Introduction
Singapore has one of the fastest aging populations in the world. Health and social needs will increase and evolve as the current cohort of middle-aged Singaporeans enter the latter halves of their lives. This study aimed to explore Singaporeans’ views on successful aging and what they desire for Singapore’s health and social care in the future.
Methods
We conducted an online survey of 567 respondents (aged 45 to 65 years old) from January to March 2019. Topics included: knowledge and experience of health and social services, technology use in daily life, social life, financial health and employment, and conceptualization of successful ageing. We performed descriptive and bivariate analyses of the data and thematic analysis for qualitative data.
Results
The mean age of survey respondents was 54.2 ± 5.0 years. 72% of respondents had contact with the healthcare system at least once a year, and 68% were satisfied with their care experience. Top concerns with healthcare were accessibility, high cost, and lack of sympathy and interpersonal skills among healthcare providers.
Almost all (97%) of respondents had some knowledge of available social services but only one-third used the services. Suggestions for future social services included: greater social connection, better access to elder support facilities and financial assistance. On social connection, 83% hope to spend more time with friends or families in the future. Social interaction was viewed as both intra-generational and inter-generational. Despite all respondents reporting having an online social network, the majority desired face-to-face interaction (92%). 40% wanted to work beyond retirement age not only for financial independence, but to keep themselves active and to meet people.
Two-thirds used technology to manage their health. The three most commonly used technologies were mobile/tablet apps (28%), wearable technology (23%) and health monitoring devices (13%). Respondents envisaged using technology in future for physical activity and diet, better diagnostic capabilities and better sharing of health and social data across providers.
Definitions of successful ageing were wide-ranging. Apart from good physical health, the majority of respondents explained that financial independence, meaningful work, autonomy, social connectedness, and mobility were important.
Discussions
Singaporeans have high expectations for the future of health and social services. Basic health and social services were still important, but Singaporeans have a more expansive view of factors contributing to overall wellbeing. The need for purposeful living and meaningful social interactions extends traditional views of healthy aging.
Conclusions
There is a need to broaden the scope of health and social policies for the future generation of older Singaporeans.
Lessons learned
The current range of healthcare and social services may not be adequate to meet the multifaceted needs of future elders.
Limitations
Respondents were primarily English-speaking ethnic Chinese and from higher income groups.
Future research
The next phase of this study will gather views from non-English speaking Singaporeans, particularly those from lower socio-economic backgrounds. The final phase will be an in-depth exploration of survey results through a series of focus group discussions leading to future policy recommendations.

1. Introduction
Frailty is a condition in which the individual is vulnerable and at increased risk of poor health outcomes including death when exposed to stressors, such as illness or injury. As we age, frailty is common, affecting one in two people aged 65 years or more.
There are many ways to measure frailty, reflecting different theoretical approaches, and different methods to address frailty. Predominantly, frailty is addressed by targeting physical therapy type activities, as loss of functional ability is one of the hallmarks of frailty, and this reflects an emphasis on loss of abilities, or an accumulation of deficits.
Other approaches include a focus on the health assets that an individual may possess, that serve a protective effect against the impact of frailty. For example, engaging in community activities.
Consistent with this approach is the idea of frailty as a fulcrum, where health assets may outweigh the impact of health deficits and so mediate the impact of frailty on an individual. This idea highlights that frailty can change over time, and that its impact on an individual can be modified.
With this approach in mind, and the observation that the majority of frailty interventions do not include health consumer partnerships, we embarked on a co-design process to better understand health consumers’ perspectives.
2. Methods – We conducted a series of co-design sessions with health consumers. We asked about their understanding of the term ‘frailty’; emotional responses to ‘frailty’; and for their partnership to help co-design the ‘Be Your Best’ frailty intervention and prevention program.
3. Results - Early engagement with consumer representatives shaped project development. Health consumers have provided input on the importance of language and knowledge about the term ‘frailty’ in the community, indicating that it is an emotionally laden term, carrying assumptions about capacity and a lack of independence. They advocated the importance of having a choice of strategies/intervention(s); and interventions considered most likely to be effective were those that addressed mobility and exercise, cognition, and mood or social connection. ‘Be Your Best’ interventions will be community-based and provide a suite of integrated options for the health consumer to choose from.
4. Discussion – These early outcomes show promise in directing a program that will develop a set of co-designed interventions, that also represents a departure from previous prescriptive approaches to addressing frailty.
5. Conclusions - Consumer engagement, and therefore choice is likely to lead to more effective and sustainable intervention outcomes.
6. Lessons learned - The importance of co-design and co-production of consumer directed care, and an emphasis on the preventive potential of frailty interventions

7. Limitations – To date, these are findings from a cohort with a defined and distinct demographic profile.

8. Suggestions for future research – Next steps are to engage with a broader population of health consumers, and to trial a pilot of the proposed interventions.

Introduction
There is little evidence on the prevalence of elder abuse in Australia, with estimates ranging from 2-10% of the population over the age of 65 experiencing abuse based on international indications, with the prevalence of neglect possibly higher . Identifying and responding to older people who are at risk of or experiencing elder abuse is not standardized across the health and community sectors. When screening does occur, clinicians can be unsure of who to refer to or available supports. It is largely under-reported due to a lack of understanding by service providers of the factors and nature of elder abuse and many older people do not recognise their experience as family violence, or are reluctant to report for fear of losing family relationships .

Method
The 2017 Department of Health and Human Services (DHHS) funding of Melbourne Health’s Integrated Model of Care (IMoC) for Responding to Elder Abuse has driven the integration of specialised staff to educate and consult with clinicians, provided therapeutic pathways for older people, their families and carers, strengthen referral pathways, update policies and identify resources to ensure these patients are recognized and supported. Current funding will continue until June 2021. Access to these services are available to all Melbourne Health patients and clients in the community catchment area who are 65 years of age or over.

Results
Outcomes of the DHHS IMoC funding to Melbourne Health have led to 350 staff in the area trained to support the conversations regarding suspected elder abuse. An average of 35 consultations per month to the Elder Abuse Prevention & Response Liaison Officer has led to continuity of care between hospital and community and the facilitation of appropriate referrals to relevant services such as specialist legal and advocacy services, the IMoC Counselling and Financial Counselling Service, Commonwealth Aged Care Services and Victoria Police as required. Sustainability of practice will be achieved through embedding these learnings into daily practice, online learning modules and updated policy guidelines.
As part of the Melbourne Health Comprehensive Geriatric Assessment undertaken on the sub-acute wards, the Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST) has found 20% of patients screened positive for higher risk of elder abuse. Ongoing analysis is reviewing the outcomes of this screening.

Conclusion
Increasing the awareness and building capacity of health and community providers is a key requirement to ensure screening, identification and support pathways are available for this vulnerable group of patients. The large numbers of staff attending training as well as ongoing counselling referrals demonstrates the need for this service to be embedded into hospitals on a wider scale.

Discussion
The DHHS IMoC funding model has addressed the requirement for specialised staff in hospitals to build expertise and pathways to support those experiencing elder abuse. Next steps include the creation of online education modules and building networks as part of the resource log to ensure transferability of learnings.

The Internet of Things plays a vital role in today’s medicine. Adding to this the demographic changes will further set a significant challenge. Innovative techniques for supporting health systems and independent life for the aging population is therefore essential, not at least in relation to fall prevention and technology for promoting a good life throughout the lifespan.
Further, participation from patients is a goal for healthcare worldwide. In line with this challenge of integrated care the patient itself will be the most important resource for promotion of health, why Co Design is needed as a method for innovation in healthcare sector. It is important for the users ‘experiences and insights to contribution in improvements but not at least because it has been shown that increased involvement with the user in care reduces the number of hospital visits. However, there are several challenges when participation and engagement are to be created together with users, as users are different in terms of health, personal needs, characteristics and behaviors why more knowledge is needed on how to integrate users to achieve the highest level of participation and commitment in a deeper and broader way, not least to develop and improve the conditions for health and a good life for future demands.

The aim was to examine innovative ways of learning, commitment and to communicate, as in Co Design, in order to support an independent, healty life for seniors related to fall prevention. We conducted the Co Design model by using a Quadraple Helix including senior citizens, technicians, researchers and professionals in healthcare sector.

From a fall perspective the QH-consortium found challenges in the fact that a person might go from being totally independent of health one day into dependency on health care services the other day. In order to meet this change of transformation to better meet the challenges in the process, the QH created three different personas using the Co Design model to more easily meet the challenges;
1. Active Alice, a woman that still have a very active and social life and have little risk for falling. In this stage the need is to be aware of the risk and her own risk behaviors to be able to actively prevent the first severe fall accident.
2. Vital Hubert, a man that may have developed one chronical illness like diabetes or heart failure in the early phase and still manage to stay active and live independent at home.
3. Lifefighter Lee, hir (he/she) still living at home but manage that by help with daily life activities from spouse and relatives and care personals that visit hir regularly.

Considering the mentioned aspects, using the current solutions can be hard for older persons to carry out independently. Meanwhile, facing the constant change in technologies is a challenge for companies when adjusting themselves to the new needs and requirements of the customers. Sustainability is a key challenge.