Chronic disease, functional status and quality of life among the elderly in Singapore
The size of the elderly population aged 65 years and above in Singapore is projected to rise dramatically from 8 per cent in 2009 to 19 per cent in 2030 (Ministry of Community Development, 1999). This unprecedented rate of population ageing in Singapore is among the most rapid in the world and has important implications. Avast and growing number of older people in the population pose enormous
healthcare and social challenges that will have to be faced much sooner rather than later. Policies and programmes to address the health and social needs of the aged have to be put in place in a relatively much shorter time than in developed countries in which population ageing has taken place gradually over many more decades. This dramatic demographic transition sparked by the baby boom ﬁve decades
ago has taken place together with an equally dramatic epidemiological transition. Owing to better environmental sanitation, vaccination, antibiotics and other public health and medical care interventions, the pattern of diseases and disability in the population prevailing in the 1950s and 1960s, characterised by the dominance of acute and communicable diseases of the lungs and gastrointestinal tract, has been quickly replaced by the dominance of cancer and chronic degenerative and metabolic diseases. This changing pattern of disease and morbidity in Singapore is well documented in oﬃcial health statistics and reports. While changing aﬄuent lifestyles and habits such as excessive calorie and
salt consumption, smoking and physical inactivity have driven up the incidence of chronic diseases, improved healthcare has contributed to reduce mortality and prolong survival, although not evidently to improve functional well-being or quality of life (as we shall see below). Without a doubt, the increasing numbers of older adults with chronic diseases and functional disability will escalate the use and costs of medical and social care, while increasing the burden of care by family and caregivers in the coming decades. The quality of care provided by the health system is a critical factor that now determines whether the current cohort of baby boomers presently in their ﬁfties and sixties face the prospect of better functional well-being and quality of life in their later
years. The available data at present do not indicate a benevolent trend of improving physical functional well-being in the near-to-medium term, hence regular monitoring of physical functional status is called for. This chapter will attempt to analyse the following issues:
What can we do now to ensure that our current policies and programmes are eﬀective in achieving longer and healthier life expectancy?