All pdf BH Issue 33 Eng

W e l c o m e
Welcome to
, the magazine
for patients and friends of Bumrungrad
International Hospital.
It seems that most people want to live a long
life, but how many are willing to make the extra
effort in maintaining their physical health in
order to ensure it? In this issue of Better Health,
we focus on the health of seniors, with the aim
to help elders, their families, and their friends
prepare for “sunset years” of health and happiness.
We begin with an article on page 4 about
geriatric medicine, a specialty currently in high
demand, and playing a major role in fast-aging
societies in countries around the world, including
Thailand. Following on page 8, we provide information
about health problems of the elderly, along
with recommendations for prevention and care.
On page 12, a feature on geriatric dentistry,
reminds us that elderly people often neglect
their oral health, unaware that many geriatric
problems start in the mouth. Followed by, an
article about how skin changes as we age, along
with care guidelines to protect and nurture
lifelong healthy skin.
We conclude with a report on four key practices
to support geriatric health. Following these
recommendations will help people of all ages
prepare for and maintain lifelong health.
As always, if you need advice or want to leave
comments about our magazine, we encourage you
to e-mail us at betterhealth@bumrungrad.com.
We look forward to hearing from you and wish
you health and happiness at every age.
C o n t e n t s
4 Geriatric medicine
Living longer, living better
8 Degenerative disorders
Health problems of the older person
12 Aging and oral health
A healthy mouth leads to a healthy life
14 Geriatric skin care
Protect and prevent, for a lifetime of
healthy skin
16 M.D. Focus
Get to know our doctors
20 Health maintenance guidelines
Good health is available for all ages
22 Health Briefs
24 Q & A
26 News from Bumrungrad International
Associate Professor Dr. Somsak Chaovisitsaree
Medical Director and Contributing Editor
8
12 22
Better Health magazine is published by Bumrungrad Hospital Public Company Limited and is produced
for Bumrungrad Hospital Public Company Limited by Native Media Limited, 10/162 The Trendy Buiding,
20fl., Room 2001C, Soi Sukhumvit 13 (Saengchan), Khlongtoey-nua, Wattana, Bangkok 10110.
Tel: +66 (0) 2168 7624 Fax: +66 (0) 2168 7625. www.nativemedia.co.th
No part of this magazine may be reproduced without the written permission of Bumrungrad Hospital
Public Company Limited. 2015 by Bumrungrad Hospital Public Company Limited. All rights reserved.
Publication of advertisements or sponsorships shall not constitute an endorsement by Bumrungrad
Hospital Public Company Limited of the products or services promoted, of the company or organization,
nor of the claims made.
Telephone: 66 (0) 2667 1000
Facsimile: 66 (0) 2667 2525
Out-patient
appointment: 66 (0) 2667 1555
Website:
www.bumrungrad.com

GERIATRIC MEDICINE
Living longer, living better
Living a long and happy life
Long life is priceless. You are given the extra time to
experience more that the world has to offer. Seems
true enough, but only if you have one thing – your health.
A long life, but with deteriorating health, leads to
dependence on others – the antithesis of freedom and
enjoyment.
Can older persons expect to have a good quality of life
longer into their later years? The answer awaits you in
this edition of .
Elders as the majority
The proportion of older persons within the population
is increasing rapidly. A 2014 survey by Thailand’s National
Statistical Office found that 14.9 percent of the kingdom’s
population is over 60 years of age, approximately 10 million
people. The Institute of Population
and Social Research, Mahidol
University, predicts that these
senior citizens will continue to
live for an average of 20 years for
men and 23.6 years for women.
Dr. Lily Chaisompong, who
specializes in geriatric medicine,
analyzes this phenomenon.
Thailand is shifting to a predominantly
aging society, in step
with global trends. “Ten years
from now, it will be the first
Dr. Lily Chaisompong
Geriatric physician
time in Thailand’s history that
there will be more people aged
60 years or older than minors,”
Dr. Lily says. “And in about 25 years, there will be about
20 million people over the age of 60, approximately onethird
of Thailand’s population.”
The increase is a result of advances in medical technology,
efficient public health management, and a continually
decreasing birth rate. “People over 80 years old today
average at least four children per household to take care
of them, whereas those just entering old age (60 years old),
now only have two children per household to look after
them.” Dr. Lily notes. “Today, families have fewer children,
but people live for up to 20 to 30 years after retirement.
The question is, how the older person can maintain a good
quality of life, independently, for as long as possible?”
To age well, start planning early
Maintaining health into older age requires long term
planning. “Start planning when you’re between 30 or 40
years old,” Dr. Lily advises. “When you meet older people
in good health, ask them what they did to stay fit. You’ll
see their answers are quite similar: a diet of nutritional
foods, regular exercise, and staying engaged in hobbies
and interests to promote good mental health.”
Dr. Lily makes clear these characteristics derive from
good habits established in early adulthood. “It’s unlikely
that people who start exercising at 60 or 70 will get the
same benefits, or even enjoy them as much, as people who
started much earlier,” she says. “The same goes for hobbies
and activities: for those who put in the effort now to develop
skills and expertise that help ward off depression and
loneliness later in life. Starting late means less time to build
this foundation and reap the benefits.”
But it’s never too late to start! Today’s older persons
must take charge of their health more so than in previous
generations to prepare themselves for longer lives that
they can enjoy.
Geriatric medicine is the answer
Geriatric medicine was developed to help older persons
maintain a good quality of life as they age. With the current
demographic trends mentioned above, this specialization
becomes ever more critical to older persons and their
families.
There are distinct changes in older adults’ bodies that
require care that is different from young and middle aged
adults. “The elderly are not sick adults, but rather, they
4

are a group that changes in every aspect – whether
physically, mentally, or socially due to aging. Therefore,
they need a special kind of care,” explains Dr. Lily.
In order to deliver the best geriatric care to older
people of various ages, we divide them into three groups:
The youngest old (60 to 69 years) are
those who have just entered older age,
most of whom are still healthy, though
some may have underlying diseases
such as diabetes or elevated blood
pressure. Care for them aims to assess
and prevent the future risk of diseases
such as osteoporosis, dementia, stroke,
or heart disease.
The middle old (70 to 85 years) is when the presence
of chronic diseases starts to increase, while the ability
to self-care starts to decrease. People in
this range, generally, want to rely on
themselves as much as possible. The
goal of care is to maintain a good
quality of life, paying particular
attention to skeletal and muscular
problems. Care includes reducing joint
degeneration from arthritis and helping
maintain mobility. There is also a focus on nutrition,
especially if people have chewing or swallowing
problems.
The oldest old (86 years and older) is
the time of increasing dependence on
family or caregivers for daily living
and self-care. Care for this group
includes training the caregivers on
nutrition and physical therapy. The
geriatrician and team also serve as
care coordinator between the patient
and their relatives, other caregivers, and other
physicians involved.
the patients’ health and ability to take care of themselves.
A fit 85 year old may be stronger and healthier than a frail
75 year old.”
Medical care for the elderly
Whichever the age group, a significant characteristic of
geriatric care is the coexistence of various diseases and
conditions. Therefore, geriatric medicine requires a holistic
approach to tackle these simultaneous health problems
safely and efficiently.
“To illustrate,” Dr. Lily says, “if an elderly patient has
dizziness, the caregiver knows he or she must call a doctor
but might not know in which field of medicine. Many things
cause dizziness: vertigo, reduced blood flow to the brain,
falling blood pressure, anemia or stress.”
Duplicated medication is a frequent problem because
elderly patients commonly have several doctors treating
several diseases. This can lead to the patient receiving
duplicate prescriptions. “But at Bumrungrad, we have a
clinical pharmacist who reviews all the patient’s medications
comprehensively to avoid duplicate treatments or drug
interactions. Additionally, our pharmacists are aware that
certain drugs are inappropriate for geriatric patients because
of side effects like depression, confusion, or causing falls,”
Dr. Lily says.
Specialists in geriatric medicine work as a collaborative,
interdisciplinary team, careful to ensure that they don’t
prescribe treatments that conflict or duplicate. “Successful
elderly medical care does not consist of individual doctors
working separately, but rather, together as a team.”
Dr. Lily says. “They assess all areas: general health, mental
and emotional health, nutrition, and even the patient’s
living environment, in reducing the risk of falls.”
“At Bumrungrad we place the older person at the center
of our geriatric program and care for them as if they were
part of our own family.” Dr. Lily says. “With the determination
to have good health, along with the assistance of our geriatric
program, the elderly can live long, healthy lives.”
“Age-oriented categorization is not always necessary,
however,” Dr. Lily says. “In practice, doctors base care on
5

6
Getting to know Bumrungrad’s
New Life Healthy Aging Clinic
Good health and an active lifestyle enable a good quality
of health in the later years. That’s why Bumrungrad
Hospital created the New Life Healthy Aging Clinic.
Its interdisciplinary team comprising of specialists in
geriatric medicine, including doctors, dentists, nurses,
pharmacists, nutritionists, and physical therapists
delivers comprehensive holistic medical services to the
older person.
Services for elderly patients include general health care,
preventive care, geriatric health consultation, and managing
complicated health problems:
Assessment of health conditions, focusing on syndromes
such as dementia, depressive disorders, and osteoporosis
Screening test for early onset dementia
Screening test for depression
Assessing risk for falls, as well as plans to reduce and
prevent fall risks in the home
Assessing risk and consultation on nutritional problems
in the older person
Assessing medication management, adverse drug
reactions, and side effects appropriate for the older
person
Vaccination program for older persons
Pre-operative assessment and post-operative care,
appropriate for the older person
Cooperation with different organizations to advise
and assist the elderly in adjusting their domestic
environments to make them safe and functional
Consultation and assistance regarding living wills and
palliative care.
For more information, please call 0 2667 2000.

DEGENERATIVE DISORDERS
Health problems of
the older person
Armed with proper knowledge about what health
changes to expect in older age, along with proper
prevention, care, and planning, older persons can
live longer and healthier lives.
As people age, tissues and organs deteriorate, causing
inevitable health problems. Knowing what to expect
and how to take action in preventing or minimizing
problems leads to overall better health in the senior years.
“We divide geriatric health problems into two major
groups,” says Dr. Lily Chaisompong, who specializes in
geriatric medicine at the New Life Healthy Aging Clinic.
“The first comprises common diseases that may be found
at the younger ages such as diabetes, high blood pressure,
heart disease, and kidney diseases, but that can become
more serious and complicated with age. The second group
comprises age-related geriatric syndromes, which can
decrease a senior’s self-care ability.
Geriatric syndromes:
1. Confusion and amnesia
Memory loss and slower thinking
come with age. However, acute
health problems such as infections,
heart, or brain conditions can
trigger mental disorientation and
confusion. Finding and treating
the underlying illnesses usually
brings the changes back to normal.
However, a more gradual and
insidious change in an older person’s
mood, behavior, or memory may signal the onset of dementia.
The warning signs of dementia include difficulty learning
or remembering new things, repeating words or questions,
the inability to perform complicated tasks, getting lost or
forgetting familiar places, no interest in socializing, speaking
less, and a change of habits.
Alzheimer’s disease is the most common cause of
dementia, but others include stroke, Parkinson’s disease,
hypothyroidism, and vitamin B12 deficiency.
Prevention and care
Consult with a doctor if the patient exhibits changes in
thinking and memory that impact daily life. Dementia is
incurable, but brain-stimulating activities such as doing
light household chores, socializing with friends and family,
reading, playing mental games such as crossword puzzles,
and physical exercise can help to slow its progression.
2. Osteoporosis
Osteoporosis, a silent and insidious
disease that causes loss of bone
mass and makes bones brittle,
shows no early symptoms. Patients
generally only become aware of
it if they happen to fall and suffer
bone fractures. Postmenopausal
women and men of over 70 years
of age are particularly at risk.
Prevention and care
Women over 55 and men over 70 should get tested
for bone mineral density (BMD), which indicates the
density of bone mass in comparison to its normal ratio
in younger adults.
Vitamin D helps the body absorb calcium. Get tested for
a deficiency, and if found, take vitamin D supplements.
Ingest foods high in calcium or supplements of 1,000
milligrams per day.
Practice weight-bearing exercises such as walking, running,
or lifting light weights.
8

If diagnosed with osteoporosis, get treatment to reduce
the risk of bone fractures.
3. Equilibrium (balance) problems
and accidental falls
Balance problems that lead to
falls have several causes. These
include joint degeneration, muscular
atrophy or weakness, brain
diseases, a decrease in blood
pressure when getting up from a
sitting or lying position, cardiac
arrhythmias, medications affecting
blood pressure or causing drowsiness,
living environments with insufficient light,
hazardous furniture, or sloping, slippery, or wet areas.
Balance problems or accidental falls are especially
dangerous for older patients with osteoporosis. Falls can
easily cause bone fractures which can lead to a multitude
of problems and complications such as the need for surgery
and prolonged hospital stays.
Prevention and care
Avoid medications that cause drowsiness or low blood
pressure.
Do exercises that focus on muscular strength and balance.
Improve the safety of the living environment, such as
by installing sufficient lighting, non-slip flooring, and
handrails.
Have a bone density test for osteoporosis and receive
treatment as necessary.
4. Insomnia
Sleep problems are very common
as we age, due to worsening quality
of sleep. These may include
difficulty falling asleep, frequent
waking, unrestful sleep, and feeling
unrefreshed in the morning.
Causes of poor sleep quality include
aging physiology, depression, stress,
anxiety, chronic pain, acid reflux,
respiratory problems, snoring, frequent urination, and the
side effects of medications.
Insomnia increases the probability of falls, depression,
and an impaired immune system, which can lead to other
health problems.
Prevention and care
Design the bedroom to promote better sleep, for example,
use curtains and bedclothes with calm and solid colors
(not too hot or too cold).
Try to sleep in the same place and at the same time
every night to regulate the body clock.
Don’t go to sleep too early. The best hours to go to bed
are from 21.00 to 22.00, and to wake up are from
4.00 to 5.00.
Drink water first thing in the morning and throughout
the day. Reduce water intake after dinner to decrease
night time urination; avoid caffeinated drinks after 14.00.
Don’t take long afternoon naps. Instead, do a stimulating
activity such as chatting with friends. If you have fatigue
or drowsiness, take a short nap no later than 15.00.
Ask your doctor to review any medications that may
cause insomnia, or any other factors that may lead to
insomnia as well.
Use sleeping pills only under a doctor’s supervision.
Prolonged use can cause dependence.
5. Urinary and fecal incontinence
Urinary or fecal incontinence results
from many factors such as pelvic
muscular weakness or atonicity,
overactive bladder, brain and
nerve related continence control
problems, certain types of medications,
infection, constipation,
prostatic enlargement, and
diabetes.
Prevention and care
Consult a doctor to find correctable causes such as
bladder infection.
Do exercises and movements to strengthen muscles such
as clenching the pelvic floor muscle 50 to 100 times
a day.
Urinate when the urge comes, but if practical, try to
extend the time between bathroom visits to train the
bladder to hold more urine.
10

Have your doctor review your medications and point
out those that may suppress appetite.
Consult a doctor or nutritionist for recommendations on
nutritional supplements and appropriate diet.
8. Hearing problems
Hearing loss problems are common in older people. Hearing
loss warning signs are the inability to perceive high-pitched
tones or high-frequency sounds such as a
female voice or high-key music, and the
inability to understand conversations
in noisy venues. Bad hearing
degrades the quality of life because
it limits social interaction and
denies simple pleasures like
listening to music or watching TV.
6. Dizziness and vertigo
Older persons are prone to
dizziness and vertigo, which
frequently lead to falls. Causes
include low blood pressure or
the side effects of medication
(painkillers, tranquilizers, or
anticonvulsants), vertigo, cardiac
arrhythmias, anemia, and anxiety.
Prevention and care
Determine the cause and change the behavior.
Move carefully, particularly when standing up from
sitting or lying positions.
Use canes, crutches, walkers, or handrails to assist
with balance.
7. Malnutrition and eating disorders
There are many causes to eating disorders and the
insufficient intake of food that leads to malnutrition. They
include dental problems, problems with
swallowing, decreased appetite,
weight loss, diseases and the side
effects of medications that suppress
appetite, depression or dementia,
and various chronic diseases.
Malnutrition in older persons
exacerbates infections and causes
osteoporosis, muscle atrophy, and
lethargy.
Prevention and care
In case of severe hearing loss, where the patient is barely
able to perceive sound (especially in both ears) and
becomes unable to communicate with others, hearing
aids might alleviate the problem.
Family, friends, and caregivers should speak closely and
slowly, in low tones, and maintain eye contact when
talking to older persons. Make sure that they can see
the speaker’s lips and choose venues that do not have
loud background noise.
9. Vision problems
Diseases such as cataracts, glaucoma,
and macular degeneration can harm
an older person’s vision, impacting
their quality of life.
Prevention and care
Older persons should have annual
eye exams to check for problems
before they arise and become untreatable
and irreversible. Finding disorders
in the early stages results in a better chance for successful
treatment.
Don’t neglect emotional care. “With so many physical
issues involved in elderly care, it’s easy to neglect mental
health problems, which are just as equally important,”
Dr. Lily says. “Older persons should strive to maintain
an active and curious mind and try to avoid emotional
stressors. Family members, friends, and caregivers play a
key role in helping elders live happily. Treating them with
gentleness, compassion, and genuine interest are at the
heart of effective care.”
Prevention and care
Consult a doctor to find and treat any possible causes.
Have a regular dental check-up, at least once a year.
Dining with family or friends can improve the appetite
and nutrition.
Prepare food in easy to eat and digest portions.
11

AGING & ORAL HEALTH
A healthy mouth leads to
a healthy life
Maintaining excellent oral health supports your overall
health and life quality much more than you might expect.
Thus, geriatric dentistry is a key component of
Bumrungrad’s multidisciplinary team that provides holistic
health care to elders. Our geriatric dental professionals
provide care for seniors with a variety of oral health
programs, whether simply for maintenance or for more
serious conditions.
talks with Dr. Matana Kettratad D.D.S., who
is specially trained in geriatric dentistry. Her practice focuses
on age-related oral diseases and
preventative oral health care.
Dr. Matana Kettratad
Geriatric dentist
Older mouths require
concerted care
Common oral health problems
in seniors include dental caries
(tooth decay), dental attrition,
gingival recession; problems with
implants and false teeth (looseness
or friction), xerostomia, angular
cheilitis, and periodontitis (also
known as pyorrhea), which
typically accompanies diabetes.
Elders with health problems need
special mouth care, especially
those with multiple chronic diseases who take multiple
medications; and cancer patients undergoing radiation
therapy around the head or throat, which affects the salivary
glands, which increases the risk for caries and mouth ulcers.
“If elders don’t address these problems, they may have
difficulty eating and may have a decreased appetite. This
can eventually lead to malnutrition,” Dr. Matana says.
“Patients at risk for respiratory infections also need to avoid
oral infections because germs in the mouth can infect
the lungs.”
Simple ways to a healthy smile
People’s mouths change as they age, which means they
must adapt to changes in their oral healthcare. For example,
older people’s sense of taste changes. Aging mouths produce
a thinner oral soft tissue. When accompanied with dry
mouth as a side effect of multiple medications, some elders
may easily develop ulcers, a burning sensation, or become
sensitive to spicy foods. These signs indicate that their
current method of oral care is no longer sufficient.
Dr. Matana suggests that seniors:
Use fluoride toothpaste and have it in contact with teeth
for at least two minutes during brushing.
Floss or use interproximal brushes daily. Dental floss
and brush size depend on the size of gaps between teeth.
Those with xerostomia or insufficient saliva can stimulate
saliva glands by eating foods with fiber and frequently
sipping water. The doctor may suggest using artificial
saliva for more severe cases.
Eat foods high in fiber to stimulate chewing, which helps
to scrape and clean the teeth.
Avoid sugary foods, which can cause dental caries.
See a dentist regularly.
“Oral health and overall health are inextricably related,”
Dr. Matana emphasizes. “But while elderly people need
special attention, younger people should also take good
care of their teeth and gums to minimize problems as they
age. Good oral health affects the quality of life, regardless
of how old you are!”
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GERIATRIC SKIN CARE
Protect and prevent,
for a lifetime of healthy skin
Changes in the skin are possibly the most visible signs of aging. However,
age is not the only factor that impacts skin health, explains Dr. Nussra
Wongrattanapasson, dermatologist and aesthetics expert to .
Change of age, change of skin
Like any organ, skin changes with age. “Adolescent skin is rather oily,”
Dr. Nussra notes. “In middle-age, the skin’s elasticity and strength deteriorates,
resulting in bigger pores and wrinkles. In life’s later years, along with wrinkles,
the skin gets dry, saggy, and loose with deep nasolabial folds and tear-trough
deformity.”
Dr. Nussra points out that skin changes differ for each person depending
on concomitant factors such as genetics and lifestyle. But the greatest threat
to healthy skin, she notes, is regular and prolonged
sun exposure without sunscreen protection.
Skin problems in the elderly
Certain well-established beauty treatments and
avoiding sun exposure can slow a range of cosmetic
skin problems as we age. But there are also more
serious skin diseases and conditions that commonly
afflict elderly people.
Melanoma and other skin cancers: Warning signs
include unusual spots, lumps, chronic wounds, and
moles that change in size and color, accompanied
by pain and bleeding. If you exhibit any of these
symptoms, have a doctor examine your skin
immediately.
Dry skin and allergic rashes: Deterioration of
Dr. Nussra Wongrattanapasson
Dermatologist
sweat glands and sebaceous glands can cause flaking and highly sensitive
skin. Severe cases can warrant the doctor prescribing topical drugs. To
maintain the improved skin condition after this treatment, the doctor
might also recommend specially formulated lotions.
Hair loss and irritated scalp: Usually caused by dry scalp and hair dyeing.
Seborrheic Keratosis, ephelides, and brown spots: Laser treatment effectively
removes these growths.
“Less common symptoms such as red spots, for example, might indicate
liver disease,” Dr. Nussra says. “Elderly people and their caregivers should
recognize and not ignore any skin symptoms because they could be signs of
possible serious underlying diseases.”
Skin care can start right now!
It’s never too late to start taking care of your skin:
Avoid taking extremely hot showers Use a sunscreen that suits your
People with particularly dry skin daily activities to protect skin
should try not to use soap, not scrub, from ultraviolet (UV) rays
and maybe shower once a day only Get good nutrition and regular
Use skin care products that have exercise
4.5 – 5.5 pH
Get adequate sleep and avoid
Don’t drink alcohol or smoke
stress that could cause insomnia.
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M.D. FOCUS
Get to know our doctors
Meet four Bumrungrad physicians who share their thoughts on a range
of healthcare topics.
Providing the highest standards of patient care requires a hospital-wide commitment and professional expertise.
Bumrungrad’s medical staff includes over 1,300 world-class doctors of the highest caliber, with outstanding
professional credentials and advanced training across the full spectrum of medical sub-specialties.
Prof. Dr. Chulaporn Roongpisuthipong, Physician specializing in Clinical Nutrition
With over 30 years of experience treating malnutrition in patients and holding important
leadership positions in the field of nutritional medicine, Prof. Dr. Chulaporn Roongpisuthipong
is known as a skilled doctor and educator in nutrition management. Before joining
Bumrungrad, she was the head of Nutritional Medicine at Ramathibodi Hospital Faculty
of Medicine and was the chairperson of the Society of Parenteral and Enteral Nutrition
of Thailand.
Q: What poses the greatest
challenge to a doctor of
nutritional medicine?
A: Educating the public on
the importance of nutrition is the greatest challenge.
Many people are suffering from malnutrition, but don’t
realize it. There is no typical malnourished person. Both
slender and overweight people can be nutritionally deficient.
Malnourished patients, who have been treated with good
practices, will have better outcomes and reduce the
length of hospital stays. For example, elderly patients
who spend long stretches in bed tend to become emaciated,
but on the appropriate nutritional programs they are
rejuvenated.
I am pleased and grateful that Bumrungrad is addressing
the problem of malnutrition and takes a leading role in
helping patients deal with the issue. We have a strong team
comprising nutritionists and nurses who assess the
nutritional statuses of every patient and recommend
specific programs to treat malnutrition.
Q: What medical situation has left the most enduring
impression on you?
A: It was the case of an elderly American woman who fell,
causing multiple fractures, and unfortunately, was also blind.
She was critically underweight, only about 40 kg, and also
had pancreatitis. As I formulated a personalized diet, her
condition quickly improved. If we had not provided nutritional
care, her injuries would have taken a much longer time to heal.
Q: What’s it like working at Bumrungrad?
A: Bumrungrad is one of the few hospitals providing the
parenteral nutrition compounding service. Nutritional
pharmacists are on call to formulate dietary supplements for
individual patients in our TPN clean room. The TPN
program’s high standards and good management system
proves that Bumrungrad places high importance on patients’
nutritional health.
Dr. Nussra Wongrattanapasson, Dermatologist, specializing in Skin Aesthetics
Dr. Nussra had graduated in Dermatology from the Faculty of Medicine, Ramathibodi
Hospital, Mahidol University. She has worked at Bumrungrad for over 17 years and was
the driving force in establishing the hospital’s renowned Skin Center (Dermatology). At
present, 29 dermatologists are on staff at the Center.
Q: Why did you join Bumrungrad?
A: We at Bumrungrad are committed to the highest
quality of patient care. All doctors have complete freedom
in doing their work, honor one another, and do not see
patients as mere customers. In complicated cases, our
medical staff works collaboratively as a team, with specialists
in different fields to help solve difficult cases. Working here
gives me great pride.
Q: What is most challenging about practicing
dermatology?
A: Gaining patients’ trust is the most challenging thing
because people tend to think that skin diseases are
insignificant and are only a matter of beauty. But that is not so
with diseases such as skin cancer or epidermolysis bullosa.
Q: How has dermatological
technology changed in the
last few years?
A: It has changed a lot. Dermatological
treatments include oral
medicines, external drugs, intravenous
injections, liquid nitrogen, and artificial ultraviolet
light. These treatments are still in use, but the quality of
drugs and equipment has continually improved. There
are new and more efficient medicines that have fewer
side effects. We now have skin-nourishing creams that
greatly reduce inflammation, which means we can cut
down on the use of steroids. There have also been advances
in aesthetic treatment technology such as botox, filler,
radio waves, and microwaves.
16

Dr. Wannee Ketmalasiri, specializing in Rehabilitation Medicine (Physical Therapy)
For more than 20 years, Dr. Wannee has improved the quality of life for numerous
patients through her work in the government and private sectors. She graduated
in Physical Medicine and Rehabilitation from Siriraj Hospital, Mahidol University,
and has resided in the USA to study hand rehabilitation and myofascial pain
syndromes.
w
Q: Describe the work you do as a physiotherapist?
A: Doctors in rehabilitative medicine have to work
with doctors from other fields such as neurologists,
orthopedic surgeons, and pediatricians. We integrate
several fields of knowledge to take care of patients in a
holistic manner. I not only provide treatment at the
hospital, but also work with patients after they leave
the hospital to help with the ongoing improvement of
their conditions. For example, I help guide patients in
organizing their living environment at home and give
advice to their caregivers to ensure that patients continue
to properly and safely recover.
Q: What’s the most memorable situation you’ve
encountered as a doctor?
A: A 20-year-old patient with neurological degenerative
disease was unable to move his body due to joint stiffness
and weakness of the whole body. He suffered from
malnutrition and was extremely thin and bedridden.
Our first challenge was
to make him able to sit.
Eventually, he was able to
walk for short distances and
could sit in a wheelchair and
control it.
Another case was a child with cerebral palsy who lived
with her mother. The patient could move and walk slowly
with crutches. I wanted to enable her to live independently.
Her mother believed that she was incapable of learning. I had
to work with her mother, the school, and others to get her
into school. Eventually, she was able to finish primary school.
Q: What principles guide you in your work?
A: My mother taught me to treat my patients with the
same care and compassion I would have for her. She also
reminded me that no one goes to see the doctor if they
are already healthy and happy. I should be patient with
them and not be the cause of any more problems or stress.
Dr. Matana Kettratad D.D.S., PhD, Cert. in Geriatric Dentistry
After graduating from the Faculty of Dentistry, Chulalongkorn University,
Dr. Matana studied Geriatric Dentistry at the University of British Columbia, Vancouver,
Canada. She was the first dentist in Thailand to graduate in this field.
Q: What sparked your
interest in geriatric
dentistry?
A: Upon graduating
from Chulalongkorn
University, I became
a faculty member at Thammasart University. The
administrators realized the population trend and the
need for oral health care within the elderly population.
They encouraged me to study geriatric dentistry because
no one had yet practiced this field in Thailand. I was
inspired to bring the knowledge back and pass it on to
the new generations of Thai dentists. Back then, there
was an increase of patients with Alzheimer’s and
Parkinson’s in the hospital, but so little we knew on
how to take care of this group of patients. So, it was not
hard for me to make the decision to go.
Q: Describe the differences between the care for
elderly patients vs. younger patients.
A: Most elderly people have several diseases or
conditions requiring several types of medications, so
planning their dental treatment is more complicated than
with younger patients. Patients who are frail or with cognitive
impairment often cannot cooperate in carrying out treatment.
Therefore, family and caregivers are essential, both at the
clinic and at home, because good oral health requires daily
attention. When I see patients’ children and grandchildren
taking care of them, I feel pleased and relieved.
Q: What are your impressions of working at
Bumrungrad?
A: Bumrungrad has a very good patient database system.
All the information we need to formulate good treatment
strategies is available on our computers. When we plan
treatment for elderly patients, it’s very important to have
easy access to all of their medication information and
medical history. For example, Bumrungrad’s New Life
Healthy Aging Clinic has teams from several fields, and
the database is specially designed to streamline our elderly
patients’ data. Besides the medical records and medication
information of individual patients, there is detailed
information about geriatric conditions, medicinal herbs,
nutritional supplements, and information for caregivers
– which optimizes the efficiency of patient care.
17

Feel great inside and out with
Anti-aging treatments
Medical science’s anti-aging technologies
revitalize, renew, and refresh.
Vitalife is proud to be the world’s first DNV GL Accredited wellness center
in the Outpatient Specialist Center Standard. The team of expert medical professionals
have earned wide recognition from leading Thai and international medical institutes
and organizations. Our dedicated doctors deliver wellness and anti-aging programs and
treatments that serve your exact needs based on your individualized lifestyle assessment
and comprehensive laboratory tests.
a Age Management Your program is custom designed to incorporate the right balance
of vitamins, minerals, and antioxidants; appropriate exercise and nutrition; and hormone
replacement for both men and women.
a Preventive & Regenerative Care Boost you immune system with a unique combination
of nutritional supplements to give you the right balance of vitamins, minerals, and
antioxidants.
a Hormones & Sexual Health To enhance your drive and energy, our hormone vitality
programs aid in countering the effects of hormonal changes in men and women in their
latter years.
a Sports Medicine Maintain bone structure, build muscle mass, and increase flexibility
with guidance from our exercise physiologist.
a Beauty & Skin Beauty and skin problems are solved from the inside using a holistic
approach to skin care. Start with the food and nutrients you eat daily. These include
personalized micronutrients from natural herbs (“nutraceuticals”), the latest beauty
technologies, tailored skin creams, and cosmeceuticals.
a Weight Management Our weight-management programs determine why you have
difficulty maintaining your optimum weight, and then employ Vitallife’s proven
methodology to help you attain your weight goals. Your program may include nutritional
support, specially prepared food supplements, personal exercise training at the Vitallife
Fitness and Sport Center, safe and natural vitamin supplements for appetite control,
laser treatments, and safe and advanced fat-burning technologies.
Additionally, Vitallife’s specialized pharmacists collaborate with our doctors to create vitamins
and supplements tailored to your health profile. You receive just the right amount of
nutrients to support optimal efficiency and help repair tissues damaged by daily activities
(such as sun exposure) and the aging process.
Vitallife Wellness Center
is a part of Bumrungrad International Hospital Public Company Limited.
For more information, please visit our website:
www.vitallife-international.com or call 66(0) 2667 2340.

Official Account :

HEALTH MAINTENANCE GUIDELINES
Good health is available for all ages
Good health is the ultimate goal for elderly people in
their retirement, which should be a time of enjoyable
rest and recreation.
At the New Life Healthy Aging Clinic we provide useful
advice for elderly healthcare. With the aim to maintain
good health for our patients, our four practices are simple
and easy to follow: attentive nutrition, regular exercise,
annual health check-up, and vaccination for immunity.
Attentive nutrition
Nutritional problems in the elderly are common and can
cause serious health problems such as weak, degenerative
muscles, low bone mass (osteoporosis and osteopenia),
anemia, weight loss, amnesia, and mood disorders.
In general, older persons should consume between 1,500
to 2,000 kilocalories a day, from all five food groups. We
recommend eating diverse types of foods, spread among
three meals and two snacks per day. Make sure to include
vegetables and fruits to increase fiber intake.
Suggested nutrients for the geriatric diet:
Protein: To maintain and strengthen muscle mass, prevent
muscle degeneration, and repair deteriorated tissue,
elderly people should regularly eat good quality protein.
Find it in lean meat, egg whites, skimmed milk, and
soybean products.
Carbohydrates: This nutrient provides energy to the body.
The older person should consume a sufficient amount
of carbohydrates in order to maintain a suitable body
weight. Choose complex carbohydrates such as brown
rice, whole wheat bread, and millet.
Fat: Older people need only a small amount of fat to
provide the body with enough essential fatty acids and
fat soluble vitamins. They should reduce or limit foods
high in fat such as fat from animals, butter, oil, coconut
milk, and concentrated cream.
Calcium: Older persons should consume at least 1,000
milligrams of calcium daily to prevent osteoporosis and
build bone density. Calcium rich foods are milk and
unsweetened dairy products, soybeans, bean flour sheets,
small fish with edible bones, and dark green and orange
colored vegetables.
Iron: This mineral helps prevent anemia and fatigue.
Foods high in iron include red meats such as lean pork
and beef, green vegetables, cabbage, cauliflower, green
beans, red beans, and black sesame seeds.
Vitamin C: Vitamin C helps the body absorb iron from
foods, prevent scurvy, and heal wounds more quickly.
High vitamin C foods are broccoli, potatoes, sweet peppers,
spinach, papayas, mangos, strawberries, guavas, and
oranges.
Potassium: Consume this to maintain normal blood
pressure, help muscular and nervous systems function
effectively, and maintain the appropriate balance of body
liquid. Potassium rich foods include bananas, oranges,
guavas, dried fruit, tomatoes, cabbage, cauliflower,
broccoli, spinach, oats, and coarse rice.
Vitamin B12: This nutrient is vital for the production of
red blood cells (erythropoiesis), brain cells, and nerves.
A prolonged vitamin B12 deficiency can cause anemia
and amnesia. Vitamin B12 is found in yogurt, milk, whole
egg, and all kinds of meat, such as beef, chicken, pork,
and fish.
Magnesium: This is an essential mineral for the functional
processes of numerous body systems such as the immune
system and bones. It plays a critical role in optimal
nervous system function, and healthy muscles and heart.
Find magnesium in fish, green leafy vegetables, bananas,
and beans.
Vitamin A: It helps maintain eyesight, prevents rapid
vision loss, promotes tissue growth, and boosts the
immune system. Foods with vitamin A include spinach,
carrots, sweet potatoes, papayas, and ripe mangoes.
Vitamin D: Vitamin D facilitates the absorption of calcium
and helps prevent bone diseases. The body can synthesize
vitamin D from sunlight exposure. Older persons who do
not get much sunlight should eat cereals and mushrooms,
and drink vitamin D fortified milk regularly.
Vitamin E: This antioxidant helps prevent the destruction
of body cells. It’s found in avocados, beans, sunflower
seeds, and sesame seeds.
Zinc: This mineral helps the immune system to work
efficiently and helps maintain appetite. Older persons may
need more zinc than younger people, as zinc absorption
decreases with age. Zinc is commonly found in meats,
seafood, and eggs.

Fiber: This material assists the excretory system in
working properly and prevents possible intestinal
problems. Remember to have vegetables and fruits with
each meal to get sufficient amounts of fiber.
Water: Water helps deliver nutrients to organs, helps
with bowel movement, prevents constipation, and
moisturizes skin. Drink six to eight glasses of clean water
(or unsweetened herbal drinks as an alternative) daily.
Regular exercise
Regular body movement and exercise helps maintain
joint health and muscular strength, and prevents joint
stiffness and pain often afflicting older people. Regular
exercise can prevent these common problems:
Exercises to halt and reverse low bone mass (osteoporosis):
The program should include weight-bearing exercises or
exercises that directly stimulate muscles. Great exercises
that use one’s own body weight include walking, Tai Chi,
dance, and cycling.
Exercises to prevent falls: Do exercises that promote
body balance, coordination of muscles, and increase
muscle strength. For example, standing up and sitting
down exercises from a chair, or lifting your legs up and
down while grabbing the back of a chair.
Exercises to reduce urinary incontinence: This involves
regular clenching of the pelvic floor muscle to increase
tightness and enhance the excretory system. Do it 50 to
100 times per day. Moreover, don’t retain urine for too
long. Doing so can lead to bladder infections, so urinate
when you first feel the urge.
Exercise to reduce knee joint degeneration: This exercise
emphasizes the strengthening of muscles around the
knee joint. Sit with your feet on the floor and stretch the
knees up and down, remaining in each position while
counting from 1 to 10. We don’t recommend exercises
that involve walking up and down the stairs, squatting,
or kneeling.
Exercises to increase the strength of the cervical and
lumbar spine: These focus on proper positions for sitting,
standing and walking. Try to sit up straight and not
crook or extend the back excessively to prevent muscle
degeneration.
Exercises to correct stiffness of the shoulder (frozen
shoulder): Try the wall climbing posture or back rubbing.
Warning: Always consult with your doctor or physical
therapist before practicing any exercise postures. If during
(or after exercise) you experience double vision, fainting,
headache, irregular heartbeat, shortness of breath, or chest
pain, stop immediately and inform your health professional.
Annual health check-up
Older persons should have a health check-up once a year,
including eye and oral examinations, to minimize the risk
of unexpected health concerns.
Package for elderly health check-up
Vital signs and physical examination, blood
tests, sugar, fasting blood sugar, and lipid
(fats) profile
Gout
Examination/test
Kidney, liver function panel, and thyroid panel
Hepatitis screening
CEA for GI cancer and AFP for liver cancer
PSA for prostate cancer
Urine examination and stool examination
with occult blood
Electrocardiogram (EKG)
Exercise stress test (EST)
Chest X-Ray
Ultrasound whole abdomen
Digital mammogram with breast ultrasound
Pap smear and pelvic exam
Vitamin B12, Vitamin D
Electrolytes: Sodium and Potassium
Calcium
Bone density L-spine & Hip
Microalbuminuria
Eye examination with dilated eye examination
55-69 Y 70+ Y
Male only
Male only
Female only
Female only
Female only
*See more information and options for a customized check-up at
www.bumrungrad.com or tel. 0-26670-1515
Vaccination for immunity
Male only
Female only
Female under 80
Vaccinations are another key component of elder health
because they prevent diseases that degrade the quality of
life, and can also help to save on medical care costs. Vaccines
suggested for older persons include:
Influenza: Get this annual vaccination, which is reformulated
every year, to guard against mutating strains.
Doctors recommend it before the rainy or winter seasons.
Tetanus: Get this every 10 years to prevent tetanus from
uncleaned wounds or wounds from accidental falls.
Pneumococcal conjugate: This prevents pneumonia, otitis
media, sinusitis, bloodstream infections, and meningitis.
Vaccination with two groups of strains provides lifetime
protection, over the age of 65.
Herpes zoster virus: People 60 years old and older should
get this vaccination to reduce the chance and severity of
developing shingles. It requires only one injection.
21

HEALTH BRIEFS
A good many friends results in a long and healthy life
Astudy from the University of Rochester, United States,
published in the Journal of Psychology and Aging, found
that reclusive habits and social withdrawal increases the risk
of early death, no less than tobacco use, excessive amounts of
alcohol, or obesity.
The study followed the daily social interactions of 133 subjects,
ranging in age from 20 to 30 years old. The survey was given
once again when they reached the age of 50, asking about the
quality of their social lives, emotional well-being, and relationships
with close friends.
The findings showed that frequent social interactions at
the age of 20 and satisfying relationships at the age of 30 are
associated with higher levels of well-being at the age of 50,
compared to those who are unsociable. The conclusion is that
young people who have the opportunity to meet people with
diverse backgrounds, and different opinions and values, can learn
to manage those differences and help define who they are –
which has a positive effect on the quality of life in later years.
Diagnosing dementia in 3 minutes
Determining whether or not someone has dementia,
and to what degree, is a complicated task that can
take many hours of testing. But a neuroscientist at Florida
Atlantic University, United States, recently developed a
method in screening for dementia, requiring only three
to five minutes. This new test provided results that are
comparable to the test that many specialists use currently.
The new Quick Dementia Rating System (QDRS) is a
10-item questionnaire printed on one page. The result
determines if the subject has dementia, and at what stage.
Most dementia patients do not get the opportunity for
a professional evaluation because of the time and cost
required. But this simple and inexpensive test provides
early detection to patients, their caretakers, and families,
enabling them to seek appropriate treatment at an earlier
stage – when it is most effective.
Healthy diet, healthy brain
Healthier food choices not only keep your body healthy,
but also reduce the risk of impairment to the brain’s
executive functions such as reasoning, memory, target
setting, and problem solving by 35 percent.
A study by the Albert Einstein College of Medicine,
United States, involved 550 seniors whose average age
was 80 years old and showing no signs of dementia. The
questions focused on diet and the brain’s executive function.
Results showed that healthy diets not only lower the
odds of diabetes and heart disease, but also affect mood
and sleep, which are both risk factors for brain deterioration.
Those who eat well also tend to exercise regularly and feel
satisfied with their lives, which all contribute to brain
health as they age.
22

Q & A
Caregiving for an elderly person who struggles
with an illness or depression takes a toll on
the caregivers. Remember, caregivers need
care, too. These suggestions will help you provide
effective and compassionate service and support
to your elder, while maintaining your own physical
and mental health.
Q: My 70-year-old aunt has arthritis with
wrist pain and is in a wheelchair. Can you
recommend some ways to arrange her
home environment?
A: When designing the home environment
for an elder with wrist pain, focus on basic
actions that require wrist twisting, turning,
pushing, and pulling such as turning doorknobs,
opening and closing drawers, and
twisting faucets. These benign activities can
become painful, impossible tasks to elders.
Consider installing easy to use doorknobs
and swivel faucets that don’t require twisting.
Ease of access is a must for physically challenged elders, whether
being able to walk or being in a wheelchair. Improve accessibility with
wide doorways (at least 90 centimeters). Clear areas so a wheelchair
is able to pass through easily. Sliding doors take up less room. Doorframes
should be at least one meter wide. Outside access to the home
and the inside, should ideally have no steps or stairways unless there
are elevators or ramps.
Reduce the risk of falls and leg and foot injuries with uncluttered
floor plans. You might want to remove unnecessary items that create
tripping hazards. To accommodate functional living needs and wheelchair
mobility, choose wheeled cabinets and furniture that you can
move quickly and easily.
Q: Caring for elders in addition to other
life responsibilities is stressful. How can
caregivers deal with stress?
A: Caregiving can take a toll on your health,
relationships, and state of mind, eventually
leading to burnout. How does one practice
healthy caregiving?
Ask for help. Do not try to do everything
yourself, which is a sure path to stress and
burnout. Spread out the responsibility.
Give yourself a break, grant permission to take
care of yourself. Get enough rest. Try to do
something that you enjoy, every day, for at
least 30 minutes each day.
Practice acceptance. Everyone has a limit.
Accepting that you need time off doesn’t make
you a selfish person. Looking after yourself
ultimately benefits the person you’re helping.
Focus on what you can do, not on what can’t
be done. Sometimes you cannot help feeling
bad about the situation you’re in. Rather than
stressing out over things you can’t control, stay
positive and focus on the way you choose to
react to problems.
Take care of your health. Don’t skip medical
appointments, eat healthily, and exercise
regularly.
Q: How can I help my depressed mother who resists my help?
A: Helping a depressed
person requires a deep
understanding. He or
she may need to seek
professional help. But
getting a depressed
person into treatment
can be difficult when
the negative ways of
thinking lead him or
her to believe that life
is hopeless. Family
members giving emotional support to the depressed person
makes a big difference.
recommends that you:
Do not try to “change” the depressed person. Be a good listener,
ready to offer support with unconditional understanding.
Patience and care are key.
Encourage and support without showing any annoyance or
frustration.
Stay positive, with both positive words and positive actions,
to inspire the person to see a brighter side of life.
Encourage participation in activities. Invite the person to join
you in uplifting activities. Be gently persistent if they decline.
Have realistic expectations. Even with optimal treatment,
recovering from depression doesn’t happen overnight.
If your loved one happens to be less anxious with you around,
maybe you can be the one to suggest getting a check-up, so the
doctor can rule out any medical causes of the depression. Refer
your loved one to a mental health medical professional. Your
unconditional support throughout treatment will be a stabilizing
force for the person to get better.
24

Dedicating the Knee Replacement Surgery
Program to Her Royal Highness Princess
Maha Chakri Sirindhorn on her 60th birthday
T
o honor Her Royal Highness Princess Maha Chakri Sirindhorn’s
60th birthday, Bumrungrad’s Joint Replacement Center, in
conjunction with the Bumrungrad Hospital Foundation, operates
the Knee Replacement Surgery Program. Since July 1, 2015,
this program has helped low-income patients with osteoarthritis
who require knee replacement surgery. Using a computer-assisted
robotic arm to perform surgery, the program’s target is to treat
sixty patients. Fifty patients have already met the initial criteria,
and seventeen have already had successful surgeries.
Celebrating Bumrungrad International’s
35th Anniversary
R
ecently, Bumrungrad International, led by Dr. Num Tanthuwanit,
Chief Executive Officer of Bumrungrad Hospital, organized a
special event to celebrate the hospital’s 35th Anniversary. The event,
titled “Check-in Bumrungrad’s 35th Anniversary”, invited visitors
to take their photo with the “heart sculpture” located at the
hospital and “check-in” via Facebook to receive a free photo
magnet. The event also welcomed a number of honored guests,
including celebrity singers, actors, and members of the press.
“Check-in Bumrungrad’s 35th Anniversary” aimed to strengthen
patients’ confidence in the hospital’s service and safety standards,
and its commitment to improving the quality of service.
The New Life Healthy Aging Clinic
official opening
D
r. Num Tanthuwanit, Chief Executive Officer of
Bumrungrad Hospital (center), Dr. Lily Chaisompong,
Geriatric Medicine Specialist (2nd from left), along with
Bumrungrad physicians and executives, participated in
the official opening ceremony of the New Life Healthy
Aging Clinic at Bumrungrad International Hospital. In
offering holistic care to aging patients, a team of physicians
and medical technicians, who are experts in geriatric
care, work together to meet the standards of excellence
in healthcare service, which Bumrungrad International
has adhered to for more than 35 years.
“Rak Jai Thai”, saving the lives of children
with congenital heart defects
S
ince 2003, Rak Jai Thai has provided heart surgeries and
given new lives to 718 children with congenital heart
disease.
Rak Jai Thai, established by Bumrungrad International and
The Bumrungrad Hospital Foundation, in conjunction with
the Cardiac Children Foundation of Thailand under the Royal
Patronage of Her Royal Highness Princess Galyanivadhana
Krom Luang Naradhiwas Rajanagarindra, is a charity program
providing no-cost heart surgeries for Thai children who lack
financial resources or access to critical cardiac surgeries. The
average cost of surgery per case, being about 550,000 baht.
To help support the program, please make donations by
26
check or by bank transfer to the
Bumrungrad Hospital Foundation
(Bangkok Bank savings account # 197-0-111157, North
Nana branch). Please fax a copy of your bank transfer
confirmation receipt to Bumrungrad’s accounting
department at 0 2667 2031. For more information, please
contact 0 2667 1398.
Additionally, you can help the children by purchasing
products at the "Lahn Nam Jai" shop, operated by the
Bumrungrad Hospital Foundation. "Lahn Nam Jai" shops
are located on the hospital’s M floor and the BI Clinic’s
G floor, open daily from 9.00 to 17.00.