Preparing for the silver tsunami

Thursday, 25 l 11 l 2010 Source: Mind Your Body; The Straits Times

By: Joan Chew

Roping in more community nurses and getting insurance companies and doctors to
collaborate on health programmes are just some ways to cope with a growing
ageing population, says geriatrician Carol Tan-Goh Yean Eng. JOAN CHEW reports

silver-tsunami

A silver tsunami is due to hit Singapore in a couple of decades, but we need not be
swamped. Much can be done to prepare for it, said Dr Carol Tan-Goh Yean Eng, a
specialist in geriatric medicine at Raffles Hospital, when she spoke to 200
policymakers, social workers and professional caregivers at the LivEnabled Week
2010 Conference earlier this month. It was organised by the Centre for Enabled
Living, a first-stop centre for persons needing care and their caregivers.

By 2030, one in five people here will be 65 years and above. Dr Tan-Goh, 48, once
headed the geriatric medicine units at both Changi General Hospital and Singapore
General Hospital. She has also been involved in direct patient care at community
hospitals which provide intermediate and long-term care for the elderly. She shares
her views with Mind Your Body on what individuals and the community can do to
meet the challenges ahead.

Q: How will the elderly of the future be different from those of past generations?

A: They will be more literate, have higher expectations of care and will want to live
well and age actively. With many still healthy, they may be working much longer,
hence accumulating more resources and savings to be able to take charge of their
golden years. However, they should take preventive measures against diseases of a
good life, such as obesity, which increases the risk of diabetes, heart disease and
arthritis later in life. With more information at their disposal, they would also be
more health literate. Those in their 40s and 50s now will be part of the silver
tsunami in 20 years time, and active ageing starts at 40 and even younger.

Q: How prepared is Singapore to cope with the silver tsunami and which aspects do
we need to improve on?

A: Coping with the silver tsunami needs to be tackled on an individual basis and also
collectively as a society. We have put in place essential steps, but we need to do
more. As individuals, people need to be aware of their lifestyle, risk factors and
family history. Were good in episodic care you have a heart attack, you go to the
hospital and the doctors can fix you quite well.

What were not good at is preventive, active ageing health care. There are some
gaps in our long-term care service, basic things like access to community services
and caregiving skills like how to feed medication to a sick person and how to turn
him over properly when he is in bed. Families need to have a pro-active approach to
managing an elderly persons minor ailments, rather than whisk him off to the
hospital each time he has a bout of fever.

Q: How can we take a leaf from other countries book?

A: In countries like Australia, where I was trained, there are community nurses who
work within the neighbourhood and become a friend to patients. This is like in the
old days where there were midwives in Singapore. Now, we dont have babies, but
we have elderly people, and they also have the same basic health-care needs.

My dream would be to have community nurses help with troubleshooting in the

homes of senior citizens, where many are afraid to go out because they have
mobility problems. We can rope in retired nurses and get them to be the ones that
the elderly can turn to.

Q: How feasible is this concept here?

A I think its very feasible and we can introduce it on a national level or perhaps
pilot it in a community. But first, we need to raise public awareness that this is a
possible solution, so that theres demand on the ground to engage policymakers
into implementing it. In Singapore, we often turn to maids for this role. Maids
receive varied forms of training and, often, the children of senior citizens have to
train the maids first. Community nurses, on the other hand, can promptly pop into
the homes of such families and help to keep an eye on the elderly before he falls.
This is a preventive form of care.

Q: Are our elderly people financially prepared to grow old?

A: I think our elderly folk are not prepared enough to handle health-care costs that
come with a longer life expectancy and increasing prevalence of chronic diseases.
Medisave will never be enough and Medishield covers only part of your large
inpatient medical bills. The cost of outpatient treatments and health-care items like
adult diapers often have to be borne by the individual.

From the time a child is born, we should look into his insurance needs. You get
better deals the younger you start on insurance as you have no health issues that
restrict the coverage. Many people rely on insurance that comes with their jobs, but
these can be unpredictable as they may lose their jobs. They should, instead, buy
their own health insurance.

Q: What is the biggest challenge now and what can we do to ride the silver
tsunami?

A: The greatest barrier is that no one organisation can tackle the silver tsunami
alone. The bigger issue is the rising numbers of elderly with health problems like
obesity, diabetes and dementia. What insurance companies and doctors can do is to
work together to enrol people in preventive health programmes run by health-care
providers and paid for by some of the premiums.

Q: Should mindsets be changed too?

A: Yes. The elderly who rely on their children for their needs should know that they
must take ownership of their health. There are certain things that nobody can do for
them even if they have the most filial children. The sandwich generation those
with young children and aged parents to care for are straining under the stress.