SingHealth Duke-NUS Academic Medical Centre

IntroductionAs the population rapidly ages, older adults are faced with a multitude of physical, psychological, and social challenges that limit their ability to age well. Intergenerational programs have gained traction as a potential solution to address social isolation and loneliness among older adults, while also improving intergenerational solidarity among young adults. The study aimed to explore and compare the experiences, facilitators, and barriers to intergenerational relationships and participation in intergenerational programs, from the perspectives of young and older adults in Singapore.MethodsA qualitative descriptive approach with semi-structured interviews was conducted with 14 young adults and 15 older adults via purposive sampling. Data were analyzed thematically using inductive coding.ResultsThree themes emerged: (1) intergenerational perceptions and attitudes towards intergenerational interactions; (2) language, interpersonal traits, and responsibility to bridge the intergenerational gap as facilitators and barriers towards intergenerational relationships; and (3) the role and impact of intergenerational programs on intergenerational relationships.ConclusionThis study highlighted the complex interplay of interpersonal, structural, and cultural factors that shape intergenerational relationships and the effectiveness of intergenerational programs in Singapore. To foster authentic and reciprocal intergenerational relationships, intergenerational programs must be intentionally designed to promote equal status, cooperation, and culturally sensitive practices that reflect the lived realities of both young adults and older adults.

Delirium is an acute neurocognitive disorder commonly affecting older adults. With Singapore's aging population, the early detection of delirium has become increasingly critical. The 4 'A's test (arousal, attention, abbreviated mental test, acute change) (4AT) assessment is a validated screening tool designed to detect delirium and is widely used in older adults. Despite its routine application, both compliance and timeliness with the Modified 4AT protocol have not yet been assessed in an acute tertiary care setting in Singapore. Delayed or inconsistent use may lead to late diagnosis and management. Therefore, this study aims to assess the compliance rate and timeliness of the Modified 4AT when screening for delirium among older adult inpatients in an acute tertiary hospital in Singapore. For this retrospective study, electronic medical records of patients aged 65 and above admitted in an acute local tertiary hospital in Singapore between 1 June 2022 and 30 June 2023 were included in the analysis. Data extraction and record reviews were conducted between September 2023 and June 2025 using the hospital's electronic medical record system. This study was submitted to the institution's review board but received an exemption due to its nature as a retrospective review without patient contact (CIRB Ref: 2023/2457). Of the 4821 admissions, 73.5% (n = 3545) received an assessment using a 4AT. Among those assessed, only 32.9% (n = 1168) underwent screening within the recommended 24 h of admission in accordance with the hospital's Nursing Operational Guidelines. The majority (n = 2377) had their 4AT assessments done after 24 h. Preliminary findings suggest suboptimal compliance with delays in Modified 4AT assessments in the acute setting, potentially affecting patient outcomes. Strengthening adherence to timely delirium screening protocols may improve the care quality for older adults who are at risk.

At work and in organizations, hierarchy often does not apply equally. Education and training is never a “one-size-fit-all”. The boundaries between systemsfocused and people-focused interventions are becoming increasingly blurred today. The Hierarchy of Intervention Effectiveness (HIE) popularized by Lucian Leape and illustrated by Cassie McDaniel represents a risk management theory, with hierarchical ranks given to interventions; depicting that systems-focused interventions are more impactful and effective than human-focused ones. We are proposing that the HIE be evolved to “The Framework for Effective Integration and Adoption”, for a variety of reasons, discussed in this paper. It aligns with the state of education and training today against the background of technological advancements.

The PREoperative therapy and Supportive Care in EarLy and Locally Advanced breast cancers (PreSCella) study, conducted within Singapore's SingHealth network, explored how quality of life (QOL) and supportive care needs change over the course of neoadjuvant therapy (NAT) for breast cancer. Using a longitudinal design, data were collected at three points: before NAT (T1), within two months post-surgery (T2), and at the one-year follow-up (T3). Of 241 patients enrolled, 235 were analysed. Overall QOL improved over time, especially emotional well-being. FACT-B scores rose from 113.3 at T1 to 114.3 at T2 and 120.6 at T3 (T1-T3 change: +7.3 points; 95% CI 4.7-9.8; effect size 0.47). Age-specific assessment tools were used. Women under 40 completed three additional surveys-Body Image Scale (BIS), Dyadic Assessment Scale (DAS), and Female Sexual Function Index (FSFI). They reported mild body image distress (BIS: 6.3 at T1 to 7.2 at T3), stable relationships (DAS: 16.5 to 17.0), but notable declines in sexual function (13% at T1, 75% at T2, 57% at T3). Patients over 65 completed tools like the Attitude Scale and prioritised QOL over survival length. Findings underscore the evolving nature of supportive care needs and the value of age-personalised interventions throughout cancer treatment.

The expansion of genomics provides opportunity to screen individuals beyond clinical indication yet the classification of genomic variants and implications for health outcomes in this context is still emerging. We investigated this further by analysing clinically relevant variants and expected clinical implications in a population with no reported medical conditions. Whole genomes from 9637 healthy unrelated research-consented participants in Singapore were analysed focusing on 1619 genes associated with severe paediatric disease. Association between causative variants and expected phenotype was assessed in correlation with participant characteristics and medical history where available. After considering protein impact, mode of inheritance and participant demographics for 110 variants, further analysis was performed for 44 variants occurring in 150 participants to understand clinical implications. Most carried variants associated with a mild phenotype (cystinuria), late onset (Fabry disease) or a potentially missed phenotype (Hajdu-Cheney syndrome). However, nine participants had variants associated with severe paediatric disease predicted to be symptomatic, such as limb-girdle muscular dystrophy and spastic paraplegia. Despite a cohort selected for absence of pre-existing health conditions, individuals were identified carrying variants associated with severe paediatric conditions. Further work is required to examine for subtle clinical symptoms or alternate genetic suppression mechanisms. This study revealed the challenge of predicting clinical outcomes from genotype-derived screening and emphasises the importance of expanding phenotype characterisation which is highly relevant in population and reproductive screening settings. Trial registration: NCT02791152.