Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective

Background: Integrated care that focuses on organising healthcare services around people and their communities rather than their diseases is promoted as the strategy to overcome the challenges associated with growing complexity in healthcare needs, demand for healthcare services and inadequate supply of services due to fragmentation in the provision of services. While conceptually appears to be simple, integrated care is made up of multicomponent delivery strategies targeting various levels of the healthcare system while engaging various stakeholders in their execution. Methods: We applied the complex adaptive system (CAS) perspective to two different initiatives that exemplify approaches towards integrating care in Singapore: the Regional Health System (RHS) model, implemented across healthcare institutions at the national level, and CARITAS Integrated Dementia Care implemented in the northern region of Singapore. We adopted an inductive approach in our analysis in which we studied the RHS and CARITAS Integrated Dementia Care according to the components of the CAS. We applied the typical characteristics of CAS: (i) diverse, interdependent and semi-autonomous actors (ii) self-organizing capacity and simple rules (iii) relationship with the bigger system, emergent behaviour and non-linearity in our analysis of key drivers behind the implementation of both the RHS and CARITAS integrated dementia care. Results: By considering the RHS and CARITAS as whole networks each comprising of interacting and adaptive components instead of separate entities within a bigger system, the CAS provided a new mind-set in surfacing issues associated to the implementation of these integrated care networks. In addition to important actors, systems, it informed understanding of relationships and dependencies between different parts of the network – revealing the lack of homogeneity, conformity and difficulties in designing any optimal system in advance given the many moving parts. Conclusions: Drawing on the two examples of integrated care networks, this paper highlights the significance of effective collaboration built on a common focus, responsiveness to emergent behaviours, simple rules, the ability to self-organize and adapt in response to unexpected situations in further development of integrated care in the Singapore context and beyond

Digits in noise testing in a multilingual sample of Asian adults

DATA AVAILABILITY STATEMENT : Data not available due to ethical restrictions.OBJECTIVE : Appropriate speech-in noise assessment is challenging in multilingual populations. This study aimed to assess whether first preferred language affected performance on an English Digits-in-noise (DIN) test in the local Asian multilingual population, controlling for hearing threshold, age, sex, English fluency and educational status. A secondary aim was to determine the association between DIN test scores and hearing thresholds. DESIGN : English digit-triplets in noise testing and pure-tone audiometry were conducted. Multiple regression analysis was performed with DIN scores and hearing thresholds as dependent variables. Correlation analysis was performed between DIN-SRT and hearing thresholds. STUDY SAMPLE : 165 subjects from the Singapore Longitudinal Ageing Study, a population-based longitudinal study of community-dwellers over 55 years of age. RESULTS : Mean DIN speech reception threshold (DIN-SRT) was −5.7 dB SNR (SD 3.6; range 6.7 to −11.2). Better ear pure tone average and English fluency were significantly associated with DIN-SRT. CONCLUSIONS : DIN performance was independent of first preferred language in a multilingual ageing Singaporean population after adjusting for age, gender and education. Those with poorer English fluency had a significantly lower DIN-SRT score. The DIN test has the potential to provide a quick, uniform method of testing speech in noise in this multilingual population.The JurongHealth Research and Development Grant Award.http://www.tandfonline.com/loi/iija20hj2024Speech-Language Pathology and AudiologySDG-03:Good heatlh and well-bein

Nutrition, sarcopenia and frailty: an Asian perspective

Despite a growing body of evidence that nutrition plays a key role in the pathophysiology, prevention and intervention programs of frailty and sarcopenia, as well as in promoting brain health, the awareness and the need to study the relationship between nutrition and functional goals of healthy ageing have not received as much attention or support from research or policy makers. This review reports on the state of knowledge relating to availability of nutrition survey data for older people relating to prevalence of frailty and sarcopenia in Asia, using data from Netherlands for comparison. Data were obtained from a meeting of a group of nutrition experts from Asia supplemented by literature search using key terms of nutrition, frailty, and sarcopenia. Although nutrition surveys may be carried out regularly in several countries, surveys are mainly carried out for the general adult population rather than specifically among the elderly population, and little data is available relating to the impact of nutrition on sarcopenia and frailty. There is an urgent need for more nutritional data relating to maintaining function with age as opposed to disease prevention, to guide health promotion policies and clinical management of increasingly older population and patients. A shift in the gathering of national nutrition data may need to include such functional measurements in relation to older people, as the latter forms the rapidly growing sector of ageing populations world-wide

Peripheral hearing loss and its association with cognition among ethnic Chinese older adults

INTRODUCTION : Many studies on hearing loss (HL) and cognition are limited by subjective hearing assessments and verbally administered cognition tests, the majority of the document findings in Western populations. This study aimed to assess the association of HL with cognitive impairment among ethnic Chinese Singaporean older adults using visually presented cognitive tests. METHODS : The hearing of community- dwelling older adults was assessed using pure tone audiometry. Cognitive function was assessed using the Computerized Cambridge Cognitive Test Battery (CANTAB). Multiple regression analyses examined the association between hearing and cognitive function, adjusted for age, education, and gender. RESULTS : HL (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz in the better ear, BE4PTA) was associated with reduced performance in delayed matching and multitasking tasks (β = −0.25, p = 0.019, and β = 0.02, p = 0.023, respectively). Moderate to severe HL was associated with reduced performance in delayed matching and verbal recall memory tasks (β = −10.6, p = 0.019, and β = −0.28, p = 0.042). High-frequency HL was associated with reduced performance in the spatial working memory task (β = 0.004, p = 0.022). All-frequency HL was associated with reduced performance in spatial working memory and multitasking (β = 0.01, p = 0.040, and β = 0.02, p = 0.048). CONCLUSION : Similar to Western populations, HL among tonal language- speaking ethnic Chinese was associated with worse performance in tasks requiring working memory and executive function.Jurong Health Research and Development Fundhttps://www.karger.com/DEMam2022Speech-Language Pathology and Audiolog

Validation of the care transition measure in multi-ethnic South-East Asia in Singapore

10.1186/1472-6963-12-256BMC Health Services Research121

Influence of the type of carbohydrate breakfasts on metabolism and endurance running capacity in man

Compared to the overnight fasted state, a high carbohydrate (CHO) breakfast 3-4 hours before exercise enhances endurance performance. However, the optimal type or composition of the pre-exercise meal to be consumed is less clear. Glycaemic and insulinaemic responses to a meal play a key role in subsequent metabolism during exercise. The investigations described in this thesis focused on the influence of I) the composition and 2) glycaemic index (GI) of CHO breakfasts 3 hours before exercise on postprandial and exercise metabolism and endurance running capacity [continued]

The Longitudinal Effects of Caregiver Grief in Dementia and the Modifying Effects of Social Services: A Prospective Cohort Study

10.1111/jgs.16717Journal of the American Geriatrics Societ

Happy people live longer because they are healthy people

Abstract Objectives Higher levels of happiness are associated with longer life expectancy. Our study assessed the extent to which various factors explain the protective effect of happiness on all-cause mortality risk, and whether the association differs between older men and women. Methods Using data from the Singapore Longitudinal Aging Studies (N = 6073) of community-dwelling older adults aged ≥ 55 years, we analyzed the association of baseline Likert score of happiness (1 = very sad to 5 = very happy) and mortality from mean 11.7 years of follow up. Cox regression models were used to assess the extent to which confounding risk factors attenuated the hazard ratio of association in the whole sample and sex-stratified analyses. Results Happiness was significantly associated with lower mortality (p < .001) adjusted for age, sex and ethnicity: HR = 0.85 per integer score and HR = 0.57 for fairly-or-very happy versus fairly-or-very sad. The HR estimate (0.90 per integer score) was modestly attenuated (33.3%) in models that included socio-demographic and support, lifestyle or physical health and functioning factor, but remained statistically significant. The HR estimate (0.94 per integer score) was substantially attenuated (60%) and was insignificant in the model that included psychological health and functioning. Including all co-varying factors in the model resulted in statistically insignificant HR estimate (1.04 per integer score). Similar results were obtained for HR estimates for fairly-to-very happy versus fairly-to- very sad). Discussion Much of the association between happiness and increased life expectancy could be explained by socio-demographic, lifestyle, health and functioning factors, and especially psychological health and functioning factors

Physical Frailty and Cognitive Impairment is Associated with Diabetes and Adversely Impact Functional Status and Mortality

10.1080/00325481.2018.1491779Postgraduate Medicine1306561-56