Associate Professor Reshma A. Merchant is the Head and Senior Consultant at the Division of Geriatric Medicine at the Yong Loo Lin School of Medicine, National University of Singapore. She is also the Geriatric Education Director for the school. Prior to this, Associate Professor Merchant had been the head of division of Advanced Internal Medicine for seven years since 2009 and under her leadership, the division has made great progress in care integration, care coordination and new models of care including acute medical unit and Innovation-42. She is actively involved in improving quality of care for the hospitalised elderly, and together with the nursing team, have introduced Eldercare Bundle hospital-wide and as head of Geriatrics, she has spearheaded many new developments including SILVER (Specialised Innovative LongeVity Elderly Recovery) unit. Her main area of research interest is in sarcopenia, cognitive frailty and successful ageing in the community. She also holds many leadership positions in national professional organisations and advisory boards. Besides clinical service and research, she is also a very enthusiastic teacher and has won multiple teaching awards. She graduated from the University of Edinburgh and obtained her postgraduate qualification from Royal College of Physician London in 1999 where she worked for several years before returning to Singapore in 2001.
Healthy Ageing Promotion Program for You (HAPPY) to Meet Ageing Population Needs
The increasing prevalence of frailty and dementia with ageing population and accompanying physical, cognitive, social and psychological complexities requires a community-health promotion and prevention program which are both sustainable and scalable. Based on initial Healthy Older People Everyday (HOPE) study (n=1051), the prevalence of frailty amongst older adult in Northwest region of Singapore was 6% and prefrailty 37%.
Healthy Ageing Promotion Program For You (HAPPY) is a community screening program and those identified to be pre-frail or have underlying cognitive impairment (mini-mental state examination score between 18-26) were invited to participate in a dual task exercise program.
HAPPY program has been ongoing since August 2017 in a few selected senior activity centers in Western region of Singapore with the aim to roll out island-wide in the next 1 year. Seniors attending four senior activity centres (SAC) were invited to participate in the screening program. FRAIL scale was used to screen for frailty, Mini-Mental State Examination (MMSE) for cognition, Even Briefer Assessment Scale (EBAS) for depression and LUBBEN scale for social integration. Physical measures included grip strength, gait speed and short physical performance battery test (SPPB). In addition, there’s ongoing HAPPY volunteer training program.
Of the 97 seniors who participated in the screening, 49 (51%) have been enrolled in dual task exercise program 60 minutes twice a week. 19 (20%) of the participants were men and 78 (80%) were women. Prevalence of frailty amongst men in SAC was 17% compared to 6% amongst women. Those enrolled in the HAPPY program were older with a mean age of 74.4 years compared to 72.0 years. Prevalence of frailty and prefrailty amongst enrolled participants was 12.2% and 87.8% respectively (p<0.001). 41 (83.7%) of participants had MMSE <24 with 9 (18%) with suspected depression. The prevalence of falls in this group was 11 (23.4%). There was no significant difference in prevalence of multimorbidity, polypharmacy and mean grip strength. However, the gait speed amongst those enrolled was significantly lower (1.09 vs 1.22 secs). The preliminary data from 1 of the centres at 3 months shows 50% of seniors improved in MMSE score by 2 points. 63% improved in tandem balance, 16% improved in gait speed and 16% improved in chair stand test.
Early results from HAPPY program is very promising in improving function and cognition. Volunteer training will enable HAPPY to be both sustainable and scalable.