1. © Tsao Foundation. No unauthorised reproduction. IFA 11 th Global Conference on Ageing “Caregiving and caregiver burden from an Asian perspective” 31 May 2012

2. © Tsao Foundation. No unauthorised reproduction. A partnership between Other regional partner areas : India (GRAVIS) and Indonesia (CAS-UI, YEL and SCI) as part of the Health Working Group within HelpAge International network

3. © Tsao Foundation. No unauthorised reproduction. Susana Concordo Harding Director, ILC - Singapore A/P Angelique Chan Dept. of Sociology, NUS HSSR, Duke-NUS Prof David Matchar Director, Program in Health Services and Systems Research, Duke-NUS Self Care for Older Persons In Singapore: An Intervention Study (SCOPE)

4. © Tsao Foundation. No unauthorised reproduction. Outline of Presentation  Aims  Hypothesis  Overview of Study Design  Barriers Faced in Providing Healthcare to OP in Singapore  Study Timeline  Inclusion Criteria  Recruitment : Bukit Merah and Ang Mo Kio areas  Research Design with Randomization

5. © Tsao Foundation. No unauthorised reproduction. Outline of Presentation  The Intervention  Approach  Training Curriculum  Measures  Indicators of Success to be Measured  Progress so far

6. © Tsao Foundation. No unauthorised reproduction. Aims 1.Evaluate a self-care intervention program aimed at enhancing the ability of mildly disabled and healthy older persons in Singapore to care for themselves 2.Evaluate the effectiveness of training health partners and community health trainers (CHTs) located within Senior Activity Centres (SACs) in Singapore to support the self-care capacity development amongst older persons in the locale

7. © Tsao Foundation. No unauthorised reproduction. Hypotheses 1.Self-care training will build the capacity of older persons for self-care as measured by improvements in functional status, quality of life, knowledge, attitudes, and preferences, and health care seeking behavior. 2.Self care training will enhance a supportive attitude among older persons 3.Self care training will increase knowledge of CHTs. 4.Self care training will improve the control of chronic diseases (diabetes, hypertension, COPD).

8. © Tsao Foundation. No unauthorised reproduction. Overview of Study Design  Randomized Controlled Trial (RCT)  18 months – Intervention runs from baseline to 6 months – Questionnaire and biomarker collection at baseline, 8 months, and 18 months  2 Arms – Intervention Arm – Control Arm(usual care)

9. © Tsao Foundation. No unauthorised reproduction. Barriers Faced in the Providing Healthcare to Older Adults in Singapore Inadequate access to care and healthcare Declining family support and strains on state services Social, economic & political exclusion Older adult’s lack of knowledge of simple coping mechanisms and self care

10. © Tsao Foundation. No unauthorised reproduction. Study Timeline Baseline 18 mo. 8 mo. Pre-intervention assessment: Baseline questionnaire Biomarker collection Distribution of event diaries INTERVENTION RECRUITMENT FOLLOW-UP Questionnaire Biomarker collection Questionnaire Biomarker collection Weekly support group sessions Training sessions Randomization

11. © Tsao Foundation. No unauthorised reproduction. Sample (N = 400  intervention group = 200, control group = 200) Older adults 55+ No ADLs Not moderately or severely ill Not cognitively impaired (based on MMSE scores) Inclusion Criteria

12. © Tsao Foundation. No unauthorised reproduction. SAC Recruitment: Ang Mo Kio and Bukit Merah 2 different areas to control for socio- economic factors

13. © Tsao Foundation. No unauthorised reproduction. Research Design with Randomization Intervention Arm Group 1 Ang Mo Kio CHT training Group 2 Bukit Merah CHW training Control Arm Group 3 Ang Mo Kio NO CHT training Group 4 Bukit Merah NO CHW training

14. © Tsao Foundation. No unauthorised reproduction. The Intervention  Subjects receive 2 hour long training sessions for 7 months  Meet with CHT to develop health plan  Training sessions include: – Health promotion – Disease prevention – Health seeking behavior – Chronic disease management – Anti-stigmatization  Subjects will receive 24 two-hour weekly group-support sessions after the intervention period

15. © Tsao Foundation. No unauthorised reproduction. Approach “UNDERSTAND” something new “VALUE” something new “DO” something new

16. © Tsao Foundation. No unauthorised reproduction. Training Curriculum Basic Core Program:  Session 1: Successful Aging and the SCOPE Program  Session 2: My Life & Health Goals / Wishes  Session 3: Getting to Know Our Bodies  Session 4: Caring for Ourselves  Session 5: Common Chronic Diseases  Session 6: Common Community Health Problems  Session 7: My Health Baseline  Session 8: Health Monitoring, Goals & Plans  Session 9: Dealing with Stress  Session 10: Reframing Emotions  Session 11: Keeping the Mind Active  Session 12: Being Positive in One’s Life  Session 13: Two Models of Medicine  Session 14: Getting Good Medical Care

17. © Tsao Foundation. No unauthorised reproduction. Training Curriculum Lifestyle Core Program:  Session 1: Ingredients of a Healthy Diet  Session 2: Eating Out & Cooking at Home  Session 3: Sensible Eating and Shopping for Food  Session 4: On Having an Eating Plan  Session 5: Keeping Fit  Session 6: Types of Exercises  Session 7: Creating a Personal Exercise Plan  Session 8: Living With Diabetes  Session 9: Living with Hypertension  Session 10: Medication Management  Session 11: Self-Care as a Personal Responsibility  Session 12: Family Dynamics  Session 13: How to Get What We Need  Session 14: Looking Ahead After the SCOPE Program 

18. © Tsao Foundation. No unauthorised reproduction. Training Curriculum – Health Partner  Session 1: Ageism & The Myths of Ageing  Session 2: Understanding Health Partnering  Session 3: The Dynamics of Health Partnering  Session 4: Effective Health Partnering and Coaching  Session 5: Communication Styles & Dynamics  Session 6: On Being an Active Listener  Session 7: Motivation and Older People  Session 8: The Partnering Sessions  Session 9: Living with Diabetes  Session 10: Living with Hypertension  Session 11: Nutrition and Healthy Eating  Session 12: Physical Activity and Exercise  Session 13: Getting Good Medical Care  Session 14: Getting What We Need

19. © Tsao Foundation. No unauthorised reproduction. Indicators of Success to be Measured: Control Risk Factors for Chronic Diseases: Diabetes – a 1% decrease in HbA1C Hypertension– an 8 % improvement in blood pressure COPD – peak expiratory flow measurements-a 10% improvement Build Older Adult Capacity for Self-Care: Improvements in functional status; quality of life; knowledge and attitudes about health care and health seeking behavior Self-Care Training Builds Stakeholder Capacity i.e. Health Partner and CHT: Stakeholders’ practical knowledge of home care for older persons and attitudes towards older persons in their care Use focus group discussions

20. © Tsao Foundation. No unauthorised reproduction. Progress so far (1)  Started June 2011  Number of participants Intervention: 165 Control: 217 Total of 382 Older Person  Community Health Trainer A total of 20 community health trainer with diverse background in nursing, social work and training have completed SCOPE Program’s Training of Trainer in April 2012.

21. © Tsao Foundation. No unauthorised reproduction. Progress so far (2)  SCOPE modules Three different sets of SCOPE modules have been developed. Each is targeted for the different education levels of the older persons.  Training Intervention Training intervention will start on the 2 nd week of June 2012 and the 28 sessions will run up to December 2012.  SCOPE in Youtube http://www.youtube.com/watch?v=OfTWjvSnyI0

22. © Tsao Foundation. No unauthorised reproduction. Thank you !