Clin Assoc Prof Samuel Chew, Senior Consultant, Department of Geriatric Medicine at Changi General Hospital (CGH), answers your questions about muscle loss in the elderly and senior's health.
Muscle loss in the Elderly - Doctor Q&A
Loss of muscle is a main cause of falls in the elderly, and brings with it a host of health issues including frailty and disability.
In fact, by the age of 70, you can expect to lose up to 25 per cent of your muscles due to ageing. (Read the article
here)
But what are the symptoms of muscle loss to look out for? Are there ways to minimise muscle loss? And when should medical help be sought?
Clin Assoc Prof Samuel Chew, Senior Consultant, from the
Department of Geriatric Medicine at
Changi General Hospital (CGH), a member of the
SingHealth group, is here to answer your questions about muscle loss in the elderly and senior's health.
This Ask The Specialist forum has closed. Thank you for your interest and participation.
1. Question by nanjingpt
Dear doctor, I am male, 62 years old. I have arthrities on both knees, with the left one being the worse of the two. I am now working out daily on the treadmill at a relatively slow speed of 5 kmh - 6 kmh which is more like brisk walking. I fear that I might not be able to continue this exercise in the years to come as my arthrities gets worse, as I believe it would. Some people had suggested swimming but I did not learn how to swim. If my legs lose muscles due to lack of exercise, then falls are likely to happen. What do you advise I could do? Thank you.
Answered by Clin Assoc Prof Chew:
Dear nanjingpt
Thank you for sharing your story on HealthXchange.
I am sorry to hear about the osteoarthritis affecting your knees. However, there are some basic principles that can help improve the symptoms and reduce the risk of muscle loss associated.
The most important principle is to keep the joint active, in order to prevent the associated muscle from becoming weaker and the knee joint stiff. At the same time care must be taken not to further aggravate any underlying injury that may be present in the knee affected.
The second principle is that by strengthening the large muscle groups which supports the knee, this will take some of the loading pressure off the knee when walking and will further stabilize the knee joint. This will improve both muscle mass in the legs and reduce the symptoms of pain and stiffness in the affected knee.
Although aerobic exercises are important (swimming, cycling, etc) part of health and fitness, some resistance-based exercise for the lower limbs are required in order to load the muscles to stimulate muscle growth, improve muscle strength and reduce the rate of muscle loss. The intensity needs to be built up gradually over time as excessive resistance or use of heavy weights may lead to more injury if done without supervision. Exercises that results in heavy impact on the ground (i.e. running) should generally be avoided.
The third principle is that stretching exercises are an important component of good joint and muscle health, and should be performed before and after every exercise session.
As such I would advise you to seek the expert opinion of a physiotherapist or sports physician for an assessment of your knees and for their recommendations on the type of resistance/weights exercises and stretching that will be best suited for you. They will also be able to give you an exercise prescription after assessment which you can then perform at home.
Done consistently, you will see and feel the improvements over time.
2. Question by Elbert
How does a balance diet soleved this issue for age over 65+ ? any sample diet will be very helpful.
Thank you
Answered by Clin Assoc Prof Chew:
Dear Elbert
Thank you for your questions.
Actually, muscle loss starts to be measurable from the age of 40 and accelerates after the age of 70, so much so that by the age of 80, about 40% of peak muscle mass is loss.
This loss, in an otherwise healthy person without any medical conditions, is largely compounded by two main factors, which are insufficient protein in the diet and a lack of physical activity, particularly the types which involves loading the muscles with some form of weight or resistance.
In terms of protein requirement for the healthy individual, we now have sufficient scientific data to recommend at least 1.2 gram of high-quality protein per kilogram of body weight for individuals above the age of 65. This recommendation is higher than the 0.8 gram per kilogram body weight for younger individuals in order to overcome the higher threshold required for muscle protein synthesis above the age of 65. The daily requirements for individuals with medical conditions or recovering from an acute medical illness will be different and advise should be sought from a medical practitioner or certified dietitian.
In general, for a 60 kilogram individual above the age of 65, this would mean a daily dietary of 72 grams of protein. Good sources of high quality protein would include white meat, fish, dairy products and tofu/soya products.
For example, one palm size or 90 grams of fish or lean chicken breast will provide about 20 to 27 grams of protein, one standard size egg about 6 grams of protein, one cup of milk about 7 to 11 grams of protein.
For a more detailed discussion and sample of healthy diet, please read the following article and see more on the Health Promotion Website:
Eat more protein to keep muscles healthy in old age
Lifestyle
The Straits Times
https://www.straitstimes.com/lifestyle/eat-more-protein-to-keep-muscles-healthy-in-old-age
My Healthy Plate
Health Promotion Board
https://www.healthhub.sg/programmes/55/my-healthy-plate
Don’t forget that good balance nutrition with sufficient protein is only part of what is required for good muscle health. Daily physical activity, particularly those which include weights or resistance, is essential. Two is better than one. One is better than none.
Follow up question by Elbert
Thank you Doctor. I am aware of the 1.2gm/kg and in my case it is about 86.2 (72kg) of protein and the my plate etc does not give guideline of the protein in take. 86.2gm is about 14 eggs or 4 portion of 90gm fish etc if did not count others. That is why my question as a senior how to have so much protein in ONE day for everyday ?
Thank you.
Answered by Clin Assoc Prof Chew:
Dear Elbert. Thank you for your follow-up question. It is true that sometimes, we have found that it is a challenge in meeting the 1.2 gram per kilogram per day of protein recommended. This is because it would involve the consumption of a significant amount of food, requiring one to have a very healthy appetite, in the Asian context. In addition, as one grows older and wiser, there is often also a reduction in one’s appetite.
One way to maintain a healthy appetite is to keep physically active. In this way, one can start a virtuous cycle where an increase in healthy physical activity, leads to an increase appetite, thereby further enhancing the health benefits by providing the energy and proteins required to maintain and improve muscle health. This will then enable one to increase the amount and/or intensity of the physical activities, completing the virtuous cycle.
The other strategy would be to include a variety of sources of protein in a single meal, i.e. meat, legumes, dairy products, egg, toufu. Each will provide a small amount of protein, but added up together will be substantial. For example, a meal made up of a palm size portion of lean chicken breast (27 grams of protein), a bowl of rice (5 grams), one square tofu (5 grams) would give one 37 grams of protein. Two similar meals would give about 74 grams of protein, leaving about another 10 grams to be made up by breakfast (one egg and one glass of milk).
The use of daily food items fortified with extra protein is another strategy. In one study in the Netherlands (Van Til et al, 2014), the researchers used bread and drinking yoghurt fortified with extra protein in their study instead of the normal version, and they managed to add an additional 40 grams of protein a day (from 72.5 grams per day to 115.3 grams per day of dietary protein) in patients above the age of 55 in a rehabilitation hospital.
During periods of illness or convalescent when one’s appetite can be greatly reduced; the use of complete and balanced oral nutritional supplements is recommended in order to reach the recommended protein and energy requirements to facilitate healing and rehabilitation. In small number of cases, the use of high protein and high energy nutrient dense supplements may be indicated and helpful. Further supplementation of dietary protein can be achieved by the use of protein powder in selected appropriate patients after a dietitian’s assessment.
I hope that the above has helped answer your question.
3. Question by Anonymous
Dear Prof Chew,
If we want to maintain our muscle mass, say for a 60 yr individual, what type and level of exercise do we need to do to maintain it.
Answered by Clin Assoc Prof Chew:
Dear Anonymous,
Thank you for your questions.
In general, the types of exercise required to preserve or improve on muscle health and muscle mass must include a component of the use of weights or resistance. The intensity of these exercises can then be progressed over time according to the individual fitness. Any pre-existing medical conditions or joint problems must also be taken into consideration.
Aerobic and balance-based exercises are also important in order to have a balance exercise program and should be integrated with the progressive weights and resistance-based exercise training.
As always, it is important to perform stretching exercises before and after the above in order to loosen up the muscles and prepare them for the exercises. This will help prevent any exercise related injuries.
In general, one will need to put the muscle group under 40% to 60% of the maximal weight that can be lifted or moved by the muscle. This weight or resistance should then be repeated 8 to 10 times per set, up to three sets per session. In general, three sessions per week for at least 12 weeks will be required to see a measurable improvement of the muscle strength and/or muscle mass.
Further increase of the weights/resistance can then be performed over time in the same manner.
For individuals with pre-existing medical conditions, it would be wise to seek medical review and advise before starting on any physical exercise program which includes the use of weights/resistance.
For all individuals whom have not used weights /resistance-based exercises before, it would be wise to consult a physiotherapist or gym trainer for proper assessment and guidance on how to perform these exercises and muscle stretching required.
Performing weights/resistance exercises without the correct technique or guidance may result in injury.
As before, please remember that physical activity with elements of weights/resistance-based exercises are only part of the what is required for good muscle health. Having enough calories and high-quality protein in the daily diet is essential for the full benefits of the weights/resistance based exercises. Two is better than one. One is better than none.
4. Question by OOIPG
When and how does muscle age? What can be done before that in terms of diet and safe exercise etc.
Answered by Clin Assoc Prof Chew:
Dear OOIPg,
Thank you for your questions.
Measurable muscle loss starts from the age of 40 and accelerates after the age of 70, so much so that by the age of 80, about 40% of peak muscle mass is loss. This is due to the reduction in size of, and the actual loss of muscle fibers, particularly the type which is responsible for generating forceful contractions.
There are many factors which contribute to this loss including changes in hormonal and endocrine levels, the lost of connections between the nerves and muscle units, the increase breakdown of muscle due to inflammation and/or intercurrent illness and inactivity, and the higher threshold of protein required by the body above the age of 65 in order to maintain the same amount of muscle protein synthesis as a young person.
Hence the two major reversible factors would be a balance diet with at least 1.2 gram of high quality protein per kilogram of body weight per day, and the incorporation of regular physical activities, which include weights/resistance base exercises in addition to aerobic, balance and stretching exercises.
In terms of diet, for a 60 kilogram individual above the age of 65, this would mean a daily dietary of 72 grams of protein. Good sources of high quality protein would include white meat, fish, dairy products and tofu/soya products.
For example, one palm size or 90 grams of fish or lean chicken breast will provide about 20 to 27 grams of protein, one standard size egg about 6 grams of protein, one cup of milk about 7 to 11 grams of protein.
For a more detailed discussion and sample of healthy diet, please read the following article and see more on the Health Promotion Website:
Eat more protein to keep muscles healthy in old age
Lifestyle
The Straits Times
https://www.straitstimes.com/lifestyle/eat-more-protein-to-keep-muscles-healthy-in-old-age
My Healthy Plate
Health Promotion Board
https://www.healthhub.sg/programmes/55/my-healthy-plate
In terms of physical activity, one will need to put the muscle group under 40% to 60% of the maximal weight that can be lifted or moved by the muscle. This weight or resistance should then be repeated 8 to 10 times per set, up to three sets per session. In general, three sessions per week for at least 12 weeks will be required to see a measurable improvement of the muscle strength and/or muscle mass.
Further increase of the weights/resistance can then be performed over time in the same manner.
For individuals with pre-existing medical conditions, it would be wise to seek medical review and advise before starting on any physical exercise program which includes the use of weights/resistance.
For all individuals whom have not used weights /resistance-based exercises before, it would be wise to consult a physiotherapist or gym trainer for proper assessment and guidance on how to perform these exercises and muscle stretching required.
Performing weights/resistance exercises without the correct technique or guidance may result in injury.
Remember that both a balance diet with sufficient high-quality protein and physical activity with a component weights/resistance exercise is required for optimal muscle health.
5. Question by kmchia
I am want to take lessons, on dieting and physical exercises, that are required to stop muscle loss. Please advise how this can be done including contact details.
Answered by Clin Assoc Prof Chew:
Dear kmchia
Thank you for your questions.
At the present moment, I regret to inform that we do not yet have an integrated national public health-based program incorporating assessment and advise on a balanced diet with adequate high-quality protein intake and physical training program incorporating component of weights/resistance exercises for the general public in Singapore.
It is possible that you may find these integrated services in specialised sports medicine clinics or private gym centres in Singapore.
As such, the advice on individualised dietary requirements will need to be sought from a dietitian or physician in general. Similarly, the individualised exercise prescription will need to be sought from a physiotherapist or sports medicine physician. Gym trainers will also be able to provide proper assessment and guidance for the exercise prescription required.
For individuals above the age of 65, GymTonic is available at 26 Senior Activity Centres/Eldercare facilities throughout Singapore.
The address for these centres can be found on their website at:
https://www.gymtonic.sg/#/coalition
6. Question by jnteo_1999
Would consumption of Ensure milk With HMB contribute to muscle tissue building and growth as claimed by the manufacturer? Thank you.
Answered by Clin Assoc Prof Chew:
Dear Jnteo_1999
Thank you for your questions.
Muscle protein synthesis is dependent on the availability of amino acids which itself is derived from high quality protein. Sufficient energy in the form of calories are also required for muscle health because if the body is deficient in energy derived from carbohydrates and fats, it will then start to break down muscles to generate the energy required to sustain life and the essential body processes. Hence, a balanced diet with sufficient high-quality protein is essential for muscle health and muscle protein synthesis.
Milk is a source of high-quality protein, and oral nutritional supplements such as Ensure is nutritionally balance and contains amongst other vital ingredients, 9 grams of protein per serving and this would contribute towards the daily dietary requirement of protein essential for muscle protein synthesis. In individuals whom are having difficulty meeting the daily protein requirement of 1.2 grams per kilogram of body weight per day through normal balance diet, especially after intercurrent illness or hospitalisation, the short fall can often be made up using oral nutritional supplements.
HMB is a by-product of the breakdown of the amino acid leucine which occurs naturally in the human body, albeit in very small quantities. Studies have shown that HMB is involved in the regulation of muscle protein synthesis. It has been found to positively affect the rate of muscle protein synthesis and negatively affect the rate of muscle breakdown.
In a small well-designed human study, HMB has been shown to reduce muscle loss as a result of inactivity and enforced bedrest. Other clinical studies which examined the use of HMB in addition to a well-balanced diet with high quality protein have shown that it can contribute to an increase in lean mass in the study subjects.
7. Question by Jane35
For a bedridden elderly, what kind of exercises are rrcommended? How frequent n how long should he or she do these exercises?
Answered by Clin Assoc Prof Chew:
Thank you, Jane, for your questions. The key concept of regular targeted exercise is to maintain good health and independent living. Once a person becomes bedridden or bed-bound, the scope for exercise interventions are usually very limited in terms of exercises with active movements initiated by the patient. Not only does being bedridden lead to significant and rapid muscle and bone loss, it also impacts on the alertness and cognition of the patient, making meaningful participation in exercise activities unlikely and unsustainable.
The main benefits for this group of patients, who also often have reduced conscious levels or severe cognitive impairments from neurological diseases like advanced dementia, stroke or Parkinson’s Disease, would be the use of daily passive stretching of the limbs to reduce the risk of the shortening of the muscles ligaments leading to permanent contractures which can be painful and make it difficult to maintain basic hygiene needs and care for the patient.
Sitting the patient up on regular intervals is another important activity that should be attempted for bedridden patients as this alone has many benefits such as increased alertness, reduces the risk of chest infection and increase ability to feed normally.
Follow up question by Jane35
Are there different types of exercises, intensity levels and duration of exercises recommended for different age groups of elderly. For example, those in 60s may still be able to running and Zumba but these may not be suitable for those in their 70s or 80s.
Answered by Clin Assoc Prof Chew:
The older a person becomes, the more different one becomes from others in the same age group. This is known as heterogeneity. Older persons are very different in terms of their cognitive, physiological and physical capabilities. Hence, instead of prescribing exercises based on age, it is better to based the intensity of the exercise based on individually assessed capabilities.
In a simplified manner, one can think of how fit or physically well an older person is by putting them into three categories, namely robust, pre-frail and frail.
In the robust group, higher intensity exercises can be recommended, including both aerobic and progressive weights/resistance exercise training.
In the pre-frail group, similar benefits will be expected from regular aerobic and progressive weights/resistance exercises, starting from a lower intensity when initiating these exercises when compared to the robust group. Some in this group may progress over time and may join the robust group as they become stronger
In the frail group, the focus of exercise would be more focused on what is known as functional exercises, i.e. sit to stand, step up on a raised surface, lifting an object and movement in different planes, etc. These movements are what is required to perform basic activities of daily living such as walking short distances, putting on cloths, using the toilet and bathing oneself. Some may improve over time to join the pre-frail group but the main focus would be to achieve some independence and ability to perform activities of daily living and to maintain ability to ambulate short distances.
8. Question by jeffrey
Hi,
I am 55 now and I exercise once a week, I have my right achilles tendon snap 2 year ago and I have it repaired. I had rest for a year and I have start my exercise again, after one year of exercise, my right leg muscle is still smaller than my left leg. Will it stay the same or I have to spend more time to exercise my right leg.
Answered by Clin Assoc Prof Chew:
Dear Jeffrey
Thank you for your questions and for sharing your story.
I am sorry to hear about the injury that you have sustained, and the subsequent expected loss of muscle from the inactivity as a result of the injury.
The amount of muscle mass generated is directly related to the intensity of the progressive weights/resistance-based exercises over time, supported by a balance diet with sufficient high-quality protein. With everything else being equal, spending more time and effort working out on one side should allow that side to catch up in terms of the lost of mass from the inactivity.
However, in view of your previous injury, I would be very cautious and seek specialist assessment and advice from a physiotherapist specialising in muscular injury or a sports medicine physician before deciding on what to do next. It is possible the intensity of weights/resistance-based exercises may need to be limited at a certain level in order to reduce the risk of recurrent injury to the healed Achilles tendon.
The specialist will be able to provide you with an individualised advice and the best plan forward.
9. Question by MH Teo
Hi
I am a 52-yr old homemaker and is currently undergoing perimenopause.
Over the past 1-2 years, I lost about 5kg and noticed the bones in my butts have become more pronounced such that at one stage, I experienced discomfort when I sit for too long. I also noticed my leg muscles are not as firm as before and have shrunk. Late last year, I also started noticing "depressions" in my skull. Not as round and smooth as I thought it should be.
I have started to take more protein and do some weights exercises upon advice from my family members. I love to do long walks but have reduced the frequency due to knee pain.
Please advise. Thank you.
Answered by Clin Assoc Prof Chew:
Dear MH Teo,
Thank you for sharing your story and for your questions.
In general, we assess the severity of weight lost based on the percentage of lost over time. Unplanned weight lost of 5% to 10% over 3 to 6 months would be significant. A weight loss of more than 10% over the same time frame would be considered as severe. A Body Mass Index (BMI) of less than 18.5 would also be in keeping with significant weight loss, particularly if your BMI was much higher prior to the weight loss.
However, based on your description of muscle loss on your face, limbs and buttocks, it will still be in keeping subjectively as significant weight loss.
If the significant weight loss is truly unintentional, or occurs despite a good appetite, or if you have a loss of appetite leading to the weight loss, it would be prudent to seek a medical assessment for common causes of weight loss due to medical conditions first before embarking on the dietary and physical activity interventions.
If the medical assessment is normal, then I would recommend a dietitian review as in the setting of significant weight and muscle loss, one would required an even higher amount of both protein (1.2 gram to 1.5 gram per kilogram body weight per day), and also a higher caloric intake in order to built back the lost muscle mass and to facilitate the increased energy requirement from the concurrent physical activity with weights/resistance based exercise component.
Again, in view of what would be keeping with osteoarthritis of your knee, it would be good to seek the advice of a physiotherapist or sports medicine physician for assessment and an individualised exercise prescription plan.
Targeted exercise for the large muscle groups related to your knee joint will help improve the stability of the knee joint and reduce the pain symptoms.
Walking is good aerobic exercise but is insufficient on its’ own if building back the muscle you have lost is the goal.
10. Question by Saijing
Hi Prof Chew. My dad is 78 years old & my mum is 72 years old. Please advise if the recommendation of 10K steps/day are still good for their age. Does this help in slowing down their muscles loss? Are these will give burden to their knee cap? If yes, if there is any recommendation of the exercise/method which could help them to have strong & healthy muscle.
Thank you very much.
Answered by Clin Assoc Prof Chew:
Thank you Saijing for your comments. All forms of exercises contribute to good health. Walking is a form of very useful and easily assessible aerobic exercise which usually does not incur any costs to perform. The recommendation of 10k steps per day will contribute to aerobic fitness and there are some studies which also suggest that this can help in the maintenance of healthy bones. However, in terms of muscle health, the best evidence comes from studies on exercises which involve the use of progressive weights/resistance, for both the maintenance and improvement of muscle mass.
One of the concerns for patients with osteoarthritis of the knees is the aggravation of the knee injury with activities involving repeated high impact forces. However, studies suggest that the benefits from regular exercise in improving the strength of the muscles related to the knee joint, and also in the increased suppleness of the knee joint itself, will be beneficial in terms of increased knee joint stability, reduced joint stiffness and pain, and improvement in the function of the knee in daily activities. Of course, any exercise in the setting of osteoarthritis of the knee or any other knee injury should be moderate and perform in conjunction with proper warm up and warm down stretching exercises. If one has any concerns with exercise and pre-existing knee injuries/pain, it would be best to consult a physiotherapist or sports physician before starting on an exercise program.
Cycling and swimming are highly recommended exercises for people with knee injuries or osteoarthritis of the knee as they are low impact exercises. Rowing exercise is another example of low impact exercise which can be used in this group of people. For the other muscle groups, there is no reason why one cannot perform progressive weights/resistance exercises in order to maintain or improve the muscle health.
11. Question by R Xu
Dear Prof. Chew,
I am 66 years old. I have been suffering from knee cap problem (both legs) since late 50s; I went for knee cap replacement surgery (right leg) at KTP hospital about 6 years ago. I also have obesity problem.
About 3 years ago, I chronologically had sore at right ankle and went to Diabetes & Metabolism Centre at SGH for wound dressing. The doctor there diagnosed me having thrombosis. So I went for vascular surgery there.
I started to feel I could not walk properly and balance myself about a year ago and went to NTFGH to continue wound dressing and consulted the vascular surgeon. They referred me to physio therapist who told me about "muscle loss". I did not follow through the program.
At middle last year I ordered a rollator from Amazon, which enables me to move around. But my legs are getting worse and now I have to sit and move around with the rollator; I can only rely on rollator to walk for short distance. One of my friends suggested that I should go through Keto diet to reduce my body weight and lessen the pressure on my knees. I started Keto diet during Chinese New Year.
I woud like to know that how Keto diet will affect me at this age and also how does it relate to muscle loss.
Thank you very much for your kind attention.
Answered by Clin Assoc Prof Chew:
Dear Roger. Thank you for your questions. I am sorry to hear about the difficulties that you are facing with your health and with your mobility. You are right in saying that carrying excess weight on your body will adversely affect the health and function of your knee joints. Often the resulting pain in the damaged knee joint will lead to subconscious avoidance of eight and load bearing on the affected joint, leading to loss of muscles related to the joint through disuse atrophy. This is why the proper assessment, treatment and targeted exercise for painful joints are so important.
The research literature suggests that for healthy sustainable weight loss, a combination of a balanced diet with reduced calories and tailored aerobic exercises to increase the metabolic rate is required. Progressive weights/resistance exercises can also be added as the improvement in muscle health and muscle mass will also increase the metabolic rate. However, one has to be mindful that an increase in muscle mass may contribute to some increase in weight, especially if performed solely without sufficient amount of aerobic exercises.
In extreme cases of overweight negatively and severely impacting on health (body mass index >30), invasive procedures involving surgery to reduce the volume of the stomach has been shown to be an important part of medical therapy, combines with dietary advice and physical exercise.
Although keto diet has been popular of late, it is not recommended as the sole method of achieving healthy sustainable weight loss. This is because a keto diet is not a balanced diet, completing omitting carbohydrates in one’s diet. The body will then require a higher intake of fat and protein in order to make up for the production of glucose, which is essential for the normal functioning of muscles, red blood cells and brain cells. This unbalanced diet high in fat/protein would be unsuitable for people with diabetes, advanced kidney disease and coronary heart disease. In addition, the initial loss of weight from a strict keto diet is as a result of loss of water from the body, not fat. As such, the weight will return once the individual on keto diet start to eat normally and include carbohydrates in their diet in the future.
Last but not least, there are many reported symptoms related to the practise of keto diet, particularly headaches, bad breath, nausea and muscle cramps. These symptoms may limit the practise and sustainability of keto diets. In summary, a strict keto diet is not recommended as a method to achieve sustainable and healthy weight loss.
About Adj Asst Prof Samuel Chew
Dr Samuel Chew is a senior consultant at the Geriatric Medicine Department, Changi General Hospital (CGH) and Adj Asst Professor of Medicine with Yong Loo Ling School of Medicine.
He is a tutor for the Centre of Healthcare Simulation at NUS and the Geriatric Medicine Modular Training Program, Academy of Medicine Singapore and Chapter of Geriatrician, College of Physicians Singapore. Dr Chew is also faculty member for the SingHealth Residency Program in Geriatric Medicine, Internal Medicine and Family Medicine.
Dr Chew has a deep passion in delivering evidence-based individualised care for the elderly, teaching undergraduate students and postgraduate trainees, and the application of technology in the real world healthcare setting. Clinical work includes acute geriatric medicine, geriatric rehabilitation and discharge planning, management of multi-morbidity in the acute and ambulatory setting, pressure injury prevention and nutrition in the elderly. He is also a member of the National Telemedicine Guideline Review Committee.
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