The recent flurry of statistics and studies published on the topic of ageing in Singapore has been worrying. In just 3 short years’ time, it is estimated that one in six Singaporeans would be at least 65 years and above. By 2030, one in four of us will be senior, while the number of old folks living alone is projected to double from the current 41,000 to a staggering 92,000.
As our society makes the transition into a “super-aged” one like Japan, there are deep concerns across the public, healthcare and social service sectors on how our country’s infrastructure and resources are going to cope.
While the authorities have started to address certain prominent issues, such as the severe shortage of nursing home beds and the need to promote active ageing, researchers have continued to produce new findings that allow us to understand the topic even better.
One of them is Duke-NUS Medical School Associate Professor Angelique Chan, who is also the Executive Director of the school’s Centre for Ageing Research and Education. A sociologist by training, she has been spending the past 20 years studying the social and psychological factors of healthy ageing.
Among the three most important findings her work has unveiled, one of them has been getting more attention lately: loneliness. Described as a public health epidemic among older persons in countries like the US and UK, loneliness is a strong predictor of mortality, Prof Chan adds.
“Although a lot of elderly folks in Singapore live with their children, we found that they are the most lonely, especially those without a spouse. This group may also include those who are sick and vulnerable. This suggests that we can’t assume they are fine just because they’re living with their children,” she says.
Prof Chan also points out that there is a distinct difference between being lonely and being socially isolated. The former suggests that one negatively perceives himself to be left out, while the latter is defined as someone who lacks social networks. “Some people are fine with being socially isolated, and those who live alone also tend to be independent and healthier. On the other hand, for those who feel lonely, it can be hard to reach them because they are presumed to already have family around them.”
The second key finding, gleaned from a study across 14 Senior Activity Centres (SACs) in Singapore, is that there are low levels of self-care in older adults. After performing a series of blood and urine tests, the research team found that two-thirds had hypertension and 60% were pre-diabetic. However, despite 29 weeks of counselling on nutrition, chronic diseases and self-care, the researchers did not see much improvement in blood pressure and glucose readings.
“The levels of patient activation were low. We gave the seniors their results but a lot of them were reluctant to see their doctor for follow-ups. One of the issues was that many SACs catered meals and their nutritional quality may not necessarily be the highest. Also, there is the behavioural issue of not buying or eating fruit due to possible dental problems, and consuming a lot of food such as porridge, Milo, and white bread, which are high in carbohydrates,” says Prof Chan.
The third key finding is in the area of caregiver burden, which Prof Chan says would increase dramatically over the coming years and require urgent attention now. “We have been documenting caregiver depression and what predicts it. It is a vicious cycle: If patient is depressed, it is likely for the caregiver to get depressed. And the more depressed the caregiver is, the more depressed the patient becomes. And the older the caregivers get, the more depressive symptoms they report.”
Prof Chan says caregivers already have a hard time scheduling work and caregiving responsibilities. In fact, in a recent study of caregivers in their 70s and 80s, her team was amazed that these old folks were dedicating up to 60 hours a week tending to their family member, usually a spouse. And most of these caregivers had one or more chronic diseases themselves, and often had one or more Instrumental Activities of Daily Living limitations. Patient memory and behavioural problems, such as dementia, also has a strong effect on caregiver stress and burnout.
Prioritising Holistic Care for Seniors
“Singapore has been doing really well in addressing ageing for the past five years or so, but we’re not there yet,” says Prof Chan. In her recommendations for combating loneliness in our old folks, she suggests creating more social programmes for them, and finding ways to reach out to those still living with their family through their adult children.
In terms of self-care, she adds that our local senior activity centres could enhance their programmes to improve their members’ dietary and dental health habits, and also to get the seniors to continue with doctor follow-ups after receiving health screenings. Support provided for aged caregivers to alleviate their burden is also crucial.
Recognising the need for early interventions for under-served seniors, Methodist Welfare Services (MWS) has been ramping up our eldercare services on these fronts and more over the past two years.
Tackling Loneliness and Need for Self-Care
This July and August, we added two more SACs, located in Kebun Baru and Pasir Ris, to our existing portfolio of five SACs islandwide. Together, our seven SACs reach out to seniors aged 55 and above from low- to middle-income backgrounds, and offer them holistic programmes that integrate their psycho-social, recreational and healthcare needs.
Components include specialised senior gym programmes, group fitness sessions, medical screenings, nutrition programmes, the building of a strong communal network and community partnerships, volunteering opportunities, and a host of social, recreational and learning activities.
For instance, MWS Wesley Seniors Activity Centre – Jalan Berseh piloted the monthly Bowl of Soup initiative, which ropes in senior volunteers to cook and serve nutritious soup to members for lunch. Healthy cooking demonstrations and inter-generational interaction sessions, which involve volunteers and are highly popular with our SAC beneficiaries, are also held regularly. Many of the centres have also increased the frequency of their group exercise programmes, partly due to high subscription rates.
Support for caregivers
In addition to opening the newly built 197-bed MWS Nursing Home – Yew Tee this August to serve the aged poor and sick, we are also in the process of integrating the strengths and capabilities of both the nursing home and MWS Home Care to look after the neighbourhood’s frail, home-bound seniors. To help reduce caregiver burden on those tending to their terminally ill family members, MWS Home Care has also begun to co-manage patients with MWS Home Hospice early this year.
As dementia management continues to be a public health priority, our MWS Christalite Methodist Home, MWS Bethany Nursing Home – Choa Chu Kang, and MWS Nursing Home – Yew Tee have rolled out new efforts to cater to pre-dementia and dementia residents, such as social and therapy programmes, as well as dementia-friendly physical environments.
Since it is also a community effort to help and support dementia sufferers who are still living at home, MWS Charis ACE – Geylang East has joined an Agency of Integrated Care (Ministry of Health)’s initiative to become a Dementia-Friendly Go-To-Point, and also implemented a related caregiver programme.
In the year ahead, MWS will continue to monitor and reassess the evolving needs of our senior population in order to enhance our Continuum of Care, which spans ageing in place and home-based assisted living, to residential-nursing services and palliative care.
AT A GLANCE: MWS’ ELDERCARE PROFILE
– 7 Senior Activity Centres: *1,100+ Senior Activity Centre members
– 5 Centres Caring For The Aged Sick: *1,200+ patients and residents
*Total number of beneficiaries served between April 2016 and December 2017.