Innovations toward Equity in Healthy Ageing: From the perspectives of Financial Inclusion, Ageing In Place and Telemedicine for Older Adults

Myat Yadana Kyaw, Thet Htoo Pan, MinhTam Thi Bui, Joshua Goh, Seokmi Hong, Myo Nyein Aung and Mohd Rohaizat Hassan

Report in Japanese 

The United Nations Decade of Healthy Ageing (2021–2030) is aligned with the last ten years of the Sustainable Development Goals to improve the lives of older people, their families, and the communities in which they live(1). Healthy ageing encompasses the dignity of older people by addressing their social, financial and health security. The 19th DIHAC cross-cultural meeting organized on 31^st October 2023, is a collection of precious presentations stemming from three Asia countries with rapidly increasing ageing populations: Thailand, Singapore, and Korea. The meeting highlighted innovative research and interventions in healthy ageing fields through three presentations from fast ageing countries – Thailand, Singapore, and South Korea.

Opening session

DIHAC study PI Associate Professor Myo Nyein Aung hosted the meeting by socializing with international participants and welcoming the chairperson Professor Mohd Rohaizat Hassan, MD, PhD, Professor, Public Health Medicine Specialist & Epidemiologist, Department of Public Health Medicine, Faculty of Medicine, The National University of Malaysia & President, Malaysian Association of Epidemiology. Professor Rohaizat is international collaborator of DIHAC study and appeared many times on stage for presentation and moderation about healthy ageing. Professors from fields of global health, gerontology, social science, economy, health care, officials from Ministry of Social Development and Human Security (MoSDHS) Thailand, program leaders, community stakeholders, entrepreneurs and PhD students from Japan, Thailand, South Korea, Singapore, Malaysia, Mexico, Indonesia, China, and the UK participated in the meeting.

Figure: Chairperson Professor Mohd Rohaizat Hassan, speakers, international audience and DIHAC study team at the 19th DIHAC meeting

Presentation 1 – Thailand

The first speaker was Professor MinhTam Thi Bui, PhD, Fellow of the Higher Education Academy (FHEA)-UK PSF, Assistant Professor of Economics, Faculty of Economics, Srinakharinwirot University, Bangkok, Thailand. Professor Bui addressed and the role of information communication technology in financial inclusion for the older persons in Thailand (2). Professor Bui is the first author of this recently published article in the journal of Borsa Istanbul Review. Thailand, one of the rapidly ageing countries in Asia, has 16.4 million older persons. One out of every 5 individuals in Thailand is aged over 60 years old (3). Among them, 1 in 3 either  lives alone or lives with a spouse (4). Since the financial transaction is essential in everyday’s life, these group of individuals face challenges for independent financial management. With advancing digital technology, internet usage and mobile money/banking play a crucial role, especially during and after COVID-19 pandemic which has accelerated digital transformation. Compared to younger generations, older individuals tend to have limited internet usage and do not possess a bank account. Older people aged over 60 occupied more than a third (36.7%) of those populations without an account and proportions of older individuals with a mobile money account is negligible. According to Dr.Bui,   level of digital financial inclusion for older persons is still low in Thailand (7%). Only 5% use mobile phones and access the internet, and 3.2% use them for accessing financial accounts or checking balances. Consequently, this poses challenges to utilising mobile banking services.

Regarding financial transactions, older people pay utility bills mainly in cash. Moreover, 73% send remittances through financial institutions, and 25% still make their transfers using cash or money transfer organisations such as post offices. For receiving remittances, older participants used bank accounts rather than cash. However, the use of mobile accounts for sending and receiving remittance is still low for Thai older persons.

The reasons for not using the internet are more related to their lack of skills and less about their interest in obtaining access. Only 10–17%of the older persons find the internet unnecessary or lack of interest in the internet, whereas 62–87% do not know how to use it. In conclusion, there is still 1^st level digital divide – access gap in owning a digital device with internet access among the older population in Thailand. Additionally, the gap is present in literacy regarding the use of digital devices and mobile financing (2^nd level digital divide).(5). Accessibility to digital devices and the promotion of financial literacy and digital literacy among older persons need attention of the policymakers and stakeholders. On the other hand, cyber security tailored for the older population will ensure that older persons have safe access to digital technology while promoting equity through financial inclusion for older individuals. In the discussion, Dr, Bui added that since the data were before the pandemic, the changes and transition brought by the pandemic and current policies changes should also be considered.

Presentation 2 – Singapore

The second presentation was delivered by Mr. Joshua Goh, EMBA, MArch, Founder and CEO of Red Crowns Senior Living, Singapore (6). Mr. Joshua shared the history of his innovative idea of senior co-living as an alternative to institutional nursing homes in Singapore. Singapore will be one of the super-aged countries following Japan and South Korea. By 2040, 1 in every 3 Singaporeans will be aged 65 or over (7). Nursing homes are overload with long waiting list. For older persons who prefer staying in the community, Red Crown facilitates assistive living by providing services to improve activities of daily living (ADL) such as meal preparation, bathing, toileting, and monitoring of health conditions for older persons who need nursing care. Co-living facilities are in the age-friendly environment within community near to public transportation. Some of them are condominiums close to family members. A typical home has 4 elderlies and 2 live-in care givers. Minimum period of stay is 6 months and generally one year-contract with automatic renewal. Residents with similar hobbies and interests are matched together in one home to promote socialization and better quality of life. For monitoring and safety confirmation, call button for assistance, surveillance cameras are installed which are also accessible to family members. The live-in caregivers were certified and trained for caring for older people and lifestyle management according to the health condition of older people. On the other hand, the quality of caregivers is assessed and ensure to provide optimal care Singapore’s innovation creates an aging-in-place environment where older people can age with dignity and autonomy within the community.

Presentation 3 – Republic of Korea

During our last presentation of the 19^th DIHAC meeting, frontline community nurse practitioner Ms. Seokmi Hong, RN, MSc (International Politics) at Saje primary health care post Wonju, South Korea shared a current project on telemedicine and mobile health care from the primary health care post for sustainable health promotion and monitoring of older persons. The Kangwon Telemedicine Program has been running as a pilot program since 2000, monitoring health conditions on a monthly basis. Community nurses from the primary health care post update and discuss patients’ status with doctors from the tertiary center via online video call. In addition, the doctor directly checks the patients’ condition online more than twice a year. From 2024, the Kangwon telemedicine system will be operated under the Digital Health Information System (DHIS) of the Ministry of Health and Welfare (MOHW), which will expand the scope of healthcare services. For sustainable care of the older persons, the mobile application “Today Health” provides customized remote health management based on frailty level and health status. The app reminds and tracks seniors’ daily health status, such as physical activity, hydration and diet, medication time, and blood pressure and blood sugar levels. Monitoring devices are provided according to needs. Currently, 10 older persons with chronic comorbidities are receiving consultations through the mobile app. After 6 months of monitoring, health status will be assessed, and incentives will be rewarded for improvement. Moreover, the primary health care post also promotes digital literacy of older persons by educating them how to use the mobile phone and join the telemedicine program. To sum up, telemedicine plays a crucial role in maintaining high-quality healthcare services in rural areas of Republic of Korea, particularly in the face of an aging population. Digital transformation strengthens the scarce human resource of healthcare. However, older persons can utilize the telemedicine program only if they have access to mobile phones and the internet. Therefore, minimizing the digital divide in assess gap will empower the equity among older persons.

Closing session

Chairperson Professor Rohaizat conclude the 19^th DIHAC meeting by highlighting insights on two global megatrends of the 21^st century: emerging digital technologies and healthy aging. In conclusion, this cross-cultural meeting takes a role to enhance innovations and the uptake of innovations from researchers and experts to fill the gap in implementation. It leads to empowerment in public health and public policy as well as facilitation in digital sociology especially for the marginalized older population by bridging the grey digital divide.

The next 20^th DIHAC cross-cultural meeting will be held on 12^th December 2023.

References

1. Organization WH. WHO’s work on the UN Decade of Healthy Ageing (2021–2030). 2021.
2. Bui MT, Luong TNO. Financial inclusion for the older persons in Thailand and the role of information communication technology. Borsa Istanbul Review. 2023;23(4):818-33.
3. Pacific: EaSCfAat. Thailand: demographic indicators.Population by age group, selected years 2023 [Available from: https://www.population-trends-asiapacific.org/data/THA.
4. Foundation of Thai Gerontology Research and Development Institute (TGRI) Institute for Population and Social Research Mahidol University; Nakhon Pathom T. Situation of the Thai Older Adults 2020. 2021.
5. Etkin K. The AgeTech Revolution: A Book about the Intersection of Aging and Technology: New Degree Press; 2022.
6. Red Crown Senior Living 2023 [Available from: https://www.redcrowns.co.
7. Pacific EAiAat. Singapore Demographic indicators. 2022.

Authors

Myat Yanada Kyaw, MD, is Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.

Thet Htoo Pan, MD, is Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan

MinhTam Thi Bui, PhD, is Fellow of the Higher Education Academy (FHEA)-UK PSF, Assistant Professor of Economics, Faculty of Economics, Srinakharinwirot University, Bangkok, Thailand.

Joshua Goh EMBA, MArch, is Founder and CEO of Red Crowns Senior Living, Singapore.

Seokmi Hong, RN, MSc (International Politics) is Community nurse practitioner, Saje primary health care post Wonju, South Korea.

Myo Nyein Aung, MD, MSc, Ph.D. is Associate Professor at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Mohd Rohaizat Hassan, MD,PhD, is Professor, Public Health Medicine Specialist & Epidemiologist, Department of Public Medicine, Faculty of Medicine, The National University of Malaysia & President, Malaysian Association of Epidemiology.