Mr Gan Kim Yong's Speech: Asia Pacific Geriatrics Conference

Introduction

            Good morning. I am happy to join you at the Asia Pacific Geriatrics Conference 2016. This year's event has a special significance, as it coincides with the 20th anniversary of the Society for Geriatric Medicine Singapore (SGMS). SGMS has been leading the professional development of geriatricians in Singapore. It has also been reaching out to Asia Pacific countries to develop innovative care strategies together to improve the clinical care of our seniors.

2.        The theme of this year's conference, "Geriatrics Beyond Borders: Are We Frailty Ready?" is particularly relevant for Singapore and also many Asia Pacific countries, as our populations are ageing rapidly. By 2030, one in four Singaporeans will be aged 65 and above. Singapore needs to be frailty ready through three approaches: first, delaying frailty through active ageing; second, early intervention through screening and risk assessments; and third, appropriate care in the community. To do these, we need to reshape our care delivery system, equip healthcare providers with geriatric care capabilities, and invest in research to build a sustainable healthcare ecosystem for our seniors.

Delaying Frailty through Active Ageing

3.         Ageing well is about our seniors staying healthy, active and engaged.  To empower our seniors to better take care of their health, the Ministry of Health (MOH) has rolled out the new National Seniors' Health Programme to systematically promote health education and preventive health services for seniors. Seniors can look forward to a set of seven easy exercises to encourage them to exercise regularly in the comfort of their own homes. The Health Promotion Board (HPB) has also introduced a Seniors' Nutrition Guide entitled "Recipe for Healthy Ageing", to encourage seniors to adopt healthy eating habits. We will also be delivering "Healthy Ageing 101" talks to seniors in the community.

4.         To keep seniors mentally and socially engaged, we have created more opportunities for them to continue learning and volunteering. This year, we are rolling out more than 10,000 learning places under the National Silver Academy. Since its launch in May this year, more than 2,700 seniors have signed up for courses that range from health and wellness, to finance, IT and science. In addition, we have started the National Senior Volunteerism Movement so that seniors can contribute their time and experience to a wide range of community initiatives. Moving forward, we will be making active ageing activities more accessible for seniors, as we build new Active Ageing Hubs in Housing Development Board (HDB) estates. These are one-stop hubs which provide active ageing as well as senior care and assisted living services for our seniors. The first Active Ageing Hub will be operational in early 2017.

Early Intervention

5.         Early intervention is important to identify risks for functional decline in our seniors. For instance, MOH supported the National University Hospital to pilot mobile health services like the Mobile Hearing Clinic. There are currently two of these Clinics, which are retrofitted, sound-proof vehicles providing hearing screening services. With a team of audiologists and their research assistants, these Clinics move around the community to provide hearing screening and hearing aid fitting for seniors, in partnership with the People's Association. Between December last year and June this year, they have covered 13 community centres, screened over 1,300 residents for hearing loss and fitted 112 residents with hearing aids. This screening service will be expanded in phases over the next two years to over 20 community centres.

6.         The Preventive Falls Risk Assessment is another pilot initiative supported by MOH, in collaboration with the Alexandra Health System. Through this programme, we aim to help seniors in the North prevent falls by addressing risk factors for falls early. Seniors are empowered to perform a self-screening quiz, and assessed by community nurses and trained staff to identify risk factors for possible early interventions. Assessment results can be shared with their family physicians and they can be referred to other health services, such as eye tests, if required.

Appropriate Care in the Community

7.         Our care delivery system must move from the acute hospitals to the community, anchored by strong primary care, twinned with good social support system. This will allow us to have early identification, assessment and management of frailty. For instance, MOH is working with the National Healthcare Group (NHG) and Tsao Foundation to pilot a Geriatric Services Hub at the Whampoa Community Club. Known as ComSA Centre, this pilot Hub will integrate primary care, case management and aged care services, to bring holistic aged care closer to seniors in the community.

8.         Another example is the Community Psychogeriatric Programme (CPGP) by Changi General Hospital (CGH) to provide training, consultation and support for family physicians and community eldercare agencies on simple psychogeriatric assessment to recognise and manage mental health issues in seniors.  For mentally-ill seniors who are unable or unwilling to visit a doctor, healthcare professionals in the CPGP team, such as geriatric psychiatrists, geriatric and psychiatric nurses, clinical psychologists, medical social workers, occupational therapists and physiotherapists, will visit them at home.          

9.         To foster greater integration of the health and social needs of our seniors, the Eastern Health Alliance (EHA) developed an innovative community care model called the Neighbours for Active Living Programme.  In this Programme, volunteers befriend and support seniors in addressing their health and social needs. During regular home visits to the seniors, volunteers will help to keep a lookout for the seniors' health, remind them about their follow-up medical appointments and inform the health and social agencies if more help is needed. By building a caring community for seniors and integrating this with our Regional Health System, we can better support seniors as they age in place.

A Geriatric Care Ready Workforce

10.       The challenge of caring for seniors with frailty and multiple co-morbidities calls for a well-trained geriatric care workforce. There are currently 83 registered geriatricians, and we hope to grow the number to 120 in the next three to four years. We also need to involve family physicians, other medical specialists, nurses and allied health professionals, and many more health and non-health professionals to bring about appropriate senior-centred care.

11.       To equip all our clinicians with geriatric care capabilities, all specialists-in-training will be required to undergo a geriatric medicine module. Furthermore, the National University of Singapore, in collaboration with SGMS, has developed the Graduate Diploma in Geriatric Medicine to train family physicians in Geriatric assessment and approach. Since its inception, more than 200 family physicians have been trained in geriatric care management, and many are now serving our nursing homes and community hospitals.

12.       Our healthcare institutions are also equipping other healthcare professionals with geriatric care capabilities. For instance, Tan Tock Seng Hospital (TTSH) was accredited in 2014 as one of the international training centres for the Nurses Improving Care for Healthsystems Elders (NICHE) programme. To date, TTSH has trained about 90 Geriatric Resource Nurses (GRNs) under this programme to identify and address specific geriatric syndromes such as falls and delirium, and to implement care strategies to promote patient mobility and expedite recovery. These GRNs ensure that geriatric issues are well-managed not just for patients under the direct care of Geriatric Departments, but also for elderly patients admitted to other wards.

13.       Beyond training healthcare professionals, the capability and well-being of caregivers are also integral to the provision of care for seniors in the community.  One example of caregiver support is the Eldersit Respite Care programme developed by the occupational therapists at the Changi General Hospital (CGH), in partnership with the Alzheimer's Disease Association (ADA).  This Programme also offers respite care services for seniors, and has expanded to three providers, with more than 120 eldersitters trained in caregiver support services.

Investing in Geriatric Services Research

14.       We must continue to innovate and develop new models of care and improve geriatric services through research in clinical and non-clinical areas of ageing. The national Geriatric Education and Research Institute, or GERI for short, is one such example.  I am glad to announce that GERI has started work since March this year at its new premise in Yishun Community Hospital. GERI will collaborate with universities, hospitals, professionals groups, and research agencies to study and create new strategies in education, research and service planning to help Singapore prepare for the challenges of an ageing population.

Conclusion

15.       Although we have started our journey to prepare for the ageing population, we have a short runway. This conference is timely and allows us to learn from one another. I am confident that interaction and sharing of ideas at this conference will spur innovation, collaboration, and thought leadership in geriatric care. For our friends from overseas, I hope that you will have a great time in Singapore, as you enjoy the sights and the great food here.

16.       Thank you.