Ms Ang Bee Lian, 31 July 2018
With improvements in science and health, people now live longer. This means that there will be more older persons in society and a greater number of older persons with disabilities. Longer life expectancies and reduced fertility rates can mean more generations alive, but it also results in a reduction in the availability of familial care and support for the oldest-old. As a result, various segments of society such as families, care agencies in the community and the private sector will increasingly have to play a part in caring for the elderly.
The size of the elderly Singapore resident population has increased substantially over the last decade with the proportion of residents aged 65 years and over increasing from 9.0% in 2010 to 13.0% in 2017 (Department of Statistics, 2017). It is estimated that the elderly population will grow by about 450,000, to 900,000 between 2018 and 2030 (Budget 2018, 2018). In 2030, the senior support ratio is also likely to be halved from 5.7 to 2.1 adults supporting one elderly person.
Trends in the past decades have resulted in structural transformations in family composition, community support networks and labour force participation. This poses stress and strain on the availability of family members and other informal supports to provide the assistance needed by the growing numbers of elderly. Changes in household patterns have also resulted in caregivers and care recipients being less likely to live with or near one another. Assistance is therefore more likely to be focused on instrumental tasks such as meal delivery, transportation and household chores, with grassroots volunteers and neighbours playing an increasingly significant role. For some family members, they serve as intermediaries between disabled elderly family members and formal care providers. In a sense, they are increasingly assuming the role as care managers, providing care management tasks such as service coordination, linkage, brokerage and information transmission including health conditions.
As a principle, most countries aim to reduce the use of nursing homes and other expensive residential settings by promoting home and community-based care. As much as possible, an older person with a disabling accident or illness will be rehabilitated and enabled to return to live in the community with services from voluntary organisations and the community. Generally, older persons prefer to reside in their own homes and within the community rather than in a more restrictive institutional setting. As such, to some extent, the move towards home and community-based care upholds individual autonomy and personal control. This move must however be accompanied by ensuring that there are resources to develop concomitantly the range, availability and affordability of community-based support services. It is important for there to be sufficient community resources and support to ensure a seamless and uneventful transition back from the hospital to the community.
In recent years, technological innovations have made it possible for various devices to be used at home to facilitate care giving. For example, telemedicine has made it possible for ongoing evaluation of patients in their homes. Such efforts lessen the stress from transportation and the crunch on time in care giving.
Technology today also has the tools to provide in-home and community monitoring and response systems to deliver both pre-emptive and responsive healthcare interventions. For example, multi-modal sensors and devices can track the whereabouts of older persons, creating alerts to trigger a medical response when needed. Wearable technology such as RFID1-tagged slippers can prevent falls or avert dementia patients from getting lost. Gloves fitted with gyroscope and sensors can even combat hand tremors in those with conditions such as Parkinson’s disease. Robotics and sensing technology can help detect feelings such as joy, sadness and anger. They can be used to conduct exercises, to enable basic cognitive tasks, and as a form of therapy for depressed older persons.
Technology has expanded the care options available for older persons and we should start tapping on such technology where possible to facilitate their care.
Our policy approach reflects the view that families should have the primary responsibility for caring for and coordinating the needs of dependent members. However, the challenge is in determining the reasonable level of support to expect from families and at what point of frailty and deterioration of health.
With our ageing population, the number of caregivers will be on the rise in the years to come. They are an important source of care and help for the elderly and should not be overlooked. Practitioners should not only help caregivers who reach out for help but be on the lookout for those who do not ask for help but are in need of help. Practitioners can intervene by providing information on services and programs that provide respite care for caregivers, organising family meetings to discuss caregiving responsibilities and stresses, connecting caregivers to support groups or other caregivers and providing resources for financial management and planning, as well as financial assistance (Nguyen, 2012). These interventions should be done in a timely and sensitive manner so that caregivers do not feel even more overwhelmed.
In addition, practitioners can introduce the use of technology, especially the readily available mobile technology, into the support system. The aim can be to tailor solutions for individuals and deliver services with the help of digital technology including digital alerts.
Here are a few useful considerations for practitioners or caregivers who work with older persons on matters concerning ageing:
It is important to give older persons choices. Each individual is unique, with different tastes and backgrounds. Some may want to dance and dabble in adventurous activities such as trekking while others may want to sign up for courses to acquire new knowledge and skills. There are also more avenues made available in recent years for seniors to pursue their passions. For example, seniors can tap on their Skillsfuture credits to take up various courses such as those offered by the National Silver Academy. Ultimately, all of us should be empowered with the opportunity to live an active life. As the Englishman George Bernard Shaw once said: “We don’t stop playing because we grow old; We grow old because we stop playing!”
While many older persons look forward to their golden years, others face different challenges as they age. It is not uncommon to hear of older persons having depression or suicidal ideation. This is usually due to loneliness, poor health or financial anxiety. Besides facing mental stress, older persons are also often easy prey for criminals and victims of ageist attitudes.
Overcoming these mind sets and challenges will require everyone – the government, the community, families and individuals – to play their part. As the government continues to reach out to caregivers and seniors with information and services, society also needs to correct the common misperception that ageing is a physically and mentally deteriorative process and to continue to promote ageing as an active and progressive stage of life. We need to work together to create a community where the elderly are treated with dignity, embraced and included in the progression of society. This will take time and there is much that we, as individuals, can do to make a difference in the lives of the elderly.
Besides exercise and health screenings, the less spoken yet important contribution to wellbeing is having a network of relationships with family and friends. The network is a good insurance for lifting older persons up when they are down or in need of support. The Council for Third Age was set up to promote the importance of growing old with purpose and meaning. Its activities provide avenues for people to meet and keep in touch.
The local community plays a large role in enabling ageing in place by helping to ensure continuity of care. We need to strive towards finding the appropriate balance in providing services by sharing the responsibility of both delivering the services and the cost of care among the individual, the family, the community and the state. The partnership will evolve as we continue to calibrate the range and extent of services that will be provided. With various segments of society working together, we can create an inclusive environment for our seniors to thrive in their silver years.
1Radio Frequency Identification Devices
Department of Statistics. (2017). Population Trends. Singapore: Department of Statistics.
Budget 2018. (2018). Budget Speech. Retrieved February 23, 2018, from http://www.singaporebudget.gov.sg/data/budget_2014/download/annexb1.pdf
Download the full letter here
MS ANG BEE LIAN
Director-General of Social Welfare