Ageing & Disability

Ageing & Disability

Causes of Severe Disabilities in Elderly of Lower Social Economic Group in Singapore

Dr Tan Jit Seng & Ms Teo Shing YuenLotus Eldercare Health Services

Lotus Eldercare Pte LtdSingapore

www.lotuseldercare.com.sg 2

Introduction

• Singapore is one of the fastest ageing societies in the world

• In 2030, citizens age 65 and above will increase to 900,000; from 220,000 in 2000

• FromStatistical Indications on the Elderly done by our Ministry of Community Development, Youth and Sports in 2005:– 1.7% requires some physical assistance to move around– 0.4% requires total assistance to move around– 0.5% is bed ridden and requires regular turning in bed.

http://app.msf.gov.sg/portals/0/Summary/publication/NSSC-2005.pdf






Interim Disability Assistance Program For the Elderly (IDAPE)

• Government assistance schemes providing financial help to needy and disabled elderly Singaporean

• Singapore Citizen born on or before 30th September 1932

• The elderly must pass a financial MEANS testing to apply for this scheme

https://www.moh.gov.sg/content/dam/moh_web/Forms/Means-Test%20Declaration%20Form(Aug%202015).pdf


Study

Investigate the causes of disability in elderly in the lower social-economic group who has

applied for IDAPE claims over the span of 2 years under Lotus Eldercare Health services in

Singapore


Method

• All patients between November 2013 and October 2015 who applied for IDAPE assessment through Lotus Eldercare

• Same assessor to assess patient’s ability to perform the 6 Activities of Daily Living (ADLs)

• Patients are either assessed in their homes, nursing care facilities or restructured hospitals in Singapore


Results

• A total of 203 patients were assessed for IDAPE by Lotus Eldercare, between the period of November 2013 to October 2015

• 66% of the patients are female and 34% are male


Results

• Age of patients

• The median age is 87 years old and mean age is 88.7 years old

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99100

101102

103104

105106

107108

0

2

4

6

8

10

12

14

16

MalesFemales


Results

• Most direct cause of disability

Stroke

Fall/

Fractu

re

Infection

Dementia

Functi

onal dec

line

Organ fa

ilure

Cance

r

Arthriti

s

Parkinso

n

Amputation

Anaemia

Spine p

roblem COPD

DVT

Intestinal

Obstructi

onARU

AVN of hip

Catarac

t

Depres

sion

GI hem

orrhag

e

Heart

disease

SIADH

Perforat

ed ap

pendici

tis

Pulmonary

embolis

m

0

5

10

15

20

25

30

35

40

45

50

No. of patients


Results

• Severity of disabilities• There are 6 Activities of Daily Living (ADLs) that

are assessed. They are:– Washing or bathing– Dressing– Feeding– Toileting– Transferring – Mobility


Results:

• Severity of disabilities:– For each activities, points are graded on the level

of dependency that patient has.• 1 point: Independent• 2 points: Minimal to Moderate Assistance• 3 points: Maximal Assistance• 4 points: Total Assistance

– Thus, for a patient who is dependent totally on the caregiver for all 6 ADLs will score 24 points


Results

24 pts 23 pts 22 pts 21 pts 20pts 19pts 18pts 17 pts 16pts 15 pts 13 pts0

10

20

30

40

50

60

70

80

No. of patients


ResultsScore (points)

No. of patients

% of patients

24 73 31.7

23 23 10.0

22 43 18.7

21 17 7.4

20 19 8.3

19 14 6.1

18 6 2.6

17 2 0.9

16 4 1.7

15 1 0.4

13 1 0.4


Results

• Time from onset of disabilities to date of assessment:– Varies greatly from a few days to 37 years– Mean is 17.6 months– Median is 4 months

www.lotuseldercare.com.sg

DiscussionFinancial security is one of the main factors in Ageing in place concept. Insurances play an important part of financial security but the cover is unlikely to be enough at prevailing rates.For disabled elderly from the lower social-economic group, who are dependent on activities of daily living, the main option will still be subsidised nursing home care. To encourage Ageing in place concept, many new policies had rolled out in the last 5 years in Singapore. Together with less stringent financial assessment, more dependent elderly are able to age at their own homes.

14


Other Policies• Enhancement for Active Seniors (EASE) provides slip resistance

treatment to existing floor tiles of bathroom; toilet grab bars and ramps installation, where technically feasible, at a very subsidised rates. (Housing & Development Board, 2012)

• Foreign domestic worker (FDW) Levy concession for families who employ full-time FDW to look after their love ones with disability can pay a lower monthly concessionary levy of $120 instead of $265. (Agency for Integrated Care, 2015)

• This is further enhanced with Foreign Domestic Worker Grant of another $120 per month for families passing the financial means testing. (Agency of Integrated Care)


Other Policies• Pioneer generation package was launched in the 3rd quarter of

2014 and with that, Pioneer Generation - Disability Assistance Scheme (PG-DAS) provides $100 cash payout a month to help dependent seniors with their care needs. (Agency of Integrated Care)

• For those very dependent elderly bed bound or on nasogastric tube feeding, after passing financial testing, dependent elderly can claim funding on 3 categories of care needs, namely, assistive devices and hospital furniture; transport; and home healthcare items (Consumables). For devices, up to 90% of actual cost of the device will be given. Both transport and home healthcare items will dependent on the level of the financial test results.


IDAPE & Eldershield

• IDAPE is but one of the sources of funding for Long term dependent care of the elderly in Singapore for the lower social economic group.

• Eldershield is the equivalent of IDAPE and the premiums are paid out from MEDISAVE under our Central Provident Fund savings.

• Singapore Citizens and Permanent Residents are automatically cover under ElderShield at the age of 40.

• The current payout of $400 per month is higher than IDAPE payout of $150 to $250 per month for 72 months.


Causes of Severe Disability• Top 5 cases of severe disability in elderly in the lower socio-

economic group includes, Stoke diseases, Falls with or without fractures, Infections like pneumonias and urinary tract infections, Dementia, and Functional Decline from multiple chronic diseases or ageing with sacropenia.

• Cancers, although one of the leading causes of mortality, are not in the top 5 causes. (Ministry of Health, Singapore, 2015)

• This could be due to a shorter physical dependency period of the patients from the start of the disability to death.

• Patients suffering from cancers might also not being advised or encouraged for IDAPE claims by the service providers and the social workers.


Questions?

Dr Tan Jit Seng: [email protected]

Ms Teo Shing [email protected]

Lotus Eldercare Health Services,Lotus Eldercare Private Limited

16 Collyer Quay Level 20 Singapore 049318

mailto:[email protected]

mailto:[email protected]

Documents

Ageing & Disability