- The Star
A neurologist shares his journey with Alzheimer's disease
It was 2006 when Dr Daniel Gibbs first noticed he was losing his sense of smell. But it wasn't what he didn't smell that tipped him off that something might be wrong. It was what he did smell: perfume, mixed with baked bread – 'The same thing, every time,' he said. The neurologist in Portland, Oregon, United States, knew this was an olfactory hallucination. And that meant something wasn't working properly in his brain. 'I attributed it to getting older, which is a common cause of decreased ability to smell,' he said. But Dr Gibbs was just 57 – not so old that he should be losing his sense of anything. 'I also knew losing your sense of smell was an early sign of Parkinson's disease, so I thought it might be that.' It wasn't. Dr Gibbs was experiencing an early symptom of Alzheimer's disease. But it would be another six years before he knew it. He has since written a book about his experience, which was turned into a documentary. He also keeps a regular blog to help people understand what it's like to live with Alzheimer's. These days, he spends a lot of his time learning and talking about how to slow progression of the disease – something he's been trying to do since he got his diagnosis more than a decade ago. Dr Gibbs and his wife, Lois Seed, discussed what he's learned about Alzheimer's dementia and how he navigates the condition for The Experts Say , an American Heart Association News series in which specialists explain how they apply their professional knowledge to their own lives. Their remarks have been edited in the below Q&A. When did you realise your symptoms were due to Alzheimer's disease? Dr Gibbs: In 2012, Lois was doing a genealogical project, so we did some genetic testing. Mine came back showing I had two copies of APOE4, a gene known to influence the risk of developing Alzheimer's disease, which totally gobsmacked me. Having two copies means it is almost certain to eventually cause Alzheimer's. I had no measurable cognitive impairment at that time. I was in charge of the neurology resident training programme at Oregon Health and Science University in Portland, and I was seeing patients in the clinic, so it was a very busy year for me. Even though it was difficult, I was still able to get all the balls to balance in the air. What did you do once you knew your genetic risk for Alzheimer's? Dr Gibbs: The first thing I did was to go to one of my colleagues and have some cognitive testing done. It was essentially normal with the caveat that all of my cognitive domains were in the 90th percentile except verbal memory, which was in the 50th percentile. So there was a strong hint that there was some incipient loss of function of verbal memory. With that in hand, I went to my department chair and explained the situation. I had no impairment, but did not feel it was safe for me to continue to practice. I retired in 2013. Seed: You also went looking for studies you could join, because it's a big deal to see people before they experience symptoms. Dr Gibbs: That's right, I went to the University of California in San Francisco, because they have a ton of studies there. The first study I was involved with was a longitudinal neuroimaging study. I had PET (positron emission tomography) scans of abnormal amyloid and PET scans for tau proteins – two protein clusters in the brain that play a role in the development of Alzheimer's disease. And I had cognitive testing. They loved having me down there because they rarely have people with as early a stage of disease as I showed up with. About a year later, I joined a clinical trial for an anti-amyloid antibody drug that is now approved by the US Food and Drug Administration (FDA) to treat early Alzheimer's disease. What else did you learn about how to slow progression of the disease? Dr Gibbs: This is not rocket science. The sort of things that are good preventive behaviour for brain disease are also good for preventing heart and vascular disease. There are evidence-based lifestyle changes that include: Getting daily aerobic exercise Eating a Mediterranean-style diet, such as the MIND diet Getting mentally-stimulating activity Staying socially engaged Getting at least seven hours of sleep nightly, and Getting good control of any cerebrovascular risk factors, such as diabetes, high blood pressure, high cholesterol, obesity and smoking. What's good for the heart is good for the brain! Dr Gibbs notes that it is difficult to know what to expect as his Alzheimer's progresses as previously, most people with the disease were only living three to five years after the diagnosis as they were being diagnosed late. How do you put this knowledge into practice? Dr Gibbs: Walking is just built into my day. I do it with my dog, Jack, an 11-year-old English cocker spaniel who is about to age out. He can't keep up with 10,000 steps as easily any more, so I take some walks by myself. We live in the hills, so I'm getting very good aerobic exercise, short of running. I used to go to the gym, but that stopped at the start of the Covid-19 pandemic. I also have a short workout at home. The first thing I do is I use resistance bands, which is a strength exercise. That takes about 15 minutes, and then I do tai chi pretty religiously, something I started six months ago. I can clearly see that it helps my balance, but I can't see if it helps my brain, which is continuing to do more poorly. And thanks to Lois, I've been eating a healthy diet, really forever. Seed: I didn't have control over those french fries you were eating. Dr Gibbs: I don't eat red meat any more. I closely follow the MIND diet, which is essentially the Mediterranean diet with more berries and nuts. It includes a heavy focus on fruits and vegetables, especially green leafy vegetables, beans, nuts, whole grains, seafood, lean poultry, and uses olive oil to cook. I'm quite happy with it. ALSO READ: What is MIND, the diet that may help protect against Alzheimer's disease? Because I lost my sense of smell, which is totally gone now, I have virtually no taste either. I eat the same thing for lunch and breakfast every day. I enjoy it. I make a sandwich on whole wheat bread that has tuna salad and garbanzo beans, avocado and arugula to get the dark leafy greens. Then some grapes or bananas, and half a dark chocolate bar. Breakfast is homemade granola, and I add cranberries or blueberries. I throw walnuts in as well. Dinner is whatever Lois picks that I can eat. I stopped drinking alcohol. There's no safe amount of alcohol if you are on this trajectory. So I got rid of it, but I used to love red wine. Do you know what to expect as the disease progresses? Dr Gibbs: That's a difficult question to answer. In the old days, when people got a diagnosis of Alzheimer's, they were only living three to five years after that because we made the diagnosis so late. There's less information out there about people who have known they have the disease for a long time and how they will do going forward. Seed: There's a lot of confusion and misconception because there are different types of dementia. Alzheimer's tends to progress more slowly. The early stage can last 20 years. Here we are 13 years after his diagnosis and Dan's really doing well. I'm a little more of a caregiver than I was a few years ago, but not by much. He dresses himself and monitors medications, and people who talk to him casually wouldn't even know. We've been at that plateau for quite some time. How would you describe the stage you're at right now? Dr Gibbs: Right now, I have mild Alzheimer's dementia. To say you have dementia is to say you are having trouble managing your personal affairs. I'm just at a stage now where I can't balance a chequebook. And as things go along, I will have more problems with memory and the ability to recognise people and remember their names. I've lost my train of thought. Seed: You were talking about what stage you're at. Dr Gibbs: When I'm not remembering where I am, then I will have severe dementia. There are memories I have going back through my whole life. They tend to be events that are emotionally-laden. I'm terrible with names. I know my immediate family members. My neighbours, I forget their names. Lois is taking over the things I can't manage any more, like the financial part of our lives, anything that involves planning ahead, scheduling, calendars, remembering all the family stuff, managing the household. She also goes with me when I have a talk to give. Seed: He gives talks on Alzheimer's, but almost every time that Dan is getting ready to speak to a group, he gets frustrated and says, 'This is the last time I'm doing this,' because getting his thoughts together is challenging. He writes out notes. Most of the talks he gives now are screening events for the film with question-and-answer sessions. Dr Gibbs: It works well if Lois is there to find ... Seed: Words. Dr Gibbs: That makes it easier. – By Laura Williamson/American Heart Association News/Tribune News Service
The Star
4 days ago
- The Star
A call for long-term care coverage
WE refer to The Star's article dated June 17 and titled 'Ageing society will deeply affect healthcare and workforce, says EPF chairman' (online at 3HWukKA). The concerns raised are timely and urgent – Malaysia is rapidly ageing, and our current healthcare and retirement systems are not adequately prepared. Healthcare costs are rising at an unsustainable pace. Health-care inflation is currently estimated at 6%-10% annually, and out of pocket expenditure remains high at around 36%, based on World Bank and World Health Organisation (WHO) estimates. Malaysians spend an average of 9.5 years in poor health, and non-communicable diseases cost the Health Ministry nearly RM9.65bil annually. All this leaves many older Malaysians financially vulnerable, especially after retirement.
The Star
4 days ago
- The Star
Undergrads' outreach provides self-sufficiency skills for the homeless
Lee washes motorcycles at the transit centre to earn an income. — Photos: CHAN BOON KAI, KT GOH/The Star (Above) Residents filling moulds with a soap mixture during the training session in soap-making. A GROUP of second-year communication students from Universiti Sains Malaysia (USM) has taken community outreach to the next level by equipping transit home residents with practical life skills to support independent living. The half-day programme, held in two parts, at the transit centre in Jalan CY Choy, Penang, focused on hands-on training in basic urban farming techniques and soap-making using recovered cooking oil. (Left) USM students teaching urban farming basics to transit centre residents. Other activities included a traditional game-based race, gotong-royong, oral health talk and a lively community celebration.. The occasion was hosted by radio DJ Fara Fauzana, whose lively and engaging presence elevated the mood of participants. Project adviser Prof Dr Jamilah Ahmad said the project was part of the students' coursework to shape them into socially responsible graduates, while the activities were designed to equip the residents with practical life skills they could use when they leave the centre. Eighty residents also learned to prepare nutritious meals using common household ingredients. They were guided too on basic hygiene and self-care which are crucial elements in supporting their transition back into society. The outreach was implemented under the university's Service Learning Malaysia – University for Society (Sulam) platform and supported by National Cancer Society Malaysia (northern region), the School of Biological Sciences USM and the Northeast District Health Office. USM School of Communica-tion undergraduate programme chairman Dr Suriati Saad and the transit centre's general manager Nazatulwanis Mohd Khorish were also present, lending support and encouragement to the students and participants. According to Nazatulwanis, the transit centre has a capacity for 88 residents, with separate dormitories for men, women and the disabled. It also has facilities like laundry, a cafe and a community centre. 'The centre is just a temporary shelter, not a long-term home, and residents can stay for a maximum of two weeks, with the possibility of extensions depending on individual circumstances. 'We also work closely together with more than 400 non- governmental organisations, companies and institutions to help provide the residents with food and other needs,' she said. Penang social development, welfare, and non-Islamic affairs committee chairman Lim Siew Khim said the programme highlighted USM's continued efforts to nurture socially responsible graduates and promote the United Nations Sustainable Development Goals through direct community involvement. In her address, Lim commended the students' efforts and highlighted the transformative power of collaborative outreach. '(Helping) the residents build their confidence and motivation to rejoin society is a noble achievement. 'This proves that unified efforts between institutions and communities drive meaningful change,' Lim noted.
