Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-12-08T13:48:29.190Z Has data issue: false hasContentIssue false

Stakeholders’ perspective on issues and challenges associated with care and treatment of aging-related cognitive impairment disorders in Singapore

Published online by Cambridge University Press:  20 June 2011

Monika Setia*
Affiliation:
Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
Amina M. Islam
Affiliation:
Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
James P. Thompson
Affiliation:
Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
David B. Matchar
Affiliation:
Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
*
Correspondence should be addressed to: Monika Setia, PhD, Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore – 169857. Phone: +65 660 11587; Fax: +65 653 48632. Email: monika.setia@duke-nus.edu.sg.

Abstract

Background: An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has concomitant implications for social and health systems. The objective of this study is to understand the perspectives of prominent stakeholders about current and future issues and challenges associated with CI/dementia among the elderly in Singapore.

Methods: Using indepth interviews, this qualitative study obtained the views of multiple stakeholders on issues and challenges associated with CI/dementia in Singapore. The 30 individuals interviewed as part of the study included clinicians, policy-makers, researchers, community workers, administrators, and caregivers. Using a framework approach, interview texts were indexed into domains and issues by utilizing NVivo 9.0 software.

Results: The stakeholders expressed concerns related to multiple domains of the CI/dementia care system: attitude and awareness, economics, education, family caregiving, inputs to care system, living arrangements, prevention, screening and diagnosis, and treatment and management of care. Within each domain, multiple issues and challenges were identified by respondents.

Conclusions: The study identifies a complex set of inter-related issues and challenges that are associated with the care and treatment of people with CI/dementia. The results suggest that CI and dementia profoundly affect patients, families, and communities and that the issues related to the two disorders are truly system-wide. These findings lay the foundation for utilization of a systems approach to studying CI/dementia and provide an analytic framework for future research on complex health care issues.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer's Association (2010). Alzheimer's disease facts and figures. Alzheimer's and Dementia, 6, 74.Google Scholar
Alzheimer's Disease International (2008). The Prevalence of Dementia Worldwide. London. Available at: http://www.alz.co.uk/adi/pdf/prevalence.pdf.Google Scholar
Alzheimer's Disease International (2010). World Alzheimer Report 2010: The Global Economic Impact of Dementia. London. Available at: http://www.alz.co.uk/research/files/WorldAlzheimerReport2010ExecutiveSummary.pdfGoogle Scholar
Brodaty, H., Draper, B. and Low, L. F. (2003). Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery. Medical Journal of Australia, 178, 231234-590.CrossRefGoogle ScholarPubMed
Brodaty, H., Thomson, C., Thomson, C. and Fine, M. (2005). Why caregivers of people with dementia and memory loss don't use services. International Journal of Geriatric Psychiatry, 20, 537546.CrossRefGoogle ScholarPubMed
Crabtree, B. F. and Miller, W. L. (1999). Doing Qualitative Research. Thousand Oaks, CA: Sage.Google Scholar
Cuijpers, P. (2005). Depressive disorders in caregivers of dementia patients: A systematic review. Aging and Mental Health, 9, 325330.CrossRefGoogle ScholarPubMed
Donovan, J. and Sanders, C. (2005). Key issues in the analysis of qualitative data in health service research. In Bowling, A. and Ebrahim, S. (eds.), The Handbook of Health Research Methods: Investigation, Measurement and Analysis (pp. 515532). Maidenhead: Open University Press.Google Scholar
Doody, R. S. et al. (2001). Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56, 11541166.CrossRefGoogle Scholar
Dunkin, J. J. and Anderson-Hanley, C. (1998). Dementia caregiver burden. Neurology, 51, S53S60.CrossRefGoogle ScholarPubMed
Etters, L., Goodall, D. and Harrison, B. E. (2008). Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners, 20, 423428.CrossRefGoogle ScholarPubMed
Forrester, J. W. (1961). Industrial Dynamics. Cambridge, MA: Productivity Press.Google Scholar
Forrester, J. W. (1975). Counterintuitive behavior of social systems. In Forrester, J. W. (eds.), Collected Papers of Jay W. Forrester (pp. 211244). Cambridge, MA: Wright Allen Press.Google Scholar
Fossey, E., Harvey, C., McDermott, F. and Davidson, L. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36, 717732.CrossRefGoogle ScholarPubMed
Inter-Ministerial Committee on Healthcare for the Elderly (1997). Report of the Inter-Ministerial Committee on Healthcare for the Elderly. Available at: http://www.moh.gov.sg/mohcorp/publicationsreports.aspx?id=2404.Google Scholar
Johnson, J. (2002). In-depth interviewing. In Gubrium, J. and Holstein, J. (eds.), Handbook of Interview Research: Context and Method (pp. 103119). Thousand Oaks, CA: Sage.Google Scholar
Kinsella, K. and He, W. (2009). An Aging World: 2008 (Series P95/09–1). Washington, DC: US Census Bureau. Available at: http://www.census.gov/prod/2009pubs/p95-09-1.pdf.Google Scholar
Mays, N. and Pope, C. (1995). Rigour and qualitative research. BMJ, 311, 109112.CrossRefGoogle ScholarPubMed
Mays, N. and Pope, C. P. (2000). Quality in qualitative health research. In Pope, C. P. and Mays, N. (eds.), Qualitative Research in Health Care (pp. 89101) London: BMJ Books.Google ScholarPubMed
Minichiello, V., Aroni, R., Timewell, E. and Alexander, L. (1990). In-depth Interviewing: Researching People. Melbourne: Longman Cheshire.Google Scholar
Ministry of Health Singapore (2002). Ministry of Health Annual Report 2001. Available at: http://www.moh.gov.sg/mohcorp/uploadedfiles/Publications/Reports/2002/MOH_AR_FA.pdfGoogle Scholar
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2008). World Population Prospects: The 2008 Revision. Available at: http://esa.un.org/UNPP/index.asp?panel=2Google Scholar
Ränders, J. (1980). Elements of the System Dynamics Method. Cambridge, MA: Productivity Press.Google Scholar
Ritchie, J., and Spencer, L.. (1994). Qualitative data analysis for applied policy research. InBryman, A. and Burgess, R. G. (eds.), Analyzing Qualitative Data (pp. 305330). London: Routledge.Google Scholar
Ritchie, J., Spencer, L. and O'Connor, W. (2003). Carrying out qualitative analysis. In Ritchie, J. and Lewis, J. (eds.), Qualitative Research Practice: A Guide for Social Science Students and Researchers (pp. 219262). Thousand Oaks, CA: Sage.Google Scholar
Spencer, L., Ritchie, J. and O'Connor, W. (2003). Analysis: practices, principles and processes. InRitchie, J. and Lewis, J. (eds.), Qualitative Research Practice: A Guide For Social Science Students And Researchers (pp. 200218). Thousand Oaks, CA: Sage.Google Scholar
Teo, P., Chan, A. and Straughan, P. (2003). Providing health care for older persons in Singapore. Health Policy, 64, 399413.CrossRefGoogle ScholarPubMed
Tew, C. W., Tan, L. F., Luo, N., Ng, W. Y. and Yap, P. (2010). Why family caregivers choose to institutionalize a loved one with dementia: a Singapore perspective. Dementia and Geriatric Cognitive Disorders, 30, 509516.CrossRefGoogle ScholarPubMed
Vernooij-Dassen, M. J. F. J. et al. (2005). Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma. International Journal of Geriatric Psychiatry, 20, 377386.CrossRefGoogle ScholarPubMed
Wimo, A., Winblad, B. and Jonsson, L. (2010). The worldwide societal costs of dementia: estimates for 2009.Alzheimer's and Dementia, 6, 98103.CrossRefGoogle ScholarPubMed
Yeoh, B. S. and Huang, S. (2010). Foreign domestic worker and home-based care for elders in Singapore. Journal of Aging and Social Policy, 22, 6988.CrossRefGoogle ScholarPubMed