Asian Bioethics Review

The much anticipated impact of a rapidly ageing population has become increasingly palpable in Singapore, particularly in the health and social care sector, where the proportion of dependent elderly has been rising almost exponentially. While many see this as a significant threat (the "silver tsunami"), there are also others who frame it more optimistically as an opportunity for growth and innovation. As the author of one of the chapters pointed out, the demographic ageing is, after all, "a remarkable achievement of clinical and social successes in making people healthier and longer-lived". Regardless of perspective, what is needed to guide policies and decisions are in-depth analyses of relevant issues, founded on a careful and objective distillation of robust data, past experiences and expert opinions. Although there have been sporadically a few publications, works of scholarship offering practical insights remain few and far between. The commentaries and reports in this compilation edited by Chan Wing-Cheong are therefore a timely addition to the relatively thin collection of academic works based on a multi-disciplinary approach to the medical, psychosocial, anthropological and legal issues associated with Singapore's ageing population.

The 10 chapters in this collection are authored by a list of well-qualified researchers and scholars. Each chapter deals with a specific area or issue related to managing healthcare and end-of-life decisions in Singapore in the face of a rapidly ageing population. Of note, five of the chapters involve discussion of empirical data on medical, functional, psychosocial and anthropological aspects of the elderly and terminally ill in Singapore, while the remaining four offer in-depth discourse on legal and ethical issues in the context of Singapore's regulatory environment. Each of these chapters has something to offer to eldercare professionals from different disciplines and specialties. [End Page 160]

As a book that purports to examine the challenging issues of an ageing population, it predictably kicks off after the introductory chapter with a "doom and gloom" essay on the alarming demographic trends and patterns. This reality check by David Phillips is anything but routine or mundane. The compelling demographic evidence, which includes countries at different stages of development in the Asia-Pacific region, is more than a mere display of tables, graphs and bar charts. The discussion directs the readers to the importance of focusing on quality of life and the consequent imperative to adopt a comprehensive set of sustainable health and social care policies and political engagement. This is followed closely by Ng Tze Pin's account of the chronic disease landscape among the elderly in Singapore, based on the data from the Gerontological Research Programme (GRP) at the National University Health System. The evidence presented is highly instructive, and reiterates the concern regarding impact of concomitant rise in prevalence of functional disability and dependence. The resulting impact on quality of life of the elderly demands a broad-based community approach towards mental health and falls prevention, and a wide spectrum of measures targeted at improving cognitive and musculoskeletal function of the elderly. Together, these two chapters provide ample motivation and guidance for current (and future) planning of health and social care delivery in Singapore.

In Chapters 3 to 7, leading academics in gerontology in Singapore offer a glimpse into specific social characteristics related to care of the elderly and the terminally ill. These include a study on older Chinese males living alone (by Leng Leng Thang), caregiver burden for terminally ill patients (Angelique Chan et al.), elder abuse (Chan Wing-Cheong) and dying at home (Arthur Beng et al.). Not intended as a broad overview, each of these chapters successfully gave a new in-depth focus into areas that have thus far received relatively less attention from local commentators in Singapore.

The study on elder abuse, in particular, sheds new light on the epidemiological features of such cases and helps to promote more open discussion on a topic often given a...