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UNDERSTANDING
THE
Quality of life OF
SENIORS
This publication is also available online at https://www.ncss.gov.sg/Press-Room/Publications
CONTENTS
06 16
PRESIDENT'S QUALITY OF LIFE
FOREWORD STUDY ON SENIORS
by Mr Hsieh Fu Hua,
NCSS President 35
THE ELDERCARE
07 SERVICE LANDSCAPE
FOREWORD
by Dr Gerard Ee, 36
Chairman of the NCSS WHAT CAN YOU DO?
Advocacy and Research
Panel 37
ACKNOWLEDGEMENTS
08
MESSAGE 38
Copyright © 2017 by National Council of Social Service from Dr Kanwaljit Soin, References
ISBN: [978-981-11-4230-7] Founding President,
Annexes
Women’s Initiative for
All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any 39 A
: Glossary of Quality
Ageing Successfully
means, electronic or mechanical, including photocopying, recording, or by any information storage of Life Domains and
Facets
system and retrieval system, without the written permission of the copyright owners. 09
AN OVERVIEW 40 B
: Glossary of
Designed and Printed in Singapore by OF ELDERCARE Eldercare Services
Oxygen Studio Designs Pte Ltd AND AGEING
www.oxygensd.com
12
Please address all queries regarding this publication to: INTRODUCTION
Advocacy and Research Team
National Council of Social Service
170 Ghim Moh Road, #01-02
Singapore 279621
Tel: 6210 2500
Fax: 6468 1012
research@ncss.gov.sg
Before I became President of NCSS, I used Regardless of ability, condition or age, our lives
to volunteer for a charity, handing out food are made up of many diverse facets, aspects and
provisions to vulnerable families. Many recipients experiences intricately woven together. Even as
were kind and invited me into their homes. What individuals, we are shaped by the ecosystem we
struck me during these visits was the sight of live in, be it the people close to us, community or
stacks of unconsumed and even expired food. wider society. Hence, focusing on a few aspects
They explained to me that when social service rather than the whole – the individual rather than
organisations offered help, it was usually food. his or her interactions with the entire ecosystem
– prevents us from seeing meaningful linkages
While well-intentioned, gifts of food address that contribute to who a person is.
hunger as opposed to what keeps people hungry.
That food goes uneaten and families remain With this in mind, NCSS carried out a series of
vulnerable tells us that hunger is but one need studies to examine the quality of life of various
among many. It also reminds us that people’s real vulnerable populations and seniors through
needs can be very different from what we believe a person-centred and holistic approach. To
them to be. understand their aspirations, needs and well-being
from their perspective, we adopted the World
In addressing these issues, NCSS advocates Health Organisation’s framework on Quality of Life,
a quality of life approach to understanding conducting surveys, interviews and discussions.
needs. Areas such as psychological well-being,
independence and having social support are vital This is one in a series of publications that presents
to living well. This entails encouraging people the results of those findings to practitioners, social
to express what they need, and to be active service professionals, volunteers and service users
participants in addressing their own needs. for their application. Each contains rich information
that can be used to guide social service providers,
PRESIDENT'S FOREWORD
The Quality of Life Study has shed valuable funders and other stakeholders in the social
insights on how all individuals can hold onto service ecosystem, to dive into understanding
their aspirations, use their abilities and be active in
FOREWORD
and developing solutions so as to empower service
society. In supporting seniors to age in place, more Dr Gerard Ee users towards achieving their fullest potential.
can be done to improve their participation in sports Chairman of the NCSS Advocacy and
Mr Hsieh Fu Hua and recreation. For seniors who are willing and Research Panel Among numerous other applications, the insights
NCSS President able, we can encourage age-friendly workplaces, gleaned from these findings have also contributed
and create employment and volunteering towards national initiatives such as the Enabling
opportunities tapping their strengths. Masterplan 3, the nation’s disability blueprint,
"Regardless of ability, as well as the Social Service Sector Strategic
"That food goes uneaten and Ultimately, it is my hope that every contributor to condition or age, our lives Thrusts, a five-year strategic roadmap for the
families remain vulnerable tells this sector can join NCSS in taking a person-first
are made up of many diverse sector developed in partnership with the public,
perspective, seeing individuals beyond recipients private and people sectors.
us that hunger is but one need of help alone and empowering all to live with facets, aspects and experiences
among many." dignity in a caring and inclusive society.
intricately woven together." I am extremely grateful to our advisors. They are
experts in the field of statistics, clinical psychology,
social work, disability, mental health, seniors and
research. I am also thankful to each and every
respondent who participated in the study, along
with the many who helped ensure that their
opinions were heard.
6 7AN OVERVIEW OF ELDERCARE AND AGEING
Ageing, once the privilege of a few, is now the
destiny of many. By 2030, Singapore is expected
to become a super-aged society, with more than
20% of its population over the age of 65. With the AN OVERVIEW OF ELDERCARE AND AGEING
retirement age creeping up and the increase in
ageing consumers, the silver age has already arrived
in more ways than one. Demographics and Key Trends1
It is therefore timely to re-examine our attitudes
towards ageing. For example, we should do away The population is ageing rapidly.
with the assumption that being old is not to be
young or vice versa, as the distinction between
what is ‘old’ – slow, unproductive, uninteresting –
and ‘young’ – fast, efficient, innovative – is a false
one that underlies what we know as ageism.
Chronological age does not equate to function
or cognition, and it is no proxy for capability.
Many older persons are just as active as their
younger counterparts, notwithstanding that the
functional limitations of ageing can be mitigated
with changes in one’s behaviour and environment,
or through medical technologies.
1970 2015 2030
Instead of allowing these and other misconceptions 1 in 31 1 in 8 1 in 4
of ageing to persist, we should work towards a
strengths-based approach, one that recognises,
affirms and prioritises the positive aspects of Singaporeans are 65 or older
MESSAGE growing old. This means appreciating that ageing
is a multi-faceted phenomenon and that seniors
are diverse – like all seniors in some aspects, like
Dr Kanwaljit Soin some seniors in a few aspects and yet, like no other. People are living longer, and staying healthy for longer.
Founding President,
Women’s Initiative for Ageing Successfully The Quality of Life Study represents a step forward
in this direction. Gathering the views of seniors
themselves, it provides a holistic profile of their
needs, venturing into areas not often discussed Average Average
"Chronological age does such as how ageing affects females more than Life Expectancy Healthy Years
not equate to function or males, or how seniors lack intimate bonds, whether
with family or friends. These and other needs, need
cognition, and it is no proxy to be told. 2004 2010 2004 2010
for capability." 79.6 yrs 81.7 yrs 72.1 yrs 75.5 yrs
With more knowledge and understanding,
Singapore will hopefully become a more gracious
country for one to spend one’s later years in a secure
and sustainable society that is amenable to older
workers, recognises them for their contributions
and values them for their experience. If one thinks
about it, we would also be destigmatising our older
selves, paving the way for a life that is as young and 1 Sources: Department of Statistics, Institute of Mental Health, Ministry of Health (Disease Control Division).
exciting, as it is old and wise.
8 9AN OVERVIEW OF ELDERCARE AND AGEING AN OVERVIEW OF ELDERCARE AND AGEING
There will be Dementia Frailty
900,000 affects
seniors by 2030,
about double the current number of 440,000.
1 in 10 1 in 2 Feeling at least three out of five
symptoms (weakness, slowness,
of those who are of those exhaustion, low physical activity
As time goes on, Resident Old-Age Support Ratio 60 and above 85 and above
(Number of working Singaporeans per senior) or unintentional weight loss), is at
there will be fewer The number of persons with dementia is expected nearly 6% among those aged 60
16
Singaporeans to more than double to 103,000 by 2030. years and older.2
13.5
of working age 14
to support our 11.3
elderly. 12 10.5
9.0
Sensory Impairment
10
7.4
8
6.0
5.7 5.4
6
4
2
Visual impairment Hearing
0
1970 1980 1990 2000 2010 2014 2015 2016
affects nearly impairment affects Social Isolation
1 in 5 who are 60 23% of those is expected to increase among seniors,
and above3 60-69 years old4 from 35,000 to 83,000 by 2030.5
2V aingankar et al. (2016). Prevalence of Frailty and its Association with Sociodemographic and Clinical Characteristics, and Resource Utilization in a
Population of Singaporean Older Adults.
3 Ho, T., Law, N. M., Goh, L. G., & Yoong, T. (1997). Eye Diseases in the Elderly in Singapore.
4 Definition taken in accordance with the National Health Survey 2010 – at least 3 frequencies out of 4 affected (500 Hz, 1000 Hz, 2000 Hz and 4000 Hz)
at 40 dB in at least 1 ear.
5 Tan, T. (2014, 2 Mar). More Singaporeans Living Alone; Trend Seen Rising.
10 11Introduction
Singapore’s ageing population has led to more conversations about
what it means to age successfully. While living longer often brings
to mind challenges to physical health, it is important to realise that
seniors have other needs that are also associated with the ageing
process, in areas such as social belonging, intimate bonds with family
and friends as well as a sense of autonomous living.
To this end, the (NCSS) supports a person-centred and ecosystem
approach towards helping individuals achieve quality of life. This
is also the value which underlies the Social Service Sector Strategic
Thrusts (2017-2021), a 5-year roadmap for the social service sector.6
Person-Centred
A person-centred approach operates on the belief that an
individual has the capacity to understand, articulate and work
through problems as well as making decisions on how to
overcome them.7
Ecosystem
Addressing individuals holistically also means seeing them as
connected to different contexts that mutually influence each
other, and which impacts every aspect of an individual’s life —
an ecosystem8 comprising caregivers and family, community
and wider society. In practice, this means that understanding
the needs of seniors necessitates taking into account their
interactions with the ecosystem, to work towards a more
holistic understanding and solution creation.
Quality of Life
Taking a multi-faceted approach to individual well-being, a
key goal is to ensure that individuals’ quality of life is optimised
in the form of a core set of diverse, essential needs to be met.
These needs are evaluated from the individuals’ own point of
view, which gives credence to people's own awareness of what
they need. This is important because researchers agree that the
assessment of quality of life is subjective9, and that individuals
perceive needs and give importance to them in different ways.
6 T he Social Service Sector Strategic Thrusts document may be found on NCSS’ website at http://
www.ncss.gov.sg/4ST.
7 The term “person-centred” was first introduced by the psychologist Carl Rogers in the 1940s.
Further information about the person-centred approach can be found at http://adpca.org/
content/history-0.
8 Bronfenbrenner, U. (1986). Ecology of the Family as a Context for Human Development: Research
Perspectives.
9 Blatt, B. (1987). The Conquest of Mental Retardation; Taylor, S. & Racino, A. (1991). Community
Living: Lessons For Today.
12 13Domains
facets
The (WHO) defines Quality of Life
Physical
as such10: 1 Pain and Discomfort 2 Energy and Fatigue 3 Sleep and Rest
Level of
An individual’s Independence 1 Mobility 2 ACTIVITIES OF 3 DEPENDENCE ON MEDICAL 4 WORK CAPACITY
DAILY LIVING TREATMENT / MEDICATION
perception of their
position in life in the Social
context of the culture Relationships 1 PERSONAL RELATIONSHIPS 2 SOCIAL SUPPORT 3 SEXUAL ACTIVITY
and value systems in
which they live and Environment
in relation to their 1 SAFETY AND SECURITY 2 HOME ENVIRONMENT 3 FINANCIAL ADEQUACY 4 HEALTH AND SOCIAL CARE
goals, expectations, 5 OPPORTUNITIES 6 RECREATION 7 PHYSICAL 8 TRANSPORT
standards and TO ACQUIRE NEW AND LEISURE ENVIRONMENT
INFORMATION AND SKILLS
concerns.
Psychological
It conceptualises Quality of Life 1 POSITIVE FEELINGS 2 THINKING, LEARNING, 3 SELF-ESTEEM 4 BODY 5 NEGATIVE
in six constituent domains, sub-
MEMORY AND IMAGE AND FEELINGS
divided into 24 facets. More details
CONCENTRATION APPEARANCE
on the domains and facets may be
found in Annex A.
Personal Beliefs
1 PERSONAL BELIEFS,
SPIRITUALITY/ RELIGION
With this in mind, NCSS conducted the Quality The results from this inaugural study also serve as
of Life Study on Seniors, a nationwide survey a baseline for future comparison, allowing changes
which sought to identify what areas they felt in quality of life to be tracked over time. This will
contributed most to their well-being and could strengthen the social service sector’s ability to
be improved upon. assess the impact of our schemes, initiatives,
services and programmes, and identify trends for
These findings support existing knowledge and future needs and gaps.
feedback, and help NCSS represent the views of
seniors. NCSS will also reference them for deeper
solutioning, research, service planning efforts, public
education and policy recommendations.
10 W
orld Health Organization. (1993). Study Protocol for the World Health Organization Project to Develop a Quality of Life Assessment Instrument
(WHOQOL).
14 15STUDIES STUDIES
QUALITY OF LIFE STUDY ON SENIORS
Research Objectives Respondent Breakdown by Gender CHRONIC DISEASE
Chronic disease such as heart disease, diabetes, stroke,
• To understand the needs of pre-seniors (50-64 Male Female and asthma affects nearly 6 in 10 aged 50 and above.
years old)11 and seniors (65 years and above), 47% 53%
across six domains of quality of life12:
Physical Respondents Who Have Used or Are Currently Accessing Services^
l Ind
Le pend Counselling and Case Management
Beli ona
313
vel ence
e
efs
Pers
6
of
Employment-Related Services
domains 190
of quality (e.g. skills upgrading, job support)
Psych
of life
ships
ion l
lat Socia
Support Groups 181
olo
al
gic
Re
Environment
Financial Assistance 174
(e.g. public assistance, grants, ComCare)
• To obtain a quantitative baseline for the
quality of life of pre-seniors and seniors Helplines 72
• To surface priority areas for action RESPONDENT BREAKDOWN BY HOUSING TYPE
1-2 Room 3 Room 4 Room 5 Room/ Befriending Services 37
7.1% 25.2% 31.7% Executive/
Method Others
This study was carried out in two stages, comprising Assistive Devices 24
28.8%
a survey as well as post-survey focus group
Private Community Home 18
discussions.
Apartment/
Condominium
Quantitative Survey Senior Activity Centre 14
7.1%
Survey participants aged 50 and above were
obtained through random sampling from the Social Day Care Centre/
Senior Care Centre 13
Department of Statistic’s database of households
with at least 1 person aged 50 and above. The survey
was administered face-to-face, and respondents Hospice Home/Day Care 10
had to complete it by themselves as far as possible
(with clarifications where necessary). The final Active Ageing Programmes 7
sample comprised 1000 responses.13
Other Senior-Specific Services 5
COMPARISON TO THE GENERAL POPULATION Respondent Breakdown by Education
As a basis for comparison, NCSS also obtained a None Primary Secondary Institute of Home Care 4
representative sample (n = 942) of the general 7% School School Technical
population through the Department of Statistics14 0 50 100 150 200 250 300 350
33.7% 33.2% Education ^
espondents were allowed to indicate their
R
as well. 1.9% attendance of more than one service Number of Respondents
Polytechnic Junior University Others 11 T his group was surveyed for the purposes of understanding needs upstream, towards ideating preventive modes of intervention.
6.9% College/Pre- Degree 0.7% 12 More details on the domains, and facets under each domain, in Annex A.
13 Comprises only those living in the community, without dementia. Number of people approached: 1410, Response Rate = 71%.
University Holders 14 Responses from the general population sample who indicated that they had mental health conditions or disabilities were removed so that the general
5.2% 11.4% population sample could be used as a control group for comparison with the other target groups. 2,000 households surveyed. Response rate: 50%.
16 17STUDIES STUDIES
In this survey, three World Health Organisation Quality of Life (WHOQOL) instruments were used. Further Key Findings
questions were asked on their satisfaction of services accessed, the types of services they require as well as Our analyses showed meaningful differences in quality of life between pre-seniors and seniors. As one
the Quality of Life domain(s) in which they desired the most improvement. All questions were translated key theme of this study was the effect of ageing on quality of life, the original sample (n = 1000, aged 50
into Chinese, Malay or Tamil where necessary. and above) is henceforth split and referred to in two groups in this section:
Quality of Life WHOQOL-BREF15 • Pre-Seniors, aged 50-64 (n = 666)
This is a 26-item scale that asks respondents to rate their perceived • Seniors, aged 65 and above (n= 334)16
WHOQOL-BREF state of well-being in the last two weeks. Questions are answered on
a five-point scale, and comprise: Towards applying the findings in a more direct manner, idea and innovations (in Singapore or from overseas)
are presented that adopt a person-centred and ecosystem approach in improving the lives of seniors.
• 24 questions that corresponded with the 24 facets of Quality of Life
Specific to Seniors • Two questions regarding their perception of life and health overall This section is not meant to be prescriptive, but to highlight both existing and innovative models to
inspire more solutions that are ground-up and suited to the community’s needs.
In addition to the sample of seniors, the WHOQOL-BREF was
administered to the general population sample as well. Finding #1
Items on
WHOQOL-OLD Activities of
WHOQOL-OLD The highest scoring quality of life domains for Pre-Seniors was level of independence. Seniors scored
Daily Living This is a 24-item, add-on module of WHOQOL-BREF that measures highest in the physical domain.
six areas important to seniors — Autonomy, Death and Dying,
Intimacy, Past, Present & Future Activities, Sensory Abilities, and However, both groups experienced a lower quality of life than the general population.
Social Participation. Questions are answered on a five-point scale,
Other Areas which include: At the domain level^, the scores for personal beliefs were the lowest. General Population (18-49)
Surveyed by NCSS
Pre-Seniors (50-64)
Domain Areas Covered 100 Quality of Life Score by Domain Seniors (≥ 65)
Autonomy Being able to live autonomously and to
make own decisions 90 69.0
75.9
1. Demographics 70.2 70.3
71.8** 65.7** 69.8
Death and Dying Concerns, worries, and fears about death 80 67.5 69.0
2. D esired Areas of 68.2 *
67.0** 67.6 67.1**
and dying 66.6* 66.3** 65.3 65.4** 62.5
**
Improvements **
65.3** 65.0**
Intimacy Being able to have personal and intimate 70 60.9**
3. P
erception of Health relationships
Quality of Life Score
Status and Health 60
Past, Present and Satisfaction about achievements in life and
Conditions
Future Activities at things to look forward to
4. Service-Related 50
Sensory Abilities Assesses sensory functioning and the
Questions impact of loss of sensory abilities on quality 40
of life
Social Participation Participation in activities of daily living, 30
especially in the community
20
Focus Group Discussions
10
To derive deeper insights into the survey findings, focus group discussions were carried out with
practitioners and leaders of organisations working to serve seniors. 0
Physical Level of Social Environment Psychological Personal Overall QOL
The discussions included open conversations on participants’ understanding and views on the needs of Independence Relationships Beliefs
and challenges faced by seniors, as well as strategies in moving forward.
* pSTUDIES STUDIES
At the facet level^, Pre-Seniors and Seniors scored lowest in areas such as recreation and leisure, financial Idea: Adopt a
adequacy as well as positive feelings. holistic approach
to understanding Ageing gracefully is not just a matter of
The highest scores were in physical environment, mobility and negative feelings17. Pre-Seniors’ and biophysical health, but should also
Seniors’ needs. be about bolstering psychological,
For more information on the Quality of Life domains/facets, please refer to Annex A.
^
emotional and community support
and resources. In particular, expanding and
Quality of Life Score by Facet diversifying community partnerships is
(Pre-Seniors and Seniors Combined) becoming increasingly important so as to
Physical Environment 73.6 enable residents to age in place. A holistic
Mobility 73.4
Top 5
approach to needs should also take a person-
Negative Feelings 72.6 centred viewpoint, prioritising not only
facets
Personal Relationships 72.4
Self-Esteem 72.1 self-reported needs but also Pre-Seniors’
Pain and Discomfort 72.0 and Seniors’ own potential in meeting them.
Transport 71.3
Activities of Daily Living 70.4
Health and Social Care 70.1
WHOQOL-BREF Facets
Safety and Security 68.7
Dependence on Medication or Treatments 67.6
The Tsao Foundation is distinctive for its The Pioneer Generation Office (PGO) was
Work Capacity
Body Image and Appearance
Sexual Activity
Home Environment
67.1
66.5
65.8
65.5
1 person-centred, integrated bio-psycho-social
approach to promoting health and wellbeing
2 set up by the government in 2014 to reach
out to Pioneers and explain to them the
Energy and Fatigue 65.1 over the life-course, which it delivers through benefits of the Pioneer Generation Package
Social Support 64.9 team-managed, interdisciplinary community (PGP). To do so, PGO kickstarted the Pioneer
Sleep and Rest 64.2 care initiatives. Generation Ambassadors Programme, which
Opportunities to Acquire Information and Skills 63.0 mobilised volunteers, also known as Pioneer
Thinking, Learning, Memory and Concentration 62.0
Personal Beliefs 62.0 Its Hua Mei Centre for Successful Ageing Generation (PG) Ambassadors, to thank, assure
Positive Feelings 59.5 Bottom 5 serves as a one-stop centre of pioneering and honour Singapore’s Pioneers through face-
facets
Financial Adequacy 57.0 healthcare services for community-dwelling to-face, personalised outreach.
Recreation and Leisure 54.0
adults, from the age of 40 to the end of life. The
0 20 30 40 50 60 70 80
Foundation also spearheads the Community for Since July 2016, this outreach has been extended
Quality of Life Score Successful Ageing (ComSA), a transformative, to all citizens aged 65 and above. During the
ground-up, community-wide approach to visits, PG Ambassadors explain complex policies
PRE-SENIORS SENIORS enable health, lifelong learning and continuous to seniors, connect them to activities and services
(50 to 64 years old) (65 and above) participation in civic society. It is currently being in the community and where needed, help
developed in Whampoa with a multi-sectoral them apply for assistance. To date, 7 out of 10
network of partners. Singaporean seniors above 65 years old have
Top 3 Facets (Best to Least Best) Top 3 Facets (Best to Least Best)
been engaged at least once by PG Ambassadors.
• Mobility • Physical Environment
The Foundation is also developing a signature
• Physical Environment • Transport
series of practitioner-to-practitioner training Apart from this, the wider programme also
• Self-Esteem • Negative Feelings
courses to build capacity in community-based provides volunteering opportunities for
aged care, breaking new ground in professional seniors, with the objective of foster a caring and
Bottom 3 Facets (Worst to Least Worst) Bottom 3 Facets (Worst to Least Worst)
training in gerontological nursing as well as compassionate society. PGO continues to serve
• O pportunities for Recreation • O pportunities for Recreation
gerontological counselling. as a community based organisation, overseeing
and Leisure and Leisure
senior engagement and partnering government
• Positive Feelings • T hinking, Learning, Memory
For more information, visit agencies and community stakeholders to help
• Personal Beliefs and Concentration
http://tsaofoundation.org. seniors age gracefully. For more information,
• Positive Feelings
interested parties may contact PGO at
info@pgo.gov.sg.
17 A high score indicates that individuals do not experience a high level of negative feelings.
20 21STUDIES STUDIES
Finding #2 Finding #3
Quality of Life was even lower for both groups, if either had complex needs (i.e. having a disability There were no significant differences in quality of life between males and females.
or a mental health issue).
Within each group, however, both reported lower quality of life with increasing age.
Quality of Life Score by Presence of Complex Needs
100 In particular, for females, Senior females experienced significantly lower quality of life in their level of
** **
90 independence as well as physical and psychological well-being, compared to Pre-Senior females.
80 67.8 66.8 Quality of Life Score by Gender
60.5 59.5
70 100 *
Quality of Life Score
60 90
50 66.3 65.0 67.8 65.0
80
40 70
Complex Needs
Quality of Life Score
30 60
No Complex Needs
20 50
**p < 0.01
10 40
0 30
Pre-Seniors Seniors
Idea: Strengthen 20
and improve access Pre-Seniors
10
to mental health
and disability Seniors 0
support systems. Staying physically fit and psychologically well are important for people *p < 0.05 Male Female
to age well and guard against disability and mental health issues.
Hence, upstream interventions and access to mental health and disability
support are crucial. A non-profit organisation dedicated to
Idea: Support females in the ageing process,
particularly in maintaining their sense promoting successful ageing among women,
Improving and increasing outreach are imperative as well, particularly to seniors the Society for Women’s Initiative for Ageing
of independence as well as physical and
who may not be aware of programmes nor know how to access them such as Successfully (WINGS) runs the flagship CoreAct
psychological well-being.
those living alone, are not ambulant, or who are single, divorced or widowed. programmes, a series of three subsidised
and interactive ageing preparation courses
designed to help ageing women in the areas
of financial education and decision-making
Changi General Hospital’s Community Psychogeriatric Programme aims to improve the mental (MoneyAct), preventive health and holistic
health of seniors aged 65 and above in the Eastern region of Singapore. It engages in partnerships well-being (HealthAct) as well as happiness
with eldercare agencies and General Practitioners. A multi-disciplinary team including medical social and self-esteem (HappinessAct).
workers, nurses, physiotherapists and geriatric psychiatrists, conducts:
More information can be found on WINGS’
• Training, consultation and support for eldercare agencies and family practitioners website at www.wings.sg/what-we-do
• On-site mental health assessments, psychosocial interventions and functional rehabilitation
Similar initiatives include the National University Hospital’s G-RACE Community Partnership (Western
region) as well as the Institute of Mental Health’s APCATS service (Central region).
22 23STUDIES STUDIES
Finding #4 Finding #5
Pre-Seniors and Seniors wanted to see improvements in their physical and psychological well-being as Seniors scored lower than Pre-Seniors in intimacy (feeling and having opportunities for love and
well as their level of independence. companionship) and coming to terms with sensory decline in their lives.
75 Level of Pre-Seniors Seniors
Independence Pre-Seniors scored lower than Seniors in the domain of death and dying.
71.6
Social WHOQOL-OLD Score by Area
Social 100
Relationships *
Relationships 68.2 Physical *
Quality of Life Score
70 Psychological 90
67.0 67.6 77.4
67.0 * 74.0
80 70.5
67.6
Personal 64.3 64.0 62.6 62.2
70 63.1 61.9 62.5
WHOQOL-OLD Score
59.9
65 Beliefs 66.0 66.0
62.5 60
65.4 65.0 Psychological 65.0 Physical
Environment Environment Level of 50
61.0 Independence
60 Personal Beliefs Pre-Seniors 40
30
Seniors
Smallest desired improvement Greatest desired improvement 20
*p < 0.05
10
Idea: Encourage 0
Autonomy Death & Intimacy* Past Present Sensory Social
independence and Dying & Future Abilities* Participation
self-reliance.
Focus groups discussions revealed that the stereotypical view that society WHOQOL-OLD Areas
Idea: Improve
has of a senior is someone who is retired and wants to relax and enjoy
Seniors’ feelings
life. However, this image fails to incorporate various anxieties of ageing, be it
of love and
retirement or potential loss of income, deteriorations in health, and fears over
companionship
loss of one’s independence.
as well as their
ability to cope
While attempts to improve marital and family bonds might work,
with sensory loss.
community activities can also be helpful, especially those that celebrate
The Marine Parade Town Council’s Town Audits involves identifying physical defects and hazards seniors’ bonds and relationships with loved ones.
in the neighbourhood that might be unsafe for older residents. Each Town Audit team comprises at
least 2 seniors and 3 volunteers, who walk along routes to popular spots often visited by seniors such
as the market, supermarket and bus stops. Teams document and identify potential physical hazards
along the way, which are subsequently surfaced to relevant agencies such as the Town Council, the In conjunction with the International Day of Older Persons, NCSS brought community, corporate
Land Transport Authority and the Housing Development Board. and social service organisations together in the Seniors Give Thanks! Campaign, in which seniors
were encouraged to thank and strengthen relationships with their loved ones through simple acts
The audits have led to more senior-friendly features in the neighbourhood such as more benches, of gratitude, such as a handwritten note or meaningful gesture.
countdown timers for the “green man” at traffic crossings, bus service information posters in larger
fonts, levelled ground surfaces as well as slip-resistant drain covers. More information may be found at: www.ncss.gov.sg/idop.
24 25STUDIES STUDIES
Finding #6
Pre-Seniors were more likely to have a lower Seniors were more likely to have a lower quality
quality of life^ if they: of life^ if they:
Had not engaged
in regular sports or
physical recreational Had a chronic
activities (3x) disease+ (3x)
In helping seniors cope with sensory decline, services targeting sensory decline should be made
more accessible, and prioritise early detection and intervention so as to anticipate or mediate Had a chronic Did not earn a
seniors’ ability to cope. disease+ (2x) personal income or
allowance (2.7x)
Reaching out to educate seniors is also important, as well as to bring them to awareness of the
impact of sensory decline on daily life such as greater risk for falls, greater caregiver burden and
increased use of savings. This is also as many communicate indifference (e.g. regarding sensory
decline as normal in ageing^), denial or fear when informed about their sensory loss.
It is further important to be sensitive to their psychosocial needs beyond providing information
Were staying in a Were staying in a
alone, as they might face anxieties over increased costs or feelings of resignation. In this manner,
1-3 room flat (1.5x) 1-3 room flat (2x)
providing peer support from ex-patients may allay the concerns of potential service users.
+
most common forms were diabetes, high blood pressure and high blood cholesterol
^
recent study conducted by Singapore National Eye Centre (SNEC) showed that 9 in 10 elderly Singaporeans assumed that there was
A ^
inary logistic regression was conducted (median QOL cutoff). Controlled for age and gender. Lower quality of life refers to scores in
B
no need to have regular eye checks if they could see well. the bottom 50th percentile.
Finding #7
Change Pre-Seniors’ Seeking to break the taboo on death and dying and encourage reflection
on end-of-life matters, the Lien Foundation and Ang Chin Moh Foundation Regardless of whether respondents were Pre-Seniors Seniors without chronic disease reported
attitudes towards
commissioned Drama Box and ArtsWok Collaborative to start Both or Seniors, those with a chronic disease+ experienced a higher quality of life than Pre-Seniors
death and dying.
Sides, Now, an arts-based civic engagement initiatives that provides a significantly lower quality of life. without chronic disease.
a platform for individuals to reflect on end-of-life matters. It comprises +
ost common forms were diabetes, high blood pressure and
m 72
Estimated Marginal Mean of QoL (composite)
diverse segments such as art installations, speaker sessions, forum high blood cholesterol
theatre performances, community conversations as well as puppetry
performances that aid in facilitating end-of-life conversations and which 70
have since travelled to more than 50 eldercare centres around Singapore.
68
More information may be found at: www.bothsidesnow.sg.
66
64
Pre-Seniors Seniors 62
No Yes
Had Chronic Disease
26 27STUDIES STUDIES
Finding #8
The Check Car, Check Body scheme
Improving access to chronic disease developed by the Health Promotion Board
Frequency of Sports Participation
Nearly half of Pre-Seniors and Seniors screening and chronic disease awareness in partnership with Comfort Delgro offers
did not participate in sports and physical 50 44.9 among community-dwelling seniors would health screening to taxi drivers while they wait
recreation. be useful in identifying symptoms early for their taxis to be serviced. It also includes
so that they may be more effectively subsequent health counselling and coaching
The following groups were less likely to participate:
40 • Females
managed. In this regard, having more programmes customised to each individual’s
• With Chronic Disease proactive forms of outreach would help health conditions.
• Living in 1-3 room flat as well.
% of respondents
30
19.1
20 15.8 Finding #9
10.8
9.4 Compared to younger workers, Pre-Senior workers reported a lower quality of life across the personal
10 beliefs, level of independence, environment and psychological well-being domains.
Quality of Life Score by Domain
100 *
0 * * *
90 75.7
More than 3 2-3 times 1-2 times Once a Not at all 73.6
Idea: Promote 68.3 68.8 68.6 69.7 69.8
times a week a week a week week 80 68.2 67.4 67.2
access to sports 65.7
63.0
and recreational 70
activities as
Quality of Life Score
well as other 60
Shifting the focus to preventive measures is imperative to help seniors
preventive age healthily. In this manner, expanding pre-seniors’ and seniors’ 50
measures. involvement in sports and recreational activities can be helpful, especially
through initiatives which involve the modification of common spaces 40
and infrastructure. Such encourages both young and old to be more 30
accustomed to and accepting of senior-friendly features in society.
20
10
Cashing into the silver dollar, the Japanese company AEON Retail has steadily embraced senior- 0
friendly infrastructure and services. In AEON Kansai, the mall opens at 7am – earlier than most Physical Level of Social Environment Psychological Personal
malls – as seniors tend to be up earlier. Apart from fashion targeted at seniors, patrons can also visit Independence Relationships Beliefs
large sections dedicated to walking, hiking and travelling which Japanese elderly enjoy. The mall Pre-Senior Workers (50-64) Younger Workers (18-49) *p < 0.05
also features a 180m carpeted walking course which makes it safe for seniors to walk in all seasons,
as well as staff who are trained in dealing with seniors who have dementia. Supermarkets feature At the facet^ level, there were no significant differences between Pre-Senior and younger workers’ quality
lighter shopping carts as well as food items that are low in salt and fat. One floor is also devoted of life with respect to:
entirely to elderly patrons, with amenities such as senior activity rooms, rehabilitation day services, • Pain and discomfort, energy and fatigue, sleep and rest (physical domain)
performances, free exercise classes and even a private gym. • Mobility, activities of daily living and work capacity (level of independence domain)
However, Pre-Senior workers scored significantly lower* than younger workers in terms of:
• Positive feelings (psychological domain)
• Personal beliefs/spirituality (personal beliefs domain)
• Opportunities to acquire new information and skills, opportunities for leisure and recreation, safety and
security, home environment and financial adequacy (environment domain)
^
For more information on the Quality of Life domains/facets, please refer to Annex A.
28 29STUDIES STUDIES
Finding #10
Among many innovative ideas
Promote gainful employment for pre-seniors and seniors by DesignSingapore Council,
Employed Pre-Seniors had a higher quality of life than unemployed Pre-Seniors, particularly in the physical through expanding public education, campaigns and Sensei.SG is a peer-sharing
and level of independence domains. initiatives targeted at encouraging employers to hire platform which helps seniors
older workers. Such endeavours should also incorporate seek meaningful engagements
100 Quality of Life Score by Domain
success stories along with data, both of which would through an online medium,
* work towards the common goal of destigmatising older which allows them to sell time,
90
* workers and re-educating employers on their perceived knowledge and experience
73.6 capabilites.
80 to interested parties. Silver
68.3 67.7 68.6
65.5
67.3 65.7 64.7
67.4 66.1 Connection is another platform,
63.0
70 61.6 Connecting seniors with forms of work that value which proposes incentives for
Quality of Life Score
experience might also be helpful. In organisations, this seniors (e.g. free vouchers)
60 could mean consulting roles where skills can be utilised to engage other seniors who
and passed down to younger workers. Alternatively, with are more socially isolated or
50
the move towards non-salaried labour, seniors could also withdrawn.
40 be supported to tap on freelance and contractual work.
More information may be found
30 at: www.designsingapore.org/
Employed what-we-do/resources/empathetic-
Pre-Seniors 20 technology-for-ageing.
Unemployed Finding #11
10
Pre-Seniors
In holistically improving the areas outlined in the WHOQOL-BREF, addressing the following aspects
*p < 0.05 0
Physical Level of Social Environtment Psychological Personal when designing initiatives can achieve the greatest effect:
Independence Relationships Beliefs
Pre-Seniors
Idea: Nurture age- • Empowering them to live autonomously and to make their own decisions
friendly workplaces • Improving their satisfaction with their past achievements, the present and what to look forward to
and employ Pre- • Providing more opportunities for them to participate in community activities and society in general
Seniors and Seniors
who are able and Hence, for instance, programmes to improve Pre-Seniors’ experience of positive feelings could focus
wish to work. Age-friendliness at the workplace involves more than physical modifications, on enabling them to make key decisions in the process of service use.
but also measures to sustain pre-seniors’ psychological well-being, sense of
independence and opportunities to information, skills as well as recreation. A Structural Equation Modelling (SEM) is used to understand the relationship between factors,
particularly that between observable and unobservable variables. It provides numerical estimates
For instance, psychological support for older workers at the workplace could also that indicate the strength of such relationships.
be enhanced, along with flexible arrangements such as part-time work, flexible
scheduling or working hours, job pooling or the option to convert a certain number PRE-SENIORS (50 to 64 years): STRUCTURAL EQUATION MODELLING^
of work days into leave. These options help to sustain access to gainful employment. WHOQOL-BREF Quality of Life of Pre-Seniors
0.31 0.28 0.23
The Korean internet content-monitoring start-up EverYoung monitors platforms like Naver, South Past, Present and Social
Korea’s Google-equivalent, to censor sensitive information on publicly available sites. It also only Autonomy
Future Activities Participation
hires employees over the age of 55.
WHOQOL-OLD
0.16 0.14
Staff work four-hour shifts, are encouraged to take a 10-minute break every hour, and enjoy benefits
such as annual eye tests, fitness centre membership and a chill-out zone that even features blood Sensory Abilities Intimacy Death & Dying
pressure monitoring machines by the sofas.
^
A simplified representation of Structural Equation Modelling – Multiple Indicators Multiple Causes Method.
30 31STUDIES STUDIES
Launched in August 2016, The Hour Glass
Kitchen Programme targets older adults
Allowing Pre-Seniors to aged 50 years and above and who are
co-produce or co-design at risk of social isolation, encouraging
service elements that them to cook together with like-minded
are suited to what they individuals in the community. Before the
want, allows them to be more invested kitchen was built, potential service users
in what they themselves participate in, were roped into the planning process.
while providing opportunities for them to For instance, a workshop was held where
contribute unique insights to programme they were invited to share on how it could
development. best serve their needs as well as their
aspirations for what it should achieve
for them. They were also consulted on Idea:
the kitchen’s layout, colour and theme. Advocate senior
*
T hese findings build on a landmark study by Dr Rahul Malhotra and
Shannon Ang from Duke-NUS Medical School, which demonstrated volunteerism.
that seniors (aged 62 to 97) receiving social support saw a short-term More information may be found at: Promoting volunteer opportunities for Seniors can help them explore
reduction to their depressive symptoms. They eventually felt less in participateindesign.org/the-hour-glass- ageing in a different way, improving social bonds and social interaction
control of their lives as they were regarded as recipients of help alone, kitchen. and allowing them to maintain physical, mental and social well-being. This could
resulting in the re-emergence of depressive symptoms.18
come in the form of skills-based volunteerism such as para-counselling, visitations
to those who have been institutionalised or befriending other seniors who are
Seniors socially isolated or non-ambulant.
• Improving their satisfaction with their past achievements, the present and what to look forward to
• Providing more opportunities for them to participate in community activities and society in general
• Providing access to early screening, sensory assistive devices and helping them come to terms with
sensory decline Among various programmes catered for The Council for Third Age (C3A) promotes
Thus, for instance, programmes designed to improve Seniors’ access to leisure activities could have
1 senior volunteers, RSVP Singapore – The
Organisation of Senior Volunteers hosts
2 active ageing in Singapore with its focus
on lifelong learning for seniors and
greater sensory stimulation as a key outcome. a Homework Supervision Programme for encouraging seniors to become volunteers. In
senior volunteers to help at-risk primary school particular, C3A is the administrator for the Silver
SENIORS (65 and above): STRUCTURAL EQUATION MODELLING^ children in school-related tasks such as homework, Volunteer Fund and the National Silver Academy.
WHOQOL-BREF Quality of Life of Seniors studying and preparation for tests, at least one
afternoon a week. The Silver Volunteer Fund supports programmes
organised by community-based organisations
0.49 0.33 0.18 It also mooted MyBuddy in 2013, a home-visit that offer volunteer opportunities and training
befriending programme targeted at discharged to seniors who wish to volunteer. Interested
Past, Present and Social elderly patients and lonely seniors. Volunteers organisations may contact svf@c3a.org.sg for
Sensory Abilities make regular home visits, offering companionship, more information.
Future Activities Participation
WHOQOL-OLD simple acts of kindness and reminders to take
medication. The National Silver Academy is a network of post-
Autonomy Intimacy Death & Dying secondary education institutions and community-
More information may be found at: based organisations offering a wide range of
^
A simplified representation of Structural Equation Modelling – Multiple Indicators Multiple Causes Method. www.rsvp.org.sg. learning opportunities to seniors aged 50 and
above. More information may be found at:
www.nsa.org.sg.
18 Tai, J. (2016, 3 Mar). ‘Support The Elderly Socially But Let Them Control Their Lives’.
32 33STUDIES
THE ELDERCARE SERVICE LANDSCAPE
In sum, the ideas may be classified into three broad areas of action:
The following are key programmes which cater to seniors19.
TRANSLATING IDEAS TO ACTION
For more information, a glossary is attached in Annex B.
Social Support &
Opportunity Personal Potential Home-Based Centre-Based Institution-Based
Inclusion
Befriending Active Ageing Community Home
Improve seniors’ physical and
Work towards full and Improve availability and
mental well-being so that they Community Case
effective participation and access to resources and Caregiver Support Community Hospital
can achieve their personal Management
inclusion of seniors in society opportunities for seniors
potential
Community Resources and Support
Expand Pre-Seniors’ ability to Improve access to mental Escort Hospice
Change Pre-Seniors’ attitudes Engagement Teams (CREST)
make choices and decisions in health and disability support
towards death and dying Food Distribution Counselling Nursing Home
the services they receive systems
Support females in the Helplines Day Rehabilitation Centre Senior Group Home
ageing process, particularly
Cater services/initiatives Home Medical Dementia Day Care Centre Sheltered Home
in maintaining their sense
to help seniors be more
of independence as well as Home Nursing Employment Development Centre Welfare Home
independent and self-reliant
physical and psychological
well-being Home Therapy Family Service Centre
Promote access to sports and recreation activities as well as Home Personal Care Financial Assistance
other preventive measures
Hospice Home Care Hospice Day Centre
Understand needs in a more holistic manner
Meals-on-Wheels Neighbourhood Link
Nurture age-friendly workplaces and employ Pre-Seniors and Seniors who are able and wish to work People’s Association
Wellness Programmes
Improve seniors’ feelings of love and companionship as well as
their ability to cope with sensory loss Outpatient Clinics
Advocate senior volunteerism Outreach
Senior Activity Centre
(Cluster Support, Rental or Studio
Apartment)
Senior Care Centre
Senior Citizen Clubs
Social Day Care Centre
Social Service Office
Support Groups (e.g. WiSHINE*)
* indicates programmes in the pilot phase
19 Programmes and services listed are not exhaustive.
34 35WHAT CAN YOU DO? ACKNOWLEDGEMENTS
At the end of the day, everyone plays an important role in the senior support ecosystem. Here are some We would like to thank all our respondents, who have been gracious and kind to share their opinions,
suggestions for what you can do:
participants and partners, for providing us with your feedback and assistance.
IF YOU ARE A… YOU CAN…
SENIOR Keep healthy and age actively – volunteer and participate meaningfully in society. Do not be afraid
to seek help. NCSS CONSULTANTS/ NCSS Advocacy and Research Team
CO NVESTIGATORS Tina Hung
Sim Gim Guan
Visit the Singapore Silver Pages’ website (www.silverpages.sg), for various programmes and schemes. Dr Lidia Suarez, Fazlin Abdullah
Tina Hung
For learning opportunities, head over to the National Silver Academy’s website (www.nsa.org.sg).
Anjan Ghosh James Cook University Dilys Tan
EMPLOYER Be open to hiring seniors who are willing and capable. With the right learning opportunities and Robyn Tan
guidance, seniors can transform their life experiences into new information and knowledge, performing RESEARCH TEAM Dr Joseph Simons,
Benjamin Tay
as well as others. Institute of High Performance
Quality of Life Study on Seniors Charmaine Lee
Computing, A*STAR
Fazlin Abdullah Lim Zhong Hao
Wee Xue Ting A/Prof Kenneth Poon, Andrew Lim
or tasks more suited to their capabilities. Give them a chance, and ascertain their strengths instead of
deciding their weaknesses. Hah Yu Wei National Institute of Education Marcus Ow
Benjamin Tay A/Prof Ng Tze Pin, Tan Zhuan Liang
SERVICE PROVIDER Share ideas, match services and link up with healthcare providers, parallel organisations or others in
the community. Lim Woan Yun National University of Singapore
Dilys Tan
In memory of:
Co-create services with service users, give them a voice and empower them to make decisions on what Lindy Teo †
Prof Michael Power (1954-2017)
they want – allowing them to take ownership of what they themselves are part of. Low Jian Jian
National University of Singapore
Omela Ng
Terence Sia …and all who have contributed to
independence and which restores their dignity. the research and this publication in
GRASSROOTS Design community activities that are more inclusive towards seniors, be it activities that also allow PUBLICATION WRITERS one way or another.
WORKERS Andrew Lim
the neighbourhood who might be socially isolated or in need of help, and ask what they need help with.
EDITORS
CO-WORKER / Avoid making assumptions about your co-worker or friend who is a senior. When in doubt, ask – be it
FRIEND their preferences or what they are comfortable with doing. Dilys Tan
Benjamin Tay
CAREGIVER /
FAMILY
Singapore Silver Pages
Self-Assessment Tool.
MEMBER OF THE If you know a senior who needs help, reach out. Be unafraid to strike up a conversation with them
PUBLIC and listen to their stories. Help them to apply for social assistance schemes and services through the
Singapore Silver Pages
Download a copy of the Removing Barriers
barriers and myths regarding seniors and ageing. Share it with others, and help them understand the
challenges that seniors face, encouraging inclusive behaviour in turn.
A list of hotlines may be found on the last page.
36 37REFERENCES ANNEX A: GLOSSARY OF QUALITY OF LIFE DOMAINS AND FACETS
Domain Facet Description
Basu, R. (2015, 14 Apr). Whampoa’s Way: Lien Foundation. (n.d.). Articles. Retrieved Vaingankar, J. A., Chong, S. A., Abdin, Physical Pain and Discomfort This facet explores unpleasant physical sensations experienced by a person
Residents Live Out Their Golden Years from www.genkikaki.com E., Picco, L., Chua, B. Y., Shafie, S., and the extent to which these sensations are distressing and interfere
in Their Own Homes. The Straits Times. ... & Chiam, P. C. (2016). Prevalence with life.
Ministerial Committee on Ageing. (2016).
Retrieved from www.straitstimes.com/ of Frailty and its Association with Energy and Fatigue This facet explores the energy, enthusiasm and endurance that a person
I Feel Young in my Singapore!:
singapore/housing/whampoas-way- Sociodemographic and Clinical has in order to perform the necessary tasks of daily living, as well as other
Action Plan for Successful Ageing.
residents-live-out-their-golden-years- Characteristics, and Resource
Singapore: Ministry of Health. chosen activities such as recreation.
in-their-own-homes Utilization in a Population of
Ministry of Health. (2015). Opening Singaporean Older Adults. Geriatrics & Sleep and Rest This facet concerns how much sleep and rest, and problems in this area,
Blatt, B. (1987). The Conquest of Mental
Address by Mr Gan Kim Yong, Gerontology International 2016, 1-11. affect the person's quality of life.
Retardation. American Psychologist,
Minister for Health, at the Singapore
31, 47-52. WHOQOL Group. (1998). Developmental Level of Mobility This facet examines the person's view of his/her ability to get from one place
National Eye Centre 25th Anniversary
of the World Health Organization Independence to another, to move around the home, move around the work place, or to
Bronfenbrenner, U. (1986). Ecology of International Meeting, 23 May 2015.
WHOQOL-BREF Quality of Life
the Family as a Context for Human and from transportation services.
Ong, Y. S. (2015). Ageing in Place in Assessment. Psychological Medicine,
Development: Research Perspectives.
Singapore. Symposium (no. 4) 28(3), 551-558. Activities of Daily Living The facet explores a person's ability to perform usual daily living activities.
Developmental Psychology, 22(6),
conducted at the SG50 Scientific
723-742. World Health Organization (WHO). Dependence on This facet examines a person's dependence on medication or alternative
Conference on Ageing in Marina
(1993). Study Protocol for the World Medication or Treatments medicines for supporting his/her physical and psychological well-being.
Chew, D. (2016, 28 Dec). Cooking Mandarin Hotel, Singapore.
Health Organization Project to
Together Brings Seniors Cheer. The Work Capacity This facet examines a person's use of his or her energy for work. "Work" is
Social Service Sector Strategic Thrusts Develop a Quality of Life Assessment
Straits Times. Retrieved from www.
Steering Committee. (2017). Social Instrument (WHOQOL). Quality of Life defined as any major activity in which the person is engaged.
straitstimes.com/singapore/cooking-
Service Sector Strategic Thrusts: Research, 2(2), 153-159.
together-brings-seniors-cheer Social Personal Relationships This facet examines the extent to which people feel the companionship,
2017-2021. Singapore: National
Yap, M. T. (2010). State of the Elderly Relationships love and support they desire from the intimate relationship(s) in their life.
DesignSingapore Council. (2015). Council of Social Service.
in Singapore 2008/2009. It also addresses commitment to and current experience of caring for and
Empathetic Technology for Ageing:
Tai, J. (2016, 3 Mar). ‘Support The Elderly Singapore: Ministry of Community providing for other people.
Rethinking Health and Wellness for
Socially But Let Them Control Their Development, Youth and Sports.
the Elderly in Singapore. Singapore:
Lives’. The Straits Times. Retrieved Social Support This facet examines how much a person feels the commitment, approval,
Ministry of Communications and Yong, C. (2017, 23 Jul). Pioneer Generation
from www.straitstimes.com/ and availability of practical assistance from family and friends.
Information. Ambassadors to Help Seniors Age
singapore/support-the-elderly-
Well. The Straits Times. Retrieved from Sexual Activity This facet concerns a person's urge and desire for sex, and the extent to which
Epidemiology and Disease Control socially-but-let-them-control-their-
www.straitstimes.com/singapore/ the person is able to express and enjoy his/her sexual desire appropriately.
Division. (2010). National Health lives
pioneer-generation-ambassadors-to-
Survey 2010. Ministry of Health. Environment Opportunities to Acquire This facet examines a person's opportunity and desire to learn new skills,
Tan, T. (2014, 2 Mar). More Singaporeans help-seniors-age-well
Retrieved at https://www.moh. New Information and acquire new knowledge and feel in touch with what is going on.
Living Alone; Trend Seen Rising. The
gov.sg/content/dam/moh_web/ Skills
Straits Times. Retrieved from www.
Publications/Reports/2011/NHS2010
straitstimes.com/singapore/more-
- low res.pdf Recreation and Leisure This facet explores a person's ability, opportunities and inclination to
singaporeans-living-alone-trend-
participate in leisure, pastimes and relaxation.
Ho, T., Law, N. M., Goh, L. G., & Yoong, T. seen-rising
(1997). Eye Diseases in the Elderly Physical Environment This facet examines the person's view of his/her environment. This includes
in Singapore. Singapore Medical the noise, pollution, climate and general aesthetic of the environment and
Journal, 38(4), 149-155. whether this serves to improve or adversely affect quality of life.
Transport This facet examines the person's view of how available or easy it is to find
and use transport services to get around.
Safety and Security This facet examines the person's sense of safety and security from physical
harm.
Home Environment This facet examines the principal place where a person lives, and the way
that this impacts on the person's life.
Financial Adequacy The facet explores the person's view of how his/her financial resources
and the extent to which these resources meet the needs for a healthy and
comfortable lifestyle.
Health and Social Care The facet examines the person's view of the health and social care in the
near vicinity.
38 39You can also read
