Older Adults In Singapore Research Articles

Classifying Types of Visual Loss Linked With Function to Inform Referral to Vision Rehabilitation for Older Adults in Singapore.

Objective: Visual impairment restricts performance in activities of daily living. The aim of this study was to classify types of visual loss associated with function in older adults based on clinical data and World Health Organization (WHO) acuity and visual field criteria. Methods: Seven hundred retrospective medical records of older adults seen at the outpatient ophthalmology clinics of a Singapore hospital were reviewed. Extracted data was mapped to the WHO low vision criteria. A flow chart was developed to classify the main types of visual loss aligned with function. Results: The flow chart developed describes four major types of visual loss: (1) full visual field with decreased visual acuity, (2) any visual field loss with greater than ten degrees of available field, (3) peripheral field loss with less than 10° of available field, and (4) any visual field loss due to a cortical event. Within each major type, sub-categories were identified reflecting the complexity of the visual impact of the eye conditions. Conclusion: The flow chart can be applied to outpatient records to identify older adults with different types of visual loss to inform targeted rehabilitation linked with function.

Evaluating the feasibility and perceptions of a senior-friendly tablet among older adults in Singapore: A mixed-methods study

Evaluating the feasibility and perceptions of a senior-friendly tablet among older adults in Singapore: A mixed-methods study

Sociodemographic characteristics associated with self-care and quality of life among community-dwelling older adults with type 2 diabetes

AimsTo assess how well community-dwelling older adults in Singapore were coping with their diabetes, and the sociodemographic characteristics that were associated with their level of coping. MethodsThis was a cross-sectional study involving 257 older adults. Multiple regression was used to assess the associations between various sociodemographic characteristics and coping measures of present quality of life and level of self-care. ResultsOlder adults mainly sought care in the primary care setting. They were not coping well given their mean scores for diabetes-dependent quality of life and the self-care index were −3.57 and 3.55 respectively. Compared to those with post-secondary education, individuals who had no formal (adjusted B −0.92, p 0.003), primary level (adjusted B −0.76, p < 0.001) and secondary level (adjusted B −0.50, p < 0.02) education reported lower present quality of life. Those with prior lowest skill level occupations were less likely to consume a healthy diet per week than those with prior highest skill level occupations (adjusted B −1.48, p 0.004). ConclusionsThere should be provision of diabetes self-care interventions targeting older adults in Singapore especially for those with lower education and work skill levels. As the first line of contacts, primary care providers should advocate for diabetes self-care and develop community-based interventions for these priority groups.

Racial disparities in hospitalization expenditures of older adults in Singapore

Caring for persons with dementia places a significant physical, emotional, and financial burden on caregivers. Although dementia caregivers may be exposed to more challenging caregiving environment than caregivers of those with other chronic conditions, little is known about how specific factors related to respite service use differ between dementia and nondementia caregivers. Thus, this study first examined factors related to respite service use among caregivers and further tested the moderating effect of dementia caregiver status in these relationships using nationally representative U.S. data. Logistic regression analyses were conducted among 1,203 caregivers (276 dementia and 927 nondementia caregivers) from the national Caregiving in the U.S. 2015 data. Caregivers’ race and ethnicity as a predisposing factor, caregivers’ self-rated health as an enabling factor, and care recipients’ living arrangement and functional limitations as need factors were significantly related to respite service use among caregivers. Moreover, dementia caregiver status moderated the association between enabling factors (i.e., household income, work status, and self-rated health) and respite service use. Our findings imply that dementia caregivers may be more in need of respite service use than nondementia caregivers when they have limited enabling factors (e.g., lower household income, nonworking status, poorer health). Policy and practice efforts that specifically support enabling factors are suggested to promote more respite service use among dementia caregivers.

Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling healthy older adults in Singapore: findings from the SHIELD study

BackgroundNutrition literacy refers to an individual’s knowledge, motivation and competencies to access, process and understand nutrition information to make nutrition-related decisions. It is known to influence dietary habits of individuals including older adults. This cross-sectional study was designed to: (1) understand the nutrition knowledge, competencies and attitudes of community-dwelling older adults in Singapore, (2) examine the differences between their nutrition knowledge, and socio-demographic factors, competencies and attitudes and (3) identify factors associated with better nutrition knowledge in older healthy adults in Singapore.MethodsA total of 400 (183 males and 217 females) nourished community-dwelling older adults aged 65 years and above took part in this study. Malnutrition Universal Screening Tool (MUST) was used to determine individuals who were at low risk of undernutrition. Nutrition knowledge, competencies, attitudes and sources of nutrition information were measured using a locally developed scale. Nutrition knowledge scores were summed to form the nutrition knowledge index (NKI). Associations between NKI, competencies, attitudes and socio-demographic variables were examined using Chi-square and Fisher’s exact tests. Factors associated with NKI were determined using a stepwise regression model with resampling-based methods for model averaging.ResultsBivariate analyses found significant differences in NKI scores for gender, monthly household earnings, type of housing, the self-reported ability to seek and understand nutrition information and having access to help from family/friends. Females had higher NKI scores compared to males (p < 0.001). Compared to females, more males left food decisions to others (p < 0.001), and fewer males reported consuming home-cooked food (p = 0.016). Differences in educational level were found for competencies like the self-reported ability to seek (p < 0.001) and verify nutrition information (p < 0.001). Stepwise regression analysis showed that being female, Chinese, self-reported ability to understand nutrition information and having access to help from family/friends were associated with higher NKI scores.ConclusionsOur study revealed that nutrition knowledge of older males in Singapore was lower than females and more left food decisions to others. Nutrition education programs could be targeted at both the older male, their caregivers and minority ethnic groups.Trial Registration This study was registered on 7 August 2017 at clinicaltrials.gov (ref. NCT03240952).

INtrinsic Capacity and its RElAtionship With Life-SpacE Mobility (INCREASE): a cross-sectional study of community-dwelling older adults in Singapore

ObjectivesTo examine the association of intrinsic capacity (IC) with life-space mobility (LSM) among community-dwelling older adults and to determine whether age and gender modify this relationship.DesignCross-sectional study.SettingPublic housing blocks, senior...

Prevalence of low muscle mass and associated factors in community-dwelling older adults in Singapore

The population is rapidly aging worldwide, and there is an age-related decline in muscle mass. Therefore, it is important to examine the prevalence and associated factors of low appendicular skeletal muscle mass index (ASMI) in older adults. The objectives of this cross-sectional study were (i) to determine the prevalence of low ASMI (ASM/height2) and (ii) to identify factors associated with low ASMI. This study included 1211 community-dwelling adults aged ≥ 65 years. Low ASMI was defined as < 7.0 kg/m2 in males and < 5.7 kg/m2 in females (bioelectrical impedance analysis). Gender-specific cut-off values of calf circumference for low ASMI were determined. The prevalence of low ASMI in the overall cohort was 59.9%, i.e., 57.0% among males and 61.8% among females, with no significant difference between genders (P = 0.1068). The prevalence of low ASMI was 81.3% in individuals at risk of malnutrition compared to 20.6% in their counterparts with normal nutritional status (P < 0.0001). Participants with low ASMI were older, had lower physical activity scores, and greater likelihood of hospitalization in prior 6 months compared with normal ASMI (all P < 0.0001). Low ASMI was associated with risk of malnutrition (odds ratio: 3.58 for medium risk, odds ratio: 12.50 for high risk), older age, smoking, drinking, smaller calf circumference, and lower bone mass (all P ≤ 0.0328). Cut-off values of calf circumference for low ASMI for males was 33.4 cm and for females was 32.2 cm. In conclusion, we found that low ASMI was highly prevalent among community-dwelling older adults at risk of malnutrition. Other significant factors associated with low ASMI were age, smoking, drinking, calf circumference, and bone mass. Screening community-dwelling older adults for risk of malnutrition can prevent or delay onset of low ASMI.

Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study.

To assess the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with mortality among older adults in Singapore. Association of SBP and DBP measured in 2009 for 4443 older adults (69.5±7.4years; 60-97years) participating in a nationally representative study with mortality risk through end-December 2015 was assessed using Cox regression. Higher mortality risk was observed at the lower and upper extremes of SBP and DBP. With SBP of 100-119mmHg as the reference, multivariable mortality hazard ratios [HRs (95% confidence interval)] were SBP <100mmHg: 2.41 (1.23-4.72); SBP 160-179mmHg: 1.51 (1.02-2.22); and SBP ≥180mmHg: 1.78 (1.12-2.81). With DBP of 70-79mmHg as the reference, HRs were DBP <50mmHg: 2.41 (1.28-4.54) and DBP ≥110mmHg: 2.16 (1.09-4.31). Management of high blood pressure among older adults will likely reduce their mortality risk. However, the association of excessively low SBP and DBP values with mortality risk needs further evaluation.

The longitudinal psychological, physical activity, and financial impact of a COVID-19 lockdown on older adults in Singapore: The PIONEER-COVID population-based study.

BackgroundSeveral countries have implemented ‘lockdown’ measures to curb the spread of the coronavirus disease 2019 (COVID‐19).AimsTo examine the psychological, physical activity (PA), and financial impact of a 2‐month COVID‐19 lockdown on older adults aged ≥60 years in Singapore, and to identify factors associated with adverse lockdown‐related outcomes.MethodWe interviewed 496 community‐dwelling adults (mean age [standard deviation]: 73.8 [7.6] years; 54.8% female) during the lockdown who had previously participated in a population‐based epidemiological study. Validated questionnaires were utilised to assess loneliness and depressive symptoms at both timepoints, while inhouse questionnaires were used to assess PA and financial difficulty during lockdown. Multivariable regression models determined the lockdown‐related change in loneliness and depression scores, and the factors associated with adverse outcomes.ResultsLoneliness increased significantly during the lockdown period (p < 0.001) while depressive symptoms decreased (p = 0.022). Decreased PA, greater financial problems, male gender, Indian ethnicity, living alone, having a greater body mass index and perceived susceptibility to COVID‐19 were all associated with worsening loneliness scores. A total of 36.9% and 19.6% participants reported decreased PA and had financial problems during the lockdown, respectively. Unemployment was associated with decreased PA, while self‐employed individuals, cleaners, retail workers and smokers had greater odds of experiencing financial difficulty.ConclusionDespite a decrease in depressive symptoms, our population of older Asians reported a significant increase in loneliness and decreased PA, with one‐fifth experiencing financial problems during lockdown. Our data suggest that more targeted public health efforts are needed to reduce repercussions of future lockdowns.

Regression-Based Norms and Validation of the Cambridge Neuropsychological Test Automated Battery among Community-Living Older Adults in Singapore.

The Cambridge Neuropsychological Test Automated Battery (CANTAB) is widely used in research and clinical settings. However, little is known about the use of the CANTAB in the local aging context. This study aimed to develop normative data for various CANTAB measures in community-living older adults in Singapore. Normative data were built using the regression-based approach. A secondary aim was to examine the concurrent validity of CANTAB measures with their traditional neurocognitive test counterparts. A total of 210 older adults (Mage = 67.27years, SD = 5.45) from an existing cohort study completed standard neurocognitive tests and a CANTAB battery. A total of 160 were normal aging, 46 diagnosed with Mild Cognitive Impairment (MCI), and one diagnosed with Dementia. Older adults with MCI and Dementia were not included in the calculation of norms but were included in other analyses. For the CANTAB battery, regression-based norms were generated for each CANTAB measure, with age, sex, and education included as covariates. Concurrent validity was examined by correlating the CANTAB measures with their traditional neurocognitive counterparts. As expected, performance across most CANTAB measures declined significantly with increasing age and decreasing education levels. There were no significant effects of sex on most CANTAB measures. Our study also showed that some CANTAB measures demonstrated good concurrent validity as they significantly correlated with their traditional neurocognitive test counterparts. We have developed age, sex, and education-specific CANTAB norms for use in the local aging context. The advantages and challenges of using the CANTAB in the local aging context are discussed.

Cost-Effective Analysis of Dual-Energy Computed Tomography for the Diagnosis of Occult Hip Fractures Among Older Adults

ObjectiveEarly and accurate diagnosis of hip fractures minimizes morbidity and mortality. Although current guidelines favor magnetic resonance imaging (MRI) for the diagnosis of occult hip fractures, a new technology called dual-energy computed tomography (DECT) seems an effective alternative. This article investigates a potentially cost-effective strategy for the diagnosis of occult hip fractures in older adults in Singapore. MethodsA decision tree model was developed to compare costs from a payer’s perspective and outcomes in terms of quality-adjusted life-years (QALYs) of different imaging strategies for diagnosing occult hip fracture, comparing MRI with DECT supplementing single-energy computed tomography (SECT) and SECT alone. Model inputs were obtained from local sources where available. Sensitivity analyses are performed to test the robustness of the results. ResultsThe MRI strategy was dominated by the DECT strategy, whereas DECT supplementing SECT provided 0.30 more QALYs at an incremental cost of SGD106.41 with an incremental cost-effectiveness ratio of SGD352.52 per QALY relative to SECT alone. DECT seemed a cost-effective strategy at a willingness-to-pay threshold of SGD50 000 per QALY. ConclusionDECT supplementing SECT is a cost-effective imaging strategy to diagnose occult hip fractures among older adults in Singapore and should be included in clinical pathways to expedite timely treatment and considered for reimbursement schemes.

Enhancing the cardiovascular protective effects of a healthy dietary pattern with wolfberry (Lycium barbarum): A randomized controlled trial

The consumption of wolfberry (Lycium barbarum), a rich source of carotenoids and bioactive polysaccharides, may serve as a potential dietary strategy for cardiovascular disease (CVD) risk management although limited studies examined its effects as whole fruits. To investigate the impact of wolfberry consumption as part of a healthy dietary pattern on vascular health-related outcomes and classical CVD risk factors in middle-aged and older adults in Singapore. This is a 16-week, parallel design, randomized controlled trial. All participants (n=40) received dietary counselling to follow healthy dietary pattern recommendations with the wolfberry group given additional instructions to cook and consume 15 g/d whole, dried wolfberry with their main meals. Biomarkers of vascular function (flow-mediated dilation, plasma total nitrate/nitrite, endothelin-1, and intercellular adhesion molecule-1), vascular structure (carotid intima-media thickness) and vascular regeneration (endothelial progenitor cell count, plasma angiopoietin 1 and angiopoietin 2), were assessed at baseline and postintervention. Serum lipid-lipoproteins and blood pressure were evaluated every 4 weeks. All participants showed an improved compliance toward the healthy dietary pattern. This was coupled with marked rises in total nitrate/nitrite concentrations (mean change wolfberry: 3.92±1.73 nmol/mL; control: 5.01±2.55 nmol/L) and reductions in endothelin-1 concentrations (wolfberry: -0.19±0.06 pg/mL; control: -0.15±0.08 pg/mL). Compared with the control which depicted no changes from baseline, the wolfberry group had a significantly higher HDL cholesterol (0.08±0.04 mmol/L), as well as lower Framingham predicted long-term CVD risk (-0.8±0.5%) and vascular age (-1.9±1.0 y) postintervention. No differences were observed in the other vascular health-related outcomes. In middle-aged and older adults, adherence to a healthy dietary pattern improves vascular tone. Incorporating wolfberry to the diet further improves blood lipid-lipoprotein profile and may lower long-term CVD risk. This study was registered at clinicatrials.gov as NCT03535844.

Shared spaces and “throwntogetherness” in later life: A qualitative GIS study of non-migrant and migrant older adults in Singapore

While there has been considerable academic interest in the topics of encounters and conviviality, including within the migration literature, little is known about how non-migrant and migrant older adults interact with one another in shared spaces, forming micro-publics that inflect the experiences of ageing for both groups. Using Qualitative Geographic Information Science (qualitative GIS), this paper identifies three types of spaces shared by non-migrant and migrant older adults from Singapore and the People’s Republic of China respectively. The first type of shared space is characterised by asynchronicity in that, despite co-located activities, intercultural interactions are less likely to be fostered between non-migrants and migrants. The second type of shared space features informal, spontaneous encounters that develop into more regular forms of interaction with ‘otherness’, but active negotiation of social difference could be limited. The third type of shared space is marked by formal, organised activities where non-migrants and migrants work towards a common goal, prompting productive negotiations with difference. Through juxtaposing these three types of shared spaces, we argue for the importance of drawing out how spatial attributes can deter or foster varying degrees of negotiations with difference, while acknowledging that the fluidity of such processes depend on the users and social contexts too. We also suggest that notions of ageing-in-place need to be analysed alongside ageing-across-borders, giving attention to how migration impacts ageing in later life—both for migrants who are adapting to life abroad temporarily as well as non-migrants who may experience “transnationalism by proxy”. (247 words; max 250 words)

The Impact of 5-Hydroxytryptophan Supplementation on Sleep Quality of Older Adults in Singapore: A Randomized Controlled Trial

Abstract Objectives Sleep quality has been associated with a number of health conditions such as cognitive impairment and cardiovascular disease. 5-Hydroxytryptophan (5-HTP) is known as a precursor of the sleep regulating serotonin and melatonin. However, 5-HTP's efficacy for improving sleep in older adults is unclear. The aim of this study is to assess the impact of 5-HTP on sleep quality in older Singaporean adults. Methods This study is a single-blinded, 12-week parallel randomized controlled trial, where 20 older adults (67 ± 4 years, mean ± SD; 8 M, 12 F) were randomly assigned to either consume or not consume 100 mg 5-HTP daily. Sleep quality data were collected every 4 weeks via both subjective and objective measures such as Pittsburg Sleep Quality Index (PSQI) questionnaire and actigraphy watch. A global sleep score (GSS) was obtained from the PSQI, where a GSS &amp;gt; 5 has been validated to be associated with poor sleep quality. In addition, other sleep quality components that were also extracted include total sleep time (TST), sleep latency (SL) and sleep efficiency (SE). The main effect and interaction of 5-HTP on sleep were evaluated by repeated-measure analysis of variance (ANOVA). Results At baseline, subjects had an overall GSS of 5.9 ± 3.1 a.u. (5-HTP group: 6.3 ± 3.8 a.u.; Control group: 5.5 ± 2.3 a.u.) and this indicated poor sleep quality. Consumption of 5-HTP after 4 and 8 weeks showed a favorable decrease in their objective SL (SLObj) from their baseline (week 4: −18.2 ± 21.1 min; week 8: −17.8 ± 19.2 min). On the other hand, the control group did not display desirable change in SLObj (week 4: 2.4 ± 21.6 min; week 8: 1.5 ± 21.4 min). Repeated-measures ANOVA revealed a significant treatment-by-time effect between 5-HTP consumption and SLObj at week 4 (P = 0.045) and week 8 (P = 0.033), but not at week 12 (P = 0.135). A significant treatment-by-time decrease in subjective TST (−0.1 ± 0.4 hrs, P = 0.027) observed at week 12. No changes in GSS and other subjective and objective measures of sleep quality were detected. Conclusions Older adults had poor sleep quality and 5-HTP supplementation helped reduce sleep latency for up to 8 weeks. Prolonged effects were not observed, and this may be due to acclimation of the body to longer-term 5-HTP supplementation. Funding Sources NUS iHealthtech Microbiome in Health, Disease and Ageing.

Carbohydrate Quality of a Middle-aged and Older Population in Singapore and Its Association with Cardiometabolic Health

Abstract Objectives Carbohydrate quality plays a key role in cardiometabolic health, though this has not been well investigated in Asian populations. This study aimed to assess the carbohydrate quality of middle-aged and older adults in Singapore, and its association with various cardiometabolic health-related markers. Methods A secondary data analysis of a cross-sectional study consisting of 104 adults (59 ± 6 years, mean ± SD) was conducted. Carbohydrate quality was evaluated by their adherence to: (i) Singapore recommended daily allowance (RDA) for dietary fiber intake, (ii) Singapore recommended daily whole grain intake, (iii) World Health Organization free sugars limit and (iv) the balanced carbohydrate metrics (BCM). The BCM was reflected by a ratio of at least 1g of fiber per 10g of carbohydrates (10:1, simple ratio), or variations including free sugars criteria. Food intake was collected using 3-day food record. Measurements of cardiometabolic health-related markers were body mass index, waist circumference, blood pressure, blood lipid-lipoprotein markers (total, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides) and glucose and 10-year risk to coronary heart disease. The association between dietary carbohydrate quality and cardiometabolic health-related markers, as well as associations amongst the 4 measures of carbohydrate quality were evaluated using Fisher's exact test. Results 36%, 20%, 87% and 34% of the population met the fiber RDA, whole grain recommendation, free sugars limit and BCM respectively. A significant association in adherence to each measure of carbohydrate quality was found across all 4 measures (P &amp;lt; 0.05), except for between the whole grain recommendation and free sugars limit. The simple ratio was associated with a lower systolic blood pressure (P = 0.04) while no association was observed with other cardiometabolic health-related markers. Conclusions Consuming a diet adhering to the simple ratio of at least 1g of fiber for every 10g of carbohydrates may improve blood pressure and subsequently lower cardiometabolic disease risk. Funding Sources National University of Singapore, Singapore Economic Development Board and Société des Produits Nestlé SA

Constructing a measure of balance recovery confidence for older persons: content themes from different stakeholders

Background: The absence of patient-reported outcome measures (PROMs) for a specific construct or target population suggests a need for such measures to be developed. A case in point is the domain of falls efficacy; a PROM for balance recovery confidence was proposed to improve older persons ’agency to arrest a fall. Appropriate participation in its development by relevant stakeholders was identified as essential to maximise the utility of the PROM and its potential to enhance patient care. There is a gap in the practice development literature in terms of PROMs for older persons. This article aims to encourage researchers to use the principles of practice development to address this gap by involving relevant stakeholders to gain greater insight. Methods: The nominal group technique and the Delphi technique were used to generate and refine the content of the measure, and content analysis was applied to assess and summarise the data. Findings: Unique themes emerged, such as ‘agency of older people in the prevention of falls ’from the community-dwelling older adults in Singapore, and ‘clinical specificity ’from an international panel of healthcare professionals. Common themes including ‘relevance to the target population’, ‘comprehensibility ’and ‘cultural and contextual sensitivity ’were found in both groups. Conclusion: A collaborative, inclusive and participatory approach involving different stakeholders, underpinned by practice development methodology, can offer rich insights for PROM developers. Implications for practice: Meaningful perspectives are generated from a diversity of views shared by representatives from all stakeholder groups involved in caregiving Participation of different stakeholders, such as physiotherapists, occupational therapists, nurses, doctors, podiatrists and older persons, provides a more robust and authentic approach to developing a PROM for older persons

Singapore multidisciplinary consensus recommendations on muscle health in older adults: assessment and multimodal targeted intervention across the continuum of care

BackgroundThe rapidly aging societies worldwide and in Singapore present a unique challenge, requiring an integrated multidisciplinary approach to address high-value targets such as muscle health. We propose pragmatic evidence-based multidisciplinary consensus recommendations for the assessment and multi-modal management of muscle health in older adults (≥65 years) across the continuum of care.MethodsThe recommendations are derived from an in-depth review of published literature by a multidisciplinary working group with clinical experience in the care of the older population in both acute and community settings.ResultsThe panel recommends screening for muscle impairment using the SARC-F questionnaire, followed by assessment for low muscle strength (handgrip strength or 5-times chair stand test ≥10 s as a surrogate for lower limb strength) to diagnose possible/probable sarcopenia. For uncomplicated cases, lifestyle modifications in exercise and diet can be initiated in the community setting without further assessment. Where indicated, individuals diagnosed with possible/probable sarcopenia should undergo further assessment.Diagnosis of sarcopenia should be based on low muscle strength and low muscle mass (bioimpedance analysis, dual-energy X-ray absorptiometry or calf circumference as a surrogate). The severity of sarcopenia should be determined by assessment of physical performance (gait speed or 5-times chair stand test ≥12 s as a surrogate for gait speed). To treat sarcopenia, we recommend a combination of progressive resistance-based exercise training and optimization of nutritional intake (energy, protein and functional ingredients). High quality protein in sufficient quantity, to overcome anabolic resistance in older adults, and distributed throughout the day to enable maximum muscle protein synthesis, is essential. The addition of resistance-based exercise training is synergistic in improving the sensitivity of muscle protein synthesis response to the provision of amino acids and reducing anabolic resistance. An expected dose-response relationship between the intensity of resistance-based training, lean mass and muscle strength is described.ConclusionsReviewed and endorsed by the Society of Rehabilitation Medicine Singapore and the Singapore Nutrition and Dietetics Association, these multidisciplinary consensus recommendations can provide guidance in the formulation of comprehensive and pragmatic management plans to improve muscle health in older adults in Singapore and Asia.

Patterns of occupational engagement among community-dwelling older adults in Singapore: An exploratory mixed method study

IntroductionThe aim of this study is to understand the patterns of occupations among community-dwelling older adults in Singapore. The objectives are to describe their occupational engagement using the Activity Card Sort Singapore, understand their occupational preferences and perceived barriers and facilitators to engagement.MethodsA convergent parallel mixed-method study was conducted over a 5-month period in 2018. Purposive and snowball sampling were used to recruit the participants. Individual 1-h interviews were conducted at participants’ homes. Quantitative data collected include demographic information, Modified Barthel Index scores and activity engagement based on the Activity Card Sort Singapore. Qualitative data was collected using semi-structured interviews.Results105 participants were enrolled in the study. Overall, older adults engaged mostly in instrumental and social activities. However, leisure and social activities were most preferred. Gender, educational level and age were found to influence occupational engagement. Overall, six main themes relating to perceived barriers and facilitators to occupational engagement were identified: cognition and physical status, self-efficacy, resources, affect and meaningfulness, social influence and environmental factors.ConclusionThe findings from this study provided insights into the occupational patterns of community-dwelling older adults in Singapore and their perceived barriers and facilitators to engagement. Recommendations for practice were identified.

Timed Up and Go (TUG) Reference Values and Predictive Cutoffs for Fall Risk and Disability in Singaporean Community-Dwelling Adults: Yishun Cross-Sectional Study and Singapore Longitudinal Aging Study

ObjectivesThe “timed up and go” (TUG) test is a simple and widely used test of overall functional mobility. There is a paucity of TUG normative data among Asian individuals who differ in habitual gait speed and fall risk from Western population. The objectives of this study were to determine TUG reference values and optimum cutoffs predicting prevalent and incident disability for community-dwelling adults. DesignOne cross-sectional (Study 1–Yishun Study) and one longitudinal (Study 2–Singapore Longitudinal Aging Study) study in Singapore. Setting and ParticipantsStudy 1 comprised 538 nondisabled, community-dwelling adults aged between 21 and 90 years. Study 2 comprised 1356 community-dwelling older adults aged ≥55 years followed for 3 years. MethodsStudy 1 collected TUG reference values and assessed physiological fall risk (PFR) using the Physiological Profile Assessment (PPA). Study 2 assessed association of TUG with disability with the Barthel Index and the Lawton scale at baseline and follow-up. ResultsFrom Study 1, mean TUG time for individuals aged 60 to 74 years was 9.80 seconds, shorter than values reported for Westerners of 12.30 seconds. It was significantly associated with high PFR [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.03–1.27], 74.0% agreement, Cohen's kappa = 0.314 (95% CI 0.238–0.390); area under the curve = 0.85 (95% CI 0.80–0.90). A TUG cutoff of 10.2 seconds discriminated high PFR from low PFR with 84.4% sensitivity and 72.6% specificity. In Study 2, the threshold for observing significantly increased risk of disability was ≥9.45 seconds for prevalent disability (OR 2.98, 95% CI 1.41–6.78), functional decline (OR 2.68, 95% CI 1.33–5.80), and incidental disability (OR 2.25, 95% CI 1.08–4.97). Conclusions and ImplicationsTUG reference values and cutoff predicting disability for community-dwelling older adults in Singapore are consistent with Asian data and lower than for Western individuals. TUG could be used to guide development and evaluation of risk screening of adverse health outcomes across the life span in Singapore.

Prevalence of Anemia and Its Association with Frailty, Physical Function and Cognition in Community-Dwelling Older Adults: Findings from the HOPE Study.

The prevalence of anemia and its impact on frailty and physical function amongst the multiethnic older populations in the Southeast Asian (SEA) countries are often not well studied. Singapore, a nation comprised of multiethnic communities, is one of the most rapidly aging population globally. We aim to evaluate the prevalence of anemia and its impact on frailty, and physical function in Healthy Older People Everyday (HOPE)- an epidemiologic population-based study on community-dwelling older adults in Singapore. Cross-sectional study. Community. 480 adults ≥ 65 years old. Data were collected from interviewers-administered questionnaires on socio-demographics, FRAIL scale, Mini-Mental State Examination, EQ-5D, Barthel Index, and Lawton index. Hemoglobin concentration and physical assessments, including anthropometry, grip strength, timed up-and-go (TUG) were measured. The overall prevalence of anemia was 15.2% (73 out of 480). The Indian ethnic group had the highest prevalence of anemia (32%, OR=3.02; 95%CI= 1.23-7.41) with the lowest hemoglobin concentration compared to the overall population (13.0±1.3g/L and 13.5±1.4g/L, p=0.02). Hemoglobin levels and anemia were significantly associated with frailty (OR=2.28; 95% CI=1.02-5.10), low grip strength (OR=1.79; 95% CI=1.01-3.03), ≥ one IADL impairment (OR=2.35; 95% CI=1.39-3.97). Each 1 g/dL increase in hemoglobin was associated with a 6% decrease in frailty odds after adjusting for potential covariates (OR = 0.94, 95% CI: 0.90-0.99). There was a significant difference in the mean TUG between the non-anemic (11.0±3.4 seconds) and anemic (12.3±6.0 seconds, p=0.01) counterparts, but no difference in the number of falls. In our multiethnic Asian population, anemia was adversely associated with frailty, decreased muscle strength, and IADL impairment. Health policies on anemia screening should be employed to avoid or potentially delay or reverse these adverse outcomes associated with anemia. Recognition, evaluation, and treatment of anemia amongst this vulnerable population is warranted.