Lotus Eldercare

Lotus Eldercare

Dr Tan Jit Seng, Chief Technology Officer of Lotus Technologies, is proud to be able to share some insights on Robotics in home care setting.

Here is the link to the event: https://www.sire.com.sg/ehome/sire2017/singapore-international-robo-expo

Here is a short write up of the presentation by the event organizers:

Dear fellow tech colleagues,

please follow my twitter for updates on my journey discovering the latest tech for eldercare!

Add me : https://twitter.com/LEGeriatronics

 Dr Jit Seng Tan, Oct 2017

 

Dear all,

Chatbots for Health is a new exiting platform for clinician like myself to configure chatbots entirely on my own without coding. Try an example of a simple chatbot I have done below!

Here is the website: https://www.chatbotsforhealth.com/public/

https://social.shorthand.com/LotusEldercare/u24qYV9Tbn/visit-to-hovikoti-finland

Here is our report from our recent visit to Hovikoti group, Finland. Please click the media below to proceed.

 

 

Nasogastric tube feeding is becoming increasingly common, as chronic sick patient load increases in our aging population. Nasogastric tube feeding traditionally is not recommended for use in long term care, it is usually only used for 4 to 6 weeks.  However, due to certain patient’s, clinical and operational factors, it is routinely use for long term care in the acute hospitals in Singapore.

Singapore’s market has been using Abbott’s Flexiflo nasogastric tubes, both size 12 and 14 in the past 5 to 10 years. However, Abbott has since decided to discontinue some of their enteral products in 2012. The stocks of the tubes in Abbott’s warehouse lasted another 2 years. In early 2014, the market was introduced to 2 other brands of nasogastric tubes for long term usage.

   Shown: Tubes after 3 month's usage

Insertions of nasogastric tube carry potential risks.  In the hospital’s standard protocols, post intubation placements will be confirmed radiologically. Hospitals also have the additional advantage to use endoscopic, fluoroscopic, electromagnetic and even surgical aided insertions. In the community, the insertions of nasogastric tubes are almost always done blind.  Non-visual placement confirmation techniques that are used in the community are air inflation and auscultation, looking out for symptoms with a trial feeding of small amounts of water with pulse oximetry monitoring and aspiration of gastric contents to confirm acidity with pH indicators.

Our patients in nursing homes and home care services using long term nasogastric tube feeding are often those with severe neurological injuries from traumatic brain injuries, stroke diseases and various forms of encephalopathies (hypoglycaemic, hypoxic etc); and the elderly population with dementia or swallowing impairment from functional and physical decline from various medical conditions and end organ failures. This group of patients will have increased risks during the insertion of nasogastric tube, with even higher risks when inserting a nasogastric tube into a demented, agitated elderly. In this group of demented patients, nasogastric tubes are usually poorly tolerated and would be removed by the patient repeatedly, causing much stress and anxiety to the care givers.

  Shown: Tubes after 3 month's usage

The main and most obvious risk of nasogastric insertion is mal-positioning. Mal-positioning of tubes can range from 0.3% intrapleural (Valentine and Turner) up to 2.4% (Sorokin and Gottlieb n= 2000) of the adult cases, with those inserted into the trachea, bronchus or even pleural spaces as the key causes of morbidity and mortality. Pulmonary formulae infusion with choking, pulmonary infections /abscesses and pneumothorax can occur in mal-positioning. Oral malposition is very common and easily detected in uncooperative and agitated patients undergoing tube insertions.

Since each insertion posed a risk of mal-positioning and various associated complications, the less frequent the tube is changed the less chance there is that the tube will be mal-positioned. Corflo tubes are labelled as nasogastric tubes, and since nasogastric feeding are not thought to be a long term solution in traditional way of usage, their official standard recommendations is to be used for only 4 weeks. However, in Singapore, for many long term chronic sick patients, nasogastric feeding can continue for even 10 years or more in some cases. Flexiflo tubes are being used previously for 2 to 3 months usually without any issues for majority of the patients. Now, with around 3 year of experience with Corflo tubes, they have been shown in my practice to be able to last around 2 to 3 months or more (our threshold is still maximum 3 monthly changes so we do not have experience on longer periods). The removed tubes (after 3 months) are observed and noted to still be in functional conditions.

 

If these tubes were to be changed monthly, and blindly inserted in community, the cost, possibility of mal-positioning of the tubes and direct trauma or discomfort to the patient will be raised by 300%. This is in my opinion, is very unfair to the patient (in having the discomfort of getting the tube replaced monthly – 12 times a year vs 4 times a year), the family (raising the cost suddenly by 300% in terms of the services and buying of the tubes) and the operator (with 300% increase in malposition risk and other associated complications which may or may not culminate to law suits against the institution)

Hence, Lotus Eldercare will recommend Corpak’s Corflo feeding tubes to be changed every 3 monthly period with proper care and maintenance.

We also have recommendations from Corflo attached here.

Here are the corflo tubes after more than 3 months, they are actually totally still usable apart from some expected discoloration from gastric contents!

     staining seen after 3 month's usage, tube is still fully patent.

Lotus Eldercare attended 2016 Elder Care Asia in Kaohsiung, Taiwan. The fair showcases some services on eldercare in Asia together with eldercare conferences. We were able to link up with a few like-minded Taiwanese enterprise there as well, in the field of telemonitoring, on cloud platforms and other eldercare related technologies. Here are some photos from the event:

https://flic.kr/s/aHskH79thc

I was honoured to be interviewed by Max over the topic on future care possibilities. While investment has been poured towards building new nursing homes and aged care facilities, my idea is to allow technology to facilitate our seniors to continue to live their lives in the place they have been. I do believe that this can be achieve through the use of robotics and smart home initiatives. We can focus on each ADL difficulties faced by the elderly and target each and every disability with the use of robots and on cloud technology.

Lotus Eldercare team visited this year's H.C.R. 2016 expo in Tokyo Big Sight, Japan this October 2016. There are many eye popping technologies, products and home furnishings on exhibition. I have no idea where to start or where to end but it was indeed an eye opener with all the innovations on show. 

How We Operate

Our doctor is available from 9.00 am to 5.00 pm. Mondays to Fridays, excluding public holidays, strictly by appointment only.  Please call to arrange for an appointment.

Our charges are fixed at $200 per doctor visit per patient for a routine visit for patients under our long term home care service, including all procedures and reviews. Medications and expendables will be charged separately if required. Our charges for acute visits for patients not under our regular service will be $300 to $500 per review and strictly subjected to availability. We are not a medical clinic service and will not support services such as immunizations or review urgent hyper-acute conditions. We also only sign CCODs for patients under our long term care.

For referrals, kindly right click our Referral button on our top right menu (then choose save link as...) to save our referral form as a pdf file. E mail the referral to us at info@lotuseldercare.com.sg and we will get back to you as soon as possible.

Technology companies please e mail us at technology@lotuseldercare.com.sg  or use this LINK to set up appointments with Dr Tan Jit Seng

Get in touch with us!

Our care coordinator will advise you on the possible options available to cater to your unique needs.

16 Collyer Quay Level 20 Singapore 049318

 

Office line : +65 6818 9512

Fax line: +65 6818 9600