SMA Editorial Board
Letters to the Editor
This site is supported by
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
28TH SMA NATIONAL MEDICAL CONVENTION, 1997
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.
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