Aw Wah Peng has been living alone ever since his wife died in 2008. And he likes it that way.
Although he has grown distant from his son and only speaks in passing to his neighbours in Marine Parade, Singapore, he remains fiercely independent: “I am used to living on my own. I don’t like being bothered by others. I feel that living alone allows me more freedom. I don’t find it troublesome at all.”
Uncle Aw, as he is known, is typical of a growing number of elderly Singaporeans who, rather than move to a nursing home, opt to continue living independently.
Now technology is being harnessed in to ensure that seniors like Aw across Singapore are well looked after in their homes, while also helping the city state cope better with its ageing population.
Doing right by the ageing population - and taxpayers
Singapore is coming under growing demographic pressures. The number of citizens over the age of 65 is expected to double by 2030, to 900,000. This will put greater demands on social services and the general public infrastructure as the need for geriatric care, mobility services and healthcare provision increases.
Supporting the advancing ‘silver tsunami’, as it has been called, is a challenge, not only in Singapore but around the world. As the traditional age pyramid continues to invert because of rising life expectancy and declining fertility, shrinking workforces will be carrying an ever-growing tax burden. Their ability to support the rest of the pyramid can only be stretched so far, so governments are being forced to find ways to do more for less, to cater for ageing populations in a sustainable way.
Source: Singapore Management University/Tata Consultancy Services: Technologies for Ageing-in-Place: The Singapore Context, March 2016 (SMU-TCS iCityLab)
The silver tsunami’s silver lining
The trend towards independent living could turn out to be a silver lining for Singapore’s authorities.
By 2030, the number of seniors choosing to stay in their own homes is set to double and they will make up nearly a tenth of the population aged over 65.
‘Ageing in place’, as it is known in Singapore, is an aspirational concept for both the elderly and the authorities. Independent living enables people like Uncle Aw to stay in their familiar environment for longer, remain within the community and access amenities they are used to. For Singapore’s administration, this means less pressure on places in nursing homes, for which there is already high demand, and less need for community care.
Then again, independent living comes with its own challenges. Elderly people who are staying alone have been found to be at a higher risk of social isolation and to have poorer access to healthcare. Depending on their physical and mental fitness, it may be difficult for them to take medication as prescribed or seek help when needed. They also face a higher risk of dying prematurely because they may not receive medical attention in time.
From the authorities’ point of view, looking after people with different care requirements in disparate locations around the city is equally testing. It relies on orchestrating a complex network of volunteer carers who visit seniors fortnightly or monthly, social workers, health professionals and local government. And the risk of a lone elderly person getting into difficulties remains.
Source: SMU-TCS iCityLab
Saved by the door sensor
Luckily for Aw Wah Peng, he lives in one of 50 social housing flats in east Singapore which have been set up as smart homes for the elderly. They are part of a technology trial by iCityLab, a research facility focused on developing technology for ‘smart cities’. It was set up jointly by Singapore Management University and Tata Consultancy Services.
As part of the project, Uncle Aw’s home was fitted with a range of sensors to monitor his movements around the flat and detect whether the main door has been opened.
Based on the information collected from these sensors, iCityLab’s system can detect if an elderly person has spent a lot of time in the same area of the home – indicating they might have had a fall, for example - or if they have been inactive for a prolonged period. The system will then alert a family member or carer to check on them, which means that help can be on hand quickly when an emergency arises.
In addition, iCityLab is trialling a medication box equipped with sensors as a simple way of tracking whether elderly people takes their medicines as prescribed. Any deviation will trigger an alert for a carer to check on the person and address any issues with them taking their drugs on time.
Source: SMU-TCS iCityLab
Early results from the trial are encouraging. For example, the sensor data revealed that a 70-year-old woman was taking her medication irregularly during the night. The data showed that she woke up two or three times nightly to take her medicine. Her carers were alerted to this changed pattern and checked on the patient.
It emerged that she had been waking up frequently because she was experiencing leg pain and had to take painkillers. The carers took her to a local clinic to see a doctor and address the issue.
Enabling active ageing through technology
iCityLab’s SHINESeniors project is just one of many attempts in Singapore to solve the challenge of caring for independently living seniors. These include the use of panic buttons, wearable technology to monitor vital signs, telemedicine systems and robots that lead workouts for the elderly.
Source: Tech in Asia / Infocomm Development Authority of Singapore (IDA)
SHINESeniors is the first part of a technology framework that will provide comprehensive and individually-tailored care to Singapore’s stay-at-home elderly. This goes beyond just healthcare, also covering social aspects to ensure they can continue to play an active part in their local community.
Ultimately, Singapore Management University and Tata Consultancy Services would like to monitor elderly people continuously, not just in their homes but wherever they go within the community, to provide broader contextual information about their behaviour.
Source: SMU-TCS iCityLab
The long-term goal is for the system to learn the daily routines of elderly people and then detect in real-time when a person’s movements and behaviours differ markedly. Once a divergent pattern has been spotted, the system will flag the anomaly and ensure that a family member or carer is dispatched to help. Such a monitoring system will also enable what health professionals call ‘pre-emptive care’. This involves identifying potential health issues early and attending to them before they become a more serious problem.
Source: SMU-TCS iCityLab
Not only can such early intervention save lives. By keeping people in good health for longer, it should also take some pressure off Singapore’s social services, primary care providers and hospitals.
Getting over the threshold
One challenge with bringing technology into elderly people’s homes is that it needs to get ‘across the threshold.’ As Xia Jia, a volunteer carer who takes part in the trial, explains: “A lot of elderly [people] really value their privacy.”
“When this sensor system was introduced, initially the seniors felt that it might be intrusive. They were worried they were under surveillance. I told them the sensor system doesn’t work in that way.”
It is clear from SHINESeniors’ experiences that it will be critical to keep seniors’ interaction with technology to a minimum and limit the extent to which they need to adapt to it. The unobtrusiveness desired by many elderly people may also limit the depth of information that can be obtained. However, as more tech-savvy generations get to retirement age, these sensitivities may disappear.
Setting a global example
The SHINESeniors project is part of a government initiative to reinvent the city state’s urban planning to become more inclusive through technology and to turn Singapore into one of the world’s first smart cities. It could set an example for other countries and cities seeking to reform their infrastructure and services to cater for an evolving population structure and its changing needs.