Aug 14, 2023

Improved fittings and facilities for elderly welcome, but other residents need to be accommodated too: Experts


Singapore will also it safer and more comfortable for seniors to move about their neighbourhoods, said Prime Minister Lee Hsien Loong in his National Day Rally speech.

An elderly man in a wheelchair in Singapore. (Photo: Calvin Oh/CNA)

SINGAPORE: Enhancements to the community and homes to enable seniors to "age in place" were welcomed by academics and welfare organisations, but these improvements need to come hand in hand with the right mindset, they said.

Experts cautioned against perpetuating negative stereotypes of seniors as "decrepit" by having too many exclusive elderly facilities in place.

At his National Day Rally speech on Sunday (Aug 20), Prime Minister Lee Hsien Loong unveiled a range of extended measures to help seniors age in their own homes and neighbourhoods. By 2030, nearly one in four Singaporeans will be aged 65 and above.

Homes will become more senior-friendly, with enhancements to the current Enhancement for Active Seniors (EASE) programme, said Mr Lee.

Under the programme today, seniors can install fittings like ramps to help them get in and out of their homes, as well as grab bars and slip-resistant flooring in toilets.

Singapore will also make it safer and more comfortable for seniors to move about their neighbourhoods. Streets and linkways frequented by seniors will be revamped, and more shelters and rest points will be built.

There will also be more therapeutic gardens, fitness trails, and exercise machines to encourage seniors to stay active.

Longer green man signals will give seniors more time to cross the road, while barrier-free ramps and raised zebra crossings will improve access for wheelchair users.

Larger and more colourful signs with familiar symbols will be installed around HDB blocks to help seniors find their way home.

The approach of enabling seniors to age in place is in line with studies which show that seniors want to live out their golden years at home, said experts and eldercare organisations.

As the government puts into place elder-friendly measures, they should also consider others in the community, especially in a land-scarce Singapore, they said.

Dr Kelvin Tan, head of programme (minor in Applied Ageing Studies) at the Singapore University of Social Sciences (SUSS) said: "We want to be conscious that we are talking about multi-generations, younger people are staying there, older people are also staying there."

While enhancements to infrastructure may engender greater awareness, appreciation and respect for seniors, they may perpetuate negative labels, said Associate Professor Helen Ko, master and PhD of gerontology programmes at SUSS.

"(They) may also perpetuate stereotypical views of seniors. For example, they are slow and have to be 'accommodated' (with respect to) the increase of duration of green man at traffic lights," she said.

"(It is) a fine balancing act between creating an age-friendly environment, yet not perpetuating a common myth that all seniors are decrepit, demented, dependent and depressed, especially among the younger generation.

"Therefore, public education emphasising the heterogeneity of older adults and (dispelling) ageist myths should simultaneously be stepped up, especially in view that we are also trying to promote seniors’ employment and voluntarism." For Lions Befrienders Service Association (Singapore) executive director Karen Wee, the key is to create community facilities that can be used by residents of all ages. She gave the example of gym equipment that can be used by both the elderly and patients undergoing rehabilitation.

"If you want to build infrastructure that is senior-friendly, you also have to (consider) how this thing is going to impact other people of the younger generation. .. And how do you then do the advocacy also?

"When you build all these saying 'oh, elderly are special, meaning (they) cannot do a lot of things. So what is it in their young minds, how will the young ones view them? Will they view them as useless?"

This is when communication to bridge the intergenerational gap and dispel such stereotypes becomes important, she said.

Duke-NUS Medical School's Ad Maulod pointed out how elder-friendly measures could accommodate other residents.

"A community that is elder-friendly, is in a similar vein, an age-friendly community," said the senior research fellow at Duke-NUS Medical School's Centre for Ageing Research and Education.

"Slower traffic, wider pedestrian walkways, these are good for families and children too. I think it organically nurtures an inter- or multi-generational usage of space.

"Intergenerational design is an area in which we can definitely push the envelope further. Currently, we do see elements of multigenerational use, but the use of these spaces (is) age-segregated."

He cited the example of an exercise corner for seniors "tucked away" from a playground for children.

A "true age-friendly design" allows individuals of any age to live and play together, he said.

At the same time, experts also see a lack of care support structure to help elders age within communities.

"You want them to age at home, but if we don't have enough home care, nursing home care, palliative home care, caregiver support, it will be very challenging - dementia support - how are they going to age at home? They can't. You must be ready, or you have to ramp it up quickly to match it," Lions Befrienders' Ms Wee said.

SUSS' Dr Tan said some seniors tend to keep to themselves.

"They take things for granted, or they become too comfortable, and the surroundings give them a false sense of security. What I mean by this is that they may not open themselves too much," he said.

"I think the social aspect ... while it's good that they stay where they like to stay, they need to be taken care of more, to ensure that if something happens to them they have their first call of support."

To tackle this, the community needs to look beyond the physical. Duke-NUS Medical School's Dr Maulod suggested a form of "social scaffolding" such as buddy support, to help the elderly.

"Our research on lonely older persons shows that it takes more than just environmental modifications to get seniors out of their homes and participate in wider community activities," he said.

"Some have low self-esteem and lack the confidence to interact with others."

In a press release on Sunday, the Ministry of National Development and Housing Development Board announced it will launch more community care apartments, which integrate senior-friendly housing with customisable care services.

The first two pilots, Harmony Village @ Bukit Batok and Queensway Canopy were launched in 2021 and 2022 respectively. A third will be launched in Bedok this year.

Weighing in on community care apartments, Tsao Foundation, a non-profit organisation which focuses on active ageing, noted that to help seniors live meaningfully and safely, Singapore needs to look at more assisted living opportunities.

Chairwoman of the Tsao Foundation Mary Ann Tsao said: “Singaporeans have smaller families, many have busy lives and face the double burden of caring for both the young and old.

"There is also a rise in the number of single seniors without children to support them. Concurrently, there is a growing number of seniors who prefer to live independently."

While acknowledging the benefits of the community care apartments, Dr Maulod stated the need to evaluate the model's effectiveness before ramping it up.

"Whether or not we should have more community care apartments requires further research and evaluation on what types of older persons would benefit from a community care apartment model, and does the model work to achieve its outcomes in terms of enabling peace of mind, forming strong social networks, access, quality and affordability of services," he said.

Care Corner Seniors Services senior director Daniel Chien described the initiative to build more community care apartments as "a good start".

"But nonetheless it will take too long and (is) too costly to cater to everyone’s needs. What’s more important is to design and plan a community-based assisted living program or services (which) can be brought to where seniors are currently staying."