Our most loyal readers on Silverevolution may remember the program Modern Aging that we wrote about in April (see the post HERE). This innovation program for young entrepreneurs with ideas for the elderly kicked off in August this year. A group of 7 entrepreneurs have been selected based on the potential of their improvement idea as well as their motivation to lead the way in transforming the elderly care sector. We are currently in the act of developing their ideas with the help of mentors and coaches and in close discussion with the elderly themselves. During the next couple of weeks the participants will blog about their ideas on the Forum for Social Innovation Sweden and we will post them here on Silverevolution as well.
First in line; introducing himself and his idea is Victor Nordlind. This is his story:
One may ask why a person who is attending one of the world’s top hotel schools would want to pursue a career in developing and improving the elderly care. Most people expected me to walk in my father’s footsteps in the restaurant industry, rather than radically changing field to Elderly care.
But as I was required to carry out a feasibility study about an existing retirement home during my first two years at Ecole Hôtelière de Lausanne (EHL), I was given the opportunity to see the true potential within this industry. It encouraged me to apply for an internship within elderly care, which I am currently pursuing within Strategy and Business Development at Ambea Sverige, whose affiliation is Carema Care. For me, elderly care is an industry where innovation is necessary in order to provide the correct quality of life, which in my opinion is the meaning of hospitality.
When I first came across the Modern Aging program, I did not have a specific idea for elderly in mind. When developing the idea, it was equally important to link the project back to my studies, as to work with something that may truly make a difference within the elderly sector. I decided to contact a friend who has several years of experience within elderly care, and who is currently working in a nursing home here in Sweden. I was convinced that my determination combined with her extensive experience would bring something innovative out of the meeting.
As expected, we had a very interesting discussion, which brought several ideas to the table. Most of them were linked to the use of more technology, which is a frequently debated topic when talking about improvements within elderly care. The trend of using technology to improve efficiency is relatively new in the industry while it has been an essential part of the hotel and restaurant industry for years. More and more apps and other technical devices are being developed to simplify everyday activities for the elderly.
However, one question that came up during the meeting was “how can we use technology to better involve the caregivers within elderly care?” These professionals have valuable knowledge and experience, which they should be able to share easily. With today’s progression of social media and online forums, a place for caregivers and other health care professionals to meet online should be developed. There, they may share ideas, knowledge and ask questions to one another over space and time. This will not only simplify and streamline the daily work, but it will also improve the quality of care in nursing homes in the long run. A forum like this needs to be strictly confidential with only registered users permitted access. The idea is also that this platform shall be the forum that compiles and disseminates knowledge of the latest advances in medical, social and technological solutions for the elderly.
My current internship at Ambea combined with the Modern Aging program has helped me to better understand the current market as well as the future prospects of elderly care in Sweden. To date, Modern Aging has hosted several seminars and workshops carried out by inspiring guest speakers from various fields, such as young entrepreneurs, lecturers from top universities, and professionals from the public health care sector. With this promising start, I am curious and eager to find out where the program is going to take us.
EU-funded unique international project aimed at providing safer and healthier aging is led by researchers at Örebro University (Sweden) in collaboration with twelve partners from six countries Sweden, Italy, Spain, Portugal, UK and Slovenia. The unique feature of the project is that it will provide seniors with smart home system combining both long-term health evaluation and caregiver-user interaction.
The project is called “Giraff” and received its name after remotely controlled mobile robot “Giraff” equipped with a display and loudspeaker. This robot lays in the heart of the smart home system in combination with continuous monitoring through a network of sensors.
Multiple sensors are installed in the apartment and can measure blood pressure, body temperature and register movements. Data from the sensors will enable to identify if someone takes a sudden fall or doesn’t move for unusually long time, analyze sleeping pattern and level of physical activity, which can be of particular importance for physiotherapists. All the data collected from sensors are analyzed by an intelligent system, which is able to quickly alert the caregiver if something goes wrong and to conduct long-term health assessment of the seniors, thus giving caregivers a tool to adapt care plan to guarantee better quality of life.
Robot “Giraff” is designed for conducting virtual visits based on users need or on caregiver’s and family member’s intention to talk to the senior about his/her health measurements. “Giraff” can move autonomously around the apartment, find where senior is located or follow the senior around the apartment during “virtual” physician visit. In future, it will be senior’s decision on whether to use “Giraff” to have a virtual meeting with caregiver or make a journey to the healthcare center instead.
When it comes to privacy of health data, it will be only user who can allow access to health information for concerned family members or other caregivers. This will contribute to creating a user-friendly environment, where seniors will understand that they can receive an opportunity to improve their quality of life while feeling secure about privacy of their data.
The project has come to a testing phase in 15 real homes in Sweden, Italy and Spain. Last news tells about system installation in the homes of elderly women living alone in Malaga (Spain) and in Örebro (Sweden).
It is inspiring to see how modern digital technology can improve quality of life for elderly people! Stay tuned for future blog posts on digital technology for elderly care.
Picture taken from:
For the last decades, development of Information Technologies (IT) and sensor technologies has resulted in a great number of new services such as smartphones, tablet PC’s, wireless video games, robotics, Skype to name a few. With some delay in time these technology advances started to change the way healthcare services are delivered with areas of mhealth (using mobile devices for healthcare service delivery) and telehealth (delivering healthcare over distance) gaining wider acceptance. So now it is time to create a series of blog posts under the common name “Digital aging” to highlight solutions that are already available and can be used. Stay tuned to the next blog posts, if You want to know more.
One of the trends of applying new technologies is remote home monitoring of elderly people using a set of sensor devices and wireless data transfer. The main advantage of these tools is that it gives today’s active seniors and their families freedom, security and the ability to manage their health at home or away. Basic functionality of the remote home monitoring system can include:
- automated fall detection
- location tracking
- remotely managed two-way voice
- alert system
Additionally, some of the systems support integration with other health measuring devices and can track blood pressure, weight, blood glucose level and even transfer all these data to the patient’s Electronic Health Record (I will tell more about it in the later posts)
How it works?
A senior active citizen will wear a lightweight pendant everywhere he goes: inside the house, to the library, swimming pool, supermarket, park, etc. This pendant will be waterproof, easy-to-use and not necessary to be taken off even while charging and constantly serving as a part of a “Mobile personal emergency response service”, which will track the senior person movements, detect any case of possible fall and location of a senior and send alert to the caregiver/assistant.
As an example, Susanne, 82 years old, wants to live an active life and not be tied to her healthcare team, which includes her family and healthcare professionals. She wears a light device with her anywhere she goes. While walking in the park, Susanne feels dizzy and presses the help button on the device, thus initiating a two-way voice conversation with a support center. She tells about her condition and the support center assistant makes a decision, whom to send to help Susanne to get home safely. In case Susanne falls, the system will automatically track her location and an ambulance car will pick her up.
I believe such techniques are very inspiring and these types of solutions are already on the market with for example “GoSafe” and “Libris”. Moreover, in US, AT&T is offering “Libris” solution as part of a managed service for doctors and health insurers already. Why not set “free” both active seniors and their families?
“AT&T and Numera Combine Personal Safety and Home Health management with New Personal Health Gateway”. Accessed at: http://www.att.com/gen/press-room?pid=23809&cdvn=news&newsarticleid=36052
Image : www.freedigitalphotos.net
“I see old people” is how this chapter begins. I’m reading “The new North – The World in 2050” by Laurence Smith. Without having finished the book, I’m excited to share some of the thoughts. This chapter really struck me.
Smith is a young professor in geography and earth and space sciences at UCLA. In his book, he analyzes four key “megatrends” – population growth and migration, natural resource demand, climate change and globalization – and projects how our world could look like in 2050.
The world is filling up with old people. Smith begins by describing the four stages of the demographic transition, which is happening everywhere in the world: 1. High and similar rates of birth and death (e.g., the preindustrial era, with a small and relatively stable total human population); followed by 2. Falling deaths but not births (initiating a population explosion); followed by 3. Falling births (still exploding, but decelerating); and finally 4. Low and similar rates of birth and death (population stabilization at a new, higher total number.
He states that most OECD countries have now passed through these stages – except for those allowing high levels of immigration like the USA – and have stabilizing or even falling populations. Most low- and middle-income countries are still in stage 2 or 3 though.
Smith summarizes that urbanization, modernization, and the empowerment of women push fertility rates downward. In other words, the urbanization of society (if associated with modernization and women’s rights) helps slow the rate of growth (with exceptions). In low-immigration developed countries like Italy and Japan, and regions like Eastern Europe, populations are falling. Consequently, if fertility rates continue to drop as they are now, the world population might be around 9.2 billion in 2050 – the population will still be growing, but about half as fast as today.
One of the most profound long-term effects of women having fewer babies is to skew societal age structure toward the elderly. Of course, improving healthcare also extends our life spans. This aging will hit some places faster and harder than others. Today, Japan is the world’s most elderly country with a median age of 44.6 years. In Pakistan, in contrast, the median age is just 22.1 years. Korea, Russia and China will join Japan as the world’s geriatric nations. Korea, Vietnam, Mexico and Iran will age radically by fifteen years or more. Countries like Afghanistan, Somalia and the Democratic Republic of Congo will still have youthful populations in 2050.
Smith asks: Is an elderly population a good thing or bad? He describes a possibly wiser and less violent society, which at the same time strains healthcare systems, and raises the economic burden on younger workers. The whole concept of “retirement” is about to undergo a major overhaul – people will have to work later in life. Big cultural shifts will be needed in the way we treat and value our elderly. Society must learn that aging and youth should be valued equally.
As the world grays, skilled young people will become a more and more craved resource, Smith concludes. Thus, those countries best able to attract skilled foreign workers will fare best. These young workers might come from Somalia, Afghanistan, Yemen, the West Bank and Gaza, Ethiopia, and much of sub-Saharan Africa, which will offer our world’s youth in 2050 based on current population structures.
Finally, the critical but open question that Smith poses is whether our poorest countries will be able to turn their forthcoming demographic advantages into the new skilled workforces needed to help care for an elderly world. This would require enormous improvements in education, governance and security. Women would have to start attending school and working in places where this is uncommon today. Terrorism would have to be sufficiently quelled. The countries that need young workers would have to accept immigrants from the countries that have them.
Hopefully, these things can be achieved.
PS: Check out Laurence Smith on Vimeo: http://vimeo.com/15715690
Hearing the term health care innovation, most people associate it with new technologies like robotic caregivers, digital imaging or breakthroughs in chronic disease treatment. The decision-making process towards the use of any of those innovative choices is based on the physician’s knowledge and experience.
“Healthcare innovation can be defined as the introduction of a new concept, idea, service, process, or product aimed at improving treatment, diagnosis, education, outreach, prevention and research, and with the long term goals of improving quality, safety, outcomes, efficiency and costs” (Omachonu et al. 2010). Thus, process innovations focus on improving quality of care for patients and enhancing health providers’ internal capabilities. However, innovation is difficult – the health field has rich evidence-based innovations, but they disseminate slowly, if at all (Berwick 2003). Six areas have been identified in making or breaking innovation in healthcare (Herzlinger 2006):
One opportunity to introduce innovation in healthcare is the use of evidence-based information, which is highly relevant to that particular patient – especially at the point-of-care. But how can the use of this kind of information be facilitated?
One tool that I came across is Elsevier’s ClinicalKey (www.clinicalkey.com). It is a tool that physicians can use to access evidence to make informed decisions at the point-of-care and throughout the patient journey. The ClinicalKey reference system links clinicians, medical librarians, and researchers to an online platform, which contains content from medical journals, books, multimedia, MEDLINE abstracts and other sources. Did you come across any similar tools?
To me, fast access to high-quality research evidence to inform decision-making in clinical practice is absolutely important for innovating – improving – health. What do we need to solve this?
Maybe we need harder, better, faster, stronger tools as such, but what I wonder more about is the role of stakeholders as the leaders in these processes. How can leadership for evidence-informed decision-making in health be encouraged? How to cure resistance to change and innovation?
Berwick DM (2003). Disseminating innovations in healthcare. JAMA, 289(15):1969-1975
Herzlinger RE (2006). Why innovation in healthcare is so hard. http://hbr.org/web/extras/insight-center/health-care/why-innovation-in-health-care-is-so-hard
Omachonu VK, Einspruch NG (2010). Innovation in healthcare delivery systems – a conceptual framework. The Innovation Journal: The Public Sector Innovation Journal, 15(1):2.
The New York Times’ Personal Health blog included an article written by Jane Brody: “Staying Independent in Old Age, With a Little Help.” Here, the writer mentions how the majority of American elderly prefer to stay in their homes as long as possible. A barrier remains, however, as the homes they stay in are outdated relevant to the modernization of our people and the rate at which aging is increasing. Therefore, solutions are mentioned here — both on the house level and the community level — that may allow for elderly to live as independently as long as possible. House level solutions include the installment of grab bars, curbless showers, and the removal of steps. Community level changes include the provision of cluster housing in walkable communities within the vicinity of stores and public transportation.
While these solutions will help prevent social isolation and improve human elderly factors, one must also be aware of the signs of when one should consider moving an elder to a more supportive environment. These signs have been mentioned by Paula Spencer Scott, senior editor at Caring.com. Accidents, falls, diminishing health, slow recovery, inability to leave the house, not picking up the mail, not checking food expiration dates, fluctuating behavior, and increased loneliness are one of few signs to tell when the time may be right. Not only these, but if it takes considerable time and effort to care for this person and you are becoming affected if you yourself are the care provider, it is probably the right time to let him or her come to a place where he or she can be helped with a more constant environment of support. The question remains if these facilities will remain available in the coming future with enough staff. This will of course remain a concern and, to boldly say, should be a target addressed in all coming worldly or national health meetings of any kind.
I came across this article from the UK about elderly people spending their merry Christmas on their own. I found it interesting, depressing, and even discovered a link to health in the whole dilemma.
While for many people Christmas is the only time in the year when they actually meet family and friends, others are not cared for by anybody or do not care for anybody (anymore). Thus, they spend the celebration of love alone, like a quarter of all people in the UK that are older than 75 and live by themselves – even though the majority of them have children.
Experts say that “family breakdown is fuelling an epidemic of loneliness in old age” and that the fact that two in five marriages fail has serious impacts for the elderly. Young people have to divide their time between parents and step-parents. Besides, ‘silver separations’ are also becoming more common, with latest figures showing that more than 11,500 over-60s were granted a divorce in 2009.
In one of the largest surveys of its kind, the think-tank polled 2,000 over-75s to test how isolated the elderly truly are. ‘I’m 88 and I have nobody at all. I’m on my own’, said one, and ‘some days the only person I speak to is the boy in the shop when I pick up my paper.’
Growing isolation and loneliness makes elderly people particularly vulnerable – also in terms of health. Related mental and physical health conditions include a weakened immune system, sleep deprivation, higher blood pressure, a higher risk of dementia and depression. What to do?
In the UK there is an initiative that involves the police, fire officers conducting home safety checks, as well as social workers who see “warning signs” to connect people to local voluntary groups that can provide companionship. But is that a solution of the problem really?
Chapman J (2011): 250,000 elderly people who’ll be spending their Christmas alone. Available: http://www.dailymail.co.uk/news/article-2078261/250-000-elderly-people-ll-spending-Christmas-alone.html#ixzz2FXDlyfWT
In 1983, the World Health Organization put cancer as a leading cause of death in South Korea. It has an immense impact with 64,000 people dying every year in Korea due to the disease. Luckily, the latest development in cancer treatment is available in Korea: Cyber Knife Radio Surgery. There are currently some hundred cyber knife systems installed in only few countries in the world. Korea was among the first to implement it and today, it has one of the most numbers of installed systems. Compared to UK and US, a cyber knife treatment costs less in Korea.
Cyber knife systems have been used to treat tumors in upper spine, head and neck since 1999 and in the rest of the body since 2001. John Adler invented the system for cancer treatment. It is made to deliver radiotherapy for malign and benign cancer tumors at all stages in specific parts of the body in a non-invasive way. It uses a real-time image guide to find tumors even if the patient is moving, and to deliver radiation with highest accuracy. It eliminates the need for invasive surgeries.
There are various benefits of the technique, e.g. faster procedures in comparison to other radiation methods, no requirement for hospitalization, no need for anesthesia and almost no post-operative care. Cyber knife surgery can even be used for tumors that have already received the maximum dose of radiation. There are no incisions or cuts, and recovery time is not needed. It can even be used for tumors in the spine, which are hard to treat because they are moving while the patient is breathing. The cyber knife can pinpoint the exact location of the tumor and beam into it without damaging other surrounding tissues. That leads to a shorter treatment period and a quick recovery. Treatment can be finished in less than five days on an outpatient basis, without spending a single night at the hospital.
One hospital in Korea is specialized in treating spine cancer. The oncology experts in Korea are highly trained and have years of experience in radiology and cyber knife cancer treatment. Medical staff in Korean hospitals are English speaking and communication will not be a problem when getting medical treatment there.
Cyber knife surgery abroad:
Cyber knife Treatment for Spine Cancer
Rheumatoid Arthritis (RA) is a chronic condition that affects between 0,5-1% of the general population. It is considered an autoimmune disorder as the inflammatory system attacks joint locations of the body — typically in the hands but also other areas such as the feet.
Enough damage will considerably lower or possibly prevent the individual’s ability to perform motor activity.
Whether the inflammatory arthritides, including RA, have a distinct presentation and course in older as compared to younger subjects as first postulated in 1941 remains unsettled. The issue has gained significant importance as the proportion of the population who are over the age of 60 continues to grow in developed nations. As multiple newer treatment strategies emerge for RA, the efficacy and safety of these in elderly populations need to be evaluated as a distinct clinical issue.
– Aviva Hopkins, MD, and Carlos J. Lozada, MD
Traditionally, treatments known as Disease-Modifying Antirheumatic Drugs (DMARDs) have been used to treat RA in order to slow the progression of the condition — with methotrexate being the gold standard. In cases of heavy or severe inflammation and/or when DMARDs fail, glucocorticoids (corticosteroids) are also used in tablet or IV form. When used over time, these drugs cause considerable damage to the body. Immunosuppressives such as cyclophosphamide are also used in cases of strong inflammation and these drugs bear considerable toxicity — including the risk of developing infertility (which is vital to understand, especially considering the majority of cases are female; 3:1 in younger-onset RA). With these factors in mind, several new treatments have been made available and the most notable are called biologic drugs. These drugs are created from a biological process rather than being chemically synthesized; most often involving recombinant DNA technology to create, for example, monoclonal antibodies and fusion proteins. An example of a monoclonal antibody used in RA is rituximab, which was created as an “antibody” to specifically target B cells — which are a vital part of the immune response. Where a healthy immune system equates to a healthy person, in the case of an autoimmune patient the inflammatory response goes out of control and must be suppressed. Taking these drugs of course can lead to a rise in the rate of infections as they very effectively do what they were made for — lowering the immune response. However, a search on PubMed or any other medical database reveals a very positive force for the usage of biologic drugs; as they are also considered safer than some traditional DMARDs. Biologics have existed for approximately 20 years, but despite evidence showing them to be significantly more effective than DMARDs, they are quite costly. Therefore, biologics are typically reserved for those patients who do not respond well to DMARDs.
If there would be a way to make these biologic drugs more cost effective, these drugs are an important milestone for an answer to worldly health with the rising rates of elderly who may potentially develop RA. Novel drugs which may be considered similar to biologics have just been introduced within the past few years and these are known as protein kinase inhibitors. More research will show if these drugs will prove to be more cost effective than the competitive biologics.
Imagine you were able to simply replace one of your organs once you fall sick. You just go to the hospital and quickly come out with a new intestine, kidney, liver or even heart, if an incurable disease was present. This sounds more like an idea from a science fiction movie than a like a feasible therapeutic option, but research on regenerative medicine and the engineering of “artificial” organs is happening to make these options a reality for many patients worldwide in the near future.
Nowadays, chronic diseases are a major health issue in almost every country – they cannot be cured and the patient’s best bet is to prevent those diseases and their complications. We are talking about e.g. diabetes, heart and kidney failure, hepatic disease and hypertension. After treatment has failed the last resort for many patients is organ transplantation. However, as simple as it may sound, there are countless complications involved, as the organ has to be compatible with the patient. The patient will have to remain on medication to lower his immune system response to the minimal for the rest of his life, which can make him more vulnerable to infections.
By the year 2010, over 90,000 people were signed in for the waiting list for a kidney transplant in the US and 3,000 at any given day for a heart transplant. Many patients who have no other choice of treatment wait, and most of the times death arrives faster than the suitable organ.
What if you could build a custom-made organ according to a patient’s need? A group of biomedical researchers at Karolinska Institutet in Sweden have pioneered what can be the first step in the beginning of a science fiction medicine: working with stem cells, which are cells capable of giving rise to any human tissue. They have managed to make a fully artificial trachea from scratch and implant it in a patient with cancer without any immunological reaction. The newly formed organ is built on a PET mold, yes the same used in bottles, which is as anatomically identical to the patient’s actual trachea – not only in shape but also in composition. The mold is filled with stem cells from the patient himself. Giving rise to a new and fully functional organ ready to be replaced.
The patient who went under this treatment is currently under annual checkups while living a normal life without health related restrictions. This is only the first step, but it is a firm step.
Thanks to Antonio Beltrán Rodríguez for sharing this post with our silverevolution-readers. Antonio is a biomedical student at Karolinska Institutet. Contact: email@example.com
Nowadays, a lot of research is conducted in the area of healthcare robotics, which has the potential to increase the quality of life for our silver population. Imagine!
I would like to tell you about the examples of New Zealand and South Korea – two countries that are combining their knowledge in order to build and develop something groundbreaking. Here, South Korea contributes from the hardware-side, while New Zealand is busy developing the latest software (check out: HealthBots Project, launched in 2008).
Healthcare robots that can take grandma’s heart rate or blood pressure are the outcome of the research. But besides simple medical jobs, robots can also play a tremendous role in monitoring, as they are able to store and manage the patient’s relevant medical data. All this can make elderly care much more cost-effective.
Another idea is that robots can enhance old people’s quality of live by offering entertainment, e.g. through music, films, games and the use of social media as Skype.
All this sounds futuristic, but the question is if it is a concept that will be feasible: Will decision-makers be willing to invest in healthcare robotics? And will our grandparents (our parents? we? our kids?) enjoy interaction with robots? A lot more studies have to be carried out in order to find out more about cost-effectiveness, but particularly about interaction between human beings and machines – and thus, about the increase (or not) of people’s quality of life.
Healthcare robots could change lives: http://www.msi.govt.nz/update-me/success-stories/research/healthcare-robots-could-change-lives/ (December 2011)
Recently, the New England Journal of Medicine (NEJM) released their 200th anniversary article titled, “Therapeutic Evolution and the Challenge of Rational Medicine,” by Greene et al. . This article gives us a walkthrough of how medicine has evolved in the past 200 years: specifically, from patient-centered in approximately the first century and a half, to pathogen-centered in the last fifty or so years. Traditionally, western doctors had an in-depth knowledge of herbs — and a wide range of (often bizarre) treatments, ranging from the application of the “Devil’s dung” plant to the practice of bloodletting, i.e. “breathing a vein,” to assist in the curing of a disease. While some of these treatments are arguably questionable, specifically the well-versed knowledge of traditional western doctors focused more on the human perspective, and, as a result, may have been a vital ingredient to the overall well-being of the patient. This component appears lost today — where our healers are efficaciously oriented toward targeting a specific pathogen, with very specific aims. This compartmentalization of focus (generating doctors with specific knowledge about specific subjects) leaves patients with any other possible ailments or concerns to hang in the dark. While the light of the brilliant doctor who shines in his specific field of focus may isolate and treat the primary cause of a disease, the flashlight he is shining with on the patient may just as well blind the patient to any other factors just as important that could improve general well-being. The flashlight will of course cast shadows of its own. As the article in NEJM subtly points out, there can be no medicine without both therapeutic enthusiasm and therapeutic skepticism, and skepticism has flourished in the rationale of science ever since the chilling specter emerged from medicines such as thalidomide, Diethylstilbestrol, Vioxx, and Avandia [ibid]. These drugs were developed for specific purposes, i.e. to prevent morning tiredness, to act as an antidiabetic, etc., and while the focus of developing these drugs may have been done through well intention, the outcomes clearly revealed something menacing lurking in the shadows.
“As the locus of disease has narrowed from the afflicted person to the molecular mechanism, and the target of magic bullets has followed suit, physicians have faced regular reminders of the limits of the reductionist approach.” 
As we have been endlessly discovering smaller and smaller particles; and smaller and smaller actions that lead to larger reactions, one might wonder if this approach is the best to solely focus on. What may be an additional approach more fitting for our new century? The Shanghai Center for Systems Biomedicine has released an interesting article titled, “Toward new drugs for the human and non-human cells in people,” by Zhao et al. . This explores the realization that the human body is only sparsely comprised of actual “human” cells. There is in fact a multitude of lifeforms that live within us and work in synergy with our body. For example, our metabolism is aided by lifeforms such as veillonella, bifidobacteria, and lactobacilli. Zhao et al. explain that humans are “superorganisms” due to the fact that we are 10% human cells and 90% microbes (primarily in the intestines).
“‘Super’” in that sense means ‘above and beyond.’ Scientists thus are viewing people as vast ecosystems in which human, bacterial, fungal and other cells interact with each another.” 
Therefore, when microbes significantly affect our genetic actions and reactions through gene regulation; i.e. on and off switching, this directly affects our immune response — and thus affects how diseases or disorders manifest. Due to this complexity, scientists realize how the reductionist approach can certainly fail — as all individuals will have a different response to treatment. We are complex beings and thus require complex interventions, and that certainly does not mean we should delve further to find even smaller particles or specialize ourselves even more. We should, on the contrary, seek a more holistic approach. For example, our own nutrition, diets, medications, mental state and physical activity (or lack thereof) completely affect the manifestation of our microbe populations within our bodies — and thus completely affect which genes are expressed and which are not. There is nature just as much as there is nurture. The so called “functional metagenomics” proposed by Zhao et al.  for developing new medicines that affect our microbes (and I say “our” for simplicity, because these organisms work together with us) are showing promise through traditional Chinese medicine (TCM) — an archaic yet thriving art of medicine that continues to prosper and grow in popularity even among the general scientific community as time passes. In the case of gene-environment reactions, most chronic conditions are involved. Here, Zhao et al. claim the gut microbiome is vital and TCM is tailored to target both the host as well as the synergistic microbes — thus being a holistic medicine, as treatments are not specifically tailored such as the conventional drug approach, which targets in an isolated fashion typical receptors within the “druggable genome.”
It appears that for the next age — moving on from an efficacious, isolated approach in primary care — we are not going back to a patient-centered approach which began in traditional western rational science, but rather a “super organismic” track that attempts to integrate as many human and non-human factors as possible.
1. Jeremy A. Greene, M.D., Ph.D., David S. Jones, M.D., Ph.D., and Scott H. Podolsky. M.D. Therapeutic Evolution and the Challenge of Rational Medicine. N Engl J Med 2012; 367:1077-1082. September 20, 2012. DOI: 10.1056/NEJMp1113570
2. Zhao L, Nicholson JK, Lu A, Wang Z, Tang H, Holmes E, Shen J, Zhang X, Li JV, Lindon JC. Targeting the human genome-microbiome axis for drug discovery: inspirations from global systems biology and traditional Chinese medicine. J Proteome Res. 2012 Jul 6;11(7):3509-19. Epub 2012 Jun 5.
There seems to be one single, simple best thing to keep our lives healthy and to prevent especially non-communicable diseases: a small, but regular dose of physical activity. This is especially relevant for elderly people as they often suffer from multi-morbidity, but could potentially stay more healthy by changing their lifestyles just a little bit.
Wouldn’t it be easy to put eating and sleeping in 23 and 1/2 hours and keep 30 minutes for physical activit? It doesn’t even have to be on a daily basis, but e.g. going for a 30 minutes walk three times a week has already proven to reduce the risk for arthritis by 47%, for dementia by 50% and for diabetes by 58%.
So how about prescribing physical activity? If doctors did that for their patients – do you think it would have an impact on people’s health?
Check out this video by Michael Evans and Mercury Films Inc. http://www.youtube.com/watch?v=aUaInS6HIGo. It has also been posted by the Swedish Professional Association for Physical Activity. http://www.yfa.se/
Also check out Michael Evans’ blog: http://www.myfavouritemedicine.com/23-and-a-half-hours/
Council of Labor Affairs in Taiwan is Piloting A Programme That Will Provide The Elderly Accessibility To Foreign Caregivers on An Hourly Basis
Taiwan, like other places in Asia, is experiencing rapid ageing. According to some estimates, by 2025, the population of those over 65 years-of-age will be 20 percent, up from 8 percent in 2008. With a population just over 25 million, this represents a huge increase in a relatively short period of time–a problem further exacerbated with population trends such as increased women in the work-place, increased people living alone –being separated from the elderly, and decreased fertility.
Adequate manpower continues to represent a challenge, in part due to Taiwan’s strict laws on foreign immigration and caregiving but also due to the aforementioned trends, such as low fertility rates. Taiwan typically provides good care to veterans and old people, but little community support is available. Little government support is also provided to those who wish to age at home.
Despite this, most elderly Taiwanese prefer to age at home and, many of them, prefer to stay at home rather than go out and partake in community services. Given this fact, recently, Taiwan is undertaking a series of building projects aimed at building age-friendly environment to keep elderly energetic and age successfully at home.
However the issue still remains–with informal caregiving structures on the decline from more women participating in the work force and more elderly ageing at home, who will be able to care for the elderly as they choose to age at home?
Starting 2013, the Council of Labor Affairs will test out a pilot programme that will allow foreign workers to work part-time by the hour.
Citizens over the age of 80 who score 60 or less on the Bartel Index will be eligible to apply for part-time foreign caregiving services. Currently, due to immigration laws, only the elderly who suffer from 1-10 severe mental or physical disabilities and score lower than 35 on the Bartel Index/require around-the-clock care are eligible to employ a foreign caregiver.
Typically these caregivers are hired full-time and the employer is responsible for providing food and accommodation. With the new pilot, the arrangement will be quite different: rather than making employers responsible for housing and accommodation, part-time foreign workers will be employed by NGOs who will take responsibility for their well-being and care.
While there will be no limits on how many hours foreign caregivers can be hired for, their employment needs to be in-line with Taiwan’s Labor Standards Act. All agreements between caregivers and non-profit organisations are to be covered in a contract, stipulating what is expected on the part of both the employee and the employer.
Reimbursement issues are still to be defined at a later time between two parties: local governments and the non-profit organisations (the prospective employers).
Receiving full-time local home-based caregiving care, is available for those elderly at a much higher income bracket. However, there are also government-supported long-term care services available to the elderly, particularly for the veterans, the poor, and those with disabilities. If the elderly is a veteran, the veteran affairs commission provides homes and long-term care services. The Council for Agriculture provides some assistance for aged farmers. For poor elderly with mild-disabilities, the Ministry of Interior provides long-term care support such as step-down care facilities, home services, dementia day care and care in a community setting, and the Bureau of Nursing and Health provides long-term care services, such as nursing home care and home nursing/home care rehabilitation to the poor and disabled.
The new pilot programme then has the potential to cater to a new market of elderly–to allow elderly who are slightly more affluent but still low to middle, middle class, who may not be in need of full-time caregiving support and who wish to age at home–the ability to receive long-term care services from a foreign caregiver who may not be as costly as a local one and only for when needed. It still remains to be seen how this programme will be operationalised and will ensure that local caregivers are adequately provided for. Also, whether or not foreign caregivers will accept the contractual terms and be willing to be part-time caregivers in Taiwan.
Our teacher once accused us: “You’re incredible! What you guys don’t find on Wikipedia does not exist in your world – or what?”
Trying to find out more about “u-health”, I remembered that and it made me smile. U-health or u-health care cannot be found on Wikipedia (yet) and on the first sight it does not seem to be on many peoples’ minds in today’s world, but dig a little deeper!
U-health stands for ubiquitous health – omnipresent, universal, ever-present health. Sounds big! And there you go with your online-search… [Small note: I found so many interesting aspects that I don’t know where to start now – so let me just give you a basic idea with this blog post and let’s explore the topic further within the following ones.]
On the Congress on Nursing Informatics 2006 in Korea, u-health did cause lively discussions. The Korean Government had started a project on u-health services for the provision of health care services in the country’s rural areas using the advanced broadband infrastructure (NI 2006).
U-health care is a developing area of technology to monitor and improve a patient’s health status. It uses different environmental and patient sensors to gather data on almost any physiological characteristic to diagnose health problems (Brown et al. 2007). U-health should stand out through availability, transparency, seamlessness, awareness and trustworthiness – anytime and anywhere (Cha 2008).
Many industrialized countries are sitting on a demographic time bomb – facing problems in health care that are related to the growing number of elderly. Their limited resources in health need to be used more efficiently and effectively. So especially these societies could benefit from u-health care and its innovations to reach better diagnosis and treatment. It also has a lot of potential in improving hospital administration and patient management with reduction of medical errors, and in enhancing service quality, communication and collaboration. (Chang) However, at the same time, u-health care confronts ethical issues, e.g. when it comes to trust, privacy and liability, or in combining computer and information ethics with medical ethics (Brown 2007).
Hence, the bottom line is that yes, u-health is and will increasingly be on peoples’ minds (and it will probably soon appear on Wikipedia).
Societies as well as individuals will have to make difficult choices in the future.
1 Korea IT Times offers a variety of more interesting articles by Cha Joo-hak on the topic: http://www.koreaittimes.com/source/cha-joo-hak
2 Brown I and Adams A A 2007. The ethical challenges of ubiquitous healthcare. International Review of Information Ethics Vol. 8. www.i-r-i-e.net/inhalt/008/008_9.pdf
3 Cha J-H (2008). Defining the Perfect Ubiquitous Healthcare Information System. Korea IT Times. http://www.koreaittimes.com/story/56/defining-perfect-ubiquitous-healthcare-information-system
4 Cha J-H (2010)Who Shall Live Better? – Health Care and Socioeconomic Choice. Korea IT Times. http://www.koreaittimes.com/story/8559/who-shall-live-better-health-care-and-socioeconomic-choice
5 Chang B-C ().Ubiquitous-Healthcare Changed paradigm after introduction of EHR. Yonsei University. www.health-informatics.kk.usm.my/resources/2_Chang.pdf
6 NI 2006. The 9th International Congress on Nursing Informatics. Seoul, Korea June 2006. http://differance-engine.net/ni2006blog/?p=22
We all know how bad our thinking can be when we don’t get a good night’s sleep, but over time poor sleep may put us at higher risk of more profound cognitive problems, like dementia.
Recent studies presented at the Alzheimer’s conference this summer show that sleep disruptions of different kinds– like sleep apnea (abnormal periods of obstructed breathing or stopping breathing), decreased time sleeping, or waking up often– can lead to real cognitive deficits.
Dr. Kristine Yaffe, from Univ of California, San Francisco, directs a clinic that evaluates and treats patients with memory disorders. Her research makes an important contribution because it looks at direct measures of sleep by observing people’s sleep quality and their subsequent development of cognitive problems 5 years later. Many other studies have looked at people’s self-report of how they sleep, which is notoriously inaccurate, and the concurrent presence of memory or cognitive problems. Such an approach does not address the question of which came first, the cogntive problem or the sleep problem, but Dr. Yaffe’s work suggests that in some people sleep problems may come first. Persons with disordered breathing (like sleep apnea) had more than 2 times the risk of dementia later on.
Let’s not all stay up even later worrying that by not getting good sleep we are imperiling our brains. The lesson is yes, get good sleep (that’s an order)! And for us that take care of patients, we should be asking them about their sleep and daytime functioning– daytime sleepiness can be an indicator that someone’s sleep at night is not adequate– and get them tested for sleeping problems. Many sleep problems can be treated, and doing so may save precious brain function.
NPR interview with Dr. Yaffe and news story: http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=159983037&m=160095742
The benefits of complementary and alternative medicine (CAM) (including massage) are readily apparent and have been shown, for
example, through a systematic review to be safe, efficacious vs. placebo, and cost-effective .
Massage is a treatment which has been shown to be efficacious when used on the practitioners themselves .
Regarding chronic care, pain was reduced and mood improved for nursing home residents with cancer . Massage is recommended to
be integrated in physical therapy for elderly; especially nowadays with the rising elderly population requiring prevention or treatment of
arthritic conditions . And among a large proportion of veterans experiencing non-cancerous chronic pain, CAM appears to have a
broad appeal after responses indicated that almost all in the study had a willingness to try CAM; with massage being the most preferred
Massage thus appears to have a benefit for both practitioners (they need care too!) and patients and is promising for chronic and elderly care. Due to its obvious cost-effectiveness (if you want to scratch out any expensive oils and just consider the most important tool: hands); ability to reduce pain and stress; and even the possibility of preventing or treating inflammation, blockages or arthritic manifestation, massage should be an essential component in general health and should be considered for incorporation into all forms physical therapy wherever possible.
1: Furlan AD, Yazdi F, Tsertsvadze A, Gross A, Van Tulder M, Santaguida L, Gagnier J, Ammendolia C, Dryden T, Doucette S, Skidmore B, Daniel R, Ostermann T, Tsouros S. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine forneck and low-back pain. Evid Based Complement Alternat Med. 2012;2012:953139. 2: Jensen AM, Ramasamy A, Hotek J, Roel B, Riffe D. The Benefits of Giving a Massage on the Mental State of Massage Therapists: A Randomized, ControlledTrial. J Altern Complement Med. 2012 Sep 4. 3: Hodgson NA, Lafferty D. Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and Improve Mood in Nursing Home Residents with Cancer: A Pilot Trial. Evid Based Complement Alternat Med. 2012;2012:456897. Epub 2012 Jul 24. 4: Hardt R. [Special features of physical therapy for elderly rheumatic patients]. Z Rheumatol. 2012 Jul;71(5):396-402. German. 5: Denneson LM, Corson K, Dobscha SK. Complementary and alternative medicine use among veterans with chronic noncancer pain. J Rehabil Res Dev. 2011;48(9):1119-28.
Over- and polymedication among the elderly is a risky business that we have covered earlier, eg. in a blog post by agjessica on Polypharmacy among the elderly. As Jessica recounts studies have shown that the risk of drug interactions (with potential negative consequences) increase from 6% to 50% in patients on 2 or 4-5 medications, respectively. Nevertheless, as the digitalization of healthcare gains grounds there are a couple of really interesting ideas out there on both how to better document the side effects caused by taking various medications at a time as well as on how to use technology to help elders (and others) out with keeping track of when they need to take their medications.
Last week I had the privilege to listen in to parts of a high level summit on the Globalization of the Healthcare Market, namely the Swedish American Life Sciences Summit, where Digital Healthcare was one of the subtopics of the year. As a former Mechatronics student I took a particular liking to two innovative solutions tackling the above challenge.
The first was presented by Nicolaus Henke, McKinsey’s Director of Healthcare Practice in Europe, the Middle East and Africa, as an example of the future potential of the mix of technology and healthcare. Dr Henke explained how Proteus Digital Health (that just got FDA approval to sell their solution as a medical device a little over a month ago) has created a pill that, swallowed, together with the gastric acids of the body gets activated and the energy needed to start analyzing real-time conditions of the body, such as information related to the medication taken. This information is communicated to a wearable patch, that apart from receiving the signal from the edible sensor also records the time that the medication was taken, as well as a number of other factors related to the person’s health, such as heart beat, temperature, physical activity, position (standing, lying down) and rest patterns. The patch further communicates this information to one’s smartphone and a secure server in order to collect and analyze data in order to support medical adherence and effective monitoring of a person’s health. The person being monitored can, in turn, choose who can see this information (physicians, caregivers and/or family members, only him-/herself etc) as well as get feedback via notifications when medications are overdue.
Fascinating piece of solution in my opinion. Proteus Digital Health’s edible sensor can currently ‘only’ monitor the time, characteristics and identity of what you swallow, but the company is working on a solution that can analyze bodily measures on a more advanced scale. Since estimations have shown that as many as a third to half of the world’s patients don’t take their medications properly solutions like these apparently have a large target market. Even though development and research on biomedical telemetry from ingestible electronics has been around since the 60s Proteus D. H. have managed to put the first (and currently only) product on the market within this particular field. Looking forward to follow what the research community on related solutions is planning in the years to come.
The second solution was developed by one of the conference participants, Mr. Robert Pakter, CEO and founder of Pilljogger, a company that has created an app that helps people track their medical intakes and thanks them when they stay on track. Mr. Pakter shared that he and his company are planning on developing a feature where patients will be enabled to report side effects that they experience when taking different medicines. Given that the Pilljogger app already will keep track of the different medications the patient is taking, this will also provide for an opportunity to track different side effects that arise from the combination of different medications in certain patients on a wider scale, providing a unique material that can later be used for further research and conclusions in the field of polypharmacy.
Thus, after my brief and intense opportunity to rub shoulders with some of the Healthcare industry’s finest, I feel reassured that we can expect to see a lot of exciting things in the field of digital health in the year’s to come.
PS. I also wanted to shine a little light on an unrelated topic, namely the Not-For-Profit research organization MEND (Medicine in Need), that I also got the chance to listen in to last week, and that are doing amazing work on the formulation of vaccines, reengineering them in order to make them more easily distributed to the developing world (mainly by taking them out of the cold chain, that is often so much more difficult to maintain in the developing world). Really inspiring work! DS.
In China, the population over age 60 has reached 180 million. It is predicted that the number will be increasing every year by 5-8 million. Beijing, for example, has the number of elderly people accounting for more than 15% of the city population. In the meantime, due to birth control (one child policy) starting in 1978 – together with the fact that more and more young people are going abroad for work or studies – the number of households with only elderly people is increasing. Senior citizens living alone have become the main characteristic of the aging situation in cities such as Beijing and Shanghai.
The retirement age normally is 50 (for women) or 55 (for men) in China, which is relatively young comparing to the western countries. What do they do after they retire? Most elderly have to provide day care for their grandchildren since maternal leave is only 3-4 months, while kids could only start going to day care at the age of three. In fact, the elderly are taking care of their grandchildren day and night during working days and the kids only stay with their parents during weekends. So when the elderly are enjoying the company of grandchildren, they have to make efforts to take care of them too.
The neighborhood community plays a key role in daily life for the elderly, especially in urban areas. The community center is an ideal place for elderly living in the same neighborhood to gather together and play chess, exercise, etc. Recently, these communities would also be responsible for the day care services (i.e. meal delivery) for the elderly who lose self-care abilities and ensure health checkups of the elderly in the neighborhood.
Transportation is a dilemma, as it is both easy and hard for the elderly. Starting with Shanghai, several other regions such as Sichuan, Lanzhou, Hangzhou, etc. allow elderly people aged above 70 to take public transportation for free. However, if they wish to take a flight, a health certificate is required by most aviation companies.
Monthly pension is normally 1000-2000 CNY (157-315 USD). However, elderly people feel insecure due to low coverage of public medical insurance (from the government). So Chinese people generally save for retirement, meanwhile support from the family is also expected especially when they are sick in the hospital – since usually medical insurance is not enough to cover the costs. Furthermore, nursing service is normally expected from family members due to Chinese tradition and unsatisfying nursing services provided by public hospitals/nursing homes.
Nursing homes are more acceptable by the elderly now than they used to be. In the past, elderly going to nursing homes has been looked down upon, since normally only solitary aged individuals would have to go there and the service from nursing homes was poor. However, due to the trend of an oncoming inverted pyramid within the population – and the improvement of service – going to nursing homes is more acceptable by the elderly nowadays. By interviewing one private nursing home owner, it was observed that compensation on the nursing homes for the elderly requires several criteria. Non-profit nursing homes are either hard to get in or equipped with poor service – with 6-8 beds in one room and one nurse for 15-20 people, while private nursing homes would have rooms with single bed available. There are also newly built public nursing homes these years with better conditions, but it could take the elderly years in the queue system to get a spot. Another issue mentioned by the interviewee was the labor system. Running nursing homes needs employees take night shifts. However, the nursing home labor system doesn’t share the same one as the hospital’s, which has made the management of employees difficult.
The Fifth Social Welfare Institute is one of the best nursing homes in Beijing. It has 230 beds in total and the normal price is 1800 CNY per month per bed. It is equipped with designated medical care (which could be reimbursed), as well as different kinds of activity rooms for dancing, playing pingpong, calligraphy, reading, etc. The reasonable price and complete setting of the nursing home attracts lots of elderly people, however, the waiting time to get in could be years.
In short, after early retirement, the elderly in China rely on pension for the expenses on daily life. While when they get sick or more senior, support from the family will be needed. They enjoy having fun with the people at the same age in the neighborhood or in nursing homes. The number of nursing homes in China is far from enough due to the rapid aging population. Though, the bed occupancy rate might be low in private nursing homes. More affordable nursing homes with upgraded and reimbursable medical services are definitely required for the elderly population in China.
According to the WHO definition of Palliative Care: “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (WHO Definition of Palliative Care).
In Singapore, palliative care started as a grassroots movement in the mid-1980s to meet the needs of patients dying of cancer at home. The first home care team worked out of a university lecturer’s apartment in Gillman Heights. No doctors were trained in palliative care and there were limitations on the kind of care and setting where care could be provided.
Things changed a few years later. Singapore saw its first doctor trained in palliative care in the late 1980s. The first palliative care home provider – the Hospice Care Group – was formed in 1987. In 1988 Assisi Home and Hospice was established. This was followed by Agape Home and Hospice and the Hospice Care Association in 1989, Dover Park Hospice in 1995, Metta Hospice Care in 2001 and the palliative arm of Bright Vision Hospital in 2002. In 2007, the Lien Centre for Palliative Care was established to promote research and education in palliative care in Singapore and the region. Since 1996, the restructured hospitals have also been building up expertise to support palliative care for their patients.
Palliative care has now advanced to the point that it can help manage and stabilise patients’ symptoms, and reduce their suffering. Due to greater and more structured training opportunities for healthcare professionals (palliative care is a subspecialty of medicine now), and a steady expansion of palliative care services, even treatments such as blood transfusions and intravenous infusion can be provided to patients in hospice care.
Palliative care is primarily provided by hospices (at an inpatient, home, or day-care setting). There are four palliative care providers that offer inpatient hospice care, six providers that offer home hospice care and two that offer day hospice care.
Many restructured hospitals, as well as some community hospitals and nursing homes have also developed palliative care services, including to meet the needs of certain specialty groups, such as children (for example, in KK Women’s and Children’s Hospital). These services have largely evolved to meet the needs of patients admitted; the provision of palliative care services is not the main function of these institutions.
Palliative care is financed primarily by government subsidies and charity dollars. Most home hospice services are free-of-charge for patients. Day hospice services, hospital-based services, and inpatient hospice services are offered at nominal fees, which can also be partly or fully waived depending on the patient’s financial ability.
Palliative care education is provided by a variety of organisations and institutions. For doctors, palliative care is part of the undergraduate medical curriculum. Subspecialty training is also available for some residency programmes. Palliative care is also incorporated in the formal generalist nursing curriculum for nurses and there are options for them to obtain an advance diploma in palliative care at the polytechnics. A number of different training programmes/certificates on palliative medicine/care are also run by different organisations for all health professionals (doctors, nurses, pharmacists, social workers and other health allied workers).
Public awareness and understanding of palliative care is still quite low. Many people still associate palliative care with giving up hope and treatment. The Singapore Hospice Council recently launched a new community outreach program to increase public awareness of inpatient, home and day hospice services available for end-of-life patients here.
Healthcare providers’ willingness to discuss end-of-life care and dying is also low. Research suggests that, even in hospitals, there seems to be some unwillingness of both patients and healthcare staff to talk about the potential of death. Since 2009, health professionals have started utilising Advanced Care Planning (ACP) as a tool to start having open discussions with dying patients and their families. ACP is currently being piloted at a few restructured hospitals, nursing homes and other end-of-life programmes.
These changes as well as some others implemented suggest that although willingness to discuss death still remains low, there has been improvement over the last few years.
In late 2011, MOH commissioned the Lien Centre for Palliative Care at Duke-NUS Graduate Medical School to formulate a National Strategy for Palliative Care in consultation with key stakeholders in the healthcare system. The report reaffirms the important role of palliative care in the health sector as well as the importance of delivering such care in a coordinated and affordable manner. The report lists ten strategic goals and associated recommendations that address the importance of supply-side interventions such as training and ensuring adequate capacity as well as demand-side interventions such as the need for greater awareness and research. It also calls for greater leadership and governance to guide the development of palliative care services in Singapore.
MOH recently accepted the report on the national strategy for palliative care. Presently, the Government has committed to expand the workforce and hospice care services to make end-of-life care more accessible to patients by committing to:
- Incorporate a greater degree of palliative care training into courses offered in universities, polytechnics and Institutes of Technical Education.
- Expand public education drives and awareness of the services to the terminally ill.
- Promote specialised research and improve understanding of palliative care, by learning and adapting models used abroad.
- Set up an implementation taskforce to put the strategies set forth by the Report on the National Strategy for Palliative Care into action in a country-wide coordinated manner.
- Ensure that palliative care remains a key part of each regional health system.
Singapore’s ageing population and the effect it will have on epidemiological trends (increased burden of non-communicable disease, frailty and dementia, etc) and the subsequent needs required of the health system (increased demand for preventive services, long-term and end-of-life care), coupled with trends of increasing affluence, demand for more choices and declines in informal care-giving structures, suggest that the case for a greater role for palliative care, to meet the needs of patients who will face terminal illnesses, is strong.
Thus, a National Strategy for Palliative Care is welcome. To fully develop, palliative care needs more measures to promote the awareness of palliative care options, ensure that there are an adequate number of skilled healthcare professionals in the sector, introduce standards of care
across providers and settings, improve the coordination of care and ensure that there is adequate capacity to meet the demands for its care.
A greater role of palliative care will help increase the options, visibility, medical and social support for people facing end-of-life and enable decision-making based on preferences. It also allows for a more efficient use of resources for the health system.
HLC 2012. Briefing: Palliative Care in Singapore, July 26, 2012 version. Healthcare Leadership College, MOHH Holdings, Inc., Singapore.
Lien Centre for Palliative Care, Duke-NUH Graduate Medical School “Report on the National Strategy for Palliative Care,” Submitted to the Ministry of Health, Singapore, 4 Oct 2011.
World Health Organization (WHO). WHO Definition of Palliative Care .Accessed April 27 2012
 2011 Report on the National Strategy for Palliative Care http://www.dukenus.edu.sg/sites/default/files/Report_on_National_Strategy_for_Palliative_Care%205Jan2012.pdf