The first study here that seeks to unlock the secrets behind the longevity of the oldest Singaporeans has thrown up a surprising observation: Living alone may not be as big a problem as one might think.
Of the Singaporeans aged 85 and older who were found to be in excellent health, one in five - or 20 per cent - lived by themselves.
Among those in the study who were considered unhealthy, 8.9 per cent lived alone.
According to 2012 figures, about 7 per cent of seniors older than 65, or 35,000 seniors, live alone.
Said Professor Koh Woon-Puay from Duke-NUS Medical School, who lauded the resilience and independence of the seniors: "This is more than what I expected. I actually thought more would live with spouses, children and grandchildren."
2 centenarians who are still active
For decades, she worked as an amah, or cleaning lady, for the British. Even when she was well into her 80s, Madam Tan Swan Eng continued working from home. She kept busy by sewing, making Chinese knot buttons, going door-to-door selling bread and packing items for Singapore Airlines.
The 102-year-old said: "My grandchildren take care of me so I don't suffer but I prefer to work, earn my own money, so I don't have to depend on my family."
Madam Tan has two children, three grandchildren and four great-grandchildren.
Ten years ago, doctors said she would be bedridden after she fractured two hip bones in a fall. She proved them wrong by walking shortly after. These days, she enjoys attending Hainanese operas.
While she stays physically healthy, Madam Tan acknowledged other health issues. "Don't live until such an old age. The brain does not work well any longer," she said.
Like Madam Tan, Mr Goh Beng, 103, pulled long hours at work. He ran his own store selling joss sticks and worked so hard, his sons hardly saw him when they were growing up. He only retired in his 80s.
"Even when you are old, you have to keep working until you die. Money runs out fast in Singapore," said Mr Goh, who has eight children, 17 grandchildren and four great-grandchildren.
The duo are fortunate not to suffer from chronic illness and they continue to keep an active lifestyle. They are among six people featured in a photo exhibition of centenarians in Singapore at Duke-NUS Medical School.
Mr Goh, who is still able to walk, even travelled to China to visit relatives earlier this year.He has regularly donated money to villages in China to build schools and roads. Now he spends his days tending to his garden for a few hours at a time under the hot sun.
Study on prolonging life v quality of life
Is living longer always a good thing? Over the years, numerous European studies have found most centenarians are actually quite sick. A majority have three to five diseases and almost all have heart abnormalities. Over 80 per cent were taking drugs.
A recent study that compared centenarians in five countries - Japan, Denmark, Sweden, France and Switzerland - also asked whether life-saving medical interventions should be used to prolong life, when the quality of life may be compromised since the person is infirm. The study examined whether prolonging life results in poorer quality of life.
Among the five, Japan has the lowest mortality rate, or the probability of death. Denmark and Sweden have the highest, with France and Switzerland in between.
The study is still ongoing but preliminary findings have shown that Japanese centenarians, while having more people who live longer than the Danish or Swedish, have poorer health than their European counterparts.
"In Japan, we keep old people alive even if they are functionally disabled," said Professor Yasuhiko Saito from Nihon University, one of the researchers involved in the study. "There is a cultural aspect to that because in Asian culture, we take care of the elderly. Even when they are sick, we keep them in beds and wheelchairs which is actually not good for them."
Given these initial findings, the researchers had the following warning: If a country mostly invests in life-saving interventions, without regard to the person's already poor health, the extension of life will likely be accompanied by worsening health.
She is leading an ongoing longitudinal study tracking about 1,000 Singaporeans who are 85 years old and older for over two decades.
This has implications for ageing policy and caregiving arrangements, given the rising number of seniors who live alone here, say researchers. The group will grow to about 92,000 by 2030.
The preliminary finding may also debunk assumptions that living alone necessarily equates to social isolation and poor quality of life.
Within the healthy group, those who lived alone were found to be more socially active than those living with family and friends.
"This means that it is viable for people who are healthy and old to live on their own. It is not that they all must be put into nursing homes," said Associate Professor Chong Yap Seng, executive director at the Singapore Institute for Clinical Sciences, and an adviser to the SG90 Longevity study that was launched last year.
"Since seniors' desire for independence may have likely led to them having long and healthy lives, others can adopt similar mindsets to achieve the same goals," said Prof Chong.
Dr Ng Wai Chong, chief of clinical affairs at Tsao Foundation, which specialises in ageing issues, said the finding was important for social services.
"Social services should not target only elders who live alone. Seniors, whatever living arrangement they are in, should be assessed for social isolation instead," said Dr Chong.
The study was among several global studies presented at the first conference here that delves into centenarian research and explores whether centenarians are the realisation of successful ageing.
Centenarians, or people who are 100 years old and older, are the fastest-growing age segment in the world. There were nearly half a million centenarians in the world last year and the group is projected to grow eightfold by 2050.
In Singapore, their number went up more than fivefold from 232 in 2000 to 1,200 last year.
At the opening session of the three-day conference held at the Duke-NUS Medical School yesterday, Senior Minister of State for Health Amy Khor said people need not worry about ageing.
"Longevity is actually good news. It is a result of advancement in public health, medicine, science and technology," said Dr Khor.
"Ageing will only present itself as a worry when people lose their social or economic relevance as they age or if they live longer years in ill health and disability."
Associate Professor Angelique Chan, executive director of the Centre for Ageing Research and Education, which organised the conference, said longevity is a product of advances in medicine and technology but the quality of those extra years is largely a social issue.
"Understanding these social and medical interactions will ensure that we are well placed to identify strategies for successful aging," said Prof Chan.
The SG90 study aims, in two years, to identify the markers of healthy ageing, such as genetics, diet or lifestyle factors, in order to come up with practical solutions to help people live longer and keep healthy.
Said Prof Chong: "We want to see if we can come up with a particular diet, exercise, drug or nutritional supplement regime that will maximise your health span."