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Aim: To assess the effect of cognition on the loss of functional dentition., Materials and Methods: We used data from the three waves of the Panel on Health and Ageing of Singaporean Elderly study (n = 4990 at baseline, 774 complete cases analysed) over 6 years (2009-2015). The outcome was the loss of functional dentition (<21 teeth). The exposure was cognitive impairment, while baseline confounders included age, sex, education, and ethnicity. Time-varying confounders included income, living arrangements, smoking, diabetes, depressive symptoms, cardiovascular disease, and body mass index. We used marginal structural mean models with inverse probability treatment weighted., Results: The mean age of the participants was 70.2 years at baseline. The proportion of participants with loss of functional dentition increased from 74.6% to 89.9% over 6 years. Women, ethnic Chinese, less educated, smokers, people with diabetes, and individuals with depression had a higher proportion of loss of functional dentition than their counterparts. Loss of functional dentition was 1.8 times higher (odds ratio 1.80; 95% confidence interval 0.88-3.69) among those with cognitive impairment after taking well-known confounders into account., Conclusions: After accounting for the time-varying exposure and confounding evidence, the association between cognition and functional dentition among the elderly in Singapore remains uncertain., (© 2022 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Introduction: Despite associated with multiple geriatric disorders, whether housing type, an indicator of socioeconomic status (SES) and environmental factors, is associated with accelerated biological aging is unknown. Furthermore, although individuals with low-SES have higher body mass index (BMI) and are more likely to smoke, whether BMI and smoking status moderate the association between SES and biological aging is unclear. We examined these questions in urbanized low-SES older community-dwelling adults., Methods: First, we analyzed complete blood count data using the cox proportional hazards model and derived measures for biological age (BA) and biological age acceleration (BAA, the higher the more accelerated aging) ( N = 376). Subsequently, BAA was regressed on housing type, controlling for covariates, including four other SES indicators. Interaction terms between housing type and BMI/smoking status were separately added to examine their moderating effects. Total sample and sex-stratified analyses were performed., Results: There were significant differences between men and women in housing type and BAA. Compared to residents in ≥3 room public or private housing, older adults resided in 1-2 room public housing had a higher BAA. Furthermore, BMI attenuated the association between housing type and BAA. In sex-stratified analyses, the main and interaction effects were only significant in women. In men, smoking status instead aggravated the association between housing type and BAA., Conclusion: Controlling for other SES indicators, housing type is an independent socio-environmental determinant of BA and BAA in a low-SES urbanized population. There were also sex differences in the moderating effects of health behaviors on biological aging.

Objectives: The association between family support exchange and personal mastery among older adults remains unclear. The present study addresses this gap. Methods: We utilized two waves of data from the Panel on Health and Ageing of Singaporean Elderly ( N  = 1398). Latent class analysis was conducted to identify distinct patterns of family support exchange. Regression analysis was then used to assess whether the identified patterns predicted personal mastery four years later. Results: Four and three prevalent patterns of family support exchange emerged for males and females, respectively. Males who received monetary and material support from their kin developed lower personal mastery than those who only received monetary support. Females who provided and received monetary support developed higher personal mastery than those who lacked support exchange. Conclusion: Our latent class approach has captured the reality of family support exchange and thus provided a valid picture of the implication of such exchange for personal mastery. Our data suggest that support provision may elevate personal mastery. This observation is discussed with reference to the self-enhancement perspective and notion of valence of support provision.

Objectives: Little is known about composite patterns of productive engagement among older people. Related, the implication of these patterns for well-being remains unclear. The present study addresses these gaps., Methods: The analytical sample comprised 2037 community-dwelling Singaporeans aged 60 years and above. We included nine productive activities and employed latent class analysis to identify prevalent patterns of productive engagement. Regression analysis was then conducted to investigate the association of these patterns with depressive symptomatology, loneliness, and cognitive function., Results: Four productive engagement patterns (Low Activity, Family Support, Moderate Working-Volunteering, and Working-Family Support) were identified. Compared with Low Activity, Moderate Working-Volunteering, and Working-Family Support related to lower levels of depressive symptomatology and loneliness, respectively, and both patterns were associated with better cognitive function., Conclusion: Productive engagement patterns are differentially linked with depressive symptomatology, loneliness, and cognitive function. We interpret these findings with reference to the role perspective. We also discuss their policy implications.

Background: Hand grip strength (HGS) has been proposed as a robust predictor for frailty and sarcopenia. Hence, identifying biomarkers for declining HGS accompanying aging could deepen our understanding of the biological underpinnings, informing pre-emptive intervention. Acylcarnitines (ACs) are metabolites generated by fatty acid metabolism in the mitochondria and are dysregulated in multiple disorders affecting the musculature. However, they have not been comprehensively profiled and examined regarding their utility in predicting variability in declining HGS, longitudinally. Thus, we aimed to: 1) validate previous findings on insignificant cross-sectional association between ACs and HGS, and 2) examine whether baseline ACs were associated with both decline and variability in HGS over 18 months, in community-dwelling older adults., Methods: We included participants who had HGS measured with dynamometer longitudinally (N = 121). We quantified ACs by targeted plasma metabolomics profiling. Multivariable linear regressions were then performed., Results: Cross-sectionally, ACs were not significantly associated with HGS. Longitudinally, baseline short-chain dicarboxylic and hydroxylated acylcarnitines (AC-DC/-OH) levels were inversely associated with and significantly explained the variability in 18-month decline in HGS. A specific AC species, the C4-OH, accounted for most of the variance explained., Conclusions: We showed novel biomarkers for declining HGS, furthering molecular understanding and informing nutritional pre-emptive programs., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Study Objectives: To determine the effects of changes in nocturnal sleep and daytime nap durations on all-cause mortality among older adults., Methods: Two-thousand four-hundred forty-eight community-dwelling older Singaporeans (≥60 years) reported their nocturnal sleep and daytime nap durations at baseline (2009) and the 2-year follow-up. At each phase, they were grouped into the recommended (7-8 hours), short (≤6 hours), and long (≥9 hours) sleep duration categories, and the none (0 hour), short (≤1 hour), and long (>1 hour) nap duration categories. Cox regression analysis was conducted to quantify the associations of changes in sleep and nap durations over 2 years with all-cause mortality risk in the subsequent 4 years (till end of 2015). Multivariable fractional polynomial regression, which treated sleep and nap durations as continuous variables was conducted as a supplementary analysis., Results: Relative to individuals who had the recommended sleep durations at both baseline and follow-up, the risks of all-cause mortality were higher among older adults who reported considerable changes in sleep duration (from short to long sleep and vice versa, hazard ratio [HR] = 2.14-2.56). Furthermore, compared to those who did not nap at both time points, significantly higher mortality risks were found in individuals who showed any increase in nap duration (HR = 1.86-2.16), or reduced their nap from long to short duration (HR = 1.86). Supplementary analysis revealed similar findings., Conclusions: In addition to the change in nocturnal sleep duration, change in daytime nap duration can also predict risks of all-cause mortality among older adults. It is crucial to track older adults' sleep and nap durations longitudinally.

ABSTRACTBackground:Aging is accompanied by cognitive decline that is escalated in older adults reporting extreme sleep duration. Social relationships can influence health outcomes and thus may qualify the association between sleep duration and cognitive function. The present study examines the moderating effects of marital status, household size, and social network with friends and relatives on the sleep-cognition association among older adults., Methods: Data (N = 4,169) came from the Social Isolation, Health, and Lifestyles Survey, a nationally representative survey of community-dwelling older Singaporeans (≥ 60 years). Sleep duration and social relationships were self-reported. Cognitive function was assessed with the Short Portable Mental Status Questionnaire., Results: Regression analysis revealed that the inverted U-shaped association between sleep duration and cognitive function was less profound among older adults who were married (vs. unmarried) and those who had stronger (vs. weaker) social networks. In contrast, it was more prominent among individuals who had more (vs. fewer) household members., Conclusions: Being married and having stronger social networks may buffer against the negative cognitive impact of extreme sleep duration. But larger household size might imply more stress for older persons, and therefore strengthen the sleep duration-cognitive function association. We discuss the potential biological underpinnings and the policy implications of the findings. Although our findings are based on a large sample, replication studies using objective measures of sleep duration and other cognitive measures are needed.

This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥ 60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.

Objectives: To assess the instrumental support from a foreign domestic worker (FDW) as a moderator of the association of 4 types of impairments (physical function, memory, behavior, and mood) among older persons (OPs) with caregiving-related outcomes among their informal caregivers (CGs)., Method: Data from a national survey of 1,190 Singaporeans aged 75 and older receiving human assistance for functional limitations and their CGs were used. Severity scores for the four OP impairments were calculated. A modified version of the Caregiver Reaction Assessment (CRA) assessed the impact of caregiving in four domains: disturbed schedule and poor health, lack of finances, lack of family support, and CG esteem. Linear regression models, one for each CRA domain, with interaction terms of the four impairment severity scores with FDW support, were developed., Results: FDW instrumental support, reported for 50% of the OPs, moderated the direct association of OP physical impairment with disturbed schedule and poor health (p = .009), OP memory impairment with disturbed schedule and poor health (p < .0001) and lack of finances (p = .02), and OP behavior impairment with lack of family support (p = .001). Although such support buffered the inverse association of OP behavior impairment with CG esteem (p = .01), it also buffered the positive association of OP mood impairment with CG esteem (p = .02)., Discussion: FDW support is associated with better caregiving outcomes. Given its aging population, the number of FDWs in Singapore is likely to increase as families try to cope with caregiving for their older members. This has policy implications for (a) immigration patterns into Singapore and (b) training of and support networks for FDWs.

Aims: To describe the prevalence of limitations in Activities of Daily Living (ADL) among older Singaporeans, examine the association of ADL limitations with various self-reported health conditions, assess perceived causes of ADL limitations, and compare prevalence of health conditions among those who perceive only 'old age' vs those who perceive at least one specific health condition as the cause of their limitations., Methods: Data from a national survey of Singaporeans 60 years and over was used. The association between ADL limitations and health conditions was assessed through logistic regression. Those with ADL limitations were asked about the perceived cause/s of their limitation/ s. Any significant difference in the prevalence of health conditions between those attributing their ADL limitations only to old age and those attributing to at least one specific health condition was ascertained., Results: Overall prevalence of ADL limitations was 9.7%. Joint/nerve pain, stroke, pelvic/femoral fractures, heart diseases, diabetes, osteoporosis, chronic respiratory illness and renal/urinary tract illness were significantly associated with ADL limitations, and the most common perceived cause was 'old age' (33%). The prevalence of most health conditions was similar in older adults attributing their limitations to only 'old age' and to at least one specific health condition., Conclusion: Clinical suspicion is called for if individuals with ADL limitations attribute them solely to 'old age'.

A comprehensive picture of the management of hypertension in the increasing elderly population in Singapore is lacking. In this study, we assess the prevalence and correlates of hypertension and of awareness, treatment and control of hypertension among 4494 elderly Singaporeans (≥60 years) participating in a recent representative survey. The weighted prevalences of hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or current use of antihypertension medication) and of awareness, treatment and control of hypertension were assessed. We assessed the extent of association of these outcomes with socio-demographic (age, gender, ethnicity, education, housing type, living arrangement and social participation) and health (body mass, diabetes and cognitive status) variables using multivariable logistic regression. Nearly three-fourths (73.9%) of participants were found to have hypertension. Of this number, 30.8% were unaware that they had hypertension, 32.0% were not being treated for the disease and 75.9% had suboptimal control of their blood pressure. Among those aware of their hypertension, only 1.9% were untreated. However, nearly two-thirds (64.5%) of treated hypertensives had suboptimal control. Age, gender, ethnicity, education, housing type, body mass and diabetes were significantly correlated with lack of awareness, treatment and control of hypertension. Although the specific 'at-risk' subgroups varied by the outcome, men and Malays had consistently higher odds for all three unfavorable outcomes. There is a need to improve awareness, treatment and especially control of hypertension among elderly Singaporeans. Primary and secondary prevention efforts targeting the elderly and their primary health-care providers are called for, as are regular data collection efforts based on representative samples.

This paper examines the effects of socioeconomic characteristics on older adult health and investigates whether these socioeconomic effects carry through from the young-old to the oldest-old ages among Singaporean adults. Previous research shows little consensus over whether the impact of socioeconomic factors on health diminish with age. The variation in these results may be due to different definitions of socio-economic status, or the use of different health indicators. We use a comprehensive set of socioeconomic indicators (income, education level, homeownership, asset possession, and perceived income adequacy) to predict three health outcomes; poor self-assessed health, the presence of chronic illness, and functional disability. We find that while socioeconomic differentials in health status exist, the associations are not as consistent, nor as strong, as those reported for Western settings. Health inequalities related with socioeconomic status decline slightly but do not disappear with old age in Singapore.

Population aging is unique in Asia given the speed at which it is occurring and the immense social and economic changes that the region is experiencing at the same time. Compared to their Western counterparts, Asian governments have much less time to prepare for population aging. Asian countries that have traditionally relied on family-based support for older family members are worried that increased numbers of older adults may stress these family systems. At the same time, information concerning the effectiveness of formal programs for older adults is scarce. This paper reviews current research on informal support versus formal support of older adults in Southeast and East Asia, with a larger aim of assessing the current well-being of older Asians and suggesting areas of policy concern. Current research reveals that formal programs in the majority of Southeast and East Asian countries have very low coverage of today's older adults, and the figures for future generations are not that much higher. However, family support of older persons may not be deteriorating as predicted by modernization theory. Asian families continue to play a major role in supporting older members, thus policies should focus on enabling Asian families to provide this support.

Background Chewing disability is associated with impaired quality of life, potentially leading to depression, and cognitive impairment. Although the chewing-ability-cognition relationship has been explored, examining whether depression mediates this relationship remains unclear. We investigated the association between chewing disability and cognitive impairment development and a potential mediation via depression among older persons. Methods Older persons without cognitive impairment at baseline (n  = 973) from the 3 waves of the Panel on Health and Ageing of Singaporean Elderly were investigated. The outcome was incident cognitive impairment by the end of the study, while the exposure was chewing disability over the study period. Time-varying depression was the mediator. Time-fixed confounders included sex, ethnicity, education, marital status, living arrangement, and housing type, and time-varying confounders included age, smoking, cardiovascular diseases, diabetes, number of teeth, and denture wearing. We used marginal structural modeling to evaluate the effect of chewing disability on cognitive impairment development. Results After 6 years, 11% developed cognitive impairment, and chewing disability was reported by 33%. Chewing disability was associated with higher odds of developing cognitive impairment (OR 1.43, 95% CI: 1.09, 1.87), of which 85.3% was explained by the controlled direct effect of chewing disability, whereas the remaining 14.7% could be eliminated if there was no depression. Conclusions Our findings indicate an association between chewing disability and cognitive impairment, while the role of depression could not be fully elucidated. Oral health should be incorporated as part of older persons' care for its potential to assess the risk for other systemic conditions. [ABSTRACT FROM AUTHOR]

Fear of crime is a complex perception and has underlying psychological, social and health repercussions. The influence of fear of crime on psychosocial outcomes, however, may be moderated by various social factors. This study examined how fear of crime influences loneliness among low‐income older adults attending a Senior Activity Centre (SAC) in multiethnic Singapore. In addition, we tested whether these associations were moderated by gender and ethnicity. We analysed cross‐sectional data (N = 1,266) from The SAC Study, a survey conducted with older adults who were attending a SAC between March 2015 and August 2015. Multilevel models were used to test whether fear of crime was associated with loneliness; and whether the association was moderated by gender and ethnicity. We found that fear of crime was positively associated with loneliness, and that this association was stronger among men than women, but ethnicity did not moderate this relationship. Findings from our study suggest that fear of crime may have a stronger negative effect on men's psychological well‐being, even though they report lower fear of crime. This highlights the importance of sociocultural context when examining the psychosocial implications of fear of crime in the population. [ABSTRACT FROM AUTHOR]

To describe the rationale, design and methodology of a geographically-representative and population-based study investigating the epidemiology, impact, personal and economic burden of age-related eye diseases, declining visual and other sensory systems in Asians aged >60 years in Singapore.PIONEER (The PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans Study) is currently a cross-sectional study targeting 3152 Chinese, Malay and Indian adults who are Singapore citizens or permanent residents aged 60 years and older living across Singapore. The study is intended to be longitudinal, with several waves of data planned to be collected in the future. The sampling frame consisted of 7000 names derived from age, gender and ethnicity-stratified random sampling of individuals >60 years. Selected individuals were invited via letters, home visits, and telephone calls for a clinical assessment at the Singapore Eye Research Institute. Individuals with limited mobility were examined in a custom-designed mobile eye clinic. Questionnaires were subsequently administered at participants' homes by trained interviewers in their preferred language. A total of 3,299 participants (from East, West, North and South Singapore) were approached from December 2017 to November 2019. Of these, 953 (28.5%) were deemed ineligible. Out of 2,346 eligible participants, 904 (38.5%) refused, and 1,442 (61.5%) attended our clinical testing protocol, giving an initial response rate of 61.5%. Of these, 1,170 (81%) were cognitively able to complete the questionnaire assessment. The mean age±SD of our participants was 73.8±8.6 years; n=798 (55.3%) were female; and 828 (57.4%) were of Chinese ethnicity. The findings from this study will allow a deeper understanding of the risk factors and impact of aging in Asian populations, particularly in relation to the visual function and other functional system. [ABSTRACT FROM AUTHOR]

The juxtaposition of a young city-state showing relative maturity as a rapidly aging society suffuses the population aging narrative in Singapore and places the "little red dot" on the spotlight of international aging. We first describe population aging in Singapore, including the characteristic events that shaped this demographic transition. We then detail the health care and socioeconomic ramifications of the rapid and significant shift to an aging society, followed by an overview of the main aging research areas in Singapore, including selected population-based data sets and the main thrust of leading aging research centers/institutes. After presenting established aging policies and programs, we also discuss current and emerging policy issues surrounding population aging in Singapore. We aim to contribute to the international aging literature by describing Singapore's position and extensive experience in managing the challenges and maximizing the potential of an aging population. We hope that similar graying populations in the region will find the material as a rich source of information and learning opportunities. Ultimately, we aspire to encourage transformative collaborations—locally, regionally, and internationally—and provide valuable insights for policy and practice. [ABSTRACT FROM AUTHOR]

In this paper, we examine predictors and consequences of living arrangements among community-dwelling older Singaporeans. We take a holistic approach and consider a range of social and economic as well as emotional and physical wellbeing indicators. Two waves (2009, 2011) of the Panel on Health and Ageing of Singaporean Elderly (PHASE) are analysed to (a) provide an overview of living arrangements in 2009 and assess the extent to which living arrangements change by 2011; (b) examine the predictors of living arrangements in 2009; and (c) examine the consequences of living arrangements over a two-year period. The majority (88%) of older Singaporeans co-reside with either their spouse and/or children. A small yet growing proportion live with others (5%) or live alone (6%). Very little change in living arrangements is observed over the two years. Our results show that women, the oldest-old and older adults with fewer children are more likely to live alone. Older adults who live alone are not particularly disadvantaged compared to those who live with their spouse and children or spouse only in their social and economic wellbeing. It is, in fact, older adults who live with their children that are disadvantaged in many aspects of social, economic and mental wellbeing. Measures to engage older adults living with their families (along with those living alone and with others) in broader social activities are imperative. [ABSTRACT FROM AUTHOR]

Use of long-term care (LTC) services among older adults in Asia has emerged as an important issue in light of rapidly aging countries and changing family structures. Simply building more LTC facilities will not result in higher usage rates, and more insight is needed on the usage of existing services. Few studies have been conducted among Asian populations outside Western settings on this topic. The multi-ethnic population in Singapore is useful for understanding the factors influencing the use of long-term care services in Asia. We present our qualitative findings on long-term care service usage in the older population (50+ years) over time. We highlight caregivers’ needs as an important determinant of LTC use. Although preferences of the care recipients were considered, caregiver needs, the availability of formal and informal care support, attitudes, perceived control, and social norms surrounding family caregiving governed the use of formal LTC services in Singapore. [ABSTRACT FROM AUTHOR]

Sri Lanka is the fastest ageing South Asian population. Using data from the Sri Lanka Aging Survey 2006, this paper documents the health of adult child caregivers and their elderly parents, nature of care provided, areas of caregiver concern, factors associated with caregiver stress, and caregiver attitudes towards elder care. Adult children (n=381), defining themselves as the elderly parent's primary caregiver, and their elderly parents (n=430), constitute the sample for this analysis. Relatively poor health among elderly parents combined with substantial time required for care-giving, and a relatively high level of stress among caregivers, is observed. Gender differences are observed in the type of elder care provided, and in the risk of being stressed/worried. Most caregivers have favourable attitudes towards home-based care, negative attitudes towards institutional care, and expect support from their children in old age. Caregiver burden will increasingly become a policy concern given Sri Lanka's ageing population and the predominant expectation that eldercare is the children's responsibility. [ABSTRACT FROM AUTHOR]

Introduces a series of articles on social science and aging.

• Poor physical strength and depression were examined as mediating factors between pain and recurrent and injurious falls within a large nationally representative dataset of community-dwelling older adults (N = 2884) in Singapore. • Poor physical strength and depression had a significant partial mediation effect between all pain characteristics on recurrent falls. • Partial mediating effects of poor physical strength were observed between the presence of pain and injurious falls. However, this was not the case between specific pain sites and injurious falls. Depression was not a mediator along the pain-injurious falls nexus as well. • Markers of deconditioning such as older age, poor handgrip strength, and vision were more indicative of injurious falls. • Findings demonstrated nuanced differences between various archetypes of fallers – recurrent fallers, injurious fallers, and potentially recurrent and injurious fallers. This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults. Data was obtained from a nationally representative longitudinal cohort study conducted in Singapore, PHASE (Wave I and II), which collected information from community-dwelling older adults above 60 years old. A hurdle negative binomial regression and binomial logistic regression were used to assess the association between pain and recurrent falls, and pain and injurious falls respectively. A subsequent mediation analysis was conducted. Almost half of the participants (N = 1144, 39.7%) reported having either mild, moderate, or severe pain at baseline, 166 (5.4%) participants experienced injurious falls and 144 (4.7%) participants experienced recurrent falls at Wave II. After adjusting for covariates, the presence of pain significantly influenced recurrent (OR 2.8; 95% CI: 1.8, 4.4) and injurious falls (OR: 1.8; 95% CI: 1.3, 2.5). Mediation analyses demonstrated that poor physical strength and depression had a significant mediation effect between all pain characteristics on recurrent falls. Poor physical strength partially mediates the effects of pain and injurious falls as well. However, the mediating effect of poor physical strength and depression was not observed between other pain characteristics and injurious falls. The findings highlighted differences in the underlying mechanisms between pain characteristics affecting recurrent and injurious falls. These insights will be useful for identifying patients most at risk for recurrent or injurious falls, and for tailoring future community-based fall intervention programmes. [ABSTRACT FROM AUTHOR]

Objectives What are normative values for hand grip strength (HGS) for elderly Singaporeans? Which elderly characteristics influence the normative values of HGS for elderly Singaporeans? Design Nationally representative, cross-sectional observational study. Setting Singapore. Participants A total of 2664 community-dwelling elderly Singaporeans aged 60 to 89 years. Measurements HGS was measured in a standing position with elbows extended twice for each hand; a Smedley spring-type dynamometer was used. Elderly characteristics known to affect HGS, including age, sex, hand dominance, height, weight, occupation, education, and ethnicity, were also assessed. Results We present single-year age, sex-, and hand-specific graphs for normative values (5th, 20th, and 50th percentiles) of HGS. The influence of specific elderly characteristics on the normative values of HGS varies by sex, hand, and considered percentile. We present equations for considered percentiles of HGS that account for such influences. Conclusions This study uses a large, nationally representative sample to establish normative values for HGS for elderly Singaporeans aged 60 to 89 years. These results will facilitate the interpretation of HGS measurements conducted using Smedley spring-type dynamometers in clinical and research settings in Singapore, and potentially other Asian countries. [ABSTRACT FROM AUTHOR]