Background Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these... more
Background Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults. Methods A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping o...
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IntroductionFalls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among... more
IntroductionFalls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore.Methods and analysisThis is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum...
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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... more
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 primar...
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Background Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying... more
Background Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of success. However, many of these care models’ implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme’s effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-match...
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Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programmes in randomised controlled trials demonstrate effectiveness in reducing falls, however, the... more
Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programmes in randomised controlled trials demonstrate effectiveness in reducing falls, however, the translation of research into the community remains challenging. While there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programmes in Singapore, with a focus on the inter-relationship between those factors. Research Design and Methods Healthcare professionals familiar with fall prevention programmes were invited to discuss the enablers and challenges to the implementation. Thi...
Introduction High users of hospital services require targeted healthcare services planning for effective resource allocation due to their high costs. This study aims to segmentize the population in the “Ageing In Place-Community Care... more
Introduction High users of hospital services require targeted healthcare services planning for effective resource allocation due to their high costs. This study aims to segmentize the population in the “Ageing In Place-Community Care Team” (AIP-CCT), a programme for complex patients with high inpatient service use, and examine the association of segment membership and healthcare utilisation and mortality. Methods We analysed 1,012 patients enrolled between June 2016 and February 2017. To identify patient segments, a cluster analysis was performed based on medical complexity and psychosocial needs. Next, multivariable negative binomial regression was performed using patient segments as the predictor, with healthcare and programme utilisation over the 180-day follow-up as outcomes. Multivariate cox proportional hazard regression was applied to assess the time to first hospital admission and mortality between segments within the 180-day follow-up. All models were adjusted for age, gend...
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Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for patients with a key focus on undergraduate interprofessional education (IPE). We sought to validate the Readiness for Interprofessional... more
Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for patients with a key focus on undergraduate interprofessional education (IPE). We sought to validate the Readiness for Interprofessional Learning Scale (RIPLS) and evaluate TriGen’s efficacy by investigating healthcare undergraduates’ attitude towards IPE. Methods: Teams of healthcare undergraduates performed home visits for patients fortnightly over six months, trained by professionals from a regional hospital and a social service organisation. The RIPLS was validated using exploratory factor analysis. Evaluation of TriGen’s efficacy was performed via the administration of the RIPLS pre- and post-intervention, analysis of qualitative survey results and thematic analysis of written feedback. Results: 79.6% of 226 undergraduate participants from 2015-2018 were enrolled. Exploratory factor analysis revealed four factors accounting for 64.9% of total variance. One item loaded poorly and was ...
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Background The first Patient-Centered Medical Home (PCMH) demonstration in Singapore was launched in November 2016, which aimed to deliver integrated and patient-centered care for patients with bio-psycho-social needs. Implementation was... more
Background The first Patient-Centered Medical Home (PCMH) demonstration in Singapore was launched in November 2016, which aimed to deliver integrated and patient-centered care for patients with bio-psycho-social needs. Implementation was guided by principles of comprehensiveness, coordinated care, shared decision-making, accessible services, and quality and safety. We aimed to investigate the impact of implementing the PCMH in primary care on quality of life (QoL) and patient activation. Methods The study design was a prospective single-arm pre-post study. We applied the 5-level EuroQol 5-dimension (EQ-5D-5L) and Visual Analog Scale (EQ VAS) instruments to assess health-related QoL. The CASP-19 tool was utilised to examine the degree that needs satisfaction was fulfilled in the domains of Control, Autonomy, Self-realisation, and Pleasure. The 13-item Patient Activation Measure (PAM-13) was used to evaluate knowledge, skills and confidence in management of conditions and ability to s...
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Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and... more
Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore. Methods This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities an...
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In this study, clinical practice guidelines were developed by a multidisciplinary team for patients with infections admitted to a surgical intensive care unit (ICU). A 51-day baseline audit period (Phase I) in a 20-bed (private rooms)... more
In this study, clinical practice guidelines were developed by a multidisciplinary team for patients with infections admitted to a surgical intensive care unit (ICU). A 51-day baseline audit period (Phase I) in a 20-bed (private rooms) surgical ICU was compared with a 34-day period in the same unit after implementation of the guidelines (Phase II). Phase I included 182 patients (670 patient days), and Phase II included 139 patients (427 patient days). There was no significant difference between patients in the Phase I and Phase II groups regarding age (65.4/19-95 vs. 64.8/18-90 yrs), gender (56% male vs. 55% male), severity of illness (mean Acute Physiology and Chronic Health Evaluation III, 38 vs. 39.1), total infections (respiratory, 8% vs. 4%; urinary tract, 15% vs. 4%; wound, 4% vs. 3%; skin/soft tissue, 3% vs. 7%; sepsis, 5% vs. 3%; intra-abdominal, 9% vs. 17%), and no infection (64% vs. 67%). Clinical outcomes of patients with infections in the Phase I group compared with those in the Phase II group were as follows: clinical improvement or cure, 64% vs. 76%; persistent infection, 17% vs. 11%; clinical failure, 0 vs. 2%; and death, 18% vs. 7% (p = NS). When patients with infections were compared, death rates were 20% in the Phase I group and 5.6% in the Phase II group (p = .02). After implementation of the clinical pathways, antibiotic costs were reduced from $676.54 per patient to $157.88 per patient (p = .001). Length of stay in the ICU was 3.7 days in the Phase I trial and a mean of 3 days in the Phase II trial (p = NS). Specimens of Escherichia coli demonstrated a trend toward a decreased resistance to all antibiotics and Pseudomonas aeruginosa to ciprofloxacin and aminoglycosides (p = NS). In this study, the use of clinical practice guidelines for patients who were admitted to the surgical ICU was shown to reduce costs, without adversely affecting patients' outcomes. This study has important implications for the use of clinical practice guidelines for the management of patients with infections who are admitted to surgical ICUs.
Research Interests: Nursing, Evaluation, Medicine, Multidisciplinary, Critical Care, and 15 moreCritical Care Medicine, Prospective studies, Humans, INTENSIVE CARE, Female, Male, Michigan, Clinical Sciences, Intensive Care Unit, Aged, Middle Aged, Cost Analysis, Intensive Care Medicine, Patient care management, and Cross Infection
Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore.... more
Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported b...
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Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.8 % of the population in 1995 and is projected to increase to 20 % by the year 2030.1 The medical community is also faced with a similar
Independent outdoor mobility is important to community-dwelling older adults as it enables reach and access to resources for everyday activities, but this becomes increasingly challenging with the progressive decline in physical... more
Independent outdoor mobility is important to community-dwelling older adults as it enables reach and access to resources for everyday activities, but this becomes increasingly challenging with the progressive decline in physical performance in ageing. We aim to understand the relationship between Indoor (IGS) and Real-Life Outdoor Gait Speed (OGS) with objectively-measured geographic life-space extent and outdoor mobility among community-ambulant older adults in Singapore. Thirty-three participants aged ≥55 years living in three neighbourhoods wore hybrid mobility trackers continuously for 7 days. Baseline 6-metre IGS was measured with a stopwatch, while OGS was from outdoor accelerometer data. Nodes were defined as significant places visited for ≥5 minutes. Multiple linear regressions examined each association between IGS and OGS on geographic life-space extent and outdoor mobility measures adjusting for confounders. Participants’ mean age was 69.2±7.1 years with mean IGS and OGS o...
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Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge and beliefs, but few have elucidated this cognitive process in older adults surrounding falls. We aim to identify risk factors for high FOF... more
Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge and beliefs, but few have elucidated this cognitive process in older adults surrounding falls. We aim to identify risk factors for high FOF amongst community-dwelling older adults (OA) and middle-aged adults (MA) in Singapore. This was a cross-sectional survey of a nationally-representative sample of OA (≥60 years) and MA (40-59 years) identified by stratified random sampling. Primary outcome was high FOF measured by a single-item (4-point scale). Independent variables were history-of-falls, quality-of-life, fall-related cognitive appraisal (balance problems, importance to restrict activities to prevent falls) and knowledge indicators (knowledge of other OA who fell, ability to identify out of 13 fall risk factors). MA were also asked if they’re caregivers. Multiple logistic regressions identified risk factors for high FOF separately by age-groups, adjusting for socio-demographics and como...
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DESCRIPTION Correlates of habitual walking and sports/leisure-time physical activity in older persons in Singapore: interaction effects between educational attainment and gender. Ann Acad Med Singapore 2003, 32(6):801-6.
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Background: Patients with complex needs require greater biopsychosocial support. Fragmented services often result in gaps, duplication or incompatibility in treatments, leading to poorer health outcomes and higher utilization of costly... more
Background: Patients with complex needs require greater biopsychosocial support. Fragmented services often result in gaps, duplication or incompatibility in treatments, leading to poorer health outcomes and higher utilization of costly hospital-based healthcare services. Patient-Centred Medical Home (PCMH) is a primary care model reform advocated as more appropriate for patients with complex needs. This analysis assessed the impact of a PCMH demonstration on healthcare utilization for patients with complex needs in Singapore. Methods: This study assessed the Community for Successful Ageing (ComSA)-PCMH in Singapore that was launched in Nov’2016. ComSA-PCMH serves adults aged 40 and above with complex needs, delivering care integrated between its primary care clinic, home-based care management, an acute hospital and other community-based services. This was a matched cohort analysis that used a difference-in-difference approach to compare quarterly healthcare utilization of PCMH study...
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1Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 2Geriatric Education and Research Institute, Singapore 3Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore... more
1Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 2Geriatric Education and Research Institute, Singapore 3Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 4Department of Medicine, Dalhousie University, Canada 5Department of Geriatric Medicine, Changi General Hospital, Singapore Address for Correspondence: Adj A/Prof Lim Wee Shiong, Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Annex, Level 2, 11 Jalan Tan Tock Seng, Singapore 308433. Email: Wee_Shiong_Lim@ttsh.com.sg Translating the Science of Frailty in Singapore: Results from the National Frailty Consensus Discussion Wee Shiong Lim,1MBBS, MRCP, MHPE, Chek Hooi Wong,2,3MBBS, FRCP, MPH,Yew Yoong Ding,1,2MBBS, FRCP, PhD, Kenneth Rockwood,4 MD, FRCPC, FRCP, Christopher Lien,5MBBS, FRCP, MPA Singapore: Translating the Science of Frailty—Wee Shiong Lim et al Commentary
Dear Editor, The ageing population in Singapore poses a growing challenge and need to realign current health services and care management pathways to treat older adults with complex medical conditions.1,2 This group of patients typically... more
Dear Editor, The ageing population in Singapore poses a growing challenge and need to realign current health services and care management pathways to treat older adults with complex medical conditions.1,2 This group of patients typically have multiple comorbidities and disabilities and are at risk of poor outcomes after they are discharged home from hospitals. Consequently, they require frequent admissions to hospitals. To address the issue of frequent readmissions of older adults with complex care needs, transitional care (TC) is offered as a care management model that can help to ameliorate this situation.1–3 Studies on TC have primarily targeted frail older patients and focused on health education, self-management and care coordination of social and community services that are nurseled.4–8 Since only care coordination is involved, frail patients with exacerbations or unresolved medical conditions had to be referred back to primary care or hospital-based physicians while patients ...
Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by... more
Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. “Diffusion of innovations” emerged as an overarching theory to contextualize PCMH in its early implementation. Three core “innovations” differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to in...
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Background: Primary care (PC) reform is imperative to meet the demands of a rising number of chronically ill patients with complex needs. Patient-Centered Medical Home (PCMH) is a new care model that was found to improve care for complex... more
Background: Primary care (PC) reform is imperative to meet the demands of a rising number of chronically ill patients with complex needs. Patient-Centered Medical Home (PCMH) is a new care model that was found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. Guided by the PCMH principles, “ComSA-PCMH” was developed to proactively deliver integrated PC to a specific population with complex needs. This study explored the change strategies, initial experience and perception, and lessons learnt during its early implementation.Methods: A grounded theory approach was employed. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners and other PC providers. The theoretical framework on diffusion of innovations by Greenhalgh and colleagues (2015) was used to determine theoretical saturation, reorganize data, and provide insights to the emerging themes.Resu...
Background Interprofessional (IP) practice is an essential aspect of healthcare to meet the challenges of an aging population. Tri-Generational HomeCare (TriGen) is an undergraduate student-initiated, longitudinal, IP home visit program... more
Background Interprofessional (IP) practice is an essential aspect of healthcare to meet the challenges of an aging population. Tri-Generational HomeCare (TriGen) is an undergraduate student-initiated, longitudinal, IP home visit program focused on older patients with frequent hospital readmissions. Methods Teams comprising healthcare undergraduates and secondary school (SS) students performed home visits for frequently admitted patients (three or more visits in past six months) on a fortnightly basis over a period of six months. They were supported and trained by healthcare professionals from Khoo Teck Puat Hospital (KTPH), a regional healthcare system, and North West Community Development Council (NWCDC), a social service organisation. A multimethod approach was used, with the administration of Readiness for Interprofessional Learning Scale (RIPLS) pre- and post-intervention, and gathering post-intervention quantitative and qualitative feedback. Results 80.1% of 226 undergraduate p...
We explore the intergenerational pattern of resource transfer and possible associated factors. A scoping review was conducted of quantitative, peer-reviewed, English-language studies related to intergenerational transfer or interaction.... more
We explore the intergenerational pattern of resource transfer and possible associated factors. A scoping review was conducted of quantitative, peer-reviewed, English-language studies related to intergenerational transfer or interaction. We searched AgeLine, PsycINFO, Social Work s, and Sociological Abstracts for articles published between Jane 2008 and December 2018. Seventy-five studies from 25 countries met the inclusion criteria. The scoping review categorised resource transfers into three types: financial, instrumental, and emotional support. Using an intergenerational solidarity framework, factors associated with intergenerational transfer were placed in four categories: (1) demographic factors (e.g., age, gender, marital status, education, and ethno-cultural background); (2) needs and opportunities factors, including health, financial resources, and employment status; (3) family structures, namely, family composition, family relationship, and earlier family events; and (4) cul...
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Fall prevention strategies informed by understanding sex differences in the perception of falls may be fruitful. Objectives: In the current research, we examined the consequence of having a recent fall episode on sex differences in fall... more
Fall prevention strategies informed by understanding sex differences in the perception of falls may be fruitful. Objectives: In the current research, we examined the consequence of having a recent fall episode on sex differences in fall perception based on the postulation that having a recent fall can lead to perceived susceptibility and attenuate male stereotypic perceptions toward falls. Methods and Results: Examining 549 older adults (337 women) living in the community, men reported higher falls efficacy, less negative perception related to the effect of a fall, and lower tendency to restrict activities to prevent falls. These sex differences were observed only among those who did not have a recent fall episode, and no significant sex differences were observed among those who fell. Discussion: The findings suggest that a recent fall episode may underlie sex differences in falls perception. The implications of sex differences in perceptions in falls for healthcare delivery and out...
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Traditional evaluation techniques are often not suitable for studying health interventions operating in real-world settings, particularly when interventions operate through complex causal pathways. We describe a mixed methods design for... more
Traditional evaluation techniques are often not suitable for studying health interventions operating in real-world settings, particularly when interventions operate through complex causal pathways. We describe a mixed methods design for evaluating an integrated home care and social support service targeting mature and older adults (55+ years) in Singapore. Here, nurses and community health workers visit patients’ homes to address health and social needs while facilitating linkages to community-based services and providing caregiver support. Our mixed methods evaluation plan is composed of three components: quantitative comparison of hospital-based service utilization, cost-effectiveness analysis, and qualitative investigation into the experiences of patients, caregivers, and individuals who declined services. This article contributes a description of how cost-effectiveness analysis adds value when incorporated into mixed methods studies.
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Introduction Previous studies have established that perceived threat can function as motivation to adopt protective health behaviours (Rogers, 1975; Tannenbaum, 2015 etc). However, while perceived falls-related threat improves intention... more
Introduction Previous studies have established that perceived threat can function as motivation to adopt protective health behaviours (Rogers, 1975; Tannenbaum, 2015 etc). However, while perceived falls-related threat improves intention and participation in falls prevention programmes (Yardley et al, 2007; Dorresteijn et al, 2012), some studies have also found that for women, perceived falls-related threat doubles as a barrier to exercise (Sandlund, 2008; Bruce et al, 2002; Cousins, 2000). The evidence is less clear for men. This paper seeks to analyse gendered differences in how falls-related threat appraisal affects perceived importance of exercise. Methods Secondary data analysis was conducted on data from the National KAP Study in Singapore, where a cross-sectional survey was conducted on community-dwelling Singaporeans aged ≥60 (N=549). Sub-group analyses were conducted for men (n=212) and women (n=337). Multiple logistic regressions were conducted to assess the effect of threa...
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Objective: To examine how neighborhood-based cognitive and structural social capital are associated with individual quality of life among a sample of community-dwelling older adults in Singapore. Method: Using survey data from 981 older... more
Objective: To examine how neighborhood-based cognitive and structural social capital are associated with individual quality of life among a sample of community-dwelling older adults in Singapore. Method: Using survey data from 981 older adults (aged 55 years and above) in nine residential neighborhoods, multilevel models simultaneously estimated the effects of independent variables at the individual and neighborhood levels on quality of life (CASP-12). Results: Social cohesion (β = 1.39, p < .01) and associational membership (β = 19.16, p < .01) were associated with higher quality of life in models adjusted for neighborhood facilities and individual sociodemographics, social networks, functional limitations, global cognitive status, and medical conditions. Discussion: The results suggest that place-based or neighborhood social capital may be important for older person’s well-being. It identifies the contribution of structural (associational membership) and cognitive (social co...
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Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at... more
Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at increased risk for long-term mortality, compared to patients by high-velocity blunt trauma (higher fall heights, road injuries, and other blunt trauma). We hypothesized that these patients are also at higher risk of readmission, compared to patients injured by high-velocity mechanisms. Competing risks regression (all-cause unplanned readmission or death) was performed. Data for 5671 patients from the Singapore National Trauma Registry data who were injured from 2011-2013 and aged 55 and over were matched to Ministry of Health admissions data. The registry uses standardized conversion metrics to convert patient histories to fall heights. Patients injured after a low fall were more likely to be readmitted to a hospital, compared to those sustaining in...
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Studies are needed to inform the preparation of community nurses to address patient behavioral and social factors contributing to unnecessary readmissions to hospital. This study uses nurses' input to understand challenges faced... more
Studies are needed to inform the preparation of community nurses to address patient behavioral and social factors contributing to unnecessary readmissions to hospital. This study uses nurses' input to understand challenges faced during home care, to derive a framework to address the challenges. Semistructured interviews were conducted to saturation with 16 community nurses in Singapore. Interviews were transcribed verbatim and transcripts independently coded for emergent themes. Themes were interpreted using grounded theory. Seven major themes emerged from 16 interviews: Strained social relationships, complex care decision-making processes within families, communication barriers, patient's or caregiver neglect of health issues, building and maintaining trust, trial-and-error nature of work, and dealing with uncertainty. Community nurses identified uncertainty arising from complexities in social-relational, personal, and organizational factors as a central challenge. Nursing ...
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To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the... more
To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3...
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Singapore is one of the fastest-aging countries in the world, and the demand for acute hospital care for older adults is expected to triple in the next 25 years. Hence, it is crucial to understand the opportunities in reducing potentially... more
Singapore is one of the fastest-aging countries in the world, and the demand for acute hospital care for older adults is expected to triple in the next 25 years. Hence, it is crucial to understand the opportunities in reducing potentially avoidable bed days (PABD), which are days spent in acute hospitals delivering only non-acute services. We aimed to access the prevalence, causes and consequences of PABD among geriatric patients. We examined all hospitalizations from 1 August through 31 December 2013 in the geriatric wards of an acute hospital in Singapore. PABD were identified using a modified Appropriateness Evaluation Protocol. Non-acute services were classified as subacute care, rehabilitative care, long-term care or social care. Hospitalization patterns were determined based on the presence or absence of non-acute services, and multinomial logistic regression was used to determine predictors of different patterns. Of the 273 bed days used by 254 patients, 49% were potentially ...
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Background There is increasing interest in examining the life space mobility and activity participation of older adults in the community using sensor technology. Objective data from these technologies may overcome the limitations of... more
Background There is increasing interest in examining the life space mobility and activity participation of older adults in the community using sensor technology. Objective data from these technologies may overcome the limitations of self-reported surveys especially in older adults with age-associated cognitive impairment. This paper describes the development and validation of a prototype hybrid mobility tracker for assessing life space mobility and out-of-home activities amongst 33 community-ambulant older adults in Singapore. Methods A hybrid mobility tracker was developed by combining a passive Global Positioning System logger, tri-axial accelerometer and radio-frequency identification. Objective measures of life space, derived from 1 week of tracking data using Geographic Information Systems, were the maximum Euclidean distance from home (Max Euclid) and the area of the minimum convex polygon surrounding all GPS waypoints (MCP area). Out-of-home activities were quantified by visu...
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Introduction A multitude of modifiable factors can contribute to one’s fall risk. Healthcare professionals (HCP) are equipped to identify such factors, and make appropriate recommendations to help older adults prevent falls. However,... more
Introduction A multitude of modifiable factors can contribute to one’s fall risk. Healthcare professionals (HCP) are equipped to identify such factors, and make appropriate recommendations to help older adults prevent falls. However, there is limited evidence on the awareness and practice of this in Asian communities. Thus, this paper aims to understand the participation and barriers for community-dwelling Singaporeans to discuss falls with their HCPs. Methods A cross-sectional survey was conducted on a nationally-representative sample of Singaporeans aged ≥60 living in the community. Participants were asked if they have fallen in the past 12 months, if they discussed what they can do to avoid falls with their HCPs (doctor/nurse) and for their perceived barriers via a semi-structured questionnaire with multiple responses. Unstructured data was coded using content analysis by two researchers and pooled with structured data. Sub-group differences between fallers and non-fallers were a...