Let’s look at seniors differently and not be afraid of growing old

I once referred an elderly dementia patient, who needed hearing aids, to an ear specialist. This patient had behavioural issues associated with dementia, including sometimes being physically and verbally aggressive.

Apparently things didn’t go well during the consultation with the specialist. I imagine the patient was uncooperative as the specialist wrote me an exasperated reply which read: “Dear Doctor Farhan, this patient’s problem isn’t in his ears but what’s in between them!!” 

I was shocked by the reply. It wasn’t just angry — it smacked of ageism and a deep-seated discrimination towards the elderly.

The reply was copied and emailed to the head of my department. To me, implying that the patient’s brain needed fixing, not his ears, was unprofessional and lacked compassion — a trait that should be essential in doctoring.

I sometimes wonder if this patient’s otherwise unheard voice would have said: “I have dementia! My mind isn’t working so well and when I cannot hear, I struggle. I need hearing aids!” 

A person with dementia often loses his ability to communicate his needs. He may also become increasingly dependent on others to fulfil basic need - getting dressed, maintaining personal hygiene.

He is in a situation which many of us fear is an inevitable consequence of ageing — losing our voice and, eventually, our independence.

This can lead to one of the most insidious forms of ageism — within ourselves, a feeling of dislike towards our older and possibly feebler future self. 

Sadly, the inappropriate treatment I described isn’t uncommon. Older people have received less care than they deserve, more than we might care to admit.  

Healthcare workers behave differently towards older people. The standard treatment an older person gets in hospital is to get diapers slapped on and special fall precautions put in place.

This includes being disallowed out of bed without help and having bedrails raised to prevent them from walking on their own. Imagine if you had to pee in diapers and be confined to bed.

Why such drastic measures? Because in hospitals, falls have such serious repercussions, for both carers and those cared for, that policies are put into place to achieve a zero fall rate, a key performance indicator in healthcare.

While older people are the majority of patients in hospitals, hospitals are far from being age friendly, and are often unintentionally “ageist”. 

A DIFFERENT NARRATIVE

Reinforcing the ageism within ourselves and society are systems which do not empower older individuals but misapply blanket rules, such as fall precautions.

This is dangerous for a greying nation like ours. By 2030, one in four Singaporeans will be aged 65 and above.

With longevity increasing, studies project that a baby girl born in the year 2050 would live up to 92, a good decade more than an average person in Singapore now.

Fulfilling the needs of the older, educated, more affluent Singaporean of the future requires thought, dialogue and systemic change.

Thankfully, there are already initiatives to prepare for a greying nation. Older Singaporeans would be ageing in place, in neighbourhoods where they have lived and built a community.

Housing estates, transport systems and public spaces are undergoing structural changes to become more elder-friendly.

Employment opportunities, upgrading skills and lifelong learning initiatives would make the older Singaporean relevant, allowing active contribution to society well into the golden years.

But we can do more, including rethinking whether age is just a number. Ageing is such a wide and diverse process that it is often more meaningful to talk about biological, not chronological age.

An 85-year-old could be running a country and jetsetting while another a decade younger could be bedbound, tube-fed and dependent.  

Previously unavailable treatments for an older person, like bone marrow transplants for blood cancers, have recently started to be offered.

Geriatric assessments identify robust elderly who might be fit for transplants by looking at performance on cognitive tests and measures of physical functions like walking speed and muscle strength.

It has been shown that assessments by a geriatrician regularly identify areas of possible treatment which are not identified in routine assessments by other doctors.

The idea of an age cut-off to determine treatment is now seen as “ageist”. Doctors should determine treatment by looking at the whole person and not just the number of their age. 

We also need to rethink the convention of life existing in three phases: The student who is expected to learn, the worker who works and the retiree who rests.

Instead, we should recognise that all three facets need to happen in every stage of life. The student needs vocation and the worker needs to spend time in rest. The retiree needs to do meaningful work.

With increasing education and wealth, the older Singaporean may not be satisfied with playing mahjong and singing karaoke in an eldercare centre, if these do not bring them a sense of purpose.

The idea of ageing in place, within our existing homes would be the way ahead. Pairing existing structures like eldercare and childcare centres is a model that exists in other greying nations.

A busy middle aged worker would drop off their children and elderly parents at the same centre, which would organise joint activities between older clients and young students.

There is a transference of energy between the two groups, the old perking up with the exuberance of youthful energy and hyperactive youngsters slowing down to blend and interact with the older people. 

Singaporeans have the privilege of some of the longest lifespans in the world. Rewriting the narrative, growing older as we want to and remaining active, contributing and productive — this is the next Singaporean story to be written.

ABOUT THE AUTHOR:

Nur Farhan Mohammad Alami, a geriatrician in private practice, has three children, including two with dyslexia. This piece first appeared in The Birthday Book (2019), a collection of 54 essays on “narratives, undiscovered and underway” in Singapore.