​Retiree Lau Eng Boon, 65, getting his blood pressure checked by community nurse Murni Nadhirah Abdul Rahim, 30. She helped him to organise his pills for various conditions, including hypertension and stroke, into pill boxes to make it easier for him to keep track of them.ST PHOTO: KELVIN CHNG

They are more likely to be admitted to hospital frequently; experts point to lack of social support and low health literacy

Yuen Sin, The Straits Times

Retiree Lau Eng Boon, 65, was making his way to the market near his rental flat at York Hill in Tiong Bahru in June last year when his vision suddenly blurred.

A wave of giddiness hit him as his legs gave way. He landed on the floor, his left shoulder bearing the brunt of the impact.

The incident left the former assistant at a casket company warded in the Singapore General Hospital (SGH) for five days.

This was already Mr Lau's second hospital stay in three months. In March last year, the diabetes patient had also been warded for numbness on the left side of his body for a day due to complications from a stroke that he had suffered in 2010.

Patients like Mr Lau who live in rental flats are at greater risk of suffering poor health outcomes compared with those who do not live in rental flats, two studies published last year found.

Living in rental flats increases one's risk of being a frequently admitted hospital patient, which refers to having three or more inpatient admissions in a year, and is also linked to a higher mortality rate, the studies found.

The research was led by Dr Low Lian Leng, a consultant at SGH's department of family medicine and continuing care.


The first study extracted anonymised data of 16,306 patients from the SGH's database in 2014, covering those who lived in areas such as Telok Blangah, Chinatown and Bukit Merah.

Of this, about 10 per cent were classified as frequently admitted patients. A fifth of them - 346-lived in rental housing. The mean age of the frequently admitted patients was 66.5 years.

It was found that those in rental housing had a 30 per cent higher risk of being a frequently admitted hospital patient.

The second, a study of 147,004 patients conducted from 2012 to 2017, found that those who lived in rental housing were 1.57 times more likely to die in the period, compared with those who were not living in rental housing.

The patients had a mean age of 50.1 years, and about 7 per cent of the sample lived in rental housing. They had used healthcare facilities covered by the SingHealth regional cluster, which includes SGH and KK Women's and Children's Hospital.

The findings of both studies have been adjusted to account for demographics and the existence of clinical conditions such as diabetes or leukaemia.

Dr Low told The Straits Times that the issue of hospital readmission is an important one as patients who are frequently admitted to hospital experience significant stress and financial burden.

"Identifying the risk factors for these patients allows us to take a proactive approach to address the root causes of unnecessary hospital readmissions," he said.

More studies should also be done to understand the social circumstances and healthcare needs of rental flat residents to improve their health outcomes, Dr Low and other researchers said in the mortality study.

The other two regional health systems, the National University Health System (NUHS) and the National Healthcare Group, did not provide data on the number of patients in rental housing who were frequently admitted to hospital.

But all three health systems, which together cover all public hospitals here, have been working with community partners to bring down hospital readmission rates over the years.

Low health literacy is one of the contributing factors for the poorer health outcomes of the lower-income group, said a spokesman for the Agency for Integrated Care (AIC), which was set up in 2009 by the Ministry of Health and now coordinates the delivery of aged care services.

"When ill, they tend to rely on their own knowledge or hearsay for remedies... Some tend to seek help only when the symptoms start to affect their daily lives," said the spokesman.

Associate Professor John Wong, senior director of NUHS' CareHub, which provides follow-up care for patients who are discharged from hospital, said this group may also have less social support, given that many of them live alone or may come from disadvantaged families.

Dr Lily Neo, an MP for Jalan Besar GRC, said this affects their ability to manage their health conditions.

"Those living in purchased flats often have maids to care for them. But some rental flat residents find it hard to cook or walk downstairs to buy food if they are in pain due to stroke complications, or if they are frail," she said.

She explained that these issues may spiral into bigger problems.

"If you don't eat, you will have giddiness, and then it will lead to falls," she said, estimating that about one in five rental flat residents in the Chin Swee area in her ward is in this category of those frequently admitted to hospital.

They may also be more likely to forget to take their medicine as there is no one around to remind them, she said, putting them at greater health risk.

The AIC also said that those who are socially isolated may not know where to seek help.

Mr Lau, a divorcee, faced some of these obstacles. He does not keep in close contact with his only son and shares a rental flat with another elderly man.

Though he was diagnosed with diabetes more than five years ago, he often skipped medication for days, resulting in giddy spells and falls.

In August last year, his blood glucose level shot up to a high of 20 mmol/l (millimoles per litre of blood). Normal blood sugar levels fall in the range of 5 to 7mmol/l before meals.

"It was very troublesome to look for all my medicine," he said, gesturing to his cramped room, where boxes of pills for various conditions, including hypertension and stroke, had been stashed in a plastic bag in the corner.

But after he was enrolled into a community care programme last year, a community nurse stationed near his flat helped him to organise the pills into pill boxes so that he would not lose track of the dosages he needs to take every morning and afternoon.

"I keep it at the foot of my bed so I will see it every morning when I wake up," said Mr Lau, who said he was initially not aware of the risks of not taking his medication.

Because complications from diabetes had affected his vision, he also had to give up his job in January last year.

Worries about his finances made him unwilling to participate in social activities and exercise schemes in his neighbourhood.

But the situation improved when he started receiving financial assistance in January this year.

Now, he attends an exercise programme conducted by a family service centre twice a week.

"I have friends there, so I don't mind going," said Mr Lau, whose blood glucose level is now a healthier 8 mmol/l.

Among older folk, those who depend on their savings to get by may also be fearful of seeking medical help as they are under the impression that it could be costly, said Mr Don Tan, 42, a senior social worker at Tsao Foundation's Hua Mei Centre for Successful Ageing.

The centre runs a daycare programme for the elderly, including those who were frequently admitted to hospital.

"It is a psychological mindset that they have and it can be very hard to change their minds, though medication is subsidised for those who need it," said Mr Tan.

Mr Saini Abdul Rahaman, 73, a former storekeeper who now takes on part-time jobs as a cleaner or a nightclub singer, for instance, did not know that all he had to do was to flash his Pioneer Generation card to get subsidies on medication for hypertension at the clinic.

This meant that he did not replenish his medicine from time to time.

"I didn't get my medication sometimes because I felt it was too expensive," said the Chai Chee rental flat resident.

"But now, I try to take it every day. I don't want to get a stroke or develop a heart condition."