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, neighbours, 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.

Social engagement and resilience have been increasingly recognised as critically important concepts in understanding ageing as well as promoting successful ageing. Research in these areas, both local and international, are however still in beginning stages with much clarity needed across definitions, measures as well as applications. CARE aims to elucidate a clearer understanding of both these concepts for the local contexts, as well as more broadly through its collaborative research with other countries. Specifically, we are keen to explore how these concepts are defined, as well as the meanings that these concepts hold for older persons.

Active social engagement has been shown to be associated with better health and health outcomes across numerous studies. Definitions, measures and terminologies that have been used in these studies, however, have been varied and not wholly consistent. Some studies on social engagement have considered social participation, that is, the involvement in social activities; other studies have examined social networks, that is, the number of contacts with friends and relatives and membership of groups and organisations; and yet others have focused on social support, that is, the level of instrumental and emotional help available to an individual. CARE’s own work will attempt to elucidate the relevance of these different dimensions for older Singaporeans.

Resilience is widely cited as the potential or ability to “bounce back” from a disruptive event and it is used to refer to the capacity and resources for recovering from adverse events. In the context of individuals - from an illness, accident, loss of job, bereavement, or other disruptive life event; and in the context of communities or economies: from natural disasters, pandemics, or economic shocks. Understanding the factors that impact on resilience is highly relevant in informing the design of interventions for and with older persons.

Caregiving is a pertinent issue that requires substantial attention across research, policy and practice. Because of Singapore's decreasing fertility rate and increasing female employment rate, 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. Cultural expectations and Singapore's healthcare system may influence the prevalence and impact of caregiver stress on caregivers' mental and physical health. Much of existing studies on caregiver stress are based on Western data, hence there is a need for more local research on the subject.

Preliminary data suggests that a crucial issue to address for caregivers is the problem of behavioural features of care recipients with dementia (e.g., aggressiveness, wandering); we hypothesise that this is not only a major cause of negative responses to caregiving, but that effective social, behavioural 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 programmes).

The Centre 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 social service agencies and other provider organizations, with the Centre contributing directly to designing innovative analytic approaches for evaluation with the aim to inform and promote wider dissemination. The Centre will also collaborate with other research institutions to study design strategies for housing, public spaces, and infrastructure to encourage active ageing.