Advice for the Young Old

Q1. What health problems should I pay extra attention to after 60?
After 60, we need to beware of possible chronic diseases such as hypertension, high blood sugar, hyperlipidemia and hyperuricemia. These silent diseases can easily be overlooked without self-monitoring. All you need to do is to measure your blood pressure regularly, see a doctor or have routine check-ups. Many people only realise that hypertension can cause heart disease when they get sick. Therefore we should check our blood pressure regularly after 60.

The same also goes for high blood sugar. In many seniors, asymptomatic diabetes are only detected upon screening. Therefore, you are advised to undergo fasting blood glucose tests at least twice a year. Early detection followed by diet and medications can alleviate many side effects.

Hyperlipidemia is not “palpable”; it is only detected in blood test. What problems does hyperlipidemia cause? It can lead to occlusion of blood vessels in the brain, heart, limbs or even kidneys. Regular check-ups such as fasting glucose tests and lipid test are necessary. The "bad" cholesterol, also known as “low-density lipoprotein”, can be put under control by proper diet and medications. They can reduce the incidence of lipid-related elderly illnesses and vascular diseases such as stroke, coronary heart disease, etc.

Age is a major factor of high uric acid level. High uric acid level can cause gout. Besides gout pain, it is also a high risk factor of cardiovascular diseases. When gout is diagnosed, dietary changes can help lower the risk of other conditions and gout recurrence by reducing the uric acid level. It can also be controlled by medications.  

Self-control and self-monitoring are essential to manage the abovementioned four problems. When you suffer from any of these four conditions, please undergo check-ups and consult a doctor regularly. Due to COVID-19, many people refrained from seeing doctors in the past two years, and it is not recommended. Patients with chronic diseases should consult doctors, take medications and undergo check-up on a regular basis. As long as the chronic diseases are effectively managed, even after 80 or 90 you can still stay healthy and become less prone to other conditions and elderly illnesses. 

Q2. What are the “Three Treasures for Elderly”?
It is prudent to have your finance organised and plan ahead with the “three treasures for elderly”. They are will, enduring power of attorney (EPA) and advance directives (AD) in relation to medical treatment. Wills are common and allow you to state in advance which hospital you are sent to or how your estate should be allocated before any accident or death. In Hong Kong, your assets are under legal protection even in the absence of a will. In case of intestacy, it would be a 50/50 split between your spouse and other relatives. A will is preferred if you intend to have your possessions shared by different persons in different proportions, make a gift to someone or even to charity.

As the second treasure, an Enduring Power of Attorney (EPA) is even more important. We have to expect more of the unexpected when we age. For example, one may become a vegetative condition in case of an acute stoke, or can no longer organise one’s finances with dementia. We may have to live with an illness and expect to be taken care of by others for quite some time. Under current legislation, no other individual can manage your assets such as stocks, properties, funds, insurance policies, etc. on your behalf. If no relevant documents are signed, an application must be made to the court. It can take at least a year and incur legal costs. In Hong Kong, EPA has been accepted as a legally effective instrument for over 20 years. While still mentally competent, with EPA a person can appoint an individual of his/her choice to manage and support his/her financially with his/her assets. The attorney thus appointed is not allowed to dispose of his/her assets without restraint; he/she is subjected to the supervision of the High Court. And the appointment is only applicable to the attorney. Therefore, it is very important to arrange EPA as early as possible after 60.

The third one is an Advance Directive (AD) in relation to medical treatment. AD is slightly different from the other two treasures. While still mentally competent, a person with AD can indicate in advance if he or she will accept or refuse life-sustaining treatments at a future time, e.g. when terminally ill or facing inevitable death. Common life-sustaining procedures include chest compressions, artificial ventilation or other adjunctive treatments such as the use of nasogastric tube. Should nasogastric tube feeding be considered when patients with severe dementia can no longer eat on their own? All these preferences can be indicated in an AD, including which treatments to be performed and withheld. AD allows doctors and family members to follow the patients’ wishes without causing undue pain to the patients as well as undue stress on their loved ones in decision making.

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