Angelique Chan

Living arrangements, social networks and depressive symptoms among older men and women in Singapore

To examine the association of living arrangements and social networks outside the household with depressive symptoms among older men and women, ascertain if these relationships differ between older men and women, and investigate whether the association of living arrangements with depressive symptoms varies by strength of social networks.

CHANGES IN SUBJECTIVE AND OBJECTIVE MEASURES OF ECONOMIC WELL-BEING AND THEIR INTERRELATIONSHIP AMONG THE ELDERLY IN SINGAPORE AND TAIWAN

Cet article examine les changements de statut economique des personnes âgees de Singapour et de Taiwan et les determinants de ces changements. A travers cela, les AA. ont observe les niveaux et les changements operes dans les mesures subjectives et objectives du bien etre economique, et les associations entre ces deux types de mesures. Ils ont egalement cherche a savoir si certaines transitions telles que le veuvage, le decin de la sante ou la retraite, affectent chez ces personnes la perception du niveau de leur revenu

Does Support From Foreign Domestic Workers Decrease the Negative Impact of Informal Caregiving? Results From Singapore Survey on Informal Caregiving

OBJECTIVESnTo assess the instrumental support from a foreign domestic worker (FDW) as a moderator of the association of 4 types of impairments (physical function, memory, behavior, and mood) among older persons (OPs) with caregiving-related outcomes among their informal caregivers (CGs).nnnMETHODnData from a national survey of 1,190 Singaporeans aged 75 and older receiving human assistance for functional limitations and their CGs were used. Severity scores for the four OP impairments were calculated. A modified version of the Caregiver Reaction Assessment (CRA) assessed the impact of caregiving in four domains: disturbed schedule and poor health, lack of finances, lack of family support, and CG esteem. Linear regression models, one for each CRA domain, with interaction terms of the four impairment severity scores with FDW support, were developed.nnnRESULTSnFDW instrumental support, reported for 50% of the OPs, moderated the direct association of OP physical impairment with disturbed schedule and poor health (p = .009), OP memory impairment with disturbed schedule and poor health (p < .0001) and lack of finances (p = .02), and OP behavior impairment with lack of family support (p = .001). Although such support buffered the inverse association of OP behavior impairment with CG esteem (p = .01), it also buffered the positive association of OP mood impairment with CG esteem (p = .02).nnnDISCUSSIONnFDW support is associated with better caregiving outcomes. Given its aging population, the number of FDWs in Singapore is likely to increase as families try to cope with caregiving for their older members. This has policy implications for (a) immigration patterns into Singapore and (b) training of and support networks for FDWs.

Prevalence, awareness, treatment and control of hypertension in the elderly population of Singapore

A comprehensive picture of the management of hypertension in the increasing elderly population in Singapore is lacking. In this study, we assess the prevalence and correlates of hypertension and of awareness, treatment and control of hypertension among 4494 elderly Singaporeans (⩾60 years) participating in a recent representative survey. The weighted prevalences of hypertension (systolic blood pressure ⩾140u2009mmu2009Hg or diastolic blood pressure ⩾90u2009mmu2009Hg or current use of antihypertension medication) and of awareness, treatment and control of hypertension were assessed. We assessed the extent of association of these outcomes with socio-demographic (age, gender, ethnicity, education, housing type, living arrangement and social participation) and health (body mass, diabetes and cognitive status) variables using multivariable logistic regression. Nearly three-fourths (73.9%) of participants were found to have hypertension. Of this number, 30.8% were unaware that they had hypertension, 32.0% were not being treated for the disease and 75.9% had suboptimal control of their blood pressure. Among those aware of their hypertension, only 1.9% were untreated. However, nearly two-thirds (64.5%) of treated hypertensives had suboptimal control. Age, gender, ethnicity, education, housing type, body mass and diabetes were significantly correlated with lack of awareness, treatment and control of hypertension. Although the specific ‘at-risk’ subgroups varied by the outcome, men and Malays had consistently higher odds for all three unfavorable outcomes. There is a need to improve awareness, treatment and especially control of hypertension among elderly Singaporeans. Primary and secondary prevention efforts targeting the elderly and their primary health-care providers are called for, as are regular data collection efforts based on representative samples.

Depressive symptoms among informal caregivers of older adults: insights from the Singapore Survey on Informal Caregiving.

BACKGROUNDnThis paper determines care recipient and caregiver characteristics and caregiving dimensions - associated with depression among caregivers of older adults, using path analysis and assesses whether the identified path model differs between spousal and adult child caregivers.nnnMETHODSnData from 1,190 dyads comprising care recipients (community-dwelling adults aged ≥ 75 years with at least one activity of daily living (ADL) limitation) and caregivers (family member/friend most involved in providing care/ensuring provision of care to care recipient), who were interviewed through the Singapore Survey on Informal Caregiving (2010-2011), were used. Using path analysis, we assessed the direct and indirect associations between primary stressors (care recipients ADL and instrumental ADL status, and memory and behavior problems), caregiver health status, receipt of assistance from a foreign domestic worker/maid, amount of caregiving, negative reaction to caregiving, caregivers self-esteem, perceived emotional support, and caregiver depressive symptoms.nnnRESULTSnOur analysis showed that primary stressors, receipt of assistance from a foreign domestic worker/maid, perceived emotional support, and caregiver health status were directly or indirectly associated with caregiver depressive symptoms, and this association was mediated by negative reaction to caregiving. Caregiver self-esteem mediated the relationship between perceived emotional support and negative reaction to caregiving only among adult child caregivers.nnnCONCLUSIONSnThe results provide insights into factors associated with depressive symptoms among spousal and adult child caregivers, and help identify targeted interventions for improving caregiver mood.

Giving help in return: family reciprocity by older Singaporeans

ABSTRACT Reciprocity is a powerful principle in social ties. The ethos of family reciprocity is especially strong in Asian societies. We study contemporaneous family exchanges, hypothesising that the more current help older Singaporeans receive from family, the more they give in return. Cross-sectional analyses were undertaken of data from two national Singapore surveys conducted in 1995 and 1999. The help received by older people is measured by income and cash support, payment of household expenses by others, having a companion for away-from-home activities, and having a principal carer. The help given by older people is measured by baby-sitting, doing household chores, giving financial help to children, and advising on family matters. Multivariate models are used to examine the factors that affect an older persons ability and willingness to give help. The results show that the more financial support Singapore seniors received from kin, the more baby-sitting and chores they provided. In their swiftly modernising society, Singapore seniors are maintaining family reciprocity by giving time in return for money. We discuss how during the coming decades, reciprocity in Southeast and East Asian societies may shift from instrumental to more affective behaviours.

Prevalence and correlates of clinically significant depressive symptoms among elderly people in Sri Lanka: findings from a national survey.

BACKGROUNDnElderly Sri Lankans (11.2% of the nations population) have witnessed many years of ethnic conflict, a destructive tsunami and increasing emigration of young adults. However, very little is known about the prevalence and correlates of depression among them. The present study utilizes data from a national aging survey to document the prevalence and correlates of clinically significant depressive symptoms among community-dwelling elderly Sri Lankans (aged > or =60 years).nnnMETHODSnThe 15-item Geriatric Depression Scale (GDS-15) was administered to 1181 elderly Sri Lankans; the presence of clinically significant depressive symptoms was defined as a GDS-15 score of > or =6. Sociodemographic and health correlates of depressive symptoms were assessed using logistic regression analysis. Interactions between gender and other correlates were also assessed.nnnRESULTSnThe prevalence of depressive symptoms was observed to be 27.8% overall: 24.0% for men, and 30.8% for women. Certain subgroups of the elderly, i.e. those with disabilities, functional limitations, perceived income inadequacy, minorities, and elderly living alone, were significantly more likely to report depressive symptoms. There was a significant interaction between gender and ethnicity.nnnCONCLUSIONnThe prevalence of depressive symptoms among Sri Lankan elderly people is higher than that reported for most Asian countries. Clinicians and caregivers need to be aware of the potential presence of depressive symptoms among the elderly, especially among those with lower educational levels, functional limitations, hearing difficulty, physical disability, perceived income inadequacy, and among those who live alone, and ethnic minority males.

Management of allergic rhinitis: a common part of practice in primary care clinics.

Background:u2002 Allergic rhinitis (AR) is an extremely common disease worldwide and one of the top‐ten reasons for a visit to primary care clinics. This study aimed to investigate the understanding of current guidelines and concepts of management for AR among general practitioners (GPs) in Singapore.

Simulating the Impact of Long-Term Care Policy on Family Eldercare Hours

OBJECTIVEnTo understand the effect of current and future long-term care (LTC) policies on family eldercare hours for older adults (60xa0years of age and older) in Singapore.nnnDATA SOURCESnThe Social Isolation Health and Lifestyles Survey, the Survey on Informal Caregiving, and the Singapore Governments Ministry of Health and Department of Statistics.nnnSTUDY DESIGNnAn LTC Model was created using system dynamics methodology and parameterized using available reports and data as well as informal consultation with LTC experts.nnnPRINCIPAL FINDINGSnIn the absence of policy change, among the elderly living at home with limitations in their activities of daily living (ADLs), the proportion of those with greater ADL limitations will increase. In addition, by 2030, average family eldercare hours per week are projected to increase by 41 percent from 29 to 41xa0hours. All policy levers considered would moderate or significantly reduce family eldercare hours.nnnCONCLUSIONnSystem dynamics modeling was useful in providing policy makers with an overview of the levers available to them and in demonstrating the interdependence of policies and system components.

Validity and reliability of the Caregiver Reaction Assessment scale among primary informal caregivers for older persons in Singapore

Previous studies evaluating the validity and reliability of the Caregiver Reaction Assessment (CRA) scale (24 items; five subscales: schedule, health, finances, family support, and esteem) in different countries are not fully congruent. This article assesses the validity and reliability of the CRA among informal caregivers of older persons in Singapore. Data from a national survey of 1190 primary informal caregivers of Singaporeans aged ≥75 years with ≥1 activity of daily living limitation was analyzed. Fit of the five-factor model was tested in half of the sample using confirmatory factor analysis (CFA) and the other half subjected to exploratory factor analysis (EFA). The CRA was modified accordingly and again subjected to CFA. The CRAs measurement equivalence/invariance (ME/I) across language of administration (Chinese/English/Malay) was assessed. CFA showed a poor fit for the five-factor model. EFA suggested the presence of four factors, three items to have neither sufficient nor unique factor loadings and items on two of the subscales to load on a single factor. CFA of the ‘modified’ CRA (21 items; four subscales: schedule and health, finances, family support, and esteem) suggested a better fit for the four-factor model than for the five-factor model. ME/I analysis supported partial invariance of the CRA across language of administration. The CRA scale should be assessed for relevance in Asian settings. With the suggested modifications, it is suitable for assessing negative and positive effects of caregiving among informal caregivers of older persons with activity limitations in Singapore.