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Trajectories of positive aspects of caregiving among family caregivers of stroke-survivors: the differential impact of stroke-survivor disability
To delineate positive aspects of caregiving trajectories among family caregivers of stroke-survivors and determine the impact of stroke-survivor disability, a time-varying factor, on the delineated trajectories.
In a longitudinal study, family caregivers of 173 stroke-survivors in Singapore were administered the Positive Aspects of Caregiving scale (PAC scale) thrice (baseline/3 months/6 months). Group-based trajectory modeling delineated positive aspects of caregiving trajectories and identified the impact of stroke-survivor disability on the trajectories.
Two distinct positive aspects of caregiving trajectories, Persistently Low and Persistently High were delineated. Increase in stroke-survivor disability was associated with a significant downward shift (reduction in positive aspects of caregiving) of the Persistently Low trajectory and a significant upward shift (increase in positive aspects of caregiving) of the Persistently High trajectory. Older caregivers were more likely to follow the Persistently High trajectory.
Care professionals should be mindful of the heterogeneity in the longitudinal pattern of positive feelings resulting from care provision among family caregivers of stroke-survivors, and the differential impact of stroke-survivor disability on the pattern of positive feelings. Younger caregivers as well as family caregivers who have low positive feelings at the start of their caregiver journey and experience worsening functional disability of their care recipient (stroke-survivor) require greater attention and support.Visit
Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants
Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.
We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.
In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.
Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.Visit
Changes in nocturnal sleep and daytime nap durations predict all-cause mortality among older adults: the Panel on Health and Ageing of Singaporean Elderly
To determine the effects of changes in nocturnal sleep and daytime nap durations on all-cause mortality among older adults.
Two-thousand four-hundred forty-eight community-dwelling older Singaporeans (≥60 years) reported their nocturnal sleep and daytime nap durations at baseline (2009) and the 2-year follow-up. At each phase, they were grouped into the recommended (7–8 hours), short (≤6 hours), and long (≥9 hours) sleep duration categories, and the none (0 hour), short (≤1 hour), and long (>1 hour) nap duration categories. Cox regression analysis was conducted to quantify the associations of changes in sleep and nap durations over 2 years with all-cause mortality risk in the subsequent 4 years (till end of 2015). Multivariable fractional polynomial regression, which treated sleep and nap durations as continuous variables was conducted as a supplementary analysis.
Relative to individuals who had the recommended sleep durations at both baseline and follow-up, the risks of all-cause mortality were higher among older adults who reported considerable changes in sleep duration (from short to long sleep and vice versa, hazard ratio [HR] = 2.14–2.56). Furthermore, compared to those who did not nap at both time points, significantly higher mortality risks were found in individuals who showed any increase in nap duration (HR = 1.86–2.16), or reduced their nap from long to short duration (HR = 1.86). Supplementary analysis revealed similar findings.
In addition to the change in nocturnal sleep duration, change in daytime nap duration can also predict risks of all-cause mortality among older adults. It is crucial to track older adults’ sleep and nap durations longitudinally.Visit
Weak social networks and restless sleep interrelate through depressed mood among elderly
Sleep disturbance is common in late life. While social interaction is a basic human concern, few studies have explored the linkage between interpersonal relationships and sleep disturbance. The present study examines the reciprocal associations between weak social networks outside the household and sleep disturbance in elderly, as well as the underlying mechanisms.
We utilized data from a nationally representative longitudinal survey of community-dwelling elderly in Singapore (n = 1417; ≥ 60 years). Participants were assessed three times over 6 years (2009, 2011, 2015). Measures included strength of social networks outside the household, restless sleep (sleep disturbance), and the mediating variables of depressed mood, chronic diseases, and cognitive impairment. A cross-lagged mediation analysis was conducted.
Bootstrapping results showed that weaker social networks were related to more restless sleep via more depressed mood. Also, restless sleep was negatively associated with social networks through depressed mood. The other mediators examined were not significant.
Weak social networks and restless sleep reciprocally influence each other through depressed mood. Recognition of this interplay can inform efforts in improving elderly’s sleep quality, social networks, and psychological well-being.
Generativity Among Elderly in a Rural Area of Maharashtra, India: Correlates and Relationship With Quality of Life
Generativity, “a concern for others and a need to contribute something to the next generation,” is a dimension of successful aging in and of itself, but also predicts other positive health outcomes. We examine its manifestations and correlates among elderly in rural India and assess the association between generativity and quality of life (QoL). Three hundred and forty-eight rural Indian elderly completed an interviewer-assisted questionnaire assessing generativity, QoL, and other personal and familial factors. Regression models were used to examine potential correlates of generativity and the relationship between generativity and QoL. Higher education, inheritance income, more living children, and a son/daughter living in the home predicted higher levels of generativity. Higher levels of generativity were associated with higher QoL. There are both personal and familial correlates of generativity, and family relationships are important for generative development. Family-oriented interventions to increase generativity among elderly Indians could improve QoL.Visit
Association of loneliness and healthcare utilization among older adults in Singapore
To assess the association between loneliness and physician visits among community-dwelling older adults in Singapore.
We obtained data from two consecutive waves (2009 and 2011) of a nationally representative longitudinal survey of community-dwelling Singaporeans aged 60 years and older. Out of 3103 responses, we excluded proxy interviews (n = 365; 11.8 %), resulting in a final analysis cohort of 2738 respondents. Using the frequency of physician visits in the past 30 days as the dependent variable, we carried out negative binomial hurdle regression controlling for predisposing characteristics, enabling factors, needs, social capital and change in loneliness status between the two waves of the survey.
Approximately 23% of respondents suffered from chronic loneliness; a further 19% developed loneliness, whereas 33% recovered from loneliness by wave 2. Chronic (OR 0.76 ± 0.11) and recently-developed loneliness (OR 0.70 ± 0.10) were significantly associated with lower odds of physician visits, compared with being never lonely. Meanwhile, those who recovered from loneliness had the same odds of physician visits, but were associated with lower number of visits (−0.71 ± 0.27) if they did utilize their physicians.
The present study found a significant association between loneliness and lower odds of physician visits regardless of whether the loneliness was recently developed or chronic. In addition, respondents who had loneliness in the past also had a significantly lower number of visits to physicians compared with those who were never lonely. Further studies on the underlying behavior and the health consequences are warranted.Visit
Classification trees for identifying non-use of community-based long-term care services among older adults
Home- and center-based long-term care (LTC) services allow older adults to remain in the community while simultaneously helping caregivers cope with the stresses associated with providing care. Despite these benefits, the uptake of community-based LTC services among older adults remains low. We analyzed data from a longitudinal study in Singapore to identify the characteristics of individuals with referrals to home-based LTC services or day rehabilitation services at the time of hospital discharge. Classification and regression tree analysis was employed to identify combinations of clinical and sociodemographic characteristics of patients and their caregivers for individuals who did not take up their referred services. Patients’ level of limitation in activities of daily living (ADL) and caregivers’ ethnicity and educational level were the most distinguishing characteristics for identifying older adults who failed to take up their referred home-based services. For day rehabilitation services, patients’ level of ADL limitation, home size, age, and possession of a national medical savings account, as well as caregivers’ education level, and gender were significant factors influencing service uptake. Identifying subgroups of patients with high rates of non-use can help clinicians target individuals who are need of community-based LTC services but unlikely to engage in formal treatment.Visit
Examination of the Psychometric Properties of the Geriatric Fear of Falling Measure Among Community-Dwelling Older Adults in the United States
This current study investigated the construct validity and reliability of the Geriatric Fear of Falling Measure (GFFM) among community-dwelling older adults in the United States. Eighty-eight participants were assessed on the GFFM together with demographics, falls, and fear of falling and falls-efficacy measures at baseline and an 8-week follow-up visit. Cronbach’s alpha, regression analyses, and correlation analyses were used to examine the psychometric properties of the GFFM. The results showed that the GFFM demonstrated good construct validity and reliability among community-dwelling older adults in the United States. Our findings provide evidence for the validity and reliability of the GFFM. Further study with a larger and diverse sample is needed to determine whether the GFFM has potential as a quick screening tool of fear of falling in clinical settings.Visit
Bilingual Text With or Without Pictograms Improves Elderly Singaporeans’ Understanding of Prescription Medication Labels
In Singapore, primarily English-language prescription medication labels challenge elderly Singaporeans, many of whom are unable to read English. We investigated whether bilingual text and pictograms can help them understand prescription medication labels.
We randomized 1,414 elderly respondents of a national survey into four prescription medication labels: English-text; English-text-and-pictograms; Bilingual-text; and Bilingual-text-and-pictograms, which were similar except for the addition of another language and/or pictograms (International Pharmaceutical Federation, FIP). Respondents answered 16 label-related questions; an expert panel rated answers for correctness. Outcomes were (1) complete understanding (16 correct); (2) any understanding (≥1 correct); and (3) number of incorrect answers among those with any understanding. We evaluated associations of each prescription medication label (vs. English-text) with outcomes (1), (2), and (3) using logistic and negative binomial regression, respectively.
The elderly respondents were similar across the four prescription medication labels (English-text, English-text-and-pictograms, Bilingual-text, Bilingual-text-and-pictograms), for which the proportions with outcomes (1) and (2) were (17.9%, 25.6%, 36.9%, 40.1%) and (50.4%, 62.6%, 75.9%, 76.5%), respectively. We observed statistically significant higher odds of outcomes (1) and (2) among those assigned the three labels (vs. English-text): English-text-and-pictograms, 1.96 and 2.51; Bilingual-text, 3.54 and 6.73; and Bilingual-text-and-pictograms, 4.51 and 7.93. Those assigned the three labels also had 0.94, 1.98, and 2.12 fewer outcome (3) on average (vs. English-text).
Adding bilingual text with or without pictograms on prescription medication labels considerably improved elderly Singaporeans’ understanding of the labels, strongly suggesting its application in practice. Other issues in prescription medication labels design and content, including adapting FIP pictograms for elderly Singaporeans, warrant further investigation.Visit
Evaluating a novel Integrated Community of Care (ICoC) for patients from an urbanised low-income community in Singapore using the participatory action research (PAR) methodology: a study protocol
Poorer health outcomes and disproportionate healthcare use in socioeconomically disadvantaged patients is well established. However, there is sparse literature on effective integrated care interventions that specifically target these high-risk individuals. The Integrated Community of Care (ICoC) is a novel care model that integrates hospital-based transitional care with health and social care in the community for high-risk individuals living in socially deprived communities. This study aims to evaluate the effectiveness of the ICoC in reducing acute hospital use and investigate the implementation process and its effects on clinical outcomes using a mixed-methods participatory action research (PAR) approach.
This is a single-centre prospective, controlled, observational study performed in the SingHealth Regional Health System. A total of 250 eligible patients from an urbanised low-income community in Singapore will be enrolled during their index hospitalisation. Our PAR model combines two research components: quantitative and qualitative, at different phases of the intervention. Outcomes of acute hospital use and health-related quality of life are compared with controls, at 30 days and 1 year. The qualitative study aims at developing a more context-specific social ecological model of health behaviour. This model will identify how influences within one’s social environment: individual, interpersonal, organisational, community and policy factors affect people’s experiences and behaviours during care transitions from hospital to home. Knowledge on the operational aspects of ICoC will enrich our evidence-based strategies to understand the impact of the ICoC. The blending of qualitative and quantitative mixed methods recognises the dynamic implementation processes as well as the complex and evolving needs of community stakeholders in shaping outcomes.