The National Silver Academy (NSA) was launched in 2016 as part of the Singapore government’s Action Plan for Successful Aging. This paper uses a grounded approach to explore and assess critical geragogical elements that are enabling, empowering and transformative for older learners. Semi-structured in-depth interviews were conducted with 48 participants who had completed an NSA course. Although three different categories of older learners were identified in this study, most tend to internalize ageism and took courses to counter ageist stereotypes of being frail, dependent and useless. In terms of geragogy, participants articulated four key learning needs at the NSA. These were: (i) relatable, empathetic and engaging instructors; (ii) interactive and versatile methods of teaching with emphasis on real-life applications; (iii) flexible and accessible curriculum and course content appropriate to learners’ capabilities and expectations and (iv) inclusive and disability-friendly learning environments catering to a wide spectrum of learners. At the NSA, instructors are crucial to the empowerment of older learners by leading the challenge against ageism, promoting learners’ confidence and self-worth as well as enabling safe spaces for personal transcendence and creative expression. This study reinforces the need for more contextualized models of geragogy to dismantle structural and internalized forms of ageism by taking into account older learners’ cultural beliefs about aging, access to education, confidence and competences to navigate both formal and informal learning environments.

Background: Nursing home nurses are pivotal in recognising resident deterioration and initiating the decision-making process on resident transfer to emergency departments. However, their decisions have not been adequately explored in the Asian context which places a strong emphasis on family connection and has a longstanding history of considering end-of-life discussion as a taboo. Aim: To explore the experiences of nursing home nurses surrounding resident transfer to emergency departments during acute deterioration. Methods: A descriptive qualitative study was undertaken. Individual semi-structured interviews were held from October to December 2019 with a purposive sample of 14 nurses from one nursing home in Singapore. Thematic analysis was performed on the data. Findings: Five themes were identified: (i) knowing the residents; (ii) challenges in honouring residents’ advance care planning; (iii) family involvement in transfer decisions; (iv) nurses as an intermediary between family and physicians; and (v) struggling to shift from curative to palliative thinking. Discussion: In-depth knowledge of residents facilitated nurses’ transfer decisions and physician referrals were made without deliberation. In their decision-making process, nurses negotiated between their own personal value system - a preference for life-sustaining therapies - and balancing the interests and preferences of residents, family members, and physicians. Priority was given to families’ decisions even in the presence of established advance care planning. Conclusion: This study highlights the need for further development of family-centred advance care planning in Asian long-term residential care. A greater acceptance of palliative care among nursing home staff and the public may improve the end-of-life care quality for residents. © 2021