Health Services, Geriatric Clinical Trial
Official title:
Self Care for Older Persons in Singapore: An Intervention Study
The main aim of the project is to evaluate a self-care intervention program aimed at
enhancing the ability of mildly disabled and healthy older persons in Singapore to manage
their health.
A secondary aim of the study is to evaluate the effectiveness of training community health
workers located within Senior Activity Centres in Singapore to support the self-care
capacity development amongst older persons in the locale.
Singapore is facing a rapidly ageing population due to its changing demographics. One of the
biggest challenges associated with older adults is providing them with adequate and
sustainable health care. There are four main barriers that make it challenging to do so in
this segment of the population: (1) Lack of knowledge of simple coping mechanisms and self
care; (2) inadequate access to care and healthcare; (3) social, economic, and political
exclusion; and (4) declining family support and strains on state services.
This proposal, is to conduct a randomized controlled trial that tests the impact of a
state-of-the-art self care training program focused on teaching older adults how to manage
their health and if present, their diabetes, hypertension or chronic obstructive pulmonary
disease. The training focuses on health promotion, disease prevention, health seeking
behavior, chronic disease management and empowerment. The study period is 18 months with
measurements taken at baseline, 8 months and 18 months. Major events (stroke, myocardial
infarction, end-stage renal disease, hospitalization, deaths) during the study will also be
recorded. A questionnaire assessing functional status (IADL), quality of life (EQ5D),
knowledge and attitude about health care, health seeking behavior, and health status
(CIRS-G) will be used. Anthropometric measures will also be taken to better understand
certain aspects related to the health and physical status of the participants as well as
biomarkers such as the levels of glycosylated hemoglobin (HbA1c), cholesterol (total HDL),
triglycerides, blood pressure and peak expiratory flow.
The main goal of the study is to improve each individual score and to measure improvement in
overall quality of life and mental well-being. The total sample size for this pilot study is
400 older persons (above 55 years of age) randomly sampled from Tiong Bahru/Bukit Merah and
Ang Mo Kio. The health care training will be based in Senior Activity Centres (SACs) located
in HDB blocks. The investigators will select 12 SACs and randomly assign 6 SACs to the
intervention group and 6 SACs to the control group. All twelve groups will receive a
baseline assessment of physical and mental health status and a follow-up at 8 and 18 months.
Two community health trainers (CHT) will be assigned to each of the intervention groups.
These CHTs will have been trained by personnel at the Tsao Foundation to conduct the
training protocol and collect data from participants. The intervention group will then
receive the health care training once a week for 2 hours over a period of seven-eight months
(56 hours total). The content of training materials focuses on health promotion, disease
prevention, health seeking behavior, chronic disease management, and anti-stigmatization. In
addition, each participant, regardless of randomization, will be given an event diary at
baseline. The diary will be used to record any health related events that occur during the
course of the study. Such events would include visits to GPs or traditional medicine
practitioners, purchasing medications, hospitalization, etc.
The investigators hypothesize that the study will demonstrate the following: 1) Improve
chronic disease outcomes for individuals presenting with these diseases: hypertension (20%
decrease in systolic blood pressure), diabetes (1% decrease in HBA1C levels), and COPD (10%
increase in peak expiratory flow) over the 18-month study period. 2) Improve quality of life
of participants and their caregivers. 3) Improve knowledge, behaviours and attitudes towards
health care utilization. 4) Develop a community health worker capacity in low-income
settings. 5) Reduce the number of hospitalizations, outpatient and emergency visits in the
intervention group.
This pilot study will also allow the investigators to test their methods for recruitment,
training, and evaluation of the self-care training program. If successful, this study will
provide evidence that older adults in the intervention group can more effectively manage
their own health care and avert or delay the onset of disability compared to older adults in
the control group. One of the long term goals is to replicate this study in Cambodia, India,
Indonesia, and Vietnam. The investigators have identified academic and practice partners in
each of these countries who have expressed an interest in the project and donors are
awaiting the results from this pilot study before funding the regional components.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Health Services Research