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Being economically and socially active in old age is also important as it gives a person a sense of self-esteem and prevents loneliness from setting in.


The theme for this year’s Convention was ‘Healthy Ageing & You’. Held on 27 April 1997 at the Suntec City Convention Centre, the event attracted almost 500 members of the public as well as doctors. For the first time, the Public Forum was conducted concurrently in English and Mandarin. The Tsao Foundation was the co-organiser of the Convention. 


Singapore - A greying population 
Over the past few decades, Singapore’s population has experienced a rise in life expectancy and a decline in fertility rate below replacement level, resulting in a society that is one of the most rapidly ageing in the world. In his welcoming speech, SMA President, Dr Cheong Pak Yean noted that while the percentage of the population over the age of 60 years was 9.1% in 1990, it is projected to rise almost three-fold to 26% in the year 2030. In comparison, the corresponding figures for the USA are 14% and 24% respectively. Moreover, the percentage of our population over 75 years old will be 7.6%. The health of this large group of people cannot be neglected and is of great personal, professional and societal interest to everyone. Although the majority of the elderly will be mobile, there are those who are home-bound and require chronic supportive care. In line with the government’s policy of providing community-based healthcare for the elderly, the SMA, in conjunction with the Tsao Foundation, has formed an adhoc committee for the development of domiciliary healthcare. 

Healthy ageing – individual and society 
Dr Aline Wong, Senior Minister for Health and Education, delivered the keynote address. She said that healthy ageing is an important and current issue which can be attained. Singapore is experiencing an increase in lifestyle-related diseases like strokes, diabetes and heart diseases with their catastrophic effects on independence, quality of life and accompanying financial burden on both the family and the healthcare system. She stressed that it is a personal responsibility of each individual to prepare himself physically, mentally and socially right from young in order to enjoy the golden years free from disease and disability as far as possible. Dr Wong proposed a two-pronged strategy towards this goal: to lead a healthy lifestyle and to be socially active. Healthy living does not merely consist of regular exercise and proper diet but also modification of the home environment to prevent injuries due to falls. Being economically and socially active in old age is also important as it gives a person a sense of self-esteem and prevents loneliness from setting in. 

Dr Wong announced the inauguration of the Division of Elderly Services of the Ministry of Health in May 1997. The division will evaluate and make projections for the healthcare needs of the elderly. It would look into the provision of day rehabilitation centres, nursing homes and other support facilities to help the elderly remain in the community. These include the training of healthcare workers and home caregivers, public education, provision of transport services to ferry the elderly for treatment and rehabilitation and advice on home modification to suit the needs of the frail and disabled elderly. To achieve its goals, the Ministry, in conjunction with voluntary welfare organisations, will re-organise its existing services into three regional networks. Healthcare financing schemes for the elderly indigent will also be reviewed. 

Preventing heart disease in the elderly 
Coronary heart disease (CHD) accounts for a quarter of all deaths. Prevention of CHD involves controlling its risk factors namely, hypercholesterolemia, hypertension, diabetes and smoking. Dr Pang Weng Sun said that dietary modification, complemented by weight reduction and exercise, is the cornerstone of treating hypercholesterolemia with pharmacologic therapy reserved for those with CHD risk factors. The National Cholesterol Education Programme (NCEP) approach to management of hypercholesterolemia is guided by an assessment of CHD risk factors. These include age of more than 45 in males or more than 55 in females, family history of premature CHD in a first degree relative, smoking, hypertension, low HDL and diabetes. With respect to hypertension, studies have shown a reduction of up to 33% in mortality due to strokes and myocardial infarction in the elderly when the systolic blood pressure was lowered to less than 160 mmHg. Non-pharmacological measures like salt restriction, weight reduction and exercise enhance the effectiveness of anti-hypertensive drugs. Smoking is the most preventable CHD risk factor and the dose-response relationship between smoking and CHD has been proven beyond doubt. CHD risk is directly related to the duration of smoking and cessation of smoking reduces CHD mortality rate to that of non-smokers. 

Nutrition and exercise 
Ms Beth Mastel-Smith spoke on two key healthy habits to reduce the risk of heart disease and other debilitating diseases in old age – good nutrition and a regular exercise programme. The ageing body is less active and requires less calories per day. However, the reduction in calories should not be at the expense of essential nutrients. A balanced diet, comprising foods from all the four food groups viz. rice and alternatives, meat and alternatives, fruits and vegetables, is necessary. Foods to eat in moderation include those containing simple carbohydrates, saturated fats and salt. These should be replaced by healthier alternatives containing complex carbohydrates, unsaturated fats and fibre. Ms Mastel-Smith encouraged the elderly to use unsaturated oils such as peanut, corn or soyabean oil for cooking and fresh meat stock and herbs instead of MSG for flavouring food. For women, it is vital to build up calcium stores by consuming low fat dairy products and bony fish to prevent osteoporosis. Regular exercise is important as it controls weight, increases HDL, reduces stress and prevents osteoporosis. Before embarking on an exercise programme, the elderly person should seek medical advice and should begin slowly with gradual increases in intensity and duration. The ideal target is thrice weekly sessions of aerobic nature of 20 minutes duration each. 

Mental health of the Elderly 
A 1994 study of 1,062 elderly people living in a housing estate in Singapore showed that 15% had depressive symptoms related to stressful life events like widowhood, family conflict, loneliness and health problems. According to A/Prof Kua Ee Heok, the principle investigator in the study, stress can exacerbate existing illness like hypertension and heart disease especially in men. This was confirmed in a British study which showed that men have a higher chance than women of suffering a fatal heart attack within the first year of widowhood. It is therefore important to keep mentally healthy in addition to being physically healthy. Prof Kua outlined three ways to keep mentally healthy in old age: to maintain a healthy lifestyle; social adjustment; and keeping mentally active. Maintaining a healthy lifestyle entails having regular exercise, eating a well-balanced diet and going for periodic medical check-ups. For those who do not suffer from chronic medical conditions, a visit to the doctor every 9 months to a year would suffice. With the slowing of physiological processes with ageing, there is a need to relinquish certain responsibilities and delegate them to friends or family members. This aspect of ageing needs careful planning well ahead of retirement. Finally, Prof Kua advised the elderly to continue to develop personal interests, attend courses, engage in self-fulfilling hobbies and volunteer their services in various welfare organisations to maintain mental agility and preserve self-esteem. 

A health screening session was conducted for participants of the public forum. Sponsored by Boehringer Mannheim Singapore Pte Ltd, the screening package included measurement of weight, height, blood pressure, serum cholesterol and glucose. About 400 members of the public participated in the screening. Their results were interpreted on the spot by a panel of six doctors who gave them advice on dietary modification and answered health-related questions. Those with abnormal results were advised to consult their family doctors. 

Editorial Note: 
Simultaneous sessions were conducted in Mandarin on the same topics. The speakers for the Mandarin sessions were Dr Lee Kng Swan, Ms Hwang Dertuan and Dr Yeo Seem Huat respectively. 

Au Kah Kay