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.

Symptom clusters of subjective cognitive decline amongst cognitively normal older persons and their utilities in predicting objective cognitive performance: structural equation modelling.

BACKGROUND AND PURPOSE: Prior literature on subjective cognitive decline (SCD) has mostly focused on memory complaints. It is uncertain whether the other non-memory complaints are equally relevant and can be used, alongside memory complaints, to identify populations at high risk of cognitive impairment. How the memory and non-memory complaints of SCD cluster with each other amongst community-dwelling individuals was investigated, and the differential utility of the symptom clusters of SCD in predicting objective cognitive performance was evaluated. METHODS: This study included 736 participants who were ≥60 years and had normal cognition, using the baseline data of an ongoing cohort study. Participants completed baseline assessments which comprised an SCD scale, a global cognitive measure and neuropsychological tests. Symptom clusters of SCD - as identified from exploratory and confirmatory factor analyses - were included in structural equation models to predict baseline changes in neuropsychological tests. RESULTS: The symptoms of SCD were split into two distinct factors, of which factor 1 was reported much more frequently than factor 2. Each standard deviation (SD) increment in factor 1 led to a 0.16-0.50 SD increase in global cognition, immediate memory, visuospatial abilities, language, attention and delayed memory (P < 0.05). In contrast, each SD increment in factor 2 worsened some of the cognitive domains by 0.18-0.37 SD. CONCLUSIONS: The various complaints of SCD can have different implications amongst cognitively normal older persons and may possibly be classified into age-related symptoms and pathological symptoms. The findings highlight the need for caution when selecting SCD measures, and illustrate the potential utility of SCD subtypes to inform on the underlying neurobiology.

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.

Depressive Symptoms Increase the Risk of Mild Neurocognitive Disorders among Elderly Chinese.

BACKGROUND: Depression is prevalent among patients with late life neurocognitive disorders but its role as an independent risk factor is not established. We aimed to examine the longitudinal relationship between depression and the incidence of mild neurocognitive disorders (NCD) in a Chinese population. METHODS: We analyzed data from 889 community-living Chinese elderly in the Singapore Longitudinal Aging Study (SLAS) cohort. All subjects were cognitively normal at baseline based on their performance on the Mini-Mental State Examination (MMSE). Depression was defined as total score of 5 or more on the 15-item Geriatric Depression Scale. Incident cases of mild NCD were ascertained at follow up after an average of 45 moths (range: 10-62). Odds ratios (OR) of associations were calculated in logistic regression models that adjusted for potential confounders. RESULTS: A total of 59 mild NCD cases were identified. Increased risk of mild NCD was observed for subjects who had depressive symptom at baseline (OR=2.56, 95%CI 1.17-5.60) after controlling for age, gender, education, hypertension, diabetes mellitus, heart disease, APOE genotype and length of follow-up. The interaction between depression and APOE genotype was not statistically significant. CONCLUSION: Depressive symptom was independently associated with increased risk of mild NCD among Chinese elderly. Effective management of late life depression may potentially reduce incident cases of NCD in the population.

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.

Association between Fish Intake and Depressive Symptoms among Community-living Older Chinese Adults in Singapore: A Cross-sectional Study.

OBJECTIVE: Our aim of this study was to investigate the association between fish consumption and depressive symptoms in senior ethnic Chinese residents of Singapore. DESIGN: A population-based cross-sectional study. SETTING: The Singapore Longitudinal Aging Studies (SLAS). PARTICIPANT: The study consisted of 2,034 participants from the Singapore Longitudinal Aging Studies (SLAS) project who were at least 55 years old. MEASUREMENTS: The presence of depressive symptoms was compared between those who self-reported eating fish at least three times a week versus those who ate fish less often. A score of 5 or greater on the 15-item Geriatric Depression Scale (GDS-15) was the cutoff for being designated as having depressive symptoms. RESULTS: Fish intake was associated with a lower prevalence of depressive symptoms ([odds ratio] OR = 0.60, 95% [confidence interval] CI 0.40-0.90; P = .015) after controlling for age, sex, marital status, housing, smoking, alcohol consumption, physical exercise, social and productive activities, self-rated health, hypertension, diabetes, heart failure or attack, stroke, fruit and vegetable intake, and Mini-Mental State Examination (MMSE) scores. CONCLUSION: Our results suggest that eating fish at least three times a week is associated with a lower odds of having depressive symptoms among Chinese adults over 55 years old living in Singapore.

Tea for Alzheimer Prevention.

The availability of empirical data from human studies in recent years have lend credence to the old axiomatic wisdom that health benefits of tea drinking extend to the area of cognition. Specifically, there is increasing interest as to whether tea drinking can delay or even prevent the onset of Alzheimer's disease (AD). Data from several cross-sectional studies have consistently shown that tea drinking is associated with better performance on cognitive tests. This association is supported by longitudinal data from the Singapore Longitudinal Aging Study, the Chinese Longitudinal Healthy Longevity Survey and the Cardiovascular Health Study. The only two published longitudinal analyses on clinical outcome reported conflicting results: one study reported that mid-life tea drinking was not associated with risk reduction of Alzheimer's disease in late life while the other one found that green tea consumption reduced the incidence of dementia or mild cognitive impairment. Two small trials from Korea and Japan reported encouraging but preliminary results. While the existing evidence precludes a definite conclusion as to whether tea drinking can be an effective and simple lifestyle preventive measure for AD, further research involving longer-term longitudinal studies and randomized controlled trials is clearly warranted to shed light on this topic of immense public health interest. Biological markers of tea consumption and Alzheimer diseases should be employed in future research to better delineate the underlying mechanisms of tea drinking's protective effect on cognition.

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.

Adjunctive mood stabilizer and benzodiazepine use in older Asian patients with schizophrenia, 2001-2009.

OBJECTIVE: This study surveyed the use of adjunctive mood stabilizers (MS) and benzodiazepines (BZD) in older Asian schizophrenia patients and examined their demographic and clinical correlates. METHOD: Information on hospitalized schizophrenia patients aged 55 years or more were extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study. A total of 1,452 patients from 9 Asian countries and territories was included in the study. The patients' sociodemographic and clinical characteristics and the prescriptions of antipsychotics, MS and BZD were recorded using a standardized protocol and data collection procedure. RESULTS: The frequency of MS prescription was 26.7% in the pooled sample, with 25.5% in 2001, 26.9% in 2004 and 27.7% in 2009. The corresponding figures for BZD were 20.7%, 20.2%, 18.4% and 23.1%, respectively. Multiple logistic regression analysis of the whole sample revealed that patients on MS were younger and more likely to be men and to have extrapyramidal side effects (EPS) and a longer duration of illness. Compared to patients in China, those in Japan were more likely to receive MS, while Korean patents were prescribed less MS. In contrast, there were no significant sociodemographic or clinical correlates of BZD use. Compared to patients in China, their Korean and Singaporean counterparts were more likely to be on BZD. CONCLUSIONS: The use of MS and BZD is not uncommon in older Asian patients with schizophrenia. Given the paucity of empirical data on the efficacy of these agents in individuals with schizophrenia of any age and concerns about added side effects in older patients in particular, the rationale for the prescription of these agents in this population warrants further examination.

Comparing the use of glycerol preserved and cryopreserved allogenic skin for the treatment of severe burns: differences in clinical outcomes and in vitro tissue viability.

Cryopreserved (CryoPA) and Glycerol-preserved (GPA) skin allografts are commonly used in the treatment of severe burn injuries. However, comparable data on their differences in clinical outcome is scarce. This retrospective review aims to study the effect of allograft viability on clinical outcomes. The records of 48 severe burn patients who either received CryoPA or GPA were reviewed. Key burn mortality determinants were used to match the 2 groups. Clinical outcomes such as mortality rate (MR) and the length of hospital stay (LOS) were obtained. A separate in vitro comparison included histological assessments and the use of tetrazolium reductase activity to compare tissue viability. Both groups showed a comparable profile in burn mortality determinants. Patients who received CryoPA had a lower MR of 25% compared to 34.8% (P=0.250) in the GPA group and a lower LOS of 39.2-45.9 days (P=0.730), respectively. The histological structural integrity was found to be well preserved with both methods although CryoPA was confirmed to be the more viable product (P<0.05). The lower MR associated with CryoPA cannot be totally ignored. However, the mechanism through which viable skin allografts improves MR of severe burns patients remains to be elucidated.

Antipsychotic polypharmacy in inpatients with schizophrenia in Asia (2001-2009).

OBJECTIVE: This study aimed to identify trends in the use of antipsychotic polypharmacy (APP) and their demographic and clinical correlates in the treatment of schizophrenia in Asia between 2001 and 2009. METHOD: A total of 6,761 schizophrenia inpatients in 9 Asian countries and territories were examined; 2,399 in 2001, 2,136 in 2004, and 2,226 in 2009. Patients' socio-demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS: The proportion of APP prescription decreased from 46.8 % in 2001, to 38.3 % in 2004, and increased to 43.4 % in 2009, with wide intercountry variations at each survey. Multiple logistic regression analysis of the whole sample revealed that patients on APP were younger, had a higher dose of antipsychotics in chlorpromazine equivalents, and more severe positive and negative symptoms. They were also more likely to receive depot and fi rst-generation antipsychotic drugs. CONCLUSIONS: The frequency of APP prescription varied between countries and territories, suggesting that a host of clinical and socio-cultural factors played a role in determining APP use in Asia. To resolve the discrepancy between treatment recommendation and clinical practice, regular reviews of prescription patterns are needed.

Tardive dyskinesia in the treatment of schizophrenia: the findings of the Research on Asian Psychotropic Prescription Pattern (REAP) survey (2001 - 2009).

OBJECTIVE: The aim of the study was to survey the frequency of tardive dyskinesia (TD) in patients with schizophrenia and its demographic and clinical correlates in selected Asian countries. METHOD: A total of 6,761 hospitalized schizophrenia patients in nine Asian countries and territories were examined from 2001 to 2009. TD was evaluated as "present" or "absent" according to the clinical judgment of experienced psychiatrists. The patients' socio-demographic and clinical characteristics and the prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS: The frequency of TD in the whole sample was 5.0% with wide variations between countries (0 - 14.9%). Multiple logistic regression analysis showed that the following variables were independently associated with TD: study time, study site, older age, male gender, more severe negative and extrapyramidal symptoms and less anticholinergic drugs. CONCLUSIONS: A generally low frequency of TD in Asian schizophrenia patients with inter-ethnic variations was recorded. It is unclear whether the low prevalence of TD compared with Western data is real or the result of it being insufficiently recognized.

Use of anticholinergic drugs in patients with schizophrenia in Asia from 2001 to 2009.

OBJECTIVE: The aim of this study was to survey the use of anticholinergic medication (ACM) in Asia between 2001 and 2009 and examine its demographic and clinical correlates. METHOD: A total of 6 761 hospitalized schizophrenia patients in 9 Asian countries and territories were examined between 2001 and 2009. The patients' socio-demographic and clinical characteristics and the prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS: The frequency of ACM prescription decreased from 66.3% in 2001, to 52.8% in 2004 and 54.6% in 2009, with wide inter-country variations at each time period. Multiple logistic regression analysis of the whole sample showed that patients taking ACM presented with more severe positive, negative, and extrapyramidal symptoms. They were also more likely to receive first-generation and depot antipsychotics and antipsychotic polypharmacy, and less likely to receive second-generation ones. CONCLUSIONS: The wide variation in ACM prescription across Asia suggests that a combination of clinical, social, economic and cultural factors play a role in determining the use of these drugs. Regular reviews of ACM use are desirable to reveal the discrepancy between treatment guidelines and clinical practice.

The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers.

Chronic recurrent ischial sores are an important cause of morbidity in paraplegics and geriatric patients. Compared to sacral and trochanteric ulcers, ischial sores are the most difficult to treat, with a low success rate following conservative therapy and a high recurrence rate after surgical treatment. We report the use of the pedicled anterolateral thigh (pALT) flap for reconstruction of a chronic ischial sore. The free ALT flap has an established role in reconstruction in the head and neck and extremities. However, there are few reports concerning its clinical applications for regional reconstruction. As a pedicled flap, it has been used in the primary reconstruction of the perineum, groin, anterior abdominal wall, thigh and ischium. We present the first reported case of a paraplegic man with a recurrent ischial sore treated successfully with an island pALT flap inset via a lateral subcutaneous approach. We discuss the indications and its role as a simple and reliable secondary reconstructive option in the treatment of recurrent ischial ulcers after first-line loco-regional surgical options have been exhausted.

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.

Interethnic differences in dementia epidemiology: global and Asia-Pacific perspectives.

The burden of dementia will continue to rise globally, particularly in developing countries, many of which lie in the Asia-Pacific region. It was initially thought that both prevalence and incidence of dementia showed little geographic variation. More recent work has suggested differences: migrant populations attain rates between their homelands and adopted countries, and higher rates have been found in African Americans and Hispanics compared to Caucasian Whites, and also among native Australians. The only interethnic studies in the Asia-Pacific region were performed in Singapore, which showed lower standardized prevalence among ethnic Chinese compared to ethnic Malays and Indians, independent of vascular risk factors. There was conflicting information about the relative frequencies of Alzheimer's disease and vascular dementia between ethnic groups in Singapore. More research, with careful attention to potential cultural confounders, is needed to further explore and better understand interethnic differences in dementia epidemiology.

The pursuit of thinness: an outcome study of anorexia nervosa.

INTRODUCTION: Anorexia nervosa (AN) is a growing problem among young female Singaporeans. We studied the demographics and follow-up data of AN patients referred to dietitians for nutritional intervention. METHODS: A retrospective nutritional notes review was done on 94 patients seen from 1992 to 2004. All patients were given nutritional intervention, which included individualised counselling for weight gain, personalised diet plan, correction of poor dietary intake and correction of perception towards healthy eating. We collected data on body mass index (BMI), patient demographics and outcome. RESULTS: 96 percent of the patients were female and 86.2 percent were Chinese. The median BMI at initial consultation was 14.7 kilogramme per square metre (range, 8.6-18.8 kilogramme per square metre). 76 percent were between 13 and 20 years old. 83 percent of the patients came back for follow-up appointments with the dietitians in addition to consultation with the psychiatrist. Overall, there was significant improvement in weight and BMI from an average 37 kg to 41 kg and 14.7 kilogramme per square metre to 16.4 kilogramme per square metre, respectively, between the fi rst and fi nal consultations (p-value is less than 0.001). The average duration of followup was about eight months. Among the patients on follow-up, 68 percent showed improvement with an average weight gain of 6 kg. Patients that improved had more outpatient follow-up sessions with the dietitians (4.2 consultations versus 1.6 consultations; p-value is less than 0.05), lower BMI at presentation (14.2 kilogramme per square metre versus 15.7 kilogramme per square metre; p-value is less than 0.01) and shorter duration of disease at presentation (one year versus three years; p-value is less than 0.05) compared with those who did not improve. Seven patients with the disease for more than two years did not show improvement with follow-up. CONCLUSION: We gained valuable understanding of the AN patients referred to our tertiary hospital for treatment, two-thirds of whom improved with adequate follow-up treatment. Patients that had suffered AN longer before seeking help appeared more resistant to improvement.

History of psychiatric education in Singapore.

Psychiatry was largely a forgotten discipline in the first 75 years of the medical school. In the last 2 decades, there has been steady progress in the extension of teaching time and clinical postings. The focus of psychiatric education has shifted from the mental institution to the general hospital and primary care. Psychiatric teaching emphasises not just clinical skills, but also, the importance of communication skills in the doctor-patient relationship.

High dose antipsychotic use in schizophrenia: findings of the REAP (research on east Asia psychotropic prescriptions) study.

BACKGROUND: High-dose antipsychotic regimes (defined as the prescription of more than 1000 chlorpromazine-equivalents milligrams of antipsychotic per day) in the management of patients with schizophrenia are not uncommon, but most reports are from western countries. Recent functional neuroimaging studies have found that the previous notion concerning the use of antipsychotic medication, especially in high doses, was unsupported and untenable. METHODS: This international study examined the use of high dose antipsychotic medication and its clinical correlates in schizophrenia patients within six East Asian countries/territories. RESULTS: Within the study group (n = 2399), 430 patients (17.9%) were prescribed high dose antipsychotics. Antipsychotic use varied significantly between countries, with Japan, Korea, and Singapore using higher doses than the other countries. High dose antipsychotic use was associated with younger age in Japan (p < 0.001), longer duration of admission (p < 0.001), duration of illness (p < 0.001, particularly in Korea and Taiwan), positive psychotic symptoms (p < 0.001, particularly in Japan and Korea), and aggression (p < 0.05, particularly in Japan), and also with a higher likelihood of extrapyramidal and autonomic adverse effects (p < 0.05, particularly in China). Country, younger age, the presence of delusions and disorganized speech, polypharmacy, and receiving depot medication but not atypical antipsychotic drugs were important predictors of high antipsychotic use. CONCLUSIONS: This survey revealed that high antipsychotic dosing is not an uncommon practice in East Asia. It behooves the prescribing clinicians to constantly reevaluate the rationale for such a practice.

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.