Social Isolation, Health and Lifestyles Survey 2009

Angelique Chan, Athel Hu, Chetna Malhotra, Rahul Malhotra, Truls Østbye, Kiersten Strombotne and Treena Wu

Older adults living alone and those with weak social networks are more likely to be at risk of social isolation. Feeling left out, the lack of companionship and feeling isolated will have consequences for the individual's health and this can be ameliorated through building a greater sense of community.

Singapore is one of the most rapidly aging countries in Asia. The proportion of older adults (aged 60 years and over) in the population, currently about 8%, is projected to increase to 19% by 2030. At the same time, the number of elderly households in Singapore is rising rapidly owing to increased prevalence of smaller, nuclear families and the trend of more people remaining single. To design evidence-based policies and programs to enhance social networks and prevent social isolation among seniors and to plan for the health care needs of the elderly in the future, the first wave of the Social Isolation, Health and Lifestyle Survey (SIHLS) was conducted. This survey was commissioned by the Ministry of Community Development, Youth and Sports (MCYS). This survey provides information comparable to similar longitudinal surveys in Indonesia and the Philippines which will enable cross country comparison.

Singapore is one of the most rapidly aging countries in Asia. The proportion of older adults (aged 60 years and over) in the population, currently about 8%, is projected to increase to 19% by 2030. At the same time, the number of elderly households in Singapore is rising rapidly owing to increased prevalence of smaller, nuclear families and the trend of more people remaining single.

To design evidence-based policies and programs to enhance social networks and prevent social isolation among seniors and to plan for the health care needs of the elderly in the future, the first wave of the Social Isolation, Health and Lifestyle Survey (SIHLS) was conducted. This survey was commissioned by the Ministry of Community Development, Youth and Sports (MCYS). The main objectives of the survey are to:

  1. Develop a longitudinal database on the physical and mental health profile of older adults (aged 60+);
  2. Determine the extent of social isolation among older adults, and changes with time, within and between income groups;
  3. Understand the interactions among health status, income, social engagement, housing, network support and loneliness;
  4. Understand the constraints on and channels for social participation;
  5. Understand the preferences for preventing and responding to isolation and;
  6. Collect anthropometric measures over time in relation to healthy aging

This survey provides information comparable to similar longitudinal surveys in Indonesia and the Philippines which will enable cross country comparison.

Results from the first wave of SIHLS indicate that those living alone and those with weak social networks outside of the household are more likely to be at risk of social isolation. Weak social networks are correlated with poorer health and a lower sense of well-being. This may be because older adults with functional limitations, cognitive impairment, poor vision or hearing may have difficulty forming or maintaining social networks outside the household. Results show that 26% of seniors who lived alone were found to have depressive symptoms as compared to only 9% who were living with others. Further, 16% of seniors with weak social networks outside the household showed depressive symptoms as compared to only 8% who had strong social networks outside of the household.

The survey shows too that there are gender differences in social isolation, health and lifestyles. Females in Singapore have longer life expectancy than males. Older females are more likely to have social networks outside the household. However they are more likely to be socio-economically disadvantaged where a higher proportion of older females than older males are widowed, have no formal education at all, have lower household incomes across their lifetimes and are more likely to have been homemakers throughout their lives.

In the multi-racial Singaporean society, results show differences in perceived social isolation, health and lifestyles by ethnic group. Older Malay adults are least likely to live alone as compared to older Chinese adults and older Indians adults which reduce the likelihood of perceived isolation. Older Indian adults have a higher prevalence of heart disease and diabetes compared to older Chinese adults and older Malay adults. Older Malay adults have a higher prevalence of hypertension compared to the other two ethnic groups.

Based on figures from the Department of Statistics, the number of seniors aged 65 and above living on their own increased from about 15,000 in 2000 to 22,000 in 2005. It is important to ensure that older adults remain connected to society.

 

Angelique Chan

Angelique Chan is an Associate Professor in the Department of Sociology FASS. She has a joint appointment in the Health Services and Systems Research Program (HSSR) at Duke-NUS Graduate Medical School, Singapore. She earned her Masters and PhD in Demography from the University of California at Los Angeles (UCLA) and her Postdoctoral fellowship from the University of Michigan at Ann-Arbor.

She is the Principal Investigator of the "Social Isolation, Health and Lifestyles Survey in Singapore" and the new "Informal Care Survey in Singapore" both funded by the Ministry of Community Development, Youth and Sports; and a Co-Principal Investigator of the "Comparative project of aging and health in Japan, Singapore, & the Philippines", funded by Nihon University, Japan & Japanese Ministry of Education. She is also the Director of the Tsao Foundation Aging Research Initiative at NUS.

A/P Chan's main areas of interest are health issues among the aged and family and social support systems for the elderly. Her published works include academic papers and book chapters that focus on ageing in Singapore and comparative analysis of Singapore with other countries in the region. A/P Chan is also the co-author of a book titled "Ageing in Singapore: Service Needs and the State".

A/P Chan is the recipient for several awards including teaching excellence award by NUS in 2004 and the NUS Faculty of Arts and Social Sciences Merit Award for work done 1997-2000.

Athel Hu

Athel Hu is a Research Assistant in the Department of Sociology. She graduated from the National University of Singapore with a Bachelor's degree (with Honors) in Sociology. She was on the Dean's list in 2009 for outstanding academic performance. She also took part in several quantitative and qualitative research projects funded by external agencies as an undergraduate student research assistant with her professors in the sociology department throughout her undergraduate years.

Her main areas of interest include aging, family, youth, sociology of education and medical sociology. For her Honors Thesis, she carried out a qualitative study on social isolation and its relationship to mental health outcomes of the elderly. By using qualitative methodology, she was able to trace the dynamics of how social isolation affects mental health and vice versa.

Currently, she is assisting with the Community Study for ILTC Services funded by the Agency of Integrated Care (AIC) and the Tsao Foundation Aging Research Initiative of NUS Homecare Study. She is also working on reports for several surveys commissioned by the Ministry of Community Development, Youth and Sports.

Chetna Malhotra

Chetna Malhotra is a Research Fellow at the Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore. She is a medically trained epidemiologist. She earned her MBBS and MD (Community Medicine) from India. She then obtained her MPH from the University of North Carolina at Chapel Hill, US during which she was awarded the Delta Omega Theta Award for Academic Excellence.

Chetna's research interests include health of vulnerable population groups including women, children and elderly. Her current work in Singapore focuses on the social determinants of health among elderly and end-of-life care issues in Singapore. She was responsible for the overall co-ordination and management of the Social Isolation, Health and Lifestyles Survey and later worked with other members of the research team in the analysis of survey data. She is also the co-investigator for a study validating mental health screening instruments in Singapore and principal investigator for a project examining preferences of Singaporeans for end-of-life care. Her published work includes academic papers focusing on health of women and children in India and health and well-being of elderly Singaporeans.

Rahul Malhotra

Rahul Malhotra a medically-trained public health researche, is a Senior Research Fellow with Prof. Truls Østbye in the Program for Health Services and Systems Research at the Duke-NUS Graduate Medical School. He underwent his basic (M.B.B.S) and specialist (M.D. in Community Medicine) medical training at Maulana Azad Medical College, University of Delhi, India. He then earned his M.P.H degree from the Harvard School of Public Health, for which he was awarded the Presidential Scholarship by Harvard University and the Inlaks Scholarship by the Inlaks Foundation.

He is intimately involved in analysis of the "Social Isolation, Health and Lifestyles Survey in Singapore", and in the design, conduct and analysis of the "Informal Care Survey in Singapore" both funded by the Ministry of Community Development, Youth and Sports.

His main areas of interest are Health of older adults, Obesity, Social Determinants of Health, Health Promotion, Dementia, and Maternal and Child Health. He has published 38 research papers, 7 of them looking at various aspects of health of older adults in different Asian countries. He has given guest lectures on various issues relevant for public health research and practice for undergraduate and graduate students at NUS.

Truls Østbye

Truls Østbye, a chronic disease epidemiologist and public health researcher, is a Professor and the Vice-Chair for Research in the Department of Community and Family Medicine at Duke University, Durham, NC, USA and a Professor in the Health Services and Systems Research Program and the Office of Clinical Sciences at the Duke-NUS Graduate Medical School, Singapore. He earned his M.D. and Ph.D. degrees at the University of Bergen, Norway, and his M.P.H degree at the Harvard School of Public Health.

He has a special interest in diseases of the elderly, obesity and global health. In Singapore, his current research includes studies of: health and lifestyles of elderly Singaporeans, physical, mental and social facets of care giving for elderly Singaporeans, risk factors for threatened and complete miscarriages, and evaluation of workplace health promotion programs. He is intimately involved in analysis of the "Social Isolation, Health and Lifestyles Survey in Singapore", and in the design, conduct and analysis of the "Informal Care Survey in Singapore" both funded by the Ministry of Community Development, Youth and Sports.

His current research in the USA includes studies of: obesity in the postpartum period and in children, use of clinical preventive services, cognitive decline, health and social support among the elderly, doctor-patient communication, and occupational health surveillance among health care workers. His global health projects include those of health and illness among textile workers in Sri Lanka, febrile illness in Sri Lanka and secondary analysis of DHS Indian datasets for maternal and child health outcomes. He currently is the PI of two R01 grants from the NIH and he has authored or coauthored over 250 peer reviewed papers in the medical and public health literature.

Kiersten Strombotne

Kiersten Strombotne is a Research Associate in the Health Services and Systems Research Program (HSSR) at Duke-NUS Graduate Medical School, Singapore. She earned her Bachelors degree in Economics and Latin American Studies from the University of North Carolina at Chapel Hill.

Her main areas of interest are the evaluation of the economic effectiveness and implementation of public health interventions as well as the economic impact of obesity. In addition, her research has focused on healthy aging and long-term caregiving issues for the elderly in Singapore.

Treena Wu

Treena Wu is a Postdoctoral Research Fellow in the Department of Sociology FASS and the Tsao Foundation Aging Research Initiative at NUS. She earned her Masters degree from New York University and PhD in Economics from Maastricht University. She wrote her PhD dissertation on family income and human capital investment in Indonesia.

Her areas of specialization are in labor economics - human capital theory (health and education) and development economics. Her main areas of interest are intergenerational transfers, economics of aging and household behavior.

Prior to coming to Singapore, she was a European Commission Marie Curie Fellow and a Haas Visiting Scholar at University of California at Berkeley. As a part of the NUS Tsao Foundation Aging Research Initiative at NUS, she studies Asian families and intergenerational transfers.

Contact

Angelique Chan This email address is being protected from spambots. You need JavaScript enabled to view it.

Athel Hu This email address is being protected from spambots. You need JavaScript enabled to view it. Phone: +65 65166717

Chetna Malhotra This email address is being protected from spambots. You need JavaScript enabled to view it. Phone: +65 65165692

Rahul Malhotra This email address is being protected from spambots. You need JavaScript enabled to view it. Phone: +65 65156721

Truls Østbye This email address is being protected from spambots. You need JavaScript enabled to view it. Phone: +65 65166394

Kiersten Strombotne This email address is being protected from spambots. You need JavaScript enabled to view it. Phone: +65 66011131
Treena Wu This email address is being protected from spambots. You need JavaScript enabled to view it. Phone: +65 65164237

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