Geriatric Medicine

Despite increases in life expectancy thanks to the development of modern medicine, it is a sad reality that many of us may have to live through the last years of our lives in wheelchairs, in hospitals, or in operating rooms. ​Find out where you stand in understanding these common lifestyle diseases that hit us in our ageing years. By equipping yourself with important knowledge on lifestyle changes, you can battle these diseases head-on and outwit, outlive, and outlast them.

Common lifestyle diseases that we may have in our ageing years:

What is metabolic syndrome?

According to Dr Stanley Liew, Specialist in Endocrinology, Raffles Internal Medicine Centre, “Metabolic syndrome is the occurrence of a cluster of conditions ranging from increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels. It can increase your risk of developing more serious diseases such as heart disease, stroke and diabetes.”

If you have one component of metabolic syndrome, such as an apple-shaped body,​ it means you’re more likely to have others. And the more components you have, the greater are the risks to your health. If you have even one of the components, it is worth checking with your doctor to avoid potentially serious health risks.

The risk of metabolic syndrome increases with age, race (Hispanics and Asians), a BMI over 25, a history of diabetes, and diseases such as high blood pressure, cardiovascular disease or polycystic ovary syndrome.

Tackling one of the risk factors of metabolic syndrome may seem tough enough, not to mention taking on all of them. But aggressive lifestyle changes and, in some cases, medication, can improve all of the metabolic syndrome components. The best way to treat metabolic syndrome and avoid the occurrence of diseases linked to it would be to increase physical activity, eat healthily, lose weight and quit smoking.

Given the connection between a big tummy and metabolic syndrome, many have considered liposuction as a cure for metabolic syndrome. Experts, however, are divided to the efficacy of this approach.

 According to Dr Liew, liposuction alone cannot remove a sufficient amount of fat to significantly improve metabolic syndrome. While some doctors believe that large volume liposuction can improve metabolic syndrome, they admit that large volume liposuction is a risky procedure that is likely to cause as many problems as it might solve.


Diabetes mellitus is a disease that affects how your body uses blood glucose, commonly known as blood sugar. Glucose is vital to your health because it is the main source of energy for the cells that make up your muscles and tissues. Diabetes causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke.

Symptoms of diabetes include increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue, blurred vision, slow-healing sores, and frequent infections.

Who is at risk of diabetes?

You are at a higher risk is you have a family history of diabetes, are overweight, lead a sedentary lifestyle. have had gestational diabetes during pregnancy, or diagnosed with polycystic ovary syndrome. For unknown reasons Hispanics, Blacks, American Indians and Asian-Americans are at a higher risk of developing diabetes.

“Depending on the type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. A pancreas transplant may be an option for select people.” Said Dr Liew, “but no matter what type of diabetes you have, maintaining a healthy diet, exercising and keeping a healthy weight are all keys to managing your diabetes.”

Carbohydrates like rice pasta and noodles are part of a healthy meal plan, as are fruits. Diabetics need not swear off these foods but should be careful with the portions, explained Ms Nehal Kamdar, Senior Dietitian, Raffles Internal Medicine Centre. When first diagnosed with diabetes, you should consult a dietitian who is aware of the treatment planned by your doctor. She can then help you balance medication with the food you eat, physical activity, and lifestyle.

Diabetes may leave you prone to gum infections, diabetes-related eye complications, and foot problems, amongst others. It may also weaken your immune system making diabetes management more than just about taking your medications. And since high or low blood sugar levels may not have symptoms, regular check-ups are essential to keep you in the pink of health.


Strokes are more common and more complicated than you think. Not only is it the fourth leading cause of death in Singapore, it is also the biggest cause of long-term disability in Singapore.

“Stroke occurs when the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients.” explained Dr Alvin Seah, Specialist in Neurology, Raffles Internal Medicine Centre.

There are two main types of stroke: ischaemic stroke and haemorrhagic stroke. More than 80% of strokes are caused by ischaemic stroke where blood vessel supplying a portion of the brain is blocked. The other type of stroke results from bleeding in the brain–a haemorrhagic stroke. Without doing a scan it is not possible to tell with certainty which type of stroke it is.

What are symptoms of stroke?

Stroke symptoms, however, are obvious. Typical symptoms are weakness, or numbness, or both, down one side of the body. You may find your speech affected.

Similar to other lifestyle diseases, risk factors of stroke include things you can’t change such as your age, gender (males are predisposed), and family history of stroke. Still there are things you can work on, such as your blood pressure, smoking, exercise, and diet – shedding any excess weight and asking your doctor if you need a cholesterol test.

Treatments for stroke

Dr Seah added, “a stroke is a medical emergency and prompt treatment is crucial. Early treatment can minimise damage to your brain and potential stroke complications. For ischaemic stroke, depending on which blood vessel and how much brain tissue is affected, eventual outcome is different in different patients. Within the first three hours, before cell death has occurred, if you can get to a hospital, doctors can attempt to open the clot and salvage the brain tissue.”

All is not lost even if you have passed the time window. However, the mainstay of treatment by then would be to prevent further ischaemic stroke by controlling risk factors, and prevent complications like infection. Anti-platelet medications will be used to reduce the chance of further episodes of blood vessel blockage. Anti-platelet medications should not be used in haemorrhagic stroke because it can worsen the bleeding or make it uncontrollable and patient may die

While strokes are more common in men, more than half of the total stroke deaths occur in women. The good news in all this, the vast majority of stroke patients survive, many with residual disabilities. Encouragement and early treatment are important to help survivors recover from stroke. Stroke survivors who go home to a healthy spouse or other companion are more likely to become independent and productive again.


Osteoporosis is a condition where your bones become so weak and brittle, that even mild stresses such as bending over or coughing may result in a fracture. One in three women above the age of 50 would suffer from osteoporosis, as would one in five men. Though more women get osteoporosis than men, it is definitely not a disease of old women alone.

As a silent lifestyle disease, there’s no pain or other obvious symptoms during early stages of bone loss. By the time symptoms such as back pain, loss of height over time, a stooped posture or, fracture of the vertebra, wrist, hip or other bones appear, your bones would have been weakened by osteoporosis.

How can we tell if we are at risk of osteoporosis?

“The only way to tell if you are at risk of osteoporosis,” said Dr David Wong, Specialist in Orthopaedics, Raffles Orthopaedic Centre, “is to go for a bone density test.”

However, you don’t have to expect a future of fractures and stooped posture in your later years. Osteoporosis is preventable. Three key factors that would keep your bones healthy include taking adequate amounts of calcium and vitamin D and regular exercise. Beyond milk, calcium can be derived from dairy products, almonds, broccoli, spinach, cooked kale, canned salmon with the bones, sardines and soy products, such as tofu.

All is not lost should you be diagnosed with osteoporosis. To relieve symptoms and to maintain your independence, you should maintain a good posture, do all you can to protect yourself from falls and discuss pain management strategies with your doctor when you experience chronic pain.

Renal Failure

Your kidneys are responsible for filtering wastes and excess fluids from your blood which are then excreted. When you have chronic kidney disease (CKD) and kidney failure, dangerous levels of fluid and waste products can accumulate in your body. Kidney failure is the final stage of chronic kidney disease. Symptoms of kidney failure may include decreased urine output or no urine output, nausea, vomiting, loss of appetite, fatigue, weakness, sleep problems, decreased mental status, swelling of the legs and itchiness.

According to Dr Ekachai Danpanich, Specialist in Nephrology, Raffles Uro-Renal Centre, “Factors that may increase your risk of developing chronic kidney disease (CKD) and kidney failure are diabetes, high blood pressure (hypertension), heart disease, high cholesterol, smoking, obesity, family history of kidney disease and age 65 or older.”

Unfortunately, there is currently no cure for kidney failure. Treatment options vary depending on the cause of chronic kidney disease and kidney failure. Your kidney doctor can help slow down progression of your chronic kidney disease e.g. treating the underlying cause, controlling diabetes and/or hypertension, reducing urine protein with medications. Lifestyle changes including special diet and regular exercise, smoking cessation are also crucial. You may also need to see dietitian to find the right diet plan for you.

When end stage kidney failure develops, you will require dialysis or kidney transplant. Both options have their benefits, risks and complications. The detailed discussion with your doctor would help you decide what the best option is for you.

Dialysis is a process that cleanses the waste products in your blood when your kidneys no longer can. It is not a cure, but it can help you feel better and live longer. Kidney transplant is the other option for you if you are fit for that. However, you may have to wait for a kidney that is a good match for your blood and tissue type and you will have to take medicine for the rest of your life to keep your body from rejecting the transplanted kidney.


Dementia is a syndrome in which one’s intellectual and social abilities are affected to the point of interfering with daily functioning. Common causes of dementia include vascular dementia and Alzheimer’s disease.

While normal memory deterioration can occur as we age, most people maintain their memory health through the years. It’s not true that the elderly would inevitably become “senile”. Normal memory loss includes forgetting your password, where you left the keys, etc. However, when you start experiencing recent memory loss, e.g.: forgetting if you have taken your medication, losing your way home, forgetting to pay or overpaying the coffee shop uncle for your coffee, it may be signalling a more serious condition than just plain forgetfulness.

According to Dr Seah, the predominant symptom of dementia is memory loss. Ultimately, other symptoms such as problems with abstract thinking, difficulty finding the right word to express themselves, disorientation, loss of judgment, difficulty performing familiar tasks, personality changes, paranoia and agitation, can also develop.

Although there’s no cure, treatment can improve the quality of life for people with dementia. A person may function fairly well for years in the early stage of dementia, or may decline rapidly depending on treatment and management of its symptoms.

“Early diagnosis and appropriate management using medications, environmental cues, cognitive therapy, can slow the pace of decline and help someone with the disease retain independence and quality of life,” said Dr Seah.

Usually, family members would be the first to notice that something is amiss. It could be through an uncharacteristic lack of concern for personal grooming, meal preparation, and the usual household tasks or getting lost wandering in the neighbourhood. It could also first appear as a memory loss or confusion.

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