Research Themes

Health can no longer be considered merely the absence of disease. Health is a multidimensional concept including physical, social and environmental aspects. The Center will study health among the older adults in Singapore in order to understand and explain education, gender, and ethnic/cultural differences. Areas of particular interest include management of chronic disease, ageing, and frailty.

A large component of healthy ageing is having a positive outlook on life. Studies of centenarians have consistent reported that being positive is a fundamental psychological quality exhibited by the oldest-old. Mental well-being as a construct, is complex, comprising of various determinants from genetic predisposition to socio-economic factors, to social networks and support in the community, and society’s perception of older adults at large. Preventing poor mental health among older adults, through continued active engagement with families, neighbors and society, is a key goal globally. Providing psychiatric and psychological support services at the individual, family, and community levels are urgent and necessary. Existing data shows a non-trivial percentage of older adults who are socially isolated, and/or exhibiting depressive symptoms. Targeted interventions that are designed to include individuals, clinicians, family members and community services are needed in the Singapore context. The development of mental health services for the older population is not well developed in Singapore and largely confined to services provided by the Institute of Mental Health. Designing programs to improve mental health and proper evaluation of these programs would lend considerable weight to the government’s promotion of successful ageing.

Visual impairment is especially common in the older adults, typically resulting from one of four major age-related eye diseases: cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy. These conditions are ameliorable with appropriate identification and treatment. As demonstrated by major surveys in Singapore under Singapore Eye Research Institute (“SERI”) as well as Program of Health Services and Systems Research at Duke-NUS (“HSSR”), a large proportion of Singapore older adults are either unaware of their condition or are otherwise not receiving effective treatment. The value add of CARE is to move away from a disease centered approach to studying the impact of eye disease on the individual, families and the broader community. This would involve the use of design and technology and most importantly translation research on how to make existing technologies useful on the ground.

Cognitive impairment imposes significant burden on patients, caregivers, and the health and social systems more broadly. The Center will promote studies that focus on applying work at Duke-NUS and National Neuroscience Institute (“NNI”) to predict development and progression of cognitive impairment, and to develop new approaches to alleviate the negative consequences of the condition. For example, investigators at Duke-NUS have shown that sleep disturbances in older individuals can appear as cognitive impairment, suggesting that better identification and treatment may improve cognitive function. Local studies indicate that Asians are more susceptible than Caucasians to vascular dementia, which makes early screening and treatment of vascular risk even more urgent in our ageing population. In Singapore, the challenges of caring for elders with cognitive impairment have been shown to be especially difficult when the older care recipient also has behavioral disturbances; improvements in therapy, particularly non-pharmacological approaches such as cognitive behavioural therapy (“CBT”) that avoid the risks of commonly used medications, would make a huge impact on the well being of caregivers.  The value add of CARE is to work with NNI to examine the social impacts of neurocognitive disorders beyond the individual, focusing on families and communities.

The changing contexts of retirement transitions will be investigated. Potential projects under this subject include:

  1. Areas on how to facilitate work and nonpaid work for older adults and how the work environment , both in terms of its physical structures as well as processes can be made more amenable for older adults' continued involvement.
  2. Labour force decision making amongst older adults aged sixty and above
  3. Longitudinal study on the impact of retirement on the wellbeing of older adults

The Center will study LTC provided in the community, in homes, and by institutions, focusing particularly on the last year of life of the older adults.  Specifically, models for long-term care, strategies for financing, estimation of need and the evaluation of outcomes will be examined.

Caregiving is a pertinent issue that requires substantial research and policy attention.  Because of Singapore's decreasing fertility rate and Singapore's increasing female employment rete there are fewer family caregivers than in the past. Caregivers are under tremendous stress and understanding the determinants of caregiver stress is the key to alleviating caregiver burden. Existing studies on caregiver stress are based on Western data. Cultural expectations and Singapore's healthcare system may influence the prevalence and impact of caregiver stress on caregivers' mental and physical health.

Preliminary data suggests that a crucial issue to address for caregivers is the problem of behavioral features of care recipients with dementia (e.g., aggressiveness, wandering); we hypothesize that this is not only a major cause of negative responses to caregiving, but that effective social, behavioral and pharmaceutical interventions are underused in Singapore. This is a substantial issue for Singapore as the numbers of dementia patients are expected to quadruple by 2050. For example, a major concern among caregivers is how to keep their cognitively impaired elder safe in the home environment.

A second more general concern is caregiver burden for caregivers to older adults with at least one ADL. Preliminary data indicates that older caregivers (age 60 and above) report less depressive symptoms and stress compared to younger caregivers (under 60). This suggests an adaptation to the caregiver role which, if more fully understood could lead to interventions that alleviate the negative and enhance the positive aspects of caregiving (e.g., social support and educational programs).

1. The Center will study and evaluate new and innovative ways of delivering care with an emphasis on the home and keeping the older adults living in the community. This effort will take advantage of partnerships with voluntary welfare organizations and provider organizations, with the Center contributing directly to design and designing innovative analytic approaches for evaluation with the aim to inform and promote wider dissemination.

2. The Center will collaborate with other research institutions to study design strategies for housing, public spaces and infrastructure to encourage active ageing.

Care Research Projects

Summary of individual research project is provided below. If you wish to get more details or information, kindly email us at care@duke-nus.edu.sg

Panel on Ageing and Transitions in Health Survey (PATHS)

PATHS seeks to understand the patterns and determinants of successful ageing from a social and health perspective among Singaporeans in late mid-life (aged 50-59) with specific emphasis on work and retirement. The data collected will...

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Transitions in Health, Employment, Social Engagement and Intergenerational Transfers in Singapore Study (The SIGNS Study I and II)

THE SIGNS Study aims to understand patterns and determinants of successful ageing from a social and health perspective among older Singaporeans (aged 60 years and above). It is a longitudinal study comprising of two waves of data...

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Caregiving Transitions among family Caregivers of Elderly Singaporeans (TraCE)

The study aims to identify longitudinal patterns of health, work and caregiving-related outcomes among caregivers. It also aims to understand the impact of transiting into caregiving by ‘new’ caregivers.

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Caring for Persons with Dementia and their Caregivers in the Community: Towards a Sustainable Community Based Dementia Care System (Cognition)

This project is designed to  evaluate a new model of dementia care aimed to support persons with moderate and severe dementia and their caregivers  within the Whampoa community. Additionally this  project will also identify...

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Prescription Medication Label Improvement for Singaporean Elderly (PROMISE)

PROMISE aims to provide the evidence-base for developing and implementing easily understood, context and culturally-appropriate prescription medication labels for elderly Singaporeans. The translational significance of PROMISE includes...

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An Evaluation of the Care Close to Home Programme (C2H): Assessing the Impacts of Home Personal Care Services on Low-Income Older Adults in Singapore

The Care Close to Home (C2H) programme supports vulnerable older adults residing in public rental flats. Localised home-based care teams co-ordinate and provide basic clinical, personal and psychosocial support for enrolled clients. This...

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Generativity: Appreciation and Measurement Among Elderly Singaporeans (GAMES)

GAMES is a study to understand the meaning of generativity to older Singaporeans. The study comprises of two phases. Phase-I: provide empirical qualitative evidence of how elderly Singaporeans understand and enact generativity, defined ...

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We are Bonded (WAB)

The study evaluates an asset based intergenerational befriending programme with the aim of harnessing the intergenerational potentials for the development of local communities.

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Ageing Well in Asia Pacific: A study of Centenarians in Singapore and Sydney

This qualitative study aims to explore the lived experiences of centenarians living in two highly urbanized cities in Singapore and Sydney to investigate their self-perceived understandings of longevity and successful ageing.

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Qualitative Evaluation of the Integrated Home and Day Care (IHDC) Programme

From providers: To identify key elements driving effective and sustainable IHDC care delivery for mainstreaming taking into consideration manpower and financial constraints. From clients/ caregivers: Awareness and knowledge about IHDC,...

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Evaluating an Enhanced Community of Care (ECoC) model for high-risk older adults in public rental housing in Singapore: What works, why and for whom? [ECoC-WoW]

This study seeks to examine and measure the impact of implementing a integrated community care model that incorporates motivational-interviewing based health coaching to health and social care coordination, on improving psychosocial and...

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Steps to Avoid Falls in the Elderly: Translating Research into Practice (SAFE-TRIP)

The general aim of this study is to advance the innovative SAFE programme, a falls prevention programme that has been demonstrated in a randomised clinical trial in Singapore to improve outcomes and reduce costs for a significant...

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Care Affiliated Projects

Exploring the Dynamic Processes of Psychological Resilience and Physical Function Recovery of Elderly Hip Fracture Patients in Singapore

Hip fracture is a common consequence of falls and the annual cost of hip fractures is SGD$40 million in Singapore. The study aims to investigate the recovery trajectories of physical function after hip fracture among elderly patients...

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Designing Future-Ready and Sustainable Nursing Homes for Person-Centric Care Models in Communities: Social Perception Survey

In collaboration with NUS Architecture, School of Design and Environment, the study seeks to gain detailed insights into the physical environment, model of care and community perception of nursing homes in Singapore. 

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Oral Health of Older Adults with Mild Cognitive Impairment (MCI) – A Community Intervention

The study aims to investigate  the effects of a dental health program targeting mildly cognitive impaired individuals and their caregivers. The intervention protocol involves the provision of weekly training to mildly cognitively...

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Injury in the Over 55: Risk Factors and Determinants for Increased Healthcare Utilisation Post-Injury

The study is the first prospective cohort study of older Singaporeans hospitalised for injury related to the most common mechanisms of injury in Singapore: falls and motor vehicle injuries. The primary objective of the study  is to...

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International Longevity Centre (ILC) Project on “Health Effects of Retirement”

This is a comparative study of nine International Longevity Centre (ILC) country participants from Czech Republic, France, the Netherlands, Israel, United Kingdom, Argentina, Japan, South Africa and Singapore. The objective of the study is ...

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Household Budgets for Elderly People in Singapore

This study aimed to establish the minimum amount of money needed for the different types of elderly households to live in Singapore in order to assess the financial situations, evaluate the implications of policy development and design...

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Understanding the Social, Mental and Physical Health Predictors of Health Care Utilisation in Singapore

Health care utilisation is often a product of physical needs modified by social factors. This study aims to understand the different social mechanisms that influence health care utilisation in Singapore.

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Predictors and Consequences of Work-family Experiences: Study of Working Caregivers of Older Adults

This study examines the antecedents (e.g., filial piety, supervisor support) and outcomes (e.g., job performance, caregiving effectiveness, physical symptoms) of work-family experiences among working caregivers of older adults.

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Self-care for Older Persons (SCOPE) in Singapore: An Intervention Study

This randomized controlled trial recruited 378 older adults in Singapore to evaluate the effect of a self-care program on health measures.

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Assessing the impact of Enhanced Primary Care (EPC) services for people with chronic conditions in Singapore

The project aims to develop a health systems model that suggests various ways in which primary healthcare services can be organized in Singapore and policy levers thereof, for an ageing population with an increasing prevalence of chronic...

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COVID-19 Virtual Disease health System Outbreak model for Singapore (CoViD-SOS) Survey

This study aims to understand the impact of the  COVID-19 pandemic on healthcare utilization and unmet needs of medically vulnerable patients through multi-stakeholder interviews including medically vulnerable patients and healthcare...

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Completed Projects

Panel on Health and Ageing of Singaporean Elderly (PHASE) Waves 1

Wave 1 is also known as the Social Isolation, Health and Lifestyles Survey (SIHLS) (2009). Panel on Health and Ageing of Singaporean Elderly (PHASE) is a longitudinal panel study that aims to develop a profile of the changes in...

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Panel on Health and Ageing of Singaporean Elderly (PHASE) Wave 2

Specific Objectives 1. To capture the transitions of health and ageing of elderly Singaporeans. 2. To understand the role of life circumstances, health behaviours, psychological and social support environment in determining longevity,...

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Panel on Health and Ageing of Singaporean Elderly (PHASE) Wave 3

Wave 3 is also known as: Singapore Assessment for Frailty in Elderly – Building upon the Panel on Health and Ageing of Singaporean Elderly (SAFE-PHASE), 2015 Specific Objectives 1. To develop and validate a comprehensive frailty...

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Knowledge, Attitudes and Practices of Falls, Fall-Related Risk Factors and Fall Prevention Among Community-Dwelling Older and Middle-Aged Adults in Singapore (2017)

The aim of the Falls Study was to obtain a better understanding of the fall-related risk factors and fall prevention practices which is needed to guide more comprehensive fall policies and programmes. It also provides a relevant and...

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User Experience of Care Integration From Hospital to Home: Perspectives of Elderly Patients and Patient Navigators in the Chinatown Project (2017)

The qualitative aim of the Integrated Community of Care (ICOC) project is to assess and evaluate the extent to which an integrated community of care service has been implemented and the impact that this has on the quality of care provided...

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Qualitative Study on Coping Strategies and Caregiving Arrangements of Lower-Income Households with Dependent Elderly (2016)

(Principal investigator: A/P Thang Leng Leng, Department of Japanese Studies) The aim of this project is to explore the micro-social strategies of lower-income caregivers from a process-based approach that examines the motivations,...

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“Transitional Care” Programme Evaluation Study (2016)

With a rapidly aging population and increased prevalence of complex chronic diseases, hospitals in Singapore are experiencing very high bed-occupancy rates which interfere with the efficient delivery of acute care services. The...

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“Ageing-In-Place” Programme Evaluation Study (2016)

The Ageing in Place (AIP) programme is an intervention in the North of Singapore based on the concept of “integrated care” to address the needs of resource-intensive patients who have chronic conditions and complex social...

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A Longitudinal Study of Factors that Influence Use of Long-Term Care Services in Singapore (2016)

A Longitudinal Study of Factors that Influence Use of Long-Term Care Services in Singapore is a national survey, conducted in 2011 – 2012, of 1586 community-dwelling older Singaporeans who had been referred to a specific type of...

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Chin Swee Community Survey (2016)

This study was implemented to assess the needs of older adults living in one-room rental flats in Chin Swee. The results are being used to impact a transitional care program designed to increase access to community-based health services....

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Self-Care For Older Persons: An Intervention Study (SCOPE) (2015)

The Self-Care for Older People (SCOPE) study is a cluster randomised controlled trial in Singapore and was designed to evaluate the impact of a self-care program for chronic disease awareness and management of specific health measures and...

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An Evaluation of the National Silver Academy: Assessing the Benefits and Impact of Senior Learning in Singapore (NSA Study)

This project uses a mixed methods research design to examine the impact of older adults’ health, well-being and learning preferences  when they participate in courses under the NSA.

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