community for successful ageing (comsa): theory, … · risk screener v2 (same 35 items + extra 35...

Dr Zoe Lim

Research Manager, Tsao Foundation

27th April 2018

Community for Successful

Ageing (ComSA): theory, tools

and implementation

© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.

Overview of presentation

1. Theories of ageing underpinning segmentation

strategies

2. Community case finding: using ComSA

BioPsychoSocial Risk Screener & comparing its

scores to InterRAI outcome scale MaPLE

3. Segmented interventions: strategy,

implementation challenges and lessons learnt


Active ageing is the process of optimizing opportunities for

health, participation and security in order to enhance quality of

life as people age.

The word “active” refers to continuing participation in social,

economic, cultural, spiritual and civic affairs, not just the

ability to be physically active or to participate in the

labour force. Older people who retire from work and those

who are ill or live with disabilities can remain active

contributors to their families, peers, communities and nations.

Active ageing aims to extend healthy life expectancy and quality

of life for all people as they age, including those who are

frail, disabled and in need of care.

Active Ageing – A Policy Framework, WHO

What is Active Ageing?

Health system

interventions

Active Ageing

Health promotion & disease

prevention

Chronic disease

managemtAcute care

Rehabili-tative care

Long term care

Palliative care

Primary care for health promotion, disease prevention & early detection

Who needs

help?

Health system

interventions

What

constitutes

adaptive

capability in

the SG

context?

Active Ageing

Health promotion & disease

prevention

Chronic disease

managemtAcute care

Rehabili-tative care

Long term care

Palliative care

Primary care for health promotion, disease prevention & early detection


RISK

Source: Dr Farah Shiraz, NUS

Segmentation according

loads-lifts balance

Adaptive Capability

Semi-structured interviews

N=40

BPS Framework analysis

Emergent themes converted into questions

(26 In total)

Questions embedded into EASYCARE-Standard 10

Tested on Singapore sample (n=1107)

Factor Analysis

Tsao-NUS ComSA RS research

Development of questions Construct Validity of questions

ComSA BPS Risk

Screener (37 items)

Risk Screener V1

(35 items)

Risk Screener V2

(same 35 items + extra 35

cultural items)

CFAA community survey

(n=1325) using

EASYCare + Lubben

Source: Dr Farah Shiraz, NUS

Biological ALREADY EASYCare New Difficulty in making yourself understood 1.3

I cannot take part in activities or hobbies because of my health ✪

Use the telephone.. 1.4

Keep up personal appearance.. 2.1

Dress yourself.. 2.2

Wash your hands and face 2.3

Use the bath or shower.. 2.4

Do your housework.. 2.5

Prepare own meals.. 2.6

Feed yourself.. 2.7

Take your own medicine.. 2.9

Accidents with your bowels.. 2.12

Use the toilet.. 2.13

Move from bed to chair.. 3.1

Get around indoors.. 3.3

Manage stairs.. 3.4

Walk outside.. 3.6

Go shopping.. 3.7

Getting to public services.. 3.8

Psychological Feeling forget things.. 7.9* ✪

Feel discriminated against.. 4.4

Feel Lonely.. 7.3

Bothered by feeling down, depressed, hopeless 7.5

Ending life.. ✪

Bothered by having little interest or pleasure 7.8

Dissatisfied with accommodation.. 5.1

Trouble sleeping due to worries.. ✪

Arguments in family that upset you.. ✪

Partner or family insult you.. ✪

Consider yourself a burden to family.. ✪

Afraid to do things outside the house..? ✪

Social Tend to eat together as a family? ✪

Do you have communication with close family or friends outside the house by phone or digital contact? ✪

Do you have close confiding relations? ✪

Do you have someone that you trust that you can talk through your troubles with? ✪

Consider your savings enough to live on for the future of your retirement? ✪

Able to pay for essentials such as groceries or bills? ✪ Source: Dr Farah

Shiraz, NUS

24 Easycare

items

13 new

cultural

items


ComSA RS Scoring System

Source: Dr Zoe Hildon, NUS


Source of Table:

Dr Zoe Hildon

Biological Psychological Social

BPS

1 2 1 2 1 2 Some

2-3

Many

4-5

High

6

Self reported health

Falls in last 12 months X X X

Cognitive functioning X X X X

Quality of life

Self reported hospitalization X X X X x

Number of Diseases X X X

ED Visits X X X X x

Length of stay in hospital X


ComSA Risk Screener community survey (2014)

16.3%

22.4%

27.6%

16.4%

11.6%

4.2%

1.6%

Distribution of Managing Score in Whampoa population aged 60 and over (n=1325)

Hildon, Z.JL., Tan, C.S., Shiraz, F. et al. The theoretical and empirical basis of a BioPsychoSocial (BPS) risk screener for

detection of older people’s health related needs, planning of community programs, and targeted care interventions.

BMC Geriatr (2018) 18: 49. https://doi-org.libproxy1.nus.edu.sg/10.1186/s12877-018-0739-x


9.03%

23.6% 24%

20%

12%

8%

4%

Managing score

Distribution of Managing Score in Whampoa population aged 60 and over (n=1107)


ComSA Risk Screener community survey (2016)


Community case finding

= finding those who cannot manage well

Having certain traits ≠ having problems, e.g. living alone ≠ social isolation

Having problems ≠ needing help if adapting well, e.g. adapting to biological with strong

psychosocial support

“Not managing well” = additive B, P and S loads (whilst lacking lifts) depleting adaptive

capability, hence limiting functional ability


Comparing ComSA RS vs. MaPLE segmentation

Managing score MaPLE

Managing score 1

MaPLE 0.188173 1

MAPLe (Method for

Assigning Priority

Levels)

• Differentiates clients

into five priority levels,

based on their risk of

adverse outcomes.

• based on presence of

ADL impairment,

cognitive impairment,

wandering, behavior

problems, and the

institutional risk.

• also predicts caregiver

stress.

http://www.interrai.org/algorithms.ht

ml


Case 1

Case 2


Managing well (RS 0-3) Not managing well (RS 3-6)

SCOPE(Self-Care of Older People)

GAB(Guided AutoBiography)

SWING & BIG SWING(Sharing Wellness and

Initiatives Group)

Hua Mei Clinic, Whampoa

Care Management

EPICC (Elder Person-centred Integrated

Comprehensive Care)

Art Projects (e.g., Curating Whampoa)

Bio

… P

sych

o…

. So

cia

l…

Counselling service

Segmented Interventions

Dementia Care Service

Learning Room (self care, financial security, caregiving support,

learning coaches, etc)

ComSA Champion

Actively promote, prevent, support, manage…

Third Agers … … Fourth Agers

Patient-

Centred

Medical

Home

(PCMH)


Managing well

Outreach challenges: reach mostly

elders already socially active*

Intervention challenges:

Difficult to group elders of

different profiles

Perception of programme

only for social purpose

Social health improvement

preceded by emotional

safety*

Challenges and pitfalls of segmentation

Not managing well

Outreach challenges: 4 in 10

rejected / unable to receive services

Intervention challenges:

Preventive health is hard sell!

Stoicism of elders: “I don’t

need help.”

Perceived lower status of

home-based services by elders

(low trust, low awareness)

*statistical significant (p<0.05)

Screening challenges: under-/over-reporting (surveyors need to be trained), manpower constraint, need for privacy for sensitive screening questions

QUESTIONS?

[email protected]

Thank you for your attention

community for successful ageing (comsa): theory, … · risk screener v2 (same 35 items + extra 35...

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