Fear of dying alone increases among elderly folk

'When I die, I want someone to know'
Cleaner's fear of dying alone is a fear shared by rising number of elderly folk living alone here
By Danson Cheong, The Sunday Times, 10 Apr 2016

Eighty-five-year-old Mr Wee Yok Tai has lived in the same one-room flat in King George's Avenue for 30 years and is terrified that he will die alone in it.

The retired cleaner has no family and lives by himself in the spartan rental unit. He counts among his possessions a worn mattress, an empty fridge and two CCTV cameras on the ceiling.

They were installed about a year ago by undertaker Roland Tay, who came up with the unusual idea when Mr Wee asked him for help.

Mr Tay paid $1,000 for the equipment and monitors live footage from it at least three times a day using his mobile phone to check that Mr Wee is all right. Should anything happen, he will head over to help.

"I am alone, and there is no one to take care of me," Mr Wee said in Hokkien. "Two of my neighbours died and people found out only because of the smell. I don't want the same thing to happen to me."

Mr Tay, known for arranging free funerals for murder victims and the needy, suggested setting up a CCTV network, with one camera monitoring the bed and the other the outside of the toilet. "I could visit him every two or three days instead, but if something happened, it would be too late already," said Mr Tay, who still makes it a point to visit Mr Wee every few weeks.

Privacy concerns are the least of the octogenarian's worries.

"I see (Mr Tay) as a friend. I'm in my old age already, and when I die, I want someone to know," said Mr Wee, who got to know Mr Tay through friends.

Mr Wee has severe arthritis and cannot walk without using a cane. The pain means he spends much of his day seated on a plastic stool in the middle of the room.

"Every day, I sit here and then I sleep, I just don't want to fall down," said Mr Wee, who fears that such an accident could kill him.

The bachelor's fear highlights a very real concern elderly residents living alone here face, a problem that social workers say will only get worse as society ages.

According to the General Household Survey released last month, the proportion of households comprising only residents aged 65 or older stood at 82,600, or 6.7 per cent of all households. About half of this number, or 41,200, is made up of residents who live alone.The Government estimates that by 2030, this number will hit 83,000.

Health concerns aside, social workers say dying with dignity is one of the foremost concerns on the minds of these elderly folk.

"Who is going to take care of their funeral matters when they are gone? This is one of their main concerns," said Mr Desmond Chee, centre manager of eldercare centre Xin Yuan Community Care, a Toa Payoh-based centre which arranges funerals for elderly residents.

Mr Chee points out that although he tells his social workers and children of elderly parents to keep tabs on their charges, the reality is they cannot be there all the time. "Let's say you have a son who visits his father every Sunday. If something happens to the father on Monday, by the time the son finds out, six days would have passed," said Mr Chee.

He encourages children who have elderly parents who live alone to install either CCTV cameras or some form of elderly monitoring system in their homes.

Some voluntary welfare organisations, such as the Lions Befrienders, have done just that. Since 2010, it has installed elderly monitoring systems in 500 homes.

Lions Befrienders executive director Chey Chor Khoon said the system combines an alarm that seniors can activate and motion sensors that detect changes in usual movement or rest patterns. An SMS alert is automatically sent to a relative or volunteer befriender when there is a change in the normal patterns.

"We have encountered incidents of seniors who press the emergency button when they fall and cannot get up," said Dr Chey.

Security companies say they have noticed more inquiries from people who want CCTV systems set up to monitor their aged parents.

Mr Marcus Tan, managing director of security company Eurekaplus, said that over the last two to three years, he has received between five and 10 inquiries a month.

About 30 per cent go on to eventually install these systems, which can cost upwards of $600.

They do this for peace of mind, said Mr Tan. "Ultimately, what price is your parents' well-being worth?"

Mr Tay has agreed to handle Mr Wee's future funeral for free.

Asked if he would go on to help other elderly folk, he said: "As long as people come to me, I will see what I can do to help."

"Two of my neighbours died and people found out only because of the smell. I don't want the same thing to happen to me",...
Posted by The Straits Times on Saturday, April 9, 2016

How not to die alone
By Neo Han Yee, Published The Straits Times, 13 Apr 2016

Three years ago, I treated a patient who was estranged from his family and lived alone in a one-room rental flat. He suffered from advanced liver cancer, which had made him incontinent and severely reduced his ability to walk.

Despite multiple attempts to persuade him to accept hospice care, he chose to die at home. His body was discovered days later by a neighbour. I could imagine his final moments - alone and fearful. He is symbolic of a growing population of elderly people living in social isolation and struggling with serious illnesses.

As a geriatrician and palliative care physician, I have encountered many elderly patients at the end of their lives. They generally fall into two distinct categories - those who are at peace in spite of dire circumstances and those who remain distressed despite good treatment options. Predicting their responses has become fairly easy. The former are almost always plugged into a strong, caring social network of family and friends, while the latter often feel physically or emotionally isolated.

Strong, fulfilling relationships can be a panacea for physical distress towards the end of life.

Research backs this claim. One of the world's longest-running studies, the Harvard Study of Adult Development, sought to determine: "How can you live a long and happy life?"

Researchers tracked 724 men over 75 years, collecting data about their occupation, mental and physical health, lifestyle habits and relationships. Happily married men reported little impact to their positive disposition, despite physical pain owing to poor health. In contrast, those in unhappy relationships reported greater physical distress.

The study also found that good relationships contributed to longer, happier lives. Men who reported being closer to their family, friends or community tended to be happier and healthier. Socially isolated individuals were significantly less happy, suffered declining physical and mental health earlier, and lived shorter lives.

In the face of a rapidly greying population, are we doing enough to promote social connectedness among our senior citizens?

The short answer is no.

According to the 2014 national census, 15 per cent of Singaporeans above the age of 55 lived alone. Nearly one-third of those were over 65, up from 20 per cent in 2010. Increased preference for independent living arrangements, both among seniors and the young, may exacerbate this trend. Especially because seniors living alone often lack traditional sources of support, such as smaller social networks, poorer healthcare access and are more likely to feel lonely.

A study under the Singapore Longitudinal Ageing Studies series found seniors who lived alone were 1.7 times more likely to die prematurely, even after controlling for chronic diseases, marital status and functional impairment.

Another study by the National Healthcare Group reported that seniors who lived alone, or with a domestic helper, and felt socially isolated were more likely to experience depressive symptoms.

Staying closer together may help maintain more fulfilling, inter-generational relationships. Current housing policies already encourage children to live close to their parents. However, financial incentives alone are insufficient. Young couples prefer estates closer to schools, transport nodes or places of work, while the elderly benefit from estates with more senior daycare or rehabilitation facilities. In an ideal world, these different needs would not be in conflict. However, reports of people petitioning against geriatric facilities built near their homes are disheartening. They reflect a prevalent negative perception of ageing and death in Singapore.

Our society is ageing. The number of elderly citizens will triple to 900,000 by 2030, when every two working-age citizens will support one elderly person over 65. We cannot ignore the needs of this huge section of society. We must encourage more open conversations about ageing and disease, as well as dispel myths or cultural taboos associated with dying. Society needs to evolve to accommodate seniors and make resources accessible for them to remain healthy, active and socially integrated.

To do this, we should first understand their fears and concerns. A street poll by the Lien Foundation and Ngee Ann Polytechnic found that most Singaporeans identified being a burden to loved ones as their greatest fear at the end of life. More services will be needed to support caregivers of frail elderly persons who require greater supervision and care. Such facilities could also offer extended operating hours, so family members can pick up the elderly folks at the end of a working day.

To further support eldercare in the community, funding for geriatric homecare services must be stepped up. They play a vital role in preventing minor illnesses from escalating into medical crises and help empower children to care for aged parents at home. Reduced caregiver burdens can, in turn, facilitate more fulfilling family relationships.

The elderly of tomorrow will be distinctly different from the elderly of today - they will be better educated, more financially secure and have higher expectations. Community efforts aimed at promoting social connectedness will not only have to match these emerging needs, but will also have to be creatively designed to encourage transgenerational participation.

Happiness during old age should never be taken for granted. While the concerted efforts of government agencies, VWOs and healthcare providers are necessary to provide a secure and comfortable social environment for our seniors to age with dignity, individuals must also recognise their part in investing wisely - not in financial or material wealth, but in meaningful relationships with their loved ones.

I have witnessed many elderly people die in the arms of loved ones, and I believe this did not happen by chance. It took them a lifetime of relationship-building to be loved as an affectionate spouse, a nurturing parent or an endearing friend.

Dr Neo Han Yee is a palliative care consultant at Tan Tock Seng Hospital and member of the National Healthcare Group, a Regional Health System for Singapore.