1
|
Srisilapanan P, Chaiprasitti S, Aw S. Community resilience in Thailand in response to stressors from a lack of caregivers: A case study of Don Kaew, a suburban village. Geriatr Gerontol Int 2024; 24 Suppl 1:409-410. [PMID: 38168079 DOI: 10.1111/ggi.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Affiliation(s)
- P Srisilapanan
- Foundation for Older Persons' Development, Chiang Mai, Thailand
- School of Dentistry, University of Phayao, Phayao, Thailand
| | - S Chaiprasitti
- Foundation for Older Persons' Development, Chiang Mai, Thailand
| | - S Aw
- International Longevity Center, Singapore, Singapore
| |
Collapse
|
2
|
Nair P, Walters K, Aw S, Gould R, Kharicha K, Buszewicz MC, Frost R. Self-management of depression and anxiety amongst frail older adults in the United Kingdom: A qualitative study. PLoS One 2022; 17:e0264603. [PMID: 36477180 PMCID: PMC9728861 DOI: 10.1371/journal.pone.0264603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Depression and anxiety are common in frail older people and are associated with high levels of morbidity and mortality, yet they typically face greater barriers to accessing mental health treatments than younger people and express preferences for self-managing their symptoms. This study aims to explore frail older adults' experiences of self-managing symptoms of depression and/or anxiety. DESIGN Qualitative semi-structured interviews, exploring experiences of depression and/or anxiety, ways participants self-managed these and the contexts within which this took place. Interviews were audio-recorded and transcribed verbatim. PARTICIPANTS 28 frail older adults in the United Kingdom, purposively sampled for neighbourhood, frailty and symptoms of anxiety/depression. ANALYSIS Thematic analysis to inductively derive themes from the data. RESULTS Our findings suggest that frail older adults find maintaining independence, engaging in meaningful activities, and socialising and peer support important for self-managing depression and anxiety. These could all be adapted to the level of frailty experienced. Drawing on life experiences, addressing the perceived cause and faith were helpful in some situations and for some personalities. Distraction and avoidance were helpful for more severe symptoms or where the causes of symptoms could not be resolved. Self-management strategies were less well-established for anxiety symptoms, especially when linked to newer health fears and worries about the future. CONCLUSIONS Developing services and sources of information that support and facilitate key therapeutic components of self-management, which align with older adults' preferred coping styles and take into account levels of frailty, may be a way of supporting frail older people waiting for mental health treatments or those who prefer not to access these. Greater awareness of anxiety and how it can be self-managed in frail older people is needed.
Collapse
Affiliation(s)
- Pushpa Nair
- Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London, United Kingdom
- * E-mail:
| | - Kate Walters
- Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London, United Kingdom
| | - Su Aw
- National University of Singapore, Saw Swee Hock of Public Health, Singapore, Singapore
| | - Rebecca Gould
- Division of Psychiatry, University College London, London, United Kingdom
| | - Kalpa Kharicha
- NIHR Health & Social care Workforce Research Unit, The Policy Institute, King’s College London, London, United Kingdom
| | - Marta College Buszewicz
- Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London, United Kingdom
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London, United Kingdom
| |
Collapse
|
3
|
Seah SJ, Harding SC, Wang J, Aw S, Lam J, Lim RBT. Effectiveness of a Cluster Randomized Controlled Trial Involving Community-Based Intervention for Older Adults With Type 2 Diabetes Mellitus in Singapore. The Science of Diabetes Self-Management and Care 2022; 48:505-521. [DOI: 10.1177/26350106221125695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The purpose of the study was to investigate the effectiveness of a community-based intervention on improving knowledge about diabetes, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus (T2DM) in Singapore, a country in Asia with a high prevalence of diabetes. Methods: A 3-arm cluster randomized controlled trial involving community-dwelling older adults ages 55 to 99 with T2DM was conducted. Intervention group 1 and 2 participants received a 12-session intervention program designed to teach knowledge and practical skills in diabetes self-care with psychological techniques for behavioral change like problem solving, goal setting, and motivational interviewing. In addition, intervention group 2 participants received a glucometer and a supply of accessories each. The control group received routine care from their health care providers. Results: Compared to the control group, intervention group 2 reported an increase in medication adherence and self-monitoring of blood glucose (SMBG) at 3-month follow-up and increased knowledge about diabetes and self-care behavior in general diet control at 6-month follow-up. Conclusions: The community-based intervention should be extended to more older adults with T2DM in the community. Glucometers and accessories could be provided at subsidized rates or be made free contingent on older adults’ income status to overcome the barrier of performing SMBG.
Collapse
Affiliation(s)
- Siang Joo Seah
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore city, Singapore
- Centre for Population Health Research and Implementation, Regional Health System, Singapore Health Services Pte Ltd, Singapore city, Singapore
| | | | - Jing Wang
- Tsao Foundation, Singapore city, Singapore
| | - Su Aw
- Tsao Foundation, Singapore city, Singapore
| | | | - Raymond Boon Tar Lim
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore city, Singapore
| |
Collapse
|
4
|
Tan JPY, Seah SJ, Harding SC, Pay JY, Wang J, Aw S, Lam J, Boon Tar Lim R. Exploring the Perspective of Diabetes, Diabetes Self-Management, and Quality of Life Among Older Adults With Type 2 Diabetes: A Qualitative Study Before and During the COVID-19 Pandemic. Sci Diabetes Self Manag Care 2022; 48:163-173. [PMID: 35446228 DOI: 10.1177/26350106221094527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to explore the perspective and impact of diabetes, diabetes self-management, and quality of life (QoL) among older adults with Type 2 diabetes (T2DM) before and during the COVID-19 pandemic to better inform T2DM self-management interventions. METHODS A qualitative descriptive approach with focus group discussions (n = 5 sessions with 5-6 older adults per session) and in-depth interviews (n = 15) was conducted with community-dwelling older adults with T2DM. RESULTS Five themes emerged. The definition of diabetes carries negative connotations, QoL is defined in terms of biopsychosocial health, diabetes self-management refers to the ability to adhere to medical advice and lifestyle changes, the QoL of older adults is differentially affected by COVID-19 measures, and important aspects of diabetes self-management activities are impacted by COVID-19 measures. CONCLUSIONS Understanding older adults' perspectives on diabetes, diabetes self-management, and QoL provided insights into the facilitators and barriers to diabetes self-management practices before and during the COVID-19 pandemic. Findings inform the need for greater bottom-up initiatives and the need for a multipronged approach that considers the intra- and interpersonal and current policy factors to encourage diabetes self-management behaviors, especially during the COVID-19 era.
Collapse
Affiliation(s)
- Jamaica Pei Ying Tan
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore City, Singapore
| | - Siang Joo Seah
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore City, Singapore.,Centre for Population Health Research and Implementation, Regional Health System, Singapore Health Services Pte Ltd, Singapore City, Singapore
| | | | - Jin Yu Pay
- Tsao Foundation, Singapore City, Singapore
| | - Jing Wang
- Tsao Foundation, Singapore City, Singapore
| | - Su Aw
- Tsao Foundation, Singapore City, Singapore
| | | | - Raymond Boon Tar Lim
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore City, Singapore
| |
Collapse
|
5
|
Seah SJ, Harding SC, Pay JY, Wang J, Aw S, Lam J, Lim RBT. Sociodemographic characteristics associated with self-care and quality of life among community-dwelling older adults with type 2 diabetes. Prim Care Diabetes 2022; 16:179-187. [PMID: 34955386 DOI: 10.1016/j.pcd.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
Abstract
AIMS To assess how well community-dwelling older adults in Singapore were coping with their diabetes, and the sociodemographic characteristics that were associated with their level of coping. METHODS This was a cross-sectional study involving 257 older adults. Multiple regression was used to assess the associations between various sociodemographic characteristics and coping measures of present quality of life and level of self-care. RESULTS Older adults mainly sought care in the primary care setting. They were not coping well given their mean scores for diabetes-dependent quality of life and the self-care index were -3.57 and 3.55 respectively. Compared to those with post-secondary education, individuals who had no formal (adjusted B -0.92, p 0.003), primary level (adjusted B -0.76, p < 0.001) and secondary level (adjusted B -0.50, p < 0.02) education reported lower present quality of life. Those with prior lowest skill level occupations were less likely to consume a healthy diet per week than those with prior highest skill level occupations (adjusted B -1.48, p 0.004). CONCLUSIONS There should be provision of diabetes self-care interventions targeting older adults in Singapore especially for those with lower education and work skill levels. As the first line of contacts, primary care providers should advocate for diabetes self-care and develop community-based interventions for these priority groups.
Collapse
Affiliation(s)
- Siang Joo Seah
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore City, Singapore
| | | | - Jin Yu Pay
- Tsao Foundation, Singapore City, Singapore
| | - Jing Wang
- Tsao Foundation, Singapore City, Singapore
| | - Su Aw
- Tsao Foundation, Singapore City, Singapore
| | | | - Raymond Boon Tar Lim
- Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
| |
Collapse
|
6
|
Frost R, Rait G, Aw S, Brunskill G, Wilcock J, Robinson L, Knapp M, Hogan N, Harrison Dening K, Allan L, Manthorpe J, Walters K. Implementing post diagnostic dementia care in primary care: a mixed-methods systematic review. Aging Ment Health 2021; 25:1381-1394. [PMID: 32911966 DOI: 10.1080/13607863.2020.1818182] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Concentrating post-diagnostic dementia care in primary care may lead to better and more cost-effective care closer to home. We aimed to assess which intervention components and contextual factors may contribute to the successful delivery and implementation of primary care-led post-diagnostic dementia care. METHODS Mixed-methods systematic review. We searched five databases (inception-March 2019) with reference list screening and citation tracking. We included studies evaluating post-diagnostic dementia care interventions where primary care had a significant role in dementia care, which assessed one or more implementation elements (acceptability, feasibility, adoption, sustainability, reach, costs, appropriateness or fidelity). Two authors independently critically appraised studies. RESULTS Out of 4528 unique references, we screened 380 full texts and included 49 evaluations of services collecting implementation process data. Most services had high acceptability ratings. The most acceptable components were information provision, social and emotional support and links to community organisations. Feasibility was chiefly influenced by provider engagement and leadership, building dementia care capacity, sufficient resources/funding and collaboration. Care quality was maximised through adding capacity from a dementia-specific health professional. On the basis of limited data, costs for various primary care-led models did not substantially differ from each other. CONCLUSION A range of primary care-led dementia care models appear feasible and acceptable. Future services should: add dementia-focussed health professionals into primary care, develop primary care leadership and provide sufficient funding and collaboration opportunities. Information, community service links and social and ongoing support should be part of services. Further exploration of service reach and formalised fidelity assessment are needed.
Collapse
Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Greta Brunskill
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Martin Knapp
- 4Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Nicole Hogan
- 4Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Louise Allan
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit on Health and Social Care Workforce, Kings College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | |
Collapse
|
7
|
Hewage SS, Aw S, Chi C, Yoong J. Factors Associated with Intended Postpartum OGTT Uptake and Willingness to Receive Preventive Behavior Support to Reduce Type 2 Diabetes Risk Among Women with Gestational Diabetes in Singapore: An Exploratory Study. Nutr Metab Insights 2021; 14:11786388211016827. [PMID: 34035651 PMCID: PMC8132084 DOI: 10.1177/11786388211016827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/15/2021] [Indexed: 11/20/2022] Open
Abstract
Aim: To assess and explore the factors affecting willingness to undergo an early postpartum oral glucose tolerance test (OGTT) and receive postpartum lifestyle modification assistance. Methods: An explanatory sequential mixed-method design was used. A prenatal cross-sectional survey questionnaire (n = 216) was given to women diagnosed with GDM in a tertiary health institution in Singapore and followed up with postpartum semi-structured interviews (n = 30). Multivariate logistic regression and thematic analysis were conducted before merging the findings. Results: Despite universal GDM education, fewer than 75% intended to take the OGTT postpartum, and only 63% felt it was very important. The plan to take the OGTT postpartum was positively associated with a prenatal care provider’s specific recommendation. In contrast, Malay women were less likely to take the test. Most women interpreted a care provider’s recommendation as implying standard practice, which encouraged intended and actual compliance with testing after giving birth. The perception of moderate to high T2DM risk in the following decade, and subsidized prenatal care, and plan to take the OGTT postpartum were positively associated with willingness to receive postpartum lifestyle behavior support. A mobile application was the preferred method to receive support. Conclusions: In the early postpartum period, women with a history of GDM were willing to receive measures to reduce T2DM risk, primarily if it was under the supervision and recommendation of a care provider. A carefully designed but simple postpartum lifestyle intervention incorporating these preferences that can be integrated into mainstream diabetes prevention programs is warranted.
Collapse
Affiliation(s)
- Sumali S Hewage
- Saw Swee School of Public Health, National University of Singapore, Singapore
| | - Su Aw
- Saw Swee School of Public Health, National University of Singapore, Singapore
| | - Claudia Chi
- Astra Women's Specialists, Singapore.,Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
8
|
Aw S, Koh GCH, Oh YJ, Wong ML, Vrijhoef HJM, Harding SC, Geronimo MAB, Hildon ZJL. Interacting with place and mapping community needs to context: Comparing and triangulating multiple geospatial-qualitative methods using the Focus–Expand–Compare approach. Methodological Innovations 2021. [DOI: 10.1177/2059799120987772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Geospatial-qualitative methods, which combine both observation and interpretative accounts during data collection through extended exposure and movement in place, have been increasingly used to explore “person–place” interactions and assess communities of place. Despite their increased use, there is a lack of reflexive discussion on how they differ in capturing person–place interactions and ways to combine them. Drawing on our experiences using three related methods—Photovoice, Walking through Spaces, and interactive Participatory Learning and Action exercise-led community focus groups—we compared the methodological advantages that each method brings to the construction of “place” and in exploring person–place interactions among the community of older adults living in a neighborhood of Singapore for a neighborhood assessment. We then illustrated how using a Focus–Expand–Compare approach for methodological triangulation can add value in generating greater depth and breadth of perspectives on a topic of interest explored for intervention development.
Collapse
Affiliation(s)
- Su Aw
- National University of Singapore, Singapore
| | | | - Yeon Ju Oh
- National Information Society Agency, Seoul, Republic of Korea
| | | | | | | | - Mary Ann B Geronimo
- Federation of Ethnic Communities Councils of Australia, Canberra, ACT, Australia
| | | |
Collapse
|
9
|
Abstract
OBJECTIVES Depression and anxiety are common in later life, particularly when people are frail. This leads to reduced quality of life, faster decline in physical health and increased health/social care use. Available treatments are commonly not tailored to people with frailty. We explored frail older peoples' experiences of depression and/or anxiety and how services could be adapted to their needs. METHODS Semi-structured interviews with 28 older people in the UK purposively sampled for practice location and severity of frailty and anxiety/depression. We asked about symptoms, interactions with physical health, help-seeking, treatments and what might help in future. We audio-recorded and transcribed interviews, using thematic analysis to inductively derive themes. RESULTS Frail older people had low expectations of their wellbeing at this point in life due to multiple physical health issues and so anxiety and mild depressive symptoms were normalised. There was a particular reluctance and uncertainty regarding help-seeking for anxiety. Treatments were considered appropriate where they aligned with coping skills developed over their lifetime, and facilitated independence and problem-solving skills. Most older people felt their knowledge of mental health was limited and relied upon information about and endorsement of therapies from an expert. This was usually their GP, but access was often problematic. Online methods of accessing information and therapies were not popular. CONCLUSION Mental health support for frail older people needs to address late-life anxieties as well as depression, account for physical health issues, align with older people's need for independence and facilitate coping skills.
Collapse
Affiliation(s)
- Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK,CONTACT Rachael Frost
| | - Pushpa Nair
- Department of Primary Care and Population Health, University College London, London, UK
| | - Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|
10
|
Aw S, Koh GCH, Tan CS, Wong ML, Vrijhoef HJM, Harding SC, Ann B Geronimo M, Hildon ZJL. Promoting BioPsychoSocial health of older adults using a Community for Successful Ageing program (ComSA) in Singapore: A mixed-methods evaluation. Soc Sci Med 2020; 258:113104. [PMID: 32559575 DOI: 10.1016/j.socscimed.2020.113104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/04/2020] [Accepted: 05/31/2020] [Indexed: 11/15/2022]
Abstract
BioPsychoSocial health promotion is increasingly emphasized for Successful Ageing. Few programs are known to target BioPsychoSocial health of older adults and their community. The Community for Successful Ageing: Community Development program (ComSA CD) was developed in Singapore for this purpose. This study assessed program effects on BioPsychoSocial health and civic engagement behaviours of participants. ComSA CD offered self-care healthy lifestyle education (Bio-physical), guided autobiography (Psychological) and a civic engagement component which galvanized participants to solve community issues (Social). Recruitment occurred through self-care or guided autobiography; following which participants were funnelled into the civic engagement component. A mixed-methods quasi-experimental evaluation was conducted, using a pre-post one-year survey (N=232) with those exposed and unexposed (rejected) to ComSA CD. Using a generalized linear model, associations between post one-year BioPsychoSocial outcomes and exposure group were quantified using percentage change, adjusting for baseline outcome and group differences. Concurrently, program effects were explored through six focus groups with program implementers and participants using thematic analysis. The program had multiple positive effects. Participants recruited via self-care also taking part in civic engagement reported 31% higher frequency of self-care (95% CI=21% to 68%) post one-year compared to unexposed participants. Qualitative findings illustrated how the civic engagement component stimulated agency of participants to push for neighborhood changes and civic engagement initiatives. The quantitative survey highlighted that this effect was strongest among those funnelled from guided-autobiography (92% higher frequency of civic engagement at post one-year than unexposed; 95%CI=41% to 178%) compared to those funnelled from self-care (53% higher than unexposed, 95%CI=17% to 114%). It was found qualitatively that guided-autobiography enabled more meaningful bonding and communication than the self-care component, explaining quantitative effects on social support only present among guided autobiography participants (36% higher than unexposed; 95%CI=11% to 68%). Findings highlighted the importance of improving group dynamics for collective action.
Collapse
Affiliation(s)
- Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Hubertus J M Vrijhoef
- Department of Patient and Care, Maastricht University Medical Centre, the Netherlands; Panaxea b.v., Amsterdam, the Netherlands
| | | | | | - Zoe J L Hildon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| |
Collapse
|
11
|
Aw S, Koh GCH, Tan CS, Wong ML, Vrijhoef HJM, Harding SC, Geronimo MAB, Hildon ZJL. Exploring the implementation of the Community for Successful Ageing (ComSA)program in Singapore: lessons learnt on program delivery for improving BioPsychoSocial health. BMC Geriatr 2019; 19:263. [PMID: 31664899 PMCID: PMC6820954 DOI: 10.1186/s12877-019-1271-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Community for Successful Ageing (ComSA) program has implemented overlapping BioPsychoSocial (BPS) components as part of a Community Development (CD) grassroots and volunteer-led initiative. Implementation of such multi-component programming is influenced by known program characteristics including novelty, complexity and observability as well as related organizational factors. As such, we explored ComSA CD's implementation from the organizational perspective, seeking to inform program improvements. METHODS We conducted four focus groups with program staff, partners and trainers (total N = 21 participants). Findings were analysed using an interpretative approach and synthesized into a line of argument informing lessons learnt. RESULTS An implementation framework was identified. It is guided by considering the influence of known program characteristics across major themes, representing three core implementation stages. These and supporting sub-themes are elaborated in turn: 1) Creating commitment toward the program was challenged by novelty and at times a lack of shared understanding of ComSA CD, particularly relating to the S component. Overall, cohesion within organizational contexts and having a strong rapport with the community (ability to engage) were needed to persuade volunteers and participants to commit to the program. 2) Coordination and resource allocation were influenced by the complexity of interconnecting BPS components - requiring aligning communication between partners and adapting the BPS sequence, given the separated management structure of program trainers. Efficiency of resource utilization was constrained by the ability to pool and match resources given the limited manpower and community partners who worked-in-silo due to a KPI-centric culture. 3) Collaborative program monitoring and appraisal increased observability of the program's benefits, but depended on partners' prior commitment. Despite appreciating its holistic BPS programming, dropout rate was used as a way to gauge program success, which has limited interpretability. Occasional uncertainty about the program value contributed to concerns about duplicating existing ageing programs, particularly those related to the B component. CONCLUSION Lessons learnt for improving BPS programming include (1) eliciting better participants' buy-in and shared program vision, (2) increasing adaptability of BPS sequence and building a culture of shared values for working together (3) and developing comprehensive monitoring systems for program appraisal.
Collapse
Affiliation(s)
- Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #08-01, Singapore, 117549, Singapore.
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-03G, Singapore, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Hubertus J M Vrijhoef
- Department of Patient and Care, Maastricht University Medical Centre, P.Debyelaan, 25, 6229 HX, Masstricht, The Netherlands.,Department of Family Medicine, Vrije Universiteit Brussel, Brussel, Belgium
| | - Susana Concordo Harding
- Tsao Foundation, 298 Tiong Bahru Road, #15-01/06 Central Plaza, Singapore, 168730, Singapore
| | - Mary Ann B Geronimo
- Tsao Foundation, 298 Tiong Bahru Road, #15-01/06 Central Plaza, Singapore, 168730, Singapore
| | - Zoe J L Hildon
- Bloomberg School of Public Health, The John Hopkins University, 111 Market Place, Suite 310, Baltimore, Maryland, 21202, USA.,London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, Keppel street, London, WC1E 7HT, UK.,Saw Swee Hock School of Public Health, National University of Singapore, 117549, Singapore, Singapore
| |
Collapse
|
12
|
Aw S, Koh GCH, Tan CS, Wong ML, Vrijhoef HJM, Harding SC, Geronimo MAB, Hildon ZJL. Theory and Design of the Community for successful ageing (ComSA) program in Singapore: connecting BioPsychoSocial health and quality of life experiences of older adults. BMC Geriatr 2019; 19:254. [PMID: 31594545 PMCID: PMC6784337 DOI: 10.1186/s12877-019-1277-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 09/10/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the emphasis on holistic health promotion in community programs for older people, few studies explicitly consider how BioPsychoSocial (BPS) health elements are interconnected and function to improve Quality of Life (QoL). The Community for Successful Ageing (ComSA) program in Singapore focuses on Community Development (CD) initiatives for older people, accounting for BPS theory in its design and content. Biological (B) health is conceived as physiological and cognitive functioning and related biological self-care; Psychological (P) health as feelings of life satisfaction, and Social health (S) as perceived social support and civic engagement. Furthermore, three overlapping sub-constructs are theorized to connect these elements. Namely Bio-Psychological (BP) health in terms of self-perceptions of ageing; the Psycho-Social (PS) aspects of interpersonal communication; and the Socio-Communal (SC) health in terms of civic engagement. BPS health is conceived as distinct from QoL, defined as composed of control, autonomy, self-realisation and pleasure (measured by CASP-19) of the older person. We examined 1) interconnections of BPS constructs and related sub-constructs and 2) their associations with QoL to inform a practical, applied program theory. METHODS A baseline survey (n = 321) of program participants (Mean = 70 years, SD = 8.73). All continuous variables were binarized as 'high' if the scores were above the median. Multivariate logistic regression was used to assess 1) the adjusted effect of each BPS construct on CASP-19, and 2) the odds of scoring high on one BPS construct with the odds of scoring high on a related sub-construct (e.g. B and BP health). RESULTS The strongest relationship with QoL was markedly with BP self-perceptions of ageing (OR = 4.07, 95%CI = 2.21-7.49), followed by P life satisfaction (OR = 3.66, 95%CI = 2.04-6.57), PS interpersonal communication (OR = 2.42, 95%CI = 1.23-4.77), SC civic engagement (OR = 1.94, 95%CI = 1.05-3.57), and S social support (OR = 1.89, 95%CI = 1.06-3.38). Core B, P and S health were closely associated with their sub-constructs. CONCLUSION ComSA CD is tightly coupled to its proposed program theory. It offers classes to improve B self-care and BP self-perceptions of ageing, group-based guided autobiography to improve P life-satisfaction and PS interpersonal communication, and community initiatives that encourage seniors to solve community issues. This holistic approach is likely to enhance ageing experiences and QoL.
Collapse
Affiliation(s)
- Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #08-01, Singapore, 117549 Singapore
| | - Gerald C. H. Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #08-01, Singapore, 117549 Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #08-01, Singapore, 117549 Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #08-01, Singapore, 117549 Singapore
| | - Hubertus J. M. Vrijhoef
- Department of Patient and Care, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Family Medicine, Vrije Universiteit Brussel, Brussel, Belgium
| | | | | | - Zoe J. L. Hildon
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #08-01, Singapore, 117549 Singapore
- Bloomberg School of Public Health, The John Hopkins University, Maryland, USA
- Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT UK
| |
Collapse
|
13
|
Uijtdewilligen L, Waters CNH, Aw S, Wong ML, Sia A, Ramiah A, Wong M, Müller-Riemenschneider F. The Park Prescription Study: Development of a community-based physical activity intervention for a multi-ethnic Asian population. PLoS One 2019; 14:e0218247. [PMID: 31185057 PMCID: PMC6559668 DOI: 10.1371/journal.pone.0218247] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 05/29/2019] [Indexed: 11/30/2022] Open
Abstract
This mixed-methods study aims to inform the development of a 'Park Prescription' intervention, including face-to-face counseling on physical activity and park use and providing weekly structured exercise sessions in the park to promote physical activity. Participants aged 40-65 years were recruited from regional health screening events in Singapore where they completed a questionnaire (N = 97) and consented to focus group (FG) participation (N = 16). The questionnaire assessed current park use, and the type, duration, and intensity of park-based activities that would be of interest. FGs explored the barriers and facilitators of physical activity (in parks). Short interviews (N = 16) with 'doers', i.e., people already engaging in park-based physical activity, identified motivational factors and ways to overcome common barriers. Participants acknowledged the health benefits of parks and valued them because of their pleasant landscapes, greenery and facilities. However, few participants engaged in physical activity at the parks, because they were too busy or too tired. Participants mostly indicated doing informal activities, such as walking, cycling or playing traditional Asian games when using the parks for exercise. A variety of low-to-moderate intensity park-based activities such as walking, cycling or aerobics were of interest to participants who expressed the willingness to engage in structured exercise sessions on weekday evenings or weekend mornings. Strategies to increase physical activity in parks included: encourage planning, create social support, identify alternatives for bad weather, improve proximity/accessibility to parks and park safety. The effectiveness of the Park Prescription intervention in promoting physical activity, park use, as well as physical and mental well-being will be tested in a one-year Randomized Controlled Trial.
Collapse
Affiliation(s)
| | | | - Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Angelia Sia
- Centre for Urban Greenery & Ecology, National Parks Board Singapore, Singapore
| | | | - Michael Wong
- Health for Life Centre, Alexandra Health Pte Ltd, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Institute for Social Medicine, Epidemiology and Health Economics, Charite Univeristy Medical Centre, Berlin, Germany
| |
Collapse
|
14
|
Malhotra R, Bautista MAC, Müller AM, Aw S, Koh GCH, Theng YL, Hoskins SJ, Wong CH, Miao C, Lim WS, Malhotra C, Chan A. The Aging of a Young Nation: Population Aging in Singapore. The Gerontologist 2018; 59:401-410. [DOI: 10.1093/geront/gny160] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research
- Centre for Ageing Research and Education, Duke-NUS Medical School
| | | | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Centre for Sport and Exercise Sciences, University of Malaya, Malaysia
| | - Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gerald Choon Huat Koh
- Health Services and Systems Research
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yin-Leng Theng
- Ageing Research Institute for Society and Education, Nanyang Technological University
| | | | - Chek Hooi Wong
- Health Services and Policy Program, Geriatric Education and Research Institute
| | - Chunyan Miao
- Joint Nanyang Technological University–The University of British Columbia (NTU–UBC) Research Centre of Excellence in Active Living for the Elderly
| | - Wee-Shiong Lim
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Angelique Chan
- Health Services and Systems Research
- Centre for Ageing Research and Education, Duke-NUS Medical School
| |
Collapse
|
15
|
Hildon ZJL, Tan CS, Shiraz F, Ng WC, Deng X, Koh GCH, Tan KB, Philp I, Wiggins D, Aw S, Wu T, Vrijhoef HJM. 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. BMC Geriatr 2018; 18:49. [PMID: 29454316 PMCID: PMC5816546 DOI: 10.1186/s12877-018-0739-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/31/2018] [Indexed: 01/29/2023] Open
Abstract
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. Electronic supplementary material The online version of this article (10.1186/s12877-018-0739-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Zoe J-L Hildon
- Johns Hopkins University, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health & Policy, London, England. .,, Singapore, Singapore.
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Wai Chong Ng
- Tsao Foundation, 298 Tiong Bahru Road, #15-01/06 Central Plaza, Singapore, 168730, Singapore
| | - Xiaodong Deng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Kelvin Bryan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Ministry of Health, College of Medicine, Building 16 College Road, Singapore, 169854, Singapore.,, Singapore, Singapore
| | - Ian Philp
- University of Stirling, Stirling, UK
| | - Dick Wiggins
- UCL Institute of Education, IOE - Social Science, University College London, 20 Bedford Way, London, WC1H 0AL, England
| | - Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,, Singapore, Singapore
| | - Treena Wu
- Tsao Foundation, 298 Tiong Bahru Road, #15-01/06 Central Plaza, Singapore, 168730, Singapore
| | - Hubertus J M Vrijhoef
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, the Netherlands.,Vrije Universiteit Brussels, Laarbeeklaan 103, 1090, Brussel, Belgium.,Panaxea, Matrix II, unit 1.08/9, Science Park 400, 1098, XH Amsterdam, The Netherlands
| |
Collapse
|
16
|
Aw S, Koh G, Oh YJ, Wong ML, Vrijhoef HJM, Harding SC, Geronimo MAB, Lai CYF, Hildon ZJL. Explaining the continuum of social participation among older adults in Singapore: from 'closed doors' to active ageing in multi-ethnic community settings. J Aging Stud 2017; 42:46-55. [PMID: 28918821 DOI: 10.1016/j.jaging.2017.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/23/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aims to identify and explain the continuum in which older people in Singapore participate in community and social life, highlighting the influence of culture and policy context on social participation. METHODS Using an ethnographic approach in a neighbourhood (n=109), we conducted focus groups with older adults of different ethnicities, exploring experiences of social participation. Next, participants took 50 photographs relating to 'lives of elders', showcasing the socio-ecological context that influenced social participation. Lastly, go-along interviews were conducted in various precincts with community leaders. RESULTS A continuum of social participation emerged among older adults, ranging from (1) marginalization and exclusion, to (2) 'comfort-zoning' alone (3) seeking consistent social interactions, (4) expansion of social network, and (5) giving back to society. Seeking consistent social interactions was shaped by a preference for cultural grouping and ethnic values, but also a desire for emotional safety. Attitudes about expanding one's social network depended on the psychosocial adjustment of the older person to the prospect of gossip and 'trouble' of managing social relations. Despite the societal desirability of an active ageing lifestyle, cultural scripts emphasizing family meant older adults organized participation in social and community life, around family responsibilities. Institutionalizing family reliance in Singapore's welfare approach penalized lower-income older adults with little family support from accessing subsidies, and left some living on the margins. DISCUSSION To promote inclusiveness, ageing programs should address preferences for social participation, overcoming barriers at the individual, ethnic culture and policy level.
Collapse
Affiliation(s)
- Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Yeon Ju Oh
- National Information Society Agency, Seoul, Republic of Korea.
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Hubertus J M Vrijhoef
- Department of Patient and Care, Maastricht University Medical Centre, The Netherlands; Department of Family Medicine, Vrije Universiteit Brussel, Belgium.
| | | | | | | | - Zoe J L Hildon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; London School of Hygiene and Tropical Medicine, Faculty of Public Health & Policy, Department of Global Health and Development, United Kingdom; Johns Hopkins Center for Communication Programs, Bloomberg School of Public Health, United States.
| |
Collapse
|
17
|
Shiraz F, Aw S, Koh G, Wong M, Vrijhoef H, Harding S, Yu Y, Hildon Z. EXPLORING PROCESSES OF ADAPTATION FOR SUCCESSFUL AGING: LIVED EXPERIENCES OF OLDER SINGAPOREAN ADULTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F. Shiraz
- National University of Singapore, Singapore, Singapore,
| | - S. Aw
- National University of Singapore, Singapore, Singapore,
| | - G.C. Koh
- National University of Singapore, Singapore, Singapore,
| | - M. Wong
- National University of Singapore, Singapore, Singapore,
| | - H.J. Vrijhoef
- National University of Singapore, Singapore, Singapore,
- Maastricht University Medical Centre, Maastricht, Netherlands,
- Vrije Universiteit, Brussels, Belgium,
| | | | - Y. Yu
- Hallym University, Korea, Korea (the Republic of),
| | - Z.J. Hildon
- National University of Singapore, Singapore, Singapore,
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
18
|
Aw S, Oh Y, Koh G, Vrijhoef H, Harding S, Hildon Z. MAPPING TYPOLOGIES OF SOCIAL PARTICIPATION TO PROGRAMMING FOR ELDERS IN THE CHANGING ASIAN CONTEXTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Aw
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | - Y. Oh
- Hallym University, ChunCheon, Korea (the Republic of),
| | - G.C. Koh
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | - H.J. Vrijhoef
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | | | - Z.J. Hildon
- John Hopkins University, Baltimore, Maryland
| |
Collapse
|
19
|
Fetter M, Aw S, Haslwanter T, Heimberger J, Dichgans J. Three-dimensional eye movement analysis during caloric stimulation used to test vertical semicircular canal function. Am J Otol 1998; 19:180-7. [PMID: 9520054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
HYPOTHESIS AND BACKGROUND Quantitative caloric testing is considered to be one of the most sensitive parameters in the diagnosis of peripheral vestibular disorders. In the past, because of limitations in the methods, the evaluation of the caloric response was restricted to mainly lateral semicircular canal functions. In this study, the authors tried to extend caloric testing to the function of all semicircular canals by using three-dimensional (3-D) analysis techniques. METHODS The authors studied in seven normal subjects 3-D eye movement responses to air caloric of the right ear with the subjects positioned in standard caloric position (lateral semicircular canal vertical) or such that one of the three semicircular canals of the right side was horizontal. Movement of the left eye was measured in 3-D with a dual-magnetic search coil. During stimulation, 10 seconds of maximum response were selected and desaccaded to yield the slow-phase velocity profile. From this profile, the average magnitude and direction of the eye rotation axis (velocity vector) were calculated in head coordinates. RESULTS In all subjects, in standard caloric position, warm caloric produced eye velocity vectors that clustered closely along the direction expected from an excitation of the right lateral semicircular canal. When the subjects were positioned with one of the vertical semicircular canals horizontal, the orientation of the velocity vectors shifted toward a direction expected from the combined excitation of the lateral and the other vertical semicircular canal and vice versa. CONCLUSIONS The 3-D eye movement recordings during caloric stimulation in different head positions allow the evaluation of the function of all semicircular canals.
Collapse
Affiliation(s)
- M Fetter
- Department of Neurology, Eberhard-Karls-University, Tübingen, Germany
| | | | | | | | | |
Collapse
|
20
|
Aw S. Immunokinetic differences among human pancreatic, salivary and milk alpha-isoamylases. Mol Immunol 1968. [DOI: 10.1016/0161-5890(68)90058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|