There are two major tooth conditions affecting the elderly: Tooth decay and gum disease.

Also known as dental decay, this is the gradual degeneration of teeth. It happens when sugars and starches are leftover on teeth after a meal and bacteria feeds on it, creating a substance known as plaque on the teeth’s surface. The plaque soon starts removing minerals in the teeth, causing decay, reduction of biting force, and eventual tooth loss.

Lack of regular and thorough brushing of teeth

Visible cavities (holes or pits) in the teeth

Sharp pain while eating or drinking something hot or cold

Toothache for no apparent reason even when teeth are not in use

Also known as periodontitis, gum disease damages the gums which hold the teeth in place, causing loosening, reduction of biting force and eventual loss of the teeth. This can also be accelerated by sweet foods and inadequate oral hygiene habits.

Swelling or pus (thick yellowish liquid) in gum area


Preventing and treating tooth decay and gum disease

Some of the same preventive steps are effective for both these dental conditions.

Ensure that the care receiver brushes their teeth twice a day with fluoride toothpaste.

Take the care receiver to regular dentist appointments.

Ensure a diet rich in foods good for the teeth and gums

Dairy products such as milk, cheese and yoghurt

Avoid foods that can damage teeth and gums

Starchy foods such as chips that can get trapped in the teeth

Likewise, both these conditions can be treated by

Fluoride treatments that kill bacteria, strengthen enamel and prevent damage from plaque


Other oral issues of elderly care receivers

Taste buds become less sensitive to tastes.


Many caregivers tend to de-prioritise teeth issues as they prioritise caring for organs such as the heart, lungs or kidney. There are good reasons for that, as conditions in these organs are life-threatening. But please do keep the teeth in mind as you care for an elderly care receiver, as teeth play a big role in maintaining a good quality of life.

Article reviewed by David Tay, Senior Principal Educator (Nursing and Prehospital Care), HMI Institute.

We often see older people who have teeth issues, including some who need to wear dentures (false teeth) as their original teeth have fallen off. But what is it that causes these outcomes?

Tooth problems in elderly care receivers

Asthma can be triggered by exposure to allergens such as pet dander, dust mites, pollen and mould. Non-allergic triggers such as smoking, pollution, cold air and weather changes can also aggravate it.

For some people, asthma is just a minor nuisance. For others, it’s a major problem that interferes with daily activities and can be life-threatening. There’s no cure for this condition, but the right knowledge can help a person and their caregivers manage it such that it doesn’t impede quality of life significantly.

Severe coughing (especially at night or early morning)

Wheezing (whistling sound during exhalation)

During an asthma attack, symptoms become much worse. An attack sometimes starts with coughing. The chest may feel tight like someone is sitting on it. Some sufferers say it’s like having air sucked out of them or trying to suck air in using a straw.

Place the person in a sitting-up position. Reassure them and help them relax.

Help them inhale a Ventolin/Salbutamol puff. This is a medication commonly carried by asthma sufferers in the form of an inhaler. Tell them to take a puff every 30 to 60 seconds until they have had 10 puffs.

Call 995 for emergency medical help if symptoms persist or are getting worse, or if the person is getting exhausted.

If emergency medical help has not arrived within 15 minutes, repeat up to 10 inhaler puffs every 20 minutes

Quick-relief medication such as Short Acting Beta Agonists (SABA) include the commonly-used 

. Asthma sufferers with frequent or severe attacks are encouraged to always have this medications on them, e.g. in the form of inhalers in their shirt or trouser pockets.

 (such as steroids, which treat the inflammation associated with asthma), 

 (helpful for asthma triggered by allergies) and long acting 

 (which relaxes the muscles around the airways of the lungs)

A combination of quick-relief and long-term medication

 of a form of medication called biologic therapies can help for those with severe asthma. They are only suitable for some asthma sufferers and may y be prescribed by an asthma specialist.

 (a form of surgery) is sometimes offered as a treatment for severe asthma.

If you know that a specific substance is triggering asthma in a person, you can take steps to ensure that the triggering substance is removed from their living and working environment.

Though there’s no cure for asthma, some or all of these above-mentioned steps can ensure that a person with asthma can manage their condition effectively and continue to enjoy a high quality of life.

, Medical Director and Co-founder, OneCare Medical

Asthma is a chronic lung condition in which airways are overly sensitive and can narrow (constrict), swell up (inflame) or produce extra mucus. This makes it harder for air to flow out of our airways when we breathe, hence the breathing difficulties commonly associated with the condition.

Asthma: Breathe easy knowing you can manage it

Cholesterol is a fatty substance found in the bodies of humans and other animals. We get a lot of it from our diet. Some of it is also produced by our liver.

As fatty substances don’t mix well with blood, cholesterol is transported in the blood by combining it with proteins. Another name for fat is lipid, so when cholesterol (a lipid) combines with proteins, what you get are lipoproteins.

This leads us to the two types of cholesterol: High Density Lipoprotein (HDL) (sometimes known as ‘Good Cholesterol’) and Low Density Lipoprotein (LDL) (Bad Cholesterol). HDL cholesterol retrieves the LDL cholesterol from the blood and returns it to the liver where it’s broken down. Thus, a higher level of HDL (good cholesterol) leads to a lower level of LDL (bad cholesterol).

Naturally, we’d like to increase our good cholesterol and decrease our bad.

Complications arising from high blood cholesterol

The level of LDL (bad cholesterol) in your blood needs to be maintained at an optimum level. Excess LDL levels can lead to

Buildup of fatty deposits in your arteries, leading to atherosclerosis (thickening or hardening of the arteries) which can damage to the heart muscle leading to heart attacks

Reduced blood flow to the brain, causing a stroke

There are no outward symptoms of high blood cholesterol until it leads to any of the above complications. That’s why it’s important for all of us to check our cholesterol levels every few months with a doctor.

High-Fat Diet: Saturated and trans fats such as full-cream milk, fatty meats, butter, cheese poultry skin, palm oil and coconut oil can increase cholesterol.

Sedentary Lifestyle: Lack of exercise reduces HDL (good cholesterol) which means there’s less HDL cholesterol to retrieve LDL cholesterol from the blood and return it to the liver, increasing LDL (bad cholesterol) level.

Being Overweight: Even if you eat healthily and exercise regularly, having a Body Mass Index (BMI) above 30 is a risk factor for high cholesterol.

Smoking: Cigarette smoke contains acrolein which inhibits HDL’s ability to retrieve LDL from the blood and return it to the liver.

Gender: Men are more susceptible than women, though the differences reduce after menopause.

Other Medical Conditions: Type 2 Diabetes, liver disease or kidney disease are risk factors.

Family History: There’s a genetic component to this, so if someone in your family has high blood cholesterol, medication may be required earlier.

Healthy Eating: Eat foods rich in fibre, heart-healthy oils and unsaturated fats. These include fruits, vegetables, brown rice, wholemeal bread, nuts, seeds, oily fish, green tea, oats and legumes such as beans, soybeans, peas, chickpeas and lentils. Avoid red meat, full-cream milk, palm oil and coconut oil.

Exercise: Get at least 150 minutes of moderate exercise or 75 minutes of high intensity exercise every week. What is generally considered moderate exercise is when you are able to speak, but not able to sing, whilst exercising.

Medication: If one’s high cholesterol cannot be controlled with all of the above, doctors may prescribe medication such as statins, fibrates, niacin and bile acid sequestrants.

Though the lifestyle changes associated with lowering cholesterol can be cumbersome, preventing serious medical conditions such as heart attacks and strokes make it an important and worthwhile goal.

We hear so much about cholesterol, but what exactly is it and how does it affect us? Importantly, what complications can arise due to high cholesterol and how can you help a care receiver reduce their cholesterol level?

High cholesterol: All you need to know

Cardiac Rehabilitation is an umbrella term for all activities that help a heart attack survivor recover after a heart attack. A caregiver with knowledge, patience and understanding is crucial in facilitating this recovery.

There are 4 pillars of Cardiac Rehabilitation

Let’s look at each of these in more detail.

The caregiver needs to ensure that the care receiver consumes a healthy balanced diet that incorporates a variety of nutrient-rich foods.

More wholegrains (e.g. brown rice, wholegrain noodles, pasta, bee hoon, chapati, millet, oatmeal, quinoa)

More lean protein (e.g. eggs, lean meat, fish, skinless chicken, low-fat milk, soy milk, legumes, tofu, peas, beans, lentils)

More unsaturated fats (e.g. olives, avocados, nuts, seeds and cooking oils made of these)

Less saturated and trans fats (e.g. butter, fatty meats, chicken skin, coconut oil, palm oil, full-cream milk)

Less sugar (e.g. sugary drinks, candy, pastries, muffins)

Less salt (e.g. salty soups, flavoured rice, chips)

Of course, it will take time for someone who has recently suffered a heart attack to get physically active again. Understand this as you slowly ease the care receiver into exercise activities.

Start within their abilities and slowly build up their confidence. A good early activity could be tai chi, qigong or walking as these are low-intensity. After a few weeks, help them progress to more vigorous activities like brisk walking and light jogs, while being constantly conscious of their limits.

The care receiver is experiencing what is probably the toughest time of their lives. On top of the fact that they’ve just had a life-threatening incident, they are also having to cope with sudden lifestyle changes, loneliness and fear of the future. It can be hard on their family members too.

This is why emotional support can be just as important as any other form of care. Be patient while physically supporting the care receiver. Be understanding in your conversations with them. Don’t become one more source of anxiety for them!

Give a man a fish and he eats for a day, teach him how to fish and he eats for a lifetime, goes a common saying.

Caregivers would do a great service to care receivers who’ve recently suffered a heart attack if they educate them on their specific conditions and explain how they can manage it by ensuring a heart healthy diet, exercising through activities most suited to them, managing stress, maintaining their weight in a healthy range, and avoiding smoking.

Once they take their health in their own hands again, care receivers would be able to look forward to their future with confidence, knowing that they have what it takes to lower their risk of further heart attacks.

, Medical Director and Cardiologist, StarMed Specialist Centre.

A heart attack is something no one ever wants to endure. The weeks following a heart attack can be physically and mentally the most demanding period of someone’s life. Thankfully, with the right care, recovery can be a little bit smoother.

The follow through: Care and recovery after a heart attack

Preventing, treating and managing swelling in elderly care receivers


Swelling or edema is the state in which excess water is retained in the body, causing visible bulging. Its causes include heart failure, kidney failure and sitting in the same position for too long. All of these are more common in elderly care receivers, increasing their likelihood of experiencing swelling.


It can be caused by a number of risk factors including

Vein conditions such as Deep Vein Thrombosis (DVT)

Bulging, cold feeling and pain in affected areas

Weight gain in affected areas (e.g. heavy legs if edema is in ankles or feet)

Difficulty breathing, shortness of breath and chest pain (if it’s pulmonary edema, i.e. edema of the lungs)

Difficulty walking (if edema is in one or both legs)

Skin ulcers due to reduced blood flow in affected area

Having an active lifestyle and avoiding a sedentary one (where the care receiver spends a long time in the same sitting or lying positions)

Reducing the risks of underlying medical conditions through a healthy diet that’s rich in fruits and vegetables and low in fatty foods, sugar and salt.

Diagnosing and treating any underlying conditions that cause the swelling.

Ensuring that the care receiver doesn’t sit in the same position for a prolonged period of time.

Elevation of affected limbs (e.g. arm or leg) such that it’s above the level of the heart and the excess fluid from it can move back towards the heart and get circulated to the rest of the body. One way of doing this is to lie down flat on a bed and elevate your affected arm or leg using pillows.

Wearing comfortable clothing and footwear around the affected area to encourage good blood circulation.


As discussed above, swelling could be a result of other, more serious conditions. Some of these conditions are more common in the elderly as various organs of their body such as the heart, liver and kidneys experience the outcomes of decades of wear-and-tear. Therefore, waste no time in seeing a doctor if an elderly care receiver has the above symptoms. Like many other conditions, early detection and prompt diagnosis can save lives.

Swelling or edema is the state in which excess water is retained in the body, causing visible bulging. All of these are more common in elderly care receivers, increasing their likelihood of experiencing swelling.

Canes are often used by those who are not able to walk properly due to arthritis, paralysis of the lower limb or any other condition that impedes mobility. Canes are made of materials like aluminum and some types of wood that are able to support the body, reduce load and improve balance.

Walking sticks (single legged canes) are for care receivers with generally good use of arms and legs, whereas multi-legged canes are for care receivers with difficulty balancing while walking but are able to support their weight on one side.

These are slightly more elaborate devices that require a care receiver to lift it with both their hands. Some types bring up the left and right frame alternately forward. They are useful for people who are able to walk but unable to support the body with a cane, or unable to remember how to use a cane. Walkers stay sturdy over longer distances than a cane.

While traditional walkers have no wheels, rollators are a variation that have between two and four wheels. Just like walkers, rollators are good for people who can walk but need a bit more stability and balance than a cane can provide. A rollator’s wheels and maneuverability make it even better at providing balance than a walker.

Basics of walking patterns using walking aids

Three-motion walking is when better stability and support are required:

Two-motion walking is when the care receiver can walk close to normally and minimal stability and support are needed:

When the healthy leg is behind the affected leg, the time of supporting the body with the affected leg is shorter, and less supporting force and balancing ability are required. The time, force and balancing ability required increase if both legs are put together, and increases further if the healthy leg is in front of the affected leg. This is why both the three-motion walking and two-motion walking try to maximise the time the affected leg is in front of the healthy leg.

Now that you’ve got a basic understanding of what are the different types of walking aids available, it’s a good time to know more about how to choose a walking aid. Check out our article about choosing walking aids at

Once you’re up to speed with that, learn more about walking patterns and caregiver assistance in 

our article about walking patterns and caregiver assistance

From sprained ankles to stroke to severe mobility issues, there are many conditions that make a care receiver require a walking aid. Walking aids (also known as mobility aids) range from canes to walkers to walking assistant carts and more. Let’s look at them one by one.

Step by step: An introduction to mobility aids

Structural risks of the buildings such as staircases, obstacles in the corridors, fixtures in the rooms etc. that create possibilities of falls and other injuries.

Air pollution, odour and noise from the surroundings.

Infection possibilities due to unclean air, water or food.

Introduce structural changes to the care site. E.g. If a step-down shower area is a fall risk, fill it up with cement and tiles to have level flooring throughout the bathroom.

Find ways to reduce risks during common everyday activities. E.g. To reduce risk of fall when transferring care receiver from bed to wheelchair, ensure that the bed is not too high and install bed rails they can hold while moving. It’s not enough to simply say “Be careful to prevent mistakes while moving from bed to wheelchair”. It’s possible only if you implement changes to ensure that.

Train themselves and the care receiver for the recommended steps to follow in the event of emergencies.

Make hygiene a core aspect of everything you do. E.g. Clean the entire premises regularly, replace soiled bed linens, encourage frequent handwashing and sanitisation, ensure clean food preparation and consumption processes, immediately dispose of any bodily fluids such as blood and vomit, wear gloves whenever handling bodily fluids and while preparing food.

Learn from close calls. Every close call is an opportunity to optimise some aspects of safety and minimise future risks.

A safety-focused attitude by the caregiver includes

Observation Ability: Keenly observe all aspects of the care site and making prompt changes if anything is a risk.

Acquisition of Knowledge: Update your knowledge of how to assess care receiver’s condition at any given time.

Skills: Develop the ability to respond to specific conditions of care receivers.

Organisation: Maintain an organised approach in constantly ensuring that the care site is free of risks.

The care receiver spends a large part of their life at the care site, whether it’s at home, in the hospital or somewhere else. As such, it’s imperative that caregivers minimise risks and maximise safety at the care site.

Better safe than sorry: Safety and risk management in care site

Our immune system has evolved to protect us from harmful substances. But sometimes, the immune system mistakes a harmless substance as a harmful one and reacts to it 

 it were harmful. Ironically, the immune system’s 

 become more harmful than the substance itself.

While not everyone will have every symptom, here are the most common symptoms of severe allergic reactions (anaphylaxis).

Skin symptoms (reported in 80-90% of cases)

Respiratory symptoms (reported in 70% of the cases)

Gastrointestinal symptoms (reported in 30-45% of the cases)

Cardiovascular symptoms (reported in 10-45% of the cases)

Central Nervous System symptoms (reported in 10-15% of the cases)

First aid for someone suffering an allergic reaction

Ensure your own safety by assessing the environment around

Remove the person from the area if the suspected allergen is in the environment.

Assist with medication such as anti-histamines. As the name suggests, anti-histamines block the functioning of histamines which are chemicals released by the body due to allergens . If the medication is not on the person, you may be able to find it in a first aid kit

If the person has a history of allergies or asthma, they may have a Salbutamol/Ventolin inhaler on their person, which can help open their airways.

Assist with administration of the drug epinephrine using an auto-injectable device called an EpiPen. Epinephrines work by constricting blood vessels, which leads to increased blood pressure and decreased swelling.

The best way to manage allergies is to keep track of every substance a person is allergic to and keep those allergens away from their environment as much as possible. This may require checking the ingredients of food items to ensure that allergy-triggering ingredients are not in it. This may also require letting doctors know about any drug allergies a person may have. Medications such an antihistamines, Salbutamol inhalers and an EpiPen should be readily available if allergic reactions are serious. Consultation with an allergy specialist (Immunologist) and immunotherapy can also be considered With these efforts, allergies can be managed and kept to the level of a lifestyle nuisance rather than an imminent threat to life.

Many people have allergies to a variety of substances. Some of them can be      commonly found in their environment or common foods, so they need to be careful to avoid those substances. Their reactions to these substances can be a minor nuisance or they could even be life-threatening. A severe life-threatening allergy is known as anaphylaxis.

Allergic reactions and how to cope with them

 Caused by wear and tear of joints, a common issue in older care receivers due to their advanced age. Warning signs that can help us recognise osteoarthritis in a care receiver include

Clicking and popping sounds while bending

 Caused by the immune system mistaking healthy joint tissue for foreign bodies and attacking them. Its warning signs include

Stiffness and swelling in multiple joints

 Caused by uric acid crystals forming in the joints. Its symptoms include

Redness and warmth at the joint affected during a flare-up

Affected area is unable to tolerate anything touching it

If you suspect that you or a loved one could be experiencing any form of arthritis, seek a doctor’s opinion immediately. Doctors can use techniques such as clinical examination, blood tests, X-rays, Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI) to diagnose arthritis.

Anti-inflammatory drugs relieve pain and inflammation

Corticosteroids reduce pain and inflammation

Anti-rheumatic drugs that slow down the spread of rheumatoid arthritis

 (also known as Physical Therapy) can improve

Ability to use assistive devices such as walkers and canes

Overall ability to perform daily activities

Joint Repair: Smoothen or realign joint surfaces to reduce pain and improve function.

Joint Replacement: Remove the damaged joint and replacing it with a new one. Commonly done on hips and knees.

Joint Fusion: Locking two ends of bones together until they fuse into one unit.

The role of caregivers when a care receiver has arthritis

Physically assist the care receiver with their movements such as walking and climbing stairs.

Help them understand their condition and treatment plans.

Keep track of their medication and appointments.

Manage their day-to-day nutrition and ensure they eat healthily.

Help them with transportation and commuting.

Arthritis, depending on the cause, can be a difficult condition to manage as it usually progresses with time. However, the right treatment and caregiver support can ensure that a care receiver with arthritis continues to enjoy a high quality of life.

Article reviewed by Dr Kenneth Koh Eu Min, Medical Director and Co-founder, OneCare Medical.

Arthritis is a range of conditions in which a care receiver’s joints degenerate, causing swelling, pain and stiffness. It can affect us at any age, but it’s particularly common in older people, so if you’re caring for an elderly care receiver, it’s something to watch out for.

When joints get old: Arthritis and how to care for it

Choose a wheelchair with sufficient space between the care receiver and each side of the seat. Don’t pick one that the care receiver has to struggle to squeeze into. For assisted-type wheelchairs, choose one that has a gap of 2 cms between the care receiver and each side. This will ensure that the caregiver can render assistance when needed. Also ensure that the wheelchair is easy to operate regardless of whether it’s self-operated or assisted.

Accidents can happen if there are defects in the wheelchair. Therefore, checking the wheelchair is one of the most important tasks of a caregiver.

There’s no wear and tear of seat and armrest

Wheelchairs are often folded and stored, which means you’ll need to unfold it before use. To do so,

Stand next to the wheelchair, hold the arm rest and open it up a little.

From the front of the wheelchair, press the seat with both hands to flatten the seat.

Once the wheelchair is unfolded, the next steps are to help the care receiver onto it. Always ensure that the brakes are applied and the wheelchair is stationary before you do this.

Once the care receiver is comfortably seated, inform them that you’ll now disengage the brake, and then do so. Stand by the side of the wheelchair, grasp the grip of the wheelchair firmly with one hand, and disengage the brake with the other. Do not access the brake from the back of the care receiver as this will force their head forward and cause discomfort.

Now you’re ready to move! While doing so, take extra caution to ensure that the wheelchair and/or care receiver’s legs do not hit walls, stairs or any other obstacles. As the caregiver is at the back of the wheelchair, it’s often a bit hard for them to have visibility of what’s happening in front of the wheelchair. One way to manage this is to move the wheelchair as slowly as possible.

Once you’ve reached your destination and helped the care receiver get out of the wheelchair and onto their new resting place, it’s time to store the wheelchair for future use:

Stand next to the wheelchair and grab the front and back of the seat.

Hold the seat and pull it up at the same time with both hands.

It’s never pleasant when a care receiver needs to be on a wheelchair due to mobility issues stemming from any condition they may have. But what can make things a bit more comfortable is choosing the correct wheelchair, ensuring that it has no issues and assembling it properly. Let’s look at each of these in more detail.

Wheelchairs: How to choose, inspect and use

As bone health becomes a challenge, elderly care receivers need more calcium and vitamin D to strengthen their bones.

Calcium can be obtained from dairy products (ideally fat-free or low-fat so as to not introduce other complications), almonds, tofu and leafy greens.

Vitamin D can be obtained from mushrooms, tofu, eggs and fatty fish such as salmon, tuna and mackerel.

Fibre reduces risks of diabetes and heart disease. It can be found in whole-grain breads, cereals and legumes such as beans, peas and lentils.

Potassium reduces risks of high blood pressure. It can be found in legumes, spinach, broccoli, bananas and avocados.

Reduce saturated fats such as red meat, coconut oil and palm oil. Increase unsaturated fats from nuts, seeds, avocados, vegetable oils and fish.


Common diet-related issues faced by elderly care receivers include dysphagia, suffocation, dehydration and under-nutrition.

Dysphagia refers to swallowing difficulties that can happen due to a decline in sensory function, decline in swallowing reflex or obstruction to the gullet passage.


Dysphagia can be prevented by ensuring good sitting posture while eating (sit back in the seat, as erect as possible, tilt head forward with chin down), assessing the eating style to minimise chances of food getting stuck, and good oral care.

It’s often said that we are what we eat. That’s the extent to which what goes into our body impacts our health. That’s even more crucial as care receivers enter old age which comes with inherent risks of various illnesses.

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