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Sum G, Sim SYH, Chay J, Ho SH, Ginting ML, Lim ZZB, Yoong J, Wong CH. An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6848. [PMID: 37835116 PMCID: PMC10572627 DOI: 10.3390/ijerph20196848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/04/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
The global ageing population is associated with increased health service use. The PCMH care model integrates primary care and home-based care management to deliver comprehensive and personalised healthcare to community-dwelling older adults with bio-psycho-social needs. We examined if an integrated PCMH reduced healthcare utilisation burden of older persons in Singapore. We compared the healthcare utilisation between the intervention group and coarsened exact matched controls for a follow-up of 15 months. Baseline matching covariates included socio-demographics, health status, and past healthcare use. We accounted for COVID-19 social distancing effects on health-seeking behaviour. The intervention group consisted of 165 older adults with complex needs. We analysed national administrative healthcare utilisation data from 2017 to 2020. We applied multivariable zero-inflated regression modelling and presented findings stratified by high (CCI ≥ 5) and low disease burden (CCI < 5). Compared to controls, there were significant reductions in emergency department (β = -0.85; 95%CI = -1.55 to -0.14) and primary care visits (β = -1.70; 95%CI = -2.17 to -1.22) and a decrease in specialist outpatient visits (β = -0.29; 95%CI = -0.64 to 0.07) in the 3-month period immediately after one-year enrolment. The number of acute hospitalisations remained stable. Compared to controls, the intervention group with high and low comorbidity burden had significant decreases in primary care use, while only those with lower comorbidity burden had significant reductions in utilisation of other service types. An integrated PCMH appears beneficial in reducing healthcare utilisation for older persons with complex needs after 1 year in the programme. Future research can explore longer-term utilisation and scalability of the care model.
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Affiliation(s)
- Grace Sum
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (S.Y.H.S.); (S.H.H.); (M.L.G.); (J.Y.)
| | - Silvia Yu Hui Sim
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (S.Y.H.S.); (S.H.H.); (M.L.G.); (J.Y.)
| | - Junxing Chay
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Soon Hoe Ho
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (S.Y.H.S.); (S.H.H.); (M.L.G.); (J.Y.)
| | - Mimaika Luluina Ginting
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (S.Y.H.S.); (S.H.H.); (M.L.G.); (J.Y.)
| | - Zoe Zon Be Lim
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (S.Y.H.S.); (S.H.H.); (M.L.G.); (J.Y.)
| | - Joanne Yoong
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (S.Y.H.S.); (S.H.H.); (M.L.G.); (J.Y.)
- Research for Impact, Singapore 159964, Singapore
| | - Chek Hooi Wong
- Research for Impact, Singapore 159964, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
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Abdin E, Chong SA, Ragu V, Vaingankar JA, Shafie S, Verma S, Ganesan G, Tan KB, Heng D, Subramaniam M. The economic burden of mental disorders among adults in Singapore: evidence from the 2016 Singapore Mental Health Study. J Ment Health 2023; 32:190-197. [PMID: 34338569 DOI: 10.1080/09638237.2021.1952958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Little is known about the economic burden of mental disorders in multiethnic Asian populations. AIMS The study aimed to estimate the economic cost of mental disorders in Singapore using data from the second Singapore Mental Health Study (SMHS 2016). METHOD The SMHS 2016 is a nationally representative survey of the Singapore Resident population aged 18 years and above. Data on mental disorders and healthcare resource utilization were obtained from the World Mental Health Composite International Diagnostic Interview and the adapted version of the Client Service Receipt Inventory. RESULTS The costs of visits to a restructured hospital doctor, other private health workers, accident and emergency, and intermediate and long-term care services and productivity losses tend to be much higher in those with mental disorders than those without mental disorders. The average annual excess cost associated with mental disorders per person was estimated to be S$3938.9 (95% CI, S$-100.8-S$7978.7). Extrapolation of these excess costs to the population suggests that the incremental costs of mental disorders in Singapore is about S$1.7 billion per year. CONCLUSION This study provides evidence of the substantial burden of mental disorders on Singaporean society - both in terms of direct medical costs and loss of productivity costs.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Vithiya Ragu
- National University of Singapore, Singapore, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | | | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Derrick Heng
- Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Sum G, Kadir MM, Ho SH, Yoong J, Chay J, Wong CH. Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:553-566. [PMID: 36189700 DOI: 10.47102/annals-acadmedsg.2022165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making. METHOD We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources. RESULTS We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primary care and private general practice) in the first 3-month and second 3-month periods after enrolment, accompanied by a significant decrease in service utilisation and mean costs for PCMH services in the second 3-month period post-enrolment. This suggested a shift in resource costs from primary care to community-based care provided by PCMH, which had added benefits of both clinic-based primary care and home-based care management. Findings were consistent with a lower longer-term cost trajectory for PCMH after the initial onboarding period. Indirect caregiving costs remained stable. CONCLUSION The PCMH care model was associated with reduced costs to the health system and patients for usual primary care, and did not significantly change societal costs.
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Affiliation(s)
- Grace Sum
- Geriatric Education and Research Institute, Singapore
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Yang J, Plassman BL, Sun S, Tan D, Pei Y, Yoon PS, Ting SKS, Hameed WSS, Teoh KH, Bryant A, Anderson RA, Wu B. Care partner-assisted intervention to improve oral health for older adults with cognitive impairment in Singapore. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Siddiqui F, Nistala KRY, Quek CWN, Shi Ying Leong V, Ying Shan Tan A, En Tan CY, Hilal S. Knowledge, Attitudes, and Perceptions Toward Dementia Among Middle-Aged Singapore Residents. J Alzheimers Dis 2022; 86:231-244. [DOI: 10.3233/jad-215262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dementia is the decline in cognitive function sufficient to impair one’s accustomed functioning. Countries with aging populations, such as Singapore, face rising rates of dementia. Dementia patients and their caregivers endure great financial and emotional stress. With the broad aim of minimizing these stresses, this study provides a cross-sectional view of the knowledge, attitudes, and perceptions (KAP) towards dementia in middle-aged Singaporean residents. Objective: We aim to examine 1) the associations between demographic correlates and KAP; and 2) the effect of dementia knowledge on attitudes and perceptions towards dementia. Methods: An online anonymous cross-sectional questionnaire was administered to Singaporeans and Permanent Residents aged 45 to 65 years old in English, Mandarin, and Malay. Knowledge was evaluated across three domains: symptoms, risk factors, and management. Total and domain scores were dichotomized as good or poor knowledge using median cut-offs. Attitudes/perceptions across six domains were evaluated on Likert scales, and responses to each question were dichotomized into positive or negative attitudes/perceptions. Results: From 1,733 responses, 1,209 valid complete responses were accepted (mean age±SD 54.8±5.12 years old, females = 69.6%). Lower socioeconomic status was associated with poorer knowledge and greater barriers to risk-mitigating lifestyle modifications. Lack of personal experience with dementia and poor knowledge were also associated with erroneous attitudes/perceptions. Conclusion: Socioeconomic status and personal experience affect KAP towards dementia. Policy and education campaigns to address KAP towards dementia should account for baseline differences across demographics, for greater improvements in dementia incidence and support.
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Affiliation(s)
- Fatima Siddiqui
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
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Rahja M, Nguyen KH, Laver K, Clemson L, Crotty M, Comans T. Implementing an evidence-based dementia care program in the Australian health context: A cost-benefit analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2013-2024. [PMID: 32431010 DOI: 10.1111/hsc.13013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/13/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
The World Health Organisation has called for the implementation of evidence-based interventions that enhance function and capability in people with dementia. In response, the Boosting Dementia Research Initiative in Australia has funded a number of projects aimed at improving such outcomes for people with dementia and their caregivers. What is not known is the economic and societal outcomes of these projects and of program implementation to the Australian healthcare system. The purpose of this study was to identify the costs and benefits of implementing an evidence-based reablement program within Australian health context. A well-used methodology familiar to governments and decision-makers was used to calculate the costs and benefits of implementing the program in Australia. Four different perspectives: market, private, efficiency (social) and referent group (key stakeholders) were considered in the cost-benefit evaluation. Almost A$6.2 million societal gain is presented through a social cost-benefit analysis. The referent (stakeholder) group analysis is used to demonstrate that people with dementia and their caregivers are the bearers of the costs and the Australian health and social care system gains the most from the program implementation. The results of this cost-benefit analysis suggest that there is a need to plan and provide subsidies or other financial incentives to assist people with dementia and their caregivers to engage in reablement programs in Australia; thus the whole society can be advantaged. Funding bodies and decision-makers are urged to recognise the potential societal benefits that can be achieved from participating in such reablement programs.
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Affiliation(s)
- Miia Rahja
- Department of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders University, Flinders Drive Bedford Park, SA, Australia
- Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Kim-Huong Nguyen
- Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders University, Flinders Drive Bedford Park, SA, Australia
- Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Lindy Clemson
- Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Aging Work and Health Research Unit, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders University, Flinders Drive Bedford Park, SA, Australia
- Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Tracy Comans
- Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD, Australia
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Roystonn K, Abdin E, Shahwan S, Zhang Y, Sambasivam R, Vaingankar JA, Mahendran R, Chua HC, Chong SA, Subramaniam M. Living arrangements and cognitive abilities of community-dwelling older adults in Singapore. Psychogeriatrics 2020; 20:625-635. [PMID: 32141156 DOI: 10.1111/psyg.12532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 12/11/2022]
Abstract
AIM Dementia is a growing public health concern. It is necessary to focus on factors that may help preserve cognitive function in late life. Limited research has examined how living arrangements are associated with cognitive function in older adults. This study aims to further our understanding of this association in community-dwelling older adults in a multi-ethnic Asian population. METHODS Data were obtained from a cross-sectional population survey of 2548 adults aged 60 and older with standardized instruments. Living arrangements were classified as living with adult children and grandchildren, living with adult children only, living with a spouse/partner only, living alone, living with other relatives, and living with non-relatives. RESULTS Cognitive function was significantly predicted by living arrangements among community-dwelling older adults. Multivariate linear regression analyses revealed that older adults in multigenerational family households had significantly poorer cognitive function than those living with a spouse/partner (β = 0.54, P < 0.02) and those living with non-relatives (β = 1.08, P < 0.02). This association was independent of the influence of age, gender, ethnicity, education, employment status, marital status, depression, disability, chronic health conditions, and self-reported health. CONCLUSION Older adults living in multigenerational households seem to be disadvantaged in their cognitive function. However, we cannot conclude this based on the evidence because of the cross-sectional nature of the data. Further research is needed to reasonably determine the relationship between living arrangements and cognitive function. Regardless, these findings add to the growing understanding of the complex relationship between living arrangements and cognition in older adults and could provide a basis to design effective strategies to delay cognitive decline in community-dwelling older adults.
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Affiliation(s)
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | | | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Devi F, Yuan Q, Wang P, Tan GTH, Roshan Goveas R, Ng LL, Chong SA, Subramaniam M. Positive aspect of caregiving among primary informal dementia caregivers in Singapore. PLoS One 2020; 15:e0237677. [PMID: 32817648 PMCID: PMC7440648 DOI: 10.1371/journal.pone.0237677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background The present study investigated the factor structure of positive aspects of caregiving (PAC) scale among primary informal caregivers providing care to persons with dementia (PWD) in Singapore. Methods 282 primary informal caregivers of PWD were recruited from the Institute of Mental Health, and Changi General Hospital and administered the 9-item PAC scale. A confirmatory factor analyses (CFA) was conducted to test the model fit of the 9-item PAC proposed by the scale developer and multiple linear regression was used to investigate the significant socio-demographic correlates. Results CFA showed that the 2-factor structure including ‘Self-Affirmation’ and ‘Outlook on Life’ had an acceptable model fit. After controlling for confounding variables, Malay caregivers were associated with higher scores on PAC and ‘Self-Affirmation’ compared to caregivers of other ethnicities. Caregivers with Secondary or below education level had higher PAC and ‘Outlook on Life’ scores. Caregivers who had received formal training scored higher in PAC, ‘Self-Affirmation’ and ‘Outlook on Life’. Discussion The present study confirmed that the 2-factor structure of the 9-item PAC was suitable for informal caregivers of PWD in Singapore. The findings have important implications for locally available interventions to enhance caregiver’s psychological well-being and reduce burden of care.
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Affiliation(s)
- Fiona Devi
- Research Division, Institute of Mental Health, Singapore, Singapore
- * E-mail:
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Richard Roshan Goveas
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152781. [PMID: 31382609 PMCID: PMC6695624 DOI: 10.3390/ijerph16152781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022]
Abstract
Background: Dementia is one of the public health priorities in China. This study aimed to examine the hospitalization costs of patients with dementia and analyzed the factors associated with their inpatient costs. Methods: This was a prevalence-based, observational study using claims data derived from two urban insurance schemes during the period from 2008 through 2013 in Guangzhou. The extended estimating equations model was performed to identify the main drivers of total inpatient costs. Results: We identified 5747 dementia patients with an average age of 77.4. The average length of stay (LOS) was 24.2 days. The average hospitalization costs per inpatient was Chinese Yuan (CNY) 9169.0 (CNY 9169.0 = US$1479.8 in 2013). The mean inpatient costs for dementia patients with the Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY 9425.0 = US$1521.1) were higher than those for patients with the Urban Resident-based Basic Medical Insurance scheme (CNY 7420.5 = US$1197.6) (p < 0.001). Having UEBMI coverage, dementia subtypes, having hypertension, being admitted in larger hospitals, and longer LOS were significantly associated with hospitalization costs of dementia. Conclusions: The costs of hospitalization for dementia were high and differed by types of insurance schemes. Dementia was associated with substantial hospitalization costs, mainly driven by insurance type and long LOS. These findings provided economic evidence for evaluating the burden of dementia in China.
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Chan EY, Phang KN, Glass GF, Lim WS. Crossing, Trudging and Settling: A phenomenological inquiry into lived experience of Asian family caregivers of older persons with dementia. Geriatr Nurs 2019; 40:502-509. [PMID: 30979516 DOI: 10.1016/j.gerinurse.2019.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022]
Abstract
Throughout Asian societies, family members often adopt the role of caregiving for older persons, providing essential care for loved ones with dementia. To date, there has been limited insight into the lived experience and meaning ascribed to the journey of these caregivers. This descriptive phenomenological study aims to explore the lived experience of Asian family caregivers of persons with dementia. Semi-structured face-to-face interviews were conducted with 16 family members caring for aged persons with dementia. Interviews were audio-recorded and data analysed using Colaizzi's technique. Analysis revealed the essential structure of a caregiver's journey with three major transitions, namely: (1) Crossing the threshold from ordinary world into caregiving world, (2) Trudging on the road of trials and obstacles, and (3) Settling into a new normalcy. Understanding the lived experience of Asian caregivers can help clinicians in targeting relevant support and information, and prepare new caregivers for the demands of their role.
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Affiliation(s)
- Ee-Yuee Chan
- Nursing Service, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore; Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore, Singapore.
| | - Koh Ni Phang
- Nursing Service, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore
| | | | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatric and Active Aging, Tan Tock Seng Hospital, 11 Jan Tan Tock Seng, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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11
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Fauziana R, Sambasivam R, Vaingankar JA, Abdin E, Ong HL, Tan ME, Chong SA, Subramaniam M. Positive Caregiving Characteristics as a Mediator of Caregiving Burden and Satisfaction With Life in Caregivers of Older Adults. J Geriatr Psychiatry Neurol 2018; 31:329-335. [PMID: 30260715 PMCID: PMC6262596 DOI: 10.1177/0891988718802111] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Satisfaction with life is recognized to be a factor in alleviating burden in stressful caregiving duties. However, the mechanism underlying this relationship is indistinct. Positive aspects of caregiving (PAC) may help to regulate caregiving burden among caregivers of older adults. The study aims to examine whether positive caregiving characteristics mediate the effect between satisfaction with life and burden of care. METHODS Participants were 285 caregivers of older adults (aged 60 and above) in Singapore and were recruited in a cross-sectional, self-report study (mean [M] = 47.0 years; 64.6% females). Measures included in the study were the Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), and the Satisfaction with Life Scale (SWLS). Mediation analyses were used to study the indirect effects of life satisfaction on caregiver burden through features of PAC. RESULTS Mean scores for the ZBI, PAC, and SWLS scales were M = 23.15 (standard deviation [SD] = 15.98), M = 34.55 (SD = 8.19), and M = 23.56 (SD = 6.62) respectively. Results from the mediation analysis revealed that the association between life satisfaction and caregiving burden was significantly mediated by the PAC ( P < .001). DISCUSSION Positive aspects of caregiving may be a mechanism that links satisfaction with life and caregiver burden. Findings may represent attempts to manage caregiving duties as well as maintaining a positive attitude toward their responsibilities.
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Affiliation(s)
- Restria Fauziana
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Rajeswari Sambasivam
- Institute of Mental Health, Research Division, Singapore, Singapore,Rajeswari Sambasivam, Institute of Mental Health, Research Division, Singapore, Singapore.
| | | | - Edimansyah Abdin
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Hui Lin Ong
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Min-En Tan
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Siow Ann Chong
- Institute of Mental Health, Research Division, Singapore, Singapore
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Lum ZK, Suministrado MSP, Venketasubramanian N, Ikram MK, Chen C. Medication compliance in Singaporean patients with Alzheimer's disease. Singapore Med J 2018; 60:154-160. [PMID: 29931376 DOI: 10.11622/smedj.2018076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Singapore has a rapidly ageing population and an increasing prevalence of Alzheimer's disease (AD). Compliance to AD medications is associated with treatment effectiveness. We investigated compliance to acetylcholinesterase inhibitors (AChEIs) and N-methyl-D-aspartate (NMDA) receptor antagonist and treatment persistence among patients seen at the General Memory Clinic of National University Hospital, Singapore. We also identified the reasons for non-compliance. METHODS Patients seen at the General Memory Clinic between 1 January 2013 and 31 December 2014, who were prescribed AChEIs and NMDA receptor antagonist, were included in this retrospective cohort study. Non-compliance to medications was indirectly measured by failure to renew prescription within 60 days of the last day of medication supplied by the previous prescription. The reasons for non-compliance were identified. RESULTS A total of 144 patients were included. At one year, 107 patients were compliant to AD medications, while 37 patients were non-compliant. Around 60% of the non-compliant patients discontinued the use of AD medications within the first six months, and the mean persistent treatment period among this group of patients was 10.3 ± 3.5 months. The main reason for non-compliance was patients' and caregivers' perception that memory loss was of lower priority than other coexisting illnesses. Other reasons for non-compliance included side effects of medications (18.9%), perceived ineffectiveness of treatment (16.2%), inability to attend clinic (5.4%) and high cost of medications (2.7%). CONCLUSION Our findings suggest that the reasons for medication non-compliance can be identified early. Better compliance may be achieved through a multidisciplinary approach to patient education.
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacology, National University of Singapore, Singapore
| | - Ma Serrie P Suministrado
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - N Venketasubramanian
- Memory Ageing and Cognition Centre, National University Health System, Singapore.,Raffles Neuroscience Centre, Raffles Hospital, Singapore
| | - M Kamran Ikram
- Departments of Neurology and Epidemiology, Erasmus Medical Center Rotterdan, the Netherlands
| | - Christopher Chen
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
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13
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Ong HL, Vaingankar JA, Abdin E, Sambasivam R, Fauziana R, Tan ME, Chong SA, Goveas RR, Chiam PC, Subramaniam M. Resilience and burden in caregivers of older adults: moderating and mediating effects of perceived social support. BMC Psychiatry 2018; 18:27. [PMID: 29385985 PMCID: PMC5793423 DOI: 10.1186/s12888-018-1616-z] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The burden of caring for an older adult can be a form of stress and influence caregivers' daily lives and health. Previous studies have reported that resilience and social support play an important role in reducing physical and psychological burden in caregivers. Thus, the present study aimed to examine whether perceived social support served as a possible protective factor of burden among caregivers of older adults in Singapore using moderation and mediation effects' models. METHODS We conducted a cross-sectional study with 285 caregivers providing care to older adults aged 60 years and above who were diagnosed with physical and/or mental illness in Singapore. The Connor-Davidson Resilience Scale (CD-RISC) was used to measure resilience and burden was measured by the Zarit Burden Interview (ZBI). The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure perceived social support. Hayes' PROCESS macro was used to test moderation and mediation effects of perceived social support in the relationship between resilience and burden after controlling for sociodemographic variables. Indirect effects were tested using bootstrapped confidence intervals (CI). RESULTS The mean scores observed were CD-RISC: 70.8/100 (SD = 15.1), MSPSS: 62.2/84 (SD = 12.2), and ZBI: 23.2/88 (SD = 16.0) respectively. While perceived social support served as a full mediator between resilience and caregiver burden (β = - 0.14, 95% CI -0.224 to - 0.072, p < 0.05), it did not show a significant moderating effect. CONCLUSIONS Perceived social support mediates the association between resilience and caregiver burden among caregivers of older adults in Singapore. It is crucial for healthcare professionals, particularly those who interact and deliver services to assist caregivers, to promote and identify supportive family and friends' network that may help to address caregiver burden.
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Affiliation(s)
- Hui Lin Ong
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Janhavi Ajit Vaingankar
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Edimansyah Abdin
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Rajeswari Sambasivam
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Restria Fauziana
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Min-En Tan
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Siow Ann Chong
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Richard Roshan Goveas
- Department of Geriatric Psychiatry, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Peak Chiang Chiam
- Department of Geriatric Psychiatry, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
| | - Mythily Subramaniam
- Department of Research Division, Institute of Mental Health, 10 Buangkok View, Hougang, 539747 Singapore
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Lacaze P, Ryan J, Woods R, Winship I, McNeil J. Pathogenic variants in the healthy elderly: unique ethical and practical challenges. JOURNAL OF MEDICAL ETHICS 2017; 43:714-722. [PMID: 28341755 PMCID: PMC5629947 DOI: 10.1136/medethics-2016-103967] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/20/2016] [Accepted: 02/06/2017] [Indexed: 05/06/2023]
Abstract
: Genetic research into ageing, longevity and late-onset disease is becoming increasingly common. Yet, there is a paucity of knowledge related to clinical actionability and the return of pathogenic variants to otherwise healthy elderly individuals. Whether or not genetic research in the elderly should be managed differently from standard practices adapted for younger populations has not yet been defined. In this article, we provide an overview of ethical and practical challenges in preparing for a genetic study of over 14 000 healthy Australians aged 70 years or older enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) Healthy Ageing Biobank. At the time of consent, all participants in this study were free of life-threatening illness, cardiovascular disease or cognitive impairment. ASPREE is thus a cohort of healthy elderly individuals with seemingly minimal burden of genetic disease recruited without ascertainment bias. The cohort presents a unique opportunity to address the penetrance of known pathogenic variants in a population without disease symptoms; however, it also raises a number of ethical concerns regarding the interpretation and disclosure of variants with known clinical actionability. Some of the challenges include (a) how to manage the interpretation, disclosure and actioning of pathogenic variants found in otherwise healthy elderly adults without disease symptoms, (b) whether or not to disclose findings for the benefit of family members rather than elderly consented donors themselves, (c) how to manage the return of genetic findings to the elderly individuals who are now in severe cognitive decline or terminal illness, (d) how to ensure quality of information and clinical service upon disclosure of results to this demographic and (e) how to prepare for the insurance implications of disclosing genetic information under Australian law. We discuss these and other dilemmas and propose a defensible plan of management. TRIAL REGISTRATION NUMBER ISRCTN83772183.
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Affiliation(s)
- Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, ASPREE - Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, ASPREE - Monash University, Melbourne, Victoria, Australia
| | - Robyn Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, ASPREE - Monash University, Melbourne, Victoria, Australia
| | - Ingrid Winship
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, ASPREE - Monash University, Melbourne, Victoria, Australia
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15
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Abdin E, Vaingankar JA, Picco L, Chua BY, Prince M, Chong SA, Subramaniam M. Validation of the short version of the 10/66 dementia diagnosis in multiethnic Asian older adults in Singapore. BMC Geriatr 2017; 17:94. [PMID: 28431511 PMCID: PMC5399400 DOI: 10.1186/s12877-017-0475-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/01/2017] [Indexed: 11/21/2022] Open
Abstract
Background To validate the short version of the 10/66 dementia diagnosis against the standard version of the 10/66 dementia diagnosis and clinical diagnosis and examine concurrent validity with the World Health Organisation Disability Assessment schedule and care needs in a multiethnic Asian older adult population in Singapore. Methods Data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older Singapore Resident population aged 60 years and above was used. The validity of the short version of the 10/66 dementia diagnostic criteria derived from the Community Screening Instrument for Dementia, the modified Consortium to Establish a Registry of Alzheimer’s Disease 10-word list delayed recall and the EURO-D depression screen were examined against the standard version of the 10/66 dementia diagnosis and clinician diagnosis as a gold standard. Concurrent validity was tested by examining the relationships between the short version 10/66 dementia diagnosis, disability and care needs. Results A total of 2373 respondents who had completed data on the short version diagnosis were included in this study. The majority (82.63%) of respondents were of Chinese descent, 9.86% were Malays, 6.12% were of Indian descent and 1.39% belonged to other ethnic group. We found the short version 10/66 dementia diagnosis showed almost perfect agreement with the standard version 10/66 dementia diagnosis (kappa = 0.90, AUC = 0.96) and substantial agreement with clinical diagnosis (kappa = 0.70, AUC = 0.87). The weighted prevalence of dementia in the population was slightly higher based on the short version diagnosis than the standard version diagnosis (10.74% vs. 10.04%). We also found that those with the short version 10/66 dementia were significantly associated with higher disability (β = 28.90, 95% CI = 23.62, 9.62) and needed care occasionally (OR =35.21, 95% CI = 18.08, 68.59) or much of the time (OR = 9.02, 95% CI = 5.21, 15.61). Conclusions The study found that the short version 10/66 dementia diagnosis has excellent validity to diagnose dementia in a multiethnic Asian population in Singapore. Further research is required to determine the usefulness of this diagnosis in clinical practice or institutional settings to aid early detection and intervention for dementia.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore.
| | | | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
| | - Martin Prince
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
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Picco L, Achilla E, Abdin E, Chong SA, Vaingankar JA, McCrone P, Chua HC, Heng D, Magadi H, Ng LL, Prince M, Subramaniam M. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res 2016; 16:173. [PMID: 27160080 PMCID: PMC4862090 DOI: 10.1186/s12913-016-1421-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/30/2016] [Indexed: 12/21/2022] Open
Abstract
Background Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost. Methods The Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors. Results The prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75–84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and ‘Other’ ethnicity were significantly associated with higher total healthcare costs. Conclusion Multimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | | | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Paul McCrone
- King's Health Economics, King's College London, London, UK
| | | | | | - Harish Magadi
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Changi General Hospital, Singapore, Singapore
| | - Martin Prince
- Institute of Psychiatry, King's College London, London, UK
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