The theoretical and empirical basis of a BioPsychoSocial (BPS) risk screener for detection of older people's health related needs, planning of community programs, and targeted care interventions.

BACKGROUND: This study introduces the conceptual basis and operational measure, of BioPyschoSocial (BPS) health and related risk to better understand how well older people are managing and to screen for risk status. The BPS Risk Screener is constructed to detect vulnerability at older ages, and seeks to measure dynamic processes that place equal emphasis on Psycho-emotional and Socio-interpersonal risks, as Bio-functional ones. We validate the proposed measure and describe its application to programming. METHODS: We undertook a quantitative cross-sectional, psychometric study with n = 1325 older Singaporeans, aged 60 and over. We adapted the EASYCare 2010 and Lubben Social Network Scale questionnaires to help determine the BPS domains using factor analysis from which we derive the BPS Risk Screener items. We then confirm its structure, and test the scoring system. The score is initially validated against self-reported general health then modelled against: number of falls; cognitive impairment; longstanding diseases; and further tested against service utilization (linked administrative data). RESULTS: Three B, P and S clusters are defined and identified and a BPS managing score ('doing' well, or 'some', 'many', and 'overwhelming problems') calculated such that the risk of problematic additive BPS effects, what we term health 'loads', are accounted for. Thirty-five items (factor loadings over 0.5) clustered into three distinct B, P, S domains and were found to be independently associated with self-reported health: B: 1.99 (1.64 to 2.41), P: 1.59 (1.28 to 1.98), S: 1.33 (1.10 to 1.60). The fit improved when combined into the managing score 2.33 (1.92 to 2.83, < 0.01). The score was associated with mounting risk for all outcomes. CONCLUSIONS: BPS domain structures, and the novel scoring system capturing dynamic BPS additive effects, which can combine to engender vulnerability, are validated through this analysis. The resulting tool helps render clients' risk status and related intervention needs transparent. Given its explicit and empirically supported attention to P and S risks, which have the potential to be more malleable than B ones, especially in the older old, this tool is designed to be change sensitive.

Families, friends, and the neighborhood of older adults: evidence from public housing in singapore.

Introduction. This empirical paper examines how the Housing Development Board (HDB) public housing neighborhood influences older urban Singaporeans' social interactions and ameliorates social isolation. Methods. Using 4,542 observations of noninstitutionalized urban adults aged 60 and above, ordered logistic regressions are run to determine the predictors of isolation while controlling for physical health and demographics. Results. 87% of older Singaporeans reside in public housing apartments while 13% reside in private market housing. The main predictor of social isolation is living alone and the second main predictor is coresidence with adult children. The relationship between coresidence with adult children and isolation is mediated when controlling for older adult functional limitations. The public apartment neighborhood and daily participation in public neighborhood events have substantial effects on reducing the risk of isolation. Older adult contact with friends alleviates isolation more than contact with non-coresiding relatives. Conclusion. Findings suggest that the public neighborhood-built environment in Singapore plays a positive role in the social interactions of the elderly. Knowledge of the factors that decrease the risk of social isolation will have implications for studying morbidity and mortality among the elderly.