Chek Hooi Wong | National University of Singapore (original) (raw)

Papers by Chek Hooi Wong

BMC Geriatrics

Background Falls in older adults are the result of a complex web of interacting causes, that furt... more Background Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults. Methods A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping o...

BMJ Open

IntroductionFalls are an important public health issue with consequences that include injuries, q... more IntroductionFalls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore.Methods and analysisThis is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum...

International Journal of Integrated Care

International Journal of Integrated Care

International Journal of Integrated Care

Annals of the Academy of Medicine, Singapore

Introduction: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in Nov... more Introduction: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making. Method: We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources. Results: We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primar...

BMC Geriatrics

Background Frailty is increasing in prevalence internationally with population ageing. Frailty ca... more Background Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of success. However, many of these care models’ implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme’s effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-match...

Innovation in Aging

Background and Objectives Falls among older adults are a significant health problem globally. Stu... more Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programmes in randomised controlled trials demonstrate effectiveness in reducing falls, however, the translation of research into the community remains challenging. While there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programmes in Singapore, with a focus on the inter-relationship between those factors. Research Design and Methods Healthcare professionals familiar with fall prevention programmes were invited to discuss the enablers and challenges to the implementation. Thi...

PLOS ONE

Introduction High users of hospital services require targeted healthcare services planning for ef... more Introduction High users of hospital services require targeted healthcare services planning for effective resource allocation due to their high costs. This study aims to segmentize the population in the “Ageing In Place-Community Care Team” (AIP-CCT), a programme for complex patients with high inpatient service use, and examine the association of segment membership and healthcare utilisation and mortality. Methods We analysed 1,012 patients enrolled between June 2016 and February 2017. To identify patient segments, a cluster analysis was performed based on medical complexity and psychosocial needs. Next, multivariable negative binomial regression was performed using patient segments as the predictor, with healthcare and programme utilisation over the 180-day follow-up as outcomes. Multivariate cox proportional hazard regression was applied to assess the time to first hospital admission and mortality between segments within the 180-day follow-up. All models were adjusted for age, gend...

The Asia Pacific Scholar

Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for ... more Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for patients with a key focus on undergraduate interprofessional education (IPE). We sought to validate the Readiness for Interprofessional Learning Scale (RIPLS) and evaluate TriGen’s efficacy by investigating healthcare undergraduates’ attitude towards IPE. Methods: Teams of healthcare undergraduates performed home visits for patients fortnightly over six months, trained by professionals from a regional hospital and a social service organisation. The RIPLS was validated using exploratory factor analysis. Evaluation of TriGen’s efficacy was performed via the administration of the RIPLS pre- and post-intervention, analysis of qualitative survey results and thematic analysis of written feedback. Results: 79.6% of 226 undergraduate participants from 2015-2018 were enrolled. Exploratory factor analysis revealed four factors accounting for 64.9% of total variance. One item loaded poorly and was ...

Critical Reviews in Oncology/Hematology, 2007

International Journal of Integrated Care

BMC Geriatrics, 2021

Background The first Patient-Centered Medical Home (PCMH) demonstration in Singapore was launched... more Background The first Patient-Centered Medical Home (PCMH) demonstration in Singapore was launched in November 2016, which aimed to deliver integrated and patient-centered care for patients with bio-psycho-social needs. Implementation was guided by principles of comprehensiveness, coordinated care, shared decision-making, accessible services, and quality and safety. We aimed to investigate the impact of implementing the PCMH in primary care on quality of life (QoL) and patient activation. Methods The study design was a prospective single-arm pre-post study. We applied the 5-level EuroQol 5-dimension (EQ-5D-5L) and Visual Analog Scale (EQ VAS) instruments to assess health-related QoL. The CASP-19 tool was utilised to examine the degree that needs satisfaction was fulfilled in the domains of Control, Autonomy, Self-realisation, and Pleasure. The 13-item Patient Activation Measure (PAM-13) was used to evaluate knowledge, skills and confidence in management of conditions and ability to s...

Age and Ageing, 2019

Introduction Older adults have been found to under- or overestimate their fall risk. However, no ... more Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore. Methods This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities an...

Critical Care Medicine, 1999

In this study, clinical practice guidelines were developed by a multidisciplinary team for patien... more In this study, clinical practice guidelines were developed by a multidisciplinary team for patients with infections admitted to a surgical intensive care unit (ICU). A 51-day baseline audit period (Phase I) in a 20-bed (private rooms) surgical ICU was compared with a 34-day period in the same unit after implementation of the guidelines (Phase II). Phase I included 182 patients (670 patient days), and Phase II included 139 patients (427 patient days). There was no significant difference between patients in the Phase I and Phase II groups regarding age (65.4/19-95 vs. 64.8/18-90 yrs), gender (56% male vs. 55% male), severity of illness (mean Acute Physiology and Chronic Health Evaluation III, 38 vs. 39.1), total infections (respiratory, 8% vs. 4%; urinary tract, 15% vs. 4%; wound, 4% vs. 3%; skin/soft tissue, 3% vs. 7%; sepsis, 5% vs. 3%; intra-abdominal, 9% vs. 17%), and no infection (64% vs. 67%). Clinical outcomes of patients with infections in the Phase I group compared with those in the Phase II group were as follows: clinical improvement or cure, 64% vs. 76%; persistent infection, 17% vs. 11%; clinical failure, 0 vs. 2%; and death, 18% vs. 7% (p = NS). When patients with infections were compared, death rates were 20% in the Phase I group and 5.6% in the Phase II group (p = .02). After implementation of the clinical pathways, antibiotic costs were reduced from 676.54perpatientto676.54 per patient to 676.54perpatientto157.88 per patient (p = .001). Length of stay in the ICU was 3.7 days in the Phase I trial and a mean of 3 days in the Phase II trial (p = NS). Specimens of Escherichia coli demonstrated a trend toward a decreased resistance to all antibiotics and Pseudomonas aeruginosa to ciprofloxacin and aminoglycosides (p = NS). In this study, the use of clinical practice guidelines for patients who were admitted to the surgical ICU was shown to reduce costs, without adversely affecting patients' outcomes. This study has important implications for the use of clinical practice guidelines for the management of patients with infections who are admitted to surgical ICUs.

International Journal of Environmental Research and Public Health

Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care ... more Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported b...

Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.... more Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.8 % of the population in 1995 and is projected to increase to 20 % by the year 2030.1 The medical community is also faced with a similar

Innovation in Aging

Independent outdoor mobility is important to community-dwelling older adults as it enables reach ... more Independent outdoor mobility is important to community-dwelling older adults as it enables reach and access to resources for everyday activities, but this becomes increasingly challenging with the progressive decline in physical performance in ageing. We aim to understand the relationship between Indoor (IGS) and Real-Life Outdoor Gait Speed (OGS) with objectively-measured geographic life-space extent and outdoor mobility among community-ambulant older adults in Singapore. Thirty-three participants aged ≥55 years living in three neighbourhoods wore hybrid mobility trackers continuously for 7 days. Baseline 6-metre IGS was measured with a stopwatch, while OGS was from outdoor accelerometer data. Nodes were defined as significant places visited for ≥5 minutes. Multiple linear regressions examined each association between IGS and OGS on geographic life-space extent and outdoor mobility measures adjusting for confounders. Participants’ mean age was 69.2±7.1 years with mean IGS and OGS o...

Innovation in Aging

Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge an... more Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge and beliefs, but few have elucidated this cognitive process in older adults surrounding falls. We aim to identify risk factors for high FOF amongst community-dwelling older adults (OA) and middle-aged adults (MA) in Singapore. This was a cross-sectional survey of a nationally-representative sample of OA (≥60 years) and MA (40-59 years) identified by stratified random sampling. Primary outcome was high FOF measured by a single-item (4-point scale). Independent variables were history-of-falls, quality-of-life, fall-related cognitive appraisal (balance problems, importance to restrict activities to prevent falls) and knowledge indicators (knowledge of other OA who fell, ability to identify out of 13 fall risk factors). MA were also asked if they’re caregivers. Multiple logistic regressions identified risk factors for high FOF separately by age-groups, adjusting for socio-demographics and como...

BMC Geriatrics

Background Falls in older adults are the result of a complex web of interacting causes, that furt... more Background Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults. Methods A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping o...

BMJ Open

IntroductionFalls are an important public health issue with consequences that include injuries, q... more IntroductionFalls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore.Methods and analysisThis is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum...

International Journal of Integrated Care

International Journal of Integrated Care

International Journal of Integrated Care

Annals of the Academy of Medicine, Singapore

Introduction: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in Nov... more Introduction: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making. Method: We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources. Results: We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primar...

BMC Geriatrics

Background Frailty is increasing in prevalence internationally with population ageing. Frailty ca... more Background Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of success. However, many of these care models’ implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme’s effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-match...

Innovation in Aging

Background and Objectives Falls among older adults are a significant health problem globally. Stu... more Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programmes in randomised controlled trials demonstrate effectiveness in reducing falls, however, the translation of research into the community remains challenging. While there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programmes in Singapore, with a focus on the inter-relationship between those factors. Research Design and Methods Healthcare professionals familiar with fall prevention programmes were invited to discuss the enablers and challenges to the implementation. Thi...

PLOS ONE

Introduction High users of hospital services require targeted healthcare services planning for ef... more Introduction High users of hospital services require targeted healthcare services planning for effective resource allocation due to their high costs. This study aims to segmentize the population in the “Ageing In Place-Community Care Team” (AIP-CCT), a programme for complex patients with high inpatient service use, and examine the association of segment membership and healthcare utilisation and mortality. Methods We analysed 1,012 patients enrolled between June 2016 and February 2017. To identify patient segments, a cluster analysis was performed based on medical complexity and psychosocial needs. Next, multivariable negative binomial regression was performed using patient segments as the predictor, with healthcare and programme utilisation over the 180-day follow-up as outcomes. Multivariate cox proportional hazard regression was applied to assess the time to first hospital admission and mortality between segments within the 180-day follow-up. All models were adjusted for age, gend...

The Asia Pacific Scholar

Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for ... more Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for patients with a key focus on undergraduate interprofessional education (IPE). We sought to validate the Readiness for Interprofessional Learning Scale (RIPLS) and evaluate TriGen’s efficacy by investigating healthcare undergraduates’ attitude towards IPE. Methods: Teams of healthcare undergraduates performed home visits for patients fortnightly over six months, trained by professionals from a regional hospital and a social service organisation. The RIPLS was validated using exploratory factor analysis. Evaluation of TriGen’s efficacy was performed via the administration of the RIPLS pre- and post-intervention, analysis of qualitative survey results and thematic analysis of written feedback. Results: 79.6% of 226 undergraduate participants from 2015-2018 were enrolled. Exploratory factor analysis revealed four factors accounting for 64.9% of total variance. One item loaded poorly and was ...

Critical Reviews in Oncology/Hematology, 2007

International Journal of Integrated Care

BMC Geriatrics, 2021

Background The first Patient-Centered Medical Home (PCMH) demonstration in Singapore was launched... more Background The first Patient-Centered Medical Home (PCMH) demonstration in Singapore was launched in November 2016, which aimed to deliver integrated and patient-centered care for patients with bio-psycho-social needs. Implementation was guided by principles of comprehensiveness, coordinated care, shared decision-making, accessible services, and quality and safety. We aimed to investigate the impact of implementing the PCMH in primary care on quality of life (QoL) and patient activation. Methods The study design was a prospective single-arm pre-post study. We applied the 5-level EuroQol 5-dimension (EQ-5D-5L) and Visual Analog Scale (EQ VAS) instruments to assess health-related QoL. The CASP-19 tool was utilised to examine the degree that needs satisfaction was fulfilled in the domains of Control, Autonomy, Self-realisation, and Pleasure. The 13-item Patient Activation Measure (PAM-13) was used to evaluate knowledge, skills and confidence in management of conditions and ability to s...

Age and Ageing, 2019

Introduction Older adults have been found to under- or overestimate their fall risk. However, no ... more Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore. Methods This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities an...

Critical Care Medicine, 1999

In this study, clinical practice guidelines were developed by a multidisciplinary team for patien... more In this study, clinical practice guidelines were developed by a multidisciplinary team for patients with infections admitted to a surgical intensive care unit (ICU). A 51-day baseline audit period (Phase I) in a 20-bed (private rooms) surgical ICU was compared with a 34-day period in the same unit after implementation of the guidelines (Phase II). Phase I included 182 patients (670 patient days), and Phase II included 139 patients (427 patient days). There was no significant difference between patients in the Phase I and Phase II groups regarding age (65.4/19-95 vs. 64.8/18-90 yrs), gender (56% male vs. 55% male), severity of illness (mean Acute Physiology and Chronic Health Evaluation III, 38 vs. 39.1), total infections (respiratory, 8% vs. 4%; urinary tract, 15% vs. 4%; wound, 4% vs. 3%; skin/soft tissue, 3% vs. 7%; sepsis, 5% vs. 3%; intra-abdominal, 9% vs. 17%), and no infection (64% vs. 67%). Clinical outcomes of patients with infections in the Phase I group compared with those in the Phase II group were as follows: clinical improvement or cure, 64% vs. 76%; persistent infection, 17% vs. 11%; clinical failure, 0 vs. 2%; and death, 18% vs. 7% (p = NS). When patients with infections were compared, death rates were 20% in the Phase I group and 5.6% in the Phase II group (p = .02). After implementation of the clinical pathways, antibiotic costs were reduced from 676.54perpatientto676.54 per patient to 676.54perpatientto157.88 per patient (p = .001). Length of stay in the ICU was 3.7 days in the Phase I trial and a mean of 3 days in the Phase II trial (p = NS). Specimens of Escherichia coli demonstrated a trend toward a decreased resistance to all antibiotics and Pseudomonas aeruginosa to ciprofloxacin and aminoglycosides (p = NS). In this study, the use of clinical practice guidelines for patients who were admitted to the surgical ICU was shown to reduce costs, without adversely affecting patients' outcomes. This study has important implications for the use of clinical practice guidelines for the management of patients with infections who are admitted to surgical ICUs.

International Journal of Environmental Research and Public Health

Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care ... more Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported b...

Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.... more Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.8 % of the population in 1995 and is projected to increase to 20 % by the year 2030.1 The medical community is also faced with a similar

Innovation in Aging

Independent outdoor mobility is important to community-dwelling older adults as it enables reach ... more Independent outdoor mobility is important to community-dwelling older adults as it enables reach and access to resources for everyday activities, but this becomes increasingly challenging with the progressive decline in physical performance in ageing. We aim to understand the relationship between Indoor (IGS) and Real-Life Outdoor Gait Speed (OGS) with objectively-measured geographic life-space extent and outdoor mobility among community-ambulant older adults in Singapore. Thirty-three participants aged ≥55 years living in three neighbourhoods wore hybrid mobility trackers continuously for 7 days. Baseline 6-metre IGS was measured with a stopwatch, while OGS was from outdoor accelerometer data. Nodes were defined as significant places visited for ≥5 minutes. Multiple linear regressions examined each association between IGS and OGS on geographic life-space extent and outdoor mobility measures adjusting for confounders. Participants’ mean age was 69.2±7.1 years with mean IGS and OGS o...

Innovation in Aging

Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge an... more Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge and beliefs, but few have elucidated this cognitive process in older adults surrounding falls. We aim to identify risk factors for high FOF amongst community-dwelling older adults (OA) and middle-aged adults (MA) in Singapore. This was a cross-sectional survey of a nationally-representative sample of OA (≥60 years) and MA (40-59 years) identified by stratified random sampling. Primary outcome was high FOF measured by a single-item (4-point scale). Independent variables were history-of-falls, quality-of-life, fall-related cognitive appraisal (balance problems, importance to restrict activities to prevent falls) and knowledge indicators (knowledge of other OA who fell, ability to identify out of 13 fall risk factors). MA were also asked if they’re caregivers. Multiple logistic regressions identified risk factors for high FOF separately by age-groups, adjusting for socio-demographics and como...