Growing Old Gracefully

Growing older does not have to mean losing independence. Dr Jamie Kee, Associate Consultant of Geriatric Medicine at Changi General Hospital (CGH), shares how a little attention and the right support can help seniors stay active, engaged and comfortable for longer.

Dr Jamie Kee checks a patient’s hearing, one of many small changes that can quietly affect daily life.

Ask most people what ageing looks like, and they will describe a familiar picture: a little less energy, achier joints, a body that moves more slowly than it once did. Dr Jamie agrees that some of this is natural. Muscle mass, bone density and stamina do ease off with the years. But she also believes something reassuring: with the right support, most people can keep doing the things they love for much longer than they expect.

“Becoming frail is not part of normal ageing,” she says. There is a real difference between simply growing older and losing one's reserves. That difference matters, because many changes people assume are inevitable can actually be supported, slowed or improved. Age, she points out, is just a number. What counts is how well someone's body and mind are being cared for.

Hidden in plain sight

Dr Jamie encourages families to pay attention to small shifts: walking a little more slowly, needing a hand to get up from a chair, feeling tired after everyday errands, or seeming a touch less steady than before. A remark as simple as “why are you always walking so far behind us now?” is often the first sign worth following up on. These changes arrive quietly, which is exactly why an observant family member matters so much.

Dr Jamie prefers to start care early, before a smallchange becomes something bigger.

A mother who has quietly stopped her usual trips to the market, even while insisting she is fine, may simply be telling her family, in her own way, that some support would help. Some changes do call for prompt medical attention, such as confusion, sudden breathlessness, or a sharp change in daily function. But most of what Dr Jamie describes are early invitations to check in, not causes for alarm.

Her approach reflects a different instinct. In many specialties, care begins once something has already gone wrong. In geriatrics, she prefers to start earlier, before a small change becomes something bigger, so whatever ability a person still has is preserved for longer.

When a patient comes to see her, often for memory concerns, occasional falls, or feeling less steady than before, Dr Jamie begins with a conversation, not a test. “I try to understand what matters to them, because that is what drives the treatment,” she explains. Someone who dreams of attending a grandchild's wedding will have very different priorities from someone who wants fewer pills and a calmer routine. From there, she runs a comprehensive assessment covering cognition, balance, nutrition, sleep and mood, before building a suitable care plan for the patient.

Never a solo journey

One of the most reassuring parts of geriatric care, as Dr Jamie describes it, is that no patient has to manage alone. At CGH, patients who have had a few falls are seen by nurses and physiotherapists before a doctor examines them. Hence, the team can work out what might help, whether that is a vision check, a look at their walking aids, or a medication review. Community nurses and occupational therapists often visit patients at home too, suggesting practical touches like grab bars, non-slip mats or brighter lighting. 

Patients with memory concerns are supported by memory nurses and doctors, with referrals onward to daycare centres or cognitive programmes. Community nurses and partners such as Community Resource, Engagement and Support Team (CREST) visit patients' homes to provide support after a dementia diagnosis. 

Getting patients to try these programmes takes patience. Older adults often warm to day rehabilitation more easily, Dr Jamie has found, since it feels like an exercise class, while daycare centres can feel unfamiliar at first, "like school." Her own grandmother refused outright, until Dr Jamie brought her to an active ageing centre, where she ran into a neighbour. Free food and familiar faces did the rest. One visit a week soon became two, and eventually she was attending a daycare centre as well. Centres like this welcome any senior simply looking to socialise and stay connected.

When a patient resists, Dr Jamie looks for what has always mattered to them. One patient loved gardening but refused to walk. Her family subsequently placed a plant just out of reach and invited her to water it several times a day; turning a simple pleasure into welcome movement. Another patient, who had spent her life as a nanny, found comfort — during a difficult period of dementia — in caring for a baby doll, soothing it to sleep the way she once had with the children in her charge. “Finding out what mattered to the patient, who this patient is, is very important,” Dr Jamie says.

The hard conversation

One of the most meaningful parts of Dr Jamie's work is helping families talk honestly about the later chapters of life, especially in later stages of frailty when there is no clear timeline the way a terminal diagnosis might provide. Families often approach end of life discussions as taboo. Patients, once given the chance, often already know exactly what they want. “I want to spend time with my family, express my final wishes,” is how she says many put it. That can mean settling their affairs, attending a wedding, or simply being left alone by unnecessary tests.

She is equally respectful of patients who would rather not know the details themselves. “Don't tell me, tell my family, discuss with them instead,” some tell her. In these cases, choosing not to know, she says, can matter to someone just as much as choosing to know. 

The cases she finds most difficult, she shares, usually come down to one thing: families who never had the chance to talk about these wishes earlier. By the time they wanted to, their loved one could no longer express them clearly. These conversations do not have to wait until death feels imminent. They matter at any stage of frailty and carry the most weight while a person can still take part in the decision themselves. That is why she encourages every family to start sooner.

Three things starting today

For families wondering where to begin, Dr Jamie keeps it simple: exercise, nutrition, and sleep. Singapore's guidelines suggest 150 to 300 minutes of moderate intensity exercise a week for those above 65, plus two sessions of strength training. Her advice for anyone starting out is to begin small, ten minutes of walking a day, growing to twenty and then thirty, adding light weights or a few squats along the way. “Any exercise more than what you were doing previously is a win,” she says.

On diet, she often recommends a Mediterranean style diet for its evidence around brain health, along with more protein through chicken, fish, eggs or tofu, since muscle needs more support with age. Sleep deserves equal care: around seven hours of good quality rest a night has been linked to lower risks of dementia.

Medication has a role too, particularly for bone health, though Dr Jamie is quick to note that no pill replaces movement, food and consistent care. Those remain the most powerful tools available, and they are within everyone's reach.

Do it with them

If a family wants an elderly parent to move more, the better approach is often to move together. Sharing a meal tends to bring far more joy and better results than recommending a diet.

She also encourages families to talk early about their wishes for the future, while a parent is healthy and happy. That includes an advanced care plan and Lasting Power of Attorney.

Having these conversations sooner, she says, is a gift rather than a burden. She also pushes back against a tendency she sees often: treating older adults paternalistically, as though age alone diminishes them. They have lived full, rich lives. That alone makes them worthy of respect. For seniors living alone,

Dr Jamie points families toward a wider circle of care: active ageing centres, community nurses, community intervention teams, medical social workers. These networks, including Agency for Integrated Care (AIC) exist so that no one has to face growing older without company close at hand.

Ageing well, in Dr Jamie's telling, is less about big interventions and more about small, consistent attention. It is about noticing the little things and remembering that behind every patient is a person whose happiness is worth prioritising, whether that means a garden, a beloved doll, or a familiar walk to the market. But a body cared for is only half the picture. The mind ages too, often more quietly, and just as differently from person to person.