Successful ageing in Singapore: prevalence and correlates from a national survey of older adults

INTRODUCTION

The current study aimed to estimate the overall prevalence and sociodemographic correlates of successful ageing, as defined by Rowe and Kahn, among a national sample of multiethnic adults aged 60 years and older in Singapore.

METHODS

Data from older adults who participated in the Well-being of the Singapore Elderly study was analysed. Successful ageing was defined with five indicators: no major diseases; no disability; high cognitive functioning; high physical functioning; and active engagement with life.

RESULTS

The prevalence of successful ageing was 25.4% in this older population. Older adults aged 75-84 years and ≥ 85 years had 0.3 times and 0.1 times the odds of successful ageing, respectively, than those aged 60-74 years. Compared to older adults of Chinese ethnicity, those of Malay (odds ratio [OR] 0.6) and Indian (OR 0.5) ethnicities were less likely to be associated with successful ageing. Older adults with lower education levels, who had no formal education (OR 0.2), some schooling but did not complete primary education (OR 0.4) or only primary education (OR 0.5), had lower odds of ageing successfully than those with tertiary education.

CONCLUSION

Older adults in Singapore tend to have much more active engagement with life as compared to their counterparts from other countries. Further research into this population is needed, both in terms of qualitative research to gain a better understanding of successful ageing from the older adult's perspective, as well as longitudinal studies that explore behavioural determinants of successful ageing.

Dataset on gene expression in the elderly after Mindfulness Awareness Practice or Health Education Program

It has been reported that relaxation techniques can improve physical health and cognitive function. A number of studies involving different types of relaxation practices showed changes in expression of genes. We investigated the gene expression pattern of a cohort of elderly subjects of Asian descent after weekly (for the first three months) and monthly (for the subsequent six months) intervention. Sixty consenting elderly subjects (aged 60-90 years) with mild cognitive impairment were assigned to either the Mindfulness Awareness Practice (MAP) or Health Education Program (HEP) group in a randomized controlled trial to assess the effectiveness of the programs in preventing further cognitive decline and evaluate the influence on neurological, cellular and biochemical factors. Blood samples were collected before the start of intervention and after nine months for gene expression profiling using Affymetrix Human Genome U133 Plus 2.0 arrays. The dataset is publicly available for further analyses.

Recognition of mental disorders: findings from a cross-sectional study among medical students in Singapore

OBJECTIVES

To assess recognition of five mental disorders (alcohol abuse, dementia, depression, obsessive-compulsive disorder (OCD) and schizophrenia) among a sample of medical students using a vignette-based approach. Socio-demographic predictors of correct recognition were also explored.

DESIGN

Cross-sectional online survey.

PARTICIPANTS

Medical students studying in Singapore.

METHODS

This was a cross-sectional online study among medical students (n=502) who were randomly assigned one of the five vignettes. Students were instructed to read the vignette, then answer the open text question, 'What do you think the person in the vignette is suffering from?' Multiple logistic regression was performed to determine the predictors of correct recognition.

RESULTS

81.7% could correctly recognise the condition described in the vignette. Depression was most well recognised (93.0%), followed by alcohol abuse (89.0%), OCD (87.1%) and dementia (79.2%), while only 60.0% of students correctly recognised schizophrenia. Females were significantly more likely to correctly recognise the disorders, while the odds of correct recognition were significantly higher among fourth-year and fifth-year students compared with first-year students. Compared with depression, dementia and schizophrenia were significantly more likely to be mislabelled.

CONCLUSION

While overall correct recognition was high (81.7%), this did vary by disorder, where schizophrenia (60%) was the most poorly recognised condition. Given that primary care providers are often the first professional help-seeking source for people with mental health problems, medical students should be equipped with the skills and ability to recognise signs and symptoms of various mental illnesses.

Self-reported sleep problems among the elderly: A latent class analysis

The present study utilized a person-centered approach to examine the different profiles of problem sleepers in a community sample of elderly. In addition, this study also explores how demographic and psychiatric variables may be related to these different profiles of sleep problems. A total of 515 participants (Mean age = 67 years, SD = 5) were administered self-report measures of sleep problems, depression and anxiety. Among them, 230 who reported significant problems in any of five selected sleep components were entered into a latent class analysis. The remaining 285 participants were assigned to a comparison control group. The profiles of 'inadequate sleep', 'disturbed sleep', 'trouble falling asleep' and 'multiple problems' were identified. The 'multiple problems' group had significantly higher levels of depression and anxiety relative to the control group. Regression analyses indicated that these different profiles had contributed to a significant increase in variance explained in anxiety but not depression levels, on top of the severity of sleep problems and demographic variables. Although sleep problems occur among the elderly with considerable heterogeneity, they can generally be classified into four different profiles. Furthermore, the inclusion of sleep problem profiles can significantly enhance the prediction of anxiety symptoms.

Head circumference, leg length and its association with dementia among older adult population in Singapore

BACKGROUND

Head circumference and leg length serve as reliable proxy indicators of early-life environment. Research studies have shown that these anthropometric measurements are associated with cognitive impairment and dementia among older adults. The aim of the present study was to assess the associations between dementia with head circumference and leg length among the older adult population in Singapore. This study also aimed to examine the sociodemographic correlates of these anthropometric measurements.

METHODS

Data were collected from 2565 older adults aged 60 years and above, in a population study on the Well-being of the Singapore Elderly. Head circumference and leg length measurements were obtained, and sociodemographic information was recorded. Dementia diagnosis was made using the 10/66 dementia algorithm. Anthropometric measurements were first stratified into quarters, and then logistic regression analysis was used to examine factors associated with head circumference and leg length, as well as to examine the association between dementia with these measurements.

RESULTS

Sociodemographic correlates of head circumference and leg length include age, gender, ethnicity and education level. Smaller head circumference was independently associated with higher odds of 10/66 dementia (OR = 2.173-2.709). When the regression analysis was stratified by gender, the association was found only in the male sample. Leg length was not significantly associated with dementia after controlling for sociodemographic variables.

CONCLUSION

Smaller head circumference is independently associated with dementia among older adults in Singapore. Findings from this study suggest that risk factors for dementia begin their influence in early life. Copyright © 2017 John Wiley & Sons, Ltd.

A comparison of clinical characteristics of older adults treated with antidepressants in general and psychiatric hospitals in Asia

AIM

This study compared the demographics, clinical characteristics, and antidepressant prescription patterns between Asian patients aged 50 years and older attending psychiatric hospitals and those attending general hospitals.

METHODS

In total, 955 patients (604 in general hospitals, 351 in psychiatric hospitals) aged 50 years or older treated with antidepressants in 10 Asian countries and territories were examined. Patients' demographics, clinical features, and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure.

RESULTS

Binary logistic regression revealed that high income and diagnosis of schizophrenia were independently associated with psychiatric hospital treatment, whereas outpatient care, diagnosis of anxiety disorders, and multiple major medical conditions were independently associated with general hospital treatment. In addition, tetracyclic and noradrenergic and specific serotonergic antidepressants were more likely to be prescribed in general hospitals.

CONCLUSION

Older adults treated with antidepressants showed different demographic and clinical features between general hospitals and psychiatric hospitals in Asia.

Effects of horticultural therapy on elderly' health: protocol of a randomized controlled trial

BACKGROUND

Due to a rapidly ageing population in the world, it is increasingly pertinent to promote successful ageing strategies which are cost-effective, easily accessible, and more likely to be acceptable to the elderly. Past research associates exposure to natural environments and horticultural therapy (HT) with positive psychological, social and physical health benefits. This Randomized Controlled Trial (RCT) is designed to evaluate the efficacy of HT in promoting Asian elderly' mental health, cognitive functioning and physical health.

METHODS/DESIGN

70 elderly participants aged 60 to 85 years old will be randomized to participate in either the active horticultural therapy group or be in the waitlist control. Sessions will be weekly for 12 weeks, and monthly for 3 months. Mental health will be assessed through self-reports of depressive and anxiety symptomatology, life satisfaction, social connectedness and psychological well-being, collaborated with immunological markers. Outcome measures of cognitive functioning and physical health include neuropsychological tests of cognitive function and basic health screening. Outcomes will be assessed at baseline, 3 months and 6 months post-intervention.

DISCUSSION

This RCT comprehensively investigates the efficacy of a non-invasive intervention, HT, in enhancing mental health, cognitive functioning and physical health. The results have tremendous potential for supporting future successful ageing programs and applicability to larger populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02495194 . Trial registration date: July 13, 2015. Retrospectively registered.

Validation of the English and Mandarin versions of the Fear of Cancer Recurrence Inventory in an Asian population

The Fear of Cancer Recurrence Inventory has shown adequate psychometric properties to assess for fear of cancer recurrence among cancer survivors. However, the use of the Fear of Cancer Recurrence Inventory in Asia is limited due to the paucity of validation studies. Participants include 331 cancer survivors who completed the English and newly developed Mandarin versions of the Fear of Cancer Recurrence Inventory. The results revealed that both versions of the Fear of Cancer Recurrence Inventory demonstrated satisfactory internal reliability, test-retest reliability, convergent validity, and concurrent validity. A confirmatory factor analysis provided support for the original seven-factor structure. The validated Fear of Cancer Recurrence Inventory is applicable to cancer survivors in Singapore.

Poor sleep quality is observed in mild cognitive impairment and is largely unrelated to depression and anxiety

BACKGROUND

Individuals with mild cognitive impairment (MCI) commonly experience a number of sleep quality related issues. However, it remains unclear if these issues are specific to MCI or are simply attributed to the elevated levels depression and anxiety symptoms frequently observed among those with MCI. The present study sought to examine group differences between participants with MCI and matched controls on self-reported measures of sleep quality while controlling for depression and anxiety levels.

METHODS

Participants with MCI (N = 48) and demographically matched controls (N = 48) were administered with self-reported measures of anxiety, depression and sleep quality. Sleep quality between both groups were first analyzed using a Multivariate Analysis of Variance, and then subsequently a Multivariate Analysis of Covariance incorporating depression and anxiety scores as covariates.

RESULTS

The MCI group had significantly higher levels of depression and anxiety than the controls. On the sleep-related measures, the MCI group had significantly worse outcomes in sleep duration, disturbances, latency, efficiency, quality and daytime dysfunction. After controlling for depression and anxiety levels, with the exception of daytime dysfunction, all other differences remain significant, and are also associated with moderate to large effect sizes.

CONCLUSION

The results suggest that sleep quality issues are present in MCI and are largely independent of depression and anxiety.

Comorbid Diabetes and Depression among Older Adults - Prevalence, Correlates, Disability and Healthcare Utilisation

INTRODUCTION

The objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation.

MATERIALS AND METHODS

Data for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM.

RESULTS

DM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed.

CONCLUSION

Given the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.

Evaluation of a brief pilot psychoeducational support group intervention for family caregivers of cancer patients: a quasi-experimental mixed-methods study

BACKGROUND

Family caregivers of cancer patients often experience an impaired quality of life (QOL) and emotional distress as a result of their caregiving duties, which may potentially influence the quality of care of their care recipients. The COPE (Caregivers of cancer Outpatients' Psycho-Education support group therapy) intervention was developed as a response to the lack of work done among family caregivers of ambulatory cancer patients in Asia. This group intervention comprised four weekly sessions simultaneously targeting psychoeducation, skills training, and supportive therapy. The present study sought to evaluate the pilot COPE intervention using both quantitative and qualitative measures. The Hospital Anxiety and Depression Scale (HADS) was used to measure both depression and anxiety, while the Caregiver QOL - Cancer (CQOLC) measured caregiver QOL. These instruments were measured at baseline pre-intervention, and immediately post-intervention. A waitlist control group design was adopted. A subset of caregivers from the intervention group were invited for a semi-structured interview post-intervention.

FINDINGS

Quantitative analyses suggest that while QOL remained stable in control group participants, intervention group participants experienced QOL improvements - both in overall QOL and in the specific domain of burden. There were no significant differences in the trajectories of depression and anxiety in both groups. Qualitative analyses suggest that this might have been a result of the intervention not only equipping participants with the relevant coping skills, but also providing a platform for emotional expression and situational reappraisal.

CONCLUSIONS

The COPE intervention has shown some efficacy in helping family caregivers of cancer patients, but more work is required before this can be implemented.

TRIAL REGISTRATION

Current Controlled Trials NCT02120183 . Registered 17 April 2014. Retrospectively registered.

Quinazoline derivative from indigenous isolate, Nocardiopsis alba inhibits human telomerase enzyme

AIM

Aim of this study was isolation and screening of various secondary metabolites produced by indigenous isolates of soil Actinomycetes for human telomerase inhibitory activity.

METHODS AND RESULTS

Extracellular extract from culture suspension of various soil Actinomycetes species were tested for telomerase inhibitory activity. The organism which produced telomerase inhibitor was identified by 16S rRNA gene sequencing. The active fraction was purified by HPLC and analysed by GC-MS to identify the compound. In GC-MS analysis, the active principle was identified as 3-[4'-(2″-chlorophenyl)-2'-thiazolyl]-2,4-dioxo-1,2,3,4-tetrahydro quinazoline. The G-quadruplex stabilizing ability of the compound was checked by molecular docking and simulation experiments with G-quadruplex model (PDB ID-1L1H). The selective binding ability of the compound with G-quadruplex over Dickerson-Drew dodecamer DNA structures showed that the compound possess high selectivity towards G-quadruplex.

CONCLUSIONS

Quinazoline derivative isolated from an indigenous strain of Nocardiopsis alba inhibited telomerase. Molecular docking and simulation studies predicted that this compound is a strong stabilizer of G-quadruplex conformation. It also showed a preferable binding to G-quadruplex DNA over normal DNA duplex.

SIGNIFICANCE AND IMPACT OF THE STUDY

This particular compound can be suggested as a suitable compound for developing a future anticancer drug. The selectivity towards G-quadruplex over normal DNA duplex gives a clue that it is likely to show lower cytotoxicity in normal cells.

Emotion regulation and emotional distress: The mediating role of hope on reappraisal and anxiety/depression in newly diagnosed cancer patients

PURPOSE

A proportion of newly diagnosed cancer patients may experience anxiety and depression. Emotion suppression has been associated with poorer psychoemotional outcomes, whereas reappraisal may be an adaptive emotion regulation strategy. Few studies have examined potential mechanisms linking reappraisal to psychoemotional outcomes in cancer patients. This study aims to replicate findings on reappraisal and suppression and further examines if hope mediates the association between reappraisal and anxiety/depression in patients newly diagnosed with cancer.

METHODS

Participants were 144 adult cancer patients (65.3% female, mean age = 48.96 years, SD = 9.23). Patients completed a set of study questionnaires, including the Emotion Regulation Questionnaire, Adult Hope Scale, and the Hospital Anxiety and Depression Scale. Path analysis was used to examine if hope mediated the association between reappraisal and anxiety/depression.

RESULTS

Prevalence of anxiety was 39.6% and depression was 25.0%. Reappraisal and hope were correlated with lower anxiety and depression, whereas suppression was correlated with higher anxiety and depression. The hypothesized mediation model provided fit to the data, comparative fit index = 0.95, Tucker-Lewis index = 0.94, root-mean-square-error of approximation = 0.05. There was a significant indirect effect of reappraisal on anxiety and depression via hope, b = -0.95, SE = 0.42, 95% confidence interval = -1.77 to -0.12, whereas the direct effect of reappraisal was nonsignificant.

CONCLUSION

The study findings suggest that hope mediated the association between reappraisal and anxiety/depression outcomes. Moreover, the high prevalence of anxiety and depression implies a need for healthcare providers to attend to the psychoemotional needs of newly diagnosed cancer patients.

Biopsychosocial correlates of hope in Asian patients with cancer: a systematic review

OBJECTIVE

To examine the factors associated with hope and hopelessness in patients with cancer in Asian countries, and the instruments used to measure hope and hopelessness.

METHORDS

A comprehensive systematic review was conducted with search terms, including cancer, hope, hopelessness and individual Asian country names, on CINAHL, Embase, PsycINFO, PubMed and Scopus databases. Only quantitative studies on adult cancer populations in Asia examining hope or hopelessness were included.

RESULTS

A total of 2062 unique articles were retrieved from the databases, and 32 studies were selected for inclusion in this review. Hope and hopelessness were most frequently measured with the Herth Hope Index and the Mental Adjustment to Cancer Scale, respectively. The biopsychosocial factors that were most consistently associated with hope and hopelessness included sociodemographic variables (education, employment and economic status); clinical factors (cancer stage, physical condition and symptoms); and psychosocial factors (emotional distress, social support and connections, quality of life, control or self-efficacy, as well as adjustment and resilience).

DISCUSSION

There is a need for more studies from South and Southeast Asia as most studies hailed from East Asia. This review highlighted the possibility of cultural differences influencing factors related to hope, suggesting that cross-cultural studies specifically would facilitate understanding behind these variations, although future reviews on hope should also include studies on hopelessness for a comprehensive understanding of the concept. Finally, more longitudinal research could be conducted to assess whether the factors associated with hope and hopelessness change over time and disease progression.

The prevalence and predictors of subsyndromal anxiety and depression in adult Asian cancer patients across the first year of diagnosis

AIM

There is an increased prevalence of anxiety and depression in Asian patients diagnosed with cancers; these are known to interfere with treatment, treatment adherence and mortality. This study sought to investigate the prevalence and predictors of subsyndromal anxiety and depression in first-year Asian cancer patients.

METHODS

A total of 206 patients newly diagnosed with cancer in Singapore completed the Hospital Anxiety and Depression Scale (HADS) at T1 (baseline; on average 2 months post-diagnosis), T2 (3 months post-baseline) and T3 (6 months post-baseline). Subsyndromal anxiety and depression were identified using locally validated cut-offs (HADS-A ≥5 and HADS-D ≥7). Adjusted odds ratios were calculated using baseline predictors.

RESULTS

Across the three time points, 68-69% of participants were identified as having subsyndromal anxiety and close to 27-38% participants were identified as having subsyndromal depression. Multivariate logistic regressions revealed a lack of predictors for T1 subsyndromal anxiety and depression. Participants with late/metastatic stages of cancer were almost four times as likely to suffer from subsyndromal anxiety at T2. Single participants had a 75% lowered odds, but those living in three to four room public housing were close to four times as likely to suffer from subsyndromal depression at T2. Older patients and those who had undergone surgery were found to significantly suffer from subsyndromal depression at T3.

CONCLUSION

The significant levels of depression and anxiety coupled with the lack of consistent predictors across the first year following cancer diagnosis further underscore the importance of careful assessment and clinician-vigilance in recognizing and identifying Asian patients who may express these emotional sequelae following the cancer diagnosis. A better understanding of patients' pathophysiological and psychological responses and individual strengths and coping skills are thus essential.