Background: While older age is associated with better emotional well-being, it is unclear whether such age advantages remain during a pandemic. This study examined differences in mental health, adaptive behaviours, social support, perceived stress, digital media usage, and perceived change in circumstances between younger and older adults during the circuit breaker period (partial lockdown) in Singapore.Methods: A door-to-door survey was administered to a nationally representative sample of 602 younger (n = 302) and older (n = 300) adults aged 21–89 years from Singapore from 17 October to 27 November 2020. All participants self-reported their depression, anxiety, stress, adaptive behaviours, social support, perceived stress, change in circumstances, and digital media usage during the partial lockdown period.Results: Older adults were found to report significantly lower levels of depression, anxiety, and stress as compared to younger adults. Although older adults were less able to perform essential activities during the lockdown, they were more adaptable psycho-socially. Logistic regression analyses revealed that for older age group, adaptability and health status significantly predicted better mental health. Older adults had higher odds of low depression scores [odds ratio (OR) 1.81, 95% confidence intervals (CI) 1.07–3.08], anxiety scores (OR 1.80, 95% CI 1.05–3.08), and stress scores (OR 3.05, 95% CI 1.72–5.41). In addition, adaptability was found to moderate the relationship between age and mental health with detrimental effects of low adaptability stronger for younger adults than older adults.Conclusions: During the lockdown period, older adults in Singapore had better mental health, perceived less stress-related concerns and were more adaptable psycho-socially as compared to younger adults. This study’s findings extend current evidence that age-related advantages in emotional well-being persisted in the wake of the COVID-19 pandemic.

Background: Stigmatisation, misinformation and discrimination have been magnified globally due to the COVID-19 pandemic. The healthcare sector was not spared from this. We conducted a transnational study, using the Health Stigma and Discrimination framework (HSDF) to explore public perception and reactions to the COVID-19 pandemic in a multicultural context. Findings from the Asian arm of the study, sited in Singapore, are reported in this paper.Methods: This phenomenological research deployed semi-structured informant interviews using non-probability sampling approaches to recruit members of the public. Interviews were coded independently by two researchers and thematic analysis was used to analyse the responses.Results: Twenty-nine members of the public (23–80 years old) were interviewed between Oct 2020 to Feb 2021. Five major themes were identified: (i) perception of stigma amongst respondents, (ii) experiences of stigma amongst respondents, (iii) views on what drove stigma and misinformation, (iv) facilitators in preventing and reducing stigma and misinformation, and (v) ageist attitudes towards older adults. Overall, construction workers living in dormitories, healthcare workers, and to some extent tourists from China, were perceived to have been stigmatised and shunned by the public. Place-based stigmatisation was common; participants responded by avoiding places that had confirmed cases of COVID-19. Perceived stigma was temporary and not enduring, driven at the outset by fear of being infected. This study also identified the role played by trust in reducing stigmatisation. The relative absence of politicising of issues and high-quality information readily disseminated to the public were reported as factors that could have reduced and prevented stigma and misinformation on the various groups. Ageist attitudes were observed in some participants with older adults being labelled as vulnerable, susceptible to misinformation and being less able to cope during the pandemic.Conclusion: Through the lens of the HSDF, this study provided an exploratory account of the nature of stigma that resulted from the COVID-19 pandemic in an Asian context. It also shed light on facilitators in preventing and reducing stigma during an outbreak especially the role of trust and communications during a public health crisis.

Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology.

Background: Transiting into the community setting often presents novel difficulties for nurses because the role demands skills that might not have been obtained through usual clinical experience or training. The Ageing-in-Place Community Care Team (AIP-CCT) Community Nurse Basic Training programme was developed to address this learning gap. This training programme prepares nurses to lead in a multi-disciplinary team in delivering patient-centred care to patients with progressive or life-limiting conditions in the community setting. This study evaluated the inaugural training programme provided to a group of nurses from an acute hospital in Singapore. Methods: Qualitative in-depth interviews were carried out with 13 participants from the training programme three-months after completion of the AIP-CCT Community Nurse Basic Training programme provided by an acute hospital to understand the programme’s impact on their knowledge, skills and clinical practice, as well as barriers and facilitators to learning. Results: Overall, perception towards the training course was mixed. Course content was found to be relevant, and participants reported that training led to improvement in their practice. However, experienced nurses felt that the content of some modules were lacking in depth. This could have explained why only junior nurses tended to hold favourable attitudes and felt that the training led to increase in their confidence level. Although medical content was assessed favourably, the course was not able to address some of the constraints faced by community nurses such as managing expectations and handling difficult patients in the home care setting. For some modules, face-to-face training was preferred and e-learning components can be improved to increase communication and interaction. Conclusion: This study provided insights into how a community nurse training programme could be developed to meet the needs of community nurses. The training was able to reinforce skills and knowledge, address knowledge gaps and provide new clinical care approaches and communication strategies. These incremental effects on experienced community nurses could be extrapolated to have greater benefits for inexperienced community nurses. Based on findings of the study, potential changes to the training programme were discussed to improve training outcomes.

Background: This study evaluated the impact of the adapted version of the Respecting Choices® The Living Matters Advance Care Planning (ACP) facilitator training programme on trainees’ attitudes on facilitation 6 months post-training. Setting and participants: Two hundred and twenty-one healthcare professionals consisting of doctors, nurses, medical social workers from different training venues in Singapore participated in the first phase of the study (pre- and post) of which 107 participated in the second phase 6 months later (follow-up). Methods: Participants self-rated their attitudes, beliefs and behavioural intentions through surveys at three time points in an evaluation design that utilised repeated measures one-way ANOVA (pre-, post-, follow-up). Between-group differences were also examined using independent t-test. Results: At follow-up, mean scores increased significantly in understanding, confidence, and competence. Changes in effect sizes were large. Although trainees continued to think that ACP is emotionally draining for facilitators, more than before, facilitation experience was considered pleasant for themselves with the positive change significant and moderate in effect size. Those who had experience completing/initiating ACP significantly held more positive views than those who did not. Conclusions: The ACP facilitator training programme had lasting effects on enhancing the understanding, competence, and confidence of trainees. Importantly, findings showed that experience in actual facilitation within 6 months after training was important and giving trainees opportunities to facilitate is recommended.

Background: Clinical empathy is a crucial skill for healthcare professionals, enhancing patient outcomes, and satisfaction. However, existing scales, such as the Jefferson Scale of Empathy, focus primarily on cognitive empathy, overlooking the affective component. This gap highlights the need for a validated tool that measures both cognitive and affective empathy in healthcare professionals. This study developed and validated a multidimensional scale—the Multidimensional Clinical Empathy Scale—for assessing both cognitive and affective empathy in healthcare professionals and students. Methods: This three-phase study involved item generation, reduction, and validation, using literature reviews, qualitative studies, and survey methodologies. Exploratory factor analysis and confirmatory factor analysis were applied to test the scale’s validity. The Multidimensional Clinical Empathy Scale was constructed using a five-domain theoretical model: Empathetic Connections, Valuing Empathy, Empathetic Behaviours, Genuine Concern, and Perspective Taking. After content validation and exploratory factor analysis, the scale was reduced to 26 items with high internal consistency (Cronbach alpha of 0.94). Results: There were a total of 977 participants, comprising doctors, medical students, nurses, and nursing students from acute hospitals, community hospitals, medical schools, and nursing schools. The final 26-item Multidimensional Clinical Empathy Scale demonstrated strong psychometric properties, with factor loadings confirming the multidimensionality of clinical empathy. Confirmatory factor analysis confirmed the scale’s four-factor structure, and the scale was validated across diverse healthcare settings with robust reliability and Content Validity Index (0.90). Conclusions: The Multidimensional Clinical Empathy Scale provides a comprehensive, validated tool for measuring both cognitive and affective empathy in healthcare professionals and students. Its multidimensional structure offers potential for broader applications in clinical education and research.