Broadcast Date: 01/03/04

The Singhealth group of healthcare institutions hopes to serve its aged patients better. Chong Ching Liang finds out why it is doing this now and what the changes involve.

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Everyone talks about Singapore becoming a graying society. Well, in less than thirty years' time, society may simply be white.

It is projected that two out of five Singaporeans will be over 65 years of age.

Hi Welcome to On the Grapevine with me Chong Ching Liang as I take a look at care for the elderly.

Singapore has one of the lowest fertility rates in the world, with a figure of just 1.37 live births per couple. The population isn't producing enough to replace itself.

Coupled with the aging statistics, it is a ticking time bomb.

Dr Carol Goh, Head of Geriatric Medicine at the Singapore General Hospital.

"The diseases that our population is facing are chronic diseases. We have a high incident of strokes and we all lead fairly sedentary lives. So we're all going to be facing a population that is going to have a lot of issues with regards to functional care. So we will have elderly who may be wheel chair bound or at least need help getting around. We are hoping that despite this, we are going to have a society where we support our elderly and promote their care and not have an elderly person left alone with no one to take care of him and no good quality of life."

Many of us already have or will have aged relatives. For superstition's sake or mere complacency, we often try not to think of bad things happening to our loved ones. So we never plan for what'll happen if our aged relatives have a nasty fall or illness that leaves them wheelchair bound.

When this happens, we panic.

There are stories of Singaporeans trying to "dump" their aged relatives onto the hospital system, or nursing homes. S-G-H's Orthopaedic Head, Tan Seang Beng describes an all too common scenario.

"All the things that we take for granted: Go to work and leave the old fogies managing by themselves. But when we have an injury suddenly is now magnified. You want to bring them home but when you find that when you physically have to do it, it is very difficult. So what do they do? They tell me, 'well, we still bring them home' and they manage the best that they can. But honestly, many of the times, most are not well managed. Because if your mother now is unable to walk well and the children or the family may be working, who's going to bring the mother to hospital?"

According to SingHealth statistics, one in three patients seeking orthopaedic treatment such as those for fractures and bone injuries are elderly.

For internal or respiratory medicines, the figure rises to nearly one in two.

And geriatric medicine, the branch of medicine looking after the ailments of the aged is terribly short-handed.

So Dr Carol Goh says it must innovate.

"For geriatrics for example, there are all of thirty in Singapore. And the number of geriatric trained nurses is very few. So if have a system that is dependent on any one specialty doing it all, then it is going to be very difficult. And that is where my orthopaedic surgeons have been most supportive. In the end this is part of what we called geriatrisation of services. You don't have to be only the geriatric trained or specialty services that manage the elderly. We are raising the awareness of the elderly in all specialities."

Singhealth plans to "geriatise" to all its institutions in two years time that is getting them to cater to the elderly. Part of this exercise is a discharge planning programme where aged patients are referred out to a community hospital for convalescence.

Taking them out of the acute-care hospitals like S-G-H, Alexandra or Tan Tock Seng hospitals will reduce their chance of catching nasty infections like pneumonia.

But there's also a social purpose explains Dr Goh.

"A lot of them are the referrals that we have diverted from nursing; this is not to say that a nursing home stay is wrong, but a lot of patients we want to give a chance when they were borderline cases. You know, the families were saying 'I am in a state of shock, my grandma fell down', 'she fractured her hip', 'I can't take care of her' and 'I don't have enough time' then the family will come to us and say, 'well, we want to put her in a nursing home.' And grandma may not want to go to a nursing home. She want to be given a chance to go back home. So they needed time. So for the grey cases especially, for those whose families were wavering, we wanted to send them to a place where they have more time, and more rehabilitation, and give her the chance."

But some of the elderly patients won't recover despite a lengthy stay. So inevitably, they will be discharged home from the community hospital. Ideally the next layer of care would be the neighbourhood doctors or GPs.

They help relatives manage their elderly relatives' chronic illnesses like diabetes or high blood pressure. But Dr Goh highlights some obstacles.

"We face two issues. Number one our GP simply don't have the time to go to patients' house because it takes a lot. But again we hope to expand and working with partners both for SGH patients as well as Ang Mo Kio as a continuum that have access to home medical. Home based service is really important. And working in partnership with Ang Mo Kio because they also have a home medical programme where they actually use a GP."

The day isn't here yet when GPs are willing to step up to this role where they take part in providing home care for the elderly.

Until that day, the public healthcare system has to pick up the slack.

One thing is for sure, if the family of aged patients feel they aren't supported enough to keep their parents home, they won't. And the ones who lose out the most will be the elders.

So this latest initiative by the Singhealth group and the Health Ministry is a breath of spring breeze for those heading into their autumn years.

This is Chong Ching Liang for Newsradio 938.

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