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The aging population in a neighbourhood creates a “Naturally Occurring Retirement Community”. How are the local public health agencies in Singapore addressing this need to support aging population and enable optimal aging? Read on to find out!
Naturally-occurring retirement communities are first defined as “a housing development that is not planned or designed for older residents, but which over time comes to house largely older people”. Naturally-occurring retirement communities may range from being an apartment buildings, to housing complex, to being an entire neighbourhood.
Characteristics of naturally-occurring retirement communities may differ based on which source is used. The minimum age of persons considered “older adults” may range from 50 to 65. Meanwhile, the minimum proportion of the population of older adults in naturally-occurring retirement communities ranged from 25% to 65%.
As of 2021, a significant population density of Singapore is aging. Due to an increase in life expectancy and low fertility rates, the proportion of the the citizen population aged 65 years and above is rising faster than the preceding decade. In 2021 alone, 17.6% of citizens are aged 65 and above, much larger than the 10.4% of the same age group in 2011.
In 1960, Singapore’s housing & development board (HDB) was established to provide quality and affordable public housing community options, mainly in the form of flats. These flats are usually found in urban settings called “planning areas”. These specific community aging initiatives, combined with the rapidly aging population, gave rise to multiple naturally-occurring retirement communities in the country.
Planning areas identified with higher proportions (one in five) of residents aged 65 years and over include Outram, Rochor, Ang Mo Kio, Bukit Merah and Kailang. In at least one of these areas, Outram, more than 90% of the population stayed in HDB flats.
In a co-published report with the American Association of Retired Persons (AARP), Harvard stated that naturally-occurring retirement communities generally scored lower overall livability than other communities. Naturally-occurring retirement communities scored lower in terms of neighbourhood amenities, opportunity, and transportation. In contrast, they scored higher in engagement, environment, and housing.
The high concentration of older adults in naturally-occurring retirement communities was stated to make the provision of support and senior services more accessible, offering some economies of scale to health care providers. Such places are, in turn, sought out by people to enjoy the company of their peers. Older adults were also observed to have higher homeownership compared to younger households, explaining the higher housing score.
Despite the advantages of naturally-occurring retirement communities in terms of engagement, environment, and housing, gaps and challenges were still observed. These include gaps in amenities such as those that help walkability, particularly for older adults. Challenges include improving rates of jobs and education to retain younger residents.
Aging in place is defined as the ability to continue to live in one’s old age home Singapore safely, independently and comfortably regardless of age, income, or ability level. This concept is what the Ministry of Health of Singapore aims for in response to its aging population and the need for facilitating healthy aging.
Currently, Singapore aims to enable its citizens to age through two main goals: (1) keeping seniors healthy, active, and safe, and (2) providing access to quality and affordable healthcare. These goals are being met through healthy NORC supportive service programs that encourage the characterizing older adults involvement, provide financial protection for seniors, and building of age-friendly neighbourhoods.
To build age-friendly neighbourhoods, the urban development authority has cited a study by Dr Belinda Yuen. The elements of a health-enhancing neighbourhood for all ages were identified as mental, social, and physical health and wellbeing. Furthermore, the following recommendations were made to be incorporated in developing NORC programs and to facilitate the NORC transformation process:
Senior populations are not as homogenous as the generalisations describe them to be. The study determined that heterogeneity in age, sociocultural characteristics, socioeconomic status, and physical and cognitive abilities exist. Likewise, neighbourhood variations were also observed based on infrastructure, environmental characteristics, and amenities.
Sensitivity in terms of the observed heterogeneity or diversity is recommended in crafting and adapting neighbourhood plans and designs. Time must be taken to address seniors’ different needs and motivations, challenges, and preferences in accessing and experiencing the neighbourhood.
Walking safely and easily around the neighbourhood is critical for a sense of independence and better access to health services and social services. Seniors end up taking routes that are relatively unsafe out of fear of getting lost. This stems from the monotonous design of relatively safe walkways, which usually confuses seniors as to where they are.
Better and less monotonous walkway designs were thus recommended. When applied to sure walkways, a renewed interest in walking was seen. Visually impaired older adult residents also found that such designs enabled them to walk along the paths more confidently.
Parks, gardens, and other public and private entities that are open spaces offer residents of all ages opportunities to engage in recreational activities. These spaces benefit seniors because they may keep them from feelings of isolation and engagement in the community.
To further encourage a healthy lifestyle, the study recommends incorporating simple exercises and activities in the design and planning of daily routes. These will be helpful to keep the minds and senses of citizens stimulated, especially for those with dementia and cognitive impairment.
Retaining recognisable landmarks in neighbourhoods is recommended as they grow and evolve. Such landmarks do not have to be extravagant, just memorable enough to be recognisable once seen. Such landmarks will reflect old memories and, more importantly, serve as cues for seniors in navigating spaces around them.
Seniors often pay close attention to social cues and interactions when they access physical spaces. They end up wondering if younger persons feel uncomfortable in their presence. Their desire not to be an imposition makes them uncomfortable. This discomfort may make seniors feel isolated.
To encourage interaction even with strangers, the establishment of amenities such as kopitiams or coffee shops is encouraged. In their observation of a neighbourhood upon establishment of a Kopitiam, the presence of coffee or tea gave a feeling of having something to do for seniors. It made them more comfortable sharing the table with strangers.
More naturally-occurring retirement communities will most likely develop in the coming years, given the aging trend of the population. Catering to the well-being of its community members does not need to be one-dimensional and can be extended to having group living care.
Making holistic improvements for all ages, such as those stated above, would be more beneficial in the long term, made possible by mobilizing untapped resources, community participation, managing collaborative partnerships, and further research on this field.
