Saturday 27 October 2012

Let's talk about sex and seniors

Mary Ann Tsao identifies irrational prejudices people have against seniors, such as about their having sex. Her role, she tells Susan Long, is fighting ageism and opening doors for older people to start a new romance, do work they love, get the education they never had and live their own lives without being pushed into a nursing home.
The Straits Times, 26 Oct 2012

DR MARY Ann Tsao, 57, wants to re-frame the national conversation on ageing.

She is tired of old age being depicted as a problem, a time bomb, a menace and a scourge. She is sick of it being couched in terms of dependency ratios, health-care expenses, wrinkles and finances.

"Every time I see the statistic that two working-age adults will support one elderly by 2030, I'm like, 'Oh No, not that again.'

"It assumes that things are fixed, always like that and that everyone has to retire at this age and no one's capable of working beyond that," says the president of the Tsao Foundation, a non-profit dedicated to enhancing the quality of life for older people. It offers community health services, geriatric care training, does its own research on ageing and engages policymakers.

Long life - so hard-won - is here. "The question is what are we going to do about it in a positive way and to take advantage of it?" What is overdue, she says, is a national conversation as a society on how best to use longevity, as she prefers to call it.

"We miss the boat when we think that all older people need are a roof over their heads, food on the table and maybe some personal care, instead of looking at their overall sense of well-being." She talks nineteen to the dozen, hardly coming up for air.

When was the last time, she asks, that a comprehensive study of the elderly took place here, that delved into their quality of life, going beyond their employability, finances and state of health? "What do we know about their inner lives and aspirations?"

Because "inner life" is seen as "fluffy" and difficult to quantify, it has not been studied or measured. But her foundation has commissioned a ground-breaking study on it, to be rolled out next year, which will hopefully spark such a national conversation.

Isolated and lonely

DR TSAO, the founder of the Hua Mei Centre For Successful Ageing, which integrates a clinic, home medical care services, acupuncture and traditional Chinese medicine, geriatric counselling, and has about 2,500 beneficiaries a year, notes that the mental well-being of the elderly has a wider implication on health-care utilisation, families and the overall community.

Happier older people are healthier. Even in their frailty, they are able to get out of bed, take their medication and get on with their day, she notes, whereas older people with poor mental health tend to be sicker, have higher disability and require more hospitalisation.

She says her work over the past 20 years with old folk here shows that many are "extremely isolated and lonely". One problem she highlights is the lack of social space for the elderly to love, learn, work and live their lives.

What has been called the Nimby ("not in my backyard") syndrome, and bandied here in the wake of the public opposition in housing estates to nursing homes being built there has moved beyond denying seniors physical space to social space, too, she charges.

Relationships among older people - widows and widowers - are often frowned upon, for example. And sniggers or sneers like "dirty old man" often follow any older person seeking a companion.

"Old people don't have sex; God forbid if they hold hands. They're 70 years old," she mimics. "That still goes on a lot. All these pre-conceived notions create a lot of restrictive boundaries on the older person, who cannot pursue what any normal person, regardless of age, would want."

Learning opportunities are also the preserve of the young, although one latent aspiration among the older working class she interacts with daily is they never finished school.

"Many say, 'If I had finished school, my life would be so different.' Or they just want to say that at the end of my life, at least I got my O levels,'" she relates.

But there are few avenues for them to do so, unlike in the United States where many mature adults go to evening classes to complete their high school diploma. Why can't school classrooms, which are empty at night anyway, be used for this, she asks.

As for the question that typically follows, "What do they need it for?" since they are past retirement age, she almost snaps: "That is not the point."

Even if everything has to drive to some economic end, education is a major factor in how people will age, she points out. "Learning improves not just employment opportunities but the sense of possibility and empowerment. It educates people to take better care of themselves, to be more resilient and to find meaning in life. It leads to health-seeking behaviour, which translates to payoffs for the health-care system."

She sees this routinely in the self-care programmes she runs for seniors. The more educated ones have a greater "ability to learn, change, pick themselves up and retain better health" as opposed to the uneducated, who feel more limited and fatalistic.

Nimby has also crept into the office. Although the Government has raised the retirement age and legislated rehiring after 62, she notes prevalent beliefs like "old dogs can't learn new tricks" turf older people out of the workplace.

Many elderly are willing to "put up with a lot" to keep working, but they run up against entrenched employer biases. She relates how a business school professor friend of hers, who retired from a university here in her 50s and became an economics adviser in another country, returned in her mid-60s to zero job openings.

"She's very sharp but couldn't find suitable work. She's not even looking for pay; she just wanted a space where she could meaningfully contribute." She continues: "There should be space for older workers to evolve into a different role. But oftentimes, they are either in or they're out. There is no other possibility."

The trouble is that older worker employment is still seen as a zero-sum game. She notes the parallel with the women's movement in the 60s, when more women started to work amid worries they would swipe men's jobs. That didn't happen. Instead, it created more jobs and opened up new markets such as convenience stores and childcare centres.

Her pet peeve remains the "fixed mindset" towards ageing. "We are looking at the future based on current realities. We keep thinking things will stay the same, therefore ageing is a problem. But it doesn't have to be that way," she says. "As a society, we need to identify longevity as something we all own and to create the space for it."

Life of service

FUNNILY enough, it was a dashing surgical resident boyfriend in medical school who clarified her life goals.

She was the envy of everyone. But during a conversation on the purpose of life, he said his goal was to "make a lot of money and have fun". She said hers was service. "I have never fallen out of love with someone so quicky," she recounts. She dumped him soon after.

Dr Tsao was born in Hong Kong, the second of four children of a wealthy Shanghainese shipping and real estate family. At 11, she was sent to California to study, went on to Wellesley College, followed by medical school and a successful paediatric practice in New York City.

She discovered her physician- activist calling as an intern in the infants' ward of a Bronx hospital, a stint that still haunts her. Within the first month, she tended to a series of babies with more than 90 per cent burns after slum landlords razed buildings for insurance money.

Her job was to change the dressing on their charred flesh. "Each time, I learnt to drown out the crying and do better," she recalls, fighting back tears. Each time, the baby would die within weeks. This happened again and again. Till one day, a resident threw down her scalpel and declared: "This is unacceptable. Any human being would stop this."

That day, Dr Tsao learnt that doing her best as a doctor treating broken bodies was not good enough. She joined the resident in petitioning the New York mayor to go after the arsonists and gave her testimony. After two years, the burnt babies stopped coming.

Over the next eight years, as she ran her own paediatric practice from a gorgeous townhouse in Greenwich Village, she never forgot the babies' faces. "I just felt like this cannot be it. Anybody with money could go and see someone else who would take just as good care of their kids."

Then in 1991, her late grandmother, Tsao Ng Yu Shun, then 86, who was a fan of Mr Lee Kuan Yew, summoned her to start a foundation for the under-served elderly in Singapore.

A year later, Dr Tsao, then 37, arrived here in a suit, high heels, stockings, "trying to be a proper foundation lady". Many at first discounted her as a "fancy rich girl from New York dabbling in charity". But she prevailed, eschewing the easier path of giving grants to the needy, putting together her own pioneering organisation that now has a staff of 70 and about 300 volunteers.

Next year, it will pilot a retirement village within a few HDB blocks, where about six elderly live together, with support from neighbours, volunteers and service staff.

The Hong Kong citizen and Singapore permanent resident thought she would be done here in five years tops and would move to Bangkok to join her African-American husband, a former IBM research scientist who moved there to start an IT business.

But her work here never got done. In 2007, he died of a sudden heart attack while they were on a ski holiday with their two children, now nine and 14.

"Life is not always how you think it will be, but you deal with it" is a truism the Buddhist utters a lot. For the past five years, she has been juggling her work, single parenting and caring for her 89-year-old mother, getting about four hours' sleep, between 10pm and 2am, each night.

What keeps her awake is worrying if she has been "bold enough and pushed hard enough" and whether her foundation can continue being a "change catalyst" after 20 years on the job.

She and her siblings are now trying to "spend down" their fortune to do more good. Their children have been duly warned they will get an education, but not much more.

Unlike many parents who no longer count on their children to take care of them in their dotage, she is bucking trend with hers and has made clear her expectations. "I tell my kids, 'I changed your diapers when you were little. And when I grow old, you're going to change my diapers, okay?' That's reciprocal," she quips.

Dr Mary Tsao on...

Older people being a ‘burden’

Honestly I see a lot more transfers from top down, not the other way around. In a lot of households, the grandparents are taking care of the grandchildren. There are a lot of hidden contributions that are not monetised. For the middle class, they help with their children’s wedding, first home and even the grandchildren’s education.

The biggest change she’s observed over 20 years

When I first came here in 1992, people were very decent, not too materialistic. Many used to agonise about putting their parents in a nursing home. Now this option is almost the first choice for many. It is seen as a safe, practical and quite an emotionally easy decision to make. We don’t even hear the term filial piety anymore. The notion of reciprocity between generations is gone. Most parents don’t even expect their kids to take care of them when they are old. 

The Nightingale Nursing Home incident

I think paying workers very poorly and working them very long hours is obviously not going to help... Would we ever consider a similar kind of situation where workers are poorly paid and poorly supervised in a childcare facility? I don't think so. This raises a lot of questions about how we see older people in general.

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