Singapore’s population is both ageing rapidly and living longer. In 2015 11.7% of Singaporeans were 65 or older and the UN estimates that by 2035 this will more than double to 26.6%. Further, life expectancy has risen to 83.1 years in 2017—from 76.9 in 1997.

However, for people to enjoy extended lifespans, they need well-supported healthspans. This requires concerted effort from both residents and healthcare providers.

Singapore’s rapid ageing will accelerate in the coming 15 years, shifting the country’s disease load. In particular, a greater proportion of people will need to manage one or more chronic diseases.

Although the government has policies to prepare for this change, survey respondents remain uneasy about whether Singapore’s residents and other stakeholders are doing enough on prevention, the healthcare system and long-term care.

 
Addressing the rise in chronic disease and multi-morbidity will require shifting attention to growing medical costs and fragmentation within the healthcare system. A shift toward person-centred, value-based care—where care is based on the needs of the patient and payment aligned to health outcomes—would go far toward meeting both requirements. The government is moving in that direction, but the transition will be challenging.

Lifestyle modifcations, in order to prevent many chronic diseases, have improved in recent years but too many people— especially younger ones—are not proactive in these areas. In addition to its existing, substantial efforts, the government may wish to consider new kinds of initiatives and ones focused on younger people. Healthcare providers should also work more actively with individual residents on prevention.

The price of long-term care is high and likely to grow increasingly beyond reach. The government is taking steps to put in place mandatory savings and insurance, but no simple funding panacea exists. Greater use of in-home medical technology could likely contribute to a potential solution.
 
 

Introduction: The fruits of achievement

Singapore has seen substantial health system and public health success in recent decades. Its already good average life expectancy has not only been growing, but has done so faster than that of other high-longevity countries. In 1997, for example, Singaporeans on average lived 76.9 years. By 2017 however, life expectancy had risen to 83.1 years. Two decades from now, the UN projects that the country will have an average longevity of 86.2.

This greater life span and a long-term decline in the birth rate (which has recently stabilised at the low level of about 1.2 births per female) have together increased the proportion of the population aged 65 or over, or what the government calls “the silver generation”. In 1995 just 6.4% of Singaporeans were in this group; by 2015, it was 11.7%. The UN projects that by 2035 this will more than double to 26.6%. By that year, one in 90 of the population will be 90 years old or older.

 
The health system has, to date, coped well. Indeed, over the past decade and a half, healthy life years have risen very slightly faster than life expectancy itself.
 

Now, though, ageing in Singapore is accelerating rapidly. In the coming decades, its speed will be “historically unprecedented”, according to Jeremy Lim, partner and head of health and life sciences, Asia Pacific, at Oliver Wyman. The country’s percentage point increase in the population over 65 between 1995 and 2015 was the 17th quickest in the world. In the two following decades, the UN projects it to be the fastest that any country has seen over such a period, and more than three times the global average.

 
The transformed health challenge

Lim Wee Shiong, a senior consultant at the Institute of Geriatrics and Active Ageing in Tan Tock Seng Hospital, explains that the population ageing occurring in Singapore is part of a “worldwide success story and a worldwide health conundrum.” The older population is not inherently unhealthy but has specific medical needs different from those Singapore has faced in the past, such as more co-existent chronic diseases and a greater prevalence of certain diseases such as dementia.

Janice Chia, founder and managing director at Ageing Asia, an ageing market consultancy social enterprise, agrees: “One of the biggest challenges facing Singapore is how we are going to prepare to help people living longer and therefore facing a longer duration of time when they have chronic diseases that need management.”

Phua Tien Beng, CEO of the Singapore operations division of Parkway Pantai, one of the country’s largest private hospital groups, adds that although Singapore engages in extensive long-term planning, ageing-related shifts would “add strain to the healthcare provision of any nation”.

One measure of disease burden, Years Lived with Disability (YLD)—the average number of years lived with a disability or any longterm medical condition—illustrates how the chronic disease challenge has already grown. The accompanying charts show the steady rise in YLDs per 100,000 people of one of the most prevalent health issues for the ageing population in Singapore—cardiovascular disease. Between 1990 and 2016 almost a third more people became afflicted, with the figure rising from 356 YLDs per 100,000 in 1990 to 529 YLDs per 100,000 in 2016.
 

Adding to the complications that this growing incidence brings is the number of older individuals who develop more than one chronic condition—called multi-morbidity. Over half of Singapore’s residents that are older than 60 fall into this category.5 Often this involves patients with not simply two diseases but more, adding to the complexity of providing care. Mr Phua explains that “if you look at anyone above 65, they probably have several chronic diseases such as diabetes, cancer, heart disease, high blood pressure, or high cholesterol, to name just a few.”

For such individuals, appropriate care requires not just expertise in specific conditions but also in how to simultaneously treat several diseases without unintended side effects or drug interactions. This typically requires care personalised to the individuals’ specific situation.

Accordingly, notes Ms Chia, “ageing is not just a question of medical services but of whole-of-life wellness: how do you keep older persons engaged to be motivated to stay healthier and active?” This includes, among other things, providing the growing proportion of the population reaching older years with appropriate levels of long-term, social care and support—whether at home or in specialist facilities. Though not strictly a medical intervention, such care is essential in many cases for maintaining health and overall quality of life.