Papers by Jacqueline De Roza
BMC Geriatrics, Mar 7, 2022
Background: Fear of falling (FoF) has far-reaching implications including activity restriction, f... more Background: Fear of falling (FoF) has far-reaching implications including activity restriction, functional decline and reduced quality of life. It is a common consequence of falls but may be present even in non-fallers. This study aimed to determine the factors associated with FoF in a segment of Singapore's community-dwelling older adults. Methods: This descriptive cross-sectional study recruited a convenience sample of adults aged 65 and above from 4 primary care clinics from September 2020 to March 2021. Data were collected on demographic factors, clinical factors such as multi-morbidity, falls characteristics such as history of falls, injuries, and reasons for falls and frailty as determined by the Clinical Frailty Scale (CFS). FoF was measured using the Short Falls Efficacy Scale-International (Short FES-I), cutoff score of 14 and above indicated high FoF. Logistic regression was used to determine factors associated with high FoF. Results: Out of 360 older adults, 78.1% were Chinese and 59.7% females. The mean age was 78.3 years and 76 (21.1%) had a history of falls in the past six months. Almost half (43.1%) were mildly to moderately frail and most (80.6%) had multi-morbidity. The mean FoF score was 15.5 (SD 5.97) and 60.8% reported high FoF. There were statistically significant differences in age, gender, ethnicity, marital status, educational level, use of walking aid, multi-morbidity, frailty status, history of falls within six months and reason for falls between patients who had high FoF versus those who had moderate or low FoF. Logistic regression found that Malay ethnicity (OR = 5.81, 95% CI 1.77-19.13), marital status, use of walking aids (OR = 3.67, 95% CI = 1.54-8.77) and frailty were significant factors associated with high FoF. Compared to those who were never married, the odds of high FoF were significantly higher in married older adults (OR = 6.75, 95% CI 1.39 to 32.76), those who were separated or divorced (OR 10.40, 95% CI 1.13 to 95.76) and those who were widowed (OR = 7.41, 95% CI 1.51 to 36.41). Compared to well older adults, the odds of high FoF were significantly higher in pre frail older adults (OR = 6.87, 95% CI = 2.66-17.37), mildly frail older adults (OR = 18.58, 95% CI = 4.88-70.34) and moderately frail older adults (OR = 144.78, 95% CI = 13.86-1512.60). Conclusions: The study found that pre frail to moderately frail older adults as determined by CFS have significantly higher risk of high FoF. The demographic factors such as marital status and ethnicity and falls characteristics associated with FoF in this study will be helpful to develop targeted and tailored interventions for FoF.
BMC Primary Care, Jan 20, 2022
Background: Insulin therapy forms a cornerstone of pharmacological management of diabetes mellitu... more Background: Insulin therapy forms a cornerstone of pharmacological management of diabetes mellitus (DM). However, there remains a lack of acceptance and adherence to insulin, thereby contributing to poor DM control. This study aimed to determine the impact of patients' beliefs about insulin on acceptance and adherence to insulin therapy. Method: This was a qualitative study using grounded theory approach. The study took place from September 2019 to January 2021 at a cluster of primary healthcare clinics in Singapore. Maximum variation sampling was used to recruit adult patients with type 2 DM on basal or premixed insulin for at least 6 months. Semistructured in-depth interviews were conducted using a topic guide and audio recorded. Data collection continued until saturation. Data analysis utilised a constant comparison procedure and a synthesis approach. Results: Twenty-one participants (mean age 61 years) were interviewed for this study. Data analyses showed that there were 6 main themes that emerged. Four themes influenced both insulin acceptance and adherence. These were concerns about insulin being a lifelong treatment, physical fear of insulin injection, erroneous beliefs about insulin, and perceived fear of DM complications. Two additional themes influenced adherence to insulin therapy. These were socioeconomic concerns, and concerns about side effects of insulin. Conclusions: Patients' beliefs about insulin impact on the acceptance and adherence to insulin therapy. Health care providers need to elicit and address these beliefs during counselling to improve acceptance and adherence to insulin therapy.
BMC Primary Care, Jan 30, 2023
Background Provision of care for frail older adults with multiple chronic diseases (multimorbidit... more Background Provision of care for frail older adults with multiple chronic diseases (multimorbidity) poses increasing challenge for family caregivers. Our study aims to evaluate to what extent caregiving competence, social support and positive aspects of caregiving can mitigate the effect of burden experienced by family caregivers of frail older adults with multimorbidity. Methods A descriptive cross-sectional study was conducted in 2 primary care clinics. Family caregivers of older adults aged 65 years and above were invited to complete interviewer-administered questionnaires. Descriptive statistics were used to describe sociodemographic and clinical data. Caregiver's burden was measured using the Zarit Burden Interview (ZBI). Mann-Whitney U test was used to compare differences in Caregiving Competence Scale (CCS), short Positive Aspects of Caregiving (S-PAC) and modified Medical Outcome Study Social support (mMOS-SS). Multivariable logistic regression was used to analyse factors associating with caregiver burden. Results A total of 188 participants were recruited. 71.8% reported caregiver burden (ZBI score ≥ 10). Caregivers who perceived burden had significantly lower CCS, S-PAC and mMOS-SS scores than those who did not (10.0 vs 11.6; 26.8 vs 29.8; 24.8 vs 31.4, p < 0.001 respectively). Factors significantly associated with higher odds of perceived burden were presence of alternative caregivers (OR 3.3, 95% CI 1.09, 10.19, p = 0.04), use of community resources (OR 4.4, 95% CI 1.15, 16.83, p = 0.03) and time spent caregiving per week (OR 1.1, 95% CI 1.02, 1.10, p = 0.003). Discussion and conclusion This study found that caregivers had high perception of burden as demand in caregiving may increase. Anticipating caregiver burden and social support needs may be important part of managing these frail older adults.
BMC Primary Care
Background Insulin therapy forms a cornerstone of pharmacological management of diabetes mellitus... more Background Insulin therapy forms a cornerstone of pharmacological management of diabetes mellitus (DM). However, there remains a lack of acceptance and adherence to insulin, thereby contributing to poor DM control. This study aimed to determine the impact of patients’ beliefs about insulin on acceptance and adherence to insulin therapy. Method This was a qualitative study using grounded theory approach. The study took place from September 2019 to January 2021 at a cluster of primary healthcare clinics in Singapore. Maximum variation sampling was used to recruit adult patients with type 2 DM on basal or premixed insulin for at least 6 months. Semistructured in-depth interviews were conducted using a topic guide and audio recorded. Data collection continued until saturation. Data analysis utilised a constant comparison procedure and a synthesis approach. Results Twenty-one participants (mean age 61 years) were interviewed for this study. Data analyses showed that there were 6 main the...
Journal of Aging and Physical Activity
This descriptive cross-sectional mixed methods study conducted in Singapore aimed to describe com... more This descriptive cross-sectional mixed methods study conducted in Singapore aimed to describe community-dwelling older adults’ differences in physical activity (PA) based on perceived safety to exercise, barriers to PA, and preferred modes of PA during a pandemic. Out of 268 older adults, 25.4% felt unsafe to exercise during the pandemic. More participants who felt unsafe were aged 75 years and older (72.1% vs. 57.0%, p = .028) and lacked formal education (54.4% vs. 37.0%, p = .040). Barriers included difficulties exercising with masks, family concerns, and exercise center closures. Those who felt unsafe were significantly more likely to exercise at home and had significantly shorter duration of exercise and walks per week (2.72 vs. 4.50 hr, p = .002). Perceived barriers and exercise preferences should be considered when developing programs to improve older adults’ PA during pandemics.
physica status solidi (a), 1982
Recently special attention of theoretical and experimental researches is drawn to the unusual phy... more Recently special attention of theoretical and experimental researches is drawn to the unusual physical properties of strongly disordered o r amorphous substances. Disorder effects in such systems may result in a localization of conduction electrons (Anderson transition) /1/ and in an essential contribution of
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2022
Introduction: Singapore is facing an ageing population and the care needs of the population will ... more Introduction: Singapore is facing an ageing population and the care needs of the population will increase in tandem. A segment of this population would be living with the multimorbidity and frailty. Our study aimed to determine the prevalence of caregiver burden for primary family caregivers of frail older adults with multimorbidity. We also investigated the factors that were associated with primary family caregiver burden. Methods: This was an interviewer-administered, cross-sectional study of primary family caregivers of frail older patients with multimorbidity that was conducted in two National Healthcare Group polyclinics. Convenience sampling was used. The 12-item Zarit Burden Index (ZBI) was used to assess primary family caregiver burden. The scores of the ZBI range from 0 to 48, with a score of 10 or above indicating that the primary family caregiver perceives burden. Descriptive statistics were used to provide information regarding the caregivers and the care recipients. Mul...
Annals of the Academy of Medicine, Singapore, 2017
Dear Editor, Ten percent of Singapore’s elderly suffer from dementia.1 This figure is set to rise... more Dear Editor, Ten percent of Singapore’s elderly suffer from dementia.1 This figure is set to rise with our ageing population. As a patient’s first contact point in the health system, family physicians working in the primary care setting are increasingly challenged to meet the healthcare needs of patients with dementia. Primary care-based multidisciplinary memory clinics have been designed and implemented in Western countries.2,3 In Singapore, this is a novel concept. We report our experience in developing such a service at SingHealth Polyclinics (SHP). The Cognitive Assessment and Rehabilitation Programme (CARe), a collaboration between SHP and National Neuroscience Institute (NNI), was set up in 2013. The team developed a workflow to receive and manage patients, standardised documentation templates, and trained healthcare personnel. Sited within polyclinics, CARe comprises a multidisciplinary team of neurologists, family physicians, and nurses. It receives internal referrals for as...
Patient Preference and Adherence, 2020
BackgroundFalls in older adults is a common problem worldwide. Fear of falling (FoF) is a consequ... more BackgroundFalls in older adults is a common problem worldwide. Fear of falling (FoF) is a consequence of falls which has far-reaching implications including activity restriction, functional decline and reduced quality of life. This study aimed to determine the factors associated with FoF in a segment of Singapore’s community-dwelling older adults. MethodsThis descriptive cross-sectional study recruited a convenience sample of adults aged 65 and above from 4 primary care clinics from September 2020 to March 2021. Data were collected on demographic factors and clinical factors including history of falls and frailty as determined by the Clinical Frailty Scale (CFS). FoF was measured using the Short Falls Efficacy Scale–International (Short FES-I), cut-off score of 14 and above indicated high FoF. Logistic regression was used to determine predictors of high FoF.ResultsOut of 360 older adults, 78.1% were Chinese and 59.7% females. The mean age was 78.3 years and 76 (21.1%) had a history ...
Journal of Nursing Scholarship
Annals of the Academy of Medicine, Singapore, 2017
Singapore Medical Journal, 2013
You are reviewing Mr Lim whose fasting plasma glucose is 7.5 mmol/L. Mr Lim works as a taxi drive... more You are reviewing Mr Lim whose fasting plasma glucose is 7.5 mmol/L. Mr Lim works as a taxi driver and consulted you last week for his increased thirst and frequent urination in the past few weeks. He is worried that he may have diabetes mellitus. Both his parents and his elder brother are diabetic, and he has heard of many accounts of diabetes mellitus from his customers. Mr Lim asks, "Doctor, is my blood test normal? Do I have diabetes?"
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Papers by Jacqueline De Roza