Lixia Ge

OBJECTIVES: To assess the relationship between various social isolation indicators and loneliness, and to examine the differential associations that social isolation indicators, loneliness have with depressive symptoms. METHODS: Baseline data for 1,919 adults (aged 21 years and above) from a representative health survey in the Central region of Singapore was used for this study. The association between social isolation indicators (marital status, living arrangement, social connectedness with relatives and friends) and loneliness (the three-item UCLA Loneliness) were assessed, and their differential associations with depressive symptoms (the Patient Health Questionnaire-9) were examined using multiple linear regression, controling for relevant covariates. RESULTS: There was significant overlap between loneliness and social isolation. Social connectedness with relatives and friends were mildly correlated with loneliness score (|r| = 0.14~0.16). Social isolation in terms of weak connectedness with relatives and with friends and loneliness were associated with depressive symptoms even after controling for age, gender, employment status and other covariates. The association of loneliness with depressive symptoms (β = 0.33) was independent of and stronger than that of any social isolation indicators (|β| = 0.00~0.07). CONCLUSIONS: The results of the study establishes a significant and unique association of different social isolation indicators and loneliness with depressive symptoms in community-dwelling adults aged 21 and above.

BACKGROUND: Caring for elderly cancer patients may cause multidimensional burden on family caregivers. Recognition of factors associated with caregiver burden is important for providing proactive support to caregivers at risk. OBJECTIVE: The aim of this study was to identify factors associated with high caregiver burden among family caregivers of elderly cancer patients. METHODS: A systematic search of 7 electronic databases was conducted from database inception to October 2014. The identified studies were screened, and full text was further assessed. The quality of included studies was assessed using a checklist, and relevant data were extracted using a predeveloped data extraction form. Best-evidence synthesis model was used for data synthesis. RESULTS: The search yielded a total of 3339 studies, and 7 studies involving 1233 family caregivers were included after screening and full assessment of 116 studies. Moderate evidence supported that younger caregivers, solid tumors, and assistance with patient's activities of daily living were significantly associated with high caregiver burden. Eighteen factors were supported by limited evidence, and 1 was a conflicting factor. CONCLUSIONS: The scientific literature to date proved that caregiver burden was commonly experienced by family caregivers of elderly cancer patients. The evidence indicated that family caregivers who were at younger age, caring for solid tumor patients, and providing assistance with patient's activities of daily living reported high caregiver burden. IMPLICATIONS FOR PRACTICE: The data provide evidence in identifying family caregivers at high risk of high caregiver burden. More high-quality studies are needed to clarify and determine the estimates of the effects of individual factors.

BACKGROUND: There is a shortage of research evidence about how social isolation, social participation, and loneliness were longitudinally associated with frailty. This study was to 1) examine the associations of social isolation, social participation, and loneliness with level of frailty among community-dwelling older adults using panel data, and 2) explore the moderating effect of gender on the association of social isolation, social participation and loneliness with frailty. METHODS: The study included 606 participants aged 60 years and above from the longitudinal Population Health Index Survey conducted in Singapore. At each timepoint, level of frailty was determined using the Clinical Frailty Scale. Social isolation was assessed by the Lubben Social Network Scale-6, and loneliness was assessed using the three-item UCLA Loneliness Scale. Fixed-effects ordinal logistic regressions were conducted with level of frailty as the dependent variable and social isolation and loneliness as the independent variables, adjusting for time-varying socio-demographic, lifestyle, and health-related factors. RESULTS: Increase in social participation was associated with lower level of frailty (odds ratio: 0.96, 95% confidence interval: 0.93-0.99) and feeling lonely was associated with higher level of frailty (odds ratio: 2.90, 95% confidence interval: 1.44-5.84). Social isolation was not associated with frailty. Gender did not have moderating effect on these associations. CONCLUSIONS: This study observed that social isolation and loneliness had differential longitudinal association with level of frailty among community-dwelling older adults and suggested that loneliness and frailty should be measured and addressed concurrently among community-dwelling older adults.

This experience provided important reminders and lessons for Singapore for managing the effects of future infectious disease outbreaks that might be applied to other countries. First, the outbreaks that occurred within the dormitories were an important caution, in particular to resource limited, low- or middle-income countries with a larger congregation of people living in informal housing [[89]Staff G-i-A. COVID-19: lesson learned? What comes next. 2020 [cited 2020; Available from: https://lkyspp.nus.edu.sg/gia/article/covid-19-lessons-learned-what-comes-next)Google Scholar]. Second, continuous investment in the public health surveillance and health systems, will ensure that the systems are prepared for any future outbreaks. Close collaborative efforts between private and public healthcare institutions during this pandemic demonstrated the importance of enhancing cohesiveness within the local healthcare system. This strong partnership added much-needed bed space and manpower [[90]Vasoo LYSaS. Lessons from a pandemic: How Covid-19 is managed and prevented in Singapore. 2020 [cited 2020; Available from: https://www.straitstimes.com/singapore/lessons-from-a-pandemicGoogle Scholar]. This has been key in keeping COVID-19 death rate low while effectively managing the rate of infection in the community. Third, clear and up-to-date accessible communication between government agencies and the public, had been key in reducing anxiety and confusion about safety measures introduced in the community. Fourth, cultivating a culture of strong community cohesiveness has led to the majority of the public adhering to safe distancing measures and to act in a more sustainable manner, especially during this pandemic [[91]Khalik S. Lessons from one million Covid-19 deaths. 2020 [cited 2020; Available from: https://www.straitstimes.com/singapore/lessons-from-one-millionGoogle Scholar].

Little is known about whether there is any difference in associations of chronic diseases with health-related quality of life and self-rated health across age groups. The purpose of the present study was to examine the associations of one specific and multiple chronic diseases with health-related quality of life and self-rated health (measured using the 5-level EQ-5D version) in three age groups: young (21-44 years), middle-aged (45-64 years), and older adults (≥65 years). Secondary data analysis of 1932 participants in the Population Health Index Survey was performed. Linear regression results showed that different chronic diseases had a characteristic effect on health-related quality of life and self-rated health among different age groups. The presence of a single chronic disease was associated with lower health-related quality of life and self-rated health in young adults. Multi-morbidity was consistently associated with decreased health-related quality of life and self-rated health in all age groups. Our findings suggest that although young adults have a lower prevalence of chronic diseases, their impacts on health-related quality of life and self-rated health can be as significant as that in middle-aged and older adults.