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Seniors stuck in their ways? Two millennials tell how they change older adults' habits when health coaching

SINGAPORE — In their 20s and 30s, Ms Nurul Shafiqah and Ms Valerie Chua have found out while working with seniors that getting them to start eating healthily and exercising regularly is not as straightforward as merely dishing out advice.

Ms Nurul Shafiqah, Tan Tock Seng Hospital's health coach, checking the blood pressure of a resident in the community she serves.

Ms Nurul Shafiqah, Tan Tock Seng Hospital's health coach, checking the blood pressure of a resident in the community she serves.

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  • Two young health coaches reveal how they get seniors to break old habits to maintain a healthy lifestyle
  • As part of their job, they monitor the health of residents in central Singapore and give them advice
  • They also conduct wellness programmes such as exercise sessions, health talks and cooking workshops
  • Helping seniors age well in the community is vital as chronic diseases are prevalent and the population ages, a dietician said
  • Part of Tan Tock Seng Hospital’s community wellness programmes that are now online are open to all Singaporeans

 

SINGAPORE — In their 20s and 30s, Ms Nurul Shafiqah and Ms Valerie Chua have found out while working with seniors that getting them to start eating healthily and exercising regularly is not as straightforward as merely dishing out advice.

There are factors such as their relationships at home with their family members and their lack of confidence that need time to adjust.

Then, there is the scepticism. Ms Shafiqah has heard this being said by the people they help on the job: “I’ve eaten more salt than you’ve eaten rice”.

This Chinese saying is uttered by elders who believe that their life experience count for more than the advice that the younger people give.

Working as health coaches, Ms Shafiqah, 26, and Ms Chua, 31, typically have to build up their social and investigative skills, their art of persuasion, their patience and their persistence.

Both are among 16 trained health coaches from Tan Tock Seng Hospital (TTSH) who work with community partners such as senior activity centres and community centres to provide personalised health coaching to residents living in the central region of Singapore.

One of the cases that Ms Chua counselled is an overweight man in his 60s with borderline high blood pressure. He was also nursing a chronic cough.

After several health counselling sessions, she uncovered the culprits behind some of his health woes. 

“He talked about how he has to finish all the food that his wife cooks — and she cooks a lot — or she would get angry and not cook for him anymore (if he does not eat up everything).” 

She also found a possible reason for his persistently scratchy throat: He had a habit of lighting up a mosquito coil every night. It had nothing to do with warding off mosquitoes; he simply liked the smell of the incense.

He later took Ms Chua’s suggestion to switch to using essential oil as aromatherapy at night and saw a significant improvement in his coughing.

Then, after learning more about food portion sizes and finding discreet ways to avoid eating too much such as getting rid of extra food when his wife is not looking, the man lost some weight.

“He was amazed by the changes and became very motivated to work on improving his health after that,” she said, adding that such encounters spur her on in her work.

WHAT DO HEALTH COACHES DO?

Ms Ng Puay Shi, principal dietitian and acting lead for the preventive care workstream at TTSH and Central Health, said that health coaches are part of a multidisciplinary community health team that includes doctors, nurses and allied health professionals from TTSH.

Central Health is a network of health and social care partners supporting residents living in Central Singapore, in districts such as Ang Mo Kio, Bishan, Geylang, Hougang, Kallang-Rochor, Novena, Serangoon and Toa Payoh. 

Serving as “health ambassadors” in the community, the health coaches have a minimum of a healthcare-related diploma that covers areas such as nutrition, sports science, coaching and nursing. They also go through training and certification by healthcare professionals, Ms Ng said.

Residents in their care include seniors who wish to improve their health as well as those who are already living with frailty, pre-diabetic or age-related chronic conditions.

Besides monitoring the residents’ health and providing advice to modify their lifestyles, the health coaches also develop and conduct wellness programmes such as workout sessions, health talks and cooking workshops.

Before the Covid-19 pandemic, residents took part in walking tours with health coaches to learn how to make healthier choices when ordering meals at food centres. Photo: Tan Tock Seng Hospital

For example, Ms Chua, who has a nursing degree and has been a health coach for six years, teaches residents how to read and interpret food labels, as well as how to make healthier food choices at home and when dining out, as part of an eight-week structured programme called Make It Siew Dai.

The aim is to help them prevent or delay type 2 diabetes through lifestyle and diet changes.

“I love working with the seniors,” Ms Chua said, adding that when she moves around the heartland areas to conduct health coaching sessions or workshops, residents would often say “hello” or ask if she has eaten.

“To me, they are like my own grandparents. They also treat me and the other health coaches like family.”

WHAT SKILLS DOES A HEALTH COACH NEED?

Getting older residents to change their long-time habits is not always easy.

Some may be more resistant to change than others due to misconceptions about chronic diseases or find it hard to change their decades-long habits.

Ms Shafiqah, who has a diploma in healthcare administration and has been a health coach with TTSH for three years, said that it is not uncommon for health coaches, most of them in their 20s and 30s, to get dismissive comments when they dole out advice to elders.

She conducts a community programme called Rolling with Wellness, which promotes a healthier lifestyle through exercises and healthier eating habits.

“Usually when they say (they know more than we do), we will just give them some space to reconsider our advice. We also give them our work phone numbers, just in case they change their minds or want more information,” she said.

Ms Shafiqah said that taking the time to build rapport and understanding with the residents are an important step to motivating them to make lifestyle changes.

“You have to get to know them as a person, find out what they like and be a friend to them,” she said.

Ms Chua agreed: “You can’t just go, ‘Ah ma, you have to change’, and demand that they change their habits immediately. They are so stuck to their ways they won’t change just because you tell them to.”

One of the strategies they use is to set goals that are achievable. This makes the changes less daunting.

“For example, if I want to get the residents started on exercising with dumbbells, I must also understand that seniors may get intimidated by such exercise equipment as they have never used it before,” Ms Shafiqah said.

“What I might do is teach them how to go through the routine without weights first. Once, they are comfortable, I’ll introduce a small 300ml- bottle filled with water to be used as weights.

“Over time, when they feel they are stronger, then we can encourage them to try the dumbbells.”

Residents learning some basic exercise from a health coach in the days before the Covid-19 pandemic: Photo: Tan Tock Seng Hospital

While challenging, winning the residents over and seeing their health improve is always rewarding for the health coaches.

“I love seeing how (their fitness) improve over the sessions,” Ms Shafiqah said.

She recalled how her regular participants had been apprehensive when she started a new exercise routine last month, which required coordination skills and stamina.

“At first, they struggled and didn’t think they could do the exercises. Now, they want me to increase the pace,” she said.

WHY HEALTH COACHING IS IMPORTANT

As chronic illnesses become increasingly common and the population ages, health coaches play a role in Singapore’s model of care.

Ms Ng the dietitian said there are studies to show that health coaching can bring about positive impact on health and lifestyle behaviours.

“By having a more community-focused approach, we can truly take care of the health of the population as a whole rather than focus only on those requiring hospital care. Healthcare does not end within the hospital walls,” she said.

“If proper care structure and support are in place in the community, we can keep residents healthier for longer in their own homes and community.”

Food preparation and cooking workshops held at the community level allow seniors to learn how to choose healthier ingredients and cook more nutritious food. Photo: Tan Tock Seng Hospital Ms Ng said that another aim of the community health programme is to build a network of peer support groups so that participants may lead and influence one another to sustain a healthy lifestyle.

TTSH has 29 peer support leaders in the community.

Since introducing the health coaching service in 2016, the number of participants increased from 68 to 6,180 in 2020.

During the Covid-19 pandemic last year, the health coaching service and wellness activities continued on virtual platforms, which boosted the number of participants each session by six-fold. 

TTSH said that its community wellness programmes held on video-conferencing application Zoom as well as its health coaching services are now open to all Singapore residents.

Ms Carina Wong (left) and Ms Nurul Shafiqah (centre) from Tan Tock Seng Hospital conducting a virtual exercise session on April 16, 2021. Photo: Nuria Ling/TODAY

For Ms Chua and Ms Shafiqah, they skills they have honed while on the job also benefit their families.

Ms Chua said that her father, who is in his 70s, took her advice and cut down on his salt and fried food intake. His chronic conditions are now “stable”.

When he was in his 50s, her father — who has high cholesterol and hypertension — stopped working due to pain and joint stiffness from arthritis and Ms Chua had to start working part-time at McDonald’s from the age of 14.

“I couldn’t help my dad when I was younger. Now, I hope to make a difference in the lives (of other elders), motivate them to age gracefully and guide them to manage their chronic conditions.”

For Ms Shafiqah, the same motivational tactics that she uses at work have helped her parents, too. She convinced her parents, who are in their 50s, to use a stationary bicycle at home. It was a milestone because they do not exercise.

They felt a huge difference in their fitness and energy levels after exercising just five to 10 minutes a day and were keen to keep it up, she said.

“I think they were initially intimidated by exercise. Now they feel more confident and recently told me that they want to get a bicycle to cycle outdoors,” Ms Shafiqah said.

“Starting slow and making small changes helped them gain confidence to try something new.”

For more information on its community wellness programmes, head to Tan Tock Seng Hospital's website under its "Central Health" section.

Related topics

health coaching Health seniors exercise Diet Tan Tock Seng Hospital

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