Caregiver interventions have been shown to reduce caregiver depression, burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers too, need care. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic workers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from having to deal with behavioural problems can lessen as the burden from coping with functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to work towards creating a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community

Caregiver interventions have been shown to reduce caregiver depression, burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers too need care. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic helpers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from having to deal with behavioural problems can lessen as the burden from coping with functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to work towards creating a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community.

Caregiver interventions have been shown to reduce caregiver depression, the burden of care, and improve their health and quality of life. Caregiver support also benefits the person with dementia (PWD). It is important to recognise that caregivers need caring too. Caregivers of PWD are usually middle-aged daughters and sons followed by spouses. Foreign domestic helpers also play a pivotal role in Singapore. Stressors arising from caregiving change at different stages of the disease. As the disease progresses into the advanced stages, stress from dealing with behavioural problems can lessen as the burden from coping with physical and functional impairments increases. For this reason, caregiver interventions should be stage appropriate. There is a need to create a positive experience in the GP consultation with the important elements of early diagnosis, providing stage specific information and interventions, and up-to-date information on dementia resources available in the community. The role of the GP in supporting the caregiver is more important than ever amid the current COVID-19 pandemic.

Aging ; Humans ; Singapore ; Spirituality

The ageing population is posing new challenges to Singapore's healthcare system. The rise of dual income and the decline of extended families, as well as an increase in age-related degenerative disorders due to increased longevity render it difficult for the family to remain the primary social safety net to care for our elderly in their own homes. Consequently, nursing homes may become increasingly relevant for resource and expertise-challenged families to cope with the burden of caring for a frail and dependent elderly. However, as the recent Nightingale Nursing Home elderly mistreatment incident attests, the standards of some have been found wanting. This paper will trace the history of nursing homes in Singapore and the evolution of government policies towards them, discuss the challenges and trade-offs of nursing home regulation, and provide suggestions for better care and governance.
Aged ; Forecasting ; Guidelines as Topic ; History, 20th Century ; History, 21st Century ; Humans ; Nursing Homes ; history ; legislation & jurisprudence ; standards ; trends ; Singapore

INTRODUCTIONThis study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore.

MATERIALS AND METHODSAdult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey.

RESULTSA total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149).

CONCLUSIONThe results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.

Adult ; Caregivers ; psychology ; Cost of Illness ; Dementia ; nursing ; Female ; Humans ; Interview, Psychological ; methods ; standards ; Male ; Middle Aged ; Psychiatric Status Rating Scales ; standards ; Stress, Psychological ; diagnosis ; ethnology

INTRODUCTIONThe survival and epidemiology of small-cell lung cancer (SCLC) in Singapore has not been described. We aim to present the characteristics as well as determine the survival outcome and important prognostic factors for SCLC patients.

MATERIALS AND METHODSA retrospective analysis of SCLC patients diagnosed from 1999 to 2002 was conducted at the Outram campus, Singapore. Clinical characteristics and treatment data were obtained from case records and survival data were checked with the registry of births and deaths on 30 May 2005.

RESULTSOne hundred and eleven patients were analysed. There were 38 (34.2%) limited-disease (LD) patients and 73 (65.8%) extensive-disease (ED) patients. The majority were current or former smokers (94.7% among LD and 94.5% among ED). More patients with LD had good performance status (92% versus 63%, P = 0.0003) and were treated with combined chemotherapy and radiotherapy (82% versus 48%, P = 0.012). The median survival time of LD patients treated with curative chemoradiotherapy was 14.2 months (95% CI, 10.96 to 17.44). Those given prophylactic cranial irradiation had a median survival time of 16.9 months (95% CI, 11.83 to 21.97). For ED patients, the median survival time was 8.17 months (95%CI, 5.44 to 10.89). None of the factors analysed were significant prognostic factors for LD patients while performance status and type of treatment given were significant among ED patients.

CONCLUSIONSWe found that the characteristics and survival of SCLC patients in Singapore are fairly similar to that of other countries.

Aged ; Carcinoma, Small Cell ; mortality ; therapy ; Combined Modality Therapy ; Female ; Humans ; Lung Neoplasms ; mortality ; therapy ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Singapore ; epidemiology

Drug Costs ; Ethics, Medical ; Health Care Costs ; Health Services Accessibility ; Humans ; Models, Economic ; Morals ; Physicians ; ethics ; Singapore ; United Nations

OBJECTIVE: Synchronous occurrence of endometrial and ovarian tumors is uncommon, and they affect less than 10% of women with endometrial or ovarian cancers. The aim of this study is to describe the epidemiological and clinical factors; and survival outcomes of women with these cancers. METHODS: This is a retrospective cohort study in a large tertiary institution in Singapore. The sample consists of women with endometrial and epithelial ovarian cancers followed up over a period of 10 years from 2000 to 2009. The epidemiological and clinical factors include age at diagnosis, histology types, grade and stage of disease. RESULTS: A total of 75 patients with synchronous ovarian and endometrial cancers were identified. However, only 46 patients met the inclusion criteria. The median follow-up was 74 months. The incidence rate for synchronous cancer is 8.7% of all epithelial ovarian cancers and 4.9% of all endometrial cancers diagnosed over this time frame. Mean age at diagnosis was 47.3 years old. The most common presenting symptom was abnormal uterine bleeding (36.9%) and 73.9% had endometrioid histology for both endometrial and ovarian cancers. The majority of the women (78%) presented were at early stages of 1 and 2. There were 6 (13.6%) cases of recurrence and the 5 year cumulative survival rate was at 84%. CONCLUSION: In our cohort, we found that majority of women afflicted with synchronous cancer of the endometrium and ovary were younger at age of diagnosis, had early stage of cancer and good survival.
Benzeneacetamides ; Cohort Studies ; Endometrial Neoplasms ; Endometrium ; Female ; Follow-Up Studies ; Humans ; Incidence ; Ovarian Neoplasms ; Ovary ; Piperidones ; Recurrence ; Retrospective Studies ; Singapore ; Survival Rate ; Uterine Hemorrhage

INTRODUCTIONIt has been established that combined chemoradiotherapy treatment benefits selected patients with stage III Non Small Cell Lung Cancer (NSCLC). However, locoregional recurrence still poses a problem. The addition of surgery as the third modality may provide a possible solution. We report our experience of using the triple-modality approach in this group of patients.

MATERIALS AND METHODSThis is a retrospective review of 33 patients with stage III NSCLC treated between 1997 and 2005. Patients have good performance status and no significant weight loss. There were 26 males (79 %) with median age of 63 years (range, 43 to 74) and median follow-up of 49 months. Seventy-six percent had Stage IIIA disease. Chemotherapy consisted of paclitaxel at 175 mg/m2 over 3 hours followed by carboplatin at AUC of 5 over 1 hour. Thoracic radiotherapy was given concurrently with the second and third cycles of chemotherapy. All patients received 50 Gray in 25 fractions over 5 weeks.

RESULTSThe main toxicities were grade 3/4 neutropenia (30%), grade 3 infection (15 %) and grade 3 oesophagitis (9%). Twenty-five patients (76%) underwent surgery. Of the 8 who did not undergo surgery, 1 was deemed medically unfit after induction chemoradiotherapy and 4 had progressive disease; 3 declined surgery. Nineteen patients (58 %) had lobectomy and 6 had pneumonectomy. The median overall survival was 29.9 months and 12 patients are still in remission.

CONCLUSIONThe use of the triplemodality approach is feasible, with an acceptable tolerability and resectability rate in this group of patients.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carboplatin ; adverse effects ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; surgery ; therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Paclitaxel ; adverse effects ; therapeutic use ; Pneumonectomy ; Radiotherapy, Adjuvant ; Retrospective Studies