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FEATURES
Urban Ageing — Helping Our Elderly Live Safer and Easier
An interview with Asst Prof Tim Xu and A/P Wee Shiou Liang from Health and Social Sciences, SIT, on helping the elder live safer and easier lives.

Better health care and hygiene, healthier lifestyles, and sufficient food has allowed us to live much longer lives than our ancestors, presenting us the phenomena dominating society today – an ageing population.

Yet, living longer also means an increased risk of disease, disability, and/or dementia. In Singapore, about 14 per cent of people are aged 65 and above, and this is set to increase to 25 per cent by 2030.

In line with the theme of World Health Day 2021 (7 April), which advocates the building of a fairer, healthier world for everyone, it begs the question, how will we care for our elderly? How will we ensure they do not get left behind?

This is an issue the Singapore Institute of Technology (SIT) has been actively tackling with its Community Health Research Programme, which aims to improve the health and well-being of older Singaporeans through an integrated preventive and support care model.

To gain a better understanding of the different ongoing research-based programmes, Asst Prof Tim Xu and A/P Wee Shiou Liang from Health and Social Sciences, SIT have granted us the privilege to an interview to learn more.

Ageing in Place – Innovation in Community Rehabilitation

A stroke occurs when blood supply to the brain is interrupted or reduced, preventing brain cells from getting oxygen and nutrients. This causes the brain cells to lose their function and lead to brain damage.

Stroke is the leading cause of adult disability with 63 per cent of stroke patients facing disability at three months. In Singapore, about 3.65 per cent of the resident population was reported to have had a stroke. This amounts to about 26 cases each day and is projected to increase with our greying population.

To support stroke survivors regain confidence and functional mobility, Asst Prof Xu developed the “Community Reintegration After Stroke” (CREATE) programme for community-living stroke survivors in Singapore.

1. Which areas of the community has the CREATE programme been implemented to help stroke survivors regain functional mobility?

Asst Prof Tim Xu, Health and Social Sciences, SIT:
So far, SIT has piloted the CREATE programme at the Singapore Stroke Station (S3) and Wellness Kampung@Yishun (Wellness Centres).

2. How will the CREATE programme be implemented in more communities across Singapore?

Asst Prof Tim Xu, Health and Social Sciences, SIT:
As part of the programme implementation, we will work with more community service providers. These include day rehabilitation centres and senior care centres, where we will train allied health professionals to be programme leaders to run the group-based CREATE programme at their respective centres. The research team will reach out to more stroke survivors living in the community via roadshows and health talks.

Community-Based Falls Prevention Programme

Falling is fairly common among the elderly. Unsurprisingly, one in three community-dwelling elderly aged 65 years and above will experience at least one fall within a year. What is worrying is that many who fall, do not report the fall nor seek medical help unless they sustained injuries. In Singapore, falls account for 40 per cent of injury-related deaths.

In collaboration with Geriatric Education and Research Institute (GERI), National Healthcare Group (NHG) and community partners, Asst Prof Tim Xu is working to carry out and assess a community-based falls prevention project in 2020.

As a ‘Stepping On’ programme master trainer in Singapore, Asst Prof Xu has run several training workshops, preparing more healthcare professionals to run the falls prevention programme. Here, Prof Xu shares a little more about the programme.

1. What is included in the community-based falls prevention programme?

Asst Prof Tim Xu, Health and Social Sciences, SIT:
As part of the National Falls Prevention Campaign, the Stepping On programme will be implemented in the northern part of Singapore in 2021. The Stepping On programme is a multifaceted falls prevention programme proven to be effective in reducing falls by 31 per cent in community-dwelling older adults. The programme covers a seven-week group-based intervention focusing on various falls prevention topics, which could include balance and strength exercises, medication review, home and community safety, vitamin D and vision, facilitated by a trained programme leader who is also a healthcare professional with experience working with this group. It is followed by a home visit four weeks from the seventh session, a three-month booster session and a six-month follow-up phone call. The programme uses adult learning principles to help older adults in a small group to learn different falls prevention strategies and encourage behavioural change in their everyday life.

2. Who will be involved in the clinical trial?

Asst Prof Tim Xu, Health and Social Sciences, SIT:
We are targeting community-dwelling older adults aged 65 years or above who are most at risk of falling. Older adults will be carefully screened for suitability before joining the programme.

Person-Centric Dementia and Long-Term Care

Nursing homes (NH) can be conceived and operated as an institution to house sick and dependent people or a home for unique individuals. Person-centric NH care is about delivering care that enables individuals to continue to maintain their sense of self and personhood in terms of autonomy, privacy and dignity. The person-centric care (PCC) model was conceived and developed in response to a care model that was very much institutional-based and management-focused. If NH is only focused on safety and efficiency, this can actually compromise a person’s quality of life, well-being and sense of self-worth. PCC is important to NH residents, in particular, persons with dementia (PWD) as it enables them to maintain their sense of self.

The components of PCC for PWD include:

  • Valuing and respecting PWD and those who care for them,
  • Treating PWD as individuals with unique needs,
  • Seeing the world from the perspective of PWD, and so to understand the person’s behaviour and what is being communicated, and validating the subjective experience that is being perceived as the reality of the individual; and
  • Creating a positive social environment in which the PWD can experience relative well-being through care that promotes the building of relationships

1. What does a person-centric design for nursing homes mean?

A/P Wee Shiou Liang, Health and Social Sciences, SIT:
Person-centric NH design integrates design with the care aspect, the social aspect, and how the community plays a crucial role. For example, design configuration for care is organised into home-like household units rather than hospital-like wards. Each ‘home’ unit is self-contained (with a dining and social space) and has the same carers who are familiar with the residents compared to an open ward like in a hospital where different carers rotate between different shifts and wards. A critical consideration of the PCC model and design is to provide choice for the family, carers, and residents - from how one personalises the space to the choice of one’s day-to-day activities. It also considers how to better leverage technology to support some of the activities and functions of the NH. Importantly, such a design also considers the integration of the NH with the surrounding communities.

2. How will the person-centric design help better cater to the needs of the elderly?

A/P Wee Shiou Liang, Health and Social Sciences, SIT:

A major aspect of the PCC model is to take into consideration the dignity of the resident. Particularly as they age or become unwell, and/or are advancing with dementia, it is important to maintain a sense of autonomy and well-being. The environmental design takes into consideration elements that ensure continuity and familiarity to them, and also characteristic features like encouragement, establishing relationships and building communities among residents.

3. How will the home-like atmosphere be achieved?

A/P Wee Shiou Liang, Health and Social Sciences, SIT:

This goes beyond NH design and environmental changes and will involve care culture reforms and change especially for PWD, which forms d a majority of NH residents.

The aspects of culture process change, particularly to better cater to the needs of PWD involved, include:

4. In what ways will nursing home caregivers be trained differently in this person-centric care model?

A/P Wee Shiou Liang, Health and Social Sciences, SIT:
Nursing home caregivers will be trained to cater to the needs of PWD, who form a majority of NH residents. The training will centre on:

  • Valuing the person first and getting to know each resident as individuals
  • Focusing on the quality of their interaction
  • Refraining from using labels such as feeder, wanderer and screamer, to describe individuals; learning to be aware of and believing in the strengths and potential in each resident, including those with dementia
  • Displaying knowledge and respect in care that all behaviour is communication, and seeking to learn what PWD are saying through their behaviour
  • For example, Frank was a professional musician and played at all of the local and regional clubs. Since he played late-night gigs, he was used to staying up late each night as well as sleeping late each morning. When Frank’s care needs became too much for his wife, she looked for a memory care centre that would support his lifelong schedule. In his new home, Frank stays up late in his room, oftentimes listening to old records. The staff let him wake on his own each morning and include that information in his care plan. Since there is a piano in the reception area, Frank often plays for other residents and visitors.
  • Seeking to understand unmet social, emotional as well as physical needs of PWD
  • Reflecting current and accurate knowledge of the field, the multiple causes for dementia symptoms, and the multiple types of dementia
  • Other aspects of their training include training resources and frequency, best practices and topics for educational goals. Staff are supported in order to build their confidence and expertise in dementia care and other skills/knowledge needed to perform their jobs with confidence and enjoyment.

About the interviewees

Asst Prof Tim Xu, Health and Social Sciences, SIT

Dr Tim Xu is an occupational therapy assistant professor in the Health & Social Sciences Cluster at the Singapore Institute of Technology (SIT) and holds a PhD in Health Sciences from the University of Sydney, Australia. He has over 20 years of experience working with older adults and stroke population in community rehabilitation settings in Singapore and Australia. Tim has been working closely with many community organisations and government agencies to promote ageing in place and community reintegration after stroke. He has successfully piloted a few community-based programs locally, such as Stepping On fall prevention program in older adults, Stepping On after stroke program, frailty management program for community-living older adults and community reintegration after stroke program.

A/P Wee Shiou Liang, Health and Social Sciences, SIT

A/P Wee has been a joint faculty with SIT since Jan 2016 and transferred his primary appointment to SIT on 1 Sep 2020.

He has also been a joint faculty and Director at the Geriatric Education and Research Institute (GERI). Set up under the Health Ministry in 2014, GERI conducts, guides, and coordinates Singapore’s research initiatives related to geriatric services and age-related healthcare issues. GERI also has a role to strengthen training content and curriculum so as to adequately equip healthcare workers with skills to better care for older adults.

Prior to GERI, Dr Wee was Head of Research, Health Information Management and Evaluation at the Agency for Integrated Care (AIC, 2009-2013) and the Deputy Director of the Sports Division at the Ministry of Community, Development, Youth and Sports (MCYS, 2008-2009).

Dr Wee is passionate and has been active in work to translate evidence into policy and practice to help people remain productive and maintain their health and function. As Faculty of Health and Social Sciences at SIT and Masters of Science in Applied Gerontology at NTU, he is also involved in educating workforce-ready health and social care professionals through integrating learning, industry and community. Dr Wee’s areas of interest include aged and integrated care, frailty and health, exercise and nutrition science, as well as health services research, which includes implementation research, program evaluation and outcomes research.

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