Browsing by Author "Malhotra, Rahul"
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Item Open Access Cohort Profile: Panel on Health and Ageing of Singaporean Elderly (PHASE).(International journal of epidemiology, 2019-12) Chan, Angelique; Saito, Yasuhiko; Matchar, David B; Østbye, Truls; Malhotra, Chetna; Ang, Shannon; Ma, Stefan; Malhotra, RahulItem Open Access Comorbid visual and cognitive impairment: relationship with disability status and self-rated health among older Singaporeans.(Asia-Pacific journal of public health, 2014-05) Whitson, Heather E; Malhotra, Rahul; Chan, Angelique; Matchar, David B; Østbye, TrulsThe objective of this study was to examine the prevalence and consequences of coexisting vision and cognitive impairments in an Asian population. Data were collected from 4508 community-dwelling Singaporeans aged 60 years and older. Cognition was assessed by the Short Portable Mental Status Questionnaire whereas vision, disability, and self-rated health (SRH) were determined by self-report. Vision impairment was present in 902 (18.5%) participants and cognitive impairment in 835 (13.6%), with 232 (3.5%) participants experiencing both impairments. Persons with the comorbidity experienced higher odds of disability than persons with either single impairment. The association of vision impairment with SRH was stronger among women (odds ratio [OR] = 6.79, 95% confidence interval [CI] = 4.64-9.92) than among men (OR = 1.71, 95% CI = 1.21-2.41). Concurrent cognitive and vision impairment is prevalent in older Singaporeans and is associated with high rates of disability. Gender differences in vision-dependent roles may affect the patient-perceived impact of this comorbidity.Item Open Access Coronavirus disease 2019 (COVID-19): an evidence map of medical literature.(BMC medical research methodology, 2020-07-02) Liu, Nan; Chee, Marcel Lucas; Niu, Chenglin; Pek, Pin Pin; Siddiqui, Fahad Javaid; Ansah, John Pastor; Matchar, David Bruce; Lam, Sean Shao Wei; Abdullah, Hairil Rizal; Chan, Angelique; Malhotra, Rahul; Graves, Nicholas; Koh, Mariko Siyue; Yoon, Sungwon; Ho, Andrew Fu Wah; Ting, Daniel Shu Wei; Low, Jenny Guek Hong; Ong, Marcus Eng HockBackground
Since the beginning of the COVID-19 outbreak in December 2019, a substantial body of COVID-19 medical literature has been generated. As of June 2020, gaps and longitudinal trends in the COVID-19 medical literature remain unidentified, despite potential benefits for research prioritisation and policy setting in both the COVID-19 pandemic and future large-scale public health crises.Methods
In this paper, we searched PubMed and Embase for medical literature on COVID-19 between 1 January and 24 March 2020. We characterised the growth of the early COVID-19 medical literature using evidence maps and bibliometric analyses to elicit cross-sectional and longitudinal trends and systematically identify gaps.Results
The early COVID-19 medical literature originated primarily from Asia and focused mainly on clinical features and diagnosis of the disease. Many areas of potential research remain underexplored, such as mental health, the use of novel technologies and artificial intelligence, pathophysiology of COVID-19 within different body systems, and indirect effects of COVID-19 on the care of non-COVID-19 patients. Few articles involved research collaboration at the international level (24.7%). The median submission-to-publication duration was 8 days (interquartile range: 4-16).Conclusions
Although in its early phase, COVID-19 research has generated a large volume of publications. However, there are still knowledge gaps yet to be filled and areas for improvement for the global research community. Our analysis of early COVID-19 research may be valuable in informing research prioritisation and policy planning both in the current COVID-19 pandemic and similar global health crises.Item Open Access Depressive symptoms among informal caregivers of older adults: insights from the Singapore Survey on Informal Caregiving.(International psychogeriatrics, 2012-08) Malhotra, Chetna; Malhotra, Rahul; Østbye, Truls; Matchar, David; Chan, AngeliqueThis paper determines care recipient and caregiver characteristics and caregiving dimensions - associated with depression among caregivers of older adults, using path analysis and assesses whether the identified path model differs between spousal and adult child caregivers.Data from 1,190 dyads comprising care recipients (community-dwelling adults aged ≥ 75 years with at least one activity of daily living (ADL) limitation) and caregivers (family member/friend most involved in providing care/ensuring provision of care to care recipient), who were interviewed through the Singapore Survey on Informal Caregiving (2010-2011), were used. Using path analysis, we assessed the direct and indirect associations between primary stressors (care recipient's ADL and instrumental ADL status, and memory and behavior problems), caregiver health status, receipt of assistance from a foreign domestic worker/maid, amount of caregiving, negative reaction to caregiving, caregiver's self-esteem, perceived emotional support, and caregiver depressive symptoms.Our analysis showed that primary stressors, receipt of assistance from a foreign domestic worker/maid, perceived emotional support, and caregiver health status were directly or indirectly associated with caregiver depressive symptoms, and this association was mediated by negative reaction to caregiving. Caregiver self-esteem mediated the relationship between perceived emotional support and negative reaction to caregiving only among adult child caregivers.The results provide insights into factors associated with depressive symptoms among spousal and adult child caregivers, and help identify targeted interventions for improving caregiver mood.Item Open Access Do healthcare needs-based population segments predict outcomes among the elderly? Findings from a prospective cohort study in an urbanized low-income community.(BMC geriatrics, 2020-02-27) Chong, Jia Loon; Low, Lian Leng; Matchar, David Bruce; Malhotra, Rahul; Lee, Kheng Hock; Thumboo, Julian; Chan, Angelique Wei-MingBackground
A rapidly ageing population with increasing prevalence of chronic disease presents policymakers the urgent task of tailoring healthcare services to optimally meet changing needs. While healthcare needs-based segmentation is a promising approach to efficiently assessing and responding to healthcare needs at the population level, it is not clear how available schemes perform in the context of community-based surveys administered by non-medically trained personnel. The aim of this prospective cohort, community setting study is to evaluate 4 segmentation schemes in terms of practicality and predictive validity for future health outcomes and service utilization.Methods
A cohort was identified from a cross-sectional health and social characteristics survey of Singapore public rental housing residents aged 60 years and above. Baseline survey data was used to assign individuals into segments as defined by 4 predefined population segmentation schemes developed in Singapore, Delaware, Lombardy and North-West London. From electronic data records, mortality, hospital admissions, emergency department visits, and specialist outpatient clinic visits were assessed for 180 days after baseline segment assignment and compared to segment membership for each segmentation scheme.Results
Of 1324 residents contacted, 928 agreed to participate in the survey (70% response). All subjects could be assigned an exclusive segment for each segmentation scheme. Individuals in more severe segments tended to have lower quality of life as assessed by the EQ-5D Index for health utility. All population segmentation schemes were observed to exhibit an ability to differentiate different levels of mortality and healthcare utilization.Conclusions
It is practical to assign individuals to healthcare needs-based population segments through community surveys by non-medically trained personnel. The resulting segments for all 4 schemes evaluated in this way have an ability to predict health outcomes and utilization over the medium term (180 days), with significant overlap for some segments. Healthcare needs-based segmentation schemes which are designed to guide action hold particular promise for promoting efficient allocation of services to meet the needs of salient population groups. Further evaluation is needed to determine if these schemes also predict responsiveness to interventions to meet needs implied by segment membership.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 Gender, educational and ethnic differences in active life expectancy among older Singaporeans.(Geriatrics & gerontology international, 2016-04) Chan, Angelique; Malhotra, Rahul; Matchar, David B; Ma, Stefan; Saito, YasuhikoAim
The aim of the present study was to compute total life expectancy (TLE), active life expectancy (ALE) and inactive life expectancy among older Singaporeans by gender, education and ethnicity.Methods
Data from a longitudinal survey of older Singaporeans were used. No difficulty in carrying out activities of daily living or instrumental activities of daily living was considered as "active." Transition probabilities across health states (active/inactive/dead) were assessed to develop multistate life tables, which estimated TLE, ALE and inactive life expectancy.Results
At age 60 years, women, versus men, had significantly higher TLE (25.9, 95% confidence interval [CI] 24.0-27.8 vs 21.6, 95% CI 20.1-23.1), but similar ALE (18.1, 95% CI 17.0-19.2 vs 18.9, 95% CI 17.7-20.2). Those with high (secondary or higher), versus low (primary or less), education had significantly higher TLE (28.5, 95% CI 25.0-32.0 vs 22.5, 95% CI 21.1-23.9) and ALE (23.5, 95% CI 21.2-25.7 vs 17.1, 95% CI 16.1-18.0) at age 60 years. Those of Chinese, versus non-Chinese, ethnicity had significantly higher ALE at age 60 years (19.4, 95% CI 18.4-20.3 vs 15.0, 95% CI 13.4-16.7).Conclusion
Unlike Western nations, there was no gender difference in ALE among older adults in Singapore. However, difference in ALE by education among older Singaporeans was similar to that observed in Western societies. Policies focusing specifically on improving women's health at all ages, in addition to policies that increase population education levels, are promising approaches to improving ALE. Recognizing ethnic differences in ALE will help target policies that increase ALE in multicultural societies.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 How long will the COVID-19 pandemic last: commentary from Singapore’s perspective(Journal of EMS Medicine) Siddiqui, Fahad Javaid; Pourghaderi, Ahmad Reza; Malhotra, Rahul; Ansah, John Pastor; Matchar, David Bruce; Wei, Sean Lam Shao; Low, Jenny G; Ong, Marcus Eng HockItem Open Access How long will the COVID-19 pandemic last: commentary from Singapore’s perspective(Journal of EMS Medicine) Siddiqui, Fahad Javaid; Pourghaderi, Ahmad Reza; Malhotra, Rahul; Ansah, John Pastor; Matchar, David Bruce; Wei, Sean Lam Shao; Low, Jenny G; Ong, Marcus Eng HockItem Open Access Impact of COVID-19 on perceived wellbeing, self-management and views of novel modalities of care among medically vulnerable patients in Singapore.(Chronic illness, 2021-12-29) Yoon, Sungwon; Hoe, Pei Shan; Chan, Angelique; Malhotra, Rahul; Visaria, Abhijit; Matchar, David; Goh, Hendra; Seng, Bridget; Ramakrishnan, Chandrika; Koh, Mariko S; Yee, Tiew Pei; Nadarajan, Gayathri Devi; Bee, Yong Mong; Graves, Nicholas; Jafar, Tazeen H; Ong, Marcus EhObjectives
This study aims to examine the impact of COVID-19 measures on wellbeing and self-management in medically vulnerable non-COVID patients and their views of novel modalities of care in Singapore.Methods
Patients with cardiovascular disease (CVD), respiratory disease, chronic kidney disease, diabetes and cancer were recruited from the SingHealth cluster and national cohort of older adults. Data on demographics, chronic conditions and perceived wellbeing were collected using questionnaire. We performed multivariable regression to examine factors associated with perceived wellbeing. Qualitative interviews were conducted to elicit patient's experience and thematically analyzed.Results
A total of 91 patients participated. Male patients compared with female patients perceived a lower impact of the pandemic on subjective wellbeing. Patients with CVD compared to those having conditions other than CVD perceived a lower impact. Impacts of the pandemic were primarily described in relation to emotional distress and interference in maintaining self-care. Hampering of physical activity featured prominently, but most did not seek alternative ways to maintain activity. Despite general willingness to try novel care modalities, lack of physical interaction and communication difficulties were perceived as main barriers.Discussion
Findings underline the need to alleviate emotional distress and develop adaptive strategies to empower patients to maintain wellbeing and self-care.Item Open Access Implications of long-term care capacity response policies for an aging population: a simulation analysis.(Health policy (Amsterdam, Netherlands), 2014-05) Ansah, John P; Eberlein, Robert L; Love, Sean R; Bautista, Mary Ann; Thompson, James P; Malhotra, Rahul; Matchar, David BIntroduction
The demand for long-term care (LTC) services is likely to increase as a population ages. Keeping pace with rising demand for LTC poses a key challenge for health systems and policymakers, who may be slow to scale up capacity. Given that Singapore is likely to face increasing demand for both acute and LTC services, this paper examines the dynamic impact of different LTC capacity response policies, which differ in the amount of time over which LTC capacity is increased, on acute care utilization and the demand for LTC and acute care professionals.Methods
The modeling methodology of System Dynamics (SD) was applied to create a simplified, aggregate, computer simulation model for policy exploration. This model stimulates the interaction between persons with LTC needs (i.e., elderly individuals aged 65 years and older who have functional limitations that require human assistance) and the capacity of the healthcare system (i.e., acute and LTC services, including community-based and institutional care) to provide care. Because the model is intended for policy exploration, stylized numbers were used as model inputs. To discern policy effects, the model was initialized in a steady state. The steady state was disturbed by doubling the number of people needing LTC over the 30-year simulation time. Under this demand change scenario, the effects of various LTC capacity response policies were studied and sensitivity analyses were performed.Results
Compared to proactive and quick adjustment LTC capacity response policies, slower adjustment LTC capacity response policies (i.e., those for which the time to change LTC capacity is longer) tend to shift care demands to the acute care sector and increase total care needs.Conclusions
Greater attention to demand in the acute care sector relative to demand for LTC may result in over-building acute care facilities and filling them with individuals whose needs are better suited for LTC. Policymakers must be equally proactive in expanding LTC capacity, lest unsustainable acute care utilization and significant deficits in the number of healthcare professionals arise. Delaying LTC expansion could, for example, lead to increased healthcare expenditure and longer wait lists for LTC and acute care patients.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.Item Open Access Older person behavioral and psychological symptoms (BPS) and functional limitations mediate the association between older person cognitive impairment and depressive symptoms in the caregiver.(Archives of gerontology and geriatrics, 2014-03) Malhotra, Rahul; Chei, Choy-Lye; Østbye, Truls; Chan, Angelique; Matchar, David BWe assess for the mediation of the association between older person cognitive impairment and caregiver depressive symptoms through older person BPS and functional limitations, and whether the mediation varies by caregiver-older person relationship (spouse/adult child). Data for 1111 older person (aged 75+ with activity of daily living (ADL) limitation)-caregiver dyads from Singapore were used. The outcome variable was dichotomous (caregiver clinically significant depressive symptoms [CSDS]: yes/no) in the primary analysis and continuous (caregiver depressive symptoms score) in the sensitivity analysis. The causal steps approach assessed for the mediation of the association between older person cognitive impairment (yes/no) and the outcome variable through the two potential mediators. A bootstrapping approach calculated point estimates and confidence intervals (CIs) of the indirect (∼mediated) effects. Variation of the indirect effects by caregiver-older person relationship was also assessed. In the primary analysis, the causal steps approach supported older person BPS and functional limitations as mediators. The bootstrapping approach confirmed both as significant mediators, though BPS (indirect effect odds ratio (OR) 1.32 [95% bootstrap CI 1.19,1.48]; %mediation: 70.6%) was a stronger mediator than functional limitations (1.04 [1.01,1.11]; %mediation: 11.5%). Variation of the indirect effects by caregiver-older person relationship was not supported. Results of the sensitivity analysis confirmed these results. We conclude that while caring for an older person with cognitive impairment is detrimental for the caregiver's mood, management of associated BPS and functional limitations, especially the former, among such older persons may reduce depressive symptoms among their caregivers. Spouse as well as adult child caregivers benefit.Item Open Access Presence of and correction for interviewer error on an instrument assessing cognitive function of older adults.(Geriatrics & gerontology international, 2015-03) Malhotra, Rahul; Haaland, Benjamin A; Chei, Choy-Lye; Chan, Angelique; Malhotra, Chetna; Matchar, David BAim
To determine the extent of interviewer error on the Short Portable Mental Status Questionnaire (SPMSQ), the association between interviewer-level variables and SPMSQ score, compare the prevalence of SPMSQ cognitive status categories before and after correction for interviewer error, and identify SPMSQ items prone to interviewer error.Methods
Data of 4542 older adults from a national survey in Singapore were utilized. Multilevel models, which adjusted for respondent-level variables known to be associated with cognitive status, were utilized to determine the intraclass correlation on the SPMSQ, association of interviewer-level variables (age, ethnicity, education and number of interviews carried out) with SPMSQ and identify SPMSQ items prone to interviewer error.Results
The intraclass correlation, after adjusting for respondent-level variables, was 0.265. Interviewer educational status was associated with SPMSQ score. Correction for interviewer error resulted in an "improvement" in cognitive status of a substantial proportion of those initially classified as moderately or severely impaired. Two of the SPMSQ items, "Please count backward from 20 by 3" and "When were you born?" were particularly prone to interviewer error.Conclusions
Investigators using the SPMSQ, and potentially, other instruments, for assessing cognitive function in surveys of older adults and using face-to-face interviews for data collection should be cognizant of the sensitivity of such instruments to interviewer error. Intensive training of interviewers to standardize instrument administration as well as assessment for interviewer error and its correction, using appropriate statistical models, such as multilevel models, is warranted.Item Open Access Projecting the effects of long-term care policy on the labor market participation of primary informal family caregivers of elderly with disability: insights from a dynamic simulation model.(BMC geriatrics, 2016-03-23) Ansah, John P; Matchar, David B; Malhotra, Rahul; Love, Sean R; Liu, Chang; Do, YoungBackground
Using Singapore as a case study, this paper aims to understand the effects of the current long-term care policy and various alternative policy options on the labor market participation of primary informal family caregivers of elderly with disability.Methods
A model of the long-term care system in Singapore was developed using System Dynamics methodology.Results
Under the current long-term care policy, by 2030, 6.9 percent of primary informal family caregivers (0.34 percent of the domestic labor supply) are expected to withdraw from the labor market. Alternative policy options reduce primary informal family caregiver labor market withdrawal; however, the number of workers required to scale up long-term care services is greater than the number of caregivers who can be expected to return to the labor market.Conclusions
Policymakers may face a dilemma between admitting more foreign workers to provide long-term care services and depending on primary informal family caregivers.Item Open Access Projecting the number of older singaporeans with activity of daily living limitations requiring human assistance through 2030.(Annals of the Academy of Medicine, Singapore, 2014-01) Thompson, James; Malhotra, Rahul; Love, Sean; Ostbye, Truls; Chan, Angelique; Matchar, DavidIntroduction
In the context of rapid population ageing and the increase in number of activity of daily living (ADL) limitations with age, the number of older persons requiring human assistance in Singapore is likely to grow. To promote informed planning for the needs of these elderly, we project the number of resident Singaporeans 60 years of age and older with 1 or more ADL limitations requiring human assistance through 2030.Materials and methods
The proportion of community-dwelling older adults with ADL limitations requiring human assistance, stratified by gender and age group, was calculated utilising a recent nationally-representative survey of older Singaporeans. The proportion of older adults in nursing homes with ADL limitations was estimated based on available literature. Together, these prevalence estimates were applied to a simulation of the future population of older adults in Singapore to derive an estimate of the number of individuals with ADL limitations requiring human assistance through 2030.Results
By 2030, the number of resident Singaporeans aged 60 years or older with 1 or more ADL limitations requiring human assistance is projected to be 82,968 persons (7% of the total population aged 60 years or older). Of this number, 38,809 (47%) are estimated to have 1 or 2 ADL limitations, and 44,159 (53%) are estimated to have 3 or more.Conclusion
The number of elderly Singaporeans with activity limitations is expected grow rapidly from 31,738 in 2010 to 82,968 in 2030. Estimates of the number of older individuals with ADL limitations requiring human assistance are of value for policymakers as well as acute and long-term care capacity planners as they seek to meet demand for health and social services in Singapore.Item Open Access Projection of young-old and old-old with functional disability: does accounting for the changing educational composition of the elderly population make a difference?(PloS one, 2015-01) Ansah, John P; Malhotra, Rahul; Lew, Nicola; Chiu, Chi-Tsun; Chan, Angelique; Bayer, Steffen; Matchar, David BThis study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥ 60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.Item Open Access Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers.(Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2016-01) Malhotra, Rahul; Chei, Choy-Lye; Menon, Edward; Chow, Wai Leng; Quah, Stella; Chan, Angelique; Matchar, David BruceGoal
We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor-caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (stroke survivor depressive symptoms and functional disability, caregiver depressive symptoms, and foreign domestic worker [FDW] assistance) on the level of the depressive symptom trajectories.Methods
Data on 172 stroke survivor-caregiver dyads in Singapore, for whom depressive symptoms were assessed thrice (baseline/3 months/6 months), were utilized. GBTM was applied to delineate depressive symptom trajectories, and to identify their predictors and time-varying covariates.Findings
Three stroke survivor depressive symptom trajectories (low and decreasing [47.6%], low and increasing [43.1%], and high and increasing [9.3%]) and 2 caregiver depressive symptom trajectories (low and stable [71.5%] and high and decreasing [28.5%]) were delineated. Caregivers with chronic diseases were more likely (odds ratio [95% confidence interval]: 8.09[2.04-32.07]) and those caring for older stroke survivors (0.94[0.90-0.98]) were less likely to follow the high and decreasing than the low and stable depressive symptom trajectory. An increase in stroke survivor functional disability and caregiver depressive symptoms led to a rise (~worsening) in stroke survivor depressive symptom trajectories. Whereas an increase in stroke survivor depressive symptoms led to a rise in caregiver depressive symptom trajectories, FDW assistance led to a decline (~improvement).Conclusion
Care professionals should be mindful of heterogeneity in depressive symptom patterns over time among stroke survivor-caregiver dyads. Reciprocal association of depressive symptoms in the stroke survivor-caregiver dyad suggests that addressing mood problems in 1 member may benefit the other member, and calls for dyadic mental health interventions.Item Open Access Simulating the impact of long-term care policy on family eldercare hours.(Health services research, 2013-04) Ansah, John P; Matchar, David B; Love, Sean R; Malhotra, Rahul; Do, Young Kyung; Chan, Angelique; Eberlein, RobertObjective
To understand the effect of current and future long-term care (LTC) policies on family eldercare hours for older adults (60 years of age and older) in Singapore.Data sources
The Social Isolation Health and Lifestyles Survey, the Survey on Informal Caregiving, and the Singapore Government's Ministry of Health and Department of Statistics.Study design
An LTC Model was created using system dynamics methodology and parameterized using available reports and data as well as informal consultation with LTC experts.Principal findings
In the absence of policy change, among the elderly living at home with limitations in their activities of daily living (ADLs), the proportion of those with greater ADL limitations will increase. In addition, by 2030, average family eldercare hours per week are projected to increase by 41 percent from 29 to 41 hours. All policy levers considered would moderate or significantly reduce family eldercare hours.Conclusion
System dynamics modeling was useful in providing policy makers with an overview of the levers available to them and in demonstrating the interdependence of policies and system components.