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Prevalence of stroke, risk factors, disability and care needs in older adults in Singapore: results from the WiSE study.

ABSTRACT: OBJECTIVES:The aims of the present study were to establish the prevalence of stroke, and to explore the association between stroke prevalence and sociodemographic and health factors, disability, cognitive functioning and care needs among older adult residents in Singapore. SETTING:Data were drawn from the Well-being of the Singapore Elderly study-a cross-sectional epidemiological survey conducted from 2012 to 2013 on older adults living in Singapore. PARTICIPANTS:Participants were Singapore residents (citizens and permanent residents) 60 years and above who were living in Singapore during the survey period . Older adult residents who were institutionalised were also included in this study. Those who were not living in Singapore or who were not contactable were excluded from the study. The response rate was 65.6 % (2565/3913). A total population sample of 2562 participants completed the survey. Participants comprised 43.6% males and 56.4% females. The sample comprised 39.4% Chinese, 29.1% Malay, 30.1% Indian and 1.4% other ethnicities . PRIMARY AND SECONDARY OUTCOME MEASURES:History of stroke, along with other health and mental health conditions, disability and cognitive functioning, were determined by self-report. RESULTS:Weighted stroke prevalence was 7.6% among older adults aged 60 and above. At a multivariate level, Malay ethnicity (OR 0.41, p=0.012, 95%?CI 0.20 to 0.82), hypertension (OR 4.58, p=0.001, 95%?CI 1.84 to 11.40), heart trouble (OR 2.45, p=0.006, 95%?CI 1.30 to 4.63), diabetes (OR 2.60, p=0.001, 95%?CI 1.49 to 4.53) and dementia (OR 3.57, p=0.002, 95%?CI 1.57 to 8.12) were associated with stroke prevalence. CONCLUSIONS:Several findings of this study were consistent with previous reports. Given that Singapore's population is ageing rapidly, our findings may indicate the need to review existing support services for stroke survivors and their caregivers. Future research could investigate the association between various sociodemographic and health conditions and stroke prevalence to confirm some of the findings of this study.

SUBMITTER: Teh WL

PROVIDER: S-EPMC5875611 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Prevalence of stroke, risk factors, disability and care needs in older adults in Singapore: results from the WiSE study.

Teh Wen Lin WL Abdin Edimansyah E Vaingankar Janhavi Ajit JA Seow Esmond E Sagayadevan Vathsala V Shafie Saleha S Shahwan Shazana S Zhang Yunjue Y Chong Siow Ann SA Ng Li Ling LL Subramaniam Mythily M

BMJ open 20180328 3

<h4>Objectives</h4>The aims of the present study were to establish the prevalence of stroke, and to explore the association between stroke prevalence and sociodemographic and health factors, disability, cognitive functioning and care needs among older adult residents in Singapore.<h4>Setting</h4>Data were drawn from the Well-being of the Singapore Elderly study-a cross-sectional epidemiological survey conducted from 2012 to 2013 on older adults living in Singapore.<h4>Participants</h4>Participan ...[more]

PMID: 29599393

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Project description:Background Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore. Methods Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables. Results In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2–6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1–8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3–30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1–21.1) in the six-month period prior to the baseline and in subsequent 6 months (IRR: 3.3, 95%CI: 1.6–7.1; 6.4, 2.4–17.2; 5.8, 1.3–25.8; 13.1, 4.9–35.0; respectively), controlling for covariates. Conclusions Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6?months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.

Project description:BackgroundAdvance care planning (ACP) is becoming increasingly important in medical care. Some suggest standardized approaches to initiate ACP with all older adults. However, the idea of patient-centered care suggests more nuanced approaches tailored to individual older adults' needs. This study investigated how older adults with different views and needs about ACP can be approached in an adequate and most beneficial way by health care professionals.MethodsWe used questionnaires, interviews, focus groups and informal conversations with older adults, living in their own homes, who volunteered to take part in our research. The research was participatory as we collaborated closely with practice partners and we used the obtained findings immediately and continuously to inform the next steps of our research throughout the process.ResultsWe identified three subgroups of older adults with differential needs regarding ACP-related activities: The first group avoids talking about their needs and wishes for care towards the end of life. These older people benefit from activities, which aim at motivating them to concern themselves with ACP-related topics. The second group consists of older adults who are in principle open for ACP-conversations but do not initiate these themselves. This group either trusts their next-of-kin or their healthcare professional to act in accordance with their wishes or does not bring up the topic in order to avoid confronting relevant others with possibly unpleasant topics. This group of people benefits from information about ACP and from healthcare professionals initiating the ACP process. The third group of older people initiates the ACP process themselves, gathers information, and takes the necessary steps for ACP. With this group it remains relevant to check carefully whether they have indeed taken all relevant steps and shared the information with all relevant involved care institutions and relatives.ConclusionsWe propose a model to simplify adjustments of ACP to individuals' needs. Our suggested approach might contribute to increasing the motivation of older people to engage in ACP conversations if these are more closely related to their own needs. Further, it might also contribute to simplifying the individual shaping of the ACP process for healthcare professionals as our suggested model offers clear guidance for approaching different types of older people in different ways. The suggested approach may in future be used for training health care professionals in the conduct of ACP conversations.

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Prevalence of stroke, risk factors, disability and care needs in older adults in Singapore: results from the WiSE study.

Publications

Prevalence of stroke, risk factors, disability and care needs in older adults in Singapore: results from the WiSE study.

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