Positive Ageing: How Can We Make It Happen?

ETHOS Issue 20, Jan 2019

Introduction: National Engagement with Ageing

Singapore’s approach to the demographic challenges was laid in the 1980s, some two decades after independence in 1965. A number of high-level committees were formed to look at issues related to ageing. These included: the Committee on the Problems of the Aged (1982), the Advisory Council on the Aged (1988–1989), the National Advisory of Council on the Family and the Aged (1989–1998), and the Inter-Ministerial Committee (IMC) on Health and Care for the Elderly (1997–1999).

Building on these foundations, the Ministry of Community Development and Sports released the IMC Report on the Ageing Population and the Eldercare Master Plan (FY2001 to FY2005)¹ in 1999 and 2001, respectively. The IMC report was put together through focus groups discussions with various civic society representatives from different ethnic, age, gender, religious, media and union groups.

The IMC report proposed 78 recommendations in the areas of Social Integration of the Elderly, Health Care, Financial Security, Employment and Employability, Housing and Land Use Policies, Cohesion and Conflict in an Ageing Society. These recommendations² aimed to realise a vision of “Successful Ageing for Singapore” as the population ages, and to translate this vision into outcomes for the individual, family, community and nation.

The Eldercare Master Plan was put up by the Services Review Committee (SRC), which was formed in 1999 to review then existing services available for the elderly.³ The goal of the SRC was to recommend a blueprint for eldercare services for 2001 to 2005. In continued support of the IMC’s vision for “Successful Ageing for Singapore”, the SRC’s blueprint recommended six areas of programme and service improvements, with a focus on the social integration of older people. These areas included: improving physical infrastructure, the restructuring of funding policies for provision of targeted services by voluntary welfare organisations, programmes for well and frail elderly as well as caregivers, and public engagement and residential care.

Building on the work of the IMC and the Ministry of Community, Youth and Sports (MCYS), the Committee on Ageing Issues (CAI)⁴ released a Report on the Ageing Population in 2006. This report, put together by a tripartite of people-public-private representatives from health, social, manpower and media sectors, speaks of Singapore’s belief that ageing is not just the concern of a specific segment of society but a whole-of-society issue. This is reflected in its recommendations, based on four key thrusts: Housing for Seniors; Accessibility for Seniors; Caring for Seniors; and Opportunities for Seniors.

The CAI was succeeded by the Ministerial Committee on Ageing, headed by then Minister in the Prime Minister’s Office Mr Lim Boon Heng in 2007. This Committee comprised ministers and senior office holders from a range of government ministries, including: National Development, Social and Family Development, Education, Law, Finance, Transport, Health, Manpower, Culture, Community and Youth, National Security and Defence. The work of the Ministerial Committee of Ageing culminated in the Action Plan for Successful Ageing, announced in August 2015.

The Action Plan for Successful Ageing

The Action Plan for Successful Ageing reflects Singapore’s tenets of aged care—ageing-in-place and community-based care—which are founded on the social philosophy of the family and the community as the first and second lines of support respectively. It may be considered Singapore’s response to the World Health Organization’s (WHO) “Global Age-friendly Cities” guidelines,⁵ and serves Singapore’s unique political, economic and social environment.

The Plan outlines three strategic thrusts to make Singapore “A Nation for All Ages”. These thrusts involve the individual (“Opportunities for All Ages”), community (“Kampong for All Ages”), and the nation (“City for All Ages”).

“Opportunities for All Ages” focuses on providing opportunities for lifelong employability, lifelong learning, volunteerism, supported by longer healthy life expectancy and financial adequacy.

“Kampong for All Ages” focuses on building cohesive intergenerational communities which can support older persons to age-in-place—in which older persons are regarded with love and respect, and in which older persons are supported to stay connected to the communities they live in. Besides these, enhancing legislative frameworks is also another aspect of building a “Kampong for All Ages”. Existing legislation which relates to the protection of older persons, such as the Maintenance of Parents Act and the Mental Capacity Act, is now complemented by a Vulnerable Adults Act. Passed in Parliament in May 2018, the Act will protect individuals 18 years old and above, who due to mental or physical infirmity, disability or incapacity, are unable to protect themselves from abuse, neglect or self-neglect. This Act will allow the Government to intervene to protect vulnerable adults. However, its exercise is viewed as a last resort, as Singapore’s underlying social philosophy is family and community as the main lines of support.

The goal of a “City for All Ages” is articulated through the City for All Ages (CFAA) project.⁶ To date, there are more than 15 CFAA communities across Singapore; the Ministry of Health (MOH) has also published a set of guidelines, “Creating Senior-friendly Communities: Tips and Tools from the City for All Ages Project”, to encourage the growth of such communities. The guidelines recommend that a CFAA should commence with community involvement. To do this, platforms such as a townhall are set up to to bring across the concept of a CFAA to residents in a community. This is followed by dialogue sessions with older residents in the community to understand their concerns and wishes for ageing-in-place, and also presentations from various government agencies on age-friendly programmes available in the community. This recommended format takes on a person-centred approach as it starts from community involvement and puts older persons in the centre of the process. The range of programmes available to seniors also gives them a chance to exercise their agency in selecting programmes they enjoy and which best suit them.

Dealing with Dementia

As the population ages, dementia becomes a significant concern, since age is a risk factor. In 2004, Singapore published a National Dementia Blueprint. This was followed by the 2009 National Dementia Strategy, which was proposed by MOH in consultation with the National Dementia Network of specialists in dementia care and family physicians.

In the 2009 National Dementia Strategy, dementia prevalence was projected to increase from 4% to 5.8% in 2030. This translates to 48,000 to 70,000 persons in 2030, of which 19,000 to 28,000 are estimated to have mild dementia and 29,000 to 42,000 are estimated to have moderate or severe dementia. The Strategy made recommendations in dementia care in the areas of primary prevention, increasing awareness and early detection of dementia, early diagnosis of dementia and comprehensive evaluation of dementia, management of dementia, collaborative model of care, audit and standards of care, as well as training, education and research.

While the 2009 National Dementia Strategy⁷ drives the public agenda on dementia, a noteworthy people/private driver of dementia concerns is the “Forget Us Not” or FUN campaign, an initiative led by the Lien Foundation, a privately funded philanthropic organisation.

The campaign seeks to create dementia-friendly communities (DFC) across Singapore,⁸ through a network of Dementia Friends who may include individuals, businesses, schools, places of worship and services. These Friends are trained to understand dementia and are equipped with the skills and knowledge to support Persons with Dementia (PwD) as they age-in-place. Since its inception, the FUN campaign has reached 13,500 individuals across 60 organisations in Singapore. Beyond outreach, the campaign has also been able to influence legislation and policies. An example is its work with the Association of Banks in Singapore to identify the legal roadblocks that prevent banks from flagging out vulnerable seniors.

A series of seminars organised by “Forget Us Not”, an initiative by the Lien Foundation, Khoo Teck Puat Hospital and Alzheimer’s Disease Association. Participants signed up as Dementia Friends to show support for the cause.

Source: Photos courtesy of Forget Us Not

How Singapore Could Become More Age-Friendly

1. INVOLVE PARTICIPANTS IN PLANNING AND IMPLEMENTATION

The success of policies, legislation, programmes and interventions to enable and empower seniors or Persons with Dementia (PwDs) to live confidently in the community is contingent on an approach which includes the voices of seniors and their care partners in design and implementation. For effective and positive outcomes, seniors—including those who have dementia—need to be advocates in their own right for their cause.

2. EVALUATE OUTCOMES

To date, there has been no systematic evaluation of the Dementia-Friendly Communities (DFC) to document their impact. Have they really achieved their goals? How many PwDs have been positively influenced by the programme? Are there areas that need improvement? While the FUN campaign has reached/trained around 13,500 individuals across 60 organisations such as banks, transport companies, supermarkets and voluntary welfare organisations, a proper evaluation of the programme would validate its effectiveness and identify gaps or areas for improvement. To encourage good practice and follow-up improvement, it is important to study the social and psychological impact of community programmes. This is the trend in developed countries such as USA and Australia as numbers alone may not tell the whole story.

A research evaluation component should be integrated at the planning stage of initiatives such as the DFC effort. A survey could be conducted on awareness and attitudes before a programme begins as well as some time (about one or two years) after the programme has kicked off.⁹ It is important to involve families of PwDs and the main caregivers in programme planning and implementation, as their views can help shape a more culturally-relevant programme. For instance, personal communication with a staff from FUN conveyed that they have challenges in reaching out to minority communities (such as Malay and Indian participants). This could be a general challenge to bear in mind in future efforts.

3. CONSIDER A BROADER APPROACH TO THINKING ABOUT AGEING

If we look into the future, what may the experience of being a senior mean to the next few generations? Should we carry on doing more of the same, or should our policies, work practices and social norms be reframed to meet the full implications of the demographic shift in population? As a gerontologist, I think that our policies, services and approach towards solutioning may still be relatively conservative and silo-minded in engaging with the ageing phenomenon. To fully expand the potential of our future generations of seniors, all sectors of society have to break out of traditional thinking about what it means to age. The inter-dependency of our needs—i.e., physical, social, psychological and spiritual—at the individual level means that society’s solutions also ought to be multidisciplinary.

Seniors may perceive problems and possibilities that the younger generations may overlook.

4. USE TECHNOLOGY TO OVERCOME CONSTRAINTS

To meet the challenges of limited manpower and the need for efficient delivery of goods and services, the potential of technology and communications will have to be exploited. The separation of older generations into the side stream of society (as the current landscape suggests) will have to be reversed, because they will gradually become mainstream in numbers.¹⁰

5. SUPPORT A CULTURE OF CONTINUAL LEARNING AND GROWTH

An older workforce is a reality, so enhancing the productivity of seniors is something that must be taken seriously. This may be accomplished through upgrading of knowledge and skills (not only through our SkillsFuture framework but also informal learning opportunities) as well as shifts in mindset away from ageism. The lifelong learning strategy to keep seniors mentally and socially stimulated has already picked up momentum in the last decade. This is one of the main thrusts of the Action Plan for Successful Ageing (2015).¹¹ Opportunities are being promoted for older persons to pursue learning and improve themselves, through formal classroom activity, e.g., classes for seniors to pursue a passion or interest such as calligraphy and painting.

Nor should seniors be regarded as a liability to be compensated for. My own experience in the field bears testimony to the wisdom of older people. Through research interviews and focus group discussions with older persons ranging from 50 to 80 years of age on topics such as retirement, widowhood, family bonds and spirituality, and listening to the ways in which they have coped with adversities and overcome them—I have been amazed by their resilience. Seniors may perceive problems and possibilities that the younger generations (due to their limited life experience) may overlook.

6. MAKE SILVER INDUSTRY WORK MORE ATTRACTIVE

Another national strategy would be to make job opportunities in the silver industry more attractive to young people, as well as those who wish to switch careers. Remuneration is not the only method. In many countries, fully subsidised training in eldercare-related sectors, supported by well-structured career pathways, has attracted young adults to join the sector (including long-term care): Japan and Taiwan are good examples (watch a short clip on "The Strengths of Senior Care Models in Taiwan" below). Young adults may have the empathy and compassion to work in the eldercare facilities, but if career pathways are truncated, they are disincentivised. Intergenerational work spaces are healthy and rich environments for both young and senior individuals; most importantly, they nurture a sense of community and ownership for our people.





7. INVOLVE AND INCLUDE ALL, REGARDLESS OF BACKGROUND OR AGE

To retain Singapore’s unique heritage and multicultural diversity, greater participation and advocacy by people of all ages and backgrounds is crucial. Policymakers should listen with their hearts. Collectively, there needs to be a social awakening to the importance of all generations working together to make our country a better home, and the world a better place. As dif ferent subgroups in society, be they cultural or generational distinctions, our apparent choices may be different—but human needs are the same and we have common aspirations. If we let this understanding guide our policies and practices, we will stay on the right course to steer through the challenges ahead.

For more information on the Master and PhD in gerontology degree programmes please visit https://www.suss.edu.sg/.

NOTES

1. Ministry of Community Development and Sports, Eldercare Masterplan (FY2001 to FY2005 (Singapore: Ministry of Community Development and Sports, 2001).
2. Ministry of Social and Family Development, Report of the IMC Workgroup on Cohesion and Conflict in an Ageing Society (Singapore: Ministry of Social and Family Development, 1999), 36.
3. The SRC comprised representatives from the Ministry of Health, the National Council of Social Service and the People’s Association.
4. Ministry of Health, Committee on Ageing Issues: Report on the Ageing Population (Singapore: Ministry of Health, 2006).
5. Ministry of Health, Creating Senior-friendly Communities: Tips and Tools from the City for All Ages Project (Singapore: Ministry of Health).
6. Ministry of Health, Report of the National Dementia Strategy (Singapore: Ministry of Health, 2009).
7. Forget Us Not: Building a Dementia-Friendly Community (website), http://www.forgetusnot.sg/.
8. Phillipson, L. (2018) Involvement of People with Dementia in raising awareness and changing attitudes in a dementia friendly community pilot project. Dementia (0): 1-16.
9. National Population and Talent Division (NPTD), A Sustainable Population for a Dynamic Singapore: Population White Paper (Singapore: NPTD, 2013), July 9, 2018, https://raw.githubusercontent.com/isomerpages/isomerpages-stratgroup/master/images/PublicationImages/chart7.png.pdf.
10. Ministry of Health, Committee on Ageing Issues: Report on the Ageing Population.