Time to help seniors age successfully

Age is an asset, not a liability. Now what's needed are the community support and eldercare to make that a reality.
By Laurence Lien, Published The Straits Times, 22 Nov 2014

TOMORROW is Grandparents' Day, a day to recognise the roles and contributions of grandparents in Singapore and a timely reminder that we are all ageing, every day, every minute.

In children and young adults, we celebrate this as becoming "mature". But when we become older, far from celebrating it, we avoid even referring to it, except when putting ourselves down, such as excusing a memory lapse with an apologetic "I'm ageing".

At mid-life, we often enter a stage of self-denial, manifested in increased visits to the aesthetics doctor, spa and gym. Many also start questioning whether they have lived a meaningful life.

We treat ageing like a disease. We embrace negative stereotypes and consider them to be representative of all older people.

Through our predominantly economic and material lens, we see seniors as a burden - sick, disabled, unproductive, grumpy, demented and unable to learn.

When these ageist attitudes are widely accepted, older people themselves accept them and act in self-fulfilling ways.

Physical and mental degradation are a natural part of ageing. But why do we fight ageing like a child grieving over a lost favourite toy even when he has so many others to play with?

Everyone has so many abilities that even when one wanes, we have so many others to exploit. Do we emphasise wellness or illness, what we can do or what we cannot?

Too much or too little

WHEN the time comes that seniors need more care, we must help them live their lives as fully as possible.

Unfortunately, in letting negative stereotypes permeate our minds, we not only lose sight of what is possible and desirable, but also risk losing what we currently have. Even if someone has dementia, exercising the mind in some way may help the condition from worsening rapidly.

We try to simplify the issues by pigeonholing seniors into neat "independent" or "dependent" categories. Seniors needing care do not suddenly become dependent and non-contributing.

Care needs exist on continuums that are dynamically complex, as humans are capable of continually evolving coping and adaptation strategies.

Instead, we end up providing either too much care or too little, with a heavy bias towards the latter.

For example, we pour a disproportionate number of services into futile care. This happens often in hospitals and nursing homes.

At other times, we undermedicalise, when for a small number of services, we could make a huge impact on someone's life.

Many people, especially those who stay at home, are not adequately served by the health-care system; care is often withheld when someone appears to be able to cope, vaporising the potential benefits of prevention and early diagnosis.

There is also the danger of overfocusing on the physical and material, forgetting that loneliness is the biggest "disease".

The incidence of depression among seniors worsens as much from them feeling unloved as from serious ailments.

In fact, a person's suffering is the best opportunity for one's loved ones to demonstrate love.

Getting it just right

THERE is much critical work to do in supporting seniors in ageing successfully.

First, we need to cultivate a positive belief about ageing. We need to see unique positives in seniors - as wise, nurturing, experienced, accomplished and insightful. Positive beliefs improve an older person's functioning - such as having better memory, greater self-confidence, reduced stress, and wellness.

Life will always throw us challenges at every age. But the human spirit has the enduring ability to manage losses and enable us to be grateful for what we still have.

Secondly, seniors must age in a community that is optimistic, empowering and mutually supportive, and that facilitates a way of life that has meaning and value.

Family is not always available as the best care support for seniors. More seniors today are single, divorced, childless or have children overseas. Even when children are present, they may lack the time, know-how and bonding ability.

Anecdotes abound of isolated elderly living with their children, disconnected from their familiar communities and close friends.

Increasingly, seniors want to control their own care and make decisions for themselves.

The dependence on foreign domestic workers hired specifically to care for older people is neither sustainable nor adequate. Most are typically inexperienced, unskilled, have communication difficulties and have to multitask excessively.

It is best that seniors are able to live in the homes where they spent many of their adult years, enabled with autonomy and choice.

To support this, eldercare services must grow significantly. We want person-centred eldercare; but too often, what is practised instead is staff efficiency, and short-term financial economy.

Ultimately, it is not about performing a service for seniors, but with them. Seniors must participate actively in the design, initiation and execution of how care is performed, so that we create a relationship-centred approach different from the current transaction-based model.

In this approach, we tap the strengths of older people and network community assets such as volunteers and health-care professionals.

Thirdly, we need new housing arrangements.

When nursing care requirements escalate, many seniors are institutionalised in nursing homes that often feel more like C-class hospital wards. For many, the nursing home environment is too unfamiliar, restrictive and dehumanising.

In its place, we need many small group homes distributed in every neighbourhood. These are much more suitable for people with dementia and those with lower medical needs. They will benefit from familiar surroundings in a domestic environment.

We also need assisted living for seniors which can provide fee-based services like 24-hour nursing care, meals, laundry, scheduled leisure activities and personal care assistance.

Assisted living facilities can be purpose-built or located in existing estates. This can also be a more cost-effective, long-term option, as it can significantly reduce institutionalisation. For purpose-built facilities, the Government must help solve the high land cost problem.

Ageing is one of Singapore's most serious social issues. We must conceive of ageing as an asset, not a liability.

This will free minds and hearts to work tenaciously at helping seniors lead fulfilling and purposeful lives - maximising what they still are able to do, while rendering less relevant the effects of frailty and ill health.

I, myself, am seriously considering setting up a social enterprise to support the care of seniors. I invite others to join me.

I also invite the Government to encourage more experimentation and innovation.

The writer is the chairman of Lien Foundation and the Community Foundation of Singapore.

'Person-centred' eldercare model the way to go

LIEN Foundation chairman Laurence Lien expounded on the many facets of ageing, and called for it to be viewed not as a liability but as an asset ("Time to help seniors age successfully"; last Saturday).

Ageing is in itself a very nebulous term that describes a passage of time that keeps moving forward, but the physical form and spirit find it difficult to cope or catch up with it.

We use catchy phrases like "ageing in place" to define an ideal state of affairs where "independents" can cope with day-to-day activities. But life as we know it is never that straightforward; it throws us curve balls like that backache you wake up with or the accidental stumble on the wet floor that bruised your knee. The solution is not to pave all floors with non-slip material or build handle bars everywhere.

We, too, need to shift our mindsets to drive every service we offer, be it within the social or health-care sector. But the reality is that ageing issues encompass social, psychological, behavioural and health issues rolled up in a messy bundle.

What is needed is a new funding model to support local research into all these issues, so we can develop more comprehensive service delivery models applicable to Singapore.

I agree with Mr Lien that a "person-centred" eldercare model is what is badly needed. We need to take bold leaps forward, not incremental service enhancements to tried-and-tested schemes that do not seem to make headway in reducing the demand for long-term institutional care.

I am in my mid-40s and my family unit is small. In 20 years' time, I will be among the 25 per cent of Singapore's population that will be aged 65 and older. My aspiration is to remain healthy, but if I become incapacitated, I hope I will not end my days in a nursing home or be reliant on a foreign helper.

If those are still the only options available in 20 years' time, then we would have failed.

There is still time to make a difference. Together with social enterprises like the one Mr Lien hopes to establish for ageing, let us create a vibrant service sector that can make ageing at home possible.

Daniel Tan (Dr)
President
Caregiving Welfare Association
ST Forum, 28 Nov 2014