It is a well-known fact now that the world is ageing and Singapore is among the fastest ageing countries in the world. The proportion of seniors 65 years and above in Singapore stands at 18.4% and it is projected that this percentage will grow to be 33.3% which is 1/3 of the population in 2050. Ageing has been on the agenda of Singapore’s national planning for a number of years now. Despite this, as a country, we are still ‘playing catch-up’ in that development of ageing infrastructure and services still lag behind the needs of the growing elder population. Hence, there are gaps in various areas, including key infrastructural support such as housing and transport provision as well as service provision. This is especially the case for the frailer segment of the elder population. The quality of services that are available is another area that requires greater focus if we want to ensure that older Singaporeans can age in ways that are productive, engaged and dignified. We have however excelled in the area of lifelong learning. With the launch of the National Silver Academy in 2015, learning opportunities for seniors had taken a monumental leap forward with all the Institutes of Higher Learning in the country opening their doors to elders.

MUSLIM ELDERS
The situation of our Muslim elders however is an even bigger concern. Ageing, as an area of focus, and by virtue of this, our Muslim elders have for the most part largely been neglected by Muslim organisations as a whole. Consequently, the development of senior services for Muslims substantially lags behind those for children, youth as well as the family. There are probably many reasons for this including resource constraints, but I would posit the main reason for this is something that is more problematic. Something which plagues societies across the world, with Muslims here not excepted – it is ageism.

Elders worldwide, due to society’s ageist attitudes, end up being neglected and side lined on many fronts. Their needs are often considered less important and hence, almost always not as prioritised as those of younger persons. Like racism and sexism when someone is discriminated against on the grounds of their race or gender, ageism is discrimination against a person on account of their age.

As an age care professional for over three decades, I am acutely cognisant of how ageism is manifested in the Muslim community. A clear example of this is the many myths held by both the leadership, as well as members of the Muslim community, about how Muslim elders are doing. The majority among us hold a firm belief that Muslim elders are doing well, and they are well taken care of by their families. The data on Muslim elders, however, paints a different picture. Muslim elders are, in fact, not doing so well when compared to their counterparts from other religious/ethnic groups.

DATA ON MUSLIM SENIORS
The data below is from a nationally representative survey conducted in 2019 by the Centre for Ageing Research and Education, Duke-NUS Medical School. As with most national surveys, data was collected based on participants’ ethnic rather than their religious backgrounds. As such, the figures below reflect those of the Malay community rather than the Muslim community per se. Nonetheless, these form good estimates of the situation with the Muslim community as the large majority of Muslims in Singapore are Malays.

Status of Physical Health

• 52.9% of Malays have 3 or more chronic conditions as compared to 59.4% of Indians and 43.5% of Chinese.
• 11.3% of Malays face 3 or more Activities of Daily Living (ADL) difficulties, which is the highest among the ethnic groups. In comparison, 6.7% of Indians and 7% of Chinese face 3 or more ADL difficulties. (ADL is defined as taking a shower; dressing; eating; sitting and getting up from chair; walking around the house; using the toilet seat.)
• 14.7% of Malays face difficulties in Instrumental Activities of Daily Living (IADL), compared to 9% of Indians and 8.7% of Chinese. (IADL is defined as preparing own meals; leaving the home to purchase necessary items or medication; taking care of financial matters e.g. paying utilities (electricity, water); using the phone; dusting, cleaning up and other light housework; taking public transport to leave home; taking medication.)

Health Behaviours
Another area that is tracked when observing older persons’ health and well-being is their health behaviours primarily because of its clear links with health status. An individual suffering from poor health can significantly improve their chances of survival if they engage in positive health behaviours such as looking after their diet, exercising regularly, as well as regular screening to avoid catastrophic impacts of diseases. Our Muslim elders, unfortunately, do not seem to pay enough attention to what they need to do to better look after their health. As such, we found the following in the same survey:

• Number of Malay elders 62 years old and above who smoke: 15.5% (Indians 9.7%; Chinese 8.6%)
• Number of Malay elders who do not meet World Health Organization’s recommendation of physical activity for older persons: 50.6% (Indians 31%; Chinese 39%)
• Number of Malay elders who never went for cancer screenings:
  • Colorectal: Malay elders 57.3% (Indians 42%; Chinese 40%)
  • Pap smear: Malay elders: 49.5% (Indians 44%; Chinese 42%)
  • Mammogram: Malay elders: 49% (Indians 38%; Chinese 32.3%)

Healthcare Utilisation
Data on healthcare use can also reveal an individual’s health behaviours and ultimately their well-being. High rates of hospital, as well as Accident and Emergency (A&E) Department admissions, are often indications that individuals are not doing enough to look after their health conditions. Essentially, they are not taking care of these conditions through the required regular primary or specialist consultation, resulting in more serious or catastrophic outcomes, hence the A&E visits and hospital admissions.

The data on these admissions for Malay elders are as follows:

• A&E Admissions of Malay elders: 11.9% (Indians 11.5%; Chinese 9.4%)
• Hospital admissions of Malay elders: 19% (Indians 14.6%; Chinese 17.7%)

Status of Mental Health
Another myth that I often hear about the well-being of Muslim elders is that even though they might not be doing well physically, they have good mental health. The data, however, indicates that things are not well either on this front with 14.4% of our elders having clinically relevant depressive symptoms.

Possible reasons for the less-than-ideal health and well-being of Muslim elders
There are many factors that probably can account for the less-than-ideal state of affairs with Muslim elders’ health and well-being, one of which is definitely the community’s relative socio-economic disadvantage. The evidence on the link between poor socio-economic status and poor health and well-being is well-documented.

What I want to highlight and discuss in this article is the reason that I highlighted earlier – ageism – which accounts for the community’s neglect of our elders.

For a start, this is the reason why we know very little about how our elders are doing despite their rising numbers compared to how much we know about our youth and their families. A major consequent of this neglect is the dire lack of services for Muslim elders as evident from the table below (Table 1) which captures all the aged care programmes run by Muslim agencies currently. Not only the number of places is short but there is a huge gap in terms of the range of services available.

This neglect is also short-sighted for another important reason. The reality is that a large cohort of Muslim elders, whether full or part-time, are in fact carers of their grandchildren. As such it is important to invest in Muslim elders’ well-being as it is tightly linked to the well-being of the young under their care.

The effects of ageism at the individual level are just as negative. Based on my encounters with Muslim elders over the decades, more often than not, I have found them to be rather fatalistic and with a passive view of their own ageing. At a drop of a hat, the words “dah tua kan (old already)” will be uttered even among those who are in their 40s, let alone those who are older. Many also tended to accept their poor health as a product of their age rather than other factors such as lifestyles and choices they make. It is more often than not seen as something outside of their control.

Muslim elders also tend to not prioritise themselves in the context of familial needs. While this self-sacrificing stance might be seen as kind and benevolent, it can also stem from the feeling that they are not worthy of attention because they are old. The consequence of such a perception, however, is detrimental as we saw through the data. Where the elders are caregivers, the effects of such self-neglect would also impact negatively on those they are caring.

POSSIBLE REDRESS
What then needs to be done to address ageing-related issues within the Muslim community?

I think the first thing that needs to happen is for the leadership of the Muslim community to remove the blinkers that they have about the elders in our community. Elders’ needs, goals and aspirations must be recognised as much as those of the younger cohorts. In the age of longevity, it is blindingly short-sighted to focus only on the younger segments of the population.

There is much to be done given that we are already behind in terms of the necessary preparation to ensure that Muslim elders can age well and with dignity. The community as a whole needs a concerted and consolidated plan because the breadth of what is required is expansive. An integral part of the plan of action is the close collaboration with others outside the community given the multifaceted nature of factors that impact ageing. At the personal level, there are issues pertaining to the individual’s physical, psychological, and cognitive health. These, however, as we know, are also affected by factors at the wider community and societal levels. Hence provisions, as well as opportunities, for elders to be financially secure, socially well supported, undertake lifelong learning as well as engaged in work and other productive pursuits are critical as these have an impact on an individual’s well-being.

Strategically, these are some recommendations for an ageing action plan for the Muslim community:

1. Development of a good understanding of Muslim elders through research such that it is possible to segment the cohorts in terms of their challenges, needs, as well as potential and contributions.
2. Development of a targeted plan of action based on the evidence gathered. The plan should comprise actions at the macro level of awareness raising through to interventions at specific levels to meet the needs of all segments of the elder population from those who are still active to those who are frail and in need of care support. The plan should comprise strategies of working with mainstream agencies to collaborate, as well as advocate, for more culturally appropriate programmes to meet the needs of Muslim elders.
3. Obtain feedback from elders themselves on the proposed action plan.
4. Develop monitoring and evaluation framework for the implementation of the plan.

CONCLUSION
To conclude, the needs and concerns of Muslim elders have been neglected for far too long. Ageism is at the crux of this neglect. With the rapid ageing of the population, we can ill afford the huge amount of resources needed to meet the needs of a population of elders who become frail or dependent before their time. We would also waste the contributions that elders can make to their community and society.⬛

Normala Manap is Director of Age Matters, a consultancy and training agency on ageing. Prior to this, she was the Senior Associate Director of the Centre for Ageing Research and Education, Duke-NUS Medical School. Her three decades of involvement in social development work has given her an in-depth experience of the health and aged care industries at all levels. She has worked across countries and cultures at different levels of programme and policy development from building innovative start-ups and managing operations to developing frameworks for national development.