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

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]

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

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

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

10.1080/00325481.2018.1491779Postgraduate Medicine1306561-56

Mixed-method evaluation of CARITAS:a hospital-to-community model of integrated care for dementia

Objectives The capability and capacity of the primary and community care (PCC) sector for dementia in Singapore may be enhanced through better integration. Through a partnership involving a tertiary hospital and PCC providers, an integrated dementia care network (CARITAS: comprehensive, accessible, responsive, individualised, transdisciplinary, accountable and seamless) was implemented. The study evaluated the process and extent of integration within CARITAS. Design Triangulation mixed-methods design and analyses were employed to understand factors underpinning network mechanisms. Setting The study was conducted at a tertiary hospital in the northern region of Singapore. Participants We recruited participants who were involved in the conceptualisation, design, development and implementation of the CARITAS Programme from a tertiary hospital and PCC providers. Intervention We used the Rainbow Model of Integrated Care-Measurement Tool (RMIC-MT) to assess integration from managerial perspectives. RMIC-MT comprises eight dimensions that play interconnected roles on a macro-level, meso-level and micro-level. We administered RMIC-MT to healthcare providers and conducted in-depth interviews with key CARITAS stakeholders. Primary and secondary outcome measures We assessed integration scores across eight dimensions of the RMIC-MT and factors underpinning network mechanisms. Results Compared with other dimensions, functional integration (mechanisms by which information and management modalities are linked) achieved the lowest mean score of 55. Other dimensions (eg, clinical, professional and organisational integration) scored about 70. Presence of inspiring clinical leaders and tacit interdependencies among partners strengthened the network. However, the lack of structured documentation and a shared information-technology platform hindered functional integration. Conclusion CARITAS has reached maturity in micro-levels and meso-levels of integration, while macro-integration needs further development. Integration can be enhanced by assessing service gaps, increasing engagement with stakeholders and providing a shared communication system