SENIORS HEALTHCARE LANDSCAPE
In the present context, the growing concern over Singapore’s ageing population has prompted the government and relevant stakeholders to devise effective strategies for promoting successful ageing among Singaporeans. Successful ageing is characterised by maintenance of high levels of physical, psychological, and social functioning in old age without significant disease. To achieve this, the government has emphasised several important factors for successful ageing in Singapore, including personal responsibility, self-reliance, and fostering strong family and social relations.[1]
However, as the population ages and the number of elderly citizens increases, the demand for alternative care sources has grown. Community-based care for seniors has gained prominence, exemplified by the Ministry of Health’s 2009 launch of the Agency for Integrated Care to enhance and integrate the Long-Term Care (LTC) sector. We have also seen the establishment of the Community Network for Seniors (CNS), an initiative by government agencies and community partners to bring “ABC” – Active Ageing, Befriending, and Care and Support – to help seniors age gracefully. This approach aligns with the “Many Helping Hands” philosophy, highlighting the collaborative involvement of the government, community, and family in delivering community-based services.
Presently, a range of community-based services, such as home nursing services, senior citizens’ clubs, and daycare centres, are available to meet the needs of the elderly. Yet, with caregiving durations extending due to longer life spans, caregivers face heightened financial and emotional burdens. Consequently, more adult children of elderly parents are turning to eldercare providers for assistance. Caregivers are also grappling with the stigma associated with seeking external help, rooted in Singapore’s tradition of filial piety, which places high value on family involvement in caring for older relatives.
IMPORTANCE OF SOCIAL PARTICIPATION FOR SENIORS
In recent years, there has been an increase in awareness of the importance of social participation and the positive effects it brings for seniors. The lack of it and the potential risks it brings have also been highlighted.[2] While physical health often takes centre stage in discourses on ageing, the impact of social engagement on the mental well-being of seniors is equally substantial. The importance of social participation for seniors cannot be overstated. It is a cornerstone of holistic well-being, impacting mental acuity, emotional resilience, physical health, and overall quality of life.
One benefit of social participation is that it acts as a cognitive output for seniors, stimulating mental faculties and promoting mental agility. Engaging in conversations, social participation, and maintaining relationships are activities that challenge the brain, helping them to stave off cognitive decline. Studies consistently show that seniors who remain socially active are less likely to experience memory loss and cognitive impairment, fostering a sharper and more resilient mind well into old age.[3]
The emotional well-being of seniors is intricately linked to their social connections as well. Loneliness and social isolation can have detrimental effects on mental health, leading to feelings of depression and anxiety. Regular social interactions provide emotional support, a sense of belonging, and opportunities for seniors to share experiences and express themselves. Strong social networks act as a buffer against the emotional challenges that can arise in later life, contributing to a more positive outlook and emotional resilience.
Social participation also plays a crucial role in maintaining physical health.[4] Engaging in social activities often involves movement and exercise, contributing to overall physical fitness. Whether through group exercises, outdoor activities, or even dancing, seniors who actively participate in social interactions are more likely to maintain mobility, flexibility, and cardiovascular health.
Social engagement also promotes healthier lifestyle choices, as seniors are encouraged to stay active and make mindful decisions about their well-being. The importance of social participation extends to its role in reducing the risk of chronic conditions prevalent in older age. Studies suggest that socially active seniors are at a lower risk of developing conditions such as heart disease, hypertension, and certain types of dementia.[5] The positive impact on physical and mental health translates into a reduced likelihood of chronic illnesses, contributing to a higher quality of life for seniors.
BARRIES FOR SOCIAL PARTICIPATION
Despite the current emphasis on the importance and benefits of social participation for seniors, there is much more that can be improved on this front. One of the barriers for this might be due to the emphasis on family as the primary support network of seniors.[6] Despite efforts to enhance healthcare affordability and accessibility, the state government continues to view the family as the primary caregiver for older adults. This expectation aligns with the deep-rooted tradition of filial piety in Asian societies, emphasising that children should directly care for their parents in old age. This concept is reinforced by the Maintenance of Parents Act, enabling Singaporean residents aged 60 and older to seek a court order against their capable children who fail to provide support.[7]
In the context of the Muslim community, on top of the social and cultural expectations, filial piety is intertwined with religious belief, as it is the moral obligation of a child to oversee the welfare and well-being of their parents in their old age.[8] This particular concept, called Birr-ul Walidayn, is central to Islamic teachings. This culture and practice of filial piety have an impact upon the social participation of seniors as their exposure and activities are restricted and dependent upon their family members whose responsibilities extend beyond caring for their elders, such as professional obligations and caring for young children. Caregivers might not have the resources to engage their elders in social programmes conducted by organisations, or perhaps they might not see its benefits. For this reason, there is more that can be improved regarding the awareness and knowledge of caregivers about programmes for seniors, and also the ability to reach out to these families.
Granted, notions of filial piety evolve as contexts change, which are leading to changing trends and practices in eldercare. One of the factors for this is the changing socio-economic factors among Singaporean families, causing a decline in co-residence among adult children and their elderly parents. Data have shown that the number of elderlies living independently has risen in recent years. The number of residents aged 65 and above who live alone in Singapore has risen from 58,000 in 2018 to 79,000 in 2022.[9] In this context, better outreach is needed to attract seniors’ attendance in social participation programmes.
SOCIAL PARTICIPATION FOR MALAY/MUSLIM SENIORS
In developing social participation programmes for seniors, one main factor that should be considered is the agency of seniors — meaning their preferences for the type of programmes that align with their interests. It is only natural that their agency is shaped by various aspects of their identity, be it gender, race, or religion. It is also important to remember that in the context of social participation, there are factors that shape the preferences of seniors in the type of activities they will engage in. This is particularly relevant for government agencies and stakeholders as they organise events and programmes for seniors.
While Singapore is a plural society with various ethnicities and religions, it must be acknowledged that different communities have varied preferences when it comes to social participation, especially in the context of seniors who have been shaped by their cultural and religious upbringing. Studies have shown that race, gender, and religion are deciding factors for the social participation of seniors.
For example, a study showed that for Malay and Indian seniors, cultural and religious activities hold particular importance. As a result, social interactions with family through celebrating cultural and religious activities occurred more frequently as compared to Chinese seniors.[10] In terms of ethnicity, Malay seniors are less likely to go out to eat or attend an event organised by their Residents’ Committee or other grassroots initiatives, but were more likely to attend a religious service, compared with Chinese and Indian older adults. The opposite pattern was found for older adults of Chinese ethnicity.[11] Studies have also shown how gender leads to differences in participation trends; Chinese men are less likely to attend religious services and do not report different rates of participation in sports compared with women. In contrast, Malay and Indian men were more likely than Malay and Indian women to engage in both sports and religious services.[12] These studies are important as they reflect the preferences of different groups of seniors. At the same time, they also indicate the centrality of the Malay seniors’ religious identities.
It is important to note that in the Senior Panel of AMP’s 4th National Convention held in 2022, one of the main take aways is the centrality of religious identity among Muslim seniors. The findings showed that the participants opined that the caregiving system does not meet the needs and desires of Muslim seniors. This understanding can be extended towards the type of social participation programmes offered for them. In the current context, while it is important to strike a balance between attracting seniors while ensuring that it remains inclusive and open for all, the discourse has shown that the religious identity of Malay/Muslim seniors must be taken into consideration for the current caregiving system to attract Muslim seniors to their social participation programmes.
One of the ways this can be done is through collaboration with relevant stakeholders from the Muslim community, be it mosques or social service organisations. Mosques have historically played an active role in supporting Muslim seniors by raising health awareness and organising various programmes and activities. There are also various organisations such as Jamiyah, Pertapis, and Muhammadiyyah Association that have long-established elder care centres or services. Nevertheless, what we can observe now is the need to improve resources within the Muslim community to conduct consistent social participation programmes for seniors. This can be done both internally through communal efforts and initiatives, or externally through collaborations with relevant stakeholders.
The lack of Muslim-centric senior homes and professional senior caregivers that are culturally and religiously sensitive to Muslim seniors’ needs are issues that were highlighted during the AMP’s 4th National Convention too. With an ageing population, the community must work hand in hand to supplement the efforts and resources of the state. However, these efforts should not be done at the expense of social integration. To ensure integration among seniors of different backgrounds, it is apt for stakeholders to find a balance between programmes that are Muslim-oriented and open for all. For example, this would mean utilising inclusive spaces and universally appreciated activities such as arts and sports.
CONCLUSION
The evolving context of Singapore means that there will be an upward trend in seniors living separately from their children. This should not be seen as a lack of filial piety, but a natural change brought upon by socio-economic factors. With the family no longer serving as the primary support network for seniors, there is a heightened need for enhanced external resources to ensure successful ageing. With increasing numbers of seniors suffering from loneliness, it is also imperative that the community supplements policies and state initiatives with our own efforts to socially engage Malay-Muslim seniors in Singapore, which can be done through existing Muslim institutions and organisations. This is only possible when the community inculcates strong empathy and awareness for the marginalised members of our society.
1 The Ministerial Committee on Ageing. (2023). Living Life to the Fullest 2023 Action Plan for Successful Ageing. https://www.moh.gov.sg/docs/librariesprovider3/action-plan/2023-action-plan.pdf
2 See Mélanie Levasseur, Lucie Richard, Lise Gauvin, Émilie Raymond, ‘Inventory and analysis of definitions of social participation found in the aging literature: Proposed taxonomy of social activities,’ Social Science & Medicine, Volume 71, Issue 12, 2010, Pages 2141-2149. See also Kathryn Dawson-Townsend, ‘Social participation patterns and their associations with health and well-being for older adults,’ SSM – Population Health, Volume 8, 2019
3 James, B. D., Wilson, R. S., Barnes, L. L., & Bennett, D. A. (2011). Late-life social activity and cognitive decline in old age. Journal of the International Neuropsychological Society : JINS, 17(6), 998–1005.
4 Dehi Aroogh, M., & Mohammadi Shahboulaghi, F. (2020). Social Participation of Older Adults: A Concept Analysis. International journal of community-based nursing and midwifery, 8(1), 55–72. https://doi.org/10.30476/IJCBNM.2019.82222.1055
5 Sommerlad, A., Kivimäki, M., Larson, E.B. et al. Social participation and risk of developing dementia. Nat Aging 3, 532–545 (2023). https://doi.org/10.1038/s43587-023-00387-0. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Behavioral, Cognitive, and Sensory Sciences; Board on Health Sciences Policy; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academies Press (US).
6 Shannon Ang, Social Participation and Mortality Among Older Adults in Singapore: Does Ethnicity Explain Gender Differences?, The Journals of Gerontology: Series B, Volume 73, Issue 8, November 2018, Pages 1470–1479. https://doi.org/10.1093/geronb/gbw078
7 Ministry of Social and Family Development. Maintenance of Parents Act. https://www.msf.gov.sg/what-we-do/maintenance-of-parents/about/about-maintenance-of-parents-act
8 Sayilgan S. Aging, Loneliness, and Filial Piety. In: God, Evil, and Suffering in Islam. Cambridge: Cambridge University Press; 2023:97-111. doi:10.1017/9781009377294.008
9 Ministry of Health. (2023, May 8). News Highlights Seniors Staying Alone. https://www.moh.gov.sg/news-highlights/details/seniors-staying-alone
10 Su Aw, Gerald Koh, Yeon Ju Oh, Mee Lian Wong, Hubertus J.M. Vrijhoef, Susana Concordo Harding, Mary Ann B. Geronimo, Cecilia Yoon Fong Lai, Zoe J.L. Hildon, Explaining the continuum of social participation among older adults in Singapore: from ’closed doors’ to active ageing in multi-ethnic community settings, Journal of Aging Studies, Volume 42, 2017, Pages 46-55, ISSN 0890-4065, https://doi.org/10.1016/j.jaging.2017.07.002.
11 Ibid.
12 Shannon Ang, Social Participation and Mortality Among Older Adults in Singapore: Does Ethnicity Explain Gender Differences? The Journals of Gerontology: Series B, Volume 73, Issue 8, November 2018, Pages 1470–1479, https://doi.org/10.1093/geronb/gbw078
Ahmad Ubaidillah Mohd Khair is currently a Research Analyst at the Centre of Research on Islamic and Malay Affairs (RIMA). He holds an Islamic Jurisprudence degree from Yarmouk University, Jordan. His research interests are literature discourse and sociology of religion. He has also written for other platforms such as Muslim.sg, Wasat Online, and Berita Mediacorp.
