THE SIGNS Study By Duke-NUS Researchers Identify Factors Affecting Active and Productive Aging

Illustration: Oliver Munday

Researchers at Duke-NUS Medical School’s Centre for Aging Research and Education (CARE) conducted a longitudinal study between 2016-2017 looking at factors influencing health, well-being, activity and productivity levels in older Singaporeans. This study is termed the ‘Transitions in Health, Employment, Social Engagement, and Intergenerational Transfers in Singapore Study’ (THE SIGNS Study) that was done in partnership with the Ministry of Health (MOH).

“THE SIGNS Study focuses on physical health and healthcare utilization, psychological wellbeing, social networks, social participation, intergenerational transfers within the family, volunteerism, life- long learning, work and retirement. All these factors affect older Singaporeans’ wellbeing, which in turn affects their ability to participate and contribute within their families, communities and the larger Singapore society as a whole,” said Dr Rahul Malhotra, Assistant Professor of Health Services and Systems Research and Head of Research at the Centre for Aging Research and Education, Duke-NUS Medical School.

The team surveyed a cohort of 4,549 community-dwelling Singapore citizens and permanent residents aged 60 years and above. Key findings of the study include:


  • Whilst about 62% of older Singaporeans rated their own health as good, very good or excellent with a similar proportion across males and females and ethnic groups, about 38% rated their health as fair or poor. These individuals reported having been diagnosed with three or more chronic diseases, with high blood pressure, high blood cholesterol, joint pain/arthritis/rheumatism or nerve pain, and diabetes being the most commonly self- reported chronic physical ailments. About 42% were pre-obese, indicating that lifestyle influences on wellbeing need to be examined more closely. In terms of psychological health, about 12% of older Singaporeans had clinically depressive symptoms, with the proportion increasing with age.
  • There was significant influence of psychological health on health care utilization, where lower levels of personal well-being were associated with higher healthcare utilization. Being lonely, on the other hand, was associated with lower levels of healthcare use.


  • The study found that stronger social networks were associated with a lower likelihood of depression as well as loneliness.
  • Social engagement and participation were found to correlate with the access to services such as financial management and environmental access e.g. grocery shopping or using public transport.

Lifelong learning

  • Only 13% of older Singaporeans took a course in the last 12 months of the survey, with major barriers cited as age, lower socioeconomic status and poor health. Women compared to men were more likely to engage in lifelong learning.

Singapore’s population is aging rapidly. Recent estimates suggest that by 2030, approximately one-quarter of the population will be above the age of 65. Longevity has been increasing steadily in Singapore and with longevity it is important to understand the social, psychological and physical health aspects of older Singaporeans, in order to assess their causes and estimate how their well- being in these domains changes over time.

“This study enables us to provide policy makers with evidence on how older Singaporeans are doing on various dimensions of their lives, which impact on their active and productive engagement in the wider community and society. This baseline understanding can guide the development of targeted policies and programs, which seek to provide them with more opportunities to actively and productively participate and contribute to Singapore society,” said Dr Chan Wei-Ming Angelique, Associate Professor of Health Services and Systems Research and Executive Director at the Centre for Aging Research and Education, Duke-NUS Medical School.

Professor Patrick Casey, Senior Vice Dean for Research at Duke-NUS Medical School, commented, “This large nationally representative study by Duke-NUS researchers provides detailed and valuable insights in areas that need to be addressed so that older Singaporeans can lead productive and active lives.”

The results from this study was presented to the policy makers on May 8, in a conference organized by CARE.

CARE is currently conducting the second wave of the study, which is scheduled to be completed by the end of 2019.

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