Tài liệu Chronic Disease, Functional Status and Quality Of Life Among The Elderly In Singapore pdf

Symposium on Health Care Challenges for an Ageing Population: Managing Health Care and End of Life Decisions in Singapore, 29 May 2009, Singapore Ng Tze Pin, Gerontological Research Pro

Symposium on Health Care Challenges for an Ageing Population:

Managing Health Care and End of Life Decisions in Singapore,

29 May 2009, Singapore

Ng Tze Pin, Gerontological Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore

 Aims:

 Identify vital areas that are likely to present the best avenues and opportunities for success in achieving longer and healthier life expectancy

Longitudinal Ageing Studies (SLAS)

 The present trend of functional disability is increasing

geriatric care, assisted living and long-term care, designs for

housing, built environment and transportation, and promotion of

‘active ageing’

 Population ageing in Singapore is

rapid and unprecedented

 8% in 2009

 19% in 2030

challenges of population ageing

have to be faced much sooner

rather than later

Percent I ncrease in Elderly Population: 2000 to 2030

transition

chronic degenerative and metabolic diseases

372 277

240 240 216 197 174 170 126 108 102 92 55 54

0 50 100 150 200 250 300 350 400

Japan United Kingdom New Zealand United States Australia Canada China India Thailand South Korea Indonesia Philippines Malaysia Singapore

Changing affluent lifestyles

and habits

Increased chronic diseases incidences

Improved healthcare

Increased chronic diseases

and functional disability

Reduce mortality and prolong survival

Little impact on functional wellbeing or quality of life

Escalate use and costs of medical and social servicesIncrease burden of care for family and caregivers

QUALITY OF CARE is now a critical factor that determines whether the current cohort of

Singaporean seniors faces the prospect of

better functional wellbeing and quality of life in their later years

Presently available data do not indicate a benevolent trend of physical functional

wellbeing in the near to medium term

Regular monitoring of physical functional status are needed

 What can we do now to ensure that our current

policies and programmes are effective in achieving longer and healthier life expectancy?

interventions that are likely to present the best

avenues and opportunities for success?

can be identified and corrected?

 Essential for optimal policy and programme planning and

provisions

 Data are available from official routine health statistics and reports (national health surveys, special surveys of the elderly)

behavioural status for elderly subjective wellbeing e.g mental

health and quality of life (healthy ageing)

 Multi-disciplinary collaboration of research aimed at understanding the ageing and health transition of Singaporean older adults

promotion for healthy and long life expectancy

primary care, and hospital and nursing home care

 Population-based observational prospective cohort study of older adults aged 55+ in South East Singapore

psychosocial and behavioral characteristics

blood tests

Cross-sectional data from the baseline interviews and examination are used to describe the health and psychosocial status and service usage

of the elderly in this presentation

 High proportion with chronic medical conditions

condition

 Hypertension (56%)

 blood lipid abnormalities (59%)

 major eye disorders (33%)

 arthritis and other musculoskeletal disorders (17%)

 diabetes (19%)

 coronary heart disease (6%)

 stroke (4%)

 13% significant depressive symptoms

 4.1% was hospitalized at least once in the year

 2 in 3 seniors visited a doctor at least once in the year

 1 in 3 reported that they did not make a single visit to a doctor (?)

3% or 4%

Depression and health services

use by Singaporean seniors

Psychogeriatrics, 2006; 11:1-16)

stay and mortality in COPD

8;167(1):60-7)

poor medication adherence

and lifestyle modification

2008;25(9):795-805).

0 5 10 15 20 25

Multiple (>5) drugs use Inappropriate drug use

Non-depressed Depressed

%

P<0.001

P<0.001

400 300

200 100

0

Days from discharge

1.0 0.8 0.6 0.4 0.2 0.0

None Dementia

only

Depression only

Depression and Dementia

Relative Risk of Hospitalization for chronic Illnesses

 Requires broad and integrated perspective

diseases

and falls prevention

Physical functional disability

Multivariate

OR P<0.05

Living with others 5.7

Poor-Fair self-rated health 3.5

Self-reported chronic condition

Ng et al, J Am Ger Soc 2006; 54:21–29.

Arthritis and cognitive impairment are the leading modifiable causes

Risk Factors and Correlates

Multiple measures targeted at improving cognitive and

musculoskeletal function is likely to make the strongest impact in improving physical functional wellbeing of the elderly

Role physical Bodily

Pain

Vitality Social

functioning General

Health

Role Emotional

Mental Health QOL (SF-12) scores

accounted mostly for reported poor quality of life

social handicap stands in the way of realizing quality of life

 Success in improving physical and social functioning and quality of life will be determined by measures taken to improve

support and the physical environment to lessen the extent of social handicap from the loss of function

 Primary care, hospital and community levels

impairment from chronic diseases

effectiveness in producing desirable care outcomes in the elderly

Avoidable Hospitalization Rates in Singapore

Ng et al, Journal of Epidemiology and Community Health, 2003; 57,1: 17-22.

 Addresses the problem at its source

harmful lifestyles and behaviour and early risk

detection

challenges and difficulties in changing health

behaviour

 Smoking rates are dramatically brought down

diabetes, hypercholesterolaemia, and physical activity

beyond doubt

 ‘Active Ageing’ embodies the practical wisdom of this approach

costs of health spending in old age, better quality of life

mental well-being throughout the life course in order to extend healthy life expectancy.'' (Ministry of Health, Canada)

Committee on Ageing Issues Report, 2006

coordinated by Council for the Third Age

Prevalence of Successful Aging in Chinese elderly aged 65+

Prevalence

1 Physical health and well functioning, % 47.9

Good or excellent self-reported health status 64.6

Independent in instrumental ADL 67.1

2 Cognitive and emotional well functioning, % 61.2

 Age single year (OR=0.90)

 Female gender (OR=1.37)

 6 years of education

(OR=2.31)

 Better housing (OR=1.41)

 Religious or spiritual beliefs

 Physical wellbeing dimension scores poorest

functional independence

 High level of morbidity and rising trend in physical disability

life

elderly to reduce physical functional impairment

and transportation should be improved to promote better social role adaptations and quality of life

Thank You

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