scholarly journals THE IMPACT OF FUNCTIONAL DISABILITY ON HOSPITALIZATION SPENDING IN SINGAPORE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S837-S837
Author(s):  
Cynthia Chen
Keyword(s):  
Older Adults ◽  
Social Protection ◽  
Functional Disability ◽  
Financial Burden ◽  
Population Data ◽  
Lifestyle Changes ◽  
Health Study ◽  
Singapore Chinese ◽  
Adl Disability ◽  
The Impact

Abstract Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 older adults will have at least one ADL disability and 1 in 3 older adults will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.

scholarly journals SOCIAL COHESION AFFECTS THE ASSOCIATION BETWEEN FRAILTY AND DISABILITY IN COMMUNITY-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S782-S782
Author(s):  
Boqin Xie
Keyword(s):  
Older Adults ◽  
Social Cohesion ◽  
Functional Disability ◽  
Community Dwelling ◽  
Analysis Of Covariance ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Physical Frailty ◽  
The Impact ◽  
Community Dwelling Older Adults

Abstract The relationships between physical frailty and perceived neighborhood social cohesion (PNSC) and functional disability among community-dwelling older adults are poorly understood. This study aims to (1) examine the associations of frailty and PNSC with disability; and (2) evaluate low PNSC as a risk factor in the association between frailty and disability. A sample of 1645 older adults using multi-stage sampling method in Shanghai were randomly selected in this cross-sectional study. Frailty operationalized as Cardiovascular Health Study criteria (OR=2.4, 95%CI 1.16-4.96 for pre-frailty; OR=7.28, 95%CI 3.37-15.73 for frailty) and PNSC measured as Neighborhood Cohesion Scale (OR=1.81, 95%CI 1.23-2.67) were independently associated with basic and instrumental activities of daily living disability. A significant interaction of frailty and PNSC on disability (F (2, 66)=4.31, P=.014) was found, using a two-way analysis of covariance (ANCOVA). Compared to robust individuals with high PNSC, pre-frailty with high PNSC was not significantly associated with disability while pre-frailty with low PNSC was associated with approximate 4-fold increased prevalence of disability (OR=3.87, 95%CI 1.46-10.24, p=.006). Frailty with high PNSC was associated with higher likelihood of disability (OR=6.47, 95%CI 2.35-17.87) and frail individuals with low PNSC stood out with 10-fold increased prevalence of disability (OR=9.94, 95%CI 3.50-28.26). All analyses were controlled for demographical and clinical covariates. Our results suggest high level of social cohesion serves as a buffer against the impact of physical frailty on functional disability. These findings notably imply to the development of interventions for older frail adults from the neighborhood perspective.

scholarly journals Emergency Department Admissions Among Older Adults Living Alone With Multimorbidity

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 583-584
Author(s):  
Jon Barrenetxea ◽  
Cynthia Chen ◽  
Woon-Puay Koh ◽  
Feng Qiushi ◽  
Kelvin Bryan Tan ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Living Arrangements ◽  
Population Based ◽  
Living Alone ◽  
Health Study ◽  
Risk Of Mortality ◽  
Hospitalization Costs ◽  
Singapore Chinese ◽  
One Year

Abstract Older adults living alone are at higher risk of mortality, morbidity and healthcare utilization. As more older adults live alone, Emergency Department (ED) admissions could rapidly increase, particularly among those with multimorbidity. We studied the association of living alone on ED admissions among older adults with multimorbidity. We used data from 16,785 older adults of the population-based Singapore Chinese Health Study (mean age: 73 years, range: 61-96 years) who were interviewed in 2014-2016 for living arrangements and medical history. Participants were followed-up for one year on ED admission outcomes (number of admissions, inpatient days and hospitalization costs). We used multivariable logistic regression to study the association between living alone and ED admission, and ran two-part models (probit & generalised linear model) to estimate the association of living alone on inpatient days and hospitalization cost. We found that compared to living with others, living alone was associated with a higher odds of ED admissions [Odds Ratio (OR) 1.28, 95% Confidence Interval (CI) 1.08-1.51)], longer inpatient days (+0.61, 95% CI 0.25-0.97) and higher hospitalization costs (+322 USD, 95% CI 54-591). Compared to those living with others without multimorbidity, living alone with multimorbidity was associated with higher odds of ED admission (OR 1.64 95% CI 1.33-2.03), longer inpatient days (+0.73, 95% CI 0.29-1.17) and higher hospitalization costs (+567 USD, 95% CI 230-906). In conclusion, living alone is associated with higher odds of ED admission, longer inpatient days and higher hospitalization costs among older adults, particularly among those with multimorbidity.

scholarly journals Factors Associated With Social Isolation Among Older Adults: The Singapore Chinese Health Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 168-168
Author(s):  
Jon Barrenetxea ◽  
Yang Yi ◽  
Woon Puay Koh ◽  
Feng Qiushi
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Social Isolation ◽  
Well Being ◽  
Population Based ◽  
Living Alone ◽  
Health Study ◽  
Factors Associated ◽  
Singapore Chinese

Abstract Social isolation is a determinant of mortality and well-being among older people. Factors associated with isolation could be different in societies where older adults live mainly with family, as individuals might feel isolated despite living with others. We studied the factors associated with isolation among 16,948 older adults from follow-up 3 of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age of 73, range: 61-96 years). We defined social isolation as having “zero hour per week” of participation in social activities involving 3 or more people and scoring the lowest decile on the Duke Social Support Scale of perceived social support. We used multivariable logistic regressions to compute odds ratio (OR) and 95% confidence interval (CI) for factors associated with likelihood of social isolation. Although only 14.4% of isolated participants lived alone, living alone remained a significant factor associated with isolation (OR 1.93, 95% CI 1.58-2.35), together with cognitive impairment (OR 1.73, 95% CI 1.46-2.04) and depression (OR 2.44, 95% CI 2.12-2.80). Higher education level was inversely associated with isolation (p for trend<0.001). In stratified analysis, among those living alone, compared to women, men had higher odds of social isolation (OR 2.18, 95% CI 1.43-3.32) than among those not living alone (OR 0.99, 95% CI 0.84-1.17) (p for interaction<0.001). Our results showed that living alone, cognitive impairment and depression were indicators of isolation among older Singaporeans. In addition, among those living alone, men were more likely to experience social isolation than women.

scholarly journals Population-based screening for functional disability in older adults

2020 ◽  
Author(s):  
Claire K Ankuda ◽  
Vicki A Freedman ◽  
Kenneth E Covinsky ◽  
Amy S Kelley
Keyword(s):  
Older Adults ◽  
Daily Living ◽  
Functional Disability ◽  
Population Based ◽  
Health Care Use ◽  
Leaving Home ◽  
Promising Strategy ◽  
Nationally Representative ◽  
Adl Disability ◽  
Design And Methods

Abstract Background and Objectives Screening for functional disability is a promising strategy to identify high-need older adults. We compare two disability measures, activities of daily living (ADLs) and life space constriction (LSC), in predicting hospitalization and mortality in older adults. Research Design and Methods We used the nationally-representative National Health and Aging Trends Study of 30,885 observations of adults ≥65 years old. Outcomes were 1-year mortality and hospitalization. Predictors were ADLs (receiving help with bathing, eating, dressing, toileting, getting out of bed, walking inside) and LSC (frequency of leaving home). Results Of respondents, 12.4% reported 3+ ADLs and 10.8% reported rarely/never leaving home. ADL disability and LSC predicted high rates of 1-year mortality and hospitalization: of those with 3+ ADLs, 46.4% died and 41.0% were hospitalized; of those who never/rarely left home, 40.7% died and 37.0% were hospitalized. Of those with both 3+ ADLs and who never/rarely left home, 58.4% died. ADL and LSC disability combined was more predictive of 1-year mortality and hospitalization than either measure alone. ADL disability and LSC screens identified overlapping but distinct populations. LSC identified more women (72.6% vs. 63.8% with ADL disability), more people who live alone (40.7% vs. 30.7%), fewer who were white (71.7% vs. 76.2%) with cancer (27.6% vs. 32.4), and reported pain (67.1% vs. 70.0%). Discussion and Implications LSC and ADLs both independently predicted mortality and hospitalization but using both screens was most predictive. Routine screening for ADLs and LSC could help health systems identify those at high risk for mortality and health care use.

scholarly journals Trends in functional disability and cognitive impairment among the older adult in China up to 2060: estimates from a dynamic multi-state population model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John P. Ansah ◽  
Chi-Tsun Chiu ◽  
Aloysius Chia Wei-Yan ◽  
Tessa Lui Shi Min ◽  
David B. Matchar
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Daily Living ◽  
Population Model ◽  
Functional Disability ◽  
Health States ◽  
Term Care ◽  
State Population ◽  
Care Services ◽  
The Impact

Abstract Background Available evidence suggests that cognitive impairment (CI), which leads to deficits in episodic memory, executive functions, visual attention, and language, is associated with difficulties in the capacity to perform activities of daily living. Hence any forecast of the future prevalence of functional disability should account for the likely impact of cognitive impairment on the onset of functional disability. Thus, this research aims to address this gap in literature by projecting the number of older adults in China with functional disability and cognitive impairment while accounting for the impact of cognitive impairment on the onset of functional disability. Methods We developed and validated a dynamic multi-state population model which simulates the population of China and tracks the transition of Chinese older adults (65 years and older) from 2010 to 2060, to and from six health states—(i) active older adults without cognitive impairment, (ii) active older adults with cognitive impairment, (iii) older adults with 1 to 2 ADL limitations, (iv) older adults with cognitive impairment and 1 to 2 ADL limitations, (v) older adults with 3 or more ADL limitations, and (vi) older adults with cognitive impairment and 3 or more ADL limitations. Results From 2015 to 2060, the number of older adults 65 years and older in China is projected to increase, of which the number with impairment (herein referred to as individuals with cognitive impairment and/or activity of daily living limitations) is projected to increase more than fourfold from 17·9 million (17·8–18·0) million in 2015 to 96·2 (95·3–97·1) million by 2060. Among the older adults with impairment, those with ADL limitations only is projected to increase from 3·7 million (3·6–3·7 million) in 2015 to 23·9 million (23·4–24·6 million) by 2060, with an estimated annual increase of 12·2% (12·1–12·3); while that for cognitive impairment only is estimated to increase from 11·4 million (11·3–11·5 million) in 2015 to 47·8 million (47·5–48·2 million) by 2060—this representing an annual growth of 7·07% (7·05–7·09). Conclusion Our findings suggest there will be an increase in demand for intermediate and long-term care services among the older adults with functional disability and cognitive impairment.

scholarly journals The virtual cognitive health (VC Health) study: design, recruitment, and baseline characteristics of a fully remote single-arm pre-post study to prevent or delay cognitive impairment in older adults (Preprint)

2018 ◽  
Author(s):  
Nick Bott ◽  
Shefali Kumar ◽  
Caitlyn Krebs ◽  
Jordan M Glenn ◽  
Erica N Madero ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Study Design ◽  
Health Study ◽  
Study Cohort ◽  
Lifestyle Interventions ◽  
Subjective Memory ◽  
Memory Decline ◽  
Cognitive Health ◽  
The Impact

BACKGROUND A growing body of evidence supports the use of lifestyle interventions for preventing or delaying the onset of Alzheimer’s disease (AD) and other forms of dementia in at-risk individuals. The development of virtually delivered programs would increase the scalability and reach of these interventions, but requires validation to ensure similar efficacy to brick and mortar options. OBJECTIVE The aims of this study are to describe the study design, recruitment process, and baseline participant characteristics of the sample in the virtual cognitive health (VC Health) study. Future analyses will assess the impact of the remotely delivered lifestyle intervention on (1) cognitive function, (2) depression and anxiety, and (3) various lifestyle behaviors, including diet, exercise, and sleep in a cohort of older adults with subjective memory decline. Additional analyses will explore feasibility outcomes, as well as the participants’ engagement patterns with the program. METHODS Older adults (age 60-75) with subjective memory decline as measured by the Subjective Cognitive Decline (SCD-9) questionnaire, and who reported feeling worried about their memory decline, were eligible to participate in this single-arm pre-post study. All participants enrolled in the year-long virtual intervention, which consists of health coach-guided lifestyle change for improving diet, exercise, sleep, stress, and cognition. All components of this study were conducted virtually, including the collection of data and the administration of the intervention. Participants were assessed at baseline, 12 weeks, 24 weeks, and 52 weeks with online surveys and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test. Intention-to-treat analysis will be conducted on all outcomes. RESULTS A total of 85 participants enrolled in the intervention and 82 are included in the study sample (3 participants withdrew). The study cohort is 74% female, 88% Caucasian, 78% overweight or obese, and 67% have at least a college degree. The average baseline RBANS score was 95.9±11.1, which is within age-adjusted norms. The average SCD-9 score was 6.0±2.0, indicating minor subjective cognitive impairment at the beginning of the study. Average baseline Generalized Anxiety Disorder (GAD-7) scores were 6.2±4.5 and Patient Health Questionnaire (PHQ-9) scores were 8.5±4.9, indicating mild levels of anxiety and depression at baseline. CONCLUSIONS Virtually delivered lifestyle interventions may represent a scalable solution for the prevention or delay of AD. The results of this study will provide the first evidence for the efficacy of a fully remote intervention and lay the groundwork for future investigations. CLINICALTRIAL NCT02969460

scholarly journals The Impact of Lifestyle Changes on the Quality of Everyday Life of People with Osteoporosis.

2020 ◽  
pp. 1-7
Keyword(s):  
Everyday Life ◽  
Functional Disability ◽  
New Technologies ◽  
Sedentary Lifestyle ◽  
Lifestyle Changes ◽  
Age Group ◽  
The Third ◽  
The Cost ◽  
The Impact

Abstract Osteoporosis has recently "walked in“ like an epidemic. It is a disorder that, due to industrialization and the application of new technologies, is today present in younger people lives. Modern devices used in everyday life have replaced the physical activity of man, and along with the sedentary lifestyle, had an impact on an increasing number of people affected by this disease. The effects of osteoporosis are significant because they represent a medical and social problem, and the cost of treating fractures requires significant economic expenditures [1,2]. Falls and injuries caused by them (e.g. fractures) are a growing problem for people in the third age group. Injuries and fractures cause pain plus functional disability, which consequently diminish the quality of life. The consequences increase costs of health care and cause mortality [3].

scholarly journals Household Expenditures And Direct Medical Costs Among Older Adults In Ghana: Evidence From Who-sage Wave 2

2020 ◽  
Author(s):  
Paa-Kwesi Blankson ◽  
Sandra Ama Hewlett ◽  
Thomas Akuetteh Ndanu ◽  
Gyaami Amoah ◽  
Matthew Owusu Boamah ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Protection ◽  
Financial Burden ◽  
World Health ◽  
Household Expenditure ◽  
Adult Health ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Younger Adults ◽  
Household Expenditures

Abstract Background: The Ghanaian population aged 60 years and older will almost double to reach 10% of the total population by 2050. Ascertaining the pattern of health expenditures among this growing population group is important to inform policy makers about the targets for financial risk protection as part of achieving Universal Health Coverage (UHC) by 2030. This study aimed to estimate household expenditures among older adults and determine the direct medical costs.Methods : The World Health Organization's Study on global AGEing and adult health (SAGE) Wave 2 was conducted in China, Ghana, India, Mexico, Russian Federation, and South Africa between 2014 and 2015, as a follow-up to Wave 0 in 2003 to 2004 and Wave 1 in 2007 to 2010. Survey questions explored sources of income and total direct expenditures in the year preceding interview. SAGE Ghana was implemented using face-to-face interviews in a nationally representative sample of persons aged 50+ years with a comparison sample of younger adults aged 18–49 years.Findings : Analyses included a total of 4,735 participants, with 1,948 (41.1%) males and 2,787 (58.9%) females, of median and mean ages of 58 years and 57.6 (±16.7), respectively. The average annual household expenditures were US$ 1,893.44 (±3,501.14). Older adults had higher expenditure levels at US$ 1,902 (± 3,876), as compared to younger adults, US$ 1,867 (±1,937). Direct health-related costs and food expenditure accounted for 18% and 46% respectively of the total household expenditure of older Ghanaian adults. The prevalence of catastrophic health expenditure among older adults in Ghana was 4.5% (95% CI 3.5% to 5.8%)Conclusion: These updated estimates on household expenditure among older adults provide needed evidence to support the inclusion of social protection mechanisms in the national ageing agenda. The National Health Insurance as presently did not reduce the financial burden for households with older adults.

scholarly journals Dietary Patterns and Self-reported Incident Disability in Older Adults

2018 ◽  
Vol 74 (8) ◽  
pp. 1331-1337 ◽  
Author(s):  
Puja Agarwal ◽  
Yamin Wang ◽  
Aron S Buchman ◽  
David A Bennett ◽  
Martha C Morris
Keyword(s):  
Older Adults ◽  
Sex Education ◽  
Functional Disability ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Mobility Disability ◽  
The Mediterranean ◽  
Adl Disability ◽  
The Mind ◽  
Mind Diet

Abstract Background or Objectives Disability in older adults is associated with low quality of life and higher mortality. Diet may be a potentially important public health strategy for disability prevention in aging. We examined the relations of the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND) diets to functional disability in the Rush Memory and Aging Project. Methods A total of 809 participants (mean age = 80.7 ± 7.2 years, 74% female) without functional disability at baseline were followed for an average of 5.3 years. Standardized measures for self-reported disability including, activities of daily living ADL), instrumental ADL, and mobility disability were assessed annually. The diet scores were computed based on a validated food frequency questionnaire administered at baseline. Results In Cox proportional hazards models adjusted for age, sex, education, smoking, physical activity, and total calories, the second (hazard ratio = 0.75, 95% CI: 0.60–0.95) and third tertiles (hazard ratio = 0.67, 95% CI: 0.53–0.86) of MIND diet scores had lower rates of ADL disability compared to the lowest tertile (p for trend = .001), whereas only the third tertiles of the Mediterranean (hazard ratio = 0.73, 95% CI: 0.57–0.94) and DASH (hazard ratio = 0.75, 95% CI: 0.59–0.95) diets were significantly associated with ADL disability. Instrumental ADL disability was inversely and linearly associated with the MIND diet score only (p for trend = .04). Mobility disability was associated with the MIND (p for trend = .02), Mediterranean (p for trend = .05) and DASH (p for trend = .02) diet scores. Conclusion These findings are encouraging that diet may be an effective strategy for the prevention of functional disability in older adults.

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