Getting smart to age well in Singapore

To deal with his dementia-stricken father's overdosing problem, Mr Vincent Ong, 60, looked to a smart pill dispenser for help.

The information technology lecturer and his siblings had been managing their 90-year-old father's condition for close to two years to no avail.

Once, their father had to be taken to the hospital after he overdosed.

Getting the smart pill dispenser gave Mr Ong a wave of relief.

His father only took his medicine when the dispenser's in-built alarm rang. Just one dose is dispensed each time. The rest are locked in the pill box.

The respite however, was short-lived.

Said Mr Ong: "He broke it after two to three months. It could have worked for longer if he had a milder temperament.

"He felt the alarm was distracting and decided to prise open the pill box. He didn't like the idea of using a gadget to start with."

His father's plight illustrates the bind Singapore is caught in.

When you think about the technology and tools that are going to make someone’s life easier, where that seems to work best is a relationship with trust, with someone in your life you will turn to in times of ill health. Dr Paul Grundy, chief medical officer and global director of healthcare transformation for IBM’s Healthcare and Life Science Industry

With a quarter of our population turning 65 or older by 2030, there is a rush to empower seniors with assistive technology so they can age in place independently. Admissions to the hospitals spiked by 9 per cent last year compared to 2015, figures from the Ministry of Health (MOH) show.

The increase is in part due to a growing number of elderly people 65 and above being admitted.

Yet our current batch of seniors are averse to technology, those aged 75 and older more so than those aged between 65 and 74, said Associate Professor Philip Yap, the director of the geriatric centre at the Khoo Teck Puat Hospital (KTPH).

"This is because the former came from a generation with little exposure to technology, especially during their working years," he told The New Paper.

IMPORTANT

As the population ages, assistive technology will be increasingly important.

Senior Minister of State in the Prime Minister's Office Heng Chee How raised this at a dialogue organised by the Royal Danish Embassy last year, where representatives of Singapore and Denmark exchanged views on how to design elderly-friendly societies.

Mr Heng said: "We can learn from the Danish experience in terms of the preventive and rehabilitative part of care."

Since 2013, Denmark has been allocating assistive technologies to its elderly and those physically challenged so they can be independent.

These include devices that help the elderly eat or to transfer a wheelchair user in and out of vehicles.

The initiative, when fully implemented this year, will help Denmark save 67 million euros (S$107 million) a year.

Dr Paul Grundy, chief medical officer and global director of healthcare transformation for IBM's Healthcare and Life Science Industry, spoke to TNP at a medical conference in August.

He said the move to integrate assistive technology into eldercare is a global trend, with middle-aged people today not wanting to encounter healthcare the same way their parents did.

He said: "They are going to expect to encounter the healthcare system the same way they encounter every other aspect of their lives, and that is going to be online and asynchronous."

KTPH's Prof Yap said Singapore has the essential technologies and clinicians who are keen to work with partners to devise innovative solutions.

But what the country needs is integrated solutions that will meet the needs of seniors here more holistically, the geriatrician pointed out.

"At the moment, we have siloed applications but lack integrated ones that can be comprehensive enough to meet the multiple needs of seniors, as well as solutions that can be customised to their particular needs. One size does not fit all," he said.

For instance, a senior living alone and has early dementia among other medical conditions will benefit not just from devices that monitor his medical parameters, but also technologies that track his daily activities and detect emergencies.

Such solutions will help seniors be more independent, make ageing at home more accessible, and take the load off our healthcare system, said Prof Yap.

The older generation's mindset, however, is proving to be a huge obstacle - the idea of living independently is just not as popular here as in the western countries, said Ms Coco Liu, who pointed to the less-than-brisk sales at her online shop Ministry of SilverLining.

The four-year-old shop, which sells devices that help people with declining physical and mental abilities, is not profitable yet.

Said Ms Liu: "Business is slowly growing but not as well as expected.

"If the elderly can get a helper to feed them in 20 minutes, they don't want to spend an hour feeding themselves with a gadget."

Senior citizens, she said, also shudder at the idea of using technology.

"The moment you mention 'gadget', they think it is complicated to use. But some of them are actually quite simple to learn," said Ms Liu.

But KTPH's Prof Yap said this trend is expected to change with time, as subsequent cohorts of seniors will have more exposure to technology in their productive years.

For instance, Mr Ong, who bought his father the pill dispenser, monitors his own health using apps on his iPhone.

For assistive technology to be a real game-changer, Prof Yap said we need adequate and sustainable funding because such solutions cannot be developed in a short time.

He added: "We need to be in for the long haul and to go through several iterations to derive more viable solutions. There must also be financial incentives with a ready market and sustainable business models."

The final piece of the puzzle is collaboration between industry experts, health care providers, commercial players, policy makers and seniors and their caregivers, said Prof Yap.

IBM's Dr Grundy said having assistive technology is just one element of a system that delivers value.

Equally important is a primary care system built on a relationship of trust between doctors and patients for assistive technology to be implemented, he said.

Said Dr Grundy: "When you think about the technology and tools that are going to make someone's life easier, where that seems to work best is a relationship with trust, with someone in your life you will turn to in times of ill health. In most places, where that works is primary care."

The Danes have done it. The number of hospitals dropped from 157 to 21 in 15 years, after Denmark redefined its primary care system to one that encourages and allows seniors to age at home.

About 90 per cent of Danes die in their homes, said Dr Grundy, and that was the way they preferred it.

Singapore has been moving towards that change in the primary care system.

The Hospital to Home programme by MOH, for instance, has supported some 5,000 patients post-discharge by bringing care to their homes and preventing hospital re-admissions.

Rolled out in April, the programme works on a predictive model that flags patients deemed to have a high risk of re-admissions.

A team made up of healthcare professionals with multiple disciplines then develops a care plan that prevents this outcome.

One of them is Madam Lee Kum Ying, a Tan Tock Seng Hospital patient in her 90s who had a stroke and suffers from a mild case of Alzheimer's disease.

Sharing her profile at the Healthcare Information Management Systems Society conference last month, Senior Minister of State for Health Chee Hong Tat said Madam Lee used to be admitted to hospital twice within three months.

TTSH's transitional care specialist led a team of healthcare professionals to develop a care plan for her.

This included training her caregivers to help them make appropriate changes to her diet and lifestyle, and teaching them the correct techniques to help Madam Lee in her daily living activities.

Madam Lee has not been re-admitted since she started on the programme, said Mr Chee.

COMMUNITY HELP

The community plays a part too, said Dr Grundy, who pointed to the Jersey postal workers' Call & Check initiative.

It involves postal workers calling on elderly islanders during their regular postal rounds, either daily or weekly.

During a visit, the postal worker will check on these elderly people for any immediate concerns or requests, such as medical attention or help with groceries.

The information is then passed on to the relevant parties.

The postal worker can also deliver repeat prescriptions and remind the customer about medication or hospital appointments.

Such concepts, said Dr Grundy, can help a technology-averse elderly population become more nimble with gadgets.

"I asked the Jersey mailmen how they did it, and one of them told me, 'I have just explained to this 87-year-old for the 26th time how to use this iPad. I will explain this again tomorrow'.

"It is about putting a support system in place," he said.