Publications (8)18.6 Total impact

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    [Show abstract] [Hide abstract] ABSTRACT: Background: Data on long-term outcomes of elderly (≥65 years) patients in ICU are sparse. Materials and methods: Adult patients (n = 1563, 45.4% elderly) admitted over 28 months were analyzed by competing risks regression model to determine independent factors related to in-hospital and long-term mortality. Results: 414 (26.5%) and 337 (21.6%) patients died in-hospital and during the 52 months following discharge, respectively; the elderly group had higher mortality during both periods. After discharge, elderly patients had 2.3 times higher mortality compared to the general population of the same age-group. In-hospital mortality was independently associated with mechanical ventilation (subdistribution hazard ratio (SHR) 2.74), vasopressors (SHR 2.56), neurological disease (SHR 1.77), and Mortality Prediction Model II score (SHR 1.01) regardless of age and with malignancy (SHR, hematological 3.65, nonhematological 3.4) and prior renal replacement therapy (RRT, SHR 2.21) only in the elderly. Long-term mortality was associated with low hemoglobin concentration (SHR 0.94), airway disease (SHR 2.23), and malignancy (SHR hematological 1.11, nonhematological 2.31) regardless of age and with comorbidities especially among the nonelderly. Conclusions: Following discharge, elderly ICU patients have higher mortality compared to the nonelderly and general population. In the elderly group, prior RRT and malignancy contribute additionally to in-hospital mortality risk. In the long-term, comorbidities (age-related), anemia, airway disease, and malignancy were significantly associated with mortality.
    Full-text · Article · Dec 2014 · BioMed Research International
  • [Show abstract] [Hide abstract] ABSTRACT: This study examined the impact of a history of suicidal behavior on suicide among elderly people in Singapore. In this coroner register-based study, characteristics of 409 elderly people who died of suicide in Singapore between 2000 and 2004 were examined. Sixty-five people were classified with a history of previous suicidal behavior and 344 people without a history of suicidal behavior. Elderly people who died of suicide and had a past history of suicidal behavior were more likely to suffer from major psychiatric disorders (26.2% vs 10.2%, p = 0.001), encounter social problems in life (33.9% vs 21.5%, p = 0.038), have alcohol detected in the blood toxicology report at autopsy (23.1% vs. 12.8%, p = 0.036), receive psychiatric treatment in the past (60% vs. 37.5%, p Keywords: characteristics; elderly; management; prevention; suicide Document Type: Research Article DOI: Affiliations: 1: Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 2: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 3: Chia's Clinic, Singapore Publication date: October 2, 2014 $(document).ready(function() { var shortdescription = $(".originaldescription").text().replace(/\\&/g, '&').replace(/\\, '<').replace(/\\>/g, '>').replace(/\\t/g, ' ').replace(/\\n/g, ''); if (shortdescription.length > 350){ shortdescription = "" + shortdescription.substring(0,250) + "... more"; } $(".descriptionitem").prepend(shortdescription); $(".shortdescription a").click(function() { $(".shortdescription").hide(); $(".originaldescription").slideDown(); return false; }); }); Related content In this: publication By this: publisher By this author: Ho, Roger C. M. ; Ho, Emily C. L. ; Tai, Bee Choo ; Ng, Wai Yee ; Chia, Boon Hock GA_googleFillSlot("Horizontal_banner_bottom");
    No preview · Article · Oct 2014 · Archives of Suicide Research
  • Louisa Tan · Philip Yap · Wai Yee Ng · Nan Luo
    [Show abstract] [Hide abstract] ABSTRACT: Background: Well-being in persons with dementia (PWD) depends much on the quality and type of care received. The Dementia Management Strategies Scale (DMSS) is a useful instrument to appraise care styles of caregivers. The present study expanded on previous research by refining and establishing the scale's content validity and psychometric properties in the Singapore context. Method: Five family caregivers and four dementia care professionals (nurse, occupational therapist, social worker and doctor) reviewed the DMSS for content validity. Two hundred and forty-six family caregivers completed questionnaires which assessed caregiver and patient characteristics, and dementia management strategies with DMSS. Internal consistency reliability was assessed and construct validity was evaluated through Pearson's correlation with extant instruments. Results: Eight items from the 28-item DMSS were omitted after content review as they were deemed inappropriate in our socio-cultural setting. A factor analysis with Varimax rotation confirmed a two-factor structure (positive and negative dimensions) for the revised DMSS (rDMSS). The two subscales showed good internal consistency (Cronbach's alpha .89 and .87). Moderate to strong correlations (.35-.53) with the scales, Zarit Burden Instrument, Revised Memory and Behavioural Problems Checklist, General Health Questionnaire, Short Sense of Competence Scale, Gains in Alzheimer's Care Instrument and Positive Aspects of Caregiving established convergent and divergent construct validity of rDMSS. Conclusion: The shortened 20-item rDMSS is a psychometrically valid instrument which can serve as a measure of dementia care strategy from the perspective of the caregiver in Singapore.
    No preview · Article · Feb 2013 · Aging and Mental Health
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    [Show abstract] [Hide abstract] ABSTRACT: Type 2 diabetes mellitus is of increasing healthcare concern worldwide, with incidence rising, complications leading to significant morbidity and mortality, posing strain on public healthcare funding. Health-related quality of life of diabetic patients is increasingly being recognised as "the ultimate goal of all health interventions". The aim of our study was to identify the quality of life predictors of diabetic patients in primary care. This study was conducted in 8 public primary care polyclinics from SingHealth Polyclinics. We carried out a cross-sectional, questionnaire-based survey on 699 diabetic patients, administered by medical students on a systematic sample of patients during their routine visit. Multiple regression analysis was used to investigate the socio-demographic and clinical characteristics as predictors of quality of life, measured by the Short Form 36 Health Survey (SF-36) and the EQ-5D self-report questionnaire. Higher quality of life in diabetic patients is associated with younger age, male gender, employed status, higher educational level and exercise. Lower quality of life is associated with comorbidities and diabetic complications. Short-term glycaemic control as measured by HbA1c did not correlate with quality of life. Most interestingly, confidence in doctor and satisfaction in clinic were related to better quality of life. Health-related quality of life is adversely associated with symptomatic complications of diabetes mellitus, but not with short-term diabetic control. This suggests that the diabetic patient may not appreciate the impact of good diabetic control immediately on his or her health-related quality of life. More effort should be invested into patient education of the importance of glycaemic control to prevent these long-term complications.
    Preview · Article · Jun 2011 · Annals of the Academy of Medicine, Singapore
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    [Show abstract] [Hide abstract] ABSTRACT: This study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore. Adult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey. A total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149). The results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.
    Full-text · Article · Oct 2010 · Annals of the Academy of Medicine, Singapore
  • [Show abstract] [Hide abstract] ABSTRACT: Caregiver gain is an important yet less-explored phenomenon. Being conceptually distinct from burden, factors associated with burden and gain can differ. This study aims to explore factors associated with the experience of gains in dementia caregiving. Cross-sectional study involving caregivers recruited from a tertiary hospital dementia clinic and the local Alzheimer's Association. Caregivers completed a questionnaire containing the following scales: gain in Alzheimer's care Instrument (GAIN), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), Revised Memory and Behavioral Problems Checklist (RMBPC) and Zarit Burden Interview (ZBI). Demographic information for the person with dementia (PWD) and the caregiver was also recorded. Initial screening with univariate analyses (t tests, ANOVAs, Pearson's correlations) was performed to identify significant (p < 0.05) variables, which were then entered into a multiple regression model to identify variables associated with gain. The final sample comprised 334 caregivers with a mean age of 51.5 years (SD = 10.9, range = 22-85), the majority of whom where Chinese (94.6%) females (71%). Mean GAIN score was 30 (SD = 6.6, range = 7-40). Regression analysis identified 3 factors significantly associated with gains (adjusted R(2) 32.3%): mental well-being of the caregiver, use of active management as a caregiving strategy, and participation in caregiver educational and support group programmes. The results have important implications for caregiver interventions. Interventions should target maintaining mental well-being, encouraging participation in educational and support programmes, and teaching appropriate coping and dementia specific management strategies to derive good outcomes.
    No preview · Article · Feb 2010 · Dementia and Geriatric Cognitive Disorders
  • Chee Wee Tew · Li Feng Tan · Nan Luo · Wai Yee Ng · Philip Yap
    [Show abstract] [Hide abstract] ABSTRACT: To examine factors associated with family caregivers' choice of care setting (own home vs. nursing home) for their relatives with dementia. Cross-sectional study involving caregivers recruited from a tertiary hospital dementia clinic and the local Alzheimer's association. Caregivers completed a questionnaire containing demographics of the person with dementia (PWD) and caregiver, their choice of care setting and the following scales: Gain in Alzheimer Care Instrument, General Health Questionnaire, Short Sense of Competence Questionnaire, Revised Memory and Behavioral Problems Checklist and Zarit Burden Interview. Multiple logistic regression was performed to identify significant variables associated with the outcome of interest. The final sample comprised 266 caregivers, the majority of whom were Chinese, female and children of PWD. Most (85.7%) preferred care at home, only 38 (14.3%) chose institutionalization. Four factors were associated with choice of nursing home: caregiver working (OR = 6.363, 2.120-19.086), no domestic maid (OR = 3.27, 1.458-7.331), lower caregiver gain (OR = 0.935, 0.882-0.992) and behavioral problems in PWD (OR = 1.011, 1.005-1.018). Strategies to minimize institutionalization must first address the provision of a dedicated caregiver at home. Consequently, interventions to help caregivers cope with behavioral problems in PWD and enhance caregiver gain are relevant.
    No preview · Article · Jan 2010 · Dementia and Geriatric Cognitive Disorders
  • [Show abstract] [Hide abstract] ABSTRACT: To describe and validate a new scale, Gain in Alzheimer care Instrument (GAIN), and to measure gains in dementia caregiving. Items in GAIN were derived through a qualitative study of family carers of persons with dementia (PWD). Content validity of GAIN was established by a team of dementia care experts (geriatrician, nurse, and social worker) and through focus group discussion with 15 family carers. Consecutive carers of PWD were administered a questionnaire containing GAIN and other measures. Ambulatory dementia clinic of a tertiary hospital and the local Alzheimer's Association. Family carers of PWD. The psychometric properties of GAIN were examined, in particular, exploratory factor analysis and construct validity through correlation with extant measures; Positive Aspects of Caregiving (PAC), Dementia Management Strategies Scale (DMSS), and Zarit Burden Interview (ZBI). Two hundred thirty-eight English-speaking carers completed the survey. Mean age of carers was 50.1 year (standard deviation [SD] 10.1) and females (68.1%) and child carers (81.3%) comprised the majority. Mean GAIN score was 30.5 (SD 6.5). Internal consistency of GAIN by Cronbach's alpha was 0.89 and test-retest reliability (2 weeks) by Intraclass Correlation Coefficient was 0.70. GAIN correlated strongly with PAC (r = 0.68, df = 236, p <0.0001), moderately with DMSS (encouragement) (r = 0.35, df = 234, p <0.0001) and DMSS (active management) (r = 0.42, df = 235, p <0.0001), and modestly with DMSS (criticism) (r = -0.14, df = 236, p = 0.03) and ZBI (r = -0.15, df = 236, p = 0.02). Principal component analysis revealed a single component with an Eigen value >1 at 5.28, accounting for 52.8% of the variance. GAIN is a psychometrically reliable and valid instrument for measuring gains in dementia caregiving. It adds an important dimension to carer assessment in dementia.
    No preview · Article · Jan 2010 · The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry