Seniors

Overview

This overview provides a synopsis of the current knowledge base. Having considered all the information, we make sense of it by taking a stab at the following: 1) What are the priority issues that deserve attention, 2) What are opportunity areas that community or voluntary organisations can already take action on, and 3) What knowledge gaps deserve further investigation?

Priority Issues

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Actionable Opportunity Areas

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Knowledge Gaps

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Definitions

Definition of Seniors

• Identify and define your target group or social issue, and state who is included or excluded to provide a sense of the scope of the issue. (For example, will the page on Animal Welfare include livestock? Or just focused on pets, community animals and wildlife?)
• It is usually easier to start with national guidelines, laws or reports from apex organisations.
• Include a comparison with how other countries define the issue if possible (e.g. Local definition of Disability does not include mental health conditions)

Definitions and Models of Aging

• Chronological aging is the common view of aging, and is based on the number of years lived from birth. However, it is problematic as someone who is 40 years old today lives differently from someone who is the same age many years ago.
• An individual can experience other forms of aging. Physiological aging refers to the physical changes that reduce the efficiency of organ systems. Psychological aging refers to mental changes in sensory and perceptual process, cognitive abilities, adaptive capacity and personality.
• Within the society, an individual has several roles. Over time, an individual may experience social aging, where there are changes to his/her roles and relationships with others and in organisations.

What counts as successful ageing?

Current models of aging are aimed at facilitating successful aging, with success being defined in various ways. There are different goals of ageing which are promoted, such as healthy ageing (Kalache & Kickbusch, 1997), active ageing (World Health Organization [WHO], 2002), successful ageing (Rowe & Kahn, 1987), and productive ageing (Butler, 1983).

• Healthy Ageing: Healthy ageing adopts a biomedical view and serves as the baseline for what one should achieve in later life. It is defined as “the process of developing and maintaining the functional ability that enables wellbeing in older age” (WHO, 2020). According to this model, older adults should monitor their health to achieve health maintenance.
• Active Ageing: Later on, WHO developed the model of active ageing to further the healthy ageing agenda. WHO defines active ageing as “the process of optimizing opportunities for physical, social, and mental well-being throughout the life course to extend healthy life expectancy” (Kalache, 1999, p. 299). This model expands beyond the maintenance of bodily health functions to incorporate social participation as an important component of later life (Kalache & Kickbusch, 1997).
• Successful Ageing: The most comprehensive model is “successful ageing”, which goes beyond health and social activity emphasised by healthy ageing and active ageing respectively and incorporates productive activity. According to this model, older adults should first have a low risk of diseases and disease-related disabilities, then maintain a high level of mental and physical functions, and finally, remain engaged in social and productive activities (Rowe & Kahn, 1987). The model has received many critiques (Masoro, 2001; Stowe & Cooney, 2015), which can be grouped into four categories: 1) “missing voices” which call for more subjective components; 2) “add and stir” which call for expansions to the model; 3) “hard hitting” which demand more inclusive definitions and less stigmatisation; 4) “new frames and names” to correct or replace Western cultural bias (Martinson & Berridge, 2015). Rowe & Kahn (2015) responded with a revised model of “successful ageing 2.0”, which focuses on the societal level and recognises the importance of environmental factors in shaping later lives. The revised model suggests three main goals: 1) reengineer core societal institutions for an ageing society; 2) adopt a life course perspective to adjust the old roles at life stages; 3) focus on human capital to capitalise on the longevity dividend (Rowe & Kahn, 2015).
• Productive Ageing: In recent years, the model of productive ageing has been gaining traction in the field. The term “productive ageing” was originally coined to highlight the contributions of older adults in the United States and counter ageist perspectives. Unlike the other models which are ego-centric, the productive ageing model is relational. It emphasises the integration and engagement of older adults in activities that contribute towards their health, family, community and society (Butler, 2002; Morrow-Howell & Wang, 2013). Productivity can occur in both paid and unpaid work (https://www.csc.gov.sg/articles/reimagining-productive-longevity#notes), and according to empirical studies, productive activities are “those that produce goods and services”, such as working, caregiving, and volunteering (Butler & Gleason, 1986; Morrow-Howell et al., 2001)

Key Statistics & Figures

• 305,586 Singaporeans aged 65 and above in 2007. In 2017, 516,692 older Singaporeans. This fast pace of ageing is due to the large cohorts of post-war baby boomers getting older. The first cohort of baby boomers turned 65 in 2012.
• Advancements in healthcare and medical technologies have also increased Singapore’s life expectancy. 50 years ago, a 65-year-old person could expect to live approximately eight years more. Today, a person who is 65 can expect to live another 21 years on average.
• By 2030, the number of Singaporeans aged 65 and above is projected to double to 900,000. That means 1 in 4 Singaporeans will be in that age group, up from 1 in 8 today. (https://www.population.sg/articles/older-singaporeans-to-double-by-2030)

Map of Key Needs & Issues

[This table and arrows acts as a kind of visual map that allows a sense of sequencing; of the broad preconditions necessary for longer term outcomes to be achieved. Hyperlink the categories below to the specific page or sub-header in the page for easy navigation, so that you can click on 'Employment' below for example, and get straight to that page / segment]

Click the links below to go directly to specific areas of interest:

		Health & Well-being / Active Ageing Exercise Nutrition Wellness	↘
				Family & Caregiving Grandparenting & Intergenerational exchange	↘
						Social Inclusion Ageism Mobility & Access	→	A Good Death / End of Life
				Community Participation & Integration	↗
				Housing & Living Arrangements	↗
				Financial Security [Links to separate page on financially vulnerable seniors] Financial crisis / abuse Financial capability / Employment Financial Planning & Management	↗
		Lifelong Learning	↗

Sub-pages

• Dementia (to cross-link from Mental Health too)

Areas of Needs / Desired Outcomes

Health and Well-Being

• Desired Outcome: [To insert]
• Synopsis:
  • Gap between intent and action wrt healthy lifestyles: recognise the importance of health but do not take action.
  • High variance in estimated prevalence of nutritional risk among the elderly in Singapore, from 30-70% (see below) but actual rates are quite low.
• Statistics: [To insert]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Physical Exercise	Gap between intent and action wrt healthy lifestyles: recognise the importance of health but do not take action.
Nutrition	High variance in estimated prevalence of nutritional risk among the elderly in Singapore, from 30-70% (see below) but actual rates are quite low. Inconsistent definitions/standards of undernutrition Personal factors for undernutrition Institutional factors for undernutrition	Need for standardized measure (Chen et al., 2001; Lim, 2010; Pirlich & Lochs, 2001)
Wellness

Exercise

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Gaps & Their Causes

• When asked how often they exercise for 20 or more minutes in a week, four in ten respondents say they do so less than twice a week and three in ten do so two to three times a week. Only two in ten indicate they regularly exercise for the duration and frequency recommended by the American Heart Association and other health organisations including Singapore’s Health Promotion Board (HPB)—30 minutes a day, five or more days a week, or 150 minutes a week. (https://readyfor100.economist.com/wp-content/uploads/2019/07/20180924-ECO035-Ready-for-100-Whitepaper-Spread.pdf)

Nutrition

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Gaps & Their Causes

• Estimated prevalence of nutritional risk among the elderly in Singapore:
  • 35 to 60 percent of the community-dwelling Chinese elderly (above 55 years old) faced nutritional risk (Yap, Niti, & Ng, 2007
  • Higher prevalence rate of approximately 70 percent of 193 free-living older adults (above 50 years old) facing nutritional risk (Tay et al., 2016)
  • A more conservative estimate that is generally accepted by the medical community: a 30 percent rate of nutritional risk across the elderly population (Lim et al., 2012)

• Actual undernutrition
  • Study of low-income, free-living elderly people (above 55 years old) on the Public Assistance (PA) scheme found a low prevalence rate of malnutrition of only 2.8 percent, even though 50.3 percent were estimated to be at risk (Koo et al., 2014)
  • A third of older adults admitted to acute care were malnourished, indicating the existence of a high-risk group within the community prior to hospital admission (Lim, 2010). Findings are limited to elderly people with preexisting medical conditions, and little information could be derived on the nutritional health of the elderly in the wider community.
  • HPB (2010) on undernutrition
• Inconsistent definitions/standards of undernutrition (Chen et al., 2001; Lim, 2010; Pirlich & Lochs, 2001)
  • Measures commonly used to help assess undernutrition include the recommended dietary allowance (RDA) or the elderly person’s calculated energy requirements. However, these measures might be unsuitable, given the elderly’s significant physiological and health differences from the general population. In general, energy requirement also tends to be a poor gauge of nutritional health. The lack of clear standards for what constitutes elderly undernutrition has led to the use of different modes of assessment across studies, creating inconsistencies in the reporting of estimates of prevalence and risk in studies
• Personal factors for undernutrition
  • Loss: physical and psychological wellbeing; deteriorating metabolic and sensory functions, oral health, mobility, financial stability
  • Loneliness: meal as a social activity
  • Chronic illnesses
  • Lack of knowledge
• Institutional factors for undernutrition
  • Inability to reach out to key (non-gov) stakeholders
  • Resistance to change: lack of enforcement (in relation to non-gov institutions’ KPIs), occupational and linguistic differences (between trainers and caregivers, community chefs)
  • Lack of resources: budget for meals, in-house dietician

Wellness: Psychosocial

• People’s Association Wellness Programme (https://www.pa.gov.sg/our-programmes/active-ageing)
• Council for Third Age
• Senior Cluster Networks
• Community Support (https://www.csc.gov.sg/articles/transforming-community-care-in-2030)

Family & Caregiving

• Click to page on Caregivers

Grand-parenting and Intergenerational Exchange

• Desired Outcome: [To insert]
• Synopsis: [To insert]
• Statistics: [To insert]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Category A
Category B
Category C

Category A Programmes

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Category B Programmes

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Category C Programmes

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Housing and Living Arrangements

• Desired Outcome: Ageing in place (?)
• Synopsis: [To insert]
• Statistics: [To insert social isolation figures]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Ageing in Place Support Foreign Domestic Worker Support? [Trying out what might be categories we can use] Housing-related Grants?	While ageing at home may be ideal for seniors, it is only feasible if at least one of the following two conditions are fulfilled: (a) the senior has caregiver support from family members and/or foreign domestic helpers (See, 2014) and; (b) the senior remains relatively healthy and mobile. The most common alternative to ageing at home is institutionalisation, a view that is said to be “simplistic and two-dimensional” (Lim, 2016). Therefore, nursing homes remain the main option for those who suffer from mild impairment, live with family members without the time or nursing expertise, or for those living alone who are unable to hire a full-time helper (Tai & Toh, 2016).
Nursing Homes Private Voluntary Sector / Social Service Agency	The manpower shortage and high turnover rates did not merely affect daily operations; these problems also had an impact on resident engagement, which involved manpower as well. Nursing home staff tended to be foreigners who were unable to speak the languages that the elderly residents spoke. However,  communication may become less of a problem for future generations of residents who would be better educated and familiar with English VWO-run nursing homes and private nursing homes, differences in levels of dignity? Staff and nurses’ perspectives vs residents’? Existing frameworks to assess quality of care focus mostly on the clinical aspect (Donabedian, 1988; Glass, 1991; Gustafson, Sainfort, Van Konigsveld, & Zimmerman, 1990).	Empower residents to enhance their dignity-conserving ability Care and treatment: improve communication and feedback channels between management and residents, provide more flexibility in timetable Interests, skills, and passions: modify according to individuals, enabled through communication and profiling and creation of interest groups, engaging wider community Changing the social climate to improve social dynamics Culture of care through communication and staff welfare Culture of (dis)trust through big data Need for more holistic approach to research on living arrangements, that take into consideration emotional, social, and spiritual needs, on top of medical, clinical ones [Wondeirng for longer and detailed explanations of solutions and models, whether we should integrate into this wiki or insert google doc, eg a google link to holistic models of care here?]
Category B
Category C

Ageing in Place Support

• [insert all the HDB related grants here; if there is a good place that HDB already summarizes this, you simply have to hyperlink to that page and give an overview. If there isn't the table you compiled and be inserted here]
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Nursing Homes

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Category C Programmes

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Community Participation and Integration

• Desired Outcome: [Participation in social activities, volunteerism, etc ]
• Synopsis:
  • Can reduce social isolation
• Statistics: [To insert social isolation figures]
  • Childless seniors: https://www.ricemedia.co/culture-people-elderly-orphans/
  • Social isolation more prevalent among single men; those under home care services
  • Senior volunteerism rates

Existing Programmes	Gaps & Their Causes	Possible Solutions
Category A		Identify block champions Levarage organically formed subgroups Challenge existing locations Reframe retirement. Gendered, socioeconomic differences in existing conceptualisations.
Senior Volunteerism [from your 'Productive Ageing' segment]	Seniors are aware of societal needs but doubt their ability to help (NVPC, IGS 2018).
Category C

Category A Programmes

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Senior Volunteerism

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Category C Programmes

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Lifelong Learning

• Desired Outcome: [To insert]
• Synopsis: [To insert]
  • Learning is negatively associated with age, not unique to SG
  • Learning is positively associated with educational attainment
• Statistics: [To insert]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Category A	Lack of time, confidence, skill levels
Category B
Category C

Category A Programmes

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Category B Programmes

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Category C Programmes

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Financial Security

• Click link to separate page on Financially Security

Social Inclusion

• Desired Outcome: Need to counter social and cultural myths about aging; ageist attitudes
• Synopsis: [To insert]
• Statistics: [To insert]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Countering Ageism		AARP's Disrupt Aging initiative
Category B
Category C

Countering Ageism

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Category B Programmes

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Category C Programmes

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End of Life

• Click link to separate page on End of Life

Resource Directory

Geriatric Education and Research Institute - GERI

http://geri.com.sg

A geriatric Institute based in Singapore to conduct research and education on age-related health issues to promote healthy ageing.

Tan Tock Seng Hospital's Institute of Geriatrics and Active Ageing - IGA

https://www.ttsh.com.sg/IGA/

Temasek Polytechnic’s Centre for Applied Gerontology - CAG

http://www.tp.edu.sg/centres/centre-for-applied-gerontology

Silver Horizon Travel

http://silverhorizontravel.com/

cooperative formed by seniors for travel

Lien Foundation's Eldercare Portfolio

http://www.lienfoundation.org/project-listing#ec

Tsao Foundation

https://tsaofoundation.org

International Longevity Centre (Tsao Foundation)

https://tsaofoundation.org/what-we-do/research-and-collaboration/about-ilc-singapore

Research unit under Tsao Foundation

Society for Continence (Singapore)

http://www.sfcs.org.sg/medi_page/site_web_sfcs/common_page.asp