JJ019

Written Report (Project name)

Group Members: Andy Chua Yi Ming

Audrey Yeo Ling Yi

Chew En Sheng Daniel

Ong Zhing Ting

Tan Pei Ya

Class: 18S01

Task 2: Investment
Table of Contents

Chapter 1: Introduction ........................................................................................................................ 3

1.1 Medical needs of elderly not met in Singapore................................................................ 3
1.2 Importance of meeting the medical needs of the elderly ..................................................... 4
1.3 Technological advancements in healthcare has helped in the allocations of
medications. ...................................................................................................................................... 5
1.4 Nutritional needs of the elderly in Singapore ........................................................................ 7
1.5 Importance of meeting the nutritional needs of the elderly ................................................. 8
1.6 Investment in healthcare has helped with the follow-up care of patients ......................... 9
Chapter 2: Aims and Objectives ...................................................................................................... 10
Chapter 3: Elder-Buddy ..................................................................................................................... 12
3.1 Rationale ................................................................................................................................... 12
3.2 Current Measures .................................................................................................................... 13
3.3 Details........................................................................................................................................ 14
3.4 Analysis and Evaluation ......................................................................................................... 20
Chapter 4: Meal Buddy ...................................................................................................................... 23
4.1 Rationale ................................................................................................................................... 23
4.2 Current Measures .................................................................................................................... 23
4.3 Details........................................................................................................................................ 23
Registration for the elderly: ........................................................................................................... 25
Registration for Homechefs: ......................................................................................................... 29
4.4: Analysis and Evaluation ........................................................................................................ 32
Chapter 5: Conclusion ....................................................................................................................... 35
Bibliography ........................................................................................................................................ 36
Annex A: Interview with Dr Rani .................................................................................................. 43

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Chapter 1: Introduction

1.1 Medical needs of elderly not met in Singapore

In Singapore, there is an ageing population whereby the elderly takes up 12.4% of the

population as of 2016.1 As the elderly age, they face more difficulties.2 One of which

is adhering to their medical needs. In Singapore, low adherence to medication and

medical appointments is a common problem among the elderly. A 2004 study done in

Singapore found that 70% of elderly patients had medication-related problems, such

as taking the wrong dosage or taking medicine, they were not supposed to.3

This problem is amplified as there is rising number of elderly with complex care needs.

According to the Channel NewsAsia, in 2016, one in four Singaporeans aged above

65 years old developed a chronic disease and the numbers are set to increase.4 5

1
Population And Vital Statistics | Ministry of Health. (2017). Moh.gov.sg. Retrieved 22 August 2017,
from
https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Population_And_
Vital_Statistics.html
2
Mental health and older adults. (2017). World Health Organization. Retrieved 25 August 2017, from
http://www.who.int/mediacentre/factsheets/fs381/en/

3
Jamie Ee. Why You Need to Take Your Medications Correctly - HealthXchange. (2017).
Healthxchange.sg. Retrieved from https://www.healthxchange.sg/medicine-first-aid/medicine/why-
take-medicines-correctly
4
Luo Er, C. (2016). Number of seniors with complex care needs set to rise in Singapore: AIC.
Channel NewsAsia. Retrieved 22 August 2017, from
http://www.channelnewsasia.com/news/singapore/number-of-seniors-with-complex-care-needs-set-to-
rise-in-singapo-7899512
5
BOH, S. (2016). 1 in 4 Singaporeans aged above 65 developed chronic disease in past year: Study.
The Straits Times. Retrieved 22 August 2017, from http://www.straitstimes.com/singapore/one-in-four-
singaporeans-aged-above-65-developed-chronic-disease-in-past-year-study

Page | 3
1.2 Importance of meeting the medical needs of the elderly

Non-adherence to medication and medical appointments is detrimental to the health

of the elderly as it may result in more emergency room visits and hospitalizations. In

2013, almost one in five elderly patients in Singapore were re-admitted to public

hospitals. This was found to be mainly due to taking wrong medication or not taking

medication altogether.6

Furthermore, elderly with chronic health conditions tend to have a longer list of

medications.7 Non-adherence to medication and medical care leads to increased risk

of treatment failure, contributing to about 20% of the cases of preventable adverse

drug events among the elderly in the ambulatory setting.8 It is hence critical to reduce

medical noncompliance in the elderly.

6
Salma, K. (2015). More patients returning to hospital within a month of discharge. The Straits Times.
Retrieved 16 July 2017, from http://www.straitstimes.com/singapore/health/more-patients-returning-to-
hospital-within-a-month-of-discharge?login=true

7
Julia, G. (2014). Consequences of Medication Non-Adherence. Imedicare.com. Retrieved 13 July
2017, from https://imedicare.com/articles/consequences-of-medication-non-adherence/

8 Adult Meducation. (2006). Adultmeducation.com. Retrieved 17 August 2017, from

http://www.adultmeducation.com/OverviewofMedicationAdherence_3.html

Page | 4
1.3 Technological advancements in healthcare has helped in the

allocations of medications.

Hospitals in Singapore have implemented various measures to better meet the needs

of patients. One such investment is technological innovations used to reduce human

error in allocation of medication. Hospitals like Tan Tock Seng hospital use Radio-

frequency identification (RFID) technology to dispense medication for patients.9 RFID

technology involves a robot which collects the correct medication and sorts it into

different shelves before sending it to patients (Figure 1).

Figure 1: RFID technology used to collect

medication

9
Desmond, N. Faster and Safer Drug Dispensing at SGH With Automated System - HealthXchange.
Healthxchange.sg. Retrieved 22 August 2017, from https://www.healthxchange.sg/medicine-first-
aid/medicine/faster-drug-dispensing-sgh-automated

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This has reduced human error in the issuing of medication from about 38 per cent to

almost zero since the implementation of this system.10 Technology can help reduce

human error therefore improving the wellbeing of patients. Similarly, an investment of

a technological nature can be used to help elderly reduce the mistakes when taking

medication and ensure adherence to their medical appointments.

Technology, like the RFID, can help reduce human error therefore improving the

wellbeing of patients. Similarly, an investment of a technological nature can be used

to help elderly reduce the mistakes when taking medication and ensure adherence to

their medical appointments.

10
Desmond, N. Faster and Safer Drug Dispensing at SGH With Automated System - HealthXchange.
Healthxchange.sg. Retrieved 22 August 2017, from https://www.healthxchange.sg/medicine-first-
aid/medicine/faster-drug-dispensing-sgh-automated

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1.4 Nutritional needs of the elderly in Singapore

Another aspect elderly struggle with is having balanced and nutritious meals. Studies

conducted by Tan Tock Seng Hospital and Abbott Nutrition in 2011 showed that 1 in

3 elderly in Singapore have high risk of malnutrition.11 The study also showed that

they are not taking enough carbohydrates, calcium and fibre. As people age, they

become less mobile and thus are unable to cook their own food. From our survey with

30 elderly, 66.7% of them skip meals at least once a week.

Figure 2: Extract of survey (Annex B)

11
Feng Zeng Kun. (2011, July 15). 1 in 3 elderly S’poreans not eating right. Retrieved from:
https://www.sgh.com.sg/about-us/newsroom/News-Articles-
Reports/Pages/1in3elderlyS%E2%80%99poreansnoteatingright.aspx

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1.5 Importance of meeting the nutritional needs of the elderly

Malnutrition brings serious consequences such as tiredness, deterioration in muscle

strength and apathy.12 This will increase the tendency of facing different dangers in

their life such as loss of muscle mass, falling and fracturing of their bones that leads

to detrimental consequences to their health.13 Hence, our group decided to focus on

meeting their medical needs and nutritional needs as these problems are most critical.

To prevent elderly from suffering from such consequences, our group will look at how

investment in the healthcare industry can be used to meet the basic needs of the

elderly. We envision to improve the elderly well-being and allow them to age in place

by meeting their medical and nutritional needs.

12
Raynaud-Simon A, Lesourd B. (2000, December 16) Malnutrition in the elderly. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/11195844

13
Malnutrition – Consequences of Malnutrition. Retrieved from
http://medicine.jrank.org/pages/1091/Malnutrition-Consequences-undernutrition.html

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1.6 Investment in healthcare has helped with the follow-up care of

patients

The investment in increasing the efficiency of the healthcare system also takes the

form of a programme, Match-A-Nurse. Through the use of mobile application with

matching capabilities (developed by MOHH and IHiS), the application will match

available nurses to patients requiring home nursing services based on proximity.

Institutional nurses who are successfully matched with patients will then provide the

necessary home nursing services.14

From the Straits Times, this is vital as it allows patients who have been discharged to

receive follow up care and review thus helping them to recover better.15

Elderly are unable to meet their medical needs alone and require long term assistance.

Match a nurse programme solves this challenge through pairing them up with nurses.

Similarly, elderly require assistance to meet their nutritional needs. Thus, such an

investment can be applied through a programme to link the elderly to a household to

provide them homemade meals, allowing the elderly to receive the adequate amount

of nutrition they need.

14
Seng Bin, A. (2016). SingHealth Match-A-Nurse Pilot Programme. Retrieved 22 August 2017, from
http://www.singaporehealthcaremanagement.sg/Documents/Posters%20Competition%202016/Operat
ions/OP051%20-%20Ang%20Seng%20Bin_KKH%20-%20Match-A-Nurse.pdf
15
Salma Khalik. (2016, October 21). ‘Bid’ to care under Match-A-Nurse. Retrieved from
http://www.straitstimes.com/singapore/health/bid-to-care-under-match-a-nurse

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Chapter 2: Aims and Objectives

Our objective is to meet the basic needs of the elderly by applying the principles learnt

from the technological investment and investment in a programme in the healthcare

sector.

We aim to meet the elderly’s medical and nutritional needs by giving them prompt

reminders on when to take the correct medication or go for medical appointments and

providing them access to nutritious home cooked food by pairing them with

households respectively.

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We thus propose two main strategies that are depicted below (figure 3).

Figure 3: Diagrammatic overview of project

Page | 11
Chapter 3: Elder-Buddy

3.1 Rationale

Elderly tend to forget to take their medicine and miss their medical

appointments. They also tend to take the wrong medication due to having many

different types of medication.16 A survey that we have conducted among elderly shows

that elderly miss their medical appointments mainly due to forgetful and inconvenient

(figure).

Figure : Diagram showing the reasons for

elderly missing their medical appointment.

16 Poon Chian Hui (May 16 2017) Avoid taking the wrong medication. The Straits Times. Retrieved
from http://www.straitstimes.com/singapore/health/avoid-taking-the-wrong-medication

Page | 12
 It is also evidenced when we interviewed Dr Rani Ramason, a geriatrician in Tan Tock

Seng Hospital. She expressed that some of her elderly patients had forgotten to take

their medication or go for their medical appointments due to various reasons. From

the TODAYonline, non-adherence to medication is deteriorating for the elderly’s

health.17 To help them adhere to the correct medication and medical appointments,

timely reminders through notifications and alarms are necessary.

3.2 Current Measures

Hospitals like the Singapore General Hospital had come up with a pictorial catalogue

to help patient identify the medication they are consuming.18 However, this may not

be effective as the elderly would have to consistently refer to the catalogue to see what

medication they should be taking, and may find it too troublesome. According to the

Singapore Silver Pages, Medical Escorts are provided to the elderly especially for

those who cannot make it to the hospital as their caregivers are not free.

However, these Medical Escort services are a little pricey, and not many elderly know

about this service. Medical Escort services charge around $25 an hour, which is very

burdensome for elderly who have frequent visits to the hospital.19

17
Eveline Gan. (April 26 2017) Mixing medicines and supplements could be harmful. Retrieved from
http://www.todayonline.com/singapore/mixing-medicines-and-supplements-could-be-harmful

18
Singapore General Hospital Suki Lor (1 May 2015) Point out the right drugs. Retrieved from
Singapore Health Issues, May-June 2015, Page 7.
19
Cheng Kenneth.(2016). Demand up for patient chaperones in ageing society. TODAYonline.
Retrieved from http://www.todayonline.com/singapore/demand-escorts-who-accompany-patients-
check-ups

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3.3 Details

The Time stated that research has shown that the elderly would prefer wearing a

smartwatch rather than a traditional medical pendent. 20 Additionally, during our

interview with Dr Rani, she expressed that a watch is suitable as it can always be with

the elderly, and visibility will not be an issue as long as the screen size is big enough

and the colour contrast is good. Therefore, our group proposed a smartwatch that will

help the elderly track the medications that they have to take. The dosage and time

they have to take the medication will also be synced into the watch.

Information from hospital databases that contain doctor’s prescriptions will be synced

to the watch. This can be easily done by caregivers who can press a button to sync

information from HealthHub. HealthHub contains an electronic medical record

compulsory for all Singaporeans.21 The data contains the dosage to take for each of

their medication which is synced into the watch. In addition, every time after the elderly

visit the doctor for medical hospital for medical appointment, the nurse will type update

the new medication profile to sync into the smartwatch.

20
Katy Steinmetz. (2015). These Companies Are Making Smartwatches for Grandma. Time.com.
Retrieved from http://time.com/3927708/senior-smartwatches/
21
Healthhub.sg. (2017). myHealth - HealthHub. Retrieved from https://www.healthhub.sg/myhealth

Page | 14
When it is time for the elderly to take their medication, a notification would sound to

inform the elderly to take the medication and the watch displays the exact dosage

alongside a picture of the tablet for the elderly’s reference (figure 4).

09.00

Please take 2
tablets of
paracetamol

Figure 4: Diagram showing how the smartwatch will remind the elderly
to take their medicine.

Page | 15
This prevents confusion with other medications. The watch will beep until the user

dismisses the notification after the elderly eat the medicine. A picture of the tablet and

the amount the elderly has to take will be shown (Figure 5). To ensure the elderly with

eyesight issues can also see the picture, a watch with a larger display will be used, so

that the elderly can see which medicine to take clearly.

Take one
metformin pill
for diabetes.

Figure 5: Diagram showing the screen of the

smartwatch when it is time for elderly to take
their medication.

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Additionally, the watch will record when and what time the elderly has a medical

appointment. Information from hospital databases that contain the elderly’s next

appointment dates are synced by hospital staff into the watch. A beep will sound and

a notification, similar to that of a text message will show both one week and one day

before the appointment as suggested by Dr Rani (figure 6).

0900 REMINDER 0900 REMINDER

Your medical
appointment is on Your medical
9/12/17, 0900 hrs appointment is
at Tan Tock Seng tomorrow, 9/12/17,
0900 hrs at Tan
Hospital.
Tock Seng
Dismiss Hospital.

0800 REMINDER

Your medical
appointment is in 1
hour, 0900 hrs at
Tan Tock Seng
Hospital.

Figure 6: Medical Appointment’s Reminder Notification

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 The notification one week before the appointment is to remind the elderly, so that they

have enough time to make the necessary arrangements with their caregivers to go for

the medical appointment. The notification one day before the appointment is to remind

the elderly that they have a medical appointment the next day, and to be prepared.

Another notification will show 1 hour before the appointment and an alarm will sound

30 minutes before the appointment. These notifications and alarms are to remind the

elderly that they have the medical appointment, so that they can get ready and make

their way to the hospital or polyclinic.

DO you think need diagram here? Prolly if can

Page | 18
Moreover, in order to aid the elderly to go for their medical appointment, free medical

escorts will be provided for them too. One-time registration for medical escort will be

required through the hospital staffs when the elderly visit the hospital for medical

appointment and for the subsequent appointment, the elderly will be automatically

signed up for medical appointment unless they opt out. According to a survey that we

have conducted, 88.6% of the elderly mentioned that they will go for their medical

appointments more often if medical escorts are provided readily (figure 7).

Figure 7: Diagram showing that 88.6% of the elderly would go for

medical appointments more often if medical escorts are provided.
(This name too long)

Page | 19
According to the TODAYonline, this service will be carried out by the community

centre and Voluntary Welfare Organisation.22

To make it user friendly for the illiterate, a button can be pressed to translate words

displayed on the screen into audio. It is available in various languages and dialects

so that it can be easily understood by elderly in Singapore as Dr Rani stated that

some elderly are illiterate and may only know one language (figure 8).

Figure 8: any idea how to do and design (Just put a text, then put
translate button, then beside the watch put the audio symbol or smth
liddat, u can put a finger to show u press on translate too)

3.4 Analysis and Evaluation

The watch will be effective in helping the elderly to have medical adherence since it

will remind the elderly when they are supposed to take medicine. As stated by Dr

22
Kenneth Cheng. (August 10 2016) Demand up for patient chaperones in ageing society. Retrieved
from http://www.todayonline.com/singapore/demand-escorts-who-accompany-patients-check-ups

Page | 20
Rani, some of the elderly might still forget to take their medication as they have

hearing impairments, and are unable to hear the alarm. Hence, features such as

vibrations and flash lights can be added to cater for elderly that have hearing

impairments, to catch their attention even if they cannot hear the alarm. ( DO we

need to show how the new features will work too?) (This one idk yet too, need wait

for our next draft)

However, the watch may be a little pricey since it is a smartwatch. Dr Rani has

stated that the smartwatch has to be introduced to the elderly and made easily

available so that elderly are able to buy it easily and and at a reasonable. Therefore

collaborations can be done with the government to introduce the smartwatch as part

of the pioneer generation package. Since the government wants to help our pioneer

generation to age independently, this smartwatch will be able to help the government

to have a healthier state of life. The watch can be sold in places like pharmacist in

Guardian, Watsons and NTUC.

Dr Rani also stated that it is important to include the specific instructions that the

doctor has given the patient to eat the medication. For example, eating the

medication with food or without food. This is important as the elderly may also forget

the specific instructions and further complicate their health issues.23

23
Janet Slugget. (2015). Why must some food be taken with medicaiton. Retrieved from
http://theconversation.com/explainer-why-must-some-medications-be-taken-with-food-34649

Page | 21
Through our survey, 75% of the elderly are willing to use a smartwatch and will use it

often. Moreover, (can use the one that say more elderly are becoming tech savvy from

the top?) according to the Time, a research has shown that elderly are more and more

willing to use a smart watch.24 This shows that the elderly will use the smartwatch all

the time which can effectively help the elderly to have medical adherence (figure 9).

Haven’t do this survey we need to do!

24
Katy Steinmetz. (2015). These Companies Are Making Smartwatches for Grandma. Time.com.
Retrieved from http://time.com/3927708/senior-smartwatches/

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Chapter 4: Meal Buddy

4.1 Rationale

To ensure that elderly get nutritious food, nutritious food must be easily accessible to

them. To do this, we propose a programme which will link elderly to meal providers

within their neighbourhood.

4.2 Current Measures

Health Promotion Board (HPB) recently came up with a new tool-kit to help elderly to

eat healthily. 25 This tool-kit consists of a nutrition guide, recipe book and an

educational poster with tips on healthier meal options and recipes, hoping to raise

awareness among elderly on the importance of good nutrition. However, such tool-kit

would only raise awareness of consumption of nutritious food by providing healthier

recipes and is difficult to ensure that elderly consume enough nutrition.

4.3 Details

Similar to match-a-nurse, our group will propose a programme, Meal-Buddy, which

links households and elderly up to cater to the nutritional needs through an online

platform would allow elderly and households to sign up and be paired based on

proximity (figure 10).

25
Carolyn Khew. (2016, May 15). New toolkit by Health Promotion Board to help senior citizens eat
healthily. Retrieved from http://www.straitstimes.com/singapore/health/new-toolkit-by-health-
promotion-board-to-help-senior-citizens-eat-healthily

Page | 23
 Figure 10: Meal Buddy’s Main Page

We propose for Meal-Buddy to be launched at the Bukit Batok as it is a mature estate

in Singapore that has a significant number of elderly and their caregivers living in the

area.26

Meal-Buddy will be advertised through flyers sent by volunteers that send meals to the

houses/community centre. Elderly and households (homechefs) who are interested in

participating in Meal-Buddy can sign up at an online platform managed by the

community centre. Elderly who are not tech-savvy can go to the nearest community

centre or receive help from caregivers who can guide them through the online platform

to sign up.

26
LEE, P. (2016). Elderly residents in mature estate the focus. The Straits Times. Retrieved from
http://www.straitstimes.com/singapore/elderly-residents-in-mature-estate-the-focus?login=true

Page | 24
Registration for the elderly:

Step 1: Elderly will register online to create an account, entering their personal

particulars (Figure 11).

Figure 11: Diagram showing how the elderly can register their particulars.

Page | 25
Step 2: Elderly can choose the top 3 choices of homechefs they wish to be paired to

(Figure 12).

Figure 12: Diagram showing the choice elderly can pick.

Elderly have specific taste, preferences and needs regarding food. It is therefore

crucial to ensure these needs are met.

The website will display the profiles of homechefs in their proximity. The profile

showcases homechefs’ personal profile, meals that they can cook along with its

nutritional benefits. Elderly can proceed to choose their top 3 choices.

Elderly have specific taste, preferences and needs regarding food. It is therefore

crucial to ensure these needs are met. By giving elderly these choices, it also improves

Page | 26
their autonomy, 27 28 29 as their interest towards food increases 30 31 since it is their

preferred food choice.

Step 3: Elderly are to indicate the days in a month that they wish to receive meals as

they might not require meals on certain days of the week, for example, every Sunday

(Figure 13).

Figure 13: Indication of required meals

27
Andresen, M., & Puggaard, L. (2008). Autonomy among physically frail older people in nursing
home settings: a study protocol for an intervention study. Retrieved 12 August 2017, from
https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-8-32
28
Dignity in care - The Dignity Factors: Choice and control. (2014). Scie.org.uk. Retrieved 12 August
2017, from http://www.scie.org.uk/publications/guides/guide15/factors/choice/
29
https://www.hindawi.com/journals/jar/2012/761291/
30
J.L. LOCHER. (2009). Food Choice Among Homebound Older Adults: Motivations And Perceived
Barriers. NCBI. Retrieved 5 August 2017, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749957/
31
Healthy Eating and Alzheimer's Disease. (2017). National Institute on Aging. Retrieved 3 August
2017, from https://www.nia.nih.gov/health/healthy-eating-and-alzheimers-disease

Page | 27
The registration is then complete and pairing would be done by the community centre

considering these 3 aspects - elderly’s choices, their dietary needs and proximity. They

would receive a letter of confirmation delivered to their home upon successful pairing.

In the letter, they will be given contact information of the homechef they are paired to.

Each household can be paired to a maximum of 2 elderly to ensure that embarking on

the Meal-Buddy programme would be manageable for them.

For households who are interested to be homechefs, they will register via the nearest

community centre / website.

The registration is then complete and pairing would be done by the community centre

considering these 3 aspects - elderly’s choices, their dietary needs and proximity. They

would receive a letter of confirmation delivered to their home upon successful pairing.

In the letter, they will be given contact information of the homechef they are paired to.

Each household can be paired to a maximum of 2 elderly to ensure that embarking on

the Meal Buddy programme would be manageable for them.

For households who are interested to be mealchefs, they will register via the nearest

community centre / website.

Page | 28
Registration for Homechefs:

Step 1: Homechefs can set up their personal profile on the Meal-Buddy website.

Information regarding their address will be taken for ease of pairing with the elderly

but will be kept confidential (Figure 14).

Figure 14: Personal Profile Page

Page | 29
Step 2: Homechefs will be directed to the page to sign up for a free, compulsory

nutrition and hygiene course at community centres (Figure15).

Figure 15:

Page | 30
The courses will be held in community centres which is more convenient for them. The

nutrition course will include cooking demonstrations, feedback and talks from

nutritionists, and will be taught on meal preparation suited more for the elderly. At the

same time, they will be taught on how to prepare and handle food hygienically

(figure16).

Figure 16:

These helps us to achieve our aim of meeting elderly’s nutritional needs by ensuring

that households provide nutritious and hygienic meals for elderly.

Step 3: They can add in images and nutritional information regarding the top 3 meals

they can cook. This allows elderly to be more informed when making their top 3

choices.

Page | 31
Step 4: Homechefs will submit their application.

Subsequently, pairing by the community centre would be done. Upon confirmation,

qualified homechefs would have the paired elderly’s personal information.

Homechefs will cook up an additional portion of nutritious lunch while preparing their

own families. This way, it would not cause a burden of preparing another meal.

After preparing the meal, the household would personally deliver the meal to the paired

elderly.

4.4: Analysis and Evaluation

Effectiveness

From our survey with 30 people including elderly and their caregivers, 76.7%

expressed support for the programme is effective as it allows them to receive nutritious

food (Figure 17).

Figure 17:

Page | 32
Some have expressed that the programme would be beneficial as they often struggle

with getting access to healthy food or have difficulties leaving their homes to purchase

food.

We also surveyed elderly caregivers, one of which expressed that the programme

would allow him to feel at ease as healthy meals that are suitable for their parents with

diabetes are hard to find and it is difficult to provide meals for them due to busy work

schedules.

This hence shows that Meal Buddy is rather effective in meeting the elderly’s needs.

However, taste in food is subjective. Even if homechefs themselves thinks it is nice,

not all elderly will find the meals to be nice tasting. Elderly might not want to consume

the meals as it does not suit their taste buds. Therefore, we propose to have an

additional feature, a feedback and ratings system (Figure 18).

Figure 18:

Page | 33
This way elderly can comment on the meals so that homechefs can improve to better

suit the elderly’s taste. Lack of sanitation regulations is another drawback in this

programme. Thus, we propose regular checks on the homechefs every 3 months to

be made.

Feasibility

Our strategy is feasible as many Singaporeans are tech savvy and able to access the

online platform with ease. For those who are not, they can head to the nearest

community centre to register for the programme. Furthermore, as Singapore has an

asian culture, households often cook their own meals hence it would be convenient

for participating households to provide meals. Our measure also directly addresses

the root cause of malnutrition in the elderly.

Based on our survey conducted on 30 housewives, XX% has expressed their interest

in participating in such a programme.

Sustainability

However, Meal-Buddy may be very taxing on homechefs in the long run. To encourage

homechefs to stay in this programme, we would like the elderly to pay an affordable

price of $2/meal, this can serve as an additional income for homechefs.

Page | 34
Chapter 5: Conclusion

In conclusion, our group proposed two strategies, Elder-Buddy and Meal-Buddy.

These two strategies would help to meet the basic needs of an elderly in terms of

medical adherence and nutritional needs. With these, an elderly would be better able

to age in place with an ageing population like Singapore.

Page | 35
Bibliography

Online news article:

1. Chan, L. (2016). Number of seniors with complex care needs set to rise in

Singapore: AIC. Channel NewsAsia. Retrieved 22 August 2017, from

http://www.channelnewsasia.com/news/singapore/number-of-seniors-with-complex-

care-needs-set-to-rise-in-singapo-7899512

2.BOH, S. (2016). 1 in 4 Singaporeans aged above 65 developed chronic disease in

past year: Study. The Straits Times. Retrieved 22 August 2017, from

http://www.straitstimes.com/singapore/one-in-four-singaporeans-aged-above-65-

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Annex A: Interview with Dr Rani

(we gave the interviewee the questions before the interview)

Qn1) Is it common among your elderly patients that they do not adhere to their medication-

Eg taking the wrong dosage, forgetting to consume some medicines or miss turning up for

their appointments?

Dr Rani: So is it common among your elderly patients that they do not adhere to their

medication- Taking the wrong dose, forgetting to consume some medicines or miss turning

up for their appointments. And the answer is yes. What do you think are possible reasons

why they do not adhere to their medication?

Daniel: Forgetfulness

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Dr Rani: Forgetfulness. Yes. So, some of them might forget to come for their appointments.

Yes. Anything else?

Zhing Ting: They find it troublesome.

Dr Rani: So why do they find it troublesome?

Daniel; They are not mobile

Dr Rani: Yes, so they are not mobile, nobody to bring them for the appointments. Any other

reasons?

Zhing Ting: They may not be financially stable

Dr Rani: But they can still come for their appointments, right? But i suppose cost may be

cost of medications, cost of the appointment, cost of transport coming all the way here right,

because they are not mobile, and they cannot take the MRT or bus, they probably have to

come in a cab and that is going to be quite expensive. Ok? Anything else you think could be

a reason why the elderly person does not adhere to the medications?

Dr Rani: So, when you mentioned troublesome? There are two things that come out of it

being troublesome. Firstly, it is expensive, it is difficult to get to the appointment. What is the

other thing? Do they think their illness is important? Do they understand? No right? They

may not understand that management of their chronic disease is important. It is important for

them to know how serious their disease is, and the consequence of not treating it

appropriately. So I think that they need to know the importance of their illness. Anything

else?

Pei Ya: Waiting time

Dr Rani: Yes. Waiting time can be long. Correct. What else?

Audrey: They may feel that they may not benefit much from the medication.

Dr Rani: So yeah. That is again education, right? On the severity of their illness and in terms

of managing chronic diseases. For example, if you have diabetes, if you manage well, you

will not get the complications. So, you need to educate them that as the symptoms may not

be visible for diabetes as it is just that your sugars are high. Unless, of course it is very

severe. If you have arthritis, then you might say if there is pain then i would go and see the

Page | 44
doctor. But for other illnesses, the symptoms may not be obvious until it is too late, then the

complications arise. So, it is important to educate the person on the importance of managing

their chronic diseases well.

Dr Rani: What do you then think could be a problem in the elderly in terms of taking the

wrong dosage?

Zhing Ting: Visual impairment.

Dr Rani: Yes. So, they may not be able to see the medicine as they could all be of the same

colour. I don’t know if you all have gone to your General Practitioner and they give you little

packet for, say, flu, and they tell you to take one time a day, and some writings may not be

legible at all. So, when you have visual impairment you cannot even see that. So hence,

they don’t know, they don’t know how much to take, they don’t know when they need to take

it. And with the elderly, because they accumulate a lot of medicines along the way, then

suddenly they would have a very complex regime. So not once a day, maybe three times a

day. And some may be related to food. So, the pharmacist will tell you, “This one must take

before food, this one must take after food, this one must take half an hour before food.” So,

imagine if you have all that, even if it is three times a day, it requires a lot of different

instructions. So, a complex regime could also be a problem why they are not taking it

correctly. Ok? So, you need to learn to understand the problems of an older person, and

what they face, before we devise something. That is why i also need you to understand.

Qn 2) What are some of the problems the elderly face when taking the medicine?

Dr Rani: What do you think?

Audrey: They might be confused between the different medicines as they look quite similar.

Dr Rani: Correct, yes. So, confusion. But maybe also too many medicines as many of them

take multiple medicines, right? So many of them may get confused with what dosages, they

all look similar, timings, anything else?

Zhing Ting: Hard to swallow.

Dr Rani: If they are very big. Correct. That’s a good point.

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Pharmacist: Do you know what they can do if it’s hard to swallow?

Zhing Ting: Cut it

Dr Rani: Cut it. Yes. There is a pill cutter for people to cut their medication. Is there anything

else, the challenges they face taking their medicine? What’s the big problem? They can’t

see. If they can't see their medicine, if they are very very small, or can't see, for example,

how often they have to take it. They also have to get the medicine, right? What happens to

the immobile elders?

Daniel: They have to queue for the medicine.

Dr Rani: If nobody gets the medicine for them, nobody brings them to the doctor’s, and that's

also a problem getting the medicine. And of course, if they are forgetful, they will forget.

Sometimes, the elderly has different symptoms, different days, one day could be giddy the

other could be pain. Sometimes they will be giddy and so they go down to the doctor and

say I’m giddy, the doctor will give them 3 different medicines. Then 2 days later, they might

have pain, then they go down the doctor again to get pain medicine and have another 3

different medicines. They would then suddenly accumulate a whole lot of medicine, of which

they don't know what is it for, or to continue taking it. So, what we call hoarding of old

medicine, seen too many doctors again, it's best to see just one right? So that one doctor

knows what you are taking and adjust the medicines accordingly. Hoarding of medicines

therefore leads to confusion. Even if you write your prescription clearly, what other problems

will the older person face?

Zhing Ting: When the symptoms go away, they will stop eating.

Dr Rani: So that’s again, what you call, understanding the importance of chronic disease

management, for those with diabetes etc. Anything else?

Zhing Ting: Maybe they consume the expired medicine when the pain come back again.

Dr Rani: So, taking expired medicines again. Anything else? Can all your grandparents read

and write?

Daniel: Some of them don't know how.

Dr Rani: So even if you write “Take one tablet 2 times a day”, will they know? No. Some of

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the older generations might be illiterate, they might not be able to understand, they might not

be able to read. So then write English, write Chinese, also cannot. As some of them never

go to school in the first place so some of them might be illiterate.

Qn 3) How beneficial will a smartwatch catering to the elderly be in ensuring that they

adhere to their medication and medical appointments?

Dr Rani: Why do you think of using a smartwatch to help them?

Audrey: It’s easy to bring around.

Daniel: They won’t forget as it's always with them.

Dr Rani: Okay, so anything else? What are the features do you want to have in your

smartwatch?

Audrey: Notification when it is time to eat their medicine, there will be a picture of the

medicine, and an alarm.

Pharmacist: How big will the picture be?

Audrey: We will try to accommodate for it to be as big as possible.

Dr Rani: Alarm system, what will be your alarm system be like? Is there sound?

Audrey: Yes. After they take the medication, they can press a button to dismiss the alarm.

Dr Rani: What if besides vision impairment, they have hearing impairment? You can have an

alarm, what else can you add so that it can really attract their attention, otherwise, they might

ignore it?

Daniel: We can have vibration.

Dr Rani: Okay, vibration is good, anything else? You see some of the smartphone right,

when there’s message, what comes out?

Daniel & Zhing Ting: Flashlight.

Dr Rani: So, you see, this is something you will want to consider, maybe 2 flashes or

something. You will have the sound, vibration and the flashlight as your alarm. As you are

Page | 47
catering to all patients, some may be visually impaired, some may be hearing impaired, then

the vibration will be good. So good your alarm system, what else? But that will be the next

question, right? So back to the question, the smartwatch will be useful, how? To remind

them, right? When to take the medicines, they must also be what?

Zhing Ting: Affordable

Dr Rani: Affordable, very good. Actually I don't understand the third and the fourth question,

is it the same?

Daniel: I think this question is asking will a smartwatch be beneficial and will other platforms

be more beneficial?

Dr Rani: Okay, so you feel that a smartwatch because they will wear it all the time?

Daniel: Yeah

Dr Rani: You hope they will wear it all the time.

Pharmacist: How many of you all wear your watch at home?

Daniel: Oh yeah that’s true.

Pharmacist: But you can still wear it, if I have such a watch I will wear it all the time except

when it is charging, so when it's charging then its medication taking time I would not know.

Dr Rani: So you must wear it all the time right? So, the cons will be when taken out right?

But I suppose if you have an alarm, hopefully they can hear, so it's like an alarm clock. So,

there’s sound, flashlight and vibration.

Pharmacist: If you take it out it does it ring?

Dr Rani: So, it must ring.

Daniel: Yeah.

Pharmacist: It needs to be in such a way it will still buzz.

Dr Rani: And flash and beep. Ok so, anything else? The other option besides a smartwatch,

what about the phone?

Zhing Ting: Most don’t have phone.

Pharmacist: Most also don’t have smartwatch.

Zhing Ting: Yes

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Dr Rani: So that's an alternative platform. You’ll see that more and more are starting to have

phones.

Pharmacist: Actually they may not have smartphones but they may have some elderly

friendly phones

Dr Rani: Now all smartphones, because there's no more 2G.

Pharmacist: Still got those elderly type, my Dad has it, I bought several because he get used

to using that so if the phone have some programmable function with the alarm can still

technically use it.

Dr Rani: Ok, so we can think about that as an alternative but if we are going to just

concentrate on the smartwatch then yes, all the time, then the cons are when it's taken out it

sound still sound. How beneficial will the smartwatch be? So, it must be used to remind them

when to take medicines. Do you think a talking watch in different languages helps? We are

talking about illiterate, right? But although if you alarm and show the picture of the medicines

I think that's quite good. Can they identify you think?

Pharmacist: Depends on whether they are just taking a photo of the tablets versus the whole

strip because it is white tablet and Panadol, calcium, everything is white.

Dr Rani: They wouldn't know.

Pharmacist: That’s why the smartphone because of the bigger screen may be more useful if

they have multiple medication but I guess to me it's the different platform will probably

appeal to different groups. So, for someone who is usually at home, I would think that most

people will not wear the watch, but they will probably have their phone, whether they leave it

on or not is another question, but if they are at home and their phone is on, the phone can

ring loud enough, they can probably still hear it. For someone who is more ambulant, who

goes out and would probably wear a watch and go out, perhaps the watch is something

more feasible.

Dr Rani: Yes, so can look at different platforms, looking at the watch must take note of the

alarm system part and you can think about the talking watch but it must have different

languages, different dialects to be programmed there. Next thing is medical appointments,

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right? We want it to also remind them of medical appointments, how? When do you think it is

appropriate? On the day of the appointment?

Daniel: There’s a notification one week before the appointment and one day before the

appointment and an alarm one hour before the appointment.

Dr Rani: So, I think it's important when its medical appointment, should be one week before,

so that they can arrange their logistics, who can bring them and all that. Because on the day

or day before it is too late. Their children may not be able to take leave for example, right?

So at least a notification one week before. Probably one day before is important in case they

forgotten, and then maybe in the morning of the appointment itself, say like the appointment

is at what time. So, it should happen at three stages.

Qn 4) What are some of the challenges and considerations we should take note in the

design of the smartwatch?

Daniel: Screen cannot be too small.

Dr Rani: So, it must be a sizeable screen right, so easily visible. This size is not bad.

Pharmacist: This is the smaller one. There’s a bigger one.

Dr Rani: But bigger must be careful with it, it must be?

Zhing Ting: Light.

Dr Rani: Yes, too heavy they won't wear so it has to be light but yet the screen needs to be

big enough to see things. So, I suppose the other option is to just have one item on it, rather

than have many things. If have many things then cannot see, like this. So, you may just

leave one thing on your watch. Ok so what else you think? Lightweight correct, clear screen,

anything else?

Pharmacist: What considerations for your smartwatch?

Zhing Ting: Battery power.

Dr Rani: Ok very good, battery power. How long do you think it should last? 3 days? Not like

your phone one day then die. So, a longer battery life. Anything else?

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Audrey: Most likely the language settings i think.

Dr Rani: Yup, the language settings.

Daniel: And must be comfortable so that they won't take it out

Dr Rani: Yes, so I think it must not only be comfortable but what else? You have to get it on,

right? And then you know the elderly, must be difficult right to wear the strap?

Zhing ting: There’s the automatic strap, right?

Dr Rani: Yes, so something that is easy to wear for them especially patients with arthritis that

don't really have a lot of dexterity in their fingers. Okay, so easy to wear so you can think

about your magnetic strap. So, anything else? So, you say talking watch, right? Different

languages you can look at. Allowing light and vibration? Correct?

Daniel: Yes

Dr Rani: Good contrast is also important, so it could be black with white or white with black,

so don’t do blue with green, it’s very difficult to see. Okay? So, it has to have good contrast,

contrast means the light and the dark has to be very contrasted so that it’s easier to see

because a lot of the elderly with cataracts, they can’t see shades of grey, it has to be black

and white. Anything else?

Zhing Ting: Dosage

Dr Rani: You said in the smartwatch you will have pictures, right? Like it will alarm and say

“time to take your medicines” right? Or time to take your whatever medicines, blood pressure

medicines, right? That would be fantastic, right? And then a picture of the blood pressure

medicines will show. Or time to take your diabetes medicines and then the picture of the

diabetes medicine comes on. I think that will be quite useful. Apparently, have you heard of

the HPB steps tracker?

Daniel: Yes.

Dr Rani: Apparently, it’s quite easy to wear, i don't know what the design looks like.

Daniel: It’s something like the hole in the strap and press down.

Dr Rani: Oh, so something like that or your magnetic strap, something that is easy to wear.

Page | 51
Q5) Are there any features you feel that can be added to improve the usage and device in

aiding medical compliance?

Dr Rani: So how you encourage your patients to keep it on right? That’s one thing. I think if

you have all these things in already, it will prompt them, but at home if you put your watch

aside, it won’t actually remind them to take it, so you have to try to encourage them to wear it

at all times. And don’t forget, waterproof, right? It has to be waterproof. So, you can shower

with it if they want. So, any other features?

Zhing Ting: Shockproof

Dr Rani: Okay but it won’t increase usage. Shockproof will be your design, right? Like your G

shock. So how can we encourage them to keep it on at all times?

Zhing Ting: Easy to put on, hard to take out.

Dr Rani: Cannot, some elderly will still take it off to shower, so cannot, must be easy to put

on easy to take out.

Daniel: Maybe if it senses that it’s not on them and it’s not charging, after a certain period of

time an alarm will ring or something.

Dr Rani: You can do that. But you still need like an incentive to keep it on. You know right

now what’s the craze?

Pei Ya: The Steps Challenge.

Dr Rani: Yeah, a Fitbit, right? Everybody puts it on because they want to calculate the steps,

right? I don’t know whether you heard about how HPB encourage their patients with regards

to the step challenge, do you know?

Daniel: they give voucher.

Dr Rani: Yeah, I think you can look into that. You can incorporate more things in your watch

so that it becomes indispensable. You can put a time, right? People love looking at the time.

You can put a Fitbit like a step tracker. You can also attach it to your smartphones like the

iWatch correct? So, you can actually receive calls, right? I mean if they want to. They can

always disable it. So, it becomes an indispensable part of you. So that you do not want to

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take it off. Correct? So, you can encourage that, okay? Try and make it as indispensable as

possible, I think you can use it like a FitBit, like a step tracker, put the time in, you can use it

as a reminder, if you have phone features you can even put it inside so that they can use.

We talk about a reward system, so if they keep it on for don’t know how many hours they

can go and collect a $5 NTUC voucher, something like that. So, if you keep it on for 5

months or 6 months, you can come and collect a NTUC voucher. And that also helps to

measure their fitness, right? Because it’s a FitBit. And if you want you can even put a GPS

because some of the confused patients, they wonder, they get lost. And you can use another

feature like the family can like find your phone right, can find your elderly. So, a lot of

features can be incorporated, so you try and make it as indispensable as possible, cannot do

without. So, we all cannot do without phones, right? Phone features, Time features, FitBit,

Step tracker, we can use it as a GPS tracker. It can even be used like when the elderly is

stuck, something that you can press that will sound an alarm, they’ve fallen down, like a call-

for-help buzzer. These are things that you can think about incorporating. So, I suppose if you

can’t have phone features, you can have emergency call features to call 999, 995 or their

family. There is an elderly phone that has a red button at the back of it, which is their next to

kin’s number which acts as an emergency number as a safety features. The watch must be

small, cheap, affordable and can be obtain from any shop such as NTUC, Guardian

Pharmacy. You can also work with health promotion board to promote the importance of

medical adherence. The pharmacist has identified that a lot of medicine looks the same, so if

you just put a picture of white pills it may not be helpful. Try to put the name of the medicine

and its purposes such as time to take your diabetes pill/medicines and the picture of the pill.

The watch must contain a lot of features so that it can attract the elderly to use it. For

example, a walking stick designed that was for the elderly has a lot of accessories such as a

pocket to put their EZ-link and a GPS tracker such that they can use it to tap for the

extension of the duration of the traffic light easily. Especially when you ask what features to

add to improve the usage and device in aiding medical compliance, adding in many features,

and not just a reminder, can definitely be useful. GPS tracker will definitely be useful, we

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have a lot of patients with dementia who wandered out to take a bus and forget how to take

back. Hence, it will definitely be useful to add this feature.

Pharmacist: A smartwatch may be too small for elderly to be able to find contact number and

call people.

Dr Rani: Ya, that’s why just one number such as the next of kin one will do.

Pharmacist: You can make it like Apple watch where the elderly can directly answer the

phone call through their watch so that it is more convenient for them too.

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