Skip to main content

Advertisement

Advertisement

Singaporeans living longer, but need to shorten years spent in ill health

SINGAPORE – Singaporeans are living longer but there is one segment of their lives that health experts and the authorities want to shorten – their years spent in ill health.

Singaporeans are living longer but there is one segment of their lives that health experts and the authorities want to shorten – their years spent in ill health. TODAY file photo

Singaporeans are living longer but there is one segment of their lives that health experts and the authorities want to shorten – their years spent in ill health. TODAY file photo

Follow TODAY on WhatsApp

SINGAPORE – Singaporeans are living longer but there is one segment of their lives that health experts and the authorities want to shorten – their years spent in ill health.

The average of eight years, out of a total of 82, that Singaporeans spend in ill health was put in sharp focus by Prime Minister Lee Hsien Loong during the National Day Rally last month.

“Eight years is a long time to be in ill health. It is tough on the old folks, and on their families too, particularly the caregivers,” Mr Lee said, citing figures from the Global Burden of Disease Study 2015.

The study, released last year, was by the University of Washington’s Institute for Health Metrics and Evaluation. It is one of the most comprehensive and up-to-date analyses of the state of the world’s health.

Although the gains in healthy years of Singaporeans’ lives have not matched the progress in longevity, Singapore did not fare badly compared to the global average, or to some developed nations. The average global life expectancy in 2015 was 71.9, while healthy life expectancy was 62.9.

Broken down by gender, Singapore’s females had an average of nine years of ill health in 2015, compared to 10.1 for Japan and 10.3 for South Korea.

Singapore’s men had 7.5 years of ill health on average, compared to 8.4 for Japan and 8.2 for South Korea.

There is potential for even more gains to be made through greater health literacy, diet and lifestyle changes as well as prevention of falls and urinary tract infections, said experts.

Breakthroughs in water sanitation, management of infectious diseases and childbirth mortality have enabled people to live longer, noted Professor Brian Kennedy.

He heads the new Centre for Healthy Ageing at the National University Health System, which will be studying the biomarkers of ageing – what stools say about one’s risk of getting certain diseases, for instance – among other topics.

A common misperception is that people need to pay attention to their health only at a later stage in life, said Prof Kennedy. Ideally, lifestyle changes should be made in anticipation of ageing from as early as 45, he said. These include healthier diets, more exercise and the reduction of stressors.

“It’s like an insurance policy,” he said.

Years of ill health take a toll not only on individuals, but also the healthcare system.

“We should be focusing on health care, not sick care, in which case focusing on prevention, screening and identifying (diseases) at an early stage before they give rise to catastrophic disability,” said Associate Professor Reshma Merchant, head of the geriatric medicine department at National University Hospital (NUH).

For instance, having a blood test to check for diabetes and to intervene early on is more affordable than multiple hospital visits to treat the condition at a later stage.

But it has been an uphill task to get more people to go for health screenings.

The People’s Association, whose wellness programme promotes health screening, has seen more people going for check-ups over the years. But others remain reluctant.

It has worked with partners such as the Health Promotion Board to offer screenings at community clubs, markets and food centres. Grassroots volunteers also promote health screening during house visits.

“The residents will more likely come forward when they see familiar faces. It is important that we befriend the residents first, build the trust and then slowly introduce programmes and activities to help them lead healthier lifestyles,” said a spokesperson.

FALLS AN AREA OF CONCERN

On the ground, doctors often find themselves treating the elderly for falls and urinary tract infections.

Flagging falls as an area of concern, Assoc Prof Merchant said seniors could develop a phobia after falling and end up restricting their activity. “(This leads to a) downward spiral of restricting mobility, functional decline, repeated falls and (being) bedbound,” she said. An NUH study conducted in the Western region of Singapore found 12 per cent of seniors have experienced falling in the preceding year but actual numbers could be higher, she said.

Patients with frequent falls usually have underlying memory issues, previous strokes with poor safety awareness and gait and balance issues. Some medications like sleeping medicine can affect balance and increase the risk of falls, as can vision impairment. Pre-frail or frail elderly who develop acute illness or are given certain medications, like muscle relaxants and sedatives, can develop functional decline and fall too, said Assoc Prof Merchant.

Seniors are often treated for pneumonia, adverse drug reactions due to multiple medications and urinary tract infections arising from insufficient water intake. “Many may not drink enough water (as they) fear having to rush to the toilet,” she said.

Urinary tract infections also affect those wearing diapers, especially females when the groin area is not cleaned properly.

In the Singapore Burden of Disease Study 2010, cardiovascular diseases and cancers accounted for nearly 40 per cent of total disability-adjusted life years (DALY) – a disease burden indicator measured by the years of life lost due to premature mortality combined with years lived with disability.For men, the five leading causes of disease burden were specifically ischaemic heart disease (12.6 per cent), diabetes (10.1 per cent), stroke (7.4 per cent), lung cancer (4.4 per cent) and vision disorders (4 per cent).

Women, on the other hand, faced diabetes (10.6 per cent), ischaemic heart disease (8 per cent), stroke (6.2 per cent), breast cancer (5.8 per cent) and vision disorders (4.9 per cent).

ASSURANCE OF GOOD HEALTH ‘WORTH PAYING FOR’

Dr Tan Sai Tiang, assistant director of Tsao Foundation’s Hua Mei Clinic, cautioned seniors in good health against becoming complacent.

Most people in good health fail to realise the importance of health checks or consultations with doctors for continuous health management. They may only visit a doctor when faced with a major health shock, such as a heart attack or disability, said Dr Tan.

“We need to … drive home the point that health advice and assurance of good health is worth paying for,” said Dr Tan. “Critically, we need to dispel the ageist myth that it is ‘normal’ to feel tired when old, ‘normal’ to fall when old.”

Associate Professor Angelique Chan, executive director of the Centre for Ageing Research and Education (Care) at the Duke-NUS Medical School, observed that the current generation of seniors continues to have an aversion to visiting the doctor. This is due to fatalistic notions of diseases, she said.

In an ongoing study on Singaporeans’ preparation for retirement and ageing, researchers from the Singapore Management University’s Centre for Research on the Economics of Ageing found that people with low health literacy – assessed through their ease in filling up medical forms among other indicators – recovered more slowly from a health scare.

“Education is a very important factor in how people maintain their lives healthily. When people have minimal schooling like primary school education, they’re less health literate and they’re less able to understand health advice from their doctor,” said Professor Rhema Vaithianathan, the centre’s senior research fellow and study director.

Assoc Prof Chan of Duke-NUS found that seniors with a low-income background lack motivation or opportunities to seek healthcare. Their diet could also be poor, consisting largely of white bread, porridge and noodles, and little fruit, she said.

Yet, a healthy diet need not cost an arm and a leg. Tempeh, tofu and lentils are examples of affordable food rich in nutrients and protein, said Assoc Prof Merchant.

Regular exercise is just as important. Resistance, balance and strength training can build muscle bulk and strength, Assoc Prof Merchant added.

“Sedentary lifestyle, even bed rest for three days in hospital, is sufficient for an older person to lose one kilogram of their muscle,” she said.

Staying mentally agile and taking care of one’s mental health are also crucial to ageing well.

“Mental health is not discussed openly enough and issues like loneliness, social isolation all impact (staying healthy in old age),” said Dr Jeremy Lim, head of the health and life sciences practice in Asia at global consultancy Oliver Wyman. Mental health issues have a strong correlation with poor control of physical diseases like diabetes and high blood pressure, he noted.

Duke-NUS’ Assoc Prof Chan urged seniors to maintain social interaction in their silver years. “There’s the element of peer support - you learn new things together. Women tend to be better at this than men. Men tend not to make new friends after they stop working. But by interacting with peers in your age group, you can manage the problems that come with age together,” she said.

Given the lower health literacy of older Singaporeans and the rapidly ageing population, the average years of ill health here might rise further before any decrease, said Lee Kuan Yew School of Public Policy health policy expert Phua Kai Hong.

He called for comprehensive health programmes catering to people of all ages to avoid unhealthy habits, while Dr Lim said healthcare players should make the experience of seeking care as comfortable and fuss-free as possible.

Perhaps, more visits need not be made in person in future. “We need to stratify healthcare into different segments and identify which ones are amenable to non in-person consults, in part or in whole,” he said. “This is especially so for health screening and follow-ups.”

 

 

Read more of the latest in

Advertisement

Advertisement

Stay in the know. Anytime. Anywhere.

Subscribe to get daily news updates, insights and must reads delivered straight to your inbox.

By clicking subscribe, I agree for my personal data to be used to send me TODAY newsletters, promotional offers and for research and analysis.