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2021

MESSAGE SUSAN TRICIA | EDITOR

Greetings Readers!

On behalf of the editorial team, I hope everyone’s keeping well and safe during the challenging global Covid-19 pandemic. In response to the associated economic and social impact, we have decided to launch a trade magazine for the growing eldercare space in Asia to facilitate continuous B2B engagement. First, Eldercare Asia Magazine will be purely digital. Second, Eldercare Asia Magazine aims to feature content we hope you will find useful in your daily work including introducing new products, services and technologies for the provision of eldercare. At Eldercare Asia Magazine, we strongly believe in the vast business opportunities presented in the trend of longer lifespans and economics of longevity. There remains in Asia many gaps to elevate the quality of eldercare and broaden the choices businesses and consumers can have in improving quality of one’s extended life. For our inaugural edition, we have looked into how Covid-19 has affected the elderly and their caregivers. For that, we are grateful to Dr Tan Jit Seng and Tristan Gwee for their practical perspectives and suggestions on caring for elders in restrictive conditions. Rather than social distancing as oft-used in the West, we advocate safe or physical distancing. To therefore talk about social distancing may suggest the lack of need for everyone to check in or stay in touch with their community and family members. More so than ever, we think that continued social engagement to prevent social isolation especially for the elderly community is even more critical. We have therefore worked with our lifestyle partners such as Electrum Fitness to roll out videos to help everyone undertake simple exercises from their own homes to stay fit. We will be collaborating with other partners to create other helpful content in a similar way. If you have an idea that might work, please contact us so that we can explore further with you. We are a new set-up. We will be open to suggestions and ideas on what are important topics to cover in Eldercare Asia Magazine. We warmly welcome you to share your thoughts on what and how we can collaborate further. If you have something you wish to contribute, be it an article or insights, feel free to drop us a note. Do continue to stay healthy, well and safe.

Editor Susan Tricia

Publisher :

The content of Eldercare Asia Magazine (and website) does not necessarily reflect the views of the editor or publishers and are the views of its contributors and advertisers. The digital edition may include hyperlinks to third-party content, advertising, or websites, provided for the sake of convenience and interest. The publishers accept no legal responsibility for loss arising from information in this publication and do not endorse any advertising or products available from external sources.

Publication Manager Joseph Yeo Content Editor Kenny Yong Media Executive Soon Hwee Cheng Marketing & Promotions Susan Tan Graphic Designer Njan Cittanando

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Eldercare Asia Magazine and its website does not warrant that the information in it will be error-free or will meet any particular criteria of performance or quality. Your use of the information contained in the Eldercare Asia Magazine and website is at your own risk. You assume full responsibility and risk of loss resulting from the use of this website or information in it. None of Fireworks Muziyi Media Pte Ltd or its affiliates, or any partners, principals, stockholders or employees of any thereof will be liable for any special, indirect, incidental, consequential or punitive damages or any other damages whatsoever, whether in an action of contract, statute, tort (including, without limitation, negligence) or otherwise, relating to the use of this website or information contained in it. No part of this publication may be reproduced or stored in a retrieval system without the written consent of the publishers. All rights reserved.

5 - 7 November (Fri - Sun) Halls 405/406


Alleviating loneliness as we age

MAGAZINE CONTENTS

MAGAZINE CONTENTS

IN THIS ISSUE

Not all solutions need to be high-tech, as mindfulness practices reveal by Stephanie Ludwig, MDiv, MA, PhD

14

8

INSIGHT 5 Ways to Manage Common Health Problems in the Elderly

FEATURE ARTICLE Healthy Ageing in the Time of Covid-19 - Trends in the UK

68

SPOTLIGHT

44

The Journal on Active Aging

The Tech Connection: Alleviating loneliness as we age

EVENT & ACTIVITIES 2019

POST-SHOW REPORT

20

8 - 10 November 2019 Halls 405/406

Post-show Report ELDEX ASIA 2019 event

“Loneliness breaks the spirit,” goes the old Jewish proverb. We are wired to be connected, and miserable when we are not. Although the sense of disengagement from others that characterizes loneliness is painful at any time in life, such disconnection can feel acutely unbearable as we age. We may face not only natural challenges like diminishing physical capacities, but also additional suffering caused by a digitalized, outerfocused world that too often breaks the bonds we need to maintain meaning and purpose in our lives.

28

COVER STORY

Research on the physical and psychological effects of loneliness confirms

Social Isolation in Older Adults Special technology issue 2019 www.icaa.cc during COVID-19 Pandemic

34

COVER STORY Why Covid-19 is so dangerous for older adults

that it adversely affects our health and longevity and is associated with depression.1 While the causes of loneliness are complex and may include heritable traits, personal history, environment and relationship quality, its prevalence among older adults today has even more adverse effects. One study linked social isolation in old age with poor health and recommended urgent social interventions to reduce the risk of cardiovascular disease and stroke.2

49

IN THE HOT SEAT

With

Tristan Gwee

42

In fact, the hazards of loneliness are so severe that they call for creative and compassionate responses. To this end, in 2018 Great Britain appointed the world’s first Minister of Loneliness following the release of a national report on this health risk.

INNOVATION & Continued on page 46 TECHNOLOGY IoT and Elderly

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64

THE FLIP SIDE: Weighing benefits VS drawbacks of innovative technologies

Fashionable elderly laundry shop owners dress up in clothes left behind by their customers

IN FOCUS

FASHION


I ns i ght

I n s i gh t

5 Ways to Manage

Common Health Problems in the Elderly

Some common health problems the elderly face include: Arthritis Heart Disease Cancer Respiratory Diseases Alzheimer’s Disease Osteoporosis Diabetes Falls Obesity Depression

What are some of the common health problems we face as we get older? What are the ways to manage these well so that we can enjoy our golden years? Learn more about old age health problems and solutions.

Quick Stats of the Elderly in Singapore According to the Department of Statistics Singapore, there are around 5.6 million people in Singapore as of 2018. 13.7% of Singaporeans are at the age of 65 and older. Among this age group, 8,7% are between 65—74 years of age, while 5% are aged 75 years and over. A study led by the Institute of Mental Health found that one in 10 people aged 60 and above (almost 82,000 people in 2018) may have dementia.

Dealing with Common Health Problems in the Elderly With higher standards of living in our society and an ever-improving healthcare system, the life expectancy of Singaporeans has increased from 73 years in 1990 to 84.8 years in 2017*. Our first batch of baby boomers has also reached their retirement age by now. These baby boomers are equipped with a higher literacy rate, armed with higher-skilled jobs and are living a better quality of life. However, living longer may not equate to a healthy and active lifestyle.

Modern science and advances in medicine have made it possible for people to live longer with better healthcare services, but it doesn’t mean that older adults can rely solely on modern medicine to stay healthy. It is still essential for us to: Continue eating healthy by eating more fruits and vegetables and avoiding unhealthy fats such as saturated fats

Stay safe while engaging in an active, healthy lifestyle no matter how old we grow.

Enhancing Daily Living for Older People with Physical Limitations As one age, the likelihood of physical limitations increases. Reduced vision, hearing, body balance, energy level, body agility and/or physical strength may be experienced. As we grow older, our immune systems may also not work as well. Some changes in our heart health and blood vessels also occur with age. In addition, the increased prevalence of chronic diseases such as heart disease and Alzheimer’s disease has also become a leading cause of death and illness in Singapore. This also leads to a further reduction of one’s mobility and ability to function independently in everyday life. With the right strategies and early intervention by an Occupational Therapist, older people with physical limitations can be empowered to live a fulfilling life with active engagement and participation in daily activities. With the impending silver tsunami, it is essential to ensure that our seniors remain in the pink of health and continue their active lifestyles by engaging in regular physical activity. Thus, promoting independence and keeping the seniors active in the community has become the crucial aims of quality living. *Updated 2019

As we grow older, it is natural to worry about our health as there is a myriad of health problems such as high cholesterol and other long-term health conditions to give pause to. 8 Vol. 1 No. 1 / Sep - Dec 2020

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I ns i ght

I n s i gh t

Here are some suggestions on how Occupational Therapists can empower seniors with physical limitations to be actively participating in daily activities happily and with great ease:

With reduced vision, it is essential that larger fonts are used to help our seniors read better.

#1

Redesigning their Daily Routines In order to help our seniors remain physically active and independent, it is essential to make healthy changes in one’s daily life. This includes planning each day with a focus on completing tasks of a higher priority. This helps them retain a strong sense of control in their lives. In our busy world, there are often too many things to accomplish within the limits of a day. Time should be set aside

to list the tasks one wants to achieve and prioritise them accordingly. This helps to reduce mental stress as well as celebrate the accomplishment. For instance, important tasks should be completed early in the morning, when one’s energy is at a prime level. This is followed by less important tasks. Incorporating frequent breaks in the daily schedule also helps to ensure that energy levels go a long way.

#2

Promoting an Easier Daily Life

There are many ways to encourage seniors with physical limitations to engage in daily activities.

Using built-up handles or universal cuffs on eating utensils can help those with grip difficulty feed themselves. Items such as the long-handled sponge, buttoner and shoehorn can be used in showering and dressing. These equipment allow seniors with trunk or upper limb stiffness to perform daily tasks in a seated position safely. Front-load washing machines and portable low height laundry racks encourage ease of laundry management. Repositioning of microwaves and induction cookers to a lower height also promotes simple meal preparation for seniors in wheelchairs. 10 Vol. 1 No. 1 / Sep - Dec 2020

#3

Enhancing Vision

This includes re-labelling and enlarging the expiry dates on food items and medication, as well as using phones or light switches with enlarged numbers or buttons. The use of magnifiers can help them with reading newspapers and other labels. Good lighting throughout the house, such as night lights along the stairways, bedrooms and toilets allow our loved ones to move safely and independently through their living spaces. Appropriate use of contrast, such as highlighting the edges of kerbs and steps with fluorescent tape or paint, can also heighten their awareness of possible hazards.

#4

Creating a Safe Home Falls may threaten the health and independence of seniors. Hence, creating a safe living environment can enhance their ability to remain independent. To reduce accidental falls, we can remove clutter around the house, as well as rearrange furniture to widen walkways. Loose wires and cables should be tied or taped to the wall or floor. Consider placing non-slip mats in wet areas around the home, installing grab bars in toilets, and using shower chairs or bedside commodes, to enhance the safety of seniors with Source of article : https://www.healthhub.sg/live-healthy/1095/healthy-living-in-your-golden-age physical limitations. Through the appropriate use of suitable adaptive equipment, we can greatly reduce the risk of falls at home. Falls may threaten the health and independence of seniors. Hence, creating a safe living environment can enhance their ability to remain independent. 11 Vol. 1 No. 1 / Sep - Dec 2020


I ns i ght

#5

Developing a Positive Social Well-being Keeping an open mind to exploring new and meaningful activities can create a positive impact on our senior’s physical and mental well-being. Encourage them to learn a new skill or pick up a new leisure activity such as granny ballet, folk dance, calligraphy or even tea appreciation. Studies have shown that continuous and lifelong learning helps maintain mental alertness.

With the availability of the Internet and social media, seniors can also easily access electronic services, grow their social network and actively participate in new social activities. They can also make new friends and renew their relationships with old ones. This can further strengthen their social network and enhance their quality of life. In conclusion, physical limitations in old age may be inevitable. However, creating successful participation in daily life can enhance their experience of old age and selfconfidence. The ideas outlined above are a few of the many other recommendations that can aid in promoting the independence of seniors with physical limitations. Occupational Therapists have a unique professional skill base of holistic assessment and enhancement of an individual’s performance through relevant interventions, consistent with promoting the experience of active and successful ageing. Source : HealthHub

Download the HealthHub app on Google Play or Apple Store to access more health and wellness advice at your fingertips. 12 Vol. 1 No. 1 / Sep - Dec 2020

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Fe at ure Ar ticle

Healthy Ageing in the Time of Covid-19 - Trends in the UK By Chris Born, Senior Healthcare Specialist, Department for International Trade UK

The Impact of Covid-19 The coronavirus has had a disproportionate impact on older people with the vast majority of deaths in the UK (88%) occurring in the over-65s, especially men (57% of all deaths). About half of the care homes in the UK and one in five domiciliary services have clients diagnosed with coronavirus, putting the staff as well as service users under great strain. Many staff have also been infected or are staying at home due to their own vulnerability. A similar picture can be seen across Europe and the world.

Fe at u re A r t i c l e • patient safety and preventing avoidable harm • clinical collaboration More than 35 UK tech companies have responded to these needs using Artificial Intelligence, offering their systems at cost price or lower to government services. In addition, NHS X selected 18 companies for TechForce19 to help vulnerable people isolated by Covid 10. For example, Elsevier have made available a free Clinical Information Toolkit to help deliver a comprehensive COVID-19 support programmes, including staff and patient education, treatment, care provision and public & patient information. Kraydel’s Konnect system enables easy video calling from the user’s own TV helping them stay connected with family and carers who can call from their phones and share photos and videos. Konnect is also an IoT platform for remotely monitoring physical wellbeing and local environment as well as connecting with other IoT devices such as medical devices and can be used to support isolation for COVID-19.

The UK’s response As well as responding to the immediate needs for ICU, PPE, ventilators and medicines, testing kits and support for staff, the health and care system has seen a blossoming of new approaches to assessing, diagnosing, testing, rehabilitation and caring for older people. This has included the creation of new “surge”“NHS Nightingale” hospitals in a matter of days and the creation of new medical devices (such as simpler, quick to build ventilators with wider functionality). The NHS website, NHS 111 (telephone and online service), NHS Pathways (clinical assessment tool) have all been mobilised to respond to the epidemic. Primary care services have responded by turning the norm of face to face consultations on its head, moving to 90% being carried out through telephone or video. A dozen UK digital medical records and consultation companies have adapted their systems to meet this need and been approved by the NHS in record time. New virtual desktop infrastructure has been created to allow GPs (family doctors) and their staff to access their systems and work from anywhere. Other new systems have been produced in rapid time for: • reporting data in real-time • managing staffing at scale • leveraging credible health information • managing virtual pathways • secure and instant clinical communication • tackling loneliness and isolation • remote monitoring and digital therapeutics • self-care, remote consultation and companion apps 14 Vol. 1 No. 1 / Sep - Dec 2020

Kraydel’s Konnect System 15 Vol. 1 No. 1 / Sep - Dec 2020


Fe at ure Ar ticle

The UK’s Care Industry The UK’s system is increasingly integrated with primary, secondary and community care linking together to meet the needs of older people. The UK has a strong history of designing healthcare around the patient and continues to develop new approaches to providing healthcare services that interlink, supported by facilities, systems and training. This means that people receive a continuum of services across health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care services.

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The aim of the NHS Long Term Plan is for all areas in England to be covered by Integrated Care Systems by next year. Within these systems, increasingly services and practitioners will work together to meet all the needs of individual people in need and their families. For example, in Wakefield, West Yorkshire Integrated Care Hubs relieve pressure on primary and secondary care, as GPs can just ring one number or complete one e-referral for a person with multiple needs. Once assessed and referred, people can be seen by a nurse, occupational therapist, physio, social care worker, voluntary worker, housing officer or mental health worker, depending on their problem. Increasingly these services are being brought together physically, for example in the Jean Bishop Integrated Care Centre in Hull. This is set to transform care for older people in Hull by providing out of hospital care, reducing unnecessary hospital admissions, enabling residents to keep fit, healthy and living independently in their own homes. In a new and unique approach to health and care, a clinically led team will primarily treat 12,000 frail older people in Hull with long term conditions who have been assessed by their GP as being at risk. Similar innovation is seen in new designs for supported community living for example for people with dementia. This includes a new dementia village in Dover and a well-researched dementia friendly home together with a competition to design a “Home of 2030”. The UK is also seeing a rapid development of diagnostics, advanced therapies, remote treatment and rehabilitation, supported by over 100 academic institutes focusing on ageing, government accelerators and national NHS developments driven by NHSX.

The UK’s Offer to Health and Care Systems and Investors As well as the Covid-specific responses, the UK has developed innovative systems to meet the needs of older people. This builds on an ecosystem of ground-breaking research and innovation institutes, Academic Health Science Networks and government and private sector investment and accelerators. The UNFPA indicated that in Asia and Pacific “by 2050, the population of older persons (aged over 60) in the region will triple between 2010 and 2050, reaching close to 1.3 billion people”. This has far reaching social and healthcare implications. This brings a multitude of opportunities for the UK to partner with countries in the region.

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16 Vol. 1 No. 1 / Sep - Dec 2020

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Fe at ure Ar ticle The UK is home to new approaches to providing care at home and in care homes with care providers and transformation consultancies ready to provide advice and training for these. The digital offer ranges from managing whole caseloads and their staffing to maintaining people’s safety and health at home to using robots for social interaction and monitoring. Taking a wider, preventive view, the UK has designed new responses to managing the common complaints of ageing e.g. hearing, eyesight, incontinence and foot problems, living well with cognitive impairment, sustaining physical activity and health at work, supporting social connections and healthy buildings and environments.

Fe at u re A r t i c l e We welcome interest in how the UK is meeting the challenges of Healthy Ageing and look forward to inspiring and successful collaborations.

The UK welcomes and supports companies that want to set up here. As well as the support that we at the Department for International Trade can give and the favourable innovation ecosystem, companies get access to a well-off consumer base. A fifth of the 12 million Brits aged over 55 have more than £100,000 in savings. Over 50s in the UK hold 68% of all UK household wealth ($10.7 trillion). The over-65s spend £114 billion per annum on goods and services and nearly £50bn on privately funded long term care. The overall demand for social care is in excess of £100bn with government funding about half of this. The UK Government has committed to a £4.7 billion increase in research and development over the next four years to address the grand challenges including the Ageing Society. This builds on support already in place through the National Institute of Health Research (NIHR), for example though its ENRICH research programme in care homes.

Meeting the Grand Challenge All this is part of a wider Industrial Strategy for the UK that puts Healthy Ageing in the forefront as one of the Grand Challenges to be met. The vision is to increase healthy life expectancy by five years by 2035. This means all sectors of society and business need to provide products and services that are suitable for al generations. This not only makes good social sense, it is a commercial imperative too. The older generations are increasing in number and in wealth, so their needs must be met if businesses are to be successful. As well as a shift in health and care from a treatment to a prevention paradigm, businesses need to think how they can enhance later life by making their products and services accessible and multi-generational. Key elements of this are age friendly work and leisure places, supportive housing and accessible transport, easy to use culture, learning and communications. To support this, financial and professional services and consumer design and products need to meet the aspirations of the older population. As each region develops its local industrial strategy, Greater Manchester have set out to be the UK’s first age-friendly city. The UK’s Design Council has brought people together to encourage entrepreneurial innovation in the design of goods and services. Investors, supported by private and government funds are spearheading the creation of the next generation of technology providers for healthy ageing. The University of Hertfordshire boasts a robot house to test at home robotics. Institutes such as the National Innovation Centre for Ageing are bringing together academics, public sector and industry to find the answer to how to live well over a 100-year life. 18 Vol. 1 No. 1 / Sep - Dec 2020

National Innovation Centre for Ageing Chris Born

Senior Healthcare Specialist Department for International Trade UK Chris.born@trade.gov.uk

C

hris is a former NHS CEO who has worked as a senior consultant specialist with Healthcare UK at the Department for International Trade (DIT) for the last eight years. He was interim Managing Director in 2016. He works with National Health Service (NHS) and commercial health and care organisations in the UK to make an integrated offer to operators, developers, investors, governments and health services in the target markets of India, SE Asia, China, the Middle East and other countries. He is very well versed in all aspects of healthcare and most recently worked on the AI in Healthcare Trade Mission to India and a major hospital programme there and healthy ageing in China and other markets. He is the DIT Ambassador for the Ageing Society Grand Challenge of the UK government’s Industrial Strategy. He has been responsible for the development of a detailed set of UK offers, including clinical services, infrastructure, training and digital health. 19 Vol. 1 No. 1 / Sep - Dec 2020


Co

S pot l i ght

Stephanie Ludwig, MDiv, MA, PhD

S po t l i gh t

The tech connection: Alleviating loneliness

In fact, the hazards of loneliness are so severe interrupt. Thus the nature of a person’s social that they call for creative and compassionate network is key to the level of social isolation responses. To this end, in 2018 Great Britain they experience. appointed the world’s first Minister of Loneliness following the release of a national TECHNOLOGIES TO THE RESCUE report on this health risk. In our increasingly mobile world, it can be Social and family relationships are key to hard at any age to keep up with tech trends health and quality of life at any age, but and changes. To keep older adults connected Stephanie Ludwig, MDiv, MA, PhD both loneliness and social isolation— to family and social networks, technologies which are different but often overlap— can on the market and in development can increase in later years. Social neuroscience help reduce any associated loneliness. researcher John Cacioppo describes This includes both high-tech and low-tech loneliness as the dicrepancy between the solutions. The AARP Foundation conducted a Alleviating loneliness as we age social connection you want and what you national survey in 2018 to better understand actually have.3 Physical isolation may result loneliness among adults over age 45.4 From This article is provided courtesy of International Not all solutions need to be highfrom living in a rural location with limited the 3,020 residents surveyed in the United Council on Active Aging (www.icaa.cc) tech, as mindfulness practices transportation options, financial constraints, States, researchers found, ironically, that education level, race or being housebound technology both reduces and contributes to reveal due to illness; but emotional isolation can social isolation, and so must be used wisely by Stephanie Ludwig, MDiv, MA, PhD compound loneliness from events like to enhance face-to-face interaction. “Loneliness breaks the spirit,” goes the old retirement and loss of community, medical Jewish proverb. We are wired to be connected, conditions like depression, geographical or Although technology should never be a that it adversely affects our health and Not solutions and all miserable whenneed we to are be not. Although emotional separation from loved ones, death substitute for physical contact, the study longevity with depreshigh-tech, mindfulnessfrom others the sense ofas disengagement that and is associated of a spouse, unhealthy relationships, or found, it can reduce feelings of loneliness 1 While the causes of loneliness sion.time practices reveal characterizes loneliness is painful at any stigmatized sexual orientation (identifying and enhance communication. And for family complex and may include heritable in life, such disconnection can feel are acutely with a socially outcast gender). Research caregivers of housebound loved ones, such traits, personal history, environment by Stephanie Ludwig, MDiv, MA, PhD unbearable as we age. We may face not only also shows that therole of caring for a loved connections can be a lifeline. and and relationship quality, its prevalence that it adversely affects our health Not all solutions need to be natural challenges like diminishing physical one has caneven often and is associated depres-older adults today high-tech, as mindfulness among moreisolate the primary family “Loneliness breaks thelongevity spirit,” goes the with capacities, but also additional suffering caused 1 caregiver.4 sion. While the causes of loneliness practices reveal In 2018 a research team reviewed 38 adverse old proverb. We are wired to world beincludethat are complex and may heritable by Jewish a digitalized, outerfocused tooeffects. One study linked social studies of group, one-to-one and solitary isolation in old age with poor health and connected, and miserable are to traits,when personal history, environment by Stephanie Ludwig, MDiv, MA, PhD often breaks the bonds we we need maintain How any of these situations is experienced interventions that sought to reduce social andof relationship quality, its prevalence recommended urgent social intervennot. Although the sense disengagemeaning purpose in older our adults lives.today has even more among “Loneliness breaks the spirit,”and goes the is ofpersonal: Loneliness is a subjective isolation and loneliness among older adults. tions to reduce the risk cardiovascular ment from others that characterizes adverse effects. One study linked social old Jewish proverb. We are wired to be and stroke.2 experience particular to an individual’s These included social group facilitation, is painful atisolation any time inage life, in old with poordisease health and connected, andloneliness miserable when we are Research on the physical and psychological perception of being isolated, whereas social psychological therapies, healthcare provision, recommended urgent social intervennot. Although the sense of disengage- can such disconnection feel acutely effects of loneliness confirms that it adversely to reduce risk of cardiovascular ment from others that characterizes objective and includes the lack animal and friendship interventions, and In fact, the hazards ofisolation lonelinessisare so unbearable as we age. tions We may facethenot 2 disease and stroke. loneliness is painful at anyour timehealth in life, and affects longevity and is associated ofcreative a strongand social network. Cacioppo and his leisure/skill development.7 Three common onlycan natural challenges like diminishing severe that they call for such disconnection feel acutely 1 with depression. While the causes of loneliness colleagues found compassionate responses. To this end, in that extended loneliness features of effective interventions were Inalso fact, the hazards of loneliness are so unbearable as we age. We may face not but physical capacities, additional are complex and may include heritable traits, severe that they call for creative and only natural challenges like diminishing for any the reason 2018 Great Britain appointed world’sheightens an individual’s adaptability to the specific needs of suffering caused by a digitalized, outercompassionate responses. To this end, in physical capacities, but also additional personal history, environment and relationship sensitivity to social threats,5 which may lead participants, involvement of participants in Minister of Loneliness following worldouterthat too2018 often breaks Great Britainthe appointedfirst the world’s suffering causedfocused by a digitalized, quality, its prevalence among older adults today to report avoidance the release of a national on thisof others and self-isolation, the development of the intervention, and bonds we need meaning and following first Minister of Loneliness focused world that too often breaksto themaintain has even more adverse effects. One study linked on thisrisk. bonds we need purpose to maintainin meaning and the release of a national report further exacerbating loneliness: That is, as we productive (reading or crafting) rather than health our lives. health risk. purpose in our lives. social isolation in old age with poor health and become lonelier, we may also become more passive (watching television) interventions. recommended urgent social interventions to onpsychothe physical and psychoself-centered6 and less desirable for others When these features were present, the Research on theResearch physical and Continued on page 46 disease Continued on page 46 reduce the risk of cardiovascular and logical effects of loneliness confirms logical effects of loneliness confirms to interact with, contributing to a vicious intervention alleviated loneliness regardless stroke.2 cycle that is vicious cycle that is difficult to 44 The Journal on Active Aging Special technology issue 2019 www.icaa.cc Courtesy of of Canyon Canyon Ranch Ranch Courtesy

Living Well With Canyon Ranch

The techas we age connection: Alleviating loneliness The Tech Connection:

as we age

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The Journal on Active Aging Special technology issue 2019 www.icaa.cc

Vol. 1 No. 1 / Sep - Dec 2020

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S pot l i ght of whether an individual was in a group, with especially when uncomfortable. I also another person or animal, or alone.8 observe that participants are more comfortable being alone with themselves Two notable interventions were participation and have a desire to cultivate a healthy in an eight-week Mindfulness-Based Stress solitude. Reduction (MBSR) program and solitary use of technology such as telephone, video There are countless creative, personalized conferencing or Internet to connect with ways for older adults to connect and engage, others. The most promising results showed and even alleviate the emotional pain of reduced subjective feelings of loneliness loneliness. For instance, Pamela Dintaman, and expression of pro-inflammatory genes MDiv, a colleague at Canyon Ranch, worked that increase morbidity and mortality risk. with an older woman who was living in a new condominium and terribly lonely. For the purposes of this article, we will This woman mentioned she used to host categorize these interventions as hightech— a book-share table in a previous setting. In the digital technologies themselves— and their discussions, she began considering low-tech, or mindfulness and self-care the possibility of creating a book-share in practices to connect more deeply to oneself her new community and was inspired to and mitigate the stress that perceived move in that direction. Her plan reflects the loneliness creates. features of effective loneliness interventions. She identified an active, adaptable way of connecting to others that was of interest LOW-TECH & MINDFULNESS to her. For older adults who experience PRACTICES aging related limitations, any shame or embarrassment can be a root cause of Mindfulness is a practice of observing and loneliness and social isolation. So the accepting, without judgment, our present practice of connecting within is a wonderful moment experience that generatesa low-tech way of reducing any age-related softening or compassion toward ourselves. stress and stigma associated with feeling Not only can an eight-week MBSR program, left out (see page 26 for “Specific mindful such as mentioned above, connect practices for tech use.”) participants to others in a meaningful shared activity, the regular solitary practice Here are some ideas for alleviating loneliness of mindfulness meditation deepens a by reconnecting us to ourselves, to others, sense of connection to ourselves that to nature and to a higher power: shifts how we perceive our experiences, including painful ones like loneliness. At • Cultivate a healthy solitude by Canyon Ranch, I regularly teach mindfulness practicing meditation or journaling to through a weeklong program entitled get in touch with your inner life. “Presence: Mindfulness in the Modern • Practise daily prayer or reading of a World.” At the conclusion of the week, sacred text to remember your participants consistently report a deepening connection to a higher power. of connection with themselves and other • Initiate a new friendship with someone participants, and greater acceptance of and who shares a common interest and be kindness toward what they are experiencing, receptive to an offer of friendship. 22 Vol. 1 No. 1 / Sep - Dec 2020

S po t l i gh t • Take a class at a community center, local college or business to learn a new subject, language, technical skill or creative hobby. • Spend time outdoors walking, hiking, gardening or birdwatching. • Visit a museum, performance or observatory to explore arts and sciences. • Get a part-time job doing something fun in an enjoyable environment. • Start or join a book discussion group. • Join a gym, take yoga or tai chi classes, or play tennis or pickleball. • Join a synagogue, church, mosque, meditation group or other spiritual community. • Join an affiliation group with people who share a common experience or identity. • Begin a therapeutic relationship with a counselor or spiritual director. • Participate in a bereavement group. • Start a progressive dinner or rotating meal circle with neighbors.

HIGH-TECH SOLUTIONS

of connectedness and less loneliness and depression.10 Especially notable are intergenerational approaches to bringing isolated older adults into social settings, including those who are housebound or in community residential settings.11 (To learn more about tech solutions and intergenerational approaches, see the page 25.)

TECH CHALLENGES AND RECOMMENDATIONS Although not a replacement for realtime human interactions, technology can help older adults maintain regular, remote contact with family, friends and others who share similar experiences, identities or passions, as well keep themselves physically and cognitively fit. However, it is true that among older adults who didn’t grow up with tech, learning and using tech devices can be daunting.12 It also can be challenging for people with vision, hearing and motor control limitations. A 2014 Pew Research Center survey13 found that 39% of adults 65 and older face a physical condition or health challenge that impedes their use of technologies like the Internet, cell phones and smartphones. 82% reported being fearful about using new technologies, and 77% reported they would need assistance to learn how to use devices and social networking sites. Tablets and e-book readers were found to be more accessible, especially for those with reading difficulties.

Although high tech is sometimes viewed as detrimental to actual physical connections (studies show this is true for millennials), it can reap untold benefits in the older-adult population, especially among boomers, who are the fastest growing tech adopters, according to Statistics Canada.9 Devices and applications already on the market, along with those in development, are addressing how to increase communication and connectivity among family, friends, caregivers and groups. Effective connection and engagement through technologies for older adults may Although results are mixed determining require adaptation to the physical capacities which are the most successful, most research agrees that those that enhance communication do lead to higher levels 23 Vol. 1 No. 1 / Sep - Dec 2020


S pot l i ght of the user, modification of some devices, education on the benefits of these technologies and training in their usage, and recognition that technology use complements face-to-face engagement but cannot replace it.

inclusive communities.15

When I work with people transitioning into retirement or the last quarter of their lives, I ask: What is your wisdom and how will you contribute it to your community in your remaining years of life? In other words, how One study’s recommendations especially will you serve as a wise elder? for community leaders10 include removing financial barriers to purchasing devices or The question is usually met with surprise, Internet, expanding Wi-Fi infrastructure and then quiet reflectivity, as I explain what and offering more tech learning programs has been lost and needs to be reclaimed especially in settings such as “living and culturally. I remind them that the wise elder care communities.” Targeting specific reaches beyond the immediate circle of populations such as older women—who family and offers something needed by a more often are likely to be widowed and wider community. Everyone has wisdom living alone—can be especially valuable. For to offer, and somewhere there is a need. families and community-based programs, Perhaps this is the optimal path to develop procuring age-friendly apps like digital for alleviating loneliness and creating games, especially like bingo or others built meaningful connection and engagement. on familiarity, can help improve cognitive functions and promote online collaborative Stephanie Ludwig, MDiv, MA, PhD, is Resorts Director interactions. of Spirituality, Canyon Ranch. Ludwig has over

PURPOSEFUL AGING Elders have traditionally held a revered place in societies that value wisdom. Over two decades ago, Rabbi Zalman SchachterShalomi wrote prophetically about turning aging into a time of meaning and joy by embracing an aging process centered upon becoming a sage in one’s community.14 Although Schachter-Shalomi may not have foreseen the explosion in technology today, the rabbi clearly understood that loneliness and social isolation have a direct and negative impact on elders’ health and quality of life. As the world’s olderadult population continues to grow, it is critical that technology-based applications, programs and policies target older adults to reduce feelings of isolation, loneliness and alienation. In turn, such compassion will also help to create healthier, kinder and more 24 Vol. 1 No. 1 / Sep - Dec 2020

20 years of professional experience teaching and accompanying people spiritually as a spiritual guide and retreat leader in private practice, as a spiritual community leader, educational program director, college instructor and crisis counselor.

HIGH-TECH SOLUTIONS Social isolation and loneliness are modern-day challenges for older adults. A 2016 study identified several technologies that help alleviate social isolation among this population:15 general information and communication technologies (ICT) (Internet/email and computer use; helps overcome mobility limitations, identify transportation routes, home food deliveries) social networking sites (Facebook, Twitter, etc., to build and maintain social relationships and support despite distance or mobility challenges, especially when facing lifechallenging events) robotics (sense of social presence and communication, including a pet robot for animalassisted therapy and a “conversational agent” for social connection)

digital/video games (e.g., especially Wii or others that mimic natural physical activities to improve cognitive and social skills; offers venue for meeting others)

3D virtual environments (where participants are represented by an avatar, mimicking face-to-face interactions; can provide emotional support)

Technology to alleviate loneliness in older adults also may focus on sensing and monitoring,16 for example to track an individual’s peer support chat rooms physical changes and social (especially when facilitated activities to determine if she by experts such as in is becoming more isolated, healthcare) such as using the phone or Internet less often. Tech Tele-Care (uses ICT to can also help adults make evaluate direct social connections: health status and Skype, Facetime, Facebook, deliver care anytime, Instagram and Twitter are anywhere; monitoring, all available Internet tools communication and to build connection and support) engagement. personal reminder information and social management (PRISM) software applications

videoconferencing (can overcome mobility challenges; only five minutes weekly with family alleviated depressive symptoms and loneliness for skillednursing residents)


S pot l i ght Editorial commentary

Editorial commentary

to a more purposeful and meaningful In this are article, Dr. important Stephanie life. These extremely concepts provides that are often in Ludwig us neglected an insightful our accelerating digitalized lives where dissection of the importance of loneliness is often overlooked understanding lonelinessand and misunderstood. The absence options to reconnect to ofa meanmore ingful loving attachments can be an purposeful and meaningful life. accelerator of aging, loss of cognitive These areeven extremely important ability and physical and physiconcepts that are often neglected ologic changes like arthritis and in our accelerating digitalized hypertension.

Richard Carmona,MD, MD,MPH, MPH,FACS FACS Richard Carmona, Mother Teresa most Mother Teresa said,said, “The “The most terterrible poverty is loneliness and rible poverty is loneliness and the feeling unloved.” the feelingofofbeing being unloved.”

lives where loneliness is often The antidote for loneliness is not just overlooked and misunderstood. beingabsence around people, for some of The of meaningful loving the loneliest people are surrounded attachments can be an accelerator by others but there is no emotional of aging, loss of cognitive connection. It has been said that “No ability and even physical and man is an island,” and this applies to physiologicchanges like arthritis humans and animals in general since and hypertension. that are to often we are genetically programmed neglected inin our accelerating seek and thrive relationships and communities.lives where loneliness digitalized is often overlooked and Loneliness is a multifactorial challenge misunderstood. The absence of that affects the loving young and the aging meaningful attachments alike. Although the causes may can be an accelerator of aging, vary, the treatment approach is the loss cognitive ability loving and even same:ofmaintain meaningful physical andand physiologic changes relationships pursue a purposeful like life. arthritis and hypertension.

and how will you contribute it to your community in your remaining years of life? In other words, how will you serve as a Wise Elder? The question is usually met with surThe antidote for loneliness is not prise, and then quiet reflectivity, as I just being for to explain whataround has been people, lost and needs some of the loneliest be reclaimed culturally. people I remindare them surrounded by others butbeyond therethe that the Wise Elder reaches is immediate no emotional It circle ofconnection. family and offers something needed by a wider commuhas been said that “No man is an nity. ”Everyone wisdom to offer, and island, and this has applies to humans somewhere there is a need. Perhaps and animals in general since wethis is the optimal path to develop for alleviare genetically programmed to ating loneliness and creating meaningful seek and thrive in relationships connection and engagement.

and communities.

Stephanie Ludwig, MDiv, MA, PhD, is

Loneliness is ofaSpirituality, multifactorial Resorts Director Canyon challenge that affects the young Ranch. Ludwig has over 20 years of professional experience teaching and and the aging alike. Although theaccompanying people spiritually as a spiricauses may vary, the treatment tual guide and retreat leader in private approach is the same: maintain practice, as a spiritual community leader, meaningful loving relationships educational program director, college inand pursue a purposeful life. structor and crisis counselor. Richard Carmona, MD, MPH, FACS, References is Chief of Health Innovations at 1. Canli, Ranch, T. (2017, September). loneliness Canyon 17th How Surgeon can make you sick. Retrieved on March 27, General of https://www.apa.org/science/ the United States, 2019, from and about/psa/2017/09/loneliness-sick. Distinguished Professor, Zuckerman College of Public 2. Valtorta, N. K., Kanaan, M., Gilbody, S., et Health, University of Arizona. al. (2016). Loneliness and social isolation

as risk factors for coronary heart disease Richard Carmona, MD, MPH, FACS, and stroke: systematic review and metais Chief of Health Innovations at analysis of longitudinal observational studies. th InSpecific this article, Dr. Stephanie Ludwig mindful practices for tech use Canyon Ranch, 17 Surgeon General Heart, 102(13), 1009–1016. doi: 10.1136/ provides us an insightful dissection of the United States, and Distinguished heartjnl-2015-308790 ofAlthough the importance ofseem understanding it may that technology andZuckerman mindfulness areofatPublic odds—one being outer oriented and the Professor, College 3. Cacioppo, J. T. (2009). Loneliness: Human loneliness and options to reconnect other inner directed—they are quite compatible when used creatively.17 Mindfulness brings awareness Health, University of Arizona. Nature and the Need for Social Connection.

to the present moment, no matter what a person is doing—or not doing. There are currently thousands New York, NY: W. W. Norton. of apps that are free or by subscription that help the user practice meditation, either by playing calming or following alongSpecial withtechnology an instructional As well, when we are using tech devices, we can The Journal on Active Aging issue 2019video. www.icaa.cc 50 music bring our attention fully to them, giving us the dual benefits of calming the mind and getting things done. • Bringing awareness to your smartphone: how it feels, how it looks, your appreciation of it, its texture and buttons and temperature. • Listening to a podcast in a seated meditation posture, bringing your awareness back to the podcast each time it wanders • Paying attention to how you feel, what emotions arise, as you surf the Internet • While watching TV, noticing the television set itself: its shape, the reflections, the light and colors that emanate from it. • Paying attention to your breath and posture while texting or emailing: Are you holding your breath? Constricting your posture by hunching over the screen? 26 Vol. 1 No. 1 / Sep - Dec 2020

RESOURCES 1. Canli, T. (2017, September). How loneliness can make you sick. Retrieved on March 27, 2019, from https://www. apa.org/science/ about/psa/2017/09/ loneliness-sick. 2. Valtorta, N. K., Kanaan, M., Gilbody, S., etal. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and metaanalysis of longitudinal observational studies. Heart, 102(13), 1009–1016. doi: 10.1136/ heartjnl-2015-308790 3. Cacioppo, J. T. (2009). Loneliness: Human Nature and the Need for Social Connection. New York, NY: W. W. Norton. www.icaa.cc Vol. 18 No. 4 The Journal on Active Aging 51 4. AARP Foundation. (2018). Loneliness and Social Connections: A National Survey of Adults 45 and Older. Retrieved on March 27, 2019, from https://www. aarp.org/ content/dam/aarp/research/ surveys_ statistics/life-leisure/2018/ lonelinesssocial-connections-2018. doi.10.26419-2Fres.00246.001.pdf. 5. Cacioppo, J. T., & Cacioppo, S. (2014). Social relationships and health: The toxic effects of perceived social isolation. Social and Personality Psychology Compass, 8(2), 58–72. doi:10.1111/spc3.12087 6. Cacioppo, J. T., Chen, H. Y., & Cacioppo, S. (2017). Reciprocal influences between loneliness and self-centeredness: A crosslagged panel analysis in a population-based sample of African American, Hispanic and Caucasian adults. Personality and Social Psychology Bulletin, 43(8), 1125–1135. doi: 10.1177/0146167217705120 7. Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation and loneliness among older people: An integrative review. Health and Social Care in the Community, 26(2), 147–157. doi: 10.1111/hsc.12367

8. Creswell, J. D., Irwin, M. R., Burklund, L. J.,et. al (2012). Mindfulness-Based Stress Reduction training reduces loneliness and proinflammatory gene expression in older adults: A small randomized controlled trial. Brain,Behavior and Immunity, 26(7), 1095–1101. doi: 10.1016/j bbi.2012.07.006htm. 10. Alibhai, K. (2017, July). Social Isolation and Technology: How technology can be used to reduce social isolation among older adults in British Columbia. Samuel Centre for Social Connectedness. Retrieved on June 25, 2019, from http://www. socialconnectedness.org/wp-content/ uploads/2018/02/Social-Isolation-andTechnology-How-TechnologyCan-be-Used-to-Reduce-SocialIsolation-Among-Older-Adults-inBritish-Columbia.pdf. 11. Baecker, R., Sellen, K., Crosskey, S., et al. (2014). Technology to reduce social isolation and loneliness. Proceedings of the 16th International ACM SIGACCESS Conference on Computers & Accessibility. Retrieved on March 27, 2019, from http://openresearch. ocadu.ca/id/eprint/1004/. 12. Haederle, M. (2011, August 29). Technology Fear Stops Older Adults From Logging On. AARP Bulletin. Retrieved on June 23, 2019, from https:// www.aarp.org/technology/innovations/ info-08-2011/elderly-fear-oftechnology. html. 13. Smith, A. (2014, April 3). Attitude, Impacts, and Barriers to Adoption. Pew Research Center. Retrieved on March 27, 2019, from http://www.pewinternet. org/2014/04/03/attitudesimpacts-andbarriers-to-adoption/.

14. Schachter-Shalomi, Z. (1997). From Age-ing to Sage-ing: A Revolutionary Approach to Growing Older. New York, NY: Time Warner Books. 15. Khosravi, P., Rezvani, A., & Wiewiora, A.(2016) The impact of technology on older adults’ social isolation. Computers in Human Behavior, 63, 594–603. doi: 10.1016/j. chb.2016.05.092 16. Gleckman, H. (2018, March 22). How to Reduce Loneliness in Old Age. Forbes. Retrieved on June 25, 2019, from https://www.forbes.com/sites/ howardgleckman/2018/03/22/how-toreduce-loneliness-in-old-age/ #488c55664574. 17. Tartakovsky, M. S. (2018, July 8) Using Technology to Help Us Practice Mindfulness. Psychology Central. Retrieved on June 25, 2019,from https:// psychcentral.com/blog/usingtechnologyto-help-us-practice-mindfulness/.


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Social Isolation in Older Adults during Covid-19 Pandemic By Dr Tan Jit Seng, Chairperson of ELDEX Asia Advisory Board

Social isolation is nothing new in this modern society whereby older adults do not live in big noisy families as in the past. Empty nest syndrome has been well studied and there are multiple social factors contributing to such social problem. Covid-19 pandemic has worsened the magnitude of such situation. Generally, I will look at the issue of social isolation from 2 populations, those cognitively intact and those cognitively impaired with mental health conditions. The main issue that social isolation can cause will be loneliness, a sense of helplessness, and hopelessness. These are all precursor of depression and risk factors for suicide in the Older Adults. This risk is magnified for those with pre-existing mental health conditions. Different cultures, traditions and habits factor heavily during the isolation. Humans are a social species and many people in most places enjoy social interactions among one another. Some depend on such interactions to make meaning to their lives. We are made

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and meant to live in a social community, totally hands off on the technology. from the time of our prehistoric ancestors. Apart from social connectiveness, we must So, what is social isolation? Social isolation is promote a regular “lockdown� lifestyle which that condition of total or near-total absence includes regular exercises and diet. This will of contact between an individual and society. be especially important to prevent physical Can it be possible since social connectivity functional decline. Exercises should include resistance training to prevent osteoporosis has been part of our human DNA? and sarcopenia, endurance for general well One study in 2013, Social Isolation: A being and flexibility exercises to keep joints Predictor of Mortality Comparable to in their full range of movements and for Traditional Clinical Risk Factors concluded balance to prevent falls. that social isolation is an independent risk factor for increase mortality risk, just as A regular diet and intake of protein rich and the usual chronic medical conditions likes calories dense food should be supplemented hypertension or smoking. In Older Adults, with exercise. One issue of depression is the isolated at home without good planned lack of appetite, which further deteriorates physical activities, nutritional support the calories intake and results in increased coupled with depression can lead to lower frailty. immunity. This can further increase the risk of severe Covid-19 disease if the Older Adults Mental exercises like meditation and for those religious Older Adults, regular praying were to be infected. should be encouraged. Since mental Physical and mental health may not be the activities can strengthen the resilient to fear only problems encountered by Older Adults. and hopelessness to the unknown. Those from the lowest social economic group may not be able to continue to work Since starting my tele-geriatrics services, from the economic downturn. This can lead I have also started 2 Older Adults on antito increase depressive mood and worsen depressants. Proper and timely use of antiphysical and mental health. With lockdowns depressant to promote a sense of wellbeing, happening, less volunteers, decreased enhance better sleep and improves the charity funding can also affect the support appetite can be extremely useful. given to at risk Older Adults in the lower For those with pre-existing mental health social economic population. issues or cognitively impaired, cared for by To counteract some of the negative effects regular caregivers, social isolation can affect of social isolation, we can first attempt to both the Older Adults and their caregivers. convert the whole direction of strategies to We often treat both parties as a unit, since promote Physical Distancing with Enhanced without good care from a sound caregiver, Social Connectiveness. Using technology the Older Adults will not be well. like phone calls, app messaging, telecommuting and even tele-presence robotics For Older Adults having exposed to daily for daily, frequent, regular interactions can be news on Covid-19, understanding they are beneficial. I personally find my tele-presence at most risk to develop serious disease, the robotics to be a convenient and lovely way fear of contacting the infection and death is to communicate daily. The advantage of tele very close and real. That can result in a sense -presence robotics is the Older Adult can be 29 Vol. 1 No. 1 / Sep - Dec 2020


Cover S tor y On the caring for the caregiver side, home caregivers can also use similar strategies. However, since caring the Older Adults should be a team-based work, it will be important to link up with the healthcare providers regularly, using technologies like tele-commuting with doctors and nurses. Caregivers can also leverage on home deliveries of medications and food items to reduce the burden. It will be good to outsource some of the work if the family resources permit. To conclude, proper planning and regular “lockdown” lifestyle should be instituted. Plans for some well-deserved activity should be done to promote hope and meaning for this fight.

of great anxiety. It will be helpful for Older Adults not to view such negativity regularly and focus their attention on something they like, such as listening to music or doing some handicrafts. Caregivers should focus on promoting a sense of safety. For example, here in Singapore, the current community spread is very low and usage of masks decreases the infection risk by a lot. Hence, the risk of contracting the virus in the community is extremely low with all these measures. With a regular “lockdown” lifestyle, Older Adults can retain some control of their life and such control can promote less anxiety as well. Finally, caregivers should give them hope for the future. Do some future planning when the pandemic is over. This will allow the Older Adults to be focused and have meaning to continue this fight. 30 Vol. 1 No. 1 / Sep - Dec 2020

Photo by Andrea Piacquadio from Pexels


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Why Covid-19 is so dangerous for older adults

Older people and people with chronic illness are at greater risk, and how we respond to the threat affects everyone. By Umair Irfan and Julia Belluz

Age, however, doesn’t tell the whole story about who is at risk of severe disease. In fact, it reveals the underlying vulnerabilities in the wider population to an illness like Covid-19. Many of these factors are concentrated among older adults, but younger people with certain underlying health problems are also at risk. (60% of Americans have at least one chronic condition; 40 percent have more than one.) The lessons we learn from older patients could help us treat and prevent the spread. That makes it all the more important to understand the variables that put older adults at greatest risk so we can develop a strategy to protect society as a whole.

Even before the Covid-19 coronavirus reached more than 100 countries around the world, early data from China — where the outbreak started — suggested that older adults were the most vulnerable to the worst effects of the disease.

IMMUNE FUNCTION DECLINES WITH AGE. THAT MAKES US MORE SUSCEPTIBLE TO MORE SEVERE ILLNESS.

Now, that data, along with emerging research from Italy — a very affected country in the world — is showing just how dangerous Covid-19 is for older people, and others with heart, lung, and immunological conditions.

As we age, the systems our bodies use to fight disease wear down. Not only does the body have a harder time fighting off new infections like Covid-19, it’s also more likely to be afflicted by chronic diseases that make the immune system weaker.

In Italy, a country with one of the world’s oldest populations, a March 4 analysis by the national health institute found that of the 105 patients who died from the virus, the average age was 81. This put a 20-year gap between the average age of people who tested positive for the virus and the deceased, the institute said. On March 6, an ICU physician in Lombardy — the epicenter of Italy’s outbreak — told JAMA (The Journal of the American Medical Association) there have been only two deaths of people under the age of 50. This finding squared with some of the other best data on the risks of the new respiratory disease, from China’s Center for Disease Control. In a late February report, researchers looked at the first 72,314 patients with confirmed or suspected Covid-19 and discovered a huge variation in the case fatality rate by age group. In short, the disease appears to be deadlier in people with each passing decade.

Christina Animashaun/Vox

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Let’s walk through the first part: how our bodies get worse at fighting foreign invaders, including viruses like SARS-CoV-2, which causes Covid-19. In older adults, the number of white blood cells that find and help eliminate infections can decline. The cells also become less adept at identifying new pathogens to fight. In the case of Covid-19, the virus can also damage the immune cells that might otherwise overcome the virus. If there are fewer of these cells to begin with, and they’re also weaker than they once were, an illness can do more damage. “Immune function is not as robust as it is in younger people,” said Sean Leng, a geriatrician and a professor of medicine at the Johns Hopkins University School of Medicine. “Studies over the years have shown that in most people, their immune function is pretty okay in their 60s, or even in their 70s. The immune functions go down rather quickly after age 75 or 80.” When a response to infection kicks in, an older person’s immune system faces a higher chance of a dangerous overreaction known as a cytokine storm. Cytokines are proteins that serve as signals to the body to ramp up its infection-fighting machinery. But during a storm, these cytokines are overproduced, which causes severe inflammation, high fever, and organ failure. In other words, it’s not just a sluggish response to infections that can harm older adults; the immune system’s overreaction to an invader can also kill, Leng said. “The cause of death of this virus is, No. 1, respiratory failure, and then No. 2, probably the cytokine storm.” The good news, as two doctors at the University of Alabama Birmingham wrote for Vox, is that we have treatments for cytokine storm syndrome, which could help save a significant number of lives in this outbreak.

Li Wei, a school teacher turned volunteer in the fight against coronavirus, takes an older resident’s body temperature in Changsha, China, on February 28, 2020. Xinhua/Chen Zeguo via Getty Images 35 Vol. 1 No. 1 / Sep - Dec 2020


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OLDER PEOPLE ALSO HAVE A HIGHER PREVALENCE OF CHRONIC DISEASE

It’s not clear why Covid-19 is especially risky for people with these diseases. But in general, respiratory diseases can be especially dangerous for people with cardiovascular disease.

The longer we live, the more likely our cells are to replicate in dangerous ways, the more damage they accumulate, and the more likely our organs are to stop functioning normally. This puts us at a heightened risk of chronic health conditions, like cancer or diabetes. Along with already weakened immune systems, these underlying diseases can make it harder for the body to ward off infections. The takeaway: It’s not just age alone that endangers people; it’s being older with one or more chronic diseases.

When the lungs don’t function properly, the heart has to work even harder. Researchers have also known that diabetes can damage the nervous system and impair the body’s efforts to clear infections from lungs. Conditions like high blood sugar associated with diabetes can also suppress immune cells.

Among the 105 patients who had died in Italy as of March 4, two-thirds had three or more pre-existing conditions. The most common was hypertension, followed by ischemic heart disease and diabetes mellitus. These chronic illnesses can leave organs degraded and more vulnerable to infection. Additionally, the treatments for these conditions can suppress the immune system, leaving the body susceptible to pathogens. In a World Health Organization report on China’s outbreak, the case fatality rate in people who reported no chronic diseases was 1.4 percent, but it shot up in groups with these conditions: “13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.” Another study on China, newly published in The Lancet, found that nearly half of the 191 hospitalized patients in the sample had another underlying illness. “These people are dying of an inflammatory process in their lungs. It’s not an infectious process, like a bacterial or viral infection. It’s inflammatory, like we see with SARS,” said Bruce Aylward, who led the WHO mission to China that produced the report. He was referring to the fact that SARS — like the new coronavirus — drove some people’s immune systems into overdrive, leading to cytokine storm. But that immune response seems to be worse in people with underlying health conditions, the Chinese data showed. Aylward said, “the proportion of people who die who had cancer was half compared to hypertension and cardiovascular disease. Diabetes is a little bit lower than those two, and cancer lower again.” The CDC recommends several measures to help prevent the spread of Covid-19: • Wash your hands often for at least 20 seconds. • Cover your cough or sneeze with a tissue, then throw it in the trash. • Clean and disinfect frequently touched objects. • Stay home as much as possible, and do not go out if you are sick. • Wear at least a cloth mask in certain public settings. • Contact a health worker if you have symptoms.

There are other problems associated with aging that play a role here as well. Older people may be less efficient at coughing and sneezing, making it harder for them to clear the Covid-19 virus, which infects the airways. Accumulated lung damage in older adults from habits like smoking or breathing polluted air can further increase vulnerability, so when Covid-19 strikes, it can lead to problems like severe pneumonia. On the other hand, it’s still only a minority of older adults who are facing the most severe consequences of Covid-19. Many have recovered, and older people in otherwise good health will likely survive the infection, Leng said. “If you have a strong immune system to begin with, you can most likely fight against the virus.”

SOCIAL FACTORS PLAY A MAJOR ROLE IN VULNERABILITY TO DISEASE Beyond physiology, how society treats older adults plays a big role in their risk from diseases like Covid-19. At the same time, measures like social distancing and quarantines remain our most effective tactics for shielding the most vulnerable during this outbreak. “Right now there isn’t a vaccine, so we have to start thinking about other ways that people can be protected,” said Julie Masters, chair of the department of gerontology at the University of Nebraska Omaha. (Geriatrics is the clinical specialty for treating the elderly; gerontology is the scientific study of aging.) But there are trade-offs with distancing tactics, particularly for isolated older adults, as Vox’s Ezra Klein observed about a major National Academies of Sciences report looking at the health consequences of isolation: The researchers found that even before the coronavirus, about a quarter of older adults fit the definition of socially isolated — which measures routine social contact — and 43 percent said they felt lonely. You can be socially isolated without reporting feelings of loneliness, and you can be lonely without being socially isolated. But both conditions seem to inflict harm on physical and mental health.

Guidance may change. Stay informed, and stay safe, with Vox’s coronavirus coverage hub. 36 Vol. 1 No. 1 / Sep - Dec 2020

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Conversely, researchers have found that robust social networks and interactions improve health for older adults. “We know that when people are more integrated socially, when they have people in their life, when they have a sense of meaning and purpose, that’s good for their overall well-being, their overall health,” Masters said.

“Given their congregate nature and residents served (e.g., older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by Covid-19,” according to the CDC’s website. “If infected with SARS-CoV-2, the virus that causes Covid-19, residents are at increased risk of serious illness.”

That’s creating a difficult situation for older people who need protection from diseases like Covid-19 but may already be quite isolated. So the concern here isn’t just older people who may get sick; it’s people who will experience a drop in their quality of life in response to the outbreak.

But these measures to limit the spread of Covid-19 can also hamper care for other chronic illnesses among older adults, particularly as the people providing the care start to keep their distance. “As a virus like this becomes prevalent, it may not be that [older adults] get sick, it may be that the person who comes into their home to care for them every day has a cough and stays home,” Eshbaugh said.

Another issue is how older adults interact with the health care system. As noted earlier, age tends to bring more chronic illnesses, which in turn demand more frequent health interventions or ongoing treatment in places like nursing homes.

A cleaning crew suits up in protective clothing before entering Life Care Center on March 12, 2020. John Moore/Getty Images

OLDER ADULTS MAY FACE THE GREATEST RISKS, BUT THE Covid-19 OUTBREAK AFFECTS EVERYONE While the majority of the people infected by Covid-19 will survive, there will be significant ripple effects if large numbers of older adults get very ill or die from the disease.

Pat Herrick lost her mother, Elaine Herrick, 89, a resident of the Life Care Center nursing home in Kirkland, Washington. Jason Redmond/AFP via Getty Images

“With our most frail, most ill older adults, it’s not just that they’re older and they have a compromised immune system, it’s also that many times they are in situations that put them at risk, in terms of congregate living,” said Elaine Eshbaugh, a professor of gerontology at the University of Northern Iowa. “They [may] live in a nursing home where if something like [Covid-19] happens, it takes off like wildfire.” We saw this happen at the Life Care Center in Kirkland, Washington, where Covid-19 infected 50 residents and killed 23 patients. The Centers for Disease Control and Prevention has now put out additional guidance for nursing homes and long-term care facilities to deal with the outbreak. 38 Vol. 1 No. 1 / Sep - Dec 2020

That’s particularly true in the United States, where the population as a whole is getting older. There are almost 50 million Americans over the age of 65, and their ranks are growing rapidly. These people are our co-workers, employers, friends, family, caretakers, and educators. They are major contributors to our economy and our social fabric, providing value beyond what’s captured by economic metrics like GDP. Only about 5 percent of seniors in the US live in assisted care facilities, which means the vast majority, even those with chronic illnesses, are living on their own or with family while going about their normal lives.

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Cover S tor y That means that everyone has to work together to control the spread of Covid-19, and we all stand to suffer if we don’t. Younger people can limit the infection’s spread to the more vulnerable with good hygiene, self-isolating when they’re sick, and practicing social distancing measures so they can avoid getting the virus and passing it along to their older family members. This is particularly important for Covid-19 Joe Biden held a press conference about the US coronavirus response in since people can transmit the virus before Wilmington, Delaware, on March 12, 2020. Saul Loeb/AFP via Getty Images experiencing any symptoms. And we’re still learning about the dangers of this disease and how quickly it’s spreading, so there may be other groups at risk that we don’t yet understand.

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Some of the factors that put older adults at greatest risk are not unique to them. Whether you’re 75 or 35, chronic illnesses worsen outcomes from infections like the new coronavirus. Younger people have already fallen ill and have died from Covid-19, though they make up a much smaller share of the afflicted. However, the potential damage from this virus could be immense: More than 10 million Americans are immunocompromised, and more than 100 million US adults have diabetes or prediabetes. So the measures we use to protect older adults, both physically and mentally, can help younger people in similar situations. “There are young people ... they’ve got those underlying conditions, and that’s what puts them at risk” from Covid-19, Masters said. This outbreak is also an opportunity to rethink and strengthen our personal health and social infrastructure. “This may be a wake-up call to us to think about our own aging and what can I do to make sure I’m in the best health possible,” Masters said. “Meaning, am I getting a good diet? Am I exercising? Do I have people in my life? Do I have social connections? All those things can keep us healthy.” But at a time when people are being forced apart with offices closing, conferences being canceled, students staying home, gyms shutting down, and individuals isolating themselves those social connections are becoming harder to maintain. We’ll need to make active efforts to stay in touch, for our own health, and for those around us.

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I nnovat i on & Techno logy

I n n ovat i o n & Te c h n o l o gy

IoT and the elderly By Isabel Kunkle, SmartBrief Telecommunications Editor

Elderly people are often stereotyped as being bad with technology -- but they are one of the groups who can benefit the most from recent technological advances. The internet of things, in the form of connected cars, wearables and particularly smart home devices, is providing an increasing number of ways for seniors to stay active, independent and safe for longer. These advances are just in time: In 2015, the World Health Organization predicted that, by 2020, 20% of the US population will be age 60 or older. One main cause of this trend is that the elderly are living longer -- a fact that creates new challenges for them and their loved ones. A recent Consumer Technology Association survey found that 70% of people caring for elderly relatives worried about them forgetting to take medications, and accidents were a concern for 60% of those 42 Vol. 1 No. 1 / Sep - Dec 2020

caregivers. Technology can help in a number of ways, but three categories particularly stand out: seniors’ health, their safety, and interaction with the wider world.

HEALTH Biometric readings and activity tracking are a growing phenomenon among all age groups. While younger people may be trying to run marathons or fit into their college jeans, seniors and caregivers are more likely to also be keeping track of blood pressure to avoid hypertension, monitoring their heart rates to make sure pacemakers or artificial valves are doing their jobs, and watching blood sugar to manage diabetes. Off the wrist and in the home, even medication containers are becoming technologically advanced. MedMinder stores medication in advance by daily doses,

Technology advancements are also looking to address ways to help seniors get and about more easily via autonomous cars. Declining vision and reflexes can make it more difficult for senior citizens to drive themselves places, and many seniors live in communities where public transit access is scarce or inconvenient, if it exists at all. Joseph Coughlin, who leads the Massachusetts Institute for Technology ENVIRONMENT AgeLab, tells the New York Times, “The Increasingly brittle bones and frailer systems aging of the population converging with mean that falls are much harder for the autonomous vehicles might close the elderly to recover from than for younger coming mobility gap for an aging society.” people. Falls are potentially even fatal, and almost half of seniors need assistance CONCERNS AND CONCLUSIONS simply getting back on their feet after a fall. Naturally, seniors have the same worries In the past, such incidents have reduced the over privacy and security that other ability of older people to live alone, but now consumers do where the internet of things smart home products such as Walabot are is concerned. Corporate harvesting and trying to address this issue by, for example, use of data, the potential for hacking and automatically detect falls or using voicesimple technological breakdowns can be activated or motion-sensing lights to reduce intimidating factors, and both technology fall frequency by increasing visibility. companies and individuals need to take these into issues account. The GrandCare product consists of a network of home sensors that feed into a The promise of independence and “aging single web portal for health care providers, in place” rather than in nursing homes caregivers and the seniors. The capabilities overcomes these concerns for a significant of GrandCare extend to detecting whether proportion of seniors, however. In the CTA or not someone opens the refrigerator door survey, monitoring and safety tech would at their usual time and alerting others if they get the green light from 64% of seniors, and have not, which could lead to timely medical 61% said they are willing to use technology intervention in the event of a stroke, heart that facilitates active aging and greater attack or other disabling medical events. independence. flashes to let a user know it’s time to take meds, then issues a series of audio reminders and finally alerts to a caregiver or relative if there’s no response. For many seniors who have to take multiple medications per day, often at very specific times, such a use of technology could be a lifesaver.

INTERACTION GrandCare is also one of a number of programs that allow elderly people to communicate with caregivers and loved ones through video chat. Social interaction is an important part of mental health, as it helps keeps the brain active to fight dementia and technology that enables communications can be vital, particularly for people who have difficulty getting out of their homes.

As the population continues to age and families further apart, technology becomes one of the vital solutions for helping elderly people stay active, healthy and connected to the wider world.

43 Vol. 1 No. 1 / Sep - Dec 2020


I nnovat i on & Techno logy

TELE-HEALTH REHABILITATION, E-SERVICES AND ROBOTS ARE TRANSFORMING THE HEALTHCARE LANDSCAPE FOR THE ELDERLY AND THEIR CAREGIVERS IN SINGAPORE.

I n n ovat i o n & Te c h n o l o gy TELE-HEALTH REHABILITATION CAN BRING ELDERLY CARE TO THE HOME Seniors who require rehabilitative services may be able to recover from the comfort of their own home soon with the help of tele-health rehabilitation systems. Therapists (or other healthcare professionals) will be able to guide their patients through the session via an internet-based video call and assess their progress through data provided by the wearable motion sensors attached to the patients’ limbs. Caregivers can also join in the session remotely through the video-conferencing service.

ASSISTIVE TECHNOLOGY THROUGH ROBOTIC ASSISTANTS Assistive technology devices for seniors are also part of the digital wave that will bring elderly care into a new era. Are you familiar with the names Pepper and Palro? In Japan, Pepper the robot works as a “carebot” in an elderly home, providing entertainment and explaining medical reports to patients, while Palro the mini robot can provide companionship and even assist in physical therapy. Meanwhile, Singapore has also been exploring how robots can help provide support for older citizens. Robocoach, developed by Ngee Ann Polytechnic, is a robot that can help seniors stay healthy by leading exercise sessions. Currently, research is underway to develop a screen radar that could help people with visual impairments have improved learning and communication experiences. Currently, research is underway to develop a screen radar that could help people with visual impairments have improved learning and communication experiences.

In Singapore, the number of senior citizens aged 65 and above is expected to reach 900,000 by 2030. Coupled with rising chronic illness demands and the nation’s low birth rate, it is important that seniors are provided with the support they need for healthy ageing. Here is where cutting edge technology plays a part. Whether they are seniors living at home or in assisted living facilities, the use of assistive technology or specially curated assistive devices for seniors can provide better home care and help seniors stay independent or improve senior care services for caregivers. Instead of alienating seniors, healthcare digital transformation can provide them and caregivers with support. As part of Singapore’s Smart Nation initiative, the country has rolled out tele-health rehabilitation, e-services and even robotic nurses, shifting the concept of elderly care from hospital to home.

SMART SENSOR TECHNOLOGY TO AID ELDERLY CARE Caregivers may soon be able to have greater peace of mind when they are away from home, thanks to smart technology, or to be more specific, smart sensor technology. Once installed, these smart sensors can passively monitor the activities of frail or elderly family members and send out an alert whenever an abnormality is detected. Smart homes will also have panic wireless buttons for the elderly to notify their loved ones in the event of an emergency. 44 Vol. 1 No. 1 / Sep - Dec 2020

WEARABLE TECHNOLOGY FOR SENIORS Regular exercise is key to healthy ageing! With the help of wearable technology (such as steps trackers) and our Healthy 365 mobile app, hundreds of thousands of participants — both young and old — took part in the National Steps Challenge. Besides tracking their steps and earning rewards, seniors can also track their diet through the Healthy 365 app.

DIGITAL HEALTHCARE COMPANION With HealthHub, seniors living by themselves can also be empowered and equipped with healthrelated knowledge and tools to take greater ownership of their health and wellness. Besides medical information, such as details of the medication they are taking and known side effects, seniors can also make use of the app on their mobile phone to locate healthier eateries and sports facilities nearby, or even set reminders for them to take their medication! Additionally, caregivers can better manage the health of their loved ones with convenient access to their medical records and appointments! To start, seniors will have to grant access to their nominated caregiver through the app in four simple steps. They can then choose which health records they want to share, including vitals, lab test results, screening results and medical information.

DIGITAL HEALTHCARE COMPANION As virtual reality paves the way to virtually visit remote locations, seniors with limited mobility are now able to combat isolation and boredom with VR apps. There are also phone apps that can help seniors monitor their heart rates, or allow their family members to track where they are. 45 Vol. 1 No. 1 / Sep - Dec 2020


I n Th fo ceuHo s t S e at

with :

Tristan Gwee

President of the Gerontological Society of Singapore Mr Tristan Gwee is the current President of the Gerontological Society of Singapore. He joined the society in 2006 and has served in various capacities of Honorary Treasurer and Secretary. He is also a member of the Singapore Association of Social Workers. He is a social service professional with more than 16 years’ experience in areas of eldercare, fundraising and volunteer development. He is a certified Prepare and Enrich Facilitator and also trained in the GottmanMethod of Couples Therapy. He obtained his Master degree in Social Work from Singapore University of Social Sciences (formerly UniSIM), and his Bachelor degree in Applied Economics from Singapore’s NanyangTechnological University. Tristan serves as board member on the ELDEX Asia Advisory Board.

Thank you for taking time out to join us for this interview. To start this off, perhaps you can share with us what is your daily routine during this period where everyone is working from home. What is your daily routine like? Photo by Andrea Piacquadio from Pexels

“Well, I kind of have a timetable I set for myself. It starts with breakfast and the usual morning routine. Then I typically scan through all my morning emails and reply all the urgent and important ones. After that, I will have a few important ‘big stone’ items on my to do list that I intend to work on. Lunch is at home. I repeat the same order after lunch. But if there are virtual meetings during the day I just work around my schedule. I try to end at 5 and go for my daily jog. Something that I picked up during the CB and I am glad I did. Good self care and stress buster!” What are the challenges facing the eldercare industry during this period of uncertainty? What are some of the measures taken to address these challenges? 49 Vol. 1 No. 1 / Sep - Dec 2020


I n The foc uHot s S eat

I n Th fo ceuHo s t S e at Source: Mr Tristan Gwee

Source: Mr Tristan Gwee

Well, generally speaking I think revenue is group homes would be more resilient in a definitely going down and costs are going pandemic situation. up, with the additional safety and manpower Another issue that emerged out of this requirements. Covid situation is our over reliance on I think in an effort to boost productivity foreign manpower. I think we need to relook and reduce manpower costs, many would at how we are renumerating our essential be looking at how to employ technology workers in the eldercare sector in order to better. I have also noticed a number of attract more locals to join. Ageism is another design thinking initiatives being organized factor that possibly discourages seniors to address the challenges brought about from joining the sector. Failure to address by the ‘new normal’. In the non-profit sector age discrimination is a missed opportunity where I work, more agencies are going into across industries. digital transformation. It is a must! Airlines and tourism-oriented industries are cutting manpower with massive Eldercare housing is another area that needs slashes on revenue, do you reckon the relooking. We should encourage more eldercare industry would be forced to assisted living facilities in anticipation of take such drastic measures and how future pandemics when family caregivers detrimental would it be on the bottom who are living apart are not able to meet. We line? have been building more and more nursing homes with big capacities. Perhaps smaller I guess it depends on what is the nature 50 Vol. 1 No. 1 / Sep - Dec 2020

of the business even when we are talking about the eldercare industry. The essential ones will definitely have to carry on whereas those more geared towards the luxury end will probably experience greater impact. Healthcare and long-term care are essential.

the various stakeholders in the eldercare ecosystem. Certain industries may not survive or scale down. It will be the employers’ market. Provide the right training and help them to adapt. Good people will join you.

With so much negativity floating and sinking in all industries, perhaps you could shed a bit of light from your perspective on what are the positive things the industry can look forward to in the next 6 months?

need to take a longer term view. The better we are able to help each other work through our problems, the better our chances at long term survival.

Suppliers to elderly homes and those in the supply chain would be affected during What are the long-term effects that you this period. How can they maintain a foresee with the current epidemic on the healthy business relationship with clients industry? during these times, and what do buyers If the economy suffers for a protracted period, look for in a supplier? then the savings of the current generation I browsed a book “Partner with Purpose” who will be entering the silver generation in written by Steve Schmida recently. I the near future will be affected and hence think working closely with the buyers their spending power. There will also be an and understanding their difficulties is an added impetus on the way we deliver care… important first step towards long term concern over transmission through human sustainability. We are all in this ecosystem interaction, we might be more reliant on together. How can we help them to do robotics and AI. better so that it is also beneficial for us? We

What is your advice to the industry feeling the slump now? And what Population is still ageing. Covid has presented additional measures should they be us with the perfect market disruption. It taking during this period? has given us an opportunity to change the narrative on ageing and how we provide Don’t lose heart! Be open and adapt to new care. We need to be more open and engage ways of operating and new opportunities. 51 Vol. 1 No. 1 / Sep - Dec 2020


I n foc u s

I n fo c u s or if you even need it? How do you best apply and monitor it? How do you ensure the most beneficial aspects of technologies are successfully implemented, and with a minimum of disruption or mistakes? And how do you retain the personal, social connections so critical to well-being, while also staying current and competitive?

Photo: Photo: Dorothy Dorothy Shi

TechTalk

Marilynn MA MarilynnLarkin, Larkin, MA

The flip side: The flip side:

Weighing benefits VS drawbacks of innovative Weighing benefits versus Organizations need to be tech savvy and technologies drawbacks of innovative

By Marilynn Larkin, MA

Have This Now

Technology: The word can evoke both excitement and uncertainty among activeaging industry providers in all settings, from senior living and seniors centers to health clubs and rehabilitation centers.

High-speed broadband Internet connections (DSL, fiber-optic, cable, wireless, satellite)

87%

87%

82%

Wireless connections that are strong in all areas of the building

77%

77%

76%

Cellular connections that are strong in all areas of the building

78%

75%

89%

Voice-activated assistants, e.g., Amazon Echo or Alexa or Google Home

26%

32%

6%

Monitors in floors and rooms to track movement patterns

16%

18%

8%

Smart technology to control light, heat, appliances

24%

25%

24%

High-speed broadband Internet connections (DSL, fiber-optic, cable, wireless, satellite)

9%

9%

9%

Wireless connections that are strong in all areas of the building

17%

18%

10%

Cellular connections that are strong in all areas of the building

14%

17%

4%

Voice-activated assistants, e.g., Amazon Echo or Alexa or Google Home

13%

17%

6%

Monitors in floors and rooms to track movement patterns

6%

7%

6%

Smart technology to control light, heat, appliances

12%

15%

4%

status quo, a learning curve and, of course,

by Marilynn Larkin, MA a cost.

How do you know if you’re choosing the right product for your wellness services—

Technology: The word can evoke both How do activeyou know if you’re choosing the excitement and uncertainty among Continued on page 58 aging industry providersright in all settings, product for your wellness services— Vol. 1 No. 1 / Sep - Dec 2020

Milner expands on that theme below. In this interview for my column, he shares examples of how technology can help—but at times work against—dimensions of wellness and society at large.

All Sr. Living & Organizations may remodel or build new structures to provide wiring and respondents care infrastructure. Does the place where you work have these today, or plan to add N = 310-394 N = 226-294 them?

from senior living and seniors centers to Organizations need to be tech savvy and equipped with health clubs and rehabilitation centers. Excitement, because new new technologies Excitement, because technologies the products and services to accomplish often provide opportunities to accomplish their customers often want provide opportunities tasks faster and more easily and may and need, says ICAA CEO tasks faster and more easily and may enable enable staff and constituents to take charge Colin Milner. But they also staff and constituents to take charge of their of their health and connect socially; need to ensure that those health and connect socially; uncertainty, uncertainty, because implementing those technologies don’t replace same applications often requires asame change interpersonal interactions— because implementing those and that they deliver on their in the status quo, a learning curve and, of applications often requires a change in the course, a cost. claims

56 52The Journal on Active Aging January/February 2020 www.icaa.cc

Or, they spend an inordinate amount of time tweaking it instead of being active. That’s part of the pitfalls of technology: You have to use it if you want it to make a difference in your life, and at the same time, you need to know when to let go, live your life and let the app do what it’s supposed to do.”

equipped with the products and services their customers want and need, says ICAA CEO Colin Milner. But they also need to ensure that those technologies don’t replace interpersonal interactions— and that they deliver on their claims

technologies

This article is provided courtesy of International Council on Active Aging (www.icaa.cc)

“Technology has become both a solution and a challenge,” states International Council on Active Aging® CEO Colin Milner. “For instance, the wonderful part about many available wellness apps is they enable us to have a greater focus on self-care, selfwellness and personcentered solutions—so that we are not only encouraged, but in some ways forced into being more responsible for our own health.

“However, there’s a flip side to those apps: In order for them to help, you actually have to use them, and use them appropriately,” Milner adds. “Too often, people download an app, set it up and forget about it.

Technology in the built environment Centers & agencies N = 49-58

Plan to add

Table 1. Technology in the built environment. Source: Ryan, P. (2020). ICAA Environments for Wellness. Vancouver, BC: International Council on Active Aging. Available at www.icaa.cc/listing.php?type=industry_research. 53 Vol. 1 No. 1 / Sep - Dec 2020


I n foc u s Since 2016, when ICAA convened its think tank to explore the future of technology for active aging,1 Milner has worked to define technology’s value for the industry and help organizations find their way. “Carefully considering the total potential impact of any given technology—that is, the upsides and possible downsides—can help organizations make the best possible decisions for their staff and members,” he says. ML: Colin, you’ve emphasized the importance of knowing your organization’s capabilities before you start looking at new products and services. Can you elaborate, and also touch on the challenges? CM: Your capabilities are critically important because everything else feeds into that. The number one capability right now is Wi-Fi, with solid broadband throughout the organization, particularly if you’re running a senior living community. If you have old buildings that challenge your broadband, meaning that connections are spotty because the building isn’t capable of handling it, then your community members and staff will have difficulty using apps that track steps or monitor vital signs, as well as operational apps that depend on all community members being able to do things like making appointments for transportation. Without full capabilities, your technology can only do so much, and not always enough. If I’m thinking of moving into a senior living community or participating in a fitness studio or a hospital wellness center, and you don’t have a capability that is part of my lifestyle—maybe I want to watch a TV show while I’m riding a bike—then you become less appealing to me. So, the more that Wi-Fi and all the different applications around it permeate society, the bigger the 54 Vol. 1 No. 1 / Sep - Dec 2020

challenges for those who don’t have it. If your organization isn’t set up with adequate Wi-Fi and broadband, it could be a deal breaker (view Table 1 on page 53 to see which technologies organizations currently plan to add or have). ML: Once you are set up, how do you decide what to buy? Is there an issue with purchasing the latest gadgets and programs? CM: We’re at a stage with technology that there is so much out there, we almost have too many choices. It’s the difference between a classy restaurant with a twopage menu and a fast-food restaurant with a 30-page book of items. It takes you a long time to examine the book, and by the time you’re finished, you’re more confused than you are thrilled. You may even have lost your appetite. It’s hard to figure out what you actually want because there are so many options to choose from. Some people buy randomly, and others just give up altogether. What people can do instead is to step back and ask, What am I actually trying to achieve with a new technology? And how can I install it in such a way that it works seamlessly with the technologies I already have? Look first at your members’ needs, because if you can’t meet them, what you personally might want doesn’t really matter. Also look at your organization’s operational and staffing needs, perhaps even what the larger community might need to work with you on programs and events. Bringing everyone in to talk about their capabilities, needs and desires can help clarify issues associated with having so many choices.


I n foc u s

I n fo c u s

ML: Sometimes it’s difficult to know where to start when it comes to addressing everyone’s needs and prioritizing them. How might you handle that?

Of course, these technologically created environments should never be encouraged as a substitute for the real outdoors or social contact where applicable.

CM: I’d start with the lifestyle of the individual and how the community supports it. Whether you’re working in parks and recreation or senior living or seniors centers, if you are addressing multiple dimensions of wellness, the question is, what technologies might help?

ML: Let’s look at another aspect of technology getting a lot of attention these days, namely robots. You’ve noted that they are becoming more common in senior living communities. CM: Mention robots in senior living and people tend to point to the seal, the dog, the cat—essentially, social robots that are supposed to help with the emotional dimension of wellness by soothing anxiety, relieving depression and so forth. Incidentally, while those might indeed be helpful for that purpose, researchers say there aren’t enough quality studies yet to confirm it?3

Consider the environmental dimension of wellness. Virtual reality (VR) is widely discussed here because some products are positioned as helpful for people with dementia; a recent small study suggests it may have some benefits.2 But when you look at virtual reality as a multidimensional wellness tool, you see additional possibilities. Increasingly, robots also fill a practical role whereby they might become a resident’s As an industry, we spend a lot of money to assistant. For example, it used to be your create internal and external environments dog that responded when you said, “Fetch that foster wellness. VR is a third me this.” Robots on the near horizon will environment—an intangible one created by do just that: You say what you want, like technology—that you can set up to foster pills or juice, and the robot will bring it to wellness in several ways. One example is you. to encourage exercise. In fact, at least one company uses virtual reality instead of actual While that technology is great for people instructors to create motivating exercise who are physically challenged, I would environments. (See “Resources” on page 61) argue that there’s a fine line between a truly assistive product for those who Also, your community might have a are mobility challenged, and one that meditation room with four white walls. potentially and unintentionally promotes Instead of an environment that is essentially inactivity even among those who are more sterile, you could transform that room able-bodied. This is a common result even with a technology that projects soothing, with technology such as escalators and changeable images onto those walls. Or, powered doors. Organizational providers it could be as simple as a technology that and members need to be mindful of both changes a room’s lighting. These are simple potential outcomes. ways to create an environment that invites people to connect with themselves.

56 Vol. 1 No. 1 / Sep - Dec 2020

Some individuals resist tech assistance. In the feature on autonomous vehicles in the 2019 Journal on Active Aging® (JAA) Special Technology Issue,4 many residents preferred to walk on campus rather than make use of the vehicle. They felt instinctively that using the driverless vehicle when they didn’t really need to might compromise physical wellness.

On the plus side, you have a few technologies such as one covered in the JAA last year, called MusicGlove.5 These rehabilitation technologies depend on your using them consistently and appropriately, and when you do, you can become stronger.

ML: Wearables are incredibly popular in active-aging settings and in the community We see a similar conundrum with at large. What should organizations be exoskeletons. These outfits, fitted with paying attention to? special technology, can do things like give you a boost when you have to get up out CM: One major consideration here is of your chair. But if you can do that on your quality. We read studies showing the own, is the technology really assisting you benefits of monitoring steps and heart or is it deconditioning you? Is it a boon rate and so forth, but the technologies to people who need to recover from an used in clinical studies, broadly referred injury or a stroke, or might it actually to as “research grade,” are not always the delay recovery because instead of trying same as what you buy over the counter. to regain their strength, they’re relying on a product that could allow them to stay For example, a study published last weaker? year in the British Journal of Sports Medicine showed wide variation in energy These are issues that industry leaders expenditure measures from wrist- or armneed to keep in mind so that monitoring worn activity monitors depending on the and adjustments are factored into any manufacturer and the type of activity purchase and installation, with a plan in being measured. 6 The researchers noted place, and staff training, in how to use new that inaccurate fitness trackers may make technologies appropriately. errors like overestimating how much 57 Vol. 1 No. 1 / Sep - Dec 2020


I n foc u s someone is exercising, increasing the person’s risk of obesity; whereas trackers that underestimate activity may lead some people to overdo it and stress their cardiovascular system. So, you have to know exactly what it is you’re buying and understand its limitations versus a research-grade device. And that has an impact on the physical dimension of wellness. The other consideration is the amount of monitoring itself. Whether it’s for physical, emotional or other dimensions, at what stage do you hit the wall and tire of entering data? You have to be clear what results you want from all this monitoring: Is it helping you achieve important wellness goals or are you losing yourself in a numbers game?

S po t l i gh t mental health apps, with the anticipation that they can change lives. Do you buy them or not? Those decisions need to be made by people and by organizations on an individual basis and with awareness of limitations. A certain technology that promotes reminiscence, for example, might not improve memory loss but could help someone feel happier. That’s a different, yet valid, goal. ML: What about social media? Some people feel it’s a great way to engage with others. CM: Yes, some may feel more connected when they’re using these tools, but a concern is the amount of time spent on social media. As always, there is no substitute for real-time social connections. Social isolation is a real issue among older adults, however, and technology can help them get and stay connected, and make fulfilling virtual friendships, too.9

Even with all these considerations, wearables already have huge potential for the industry. These tools not only motivate people to adopt and sustain healthier behaviors, but also help users become better attuned to overall health. My feeling is that wearables— Support is warranted for social media which are still relatively new—will improve literacy. If people know the upsides and over time. downsides of social media ahead of time, they will be better prepared to navigate ML: What about cognitive fitness tech, like this space. For example, oftentimes brain games? individuals post what seems like a perfect life to Instagram and other platforms, even CM: Unfounded claims is an issue. The though they may struggle as much as United States Federal Trade Commission the next person. According to anecdotal sued one company for allegedly deceiving reports, constantly seeing these kinds of customers by saying its games could posts can affect people’s mental health, as help people do better at work and delay an article in The Guardian10 suggested last cognitive impairment.7 year. Unfortunately, there is a rapidly growing market offering products that are unproven, with no science behind their claims.8 People spend a lot of money on these products, whether they’re brain games, chronic disease management tools or 58 Vol. 1 No. 1 / Sep - Dec 2020

Get your copy now at S$22.99 (before 7% GST). Quote ‘ELDEXRocks!’ to enjoy a 10% discount. Delivery charges may apply. To order, please contact : info@eldexasia.com

My concern is also for the spiritual dimension of wellness. Are we going to not only lose the human touch, but also the human connection? Let’s remember, everything in moderation. 59 Vol. 1 No. 1 / Sep - Dec 2020


I n foc u s

I n fo c u s

ML: You’ve also expressed broader concerns and data and protect privacy with utmost with technology that you think the industry care. Members and residents also need to know what to do. should prioritize. Can you elaborate? CM: Online security is a primary concern. AARP did a survey in 2018 showing that most people don’t protect their digital identities.11 They don’t do basic things like changing passwords, monitoring their online banking accounts for suspicious activity, looking at all the information a phone app is privy to before installing it, or changing default privacy settings on their devices and social media platforms. Consider that devices like Alexa and other smart speakers and smartphones have listened in on private conversations.12 So, people are giving away their identity and their privacy, plus their time, for convenience’s sake. On the flip side, smart homes with digital personal assistants also provide safety and assistance for those aging in place in their homes and living in seniors housing. We need to look at both the advantages and disadvantages. In fact, we had a session at the ICAA Forum in October 2019 about the legalities around technology, what data providers can or can’t access and how that might affect people’s ability to age well. A multidisciplinary team from the University of Arizona—including Dr. Richard Carmona, former US Surgeon General and now chief of health innovations at Canyon Ranch—gave Forum participants an overview of what it means to adopt these technologies. And the team followed up with a recent article in the JAA on digital health privacy in active-aging settings. This article shares issues discussed at the Forum, describing the benefits of digital health technology as well as privacy challenges and solutions. I encourage everyone to give this article a read. Individuals, organizations and industries must know how to secure access 60 Vol. 1 No. 1 / Sep - Dec 2020

In addition, it’s important to remember that technology creates “haves” and “havenots.” Some individuals simply don’t have access to technology, period, whether it’s because of income, or the area they live in or other circumstances. Things many of us take for granted—staying updated, for example, which is relevant for current or future employers, or even communicating with government offices—can become a challenge. ML: What does technology’s double-edged sword mean for the industry as a whole, Colin? I know ICAA supports the implementation of useful technologies. CM: With technology, as with anything else, it’s “buyer beware.” We all need to do our homework to uncover both benefits and pitfalls. Just because something is on the shelf or advertised on TV doesn’t mean it works or is needed. At the end of the day, technology is part of 21st-century life. Industry leaders can embrace devices to address their clients’ needs while also ensuring technologies don’t replace interpersonal interactions—and that they deliver on their claims. Ultimately, it’s the human cost that we should care about, to be sure that social connections don’t get replaced or forgotten in the rush to keep up to date with innovative and helpful technologies. To me, that’s key for an industry focused on quality of life. We can circumvent a lot of these issues by taking control: What information we release is in our control; how much time we spend is in our control; what we do with any device is in our control. This is what it means to use technologies appropriately.

Whatever the “dark side” is, there is always a Jedi-like Luke Skywalker to “illuminate” the positives. And that can be each and every one of us. Marilynn Larkin, MA, is an award-winning medical writer and editor, an ACE-certified personal trainer and group fitness instructor, the editor of ICAA’s Research Review, and a contributing editor and technology columnist for the Journal on Active Aging®. Resources Internet International Council on Active Aging (ICAA) www.icaa.cc Wellness Solutions www.wellnesssolutions.com.au

Source : Tristan Le from Pexels

References 1.

International Council on Active Aging. (2016, May 4). The future of technology for active aging. Report from the ICAA Forum 2016. Available for free download in the “White papers” section at https://www.icaa.cc/business/ businesscase.htm.

2.

Tabbaa, L., Ang, C. S., Rose, V., et al. (2019, May). Bring the outside in: Providing accessible experiences through VR for people with dementia in locked psychiatric hospitals. Proceedings of 2019 CHI Conference on Human Factors in Computing Systems Proceedings, paper no. 236, pages 1–15. https://doi. org/10.1145/3290605.3300466

3.

Pu, L., Moyle, W., Jones, C., & Todorovic, M.(2019). The effectiveness of social robots for older adults: A systematic review and metaanalysis of randomized controlled studies. The Gerontologist, 59(1), e37–51. https://doi.org/10.1093/geront/gny046

Multimedia Flint Rehabilitation YouTube video: Everything you need to know about MusicGlove https://youtu.be/Pfa9utDRabA Print Galvan, T. (2019). Taming the tech tidal wave. Journal on Active Aging, 18(4), 34–41; July/Special 4. Technology Issue. Larkin, M. (2019). Reality check: What you need to know about products promoted for Alzheimer’s disease. Journal on Active Aging, 18(3), 26–33; May/June/July issue. Sklar, T., Carmona, R., Insel, K., & Robertson, C. (2019). Digital health privacy in active-aging settings: Will the law let you age well? Journal on Active Aging, 18(7), 34–42; November/December issue.

Larkin, M. (2019). Autonomous vehicles: Driving independence, mobility and wellness in activeaging communities. Journal on Active Aging, 18(4), 22–31; July/Special Technology Issue. Available free online to ICAA members in the “Articles” archives [search using keywords “autonomous vehicles”] at https://www icaa.cc.

5.

Larkin, M. (2019). MusicGlove: New robotics facilitate hand rehabilitation in stroke survivors. Journal on Active Aging, 18(2), 50–58; March/ April/May issue. Available free online to ICAA members in the “Articles” archives [search using keywords “MusicGlove”] at https://www icaa.cc

6.

O’Driscoll, R., Turicchi, J., Beaulieu, K., et al. (2018). How well do activity monitors estimate energy expenditure? A systematic review and meta-analysis of the validity of current technologies. British Journal of Sports Medicine. Published online first: September 7, 2018. https://doi. org/10.1136/bjsports-2018-099643

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I n foc u s 7.

United States Federal Trade Commission. (2016, January 5). Press release: Lumosity to Pay $2 Million to Settle FTC Deceptive Advertising Charges for Its “Brain Training” Program. Retrieved from https://www.ftc.gov/ newsevents/press-releases/2016/01/lumosity-pay-2million-settle-ftc-deceptive-advertising-charges.

10. Hern, A. (2018, September 17). Instagram Is Supposed to Be Friendly. So Why Is It Making People so Miserable? The Guardian. Retrieved from https://www.theguardian. com/technology/2018/sep/17/instagram-issupposedto-be-friendly-so-why-is-it-makingpeopleso-miserable.

8.

Larkin, M. (2019). Reality check: What you need to know about products promoted for Alzheimer’s disease. Journal on Active Aging, 18(3), 26–33; May/June/ July issue. Available free online to ICAA members in the “Articles” archives [search using keywords “reality check”] at https://www.icaa.cc.

11. Lilleston, S. (2018, September 5). Most People Don’t Protect Their Digital Identities. AARP. Retrieved from https://www.aarp.org/money/scams-fraud/info-2018/ online-identityprotection-survey.html.

9.

Ludwig, S. (2019). The tech connection: Alleviating loneliness as we age. Journal on Active Aging, 18(4), 44– 51; July/Special Technology Issue. Available free online to ICAA members in the “Articles” archives [search using keywords “tech connection”] at https://www.icaa.cc.

62 Vol. 1 No. 1 / Sep - Dec 2020

12. Su, J. B. ( July 30, 2019). Confirmed: Apple Caught In Siri Privacy Scandal, Let Contractors Listen To Private Voice Recordings. Forbes. Retrieved from https://www.forbes. com/sites/jeanbaptiste/2019/07/30/confirmed-applecaught-in-siri-privacyscandal-let-contractors-listen-toprivate-voicerecordings/#524db7f07314.


Fas hi on

FASHIONABLE ELDERLY LAUNDRY SHOP OWNERS DRESS UP IN CLOTHES LEFT BEHIND BY THEIR CUSTOMERS

What would you do if you owned a laundry shop and some of your customers have been forgetting to pick their clothes up? You’ll probably discard them, turn them into reusable bags or kitchen rags, donate them or possibly even sell them. But what this 80-year-old adorable couple from Taiwan did takes the cake. Ladies and gentlemen, introducing Wanji and Sho-Er.

THEY STARTED DRESSING UP.

Fa s h i o n

MAJORITY OF THE OUTFITS ARE PRETTY VINTAGE WHILE OTHERS ARE PRETTY TRENDY.

Apparently the grandkids couldn’t bear to see their grandparents so bored out of their Facebook page The Idea King first shared a wits that they began this tiny fashion project. series of images of the couple who posed adorably in outfits that were forgotten by And boy do they have some really good their customers. The post received over 17,000 shares. taste in fashion.

64 Vol. 1 No. 1 / Sep - Dec 2020

65 Vol. 1 No. 1 / Sep - Dec 2020


Fas hi on

C

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CM

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CMY

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AREN’T THEY FASHIONABLE? THE COUPLE ALSO HAVE AN INSTAGRAM PAGE AND BASED ON THE DESCRIPTION IN THE BIO, THE IDEA TO POSE WITH THESE FORGOTTEN CLOTHES WERE THEIR GRANDCHILDREN’S. Each Instagram post is accompanied by a description of the outfit with details on the age and material of the item provided. The description of the page reads, “Even though the clothes are over a decade old, they can still be trendy. Even though grandma and grandpa are 84, they can still be young.” Source : https://sea.mashable.com/ culture/11597/fashionable-elderlylaundry-shop-owners-dress-up-inclothes-left-behind-by-their-customers 66 Vol. 1 No. 1 / Sep - Dec 2020


HIGHLIGHTS

Post-show report Halls 405/406 Suntec Singapore and Exhibition Centre

103 exhibiting companies from Singapore, Malaysia, Philippines, Japan, South Korea, Taiwan, New Zealand, United Kingdom, USA and Canada

Visitor Profile Eldercare homes, retirement homes decision makers and real estate developers Healthcare and senior care professionals from government agencies, hospitals, hospices

Wholesalers, distributors, retailers HR Practitioners, Investors, VC, PE, Funds Consumers, end-users & caregivers

Healthcare and senior care service providers: specialists, doctors, nurses and allied health professionals including therapists, social workers

ELDEX 2019 RECAP Highlights of ELDEX Asia 2019 Participants at the inaugural ELDEX Asia 2019

Over 5,400

Professional Visitors

Over 2,750

Consumer Visitors

Over 2,688

Trade Visitors Satisfied

Dissatisfied

Consumer Visitors Satisfied

Dissatisfied

7%

7%

25% Very Satisfied

21% Very Satisfied 93%

93%

Medical Conference Pre-registered delegates

420

Medical Conference Satisfied

Dissatisfied

51.4% nurses 13.6% doctors

0%

35.0% allied health 6.4% from overseas

100%

SkillsFuture Singapore launched new skills framework 1 full day medical conference and B2B Workshops with 21 renowned local and international speakers

2 days B2C workshops with 19 speakers covering major eldercare topics on dementia care support, active aging featuring Team Strong Silvers


Seeing Eye Health Differently

Get your copy now at S$22.99 (before 7% GST). Quote ‘ELDEXRocks!’ to enjoy a 10% discount. Delivery charges may apply. To order, please contact : info@eldexasia.com

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Designing a system to allow the wheelchair rear wheel to retract backward to facilitate patient transfer with the use of transfer board and slide sheet.

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Elder Care Asia Magazine [Sep-Dec 2020]  

Elder Care Asia Magazine is a quarterly B2B eMagazine which aims to be the voice of Asia’s rapidly growing eldercare industry with longer li...

Elder Care Asia Magazine [Sep-Dec 2020]  

Elder Care Asia Magazine is a quarterly B2B eMagazine which aims to be the voice of Asia’s rapidly growing eldercare industry with longer li...

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