RETHINKING AGEING Annual Report 2017/2018 VISION A research institute to help Singapore better prepare for the challenges of an ageing population. PURPOSE A geriatric institute based in Singapore to conduct research and education on age-related health issues to promote healthy ageing. MESSAGE FROM PROF PANG WENG SUN EXECUTIVE DIRECTOR Here at GERI, we are committed to our goal of conducting research and education on age-related health issues to promote healthy ageing. In the past year, we have grown, not only in terms of staff strength, but also in the size and scale of the projects that our research programmes are working on. In 2017, GERI completed 21 research projects and have 32 currently ongoing projects. These projects were mostly supported by GERI’s Intramural funds of $1,066,861. For work with several other external collaborators in two separate projects, GERI was awarded a total of $827,524.80 in extramural funding under the Land and Liveability National Innovation Challenge (L2 NIC) by the Ministry of National Development (MND) and National Research Foundation (NRF). This year, we officially teamed up with the Ageing Research Institute for Society for Education (ARISE) at the Nanyang Technological Institute (NTU), having signed an agreement in November. Through this collaboration, we will be able to harness each other’s multi-disciplinary expertise to better understand the needs of the elderly and improve care provision for our ageing population in Singapore. Moving forward, GERI will continue to strive for excellence in our research, to find innovative and current ways to serve the ageing population in Singapore with our findings. We believe that it is imperative that we come together with our external collaborators and community partners to continually meet the needs and improve the lives of seniors in Singapore. Therein lies the true essence of Rethinking Ageing. SENIOR MANAGEMENT Prof Pang Weng Sun A/Prof Ding Yew Yoong Dr Wong Chek Hooi Executive Director Deputy Executive Director Deputy Executive Director Programme Lead Programme Lead (Clinical Geriatrics & End of Life) (Health Services & Policy Research, Senior Care Delivery) A/Prof Wee Shiou Liang A/Prof James Alvin Low Yiew Hock Ms Kong Lai Ho Director Programme Lead Senior Finance Manager Programme Co-Lead (Geriatric Education Research) (Frailty Identification, Prevention & Care Model Research Programme) JOINT FACULTY • Dr Chong Mei Sian (The Geriatrics Practice) • A/Prof Ng Tze Pin (National University of Singapore) • Dr Tew Chee Wee ADJUNCT FACULTY • Dr Allyn Hum (Tan Tock Seng Hospital) • A/Prof Angelique Chan (National University of Singapore) • Dr Christine Chen (Changi General Hospital) • Dr Christopher Lien (Changi General Hospital) • Dr David Matchar (National University of Singapore) • A/Prof Edward Poon (Ang Mo Kio - Thye Hua Kwan Hospital) • A/Prof Gerald Koh (National University of Singapore) • Dr Laura Tay (Sengkang General Hospital) ADJUNCT FACULTY • Dr Laurence Tan (Khoo Teck Puat Hospital) • Dr Mallya Ullal Jagadish (Khoo Teck Puat Hospital) • A/Prof Philip Yap (Khoo Teck Puat Hospital) • Dr Raymond Ng (Tan Tock Seng Hospital) • Dr Samir Sinha (Mount Sinai Hospital, Canada) • A/Prof Tan Hwee Pink (Singapore Management University) • Dr Mathew Mathews (Institute of Policy Studies, National University of Singapore) OUR PEOPLE OUR ADMIN TEAM From left to right: Qiu Shijia (Research Governance & Administration) Teresa Elizabeth Koh, Stephanie Fong (Operations) EVENTS The Art of Data Science Data Analytics is a scientific and data-driven approach to help organisations solve problems, make better decisions and increase productivity. Our Senior Research Fellow, Dr Reuben Ng, held a session to share the learning points of successful analytics projects from a practitioner’s perspective. Identifying Causal Relationships in Observational Research In health research, identifying causal relationships is often more meaningful than merely demonstrating its association. A/Prof Ding Yew Yoong conducted a learning session and introduced a graphical approach to causal inference, which also served to motivate researchers to include this approach in their methodological toolbox. PUBLICATIONS • Heywood R, Gao Q, Nyunt MSZ, Feng L, Chong MS, Lim WS, Yap P, Lee TS, Yap KB, Wee SL & Ng TP. (2017). Hearing Loss and Risk of Mild Cognitive Impairment and Dementia: Findings from the Singapore Longitudinal Ageing Study. Dementia and Geriatric Cognitive Disorders. 2017-43(5-6):259-68. • Teo N, Gao Q, Nyunt MSZ, Wee SL and Ng TP. Social Frailty and Functional Disability: Findings from the Singapore Longitudinal Ageing Study (SLAS). Journal of the American Medical Directors Association. 2017 Jul 01:18(7):637e13- e19. • Ng TP, Nyunt MSZ, Gao Q, Wee SL, Yap P, Yap KB. Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA): Development and Validation of a Nutritional Prognostic Index. Clinical Nutrition ESPEN. 2017 Aug 30:22:54-63. • Wei K, Nyunt MSZ, Gao Q, Wee SL, Ng TP. Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community-Dwelling Older Adults: Singapore Longitudinal Ageing Studies. Journal of the American Medical Directors Association. 2017 Dec 1:18(12):1019-28 • Tam WJ, Koh GC, Legido-Quigley H, Ha NHL, Yap PLK. “I Can’t Do This Alone”: A study on foreign domestic workers providing long-term care for frail seniors at home. International Psychogeriatric Association. 2017 Nov 20:1-9. • Chen TY, Tan PJ, Chan A. Ethnicity predicts falls among community-dwelling older adults in Singapore. Geriatrics & gerontology international. 2018 Jan;18(1):72-79. • Wong AK, Ong SF, Matchar DB, Lie D, Ng R, Yoon KE, Wong CH. Complexities and Challenges of Singapore Nurses Providing Postacute Home Care in Multicultural Communities: A Grounded Theory Study. Journal of Transcultural Nursing. 2017 Oct 1:1043659617736884. PUBLICATIONS • Mat S, Ng CT, Tan PJ, Ramli N, Fadzli F, Rozalli Fl, Mazlan M, Hill KD, Tan MP. Effect of Modified Otago Exercises on Postural Balance, Fear of Falling, and Fall Risk in Older Fallers with Knee Osteoarthritis and Impaired Gait and Balance: A Secondary Analysis. American Academy of Physical Medicine and Rehabilitation. 2017 Aug 18. pii: S1934- 1482(17)30007-2 • Tan Q, Chye L, Ng D, Chong MS, Ng TP, Wee SL. Feasibility of a community-based Functional Power Training program for older adults. Clinical Interventions in Aging. 2018: 13 309-316 • Siddiqui S, Chua M, Kumaresh V and Choo R. A comparison of pre ICU admission SIRS, EWS and q SOFA scores for predicting mortality and length of stay in ICU. The Journal of Critical Care. 2017 May 25:41:191-3 • Tay HEF, Thompson C, Nieh CM, Koh HM, Tan JJC, Yap P. Person-centered care for older people with dementia in the acute hospital. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 2017:4:19-27 • G Magpantay, HJ Toh, JA Low, WK Chia. Analysis of reasons for potentially preventable hospital transfers using the modified INTERACT-II Tool- Letter to the Editor. Journal of the American Medical Directors Association. 19 (2018) 181e184. • Dent E, Lien C, Lim WS, Wong WC, Wong CH et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. Journal of the American Medical Directors Association. Jul 1;18(7):564-575. • Zhou K, Vidyarthi AR, Wong CH, Matchar D. Where to Go If Not the Hospital? Reviewing Geriatric Bed Utilization in an Acute Hospital in Singapore. Geriatrics & Gerontology International. 2017 Oct;17(10):1575-1583. CLINICAL GERIATRICS & END OF LIFE “With our ageing population, there is an increasing need to address age-related conditions, multimorbidity, polypharmacy, rehospitalization, advanced illness and end life care, as well as caregiving. Thus, in collaboration with partners in our healthcare system and academic institutions, we aim to conduct research that impact practice in clinical care of older adults. CLINICAL GERIATRICS & END OF LIFE OUR TEAM From left to right: A/Prof Ding Yew Yoong, Penny Lun CLINICAL GERIATRICS & END OF LIFE UPCOMING PROJECTS Prediction of Survival in Advanced Dementia: Developing Prognostic Models Collaborators: Tan Tock Seng Hospital (TTSH), Khoo Teck Puat Hospital (KTPH), Health Services & Outcomes Research (National Healthcare Group) Palliative care is a specialized, multi-disciplinary, and holistic approach to caring for seriously ill people and providing support to their families. Currently, access to palliative care in advanced dementia is hindered due to the difficulty in prognostication. We aim to study variables which enable clinicians to identify patients with end stage dementia who are suffering from burdensome symptoms, thus improving access for them to further supportive care. A prognostic assessment tool which is applicable across different healthcare settings will ensure that patients dying with dementia do not have unaddressed symptoms, communication and palliative needs which are particularly prevalent in the last year of life. Delineating Potentially Modifiable Causes for Early Re-Admission in Seniors following Acute Hospital Discharge: CEASE Study Collaborator: Sengkang General Hospital (SKH), Tan Tock Seng Hospital (TTSH) Older adults are at increased risk of hospital admission and re-admissions, imposing significant burden on the individual as any hospital admission is hazardous for the frail elderly. The primary objective of this study will be to delineate potentially modifiable patient-, social- and healthcare system-related risk factors for unplanned