Difference between revisions of "Seniors"
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Resources above are available for individuals to plan and record their end-of-life wishes. However, there are several barriers that impede end-of-life discussions which are required for using these resources. | Resources above are available for individuals to plan and record their end-of-life wishes. However, there are several barriers that impede end-of-life discussions which are required for using these resources. | ||
# Cultural and social barriers to discuss death and dying. [https://www.moh.gov.sg/news-highlights/details/tools-available-to-encourage-discussions-about-end-of-life-care] For example, the Chinese tend to regard death as evil and inauspicious and hence do not discuss it out of fear of inducing bad luck. [https://www.ncbi.nlm.nih.gov/pubmed/12226932] | # Cultural and social barriers to discuss death and dying. [https://www.moh.gov.sg/news-highlights/details/tools-available-to-encourage-discussions-about-end-of-life-care] For example, the Chinese tend to regard death as evil and inauspicious and hence do not discuss it out of fear of inducing bad luck. [https://www.ncbi.nlm.nih.gov/pubmed/12226932] | ||
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# Family's difficulty accepting the patient’s dismal prognosis and impending death. Hence, they avoid conversations on death and dying as a coping mechanism to maintain hope and optimism regarding the patient’s disease recovery; protect themselves from emotional vulnerability associated with losing a loved one; and prevent intensifying negative emotions within the family.[https://doi.org/10.1080/03637751.2011.618141] | # Family's difficulty accepting the patient’s dismal prognosis and impending death. Hence, they avoid conversations on death and dying as a coping mechanism to maintain hope and optimism regarding the patient’s disease recovery; protect themselves from emotional vulnerability associated with losing a loved one; and prevent intensifying negative emotions within the family.[https://doi.org/10.1080/03637751.2011.618141] | ||
| − | # Physicians avoid initiating end-of-life conversations for fear of reducing patients’ hope in the success of curative treatment. [https://doi.org/10.1002/cncr.24761][https://doi.org/10.1111/jgs.15374][https://doi.org/10.2215/CJN.05960809] However, what is important for maintaining patient’s hope is not the statistical effectiveness of medical treatment to prolong their life [https://doi.org/10.1136/bmj.38965.626250.55]. Patients conceive of hope in terms of the preservation of one’s self-identity - sustaining everyday routines and roles, preserving personal relationships, and maintaining control over their life (ibid). They are concerned with how medical interventions would affect their concept of self; how they could still find meaning in social relationships; and how they could minimise distress (ibid). | + | # Physicians avoid initiating end-of-life conversations for fear of reducing patients’ hope in the success of curative treatment. [https://doi.org/10.1002/cncr.24761][https://doi.org/10.1111/jgs.15374][https://doi.org/10.2215/CJN.05960809] However, what is important for maintaining patient’s hope is not the statistical effectiveness of medical treatment to prolong their life [https://doi.org/10.1136/bmj.38965.626250.55]. Patients conceive of hope in terms of the preservation of one’s self-identity - sustaining everyday routines and roles, preserving personal relationships, and maintaining control over their life (ibid). They are concerned with how medical interventions would affect their concept of self; how they could still find meaning in social relationships; and how they could minimise distress (ibid) |
| + | # Physicians often wait until all available curative treatments have been exhausted or symptoms of impending death surfaces before discussing end-of-life options with terminally ill patients. [https://doi.org/10.1001/jama.284.12.1573 <nowiki>[5]</nowiki>] Physicians may perceive death as an enemy they need to help patients avoid and defeat, not prepare for its arrival (ibid). Hence, they find it hard to initiate end-of-life discussions with patients as it equates to an admission of failure in their duty. [https://doi.org/10.1002/cncr.24761 <nowiki>[6]</nowiki>] | ||
| + | # No formal/routine procedure within healthcare system for physicians to engage in end-of-life discussions with patients.[https://doi.org/10.1371/journal.pone.0091130 <nowiki>[7]</nowiki>] Hence, clinicians often lack proper structure and dedicated time to discuss end-of-life issues with patients (ibid). | ||
'''Possible Solutions''' | '''Possible Solutions''' | ||
# "Live Well. Leave Well." 3-year public education campaign by MOH and Singapore Hospice Council.[https://www.moh.gov.sg/news-highlights/details/tools-available-to-encourage-discussions-about-end-of-life-care] The campaign seeks to change how people perceive death and dying; encourage open discussions on what matters to them, and make plans in advance. In turn, it seeks to reduce situations where people make emotionally-charged decisions during a crisis, or loved ones are stressed out by surrogate decision-making as they are unsure of the individual's wishes.[https://singaporehospice.org.sg/livewell-leavewell/] | # "Live Well. Leave Well." 3-year public education campaign by MOH and Singapore Hospice Council.[https://www.moh.gov.sg/news-highlights/details/tools-available-to-encourage-discussions-about-end-of-life-care] The campaign seeks to change how people perceive death and dying; encourage open discussions on what matters to them, and make plans in advance. In turn, it seeks to reduce situations where people make emotionally-charged decisions during a crisis, or loved ones are stressed out by surrogate decision-making as they are unsure of the individual's wishes.[https://singaporehospice.org.sg/livewell-leavewell/] | ||
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Revision as of 13:29, 1 April 2020
Contents
- 1 Definitions and Scope
- 2 Desired impact for target group
- 3 Needs of [insert client type]
- 4 Resource Directory
- 4.1 Geriatric Education and Research Institute - GERI
- 4.2 Tan Tock Seng Hospital's Institute of Geriatrics and Active Ageing - IGA
- 4.3 Temasek Polytechnic’s Centre for Applied Gerontology - CAG
- 4.4 Silver Horizon Travel
- 4.5 Lien Foundation's Eldercare Portfolio
- 4.6 Tsao Foundation
- 4.7 International Longevity Centre (Tsao Foundation)
- 4.8 Society for Continence (Singapore)
Definitions and Scope
Target Population: [name of target group]
[identify target group and define who is included or excluded in this category: you want to get it just right: not too broad that it includes those you may not want to include, and not too narrow that it excludes those you want to help. You might be too exclusive: e.g. defining ‘vulnerable’ seniors as ‘low-income’, but you may want to include those without family support. Therefore, you may want to define vulnerable as ‘poor and/or with low family support’. You might be too inclusive: e.g. ‘latchkey kids’ may include those who have working parents, or those with serious behavioural problems.]
Client Segments
[Eg. For at risk youth, some could have behavioural problems and be beyond parental control. Others could merely be disengaged and bored in school. Because it seems like different engagement strategies can be customized to these sub-types, it may make sense to segmentize.]
Financially Vulnerable Seniors
Childless seniors
- https://www.ricemedia.co/culture-people-elderly-orphans/
Dementia
- https://www.todayonline.com/commentary/creating-dementia-inclusive-society-singapore
- https://www.asiaone.com/lifestyle/what-happens-if-my-parents-get-dementia-step-step-guide
- Infrastructural Support
- Thirty therapeutic gardens designed for seniors and those with conditions such as attention deficit hyperactivity disorder and dementia will also be built by 2030 (https://www.straitstimes.com/politics/parliament-more-nature-parks-park-connectors-as-singapore-transforms-into-city-in-nature-in)
- https://www.straitstimes.com/singapore/home-nursing-foundation-launches-elder-daycare-and-dementia-care-centre-in-hougang
- https://www.straitstimes.com/singapore/health/dementia-care-village-will-benefit-residents-in-many-ways
- https://www.straitstimes.com/singapore/new-st-john-dementia-day-care-centre-in-beach-road-opens-officially
- https://www.straitstimes.com/singapore/health/nee-soon-estate-to-get-features-to-aid-those-with-dementia
- https://www.straitstimes.com/singapore/proposed-dementia-village-at-gibraltar-crescent-draws-only-one-bid
- Financial Support
- From January 2021, patients with complex chronic conditions such as diabetes, stroke and dementia, can withdraw up to $700 from their Medisave account each year for their treatment, up from $500 (https://www.straitstimes.com/politics/singapolitics/parliament-higher-medisave-withdrawal-limit-for-patients-with-complex-chronic
- Caring for Dementia Patients
- https://www.straitstimes.com/singapore/an-app-to-help-unlock-dementia-patients-memories
- https://www.straitstimes.com/singapore/dbs-posb-staff-being-trained-to-aid-clients-with-dementia
- https://www.straitstimes.com/singapore/engaging-youth-in-dementia-outreach-activities
-
Size of the Problem
[Size of the universe (size of total potential need/demand for services)] [Size of expressed need (those receiving services and on waitlist)]
Desired impact for target group
[If we have no conception of what counts as a ‘good death’, ‘social inclusion’, ‘engaged youth’ , then it would not be possible to determine whether our policies and services are performing well]
Needs of [insert client type]
Need for [ insert description ]
[Needs should not be identified in term of its specific solutions—eg youths need mentoring, seniors need hospice care, people with disabilities need day care (these are specific solutions we can be in the next column)—Instead, they should be defined in more ‘perennial terms’ because the solutions can change but the needs remain; I don’t need a CD player, or even an mp3 player, I need ‘portable music’ and currently the best solution seems to be Spotify]
[Also indicate the size of this specific need & projected demand were data is available]
Existing Resources
[e.g. existing services or programmes both private or public; relevant policies and legislation]
Gaps and Their Causes
[Some gaps could be due to 1) capacity of solution to meet size & projected demand, 2) quality of solution (effectiveness, efficiency, sustainability, scalability etc.), 3) accessibility (geographical, cost to client)]
Possible Solutions
[Based on the specific gaps and reasons for those gaps, what might be solutions that can help? Insert existing but untapped resources, or new ideas that have not been considered yet]
Need for counter social and cultural myths about aging
Existing Resources
d
Gaps and Their Causes
Possible Solutions
AARP's Disrupt Aging initiative
Need for End-of-Life Planning
Existing Resources
- Lasting Power of Attorney (LPA) allows a person of minimum 21 years old to voluntarily appoint one or more persons to make decisions and act on his behalf in the event of loss of mental capacity. The appointed person(s) can make decisions within broad categories of either 'Personal Welfare' or 'Property & Affairs' or both.[1]
- Advanced Medical Directive (AMD) is a legal document signed in advance to inform the doctor that one does not desire any extraordinary life-sustaining treatment to extend one's life in the event of terminal illness and unconsciousness. Anyone who is aged 21 years and above and without a mental disorder can make an AMD. [2]
Gaps and Their Causes
Resources above are available for individuals to plan and record their end-of-life wishes. However, there are several barriers that impede end-of-life discussions which are required for using these resources.
- Cultural and social barriers to discuss death and dying. [3] For example, the Chinese tend to regard death as evil and inauspicious and hence do not discuss it out of fear of inducing bad luck. [4]
- Family's difficulty accepting the patient’s dismal prognosis and impending death. Hence, they avoid conversations on death and dying as a coping mechanism to maintain hope and optimism regarding the patient’s disease recovery; protect themselves from emotional vulnerability associated with losing a loved one; and prevent intensifying negative emotions within the family.[5]
- Physicians avoid initiating end-of-life conversations for fear of reducing patients’ hope in the success of curative treatment. [6][7][8] However, what is important for maintaining patient’s hope is not the statistical effectiveness of medical treatment to prolong their life [9]. Patients conceive of hope in terms of the preservation of one’s self-identity - sustaining everyday routines and roles, preserving personal relationships, and maintaining control over their life (ibid). They are concerned with how medical interventions would affect their concept of self; how they could still find meaning in social relationships; and how they could minimise distress (ibid)
- Physicians often wait until all available curative treatments have been exhausted or symptoms of impending death surfaces before discussing end-of-life options with terminally ill patients. [5] Physicians may perceive death as an enemy they need to help patients avoid and defeat, not prepare for its arrival (ibid). Hence, they find it hard to initiate end-of-life discussions with patients as it equates to an admission of failure in their duty. [6]
- No formal/routine procedure within healthcare system for physicians to engage in end-of-life discussions with patients.[7] Hence, clinicians often lack proper structure and dedicated time to discuss end-of-life issues with patients (ibid).
Possible Solutions
- "Live Well. Leave Well." 3-year public education campaign by MOH and Singapore Hospice Council.[10] The campaign seeks to change how people perceive death and dying; encourage open discussions on what matters to them, and make plans in advance. In turn, it seeks to reduce situations where people make emotionally-charged decisions during a crisis, or loved ones are stressed out by surrogate decision-making as they are unsure of the individual's wishes.[11]
Need for [ insert description ]
Existing Resources
Gaps and Their Causes
Possible Solutions
Need for [ insert description ]
Existing Resources
Gaps and Their Causes
Possible Solutions
Resource Directory
Geriatric Education and Research Institute - GERI
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
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/eldercare
Tsao Foundation
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