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
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
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
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
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
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
ComSA RS Scoring System
Source: Dr Zoe Hildon, NUS
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
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
Source: Dr Zoe Hildon, NUS
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
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
9.03%
23.6% 24%
20%
12%
8%
4%
Managing score
Distribution of Managing Score in Whampoa population aged 60 and over (n=1107)
Source: Dr Zoe Hildon, NUS
ComSA Risk Screener community survey (2016)
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
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
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
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
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
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)
© 2018. Tsao Foundation. Not to be reproduced or disseminated without permission.
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