Singapore’s population is reportedly the fastest aging in the world. This demographic change is a result of its relatively low immigration and
emigration rates and post-war baby boom, combined with a highly effective
national family planning policy from 1965 to 1970. The reduced
birth rates from the mid-1960s onward have resulted in a trough on the
population demographic chart. This trough, combined with the relatively
higher peak of baby boomers born before 1965, will result in a predicted
18.4% of its population being over 65 years in the year 2030. Currently,
7.3% of Singapore’s 4 million people are over 65 years old.
Singapore’s decision to review healthcare programs for the elderly began
in the 1980s. The Committee on the Problems of the Aged was appointed
in 1982 to address key issues pertaining to health care, employment,
finance, recreational needs, social services, institutional care and family
relations. The Ministry of Health’s Department of Health Service for the
Elderly was subsequently established in 1985 to oversee old age healthcare.
Geriatric medicine departments were set up in 1988, 1993 and 1994
at government general hospitals Tan Tock Seng Hospital, Changi General
Hospital and Alexandra Hospital, respectively. Currently with a complement
of 22 specialist geriatricians, these three hospitals serve the central,
eastern and western sectors of the island state, respectively. Concomitantly
in the 1980s and 1990s, a core handful of psychiatrists were sent to the
UK and Australia for fellowship training in geriatric psychiatry. In 1993,
the Department of Geriatric Psychiatry was set up in the newly built
Institute of Mental Health at Woodbridge Hospital. This state psychiatric
hospital provides special care wards for acutely disturbed psychogeriatric
patients. The department also provides consultation-liaison psychogeriatric
services to the various general and community hospitals that do not
have in-house psychiatric departments. It also runs psychogeriatric outpatient
clinics.
In 1997, the Inter-Ministerial Committee on Health Care for the Elderly recommended
other enhancements, including a disability primary prevention
program, a geriatric health screening program, and undergraduate and
postgraduate training in geriatrics and psychogeriatrics. Also, a number of
hospitals now offer geriatric psychological assessment services, including the
Institute of Mental Health’s Geriatric Psychiatry Clinic; National University
Hospital’s Memory Clinic; Singapore General Hospital’s Neurodegenerative
Diseases Clinic; Tan Tock Seng’s Hospital Memory Clinic; and Changi
General Hospital’s Psychological Medicine Service.
Management of psychological conditions in the elderly is not limited to
psychogeriatricians, however. Other non-geriatric psychiatrists, geriatricians,
neurologists, neurosurgeons and general practitioners are involved.
Today, of 86 registered practicing psychiatrists in Singapore, 5 specialize
in psychogeriatrics. This gives a ratio of 1 psychiatrist to 45,000 persons,
and 1 psychogeriatrician to 60,000 elderly persons (aged 65 and above).
An estimated 7,000 persons have been diagnosed with the dementia.
This will more than double to 16,000 by 2020, and triple to 24,000 by
2030. Last year, the Ministry of Health published a handbook on
Clinical Practice Guidelines for Dementia.
The National Council of Social Service oversees member not-for-profit
voluntary welfare organizations (VWOs) and provides funding for various
community programs. Among its members involved in old age care
are Alzheimer's Disease Association, Tsao Foundation, Singapore Action
Group for Elders, Home Nursing Foundation, and various nursing
homes and day centers. The Alzheimer’s Disease Association, which is
the local chapter of Alzheimer’s Disease International, coordinates the
provision of community care for patients with dementia. It runs two
dementia day care centers and organizes family support groups for
careers. Other non-government organizations like the Tsao Foundation
provide career training and public education. Respite care is provided by
various hospitals while long-term care is catered for by nursing homes
run by VWOs and privately (for-profit). A 200-bedded purpose-built
dementia-specific VWO nursing home was opened in 1999.
Singapore caters for subsidized health care through government grants
to state hospitals and outpatient clinics. Patients have access to affordable
treatment, paying out-of-pocket for services. The majority of
patients do not have private health insurance. Those that do are mainly
covered through their employers. Health costs have been increasing over
the years and individuals are being encouraged to be more responsible
for their own care through private health insurance.
In 2001, the Ministry of Health and Ministry of Finance finalized a
national severe disability insurance plan for the elderly called Eldershield.
ElderShield covers those aged 40 and above with a basic severe disability
insurance plan that extends beyond age 70 to help defray out-of-pocket
expenses. This supplements the existing medical financing framework of
Medisave, MediShield and Medifund.
Social work services, under the Ministry of Community Development,
have also been updated. In 2001, through its Inter-Ministerial Committee
on the Aging Population, it secured $93 million to develop eldercare services
over five years. Newly built centers have been established around the
island to provide a range of social support services to the community, covering
eldercare and family-related services.
Where it took Western countries about 100 years to double its elderly
population, Singapore has only 20 years to prepare for this demographic
transformation. An onerous task lies ahead as
Singapore strives in its aim to provide health care service for the elderly in the coming years.
Francis Ngui (francisngui@md-sh.com) is a consultant
psychiatrist with Adam Road Hospital and MD
Specialist Healthcare, and a visiting consultant psychiatrist
to Changi General Hospital. He is IPA Bulletin’s
assistant editor for Singapore.
Reprinted from IPA Bulletin Volume 19 Number 3
Copyright 2012 International Psychogeriatric Association
