top of page

Silver Tsunami

Preface

This article is written as a response from the NUS interview question:

“What do you think are some of the issues with our current healthcare system?”

 

This will be part one of 4 covering Obesity/Diabetes, Mental Health, ageing population and Covid.

Ageing population

Screenshot_1.png

Ok to start off, let me first give some preliminary statistics published by CNA. In 2019, 14.4% of our population is 65 years or older, this figure is expected to increase to nearly 25% in 2030 due to rising life expectancy and low birth rates. This trend is colloquially known as the “Silver tsunami” due to the increased number of people belonging to the silver generation Eg people above the age of 65. Following this, I asked myself, given this exponential increase in our elderly population, are we and our healthcare facilities prepared for this development? 
Well the short answer is no, the long answer is it depends.

​

I personally believe that overall, Singapore's healthcare system has the capacity to cope with our rapidly greying population. However, the services provided are more geared towards treating the symptoms of old age, and therein lies the problem. Let's take a step back and ask ourselves, “are we looking at ageing the wrong way?”
 

Oftentimes, we liken ageing to a disease, seeing its symptoms like fragility, heart disease and dementia. In doing so, we detach ourselves from the root of the issue and start viewing old age clinically, and treating it’s symptoms instead of its patients. Although I acknowledge that a clinical mindset is required, I also believe that sometimes an unconventional approach is required especially when it comes to issues like old age. Ageing is a fact of life, we are no more likely to “cure ageing” then we are to time travel. So the question isn’t how to stop ageing and or treat its symptoms, it's how we can extend the quality years we have remaining,unburdened by major diseases and living with the effects of old age to the fullest. Hence to this end, I think we should be investing more resources into palliative care to extend and improve our quality-adjusted life years (QALY). QALY is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions. One QALY equates to one year in perfect health. QALY scores range from 1 to 0.

​

Another thing is a particular shortage in residential elder care options. Currently, we are treating ageing too much as a blanket illness without considering the individual needs of our elders who may not agree to being sent to nursing homes. Our growing silver population is a heterogenous group with different needs and life trajectories hence a diversity of options is critical. Currently, to my knowledge, our services/options are limited to 2 extreme ends, “get some services at home” or “nursing home” with very little options in between. In fact, a recent survey conducted by CNA showed that 86% of elderly residents preferred to “age in place” from the comfort of their own homes or nursing homes where their friends are without being made to transfer to different facilities. So now the question becomes how are we able to meet the needs and wishes of our elders? Well the [Assisted Living Model] and/or [Continuing care retirement communities Model] may provide the “missing link” which we needed.
 

Assisted Living Model

This model provides dignity and autonomy to seniors who need some care, but are not enough to where they need to be institutionalised. 

Recently, HDB and MOH jointly rolled out Community Care Apartments:

  • residents subscribe to a basic service package which includes services like 24 hour emergency monitoring and regular health check ups. 

  • They may also opt for additional services like catered meals, laundry and cleaning but will come with extra charges.

  • Under this project, residents pay in the ballpark of $5000/month before subsidies apply.

Looking at this project, I feel that the concept and idea behind the apartments are correct, but perhaps more may be done for the affordability given that the vast majority of elderly may not be able to afford the high monthly prices.

Continuing Care Treatment Communities Model

This model, In my opinion, most suitably meets the needs and demands expressed by our elderly population, that they wish to “age in place”. This model presents an All-in-One option, providing a spectrum of services including options for independent living, assisted living and nursing home care. Essentially, this means that seniors can stay with their friends in the same community over time even if they're needs intensifies which I think is a great idea.

Screenshot_2.png

Current issues associated to ageing population

So, now that we have a basic understanding of our systems and schemes in place to manage a rapidly ageing population, let's discuss issues associated with an ageing population. In this section I will name be touching on:

  1. What are some pitfalls with our current elder care system?

  2. What are the medical concerns related to an ageing population?

 

(note: I won't be detailing the impacts that an ageing population has on the younger generations etc as I believes that falls outside the jurisdiction of the topic question mentioned at the start)

Pitfalls of our current eldercare system

As said earlier on in this article, I believe that our government has done a stand up job in trying to manage an ageing population and have put in place a multitude of healthcare schemes, grants etc to manage the growing demand for palliative care. However, the onus shouldnt be just on them to facilitate change, we must also play our own role in this system. And this leads me to my first obstacle: “NIMBY” syndrome

 

“Not in my backyard” or NIMBY syndrome basically states how most people can agree that having more nursing homes or elderly care facilities are generally beneficial to society but do not want these facilities built near their home for various reasons. Hence there lies the disparity, where people want more healthcare but are unwilling to bear the burden. I think this issue is particularly prominent in Singapore because of our limited land area. With just 730 sq km of land area, which is even smaller than New York City, it becomes increasingly difficult to manage the growing needs of the population and not impose more burden on the people.

So what can be done about this mentality?

 Well one practical solution which has sprung up recently is “vertical Kampungs”, a new trial project being developed right where I live at Yew Tee. Following the trend of vertical farming, this project offers seniors housing and healthcare facilities stacked on top of one another! 

A more optimistic solution would be a change in public mentality. As our population rapidly ages and more and more people's parents get old, perhaps this may catalyse a change in public attitudes and make people more accepting towards more nursing homes being built near their residences.

 

The issue which I believe will grow into a much larger social problem later on is technology. When you give your 5 year old a phone, they can pick up how to use it almost immediately, knowing how to use all the basic apps, surfing the internet and creating unfunny tiktoks. Me, a 20 year old, am already confused with some of the new apps, games and social media widgets that my juniors seem to be using. So it would be safe to assume that most seniors today are not very tech savvy and probably do not have a good handle on using electronics. Given the exponential rate of technological progress today, with new Iphones, operating systems and blockchains coming up every year, I conjecture that this will lead to a growing issue in our senior population. Hence this actually also poses a significant issue for our healthcare system. With more and more services being digitised and information on new services, schemes etc all published online, a significant number of seniors may not know how to access these services hence this limits the amount of assistance we are able to provide. This issue is further compounded by the current Covid-19 pandemic as more services are transferred online such as QR code payments and menus, Contactless delivery services and virtual patient consultations. 

So the question is now how may we disseminate information to the elderly masses in a form which they can easily understand and access? A question for another time perhaps.

Medical concerns of an ageing population

Covid

​

This is quite an obvious and current issue plaguing the silver generation across the world. Multiple studies have shown how older people are at higher risk of having severe complications from covid and having long lasting respiratory damage, particularly from more severe variants like delta. Their vulnerability stems largely from immunocompromisation as our immune systems and ability to fight off diseases deteriorate overtime. Furthermore, as people age, their likelihood of developing a severe debilitating illness such as heart diseases, cancers or dementia increases exponentially. Hence, overlapping issues may arise which may prevent some elderly people from being vaccinated. Anecdotally, in my current internship under a senior consultant at the national cancer centre, I have noticed how a significant proportion of eldery people are not allowed to take their booster shots because of on-going chemotherapy. Hence this creates a healthcare impasse as although they are the most vulnerable and in need of vaccination/booster shots, many are not medically able to because of on-going therapy for other ailments.

Screenshot_4.png

Global warming

​

I've written about this in a separate article detailing the impacts and measures of climate change, but I felt the need to add it again here to reiterate the health impacts of global warming. 

 

The main thing is heat stress. Elderly or those with a chronic heart condition will be the ones who are most impacted by the rising temperatures, in fact Singapore is approximately 1.8 degrees hotter than in 1948! Higher temperatures place more stress on the body, to dissipate the heat, the heart has to work harder to pump blood to the capillaries near the skin and divert some blood away from vital organs. For most healthy adults and youths, this change may seem trivial, but to someone with a heart condition, this may lead to oxygen depletion to organs, which is quite obviously very bad for them. Furthemore, increasing sweat production for homeostasis may be problematic for those on fluid restrictions due to kidney related issues.  

Another one that may not be known is actually dengue. The warmer climate and humid conditions allows mosquitoes to breed faster. For tropical nations like Singapore, this has resulted in an increase in frequency of dengue and malaria which places our older generations at risk.

References

  1. Buckland, D. (2020, February 12). Ageing population: We're living longer, but are we healthier? Raconteur. Retrieved January 31, 2022, from https://www.raconteur.net/healthcare/ageing-population-healthier/

  2. Center for Food Safety and Applied Nutrition. (n.d.). Food Safety and the coronavirus disease 2019 (covid-19). U.S. Food and Drug Administration. Retrieved January 31, 2022, from https://www.fda.gov/food/food-safety-during-emergencies/food-safety-and-coronavirus-disease-2019-covid-19

  3. Cheryl Lin @CherylLinCNA, Lin, C., & Bookmark Bookmark Share WhatsApp Telegram Face. (n.d.). Growing preference among elderly residents to 'age in place': HDB survey. CNA. Retrieved January 31, 2022, from https://www.channelnewsasia.com/singapore/elderly-hdb-ageing-assisted-living-sample-household-survey-341871

  4. Cheryl Lin @CherylLinCNA, Lin, C., & Bookmark Bookmark Share WhatsApp Telegram Face. (n.d.). In focus: Amid a rapidly ageing population, what are the missing pieces in Singapore's residential eldercare puzzle? CNA. Retrieved January 31, 2022, from https://www.channelnewsasia.com/singapore/focus-amid-rapidly-ageing-population-what-are-missing-pieces-singapores-residential-eldercare-puzzle-2308441

  5. Singapore Care System Population Aging. (n.d.). Retrieved January 31, 2022, from https://www.adb.org/sites/default/files/publication/637416/singapore-care-system-population-aging.pdf

  6. Singapore property, property for sale/rent, singapore real ... (n.d.). Retrieved January 31, 2022, from https://www.propertyguru.com.sg/

  7. Today. (n.d.). Continue to exercise social responsibility, take precautions against covid-19 during festive period: PM Lee. TODAY. Retrieved January 31, 2022, from https://www.todayonline.com/singapore/continue-exercise-social-responsibility-take-precautions-against-covid-19-during-festive-period-pm-lee-1803121

  8. Today. (n.d.). New Community Care Apartments for seniors in Bukit batok to offer elder-friendly features, services. TODAY. Retrieved January 31, 2022, from https://www.todayonline.com/singapore/new-community-care-apartments-seniors-bukit-batok-offer-elder-friendly-features-services

  9. Wikimedia Foundation. (2021, November 24). Quality-Adjusted Life year. Wikipedia. Retrieved January 31, 2022, from https://en.wikipedia.org/wiki/Quality-adjusted_life_year

  10. Yuen-C, T. (2022, January 24). Trust, stewardship and collective action necessary to build future Singapore, says Desmond Lee. The Straits Times. Retrieved January 31, 2022, from https://www.straitstimes.com/singapore/politics/trust-stewardship-and-collective-action-necessary-to-build-future-singapore-says-desmond-lee

bottom of page