Perception of Matured Estate in Singapore Psychosocial ...quin/wp-content/... · Psychosocial Well-Being of the Elderly and Their Perception of Matured Estate in Singapore, Journal

Full Terms & Conditions of access and use can be found athttp://www.tandfonline.com/action/journalInformation?journalCode=wjhe20

Download by: [Keng Hua Chong] Date: 16 September 2015, At: 20:20

Journal of Housing For the Elderly

ISSN: 0276-3893 (Print) 1540-353X (Online) Journal homepage: http://www.tandfonline.com/loi/wjhe20

Psychosocial Well-Being of the Elderly and TheirPerception of Matured Estate in Singapore

Keng Hua Chong, Wei Quin Yow, Debbie Loo & Ferninda Patrycia

To cite this article: Keng Hua Chong, Wei Quin Yow, Debbie Loo & Ferninda Patrycia (2015)Psychosocial Well-Being of the Elderly and Their Perception of Matured Estate in Singapore,Journal of Housing For the Elderly, 29:3, 259-297, DOI: 10.1080/02763893.2015.1055025

To link to this article: http://dx.doi.org/10.1080/02763893.2015.1055025

Published online: 15 Sep 2015.

Submit your article to this journal

View related articles

View Crossmark data

http://www.tandfonline.com/action/journalInformation?journalCode=wjhe20

http://www.tandfonline.com/loi/wjhe20

http://www.tandfonline.com/action/showCitFormats?doi=10.1080/02763893.2015.1055025

http://dx.doi.org/10.1080/02763893.2015.1055025

http://www.tandfonline.com/action/authorSubmission?journalCode=wjhe20&page=instructions

http://www.tandfonline.com/action/authorSubmission?journalCode=wjhe20&page=instructions

http://www.tandfonline.com/doi/mlt/10.1080/02763893.2015.1055025

http://www.tandfonline.com/doi/mlt/10.1080/02763893.2015.1055025

http://crossmark.crossref.org/dialog/?doi=10.1080/02763893.2015.1055025&domain=pdf&date_stamp=2015-09-15

http://crossmark.crossref.org/dialog/?doi=10.1080/02763893.2015.1055025&domain=pdf&date_stamp=2015-09-15

Journal of Housing for the Elderly, 29:259–297, 2015Copyright © Taylor & Francis Group, LLCISSN: 0276-3893 print / 1540-353X onlineDOI: 10.1080/02763893.2015.1055025

Psychosocial Well-Being of the Elderlyand Their Perception of Matured Estate

in Singapore

KENG HUA CHONG, WEI QUIN YOW, DEBBIE LOO,and FERNINDA PATRYCIA

Singapore University of Technology and Design, Singapore

This article explores various relationships between the elderly’s psy-chosocial well-being and components of aging-friendly community(continuity, compensation, connection, challenge, and contribu-tion), in order to understand their perception of a matured estateand to discuss implications in housing neighborhood urban de-sign. Interviews with elderly residents living in Bukit Merah (Red-hill), one of the matured housing estates in Singapore with a highpercentage of elderly residents, were conducted to understand howeldercare infrastructure and social spaces developed within the fab-ric of a high-rise, high-density public housing estate can supportor inhibit their psychosocial well-being, as indicated by the Geri-atric Depression Scale (GDS). Our results postulate that differentgroups of elderly form friendships and participate in activities inboth formal social service centers and informal public spaces. Thefriendships formed in these places and the convenience of ameni-ties around their houses may affect their perception of their currentresidences. While the elderly residents are generally satisfied withphysical infrastructure, a comprehensive, integrated urban designis further needed to facilitate physical activities, social interactions,and active aging in the elderly in order to enhance their psychoso-cial well-being.

KEYWORDS psychosocial well-being, matured estate, housingneighborhood urban design, aging-friendly community, senior ac-tivity center, Singapore

Address correspondence to Keng Hua Chong, Singapore University of Technology andDesign, 20 Dover Drive, Singapore 138682. E-mail: [email protected]

Color versions of one or more of the figures in the article can be found online atwww.tandfonline.com/wjhe.

259

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

260 K. H. Chong et al.

INTRODUCTION

The built environment and the aging phenomenon are intrinsically related,especially in this present-day high-density urbanity. The concept of aging inplace, as promoted by various state governments of countries facing an agingpopulation, would have to deal with issues of not only a larger proportionof elderly living in the city, but also a large percentage of those living in oldhousing neighborhoods since their youth. Over the decades, the process ofaging spares neither humans nor their built environment. To continue livingin these estates as one ages thus requires necessary interventions, both toadapt to the changing needs of the elderly and improve the deterioratingenvironment for better liveability. It will require not only housing modifica-tions to compensate for and assist in the elderly’s adaptation to a decliningfunctional capacity in their daily life (Iwarsson, 2005), but also a thoroughplanning of social infrastructure that can help them maintain their quality oflife. According to Person-Environment (P-E) fit theory (Carp, 1987), whichhighlights the importance of environment on quality of life, the predictorsof P-E fit interaction are not only personal competencies or environmentalconditions, but also the goodness of fit between person and environment,for example, the congruency between the individual’s environment and hisor her physical and cognitive abilities and emotional needs (Wheeler, 1995).It is under this premise that the research on Singapore elderly’s perception oftheir matured estate was carried out to assess their psychosocial well-beingin relation to their physical housing environment and provision of socialinfrastructure.

Singapore is currently undergoing a tremendous shift in its demogra-phy. Twenty-five percent of the current citizen population will be 65 yearsand older by 2030 (National Population and Talent Division [NPTD], 2013).This number will have more than doubled from 9.9% of its resident popu-lation (Department of Statistics [DOS], 2012). The concept of aging in placeis highly relevant to Singapore’s urban environment due to its highly struc-tured urban housing landscape, i.e., the provision of high-rise public housingby the Housing and Development Board (HDB) since 1960. Many of thesehousing estates have been refurbished or demolished and redeveloped sincethe 1990s. However, as some matured estates house a much higher percent-age of elderly than others, relocation of elderly residents and redevelop-ment of these estates become challenging and often undesirable. Severalinitiatives have been implemented by the state to provide eldercare servicesand improve physical accessibility in these estates. The outcomes of theseimplementations, however, have yet to be systematically studied. Therefore,our research investigates whether the social-psychological well-being of theelderly within the matured estate is dependent on their perception of theirhome and larger urban environments, as one’s sphere of mobility and inter-action tends to be reduced with age.

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

Psychosocial Well-Being of the Elderly 261

In this article, we will focus on the housing estate of Bukit Merah Plan-ning Area in Singapore. Bukit Merah was selected for this study because ofits visible dissemination of eldercare infrastructure within the fabric of thehigh-rise, high-density public housing estate, to cater for a relatively highpercentage of elderly residents. Interviews with the elderly who live withinBukit Merah were conducted to understand how housing and neighborhooddesign can support or inhibit their psychosocial well-being, as indicated bythe Geriatric Depression Scale (GDS). These quantitative surveys as wellas qualitative interviews were used to collect the elderly’s perceptions andneeds in five aspects of “aging-friendliness”: Continuity, Compensation, Con-nection, Contribution, and Challenge (Scharlach, 2012). Through the analysisof these results, alongside a study of provision of eldercare facilities and othersocial spaces, relationships are drawn between key factors that impact andaffect the seniors’ perception and experience of their housing environment.

LITERATURE REVIEW

Various studies have shown that many aspects of housing are associated withthe elderly’s psychosocial well-being (Addae-Dapaah, 2008; Lam & Boey,2005; Oswald et al., 2007; Oswald, Wahl, Mollenkopf, & Schilling, 2003;Rioux, 2005; Stark, 2004). In a study on 16 older adults with functionallimitations, Stark (2004) found that removing the environmental barriers fromthe homes significantly enhanced the older adults’ occupational performanceand their satisfaction with their ability to perform daily activities. In HongKong, respondents’ scores on the Geriatric Depression Scale-15 (GDS-15;Sheikh & Yesavage, 1986) were correlated with type of housing, availabilityof helpers, financial status, and family support (Lam & Boey, 2005). In theirstudy, 397 elderly aged 75 to 89 living in urban areas were asked whetherthey reside in private housing with independent tenancy, private housingwith shared tenancy (e.g., cubicles), or public housing. Those living in privatehousing with independent tenancy (a better living condition) scored lower onthe GDS than those living in private housing with shared tenancy. Moreover,another study showed that the elderly’s perceptions of their well-being arenot only associated with objective aspects of housing (e.g., the magnitudeof accessibility problems), but also with their perceptions of the home’smeaning and usefulness (Oswald et al., 2007).

Nevertheless, as we learn from P-E fit theory that what matters is thematch between environment and individuals’ needs and abilities, merelygood housing and a well-perceived home are inadequate to enable the el-derly to cope with various changes in their life. There is an increasing needto shift the discourse of improving the well-being of the elderly from beingcompartmentalized into either psychological or physiological aspects withinthe specific house-unit, to a broader and more inclusive, multidisciplinary

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


understanding of aging populations vis-a-vis their neighborhood’s environ-mental liveability.

Since the 1990s, various urban planning reform movements have aimedto improve both the physical and mental health of residents. One of thesemovements is the Smart Growth Movement, which was initiated first bythe American Planning Association, U.S. Department of Housing and UrbanDevelopment, and the Henry Jackson Foundation, and secondly from theNatural Resources Defense Council and the Surface Transportation PolicyProject. The characteristics of this movement are mixed-land use, availabil-ity of open space, defined activity centers, walkable streets, and creatinga greater sense of community (Ewing, Meakins, Bjarnson, & Hilton, 2011).Furthermore, recent design movement has emphasized the importance ofcreating informal social interaction, such as creating more opportunities forneighbors to meet each other. One way to do this is by locating publicfacilities near to each other or by grouping these facilities together, for ex-ample, by designing them in such a manner that someone who is walkingtoward a library will pass other facilities, such as an art center or post office,and have chance encounters with other people (Ball, 2012). The role of theelderly in making decisions about their communities has also been morerecognized, for example, by including them in planning their own senior co-housing communities (Durrett, 2009). These changes in urban design implythat increasing the congruency between individuals and environment goesbeyond barrier-free environment.

Consistent with these movements in urban design, Scharlach (2012) hasproposed that the “aging-friendliness” of a community can be explained inthe following aspects based on various theories of lifespan developmen-tal psychology: Continuity (ability to maintain established patterns of socialbehaviors and social circumstances), Compensation (availability of prod-ucts and services to meet the basic health and social needs of individualswith age-related disabilities), Connection (opportunities for meaningful in-terpersonal interactions that foster reciprocal support and maintain socialconnectedness), Contribution (lifelong need to make a positive impact onone’s environment), and Challenge (age-appropriate opportunities for phys-ical, intellectual, and social stimulation to ward off the physical and mentaldecline caused by lack of stimulation). Scharlach proposed that the physicaland social infrastructure of a community should respond to elderly needs’ inthese five aspects (abbreviated hereafter as “5 Cs”).

One study that shows the example of the importance of Continuity isa qualitative study conducted by Aberg (2008) on 15 elderly, aged 80 to94 years, who were undergoing geriatric rehabilitation in Sweden. It wasfound that the two common themes the elderly regard as important in theirlife satisfaction are (a), the ability to manage personal care and to carryout their hobbies, and (b) continuity in routine activities, especially keepingin touch with other people. Regarding Compensation, an empirical study

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


that shows the importance of this aspect was a study conducted on 1,966older adults in 50 neighborhoods in Bogota, Colombia (Parra et al., 2010).They found that those who resided in areas with more than 8% of land cov-ered by public parks tend to rate their health better. Regarding Connection,there have been many studies that show the importance of social interac-tion among the elderly (Gouda & Okamoto, 2012; Janevic, 2004). In fact,Lim and Kua (2011) found that loneliness is a better predictor of depressionthan one’s living arrangement (i.e., living alone). Thus, older adults who feellonely tend to be more depressed, but older adults who live alone may notfeel depressed if they do not feel lonely. These findings suggest that thethree aspects of Continuity, Compensation, and Connection influence thesocial-psychological well-being of the elderly. Nevertheless, the perceptionsof the elderly about their neighborhood in these three aspects, in relation totheir psychosocial well-being, have not been investigated before.

In the aspect of Contribution, according to the WHO Global Age-Friendly Cities guide (2007), social participation, civic participation, and em-ployment are marked as important aspects of age-friendly cities, togetherwith other aspects, such as transportation and housing. Furthermore, in aseven-year longitudinal study on 7,322 elderly respondents aged 70 andabove, it was also found that volunteering slows the increase in depres-sion level (Lum & Lightfoot, 2005). In a study conducted in Singapore, itwas found that more frequent engagement in different types of activitiesis associated more with lower risk of cognitive decline, which shows theimportance of aspect Challenge (Niti, Yap, Kua, Tan, & Ng, 2008). How-ever, little is known on how Contribution and Challenge aspects as whatpeople understand as “active-aging” are related to neighborhood design andaging-friendly community.

Based on this concept of “aging-friendliness” of a community in thesefive aspects, our research posits that active aging and good neighborhooddesign are actually two sides of the same coin. This area of study has largelybeen unexplored in Singapore’s context in recent years. Teo (1997) exam-ined the provision of facilities and services for elderly persons in urbanSingapore, and posited that policies concerning this group are socially con-structed spatial forms that may not adequately meet their needs, emphasizingthe significance of subjectivity in environmental strategies of designing forolder people—especially in land-scarce Singapore. In particular, Teo con-ducted surveys on 148 elderly living in Tampines and Bukit Merah to in-vestigate their use of public space and various designated elderly cornersand services provided by the state (e.g., community centers). She foundthat almost one third of them did not use any state-initiated services, andthose who did use these services did so for health-related reasons (e.g., toexercise or to go to physiotherapy). Since then, there have been variousnew initiatives in improving the built environment for elderly, for exam-ple, the development of studio apartments and the new Accessibility Codes

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


(Building and Construction Authority [BCA], 2013). However, there is stilllack of understanding about the relationship between neighborhood designand active aging. Addae-Dappah (2008) administered a questionnaire to 390elderly respondents living in studio apartments in Singapore that addressedvarious aspects of housing (i.e., size of apartment, noise level, transportationnetwork, and ease of maintenance). It was found that even though residentswere satisfied with the housing quality of their studio apartments, 49.9% ofthe residents were dissatisfied with the concept of age segregation in studioapartments. However, compared to other studies, Addae-Dappah did notassess psychosocial well-being using any standardized assessment. Further-more, the relationship between the housing design and active aging lifestylehas not been investigated in Singapore.

THE CASE OF BUKIT MERAH (REDHILL)

Singapore’s unique condition of an urban city-state is both a boon and banein the face of its growing elderly population. The increasing pressure of theaging urban population of Singapore impresses upon the scarcity of land inthe 715 square kilometers that make up this island city-state, especially sofor housing and health-care provision. Nevertheless, its efficiency in policymaking, coupled with its highly dense urban condition and pervasive publichousing landscape, empowers it to address this aging situation in a swiftmanner. As 82% of the population lives in public housing, we look to thehighly dense and largely mature region of the Bukit Merah Planning Area,situated just off Singapore’s Centre Business District, for our study. BukitMerah, which literally means ‘Red Hill’ in the local Malay language, presentlyhas the second highest percentage of elderly population (16.7%) amongthe public housing estates in Singapore, only after Marine Parade (DOS,2012) (Figure 1). Bukit Merah is also ranked second in terms of the numberof elderly residents who are 65 years old and over (25,600), after anothermatured estate Bedok (35,300) (DOS, 2012). In addition, most of the residents(94.6%) in Bukit Merah stay in HDB public housing (DOS, 2012) (Figure 2).

Owing to its large elderly population, Bukit Merah boasts a relativelylarge number of social services catering to the elderly (Figure 3). These cen-ters occupy the previously empty space on the ground floor of the housingblocks, which are referred to locally as “void decks.” The void decks are pub-lic communal spaces that emerged from the modern housing planning andserved to enhance cross-ventilation, visibility, and community surveillance(Liu, 1975). Designed as an empty, flexible expanse of sheltered ground-levelspace, it was used variously by the community as play areas for children,spaces for male elderly to hang bird cages, conversation areas for female el-derly, and for events like funerals and weddings. Due to the ubiquitous voiddecks prevalent in every public housing estate, the state began in the 1980s

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

FIG

UR

E1

Map

ofSi

nga

pore

show

ing

pro

portio

nofre

siden

tpopula

tion

aged

65ye

ars

and

ove

rby

pla

nnin

gar

ea,Ju

ne

2012

.So

urc

e:D

OS,

2012

.

265

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

FIG

UR

E2

Map

ofSi

nga

pore

show

ing

pro

portio

nofre

siden

tpopula

tion

stay

ing

inH

DB

flat

sby

pla

nnin

gar

ea,Ju

ne

2012

.So

urc

e:D

OS,

2012

.

266

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

FIG

UR

E3

Map

show

ing

loca

tions

ofva

rious

elder

care

serv

ices

loca

ted

with

inth

eB

uki

tM

erah

Pla

nnin

gA

rea.

Sourc

e:A

uth

ors

.

267

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


and 1990s to insert a wide variety of services ranging from child care to eldercare. Managed and run by various volunteer welfare organizations (VWOs),these facilities sprung up specifically in response to the needs of the agingpopulation, and filled the increasing need for planned activity spaces for theelderly.

Some of these eldercare facilities found in Bukit Merah include senioractivity centers (SACs)—spaces for social and recreational activities for el-derly living in one-room rental flats and studio apartments—that are run byseveral VWOs (e.g., NTUC Silver Ace, Thye Hua Kwan, and Redhill Moral).One SAC usually serves one or two flats nearby. There are also numer-ous other program-centric eldercare institutions such as the Senior-ConnectPlus Center at Bukit Merah Community Center and the Befriender Servicethat reach out to elderly who live alone through home visits, the Day CareCenter for elderly with medical or neurological conditions (e.g., dementia,stroke, or Parkinson’s Disease), and the Day Rehabilitation Center for elderlywho require post-hospitalization care (Figure 4). One such program is theApex Day Rehabilitation Centre for the Elderly located at Bukit Merah View,which was one of the first eldercare and rehabilitation centers in Singapore.It was set up here as a pilot project by the National Council of Social Ser-vice (NCSS) in 1980. These formal and regulated private social services areseparated from the public realm, being designated community zones for theaged.

On the other hand, social spaces that are more public in nature are alsoprovided in the estate, such as exercise corners (including those particularlydesigned for the elderly), pavilions, pocket gardens, neighborhood parks(including Tiong Bahru Park in the north and Telok Blangah Hill Park inthe south), as well as the new Park Connector Network (PCN) that links upthe various parks and gardens in SingaporeElderly are also seen in otherpublic spaces such as children’s playgrounds, void decks (those that are notoccupied by service facilities), eating outlets such as “hawker centers” (foodcenters housing multiple food stalls under one roof), coffeeshops, and publicinstitutions like the Bukit Merah Public Library (Figure 5).

With the insertion of all these eldercare facilities and the provision ofsocial spaces, the matured estate of Bukit Merah offers a unique case ofstudying the elderly’s perceptions of their housing environment in relationto their psychosocial well-being. Both quantitative surveys as well as quali-tative interviews with the elderly who live in Bukit Merah were conducted.Specifically, two groups of elderly were identified—those interviewed at var-ious social service centers and those interviewed on the streets—in order toinvestigate their attitudes toward the planning and provisions of differentsocial spaces. Through the analysis of these results, along with the study ofprovision of eldercare facilities and other social spaces, broader relationshipswere also drawn between key factors that affect the elderly’s perception andexperience of their housing environment. It is with such understanding that

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

FIG

UR

E4

Photo

grap

hs

ofva

rious

elder

care

faci

litie

sin

Buki

tM

erah

asdes

ignat

edso

cial

spac

esfo

rth

eel

der

ly.So

urc

e:A

uth

ors

.

269

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

FIG

UR

E5

Photo

grap

hs

ofva

rious

public

spac

esin

Buki

tM

erah

freq

uen

ted

by

the

elder

ly.So

urc

e:A

uth

ors

.

270

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


this article discusses and proposes recommendations for neighborhood ur-ban design and social service provision in matured housing estates.

METHODS

Participants

We interviewed 33 healthy participants aged 55 or older who live in BukitMerah. Of the 33 participants, 17 were males and 16 were females. Twentyof the 33 participants were recruited from senior activity centers (SACs) andday rehabilitation centers, while 13 participants were recruited through streetinterviews at places in Bukit Merah where elderly congregated, such as theRedhill Market and Food Center, Tiong Bahru Park, and pavilions.

Materials

Demographic Questionnaire. This questionnaire requested basic demo-graphic information from participants, such as gender, age, health status,marital status, education level, employment status, language(s) spoken, andinformation about the participants’ house and neighborhood (number ofrooms, type of housing, composition of neighbors, preferred living arrange-ment, etc.). The first section consisted of 12 questions on basic demographicdata (adapted from Addae-Dappah, 2008, and Yow & Markman, 2011). Thesecond section consisted of 8 questions about the participant’s house andneighborhood, as well as the individual’s opinions on various living arrange-ments (adapted from Elderly Accommodation Counsel, 2002).

Subjective physical health questionnaire. This questionnaire consisted of12 questions (adapted from Freedman et al., 2012) about whether participantshave been diagnosed with any serious medical conditions (e.g., asthma, heartattack) and how this physical discomfort has affected their activities using a4-point rating scale (from Not at all to Limited a lot). This measure is used toexamine whether physical well-being might affect participants’ psychologicalwell-being and perception of their living environment.

Montreal Cognitive Assessment (MOCA) (Nasreddine et al., 2005). Thisinstrument screens for mild cognitive impairment. It consists of 11 ques-tions and assesses visuospatial ability, executive functioning, picture naming,memory, attention, language, abstraction, delayed recall, and orientation. Weused the MoCA Singapore versions (English-, Chinese-, and Malay-languageversions) in this study, which were developed and modified from the origi-nal MoCA by the Memory Aging and Cognition Center in Singapore (Donget al., 2010). The original MoCA cutoff score is 26, which implies that indi-viduals who score below 26 are at risk of cognitive impairment. However,there were no normative studies to identify the recommended cutoff score in

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


using the MoCA Singapore versions, although Dong et al. (2010) suggestedan optimal cutoff score of 21 to 22 to screen high-risk and low-risk cognitiveimpairment based on 118 patients in Singapore.

Geriatric Depression Scale-15 (GDS-15; Sheikh & Yesavage, 1986). Thisaspect of psychological well-being measures an individual’s risk of depres-sion. This questionnaire consists of 15 questions that ask people about theirfeelings in the past week; participants answer yes or no to questions such as“Do you often get bored?”.This questionnaire is commonly used as a mea-sure of psychological well-being (Lam & Boey, 2005; Ng et al., 2009). TheChinese and Malay versions that we used were developed by the Geronto-logical Research Programme (Broekman et al., 2008; Nyunt, Fones, Niti, &Ng, 2009). Scores of 10 points or higher almost always indicate depression.Scores that are more than 5 points suggest depression and in clinical diagno-sis. It is recommended that individuals with these scores undergo follow-upinterviews (Sheikh & Yesavage, 1986).

The 5Cs Questionnaire: Psychological Well-Being of Seniors, Physical En-vironment, and Social Infrastructure in Housing Estate questionnaire. Thisquestionnaire consists of five sections (Continuity, Compensation, Connec-tion, Contribution, and Challenge)–each section has a quantitative survey anda qualitative interview component (adapted from Scharlach, 2012). The sec-tions Continuity, Compensation, and Connection ask about subjective expe-rience using a 5-point rating scale (from strongly disagree to strongly agree).The Contribution and Challenge sections ask about frequency of engagementin various activities (1 = never/less than once a month, 2 = sometimes/oncea month or more but less than once a week, 3 = once a week or more). Theopen-ended questions further investigate the availability of the services andthe factual information about the participants’ house, neighborhood, andcommunity in relation to these five components (Appendix A). These com-ponents were chosen based on various studies that investigate the relation-ship between elderly psychosocial well-being and various aspects of housing(Appendix B).

Procedure

This study was approved by the Singapore University of Technology andDesign Institutional Review Board. The survey was conducted via one-to-oneinterviews at SAC, The Apex Day Rehabilitation Centre, or in public places.All participants were informed about the study and given consent forms inone of three languages: English, Mandarin, or Malay. The interview lasted 60to 90 minutes and was administered by research assistants who were fluentin at least two of the three languages. The interview was based on the fivequestionnaires mentioned above, and the questionnaires were administeredin no particular order. Participants could choose whether they wanted to be

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


audio-recorded during the interview. Four additional participants’ data werenot included in the analysis either because they withdrew in the middle ofthe study or because they could not understand the instructions or questionsin the questionnaire.

RESULTS

Demographics and Physical and Mental Health Profiles of Participants

A detailed demographic table is presented in Appendix C. Participants camefrom diverse backgrounds in terms of household size, marital status, andhousing size (Appendix D). The majority of the participants were Chinese,and most reported themselves as mobile and healthy. The highest educationlevel was mostly secondary school and below, and the average monthlyincome was $1,000 and less. Only five of the participants were currentlyworking: one of them worked to support family members, and another oneworked to interact with other people, while the rest did not explain thereason they worked. More than half of the participants had lived in theircurrent house for more than 10 years, and most of them were satisfied withtheir living arrangement. Twenty-five of them (76%) preferred to stay in theircurrent residence in the future.

Overall, the participants were healthy in terms of their physical andpsychological well-being. Most of them did not have serious medical condi-tions (Appendix E). Across all participants and various medical conditions,only four participants indicated that these medical conditions limited theiractivities a little, while the rest of the participants perceived that their med-ical conditions did not limit their activities at all. Our participants were alsogenerally not depressed (Appendix F). Slightly more than half of the partici-pants scored above the suggested cutoff score in MoCA based on Dong et al.2010 (Appendix G). Of those who scored less than 22, one was visually im-paired and the majority of the remaining 11 participants expressed difficultyin understanding the tasks.

Responses to the 5Cs Questionnaire

The 5-point Likert scale from the Continuity, Compensation, and Connectionsections were recoded to a 3-point scale (1 = strongly disagree/disagree,2 = neither agree nor disagree, 3 = strongly agree/agree) for ease ofcomparison with Contribution and Challenge. It should be noted, however,that the 3-point scale for Contribution and Challenge referred to frequencyof engagement instead (1 = never or less than once a month, 2 = sometimesor once a month or more but less than once a week, 3 = often or once a weekor more).

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


TABLE 1 Mean, Median, and Standard Deviation of 5Cs Scores

Variables Median Mean Standard Deviation (SD)

Continuity∗ 2.78 2.72 .33Compensation∗ 2.86 2.81 .24Connection 2.33 2.19 .56Contribution∗ 1.24 1.28 .21Challenge∗ 1.42 1.40 .22

Note.∗Scores significantly differ from midpoint (score of 2), p < .05.

As most of the scores are not normally distributed (Appendix H), one-sample Wilcoxon signed-rank tests were used. Results show that, out of amaximum score of 3, median scores of Continuity and Compensation scoreswere significantly above 2, and median scores of Contribution and Chal-lenge are significantly below 2 (ps < .05) (Table 1). Our results imply thatparticipants generally felt that they were able to make decisions about theirhouse and manage themselves and their house, and were positive about thelocation of the amenities around their house and the availability of outdoorfacilities (high Continuity and Compensation scores). They were marginallyagreeable with the overall cohesiveness of their community (Connectionscore, p = .077). However, participants rarely engaged in the various activi-ties listed in the Challenge and Contribution sections.

Relationships Between the Different Measures Employedin the Study

Similarly, Spearman’s correlation analysis was used since most of the scoresare not normally distributed. Those who had a lower risk of cognitive im-pairment (higher MoCA score) tended to have a lower risk of depressionand a higher monthly personal disposable income (Table 2), suggesting aprotective effect of cognitive functioning on psychological well-being that iscorrelated with an individual’s income level. Depression scores are also neg-atively correlated with Compensation and Connection scores: Participantswho were more satisfied with the location of the amenities around theirhouse and with the availability of outdoor facilities (higher Compensationscore) and who perceived their community to be more cohesive (higherConnection score) tended to have lower GDS scores. Participants who havea higher education background also tended to contribute more to their fam-ily and community (higher Contribution scores) and were more engaged instimulating activities (higher Challenge scores). The frequency of going toSACs is positively related to Continuity, Compensation, Contribution, andChallenge scores and negatively related to monthly personal disposable in-come. Our results suggest that active participation in senior-related activities

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


TABLE 2 Summary of Significant Correlations Between 5C Components and Other Variables

Variable 1 Variable 2Spearman’s

rho (rs) N p

MoCA GDS –.391∗ 29 .036MoCA Monthly

personaldisposableincome

.402∗ 27 .038

GDS Compensation –.357∗ 31 .049GDS Connection –.379∗ 31 .036Education level Contribution .390∗ 32 .028Education level Challenge .381∗ 32 .031Frequency of going to SAC Monthly

personaldisposableincome

–.393∗ 28 .038

Frequency of going to SAC Continuity .496∗∗ 32 .004Frequency of going to SAC Compensation .357∗ 32 .045Frequency of going to SAC Contribution .440∗ 31 .013Frequency of going to SAC Challenge .583∗∗ 32 .001

∗p < .05, two-tailed.∗∗p < .01, two-tailed.

is related to a greater level of satisfaction in various aspects of housing, butparticipants with higher income were less likely to be involved in activitycenters.

Correlation analysis among the 5Cs revealed that the more satisfiedthe participants were with the facilities around them (higher Compensationscores), the more cohesive they perceived their neighborhood (higher Con-nection scores), and the more often they were engaged in various activities(high Challenge scores) (Table 3). The relationship between Compensationand Challenge is reflected in some of our participants. For example, a manwho goes to SAC regularly commented:

TABLE 3 Correlations Between 5Cs Components (Spearman’s rho (rs))

Continuity Compensation Connection Contribution Challenge

ContinuityCompensation .164Connection –.143 .356∗

Contribution .505∗∗ .082 –.195Challenge .333 .427∗ –.011 .591∗∗

∗p < .05, two-tailed.∗∗p < .01, two-tailed.

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


It’s important to have exercise corners, especially special fitness cornersfor the elderly. Preferably not too far from home, 5 to 10 minutes isideal. Currently walking to SAC takes more or less 10 minutes, but SAC isconstrained by operating hours. It would be nice to have integrated parkwith library (like Tampines). I like Chinatown Point Library because it hasvery nice Chinese books. Here I would like to grow my own vegetables,herbs, plants that are edible.

Furthermore, the more the participants were engaged in various ac-tivities (high Challenge scores), the more they tended to contribute to theirfamily and community (high Contribution scores). Continuity, in turn, is posi-tively associated with Contribution, such that the more participants perceivedthey were able to make decisions about their house and manage themselvesand their house (high Continuity scores), the more often they contributed totheir family and community (high Contribution scores) (Please see AppendixI for significant correlations among various subscales).

In summary, the results suggest that satisfaction with the facilities aroundhousing neighborhoods contributes positively to how frequently an elderlyengages in various activities, which could lead to a greater sense of cohe-siveness with their community, a greater sense of self-efficacy, and a lowerrisk of depression.

Comparison Between Subgroups of Participants

Twenty participants were recruited from centers and 13 participants were re-cruited from the streets. While Mann-Whitney U tests showed that these twogroups of participants did not differ in their risk of cognitive impairment anddepression (U = 104.5 and U = 104.5, respectively, ps > .10), participantsrecruited from the centers scored higher than participants recruited from thestreets in three of the components: Continuity, Contribution, and Challenge(U = 66.5, U = 63.5, U = 41, respectively, ps < .05) (Table 4). Compared toparticipants recruited through street interviews, participants from the centerswere able to make decisions about their house and manage themselves andtheir house (Continuity), tended to participate more in stimulating activities(Challenge), and do more activities for people living around them (Contribu-tion)However, both groups tended to have similar scores for Compensation(U = 108, p = .402) and Connection (U = 98.5, p = .243), suggesting thatboth groups have similar views toward the facilities, housing conditions, andsocial cohesiveness of their neighborhood (Please see Appendix J for moredetailed comparison of scores between participants recruited through streetinterviews and interviews conducted at activity centers).

In general, participants were rarely engaged in structured voluntarywork, but they often mentioned their spontaneous contribution to peo-

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


TABLE 4 Medians and Means (Standard Deviations in Parentheses) of Scores Between Par-ticipants Recruited Through Street Interviews and Interviews Conducted at Activity Centers

Street InterviewsCenter-BasedInterviews p

Variables Median Mean (SD) Median Mean (SD) Value

MoCA 23.00 21.55 (4.97) 22.00 21.15 (5.21) .000∗∗

GDS 2.00 3.17 (3.44) 2.00 2.39 (2.25) .819Continuity 2.75 2.61 (0.35) 2.89 2.79 (0.30) .018∗

Compensation 2.79 2.80 (0.19) 2.93 2.82 (0.27) .402Connection 2.33 2.32 (0.50) 2.17 2.11 (0.60) .243Contribution 1.11 1.20 (0.22) 1.35 1.34 (0.19) .021∗

Challenge 1.26 1.25 (0.19) 1.50 1.50 (0.17) .002∗∗

Frequency going toSAC (including day care)

1.00 1.17 (0.58) 3.00 2.80 (0.62) .000∗∗

∗∗Significant difference between the two groups of participants (p < .01); see Appendix J for moredetailed descriptive statistics.

ple around them, such as helping neighbors to buy necessities, pushingwheelchairs, or assisting other elderly to board the bus. Participants re-cruited from both street interviews and centers enjoyed doing exercise andengaging in socially stimulating activities. The most common intellectuallystimulating activity that they did was reading the newspaper. However, thenature of the social activities that they were engaged in was slightly differ-ent as participants who go to senior activity centers were more aware ofavailable courses, such as SCOPE (Self-Care for Older Persons in Singapore)and various outings organized by the SAC in collaboration with companiesor schools. Among the participants, only two did not know about SAC orCommunity Center, or how to join these activities.The rest of the street in-terview group were aware of the activities, but they did not have time for orthe interest in attending the activities (Table 5).

Participants recruited from centers also consisted of significantly morefemales than the street interview group (U = 42.5, p < .001). In fact, onlyone female participant was recruited through a street interview, while 15out of 20 participants recruited from centers were females. Female partici-pants visited and used the facilities at SACs more frequently than males (U= 72, p < .05) (Table 6). Hence, it is not surprising that males scored sig-nificantly lower than females in Continuity, Contribution, Challenge, andfrequency of going to SACs. This difference is consistent with the dif-ference between participants recruited through street interviews and par-ticipants recruited from SACs (compare Tables 4 and 6). However, de-spite the fact that males did not visit SACs as often as females and theirGDS scores did not differ significantly from the female participants, theyperceived greater social cohesiveness of their neighborhood (U = 69,p < .05). On the other hand, there is no significant difference in Connectionbetween participants recruited from centers and those recruited via street

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


TABLE 5 Excerpts of Participants’ Comments in 5Cs Questionnaires

Center-Based Interviews

Male Female

Mr. CH, 71 Mrs. AX, 72“I would like to teach if possible/ there ischance, but it’s not necessary to mywell-being. Even if I share my stories withyoung people or try to teach them, some ofthe places that I remember do not existanymore. Areas or buildings are all goneand this makes communicating with theyoung people hard. Other than the activitieslisted in the Challenge sections, I watchYouTube and go to Expo. I go to Residents’Committee (RC), CC, SAC regularly; I seeactivities depend on schedule of the centers.I exercise at SAC every day and atHenderson Wave parks.”

“Sometimes SAC organizes outing to the zooor parks (e.g., Alexandra). At SAC, I joinAngklung (musical instrument ensemble)and yoga. I also often help calling the people(at SAC) according to numbers when theyconduct regular blood-pressure checks atSAC.

Mrs. LM, 64“I go to SAC every day. I don’t becomevolunteer, only if people ask for help, I’d liketo help. My husband said what if I sign upas a volunteer, but then I don’t have timewhen they need me? So I don’t sign up. I liketo go to Geylang Serai once in two to threemonths. I also like to go to Woodlands, toCauseway Point. Sometimes there’s outingsat SAC, but sometimes I don’t know thedetails.”

Street Interviews

Male Female

Mr. TZ, 73 Mrs. JH, 70“I used to go fishing, but now no place tofish. I walk toHenderson Park to exercise 15 minutesevery morning. I don’t have education,don’t know reading/writing. I organize owngroup to go out. I like to go Pulau Ubin andgo sightseeing, eating, drinking coffee. Isometimes go to Buddha Tooth Temple. Idon’t like to go to SAC, I don’t like to mixwith those older folks with differentbehaviors (70s to 80s). They are too old,troublesome, selfish, no image. I only joineddinner at CC once. I don’t like to join thesepeople. I prefer to be with friends stayingaround Block 19.”

“I have never gone to CC because I don’tknow how to join CC.”

Mr. YT, 67“There is GRC (Group RepresentationConstituency) activity center. I volunteerEnglish-Chinese translation at lawyerfriend’s place, but not too often. I think theactivities organized by CC are good, butsometimes I don’t have time. I used to do taichi in the past.”

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


TABLE 6 Medians and Means (Standard Deviations in Parentheses) of Scores Between Maleand Female Participants

Male Female

Variables Median Mean (SD) Median Mean (SD) p value

MoCA 23.00 22.4 (4.85) 21.00 20.25 (5.16) .170GDS 2.00 2.78 (3.14) 3.00 2.64 (2.41) .936Continuity∗∗ 2.75 2.62 (0.31) 2.95 2.82 (0.33) .002∗∗

Compensation 2.86 2.84 (0.18) 2.86 2.78 (0.29) .576Connection∗ 2.50 2.42 (0.47) 1.82 1.95 (0.56) .015∗

Contribution∗∗ 1.11 1.19 (0.20) 1.39 1.38 (0.18) .003∗∗

Challenge∗ 1.29 1.31 (0.21) 1.52 1.50 (0.18) .012∗

Frequency of going to SAC∗ 1.00 1.75 (1.00) 3.00 2.63 (0.81) .013∗

∗Significant difference at p < .05.∗∗Significant difference at p < .01.

interview (Please see Appendix K for more detailed comparison of scoresbetween male and female participants).

DISCUSSION

Well-Being of Elderly in Relation to Independence, Neighborliness,and Cohesiveness

The participants generally had high satisfaction in their ability to be indepen-dent in making decisions about their house and to manage themselves andtheir house. They were also satisfied with the location of their house and theoutdoor support, services, and facilities around their house. For example,almost all participants felt that they had enough time to cross at traffic inter-sections and that the location of their house was convenient to shops, clinics,and activity centers. These reflect positive feedback on all the elder-friendlyinfrastructure and facilities provided in the matured estate of Bukit Merah.Our results also show that participants who were more satisfied with thelocation and availability of outdoor support around their house tended tofeel less depressed. Furthermore, those who perceived themselves as inde-pendent and able to manage themselves and their house tend to contributemore to their family and community.

On the other hand, the participants did not have any strong opinions inevaluating the cohesiveness of their neighborhood. Nevertheless, the morepositive they valued the cohesiveness of their neighborhood, the less pronethey were to depression. It is understandable that participants who havecloser friends around the neighborhood might tend to perceive their neigh-borhood as more cohesive, and therefore tend to be less depressed. One ofthe participants who scored 2 in the GDS commented:

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


Mine is a close-knit neighborhood because it’s a common corridor. I havegood neighbors, but neighbors keep things to themselves.

Thus, more could be done in neighborhood planning and design toencourage social connectedness among elderly and between elderly andothers in the matured estate.

Well-Being of Elderly in Relation to Active Aging and Volunteerism

Despite the general trend of extremely high perceived independence andneighborliness in this sample, most participants were not engaged in var-ious activities frequently—neither in stimulating activities as listed in theChallenge section, nor in other activities that require interaction with familyand community as listed in the Contribution section. Interestingly, the Chal-lenge score was also found positively associated with Compensation, de-spite the low Challenge scores and high Compensation scores in the presentstudy. The result implies that improvements in neighborhood design couldhelp; more specifically, there is still room to improve neighborhood designand planning in matured estates that could intrinsically encourage the el-derly to participate in various physical activities and social activities in thecommunity.

Provision and Planning of Formal and Informal Social Spaces

Participants who attended activities at SAC enjoy outing activities organizedby the center. As shown earlier, SACs tended to attract more females thanmales, as women tend to establish friendships at activity centers. For exam-ple, Mrs. LM (64 years old), who attended SAC activities every day, sharedthat she “meets up with SAC friends and goes shopping.” This aligns wellwith the findings that elderly women who live alone felt that they haveformed close friendships since they came to senior centers (Aday, Kehoe, &Farney, 2006). Furthermore, women also perceived greater health benefitsfrom attending senior centers compared to men (Fitzpatrick, McCabe, Gitel-son, & Andereck, 2006), and women with higher levels of education andbetter subjective physical health assessments tended to be frequent users ofsenior centers (Yoo & Kim, 2005). On the other hand, one of the reasonsindicated by male participants for not going to activity centers was that theirfriends did not go to these centers. Two of the male participants who wererecruited through street interview commented:

I don’t go to SAC because (I) work part time and meet friends at thepark. I don’t have friends there so I don’t go.

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


It is not surprising that most male participants who did not visit activitycenters scored lower in Continuity (noting that the result could be skewedby men generally being less active in managing households), Contribution,and Challenge.

Based on open interviews, in addition to meeting their friends regularlyat SACs, female participants also meet their SAC friends at coffeeshops orhawker centers nearby. For example, Mrs. KN (72 years old) commented:

I visit my son once in two weeks (he lives in Woodlands). I go shoppingwith friends; eat together (we leave from SAC). Twice a month go totemple at Toa Payoh then eat there.

Mrs. HM, age 63, also explained:

My relatives stay in Chua Chu Kang, Ang Mo Kio, and Sengkang, butmost of my friends live nearby. We usually go to the market and drinkcoffee.

While many studies have focused on improving accessibility in housesand around the houses, our results posit that improving lives for elderlyshould also take into account the provision of public spaces to gather. Ourresults also reveal that while services provided by various activity centersprovide opportunities for elderly residents to engage in stimulating activities,not all people are attracted to activities at such centers. There are otherpeople who do not join these activities and choose to gather in informalpublic spaces, yet they have similar (low) scores in GDS. For example,participants recruited from street interviews indicated the importance ofpavilions and public parks. This aligns with the previous study conductedby Teo (1997) on 148 elderly living in Bukit Merah and Tampines, whichalso showed that elderly meet up not only at structured social spaces likeSACs, but also at informal public spaces such as coffeeshops and void decks.In addition, male participants, who were mostly recruited through streetinterviews, perceived social cohesiveness significantly higher than femaleparticipants. Although it was found that male participants were less likelyto express their dissatisfaction about their neighbors as compared to femaleparticipants, the result still suggests the positive values of open publicspaces in enhancing perceived social cohesiveness in matured estates.

When asked about activities that they thought were most important fortheir well-being, most participants replied that exercise or walking was animportant activity for them. They also considered eating out and going tovarious places as important activities. As for activities that they usually didwith their friends, the participants often mentioned drinking coffee, goingto the market, and going to shopping malls. Exercising together was alsoa common activity between the participants and their friends, especially

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


those who went to activity centers regularly. The results imply that a strongconnectivity between formal and informal public spaces is very importantfor the elderly. While the elderly formed friendships in activity centers,their activities often extended beyond the centers to places like parks,markets, and hawker centers. Even elderly who did not visit activity centersoften had an unspoken but specific meeting place with their friends, forexample, at a designated pavilion where they would play chess, talk, smoke,or simply take a nap.

Therefore, with regard to urban design in matured estate, the connectiv-ity among activity centers, markets, hawker centers, coffeeshops, and parkscan still be improved to encourage more active participation from elderly inways that do not require them to change their lifestyle abruptly. Ball (2012)proposed that it is not sufficient to have facilities that are near to each other,yet isolated from each other. To create more possibility of having chance en-counters with each other and to enhanced perceived cohesiveness, therebyimproving the elderly’s psychosocial well-being, our results posit a moreintegrated planning and urban design of all these social spaces, improvingtheir connectivity, blurring their boundaries, and offering a wider array offormal and informal public spaces to cater to diverse groups of elderly.

LIMITATIONS

Nevertheless, the limitations of this study are the small sample sizeand the unbalanced gender composition in our sample, as most partici-pants who volunteered to participate in surveys or interviews at activitycenters were females—a trend that also occurred in previous studies(Fitzpatrick et al., 2006; Kim et al., 2011; Yoo & Kim, 2005). Further studieson the elderly with a wider range of health status, education background,and income level can be conducted in the future. As most of the participantswere mostly healthy elderly who were able to move around independently,which explains the positively skewed scores of Compensation, Continuity,and GDS, further studies on the elderly with various health and mobilitystatus are needed. The relatively low education status of our sample (mostlysecondary school education and incomplete primary school education) mayalso explain the low Challenge and Contribution scores. As our results showa significant positive relationship between education status and Challengeand Contribution scores, further studies are also needed to include elderlywith higher education status to explore future trends.

CONCLUSIONS

This article has explored various relationships between the elderly’s psy-chosocial well-being and components of aging-friendly community as mea-

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


sured by the 5Cs Questionnaire (Continuity, Compensation, Connection,Challenge, and Contribution), in order to understand their perception ofa matured estate and to discuss implications in housing neighborhood urbandesign.

Our results postulate that different groups of elderly form friendshipsand participate in activities in both formal social service centers and informalpublic spaces. The friendships formed in these places and the convenienceof amenities around their houses may affect their perception of their currentresidences. Our results have also indicated that elderly residents are gener-ally satisfied with the physical infrastructure in matured estate of Singapore,particularly in Bukit Merah. However, the social infrastructure and urbandesign of the housing estate can still be further improved to help the elderlymaintain their connections with other people and encourage more contri-bution to the community.A comprehensive, integrated urban design is alsoneeded to facilitate physical activities, social interactions, and active aging inthe elderly in order to enhance their psychosocial well-being.

REFERENCES

Aberg, A. C. (2008). Care recipients’ perceptions of activity-related life space andlife satisfaction during and after geriatric rehabilitation. Quality of Life Research,17(4), 509–520.

Aday, R. H., Kehoe, G. C., & Farney, L. A. (2006). Impact of senior center friendshipson ageing women who live alone. Journal of Women & Ageing, 18(1), 57–73.

Addae-Dappah, K. (2008). Age segregation and the quality of life of the elderly peo-ple in studio apartments. Journal of Housing for the Elderly, 22(1–2), 127–161.

Ball, M. S. (2012). Liveable communities for aging populations: Urban design forlongevity. Hoboken, NJ: Wiley.

Broekman, B. F., Nyunt, S. Z., Niti, M., Jin, A. Z., Ko, S. M., Kumar, R., . . . Ng, T.P. (2008). Differential item functioning of the Geriatric Depression Scale in anAsian population. Journal of Affective Disorders, 108(3), 285–290.

Building and Construction Authority (BCA). (2013). Code on accessibility in the builtenvironment. Retrieved April 28, 2014, from http://www.bca.gov.sg

Carp, F. M. (1987). Environment and aging. In D. Stokols & I. Altman (Eds.), Hand-book of environmental psychology (pp. 330–360). New York, NY: Wiley.

Department of Statistics (DOS). (2012). Population trends 2012. Retrieved fromhttp://www.singstat.gov.sg

Dong, Y., Sharma, V. K., Chan, B. P., Venketsubramanian, N., Teoh, H. L., Seet, R., . . .& Chen, C. (2010). The Montreal Cognitive Assessment (MoCA) is superior to theMini-Mental State Examination (MMSE) for the detection of vascular cognitiveimpairment after acute stroke. Journal of the Neurological Sciences, 299(1–2),15–18.

Durrett, C. (2009). The senior cohousing handbook: A community approach to inde-pendent living (2nd ed.). Gabriola Island, Canada: New Society Publishers.

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


Elderly Accommodation Counsel. (2002). Housing Options for Older People. Retrievedfrom http://hoop.eac.org.uk/

Ewing, R., Meakins, G., Bjarnson, G., & Hilton, H. (2011). Transportation andland use. In A. L. Dannenberg, H. Frumkin, & R. J. Jackson (Eds.), Makinghealthy places: Designing and building for health, well-being, and sustainabil-ity (pp.149–169). Washington, D.C.: Island Press.

Federal Publications. (1996). Bukit Merah: From a hilly kampong to a modern town.Singapore: Federal Publications.

Fitzpatrick, T. R., McCabe, J., Gitelson, R., & Andereck, K. (2006). Factors that in-fluence perceived social and health benefits of attendance at senior centers.Activities, Adaptation, and Ageing, 30(1), 23–45.

Freedman, V. A., Stafford, F., Schwarz N., Conrad, F., & Cornman, J. C. (2012).Disability, participation, and subjective well-being among older couples. SocialScience & Medicine, 74(4), 588–596.

Gouda, K., & Okamoto, R. (2012). Current status of and factors associated with socialisolation in the elderly living in a rapidly ageing housing estate community.Environmental Health and Preventive Medicine, 17(6), 500–511.

Iwarsson, S. (2005). A long-term perspective on person–environment fit and ADLdependence among older Swedish adults. The Gerontologist, 45(3), 327–336.

Janevic, M. R., Janz, N. K., Dodge, J. A., Wang, Y., Lin, X., & Clark, N. M. (2004). Lon-gitudinal effects of social support on the health and functioning of older womenwith heart disease. International Journal of Aging and Human Development,59(2), 153–175.

Kim, H., Harada, K., Miyashita, M., Lee, E., Park, J., & Nakamura, Y. (2011). Useof senior center and the health-related quality of life in Korean older adults.Journal of Preventive Medicine and Public Health, 44(4), 149–156.

Lam, C. W., & Boey, K. W. (2005). The psychological well-being of the Chineseelderly living in old urban areas of Hong Kong: A social perspective. Ageing &Mental Health, 9(2), 162–166.

Lim, L. L., & Kua, E. (2011). Living alone, loneliness, and psychological well-beingof older persons in Singapore. Current Gerontology and Geriatrics Research,2011 (2011), 1–9. http://dx.doi.org/10.1155/2011/673181

Liu, T. K. (1975). Design for better living conditions. In S. H. K. Yeh (Ed.), Pub-lic housing in Singapore: A multi-disciplinary study (pp. 117–184). Singapore:Singapore University Press for Housing and Development Board.

Lum, T. Y., & Lightfoot, E. (2005). The effects of volunteering on the physical andmental health of older people. Research on Aging, 27(31), 31–55.

Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V.,Collin, I., Cummings, J. L., & Chertkol, H. (2005). The Montreal Cognitive As-sessment, MoCA: A brief screening tool for mild cognitive impairment. Journalof the American Geriatrics Society, 53(4), 695–699.

National Population and Talent Division (NPTD). (2013). Population white paper: Asustainable population for a dynamic Singapore. Retrieved April 28, 2014, fromhttp://www.population.sg

Ng, T. P., Broekman, B. F., Birit F. P., Niti, M., Gwee, X., & Kua, E. H. (2009).Determinants of successful ageing using a multidimensional definition amongChinese elderly in Singapore. The American Journal of Geriatric Psychiatry,17(5), 407–416.

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


Niti, M., Yap, K. B., Kua, E. H., Tan, C. H., & Ng, T. P. (2008). Physical, socialand productive leisure activities, cognitive decline and interaction with APOE-epsilon 4 genotype in Chinese older adults. International Psychogeriatrics,20(2), 237–251.

Nyunt, M. S. Z., Fones, C., Niti, M., & Ng, T. P. (2009). Criterion-based validityand reliability of the Geriatric Depression Screening Scale (GDS-15) in a largevalidation sample of community-living Asian older adults. Ageing and MentalHealth, 13(3), 376–382.

Oswald, F., Wahl, H., Mollenkopf, H., & Schilling, O. (2003). Housing and lifesatisfaction of older adults in two rural regions in Germany. Research on Ageing,25(2), 122–143.

Oswald, F., Wahl, H., Schilling, Ol., Nygren, C., Fange, A., Sixsmith, A., Sixsmith, J.,Szeman, Z., Tomsone, S., & Iwarsson, S. (2007). Relationships between housingand healthy ageing in very old age. The Gerontologist, 47(1), 96–107.

Parra, D. C., Gomez, L. F., Sarmiento, O. L., Buchner, D., Brownson, R., Schmid,T., Gomez, V., & Lobelo, F. (2010). Perceived and objective neighborhoodenvironment attributes and health related quality of life among the elderly inBogota, Colombia. Social Science & Medicine, 70(7), 1070–1076.

Rioux, L. (2005). The well-being of ageing people living in their own homes. Journalof Environmental Psychology, 25(2), 231–243.

Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997). Neighbourhoods and violentcrime: A multilevel study of collective efficacy. Science, 277(5328), 918–924.

Scharlach, Andrew. (2012). Creating aging-friendly communities in the United States.Ageing International, 37(1), 25–38.

Sheikh, J. I., & Yesavage J. A. (1986). Geriatric Depression Scale (GDS): Recentevidence and development of a shorter version. In T. L. Brink (Ed.), Clinicalgerontology: A guide to assessment and intervention (pp. 165–173). London, UKand New York, NY: Routledge.

Stark, S. (2004). Removing environmental barriers in the homes of older adults withdisabilities improves occupational performance. Occupation, Participation andHealth, 24(1), 32–39.

Teo, P. (1997). Space to grow old in: The availability of public spaces for elderlypersons in Singapore. Urban Studies, 34(3), 419–439.

Timiras, P. (2007). Physiological basis of ageing and geriatrics (4th ed.). London, UK:Informa Healthcare.

Wheeler, W. M. (1995). The evolution of places as residence. New York, NY: GarlandPublishing.

World Health Organization (WHO). (2007). Global age-friendly cities: A guide. Re-trieved April 28, 2014, from http://www.who.int/en/

World Health Organization (WHO). (2007). The world health report 2007—A saferfuture: Global public health security in the 21st century. Retrieved April 28, 2014,from http://www.who.int/whr/2007/en/

Yoo, S. H., & Kim C. S. (2005). Factors affecting the senior center participation inKorea. Asia Pacific Journal of Social Work and Development, 15(1), 63–73.

Yow, W. Q., & Markman, E. (2011). Young bilingual children’s heightened sensitivityto referential cues. Journal of Cognition and Development, 12(1), 12–31.

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX A

Table A1 Description and Examples of the 5C Components

5Cs Description Format

Continuity(2 aspects)

Independence Ability to make decisions about thehouse

3 questions using5-point Likert scaleand 3 open-endedquestions

Examples:1. I am free to make decision about

my house and live in it as I please.(Likert scale: strongly agree/agree /

neither agree nor disagree /disagree / strongly disagree)

2. Do you wish to be moreindependent? What are the thingsyou wish to do by yourself andwhat are the things you wishothers to help? (Open-ended)

Managing Ability to manage oneself and thehouse (e.g., preparing daily meal,gardening)

6 questions using5-point Likert scaleand 4 open-endedquestionsExamples:

1. I am able to manage keeping myhouse clean. (Likert scale)

2. Is there anything you used to beable to do, but you cannotmanage now? Why? (Open-ended)

Continuity(2 aspects)

Location How convenient it is to go to theclinic, to buy food, and to go toactivity centers and other serviceproviders?


Examples:1. My home is convenient to shops.

(Likert scale)2. How often do you visit a senior

activity center or integrated dayfacilities around your home (ifthere are any)? Why?(Open-ended)

OutdoorSupport

Ability to cross traffic intersection intime, availability of shadedoutdoor spaces, communitygarden, etc.


Examples:1. I am satisfied with the availability

of well-lit seating areas around myresidence. (Likert-scale)

2. Five years from now, do you thinkyour house and neighborhood willstill be suitable for you? Why?(Open-ended)

(Continued on next page)

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


Table A1 Description and Examples of the 5C Components (Continued)


Connection(2 aspects)

SocialCohesiveness

Self-assessment on how much theytrust their neighbors


Examples:1. People here are willing to help

their neighbors. (Likert scale)2. What is your ideal frequency in

meeting up with your goodfriends? Do you get to do this?(Open-ended)

Profile ofInteraction

Frequency of meeting up withfamily and friends, activities thatthey do during this interaction,and perception on what hindersor helps this interaction

11 open-endedquestions

Examples:1. What activities do you usually do

when you meet up? (Do you visitthem? Do they visit you? Do you goout together? What do you doduring the visit or when you goout with them?)

Contribution(4 aspects)

FamilyContribution

Frequency of their contribution tothe family, such as cooking, takingcare of grandchildren, etc.

6 questions using3-point frequencyscale

Examples:1. How often are you engaged in

preparing meals?Frequency scale:

• never or less than once a month• sometimes or once a month or

more, but less than once a week• often or once a week or more

Social/VolunteerWork

Frequency of their contribution totheir community, such asattending fundraising events,befriending other elderly withphysical or mental disabilities, etc.



teaching a class, e.g., linedancing, calligraphy, cooking,etc.? (Frequency scale)

ExpertiseVolunteerWork

Frequency of their contribution totheir community in their specificskills, such as mentoring youngprofessionals, teaching IT skills,etc.



organizing fundraising events?(Frequency scale)


Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


Table A.1 Description and Examples of the 5C Components (Continued)


WorkContribution

Current job/last job and amount oflast salary

2 multiple-choicequestions

Examples:Employment characteristics:a. work full-time,

industry _________b. work part-time, industry ________c. retired, industry of the last

job ________

Challenge(4 aspects)

Physical Frequency of their physicalactivities, such as jogging, tai chi,etc.


1. How often are you engaged inwalking/ jogging? (Frequencyscale)

Examples:Intellectual Frequency of their intellectually

stimulating activities, such asreading newspaper, takingcourses, etc.



browsing news on the Internet?(Frequency scale)

Social Frequency of their social activities,such as playing mahjong, going toactivity centers, etc.



attending church/ mosque/temple?(Frequency scale)

Technology Frequency of their usage of Internet,such as browsing Internet, usingFacebook, etc.

4 questions using3-point frequencyscale and 4open-endedquestions

Open-ended questions on the usageof smartphone (e.g., reason,benefits of the device in theirdaily activities) and their use ofsocial networking sites.


using social networking sites(Facebook/Twitter, etc.)?(Frequency scale)

2. Do you use a smartphone/smartdevice?

Why? (Open-ended)(Continued on next page)

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


Table A1 Description and Examples of the 5C Components (Continued)


General Remarks AboutPsychological Well-Beingand Housing

Summary of their perspectives ontheir activities and the facilitiesaround them

2 questions using5-point Likert scaleand 2 open-endedquestionsExamples:

1. Please list 5 activities that aremost important to your well-being.(Open-ended)

2. How satisfied are you with thefacilities around your home tosupport your activities?

(very satisfied/ satisfied/ neithersatisfied nor dissatisfied/dissatisfied/ very dissatisfied)

APPENDIX BTABLE B1 Sources of Each Component of the 5Cs Questionnaire

5Cs Sources

Continuity Housing Options for Older People (Elderly AccommodationCounsel, 2002)

Compensation Global Age-Friendly Cities: A Guide (WHO, 2007)Housing Options for Older People (Elderly AccommodationCounsel, 2002)

Connection Social Cohesion/Trust Questionnaire (Sampson et al., 1997)Contribution Leisure Activities Questionnaire (Niti et al., 2008)Challenge Leisure Activities Questionnaire (Niti et al., 2008)

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX CTABLE C1 Demographic Details of Participants (N = 33)

Variables N (%)

Language of Questionnaire CompletionEnglish 11 (33.33%)Mandarin 16 (48.48%)Malay 6 (18.18%)

Age55–70 12 (36.36%)More than 70 21 (63.64%)

Health StatusMobile/healthy 30 (90.91%)Immobile/Has disabilities 3 (9.09%)

Employment StatusWork full-time 1 (3.03%)Work part-time 4 (12.12%)Retired 25 (75.76%)Unemployed 3 (9.09%)

Marital StatusSingle 6 (18.18%)Married 15 (45.45%)Divorced/Separated 3 (9.09%)Widowed 8 (24.24%)Missing 1 (3.03%)

EthnicityMalay 4 (12.12%)Chinese 28 (84.84%)Other 1 (3.03%)

Highest educationNo formal education 10 (30.30%)Primary school 7 (21.21%)Secondary school 12 (36.36%)A level/Diploma 3 (9.09%)Bachelor’s degree 1 (3.03%)

Monthly income in Singapore dollarsLess than 500 14 (42.42%)500–1,000 11 (33.33)1,001–2,500 4 (12.12%)Missing 4 (12.12%)

Source of income∗

Earnings from work 3 (9.09%)CPF/Government pension/Retirement benefits 10 (30.30%)Children 16 (48.48%)Savings 5 (15.15%)Other 9 (27.27%)

Number of languages the respondent is exposed to1 4 (12.12%)2–3 20 (60.61%)More than 3 5 (15.15%)Missing 4 (12.12%)

English language exposure∗∗

None 17 (51.52%)Less than 30% 5 (15.15%)


Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


Table C1 Demographic Details of Participants (N = 33) (Continued)

Variables N (%)30% or more 6 (18.18%)Missing 5 (15.15%)

Malay language exposure∗∗

None 22 (66.67%)Less than 30% 1 (3.03%)30% or more 5 (15.15%)Missing 5 (15.15%)

Mandarin language exposure∗∗

None 10 (30.30%)< 30% 8 (24.24%)> 30% 7 (21.21%)Missing 8 (24.24%)

Chinese dialects exposure∗∗

None 8 (24.24%)< 30% 3 (9.09%)> 30% 18 (54.55%)Missing 4 (12.12%)

Note. ∗Participants could choose more than one source of income.∗∗Participants listed all languages to which they were exposed.Central Provident Fund (CPF)

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX DTABLE D1 Housing Information of Participants (N = 33)

Variables N (%)

Number of people living with respondentNo one 6 (18.18%)1 person 13 (39.39%)2–3 persons 11 (33.33%)4 or more persons 3 (9.09%)

House typeHDB 31 (93.94%)Condominium 1 (3.03%)Missing 1 (3.03%)

Housing size1 room 11 (33.33%)2–3 rooms 4 (12.12%)3 or more rooms 17 (51.52%)Missing 1 (3.03%)

TenurePaid 18 (54.55%)Leasehold 4 (12.12%)Rented from HDB 7 (21.21%)Missing 4 (12.12%)

Satisfaction with current living arrangementYes 27 (81.82%)No 3 (9.09%)Missing 3 (9.09%)

Length of residenceLess than 10 years 9 (27.27%)10–19 years 9 (27.27%)20 or more years 12 (36.36%)Missing 3 (9.09%)

House preferenceStaying in the current residence 25 (75.76%)Moving out 2 (6.06%)Missing 6 (18.18%)

Preferred neighbors on the same floorMostly senior citizens 7 (21.21%)Mostly young families 0Balanced number of senior citizens and

young families11 (33.33%)

No preference 10 (30.30%)Missing 5 (15.15%)

Will you consider staying in a studioapartment?

Yes 2 (6.06%)No 10 (30.30%)Missing 21 (63.64%)


Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX DTABLE D1 Housing Information of Participants (N = 33)(Continued)

Will you consider staying at a nursinghome?

Yes 3 (9.09%)No 14 (42.42%)Missing 16 (48.48%)

Will you consider staying at a retirementvillage?

Yes 6 (18.18%)No 6 (18.18%)Missing 21 (63.64%)

Housing Development Board (HDB)

APPENDIX ETABLE E1 Number and Percentage of Participants with the Following Medical Conditions

Medical Condition n %

Stroke 0 0Heart attack 3 9.09Coronary heart disease 1 3.03Angina 0 0.00High blood pressure 13 39.39Asthma 2 6.06Lung disease 1 3.03Diabetes 5 15.15Arthritis 6 18.18Learning disorder 0 0.00Cancer 0 0.00Psychiatric problem 1 3.03

APPENDIX FTABLE F1 Summary of GDS Scores

Scores of Scores of Scores of MeanN < 5 5–10 > 10 (SD)

GDS∗ 31 24 7 0 2.72 (2.79)

Note.∗Scores ≥ 5 indicate risk to depression; scores >10 almost always indicate depression.

APPENDIX GTABLE G1 Summary of MoCA Scores

Scores of Scores of Scores of Scores of MeanN < 8 8–14 15–21 22–28 (SD)

MoCA∗ 31 0 4 8 19 21.29 (5.05)

Note.∗Original MoCA cutoff score is 26. Suggested cutoff score in Singapore version is 21–22.

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX HTABLE H1 Mean, Standard Deviation, and Distribution of Scores (p < .05 indicates violationof normality assumption)

Shapiro-Wilk

Variables N Mean (SD) Statistic df p

Continuity 33 2.72 (0.33) .773 33 .000Continuity—Independence 33 2.87 (0.31) .495 33 .000Continuity—Managing 33 2.64 (0.43) .779 33 .000

Compensation 33 2.81 (0.24) .769 33 .000Compensation—Location 33 2.85 (0.23) .677 33 .000Compensation—Outdoor

Support33 2.68 (0.58) .583 33 .000

Connection 33 2.19 (0.56) .945 33 .093Contribution 32 1.28 (0.21) .948 32 .126

Family contribution 32 1.60 (0.43) .901 32 .007Social/volunteer work 32 1.24 (0.34) .753 32 .000Expertise volunteer work 32 1.01 (0.06) .172 32 .000

Challenge 33 1.36 (0.32) .799 33 .000Physical challenge 33 1.53 (0.49) .898 33 .005Intellectual challenge 33 1.28 (0.33) .837 33 .000Social challenge 33 1.54 (0.44) .918 33 .016Technology challenge 33 0.98 (0.20) .295 33 .000

MoCA 31 21.29 (5.05) .920 31 .024Age 33 70.85 (7.48) .972 33 .549GDS 31 2.72 (2.79) .863 31 .001Highest education 33 2.33 (1.11) .875 33 .001Size of house (HDB type) 32 2.38 (1.16) .828 32 .000Monthly personal disposableincome

29 1.66 (0.72) .767 29 .000

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX ITABLE I1 Significant Correlations Among Various Subscales

Spearman’sNo. Variable 1 Variable 2 rho (rs) N p

1 Continuity—Managing Frequency of going toSAC/IDF

.422∗ 32 .016

2 Compensation—Location Compensation—OutdoorSupport

.455∗∗ 33 .008

3 Compensation—OutdoorSupport

Frequency of going toSAC/IDF

.366∗ 32 .040

4 Compensation—OutdoorSupport

Connection .323 33 .067

5 Contribution Continuity—Managing .524∗∗ 32 .0026 Contribution Challenge—Physical .524∗∗ 32 .0027 Contribution Challenge—Social .523∗∗ 32 .0028 Contribution—Family Challenge—Physical .449∗∗ 32 .0109 Contribution—Family Challenge .395∗ 32 .02510 Contribution—Family Continuity—Managing .451∗∗ 32 .01011 Contribution—Family Continuity .403∗ 32 .02212 Contribution—Social Challenge—Intellectual .422∗ 32 .01613 Contribution—Social Challenge—Social .567∗∗ 32 .00114 Contribution—Social Frequency of going to

SAC/IDF.591∗∗ 31 .000

15 Contribution—Social Continuity—Managing .409∗ 32 .02016 Contribution—Social Continuity .448∗ 32 .01017 Challenge Continuity—Managing .361∗ 32 .04218 Challenge Compensation—Location .447∗ 32 .01019 Challenge Compensation—Outdoor

Support.389∗ 32 .028

20 Challenge—Physical Challenge—Intellectual .381∗ 32 .03221 Challenge—Physical Challenge—Social .544∗∗ 32 .00122 Challenge—Physical Compensation—Outdoor

Support.357∗ 32 .045

23 Challenge—Physical Compensation .352∗ 32 .04824 Challenge—Intellectual Challenge—Social .422∗ 32 .01625 Challenge—Intellectual Frequency of going to

SAC/IDF.573∗∗ 31 .001

26 Challenge—Intellectual Compensation—OutdoorSupport

.446∗ 32 .011

27 Challenge—Social Frequency of going toSAC/IDF

.587∗∗ 31 .001

28 Challenge—Social Compensation—Location .502∗ 32 .00329 Challenge—Social Compensation .403∗∗ 32 .022

∗p < .05, two-tailed. ∗∗p < .01, two-tailed.Senior Activity Center (SAC); Integrated Day Facility (IDF)

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX JTABLE J1 Comparison of Scores Between Participants Recruited Through Street Interviewsand Interviews Conducted at Activity Centers

Street interviews Center-based interviews

Variables Median Mean (SD) Median Mean (SD)

MoCA 23.00 21.55 (4.97) 22.00 21.15 (5.21)GDS 2.00 3.17 (3.44) 2.00 2.39 (2.25)Continuity∗ 2.75 2.61 (0.35) 2.89 2.79 (0.30)

Continuity—Independence 3.00 2.87 (0.29) 3.00 2.87 (0.33)Continuity—Managing∗ 2.67 2.47 (0.52) 2.83 2.75 (0.33)

Compensation 2.79 2.80 (0.19) 2.93 2.82 (0.27)Compensation—Location 2.88 2.84 (0.15) 3.00 2.86 (0.27)Compensation—Outdoor

Support2.80 2.74 (0.34) 3.00 2.65 (0.70)

Connection 2.33 2.32 (0.50) 2.17 2.11 (0.60)Contribution∗ 1.11 1.20 (0.22) 1.35 1.34 (0.19)

Family contribution 1.33 1.44 (3.45) 2.00 1.71 (0.46)Social/Volunteer work∗ 1.00 1.13 (0.37) 1.33 1.32 (0.29)Expertise volunteer work 1.00 1.03 (0.09) 1.00 1.00 (0)

Challenge∗∗ 1.26 1.25 (0.19) 1.50 1.50 (0.17)Physical challenge 1.40 1.38 (0.40) 1.80 1.71 (0.38)Intellectual challenge∗∗ 1.17 1.19 (0.20) 1.33 1.41 (0.24)Social challenge∗∗ 1.38 1.36 (0.29) 1.75 1.74 (0.31)Technology challenge 1.00 1.04 (0.14) 1.00 1.00 (0)

Frequency of going toSAC/IDF∗∗

1.00 1.17 (0.58) 3.00 2.8 (0.62)

∗Significant difference at p < .05. ∗∗Significant difference at p < .01.Senior Activity Center (SAC); Integrated Day Facility (IDF)

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015


APPENDIX KTABLE K1 Comparison of Scores Between Male and Female Participants

Male Female

Variables Median Mean (SD) Median Mean (SD)

MoCA 23.00 22.4 (4.85) 21.00 20.25 (5.16)GDS 2.00 2.78 (3.14) 3.00 2.64 (2.41)Continuity∗∗ 2.75 2.62 (0.31) 2.95 2.82 (0.33)

Continuity—Independence 3.00 2.90 (0.26) 3.00 2.83 (0.36)Continuity—Managing∗∗ 2.60 2.47 (0.45) 3.00 2.82 (0.35)

Compensation 2.86 2.84 (0.18) 2.86 2.78 (0.29)Compensation—Location 2.89 2.86 (0.14) 3.00 2.84 (0.30)Compensation—Outdoor

Support3.00 2.81 (0.32) 2.90 2.55 (0.76)

Connection∗ 2.50 2.42 (0.47) 1.82 1.95 (0.56)Contribution∗∗ 1.11 1.19 (0.20) 1.39 1.38 (0.18)

Family contribution∗∗ 1.33 1.39 (0.31) 2.00 1.84 (0.43)Social/volunteer work∗ 1.00 1.17 (0.35) 1.33 1.32 (0.30)Expertise volunteer work 1.00 1.02 (0.08) 1.00 1 (0)

Challenge∗ 1.29 1.31 (0.21) 1.52 1.50 (0.18)Physical challenge 1.40 1.46 (0.41) 1.80 1.71 (0.39)Intellectual challenge 1.33 1.28 (0.26) 1.33 1.37 (0.23)Social challenge∗ 1.43 1.44 (0.32) 1.75 1.75 (0.31)Technology challenge 1.00 1 (0) 1.00 1.03 (0.13)

Frequency of going toSAC/IDF∗∗

1.00 1.75 (1.00) 3.00 2.63 (0.81)

∗Significant difference at p < .05. ∗∗Significant difference at p < .01.Senior Activity Center (SAC); Integrated Day Facility (IDF)

Dow

nloa

ded

by [

Ken

g H

ua C

hong

] at

20:

20 1

6 Se

ptem

ber

2015

Documents

Perception of Matured Estate in Singapore Psychosocial ...quin/wp-content/... · Psychosocial Well-Being of the Elderly and Their Perception of Matured Estate in Singapore, Journal