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.