Opening Of The International Conference On Evidence-Based Medicine 2003 / 10th Annual Singapore General Hospital - Stanford University Hospital Joint Update

01 Nov 2003

By Dr Balaji Sadasivan

Venue: Mount Elizabeth Hospital

INTRODUCTION

This is the first formal function I am attending since the end of theSARS outbreak. I would like to acknowledge the great contribution madeby the private sector in our fight against SARS. There was a period inmid-April when I was greatly concerned about the consequences of SARSon our health-care system. Tan Tock Seng Hospital had been convertedinto a SARS hospital. We had discovered SARS patients in both SGH andNUH. There was a possibility that our three major public hospitalswould not be able to take care sick patients because of SARS or becausethe healthcare workers were in quarantine. If that occurred, theprivate hospitals would have to look after the workload of thesehospitals. IT was essential that the private hospitals remain free ofSARS. The private hospitals rose to the challenge and instituteddrastic anti-SARS measures. In particular, Mt Elisabeth Hospital,Gleneagles Hospital and Raffles Hospital had the most stringentmeasures. These measures ensured that SARS did not infect yourhealthcare workers or patients and kept your hospitals SARS free. Iwant to congratulate you for that achievement. The measures greatlydisrupted the medical practice of many doctors but your courage,resilience, and support to the national effort is commendable andgreatly appreciated by everyone. SARS is now history and we hope tokeep it that way. Looking into the future, one of Singapore's bigmedical challenges will be the ageing of our population.

AGEING

Today worldwide, there are around 600 million persons aged 60 years andabove, this total is expected to double by 2025 and will virtuallyreach 2 billion by 2050. Likewise, in Singapore, with better nutrition,healthcare quality and awareness of a healthy lifestyle, lifeexpectancy at birth has risen to 78.7 years, up from 66 years old 30years ago. Today, approximately 7.5% of our resident population is 65years and above, a higher proportion than at any time in our history.This figure is also expected to rise at an accelerated pace over thenext 10-20 years, reaching about 19% by the year 2030.

This global ageing phenomenon makes ageing one of the top political andsocial challenges in many countries, including Singapore. On one hand,ageing is one of humanity's greatest triumphs but on the other hand, itis also an economic and health dilemma. There may be increased health,economic and social demands on the nation if the health of the elderlypopulation deteriorates, resulting in multiple medical conditions orinjuries and finally culminating in the 3 Ds: death, disability anddementia.

The challenge in looking after the aged is to add health and quality oflife to the extra life years in the elderly and one way is through"Active and Healthy Ageing".

ACTIVE AND HEALTHY AGEING

According to the World Health Organisation, "Active ageing"refers to the elderly being given the opportunities to continuallyparticipate in social, economic, cultural, spiritual and civic affairs,not just the ability to be physically active or to participate in thelabour force. In addition, "Healthy Ageing" includes morethan the mere absence of disease. It also means everyone can enjoy agood quality of life and have a recognized role to play as usefulmembers of society.

Using self-assessed health status as a rough proxy for quality of life,in the national health survey 2001, only 46.8% of Singaporeans aged 65and above felt that their health status was good or very good, whereasmore than half or 53.2% felt that their health status was moderate tobad/very bad. Therefore, for more elderly to feel good about theirhealth status, more effort is needed in health promotion, healthprevention and early detection of disease.

HEALTHY LIFESTYLES

The leading causes of mortality amongst the elderly are heart diseases,cancer and stroke - chronic diseases that not only result in prematuredeath but also reduce the quality of life. From the national healthsurvey done in 2001, approximately 14.1% of all Singaporeans aged 65and above have reported high blood cholesterol levels, 19.3% arediagnosed diabetics and 32.6% are hypertensives. We know, for example,how the debilitating diabetic neuro-, renal and retinal complicationscould affect the quality of life twice as fast and more severely inadvanced age, and cause a deteriorating functional status and ofteninactivity. This often leads to stress and depression, leading todownward spiral of the health status of the elderly. Such poor qualityof life in an elderly is not desired both for themselves and forsociety.

Many non-communicable diseases originate from health-damaging behavior.From the survey in 2001, 64.4% of Singaporeans aged 70 and above arefound to be completely sedentary with only 27.6% doing regularexercises whereas 10.2% are still daily smokers. These statistics showthat the elderly need encouragement to lead a healthier lifestyle bybeing more physically active, eat a healthy diet, stop smoking andmaintain a good mental frame of mind. For example, regular moderatephysical activity can increase physical fitness, muscle size, andstrength in older people, thereby improving balance, reducing risks offalls and countering the development of fragility.

This is what Health Promotion Board (HPB) was set up for, since 2000.And they have rolled out plenty of useful health education andpromotion programmes, one of which is the osteoporosis preventionprogramme - to educate the public about osteoporosis, its risk factorsand the preventive measures, especially on the importance of a healthydiet rich in calcium and regular weight-bearing exercises to attainpeak bone mass in the young and slow down bone loss after the age of30.

EARLY DETECTION

Besides prevention, it is also important to detect any diseases earlyso as to manage them early and prevent any complications from ensuing.Some good screening programmes introduced by HPB include the:-

National "Check Your Health" Community Health ScreeningProgramme for high blood pressure, diabetes and high blood cholesterolsince July 2000, where Singaporeans aged 50 years and above just needto pay a heavily subsidized rate of $5 each to undergo the screening;

BreastScreen Singapore, a national breast screening programme launchedin January 2002, subsidises women aged 40 and above for their regularmammography at designated screening centres;

Cervical Screen Singapore programme, launched as a one-year pilotprogramme in all SingHealth polyclinics since November 2002 and will beextended to all polyclinics from next July onwards.

HOW ELSE SHOULD ELDERLY REMAIN ACTIVE?

To be consistent with the message of active ageing, it is important toensure there are continual avenues in the society for the elderly to beactive and healthy. Retirement should be viewed as another preciousopportunity for the elderly to contribute creatively to many problemsthat our economy and society face. The elderly represent anaccumulation of human wealth and wisdom. They have more free time tocontribute to the society through formal or informal community work.

One good example of the contribution of the elderly is the recentHealthy Lifestyle Ambassador Award in the National Healthy LifestyleCampaign in 2003. This was launched to give recognition to individualswho live a healthy lifestyle and have contributed to promoting healthylifestyle at the community level. 23.1% of the nominees were seniorcitizens and out of the 34 awards given, 38.2% were elderly.

CONCLUSION

A famous Swedish director once said, "Ageing is like climbing amountain; you get out of breath but you have a magnificent view";we should ensure that longer lives for the elderly should be free ofdisabilities and diseases for as long as possible and add quality yearsfor the added years, so that they can age gracefully and happily withdignity and magnificence.

In conclusion, I would like to congratulate Dr Low Cze Hong and theorganizing committee for their efforts in organizing this scientificand clinical meeting that brings together doctors and specialists tobring forth more new ideas for our ageing society on "Leading theWay in Health and Quality of Life".

Thank you.