Instead of push-ups, sit-ups and a 2.4km run for Individual Physical Proficiency Test (IPPT), a group of senior citizens go through a different set of physical tests such as back reach, chair risers, sit and reach, grip strength as well as a 10m walk. But it doesn’t just stop there. It is combined with a comprehensive questionnaire to screen their risk of frailty. Upon completion, they receive a health booklet with their results and a ‘Pass’, ‘Silver’ or ‘Gold’ award.
This programme called the IPPT for Seniors or “IPPT-S”, is a comprehensive community frailty screening programme developed by a multi-disciplinary team of doctors and allied health professionals (AHPs) from Singapore General Hospital (SGH) and Sengkang General Hospital (SKH). The physical component addresses specifically health indicators such as flexibility, balance, strength, power and cardio-respiratory endurance. The questionnaire looks into the seniors’ nutritional status, ability to perform daily living activities and psycho-social risks.
“The development of frailty as one ages is very subtle and often goes unnoticed until a health crisis occurs. Based on evidence-based practices, the programme aims to identify the robust, pre-frail and frail in the elderly so that targeted interventions can happen. Studies have shown that if detected early, frailty is reversible with appropriate physical, nutritional and cognitive approaches. In other words, we can help these seniors make lifestyle changes to nip any problems before their conditions get more complex, “said Associate Professor Ng Yee Sien, Senior Consultant, Department of Rehabilitation Medicine, SGH and SKH, who was instrumental in putting together the programme.
Recognising that health is both physical and social, the IPPT-S is intentionally held in collaboration with community partners, such as Senior Activity Centres (SACs) located within residential estates. Besides facilitating some aspects of the IPPT-S, the SAC staff and volunteers are also equipped to follow up with participants including running structured exercise and nutrition programmes, co-developed with SKH.
A recent IPPT-S community frailty screening conducted in collaboration with COMNET Senior Services @ Rivervale Crescent under AMKFSC Community Services and Rivervale Community Centre over 8 days in June-July 2017 showed that approximately one-third of those screened were pre-frail, 2% were frail and 22% were at risk of malnutrition. Low mood and malnutrition were significant risk factors for being frail and pre-frail.
Residents in the Northeast, 55 years old and above who are able to walk were encouraged to sign up. Doctors involved in the screening referred these seniors to primary care providers if medical conditions requiring further consult were detected. Physiotherapists and dietitians helped the seniors set specific personal health goals by providing individualised advice on proper exercise and nutrition. Follow-ups are then to be done 6 and 12 months after the initial assessment, to help participants track their progress on goals made. They are informed of their frailty risk and taught to work on self-management plans for healthy aging.
“While Singapore’s life expectancy is one of the highest in the world, people living longer may not be mirrored by them living healthier in old age, with the likelihood of the last 10 years of life being spent in disability. To address the impact of frailty in rapidly ageing Singapore, the team at SKH seeks to raise public awareness on age-related frailty, timely recognition of frailty (and pre-frailty), and feasible and sustainable interventions through community-based self-management to prevent adverse outcomes due to frailty,” said Dr Laura Tay, Consultant Geriatrician at Sengkang General Hospital.
