Singapore Gerontological Society's 20th Anniversary Celebration

11 Feb 2006

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health

Venue: York Hotel

Mr Henry Lim, President of the Gerontological Society,

Distinguished guests,

Ladies and gentlemen,

It is a pleasure to be here with you to celebrate your society's 20th anniversary. My congratulations to the Gerontological Society and its founding fathers, for their foresight in starting the gerontological movement in Singapore 20 years ago.

Changing Trends

In the past 20 years, we have seen our young country greying rapidly. The elderly population aged 65 years and above increased from 5% of the population in 1985 to 8% in 2005. The next 20 years will see our population ageing further and faster as the baby boomers reach 65 years. By 2030, the elderly population is expected to reach 870,000, triple the number today. About 1 in 5 persons will be an elderly person.

The elderly of the future will comprise more who are "old-old", single and living alone. But, they will also be more educated and financially more independent. The proportion of elderly with at least secondary education is projected to increase from the current 14% to more than 60% in 2030. They will have higher expectations about the lifestyle that they want to lead in their golden years.

At the same time as their life expectancy increases, their consumption of healthcare services will also increase with age. This is because the elderly population are more prone to age-related chronic diseases and functional disability.  Because of the rising life expectancy, over the last 10 years, the proportion of semi- and non-ambulant elderly has increased from 8% to 11%. This demographic shift presents both challenges and opportunities for Singapore.

CAI  RECOMMENDATIONS

The Committee on Ageing Issues (CAI), which I chair, has just released its recommendations. One recommendation that the committee made was with regard to the family physician. The committee recommended that family physicians play a pivotal role in managing the healthcare needs of the elderly. Family physicians are in close proximity to seniors because they operate within the community. As such, they are in the best position to provide holistic care to these patients.

The elderly often have multiple medical problems, many of which may be chronic. Currently many of the elderly have to visit multiple specialist outpatient clinics in order to obtain their treatment for chronic illnesses. Two weeks ago, I saw one such elderly gentleman at my Meet-the-People-Session. This man visits four specialist clinics each month. This means he sees four different doctors and pays four separate SOC fees. His family also have to take time off to bring him to the SOC four times each month. We should try and improve on this and integrate more extensively the role of the family physicians in our current system of managing chronic illnesses.  For example, we should run CME modules for our GPs on the protocols that the various specialist clinics use for chronic disease. Then, the patient can select a GP who has attended the CME modules on chronic illness in the elderly as his family physician and have the same SOC follow-up and treatment administered by the family physician. Instead of four visits to the hospital, he would need to make only one visit to the family physician located close to his home. In a way, this is a form of out-sourcing. In appropriate cases, the hospital out-sources follow-up of chronic illnesses, which are normally done at the SOC clinic, to family physicians. This out-sourcing should lead to greater convenience and lower cost to elderly patients. It will improve the care of the elderly, making the delivery of healthcare services to them more holistic and more efficient.

Commendation to Gerontological Society

Over the last 20 years, the Gerontological Society has played an active role in dispelling ageism and promoting active ageing through its public education programmes and conferences. Your members also partook in the various national committees managing issues related to the ageing population. The Society was represented in the CAI. Your mission and work will, year by year, become more important as the population of the aged increases. You have a critical role in making our society an elder friendly society where one can look forward to living a fulfilling life when one is elderly. I look forward to your continued contribution to the elderly and future elderly of Singapore.

Once again, my warmest congratulations to the President and Council members on the Society's 20th anniversary celebration today, and my best wishes to the Society for all your future endeavours in promoting the interests of the elderly in Singapore.

Thank you.

Annex A: Awardees of the Clinician Scientist Investigator Award

1. Associate Professor Hui Hoi Po, James

Use of cell based therapy and drug supplements for the repair of cartilage defect in the young

A/Prof Hui is currently the Group leader (Cartilage Division) of the National University of Singapore Tissue Engineering Program (NUSTEP) and b) Director of Therapeutic Tissue Engineering Laboratory of National University Hospital.

The cartilage division of NUSTEP under A/Prof Hui's leadership has been actively engaged in the research of 3 different types of cartilages namely physeal, fibro and articular cartilages.

The effect of damage to growth plate of Physeal cartilage has been extensively studied. Various modalities of cell-based therapy have been attempted to rectify damage caused by growth arrest. Cell sources including bone marrow, periosteal, and adipose derived stem cells, with the use of bio-absorbable scaffolds, was found to be successful in correcting misalignment as a result of growth arrest.

Bone marrow derived stem cells (BMSCs) was able to enhance the repair of meniscal tear, which is fibro cartilage in nature. BMSCs were also found to restore the ligament-bone interface in anterior cruciate ligament in both autograft and allograft reconstruction.

Till May 2005, NUH Therapeutic Tissue Engineering Laboratory has done more than 90 cases of Autologous Chondrocyte Transplantation (ACT) clinically for repair of articular cartilage. Efficacy of intra-articular therapy of chrondroitin sulphate with or without hyaluronal acid is also being investigated in animal models of osteoarthritis.

A/Prof Hui is also conducting studies on chondrogenic potential of bone marrow derived stem cells and adipose derived stem cells from the same individual as possible cell sources for transplantation. Since 2005, he started to conduct clinical trial on use of stem cells in repairing cartilage in human.

While joint replacement is the treatment of choice in the elderly with cartilage defects, it is not feasible in the young as the implant would need to be revised with wear and tear. The trend of treatment in the young would be repair of the cartilage defect. A/Prof Hui's research aims to investigate the two pronged approach, using cell based therapy and drug supplements to solve this problem. The cell based therapy approach would potentially allow transplantation of stem cells to the cartilage defect in a minimally invasive way, while the drug supplements approach will be a more natural mode of treatment that does not require the injection of cells near the joint.

In the area of paediatric orthopaedics, A/Prof Hui has also been actively involved in clinical research in the areas of deformity of the upper limb, deformities of the spine and in the musculoskeletal in children.

2. Assoc Prof Christopher Chen Li Hsian

Translational research and clinical trials in stroke and dementia

The major research and clinical interests of A/Prof Chen are the neurochemistry, molecular biology and treatment of stroke and dementia.

A/Prof Chen's research in Behavioural and psychiatric disorders in dementia is in collaboration with colleagues from Oxford, London, UCLA and NUS. They have been investigating the neurochemistry of patients with Alzheimer's Disease and other related disorders. By correlating these with prospectively studied clinical features and genetic markers we aim to identify novel therapeutic targets.

Apart from international collaborative research programmes, A/Prof Chen works very closely with scientists from A*STAR and NUS. They have been studying biochemical and genetic markers underlying the pathophysiology of stroke. Longitudinal studies are also in progress to study the natural history, risk factors for and treatment to prevent cognitive impairment and dementia after stroke. We aim to discover new therapeutic approaches.

A/Prof Chen has also developed an international reputation for participation in academically driven as well as industry sponsored clinical trials. His current focus is on developing a regional network for innovative trials into conditions prevalent and pertinent to Asia. We also plan on enhancing our capability for conducting increasingly sophisticated Phase II studies utilizing biomarkers such as neuroimaging.

A/Prof Chen's aim is to develop synergies with basic neuroscience research and to translate novel scientific findings into therapeutic possibilities as well as to provide clinical insights for disease specific laboratory research.

3. Dr Lee Soo Chin

To develop reliable and robust biomarkers in breast cancer chemotherapy through high-throughput proteomic profiling

While many chemotherapy drugs are active in breast cancer, no reliable tests exist to predict which drug works best for each patient. High-throughput technologies that simultaneously analyze hundreds of proteins may generate tumor-specific signatures, and we are the first to apply this to predict chemotherapy response in breast cancer. By studying 90 patients, Dr Lee Soo Chin identified a panel of protein markers predictive of chemotherapy response. He also plans to extend this work in the next 3 years through a series of clinical trials to identify and verify predictive markers. Tests will be developed for their rapid detection for clinical application to guide treatment choice.

4. Dr Dan Yock Young

Liver Epithelial Progenitor cells and their therapeutic potential

Advances in regenerative medicine have raised the possibility of using liver stem cells for the treatment of liver diseases. However there are still significant hurdles that need to be overcome. Understanding the fine control of how liver stem cells mature into functional liver cells is critical. Dr Dan Yock Young's study will allow us to explore how we can isolate liver stem cells, grow them in the lab and test out how they can be optimally used for treatment. The knowledge gained from the study will pave the way towards realizing the eventual aim of harnessing these cells to save human lives.

5. Dr Lee Yung Seng

Obesity Gene Study (OGS): uncovering genetic variations which predispose to human obesity and obesity-related complications

Obesity is one of the most common health problems in Singapore, and it is the substrate for other chronic diseases such as diabetes mellitus, hypertension, high cholesterol level and coronary heart disease. Obesity is the result of poor dietary habits and physical inactivity, and it is believed that certain individuals are more prone to develop severe obesity because of their genetic makeup. Dr Lee Yung Seng's research aim is to uncover the genetic factors which predispose an individual to the development of severe obesity, as well as obesity-related complications. He will be screening the DNA of an existing group of obese children in a bid to uncover these genetic factors. He will also be inviting new participants who have been obese since young to participate in this study in the next three years. The research will contribute to efforts to unravel the biology of our weight regulating mechanism.

6. Dr Chan Ling Ling

Prospective study of Magnetic Resonance Diffusion Tensor Tractography in patients with vascular gait disorders: Topographical correlation

Gait disorder is a common problem in the elderly population. Problems with walking such as slowness and poor balance can be part of normal aging or due to a variety of causes such as stroke or degenerative brain diseases. Dr Chan's research focuses on the clinical utility of non-invasive advanced functional MR imaging of the brain in the evaluation, diagnosis and monitoring of treatment response in patients who present with gait disorders as compared to healthy individuals.

Annex B: The Clinician Scientist Investigator Award

The Clinician Scientist Investigator (CSI) Award is an initiative by the A*STAR's Biomedical Research Council (BMRC) and MOH's National Medical Research Council (NMRC).

The Award provides between 3 to 5 years of support to clinicians in public hospitals and disease centres. They will be required to commit at least 60% Full Time Equivalent (FTE) of their work hours conducting research and developing their research careers.

The Award will fund part of the clinician scientists' salary commensurate with the proportion of time spent in research up to a period of 3 years for junior clinician scientists and up to a period of 5 years for senior clinician scientists. In addition, junior clinician scientists will receive up to S$200,000 funding for their research projects.

The host institution and awardees must ensure that the research complies with all laws, rules and regulations pertaining to animal and human ethics, including the Singapore Good Clinical Practice guidelines, and, in the absence of such local guidelines, is in accordance with internationally established guidelines. All necessary licenses and approvals must be obtained for the research conducted.