We try to get Grandma out and about as much as possible. Somedays, she is just too tired, but sometimes we succeed. Today, my aunty got her out of bed and over to the day activity centre where she met her old friends, did some activities, and most importantly, enjoyed time outside of the bedroom.  Although she is getting more tired, being stuck in bed all day is not good for her bedsores, so its really good for her when she is able to get out and just move from bed to wheelchair for a change.

Fun with balloon tennis 

Bouncing fitness balls

Grandma loves buying 4D. Although she can't buy the numbers herself now, she tasks my aunty to take down her favourite numbers and to place the bets for her. Buying lottery is probably a national hobby amongst our elders in Singapore. Checking the results when its published three times a week is an important activity.  Aunty found a way to engage grandma by asking her to write down the winning numbers. 

Although we have all come to accept that grandma is going through her end of life journey, nothing really quite prepares us to see her getting weaker. Some days, she looks really really frail, her hands are cold, her feet are cold, and she looks really tired. I am almost reluctant to head home at night, and even when I get home, i wake up often in the middle of the night, checking my phone, making sure its not on silent, and then convincing myself that I am over thinking before I head back to sleep again.  But I guess the great thing about grandma is that her mind is stronger than her body. And when I head back the next day, she is almost like a brand new person. She eats well, she is chatty, energetic and she is filled with life again. She is definitely shrinking, its inevitable, the weight loss, but I bet if we did a brain scan, she is definitely having a very healthy brain. Perhaps its her positive outlook in life that is helping her body over come this very tough period. Bright and optimistic, enthusiastic about life, she is always ready to overcome any challenges ahead. She has been bed ridden for two weeks now, but she is not giving up on her exercises. She is still trying to do what she can, moving her toes, lifting her feet, showing off her many exercise moves with her hands to me. 

Spending time having fun and laughing makes the pain go away.

Did we know she had cancer? No. We found out only on Oct 13 when she was at A&E and the doctors told us. Did we guess? Yes. Cause she had been experiencing a rapid weight loss over the last few months. Maybe she knew something was wrong, but she didn't really want to get it checked, and we didn't insist either. Grandma has always had an active life, and fully independent. A few years back, she started using a walking stick, but she would still go about her daily activities on her own without help. She would go the near by market and kopitiam to meet her friends, do her hair and nails, every tuesday and thursday, she would volunteer at The Salvation Army Peacehaven Nursing Home in Changi, chatting with fellow elderly, exercising with them. I don't think she really knows what volunteer means, but she would start making friends with everyone from the staff to the more chatty elderly who where there with her, and she has a good buddy there, Lay Ha.  Grandma's current frailty and decline is difficult to see as a family member, but, its what I always envision it to be. She would be fit and healthy for as long as possible, the decline would be fast and she would go to sleep. I really wouldn't want her living in a nursing home for the next 10 years of her life. For Grandma, she valued being active, being amongst people and being independent. This was the quality of life she wanted, and she maintained it for as long as she could hold on. 

Grandma has left most of the medical decisions for the family to decide. But, because she is still mentally sharp and aware, we have been keeping her involved in the major medical and care decisions. From the hospital, we had doctors and family sit with her to explain her condition and help her to understand what was going on, and now that we are in a nursing home, the pastoral care and social work team helped us to take the step further. Today, she was involved in her advanced care planning, sharing with us how she would like to be treated in the event she needed medical assistance, would she want CPR that may lead to an ICU stay, would she want to pass away without medical intervention? How would she like her funeral to be conducted? These are all difficult questions that will face all of us in an ageing population, but we have address them. In a way, grandma is lucky she can make those decisions and when the time comes, we can act according to her wishes. Essentially, she doesn't want pain, no tubes, no injections, no prolonging of her life if she is no longer able to do it herself. I am amazed by her strength as she addressed each of the questions posed in a calm manner, and at times, funny too. eg. Why would I want vegetarian food at the funeral, I don't really like that when I am alive. Or, actually, you guys can decide for me, I won't be around by then. Its just her trying to inject some humour into the situation, but thats her, always laughing, smiling. Having some fun with whatever card that life deals us. Humorously, she told the pastoral care team, would you like me to sign any documents?

We can create fun moments at every corner. This is us at The Salvation Army Peacehaven Changi Nursing Home Thrift Shop. We tried on a pair of glasses and had an impromptu selfie. She laughed when she saw the pic. Absolute kodak moment. The shop opens six days a week. Do drop by to donate or purchase something to support them.

Grandma is currently going through end of life care and I will use this blog to share her story and my experience as a primary caregiver. 

Here is when it began. We noticed grandma's weight loss from a few months ago, and she started losing more and more weight. We knew something was up, we had a feeling it might be bad, but she didn't want to get it checked. Finally on that day, she told my aunty that her discharge in diapers had been more than normal and she agreed to visit a GP. But even so, she still went for her usual exercises for the day. The GP said she should go to A&E for further checks, we tried not to scare her, so she had some oats first before taking a taxi with Aunt and Mum to the hospital. At the A&E, the usual triage process happens and grandma went thru a whole barrage of checks before finally getting a bed at 2am. From 6pm, she was wheeled into the patient's only area where family was not allowed. Total wait time for 84 year old elderly lady = 9 hours. Doc did give us a quick update at 630pm and it confirmed that she did have a growth and its likely to be end stage cervical cancer and they found  large lump (5cm) and she would have to be warded. It wasn't a big surprise, we kinda knew.  I hope she would get a bed soon and she can undergo the care needed. But the wait continued and we waited outside. It's pretty much a waiting game at A&E. I decided to go bug the staff at 8pm and I managed to give her some dinner. From the caregiver's perspective, I felt at a loss waiting outside in the waiting area cause I was not allowed inside where grandma was kept at, yet I had no information given to me about what was going on with her. It was frustrating and worrying at the same time. I decided to play the sad puppy card and told the security guards about grandma and that i wanted to give her water, could they let me in, which they kindly did. (Grandma is frail so she would have been unable to get her own water or food). Finally at 11pm, I went to bug them again, and thats when they said they would message us on the phone when she got a bed. At this point, grandma had fallen asleep inside already. I understand the healthcare system and the A&E process, but as our population faces a rapidly ageing challenge, I think we need more sensitivity to the needs of the elderly when they are in the A&E. Eg. blankets, water, diaper changes, having the emergency bell available to them instead of hidden away in some corner, access to food if they are expected to wait longer. Healthcare teams focus on treatments, which is great, but sometimes we do need a little more empathy for the elderly patients because their needs are a little different to the average patient. 

I came across this video that features the use of voice technology to engage elderly in Japan in a sumo wrestling match. This really looks interesting, and I see a lot of potential where rehabilitation can be made more fun and interactive for our elderly staying in the facilities.  

Check out video link here

Photo credit: https://www.coloribus.com/adsarchive/casestudy/geriatric-health-services-facility-hitorizawa-ton-ton-voice-sumo-video-21387505/

Keen to learn more? Drop me an email: janicechia@ageingasia.com

Having fun cooking up a storm and eating too! Here is a sneak peak at the wonderful delights that our members have been cooking and sharing.