Salutogenic Healthy Ageing Programme Embracement (SHAPE) for elderly living alone

In view of Singapore’s ageing population and its significant impact on health resources and social safety nets, this project seeks to  develop and evaluate an evidence-based intervention to achieve better health outcomes and quality of life for elderly living alone, through healthy ageing. Such a programme could reduce healthcare costs in the long run, given that dependent elderly place a large financial burden on healthcare services and society at large. Hence, this study has the potential to benefit the elderly by improving support services, as well as informing eldercare policies on healthy ageing.

Broad Findings

A two-phased study to understand the needs and perspectives of older adults residing in senior-only households to develop a comprehensive health resource intervention using the salutogenic model of health.

For phase one, six focus group discussions were conducted with 27 seniors at Boon Lay Constituency, to explore their perceptions of healthy aging and how they coped with existing resources to promote their health and well-being. Interview findings revealed the following:

• As age advances, older adults residing in senior-only households came to terms with their physiological aging body, psychosocial stresses (e.g., children moving out of parental house, caring for sick spouse and demise of loved ones) and the vulnerable circumstances requiring tangible proximal help when in distress (e.g., sudden fall at home).

• Having health, which was commonly understood to be disease-free and happy, was perceived as a resource to achieve an individual’s desired activities. Stories of healthiest moments were experiences of work, family or personal leisure accomplishments which give positive feelings about self, a deep sense of purpose and worthiness, disease absence and being happy. Healthy aging was perceived impossible for those who related health to having no disease. Living on their own meant that they had to be independent and self-care was a personal responsibility.

• To cope with the unpredictability of old age, they took a short outlook towards life by taking one day at a time (一天过一天) and not to struggle beyond each day. While some older adults took each day at a time by keeping themselves occupied daily with a mix of meaningful activities, others performed daily activity routines to fulfil basic living needs and waited for ‘their time to come’.

• Regardless, with the wealth of personal strengths, knowledge and experiences, they were generally resourceful in navigating around their resource-rich environments to cope with the challenges of everyday lives. However, they were at times limited by personal factors (e.g., negative life disposition, limited knowledge) that influenced the way they understand, access, maintain and utilise personal, social and environmental resources.

With the contextual understanding of the older adults’ health orientation towards aging and their usage of existing resources, a 12-week health resource programme was developed and piloted, entitled Salutogenic Healthy Aging Program Embracement (SHAPE) for older adults residing in senior-only households. The content-validated programme comprised 12 weekly group sessions on aging-related topics, at least two home visits and a health resource book. We examined the feasibility and potential effects of SHAPE on sense of coherence, self-efficacy, quality of life and health promoting behaviours among these older adults. Although the pilot study found challenges in recruiting participants, treatment adherence and data collection processes were satisfactory. Older adults who received SHAPE intervention found it useful and relevant, and they benefited from the knowledge gained on health resources. Positive trends were observed in their sense of coherence, overall health behaviour and spiritual growth. The SHAPE intervention is a useful and feasible complex intervention that can be implemented among senior-only households. However, further evaluation on its effectiveness will be required using a large sample size.

Key study implications include suggestions of (1) reframing the definition of health to pursuing and fulfilling valued accomplishments, (2) community care practitioners playing a role in integrating resources as resource facilitators to encourage older adults to pursue endeavours and perform self-care and positive behaviours that create health, (3) harnessing older adults’ resourcefulness by encouraging social engagement and meaningful exchanges with peers in their neighbourhood and create sustainable social groups, and (4) focusing public education efforts for people to plan ahead for their late life, which encompass their physiological, mental, social, financial and environmental states.