Relevant studies on ageing – related issues

Age-friendly living

Addae-Dapaah, K., & Wong, G. K. M. (2001). Housing and the elderly in Singapore–financial and quality of life implications of ageing in place. Journal of Housing and the Built Environment, 16(2), 153–178.
In spite of the unprecedented success of public housing in Singapore, the rapid rate at which the population is greying is causing housing stress in the matured Housing and Development Board (HDB) estates. Although new housing options such as studio apartments are being provided by the public sector while a recently formed housing cooperative is developing a retirement village, the majority of the elderly in Singapore prefer to age in place, notwithstanding the imbalance between the demands of their homes and the functioning level of the elderly persons’ physical and biological systems. This implies that home modification, rather than new-built elderly housing, may be a more pragmatic solution to the elderly Singaporeans’ housing problems that could also improve their quality of life. Since 85% of the population of Singapore live in public housing, this paper examines the types of home modifications that could be carried out to the existing stock of public housing so asto create a suitable living environment for the elderly. In addition, the paper considers the housing finance predicaments of the elderly Singaporean and explores possible financing instruments that could be implemented to support home modifications for Singapore’s greying population. The paper concludes that since home modification(s) could improve the quality of life of the elderly persons more than specialised housing, public funds should be diverted from building new specialised housing to home modification(s) for elderly home owners.

Alley, D., Liebig, P., Pynoos, J., Banerjee, T., & Choi, I. H. (2007). Creating Elder-Friendly Communities. Journal of Gerontological Social Work, 49(1-2), 1–18.  
Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. ‘Age-prepared communities’ utilize community planning and advocacy to foster aging in place. ‘Elder-friendly communities’ are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care, safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities.

Bozovic-Stamenovic, R. (2015). A supportive healthful housing environment for ageing: Singapore experiences and potentials for improvements. Asia Pacific Journal of Social Work and Development, 25(4), 198–212.  
A supportive healthful housing environment for ageing requires further adjustments of the Singapore Housing Development Board model of social housing. Suggestions for improvements follow the critical examination of typical examples according to common criteria for healthfulness. Deficiencies of the current linear model directly connecting needs to design solutions are addressed in the proposed network model in which aspirations are realised through environmental choices and opportunities. A transdisciplinary approach to environmental support unveils the need to consider design and spaces as social care tools. In conclusion, design of supportive healthful environments requires empowering the user-experts and embracing the holistic approach to design, upgrade and reuse of the ample HDB stock.

Fitzgerald, K. G., & Caro, F. G. (2014). An Overview of Age-Friendly Cities and Communities Around the World. Journal of Aging & Social Policy, 26(1-2), 1–18.

Krishnasamy, C., Unsworth, C. A., & Howie, L. (2013). Exploring the mobility preferences and perceived difficulties in using transport and driving with a sample of healthy and outpatient older adults in Singapore. Australian Occupational Therapy Journal, 60(2), 129–137.  
Background/aim: While activity engagement is important to older adults, limitations in ability can affect transport mode choice and subsequent activity participation. Therefore, this study aimed to explore the mobility preferences and difficulties in using public transport and driving with a sample of older adults in Singapore, with specific reference to accessing everyday activities. Methods: One hundred and sixty-two persons aged 50 years and over were recruited through a community event, and an outpatient occupational therapy department. They self-completed structured questionnaire forms which were analysed using parametric and non-parametric statistics, including t-tests and ANOVAs.  Results: The majority of the participants were in the paid workforce and no significant differences were found between gender and the importance of transport for access to various activities, but a significant association was found for age and use of transport for going to work, F(5,101) = 3.07, P = 0.01. The majority of the drivers drove at least once a day, and 19% of them reported having noticed declines in their driving capabilities in the past four years, and indicated driving less often because of these concerns.  Conclusions: This study explored public transport and car use among a sample of older adults in Singapore to access desired activities. It identified difficulties with both public and private transportation use, such as difficulty maintaining balance/obtaining a seat, and concerns with decreased ability to respond quickly to traffic situations. This study has highlighted that transportation methods should be considered in occupational therapy practice with older adults.

Low, L. L., Wah, W., Ng, M. J., Tan, S. Y., Liu, N., & Lee, K. H. (2016). Housing as a Social Determinant of Health in Singapore and Its Association with Readmission Risk and Increased Utilization of Hospital Services. Frontiers in Public Health, 4, 109.  
BACKGROUND: Residence in public rental housing is an area-level measure of socioeconomic status, but its impact as a social determinant of health in Singapore has not been studied. We therefore aimed to examine the association of public rental housing with readmission risk and increased utilization of hospital services in Singapore. METHODS: We conducted a retrospective cohort study using retrospective 2014 data from Singapore General Hospital’s electronic health records. Variables known to affect readmission risk and health-care utilization were identified a priori and include patient demographics, comorbidities, health-care utilization in the preceding 1 year and clinical variables from the index admission in 2014. Multivariate logistic regression was used to evaluate public rental housing as an independent risk factor for admission risk, emergency department (ED), and specialist outpatient clinic attendances. RESULTS: A total of 14,457 unique patients were analyzed, and 2,163 patients (15.0%) were rental housing residents. Rental housing patients were significantly more likely to be male; required financial assistance; have chronic obstructive pulmonary disease; usage of anti-depressant and anti-psychotic medications; longer length of hospital stay during the index admission; and higher Charlson Comorbidity Index scores. After adjusting for demographics and clinical variables, staying in public rental housing remained an independent risk factor for readmission within 15 and 30 days, frequent hospital admissions and ED attendances in Singapore. CONCLUSION: Our study showed an association between public rental housing with readmission risk and increased utilization of hospital services in Singapore. A deeper understanding of the residents’ social circumstances and health seeking behavior would be insightful.

Nyunt, M. S. Z., Shuvo, F. K., Eng, J. Y., Yap, K. B., Scherer, S., Hee, L. M., … Ng, T. P. (2015). Objective and subjective measures of neighborhood environment (NE): relationships with transportation physical activity among older persons. The International Journal of Behavioral Nutrition and Physical Activity, 12, 108.  
BACKGROUND: This study examined the associations of subjective and objective measures of the neighbourhood environment with the transportation physical activity of community-dwelling older persons in Singapore. METHOD: A modified version of the Neighborhood Environment Walkability Scale (NEWS) and Geographical Information System (GIS) measures of the built environment characteristics were related to the frequency of walking for transportation purpose in a study sample of older persons living in high-density apartment blocks within a public housing estate in Singapore. Relevant measured variables to assess the complex relationships among built environment measures and transportation physical activity were examined using structural equation modelling and multiple regression analyses. RESULTS: The subjective measures of residential density, street connectivity, land use mix diversity and aesthetic environment and the objective GIS measure of Accessibility Index have positively significant independent associations with transportation physical activity, after adjusting for demographics, socio-economic and health status. CONCLUSION: Subjective and objective measures are non-overlapping measures complementing each other in providing information on built environment characteristics. For elderly living in a high-density urban neighborhood, well connected street, diversity of land use mix, close proximity to amenities and facilities, and aesthetic environment were associated with higher frequency of walking for transportation purposes.

Thompson, C. W., Curl, A., Aspinall, P., Alves, S., & Zuin, A. (2014). Do changes to the local street environment alter behaviour and quality of life of older adults? The ‘DIY Streets’ intervention. British Journal of Sports Medicine, 48(13), 1059–1065.  
Background: The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans ‘DIY Streets’) allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults’ activities, health and quality of life. Methods Pre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records. Results: The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one’s car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations. Conclusions: Our study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.