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This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore.
This analysis utilised data from the Singapore Mental Health Study (SMHS 2016).
SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents.
Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay.
The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency.
The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.
A beneficial environment is of utmost importance for the well-being of people with dementia. This environment comprises different aspects and levels. We start the chapter with a discussion on the importance of relationship-centred care, as a more holistic alternative to person-centred care. One way to put this concept into practice, is by using the ‘Senses Framework’. We continue with a description of how architecture can be favourable for people with dementia by taking them into account as social beings within their cultural context. In this way architecture is more about creating a proper environment for continuing daily activities and social interaction. We subsequently elaborate on dementia-friendly communities, where persons with dementia can navigate, feel safe and maintain their social networks. Singapore is used as a case study. Importantly, technology and the “virtual” environment is taking up more and more place in our existence, and expands our natural environment. This provides us with a whole new range of possibilities for assessment and assistance in dementia. We conclude with the example of nighttime agitation, where different aspects of the social and physical environment (architecture, care, technology) interrelate with this core symptom of dementia.
Older adults are among the most susceptible to sustain traumatic brain injury (TBI). The study aimed to determine the (1) prevalence of TBI among older adults in Singapore, and (2) socio-demographic, lifestyle, and clinical correlates of TBI.
Data were extracted from the cross-sectional, Well-being of the Singapore Elderly (WiSE) study. The study included 2,565 participants aged 60 years and above (Mean = 72.75, SD = 9.54). Information on TBI, socio-demographic, and lifestyle factors were collected using participant self-report and verified with the informant report where necessary. Disability was measured using the World Health Organization – Disability Assessment Schedule 2.0 (WHO-DAS 2.0). Data were analyzed using logistic regression analysis.
The prevalence of TBI was 3.6%. Being female (vs. male) was found to be associated with decreased odds of having TBI. Having completed secondary education or lower (vs. tertiary education) was found to be associated with increased odds of having TBI. A history of fainting and diabetes were associated with the presence of TBI. Those with TBI were associated with higher disability scores on the WHO-DAS 2.0 than those without TBI.
The current study provides information on the prevalence and associated factors of TBI in the older adult population in Singapore. Since TBI was associated with older adults with diabetes, they must be cautioned about fall risk. Also, given the association with disability, older adults with TBI are likely to require support and rehabilitative care to ensure good quality of life.
This study assessed the prevalence and factor structure of behavioral and psychological symptoms of dementia (BPSD) in a community-based sample of older adults with dementia and identified their correlates.
Data collected from 399 Singapore residents with dementia aged 60 years and above, interviewed along with a family/friend during a national survey, were used for this analysis. Neuropsychiatric Inventory Questionnaire assessed older adults’ BPSD. Other data included socio-demographics, dementia severity, cognition, chronic physical conditions, disability, and caregivers’ burden. Exploratory factor analysis assessed BPSD sub-groups, factor scores of which were used to identify socio-demographic, and clinical correlates.
Prevalence of BPSD was 67.9% and 30% of the population had experienced three or more BPSD in the past month. Two distinct and moderately correlated symptom groups representing “psychosis and behavior dysregulation” and “mood disturbance and restlessness” were identified. As factor scores for both the groups increased with older age, poor cognition and caregiver burden, the former was also related to being never married and having no formal education.
Study provides evidence of two distinct groups of BPSD and their important correlates. Clinicians treating BPSD should consider their age and cognitive impairment and be cognizant of their caregivers’ burden.
Psychotic symptoms are common among older adults and are seen in a wide range of conditions. Most studies examining the prevalence and correlates of psychotic symptoms among older adults have been conducted in Western populations. To address this gap the current study was undertaken to establish the prevalence and correlates of psychotic symptoms and paranoid ideation within a community sample of older adults without dementia in an Asian population.
The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. All respondents were assessed using the Geriatric Mental State examination (GMS). Specific questions of the GMS were then used to establish the prevalence of hallucinations and persecutory delusions.
A total of 2,565 respondents completed the study giving a response rate of 65.6%. The prevalence of any psychotic symptoms in this population of older adults was 5.2%. The odds of hallucinations and any psychotic symptoms were significantly higher among those of Malay ethnicity, and those who had no formal education. Older adults aged 75–84 years were significantly associated with lower odds of having hallucinations (vs. older adult aged 60–74 years), while homemaker status was significantly associated with lower odds of having any psychotic symptoms.
The prevalence of psychotic symptoms among older Asian adults without dementia was higher than that reported from Western countries. Psychotic symptoms were associated with Malay ethnicity, poor cognitive performance and fewer years of schooling, visual and hearing impairment as well as depression and irritability.
Few studies have estimated care burden in large, representative, multi-ethnic Asian population-based informal caregivers of older adults with care needs. This study describes informal caregivers’ care participation for a population-based sample of older adults with care needs in Singapore, investigates differences by dementia status, and examines correlates of caregivers’ burden.
Data collected from 693 pairs of older adults, aged 60 to 100 years, having any care needs, and their informal caregivers, who were aged 21 to 88 years, closely involved in their care and “knew the older resident best,” and were interviewed during a cross-sectional national survey, were used. Clinical characteristics of older adults, including behavioral and psychological symptoms of dementia (BPSD) and dementia diagnosis, care needs, and socio-demographic characteristics of participants were obtained. Care burden was assessed with the Zarit Burden Interview.
Informal caregivers’ participation was highest in activities related to communication (35.1%), feeding (32%), and bathing (21.1%). Among the older adults with any care need, 356 (51.4%) had dementia. Care burden was significantly associated with married caregivers (odds ratio (OR) 2.4 vs. never married), when their relative belonged to a younger cohort (OR 2.5 vs. >84 years), needed care much of the time (OR 2.5 vs. no care needed), exhibited BPSD (OR 3.5 vs. no BPSD), and had dementia (OR 2.52 vs. no dementia).
Factors related to older adults – more care needs, presence of BPSD, and dementia – were significant contributors to informal caregivers’ burden, and these should be considered while planning interventions to alleviate care burden.
The Singapore Mental Health Survey was undertaken to establish the prevalence of mental disorders in Singapore. This necessitated translation of several modules of the WHO's Composite International Diagnostic Interview (CIDI) into Bahasa Melayu. The aim in translation was to achieve a conceptually equivalent version to the original instrument. The translation procedure was a four-step process: 1) forward translation, 2) expert panel review, 3) pre-test and cognitive interview and 4) development of the final version. The translation procedure was effective in identifying and resolving translation problems, and adapting the language of the instrument to suit the local Malay-speaking population. We recommend this four-step process for future studies to attain a fair representation of minority groups in nation-wide studies.
This study aimed to explore the experiences and challenges of informal caregivers in Singapore with the intent of identifying the multi-dimensional unmet needs from their perspective and generating caregivers’ needs checklist based on the findings.
Informal caregivers were relatives of people with dementia and were responsible for organizing care and providing regular physical and/or financial support. Using a qualitative research design, informal caregivers’ experiences were explored. A total of ten focus group discussions and 12 semi-structured interviews were conducted with adult caregivers. Caregivers’ perceived unmet needs were identified using thematic analysis. Findings from the qualitative study were combined with inputs from professionals to create a checklist of caregivers’ needs for dementia.
The average age of the participants was 52.9 years; the majority of the participants were of Chinese ethnicity (50%), followed by Indian (23%), Malay (22%), and other (3%) ethnic groups. Informal caregivers perceived four categories of unmet needs: (i) emotional and social support, (ii) information, (iii) financial support, and (iv) accessible and appropriate facilities. Caregivers strongly expressed the need for emotional support to overcome the psychological and physical burden of care. Challenges with obtaining adequate information, access to services, and financial barriers were discussed. Based on these findings and expert panel discussions, a checklist of 26 items representing their unmet needs was designed.
Informal caregivers face several challenges while caring for their relative with dementia and hence there is a clear demand to address their unmet needs for information, services, respite, and emotional and financial support.
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