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  Acute and communicable diseases are replaced by cancer and chronic degenerative and metabolic diseases 372 277 240 240 216 197 174 170 126 108 102 92 55 54 0 50 100 150 200 250 300 350 400 Japan United Kingdom New Zealand United States Australia Canada China India Thailand South Korea Indonesia Philippines Malaysia 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 interventions that are likely to present the best avenues and opportunities for success?  What are the present deficiencies and barriers that can be identified and corrected?  Essential for optimal policy and programme planning and provisions  Data are available from official routine health statistics and reports (national health surveys, special surveys of the elderly)  Not comprehensive or relevant enough  Lack detailed information on relevant biological, psychosocial and behavioural status for elderly subjective wellbeing e.g mental health and quality of life (healthy ageing)  Multi-disciplinary collaboration of research aimed at understanding the ageing and health transition of Singaporean older adults  Goal to help formulate strategies of disease prevention and health promotion for healthy and long life expectancy  Wide range of research topics and issues relevant to public health, primary care, and hospital and nursing home care  Population-based observational prospective cohort study of older adults aged 55+ in South East Singapore  2,808 participants (78.5% response)  Baseline data on a wide range of demographic, biological, clinical, psychosocial and behavioral characteristics  Extensive battery of structured health interviews, assessments and blood tests.  Follow up assessment after 2 years and 4 years. Cross-sectional data from the baseline interviews and examination are used to describe the health and psychosocial status and service usage of the elderly in this presentation [...]... 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. .. burden of care and high costs of health spending in old age, better quality of life The process of optimizing opportunities for physical, social and mental well-being throughout the life course in order to extend healthy life expectancy.'' (Ministry of Health, Canada) Officially promoted by the World Health Organization (2002) and Committee on Ageing Issues Report, 2006 Active ageing policies and programmes... 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 Need to be sustained over long term and overcome challenges and difficulties in changing... hospitalized at least once in the year 2 in 3 seniors visited a doctor at least once in the year 1 in 3 reported that they did not make a single visit to a doctor (?) The elderly make greatest demands on the healthcare system Healthcare expenditure will inevitably increase from the present 3% or 4% Relative Risk of Hospitalization for chronic Illnesses Depression and health services use by Singaporean seniors... wellbeing dimension scores poorest Need to strengthen measures aimed at improving functional independence Especially through facilitating social role adaptations High level of morbidity and rising trend in physical disability Social and environmental impediments to quality of life Quality of medical care should be improved for the elderly to reduce physical functional impairment Social services, housing... 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... to be coordinated by Council for the Third Age Successful Ageing Prevalence: 28.6% Prevalence of Successful Aging in Chinese elderly aged 65+ Prevalence Determinants: Age single year (OR=0.90) Total sample size 1,281 Female gender (OR=1.37) 1 Physical health and well functioning, % Good or excellent self-reported health status Independent in instrumental ADL 47.9 64.6 67.1 2 Cognitive and emotional... Smoking rates are dramatically brought down Modest improvements in levels of hypertension, diabetes, hypercholesterolaemia, and physical activity Levels of obesity increased Levels remain high and longer-term sustenance is not beyond doubt ‘Active Ageing’ embodies the practical wisdom of this approach Promotes the highest possible level of wellbeing in old age Best long-term prospect for alleviating... emotional well functioning, % MMSE and GDS . 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 . from the baseline survey of participants in the Singapore Longitudinal Ageing Studies (SLAS)  Thesis:  The present trend of functional disability is increasing