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Effect of Caregiving Relationship and Formal Long-Term Care Service Use on Caregiver Well-being.
Despite efforts to revise the traditional long-term care (LTC) model, informal caregivers continue to provide a substantial amount of support to older adults as front-line care providers. The present study aimed to understand the effect of informal caregiving on caregivers’ well-being in Singapore with respect to different types of patient-caregiver relationships. Second, this study examined the association between formal LTC service use and caregivers’ well-being.
Two waves of data for 781 dyads of patients with LTC needs and their caregivers from a longitudinal study were analyzed. Multilevel regression models were used to examine the association between caregivers’ well-being (self-rated general health, stress level and quality of life) and LTC service use among different patient-caregiver relationships.
Spousal caregivers reported significantly lower quality of life compared with adult children caregivers. Non-immediate family caregivers showed better overall well-being compared with spouse and adult children caregivers. Caregivers of patients referred to nursing homes reported higher levels of stress and poorer self-rated general health compared with caregivers of patients referred to community-based services. Spouse and non-immediate family caregivers of patients who utilized nursing home or home-based services presented poorer self-rated general health than caregivers of the patients who did not use any formal services.
Developing a better understanding of the associations between well-being and formal LTC service use for different types of patient-caregiver relationships is critical for policy makers and healthcare providers who aim to create holistic systems of care.Visit
Importance of social relationships in the association between sleep duration and cognitive function: Data from community-dwelling older Singaporeans
Aging is accompanied by cognitive decline that is escalated in older adults reporting extreme sleep duration. Social relationships can influence health outcomes and thus may qualify the association between sleep duration and cognitive function. The present study examines the moderating effects of marital status, household size, and social network with friends and relatives on the sleep–cognition association among older adults.
Data (N = 4,169) came from the Social Isolation, Health, and Lifestyles Survey, a nationally representative survey of community-dwelling older Singaporeans (≥ 60 years). Sleep duration and social relationships were self-reported. Cognitive function was assessed with the Short Portable Mental Status Questionnaire.
Regression analysis revealed that the inverted U-shaped association between sleep duration and cognitive function was less profound among older adults who were married (vs. unmarried) and those who had stronger (vs. weaker) social networks. In contrast, it was more prominent among individuals who had more (vs. fewer) household members.
Being married and having stronger social networks may buffer against the negative cognitive impact of extreme sleep duration. But larger household size might imply more stress for older persons, and therefore strengthen the sleep duration–cognitive function association. We discuss the potential biological underpinnings and the policy implications of the findings. Although our findings are based on a large sample, replication studies using objective measures of sleep duration and other cognitive measures are needed.Visit
Factors of nocturnal sleep and daytime nap durations in community-dwelling elderly: A longitudinal population-based study
Durations of nocturnal sleep and daytime nap influence the well-being of older adults. It is thus essential to understand their determinants. However, much previous research did not assess sleep duration and nap duration individually, and longitudinal data is lacking. This study aimed at examining the impact of demographic, psychosocial, and health factors, including ethnicity, social networks outside the household, smoking and physical exercise on sleep duration and nap duration among community-dwelling elderly.
Our study involved over 2,600 older adults (≥60 years) from a longitudinal, nationally representative survey – the Panel on Health and Ageing of Singaporean Elderly. Sleep and nap durations at Time 2 (two years later) were regressed on predictors measured at Time 1.
Time 2 short nocturnal sleep duration was predicted by Malay ethnicity (relative to Chinese and Indian), older age, lower education level, more depressive symptoms, and obesity, whereas future long nocturnal sleep duration was predicted by weaker social networks, older age, and more chronic diseases. Furthermore, smoking, obesity, Malay or Indian (relative to Chinese), older age, male gender, and cognitive impairment predicted longer daytime nap duration in the future.
Older adults’ nocturnal sleep and daytime nap durations may be affected by different demographic, psychosocial, and health factors. Thus, it is important to differentiate these two attributes in this age group.Visit
Caregiving-related needs of family caregivers of older Singaporeans
To describe the extent and correlates of caregiving-related needs among family caregivers of Singaporeans aged 75+ with ≥1 activity of daily living limitations (care-recipients).
National survey data of 1181 care-recipient/caregiver dyads were used. Caregiver’s report (yes/no) of 16 needs was assessed. Care-recipient and caregiver correlates of each need were determined through logistic regression analysis. Caregiving-related needs were expressed by 42.3% caregivers. The most commonly reported need was keeping care-recipient safe at home (24.5%). Needs concerned with caring for care-recipients were more frequent than those concerned with the caregiver’s own needs. The most frequent correlate was care-recipient’s extent of mood impairment (associated with 13 needs).
Caregivers should not neglect themselves when engaging in care provision. Families and service providers should explore whether reported lack of needs reflects limited awareness and/or under-reporting.Visit
Living Arrangements of Community-dwelling Older Singaporeans: Predictors and Consequences
In this paper, we examine predictors and consequences of living arrangements among community-dwelling older Singaporeans. We take a holistic approach and consider a range of social and economic as well as emotional and physical wellbeing indicators. Two waves (2009, 2011) of the Panel on Health and Ageing of Singaporean Elderly (PHASE) are analysed to (a) provide an overview of living arrangements in 2009 and assess the extent to which living arrangements change by 2011; (b) examine the predictors of living arrangements in 2009; and (c) examine the consequences of living arrangements over a two-year period. The majority (88%) of older Singaporeans co-reside with either their spouse and/or children. A small yet growing proportion live with others (5%) or live alone (6%).
Very little change in living arrangements is observed over the two years. Our results show that women, the oldest-old and older adults with fewer children are more likely to live alone. Older adults who live alone are not particularly disadvantaged compared to those who live with their spouse and children or spouse only in their social and economic wellbeing. It is, in fact, older adults who live with their children that are disadvantaged in many aspects of social, economic and mental wellbeing. Measures to engage older adults living with their families (along with those living alone and with others) in broader social activities are imperative.Visit
Validity and reliability of the Positive Aspects of Caregiving (PAC) scale and development of its shorter version (S-PAC) among family caregivers of older adults
To (a) assess the validity and reliability of the 9-item Positive Aspects of Caregiving (PAC) scale among a national sample of caregivers for older adults with functional limitations, (b) develop a shorter version (short-PAC [S-PAC] scale) and assess its psychometric properties, and (c) investigate both scales’ measurement equivalence/invariance (ME/I) across language of administration (Chinese/English/Malay).
For the 9-item PAC scale, the “original” 2-factor CFA model had a poor fit; its EFA and scale/item measurement properties supported a single factor. Among alternate CFA models, a bi-factor model (all nine items: first factor [overall PAC]; six items: second factor [self-affirmation]; three items: third factor [outlook-on-life]) had the best fit. The bi-factor CFA model also had a good fit for the S-PAC scale, developed after eliminating 2 items from the 9-item PAC scale. Both scales demonstrated convergent and divergent validity, and partial ME/I across language of administration.
Both the 9-item PAC and 7-item S-PAC scales can be used to assess positive feelings resulting from care provision among family caregivers of older adults with functional limitations.Visit
The role of a multicomponent home-health intervention in reducing caregiver stress in Singapore: A qualitative study
The relationship between caregiving and negative health outcomes is well established in the literature. Previous studies have shown that community-based programs reduce caregiver stress. However, the mechanisms by which this happens have not been well investigated. This qualitative study examines caregivers’ experiences as a part of the Aging-In-Place intervention, a home-health program in Singapore targeted at frequently hospitalized patients and their caregivers.
We interviewed 32 caregivers to study the underlying processes by which caregiver stress was ameliorated. Transcripts from semistructured interviews were analyzed thematically within the theoretical framework of the stress process model.
Primary stressors related to routine patient care were reduced through the intervention program that provided health monitoring to patients and facilitated linkages to community-based services. Increased access to advice and medical information provided by intervention staff reduced caregivers’ uncertainty, a substantial secondary stressor. Caregivers who employed a foreign domestic worker (FDW) gained additional reductions in both primary and secondary stressors.
The multidimensional home-health intervention reduced both primary and secondary stressors for caregivers. FDWs constituted a resource that caregivers could rely on and the training provided to FDWs by intervention staff further reduced caregiver stress. Implications for program planning and future research are discussed.Visit
Dental health status of community-dwelling older Singaporeans: Findings from a nationally representative survey
To assess the dental health status of older Singaporeans by age, gender and ethnicity. Poor dental health in elders has been linked to a number of adverse health conditions and is often associated with an increased risk of mortality in older people.
Data came from a nationally representative cross-sectional 2009 survey of community-dwelling Singaporeans aged 60 and over. The distribution of the number of natural teeth, chewing ability and the presence of dentures were assessed by age, gender and ethnicity (Chinese/Malay/Indian) using sampling weights.
With increasing age, there was a decrease in the average number of natural teeth, a decrease in the proportion of people with 20 or more natural teeth and with the strongest chewing ability, and an increase in the proportion that was edentulous or had dentures. Women, vs. men, had a lower average number of natural teeth (10.3 vs. 12.8), and they were more likely to be edentulous (37 vs. 24%) and to have dentures (73 vs. 63%). Across ethnic groups, Indians had the highest average number of natural teeth (17.0). However, among those who had dentures, Indians were the least likely to have the strongest chewing ability.
The findings demonstrated differences in dental health status by age, gender and ethnicity. They highlight the need for improvements in the dental health status of all older Singaporeans, especially older women. The data presented herein may serve as a baseline for policymakers to evaluate the impact of recent schemes launched by the Ministry of Health (Singapore) to subsidise dental treatment.Visit
Older nurses in Singapore: Factors associated with attitudes towards extending working life
We aim to determine associations between demographic variables, motivation to work, economic factors, work demands and organisational attitudes towards older workers and whether nurses want to extend working life. Singapore’s ageing workforce, coupled with the government’s enactment of re-employment legislation, calls for attention on older nurses’ concerns and views about working longer.
A cross-sectional survey with nurses aged 50 and above was conducted. Data from 355 respondents was analysed. Malay nurses were significantly less likely (OR 0.3, 95%CI 0.1–0.6) than Chinese nurses to want to work longer. Financing one’s retirement, societal trends in postponing retirement and physical capability to continue working were factors significantly associated with older nurses’ decisions to extend working life. Approximately 40% of older nurses in Singapore want to work up to and above age 65. Race, societal attitudes and economic factors contribute in older nurses’ decisions on retirement.
Given an ageing workforce and manpower shortage, it is important for nurse managers and higher authorities to devise strategies to keep nurses in the workforce as long as possible. This study highlights concerns and attitudes of older nurses towards extending working life, and could inform future planning of strategies to retain older nurses.
Fifteen Dimensions of Health and their Associations with Quality of Life among Elderly in Rural Villages in Maharashtra, (India)
Elderly health is a growing priority given growing older-adult populations worldwide. The present study aimed to identify factors that influence health and quality of life (QoL) specifically in rural-dwelling elderly Indians. A cross-sectional survey of 352 elders (=60y) from 10 villages near Pune, Maharashtra, India was conducted to measure the prevalence of 15 dimensions of health: vision, hearing, cognition, mental, social (generativity), physical activity, substance-use, physical-strength, independence in activities of daily living (ADL) and instrumental ADL (IADL), dental, nutrition, chronic-pain, sleep and safety (falls).
The researchers then examined the associations between these health dimensions and QoL using linear regression. It was found that in general, these elders were physically active (70%), independent and cognitively-intact (55%), however only a minority were free from problems relating to vision (33%), dental (45%), nutrition (30%), mental health (34%) and chronic pain (40%). Adjusted analysis revealed that higher QoL scores were associated with healthy status in seven dimensions: vision (β=4.9, p<0.001), hearing (β=3.5, p=0.003), sleep (β=4.1, p<0.001), dental (β=2.6, p=0.017), mental (β=2.1, p=0.048), independence in ADL (β=4.6, p=0.016) and social health (β=0.3, p<0.001). On the basis of these findings it may be concluded that to achieve comprehensive health and QoL in Elderlies, a proactive and diverse approach to optimizing all significant dimensions of health should be adopted. This is particularly important in rural areas where available medical resources may be limited when it comes to addressing elderly health decline.Visit