MEDICAL PLANS FOR AN AGEING POPULATION

MEDICAL PLANS FOR AN AGEING POPULATION: 8.

Mdm Cynthia Phua asked the Minister for Health (a) how are our medical training programmes and facilities at hospitals oriented towards coping with the needs of an ageing population; (b) how many of our doctors are trained in gerontology; and (c) whether there are plans to set up a special centre for gerontology in Singapore.

The Minister of State for Health (Mr Heng Chee How) (for the Minister for Health): Sir, as our population ages, the skills of our healthcare professionals and the care facilities will need to change to meet evolving patient needs.

To help doctors prepare for the care of the elderly, Geriatric Medicine is now a core module for undergraduate medical training. The Ministry has also taken steps to increase the exposure of doctors to this field and to encourage more to take up this specialty. Today, there are over 40 geriatricians in Singapore, and this is double the number in 2002. In addition, we have 46 doctors who completed the NUS Graduate Diploma in Geriatric Medicine over the last five years.

Efforts are also in place to prepare nurses to take care of our elderly patients. Over the past 10 years, 177 nurses have been trained in Gerontology under the Nanyang Polytechnic’s Advanced Diploma Programme. The NUS Master of Nursing programme also offers Gerontology as an area of specialisation.

Given that elderly patients tend to have multiple medical needs, all restructured hospitals have in place geriatric departments or services which work closely with other specialties to coordinate care for elderly patients. Some hospitals also arrange for their geriatricians and other specialists to provide continued care for patients when they are

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transferred to community hospitals for rehabilitation.

Besides specialist care within hospitals, there is also an important role for Family Physicians in helping society deal with the health challenges of an ageing population. A good Family Physician will know the medical history of his patient well and is in the best position to help coordinate that patient’s need for specialist care.

In this regard, MOH has made changes to the training programme for family physicians to better prepare them for an ageing population. Elderly care is now a compulsory module for all family medicine training programmes.

In addition, from May 2007 onwards, all trainees in Family Medicine will go through a compulsory posting in hospital geriatrics departments. They will also be given the option to do additional posting in community hospitals.

Finally, we are not aware of any plan to set up a special centre for gerontology.

Mdm Cynthia Phua (Aljunied): Sir, I would like to ask MOS whether we have a section on gerontology in the polyclinics now. If not, are there plans to set up, because a lot of our residents are now going to polyclinics for such help?

My second question is: what are the three top common ailments among the elderly?

The third question is: how is the physiotherapy department coping with the demand now? If there is a shortage of these physiotherapists, what are the plans to address this problem?

Mr Heng Chee How: Sir, on the different ailments of the elderly, you can divide them into diseases that become

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more prevalent as one ages, as well as the risk associated with one's physical condition as one ages. On both fronts, we will have to put in efforts. We know that recently, the Ministry has introduced a chronic disease management programme. This one actually takes the society from the point of middle-age onwards and we have included four diseases in that programme - diabetes, hypertension, high cholesterol and stroke. The idea is to say that, as we prepare an ageing society to better take care of itself, we also organise the resources, both in the community as well as in the medical community, to gear up for this increasing need. These are not the only four diseases, but certainly, these would be diseases that we would want to care for. Obviously, as one ages, there will be other diseases, such as Alzheimers, for example, that would also become more prevalent. So there is a wide range. I do not have the exact rank order to provide to the Member. But, certainly, we will have to address that.

In terms of the risk to the physical condition of the elderly, we all know that falls and hip fractures, for example, would be one category. It is something that we can do a lot about, both in terms of how do you help an elderly person who has suffered a fall to recover, and also at the same time, what can be done within the home setting, for example, to prevent these occurrences. I want to address the concern of the Member by saying that it is not only the medical facilities that we have got to look at, but it is an entire societal effort. Certainly, within the medical side of things, the emphasis is on what we call "right siting". What do we mean by "right siting"? It means that we try to address the needs as close to the community and as close to the person as possible, rather than to wait for a deterioration and for this person to be bumped around in a complex organisation and finally ending up in acute care which is actually very expensive and perhaps too

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late. So it is precisely in this connection that we have and will continue to emphasise the role of family physicians and how we can better equip them. These GPs are the best gatekeepers in helping to refer our elderly patients in a familiar setting for the help that they need. Certainly, in this regard, our polyclinics is also part of this community network and we will look at our facilities there and to adjust to the needs.

In the area of training up more manpower of the right kind to address this need, I have already earlier given some figures.

Mdm Halimah Yacob (Jurong): I would like to ask MOS, in line with the wish on the part of MOH to keep the elderly sick at home and in the community, are there plans on the part of MOH to intensify efforts to help caregivers take care of the elderly sick at home because the services and facilities currently available are extremely lacking?

Mr Heng Chee How: Sir, I would agree with the Member that, as a society, much more can and should be done in the area of preparing all of us to take better care of the elderly in a home setting and in a community setting.

On the question of specific examples of what could be done, I recently visited the Jurong Medical Centre. There, I saw a particular section that has been constructed, specialising not only in showing people how they could configure the home setting in order to better provide for the safety, comfort and care of the elderly, but they also emphasise on the training of caregivers to use in the correct way such equipment and to provide such care. That is for family members. I believe that the Jurong Medical Centre is one good example, but there are other programmes in the other institutions as well.

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Beyond that, I would also like to say it is the on-going participation of the community in better understanding the risks involved in the care of our elderly and how we can exchange this information and, as a result, pick up more knowledge as a society, moving forward, and improve this programme as we go along.

Mr Sin Boon Ann (Tampines): I am glad to learn from the Minister of State that the Ministry is looking at the right sizing of the care institutions. What I want to hear from the Minister is whether or not the Ministry is also working towards right timing because one of the concerns is that when you need medical attention, you do not need to wait nine months to see a specialist when the time comes.

Mr Heng Chee How: Sir, just to clarify, I said "right siting" and not "right sizing", meaning as close to the community as possible.

With regard to right timing, the Ministry assures the Member and this House that first, nobody who requires medical care will be denied it on account of a lack of means and that each person will be attended to according to the urgency of his need as assessed by medical practitioners.