Background: To ascertain the construct validity and reliability of a self-administered web-based assessment of intrinsic capacity (IC). The study design was a cross-sectional analysis using data from a prospective cohort. Methods: We included data from 6,434 respondents (mean age 65.33±5.81 years; 52.4% women) of the Singapore Life Panel population study who participated in the online surveys in March 2022 and May 2022. Incremental nested factor structures of IC were modelled with confirmatory factor analysis (CFA) and their goodness-of-fit were assessed mainly with root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR). With the most parsimonious model as our eventual factor structure, we further evaluated IC and its domains with reliability indices. Results: CFA demonstrated construct validity for the second-order factor structure with acceptable overall model fit: χ2(147)=7,696.276, p<0.001; CLI=0.947; TLI=0.938; RMSEA=0.089; SRMR=0.051. Amongst the domains, vitality had highest factor loading (0.889), whereas locomotion and cognition (0.534 and 0.601, respectively) had lowest loadings with the second-order IC factor. All five IC domains and the general IC factor fulfilled reliability thresholds (construct validity [CR] or hierarchical omega ≥0.7; average variance extracted ≥0.5); psychological and locomotion domains have high CR (>0.9), whereas vitality and sensory domains have lower values of CR. Conclusion Our study provides proof-of-concept evidence regarding the construct validity and reliability of a self-administered web-based assessment of IC index that can potentially be scalable in other population settings.

INTRODUCTION: Timely detection of dementia enables early access to dementia-specific care services and interventions. Various stakeholders brought together to refine Singapore's dementia care strategy identified a lack of a standardised cognitive screening tool and the absence of a comparative review of existing tools. We hence conducted a rapid review to evaluate the diagnostic performance of brief cognitive screening tools in identifying possible dementia among community-dwelling older adults in Singapore. METHOD: Brief cognitive screening tools were defined as interviews or tests administered in ≤5 minutes. Studies performed in Singapore on older adults ≥60 years, which used locally-validated comparators and reported outcomes of clinician-diagnosed dementia were included. Rapid review methodology was used in study screening and selection. Quality Assessment of Diagnostic Accuracy Studies version 2 tool was used for risk-of-bias assessment. A negative likelihood ratio (LR-) of ≤0.2 was defined a priori as having a moderate effect in shifting post-test probability. RESULTS: Fourteen studies were included in qualitative synthesis: 3 studies evaluated self-/informant-based tools only, 4 evaluated performance-based measures only and 7 evaluated combination approaches. Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) was the most studied self-/ informant-based tool. One study found informant AD8 (iAD8) superior to self-rated AD8. Another study found iAD8 superior to Mini-Mental State Examination. Among performance-based measures, Abbreviated Mental Test, Visual Cognitive Assessment Test-Short form version 1 (VCAT-S1), VCAT-S2 and Mini-Cog had LR- <0.2. Minimal improvement of combination approaches compared to iAD8 alone was demonstrated. CONCLUSION Our review suggests the limited utility of dementia screening in communities with low dementia prevalence and supports a case-finding approach instead. With a reliable informant, iAD8 alone has sufficient discriminant ability. Further research is needed to specifically assess the diagnostic ability of performance-based tools in community settings.
Humans ; Singapore ; Dementia/diagnosis* ; Aged ; Independent Living ; Mass Screening/methods* ; Middle Aged ; Aged, 80 and over

Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaemic control in a single injection. The glucose level-lowering efficacy of IDegAsp is reported to be superior or non-inferior to that of the currently available insulin therapies with a lower rate of overall hypoglycaemia and nocturnal hypoglycaemia. An expert panel from Malaysia aims to provide insights into the utilisation of IDegAsp across a broad range of patients with type 2 diabetes mellitus (i.e. treatment-naïve or insulin-naïve patients or patients receiving treatment intensification from basal-only regimens, premixed insulin and basal–bolus insulin therapy). IDegAsp can be initiated as once-daily dosing for the main meal with the largest carbohydrate content with weekly dose adjustments based on patient response. A lower starting dose is recommended for patients with cardiac or renal comorbidities. Dose intensification with IDegAsp may warrant splitting into twice-daily dosing. IDegAsp twice-daily dosing does not need to be split at a 50:50 ratio but should be adjusted to match the carbohydrate content of meals. The treatment of patients choosing to fast during Ramadan should be switched to IDegAsp early before Ramadan, as a longer duration of titration leads to better glycated haemoglobin level reductions. The pre-Ramadan breakfast/lunch insulin dose can be reduced by 30%–50% and taken during sahur, while the pre-Ramadan dinner dose can be taken without any change during iftar. Education on the main meal concept is important, as carbohydrates are present in almost all meals. Patients should not have a misconception of consuming more carbohydrates while taking IDegAsp.
insulin degludec [Supplementary Concept] ; Insulin Aspart ; Glucose ; Hypoglycaemia ; Diabetes Mellitus, Type 2

Biomedical Research ; Frailty ; Geriatrics ; Health Policy ; Health Services ; Humans ; Practice Guidelines as Topic ; Singapore