{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:07:38Z","timestamp":1769508458067,"version":"3.49.0"},"reference-count":32,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Against a rapidly aging population, projections are done to size up the demand for long-term care (LTC) services for long-range policy planning. These projections are typically focused on functional factors such as disability. Recent studies indicate the importance of social factors, for example, socially isolated seniors living alone are more likely to be institutionalized, resulting in higher demand for LTC services. This is one the first known studies to complete a 40-year projection of LTC demand based on disability and social isolation. The primary micro dataset was the Retirement and Health Survey, Singapore\u2019s first nationally representative longitudinal study of noninstitutionalized older adults aged 45 to 85 with over 15,000 respondents. Disability prevalence across the mild to severe spectrum is projected to increase five-fold over the next 40 years, and the number of socially isolated elders living alone is projected to grow four-fold. Regression models of living arrangements revealed interesting ethnic differences: Malay elders are 2.6 times less likely to live alone than their Chinese counterparts, controlling for marital status, age, and housing type. These projections provide a glimpse of the growing demand for LTC services for a rapidly aging Singapore and underscore the need to shore up community-based resources to enable seniors to age-in-place.<\/jats:p>","DOI":"10.3390\/ijerph17144950","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T10:45:19Z","timestamp":1594291519000},"page":"4950","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["40-Year Projections of Disability and Social Isolation of Older Adults for Long-Range Policy Planning in Singapore"],"prefix":"10.3390","volume":"17","author":[{"given":"Reuben","family":"Ng","sequence":"first","affiliation":[{"name":"Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259772, Singapore"},{"name":"Lloyds Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore 117602, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2335-8024","authenticated-orcid":false,"given":"Si Qi","family":"Lim","sequence":"additional","affiliation":[{"name":"Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259772, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su Ying","family":"Saw","sequence":"additional","affiliation":[{"name":"Ministry of Health, Singapore 169854, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin Bryan","family":"Tan","sequence":"additional","affiliation":[{"name":"Ministry of Health, Singapore 169854, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1377\/hlthaff.21.2.78","article-title":"The case for more active policy attention to health promotion","volume":"21","author":"McGinnis","year":"2002","journal-title":"Health Aff."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e0126471","DOI":"10.1371\/journal.pone.0126471","article-title":"Projection of young-old and old-old with functional disability: Does accounting for the changing educational composition of the elderly population make a difference?","volume":"10","author":"Ansah","year":"2015","journal-title":"PLoS ONE"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"130","DOI":"10.5694\/j.1326-5377.2003.tb05470.x","article-title":"Disability in older Australians: Projections for 2006\u20132031","volume":"179","author":"Giles","year":"2003","journal-title":"Med. J. Aust."},{"key":"ref_4","unstructured":"United Nations, D. of E. and S.A (2019). World Population Ageing 2019: Highlights (ST\/ESA\/SER. A\/430), United Nations Publications."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E43","DOI":"10.1111\/ajag.12415","article-title":"Projections of the number of Australians with disability aged 65 and over eligible for the National Disability Insurance Scheme: 2017\u20132026","volume":"36","author":"Biddle","year":"2017","journal-title":"Australas. J. Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1016\/S2468-2667(17)30091-9","article-title":"Forecasted trends in disability and life expectancy in England and Wales up to 2025: A modelling study","volume":"2","author":"Bandosz","year":"2017","journal-title":"Lancet Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1093\/geront\/32.5.618","article-title":"A path not taken: A cultural analysis of regrets and childlessness in the lives of older women","volume":"32","author":"Alexander","year":"1992","journal-title":"Gerontologist"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jclinepi.2010.04.018","article-title":"Future disability projections could be improved by connecting to the theory of a dynamic equilibrium","volume":"64","author":"Klijs","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jamda.2012.08.014","article-title":"Domains contributing to disability in activities of daily living","volume":"14","author":"Schuurmans","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1477-7525-2-52","article-title":"Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia","volume":"2","author":"Andersen","year":"2004","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_11","unstructured":"Jalelah, A.B. (2020, April 23). News $200 Monthly Grant to Offset Costs of Long-Term Care Giving by End-2019: MOH. Available online: https:\/\/www.channelnewsasia.com\/news\/singapore\/new-caregivers-monthly-grant-offset-costs-ministry-of-health-11238776."},{"key":"ref_12","first-page":"193","article-title":"Living arrangements of older persons and family support in more developed countries","volume":"43\/44","author":"Gierveld","year":"2001","journal-title":"Popul. Bull. United Nations"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"576","DOI":"10.47102\/annals-acadmedsg.V43N12p576","article-title":"Association of socioeconomic status (SES) and social support with depressive symptoms among the elderly in Singapore","volume":"43","author":"Ng","year":"2014","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lim, L.L., and Kua, E.-H. (2018, July 20). Living Alone, Loneliness, and Psychological Well-Being of Older Persons in Singapore. Available online: https:\/\/www.hindawi.com\/journals\/cggr\/2011\/673181\/.","DOI":"10.1155\/2011\/673181"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/21620555.2015.1032162","article-title":"Living arrangements of the elderly in China and consequences for their emotional well-being","volume":"47","author":"Ren","year":"2015","journal-title":"Chin. Sociol. Rev."},{"key":"ref_16","unstructured":"Population Division, Department of Economic and Social Affairs, United Nations (2005). Living Arrangements of Older Persons around the World, United Nations Publications."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1177\/0265407593103004","article-title":"The differential availability of relationships and the provision and effectiveness of support to older adults","volume":"10","author":"Dykstra","year":"1993","journal-title":"J. Soc. Pers. Relatsh."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2307\/3090242","article-title":"Health in household context: Living arrangements and health in late middle age","volume":"43","author":"Hughes","year":"2002","journal-title":"J. Health Soc. Behav."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1177\/0363199012440948","article-title":"Living arrangement preferences of elderly people in Taiwan as affected by family resources and social participation","volume":"37","author":"Chen","year":"2012","journal-title":"J. Fam. Hist."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"39","DOI":"10.17645\/pag.v6i4.1757","article-title":"Cloud computing in Singapore: Key drivers and recommendations for a smart nation","volume":"6","author":"Ng","year":"2018","journal-title":"Politics Gov."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/S0140-6736(96)07492-2","article-title":"Alternative projections of mortality and disability by cause 1990\u20132020: Global burden of disease study","volume":"349","author":"Murray","year":"1997","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1377\/hlthaff.2014.0556","article-title":"Expectations about future use of long-term services and supports vary by current living arrangement","volume":"34","author":"Shippee","year":"2015","journal-title":"Health Aff."},{"key":"ref_23","unstructured":"(2020, April 23). Agency for Integrated Care. Available online: https:\/\/www.aic.sg\/."},{"key":"ref_24","unstructured":"Toh, Y.C. (2020, April 23). Singapore Budget 2018: Support Network for Seniors to be Expanded. Available online: https:\/\/www.straitstimes.com\/politics\/support-network-for-seniors-to-be-expanded."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/geront\/gnr083","article-title":"The \u201cVillage\u201d model: A consumer-driven approach for aging in place","volume":"52","author":"Scharlach","year":"2011","journal-title":"Gerontologist"},{"key":"ref_26","unstructured":"Chan, L. (2020, April 23). National Electronic Patient Database Soon to Be Mandatory for Healthcare Providers. Available online: https:\/\/www.channelnewsasia.com\/news\/singapore\/national-electronic-health-record-mandatory-clinics-9385666."},{"key":"ref_27","unstructured":"Ng, R., Hiew, Y.L., Goh, H.L., and Tan, K.B. (2018). Implementing a nationwide predictive model for frequent readmissions in Singapore public hospitals, Submitted for publication."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ng, R., Allore, H.G., Trentalange, M., Monin, J.K., and Levy, B.R. (2015). Increasing negativity of age stereotypes across 200 years: Evidence from a database of 400 million words. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0117086"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ng, R., and Lim, J. (2020). Ageism linked to culture, not demographics: Evidence from an 8-billion-word corpus across 20 countries. J. Gerontol. B Psychol. Sci. Soc. Sci., under review.","DOI":"10.1093\/geronb\/gbaa181"},{"key":"ref_30","unstructured":"Ng, R. (2020). OK, Boomer: Ageism in the US and UK from a pooled database of 1.1 billion words. Nature, under review."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"20e","DOI":"10.1097\/PRS.0000000000003439","article-title":"The ideal buttock size: A sociodemographic morphometric evaluation","volume":"140","author":"Heidekrueger","year":"2017","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1097\/SAP.0000000000000001","article-title":"Aesthetic breast shape preferences among plastic surgeons","volume":"74","author":"Broer","year":"2015","journal-title":"Ann. Plast. Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/4950\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:49:21Z","timestamp":1760176161000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/4950"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,9]]},"references-count":32,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["ijerph17144950"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17144950","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,9]]}}}