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Learning Points from Dr. Dale Avers

This is a write-up on learning points of rehabilitating the frail by Ms Heng, a Senior Physiotherapist at Khoo Teck Puat Hospital, based on some suggestions from Visiting Expert Professor Dale Avers from USA. Professor Avers is a Professor of the Department of Physical Therapy Education at Upstate Medical University, Syracuse New York.

Khoo Teck Puat Hospital, Tan Tock Seng Hospital, together with Renci Hospital, hosted HMDP (Health Manpower Development Plan) visiting Expert



Professor Dale Avers


Professor Dale Avers (USA) in Singapore from 5th – 9th March 2018. During this coordinated visit, Professor Dale Avers was invited to deliver teachings on the topic of Frailty. She discussed various issues and learnings relating to frailty in our older population. During her visit, she also had the opportunity to gain understanding of the local healthcare context and played a role in helping us identify challenges, possible suggestions as well as potential points of concern to help us direct better care for our clients.


Some of the recommendations that targets frailty care, as suggested by Professor Dale, include encouraging healthcare workers to reflect on:


1. Paternalistic and “Safety” Culture in healthcare, including institutional care (e.g. in acute and community hospitals) where it has an ongoing detrimental impact on the older person’s physical health with the amount of bed rest. Frequent barriers to exercise introduced include cultural influences such as families promoting dependency, use of domestic helpers that worked at cross purposes to activity goals, general lack of physical activity and exercise amongst all Singaporeans. These cultural factors while valid, need to be addressed, as they do present significant barriers to mobility.


2. To promote a culture of genuine listening with desires to deeply understand patient’s and families’ concerns, values, and desire. While time may be a constraint, simple methods of obtaining patient values and desires should be promoted among all healthcare professionals, across disciplines. This should aim to become a norm for all patient encounters as the alignment of patient’s goals provides a platform for patient advocacy at all levels and reduce the presence of paternalism in healthcare.


3. Culturism, similar to ageism, may a barrier that implies that nothing can be done an excuse.


4. There is a lack of cross talk among disciplines and healthcare professionals within and across healthcare organisations. Sharing of information is not just to inform the end- users but to meaningfully involve them for collaboration and encourage ownership of care.

Professor Dale applauded the local healthcare system on the standards of our physical facilities and the presence of caring healthcare providers who are actively working towards improving care for our population. She observed an active shift of healthcare towards community services and agreed that this is a timely move.

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