Symposium on Health Care Challenges for an Ageing Population:
Managing Health Care and End of Life Decisions in Singapore,
29 May 2009, Singapore
Ng Tze Pin, Gerontological Research Programme, Department of Psychological
Medicine, Yong Loo Lin School of Medicine, National University of Singapore
 Aims:
 Assess salient health and social needs of elderly Singaporeans
 Identify vital areas that are likely to present the best avenues
and opportunities for success in achieving longer and healthier
life expectancy.
 Methodology:
 Data from the baseline survey of participants in the Singapore
Longitudinal Ageing Studies (SLAS)
 Thesis:
 The present trend of functional disability is increasing
 It should be reversed by measures taken to improve quality of
geriatric care, assisted living and long-term care, designs for
housing, built environment and transportation, and promotion of
‘active ageing’.
 Population ageing in Singapore is
rapid and unprecedented
 Persons aged 65 +
 8% in 2009
 19% in 2030
 Enormous health care and social
challenges of population ageing
have to be faced much sooner
rather than later
Percent Increase in Elderly Population: 2000 to 2030
 Demographic transition is accompanied by epidemiological
transition

Singapore
Changing affluent lifestyles
and habits
Increased chronic
diseases incidences
Improved healthcare
Increased chronic diseases
and functional disability
Reduce mortality and prolong
survival
Little impact on functional
wellbeing or quality of life
Escalate use and costs of
medical and social services
Increase burden of care for
family and caregivers
QUALITY OF CARE is now a critical factor that
determines whether the current cohort of
Singaporean seniors faces the prospect of
better functional wellbeing and quality of life in
their later years
Presently available data do not indicate a
benevolent trend of physical functional
wellbeing in the near to medium term
Regular monitoring of physical functional
status are needed
 What can we do now to ensure that our current
policies and programmes are effective in achieving
longer and healthier life expectancy?
 What are the vital areas of health and social

 2808 seniors aged 55 to 98
 Mean age 66
 49% were aged 65 +
 13% aged 75 +
 63% women
 1/2 at least a secondary education
 82% Chinese
 2/3 resident in larger and higher end housing units (at least 4
rooms HDB)
 Note: relatively better socio-demographic profile of study
respondents
 High proportion with chronic medical conditions
 9 out of 10 seniors reported having at least one chronic health
condition
 43% have at least three multiple conditions
 Hypertension (56%)
 blood lipid abnormalities (59%)
 major eye disorders (33%)
 arthritis and other musculoskeletal disorders (17%)
 diabetes (19%)
 coronary heart disease (6%)
 stroke (4%)
 13% significant depressive symptoms
 11% psychiatric disorder diagnosis
 24% cognitive impairment
 6% dementia (65+ years)
 3.5% reported history of treatment for mental illness
 2% reported at least two falls in the past six months
 Higher rates of chronic health conditions in older age groups
 4.1% was hospitalized at least once in the year

Non-depressed
Depressed
%
P<0.001
P<0.001
4003002001000
Days from discharge
1.0
0.8
0.6
0.4
0.2
0.0
Proportion of Patients Survived
Non-depressed
Depressed
0.58
0.93
2.48
1
0.00
0.50
1.00
1.50
2.00
2.50
3.00
None Dementia
only
Depression

55+

4.1%

7.4%
7.8%
75+
14.4% 26.3% % are for Dependency on Basic Activities of Daily Living (ADL) Multivariate
OR
P<0.05 Age (vs 60-69)

70-79
4.4
80+
13.6 Female gender

24.2 Cognitive functioning

MMSE 24+
1.0
MMSE 19-23
4.7
MMSE ≤18
10.5 Hearing impairment
3.1
Visual impairment
2.5

Population
attributable risk
Arthritis
14.0%
Cognitive impairment
19.0%

Ng et al, J Am Ger Soc 2006; 54:21–29.
Arthritis and cognitive

Emotional
Mental
Health
QOL (SF-12) scores
 Lower for physical dimensions than mental dimensions
 For both physical and mental dimensions, social role limitations
accounted mostly for reported poor quality of life
 In the face of impaired physical and mental functioning, perceived
social handicap stands in the way of realizing quality of life
 Success in improving physical and social functioning and quality of life
will be determined by measures taken to improve
• Access and quality of medical care
• Assisted living and long-term care
• Designs for housing, built environment and transportation,
• Promotion of ‘active ageing’
 Greater attention should be given to improving the level of social
support and the physical environment to lessen the extent of social
handicap from the loss of function
 Primary care, hospital and community levels
 Direct and immediate impact on reducing physical
impairment from chronic diseases
 Current medical care appears to have limited
effectiveness in producing desirable care outcomes in
the elderly
Avoidable Hospitalization Rates in Singapore
Ng et al, Journal of Epidemiology and Community Health, 2003; 57,1: 17-22.
 Addresses the problem at its source
 Effective programme of mass education to modify
harmful lifestyles and behaviour and early risk
detection