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Bouldin ED, Brintz BJ, Hansen J, Rupper R, Brenner R, Intrator O, Kinosian B, Viny M, Dang S, Pugh MJ. Trajectories and Transitions in Service Use Among Older Veterans at High Risk of Long-term Institutional Care. Med Care 2024:00005650-990000000-00259. [PMID: 39146392 DOI: 10.1097/mlr.0000000000002051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
BACKGROUND We aimed to identify combinations of long-term services and supports (LTSS) Veterans use, describe transitions between groups, and identify factors influencing transition. METHODS We explored LTSS across a continuum from home to institutional care. Analyses included 104,837 Veterans Health Administration (VHA) patients 66 years and older at high-risk of long-term institutional care (LTIC). We conduct latent class and latent transition analyses using VHA and Medicare data from fiscal years 2014 to 2017. We used logistic regression to identify variables associated with transition. RESULTS We identified 5 latent classes: (1) No Services (11% of sample in 2015); (2) Medicare Services (31%), characterized by using LTSS only in Medicare; (3) VHA-Medicare Care Continuum (19%), including LTSS use in various settings across VHA and Medicare; (4) Personal Care Services (21%), characterized by high probabilities of using VHA homemaker/home health aide or self-directed care; and (5) Home-Centered Interdisciplinary Care (18%), characterized by a high probability of using home-based primary care. Veterans frequently stayed in the same class over the three years (30% to 46% in each class). Having a hip fracture, self-care impairment, or severe ambulatory limitation increased the odds of leaving No Services, and incontinence and dementia increased the odds of entering VHA-Medicare Care Continuum. Results were similar when restricted to Veterans who survived during all 3 years of the study period. CONCLUSIONS Veterans at high risk of LTIC use a combination of services from across the care continuum and a mix of VHA and Medicare services. Service patterns are relatively stable for 3 years.
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Affiliation(s)
- Erin D Bouldin
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, TX
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement, and Analytic Sciences Center
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, TX
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement, and Analytic Sciences Center
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jared Hansen
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, TX
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement, and Analytic Sciences Center
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Rand Rupper
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, TX
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, UT
| | - Rachel Brenner
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, UT
| | - Orna Intrator
- Geriatrics & Extended Care Data Analysis Center and Finger Lakes Healthcare System, Canandaigua Veterans Affairs Medical Center, Canandaigua
- Department of Public Health Sciences, University of Rochester, Rochester, NY
| | - Bruce Kinosian
- Geriatrics and Extended Care Data Analysis Center and Corporal Michael J Crescenz Veterans Affairs Medical Center
- Division of Geriatrics, School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mikayla Viny
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, TX
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement, and Analytic Sciences Center
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Stuti Dang
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, TX
- Miami Veterans Affairs Geriatric Research Education and Clinical Center (GRECC)
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, FL
| | - Mary Jo Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, TX
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement, and Analytic Sciences Center
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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Boucaud-Maitre D, Letenneur L, Dramé M, Taubé-Teguo N, Dartigues JF, Amieva H, Tabué-Teguo M. Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review. PLoS One 2023; 18:e0286527. [PMID: 37256888 DOI: 10.1371/journal.pone.0286527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.
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Affiliation(s)
- Denis Boucaud-Maitre
- Centre Hospitalier Le Vinatier, Bron, France
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
| | - Luc Letenneur
- Inserm, U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Moustapha Dramé
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Nadine Taubé-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | | | - Hélène Amieva
- Inserm, U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Maturin Tabué-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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Hoang MT, Kåreholt I, Schön P, von Koch L, Xu H, Tan EC, Johnell K, Eriksdotter M, Garcia-Ptacek S. The Impact of Educational Attainment and Income on Long-Term Care for Persons with Alzheimer's Disease and Other Dementias: A Swedish Nationwide Study. J Alzheimers Dis 2023; 96:789-800. [PMID: 37840486 PMCID: PMC10657673 DOI: 10.3233/jad-230388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Long-term care improves independence and quality of life of persons with dementia (PWD). The influence of socioeconomic status on access to long-term care was understudied. OBJECTIVE To explore the socioeconomic disparity in long-term care for PWD. METHODS This registry-based study included 14,786 PWD, registered in the Swedish registry for cognitive and dementia disorders (2014-2016). Education and income, two traditional socioeconomic indicators, were the main exposure. Outcomes were any kind of long-term care, specific types of long-term care (home care, institutional care), and the monthly average hours of home care. The association between outcomes and socioeconomic status was examined with zero-inflated negative binomial regression and binary logistic regression. RESULTS PWD with compulsory education had lower likelihood of receiving any kind of long-term care (OR 0.80, 95% CI 0.68-0.93), or home care (OR 0.83, 95% CI 0.70-0.97), compared to individuals with university degrees. Their monthly average hours of home care were 0.70 times (95% CI 0.59-0.82) lower than those of persons with university degrees. There was no significant association between education and the receipt of institutional care. Stratifying on persons with Alzheimer's disease showed significant association between lower education and any kind of long-term care, and between income and the hours of home care. CONCLUSIONS Socioeconomic inequalities in long-term care existed in this study population. Lower-educated PWD were less likely to acquire general long-term care, home care and had lower hours of home care, compared to their higher-educated counterparts. Income was not significantly associated with the receipt of long-term care.
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Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Pär Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Edwin C.K Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, New South Wales, Australia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Theme, Karolinska University Hospital, Stockholm, Sweden
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Reckrey JM, Li L, Zhan S, Wolff J, Yee C, Ornstein KA. Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community With Dementia. J Gerontol B Psychol Sci Soc Sci 2022; 77:S11-S20. [PMID: 35034123 PMCID: PMC9122661 DOI: 10.1093/geronb/gbac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Paid caregivers (e.g., home health aides) often work with family caregivers to support persons living with dementia at home. We identify (a) unique trajectories of paid and family caregiving support among persons living with dementia with high care needs and (b) factors associated with these trajectories. METHODS We used group-based multiple trajectory modeling to identify distinct trajectories of paid and family caregiving hours among National Health and Aging Trends Study respondents with dementia who died or moved to a nursing home (n = 334, mean follow-up 5.5 years). We examined differences between trajectory groups and identified factors associated with group membership using generalized estimating equation modeling. RESULTS A 3-group model best fit our data: (a) "low/stable care" (61.3% of respondents) with stable, low/no paid care and moderate family care, (b) "increasing paid care" with increasing, moderate paid and family care, and (c) "high family care" with increasing, high family care and stable, low paid care. While both the "increasing paid care" and "high family care" groups were more functionally impaired than the "low/stable care" group, the "high family care" group was also more likely to be non-White and experience multiple medical comorbidities, depression, and social isolation. DISCUSSION Study findings highlight the importance of considering unique arrangements in dementia care. Receipt of paid care was not only determined by patient care needs. Creating equitable access to paid care may be a particularly important way to support both persons living with dementia and their family caregivers as care needs grow.
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Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Lihua Li
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Serena Zhan
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jennifer Wolff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cynthia Yee
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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5
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Giebel C, Hollinghurst J, Akbari A, Schnier C, Wilkinson T, North L, Gabbay M, Rodgers S. Socio-economic predictors of time to care home admission in people living with dementia in Wales: A routine data linkage study. Int J Geriatr Psychiatry 2021; 36:511-520. [PMID: 33045103 PMCID: PMC7984448 DOI: 10.1002/gps.5446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Limited research has shown that people with dementia (PwD) from lower socio-economic backgrounds can face difficulties in accessing the right care at the right time. This study examined whether socio-economic status (SES) and rural versus urban living location are associated with the time between diagnosis and care home admission in PwD living in Wales, UK. METHODS/DESIGN This study linked routine health data and an e-cohort of PwD who have been admitted into a care home between 2000 and 2018 living in Wales. Survival analysis explored the effects of SES, living location, living situation, and frailty on the time between diagnosis and care home admission. RESULTS In 34,514 PwD, the average time between diagnosis and care home admission was 1.5 (±1.4) years. Cox regression analysis showed that increased age, living alone, frailty, and living in less disadvantaged neighbourhoods were associated with faster rate to care home admission. Living in rural regions predicted a slower rate until care home admission. CONCLUSIONS This is one of the first studies to show a link between socio-economic factors on time to care home admission in dementia. Future research needs to address variations in care needs between PwD from different socio-economic and geographical backgrounds.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Joe Hollinghurst
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK
| | - Ashley Akbari
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Administrative Data Research WalesSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Christian Schnier
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK
| | - Tim Wilkinson
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK,Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Laura North
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Mark Gabbay
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Sarah Rodgers
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
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Szabo S, Lakzadeh P, Cline S, Palma Dos Reis R, Petrella R. The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada. Int J Geriatr Psychiatry 2019; 34:1677-1688. [PMID: 31353572 DOI: 10.1002/gps.5182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/08/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the clinical and direct medical economic burden among Alzheimer disease (AD) caregivers using real-world, longitudinal patient-level data in Canada. METHODS/DESIGN This retrospective observational study assessed the clinical and direct medical economic burden among individuals who cohabitate with AD patients ("AD caregiver cohort") compared with older adults who were cohabiting with another adult without dementia ("comparison cohort") using real-world data from the Southwestern Ontario database, a representative Canadian electronic health record (EHR) longitudinal EHR. RESULTS The AD caregiver cohort (n = 2749; mild AD: n = 2254, moderate AD: n = 302, and severe AD, n = 193) had a similar or higher level of clinical and economic burden than the comparison cohort (n = 12 152). The overall AD cohort and caregivers of patients with mild AD had a similar clinical burden to the comparison cohort. Those caregiving for more severely affected AD patients had an increased risk of comorbidities and required more medication, physician attention, and hospital encounters compared with caregivers of less severe AD patients and the comparison cohort. Mean annual costs were higher among the AD caregiver cohort than the comparison cohort, and those caregiving for moderate and severe AD patients incurred the highest costs. Overall mortality was higher in the AD caregiver cohort compared with the comparison cohort. CONCLUSIONS Caregivers of patients with mild AD had a similar clinical and direct economic burden to older adults who were not dementia caregivers, whereas the burden among caregivers of moderate and severe AD patients was much greater.
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Affiliation(s)
| | | | | | | | - Robert Petrella
- Department of Family Practice, University of Western Ontario, London, ON, Canada
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Abstract
AbstractDementia, a term that describes a variety of brain conditions marked by gradual, persistent and progressive cognitive decline, affects a significant proportion of older adults. Older adults with dementia are sometimes perceived less favourably than those without dementia. Furthermore, compared to persons without dementia, those with dementia are often perceived by others as having reduced personhood. This study was aimed at investigating whether differences in attitudes towards dementia and personhood perceptions vary as a function of age group, care-giver status, attitudes towards ageing, dementia knowledge, gender and education. In total 196 younger, middle-aged and older adults were recruited. Findings revealed that being a care-giver as well as having less ageist attitudes were predictive of being more comfortable around persons with dementia, having more knowledge about dementia and ascribing greater personhood to people with dementia. Those with more dementia knowledge (prior to the study) were less comfortable around people with dementia. Finally, when controlling this prior dementia knowledge, older adults were more comfortable around people with dementia compared to younger and middle-aged adults. Gender and education were not associated with any of the variables under study. Findings contribute to a better understanding of the role of age- and care-giver-related factors in the determination of attitudes towards dementia.
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Lai SH, Tsoi T, Tang CT, Hui RJY, Tan KK, Yeo YWS, Kua EH. An integrated, collaborative healthcare model for the early diagnosis and management of dementia: Preliminary audit results from the first transdisciplinary service integrating family medicine and geriatric psychiatry services to the heart of patients' homes. BMC Psychiatry 2019; 19:61. [PMID: 30736756 PMCID: PMC6368696 DOI: 10.1186/s12888-019-2033-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The number of dementia cases is expected to rise exponentially over the years in many parts of the world. Collaborative healthcare partnerships are envisaged as a solution to this problem. Primary care physicians form the vanguard of early detection of dementia and influence clinical care that these patients receive. However, evidence suggests that they will benefit from closer support from specialist services in dementia care. An interdisciplinary, collaborative memory clinic was established in 2012 as a collaborative effort between a large family medicine based service and a specialist geriatric psychiatry service in Singapore. It is the first service in the world that integrates a family medicine based service with geriatric psychiatry expertise in conjunction with community-based partnerships in an effort to provide holistic, integrated care right into the heart of patients' homes as well as training in dementia care for family medicine physicians. We describe our model of care and the preliminary findings of our audit on the results of this new model of care. METHODS This was a retrospective audit done on the electronic medical records of all patients seen at the Memory Clinic in Choa Chu Kang Polyclinic from August 2013 to March 2016. The information collected included gender, referral source, patient trajectories, presence of behavioural and psychological symptoms of dementia and percentage of caregivers found to be in need of support. A detailed outline of the service workflow and processes were described. RESULTS A majority (93.5%) of the patients had their memory problems managed at the memory clinic without escalation to other specialist services. 22.7% of patients presented with behavioural and psychological symptoms of dementia. When initially assessed, a majority (82.2%) of patients' caregivers were found to be in need of support with 99.5% of such caregivers' needs addressed with memory clinic services. CONCLUSION Our model of care has the potential to shape future dementia care in Singapore and other countries with a similar healthcare setting. Redesigning and evolving healthcare services to promote close collaboration between primary care practitioners and specialist services for dementia care can facilitate seamless delivery of care for the benefit of patients.
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Affiliation(s)
- Shan Hui Lai
- Choa Chu Kang Polyclinic, National University Polyclinics, 2 Teck Whye Crescent #01-00, Singapore, 688846 Singapore
| | - Tung Tsoi
- Department of Psychological Medicine, National University Hospital, NUHS Tower Block Level 9, 1E, Kent Ridge Road, 119228 Singapore
| | - Chao Tian Tang
- National Healthcare Group(NHG) National Psychiatry Residency Programme, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543 Singapore
| | - Richard Jor Yeong Hui
- Choa Chu Kang Polyclinic, National University Polyclinics, 2 Teck Whye Crescent #01-00, Singapore, 688846 Singapore
| | - Kim Kiat Tan
- Choa Chu Kang Polyclinic, National University Polyclinics, 2 Teck Whye Crescent #01-00, Singapore, 688846 Singapore
| | - Yehudi Wee Shung Yeo
- Choa Chu Kang Polyclinic, National University Polyclinics, 2 Teck Whye Crescent #01-00, Singapore, 688846 Singapore
| | - Ee Heok Kua
- Choa Chu Kang Polyclinic, National University Polyclinics, 2 Teck Whye Crescent #01-00, Singapore, 688846 Singapore
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