Travelling outdoors is beneficial for your loved ones with mobility issues as it will give them the encouragement that they can lead a relatively normal lifestyle despite having mobility issues. Safety and comfort should be your top priorities when travelling outdoors. Here are some tips on how to transfer your loved ones from the wheelchair to the car or vice versa.

Wheelchair to Car

Image by DHS

1. Position the wheelchair beside the car.
2. Ensure that you have enough room for the transfer. Push the car-seat as far back as possible.
3. Remove patient’s legs from foot-rests.
4. For the wheelchair, ensure that you have enabled the brakes and remove/move the foot-rests away.
5. Put your arms under the patient’s armpits and lock your hands. Straighten your back and bend your knees before lifting the patient. This is to avoid any back injury.
6. Count to three before lifting the patient.
7. Take small steps toward the door. Use the side of the car for support if needed.  
8. Ensure that the patient’s buttocks are placed as far back to the seat as possible before putting his/her legs into the car. This is to prevent the risk of the patient falling.

Car to Wheelchair

1. Position the wheelchair beside the car.
2. Lock the brakes of the wheelchair and remove the leg-rests.
3. Remove the seat-belt on the patient.
4. Position your left arm on the patient’s back and place your right arm under the knees.
5. Ensure legs are firmly placed on the ground.
6. Place your hands under the patient’s armpits. Bend your knees and straighten your back before lifting the patient.
7. Count to three before lifting the patient out of the car seat.
8. Take small steps towards the wheelchair.
9. Lower the patient on the wheelchair.
10. Put the foot-rests back and place patient’s feet on the foot-rests.

Need a visual demonstration? Watch this video here!

About Jaga-Me 

At Jaga-Me, we believe in the empowerment of our caregivers. You can engage with a professional nurse or occupational therapist to guide you on how to do proper transference techniques for your loved ones. Alternatively, you can engage our home care services and our professional JagaPros will provide you with caregivers’ training on how to move your loved ones around safely and easily while travelling outdoors! 

Bed Mobility

• Moving up the bed

Image source: The Brookside Associates

1. Ensure you are standing at the side of the bed.
2. Ensure the patient’s knees are bent. You can ask your loved one to bend their knees or you can help them to do so.
3. Put one arm under the patient’s shoulder blade and the other arm under his thigh
4. Count to three before lifting.
5. Lift the patient. Ensure that you ask the patient to push himself up as much as possible during the lift.

• Lying to sitting position

Image Source: The Brookside Associates

1. You should ask the patient to bend his knees or you can help him or her to do so before you start.
2. Put one hand on the patient’s knees and the other hand on the shoulder that is further away from you. Roll the patient towards you. His current position should be lying on his side.
3. You can swing his leg down the side of the bed.
4. You should then put one hand under the patient’s shoulders [the shoulder that is lying on the mattress] and the other hand on his upper-hip.
5. Count to three before lifting. Ask the patient to push himself up as much as possible during the lift. This is to encourage the patient to be more independent and you can save some strength and effort as well.

Bed to Chair/Wheelchair

Image Source Fairview

1. Ensure you have plenty of room for transfer.
2. Position the wheelchair at about 90 degrees from the bed surface.
3. Ensure that the wheelchair’s brakes are engaged before commencing the transfer.
4. Put your arms underneath the patient’s armpits and lock your arms. The patient may hold you around your waist to feel more secure.
5. Ensure that the patient’s knees should be positioned 90 degrees and feet are placed firmly on the ground.
6. Count to three before proceeding to lift.
7. Lift the patient up and encourage the patient to lift himself up as much as possible during the lift. This is to reduce the amount of energy needed to lift him up.

About Jaga-Me 

If you are unsure of how to transfer your loved ones safely at home, you can engage with a professional nurse or occupational therapist to guide you on how to do proper transference techniques. At Jaga-Me, we believe in the empowerment of our caregivers. You can engage Jaga-Me’s professional home care services and our certified JagaPros will guide you on the proper techniques of how to move your loved ones around safely and easily at home.

Award winning Home Care trusted by health professionals – Jaga-Me

Stroke is one of the most common chronic diseases that strike us when we are unaware. However, not many people are aware of the risk factors or might have misunderstood stroke as a type of heart disease. Here are ten misunderstood facts about stroke that you might not know about:

Stroke: Background Facts

1. Stroke only happens to older people

Stroke can happen to anyone at any age. It is true that the risk of stroke increases as we age because the arteries in our bloodstream hardens and becomes narrow as we grow older. However, according to the National Registry of Disease Office (2016), there is an increasing prevalence of people under the age of 65 suffering from a stroke. Our sedentary lifestyle can lead to obesity, high blood pressure and diabetes. All of these chronic diseases are risk factors of stroke.

2.  Stroke is not preventable

Stroke IS preventable! Even though there are some non-preventable risk factors – like genetics and age. However, you still have control and lower the chances of having a stroke. The risk factors for strokes include hypertension, high blood cholesterol and diabetes. Many strokes happened because of unhealthy and sedentary lifestyles – this includes an unhealthy diet, lack of physical exercise, smoking, excessive alcohol intake and obesity.

3. “I am skinny. I have lower chances of getting a stroke.”

False. If you have been leading an unhealthy and sedentary lifestyle, you will have a higher chance of having a stroke. It is important to eat healthily and aim to have a minimum of 150 minutes of exercise every week.

4. Stroke is uncommon

Stroke is has become more prevalent – according to the National Registry of Disease Office (2016), stroke is the 9th most common condition in hospital admission and the 4th leading cause of death in Singapore. The number of people having stroke have also increase over the years – thus it is important to lead a healthy and active lifestyle to lower the risk of a stroke.

5. Stroke is a type of heart disease

False. A stroke happens when the blood supply in the brain is restricted and blocked or a blood vessel in the brain has burst. It is essentially a brain attack.

Stroke: What to do when a stroke happens?

6. If a stroke happens – visit a General Practitioner or a Family Doctor

Do not visit a GP or a family doctor. When a stroke happens, call for an emergency ambulance and ensure that your loved one is transported to the emergency department of the nearest hospital ASAP.

7. “It’s a false alarm!” When stroke symptoms happen, you don’t have to see a doctor.

When you experience a Transient Ischemic Attack (TIA) or a mini-stroke, you still have to visit a doctor. Usually the risk of a stroke increases after experiencing a mini-stroke.

TIA Symptoms:

1. Numbness on one side of your face, arm or leg.
2. Temporary vision loss in one eye
3. Difficulty talking
4. Not able to process your surroundings
5. Dizziness
6. Difficulty swallowing

Stroke: Recovery Phase

8. You can never recover from a stroke.

False. You can recover from a stroke – many patients who are treated fast and quick enough are able to recover.

Use can use F.A.S.T to determine the warning signs of stroke:

F – Face (Ask the person to smile)

A – Arms (Ask the person to raise both hands)

S – Speech (Ask the person to repeat after you – check if the speech is slurred)

T – Time (Call the ambulance IMMEDIATELY, if the person is unable to do these simple actions)

9. You can recover fast from a stroke

This depends on how fast the stroke was spotted and treated. Sometimes recovery can span to 2 years. Stroke patients can benefit from physiotherapy and occupational therapy after the stroke occurs.

10.  After you recover from a stroke, it will not happen again.

False. If you have recovered from a stroke, you are at higher risk of having another stroke if you continue to lead an unhealthy and sedentary lifestyle. Ask advice from your doctor on how to prevent another stroke from happening.

We also recommend reading Your Guide to Oral Nutritional Supplements (ONS) and Apps For Diabetics: 5 Aspects To Look Out For.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

Types of transport services available

Bed-Bound Patients

Private Ambulance Service

You would need to consider the type of transport your loved ones need. If he/she requires space, more help or medical equipment you would need to consider hiring a private ambulance service

Here are some contacts:

Lentor Ambulance: 6100 1777

Angel Ambulance: 8338 2526

Wheel-chair Users 

Wheel-Chair Accessible Taxi (WAT)

Travelling with a wheel-chair user is convenient with the availability of Wheel-Chair Accessible Taxis. Many transport companies have rolled out taxis that provide wheel-chair assistance.

Here are some options:

GrabAssist: Grab provides on-demand transport services. With their GrabAssist option, you can book a car that accommodates to foldable wheel-chairs, walking sticks and collapsible scooters. The Grab drivers are also trained to handle patients with limited mobility.

How to book: Download the Grab App. Input your pick up and drop off point. And simply, select the “GrabAssist” option

Maxi Cab: If you need a seating capacity of 7 people and 1 wheel-chair bound patient, you can book a Maxi Cab. There will be ample space in a Maxi cab to accommodate a wheel-chair bound patient.

How to book: Call (+65) 8333 6006

Public Transport

Our public transport in Singapore is becoming more accessible to users with mobility issues. The MRT is user-friendly to wheel-chair users – they have barrier-free routes and wheelchair accessible toilets. They have also installed ramps for wheel-chair bound users. More than half of the buses in Singapore are wheel-chair accessible with ramps installed and 95% of bus-stops are barrier-free.

Medical Escorts

Accompanying your loved ones for their medical appointments can be challenging if you’re working as you have to apply for time off work. In addition, you have to worry about arranging transportation. An alternative you can consider is engaging medical escort services. Medical escorts are trained professionals (often nurses or trained care aides) who will accompany your loved ones to their medical appointments and back safely home.

What to expect from Jaga-Me’s medical escorts?

• Arrangement of Transportation

Our medical escorts will arrange for a Taxi /Grabcar for your loved ones. We will accompany your loved one to the medical appointment and back home safely.

• Ensure safe transfers

Our trained medical escorts will ensure that they safely transfer your loved one from the vehicle to the wheelchair. Safety will be their top priority throughout the journey. 

• Liaising with hospital

Our medical escorts will communicate with the doctors/nurses and take notes on the patient’s condition, doctor’s instructions and collection of medicine. They will then relay the information to the caregiver.

• Companionship 

Our friendly medical escort can provide a listening ear and accompany your loved one throughout the trip.

Having access to transportation can be challenging for people with limited mobility. Caregivers may also find it difficult to accompany their loved ones to all their medical appointments, especially if they are working full time. As such, it is helpful to be aware of the resources available for people with limited mobility in Singapore. If you need a trained healthcare professional to accompany your loved one to and from his/her medical appointments, you may engage a medical escort from Jaga-Me.

Award winning Home Care trusted by health professionals – Jaga-Me

This approach will help them to regain their strength and energy faster, and give them a quicker recovery period, which will last through their rehabilitative treatments. Healthy eating and lifestyle habits will ultimately improve their health and reduce their risk of getting another stroke.

Click here for A Guide To Nutrition For Stroke Survivors Part 1.

Reduce the Risks: What You Can Do to Help 

Malnutrition*

This serious condition occurs when your loved one suffers from a low appetite and food intake with weight loss as their caloric needs cannot be met. Usually dysphagia is a culprit that affects their ability to eat after a stroke. Malnourished people end up with more infections and trips to the hospital, therefore it’s important to ensure that we identify and act early.  

1. Sometimes stroke survivors end up with a weaker sense of smell and taste. Therefore, strong-tasting food can help to stimulate appetite. Use flavourful oils, vinegar, soy sauce, curry, chilli to amp up the taste.
2. Promote protein at every meal ( e.g. pork, lamb, mutton, beef, chicken, turkey, quail, fish, cheese, yoghurt, nuts, legumes such as baked beans, soybean curd, soy milk, red/green beans, eggs and tofu). ¹
3. Promote dairy products such as milk, cheese and yoghurt which are high in calcium and have protein. 
4. Avoid low-calorie, low-fat and low-sugar foods as these are “empty calories”. For a person with poor appetite, the goal is to prevent them from losing weight.
5. If they are eating poorly, make sure that water is given between meals rather than before a meal, so that they do not feel too full to eat.  
6. Offer high-energy snacks throughout the day (e.g. puddings, jellies, buns,  agar-agar, ice cream, egg custard, stewed fruit, local desserts like red and green bean soups, pulut hitam, soybean curd,  local snacks like soon kueh, ang ku kueh, yam cake, chwee kueh, chee cheong fun or pastries, croissants, potato chips, chocolates, cream cakes, dimsum etc.) ²
7. Add peanut butter, jam, honey, or chocolate sauce to their morning porridge to bulk up the calories.
8. Add margarine and oils, mayonnaise, cream, sour cream ,full cream dairy products, dried fruits, nuts, honey, jam to their meals. 
9. It may be easier to start a meal support service that reduces their risk of malnutrition and allow them to remain happily living in their home. ³
10. Consider nutrition supplements if they are losing weight.

*It’s better to get a referral to a Dietitian to assess the problem as they can recommend a meal plan that will help your loved one recover from malnutrition. In doubt, you can reach out to our teleconsultation doctors.

Dehydration

Many stroke patients don’t feel the thirst sensation, by then, they may already be dehydrated, so it’s important to keep offering them fluids ( especially so if they are unable to communicate) regularly to prevent complications.

1. Provide them moist foods, such as stews and foods with sauces.
2. Provide at least 8 to 10 cups of fluids daily. These can include water, milk, juices, soups and other beverages (Try to cut down caffeinated drinks e.g. coffee and cola drinks as they tend to dehydrate the body).
3. Offer hydrating jellies as a form of fluid. These tend to be better tolerated taste wise.⁴
4. Keep their mouth and lips moist by helping them with mouth care.
5. It is common for stroke survivors to end up constipated due to limited mobility or damage in the part of the brain that controls bowels and continence. Ensure they receive plenty of hydrating snacks, fluids and consider a natural fibre supplement if they are having irregular or infrequent bowel movements. ^4,5

Fatigue

A lot of people experience this condition after a stroke due to the immense physical and mental changes they go through. This type of post stroke fatigue doesn’t just go away after rest, it can last for weeks and months and make it harder for someone to recover and delay their rehabilitation, therefore it’s important to speak with their doctor to identify if your loved one is experience fatigue and how you can help to manage it.

1. Give your loved one plenty of time to complete their tasks. Do not rush them. Help them understand that it will take time to get better.
2. Keep a diary of good days and bad days. Make sure they don’t exert themselves too much on days they feel better, otherwise they will end up exhausted later on.
3. Help them with gentle exercises and social activities and take frequent breaks in between such activities.
4. Establish a proper day, mealtime and night time routine.

Chewing and Swallowing problems*

These problems can occur due to the weakening of the tongue or loss of coordination from their tongue movements. Some general recommendations to help your loved one cope are:

1. Choose soft and moist foods that are easy to swallow, such as bread dipped in milk/milo, scrambled eggs, steamed fish, ice cream and yoghurts. 
2. Refrain from sticky foods like glutinous rice.
3. Cold food and drinks are helpful in soothing painful ulcers. 
4. It’s easier to manage food of the same texture, instead of mixing solids and liquids in the same mouthful. E.g. When serving rice/noodles with runny soup, the soup tends to slip down the throat much faster, potentially causing choking. To make it safer and easier to swallow, try thickening the soup so that it’s less runny and coats the rice/noodles properly. This thickened soup helps to moisten the noodles/rice while reducing the risk of liquids slipping down the throat too quickly. 
5. Cut foods into small pieces if chewing is a challenge. 
6. Make food easier to chew and swallow by changing the texture. Mince, chop, grate or mash. In some cases, food may need to be pureed (blended). ³
7. Use a thickener to thicken up liquids to a safe consistency for them. ⁶
8. Consider organising home delivered texture modified meals for your loved one. This way, it takes away the hassle of preparing specific textured meals and you can be assured it complies with the dysphagia diet guidelines. ³

*It’s better to get a referral to a Speech Therapist to assess the problem as they can suggest the safest texture and consistency of foods and fluids.

Limit Sodium in their Diet

It is important to limit food and drinks containing added salt, as excess sodium in the body ( found in salt and salty foods) raises blood pressure and may put your loved one at risk of another stroke. Assure them that as they reduce their salt intake gradually, their taste buds will adjust in a few weeks.

1. Foods such as salted snacks, soups and gravies prepared outside, canned foods, preserved and processed foods such as hot dogs, luncheon meat, stock cubes, seasonings and sauces are high in sodium and should be reduced.
2. When cooking at home, use whole spices, lemon juice or natural seasonings such as shallots, onions, garlic and parsley to spice up the cooking instead of adding table salt.
3. Only add a small amount of salt or sauces after cooking. If necessary, taste the food before salt is added.
4. Avoid giving pickles, sambal belachan, papadum or chutneys with their meals.
5. Minimize the number of times they eat out as most food sold outside is highly salted.
6. When dining out, ask for less gravy, avoid drinking the soup and limit preserved foods such as salted egg and salted fish. Also remember to request for freshly cooked items without salt, MSG or soy sauce.
7. When purchasing foods, choose foods that have the ‘Healthier Choice’ symbol or those labeled ‘Low in Sodium’ or ‘No Added Salt’.
8. Read food labels to compare similar foods per 100g and choose the lower sodium version.

Limit High Saturated Fat and Trans Fat foods

High saturated and trans fat foods can contribute to high cholesterol levels, and we all know that high cholesterol levels increase one’s risk of stroke. Limit:

1. Fatty meats (pork/mutton/beef) and lard
2. Skin and fat on chicken/duck
3. Canned or processed meats (sausage/salami/luncheon meat/burger patty.
4. Deep fried foods (such as fried chicken/meat/fish)
5. Full cream milk and dairy products
6. Coconut milk/oil and coconut products (e.g. kueh and coconut milk based dishes)
7. Foods containing butter, palm/palm kernel oil, ghee
8. Potato chips, pastries, cookies and cakes
9. Margarine and shortenings ( e.g. Crisco, Planta)
10. Shellfish
11. Organ meats ( liver/brain/kidneys/intestines)

Smart Carbohydrate Choices

In general, people with diabetes are more likely to get a stroke than those without. When there is too much sugar in the blood over time with poorly controlled diabetes, clots or fat deposits can occur in the blood vessels in the neck or brain. Over time, these vessels can narrow or become completely blocked, leading to a heart attack or stroke. Therefore, it’s important to choose healthier types of carbohydrates to control blood sugar levels.

1. Have whole grain/brown varieties of bread, rice, noodles, pasta and oatmeal. 
2. Limit refined grains such as white flour, white rice, pastry and sweetened breakfast cereals.
3. Add starchy vegetables (pumpkin, sweet potatoes, corn) and legumes ( beans, lentils, split peas) to your loved ones diet.
4. Encourage more fruits and vegetables (e.g.spinach, kale, chye sim, nai bai,tomato, capsicum, brinjal, bitter gourd, broccoli and cauliflower)to their daily diet.
5. Limit sweetened canned/packet drinks, bubble milk tea, milkshake, flavoured coffee drinks, energy drinks, flavoured milk and cultured milk drinks.
6. Limit canned fruit with syrup, dried fruit coated with sugar/honey/juice concentrates, fruit punch, fruit juice, preserved fruits.

If you found this article helpful, we recommend reading When Memories No Longer Exists: Understanding Dementia and Nutrition in Parkinson’s disease.

About Health Food Matters

At Health Food Matters, their team of healthcare experts and food technologist develop scrumptious Delisoft Easy Meals which are nutritious and they come in different textures. They also carry a range of snacks and desserts from their Special Pantry to provide an extra boost for those who struggle getting enough nutrition every day.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

Rehabilitation

The purpose of Rehabilitation is for patients to return to a normal and healthy condition through therapies and physical activities. The types of rehabilitative therapies and exercises you need will be assessed and determined by your stroke care team.

Before planning your post-discharge care plan, it is important to arrange and prepare for rehabilitation sessions for yourself or your loved one. The stroke care team at the hospital will assess the patient’s mobility function and decide on a suitable post-discharge care plan for the patient and offer caregiver’s training.

Source: HealthHub

4 Steps to Post-Discharge Care Plan

Preparing for your loved one’s discharge is very stressful and confusing. Here is a quick  breakdown of what to expect:

1. Communicate with the primary care doctor at your neighbourhood GP or polyclinic – to keep doctor’s appointments convenient for you or your loved one.
2. Request for an “AIC” referral from the hospital or a medical social care worker to prepare and arrange for services such as Community Hospitals, Day Care Services, Day Rehabilitation Centres, Home Medical, Home Care Services or Nursing Homes (See which option and arrangement suit you or your loved one best).
3. Seek help or recommendations from your stroke care team about preparing your home for your post-hospitalisation discharge. E.g Home Modifications, Medical or Mobility Equipments.
4. Scheduling of medical appointments, outpatient treatments or rehabilitative therapies for yourself or your loved ones. Coordinate and work with your stroke care team!

Lifestyle Change: Prevention of another Stroke

If you are a stroke survivor, the chances of a stroke happening again are greater. Here are some ways you can prevent another stroke from happening.

Medication

Your doctor may suggest and prescribe these types of medications:  

• Anti-Platelet Medications

This can help to prevent blood cell platelets from sticking together and forming a blot clot – which can cause another stroke.

• Anti-Coagulant Medications

Anti-Coagulant medication is blood thinner prevents the formation of blood clots. It also prevents existing blood clots from becoming bigger.

• Cholesterol Medications

Helps to reduce cholesterol levels and lower the risks of heart diseases and stroke.

Lifestyle Modifications

Managing your bad habits and making small steps towards a healthier lifestyle can reduce risks of stroke or other debilitating diseases.

• Stop smoking.
• Reduce alcohol consumption.
• Ensure that you have a healthy and well-balanced diet (Include more vegetables and fruits in your diet, reduce consumption of red meat and consume whole grains).  
• Exercise regularly – About 20 minutes of moderate exercise – E.g. Brisk Walking (Consult with your doctor about your physical health before attempting to exercise).
• Ensure that you or your loved one take medications on time.
• Ensure that you or your loved one keeps up with your doctor’s appointment.

Emotional and Mental Health Support

Besides taking care of your physical health, it is important to care for your mental and emotional well-being as well. Never be afraid to ask for help or assistance if you need it! For stroke survivors or caregivers you can:

• Seek emotional support from professional counsellors/ psychiatrists:
• Talk to a professional counsellor/psychiatrist about your worries, struggles or positive improvement of your recovery journey.

Attend/Join Support Groups:

You are not alone in your journey to recovery. Find solace and support from other stroke survivors and caregivers through support groups or wellness programmes organised by Singapore National Stroke Association or S3A.

• Stroke Support Group Singapore
• Stroke Club @ Bright’s Vision Hospital
• S3A Wellness Programmes

We have more articles for Stroke. Continue reading more stroke articles here.

References:

1. Today Online (2016, January 13) Mental States of Stroke Survivors, Caregivers are Interlinked: Study. Retrieved from https://www.todayonline.com/singapore/mental-states-stroke-survivors-caregivers-are-interlinked-study
2. HealthHub Singapore (2019, January 17). Stroke: Hospital Stay and Care Experience. Retrieved from https://www.healthhub.sg/a-z/medical-and-care-facilities/64/your-hospital-journey
3. HealthHub Singapore (2019, January 17). Stroke Rehabilitation: Post Stroke Care. Retrieved from https://www.healthhub.sg/a-z/medical-and-care-facilities/65/care-after-stroke
4. Stroke Support Station (n.d.) S3 Wellness Programmes. Retrieved from http://www.s3.org.sg/programmes

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

FAST stroke symptoms and signs

The FAST acronym is a good framework to remember and follow the signs of stroke.

• F for Face drooping: A stroke can cause a person’s faces to droop down. If you spot someone’s face hanging unevenly especially when he/ she smiles, or if one side of the face feel numb, this is probably a sign of stroke.
• A for Arm weakness: If the person feels particularly weak or numb on one side of the arm, is a sign for arm weakness.
• S for Speech difficulty: People who are having a stroke will have slurred speech and trouble enunciating their words. If you spot any kind of speech abnormality, or if a person is speaking incoherently, it may be a sign of stroke.  
• T for Time to call 995: Get help FAST by calling the emergency hotline. Singapore’s hotline is 995.

Coping as a caregiver to a family member with stroke

Being a caregiver to a stroke patient can be demanding and stressful. A stroke patient requires more after care and therapy to recover mobility and certain motor functions. To cope with stroke aftercare, it is advisable to work closely with your doctor and nurses to devise a proper care plan for your loved one. Healthcare alternatives, such as home care services that provide procedural and respite care for your loved ones in the comfort of your own homes can bring respite and an ease of mind for caregivers when they are feeling stressed or burnt out.

Finding support is also important to help you relief caregiver burden. Start by reading the testimonials of other stroke caregivers, and find support groups that can allow you to meet people who have experienced what you are experiencing now. There is no better way to gain caregiving knowledge than to receive tips and tricks from people who have walked in the shoes you are walking in now.

Award winning Home Care trusted by health professionals – Jaga-Me

What is Stroke?

A stroke is a “brain attack” which occurs when blood flow to an area in the brain is cut off. The brain cells, deprived of the oxygen and glucose needed to survive, die. If a stroke is not caught early, permanent brain damage or death can result.

Types of Strokes

Ischemic Stroke 

This is the most common stroke – about 74% of all strokes in Singapore. Ischemic stroke is similar to a heart attack but occurs in the brain instead. This stroke occurs due to:

• clots forming in the brain’s blood vessels or other blood vessels leading to the brain. These clots block blood flow to the brain.
• clogging of brain’s blood vessels when there is too much plaque (fatty deposits and cholesterol)

Hemorrhagic Stroke

This is the second most common form of stroke which occurs when blood vessels in the brain breaks or ruptures. When this happens, blood seeps into the tissues of the brain, causing damage to the surrounding cells.

Hemorrhagic Strokes are commonly caused by high blood pressure and brain aneurysms (weakness or thinness in the blood vessel wall).

Symptoms

It is extremely vital to be able to quickly recognise the signs of stroke. The F.A.S.T test is an easy technique used to recognise and remember the most common signs of stroke. Other symptoms include difficulty in swallowing, dizziness, severe headache, – usually described as the “worst headache ever had” – confusion or numbness.

Risk Factors 

About 4 in 10 people will suffer a repeated stroke experience within 10 years. However, poor control over risk factors will increase the chance of a repeated occurrence.  

Controllable Risk Factors

Non-controllable Risk Factors

Age

The risk of stroke increases with age. This is because our arteries narrow and harden as we age

Family history

If your relative (e.g. parent, sibling) has had a stroke, your risk may be slightly higher

Genetic conditions

Certain rare genetic conditions can increase the risk of stroke. Your doctor will be able to advise you if you have one, and what to take note of.

Stroke is the largest cause of long-term physical disability or limited mobility in Singapore. With a rapidly ageing population, the burden of stroke is expected to increase exponentially in the none too distant future, posing challenges to the healthcare system and society.

How can Jaga-Me Help?

If you know someone with stroke and would like them to recover at the comforts of their own home, Jaga-Me provides professional stroke care for your loved one. If you need personalised caregiver training, you can simply ask our nurses! We will assess the condition of the patient and provide you a personalised care plan on how to care for her.

Award winning Home Care trusted by health professionals – Jaga-Me

The lifetime impact of stroke on younger adults also carries substantial costs to the individual and their families. A 2014 study, Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) showed that even after 10 years, about 1 of 8 patients (12.9%) with an Ischemic or Intracranial Hemorrhagic Stroke at a young age was not able to function independently. In patients with transient Ischemic Stroke, this was 1 of 15 (6.5%) survivors.

When younger adults(under 45 years old) suffer from a Stroke, it is important to find the cause as there is an increased possibility of a recurrent Stroke. What are the risk factors of Strokes in young adults?

Risk Factors of Stroke in Young Adults

• Heart Conditions: Cardiogenic causes (Rheumatic heart disease, heart valve abnormalities) represent approximately 20–30% of all Ischemic Strokes, a condition when an artery stops supplying blood to a part of a brain. This happens due to blood clots in the artery caused by cholesterol plaque build-up and usually affects young adults under the age of 45.

• Migraine: Even though migraine-induced Stroke is uncommon, it usually affects younger women. Migraine is caused by internal factors like genetics, hormonal imbalance or external factors like stress.

• Dyslipidemia: Dyslipidemia happens when there is an increase of lipids (fatty substance) in your bloodstream. This is caused by a lifestyle diet.

• Smoking: Smoking has an adverse effect on your body – it thickens your blood, increase the risk of blood clot and restrict oxygen in your blood.

• Hypertension (High Blood Pressure): Hypertension can damage your arteries and cause them to be narrower. This will lead to an increased risk of Stroke.

• High Blood Cholesterol: With high blood cholesterol, there is a higher risk of the cholesterol depositing itself in the walls of the artery. This cause the heart to work harder to pump blood through the arteries leading to hypertension and increasing the risks of stroke.

The Awareness Gap

“If you think that the pursuit of good health is expensive and time consuming, try illness.” – Lee Swanson

According to Prudential Singapore’s Health Poll, more than 70% of people in Singapore believe that they are healthy. However, the survey has also shown that the majority do not consume enough vegetables and fruits in their diet and that 1 in 3 Singaporeans are not exercising enough. There is still a gap in awareness when it comes to personal health matters. Prevention is better than cure so start making these changes in your lifestyle.

1. Balanced Diet – Include whole grains, more leafy vegetables and fruits in your diet. Reduce intake of salt and sugar in your diet. Find out how you can plan your diet using Health Promotion Board’s My Healthy Plate.
2. Exercise – It is recommended that you have at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise weekly. Set aside 20 minutes of your time every day to fulfil this!
3. Not Smoking – Avoid smoking at all costs.
4. Get adequate sleep – Findings have shown that Singaporeans are sleep-deprived and they are not getting adequate sleep due to long hours of work. Not having adequate sleep contributes to multiple health risks like increased risk of heart diseases, heart attack, heart failure, diabetes, hypertension and stroke.
5. Work-Life Balance – Find time to destress and power down. Studies have shown that 9 in 10 Singaporeans do not know how to “power down” and relax.
   

Eating healthy and getting fit does not have to be expensive or time consuming. It will require time and effort but you can spend more time with your friends or family to cook healthier food at home or exercise together.

We also recommend reading Your Guide to Oral Nutritional Supplements (ONS) and Apps For Diabetics: 5 Aspects To Look Out For.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

Moving around at home 

A Commode Chair 

Commode Chairs are mobile toilets designed for patients with limited mobility. It is usually placed beside the patient’s bedside for easy access.

These are the features you need to consider before purchasing the right commode chair for your loved one:

1. 1. The number of brakes – Check if the brakes are on 2 or all 4 wheels.
   2. Padded or plastic padding on the seat
   3. The type of arms-rest – Check if the arms rest are removable or swing-aways.

1. The type of foot-rest – Check if the foot-rests are swing-aways or a foot-plate.
2. The back support of the commode chair
3. The durability of the frame
4. Check if the commode chair is the same height as the bed

A commode chair is one of the few essentials for a patient with limited mobility. Before transferring your loved one from the commode chair to the bed or vice versa, always check to ensure that the brakes are put in place to prevent falls.

A Geriatric Chair 

A geriatric chair is a mobile chair for patients with limited mobility. The geriatric chair provides the necessary support – padded seats and designed for patients with limited mobility to lounge comfortably and move around safely between rooms at home. It is a more comfortable form of mobility device as compared to a wheelchair.

We offer a range of geriatric chairs on our e-commerce website that can be delivered straight to your home. Click here to find out more.

Travelling outdoors

With the aid of mobility devices, patients can maximise their mobility. By maximising mobility, patients with mobility issues are still able to maintain their social life and meet their friends or other family members. With the aid of mobility device, it gives them a sense of normalcy in their life. Here are some tips on how to choose proper mobility devices that are suited for travelling outdoors.

Walking Aid

How to use:

1. Standing Posture

• • Adjust the walking aid’s height. Ensure that the patient’s arm is extended and the handle is at waist height.

• • The patient should stand tall and not hunch over. With good standing posture, it will decrease the chance of fatigue.

• The patient should always position him/herself about 1 or 2 step behind the walking aid.

2.  Walking (with a walker)

• • The caregiver should stand behind and on the weaker leg of the patient.

• • The patient should put the walker in front of him or her.

• • Do not slide the walker forward without lifting the walker.

• • Ensure that all 4 legs are on the floor.

• • The patient should step forward first with the weaker leg.

• Followed by the other leg.

3.  Walking (with a stick)

• • The caregiver should stand behind and on the side of the weaker leg.

• • The patient should hold the walking stick with the opposite hand of the weaker leg.

• • Move the walking stick first.

• • Followed by moving the weaker leg.

• Always move the stronger leg last.

Wheel-Chair

A wheel-chair is essential for your loved one to travel outside of his/her home.

6 features to consider: These are the features you need to consider before buying a wheel-chair.

1. The type of arm-rest and foot-rest

• Check if it is fixed or removable.

2. The type of arm-rest and foot-rest

• Check if it is the stand or elevated leg-rest.

3. Desk-arms

• Check if you can fit the desk arms under the desk.

4. Frame

• Check the frame of the wheel-chair if it is a light-weight or standard frame.

5. Indoor/Outdoor Wheelchair

• Consider if you will be using the wheelchair at home or outdoor more.

6. Seat-belt

• See if there are seat-belts installed to the wheel-chair. Seat-belts need to be used if your loved one has poor seating balance.

Ensure that the brakes are in place before transferring your loved one from the wheelchair to the bed or vice versa. This is to prevent the risk of falling. 

About Jaga-me

Jaga-Me provides professional home care services, if you need help in operating any of these mobility devices safely you should seek help from a certified nurse or occupational therapist. Alternatively, you can engage with our services and our professional nurse will guide you on how to use the mobility device safely and execute proper transference techniques.

At Jaga-Me, we believe that ageing well is still possible despite the loss of mobility. There are many mobility devices available on the market that helps maximise mobility for your loved one at home and for travelling outdoors. With the aid of these mobility devices, ageing at home is possible.

Award winning Home Care trusted by health professionals – Jaga-Me

Anxiety a risk factor for Stroke?

Many patients with stress induced anxiety are shown to have an effect on their high blood pressure due to lack of proper rest, sleep deprivation and unhealthy eating habits. High Blood Pressure is a strong risk factor to Ischemic Stroke.

Stroke due to stress at work

In 2016, then Finance Minister Mr Heng Swee Keat collapsed from a stroke during a Cabinet meeting. According to Law & Home Affairs Minister K. Shanmugam, “[Mr Heng] was carrying an incredible load – handling the Financial Ministry, various projects, SG50 celebrations and the Committee for Future Economy”.

“I could see that he was very tired. I have been telling him that he was overworking so much that it will affect his health.”

Law & Home Affairs Minister K.Shanmugam

How can I manage my anxiety or stress?

Feelings of being overwhelmed with constant demands, lack of motivation, low energy levels and low productivity are signs of burnout. It is important to know how to manage anxiety and stress. It is also crucial to recognise the need to seek help if your anxiety interrupts your daily routines.

Exercise

Find time to exercise every day for at least 20 minutes. Take time to brisk walk around your neighbourhood park or find a friend to exercise with you. Exercise is known to release endorphins, which are chemicals in our brain that helps improve our overall mood.

Sleep

With exercise, you can sleep better at night. With better sleep, your overall mood will be improved significantly in the day.

Try Journalling

Consider writing down your thoughts and what you are stressed or anxious about. You can write down your feelings or what you are grateful for the day – the little things make a difference.

Spend more time with your family and friends

Make the effort to find time with your friends and family. Talking about your anxieties and stresses can help you to process your feeling better.

Even though there is no direct link between anxiety and stroke, however, the physical effects anxiety has on an individual’s lifestyle may be risk factors of stroke. Taking care of your mental and emotional well-being is as important as your physical well-being.

References:

1. HealthXchange Singapore (n.d.) Anxiety in Singapore: Stats, Types and Who’s At Risk. Retrieved from  https://www.healthxchange.sg/wellness/mental-health/anxiety-singapore-stats-types-risk
2. The Straits Times (24 May 2016). Stressed at Work? Beware of Stroke. Retrieved from https://www.straitstimes.com/singapore/health/stressed-at-work-beware-of-stroke
3. American Heart Association (n.d.) Anxiety Linked to Long Term Stroke Risk. Retrieved from https://www.goredforwomen.org/en/about-heart-disease-in-women/latest-research/anxiety-linked-to-long-term-stroke-risk
4. Pérez-Piñar, M., Ayerbe, L., González, E., Mathur, R., Foguet-Boreu, Q., & Ayis, S. (2017). Anxiety disorders and risk of stroke: a systematic review and meta-analysis. European Psychiatry, 41, 102-108.
5. Today Online (12 May 2016). Heng Swee Keat appeared ‘very tired’ at Cabinet meeting before he collapsed. Retrieved from https://www.todayonline.com/singapore/heng-swee-keat-appeared-very-tired-cabinet-meeting-he-collapsed
6. Healthline (n.d.) 16 Simple Ways to Relieve Stress and Anxiety. Retrieved from https://www.healthline.com/nutrition/16-ways-relieve-stress-anxiety
7. Institute of Mental Health (n.d.) Generalised Anxiety Disorder. Retrieved from https://www.imh.com.sg/clinical/page.aspx?id=254

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

• Suffer a loss of appetite that persists over a period of time 
• Experience unintentional weight loss* 
• Are on tube feeding 

*It is recommended to consult a doctor to examine the cause of unexplained weight loss. If in doubt, you can engage our teleconsultation services in Singapore. 

There is an increasing range of ONS in the market, making it overwhelming to choose one that best suits the needs of you or your loved ones. Here is an overview of the common ONS you may come across. 

Common Types of ONS

Standard milk feeds (e.g. Ensure, Boost Isocal, Jevity)

Most of the feeds come in vanilla flavour. Some contain fiber. They are suitable for most people. 1 serving (200-250ml) generally provides 240-270kcal, 30-45g carbohydrate, 8-10g protein and 6-9g fat. 

Find out more about Ensure Milk and Jevity from our JagaStore.

Milk feeds suitable for diabetes (e.g. Glucerna, Nutren Diabetes, Diaben)

They contain fiber and have lower carbohydrate content to help with blood sugar control. 1 serving (200-250ml) generally provides less than 30g carbohydrate, 10-16g protein, 8-17g fat and 3-5g fiber. Some are designed to provide more nutrients in less volume.

Find out more about Glucerna and Nutren Diabetes from our JagaStore.

Concentrated milk feeds (e.g. Ensure Plus, Resource Plus, Fresubin 2kcal)

They come in different flavours and provide more nutrients in less volume. Some contain twice the amount of nutrients in standard milk feeds. They are suitable for people with very poor appetite or people who are advised to restrict their daily fluid intake for certain medical conditions. 1 serving (125-200ml) generally provides 300-400kcal, 35-55g carbohydrate, 12-20g protein and 10-16g fat.

Find out more about Ensure Plus Milk from our JagaStore.

Juice-based feeds (e.g. Fortijuice, Resource Fruit Flavoured Beverage)

These are fat-free feeds suitable for people who are unable to tolerate milk feeds. They are not suitable for people on long term tube feeding as they lack the essential nutrients for our bodies to function optimally. 1 serving (200-240ml) generally provides 250-300kcal, 8-9g protein and 55-67g carbohydrate.

Other ONS (e.g. Novasource Renal, Nepro LP, Peptamen, Souvenaid) are developed for specific groups of population. These supplements usually contain nutrients that are targeted at specific medical conditions. Consult a dietitian or doctor before making any purchase as this type of ONS may only be effective with the right dosage over a recommended period of time. 

Find out more about Nepro LP from our JagaStore.

As a general guide:

• If you do not have swallowing difficulty or other medical conditions that restrict oral food intake, you should continue to have regular meals and snacks while using ONS to optimise your overall nutritional intake. 
• For people with dysphagia (i.e. swallowing difficulty), thickener (e.g. Thixer, ThickenUp) may be required to achieve the recommended fluid consistency. 
• While some of these feeds contain lactose, majority of them contain minimal lactose and thus are suitable for people with lactose intolerance. 
• ONS should be stored in a cool dry place before opening and can be consumed chilled, warmed (in a hot water bath) or at room temperature. Most supplements can be stored in the fridge up to 24 hours after opening.  

At JagaStore, you will find a range of ONS that may be suitable for you or your family members who are unable to meet nutritional needs from usual dietary sources. If you have queries regarding ONS or tube feeding regime, please discuss with a dietitian or doctor.

We also recommend reading Your Guide to Oral Nutritional Supplements (ONS) and Apps For Diabetics: 5 Aspects To Look Out For.

About the Author:
This article is written by Ong Sik Yin for Jaga-Me. Sik Yin holds a Master’s degree in Nutrition and Dietetics from Flinders University. She is an Accredited Dietitian of Singapore (Singapore Nutrition and Dietetics Association) and an Accredited Practising Dietitian (Dietitians Association of Australia). She is an advocate of building a supportive ecosystem and conducive environment to promote health and wellness. She has over 10 years of experience providing nutritional advice and sharing her knowledge in hospital settings and public forums. 

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional