Easing into old age: Studying life space and good health with the EASE project

What does travelling around in one’s neighbourhood have to do with good health? As it turns out, plenty. The EASE project, a landmark study by SingHealth Centre for Population Health Research and Implementation (CPHRI), seeks to study this concept known as Life Space in greater detail, and how it contributes to population health as a whole.

Tomorrow’s Medicine catches up with Associate Professor Ng Yee Sien, Senior Consultant of Rehabilitation Medicine, Singapore General Hospital and Sengkang General Hospital, and Principal Investigator in the EASE project.

What is EASE?

To understand the importance of the EASE study, it is crucial to understand the significance of Life Space—which is the area where people move around to achieve life goals like self-care, employment, and social and recreational needs, and improve their overall sense of well-being.

In a nutshell, the EASE project (which stands for Elderly Life Activity-Space Envelopes) is an ongoing community project that studies how seniors above the age of 50 interact with their Life Space. Life Space is the area in which people move around to achieve self-care, employment, and social and recreational needs. A mobile app that helps to track their travel patterns for 14 days, as well as onsite fitness assessments, and extensive questionnaires.

Comprising a person’s travel and activity patterns, life space is an important aspect of active and healthy ageing.

“While it may not seem obvious from the start, diminished life space is associated with adverse health outcomes, such as the onset of chronic diseases, and increased admissions into hospitals and nursing homes,” explained Dr Ng. Conversely, good quality life space is associated with good health.

He added: "This is really key to ageing actively and well, because studies have shown that medication only accounts for 15% of the solution to better health!"

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Travel habits of seniors in Singapore

Since it began in March this year, EASE has tracked the travel patterns and habits of about 500 seniors.

What EASE has uncovered so far is heartening. Dr Ng noted that generally, seniors of all ages are travelling more than expected.

"Also, we found that seniors on average take about 6 trips a day! That's not too bad, really. Their distance travelled may be short - about 400-500m on average, and less than 1km - but it is encouraging to know that our seniors are going out and about now, even before we try to optimise their life space considerations.”

Singaporeans also have a higher life space score than seniors from other developed countries, like Australia.

This score, known as the Life Space Index, is scored from 0-120, with 0 being the lowest and 120 being the highest. Anything more than a score of 60 is interpreted as good movement. And Singapore scores somewhere between 80 to 90, which shows that seniors in Singapore do generally have good movement.

Dr Ng Yee Sien (extreme right) with his team and partners from Pacific Activity Centre @ Punggol Emerald.

Life Space design

Said Dr Ng: "There are three main factors that affect how seniors interact with their life spaces: and they are health, social, and environmental in nature. Of the three, our EASE study hopes to uncover patterns that will improve environmental domain interactions for better health outcomes."

Kampung Admiralty is one such example of an integrated neighbourhood. The modern kampung estate includes amenities for daily living like a medical centre providing specialist outpatient care, an Active Ageing Hub that is co-located with a childcare centre, dining and retail outlets, and a hawker centre.

"Furthermore, the community spaces within the estate are intended to encourage social interactions and a sense of ownership within the community,” added Dr Ng.

All these amenities and infrastructural considerations do much in the way of removing barriers to life space for the elderly, but Dr Ng noted that providing facilitators to life space is just as important.

“We want to make it possible to achieve better life space by looking at health, social, and environmental determinants in the community, to see where the gaps are and how to close them to improve life space. That is what we hope to uncover with the EASE project’s findings.”

Following a more qualitative, in-depth study of 60 people as part of the EASE study, it was discovered that some sites drew people to them because of sentimental reasons.

“It could be a park bench they had their first date on, or a hawker centre they had good memories at–we found out quite unsurprisingly that people do tend to travel to places they feel a connection with too,” said Dr Ng, explaining that life spaces must be seen as full experiences in themselves.

Going forward

Dr Ng explained that given what we know so far, the current push for more integrated buildings and natural spaces, integrated communities, spaces where people feel connected, a car-lite society, and smart places, seem sensible and entirely logical.

On that same note, Dr Ng also emphasised that it is crucial for all specialists to pay closer attention to population health, both within their respective specialities and collaboratively with other clinical specialisations.

"I think all specialists should look at population health because it impacts all the patients they manage. For a cardiologist, population health would mean people with heart disease; for an endocrinologist, population health would mean people with diabetes,” he said with conviction. “Intervention needs to start early, before medications are given. This is where life space planning will make a difference, because there are a huge number of health, social, and environmental factors that we are looking at.”

Moreover, as our population continues to age, Dr Ng acknowledged cautiously that the goalposts will keep shifting, long after the EASE study ends.

“We must understand that the profile of seniors will change as the years go by, with more seniors remaining active to an older age and being more tech-savvy,” said Dr Ng. “There is a push towards ageing in place, where seniors and continue to live in the community as opposed to instead of moving to a nursing home. With these, seniors will have more autonomy to plan the kind of environment they would like to grow old in, to improve their life space interactions, and ultimately have better health outcomes.”

Click here to find out more about the EASE project.