Mum is currently on post stroke rehab. She is impaired on left side of body. Her progress to regaining use of hand and leg seems very slow to me. What are markers I can use to check for a real progression towards regaining of function and mobility?

Hi G****, I’m sorry to hear about your mother’s stroke.

The prognosis of recovery depends on the area of the brain affected by the stroke, whether there are any secondary complications (e.g. re-bleed), what bodily functions are affected by the stroke (e.g. strength, sensation, balance and cognition) and also the extent that the patient is able to regain function after first 3 months of active rehabilitation.

There are various scoring systems or scales used to predict functional recovery. For a more accurate measurement, I would suggest consulting your mother’s regular doctor (be it her family physician, neurologist or rehabilitation specialist) and therapists who would be more familiar with her condition and progress.

Dr, my mother has type 2 diabetes. Are there any infections that she is extra susceptible to? Also, if she has any cuts or wounds, can you share some tips for wound care? Thanks. 

Dear K*****, thank you for your questions.

Patients with Diabetes Mellitus are generally more susceptible to influenza, pneumonia, urinary tract infection, skin and soft tissue infections and shingles. We need to be mindful of dengue and COVID-19 infections in our current setting as well.

The management of cuts and wounds largely depends on the extent of the wound, degree of contamination, how the injury occurred and the condition of the surrounding tissues.

Generally, simple first aid is important for all cuts and wounds. This minimally includes irrigating the wound with clean water and applying a simple dressing. Most uncomplicated small abrasions can be managed without a doctor’s consultation but I would recommend you to monitor such wounds daily for any deterioration. For more serious injuries, I would advise you to bring her to a family physician for a consultation.

What are common infections that the elderly faces, and can they be prevented? If yes, how?

Hi J***, thank you for your question.

Common infections among the elderly include respiratory tract infections (including the common cold, influenza and pneumonia), urinary tract infections and shingles. There are also many infections that can potentially be more serious in the elderly, such as COVID-19. Hence it is important to stay tuned to local updates from the Ministry of Health on these infections.

Many infections in the elderly can be prevented by avoiding contact with people who are known to be ill with such infections. Good hygiene habits like regular hand washing and maintaining good cleanliness are also helpful. For urinary tract infections, it is important for the elderly to drink enough water and pass urine regularly.

Some infections such as influenza, pneumonia and shingles can also be prevented by timely vaccinations. It is also important to follow the Health Ministry’s guidelines on safe distancing for COVID-19. I will recommend our seniors to approach their regular family physician on further details of these health tips and vaccinations.

Are there signs that I should look out for to know that I should begin preparing my elderly parents about the idea of home care? This is because my parents will require some time to accept such an idea as they may feel uncomfortable about it. Do you have any suggestions on how I should begin discussing this topic with them?

Hi N****, thank you for your question.

Home care traditionally refers to the provision of formal medical care at home rather than in a clinic setting. Patients who require home care are usually immobile (e.g. elderly is bed-bound) and have multiple medical and nursing needs (e.g. elderly requires care of pressure sores, feeding tubes and urinary tubes).

Usually, such patients are stable and are referred by the tertiary hospitals to either family physicians or home care service providers (including Home Nursing Foundation) who visit the patient at home every 1-3 times monthly.

Some early signs of frailty in the elderly are functional decline and increasing care needs. When we observe these signs, we should consult a doctor to promptly address and treat the conditions.

One suggestion to start the conversation on advance care planning would be to use a hypothetical scenario and understand the reasons for their responses.

When the urine of the elder is extremely foul smelling & carries a metallic hint, is this a sign of Urinary Tract Infection (UTI)? The colour of the discharge is clear however (not very yellowish), and when he takes extra water, it results in edema at his feet and nocturia (excess night urine). He has been complaining of weakness in the legs recently with no strength to sit up or stand and walk, as well as backache and also fatigue in the day - sleeping every other minute. We are not sure if he is suffering from any infection or dehydration or are these early signs of more serious illnesses warranting attention?

Dear J****, thank you for your questions.

You are right to point out that foul smelling urine could be a sign of urinary tract infection.

The symptoms of fatigue, edema of the feet and nocturia suggest that the person you are describing may have a weak heart, where the heart muscles may not be pumping blood effectively.

Also, the recent weakness of his legs and backache may be symptoms of spinal cord compression, which requires prompt medical attention.

I would recommend you to bring this person for an urgent medical assessment by a family physician, who will be able to make a referral to the emergency department if necessary.

Now that many are working from home, is it still necessary to put on sunscreen or moisturiser?

Dear T*****@gmail.com, thank you for your question.

I would recommend you to apply moisturiser even at home as the skin of seniors tend to be drier, especially with exposure to air-conditioning. Moreover, do continue to ensure adequate hydration and avoid prolonged exposure to the sun and air-conditioning, hot baths and harsh soaps as these dry up the skin.

Sunscreen may not be required if there’s no exposure to the sun.

Dear Dr,

My father has a hernia, prostate swell that resulted in him using the catheter for more than 2 years now, he also had his heart operated many years ago. With the 2 highs of high BP and cholesterol, now at 84 y/o, he seems to have dementia developing over the past 1 year, the doctors all said he's taking so many medicines and doesn't need to add on any more hence refuse to refer him to a specialist. But we children at home aren't sure what is his real condition and how serious he is and are very worried by his behaviors, this month he had turned on the gas and forgotten how to use the lighter to light and walked to my room asking me for help, this walking speed by the time he reaches me and me running back to the kitchen could have leaked so much gas and caused an explosion or fire. I'm very paranoid and anxious these days, it's making my depression and anxiety worse and no one else in the family cares. 

Also, he has been mix taking Chinese and western medicines one after another when his stomach (hernia) pains don't get better. while he can't remember the time and type of painkillers he just took, sometimes in a day he takes 3 bottles of Po Chai Pills and some tablets of panadol in less than 2 hours.

Doctor, how should I help my father now? Will he be getting worse? If we eventually get to bring him to see a Specialist for his case and he's refusing to take meds (like most days now he dislikes the bunch of hospitals prescribed meds) is there another therapy to help him? 

Regards and thank you.

Dear K********, thank you for your questions.

It is not uncommon for seniors to have multiple medical conditions, medications, appointments and problems with health literacy and self-care. It must be really tough for you with the safety concerns and lack of support.

In my opinion, your father will benefit from a holistic goal-directed approach to his care in the community, led by a multi-disciplinary team. This team will include:

1.A medical doctor who is familiar with your father's medical condition and manage them effectively. He or she may decide on referrals if necessary and facilitate discussions on advance care planning.

2.Nurses to advise on the care of his urinary catheter and assess his health and medicine literacy.

3.Therapists to advise on safety at home and optimise his physical functions through exercises.

4.A social worker to discuss alternative caregiving plans and financial support, if required.

You may enquire about such multi-disciplinary services through a family physician. Such services are available at polyclinics, family medicine centres and family clinics which participate in primary care networks.

I am 74yrs old and the usual testing show pulse rate always below 60, systolic between 108 to 127, Diastolic between 63 to 80. Last 2day, sometime the pulse rate even go to 46-48, The hands get numb at night, what is the problem? Thank you.

Dear J*********, thank you for your question.

The normal blood pressure for people of your age is generally less than 130/85mmHg with the lower limit of systolic blood pressure around 100mmHg. A normal heart rate is usually between 60 to 100 beats per minute.

However, before we interpret these readings, we need to consider if the person has any chronic medical conditions, recent illnesses, medicine usage or recent physical activities and the time of the day the measurements were taken. The target blood pressure and heart rate may be different for certain medical conditions.

One common cause of numbness of the hand at night is carpel tunnel syndrome, where one of the nerves is compressed in a narrow space around the wrist.

I would recommend you to consult a family physician for your low heart rate and numbness of your hands as these issues will require a detailed assessment.

Hi Dr.

My mum fell a month ago while trying to stand up from her bed and hit her right hip. X-ray showed no fracture on her right hip. She cannot stand even with assistance, complaining of knee pain and has been bed-ridden since. Polyclinic did not order x-ray on her legs as she did not mention the pain in her legs.

Before her fall, she was already walking with great difficulty as she experienced pain in her legs and back. In the earlier days after her fall, she could still sit up on her bed occasionally without assistance.

But her condition deteriorated and now she cannot turn to lie on her left and has been lying on her right or in prone position. She eats less than half a rice bowl of food and drinks 500-700ml of water with much persuasion. Her urine is sticky and she passes motion 3-4 days. Do I need to bring her back to the polyclinic for further investigations? Thank you.

Dear E*****, thank you for your question.

From what you shared, it appears that your mother has deteriorated over the past 1 month after the fall. I will need further details about her urination and bowel habits before I comment. However, her ongoing pain, functional decline and reduced appetite are of great concern.

I would suggest you to bring her to see a family physician (either in a polyclinic or a GP clinic) who can perform a detailed assessment of her problems.