txt-20240203213812.txt

Science and technology : my name is dr. Andy and an associate professor of psychology at the school of sciences. This week we’ll be looking at from a social science perspective , and i’m glad to be able to share with you today some of the work that we’ve been doing in the school , looking at life ca...

Science and technology : my name is dr. Andy and an associate professor of psychology at the school of sciences. This week we’ll be looking at from a social science perspective , and i’m glad to be able to share with you today some of the work that we’ve been doing in the school , looking at life care and advanced care. Planning to start this week coming up. I think this quote is one of the few reality of the human experience. The death is the only certainty in a life full of uncertainty every one of us will deal with our own life and face the mortality of our loved one. But the problem is that no one has really taught us how to deal with all these challenges. And while death is a certainty the way that we die have evolved drastically over the past decades and hundreds of years. When we think back into nineteen hundred , the average life expectancy of a normal human being is about forty plus years. They’re mostly living at home. The cause of death is mostly because of acute infectious disease and therefore there isn’t much suffering for the moment of prognosis to the moment of death , and the type of support these patients receive are mostly coming from family , the neighbors the community as well as the support network. Fast forward one hundred and twenty years later. In today’s context , most of us die from chronic life threatening illness and we’re living much longer. The average life expectancy of a singaporean is between eighty three to eighty five years old , depending on your gender. We are mostly being cared for not by our family but by professional healthcare team , and there’s tons of cost in relationship for treatment in order for us to get the type service that we need. And we often don’t receive much support from our community anymore people often die in isolation , in icu in intensive care units of the hospital , and there’s a reason for this change. This is because the cause of death has changed and transformed in the decades that has passed. If you think back to a hundred years ago , most people really did die from neomia diarrhea disease , other type of infectious acute illnesses if we look at today’s context , most of us don’t die from these conditions anymore apart from covid but most of us in fact die from stroke , we die from lung disease , ocpd we die from other types of chronic , life threatening illnesses if the changes in our mortality , what does translate into is an aging population. This is because many of us will live much longer than we used to from our ancestor but despite the fact that we’re living longer , it does not mean that we’re living healthier in fact , most of us will spend the last ten years of our life coping with chronic life threatening condition. Not only is population aging a result of longevity it’s also because of decrease in fertility rate , and therefore it’s not surprising that singapore will soon become a super age population. By two thousand thirty. It’s projected that one in four of us we age sixty five and above , and with the end of life changing drastically from acute illness to chronic long term condition , the trajectory of death has also revolutionized in contemporary medicine with the various changes in the causes of mortality. Various researchers has found that there are three different types of trajectory of death that we face as a modern human species. The first one depicted in this graph is one that is reflective of a cancer patient , whereby their functional capacity remain relatively at a high level until the very last few weeks or month of life , when the condition progressively deteriorate until the very last stages of the life. The second trajectory are those concerning people with chronic heart disease or organ failure , when they begin the functional capacity at the point of prognosis to be relatively low , and every time they experience an episode that requires hospital mission , their functional capacity dropped to a critical level. They may recuperate they may recover , but they will never go back to the same level of function they had before , and this process , from onset of disease to the point of death , can last between three to four years. The third most common type of trajectory of death , according to literature , are concerning those dealing with fragility as well as long term chronic , progressive deteriorating condition such as alzheimer’s disease and dementia disease. From a moment of illness onset to the moment of death. This could last anywhere between six to eight years , is a prolonged process that people can suffer greatly because of the illness itself and regardless of what type of illness we’re suffering from , regardless of our dying trajectory what everyone needs to be able to come to terms with is to see the dying process is a difficult and challenging one. Not only is it taxing on our physical body , but it’s also demanding on our emotional and psychological health. There are many different symptoms the patients have to deal with , dealing with fatigue symptom control as well as pain management. There is also this notion of being dependent on the family caregiver or the healthcare team that could lead to a reduction of self efficacy as well as the diminishing of their personhood there is also a very important decision to be made about end of life care. What type of treatment do i want ? What type of treatment do i don’t want ? All of these uncertainty can lead to fear , guilt and uncertainty in a journey of death , causing a great deal of discomfort as well as anxiety and sometimes even depression. As bessie carpenter from the santa fe medical center have suggested , all of these decisions that we need to make at the end of life poses great ethical dilemma for everyone involved. No matter what decision that you make is going to be a challenging decision , because if we don’t know what the dying patient wants , every decision that we make could be problematic and we begin to doubt ourselves whether we made the right choice. So what are some of these decisions regarding the end of life ? Well , when patient reaches the last stages of life , it is important to know whether we want to continue to provide them with treatment , life sustaining treatment that is artificial or just allow the dying process to take its natural course. We want to be able to make sure that whatever treatment we give to the patient is not going to cause more suffering but to benefit them. And this means that we want to be able to make advanced medical directive to tell doctors and healthcare teams ahead of time what we want before becoming incapacitated in more recent years , there has been a surge in the notion of being able to make our advanced care planning not just make decisions , but actually have conversation , have the time to explore what is my needs , what is my desire , what is my concern and then make the decision in an informed manner. There are other considerations about terminal sedation euthanasia or even physician assisted suicide. While these are all important topics , what we want to cover today is advanced medical directive and advanced care planning. While advanced medical directive seems to be a recent policy of adult years should have the power and self determination to decide what is to be done on her body or not. And if the physician do not gain consent from the patient and do it on its own term , then the physician is legally liable that whole court battle case lead on to a century long of discussion about euthanasia physician assisted suicide , and most importantly the notion of patient self determination. After almost a decade long of public discourse and discussion and legal court battles , what has emerged in the nineteen nineties in the united states is the enactment of the patient self determination act , which really empowers people from all walks of life to make informed medical decisions about their care before they become incapacitated to illness. This had also led to the enactment of advanced medical directive , which aspired to protect patients with respect and to grant the wishes and respective preferences and care. It also helped patients to make informed decisions about the end of life care with information with knowledge about the risk of all the procedures. Advanced medical directive also empower patients to designate a person , a person with power to make informed decisions for them when they become incapacitated and ultimately , it helps to reduce any unnecessary and aggressive treatment to the patient that could lead to more harm than good. It all ends up in this notion of permitting a peace of mind when someone is going through the various challenges of the end of life with the enactment of man’s medical directive in the united states and many parts of the world , including europe , parts of southeast asia , including australia , what we found is that it has become a cornerstone for quality public care because the notion of making your own medical decision beforehand allows you to establish a personalized end of life care plan. It also can potentially integrate psychosocial care with spiritual care. In the end of life care process , can potentially reduce hospital mission because people are not seeking aggressive treatment anymore and it can also lead to patient’s quality of life to be enhanced at the end of life. But however , despite its being implemented for many years now , most of the research on advanced medical directive are using metrics that are looking at hospital admission rates , hospital stays and hospice utilization it doesn’t truly capture the essence of what advanced medical directive wants to do , which is to improve quality of life and improve quality of death. And because of the structure of the medical directive , whereby people are given different options to choose , it can very easily and quickly turn into a checkbox exercise that doesn’t truly reflect what the patient needs and what their concerns are. So despite years of development , advanced medical directive is now progressively moving into advanced care planning. In fact , advanced care planning has been around for almost twenty to thirty years now , and this is really taking advanced medical directive into a step further. Instead of just checking boxes , we’re trying to engage patients in long duration of useful , meaningful dialogue and discussion , to really explore what they want at the end of life. What is the fear ? What is the concern ? What are the values , what are the goals of the belief system , so that they can explore and reflect this , to gain a degree of self understanding , once they have that self understanding that they’re much more capable and competent to make decisions for the end of life care and future health care decision as well. Advanced care planning also involved appointing someone with the power to make decisions for the patient in the case that they become incapacitated there are many decisions that we could potentially be making with advanced care planning , including : do not resuscitate if i feel unconscious if my heart stopped , if i’m eighty ninety years old , do i still want to be resuscitated because that act in itself can be traumatic and aggressive and can lead to more harm than good ? Whether we want to have artificial nutrients and hydration that we want to be intubated do i want a machine to help me breathe can i choose my own place of death , my place of care and also who are the people that can make decisions for me ? These are all the major decisions that at the end of an advanced care planning discussion can come into play. I must also emphasize that advanced care planning is not a legal document , but it can inform people making an advanced medical decision , which in itself is a legal document. So starting from advanced care planning process , detailed , thorough discussion and exploration leading to making an informed legal decision about care. Now in singapore , we have also been able to initiate advanced care planning on a large public scale. In two thousand eleven , the ministry of health together with the agency for integrated care have initiated the living matters program , an advanced care program in singapore. The aim was to give patience greater autonomy and greater self determination in navigating through the many complexity of mortality , especially for those facing the end of life. However , despite millions of dollars spent and years of implementation , the take up rate remains relatively low. And from the research that ntu has been able to do and conduct evaluating the national advanced care planning program , what we were able to identify is that one of the core challenges is that people are not ready to talk about death and dying. When people are introduced to the concept , they think it’s a major to move. If i talk to my mother or my father , who is aging about death , it could be disrespectful for them , and therefore that cultural identity , that sense of piety can be a great barrier towards people engaging in the process of advanced care planning. Apart from cultural attitudes and taboo towards death , that has really undermined people’s willingness to engage in advanced care planning discussion , other concerns of the way that acp is being implemented is that it is still very heavily medically oriented. It doesn’t really capture what are the concerns and fears that patients have , how they want to live the remainder of their lives , what are some of the important accomplishment that they want to be able to achieve before they die , and how do they want to be remembered ? How do they want a loved one to be cared for ? All of these discussions can lead to a much more positive experience at the end of life , and while we face mortality , it can be hopeful too. So to end this lecture , i would like to throw that question to all of you : what do you think we can do with technology , virtual companies and even artificial intelligence and chatbots as conduits to support and promote more people to take on advanced care planning so that they’re in more control , have more autonomy and self when facing their own mortality with greater positivity and hope. Thank you. Hi everyone , my name is ching hong. I am an assistant professor of psychology at the school of social sciences at ntu i also hold a joint appointment at the lkc school of medicine. I am a cognitive neuroscientist by training and my research interests are in understanding the complex interplay of biological and psychological factors in the process of healthy and pathological brain and cognitive aging today , in this brief lecture for cc zero zero zero seven : science and technology for humanity , i will be bringing our focus towards two important psychological factors in depression and social isolation. We will be discussing the role that they play in brain aging specifically in the context of alzheimer’s disease. Let us begin with a brief introduction to alzheimer’s disease. Aging is the biggest risk factor for alzheimer’s disease and related dement with an aging population , the number of individuals living with dementia is expected to rise dramatically not just in singapore , but all over the world. The alzheimer’s disease , or ad continuum can be classified broadly into three phases. A preclinical phase , with no symptoms but with possible biological changes are already detectable in brain. This is followed by a more cognitive impairment or mci phase , with mild symptoms that may not yet disrupt our ability to engage in everyday activities. The last phase is dementia that has three different stages of severity more moderate and severe. Here , even though the arrows are of equal size , the duration of each phase or stage may differ between different individuals. Our current state of understanding is that the preclinical phase can be quite long , lasting more than twenty or thirty years before the overt sentence starts to surface , suggesting that in this earlier phase of the disease we have a substantial long runway for designing and implementation of intervention programs in order to tackle alzheimer’s disease. A large amount of funding has been invested and dedicated to the discovery of drugs and therapeutics to treat and cure alzheimer’s disease. You can see from this graph in red that from the year nineteen ninety five to twenty twenty one , an estimated forty two point five billion us dollars has been spent on research and development of biological therapeutic this disease task force. All these six drugs have been approved in the us. They are predominantly only able to treat symptoms of alzheimer’s disease and are not considered to be disease modifying they can also be costly and patients may experience side effects. This graph shows the percentage changes in selected cases of death from the year two thousand to twenty nineteen although these data are from the us , i think it illustrates the point quite well that we have had very limited success in stemming the tide of ad related mortality , especially in comparison with other diseases such as heart disease , stroke and especially hiv. While the increase in mortality represents a huge challenge in our lifetime , it also represents a great opportunity where a lot of good contribution to society and humanity can be achieved. We do know a lot about the biology of it. There are a great number of efforts they have been dedicated to developing biological treatments for ad , but it is also important for us to enlarge the spotlight beyond therapeutics to further understand the multifaceted nature of the ad process. After all , it is the case that many individuals with biological disposition and family history of ad do not actually go on to develop ad in their lifetime. It is also the case that many individuals without strong biological disposition or family history develop in old age. In order to understand this complex alzheimer’s disease process , we must leave no stone unturned and we need to investigate more deeply other factors , particularly psychological factors , that are implicated in the alzheimer’s disease process. In this figure , we can see a broad overview of the known risk factors for dementia across the lifespan from early life in green on the left , to midlife in blue and lastly later life in purple. The numerical percentage in each of the circle represents the percentage reduction in dementia prevalence if the particular risk factor is eliminated. For example , the provision of adequate length of education , perhaps universal education , in early life , is associated with a seven percent reduction in dementia prevalence there are also a slew of other factors that you should have encountered already in the earlier parts of the course , and they should not be unfamiliar with all of you , such as physical inactivity and diet associated factors such as obesity and diabetes. What we will focus on in the next few slides are two important psychological factors in late life , namely depression and social isolation that contributes a total of eight percent to dementia prevalence before we do so , however , it should be noted that our knowledge of risk factors is incomplete and sixty percent of unknown risk remains. What could they be ? Perhaps some of these unknown risks may also be related to more psychological aspects of the human condition beyond depression and social isolation. It is also important that i make the point here that these factors may be intertwined and health related behaviors and choices may be influenced by a complex interplay of social , psychological and biological variables. For example , smoking behavior may be influenced by psychological related factors of social pressure , need for belonging , stress , anxiety or biological responses to addiction. I hope that you are able to see the need for an interdisciplinary approach and understanding of the multitude of factors that can influence dementia incidence now let’s dive a little into the scientific literature on the relationship between depression and dementia incidence when we think about alzheimer’s disease , we most commonly associated with the presence of memory deficits but alzheimer’s disease not only affects cognition it is also associated with many neuro psychiatric symptoms such as apathy agitation hallucinations delusions motor disturbances and , of course , depression , all of which may become more severe in later part of the disease , in particular for depression. A meta analysis of thirty two studies. For the overall , the presence of depression almost doubles the odds of incident dementia while depression is clearly implicated in the alzheimer’s disease process , we do not yet have a complete understanding of its role. There are some evidence that in early stages , depression may increase risk of dementia but in later stages , dementia may also contribute to depression onset and severity the presence of other neuro psychiatric comorbidities that we have mentioned also complicates the picture. However , it is quite clear that overall depression , or perhaps more broadly mental or psychological health , is important not just for healthy well being across the lifespan but politely plays an important role in preventing and delaying the onset of dementia moving on from depression , social isolation and loneliness are also important psychological risk factors for dementia in this meta analysis of more than fifty studies , researchers found that greater social activity and larger social networks are correlated with better cognition although the effects are modest and there is some heterogeneity they are all statistically significant , although we are unable to infer causality from these results and the underlying mechanisms require further investigation. Overall , the findings point to a beneficial aspect of not being socially isolated and better cognition when we grow older , or perhaps in retirement , we may feel disconnected with our work communities and social communities , or even our family , and become more socially isolated. This may be associated with a loss of a sense of purpose and meaning in life. Well , not as much studies have been conducted in this area. A meta analysis of a few large cohort studies suggests that individuals who reported higher purpose and meaning in life have lower risks of dementia incidents , as represented by a ratio of less than one in the figure. Some of you may be wondering how do we measure and detect social isolation and loss of meaning in life and older adults in the community ? For the measurement of more biological risk factors like the amount of physical activity , blood pressure , education levels are much more easier to quantify the study. The psychological risk factors such as social isolation , social connectedness meaning and purpose in life are much more abstract and consequently more difficult to study. However , it is also the case that these abstract factors , involving our emotions , our thoughts , constitute an important aspect of what it means to be human and a link to cognition and dementia incidence in closing , psychological factors such as depression and social isolation play important roles in brain and cognitive aging although they may be difficult to measure and monitor , there is also less opportunity to leverage on technology and devise ways to target them for intervention , with the ultimate goal of preventing or delaying the onset of alzheimer’s disease and dementia so that we can continue to live fulfilling lives even in our age. Hello , my name is hedwig alfred and i’m , a journalism lecturer at the weekly school of communication and information here at ntu in the following minutes , i will talk about the challenges of communicating with seniors in singapore , some missteps and unusual steps that have worked. You would have heard by now , the number of singaporeans aged sixty five years or older has risen significantly and by twenty , thirty , less than eight years from now , this group will account for one in four people here. Think about it. One in four of us will be aged sixty five and into our seventies eighties nineties and beyond. So why highlight communication with this group ? Because there are significant government policies directed at them , because of an unprecedented health crisis , and because it is important to continue to engage this group , which still has much to offer. Most communication textbooks will tell you that to deliver a message well , you need to know your audience , make the purpose of your message clear and choose the right platform to deliver the message. But think about communicating a message to older people in singapore and you are likely to get stuck at step one. In singapore , more so than in other countries , communication challenges involving the elderly include divergent factors such as race , languages spoken , educational levels , work experience and cultural differences. In twenty fourteen , when the government formed the pioneer generation office to reach out to singaporeans sixty five years and older with a message of thanks for their part in nation building and offering a slew of concessions and benefits. Its first task was to figure out how to get the news to the pioneers. The usual method of a press conference followed by coverage in the traditional media would only work for those who read newspapers and watch television. Letters in the mail to inform recipients of the benefits would also be limited to those who could read the four official languages and would understand the information included. So in addition to the use of the media and mailing letters , the pioneer generation office set out to train volunteers who would deliver the information door to door to seniors to be effective , the teams had to include speakers of the official languages and the chinese dialects , and a script was prepared with volunteers prepped to answer possible queries it was a huge undertaking with months of planning and even more months of fieldwork which was mostly well received. The negative feedback , however , included those who were suspicious of the many questions volunteers asked about the senior’s well being. Some were even offended by questions about their children and how often they visited. Why so many questions ? The seniors asked ? Why now ? What did the government want in return ? The more educated who read newspapers regularly complained the volunteers talked down to them and said they already knew about the benefits. Some even wondered if the volunteers were part of a scam so while every effort was made to reach the members of the senior group , a one size fits all script did not go down well for some. When the pandemic hit , it became important to be able to pass on good information from the government task force , disease experts and frontline agencies to the public. While the announcements were significant for our day to day living , the messages were not always easy to understand. The government multi ministry task force had regular updates on new steps and regulations to keep singaporeans safe. Medical experts were present to explain the reasons behind the steps and their explanations regularly included jargon special words or terms used by a particular professional group in the pandemic this included words such as rna , ventilator asymptomatic endemic , epidemiology incubation immunocompromised anaphylaxis self isolation and the list goes on. The science speak was difficult for many in the general public , let alone for seniors also , those not reading newspapers or watching tv relied on others to tell them what was happening in an unprecedented health crisis here and globally the volunteers who were still in touch with many older singaporeans had to stop home visits in the lockdown they considered getting on zoom calls or just phone calls to update seniors about the latest restrictions or explain what was happening but found many did not have the devices for such calls. This resulted in further isolation for many seniors who were getting increasingly fearful and a significant number started to believe rumors and half truths about vaccines and side effects. The fake news being circulated among the senior group was significant enough for the government to take steps to curb it. But it was not all lost. After decades of discouraging the use of chinese dialects , the ministry of communication and information started investing in dialect programs on channel eight. The ministry commission programs such as have you eaten and how are you , which included messages in various dialects about health assistance schemes , the silver support scheme , and active aging in the storylines the ministry also tacked on a senior favorite , gati usually a stage performance at hdb estates during the hungry ghost festival or chinese new year. With the covid restrictions , the gut type performers moved their ex onto facebook and youtube. And while the program still focused on singing , the host now weaved in messages about staying home , exercising at home , and staying safe. Seniors here now have no choice but to embrace some form of technology in their everyday lives. We have smartphones and smart tvs and seniors need to learn how to use these devices for their entertainment , to stay in touch with family members , to make appointments at hospitals , to pay bills , to read menus and until recently , to get into shopping malls and supermarkets a church here recently decided to forego hymnals and prayer books in a bid to reduce the risk of infection. So the churchgoers were expected to scan a qr code for the words of the hymns to be sung. The result was a very quiet church , probably because the congregation , many of whom are older adults , is not inclined to whip out their phones in church and read him lyrics in a tiny font. So why do seniors have so much trouble with technological devices ? One , the devices have traditionally been designed by young engineers , targeting young users , and seniors have been forced to adapt or lose out. Two , the accompanying manuals or user guides are not helpful because of the small text font , the small pictures in black and white with tiny captions three seniors don’t have the same baseline level as younger people for learning about computers , smartphones websites and apps. Often those who try to teach older adults how to use technology end up being frustrated and wonder why do these older adults not get it ? And for the devices can be difficult for those with age related disabilities such as hearing loss , word retrieval problems and slowing of cognitive function. On the positive side , recommendations are being considered for user guides to be more senior friendly. They include typeface type of the use of color and backgrounds to make reading instructions easier. Clear writing or animation could also help and navigation on a website could be made easier with consistent layouts menus and hyperlinks also in the works are communication devices that recognize speech and can turn it into text , low vision magnifiers electronic page turners and talking books and illustrations. Gps systems will soon not only inform older people how to get somewhere , but also remind them where they are going. Still , the push to digitalize in singapore has come with a price. Seniors with headphones have become the target of scams and they have lost large sums including their life savings , to tricksters pretending to be from banks and government agencies. So now more communication is needed to educate seniors about the dangers lurking in their devices. Seniors in singapore are now healthier and living longer. They are also more educated and want to live active lives , travel and be useful to society. When you think of seniors whom do you think about ? Your grandparents parents , neighbors former teachers ? Cleaning aunties as a community , we would not want to stand by and watch a group feel and become increasingly isolated. So if we agree they are worth engaging the question becomes how low hanging fruit include the absence of this group on social media. So many seniors spend hours online but do not see people like themselves on videos or instagram. In the us , an older group of people have been making tiktok videos of themselves and newspapers have called them influencers and what about traditional media and how they portray seniors during the lockdown there were several stories of older people who were found breaking the rules , eating in hawker centers or not using the trace together app. The media appears to go for the extreme , featuring either a lonely old staring blankly out a window or a fit older tv actor showing off his abs , when in fact most in this group lie somewhere in between. Arguably the most important problem facing the planet now is the climate crisis , and the focus appears to be on the younger generation and steps they can take to stop rising temperatures. But what about the almost one quarter of singaporeans the seniors they too have a role to play. Don’t they ? What habits could they change ? How to get the message across to them in a lift ? Inishan i saw a poster to encourage recycling and it showed what items should and should not go into the recycling bins the entire poster was in pictures with green ticks and red crosses. No need for text in english , chinese , malayan tamil. What are some original ideas you can come up with to engage this segment of singaporeans here then , are some takeaways from this session. One , no one platform can reach all sections of the seniors group. Two , solutions for outreach may overturn current thinking. Three , technology can be enhanced to improve the lives of seniors and finally , everyone gains when seniors are engaged.