title: Stakeholders' perspective on issues and challenges associated with care and treatment of aging-related cognitive impairment disorders in Singapore.
abstract: BACKGROUND
  An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has concomitant implications for social and health systems. The objective of this study is to understand the perspectives of prominent stakeholders about current and future issues and challenges associated with CI/dementia among the elderly in Singapore.
  
  
  METHODS
  Using indepth interviews, this qualitative study obtained the views of multiple stakeholders on issues and challenges associated with CI/dementia in Singapore. The 30 individuals interviewed as part of the study included clinicians, policy-makers, researchers, community workers, administrators, and caregivers. Using a framework approach, interview texts were indexed into domains and issues by utilizing NVivo 9.0 software.
  
  
  RESULTS
  The stakeholders expressed concerns related to multiple domains of the CI/dementia care system: attitude and awareness, economics, education, family caregiving, inputs to care system, living arrangements, prevention, screening and diagnosis, and treatment and management of care. Within each domain, multiple issues and challenges were identified by respondents.
  
  
  CONCLUSIONS
  The study identifies a complex set of inter-related issues and challenges that are associated with the care and treatment of people with CI/dementia. The results suggest that CI and dementia profoundly affect patients, families, and communities and that the issues related to the two disorders are truly system-wide. These findings lay the foundation for utilization of a systems approach to studying CI/dementia and provide an analytic framework for future research on complex health care issues.
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore. monika.setia@duke-nus.edu.sg
authors.forename: Monika
authors.initials: M
authors.lastname: Setia
authors.forename: Amina M
authors.initials: AM
authors.lastname: Islam
authors.forename: James P
authors.initials: JP
authors.lastname: Thompson
authors.forename: David B
authors.initials: DB
authors.lastname: Matchar
mesh_terms: D000288:Administrative Personnel; D000368:Aged; D001294:Attitude to Health; D017028:Caregivers; D003072:Cognition Disorders / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D003695:Delivery of Health Care; D003704:Dementia / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D006270:Health Facility Administrators; D006801:Humans; D007407:Interviews as Topic; D012846:Singapore