The Big Read

Professor Kua Ee Heok offers insights into ageing and the elderly in Colours Of Ageing

Colours Of Ageing by Professor Kua Ee Heok (above) is a fluid blend of scientific findings, memoir and anecdotes, and is full of insights into ageing in Singapore.
Colours Of Ageing by Professor Kua Ee Heok (above) is a fluid blend of scientific findings, memoir and anecdotes, and is full of insights into ageing in Singapore.PHOTO: WRITE EDITIONS
Colours Of Ageing by Professor Kua Ee Heok is a fluid blend of scientific findings, memoir and anecdotes, and is full of insights into ageing in Singapore.
Colours Of Ageing by Professor Kua Ee Heok is a fluid blend of scientific findings, memoir and anecdotes, and is full of insights into ageing in Singapore.PHOTO: ST FILE

That is the best way to tackle dementia, says Singapore's mental-health doyen Kua Ee Heok in his new book

One day in 2006, British general practitioner Jennifer Bute was discussing dementia care with fellow doctors when she suddenly turned to one among them and asked him to introduce himself.

As Dr Bute, now 70, told Britain's Daily Mail newspaper in January 2013, he huffed: "I'm a mental- health officer and I've known you for years, Jennifer. What do you mean you don't know who I am?"

It then dawned on the married mother of three, who had been diagnosing dementia among her patients for years, that she herself now had the ailment, which soon led her to embarrassments such as being unable to recognise relatives, watching bananas explode after she left them on her burning stove and fending off the imaginary attacking bees from her hallucinations.

Dementia, which includes Alzheimer's, which Dr Bute has, happens when the brain is injured or changed in some way, such as when its cells die from a lack of oxygen.

She retired from her practice in 2009, at age 63, but is now helping fellow dementia patients more than ever by speaking at conferences on dementia and making the 2015 radio documentary Remember Me.

As Singaporean mental-health doyen Kua Ee Heok, 68, notes in his inspiring new book Colours Of Ageing, Dr Bute has found innovative ways for her and her family to cope. For example, she made leaflets about dementia for them; she now carries around a GPS device to find her way home whenever she is lost; and she is grateful for Facebook's matching of photographs to names and short, easy-to-grasp messages, as it helps her remember people. You can learn more about her at Health/Living-with-Alzheimers-Dr- Jennifer-Bute-s-story.


  • By Kua Ee Heok

    Write Editions/Hardback/154 pages/ $37.45 with GST from Books Kinokuniya or on loan from the National Library Board under the call number English 618.97689 KUA

Professor Kua, who is a former chief executive and medical director of the Institute of Mental Health and former vice-dean of National University of Singapore's (NUS) faculty of medicine, is now the Tan Geok Yin Professor of Psychiatry and Neuroscience at NUS' Department of Psychological Medicine and Senior Consultant Psychiatrist in the National University Health System. He is also a member of the World Health Organisation's Global Study of Dementia team.

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The "colours" of ageing in his book's title are hope, will and the imagination of an "undefeated mind", which is crucial to living with one's faculties intact.

  • Five questions this book answers

  • 1 Why is moral fibre so crucial to self- preservation?

    2 How does the state of mental health in Singapore compare with that in the West?

    3 Why and how do meditation, playing mahjong and eating curry boost the quality of life?

    4 Who has improved the lot of the elderly in Singapore?

    5 What still needs to be done to help the elderly in Singapore continue to thrive?

When he began studying dementia among elderly Singaporeans in the 1980s, their life expectancy at birth was 74 and they retired at 60. Today, that life expectancy has jumped to 83 and many Singaporeans are still working well into their mid-70s, with about 462,000 Singaporeans today aged 65 and older.

The dilemma of ageing is that everyone wants to live as long as possible, and yet also do not want to live too long because of the various aches and indignities that old age brings. Worse yet, dementia creeps up on a person and is hard to detect early but, like life-threatening diseases, needs to be spotted early if the sufferer is to have quality of life that is adequate.

But when Prof Kua red-flagged that urgency to the medical community here 30 years ago, almost nobody was interested in looking into medical health among the elderly, or geriatric medicine, much less researching their mental health. Worse, society poked fun at those with dementia for their forgetful and ever-confused ways.

So while Singaporeans actively chased the 5Cs - cash, credit cards, cars, condominiums and country- club memberships - he and his small team studied the 5Ds among the elderly here - decrepitude, dementia, depression, delusion and delirium. Three "tortuous" decades and five major studies of elderly mental health later, they and their partners, such as the People's Association and the National Parks Board, have shaped the groundbreaking Dementia Prevention Programme, which has led more elderly Singaporeans to boost their mental well-being with exercise, gardening, choral singing and visits to sanctuaries such as the Therapeutic Garden at Hort Park.

Better yet, he notes, from next month, a cross-disciplinary group of experts will embark on an experiment in Toh Yi Drive for the elderly to "age in place" by mingling with everyone else in their estate, to stave off the quicker deaths that come from being isolated against their will from meaningful contact.

Prof Kua's book is a fluid blend of scientific findings, memoir and anecdotes, and is full of insights into ageing in Singapore, as well as signposts to illuminating thinkers on the subject.

In achieving such fluidity, however, he has shorn so much detail from his many studies that you cannot see the big picture on dementia here easily. Still, his pithy, folksy and inspiring storytelling will likely pique his reader's interest to seek out more information on the subject.

In a nutshell


Singaporean mental-health doyen Kua Ee Heok has charted the evolution of research and treatment of mental health among the elderly in a heartfelt, assured and deceptively simple way.

In pointed yet gliding prose, he weaves important characteristics and findings about their resilience and well-being with nods to community heroes of yore, such as Cantonese master storyteller Lee Dai Sor, (whom he refers to as Lee Tar Sar), as well as to his pioneering mental-health mentors and beloved mother, who lavished love on her family with such yummy treats as "Nixon's bombs" (squid stuffed with meat).


This book is sorely in need of a glossary as Professor Kua does not break down jargon such as "translational research", "paraphrenia" or "epidemiological", all of which are crucial for the average reader to be able to follow his narrative.

Many authors these days expect their readers to turn to Google for meanings of words they do not know, but given human nature's predilection for quick fixes, it may be folly to assume that readers would want to work harder at understanding a subject that most would have a passing interest in, at best.

A version of this article appeared in the print edition of The Straits Times on June 20, 2017, with the headline 'Living with hope, will and imagination '. Print Edition | Subscribe