Browsing by Author "Seow, Dennis Chuen Chai"
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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.Item Open Access One-year and three-year mortality prediction in adult major blunt trauma survivors: a National Retrospective Cohort Analysis.(Scandinavian journal of trauma, resuscitation and emergency medicine, 2018-04-18) Wong, Ting Hway; Nadkarni, Nivedita Vikas; Nguyen, Hai V; Lim, Gek Hsiang; Matchar, David Bruce; Seow, Dennis Chuen Chai; King, Nicolas KK; Ong, Marcus Eng HockSurvivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of 1-year and 3-year mortality for major blunt trauma adult survivors of the index hospitalization.Using data from the Singapore National Trauma Registry, 2011-2013, we analyzed adults aged 18 and over, admitted after blunt injury, with an injury severity score (ISS) of 12 or more, who survived the index hospitalization, linked to death registry data. The study population was randomly divided 60/40 into separate construction and validation datasets, with the model built in the construction dataset, then tested in the validation dataset. Multivariable logistic regression was used to analyze 1-year and 3-year mortality.Of the 3414 blunt trauma survivors, 247 (7.2%) died within 1 year, and 551 (16.1%) died within 3 years of injury. Age (OR 1.06, 95% CI 1.05-1.07, p < 0.001), male gender (OR 1.53, 95% CI 1.12-2.10, p < 0.01), low fall from 0.5 m or less (OR 3.48, 95% CI 2.06-5.87, p < 0.001), Charlson comorbidity index of 2 or more (OR 2.26, 95% CI 1.38-3.70, p < 0.01), diabetes (OR 1.31, 95% CI 1.68-2.52, p = 0.04), cancer (OR 1.76, 95% CI 0.94-3.32, p = 0.08), head and neck AIS 3 or more (OR 1.79, 95% CI 1.13-2.84, p = 0.01), length of hospitalization of 30 days or more (OR 1.99, 95% CI 1.02-3.86, p = 0.04) were predictors of 1-year mortality. This model had a c-statistic of 0.85. Similar factors were found significant for the model predictor of 3-year mortality, which had a c-statistic of 0.83. Both models were validated on the second dataset, with an overall accuracy of 0.94 and 0.84 for 1-year and 3-year mortality respectively.Adult survivors of major blunt trauma can be risk-stratified at discharge for long-term support.Item Open Access Systems modelling as an approach for eliciting the mechanisms for hip fracture recovery among older adults in a participatory stakeholder engagement setting.(Frontiers in rehabilitation sciences, 2023-01) Ansah, John Pastor; Chia, Aloysius Wei-Yan; Koh, Vanessa Jean Wen; Lai, Wei Xuan; Koh, Joyce Suang Bee; Goh, Kiat Sern; Yeo, William; Howe, Tet Sen; Seow, Dennis Chuen Chai; Mamun, Kaysar; Balasubramanian, Diraviyam; Varman, Surendra Doraiswamy; Yeo, Andy Kuei Siong; Elamin, Amal; Chan, Angelique Wei-Ming; Matchar, David BruceIntroduction
Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, psychological, and social factors often affects the recovery trajectories of older adults with hip fractures, often complicating the recovery process.Methods
This research aims to actively engage stakeholders (including doctors, physiotherapists, hip fracture patients, and caregivers) using the systems modeling methodology of Group Model Building (GMB) to elicit the factors that promote or inhibit hip fracture recovery, incorporating a feedback perspective to inform system-wide interventions. Hip fracture stakeholder engagement was facilitated through the Group Model Building approach in a two-half-day workshop of 25 stakeholders. This approach combined different techniques to develop a comprehensive qualitative whole-system view model of the factors that promote or inhibit hip fracture recovery.Results
A conceptual, qualitative model of the dynamics of hip fracture recovery was developed that draws on stakeholders' personal experiences through a moderated interaction. Stakeholders identified four domains (i.e., expectation formation, rehabilitation, affordability/availability, and resilience building) that play a significant role in the hip fracture recovery journey..Discussion
The insight that recovery of loss of function due to hip fracture is attributed to (a) the recognition of a gap between pre-fracture physical function and current physical function; and (b) the marshaling of psychological resilience to respond promptly to a physical functional loss via uptake of rehabilitation services is supported by findings and has several policy implications.