CHI study: protocol for an observational cohort study on ageing and mental health in community-dwelling older adults.

INTRODUCTION: Ageing is associated with a multitude of healthcare issues including dementia, depression, frailty, morbidity associated with chronic disease and high healthcare utilisation. With Singapore's population projected to age significantly over the next two decades, it has become increasingly important to understand the disease burden and etiological process among older adults. The Community Health and Intergenerational study aims to holistically examine ageing in place by investigating the resilience and vulnerability factors of the ageing process in the biological, psychological and social domains within the environment. METHODS AND ANALYSIS: Using a cohort multiple randomised controlled trial design, comprehensive health profiles of community-dwelling older adults will be collected. The objective is to recruit 1000 participants (aged 60-99 years) living in the western region of Singapore within a period of 3 years (2018-2020). Assessments include basic sociodemographic, physical health and function (cardiac, oral and blood profiles and visual function), cognitive functioning, daily functioning, physical fitness, emotional state, free-flowing speech, sleep quality, social connectedness, caregiver burden, intergenerational communication, quality of life, life satisfaction, attitudes to ageing and gratitude and compassion. Results from the cohort will enable future studies to identify at-risk groups and develop interventions to improve the physical and mental health and quality of life of older adults. ETHICS AND DISSEMINATION: Approval of the cohort study by the National University of Singapore Institutional Review Board (NUS-IRB Reference code: H-17-047) was obtained on 12 October 2017. Written consent will be obtained from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local stakeholders.

Associations of Long-Term Tea Consumption with Depressive and Anxiety Symptoms in Community-Living Elderly: Findings from the Diet and Healthy Aging Study.

OBJECTIVE: To examine the association between long-term tea consumption and depressive and anxiety symptoms in community-living elderly. DESIGN: Community based cross-sectional study. SETTING: The Diet and Healthy Aging Study (DaHA), a prospective cohort study in Singapore. PARTICIPANTS: 614 elderly aged 60 years and above, who were free of dementia and cognitive impairment. MEASUREMENTS: Information on tea consumption was obtained through interviewer-administered questionnaire. Long-term tea drinking was defined as regular consumption for at least 15 years. Depressive and anxiety symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15) and the 20-item Geriatric Anxiety Inventory (GAI), respectively. A generalized structural equation model (gSEM) was applied to ascertain the association between long-term tea consumption and depressive and anxiety symptoms. RESULTS: About 59% of the subjects had consumed tea for over 15 years. Long term tea consumption was significantly associated with a reduced odds of having depressive and anxiety symptoms, after adjusting for demographics (i.e., age, gender, education and ethnicity), comorbid conditions (i.e., heart disease, diabetes, stroke, hypertension and hyperlipidaemia) and long-term coffee consumption. CONCLUSION: There was evidence suggesting that long-term tea consumption was associated with reduced depressive and anxiety symptoms among community-living elderly. This suggests that it is worthwhile to further investigate the role of tea's bioactive compounds in promoting mental health in aging.

Tea Consumption Reduces the Incidence of Neurocognitive Disorders: Findings from the Singapore Longitudinal Aging Study.

OBJECTIVES: To examine the relationships between tea consumption habits and incident neurocognitive disorders (NCD) and explore potential effect modification by gender and the apolipoprotein E (APOE) genotype. DESIGN: Population-based longitudinal study. SETTING: The Singapore Longitudinal Aging Study (SLAS). PARTICIPANTS: 957 community-living Chinese elderly who were cognitively intact at baseline. MEASUREMENTS: We collected tea consumption information at baseline from 2003 to 2005 and ascertained incident cases of neurocognitive disorders (NCD) from 2006 to 2010. Odds ratio (OR) of association were calculated in logistic regression models that adjusted for potential confounders. RESULTS: A total of 72 incident NCD cases were identified from the cohort. Tea intake was associated with lower risk of incident NCD, independent of other risk factors. Reduced NCD risk was observed for both green tea (OR=0.43) and black/oolong tea (OR=0.53) and appeared to be influenced by the changing of tea consumption habit at follow-up. Using consistent non-tea consumers as the reference, only consistent tea consumers had reduced risk of NCD (OR=0.39). Stratified analyses indicated that tea consumption was associated with reduced risk of NCD among females (OR=0.32) and APOE ε4 carriers (OR=0.14) but not males and non APOE ε4 carriers. CONCLUSION: Regular tea consumption was associated with lower risk of neurocognitive disorders among Chinese elderly. Gender and genetic factors could possibly modulate this association.

Tea drinking and cognitive function in oldest-old Chinese.

OBJECTIVE: We examined the longitudinal association between tea drinking frequency and cognitive function in a large sample of oldest-old Chinese. DESIGN: population-based longitudinal cohort study. SETTING: The Chinese Longitudinal Healthy Longevity Survey (CLHLS). PARTICIPANTS: 7139 participants aged 80 to 115 (mean age 91.4 years) who provided complete data at baseline (year 1998). MEASUREMENTS: Current frequency of tea drinking and past frequency at age 60 were ascertained at baseline, and baseline and follow-up cognitive assessments were performed in the years 1998 (n=7139), 2000 (n=4081), 2002 (n=2288) and 2005 (n=913) respectively. Verbal fluency test was used as measure of cognitive function. RESULTS: Tea drinking was associated at baseline with higher mean (SD) verbal fluency scores: daily=10.7 (6.6), occasional=9.2 (5.8), non-drinker=9.0 (5.5). In linear mixed effects model that adjusted for age, gender, years of schooling, physical exercise and activities score, the regression coefficient for daily drinking (at age 60) and occasional drinking was 0.72 (P<0.0001) and 0.41(P=0.01) respectively. Tea drinkers had higher verbal fluency scores throughout the follow-up period but concurrently had a steeper slope of cognitive decline as compared with non-drinkers (coefficient for the interaction term Time*Daily drinking= -0.12, P=0.02; "Time" was defined as the time interval from baseline to follow-up assessments in years). Similar results were found for current tea drinking status at study baseline year (1998) as predictor variable. CONCLUSION: Regular tea drinking is associated with better cognitive function in oldest-old Chinese.

Cognitive function and tea consumption in community dwelling older Chinese in Singapore.

OBJECTIVES: We aimed to examine the relationship between tea consumption and cognitive function in older adults. DESIGN: Cross-sectional study. SETTING: The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban Singapore. PARTICIPANTS: 716 Chinese adults aged > or = 55 years. MEASUREMENT: Self-reported current tea consumption habits (frequency and type). Cognitive performance was assessed by a battery of neuropsychological tests; composite domain scores on attention, memory, executive function, and information processing speed were computed using raw test scores. The Mini-Mental State Examination (MMSE) total score was used as a measure of global cognitive function. RESULTS: After adjusting for potential confounders, total tea consumption was independently associated with better performances on global cognition (B=0.055, SE=0.026, p=0.03), memory (B=0.031, SE=0.012, p=0.01), executive function (B=0.032, SE=0.012, p=0.009), and information processing speed (B=0.04, SE=0.014, p=0.001). Both black/oolong tea and green tea consumption were associated with better cognitive performance. There was no association between coffee consumption and cognitive function. CONCLUSIONS: Tea consumption was associated with better cognitive performance in community-living Chinese older adults. The protective effect of tea consumption on cognitive function was not limited to particular type of tea.

The use of Chinese herbal medicines and their correlates in Chinese older adults: the Singapore Chinese Longitudinal Aging Study.

BACKGROUND: There are very few studies of the use of Chinese herbal medicine and their psychosocial and health-related determinants in older adults. OBJECTIVES: To determine the prevalence of use of Chinese herbal medicine in community-living Chinese older adults in Singapore and its associations with socio-economic status, social support, health behaviour, health and functional status. DESIGN: Cross-sectional analyses of baseline data from a longitudinal cohort study of old adults (Singapore Chinese Longitudinal Aging Study). SETTING: Community of Toa Payoh in Singapore (total population 22800 out of 3 million). PARTICIPANTS: community residents comprising 2010 Chinese older adults aged 65 years and above. MEASUREMENTS: participants completed a questionnaire on Chinese herbal medicine use and other information on psychosocial and health-related variables. RESULTS: The use of Chinese herbal medicine over the past year was reported by 25.3% of the subjects, among whom 52% reported concurrent use of Western prescription medications. Significant factors that were strongly and independently associated with Chinese herbal medicine use were limited to extensive social support (OR = 2.66-5.56), current smoking (OR = 1.35), regular taiqi (OR = 1.94), arthritis (OR = 2.36), cancer (OR = 3.15), hypnotic use (OR = 2.08), IADL disability (OR = 1.72) and poor treatment compliance (OR = 2.35). CONCLUSION: Positive and negative psychosocial and health-related factors determine the use of Chinese herbal medicine use in Chinese older adults, consistent with the dual-pattern use of Chinese herbal medicine as health supplement and complementary/alternative medicine.

Spirit possession and healing among Chinese psychiatric patients.

This is a study of the illness behaviour of 100 Chinese psychiatric patients referred consecutively to the psychiatric unit of a general hospital in Singapore. More women than men felt that their illness was due to spirit possession; but belief in possession was not related to educational status. Thirty-six patients or their relatives had consulted a traditional healer before going to the hospital. Duration of illness, sex and educational status were not associated with the tendency to seek help from the traditional healer; there was also no significant difference between psychotic or neurotic patients. The majority of depressed patients (72%) presented with somatic complaints of chest discomfort, headache and abdominal discomfort. Somatization was not related to the educational level or sex of the patients.