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Choic diseases case abot two otof evey thee deaths woldwide today.

These log-tem medical coditios,

which ogess gadally, ae a key

case of death ad illess. I Sigaoe,

these diseases accot fo 83 ecet

of all deaths. Knnh Gh ds ot the

eal state of healthcae ogammes

i Sigaoe ad how effective they

have bee i sotig the fast-ageig

olatio i the city-state.

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in August 2012, Singapore was

named worlds healthiest countryby Bloomberg, beating Italyand Australia. In its rankings,Singapore scored the lowest in

risk indicators, such as obesity and in-cidence o smoking. This stems roma comprehensive buet o preven-tive healthcare programmes by theMinistry o Health, targeted at youths,adults and the elderly.

According to the HealthPromotion Board (HPB),common chronic diseases includehypertension, stroke, diabetes, lung

disease and lipid disorders (highblood cholesterol). While thesediseases usually show up in onestwilight years, it is better to nip themin bud or better still, prevent them.

Hectic work schedules thatmany adults ace can heighten risko getting chronic diseases throughactors such as unhealthy diet,physical inactivity and smoking.

According to the National HealthSurvey 2010, obesity rates climbedrom 6.9 percent in 2004 to 10.8

percent in 2010. The good newsis that these actors are mostlymodiable.

According to a HPB spokesperson,key strategies targeted at adultsinclude making healthier liestylechoices accessible, convenientand aordable. Some programmesinclude Lose to Win Programme,a 12-week holistic weight lossprogramme, whereby participantsattend group exercise sessions andnutrition workshops.

Another strategy is to establish

sustainable partnerships to buildground-up preventive healthcareinitiatives. One such way is throughthe Workplace Health PromotionGrants, which provides nancialassistance or organisations to starthealth programmes or employees.An example is the chronic diseasemanagement programme, whichconsists o liestyle modication,nutrition and stress management.

HPB noted that the mainchallenge in implementingprogrammes targeted at adults is tosustain the choice to eat right andregular exercise in the long term.

It is about doingthings right whenyou are young -practising healthylifestyle habitsfrom the ageof 40 can also

achieve healthyoutcomes atold age.

Dr Grd Kh, Associatepofesso ad Diecto of medical

degadate edcatio, nuS Saw

Swee Hock School of pblic Health

(nuHS) o healthy ageig.

Brng fr h im f

Svr tsunmSingapore is among the worlds ast-est ageing societies with one in vepeople being more than 65 years oldby 2030. There is a pressing need tokeep chronic diseases at bay, lowering

Singapore is among the worlds fastest ageing societies with one in ve people being more than

65 years old by 2030.

stress on limited healthcare resources.

Dr Gerald Koh, AssociateProessor and Director o medicalundergraduate education, NUS SawSwee Hock School o Public Health(NUHS) noted healthy ageing is theway to go. It is about doing thingsright when you are young - practisinghealthy liestyle habits rom theage o 40 can also achieve healthyoutcomes at old age, he said.

He added that while healthprogrammes are making it a normor people to be healthy at middleage, there is also a need to prepare

the elderly or the natural eects oageing, such as the slowing down obodily unctions.

There have been concerted eortsto provide a seamless continuumo medical services rom hospitalsproviding acute and episodic care,to intermediate care in communityhospitals, and long-term care in thecommunity-nursing homes and dayrehabilitation centres. Senior activitycentres also organise health screen-ings to monitor chronic diseases and

keep the elderly socially engagedthrough communal activities.Dr Koh noted that while organ

damage caused by chronic diseasescan be treated in hospitals, ollow-up care and rehabilitation has to be

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continued in the community andat home. He said: With an ageingpopulation, the chronic diseasemanagement system is insucient

or to manage those with chronicdiseases leading to disability,increasing an emphasis on theintermediate and long-term care(ILTC) sector.

Ms Lim Sia Hoe, General Managero NTUC Eldercare believes thattaking a holistic and integrativeapproach is a step in the rightdirection. She noted that hospitalsare starting to have sincere andcommitted engagement with the

community players in implementinghealthcare programmes. She said, Itis a breakthrough or me to see moreconversations and synergy between

acute and community care providers.

affrdbyTreating chronic disease has beenmade aordable through the use oMedisave or outpatient treatments.Patients can slash out-o-the-pocketpayments with this scheme, whichcan also be used in private clinics.There is also the mobility und orseniors, which assists the elderly ingetting subsidised mobility equip-

We need topay peopleappropriatelyto value theircontributions, asprofessionals, andnot as volunteers.

Ms lm S H, Geeal Maage,nTuC Eldecae, o why the allied

healthcae secto eeds a image

evam.

Lack of allied health and social care professionals for the intermediate and long-term care (ILTC)

sector is a neglected jigsaw puzzle piece in Singapore.

ment, and community health assistscheme, which enables the middle tolower-income groups receive subsi-dies or medical treatment.

While there are no lack oschemes and subsidies or elderlypreventive healthcare programmes,its accessibility can be marredby cumbersome and complexpaperwork procedures. Dr Koh said:The government has come up withsound healthcare policies, but whenit comes to implementation, do werealise the challenges that people onthe ground aces?

An example is the dierent meanstesting systems used in hospitals andcommunity care acilities requiringrepeat applications. He added:There should be a greater elemento trust and fexibility based on trueneeds and compassion, backed by anelement o monitoring.

Ms Lim also noted that there areno personal saving schemes or earlyintervention health programmesand eldercare services. She suggestscreating a new scheme, or enhancingMedishield and Eldershield, whichcurrently only covers severe medicalconditions. She said: These schemes

will allow people to consumeprogrammes that are more relevantto their health needs at a youngerage, and not wait till one is severelydisabled.

Mnwr crunhOne looming challenge that Dr Kohand Ms Lim highlighted is a man-power crunch or allied health proes-sionals, ranging rom medical socialworkers, to healthcare attendants andphysiotherapists.

While Singapore has been doingwell building up on the hardware,much needs to be done on to boostits sotware. Dr Koh noted that whiletraining tracks or doctors and nursesare drawn out well, the lack o alliedhealth and social care proessionals orthe ILTC sector is a neglected jigsawpuzzle piece in Singapore. He be-lieved that healthcare cannot unctionin isolation with social services.

It is time to ocus on theimportance o non-doctors in long-term, preventive healthcare, as we

may have underestimated the needto build this sotware, he said.Ms Lim also noted that caring

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What stated ot as a aalysis of the high demad fo sbsi-

dised beds at the hosital ovided istead a imets fo

Khoo Teck pat Hosital (KTpH) to exted cae fo atiets

at home afte dischage.

Sice Setembe 2011, KTpH hot-

sotted ad visited a go of atiets

who had mltile admissios to the

hosital. Dbbed affectioately as

feqet ies, these atiets wee

admitted at least thee times withi a

six-moth eiod.

M La Wig Chew, KTpHs Chief

Tasfomatio Ofce exlaied,

By visitig o atiets i thei homes,

we hoe to idetify ways we ca hel

them to stay healthy ad maage thei

illess so as to miimize ecessay

admissios.

To date, they have visited moe

tha 500 atiets esidig i the oth.

Abot half of these atiets ae moe

tha 70 yeas old.

Thogh the home visits, the team

idetied vaios otetial isks: safe

home eviomets that ca lead to

falls, wog sage of medical devices, oo comliace to escibed medica-

tios ad evalece of self medicatio. Althogh social sevices ae available

i the commity, most of these atiets did ot destad how they ca

tilise the sevices to thei beet, he added.

Ce KTpHs Agig-i-place iitiative, which coodiates ad itegateshealth ad social sevices to ovide a holistic aoach to addess thei

health ad wellbeig. These effots have aid off. A aalysis of a samle of

100 atiets who had bee i the ogamme shows a edctio of admis-

sios, fom a aveage of 3.9 times i the six moths io to these visits ad

itevetios, to a aveage of 1.4 times afte.

KHOO TECK puAT HOSpITAL

agng-in-p prgrmm

Through the homevisits, the teamidentied various

potential risks: unsafehome environmentsthat can lead tofalls, wrong usageof medical devices,poor complianceto prescribedmedications andprevalence of selfmedication.

Mr lu Wng chwChief Tasfomatio

Ofce

Khoo Teck pat

Hosital

Social factorssuch as livingconditions,

unemployment,relationships, canimpact on health.Similarly, healthproblems canexacerbate socialissues.

Dr Wng Sw FunSeio Cosltat i

Geiatic Medicie

Khoo Teck pat Hosital

or the elderly is considered anunglamourous acet o healthcare.This has proven to be a barrier toattract manpower. She believes thatthe allied healthcare sector needsan image revamp to proessionaliseit. Ms Lim said, We need to pay

people appropriately to value theircontributions, as proessionals, andnot as volunteers.

Despite these gaps, some arestill passionate about caring orthe elderly, such as Khoo TeckPuat Hospitals senior sta nurse,Seni Bte Chari who is involvedin the hospitals Ageing in Placeprogramme (see sidebox). She gainssatisaction rom instilling positivityin the elderly so that they listen toadvise and comply with medicalinstructions. She said, Sometimes

we pick up complimentary therapiesrom the elders on such as gingerheat therapy.

Dr Wong Sweet Fun, SeniorConsultant in Geriatric Medicine,said, Social actors such asliving conditions, unemployment,relationships , can impact on health.Similarly, health problems canexacerbate social issues.

In programmes where the hospitalworks with community service pro-viders such as Thye Hua Kwan Moral

Society, NTUC Eldercare and HospiceCare Association to provide home-based care services, the nurses are

also trained to recognise some socialissues and reer patients to relevantsocial welare programmes as wellas community assistance provided

by grass-root agencies. This helps tolevel the health-social divide.With Singapores ageing

population, it has become imperativeto address the various gaps inpreventive healthcare, manpowerneeds and aordability. Singapore is

already taking steps to move romprimary to community care as thenation awaits the Silver Tsunami.