​Geriatric Medicine - Doctor Q&A

As we age, we might be faced with health concerns like frailty, dementia and the decrease in bone density. Our daily functions might be affected by the process of ageing but what can we do to manage these health concerns? For January’s Q&A forum, find out from our geriatric specialist on how you can better prepare yourself and your loved ones for the golden years ahead.

Answering your questions is Dr Alexis Ang Guat Cheng, Senior Consultant from the Department of Geriatric Medicine at Changi General Hospital (CGH), a member of the SingHealth group.

This As​k The Specialist forum has closed. Thank you for your interest and participation.

1. Question by G******
Dr Alexis, I am taking alendronate 70mg for osteoporosis. It causes body stiffness and mild body ache. Can I discontinue - thank you

Answered by Dr Ang:
Hi G******,
Alendronate is usually given for osteoporosis patients and to reduce the complications of fracture. Some examples of fractures are:
1.Fractures of the back bones (Vertebral) which commonly causes debilitating pain that affects the ability for self-care while awaiting healing and rehabilitation.
2.Fractures of the hip bones (Femoral), which usually requires surgery and a period of rehabilitation. 

It is advisable to continue your medication and if you have been taking the medication for more than three years, it is best to discuss with your primary care doctor, who will be able to advise if you can change to a different type of osteoporosis medication or if a further assessment of the causes of body aches need to be made.

2. Question by L**
Is it true that joint pains will eventually happen to all old people & it is not preventable?  
For those already having joint issues, can that be reversed with the right diet or exercise or whatever advice you have?

Answered by Dr Ang:
Hi L**,
Osteoarthritis is the commonest cause of joint pains in the older adults. It usually happens after decades of wear and tear. There are many other causes such as Rheumatoid arthritis, Gout, Lupus etc. 

For joint pains caused by Osteoarthritis, a combination of aerobic and strengthening exercises is useful. For a person who is overweight/obese and experiencing knee pain, a 10 percent body weight loss may help to manage the pain. There is currently limited evidence on the types of diet that can reverse the process of joint issues.

3. Question by M** 
Hi Dr Alexis,
My dad just entered demented phase last year Jan 2020 when his behaviour changed and he stopped working as a TCM doctor. He was born in 1937 in Singapore. Now, he seldom talks and has difficulties answering questions. He has recently been medically tested, I believe for free thyroxine and thyroid stimulating hormone (TSH). He also had a CT scan of his brain taken. May I know what these tests and scans are for? 

In my dad's tests results, Creatinine and Alkaline Phosphatase were shown to be higher than normal in his serum. May I know what do these indicate? Why were Vitamin B12 and Gamma-Glutamyl Transferase tested? 

I understand that dementia is probably caused by multiple medical conditions and currently has no cure. However, I'd like to know if there are ways to slow down the genetic progression of a person like me towards dementia. 

I am currently on medication for schizophrenia and OCD are Risperidone and Fluvoxamine, respectively. I've also purchased OTC health supplements, such as multi-vitamins, micro dose lithium, omega 3-6-9, magnesium citrate, and GPC Choline, to take on a quite regular basis. Will these help keep dementia away? 

I'm also considering additional supplements, such as Fisetin, Senolytics, Curcumin, Resveratrol, pomegranate extracts, and nootropics. Will these help keep dementia away?

Answered by Dr Ang:
Hi M**,
Usually, once a diagnosis of dementia is suspected, some investigations such as a free thyroxine test, thyroid stimulating hormone (TSH) and a CT scan of the brain will be made, to look out for potential mimics of dementia and to determine the causes of dementia. These investigations will usually include measuring the individual’s levels of vitamin B-12/Folate and Calcium.

A raised Creatinine can indicate some kidney impairment or kidney disease. As for raised Alkaline Phosphatase levels, it might indicate some problems with his bones or liver. Gamma-Glutamyl Transferase is part of the test for liver panel and I would advise to discuss with the reviewing doctor to see if further tests or monitoring is required.

Currently there is no cure for dementia, however, there are means to slow down the disease progression such as regular exercise (150 minutes per week), activities engagement (mind stimulating activities such as chess, Sudoku and social interaction) and dementia medications.

For over-the-counter health supplements to keep dementia away, there is currently limited evidence to support their use and efficacy. You might want to consider speaking to your doctor regarding the supplements that you are taking as some might have potential interactions with your current regime of medications. 

For diet types, a Mediterranean diet (high in fruits, vegetables, whole grains, beans, nuts, seeds and olive oil) has been associated with the reduction of cardiovascular risk, which may indirectly reduce dementia risk.

About Dr Alexis Ang Guat Cheng

Dr Alexis Ang Guat Cheng is a Senior Consultant at Department of Geriatric Medicine in Changi General Hospital. She received her medical degree from National University of Ireland in 2004 and completed her specialist training in Geriatric Medicine from Changi General Hospital.

She has experience in managing acute and chronic complex general medical issues in the elderly. Her interests include falls and frailty, orthogeriatrics, incontinence, depression, delirium, dementia and deconditioning in the elderly. She is also experienced in managing end of life issues in the elderly including end stage organ disease and advanced care planning.

Dr Alexis Ang believes in ageing gracefully with a person-centered care and effective communication as her main tenets. She is passionate in teaching and continues to nurture the next generation of geriatrician. She is also involved in clinical research.

Ref: K21