Published on 14 Aug 2023

Forging a path towards holistic healthy ageing

NTU experts from the social sciences and humanities are offering comprehensive solutions for the impending silver tsunami.

Elderly woman exercising

Populations globally are ageing rapidly. Today, nearly one in every five Singaporeans is a senior citizen. In five years’ time, ageing will ratchet up and one in four will be considered elderly.

As the median age of a country’s population increases, so will the frequency of conditions that come with ageing. For instance, dementia, a condition characterised by impaired cognitive abilities, will become a more common diagnosis, as will the bone-weakening disease osteoporosis, hearing loss and cataracts.

Medical advances have solutions to these conditions. However, ageing will also pose problems that cannot be answered through a medical lens alone, such as communication and healthcare financing challenges.

To pave the way to holistic healthy ageing, NTU researchers are drawing insights from the humanities, as well as the social and behavioural sciences.

Boosting older adults' mental and physical fitness 

To help the elderly maintain their mental abilities and lead active lifestyles, researchers at NTU are developing non-pharmacological interventions that aim to slow the decline in cognitive functions associated with ageing.

Prof Annabel Chen of NTU’s School of Social Sciences (SSS) is spearheading a lifestyle intervention programme called ExCITE, together with Assoc Prof Masato Kawabata from the National Institute of Education, Singapore’s teacher training institute at NTU. ExCITE combines cognitive and physical exercise to boost cognition. Participants are asked, while standing in the middle of a square boundary, to step towards the numbered corners according to a given sequence.

In a pilot analysis, Prof Chen found that while the programme did not directly enhance cognitive performance for older adults, they gradually became better at the physical exercise, indicating improvements in physical function. The study’s results demonstrate the potential of non-prescription interventions to promote healthy ageing.

Since then, the NTU team has been working with Sport Singapore’s ActiveSG movement to provide cognitive and neuroscience evidence for the benefits of a similar exercise-cognition programme.

Also vital in promoting healthy ageing among senior citizens is ensuring their caregivers do not burn out mentally.

To address this, Assoc Prof Andy Ho from SSS developed with his team the Mindful-Compassion Art-based Therapy programme that integrates mindfulness practices with creative expression, such as meditation and artmaking. The aim is to teach healthcare workers to be more understanding of and compassionate to themselves and others.

A paper published in Frontiers in Psychology, with Assoc Prof Ho as the first author, showed that the programme helped hospice workers to reduce burnout and exhaustion, as well as improve emotional regulation and mental resilience.

“A healthier and more resilient healthcare workforce is crucial for supporting a national healthy ageing programme,” he says. “These workers not only help intervene to treat illnesses but also promote healthy living.”

Tech-ing the road to healthy ageing

While programmes that encourage the elderly to keep mentally and physically fit are promising, initiatives that push or promote these can face challenges if they are not well communicated.

For instance, seniors who are hard of hearing may miss crucial instructions for lifestyle interventions. Some of the elderly are also not motivated to participate in intervention programmes. These factors could make adhering to such programmes more difficult and lead to lapses in adopting healthy lifestyles.

Researchers at NTU are working to identify and understand these communication issues, as well as to develop technological solutions that could overcome these obstacles.

Prof Theng Yin Leng from NTU’s Wee Kim Wee School of Communication and Information is looking at tapping communication and information technologies, as well as data analytics, such as using telehealth apps and wearables to provide health coaching and healthcare management to the elderly.

“Technological development can support healthy ageing in many ways. For example, the use of wearable devices can promote healthy ageing, monitor older adults’ health and provide continuous feedback on their conditions,” says Prof Theng, who is also Executive Director of the Ageing Research Institute for Society and Education, a pan-university institute at NTU.

In another study, Prof Theng and her team leveraged their technological innovations and communications expertise to establish a no-contact health coaching service for older adults amid the COVID-19 pandemic. Having a human touch is important too. Trained volunteers delivered the counselling intervention through online channels, which the elderly participants found effective.

Feedback from seniors showed that the contactless intervention through health coaches helped to improve their wellbeing, diet, exercise and social life. Furthermore, the companionship that the seniors received from the health coaches helped them tide over periods when Singapore had measures that limited gatherings to reduce COVID-19’s spread.

For senior citizens who lack the motivation to exercise, gamification strategies in motion-controlled games that turn physical activities into fun gaming experiences encouraged them to exercise, according to research on healthy and active ageing by Prof Theng and her team.

Financing healthcare for the aged

As people age, financial wellness is important for maintaining good health and to help them cope with unforeseen medical issues.

“When people cannot afford the healthcare they need, they may delay seeking medical care, which can lead to a deterioration in health,” explains Asst Prof Sabrina Luk from SSS.

She adds that senior citizens spend about three times as much on medical services compared to their younger counterparts.

This is where the government and health financing policies come in. For example, MediSave is a national mandatory medical savings scheme in Singapore that helps individuals set aside part of their income to pay for medical expenses, as well as their healthcare needs in old age.

The Singapore Government also runs MediShield Life, a basic health insurance plan that helps to pay for large hospital bills and selected costly outpatient treatments. MediShield Life, which provides lifelong protection for all Singaporean citizens and permanent residents, is designed based on inclusiveness and greater collective responsibility, says Asst Prof Luk.

Despite robust national health financing schemes, some older adults may still fall through the cracks. For instance, those with very severe conditions may incur costs that fall outside the coverage of these funds. Seniors who had a low income for most of their careers may not have enough savings for old age too.

“Poor physical health can lead to higher medical and long-term care needs and expenses. Safety nets are then vital for vulnerable senior citizens who cannot afford the healthcare that they need,” Asst Prof Luk says.


The article appeared first in NTU's research & innovation magazine Pushing Frontiers (issue #21, December 2022).