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Live long and prosper? A super-aged Singapore society does not have to be a sad one (Straits Times Premium)

by Abhijit Visaria and Rahul Malhotra for The Straits Times

A cause for celebration where it reflects longer life expectancy, Singapore must continue to evolve to be accommodative of seniors.

We often use the word “super” to denote something excellent or the best of its kind.

Over the course of 2023, and most recently in the Prime Minister’s National Day Rally speech, we have heard it used in the context of the ageing of our population: that Singapore will be a “super-aged” nation in 2026.

A country is commonly considered super-aged when the proportion of individuals aged 65 years and older in its population reaches about 21 per cent. 

By becoming super-aged, Singapore will join a select league of nations, including Japan, Germany and Italy. By 2030, several other countries, including South Korea and the United States, will also become super-aged.

Raised life expectancy

This upcoming milestone of becoming a super-aged nation is in many ways a cause for celebration. It reflects Singapore’s continued success in reducing mortality, with consequent increases in life expectancy, through public health and healthcare system interventions. 

Except for 2020 to 2022, which saw additional deaths owing to Covid-19, life expectancy at birth in Singapore has risen every year since 1965. It was 64.5 years in 1965 and had risen to 78 at the turn of the century in 2000. At 83 years in 2022, it is among the highest in the world. 

Life expectancy at the age of 65 also increased over this period, doubling from 8.3 years in 1965 to 16.9 years in 2000, and increasing to 20.7 years in 2022.

The Deep Tunnel Sewerage System in Singapore that completed a construction milestone this week stands out as among the type of investments to improve sanitation and hygiene in Singapore that we have taken for granted and which have contributed significantly to enhancing population health and longevity. Over the years, the expansion and advancement of Singapore’s healthcare system and access to improved living conditions, including housing and nutrition, have enabled Singaporeans to live longer.

Still, being a super-aged nation comes with significant demographic, health, social and economic implications that Singapore must confront. 

Narrowing the poor-health gap

Despite living longer, Singaporeans are also spending more years in poor health.

To narrow the gap between life expectancy (years lived) and healthy life expectancy (years lived in good health), the Government has embarked on strengthening primary healthcare and renewing the emphasis on preventive behaviours and chronic disease management through Healthier SG. There is recognition that longevity will remain a boon only if individuals take charge of their health.

Here, there is good news suggesting that Healthier SG could have significant impact as Singaporeans are encouraged to work with primary care physicians on individualised health plans and follow-ups. Nationally representative data collected at the Centre for Ageing Research and Education (Care) at Duke-NUS Medical School suggests that among older Singaporeans, knowledge about their own chronic physical ailments and the confidence in being able to manage them are already fairly high.

Health plans in Healthier SG involve individuals and physicians working together to set goals – to maintain or reach key blood pressure, cholesterol or blood glucose levels, and targets in other identified areas such as weight, sleep, smoking and physical activity. Barriers to such goals will be articulated in advance, and action plans drawn up to overcome them. 

People know they are likely to live longer and better if they keep active, eat well and avoid smoking, but goal-setting along with reminders and follow-ups can help keep plans on track. The planned expansion of Healthier SG to individuals below 60 will benefit tomorrow’s seniors by encouraging healthy ageing and cultivating good habits.

Having no difficulty in physical functions is one important marker of being in good health. You can walk from one bus stop to the next, climb 10 stairs without resting or lift a 5kg object. And you can easily engage in basic activities of daily living – walking indoors, bathing, dressing or using the toilet. Our research shows that Singaporeans reaching the age of 60 who can check these boxes spend a greater deal of their remaining years in good health compared with those who have difficulties in these physical functions by that age. 

The Age Well SG initiative announced at the National Day Rally, a comprehensive nationwide transformation across housing, transport, active ageing and care services, may also go some way towards encouraging seniors to be more active. It will be important for Age Well SG to focus on tomorrow’s seniors too, considering that health and ageing should be addressed from a life-course perspective.

Strengthening community bonds

As it ages, Singapore must find new ways of keeping seniors meaningfully engaged and connected, including with those from younger generations. This means creating opportunities for seniors to share their knowledge, skills, experience and wisdom, and avoid undermining them.   

Lonely seniors have shorter lives and fewer years of life in good health than their peers who are not lonely, research at Care shows. Seniors with diverse social networks – ties with household members and others outside the household and in the larger community – also have a lower risk of mortality than seniors with a more limited social network made up primarily of their own household members.

The expansion of avenues where seniors can engage with peers and younger individuals within and outside the family could help a super-aged Singapore. These could include shared-interest activities, irrespective of age, at the new active ageing centres or other venues in the community; the co-location and integration of socio-recreational spaces such as playgrounds for children and exercise stations for seniors; and moves to enable seniors to safely and comfortably use digital tools for social engagement, thereby allowing virtual connections, even for those with restricted mobility. 

Seniors are integral to society. Our research finds that seniors are motivated to nurture younger people. They are driven by their concern for young people, including the desire to inculcate good values, pass down traditions, their perceived intrinsic role of being elders in the family and society, and their belief in the potential of younger people.

However, not all seniors have the confidence or opportunity to act on their motivations, often because of perceptions that their knowledge and skills are outdated and not relevant to younger people, or because of the lack of platforms or avenues to interact with youth, especially outside their families.

Fighting ageism, finding creative solutions

At the heart of managing the transition to a super-aged society are mindsets and social ethos. Making a super-aged society more inclusive requires ending the use of ageist phrases and metaphors. 

A phrase to describe rapid population ageing that is regrettably common in usage is “silver tsunami”. An attempt at euphemism by using “silver” instead of “grey” to refer to seniors is no better. 

Likening the increase in the number of seniors in society to a natural disaster and the imagery of destruction and despair is ill-informed and perpetuates a negative stereotype of seniors.

As Singapore ages, recognising the increasing diversity of backgrounds and experiences, needs and preferences among seniors can uncover new ways of improving the quality of life in old age. Participation by seniors in research on different aspects of ageing – physical health, biology, economics, social and psychological well-being, and others – will enable the formulation of policies that cater to this diversity. 

Being and succeeding as a super-aged society will require, as is frequently said in Singapore, a whole-of-society approach and effort. The extent to which the implications are meaningfully addressed will make a difference to whether Singapore will be a super aged society or simply a super-aged society.

Abhijit Visaria is a senior research fellow at the Centre for Ageing Research and Education at Duke-NUS Medical School. Rahul Malhotra is an assistant professor and the deputy director and head of research at the same centre.

Originally published in The Straits Times (Premium): Live long and prosper? A super-aged Singapore society does not have to be a sad one