Positive aspects of caregiving among informal caregivers of persons with dementia in the Asian context: a qualitative study.

BACKGROUND: Positive aspects of caregiving are important coping resources for informal caregivers of persons with dementia (PWD). However, existing studies mostly focused on caregivers from western societies and less attention was paid to the potential cultural differences. This study aims to explore positive aspects of caregiving in the Asian context. METHODS: A qualitative methodology with semi-structured interviews was adopted. A total of 29 informal caregivers of PWD in Singapore were interviewed from Apr 2019 to Dec 2020. All the interviews were audio-recorded and transcribed verbatim for the analysis. Inductive thematic analysis was conducted. RESULTS: The results revealed a total of three major themes with 11 sub-themes including: 1) positive aspects within self (i.e., better understanding of dementia and caregiving, personal growth, role satisfaction, and improved awareness of self-care); 2) positive aspects between caregiver and PWD (i.e., chance to demonstrate filial piety towards PWD, happiness and positive attitudes of PWD, positive interactions with PWD, and closer relationships with PWD); and 3) positive aspects between caregiver and others (i.e., empathy towards other caregivers, befriending peers, and sharing dementia and caregiving knowledge with others). DISCUSSION: Findings from this study improved our understanding on positive aspects of caregiving among informal caregivers of PWD in the Asian context. In addition to similar themes across cultures such as personal growth, our study identified a few unique themes like improved awareness of self-care and chances to demonstrate filial piety. For future studies targeting Asian caregivers, it is necessary to include these cultural-specific positive aspects of caregiving.

The impact of having foreign domestic workers on informal caregivers of persons with dementia - findings from a multi-method research in Singapore.

BACKGROUND: Informal caregivers of persons with dementia (PWDs) sometimes engage foreign domestic workers (FDWs) to support their caregiving journey. However, there has not been much research to establish if this is really beneficial. The current study aims to investigate whether engaging FDWs specifically for caregiving of PWDs truly moderates caregiver stress and to explore caregivers' experiences of engaging FDWs. METHODS: A multi-method study design with a quantitative and qualitative sub-study was adopted. For the quantitative sub-study, 282 informal caregivers of PWDs were recruited. Propensity score matching analysis was used. For the qualitative sub-study, 15 informal caregivers with FDWs were interviewed. Inductive thematic analysis was conducted. RESULTS: The quantitative sub-study confirmed that engaging FDWs did moderate the depressive symptoms of informal dementia caregivers (marginal effect = -3.35, p = 0.0497). However, such support did not affect their caregiving burden, self-efficacy, and perceived positive aspects of caregiving. The qualitative sub-study suggested that engaging FDWs is an ambivalent experience, which entails both support and challenges. CONCLUSIONS: The current study confirmed previous research findings, that engaging FDWs moderated depressive symptoms among caregivers of PWDs, and it could be through their physical support such as in daily caregiving activities. Policy-makers may consider providing more subsidies to caregivers caring for PWDs with mobility issues to hire FDWs. They may also consider providing training to FDWs on dementia caregiving skills and improving the intake of such training as this might be helpful for both FDWs and caregivers during this journey.

Factors associated with caregiving self-efficacy among primary informal caregivers of persons with dementia in Singapore.

BACKGROUND: Informal caregivers of persons with dementia (PWD) are often associated with negative health outcomes. Self-efficacy in dementia caregiving has been reported to have protective effects on caregiver's health. This study aims to examine the factors associated with the domains of caregiving self-efficacy among informal caregivers in Singapore, a country with a rapidly aging population and a 10% prevalence of dementia among older adults. METHODS: Two hundred eighty-two informal caregivers were recruited and data including participant's caregiving self-efficacy, sociodemographic information, perceived social support, positive aspects of caregiving, knowledge of dementia, as well as behavioral and memory problems of care recipients were collected. A confirmatory factor analysis (CFA) was performed for the 3-factor model of the Revised Scale for Caregiving Self-Efficacy (RSCSE), and multiple linear regressions were conducted using the RSCSE subscales as dependent variables. RESULTS: Our CFA found that the RSCSE 3-factor model proposed by the original scale developer was an acceptable fit among informal caregivers in Singapore. Having established that the 3-factor model of the RSCSE was compatible among our sample, a series of multiple regressions were conducted using each of the factors as a dependent variable. Regressions revealed several factors that were significantly associated with caregiving self-efficacy. Importantly, outlook on life was positively associated to all 3 domains of the RSCSE, while social support was positively associated with self-efficacy in obtaining respite and controlling upsetting thoughts. CONCLUSION: The 3-factor model of the RSCSE was found to be an appropriate fit for our sample. Findings from this study elucidated important novel insights into the factors that influences caregiving self-efficacy amongst informal caregivers in Singapore. Crucially, caregivers' outlook on life and social support should be improved in order to enhance their caregiving self-efficacy.

The association between caregiver burden, distress, psychiatric morbidity and healthcare utilization among persons with dementia in Singapore.

BACKGROUND: Caregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity. The present paper examines how these are associated with healthcare utilization of the PWD in Singapore. METHODS: The data of 399 caregiver-PWD dyads were extracted from a national cross-sectional survey. PWD completed the Client Service Receipt Inventory, which provided information on their healthcare utilization (i.e. emergency service use, hospital admission, length of stay in hospital, and number of outpatient visits) within a frame of 3 months. The Zarit Burden Interview  (ZBI), Neuropsychiatric Inventory Questionnaire (NPI-Q), and Self Reporting Questionnaire (SRQ-20) were administered to caregivers. Information on severity of dementia, physical multimorbidity of the PWD, household composition, and caregivers' sociodemographic characteristics such as age, gender, and education were collected. Variables significantly associated with healthcare utilization in the univariate analyses were selected and included in the final regression models. Emergency service use and hospital admission were investigated using logistic regression analyses, whilst negative binomial models were utilized for length of stay in hospital and number of outpatient visits. RESULTS: After adjusting for significant correlates such as dementia severity and multimorbidity, only caregiver distress from responsive behaviours was positively associated with emergency room utilization, while caregiver burden was positively associated with length of hospital stay in the final regression model. Psychiatric morbidity was associated with healthcare utilization outcomes at the univariate level but did not reach statistical significance in final models. CONCLUSION: The study identifies caregiver variables associated with the healthcare utilization of PWD. Policy makers and healthcare professionals should provide interventions to ease burden and distress amongst caregivers of PWD.

Combining a variable-centered and a person-centered analytical approach to caregiving burden - a holistic approach.

BACKGROUND: Informal caregivers of persons with dementia often experience elevated levels of caregiving burden. However, existing studies tend to use a variable-centered approach to explore it. This study aims to understand the caregiving burden of informal caregivers of persons with dementia in Singapore through a combination of variable-centered and person-centered analytical approaches, and explore the correlates of identified factors and latent classes of caregiving burden. METHODS: Zarit Burden Interview was used to gauge the caregiving burden of 282 primary informal caregivers of persons with dementia recruited through convenience sampling in Singapore. Factor analysis and latent class analysis were conducted to identify the latent factors and the latent classes of Zarit Burden Interview, followed by multiple linear regression and multinomial logistic regression to explore their significant correlates. RESULTS: The analyses suggested a 17-item 3-factor structure for Zarit burden interview and three mutually exclusive caregiving burden classes. Regression analyses found that caregiving related variables especially care recipients' memory and behaviour problems were correlated with both the factors and latent classes of caregiving burden. CONCLUSIONS: The combination of these two approaches suggests that caregivers experiencing higher burden on one domain are likely to experience higher burden on the other two domains. This further supports the point that more attention should be given to caregivers who experience an overall high burden. Future research could explore the generalizability of our findings among caregivers elsewhere and explore the type of support needed by caregivers, especially those experiencing high burden.

Dementia knowledge and its demographic correlates amongst informal dementia caregivers in Singapore.

Objectives: The Dementia Knowledge Assessment Scale (DKAS) is a validated assessment tool to measure dementia knowledge. However, the factor structure of the DKAS has yet to be validated in Singapore. This study aims to investigate the DKAS factor structure amongst a sample of informal dementia caregivers in Singapore, as well as their sociodemographic correlates.Methods: A total of 282 participants were evaluated on their knowledge of dementia by an interviewer administering the DKAS. Confirmatory factor analysis (CFA) of factor models proposed by previous study yielded poor fit for our sample. Thus, an exploratory factor analysis (EFA) was conducted. Multiple linear regression was then performed to examine the sociodemographic correlates of DKAS factors.Results: EFA revealed a 23-item 3-factor model - 'misconceptions about dementia' (MD), 'caregiving considerations towards dementia' (CD) and 'dementia symptoms' (DS). Being a male caregiver and having lower educational levels were associated with poorer scores on MD and CD.Conclusion: A 3-factor model of the DKAS was found to be more appropriate with the sample in this study. Findings from this study suggests the need for more dementia literacy intervention for caregivers of dementia patients in Singapore, especially for male caregivers and those of lower education levels.

Behavioral and psychological symptoms of dementia: prevalence, symptom groups and their correlates in community-based older adults with dementia in Singapore.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

The correlates of slow gait and its relation with social network among older adults in Singapore.

OBJECTIVES: This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status. METHODS: Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample. RESULTS: The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score. CONCLUSION: Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

The relationship among unawareness of memory impairment, depression, and dementia in older adults with memory impairment in Singapore.

BACKGROUND: Previous research has studied the relationships among unawareness of memory impairment, depression, and dementia in older adults with severe dementia, but it has not considered the associations and clinical implications at earlier stages of memory impairment. This study therefore sought to examine the relationship among unawareness of memory impairment, depression, and dementia in older adults with memory impairment in Singapore. METHODS: The participants were 751 older adults with memory impairment in Singapore. They were assessed for objective and subjective memory loss, depression, and dementia severity. Participants' subjective memory loss was determined based on a self-appraisal question on memory, and their objective memory loss was calculated based on their performance on three cognitive tasks. Unawareness was assessed based on the contrast between subjective and objective memory loss. RESULTS: Descriptive statistics revealed a high prevalence of unawareness (80.4%). Logistic regression analysis revealed that gender and marital status were significantly associated with unawareness. Men (odds ratio (OR) = 2.5) and those who were divorced or separated (OR = 23.0) were more likely to be unaware than women and those who were married, respectively. After chronic conditions and demographic characteristics were controlled for, multivariate logistic regression analyses revealed that older adults with depression were less likely (OR = 0.2) to be unaware than those without depression. Unawareness was also related with dementia severity; older adults with questionable (OR = 0.3) and mild dementia (OR = 0.4) were less likely to be unaware than someone without dementia. CONCLUSION: Unawareness of memory impairment was common among older adults with memory impairment. However, unawareness may be the result of denial as a strategy for coping with memory loss of which the older adult is aware. Psychological care should be integrated into the overall treatment management of dementia to mitigate the possible risk of depression while increasing individual awareness of memory loss.

Care participation and burden among informal caregivers of older adults with care needs and associations with dementia.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Economic burden of multimorbidity among older adults: impact on healthcare and societal costs.

BACKGROUND: Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost. METHODS: The Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors. RESULTS: The prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75-84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and 'Other' ethnicity were significantly associated with higher total healthcare costs. CONCLUSION: Multimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.

Diagnosis of dementia by medical practitioners: a national study among older adults in Singapore.

OBJECTIVES: Dementia is inevitably associated with an ageing population which has tremendous public health, social and economic implications. Yet the extant evidence suggests that the diagnosis of dementia in general is neither timely nor accurate. The aim of this present study was to establish the prevalence of dementia as diagnosed by medical practitioners in Singapore and its associated factors. METHOD: The analysis is based on a national epidemiological study of older adults in Singapore which had established the prevalence of dementia using the 10/66 protocol. It was a community based survey, and face-to-face interviews were conducted with 2565 respondents (a response rate of 66%) and 2421 informants. RESULTS: In all, 3% of the respondents were diagnosed by a medical practitioner to have dementia of which 11.5% were diagnosed by general practitioners. Only 30.3% were prescribed medications specifically for dementia. Those with comorbid depression were more likely to be diagnosed to have dementia. CONCLUSION: The apparent low rate of diagnosis by medical practitioners is in line with studies done in the West. There is a need to elucidate the reasons underlying this under-diagnosis in order to better address this gap.

Evaluating a mobile-based intervention to promote the mental health of informal dementia caregivers in Singapore: Study protocol for a pilot two-armed randomised controlled trial.

BACKGROUND: Informal caregivers of persons with dementia (PWD) often suffer adverse impacts on their mental health and require interventions for effective support. As they are often occupied with providing care, web-based interventions could be more convenient and efficient for them. However, there is currently a dearth of evidence-based mobile interventions to enhance the mental well-being of dementia caregivers locally, especially ones that are user-centered and culturally relevant. Hence, having designed an app based on feedback from local dementia caregivers, this study will evaluate the effectiveness of this mobile app in promoting the mental health of informal caregivers of PWD in Singapore. METHODS: A pilot two-armed randomised controlled trial will be conducted on 60 informal caregivers of PWD recruited via convenience and snowball sampling. Thirty participants will be assigned to the intervention group, while another 30 will be in a waiting-list control group. Questionnaires will be administered at baseline and one month after, with the primary outcome being the difference in the change of depressive symptoms among the two groups. STATISTICAL ANALYSIS: Primary analyses will follow the intention-to-treat principle and compare changes from baseline to the one-month follow-up time point relative to the control group. A repeated measures ANOVA will be conducted to examine differences between the groups over time. SIGNIFICANCE: To our knowledge, this is the first study in Singapore that seeks to promote the mental health of informal dementia caregivers through a mobile-based intervention. The findings can inform the development and evaluation of future evidence-based digital interventions for local informal caregivers of PWD to address the gap in availability of such resources for them. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05551533). Registration date: September 22, 2022.

Coping Patterns Among Primary Informal Dementia Caregivers in Singapore and Its Impact on Caregivers-Implications of a Latent Class Analysis.

BACKGROUND AND OBJECTIVES: Existing studies typically explore the factor structure of coping strategies among dementia caregivers. However, this approach overlooks the fact that caregivers often use different coping strategies simultaneously. This study aims to explore the coping patterns of primary informal dementia caregivers in Singapore, examine their significant correlates, and investigate whether different patterns would affect the depressive symptoms of caregivers. RESEARCH DESIGN AND METHODS: Two hundred eighty-one primary informal caregivers of persons with dementia (PWD) were assessed. Coping strategies were measured by the Brief Coping Orientation to Problem Experienced inventory. A latent class analysis was performed to explore caregivers' coping patterns, followed by logistic regressions to identify the significant correlates and the relationships between coping patterns and caregiver depression. RESULTS: The latent class analysis suggested a three-class solution that was featured by the frequency and variety of coping strategies used by caregivers-high coping (36.3%), medium coping (37.7%), and low coping (26.0%). Factors influencing the coping patterns of our sample were mainly related to caregivers' individual resources such as personal characteristics and caregiving stressors like PWD's problematic behaviors and caregiving burden. Compared to caregivers in the low coping group, those in the medium coping group had significantly higher risks of potential depression. DISCUSSION AND IMPLICATIONS: The current study confirmed that there are distinct coping patterns among primary informal dementia caregivers, and caregivers with the low coping pattern had fewer depressive symptoms. Future research is needed to explore if coping patterns from our sample are generalizable to dementia caregivers elsewhere.

Strategies for the use of Ginkgo biloba extract, EGb 761® , in the treatment and management of mild cognitive impairment in Asia: Expert consensus.

BACKGROUND: Mild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761® , is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits. AIMS: To present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761® in MCI. MATERIALS & METHODS: The ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761® as a treatment option. RESULTS: EGb 761® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761® may help delay progression from MCI to dementia in some individuals. DISCUSSION: EGb 761® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761® may benefit MCI patients with underlying CVD. CONCLUSION: As an expert group, we suggest it is clinically appropriate to incorporate EGb 761® as part of the multidomain intervention for MCI.

Positive aspect of caregiving among primary informal dementia caregivers in Singapore.

BACKGROUND: The present study investigated the factor structure of positive aspects of caregiving (PAC) scale among primary informal caregivers providing care to persons with dementia (PWD) in Singapore. METHODS: 282 primary informal caregivers of PWD were recruited from the Institute of Mental Health, and Changi General Hospital and administered the 9-item PAC scale. A confirmatory factor analyses (CFA) was conducted to test the model fit of the 9-item PAC proposed by the scale developer and multiple linear regression was used to investigate the significant socio-demographic correlates. RESULTS: CFA showed that the 2-factor structure including 'Self-Affirmation' and 'Outlook on Life' had an acceptable model fit. After controlling for confounding variables, Malay caregivers were associated with higher scores on PAC and 'Self-Affirmation' compared to caregivers of other ethnicities. Caregivers with Secondary or below education level had higher PAC and 'Outlook on Life' scores. Caregivers who had received formal training scored higher in PAC, 'Self-Affirmation' and 'Outlook on Life'. DISCUSSION: The present study confirmed that the 2-factor structure of the 9-item PAC was suitable for informal caregivers of PWD in Singapore. The findings have important implications for locally available interventions to enhance caregiver's psychological well-being and reduce burden of care.

Person-centred creative dance intervention for persons with dementia living in the community in Singapore.

This paper examines the efficacy of the use of creative dance intervention for persons with mild to moderate dementia, living in the community. Pre- and post-intervention data were collected on the sample of 35 older people to track the impact of the intervention on the domains of function, quality of life and well-being and caregiving stress through the use of the gait speed test, CONFbal scale, Functional Independence Measure, Quality of Life-AD, Dementia Care Mapping and Zarit Burden Interview. There was an overall improvement in all the domains. Statistically significant improvement was found in the Quality of Life reports (p = 0.002) and well-being as measured by Dementia Care Mapping (p < 0.001). The findings assert the positive contributions of person-centred creative dance towards an approach and environment that promotes dementia care. Future studies on determining sustainability of such intervention are recommended.

Staging dementia based on caregiver reported patient symptoms: Implications from a latent class analysis.

BACKGROUND: Tailoring interventions to the needs of caregivers is an important feature of successful caregiver support programs. To improve cost-effectiveness, group tailoring based on the stage of dementia could be a good alternative. However, existing staging strategies mostly depend on trained professionals. OBJECTIVE: This study aims to stage dementia based on caregiver reported symptoms of persons with dementia. METHODS: Latent class analysis was used. The classes derived were then mapped with disease duration to define the stages. Logistic regression with receiver operating characteristic curve was used to generate the optimal cut-offs. RESULTS: Latent class analysis suggested a 4-class solution, these four classes were named as early (25.9%), mild (25.2%), moderate (16.7%) and severe stage (32.3%). The stages based on the cut-offs generated achieved an overall accuracy of 90.8% compared to stages derived from latent class analysis. CONCLUSION: The current study confirmed that caregiver reported patient symptoms could be used to classify persons with dementia into different stages. The new staging strategy is a good complement of existing dementia clinical assessment tools in terms of better supporting informal caregivers.

A Prospective Longitudinal Study of Caregivers of Community Dwelling Persons with Severe Dementia (PISCES): Study Protocol.

Although many persons with severe dementia (PWSDs) are cared for at home by their family caregivers, few studies have assessed end of life (EOL) care experiences of PWSDs. We present the protocol for the PISCES study (Panel study Investigating Status of Cognitively impaired Elderly in Singapore) which aims to describe the clinical course, health care utilization, and expenditures for community-dwelling PWSDs; and perceived burden, coping, resilience, anticipatory and prolonged grief among their caregivers. This ongoing multi-center prospective longitudinal study is recruiting primary informal caregivers of 250 PWSDs from major restructured public hospitals, community hospitals, home care foundations, and hospices in Singapore. Caregivers are surveyed every four months for two years or until the PWSD passes away and then at eight weeks and six months post-death to assess the bereavement of the caregiver. Survey questionnaires included validated tools to assess PWSDs' quality of life, suffering, behaviors, functional status, resource utilization; and caregiver's satisfaction with care, awareness of prognosis, care preferences, resilience, coping, perceived burden, distress, positive aspects of caregiving, anticipatory grief, and bereavement adjustment. We also conduct qualitative in-depth interviews with a sub-sample of caregivers. The survey data is being linked with medical and billing records of PWSDs. The study has been approved by an ethics board. Results from the study will be disseminated through publications and presentations targeting researchers, policy makers and clinicians interested in understanding and improving EOL care for PWSDs and their caregivers.

Successful ageing in Singapore: prevalence and correlates from a national survey of older adults.

INTRODUCTION: The current study aimed to estimate the overall prevalence and sociodemographic correlates of successful ageing, as defined by Rowe and Kahn, among a national sample of multiethnic adults aged 60 years and older in Singapore. METHODS: Data from older adults who participated in the Well-being of the Singapore Elderly study was analysed. Successful ageing was defined with five indicators: no major diseases; no disability; high cognitive functioning; high physical functioning; and active engagement with life. RESULTS: The prevalence of successful ageing was 25.4% in this older population. Older adults aged 75-84 years and ≥ 85 years had 0.3 times and 0.1 times the odds of successful ageing, respectively, than those aged 60-74 years. Compared to older adults of Chinese ethnicity, those of Malay (odds ratio [OR] 0.6) and Indian (OR 0.5) ethnicities were less likely to be associated with successful ageing. Older adults with lower education levels, who had no formal education (OR 0.2), some schooling but did not complete primary education (OR 0.4) or only primary education (OR 0.5), had lower odds of ageing successfully than those with tertiary education. CONCLUSION: Older adults in Singapore tend to have much more active engagement with life as compared to their counterparts from other countries. Further research into this population is needed, both in terms of qualitative research to gain a better understanding of successful ageing from the older adult's perspective, as well as longitudinal studies that explore behavioural determinants of successful ageing.