Written by Sébastien Monnet, STC, Embassy of Switzerland in Singapore
While many Southeast Asian nations fear tsunamis, Singapore is bracing for the silver tsunami projected to hit its shores by 2030. Nearly every developed country in the world is confronted with an ageing population, yet the extent of the phenomenon in Singapore is acute. The government listed a rapidly ageing population as one of its key challenges looking ahead and research and technology are perceived as key enablers of its holistic action plan to allow the elderly to “age-in-place successfully”. Telehealth solutions are gaining traction and are moving into mainstream healthcare. Highly specialized business accelerators and startups are seeing this challenge as an opportunity and developing solutions to cater to the elderly.
A unique context
Since its inception in 1965, Singapore experienced tremendous economic and social changes over its relative short life. From a third-world, minuscule, natural resources-deprived backwater island to a first-world financial and technological regional hub, Singapore defied the odds. On par with this stunning evolution, the population demography changed significantly and rapidly. The change took everyone by surprise, including the government who had to make a 180º turn in the early 1980s on population planning policies advocating then controlled birthrate although fertility rate were continuously reaching alarming lows.
Fertility rates and life expectancies are respectively among the world’s lowest and highest, so much so that by 2030 one in four Singaporeans is projected to be 65 and above while only two working adults will then be supporting one elderly. Moreover, the trend of the number of seniors living alone is estimated to increase from 35’000 in 2015 to 83’000 over the same time horizon.
With an estimated 900’000 seniors to care for in less than 15 years’ time and a current population of 5.6 million inhabitants, the country faces a monumental challenge. In conjunction with the shrinking workforce, the shortages of care facilities, as well as the immense economic cost incurred, only make the situation more challenging and new paradigms in terms of ageing and eldercare are called for.
Singapore has a unique context. Roughly the size of the canton of Glarus yet 140 times more populous, the country adheres to a top-down system that fosters agile policy-making. The lack of resources can be considered Singapore’s curse but it also fuels its engine and its constant urge to succeed and maintain high living standards. So, what can we take away from Singapore?
An action plan to “age successfully”
Earlier this year, the Ministerial Committee on Ageing (MCA) formed in 2007 to spearhead Singapore’s endeavor on ageing and currently chaired by Mr Gan Kim Yong, Minister of Health and Minister-in-Charge of Ageing, unveiled its S$3 billion action plan to enable Singaporeans to “age successfully” . This plan is the result of nation-wide public consultations that engaged over 4’000 citizens between 2014 and 2015 to understand their aspirations on ageing. The holistic plan covers 12 main areas, namely, health and wellness, learning, volunteerism, employment, housing, transport, public spaces, respect and social inclusion, retirement adequacy, healthcare and aged care, protection for vulnerable seniors and research.
Among the key research initiatives of the action plan is a S$200 million fund allocated to the National Research Foundation for a National Innovation Challenge on Active and Confident Ageing to stimulate research related to ageing and the establishment of the DUKE-NUS Centre for Ageing, Research and Education (CARE) and of the Geriatric Education and Research Institute (GERI). The Agency for Science, Technology and Research (A*STAR) is supporting the action plan by pushing R&D in assistive medical technologies, therapeutics and cohort study. It recently launched the SG90 Longevity Cohort Study with National University Health System (NUHS) to identify biomarkers linked to successful ageing on individuals aged 90 and above. This will be the first such study in the world to focus on three major Asian ethnicities, making it representative of half of the world population, and with immediate applications to the local population.
Central to the action plan is the ageing-in-place model, whereby provision of care is shifted to the home and community where the seniors are living in. It constitutes a way to mitigate the shortage of care facilities and workforce and a way to improve the elderly’s quality of life. This is where technology kicks in. Much the success of the model relies upon the integration of care across social and health services and a collective effort of the community. The use of technological solutions allows to better coordinate and to optimize the limited resources at hand.
Telehealth solutions moving into mainstream healthcare
In this context, the incredible developments the information and communications technology (ICT) sector experienced over the last few decades appear as a boon to tackle the challenges of ageing and to achieve the ageing-in-place vision. Examples of such technologies range from smart gears to track vital signs, home monitoring systems including sensors and panic buttons, robots that guide seniors through personalized workout session, to telehealth systems and e-health applications that enable self-management to empower the patient and provide care remotely.
Telehealth solutions have the potential to spread the medical net wider. Prof James Yip from the NUHS, started a telehealth programme and teamed up with MyHealth Sentinel, a healthcare technology company. They developed Singapore’s first integrated tele-health monitoring system, targeting patients with hypertension, heart failure and diabetes. The system allows patients to be cared for remotely using tele-health tools such as blood pressure monitoring systems, glucometers and weighing scales to adjust their medications. Some 1,300 chronically ill patients have benefited from being monitored online so far and the results show significant benefits.
A group of researchers led by Associate Professor Gerald Koh from the National University of Singapore (NUS) Saw Swee Hock School of Public Health (SSHSPH) is pioneering tele-rehabilitation systems by leveraging on wireless wearable sensor and video-conferencing technologies. It developed a system that uses tablets to guide stroke patients through exercises on videos, whilst motion sensors capture data about their progress, allowing patients to perform their rehabilitation exercises from the comfort and convenience of home.
According to Prof Arthur Tay of the Department of Electrical and Computer Engineering in the NUS Faculty of Engineering, most of a patient’s motor functions return within the first three to six months after a stroke; this window is a crucial period for rehabilitation. Only one-third of patients regularly return for rehabilitation sessions, thus highlighting the need to better bridge the gap between patients and rehabilitation. Preliminary clinical trials are ongoing to confirm the potential health benefit and cost-effectiveness this system could bring about.
Given the increasing constrains faced by health systems in caring for the elderly, telemedicine or telehealth is increasingly recognized as a complementary and valid solution. It can help bridge the constraints of distance and save time and costs, and even provide healthcare services more seamlessly and in a timely manner. The Singapore Management University (SMU) via its SMU-TCS iCity Lab is leading SHINESeniors a research project to develop a technology in-home monitoring ecosystem that enables the elderly living alone to age-in-place. A multidisciplinary approach and a joint effort with A*STAR and various government bodies such as the Ministry of Health (MOH), the Housing and Development Board (HDB), and the Urban Redevelopment Authority (URA), SHINESeniors aims at improving responsive and pre-emptive care capacities by providing sensor-enabled homes and personalized home care for senior citizens. The four key technological components of the project are user interfaces to disseminate information across the range of care stakeholders, data analytics to provide holistic and personalized care, home and community care platforms to integrate and store health data and in-home monitoring systems to collect data.
Sparking off a startup ecosystem to meet the needs of the elderly
The collected data are essential to build up living patterns that allow the caregivers to detect the changes in an elderly’s well-being before health condition deterioration. Community caregivers can then provide personalized care and intervention, in a timely manner – especially in emergency situations. Nevertheless, the challenge of current monitoring technology solutions is to avoid false alerts which cause inconveniences and can delay care responses. Pioneering new detection technology is at the core of SoundEye’s selling proposition. The young startup developed an intelligent sensor that can monitor a room and detect abnormal sound and motion. SoundEye’s uses ultrasonic detectors, a microphone a camera to detect both falls and screams or calls for help, and alert caregivers and emergency services. It also gathers data on the elderly person’s activity, including waking and sleeping times, bathroom visits, allowing community caregivers to build up living patterns.
Dr Yeow Kee Tan, SoundEye’s Founder and CEO and a former A*STAR’s engineer, recalls the interaction with a senior living alone who drank water from the toilet bowl during three days after a fall before being rescued as the reason that prompted him to address the need of this population. Over the past few years of research and development, SoundEye received various awards around the Asia Pacific region and took part to Modern Aging Singapore’s inaugural acceleration programme in 2015. Modern Aging is a highly specialized business accelerator designed to facilitate the creation of businesses that meet the needs of the elderly. It is supported by the Ministry of Health and run by ACCESS Health International and NUS Enterprise. This programme combines online learning and focused workshops with individual mentoring and allows the participants to tap on ACCESS Health and NUS Enterprise unique combination of expertise and networks. This initiative is meant to further encourage Singapore-based entrepreneurs to look into the elder market by building up a community and sustaining an information effort across Singapore’s healthcare and ageing landscape.
Leveraging the favorable framework put into place by the government as well as the potential of a huge market in the making, a growing number of entrepreneurs and startups are focusing on solutions that meet the needs of the elderly. SoundEye’s fellow “Modern Aging graduates” PillPresso for instance proposes a smart pill dispenser to deliver convenience in medication management and improve adherence while Altrue created Silver Lining, a smart sensor used in adult diapers to protect bedridden patients from pressure ulcers and infections. Another start-up developing products for the elderly is Neeuro. It proposes a headband that can detect brainwaves, allowing the wearer to control his brain activity to play games designed to improve memory, attention span, spatial skills and various other cognitive functions.
User-centric design for improved products and services
Understanding the needs of the seniors is a challenge for entrepreneurs and businesses aspiring to tap on this booming market. Technology solutions developed for other markets or purposes with potential applications in the eldercare sector are increasingly numerous on the market, yet synergies and interoperability are rarely exploited. Encouraging a more user-centered design approach is yet another endeavor the government is currently pushing forward. The DesignSingapore Council released in 2015 the results of a design ethnography study to gather qualitative insights into the habits and behaviours of the seniors. The result – Empathetic Technology for Ageing – Rethinking Health & Wellness for the Elderly: Infocomm Technology Sector – documents user-centered innovation methodology and research findings about the elderly in Singapore and proposes design principles that can help create better solutions for the elderly using ICT.
Singapore is tackling the ageing challenge in the most holistic way; the narrative is that of a whole-of-government and whole-of-society necessary effort. Ageing is affecting virtually everybody and as with other endeavor, Singapore will have to rely on its main available resource, its people. In line with its overarching vision of becoming a Smart Nation, Singapore perceives technology and research as key enablers of its ageing-in-place vision, yet a technology-enabled eldercare system is conditional to its adoption by the caregivers, the community and of course the elderly. As the numbers of elderly grow, the market for elderly solutions is rapidly booming, not just in Singapore but also across the region. This means a rising demand for healthcare and eldercare products and services and most certainly more and more start-ups and technology providers dreaming of capturing the immense economic potential of the silver tsunami.
 Ministerial Committee on Ageing. $3billion Action Plan to Enable Singaporeans To Age Successfully. Ministry of Health, Singapore. Aug 2015 [Online] Available: https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2015/-3billion-action-plan-to-enable-singaporeans-to-age-successfully.html [Accessed: Oct 2, 2016]
 Ministerial Committee on Ageing. Action Plan For Successful Ageing. Ministry of Health, Singapore. 2016 [Online] Available: https://www.moh.gov.sg/content/dam/moh_web/SuccessfulAgeing/action-plan.pdf[Accessed : Oct 2, 2016]
 The biology of ageing: Tackling the silver tsunami through a fundamental approach. A*STAR. Oct 22, 2015 [Online] Available: https://www.a-star.edu.sg/News-and-Events/News/Press-releases/ID/4944/The-biology-of-ageing-Tackling-the-silver-tsunami-through-a-fundamental-approach.aspx [Accessed : Oct 2, 2016]
 My Smart HDB Home @ Yuhua. The Smart Elderly Monitoring and Alert System (SEMAS). Housing Development Board, Singapore. 2016 [Online] Available: http://www.hdb.gov.sg/cs/infoweb/about-us/our-role/smart-and-sustainable-living/hdb-smart-home-exhibition [Accessed : Oct 2, 2016]
 Robocoach exercise with the elderly. Ngee Ann Polytechnic. Oct 30, 2015 [Online]. Available: http://www.np.edu.sg/sg50/events/Pages/20150101_npevents_robocoach.aspx [Accessed : Oct 2, 2016]
 Joyce Teo. Telehealth helps spread medical Net wider. Straits Times. Oct 20, 2015 [Online]. Available: http://www.straitstimes.com/singapore/telehealth-helps-spread-medical-net-wider [Accessed : Oct 2, 2016]
 Tele-rehabilitation solution for stroke patients to boost physical recovery. National University of Singapore. Apr 8, 2014 [Online]. Available: https://news.nus.edu.sg/highlights/7560-tele-rehabilitation-solution-for-stroke-patients-to-boost-physical-recovery [Accessed : Oct 2, 2016]
 White paper. Technologies for ageing-in-place: The Singapore context. SMU-TCS iCity Lab, Singapore Management University. Mar 2016 [Online]. Available: http://icity.smu.edu.sg/technologies-ageing-place-singapore-context [Accessed : Oct 2, 2016]
 SoundEye video. Sept 27, 2016 [Online]. Available: https://www.youtube.com/watch?v=NcgsNqm-1Ew&feature=youtu.be [Accessed : Oct 2, 2016]
 Chia Yan Min. Growing focus on creating products for the elderly. Straits Times. Jul 14, 2016 [Online]. Available: http://www.straitstimes.com/business/growing-focus-on-creating-products-for-the-elderly [Accessed : Oct 2, 2016]
 DesignSingapore Council. Empathetic Technology for Ageing – Rethinking Health & Wellness for the Elderly: Infocomm Technology Sector. Ministry of Communications and Information. 2015 [Online]. Available: https://new.designsingapore.org/design-news/publications/empathetic-technology-for-ageing [Accessed : Oct 2, 2016]
 Lim Yan Liang. Four key challenges for Singapore in next 50 years. Straits Times. Mar 29, 2016 [Online]. Available: http://www.straitstimes.com/singapore/four-key-challenges-for-singapore-in-next-50-years [Accessed: Oct 2, 2016]