Search

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. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Traditional evaluation techniques are often not suitable for studying health interventions operating in real-world settings, particularly when interventions operate through complex causal pathways. We describe a mixed methods design for evaluating an integrated home care and social support service targeting mature and older adults (55+ years) in Singapore. Here, nurses and community health workers visit patients' homes to address health and social needs while facilitating linkages to community-based services and providing caregiver support. Our mixed methods evaluation plan is composed of three components: quantitative comparison of hospital-based service utilization, cost-effectiveness analysis, and qualitative investigation into the experiences of patients, caregivers, and individuals who declined services. This article contributes a description of how cost-effectiveness analysis adds value when incorporated into mixed methods studies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Vision and hearing impairment may impact both life expectancy (LE) and health expectancy, that is, duration of life with and without health problems, among older adults. We examined the impact of self‐reported vision and hearing impairment on years of life with and without limitation in physical function and in activities of daily living (ADLs). DESIGN: Life table analysis, using a nationally representative longitudinal survey of community‐dwelling older adults aged 60 years or older, Panel on Health and Ageing of Singaporean Elderly. SETTING: Singapore. PARTICIPANTS: Survey participants (n = 3452) who were interviewed in 2009 and followed up in 2011‐2012 and 2015. MEASUREMENTS: Participants reporting difficulty with any of nine tasks involving upper or lower extremities were considered to have a limitation in physical function. Those reporting health‐related difficulty with any of six basic ADLs or seven instrumental ADLs were considered to have a limitation in ADLs. We used the multistate life table method with a microsimulation approach to estimate health expectancy, considering self‐reported sensory impairment status as time varying. RESULTS: Either or both impairments, vs neither, were associated with less years without limitation in physical function and in ADLs and more years with limitation in physical function and in ADLs, with the greatest impact on health expectancy among those with both impairments, who also had the lowest LE. For example, at age 60, those with both impairments, vs neither, could expect not only shorter LE (4.2 [95% confidence interval [CI] = 1.9‐5.7] less years; 20.7 [95% CI = 18.9‐22.5] vs 24.9 [95% CI = 23.8‐26.0]) but also more years of life with limitations in physical function (3.3 [95% CI =.9‐5.8] more years; 12.8 [95% CI = 10.7‐14.8] [about 61.7% of LE] vs 9.5 [95% CI = 8.4‐10.5] [about 38.0% of LE]). CONCLUSION: Timely and appropriate management of vision and hearing impairment, especially when coexisting, among older adults has the potential to reduce the years of life they live with limitation in physical function and in ADLs. J Am Geriatr Soc 67:2528–2536, 2019 [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]

Abstract: Aim: The present study examined whether ethnicity independently predicted future falls among community‐dwelling older Singaporeans, and whether ethnicity moderated the relationships between falls risk factors at baseline and falls at follow up. Methods: Data from a longitudinal survey of older Singaporeans were used. Baseline assessment included handgrip strength, global cognitive function, mobility difficulties, health and psychosocial status. One‐year retrospective falls information at follow up was the primary outcome. Results: Final analysis included 1975 participants (mean age 73.6 ± 6.2 years, 53% women). Indians, followed by Malays, had a higher risk of falling compared with Chinese at follow up. This association remained after controlling for falls risk factors. Self‐reported pain and poor global cognitive function imposed a substantial increment in the risk of falling among Malays compared with Chinese, but not Indians. Conclusion: Ethnicity was a significant predictor of future falls among older Singaporeans. Falls screening and intervention should take ethnicity into account to reach and support the appropriate target population. Geriatr Gerontol Int 2018; 18: 72–79. [ABSTRACT FROM AUTHOR]

Abstract: Context: Understanding preferences for end-of-life care is important for planning and improving services that provide such care. However, little is known about the perspective of Singaporeans regarding good end-of-life care. Objectives: To identify the key components of good end-of-life care as perceived by middle-aged and older Singaporeans (≥50 years). Methods: Nine focus groups were conducted with a total of 63 participants. Preferences regarding end-of-life care were discussed. Thematic analysis was conducted on the transcribed results of the focus groups. Results: Eight components of good end-of-life care were identified: 1) have physical comfort at the end of life, 2) avoid inappropriate prolongation of the dying process, 3) maintain sensitivity toward religious and spiritual beliefs, 4) avoid burden on the family, 5) avoid expensive care, 6) be cared for by a trustworthy doctor, 7) maintain control over care decisions, and 8) achieve a sense of completion. Conclusion: Eight components of good end-of-life care involving the person, family, and health services were identified among middle-aged and older Singaporeans. A focus on better management of pain, training of caregivers and doctors, shared decision making, and availability of affordable care may improve care at the end of life. [Copyright &y& Elsevier]

Abstract: The objective of this paper is to test and correct for systematic differences in reporting of pain severity among older adults by age, gender, ethnic group and socio-economic status using anchoring vignettes. Data from a national survey of community-dwelling older Singaporeans (aged 60years and over) conducted in 2009 was used. Respondents were asked to rate the severity of their own pain as well as that of others described in the vignettes on a five-point scale ranging from none to extreme. An ordered probit model was used to estimate the coefficients of the independent variables (age, gender, ethnic group, education, housing type) on self-reported pain. Reporting heterogeneity in pain severity was then corrected using a Hierarchical Ordered Probit model. The results showed that before correcting for reporting heterogeneity, women, those older, and those of Malay ethnicity reported greater severity of pain, while there was no association of reported pain severity with housing type and education. However, after correcting for reporting heterogeneity, while women and those older were found to have an even greater severity of pain than what they had reported, Malays were found to have a lower severity of pain than what they had reported. We conclude that there are systematic differences in reporting pain severity by age, gender and ethnic group. We propose that pain management may be improved if medical professionals take into account reporting heterogeneity for pain severity among various population sub-groups in Singapore. [Copyright &y& Elsevier]

Objective: To examine changes in the prevalence of mobility limitations and mobile life expectancy of Singaporeans aged 55+. Method: Data came from the cross-sectional 1995 and 2005 National Survey of Senior Citizens (NSSC; n = 4,750 and n = 4,591, respectively). The prevalence-based Sullivan method was used to disaggregate total life expectancy into expected life time without and with mobility limitations. Results: Increases in life expectancy in the city-state were accompanied by increases in the prevalence of mobility limitations--from 3.0% to 5.7% for men and 5.1% to 9.7% for women. The impairments mostly began after age 65 and increased with age particularly at ages 85+. The proportion of life expectancy without mobility limitations declined over time, at all ages, and for both genders, with women still experiencing a higher proportion with mobility problems compared to men. Discussion: The overall results provided support for the expansion of morbidity hypothesis, and we discussed some possible reasons. From a policy perspective, the findings could suggest a need to develop infrastructures that would enable older Singaporeans to remain mobile in a highly urban setting. [ABSTRACT FROM AUTHOR]

Background: In Singapore, the proportion of individuals over 65 years old is increasing rapidly: from 7% in 2000 to a projected 23% in 2030. Population aging presents substantial challenges for hospitals, community-health services, and long-term care providers as health systems attempt to provide high-quality treatments to older adults across the continuum of care. Khoo Teck Puat Hospital is a public hospital in the North Region of Singapore and serves a community of approximately 500,000 individuals. The occupancy rate within the government-subsidized inpatient wards exceeded 90% within six months of opening in July 2010. Administrative review identified a relatively small cohort of individuals who were repeatedly admitted for inpatient treatment within very short time periods. In early 2011, the Aging-in-Place (AIP) program was implemented to provide comprehensive patient-centered care to individuals with complex care needs as they transitioned from the hospital back into the community. Patients who experienced three or more inpatient episodes within a six month period were eligible to join the program at no cost regardless of diagnosis. Through home-visits and telephone consultations, community nurses and community health workers provided medical monitoring, decision making support, and facilitated linkages to additional services. The goal of this program was to integrate primary care with preventive and social services to help decrease individuals' dependency on inpatient treatment. In this presentation, we outline a three-phase mixed-methods evaluation designed to measure the effectiveness of the AIP program. Literature review: Patients transitioning from inpatient settings back into the community often encounter difficulties in maintaining continuous care. Fragmentation of services increases the potential for a number of adverse events including serious medication errors. In fact, an estimated 40% to 50% of older adults in the United States experience an adverse event in the peridischarge period. Qualitative studies indicate that patients and their caregivers are often unprepared to manage complex health conditions, do not fully comprehend patients' care needs, and feel under supported from hospital staff during the transition phase. Formal transitional care programs typically incorporate home-health components comprised of caregiver training, medication monitoring, and care coordination in an attempt to integrate services between the hospital and community settings. Existing programs typically include a combination of face-to-face visits and telephone follow-ups by which professionally trained staff draw upon a constellation of health management techniques to help patients and their caregivers successfully navigate the transition from the hospital back into the community. Results for transitional care programs are mixed due to differences between specific programs and patient populations, but high-quality programs have demonstrated reduced readmission rates, shorter inpatient lengths of stay, improved quality of life, as well as substantial cost savings. Discussion: We designed a three-part evaluation to assess the effectiveness of the AIP program. The first part consisted of a retrospective analysis of administrative data to determine the extent to which the AIP program altered patients' hospital-based service use. AIP intervention patients were compared to a group of control individuals who also experienced three hospitalizations in a six month period but did not live within the AIP catchment area. Using hospital administrative data, we employed a difference-in-difference design comparing hospitalization rates, inpatient lengths of stay, and emergency service utilization between the intervention and control groups. Secondly, we conducted a prospective cohort study of AIP intervention patients and control individuals. This portion of the evaluation determined if the financial costs of implementing the AIP program were offset by savings in both hospital- and community-based medical services. The third portion of the evaluation consisted of a qualitative study of AIP program participants, their caregivers, and individuals who were referred to the program but decided not to participate. Information from semi-structured interviews informed us of participants' satisfaction with the intervention, caregivers' assessments of the assistance they received from staff, and reasons behind declining the services for those who rejected the program. Conclusion: Our goal was to design a comprehensive mixed-methods evaluation to assess the effectiveness of the AIP program. The results from the two quantitative phases determined whether the integrated care intervention reduced unplanned hospital-based service use and whether the program was cost effective from both financial and societal standpoints. The qualitative portion allowed us to evaluate patients' and caregivers' experiences of the program while uncovering why frequently hospitalized patients chose not to participate in the intervention. Through the use of multiple data sources, we aimed to identify areas where this program succeeded in improving patients' and caregivers' lives, and determined areas where further developments were needed. [ABSTRACT FROM AUTHOR]

The importance of social network in mortality among older adults has been acknowledged. However, existing studies typically overlook the interplay among social network indicators, and seldom consider the change in social network over time. We take a person-centered approach to identify transitions between social network profiles, and examine the linkage of such transitions with subsequent mortality risk. Data came from 2738 older Singaporeans enrolled in a longitudinal study. Latent transition analysis examined nine social network indicators assessed at two time points, two years apart to reveal the corresponding transitions between social network profiles. Adjusted Cox regression then associated the identified transitions with all-cause mortality risk in the subsequent four years. We observed three diverse social network profiles (that featured diversified social interaction and involved both household and non-household members) and three relatively restricted social network profiles (that focused on household or non-household members). Compared to sustained diverse profiles over time, sustained restricted profiles or a transition from diverse to restricted profiles entailed increased mortality risk. The mortality risk following a restricted-to-diverse profile transition could be as low as that associated with sustained diverse profiles. Dynamics of social network profiles have implications for mortality risk in later life. To promote longevity, initiatives are needed to help older people to maintain or shift to diverse social network profiles. • There emerge diverse and restricted social network profiles in old age. • Latent transition analysis reveals transitions between social network profiles. • Sustained diverse profiles are accompanied by reduced mortality risk. • A restricted-to-diverse profile transition may also entail reduced mortality risk. [ABSTRACT FROM AUTHOR]