For decades, housewife Lee Whye Keng, 72, had taken care of her home and family. But things changed when she began to feel pain in her hands.
"For six months last year, I was very stressed as my maid had quit. There was a lot of housework but I found that I couldn't do as much of it as I used to," she said.
Madam Lee has hand osteoarthritis, a degenerative joint disease that occurs when the cartilage that covers the bone surfaces at the joints wears out. It has affected at least three fingers on each of her hands.
"Some of my finger joints are swollen. If I hold a knife for too long, I will feel the pain," she said. "I can't chop anything properly and I can't do gardening. I used to be able to do everything. Now I can't.
About 20 to 30 per cent of the elderly population may have hand osteoarthritis that is symptomatic.
DR LEUNG YING YING, a senior consultant at Singapore General Hospital's department of rheumatology and immunology, and one of the authors of the study of older patients with the condition.
"The worst part is when I want to clean myself. I feel very frustrated. I want to wring the face towel dry but I also can't do that anymore."
HOW TO LESSEN THE PAIN AND STIFFNESS
Hand osteoarthritis is a degenerative joint disease that can cause pain, stiffness and deformity.
It occurs when the smooth cartilage that covers the bone surfaces at the joints is injured or wears out over time.
There is no cure but you can manage the symptoms with treatments.
Exercises can help lessen the pain and stiffness in your hands, said Ms Lin Ying Ying, a senior occupational therapist at Singapore General Hospital,
You can do them three to five times a day, with 10 to 20 repetitions each time. You can choose to do up to 30 repetitions, if needed, but not more than that, as you risk getting repetitive stress injury, she said.
If you have a lot of pain or swelling in your joints, you should avoid the strengthening exercises as they could worsen the pain, she said.
EXERCISES TO MAINTAIN FLEXIBILITY IN THE HAND
1 Bend your fingers into a hook (above), grip into a fist and straighten the fingers fully. Count to five at each stage, before letting go.
2 Touch the tip of the pinky finger with your thumb (above), before sliding the thumb down to the first palmar crease (the first groove or line that runs across the palm of the hand). Return to starting position. Count to five at each stage.
3 Flex your wrist up and down (above). Use a support for your forearm, so that you are moving your wrist instead of your forearm. Count to five at each stage.
EXERCISES TO MAINTAIN STRENGTH IN THE HAND
1 Squeeze a stress ball (above) or use a hand gripper, a compact device that is used to train hand muscles. Count to five before letting go.
2 Hold a light weight or a 500ml water bottle (above) in your hand with your palm facing up. Flex your wrist up and down. Turn your hand, with your palm facing down and do the same thing.
She has since learnt to cope. Her physiotherapist suggested cleaning her face with a paper towel or pressing the towel against the table to get the water out.
Patients with hand osteoarthritis often feel that their struggles with daily activities are not recognised as their condition is perceived as mild.
This view is supported by a Singapore General Hospital (SGH) study published last year, which showed that the impact of hand osteoarthritis on the quality of life of older Asian patients is a problem that is under-recognised.
The hospital's department of rheumatology and immunology held focus-group discussions with 26 patients aged between 52 and 78.
Dr Leung Ying Ying, a senior consultant at the department and one of the authors of the study, said: "About 20 to 30 per cent of the elderly population may have hand osteoarthritis that is symptomatic."
Yet, even though this is a common condition, not much is known about how it affects the patients' quality of life.
From the study - the first one done in Asia on the psychological impact of hand osteoarthritis - it is clear that patients feel misunderstood.
And it is not just the general public who think it is a trivial condition. Dr Leung said: "Patients feel that healthcare workers don't take it too seriously as it's not something that needs surgery or chemotherapy."
The patients in the study said it is not just the pain and swelling caused by hand osteoarthritis that they have to put up with.
The bigger issue is that it greatly interferes with their ability to perform daily tasks due to the loss of grip- and-pinch strength.
They told the authors of the study about their difficulty doing simple tasks like opening jars or food packages, using a pair of scissors, tying shoe laces or fastening a bra.
Eating with chopsticks or even their hands also became challenging. Several patients referred to the pain and numbness, and said they found it difficult to use these utensils to grip the food when they eat.
Some patients said they could not take care of their grandchildren as they had difficulties with small tasks like carrying the tots or picking up their toys. Patients also said they could not enjoy leisure activities.
Some men with the condition had difficulty pulling up their pants or doing tasks such as helping to carry heavy grocery bags, said Dr Leung.
Osteoarthritis is a common affliction as one ages and it can affect any joint.
There is no cure for hand osteoarthritis but doctors said it can be managed with treatments such as pain- relief medication, heat therapy, topical cream products and exercises.