The Healthy Ageing Questionnaire Index: Validation in the Singapore Longitudinal Ageing Study.

INTRODUCTION: Healthy ageing (HA) indices typically use full questionnaire, performance- or blood-based assessment of functional ability which are time-consuming and resource-intensive. We developed and validated a simple and brief Healthy Ageing Questionnaire (HAQ) index with comparable measurement accuracy. METHODS: The 15-item HAQ (scored 0-100) was developed using data of 500 participants in the Singapore Study of Successful Ageing (SSOSA), a sub-cohort of the Singapore Longitudinal Ageing Study (SLAS-2). Its construct, concurrent, and predictive validity were evaluated in 2,161 participants in the SLAS-2 who were non-participants of the SSOSA. RESULTS: The HAQ index (mean = 64.0, SD = 11.8) showed a coherent 3-factor structure (Cronbach's alpha = 0.735). HAQ scores were higher among participants who were female, highly educated, not living alone, non-smoking, non-alcohol drinkers, not at risk of malnutrition, were robust or pre-frail, not disabled, had no or <5 medical conditions, and no recent fall or hospitalization. It was positively correlated with Mini-Mental State Examination and life satisfaction, and negatively correlated with age, logMAR vision, 5 times sit-and-stand, and timed-up-and-go. The HAQ index was significantly correlated but showed modest concordance with the Rowe-Kahn SA index. Increasing HAQ index quintiles were associated with decreased mortality risks from 40.6 to 9.7 deaths per 1,000 person-years; covariate-adjusted hazard ratio for the highest Q5 levels (HAQ score >70) was 0.44 (95% CI = 0.28-0.67). Using receiver operating characteristics analysis of predictive accuracy for survival, the area under the curve of HAQ was 0.675, and Rowe-Kahn SA index was 0.660 (p = 0.361). CONCLUSION: The HAQ is a brief and accurate HA index that is potentially useful across diverse settings and purposes in research, healthcare, and policy-making.

Physiological and Cognitive Determinants of Gait Variability of Asian Population: The Yishun Study.

INTRODUCTION: Gait variability is associated with frailty, dementia, and falls. Studies on the association of physiological and cognitive factors with gait variability have seldom included middle-aged adults, even though these adults already experienced loss of muscular strength and postural stability. This study aimed a) to examine and compare the trend of gait variability in men and women, across the adult age spectrum, and b) to identify and compare the contributions of physiological and cognitive factors to gait variability. METHODS: This was a population-based cross-sectional study at a single center. A random sample of 507 community-dwelling, well-functioning adults aged 21-90 years were studied. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status. Physiological factors examined included visual contrast sensitivity (VCS), postural sway, hand reaction time, handgrip strength (HGS), knee extensor strength, and gait variability (coefficient of variation [CoV]). Multivariable regression models were used to examine the association between physiological and cognitive performance with gait CoV. RESULTS: Women walked with greater stride width CoV (p < 0.01) and double support time (DST) CoV (p < 0.01) than men. The stride width (p = 0.01) and DST variability (p = 0.03) were significantly higher in older men as compared to men in younger age-groups. Gait speed accounted for most of the gait CoV variances and attenuated the effects of physiological performance and/or attention cognition on most gait variability, except for CoV of DST and stride width. Adults with better VCS (ß = -0.19), faster hand reaction (ß = 0.12), and greater HGS (ß = -0.15) had lower variability in step length. CONCLUSION: The trends of stride width CoV and DST CoV across adult age spectrum were different between men and women. Greater stride width variability was partly attributed to greater HGS, possibly to better control lateral stability during walking. Physiological factors outweigh cognition in regulating most of the gait CoV in this study. They are modifiable and potential targets for healthy aging program.

Effects of Humanitude care on people with dementia and caregivers: A scoping review.

AIMS AND OBJECTIVES: This study aimed to comprehensively review the research literature to provide an overview of the effects of Humanitude on people with dementia and their caregivers. BACKGROUND: Humanitude is a relationship-centred and compassionate care approach that focuses on improving the communication between people with dementia and their caregivers. There is a lack of updated and comprehensive synthesis on the evidence of the effects of Humanitude in dementia care. DESIGN AND METHODS: This paper adopted the scoping review framework by Arksey and O'Malley. We searched through the following databases: Pubmed, CINAHL, EMBASE, PsycINFO, ProQuest, Scopus and Web of Science from its inception to 3 September 2021. Three investigators independently screened the titles and abstracts and assessed the full-text articles for eligibility. The PRISMA-ScR checklist was included in this scoping review. RESULTS: We retrieved 1317 articles from databases and grey sources. Eleven studies were included after the screening. The synthesised results suggest that Humanitude can reduce agitation and psychological symptoms and improve the general well-being of people with dementia. Humanitude also has positive effects in improving care communication, empathy, job satisfaction and reducing burnout among caregivers. CONCLUSION: Humanitude shows the potential for positive effects on people with dementia and their caregivers. However, most studies did not include a comparator group and could not provide rigorous findings as compared to randomised controlled trials. There is a need for randomised controlled studies to demonstrate the effectiveness of Humanitude on people with dementia and their caregivers. RELEVANCE FOR CLINICAL PRACTICE: This paper reviewed the literature on all types of publications that examine the use of Humanitude in people with dementia and their caregivers. Thus, it provided an up-to-date overview of the effects of Humanitude to inform clinical practice.

Adaptation and Validation of the Person-Centred Assessment Tool for the Acute Care Setting.

INTRODUCTION: Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. Despite this, PCC is not routinely assessed, and there is no validated tool for in the acute care setting. We aimed to validate the Person-Centred Assessment Tool (P-CAT) in an acute setting. METHODS: P-CAT was administered independently to a total of 161 nurses (n = 16, from a specialized dementia unit with PCC training; n = 116, geriatric wards; n = 30, medical/surgical wards). The word "residents" was replaced with "patients" in P-CAT. We employed confirmatory factor analysis with principal component extraction to verify the previously reported three- and two-factor solutions. A one-way between-groups ANOVA was then used to investigate group differences in the P-CAT score (total scale and subscale). RESULTS: Factor analysis revealed a two-factor solution (explained variance 42.28%): (i) extent of personalizing care and (ii) amount of organizational and environmental support. Out of the 13 items, only 2 items did not load as expected. The internal consistency reliability of the scale was satisfactory (Cronbach's α = 0.77). Nurses' P-CAT scores were significantly different across ward settings [Welch's F(2,37.20) = 13.01, p < 0.001, ω2 = 0.09], with the highest among those PCC trained. Post hoc analyses revealed a significant difference in mean subscale scores between PCC-trained nurses and nurses from the other two ward settings. P-CAT scores were not significantly correlated with age, r(159) = 0.01, p = 0.861, or with nursing experience, r(159) = 0.04, p = 0.615. DISCUSSION/CONCLUSION: P-CAT possesses adequate validity and reliability as a quantitative assessment tool of PCC in the acute care setting.

Cardiometabolic and Vascular Disease Factors and Mild Cognitive Impairment and Dementia.

INTRODUCTION: There is empirical evidence that cardiovascular risk factors and vascular pathology contribute to cognitive impairment and dementia. METHODS: We profiled cardiometabolic and vascular disease (CMVD) and CMVD burden in community-living older adults in the Singapore Longitudinal Ageing Study cohort and examined the association of CMVD risk markers with the prevalence and incidence of mild cognitive impairment (MCI) and dementia from a median 3.8 years of follow-up. RESULTS: Prevalent MCI and dementia, compared with normal cognition, was associated with higher proportions of persons with any CMVD, hypertension, diabetes, coronary heart disease, atrial fibrillation, or stroke. Diabetes, stroke, and the number of CMVD risk markers remained significantly associated with dementia or MCI after adjusting for age, sex, formal education level, APOE-ε4 genotype, and level of physical, social, or productive activities, with odds ratios ranging from 1.3 to 5.7. Among cognitively normal participants who were followed up, any CMVD risk factor, dyslipidemia, diabetes, or heart failure at baseline predicted incident MCI or its progression to dementia after adjusting for potential confounders. CONCLUSION: Older adults with higher burden of CMVD, driven especially by diabetes, are likely to increase the risk of prevalent and incident MCI and dementia.

Associations of low handgrip strength and hand laterality with cognitive function and functional mobility - the Yishun Study.

BACKGROUND: Emerging evidence suggest that in addition to low hand grip strength (HGS), HGS asymmetry is associated with declining cognitive and physical functions. We examined the associations of low HGS and asymmetry with cognitive function and functional mobility in older adults. METHODS: Cross-sectional data of 330 community-dwelling adults (55.2% women) aged ≥ 55 years included HGS, Repeated Battery for the Assessment of Neuropsychological Status (RBANS), and Timed-Up-and-Go (TUG). Low HGS was defined as < 28 kg for men and < 18 kg for women. Participants with HGS above 10% stronger on either hand were considered as having HGS asymmetry. Multiple linear regression models were adjusted for sociodemographic, smoking, education, comorbidity count, physical activity participation, obesity, self-rated health and hand dominance. RESULTS: Low HGS, but not asymmetry, was independently associated with lower functional mobility performance (ß = 1.3, 95%CI = 0.6,1.9), global cognitive function (ß = -10.4, 95%CI = -17.0,-3.8), immediate (ß = -2.6, 95%CI = -4.5,-0.7) and delayed (ß = -2.8, 95%CI = -5.0,-0.7) memory. Compared to normal and symmetric HGS participants, low HGS in combination with HGS asymmetry was associated with poorer language scores. In participants with normal HGS, asymmetric HGS was associated with slower TUG than corresponding groups with symmetric HGS. CONCLUSION: Low HGS, but not asymmetry, was associated with lower cognition and functional mobility. Associations of combined low HGS and asymmetry with cognitive and physical functions were driven by grip strength rather than asymmetry.

Person-Centred Dementia Care in an Acute Hospital: Experiences from Nurses Working in a Specialized Dementia Unit.

BACKGROUND: Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. However, the research focus has been in long-term care settings with less attention in acute hospitals. We aimed to study the perspectives and experiences of nurses implementing PCC in an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]). METHOD: This was an exploratory qualitative study involving individual, face-to-face, semi-structured in-depth interviews. A purposive sample of 10 nurses participated in the interview. We employed an inductive thematic analysis approach to analyse the qualitative data. RESULTS: The findings highlighted the positive experiences, for example, meaningful connection with patients and the challenges, for example, managing challenging behaviour in providing PCC. The initial challenges were due to a lack of prior knowledge and experience. Through formal and informal learning, the nurses built confidence and competence, and also provided support to one other. They emphasized the importance of teamwork and camaraderie in the CAMIE team but raised concerns about the negative perceptions of non-CAMIE nurses on the value of their work. CONCLUSION: Despite the challenges, adequate knowledge and robust organizational level support are the key support for nurses to embrace PCC as their care ethos in the acute care setting.

Physiological and Cognitive Determinants of Dual-Task Costs for Gait Parameters: The Yishun Study.

BACKGROUND: Studies indicate that physiological and cognitive aging are causally related and functionally interdependent. However, the relative contribution of physiological factors and cognition to dual-task costs (DTC) of gait parameters has not been well studied. In this cross-sectional study, we examined the trajectory of DTC of gait parameters across the adult age spectrum for both sexes and identified the contributions of physical and cognitive performance to DTC of gait. METHODS: A total of 492 community-dwelling adults, aged 21-90 years, were randomly recruited into the study. Participants were divided into 7 age groups, with 10-year age range for each group. Demographic data, height, body mass, education level, and information on comorbidities were recorded. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status. Physical performance included visual contrast sensitivity, postural sway, hand reaction time, handgrip strength, knee extensor strength, and single-task and dual-task gait assessments. Stepwise multivariable regression was used to examine the association between physical and cognitive performance with DTC of gait parameters. RESULTS: Women were found to have significantly higher DTC of gait speed (p = 0.01), cadence (p < 0.01), and double support time (p < 0.01) than men. However, significant aging effect on DTC of gait speed (p = 0.01), step length (p = 0.01), and double support time (p = 0.01) was observed in men but not in women. Immediate memory was the primary determinant for the DTC of gait speed (ß = -0.25, p < 0.01), step length (ß = -0.22, p < 0.01), and cadence (ß = -0.15, p = 0.03) in men. Besides immediate memory, postural sway (ß = -0.13, p = 0.03) and hand reaction (ß = 0.14, p = 0.02) were also significantly associated with DTC of step length and cadence, respectively, in women. CONCLUSION: There were sex differences in the amplitude and trajectories of DTC of gait parameters. The DTC increased with age in men but not in women. Immediate memory was the primary determinant of DTC of gait parameters in men while immediate memory, postural sway, and reaction time were associated with DTC of gait in women. Future studies should investigate the clinical implications of the sex differences in the DTC with fall risks.

Mapping modified Mini-Mental State Examination (MMSE) scores to dementia stages in a multi-ethnic Asian population.

ABSTRACTThe MMSE is used to screen for cognitive impairment and estimate dementia severity. In clinical settings, conventional cut-off scores have been used to distinguish between dementia stages. However, these scores have not been validated for different populations. This study maps scores from the modified version of the MMSE to dementia stages delineated by the Diagnostic and Statistical Manual of Mental Disorders-3rd revised edition (DSM-III-R), the Clinical Dementia Rating (CDR) and Functional Assessment Staging Test (FAST). We used cross-sectional data from a tertiary hospital memory clinic. Subjects were stratified into "primary education and below" (PE) or "secondary education and above" (SE). Receiving operating characteristic (ROC) analyses and Cohen's κ were performed to determine MMSE cut-off scores for dementia stages. Our derived cut-off scores were lower compared to the conventional scores. Scores also differed between subjects of different education levels. MMSE cut-off scores were 19, 15, and 9 for CDR stages 1, 2, and 3 respectively in PE subjects, and 23, 17, and 10 for SE subjects. Cut-off scores were comparable for staging by DSM-III-R Criteria and FAST. There is a need for locally derived stage-specific MMSE cut-off scores for the Asian population adjusted for education.

"I Can't Do This Alone": a study on foreign domestic workers providing long-term care for frail seniors at home.

ABSTRACTBackground:Foreign domestic workers (FDWs) play an important role in long-term caregiving of seniors at home. However, how FDWs cope with the caregiving demands, the dynamic interaction between familial and FDW caregivers and its impact on care recipients remain largely un-explored. Existing caregiver interventions mainly target familial caregivers; little assistance is available for FDW caregivers. This study explores FDWs' challenges, coping strategies, and the support they need in caring for seniors. METHODS: FDWs were recruited from a geriatric ward and outpatient clinic of a tertiary hospital in Singapore. Qualitative in-depth interviews were conducted with 25 FDWs caring for frail seniors and five healthcare staff. Interviews were transcribed and analyzed using thematic analysis. RESULTS: FDWs were from Indonesia, Philippines, and Myanmar. Nineteen cared for seniors with dementia (SWDs). We derived six subthemes, clustered into three salient themes: two described social support to FDWs by the senior's family members, two described their coping strategies, and two described their job satisfaction. Those who cared for SWDs faced more difficulties. We derived two family models of care: FDW-centered family dynamics, where family members rely on FDWs to perform most duties, causing poor impact on seniors' well-being and team-based family dynamics, where family members and FDWs share the caregiving burden, resulting in better impact on seniors' well-being. CONCLUSION: FDWs face significant challenges in eldercare. Improving FDWs' access to training courses in eldercare, providing them with more emotional support, engaging employers to create healthy caregiving spaces at home, and improving access to senior care services can be helpful.

Caregiving burden in foreign domestic workers caring for frail older adults in Singapore.

ABSTRACTBackground:Although foreign domestic workers (FDWs) play a significant role in caring for frail seniors in Singapore and are vulnerable to caregiving burden, there has been little research conducted hitherto. We explored caregiver burden and its determinants in this study. METHODS: FDWs (N = 221, Mage = 32.3, SD = 6.23) recruited from a hospital geriatric unit completed the Zarit Burden Interview (ZBI) administered in English, Bahasa Melayu, or Burmese. Univariate and multivariate regression were employed to investigate factors influencing caregiving burden in FDWs. RESULTS: Majority were Indonesians (60.0%), married (57.5%) with children (62.4%), with secondary-level education (59.7%), and providing care for >1 year (79.9%). Importantly, 25.1% reported physical health problems and 23.1% encountered language difficulties with employers. Univariate analysis revealed three significant factors associated with caregiving burden: nationality (p < 0.001), lack of privacy (p = 0.029), and caring for persons with dementia (PWD) (p = 0.001). On multivariate regression, FDWs who cared for PWD were 5.47 times (p = 0.013) more likely to experience burden, while FDWs who encountered language difficulties were 5.46 times (p = 0.030) more likely to experience burden. Filipinos FDWs were 9.73 times more likely to express burden (p < 0.001) compared to their Indonesian and Burmese counterparts. CONCLUSION: The study highlights caregiver burden in FDWs and potential ways to alleviate it by empowering FDWs with dementia-specific caregiving skills, providing language training opportunities, and supporting particular FDW ethnic groups with more emotional and practical help.

Unmarried patients with early cognitive impairment are more likely than their married counterparts to complete advance care plans.

BACKGROUND: Patients with early cognitive impairment (ECI) face the prospect of progressive cognitive decline that impairs their ability to make decisions on financial and personal matters. Advance care planning (ACP) is a process that facilitates decision making on future care and often includes identifying a proxy decision maker. This prospective study explores factors related to completion or non-completion of ACP in patients with ECI. METHODS: Patients with ECI (n = 158, M age = 76.2 ± 7.25 years) at a memory clinic received psycho-education and counseling on the importance of ACP and followed-up longitudinally for up to 12 months to ascertain if ACP had been completed. Univariate and logistic regression were used to analyze factors related to completion and non-completion of ACP. RESULTS: Seventy-seven patients (48.7%) were initially willing to consider ACP after the counseling and psycho-educational session but only 17 (11.0%) eventually completed ACP. On logistic regression, patients who were single were 8.9 times more likely to complete ACP than those who were married (p = 0.007). Among those initially willing to consider ACP, factors impeding completion of ACP included patient (48.0%), process (31.0%), and family factors (21.0%). CONCLUSIONS: As unmarried patients may not have immediate family members to depend on to make decisions, they may perceive ACP to be more important and relevant. Understanding the barriers to ACP completion can facilitate targeted interventions to improve the uptake of ACP.

Person-Centred Care Transformation in a Nursing Home for Residents with Dementia.

BACKGROUND: Conventional nursing homes in Singapore adopt an institutional and medical model of care with a focus on safety and risk management. As such, less regard is placed on upholding the dignity and autonomy of the resident, which compromises quality of care and the well-being of the resident. Today, person-centred care (PCC) has become synonymous with high-quality care that sustains the well-being and personhood of the care recipient. OBJECTIVES: To describe the model of PCC adopted by a nursing home, Apex Harmony Lodge (AHL), with a logic model and evaluate outcomes on residents' well-being, care quality, and staff attrition by comparing pre-PCC initiation (2015) to post-implementation (2016). METHODS: Male residents in a 30-bed assisted living facility for persons with dementia in AHL were assessed using Dementia Care Mapping. Residents' well-being and staff attrition were measured before and after PCC implementation. RESULTS: There were statistically significant improvements in resident well-being (Δ = 0.44, p = 0.029), Positive Engagement Potential (Δ = 0.17, p = 0.002), and Occupational Diversity (Δ = 0.12, p = 0.014) in 2016. Withdrawal and Passive Engagement in the residents were reduced significantly as were Care Detractors. There was also a 55% reduction in staff attrition rates post-PCC. CONCLUSIONS: Post-PCC implementation, the outcomes indicate a superior quality of care, enhanced resident well-being, and better staff retention. The AHL PCC model could serve as a roadmap for other nursing homes aspiring to raise the quality of care and influence long-term care standards and regulations for policy makers and legislators.

Performance-based IADL evaluation of older adults with cognitive impairment within a smart home: A feasibility study.

INTRODUCTION: Mild cognitive impairment (MCI) is characterized by subtle deficits that functional assessment via informant-report measures may not detect. Sensors can potentially detect deficits in everyday functioning in MCI. This study aims to establish feasibility and acceptability of using sensors in a smart home for performance-based assessments of two instrumental activities of daily living (IADLs). METHODS: Thirty-five older adults (>65 years) performed two IADL tasks in a smart home laboratory equipped with sensors and a web camera. Participants' cognitive states were determined using published criteria including measures of global cognition and comprehensive neuropsychological test batteries. Selected subtasks of the IADL assessment were autonomously captured by the sensors. Total time taken for each task and subtask were computed. A point scoring system captured accuracy and number of attempts. Acceptability of the smart home setup was assessed. RESULTS: Participants with MCI (n = 21) took longer to complete both tasks than participants with healthy cognition (HC; n = 14), with significant time differences observed only in "Cost calculation." Completion time for IADL tasks and scores correlated in the expected direction with global cognition. Over 95% of the participants found the smart home assessment acceptable and a positive experience. DISCUSSION: We demonstrated the feasibility and acceptability of the use of unobtrusive commercially available sensors in a smart home for facilitating parts of the objective assessment of IADL in older adults. Future studies need to identify more IADLs that are suitable for semi-automated or automated assessments through the use of simple, low-cost sensors.

Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial.

BACKGROUND: Cognitive training can improve cognition in healthy older adults. OBJECTIVE: The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. METHODS: A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]). RESULTS: A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=-0.57, P=.01, 95% CI [-1.00 to -0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=-13.5, P=.01, 95% CI [-23.95 to -3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [-0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=-0.36, P=.08, 95% CI [-0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [-0.05 to 0.96]) that were not statistically significant. CONCLUSIONS: CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities. TRIAL REGISTRATION: ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591.

90-Day Hospital Readmissions of Patients in a Geriatric Acute Care Ward in Singapore.

The objective of the study is to examine the 90-day readmission rate and identify the predictors for 90-day readmissions at a geriatric ward in a tertiary hospital in Singapore. A secondary analysis of case-control data was performed. Data of patients discharged from a geriatric ward between January 2015 and January 2016 were retrieved from an existing data set. Out of 564 index admissions involving older adults, the 90-day geriatric readmission rate was 10.1%. Activities of daily living dependency (odds ratio [OR]: 0.988, 95% confidence interval [CI]: [0.978, 0.999]) and living with the spouse (OR: 2.988, 95% CI: [1.388, 6.432]) were identified as significant predictors of 90-day geriatric readmissions. The study suggests that rehabilitation to restore the geriatric patient's ability to perform daily activities and adequate caregiver training for the spouse are essential in reducing geriatric readmissions. Also, postdischarge follow-up with both the patient and caregiver can greatly reduce the risk of readmission in geriatric patients.

Enablers and Barriers of a Cross-Cultural Geriatric Education Distance Training Programme: The Singapore-Uganda Experience.

BACKGROUND: By 2050, 80% of the world's older population will reside in developing countries. There is a need for culturally appropriate training programs to increase awareness of eldercare issues, promote knowledge of how to better allocate resources to geriatric services, and promulgate elder-friendly policies. A monthly distance geriatric education programme between a public hospital in Singapore and health institute in Uganda was implemented. This study explored the enablers and barriers to the delivery of culturally appropriate geriatric education programmes via a videoconferencing platform. METHODS: We conducted 12 in-depth interviews with six teachers from Singapore and six learners from Uganda. The interviews were audio-recorded, transcribed and analyzed using an inductive thematic approach to analysis with the aid of the NVivo software. RESULTS: Enablers included inter-personal real-time interactions between teachers and learners whereas misaligned perceptions of cross-cultural differences between Singaporean teachers and Ugandan learners were a barrier. Rapport building, teacher motivation and institutional support were perceived to contribute to the programme's sustainability. Overall, Ugandan learners perceived that the training improved knowledge, skills, attitude and practice of geriatric care. Participants suggested that future initiatives consider aligning cross-cultural perceptions between partners, conducting a training needs analysis, exploring complementary modes of information dissemination, and allotting time for more interaction, thereby reinforcing mutual sharing. Adequate publicity and appropriate incentivisation may also better sustain the programme. CONCLUSIONS: Our findings suggest that cross-cultural training via a videoconferencing platform was feasible. Our results inform planners of future distance educational programmes of how to improve standards of cross-cultural competency and forge promising international partnerships.

Reference Values of Gait Speed and Gait Spatiotemporal Parameters for a South East Asian Population: The Yishun Study.

BACKGROUND: Age-related slowing of gait has been reported to start as early as the fifth decade and accelerate beyond the seventh decade of life. A single cut-off for slow gait may not be appropriate for men and women of different ages. We aimed to report reference values for gait speed and spatiotemporal gait parameters of adult age groups in a South East Asian population. METHODS: A total of 507 community-dwelling adults, aged 21-90 years were recruited into the study through random sampling, filling quotas of 20-40 participants in each sex and age group (10-year age groups between 21 and 60 years; 5-year age groups beyond age 60 years). Demographic data, height, weight and information on comorbidities were recorded. Habitual gait speed and spatiotemporal parameters were measured, and the average of three trials was recorded using the GAITRite system. RESULTS: Gait speed peaked in their 40s for both men and women, but the trajectories differed slightly across age groups. Although similar for men in their 50s and 60s, gait speed was significantly slower among those aged 71 years and older. For women beyond 50 years old, gait slowed with age. After adjusting for height, women were found to walk significantly faster and with a longer step length than men. Women also walked with a significantly narrower stride width and less external rotation of the feet. The lowest quintile for gait speed in our study cohort was 0.9m/s, below the recommended cut-off of 1.0m/s. CONCLUSION: We established the reference values as well as the quintiles for gait speed and spatiotemporal gait parameters across adult age groups in a multi-ethnic Asian population. This contributes to a valuable database for gait assessment and evaluation of preventive or rehabilitative programs.

Orthostatic hypotension, hypotension and cognitive status: early comorbid markers of primary dementia?

OBJECTIVE: Few studies have explored the relationship between orthostatic hypotension (OH) and cognition. The aim of this study was to examine the association of OH with cognitive impairment and decline in a cohort of Chinese elderly, and its effect modification by blood pressure (BP) status at baseline. METHOD: Among 2,321 community-living older adults, free of cardiovascular disease and stroke, baseline BP measurements were used to determine the presence of OH and categorize participants as hypotensives, normotensives or hypertensives. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment (MMSE score <24). Cognitive decline (decrease in MMSE score by > or =1) was assessed from 1 to 2 years of follow-up for 1,347 participants without baseline cognitive impairment. RESULTS: Mean age of the subjects was 65.5 years and 381 (16.6%) showed OH. OH was not associated with cognitive impairment overall. However, among hypotensives, OH increased the odds of cognitive impairment (OR = 4.1, 95% CI = 1.11-15.1), while hypertensives with OH showed reduced odds of cognitive impairment (OR = 0.48, 95% CI = 0.26-0.90). Among cognitively intact participants, OH was not associated with cognitive decline overall or in BP subgroups. CONCLUSION: The increased risk of cognitive impairment in hypotensives with OH suggests that hypotension with OH may be an early comorbid marker of a primary incipient dementia.