With a growing ‘silver’ population in Singapore, it is substantially necessary for the country to develop its healthcare and eldercare system to meet the demands. In addition, there is a need to not only construct a dense network of community-based services, but also to ensure long-term sustainability in the provision of these services. The blueprint for a holistic and affordable eldercare must also incorporate the concept of ageing-in-place, where seniors can continue residing in the community which they are familiar with. Altogether, the Committee on Ageing Issues (CAI) has proposed 4 key approaches towards achieving this;
Develop support services within the community
In terms of the management of elderly healthcare needs, a holistic Family Physicians (FPs)-centered approach should be adopted. This is because of the close proximity the FPs are to provide primary prevention, maintenance of health and screening of diseases to the elderly in the community. The increasing presence of Community Health Centres (CHCs) also help to supplement the FPs with support services. In addition, there is a need to establish a variety of community-based nursing services for the elderly who would prefer to continue living in the community. Caregiver Centres on the other hand will offer an alternate support to families by providing care for the elderly.
Facilitate integrated service planning and delivery
There are plenty of rooms for improvement in this aspect. Follow-up care for discharged elderly patients can be enhanced via the closer integration between hospital systems and the community. The CAI also believe that the integrated service models of day care and day rehabilitation centres for the elderly must be flexible against market changes in order to be cost-efficient. More importantly, data requirements across all agencies must be streamlined to ensure that medical information is exchangeable between step-down healthcare facilities and community-based elder-care facilities.
Expand diversity and capability development within the health and eldercare sector
With the growing complexity of needs and expectations of the elderly, it is increasingly important to enhance healthcare capabilities and tailor social and personal care services to suit their range of requirements. The CAI is of the belief that in order to spur private sector participation and innovation in health and eldercare, the government should revise its policies and undertake a facilitating role in the industry. Essentially, certain aspects such as manpower and service standards must also be improvised to meet the rising demands of an ageing population.
Ensure affordability of health and eldercare services
This is achieved through a flexible multi-tiered safety net consisting of government subsidy for Class B2 / C wards, Medisave, MediShield, Medifund and ElderShield. As much as 80% of actual medical expenditures at Class B2 and C wards of public hospitals are being subsidized by the government while the remaining schemes provide greater financial protection for the elderly against huge medical bills.
As we can see, the Government’s role goes beyond financing the use of services. It also has an essential role to play with regards to manpower development, regulations and the establishment of standards for the sector. More importantly, it must facilitate the planning and development of the sector in order to achieve a holistic and affordable eldercare for our future seniors.
(Image source: Khoo Chai Ling)
A while back I heard about a compelling initiative by an organisation named Äldrekontakt (older contact, or contact with elders) that sets up social coffee gatherings in peoples homes. A group of 6-8 elderly people living alone are picked up by volunteer drivers and taken to a volunteer’s home, with most volunteers being between 25 and 40, where they are treated to coffee, baked goods and, above all, great conversation. The same group of elderly people meet each month but the volunteers vary, giving consistency to the participants but also limiting the necessary commitment of volunteers.
When looking for inspiration on what to write my Boxing Day blog post about, I felt something related to the season would be adequate, thus a google search on ‘oldies + Christmas’ was a given.
I don’t know what I had expected to find, but the obvious ten top hits were all related to favourite Christmas oldies, as in ‘old Christmas songs’. And then it struck me. Have you ever thought about that so many of the Christmas songs and carols that we still consider our favourites were all recorded in the the 40s, 50s and 60s? Around the time when the people that are getting ready for retirement nowadays were born and young? I hadn’t. So I dug a little deeper and guess what I found?
Out of the 25 most popular Holiday songs in the US in the past decade (as in most played both on radio and i-Pods) all but two were songs initially recorded during the 30s, 40s, 50s and 60s. If you look at the top 10 songs for this holiday season all of them are from the same decades.
The single with most sold copies worldwide all time (regardless of genre) is White Christmas by Irving Berlin with Bing Crosby from 1942 and according to a Wikipedia compilation of the top ten songs with most copies sold worldwide three of them are Christmas carols, recorded during the 30s and 40s (#3 Bing Crosby – Silent Night, 1935 (even if this particular song is based on an Austrian song from 1818), #1 Bing Crosby – White Christmas from 1942 and #8 Gene Autry – Rudolph The Red-nosed Reindeer from 1949).
When cross-checking and putting together the numbers I was quite fascinated, even if the metrics of ‘copies sold’ in particular might not be the most fair to songs released in our later digitalized music era.
I also found an intent of giving an explanation as to why it’s so hard to come up with another ‘Rudolph’ Christmas hit and that was given by a Canadian newspaper in 1979. The article explained that back in the day when Rudolph The Red-nosed Reindeer was released, such a hit would be released already in September and therefore have a longer period of time to reach popularity, whereas in 1979 (and still today) most malls and radio stations won’t start playing Christmas songs until late November (after Thanksgiving), making Christmas hits a less lucrative business having only a couple of weeks to create the same billboard sensations.
Whichever the reason, one thing is certain: for the seniors joining the 65+ silverevolution in the coming years, much will have changed since they were young, but when it comes to the favourite songs played each year around Christmas, the are likely to keep reminding them of their childhood for many years to come.
With that said I’d like to take the opportunity to wish all of you a belated Merry Christmas and Happy Holidays with one of my own favourite Christmas songs (that got to #3 on the music charts back in its day in 1946):
Hands can make tools, and hands can be tools themselves.
When one really takes time to think about it, hands are incredible. The science of touch is a rarely discussed topic, primarily due to the sensitivity the topic entails when taking some cultural and social norms into consideration. But the fact is, without touch, we would not be here. It is proven that babies do not develop properly if they do not have skin contact. Apparently, touch is required as a triggering mechanism for promulgation of brain activity, emotional response, as well as the immune system.The touch of a newborn baby’s hand forms tears in the eyes, and the touch of an elder’s hand cannot help but make one think of the wisdom one can learn of the world. The touch of hands have incredible potential. Just as they have let us discover fire, craft tools, and even use smartphones, they have been used in treatment for as long as history can recall.
Two such forms of the application of hands for treatment include massage and acupuncture. While massage involves direct skin contact through the hands, guided by fluid movements, acupuncture involves the intuition of the hands to gently guide needle tools serving as extensions of the hands — affecting meridians of the body that are stimulated through touch. Without the needle tools, this is known as acupressure.
According to the American News Report, studies have shown that, for massage, treatment is effective for treating pain regarding inflammation after exercise (reducing inflammation of acutely damaged skeletal muscle), osteoarthritis knee pain (pain reduction), chronic low back pain (significant pain reduction), and fibromyalgia (pain reduction and improved quality of life). Exhaustive amounts of studies exist for acupuncture, and publications from the China Academy of Chinese Medical Sciences revealed, for example, the potential of acupuncture treatment for depression as well as chronic fatigue syndrome (CFS). Regarding CFS, acupuncture has shown to significantly improve quality of life.
These are just two methods of the science of touch, but this is an almost endless avenue to explore. Ready for an adventure? The skies are the limits… but not for the hands. Hands built space programs.
Hands are incredible.
Greenville Hospital System. The Magic Hour. Retrieved May 24th, 2012 from: http://www.ghswomens.org/the-magic-hour.php
American News Report. Studies Show Massage Relieves Chronic Pain. Retrieved May 24th, 2012 from:
PubMed. Development of studies on on neurochemical mechanism of acupuncture underlying improvement of depression. Retrieved May 24th, 2012 from: http://www.ncbi.nlm.nih.gov/pubmed/22073894
PubMed. A meta analysis on randomized controlled trials of acupuncture treatment of chronic fatigue syndrome. Retrieved May 24th, 2012 from: http://www.ncbi.nlm.nih.gov/pubmed/20209981
PubMed. Randomized controlled study on influence of acupuncture for life quality of patients with chronic fatigue syndrome. Retrieved May 24th, 2012 from: http://www.ncbi.nlm.nih.gov/pubmed/19873911
An elderly woman boards the bus with relative ease. A good-natured banter then ensued between the bus captain and the elderly woman herself as the journey continues. Visibly delighted, she spoke of her hearty lunch at a food centre nearby. Strangely enough, she was also offering words of encouragement to the captain who is beginning to look a little familiar. Some serious mulling later and it hit me; the driver who appeared on the news for the wrong reason a week ago is now behind the wheel of our bus. Towards the end of the journey, I had the privilege to witness a particularly heartening moment as the elderly lady presented the gratified driver with a token of encouragement.
Emotions aside, I have also come to realize that our accessible environment has given the elderly woman the independence to integrate with the wider community and lead an active live. On the bus, low floor, step-free and access ramp features provide accessibility to the elderly and handicapped persons. Over the past few years, public transport operators such as Singapore Mass Rapid Transit (SMRT) and Singapore Bus Service (SBS) have been introducing these senior-friendly buses into the roads while Mass Rapid Transit (MRT) stations have undergone retrofitting regimes to improve accessibility to the elderly.
The demand for Alzheimer’s care facilities has risen dramatically during the past decades with two thirds of patients at nursing homes in the USA suffering from dementia, and it is expected to continue to rise as populations age and the amount of people diagnosed with Alzheimer’s in the USA alone is expected to increase 50% by 2030, from 5.2 to 7.7 million, and it is predicted that it may triple by 2050: reaching 16 million.
Recognizing the need for more options when it comes to Alzheimer’s care facilities, the Beatitudes nursing home in Phoenix, Arizona has stepped in to offer non-traditional care. Beatitudes approach is to offer individualized care; indulging the vices of their residents rather than enforcing strict guidelines such as the set meal times and bed times that are common place at nursing homes overcrowded with patients and lacking resources.
Not only is falling in your home a great worry among elderly; the effort to pick them up is also one of the heaviest and most ergonomically complicated tasks in nursing care. For this reason, the engineers at the Stockholm-based Centre for Health and Building, CHB, were induced to build a helping device. The result is a wheeled walker that through its innovative design can help a fallen person back on his feet.
Like any doctor, geriatricians use lots of specific terms. Below, I explain a few to help you venture into their murky literature and professional articles.
Firstly, geriatrics versus gerontology. Geriatrics is the medical specialty that treats older adults and focuses on clinical care. Gerontology is related but broader and refers to the study of aging—including social, biological, and psychological inquiry.
Philippines is home to several calamities, disasters and humanitarian crises. In fact, it is the third among the countries in Asia most frequently hit by disasters in 2010 that affected almost 4 million people (Citizens’ Disaster and Response Center (CDRC), 2010) . Especially during these inevitable disasters, our elderly are among those who are in need of extra assistance and support. At present, the roles of the older persons in relief services are only restricted to be at the receiving end and this puts them in a more vulnerable position. Because of climate change, the wide implementation of disaster preparedness programs and services in the country has been in the priority list of the government.
A local study by the Coalition of the Services of the Elderly (COSE) conducted among 92 elderly respondents has identified the needs of the older persons during calamities. 17% reported that they get separated from their families which adds to the burden as they have difficulty in doing their ADL’s without a family member that could provide assistance. It was also found out that food donations from several organizations had been their sustenance after the crises. However almost half of the respondents claimed they received uncooked food and food donations were only available for a day .Water supply is also insufficient; 45 respondents had water supply but 10 had no access to water and 26 reported water sources were submerged in flood water. Calamities put the elderly in higher risk in terms of water supply potability such that 70% in the study had sanitation related illnesses like diarrhea.
In the same study, respondents mentioned that the evacuation centers were overcrowded.They were also compelled to sleep in the cold cement floor. Most of them were also unable to travel to evacuation centers because of weakness due to arthritis or rheumatism. Medical services were provided free however, medicines were not enough for the affected population.
Filipino communities rely in the different disaster preparedness programs of several organizations. One particular project is CDRC’s Disaster Preparedness and Mitigation for Flood and Landslide Prone Communities which from its start has contributed in educating the people in disaster readiness.
The Committee on Aging Issues (CAI) is an inter-agency forum that serves to discuss and put up proposals related to population aging. It comprises of representation from the government, people, private, media and academic section.
One of its very vision is to better prepare Singapore for the opportunities and challenges of an aging population. The committee aims not only to knit closer family ties, but also to construct an extensive network of community services in order to supplement the elderly’s independence and foster a stronger sense of community belonging. Society must also be sufficiently prepared for the “Silver Tsunami” in order to achieve “Successful Aging for Singapore.”
Fundamentally, the CAI views the seniors as active contributors rather than passive members of society. They believe that national policies must cater to not only the frail and ill, but also to the well and healthy. Families are regarded as the first line of care, providing support as the main care-giver of the elderly. In the absence of the families, the community will acts as a safety net while institutionalization remains a last resort.
Collective responsibility from individual, family and community level represents one of the key guiding principles of the committee in shaping its approach. Altogether, there are 4 strategic concepts adopted by the CAI to manage the entailing opportunities and challenges of an aging society;
1) Elderly-friendly living environment
Inserting senior-friendly features into residences and estates to improve the standards of aging-in-place. More importantly, community-based living also offers a familiar surrounding that provides mental and emotional support to the elderly.
2) Barrier-free accessibility
Refurbishing the current state of environment into one that is tailored to the mobility requirements of an aging society. This includes public amenities, community facilities and transportation nationwide to ensure that the elderly are able to resume their community and private activities just like any other person.
3) Comprehensive yet affordable health and eldercare services
Elder-care services and programmes must be coordinated to ensure a smooth transition between step-down healthcare facilities and community-based elder-care facilities.
4) Active lifestyle and well-being
A greater range of options in leisure activities, learning choices, as well as engagement and
volunteer opportunities must be provided to leverage on the energy and experience of the elderly.
To sum it up, these 4 strategies are all equally important in order to achieve the objective of “Successful Aging for Singapore.” In some cases, these efforts may also be useful to other groups. For instance, a barrier-free environment is beneficial to the disability group as well.
Next week, we will explore these approaches in greater depths and look at the ongoing works of the CAI to brace Singapore for impact from the imminent “Silver Tsunami.”
(Image source: Red Lantern Images)
Today, population aging is emerging as a major demographic trend worldwide. The island nation of Singapore is no exception to the greying of its population, with an estimated 20% of its residents hitting the full retirement age of 65 by 2030. The first wave of the Baby Boom generation is expected to reach the 65 mark by the coming 2012.
In retrospect, Baby Boomers in Singapore played an instrumental role in building the country into one of the world’s advanced economies. They were the beneficiaries of a developing educational system and also the primary contributors of industrialization growth.
More importantly, a majority of this generation will have better health and education. Up to 87% of the elderly were found to be physically independent while the number of them with university education will rise from 4% in 2010 to 13% by 2030. The Baby Boomers are also likely to be wealthier as well. Statistics show the rise in average monthly income from work at similar life stage down the years;
This generation of future elderly represents a sizable ability pool with bountiful of experience and energy. It presents an array of opportunities for us to not only engage their participation, but also to leverage on their talents so that they can continue to contribute meaningfully to their families, communities and to society.
These group of elderly are also likely to be active in the fields of social and economic initiatives. They will have varying needs and aspirations that may pose as a challenge to policy makers. Policies and programmes designed for elderly care must be tailored sensitively to suit their range of requirements.
Aging issues are sophisticated and diverse. It is essential that the government, community agencies and the private sector work hand in hand towards an integrated approach to solve the growing problem. The Committee on Ageing Issues (CAI) established in 2004 was tasked to focus on the issues of elderly care. In the next post, we will take a closer look at the guiding principles and strategic framework adopted by the CAI in a bid to achieve their goal of “Successful Aging for Singapore.”
(Image source: Straits Time)
Silviahemmet is a Swedish foundation including both a nursing home for patients suffering from dementia as well as a dementia education branch founded by Professor Barbro Beck-Friis in 1996. As part of the education branch, an entire dementia unit can be educated to receive the unique quality indicator of the Silviahemmet certification. In order to receive the certification, ALL personnel including nurses, housecleaners, janitors and directors need to be educated in dementia according to the foundation’s guidelines. The aim of the certification is to incorporate a comprehensive view and understanding of the care of dementia patients across all levels in the unit. The certification is followed up yearly and needs to be renewed regularly. Professor Beck-Friis is a geriatrician and a leading expert in the world regarding the care of elderly with dementia and her philosophy is based on four cornerstones;
1) Patient-focused care/symptom control
3) Support to relatives
4) Communication and relationships
Most recently she was awarded the Japanese “Order of the Rising Sun, Gold Rays with Rosette” for her outstanding contribution to the development of elderly care in Japan and enhancement of the relationship between Japan and Sweden. The reason the Government of Japan awarded her was because she played a vital role in introducing the concept of group home to Japan by accepting many study visits.
Sweden, as one of the countries in the world with the most choir singers/capita (about every 15th person sings in a choir), is, needless to say, an enthusiastic contributor to the Eurovision Song Contest. If you haven’t, however, thought of dedicating your life to a music career at an early age, popular artist scout and event guru Lasse Lingman has arranged so you can get a second chance.
Dating more than 20 years back he and his production company has been arranging a competition called Seniorchansen, ‘The Senior Chance’, since last year renamed PROstjärnan, ‘The PRO Star’, after the Swedish National Pensioners Association’s (PRO – Pensionärernas Riksorganisation (the largest Pensioners Association in Sweden and the Nordics)) support for the competition. After eight regional ‘pre-finals’, eight winners are sent off to compete in the finals during a cruise on the Baltic Sea with another 1500 pensioners for one and a half days.
The competition attracts a lot of people that have dedicated their spare time to making music, be it singing or playing instruments or both. (It’s actually defined as a talent show, and not necessarily a music talent show, but the focus in the past years has been on music acts.) One of them is Elsa-Doris Ekman, who won the competition in 2002 as a 70 year old woman. Since then she’s received quite a bit of attention both from Swedish National Television on big Saturday night shows such as ‘Det kommer mera’ (‘There will be more’) and as entertainer on cruises in the Baltic Sea to mention a few examples. Nowadays she’s splitting her time between Sweden and Gran Canaria, Spain, where she, among other things, has become an alternating part of the house band at venues in Playa del Inglés.
Below you can see her perform ‘Lilla vackra Anna’ (‘Little beautiful Anna’) in January this year, as a 79 year old, at ‘Trollstugan’ (The Troll Lodge), a restaurant and meeting place for Scandinavians, Playa del Inglés, Gran Canaria (Canary Islands), Spain.
Featured image source: http://www.flickr.com/photos/42931449@N07/5771025070/sizes/m/in/photostream/
A fire that ripped through an Australian aged care facility has abruptly shone a light on this mostly hidden portion of our population.
Nine elderly people were killed, and many more were injured, in a fire that has now been concluded to be arson. One of the nurses has been taken into custody, awaiting trial for murder.
Beyond the human tragedy of the fire, there has been a ripple effect through Australian society. There have been calls for better fire regulation of elderly homes, which are needed but will probably lead to the collapse of several facilities that cannot pay for the expensive renovations to comply.
More interestingly, perhaps, has been the public reaction to the event. It has demonstrated that the general public remains uniquely uncomfortable about the concept of aging, and the way their elderly relatives are treated. New stories that showed pictures of the elderly lying in ambulances outside the burned facility received complaints for “gross insensitivity”. Many treated the story with shock. This is, in part, due to the way our society keeps our elderly hidden. Seeing the lives and treatment of the elderly is profoundly uncomfortable for the public, who don’t like to think about people so dependent on others for food, movement, and support.
The aging population is not a problem that will go away if it is ignored. Indeed, the slower we act, the worse the problem will become. It is essential that we turn this lack of comfort with the elderly into a driving force for change. Otherwise the future of our society is in jeopardy.
Filipinos are known to have a high regard for their elderly. And the reason why there are only 13 nursing homes in the 7,107 islands of the country is that we want them to age in their own homes. A country is considered to be aging if people aged 60 years old and above comprise 10% of the population. Projections show that by 2020, NCR and Ilocos Region will be the first regions in the country to reach 10% followed closely by Central Luzon, Calabarzon, Cagayan Valley, Western and Central Visayas in 2025( Ogena, 2006) . However, if you look closely into a city’s demographics, some is just a fraction away from 10%.
Recent local data shows that the elderly comprises 6.8% of the total population and 5.4% of them lives alone. Adding to their vulnerability, 34.9% of the total people with disabilities (PWDs) are elderly.However, an emerging issue for the Filipino elderly would be the decrease in capability of the responsible member of the family to support them with their needs. In fact by 2040, the Potential Support Ratio of the country will decrease from 15 in the year 2000 to 7; meaning that 7 people from working age group will support one elderly. (NCSB, 2010)
Programs that attend to the social, emotional, mental, physical, occupational and recreational needs of the elderly are readily available in the metropolitan. But still, there is a wide gap on whether these services actually reach this marginalized vulnerable population.Social dynamics demonstrate that even if a health center is accessible, a Filipino elderly rarely go to these facilities because they feel powerless with the long queue of younger people. Oftentimes, they would ignore mild signs and symptoms like cough because they do not want to disturb their children from their work to tag along with them to the center. Especially in a working city, elderly are left alone in their homes because the family members need to go to school or work.
How can we address this issue? The use of telehealth is a cost-effective intervention that has increased the access of the population to health, developed educational opportunities, improved the quality and equity of care and enhanced the quality of life and social support (Legare et al, 2010). Innovations on elderly health are now in place in developed countries but in a country that has not reached an aging cut-off, Filipinos still prefer the traditional trend.
Legare E et al. Telehealth readiness assessment tools. J Telemed Telecare. 2010;16(3):107-9.
Ogena N. The Low and Slow Aging in the Philippines: Auspicious or Challenging? University of the Philippines Population Institute Publication
Antipolo J. Are we an aging country? Accessed Online: http://www.makati.uhcaction.org/2011/12/are-we-an-aging-country/ December 10,2011
A young sailor clad in his uniform races zealously along the crowded streets of Times Square as a photographer trails his every movement. What would unfold before the flashing camera of Alfred Eisenstaedt was to become an iconic moment in history, as the sailor leans in for that famous kiss with the nurse in white. For them and the rejoicing faces at the background, the gruelling war is finally over and peace has been restored.
This marked the start of the baby boom generation spanning between 1946-1964 as countries like US, UK, Australia and Canada witnessed a sharp increase in birth rates. The Baby Boomers benefited from longer life spans, better health conditions and greater wealth through a relatively peaceful period without much wars. Interestingly in Russia, these off-springs were coined as the Sputnik Generation, a reference to an epoch where a swelling population meets the launch of their patented space crafts.
In the present 21st century however, population aging is arising as a major demographic trend worldwide. January 2011 heralded the first wave of aging Baby Boomers who will be reaching the full retirement age of 65. In US, the number of aging Baby Boomers is expected to rise from 35 million to 77 million over the next 20 years due to falling fertility rates and improved medical and disease control. China, India and Japan with the world’s largest elderly populations will also continue to see a massive increase in their ‘silver’ populations, a phenomenon popularly dubbed as the “Silver Tsunami” in Asia. Future projection estimates that Africa will remain the world’s youngest continent with only 5% of its population hitting the retirement age by 2050. Yet, for the first time in global history, the proportion of people aged 65 and over will exceed the number of children below the age of 5.
The silver evolution has ushered in a new era where greater emphasis is being placed on senior care. An array of issues ranging from insufficient primary care providers to the growing demand for elderly-friendly infrastructures are just some of the problems governments across the world must cope with. Healthcare and technological firms must also capture the ‘silver’ value and ride on the wave of new developments to ensure that they are well-poised to meet the future demands of an aging society.
(Image source: Alfred Eisenstaedt)
(Video source: CBS News)