Health-seeking behaviour of the elderly living alone in an urbanised low-income community in Singapore.

INTRODUCTION: Elderly persons who live alone are more likely to be socially isolated and at increased risk of adverse health outcomes, unnecessary hospital re-admissions and premature mortality. We aimed to understand the health-seeking behaviour of elderly persons living alone in public rental housing in Singapore. METHODS: In-depth interviews were conducted using a semi-structured question guide. Participants were selected using a purposive sampling approach. Interviews were conducted until theme saturation was reached. Qualitative data collected was analysed using manual thematic coding methods. RESULTS: Data analysis revealed five major themes: accessibility of healthcare services and financial assistance schemes; perceived high cost of care; self-management; self-reliance; and mismatch between perceived needs and services. CONCLUSION: Elderly persons living in one-room rental flats are a resilient and resourceful group that values self-reliance and independence. Most of the elderly who live alone develop self-coping mechanisms to meet their healthcare needs rather than seek formal medical consultation. The insightful findings from this study should be taken into consideration when models of healthcare delivery are being reviewed and designed so as to support the disadvantaged elderly living alone.

A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore.

INTRODUCTION: It is well-established that low socioeconomic status (SES) influences one's health status, morbidity and mortality. Housing type has been used as an indicator of SES and social determinant of health in some studies. In Singapore, home ownership is among the highest in the world. Citizens who have no other housing options are offered heavily subsidised rental housings. Residents staying in such rental housings are characterised by low socioeconomic status. Our aim is to review studies on the association between staying in public rental housing in Singapore and health status. METHODS: A PubMed and Scopus search was conducted in January 2017 to identify suitable articles published from 1 January 2000 to 31 January 2017. Only studies that were done on Singapore public rental housing communities were included for review. A total of 14 articles including 4 prospective studies, 8 cross-sectional studies and 2 retrospective cohort studies were obtained for the review. Topics addressed by these studies included: (1) Health status; (2) Health seeking behaviour; (3) Healthcare utilisation. RESULTS: Staying in public rental housing was found to be associated with poorer health status and outcomes. They had lower participation in health screening, preferred alternative medicine practitioners to western-trained doctors for primary care, and had increased hospital utilisation. Several studies performed qualitative interviews to explore the causes of disparity and concern about cost was one of the common cited reason. CONCLUSION: Staying in public rental housing appears to be a risk marker of poorer health and this may have important public health implications. Understanding the causes of disparity will require more qualitative studies which in turn will guide interventions and the evaluation of their effectiveness in improving health outcome of this sub-population of patients.

Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia.

Many patients with pernicious anemia are treated with lifelong intramuscular (IM) vitamin B12 replacement. As early as the 1950s, there were studies suggesting that oral vitamin B12 replacement may provide adequate absorption. Nevertheless, oral vitamin B12 replacement in patients with pernicious anemia remains uncommon in clinical practice. The objective of this review is to provide an update on the effectiveness of oral vitamin B12 for the treatment of pernicious anemia, the recommended dosage, and the required frequency of laboratory test and clinical monitoring. Relevant articles were identified by PubMed search from January 1, 1980 to March 31, 2016 and through hand search of relevant reference articles. Two randomized controlled trials, three prospective papers, one systematic review, and three clinical reviews fulfilled our inclusion criteria. We found that oral vitamin B12 replacement at 1000 µg daily was adequate to replace vitamin B12 levels in patients with pernicious anemia. We conclude that oral vitamin B12 is an effective alternative to vitamin B12 IM injections. Patients should be offered this alternative after an informed discussion on the advantages and disadvantages of both treatment options.