SINGAPORE: A few years back, my wife and I noticed my 83-year old father needed more time with several daily activities.

He walked slower. Putting on a shirt and pants seemed a more laborious chore than before.

Still, he remained determined to “report for work” at his hawker stall, where he runs his own business selling coffee and drinks for half a day.

Recently, he told me he wants to retire soon. My father enjoys working and does not rest except during Chinese New Year, so this is a big step.

He has finally decided to listen to his body. Age is catching up.

Though it is a relief that my dad is coming to terms with this new reality, I worry that he may become frail if he does not maintain some level of physical activity.

READ: Commentary: Here’s how our elderly can better protect themselves against COVID-19

READ: Commentary: Older workers vulnerable to rising tide of retrenchment as ageist mindsets persist

HELPING FRAIL SENIORS A HEALTHCARE PRIORITY

My father is one of the many elderly among us experiencing life-altering changes. One in four Singaporeans will be 65 and above in 2030.

Studies show that as seniors age, they may eat less, lose muscle, and become more prone to illness. When they fall ill, they can take longer to recover.

Frailty is characterised by ageing-related weight loss, reduced muscle strength and a slower walking pace.

Clinicians increasingly believe that frailty can be a key factor leading to longer hospital stays or poor recovery.

It’s in the hospital where tackling frailty can make a huge difference in a senior’s quality of life but healthcare workers are often more focused on managing their admitting diagnosis, and not the syndromes commonly associated with frailty.

LISTEN: COVID-19 diaries: A nurse fighting on the frontlines

NURSES ARE STEPPING UP

What gives me hope after over two decades as a nurse, is how vast an improvement my peers and I have seen in the upskilling in the profession, spanning administration, research, education and even informatics.

We believe nurses can play a leading role in addressing the needs of the silver tsunami, in addressing two common health issues: Frailty and caring for chronic wounds.

These are key challenges for Tock Seng Hospital (TTSH), which sees a large majority of patients who are above 65.

READ: Commentary: COVID-19 – an ageing world makes it harder to fight pandemics

For such reasons, TTSH along with Changi General Hospital were the first hospitals to subscribe to NICHE – Nurses Improving Care for Healthsystem Elders, a nurse training programme that tackles ageing-related conditions such as impaired cognition, incontinence or gait instability.

Over 500 nurses have undergone this week-long training with subsequent on-the-job assessment.

Under this programme, nurses take up primary roles to manage the care of hospitalised seniors. They are trained to look out for common problems associated with skin care, mobility, nutrition, hydration, continence and delirium that may delay recovery.

During a defined study period involving over 4,200 seniors at TTSH from August 2016 to October 2017, nearly half were provided nurse-led interventions such as early assessment to look out for conditions such as frailty, fall risk or cognitive impairment, nutrition screening and counselling for patients and families were done.

In daily care, nurses encouraged the elderly to move about, assisting patients with sitting out of bed and ensuring regular bathroom breaks to encourage independence especially after discharge. These actions have shown to reduce episodes of delirium, bed sores, as well as the use of diapers and restrainers among elderly patients who were provided specialised geriatric care.

Nurses also play a key role in helping reduce hospital admission rates among seniors. In the United Kingdom, nurses assess elderly patients for signs of frailty, nutrition deficiencies, or issues arising from dementia or delirium at the emergency department, so they may be directed to community services if hospitalisation is assessed to be a less optimal solution.

In other advanced countries, nurses in home care services have stepped up to manage frailty and the common geriatric syndromes.

READ: Commentary: Opening earlier and more – some senior care centres in Taiwan take service to new levels

READ: Commentary: It is high time for a Ministry on Ageing Issues

In Singapore, nurses are well-positioned to do the same, particularly community nurses, who visit discharged patients at home to keep them from being readmitted into the hospital.

These nurses are equipped with a myriad of skills taught by physicians, physiotherapists and occupational therapists to care holistically for patients with non-complex conditions such as arthritis, hypertension and moderate diabetes.

Meanwhile, a homecare nurse can be the single contact point to provide care and advice to a frail elderly with malnutrition who may be experiencing side effects from the multiple medications he or she has been taking.

Such a one-stop point of care would improve affordability and help coordinate care needs. Regular health reviews can also build trust between seniors and their healthcare provider.

NURSES CAN TRAIN VOLUNTEERS

Yet relying on nurses alone for elder care is not sustainable in the long run, as developed countries grow greyer.

We know this and have therefore worked with our larger community to enlist the help of ordinary citizens. At TTSH, we have more than 500 active volunteers across 33 volunteer programmes, who contribute and support our clinical teams in various ways.

In one programme, volunteers first receive online training led by nurses to understand what delirium looks like and guided in engaging with and caring for patients. Volunteers play puzzles, memory games, and even conduct reminiscence therapy with patients; activities which have been proven to prevent delirium episodes.

Another programme trains volunteers to help patients in simple rehabilitation exercises to enhance their recovery.

Anyone who is willing can learn these skills. Volunteers who contribute to patient care could help free up nurses for more urgent, higher-order tasks.

READ: Commentary: Philippines’ COVID-19 fight depends on the exploitation of healthcare workers

READ: Commentary: COVID-19 outbreak has overworked some but left more with little to do

NURSES CAN HELP SUPPORT CAREGIVERS

One other group deserving of more attention are family caregivers of patients with chronic illnesses, whom nurses are also equipped to help.

We often hear stories of how caregivers, who may be seniors themselves, experience burn-out.

A nursing research team at TTSH recently developed an assessment tool to determine how a caregiver is coping. They are now looking at how to design support services and validate training programmes for caregivers.

In due time, nurses may have yet an additional role to identify and help distressed caregivers. We do this knowing that with good caregiver training, we can also avoid mismanagement of chronic wounds, and help caregivers care for such seniors living with them.

Technology and telehealth has made wound care more accessible to caregivers. The Home Nursing Foundation has used a wound imaging app that can digitally record the appearance and size of the wound. Nurses can then determine an appropriate treatment plan.

Colleagues tell me bed sores and diabetic wounds are common among the elderly. Unsurprisingly, many patients and their caregivers may easily dismiss a skin tear on a bed-bound elderly or a small cut on the foot of a diabetic.

This can be dangerous. Though such wounds may look harmless initially, they can deteriorate fairly quickly and become septic if inadequately managed.

READ: Commentary: Living with dementia, anguish and guilt plague families caring for loved ones

READ: Commentary: When memory fails in old age – the fight for independence, well-being shouldn’t be a lonely one

LIGHTING THE WAY FOR NEW NORMS IN NURSING

The impact of the silver tsunami on healthcare cannot be underestimated.

With nurses forming 30 per cent to 40 per cent of the healthcare workforce, we know we can play a significant role in aged care if we pool our expertise, skillsets and compassion to help caregivers, volunteers and members of society build basic knowledge in managing common health problems surrounding ageing.  

Together we can help our seniors age well in their homes and communities, and strengthen the fabric of society to be more elderly-friendly.

Adjunct Associate Professor Yong Keng Kwang is a veteran nurse at Tan Tock Seng Hospital. He has been Chief Nurse at TTSH since 2011 will take on the portfolio Group Chief Nurse at the National Healthcare Group (NHG) from Oct 1.

SINGAPORE: There are those who dream of founding a tech start-up like Zoom, Snowflake or Facebook – and the fame, wealth and recognition that they imagine must follow.

At 18, Singaporean Dalton Prescott Ng is already the founder of modestly successful tech start-ups, and serves as chief technology officer (CTO) of his latest venture.

But if you ask him, he’ll say that his life is anything but glamorous. “What they see on film is people in suits on private jets,” he said. 

The reality is, “a lot of it is sitting in front of a laptop, 10 hours getting work done, writing code. It’s a tonne of work.”

There are some, he says, who think he lives in luxury. The polytechnic student who lives with his parents says: “I don’t buy branded clothes. I buy one pair of shoes and I wear it for a year until it breaks. I eat cai fan (economy rice) every day.”

Young entrepreneurs like Dalton are shaping this country into a smart nation with their innovative start-ups, building companies that rake in thousands to millions of dollars.

But what does it take to be a successful teen entrepreneur – and as the programme On The Red Dot finds out, how can these start-ups succeed in the competitive industry of app development?

WATCH: At 18, my life as a tech start-up founder (3:56)

HOW HE GOT HIS START – WITH MINECRAFT

There has been a huge increase in demand for mobile apps in recent years, and consumer spending on mobile apps is expected to hit US$171 billion (S$232 billion) by 2024, double the amount from 2019.

Many of these apps are developed by talented designers under the age of 20.

Dalton was only 14 when he launched his first venture with friends. That failed because of their lack of business experience.

But he has since gone on to found other start-ups, including MasterApp, that dealt with cognitive learning; and current venture OohSpots, an app that will let users like small businesses conveniently buy out-of-home advertising spots.

His journey into programming started when he was 11, when he got bored with the Minecraft game he was playing. He borrowed books on programming from the library and learnt Java programming language to build mods for the game.

Back then, the computer he was using was an old and slow laptop that was shared with his five siblings, but it didn’t matter.

“I started to fall in love with programming and the ability to create an experience,” said Dalton. “What was just a hobby eventually became a career choice.”

At 14, he told his mother about his plans to launch a software development company, and she thought he was crazy.

“I think especially for Singapore parents, they want us to play it safe. For her, playing it safe would be going to school, doing well, going to a JC (junior college), then going to university,” he said.

But she didn’t stop him from pursuing his interest. At 16, Dalton became the youngest recipient of the prestigious Apple WWDC scholarship for two years running in 2018 and 2019.

For him, going to the Apple Worldwide Developers Conference (WWDC) in California was a humbling experience. In Singapore, he was well regarded as an app developer, but in the US, he met younger kids who were able to build higher-level apps than he could.

“If you are someone with any form of superiority complex, when you go there, you’re going to lose it,” he said.

FROM POTATO PIRATES TO CYBERSECURITY

In four years, Dalton has made thousands of dollars from developing some 10 apps.

And he is aiming to make it big with his new advertising app – but every day, it’s estimated that nearly 5,000 new apps go live, and only a fraction of them will actually turn a profit.

“There are no major players (in this space) right now. We really need to rush out development because once the foothold in the market has been taken, it’s very hard to get it back,” he said.

The original plan to launch it by July 2020 has been delayed because of the COVID-19 pandemic. But his team has also been working on a mobile gaming app, Potato Pirates, for software company CODOMO.

And meanwhile Dalton – who is completing his diploma in infocomm security management at Singapore Polytechnic – was also busy until recently with an internship at DSO National Laboratories. As a cyber security engineer, he helped build a communications app for Singapore’s largest defence R&D organisation.

“I’m working on so many different things, it helps that I have multiple income streams coming in. If one of them were to fail, I can rely on others,” he said.

Many developers build apps with the goal of monetary gain. But Dalton thinks one should build an app to solve a problem first, and not to squeeze profits.

“Focus on charging customers the right amount so that you solve their problem and they are happy. That’s how you build a successful business,” he said.

HAVING TO PROVE HIMSELF

It has only recently occurred to him that he shoulders more responsibilities than his average peer: A stressful role as CTO, managing his team, his studies, even having to source for funding.

“When I talk to my friends, I realise the kind of stuff that I am thinking about is very different,” he said. “I am concerned about the ROI (return on investment) or what if I were to spend this much on developing the product. And (they are) thinking about what they want to eat tomorrow.”

While being a young entrepreneur has its advantages, including having more energy and more time to learn the business, Dalton has to work harder to prove himself because of his age.

“It is hard (for investors) to entrust someone who’s 17 or 18 with that kind of money,” he said. “So it was definitely a struggle for me.”

To reassure investors, his company appointed an older, more established entrepreneur as CEO.

“So when we go to an investor, he can definitely see that the company is set up properly,” he said. “What a lot of investors are looking for is traction and the ROI. As long as you can show them those two things, then you can most probably get an investment.”

WATCH: Young and boss: Teen app developers (full episode, 22:40)

HYPERVENTILATING UNDER A BLANKET

Learning how to deal with stress, failure and people are skills that this teenager had to pick up.

As a younger boy in secondary school, he wasn’t able to deal with feedback and would get upset when someone criticised his coding. He also took failure hard.

“When things weren’t going well, when we were running into issues, I’d find myself under my blanket hyperventilating,” he described. “I didn’t know how to deal with these emotions, I didn’t know how to reason with myself that it’s okay, that if things aren’t going well, you can find another way.”

These days, he has learnt to leave his “ego at the door”.

I think especially in small startups, it is very important that you can take brutal honest feedback.

“If someone tells you that your design is ugly, they are not trying to insult you, they are trying to help you make your product better,” he said.

But the long hours and workload have taken their toll on his health.

Showing a photo of himself with ripped six-pack abs two years ago, Dalton pointed to all the weight he’s put on since he stopped exercising and turned to stress-eating.

“I worked long hours, I drank a ton of energy drinks,” he said. “That kind of led to a bit of a burnout situation, where I stopped working for a while and just took some time to recover.”

Dalton has also missed out on some parts of teenage-hood – like the Marvel series of superhero movies in recent years.

“In many ways, I wish I could have fewer responsibilities… My job is stressful. But I also know that I wouldn’t be happy doing anything else,” he said.

And while some might think he’s already hit career heights at this young age, he sees himself “at the bottom” with “still has a long way to go”.

“I hope that I’ll be successful enough that I can make it to Forbes’ 30 under 30 Asia list,” he added.

Watch the episode of  On The Red Dot: Young And Boss here.

SINGAPORE: Every week I read about another university in the United States forced to abandon in-person instruction due to a sudden rise in coronavirus cases: UNC-Chapel Hill, Notre Dame, James Madison.

This sudden change of direction has taken a toll on students, who are now restricted to remote instruction and self-isolation after moving to campus only weeks before.

It has also impacted faculty members, now forced to redesign their modules in the midst of the semester.

Here in Singapore, I have been planning for online teaching since May, when the NUS Faculty of Arts and Social Sciences made the controversial decision to offer nearly every course online this semester.

STARTING EARLY

The decision was unpopular with many colleagues, including me. After all, nearly everyone prefers face-to-face instruction.

READ: Commentary: How ready are Singapore universities to start the new term as COVID-19 rages on?

READ: Commentary: Home-based learning is strange, new ground. But we can conquer that too

COVID-19 has completely disrupted higher education around the world. Student exchange has been suspended, orientation camps cancelled, and academic conferences moved online.

I have felt these disruptions deeply as a lecturer at the National University of Singapore. But not all is lost, and in fact, much has been gained in these unusual times. 

Going completely online turned out to be the pragmatic choice. Deciding early gave me precious time to plan for online teaching and to consult with others.

I had time to redesign my modules, rethink my teaching style, learn new skills, experiment with new technologies, and plan new ways to encourage active learning made possible by – not in spite of – the online teaching environment.

Now that the semester is well underway, and I have had more time to reflect on what we have lost and gained through purely online teaching, I can say one thing for certain: Online teaching doesn’t (have to) suck. In fact, the results have been far better than I expected. 

In ten years spent teaching at NUS, I have been fortunate to share the classroom with thousands of amazing students whom I care about very much. 

I realise now this is precisely why FASS chose to go fully online: We care about the health of our students and their families, and we have a duty to both protect them, while also providing a world-class education.

WHAT WE HAVE LOST

But we all start from the premise that something is missing in online learning when face-to-face instruction forms most of what we’ve known to be higher education.

I also have been to enough concerts, sporting events, weddings, graduation ceremonies, National Day Parades, and theatrical productions to know the power of sharing an experience with others in the same space.

READ: Commentary: This National Day, let’s celebrate Singaporeans too

READ: Commentary: Will COVID-19 spell the end of strata malls?

There is something undeniably intentional about walking into a classroom, committing oneself to a chair, making eye contact or mingling with those sitting nearby, and getting ready for what’s to come.

As an educator, I miss feeding off the energy of my students while lecturing, and I miss the sound of a room buzzing from small-group discussion.

WHAT WE HAVE GAINED

But as an educator, I know there’s potential for gains when we experiment with new ways of learning.

In years past, when I lectured to a group of 400-plus, I encouraged student engagement through hand-held response devices and smartphone apps.

I even used specialised software to elicit written questions during lecture, but not many volunteered.

The design of the lecture theatre can make students feel tiny and vulnerable. It takes a brave soul to raise one’s hand in such a large room.

And do you shout your question, or wait for the lecturer to hand you the microphone? In my experience, not many students are ready for that kind of potential public embarrassment.

Since moving to online learning, questions flow like water, and students are active at levels I never quite reached with technologies alone. But it’s not because of the technology, it’s because of the context.  

Now, I pre-record lectures and ask students to watch them before we meet. Then, we devote our precious time together to clarifying the material and delving deeper into areas of interest to the students.

One question often fuels another, until suddenly dozens of students raise their virtual hands or type their questions.

Plus, more students are emailing with follow-up questions and contacting me for one-on-one online meetings.

READ: Commentary: COVID-19’s education revolution – where going digital is just half the battle

READ: Commentary: How to sabotage your child’s future – five dangerous notions about life, careers and education

The tools for active learning have been around for years, but the pandemic and learning online seems to have inspired students to take advantage of them in new ways.

And I am not alone. Colleagues from around NUS tell me they are fielding more questions with online teaching than they ever received in person.

FLATTENED HIERARCHY

Online, there is none of the hierarchy built into classroom design.

Our faces are the same size, and we all face the same direction – into the camera. We all look directly at each other, giving each other equal respect.

Online, students can take their time to carefully formulate a question, and I can request each student to turn on their microphone and video camera and ask their question to the entire class.

I can even click a button and place students in breakout rooms to discuss a question. This recreates the buzz of the classroom without the time and commotion of moving desks or awkwardly turning in one’s seat. 

MORE INTERACTION

Even in a small class, online teaching can lead to surprising outcomes. One comment in particular from a 5-week module I taught during the school break sticks out: “Actually I find that the Zoom platform might be more social than in the classroom setting (maybe it’s something to do with seeing everyone’s faces head-on, so it feels more personal somehow).”

Of course! When I stand at the front of the classroom, I see everyone’s faces. But students only see the back of each other’s heads. Classrooms are designed that way.

Online, students’ names are always visible on the screen, which helps them get to know each other better.

As another student from my July module wrote, “It’s the first time in uni that I actually know my classmates better and I’m comfortable speaking up around them.” 

MORE COLLABORATION

None of these benefits come by chance. Online teaching requires completely rethinking the relationship between student and teacher. It requires redesigning assessments so they can be done synchronously or asynchronously, across space.

I purposefully included more small-stakes group work, and I take the time to rotate group members so everyone gets to know each other. Taking this extra step in a physical classroom is difficult.

Students are creatures of habit: Where they sit on the first day of class is where they tend to remain all semester. Online learning shakes up habits, ensuring that they interact with more students and thus hear more perspectives.

Students learning online may not have the same social life outside the classroom, but they need not feel isolated. We can create opportunities for them to make friends and collaborate as learners. 

READ: Commentary: Teachers now have new jobs. Schools will never be normal again after COVID-19

READ: Commentary: It is time to rethink how we do online education

ADAPTING AGAIN

Recently, as coronavirus cases in Singapore have dwindled, I have been asked to consider adopting a hybrid model for one of my modules of fewer than 25 students.

Hybrid teaching would mean meeting some students in person and others online. I choose to remain online. I spent months carefully planning for online learning. Changing course midstream threatens to undo all that work and to disrupt my students’ new learning habits.

Just as one cannot smoothly go online overnight, one cannot go hybrid without careful thought and planning. Plus, colleagues who have asked students about the possibility of going hybrid found that a large majority prefer to continue with online learning only.

Some students worry about spreading the virus to family members, while others have become comfortable and thrived with new online learning habits. They are asking more questions, collaborating across time and space with more peers, and connecting more with their professors. 

When it is safe to return to the classroom, I will be the first person through the door.

In the meantime, carefully designed online teaching is not a worse option or a stopgap. 

It is a tool to engage active learners and break down some of the biggest barriers to learning in higher education. 

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Chris McMorran is Associate Professor in the Department of Japanese Studies at the National University of Singapore. He is also past recipient of the NUS Outstanding Educator Award and FASS Inspiring Mentor Award.

SINGAPORE: Online cashback portal ShopBack said it has initiated an investigation after being alerted to an incident involving “unauthorised access” to its systems containing customers’ personal data. 

In an email to its customers on Friday (Sep 25) seen by CNA, ShopBack said it was currently confirming what data had been compromised. 

“To date, we have no reason to believe that any of your personal data has been misused, however the possibility still exists,” said the Singapore-based company. 

Customers’ cashback balances or unutilised vouchers were also not affected by the incident, said ShopBack in an FAQ page on its mobile app. 

“Your credit cards are safe as we do not store your 16-digit card number or CVV on any of our systems,” it added. 

ShopBack said customers may continue to access their accounts as business operations have not been affected. 

But the company encouraged customers to reset their passwords as a precautionary measure, even though the existing ones are encrypted.

“UNSETTLING NEWS”

On its FAQ page, ShopBack said that apart from email addresses and “limited transactional information”, the company does not have additional data that customers had not provided directly. 

Types of data that may have been provided to ShopBack include names, contact information, gender, date of birth, identification numbers, and bank account numbers. 

“As soon as we became aware of the issue, the unauthorised access was removed,” said the company. 

“We immediately initiated an investigation and engaged leading cybersecurity specialists to assess the extent of the incident and to further enhance our security measures,” said ShopBack, adding that it was also collaborating with relevant authorities.

The company has also tightened the monitoring of internal logs to “ensure heightened detection of unauthorised access if any were to occur”, it said. 

“We recognise that this is unsettling news and we are deeply sorry for any inconvenience this might cause you,” said the company. 

“The security and privacy of our customers is of utmost importance to us, and we commit to taking all the steps we can to minimise the risk of a similar incident occurring again in the future.” 

CNA has reached out to ShopBack to ask how many customers have been affected by the incident.