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Update From Modern Aging Singapore: Kickoff Workshop

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Modern Aging Singapore kicked off in the middle of August. So far, the program has seen active participation and support from aspiring entrepreneurs. About three hundred students, health practitioners, researchers, and members of the public attended the Kickoff Workshop held at the NUS I Cube Building Auditorium on the morning of August 15.

Attendees were treated to four presentations from experts in aging and business: Overview of Aging by Prof. Angelique Chan of Duke-NUS Graduate Medical School, Healthcare and Business by Dr. Jeremy Lim of Oliver Wyman, Home and Center Based Care by Dr. Ng Wai Chong of the Tsao Foundation, and Product Design for Seniors by Hunn Wai of design firm Lanzavecchia + Wai.

MA2Prof. Chan highlighted some key trends and statistics on aging in Singapore. One surprising point was the high prevalence of social isolation among seniors here. This finding spurred aspiring entrepreneurs to think of novel solutions to address this trend.

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Dr. Lim went on to outline the aging sector in terms of business potential. One suprising finding, according to theNational Center for Policy Analysis, is the average net worth in 2010 was 848,000 USD for sixty five to seventy four year olds and nearly seven hundred thousand dollars for those above seventy five. These figures encouraged aspiring entrepreneurs to enter the aging sector.

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Dr. Ng discussed the current status of home and center based care in Singapore. He highlighted specific needs in these care settings frequently used by seniors. This discussion allowed aspiring entrepreneurs to hone in on key areas of need and address these pain points. For example, some challenges in these settings include the quick and painless transferring of patients from bed to chair and vice versa, and increasing the time health practitioners can spend with seniors.

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Mr. Wai rounded off the presentations with insights from product and design perspectives. He introduced examples of good design for seniors, such as mixed use canes and walkers, or stylish back braces. This presentation especially inspired aspiring entrepreneurs to consider seniors’ lifestyles and tastes when introducing new product ideas.

In addition to expert presentations, attendees also heard two senior role models share their life experiences and lessons. Younger members of the audience seemed glad to hear the wise advice dispensed by the seniors. The kickoff event concluded with a networking lunch. Participants became so engrossed in conversations around aging that they lingered past the scheduled end time.

Currently, Modern Aging Singapore has progressed to the business curriculum and selection phase. The top twenty teams have been selected and paired with industry mentors to hone their business ideas. The twenty teams will soon be pitching at the semifinals judging event for the top six spots. Meanwhile, all participants of Modern Aging Singapore are able to access the same business and aging curriculum on the Modern Aging Online Learning Portal to continue learning and improving their business ideas. If you would like to access the Portal, please write an email request to info@modernaging.org.

Find out more about Modern Aging, at www.modernaging.org.

Informal Child and Elder Care in Singapore: South Central Community Family Service Center

At ACCESS Health International, we like to feature good examples of community and elder care. A recent visit to the South Central Community Family Service Center in Singapore reveals a thriving space where different generations of neighbors visit, work, and play with one another.

The South Central Community Family Service Center is located in the southern part of Singapore. The Center is shown as a red dot on the map.

The South Central Community Family Service Center is located in the southern part of Singapore. The Center is shown as a red dot on the map.

The South Central Community Family Service Center is just one of many other Family Service Centers in Singapore. Family Service Centers are an important part of the “Many Helping Hands” approach of the Singapore government toward social services. The Many Helping Hands approach emphasizes the involvement of multiple sectors in providing for the social welfare needs of people. Family Service Centers are run by Voluntary Welfare Organizations and are supported by the Ministry of Social and Family Development, the National Council of Social Services, Community Chest, or the Singapore Totalisator Board [1]. This is one way the government supports and encourages care provision by nongovernmental entities.

The South Central Community Family Service Center is unique in one respect. In January 2013, the Center became an independent entity with its own board of directors. The mission of South Central Community Family Service Center remains the same: to promote the wellbeing and self reliance of families. The main focus is supporting lower income individuals and families in the Bukit Ho Swee, Henderson, Redhill, and Indus Road neighborhoods. Between 2013 and 2014, the Center managed an average of four hundred cases. Casework involves counseling or referral to specialized services. For example, children from families lacking in basic necessities may face challenges in schoolwork or dealing with classmates. Center staff can counsel children or their parents on managing these problems. Where necessary, families are referred to other services, such as specialized psychiatric help or financial aid.

The entrance was decorated with cheerful cartoon sheep to welcome the year of the sheep.

The entrance was decorated with cheerful cartoon sheep to welcome the year of the sheep.

Besides casework, another focus of the Center is community engagement. To this end, Center staff organize events to involve nearby residents and create community spirit. As the Center is located on the ground floor of a block of residential flats, it is accessible and open to residents in the neighborhood. Our visit took place during the Lunar New Year period. As seen in the photo, festive decorations lining the entrance created a welcoming and friendly atmosphere.

Outreach worker Erwin showed us around the Center. Erwin explained to us that a guiding principle for the Center and staff is community cooperation and participation. This principle is informed by the Asset Based Community Development approach to community work. This approach ensures sustainability because initiatives are driven by the residents themselves. Residents volunteer to help care for their neighbors’ elderly relatives or children. Residents worked together to plant a community garden full of useful medicinal herbs.

Residents take ownership of the community garden and bond while caring for the plants. (Photo: South Central Community Family Service Center)

Residents take ownership of the community garden and bond while caring for the plants. (Photo: South Central Community Family Service Center)

The Center is a collaborative environment. The community garden is a visible fruit of this collaborative environment. The garden had been an empty space in front of the Center. Center staff wanted to galvanize residents to work on a common project. Residents contributed ideas and voted for the winning project: a medicinal herb and vegetable garden. Because the idea came from residents, the garden has been adopted and cared for by residents.

Residents contribute ideas to keep the garden fresh and growing. Residents can vote for the next plant type by placing a marble in the respective bottle.

Residents contribute ideas to keep the garden fresh and growing. Residents can vote for the next plant type by placing a marble in the respective bottle.

In the picture above, one can see a board where residents can vote on the next plant type. At the time of visit, sweet potato leaf was the leading candidate. The board itself was constructed by hand by a resident who is a carpenter by trade.

The Request and Offer board matches community resources to areas of need.

The Request and Offer board matches community resources to areas of need.

Inside the Center hangs another board, where residents can request items or services they need, or post offers of items or services they can give. The platform helps match community resources to people who need them most.

Residents streamed in and out of the Center throughout our visit. Erwin pointed out a pair of young siblings playing games on the couch. Erwin told me the siblings come to the Center after school ends to wait for their parents to get off work. I also saw groups of elderly chatting with one another at tables and chairs. The open space created by the South Central Community Family Service Center helps with informal child and elder care as residents look out for and engage with one another.

Outreach worker Erwin, in gray, briefs volunteers on a house visit activity.

Outreach worker Erwin, in gray, briefs volunteers on a house visit activity.

Near the end of our visit, there was a briefing for a large group of about twenty five volunteers, both young and old. They were preparing to give out yusheng packs to shop owners and residents at the Lengkok Bahru neighborhood. This showcased lower income families and children as goodwill ambassadors as part of this “Lo Hei Outreach”. The yusheng salad is traditionally eaten during the Lunar New Year, and Lo Hei is the dialect term for tossing the salad. Family and friends gather to Lo Hei together, signifying prosperity and togetherness. The briefing was punchy and positive with the staff recognizing the contributions of volunteers.

The South Central Community Family Service Center is an example of successful informal community and elder care. The staff and volunteers have created an open venue where residents are encouraged to join community activities and contribute their talents. Can their model of community involvement and ownership be replicated elsewhere? For example, could elder care as a larger industry move toward being more community based and operated? Share your thoughts with us by leaving a comment.


1. The Singapore Totalisator Board, also known as Tote Board, manages the surplus funds generated by Singapore Turf Club and Singapore Pools. They channel funds in support of various causes in Singapore such as arts and culture, social services, community development, education, health, and sports.

A New Perspective: Design Thinking for the Elderly

This post is the first in a series of articles focused on design thinking and aging. In future posts, we will explore the use of personas in designing solutions for seniors. We will also address problems identified by seniors themselves.

Imagining the ecosystem surrounding seniors in Singapore. Examples given are not exhaustive.

Imagining the ecosystem surrounding seniors in Singapore. Examples given are not exhaustive.

Last week, the ACCESS Health Singapore team attended a DesignSingapore forum titled Rethinking Health and Wellness for the Elderly. Among the fresh perspectives and opinions shared at the forum, one point really stood out to us: Often, designers who design products for seniors view seniors as isolated individuals. In reality, the elderly live and interact with others in their families and communities, such as family members and health professionals. They engage others in their external environment multiple times throughout the day: when getting coffee, seeing their neighborhood doctor, seeing specialists at hospitals, visiting community centers, going to the supermarket, and even through online sites and discussion boards. Behind these interactions, or touchpoints, lie many higher level entities that share an active interest in the wellbeing of the elderly, such as ministries or charities.

This learning point came from applying design thinking and ethnography to aging. One principle of design thinking is that all design activity is social in nature. Ethnography aims to explore social phenomena from the point of view of the subject, in this case seniors. At the forum, videos were shown of interviews with various seniors and their caregivers. These seniors and caregivers were asked what challenges they faced in daily living. Beyond these answers, researchers also followed the seniors on their daily activities, like cooking and exercising, in true ethnographic fashion.

In one clip, a frail senior was shown cooking for himself. His legs are weak so he sits on his wheelchair at the stove. But this position is often low and awkward. Upgrading to an adjustable height chair could make cooking easier for him.

A video still showing a senior cooking. An adjustable height chair could make cooking easier. (Photo: DesignSingapore)

A video still showing a senior cooking. An adjustable height chair could make cooking easier. (Photo: DesignSingapore)

One woman interviewed in the video had left her job to care for her father full time. Even while providing fulltime care, she said, there are moments when she cannot be there, physically, to catch her father if he falls. Such personal examples peppered the forum, turning abstract issues into real and moving stories.

When we think of the people, places, and organizations seniors interact with, many opportunities come to light. One senior featured in the video had lost his leg to amputation due to diabetes. After being fitted with a prosthetic, he still found it tiring to navigate his neighborhood. He told the interviewers that he was truly glad to receive a motorized personal vehicle from a welfare organization. Some limitations remain. Narrow corridors and places without ramps are inaccessible to him. However, he is now able to take public trains and go shopping, everyday tasks that would have been nearly impossible before. The motorized vehicle has improved his quality of life. In this case, an organization found a solution that has allowed this senior to engage more with the people and places around him.

A motorized personal transport like the one pictured can help seniors unlock and explore more of their community and environment. (Photo: Free Images)

A motorized personal transport like the one pictured can help seniors unlock and explore more of their community and environment. (Photo: Free Images)

Engaging ethnography and design thinking for the elderly may seem unconventional. But some researchers acknowledge the benefit of taking into account social and environmental aspects of aging. A recent BMJ article reviewed existing ideas and concepts of Successful aging refers here to physical, mental, and social wellbeing in older age. The authors found that traditional conceptions of successful aging focused largely on individual bodily health. For example, the Activities of Daily Living scale tests a senior’s ability to complete a basket of self care tasks. These tasks include feeding, toileting, and grooming.

The authors found in their review that psychosocial and external factors are important to successful aging too. Yet, the authors found that these factors are underrepresented in traditional models of successful aging. For example, the Activities of Daily Living scale does not measure social activities such as holding a conversation or enjoying a sport outdoors. The authors wrote, “[Successful aging] is clearly not simply a physiological construct, so it seems intuitive that psychosocial components should be included in otherwise biomedical models of [successful aging].” The authors concluded that conventional models for aging can benefit from including social and external components of seniors’ lives.

Design thinking and ethnography can be applied at all levels of the ecosystem surrounding seniors. Consider seniors, the people they interact with, the people and places they engage with, and the organizations that help support them. Imagine a senior living out a typical day in this environment. What gaps and opportunities do you see? Are there any potential collaborations between organizations? We feel these added perspectives will help craft more targeted, efficient products and solutions to help seniors.

Taking a Cue from Lee Kuan Yew on Aging Well

Mr. Lee celebrating his seventy seventh birthday with his wife, Kwa Geok Choo, on September 16, 2000. (Photo: Edward Wray, Associated Press)

Mr. Lee celebrating his seventy seventh birthday with his wife, Kwa Geok Choo, on September 16, 2000. (Photo: Edward Wray, Associated Press)

Lee Kuan Yew, the founding prime minister of Singapore, passed away on Monday morning. As the first prime minister, Mr. Lee helped shape many policies in the formative years of independence. As the Singapore population matured, aging became an issue of concern for Mr. Lee. He shared some personal views on aging at a forum in 2010, when he himself was close to ninety.

Mr. Lee said, “I think the most important single lesson I learned in life was that if you isolate yourself, you’re done for. The human being is a social animal – he needs stimuli, he needs to meet people, to catch up with the world.”

Mr. Lee also said, “You must have an interest in life… If you’re not interested in the world and the world is not interested in you, the biggest punishment a man can receive is total isolation in a dungeon, black and complete withdrawal of all stimuli, that’s real torture.”

Indeed, part of aging well is maintaining social support and engagement in activities. Population trends in Singapore indicate that, in the future, many more elderly will be single and living alone. We must create opportunities to help these elderly avoid isolation.

How can this be done? Many are thinking of solutions. The ACCESS Health Singapore team spoke to a professor in architecture. She explained to us that simply adding a small space to common corridors for residents to sit and mingle can draw them out of their flats. Eventually, she said, the residents may venture down their blocks and into the community.

There must be other ways to help our elderly age well. People from all sectors are thinking of novel ways to make a difference in the Singapore silver industry, a promising development. Mr. Lee’s advice was for individuals to take an interest in the world and to avoid isolation. How we can help is to think of creative ways to encourage these individuals to do so.

Perhaps then we can live out Mr. Lee’s wish, “Have a purpose driven life and finish well, my friends.”

The Challenges from the Chinese “421 Family”

Entering the era of the first generation (those born in the 1980s) of the “one-child policy” parents, “421” has become the typical family structure and challenge for Chinese society.

What is a “421” family structure? It is an inverted pyramid family structure, composed of 4 grandparents, 2 parents, and 1 kid in a closely bonded Chinese family.19300000312288133370361297173

Those who were born in the 1980s were once seen as the happiest generation since they were the only kids in the family and were raised and perhaps spoiled as princes and princesses in the family by parents. It was easier for these children to enter colleges than their parents’ generation since the expansion of universities across the county occurred during that time. However, these “princes” or “princesses” also felt an increasingly unprecedented pressure by the time they grew up. The universities did expand and allowed more students than before, while job openings didn’t increase accordingly by the time they graduated. In recent years, when these children started to build up their own families, they found it even more difficult to get an economical apartment, raise a kid, or support their parents who were getting old. Most of the children of the 80s thus came to call themselves “slaves to housing, kids, credit cards, and elderly parents.” This was due to the national situation as well, as housing is extremely expensive in the most populous cities such as Shanghai or Beijing. Education for kids is costly. When the “grandparents” would get old enough, the “parents” would have to be ready to take care of the elderly both financially and in terms of physical and mental health — due to the Chinese culture, as well as limited pension funds from the government.

Elderly homes are not welcomed by the elderly in China. One of the main reasons for this is due to their unsatisfying service and high prices. In addition, according to the traditional Chinese culture (bringing up children for the purpose of being looked after in old age), being delivered to the elderly home has made the elderly people feel they are left out or ditched by the family. On the other hand, the “empty nest elderly” has reached over 30% on average in big cities, or even more than 50% in some individual cities.

As the most populous country in the world, the number of elderly people has reached over 141 million, which makes it the country with the most elderly people in the world as well. It accounts for ⅕th of the global elderly population, and half of the Asian elderly population. Generally, the reasons of the trend of elderly society are: the extension of life expectancy, the decrease of the birth rate, and the decrease of the mortality rate. However, for China, the three main causes are happening all together and on extreme levels. The “one child policy” since 1978 was a sudden change for China after the populous number of births during Mao’s era.  Together with the decrease of mortality which was brought by the development of the economy, it took only 18 years for China to change into an “elderly country” from an “adult country,” which was an extremely fast transition when compared with high-income countries. China is facing a severe challenge with the aging society.

In most high-income countries, urbanization and industrialization come together with the aging situation. When the seniors (people aged over 60) reached 10% of the total population, their GDP per capita generally reached 10,000 USD or more. They became rich before they grew old. Unfortunately, for China, it is the other way around.

As recognized in international standards, an aging society is defined as the following: over 7% of the total population having reached the age of 65, or over 10% of the total population having reached the age of 60. In this case, China has become an aging society since 2000. However, there are only around 40,000 elderly homes with 1.6 million beds, which means there are only less than 9 beds for every 1,000 elderly people who are aged 60 or above.

As for the support from the next generation, as mentioned earlier, there will be a very long time for the country to move forward when “two young people are taking care of four old people.” In addition to young people’s pressure to survive, and the family separation in different cities or countries due to urbanization, traditional family support would be very difficult to implement.

The change of the economic level, population structure, and the traditional concept of family support or traditional elderly life have brought people to start thinking. Nowadays topics like the methods of generating or expending the pension, the extension of the retirement age, etc. were hotly debated in China. People are all aware of the changes. But how much can they accept the changes, especially for the elderly people? Can they be emotionally independent enough from their kids like the westerners? Even if they can, would the society be able to provide the facilities or benefits for the elderly after they’ve contributed to the society for several decades?

Of course, effort from only one side would never be enough for a country like China especially when it comes to such a big change. In the “421” family, the “2” are still trying to support the “4” in every way they can while taking care of the “1.” The “4” are also doing best they can for themselves to be independent and to try to accept all the changes they never thought would happen. There are some 50-60 people initiating online that they could build up a small elderly home to live together and take care of each other. From the society, there are also proposals that “flexible retirement” might work instead of compulsory early/late retirement. People or companies could choose the best for themselves, since each industry is different after all. There is no rule that applies to all.

References:

http://biz.cn.yahoo.com/10-09-/139/y9ar.html

http://biz.cn.yahoo.com/10-08-/127/y4am.html

http://zxz.rednet.cn/c/2007/05/18/1205173.htm

How Singapore is preparing for future elderly care

Affordable Excellence

William A Haseltine, President of ACCESS Health International, has written a book called “Affordable Excellence: The Singapore Healthcare Story. How to build and Maintain Sustainable Healthcare Systems”. For anybody interested in policymaking regarding elderly care, the last chapter about how Singapore is planning for the future, is of particular interest and well worth reading. This chapter explains why it makes sense for other countries to watch and study what Singapore is doing to prepare for a major increase of elderly in the population. The chapter gives an understanding of the demographic challenges that Singapore is facing and goes through all major initiatives that are undertaken to address these challenges, both public and private.
The book is published by the Brookings Institution and National University of Singapore Press and can be downloaded at no charge from the ACCESS Health website and from Amazon as an e-book, also at no charge.
Source:Affordable excellence : the Singapore healthcare story : how to create and manage sustainable healthcare systems / William A. Haseltine. – Singapore : Ridge Books, c2013.

Let the cyber knife take away your pain

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.

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Cyber knife surgery abroad:
http://www.medicaltourismco.com/oncology/cyber knife-cancer-radiotherapy-overseas.php

Cyber knife Treatment for Spine Cancer
http://www.medicaltourismco.com/south-korea-hospitals/cyber knife-surgery-korea.php