Browsing by Author "Chan, Kim Chai"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Item Open Access Frailty and length of stay in older adults with blunt injury in a national multicentre prospective cohort study.(PloS one, 2021-01) Tan, Timothy Xin Zhong; Nadkarni, Nivedita V; Chua, Wei Chong; Loo, Lynette Ma; Iau, Philip Tsau Choong; Ang, Arron Seng Hock; Goo, Jerry Tiong Thye; Chan, Kim Chai; Malhotra, Rahul; Ong, Marcus Eng Hock; Matchar, David Bruce; Seow, Dennis Chuen Chai; Nguyen, Hai V; Ng, Yee Sien; Chan, Angelique; Wong, Ting-HwayBackground
Patients suffering moderate or severe injury after low falls have higher readmission and long-term mortality rates compared to patients injured by high-velocity mechanisms such as motor vehicle accidents. We hypothesize that this is due to higher pre-injury frailty in low-fall patients, and present baseline patient and frailty demographics of a prospective cohort of moderate and severely injured older patients. Our second hypothesis was that frailty was associated with longer length of stay (LOS) at index admission.Methods
This is a prospective, nation-wide, multi-center cohort study of Singaporean residents aged ≥55 years admitted for ≥48 hours after blunt injury with an injury severity score or new injury severity score ≥10, or an Organ Injury Scale ≥3, in public hospitals from 2016-2018. Demographics, mechanism of injury and frailty were recorded and analysed by Chi-square, or Kruskal-Wallis as appropriate.Results
218 participants met criteria and survived the index admission. Low fall patients had the highest proportion of frailty (44, 27.3%), followed by higher level fallers (3, 21.4%) and motor vehicle accidents (1, 2.3%) (p < .01). Injury severity, extreme age, and surgery were independently associated with longer LOS. Frail patients were paradoxically noted to have shorter LOS (p < .05).Conclusion
Patients sustaining moderate or severe injury after low falls are more likely to be frail compared to patients injured after higher-velocity mechanisms. However, this did not translate into longer adjusted LOS in hospital at index admission.Item Open Access Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons - A National Multicentre Prospective Cohort Study.(Journal of the American Medical Directors Association, 2021-11-27) Wong, Ting-Hway; Tan, Timothy Xin Zhong; Malhotra, Rahul; Nadkarni, Nivedita V; Chua, Wei Chong; Loo, Lynette Ma; Iau, Philip Tsau Choong; Ang, Arron Seng Hock; Goo, Jerry Tiong Thye; Chan, Kim Chai; Matchar, David Bruce; Seow, Dennis Chuen Chai; Nguyen, Hai V; Ng, Yee Sien; Chan, Angelique; Fook-Chong, Stephanie; Tang, Tjun Yip; Ong, Marcus Eng HockObjective
Frailty is associated with morbidity and mortality in older injured patients. However, for older blunt-trauma patients, increased frailty may not manifest in longer length of stay at index admission. We hypothesized that owing to time spent in hospital from readmissions, frailty would be associated with less total time at home in the 1-year postinjury period.Design
Prospective, nationwide, multicenter cohort study.Setting and participants
All Singaporean residents aged ≥55 years admitted for blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS) ≥10 from March 2016 to July 2018.Methods
Frailty (by modified Fried criteria) was assessed at index admission, based on questions on preinjury weight loss, slowness, exhaustion, physical activity, and grip strength at the time of recruitment. Low time at home was defined as >14 hospitalized days within 1 year postinjury. The contribution of planned and unplanned readmission to time at home postinjury was explored. Functional trajectory (by Barthel Index) over 1 year was compared by frailty.Results
Of the 218 patients recruited, 125 (57.3%) were male, median age was 72 years, and 48 (22.0%) were frail. On univariate analysis, frailty [relative to nonfrail: odds ratio (OR) 3.45, 95% confidence interval (CI) 1.33-8.97, P = .01] was associated with low time at home. On multivariable analysis, after inclusion of age, gender, ISS, intensive care unit admission, and surgery at index admission, frailty (OR 5.21, 95% CI 1.77-15.34, P < .01) remained significantly associated with low time at home in the 1-year postinjury period. Unplanned readmissions were the main reason for frail participants having low time at home. Frail participants had poorer function in the 1-year postinjury period.Conclusions and implications
In the year following blunt trauma, frail older patients experience lower time at home compared to patients who were not frail at baseline. Screening for frailty should be considered in all older blunt-trauma patients, with a view to being prioritized for postdischarge support.Item Open Access Negative and positive experiences of caregiving among family caregivers of older blunt trauma patients.(PloS one, 2022-01) Wong, Ting-Hway; Tan, Timothy Xin Zhong; Loo, Lynette Ma; Chua, Wei Chong; Iau, Philip Tsau Choong; Ang, Arron Seng Hock; Goo, Jerry Tiong Thye; Chan, Kim Chai; Nguyen, Hai V; Nadkarni, Nivedita V; Matchar, David Bruce; Seow, Dennis Chuen Chai; Ng, Yee Sien; Chan, Angelique; Fook-Chong, Stephanie; Tang, Tjun Yip; Ong, Marcus Eng Hock; Malhotra, RahulObjectives
Family caregivers play a fundamental role in the care of the older blunt trauma patient. We aim to identify risk factors for negative and positive experiences of caregiving among family caregivers.Design
Prospective, nationwide, multi-center cohort study.Setting and participants
110 family caregivers of Singaporeans aged≥55 admitted for unintentional blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS)≥10 were assessed for caregiving-related negative (disturbed schedule and poor health, lack of family support, lack of finances) and positive (esteem) experiences using the modified-Caregiver Reaction Assessment (m-CRA) three months post-injury.Methods
The association between caregiver and patient factors, and the four m-CRA domains were evaluated via linear regression.Results
Caregivers of retired patients and caregivers of functionally dependent patients (post-injury Barthel score <80) reported a worse experience in terms of disturbed schedule and poor health (β-coefficient 0.42 [95% Confidence Interval 0.10, 0.75], p = .01; 0.77 [0.33, 1.21], p = .001), while male caregivers and caregivers who had more people in the household reported a better experience (-0.39 [-0.73, -0.06], p = .02; -0.16 [-0.25, -0.07], p = .001). Caregivers of male patients, retired patients, and patients living in lower socioeconomic housing were more likely to experience lack of family support (0.28, [0.03, -0.53], p = .03; 0.26, [0.01, 0.52], p = .05; 0.34, [0.05, -0.66], p = .02). In the context of lack of finances, caregivers of male patients and caregivers of functionally dependent patients reported higher financial strain (0.74 [0.31, 1.17], p = .001; 0.84 [0.26, 1.43], p = .01). Finally, caregivers of male patients reported higher caregiver esteem (0.36 [0.15, 0.57], p = .001).Conclusions and implications
Negative and positive experiences of caregiving among caregivers of older blunt trauma patients are associated with pre-injury disability and certain patient and caregiver demographics. These factors should be considered when planning the post-discharge support of older blunt trauma patients.