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Aging and disease    2020, Vol. 11 Issue (6) : 1444-1458     DOI: 10.14336/AD.2020.0206
Orginal Article |
Rationale and Methodology of The PopulatION HEalth and Eye Disease PRofile in Elderly Singaporeans Study [PIONEER]
Preeti Gupta1, Ryan Eyn Kidd Man1, Eva K Fenwick1,2, Amudha Aravindhan1, Alfred TL Gan1, Sahil Thakur1, Bao Lin Pauline Soh3, Joanne M Wood4, Alex A Black4, Angelique Chan2, David Ng2, Teoh Khim Hean5, Edwin Goh5, Chong Foong-Fong Mary6, Jenny Loo7, Ciaran Gerard Forde8, Charumathi Sabanayagam1,2, Ching-Yu Cheng1,2,9, Tien Yin Wong1,2,9, Ecosse L Lamoureux1,2,9,*
1Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.
2Duke-NUS Medical School, Singapore.
3Singapore Institute of Technology, Health and Social Sciences, Singapore.
4Queensland University of Technology, Brisbane, Australia.
5National Dental Centre, Singapore.
6Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
7National University Hospital, Singapore.
8Singapore Institute for Clinical Sciences, National University of Singapore, Singapore.
9Department of Ophthalmology, National University of Singapore, Singapore
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To describe the rationale, design and methodology of a geographically-representative and population-based study investigating the epidemiology, impact, personal and economic burden of age-related eye diseases, declining visual and other sensory systems in Asians aged >60 years in Singapore.PIONEER (The PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans Study) is currently a cross-sectional study targeting 3152 Chinese, Malay and Indian adults who are Singapore citizens or permanent residents aged 60 years and older living across Singapore. The study is intended to be longitudinal, with several waves of data planned to be collected in the future. The sampling frame consisted of 7000 names derived from age, gender and ethnicity-stratified random sampling of individuals >60 years. Selected individuals were invited via letters, home visits, and telephone calls for a clinical assessment at the Singapore Eye Research Institute. Individuals with limited mobility were examined in a custom-designed mobile eye clinic. Questionnaires were subsequently administered at participants’ homes by trained interviewers in their preferred language. A total of 3,299 participants (from East, West, North and South Singapore) were approached from December 2017 to November 2019. Of these, 953 (28.5%) were deemed ineligible. Out of 2,346 eligible participants, 904 (38.5%) refused, and 1,442 (61.5%) attended our clinical testing protocol, giving an initial response rate of 61.5%. Of these, 1,170 (81%) were cognitively able to complete the questionnaire assessment. The mean age±SD of our participants was 73.8±8.6 years; n=798 (55.3%) were female; and 828 (57.4%) were of Chinese ethnicity. The findings from this study will allow a deeper understanding of the risk factors and impact of aging in Asian populations, particularly in relation to the visual function and other functional system.

Keywords epidemiology      aging      eye disease      visual impairment      visual function system      population-based study     
Corresponding Authors: Lamoureux Ecosse L   
About author:

these authors contributed equally to this work.

Just Accepted Date: 02 April 2020   Issue Date: 19 November 2020
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Gupta Preeti
Man Ryan Eyn Kidd
Fenwick Eva K
Aravindhan Amudha
Gan Alfred TL
Thakur Sahil
Soh Bao Lin Pauline
Wood Joanne M
Black Alex A
Chan Angelique
Ng David
Hean Teoh Khim
Goh Edwin
Mary Chong Foong-Fong
Loo Jenny
Forde Ciaran Gerard
Sabanayagam Charumathi
Cheng Ching-Yu
Wong Tien Yin
Lamoureux Ecosse L
Cite this article:   
Gupta Preeti,Man Ryan Eyn Kidd,Fenwick Eva K, et al. Rationale and Methodology of The PopulatION HEalth and Eye Disease PRofile in Elderly Singaporeans Study [PIONEER][J]. Aging and disease, 2020, 11(6): 1444-1458.
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Figure 1.  PIONEER sampling strategy and target sample size.
Figure 2.  PIONEER study protocol.
Figure 3.  A custom-designed mobile eye clinic, equipped with all necessary equipments to undertake the study protocol for participants with limited mobility.
Figure 4.  PIONEER battery of clinical and questionnaire assessments.
Mean ± SD or n (%)
n = 1442
n = 904
Age73.8 ± 8.677.6 ± 8.7<0.001
Male642 (44.5%)357 (39.5%)0.015
Female798 (55.3%)547 (60.5%)
Chinese828 (57.4%)673 (74.5%)<0.001
Indian420 (29.1%)165 (18.3%)
Malay160 (11.1%)66 (7.3%)
Table 1  Age, gender and ethnicity of participants (n=1442) vs. non-participants (n=904).
[1] Vaupel JW (2010). Biodemography of human ageing. Nature, 464:536-542.
[2] Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. (2016). The World report on ageing and health: a policy framework for healthy ageing. Lancet, 387:2145-2154.
[3] Choo PW, Lee KS, Owen RE, Jayaratnam FJ (1990). Singapore--an ageing society. Singapore Med J, 31:486-488.
[4] Rogerson A, Stacey S (2018). Successful Ageing in Singapore. Geriatrics(Basel), 3.
[5] Bai R, Wei J, An R, Li Y, Collett L, Dang S, et al. (2018). Trends in Life Expectancy and Its Association with Economic Factors in the Belt and Road Countries-Evidence from 2000(-)2014. Int J Environ Res Public Health, 15.
[6] Chader GJ, Taylor A (2013). Preface: The aging eye: normal changes, age-related diseases, and sight-saving approaches. Invest Ophthalmol Vis Sci, 54:ORSF1-4.
[7] Hsu WM, Cheng CY, Liu JH, Tsai SY, Chou P (2004). Prevalence and causes of visual impairment in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology, 111:62-69.
[8] Nakamura Y, Tomidokoro A, Sawaguchi S, Sakai H, Iwase A, Araie M (2010). Prevalence and causes of low vision and blindness in a rural Southwest Island of Japan: the Kumejima study. Ophthalmology, 117:2315-2321.
[9] Liang YB, Friedman DS, Wong TY, Zhan SY, Sun LP, Wang JJ, et al. (2008). Prevalence and causes of low vision and blindness in a rural chinese adult population: the Handan Eye Study. Ophthalmology, 115:1965-1972.
[10] Dandona R, Dandona L, Naduvilath TJ, Nanda A, McCarty CA (1997). Design of a population-based study of visual impairment in India: The Andhra Pradesh Eye Disease Study. Indian J Ophthalmol, 45:251-257.
[11] Zhao J, Ellwein LB, Cui H, Ge J, Guan H, Lv J, et al. (2010). Prevalence of vision impairment in older adults in rural China: the China Nine-Province Survey. Ophthalmology, 117:409-416, 416 e401.
[12] Jonasson F, Arnarsson A, Sasaki H, Peto T, Sasaki K, Bird AC (2003). The prevalence of age-related maculopathy in iceland: Reykjavik eye study. Arch Ophthalmol, 121:379-385.
[13] Klaver CC, Wolfs RC, Vingerling JR, Hofman A, de Jong PT (1998). Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol, 116:653-658.
[14] Mitchell P, Smith W, Attebo K, Wang JJ (1995). Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology, 102:1450-1460.
[15] Livingston PM, Carson CA, Stanislavsky YL, Lee SE, Guest CS, Taylor HR (1994). Methods for a population-based study of eye disease: the Melbourne Visual Impairment Project. Ophthalmic Epidemiol, 1:139-148.
[16] Leske MC, Connell AM, Schachat AP, Hyman L (1994). The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol, 112:821-829.
[17] Munoz B, West SK, Rodriguez J, Sanchez R, Broman AT, Snyder R, et al. (2002). Blindness, visual impairment and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER. Invest Ophthalmol Vis Sci, 43:608-614.
[18] Klein R, Klein BE, Linton KL, De Mets DL (1991). The Beaver Dam Eye Study: visual acuity. Ophthalmology, 98:1310-1315.
[19] Munoz B, West SK, Rubin GS, Schein OD, Quigley HA, Bressler SB, et al. (2000). Causes of blindness and visual impairment in a population of older Americans: The Salisbury Eye Evaluation Study. Arch Ophthalmol, 118:819-825.
[20] Varma R, Paz SH, Azen SP, Klein R, Globe D, Torres M, et al. (2004). The Los Angeles Latino Eye Study: design, methods, and baseline data. Ophthalmology, 111:1121-1131.
[21] Tielsch JM, Sommer A, Witt K, Katz J, Royall RM (1990). Blindness and visual impairment in an American urban population. The Baltimore Eye Survey. Arch Ophthalmol, 108:286-290.
[22] Foong AW, Saw SM, Loo JL, Shen S, Loon SC, Rosman M, et al. (2007). Rationale and methodology for a population-based study of eye diseases in Malay people: The Singapore Malay eye study (SiMES). Ophthalmic Epidemiol, 14:25-35.
[23] Lavanya R, Jeganathan VS, Zheng Y, Raju P, Cheung N, Tai ES, et al. (2009). Methodology of the Singapore Indian Chinese Cohort (SICC) eye study: quantifying ethnic variations in the epidemiology of eye diseases in Asians. Ophthalmic Epidemiol, 16:325-336.
[24] Haegerstrom-Portnoy G, Schneck ME, Brabyn JA (1999). Seeing into old age: vision function beyond acuity. Optom Vis Sci, 76:141-158.
[25] Owsley C, McGwin G Jr, Sloane ME, Stalvey BT, Wells J (2001). Timed instrumental activities of daily living tasks: relationship to visual function in older adults. Optom Vis Sci, 78:350-359.
[26] Owsley C, McGwin G Jr, (2004). Association between visual attention and mobility in older adults. J Am Geriatr Soc, 52:1901-1906.
[27] Kim JM, Kim SY, Chin HS, Kim HJ, Kim NR, Epidemiologic Survey Committee Of The Korean Ophthalmological Society O (2019). Relationships between Hearing Loss and the Prevalences of Cataract, Glaucoma, Diabetic Retinopathy, and Age-Related Macular Degeneration in Korea. J Clin Med, 8.
[28] Upadhyaya AK, Rajagopal M, Gale TM (2010). The Six Item Cognitive Impairment Test (6-CIT) as a screening test for dementia: comparison with Mini-Mental State Examination (MMSE). Curr Aging Sci, 3:138-142.
[29] Wong TY, Foster PJ, Seah SK, Chew PT (2000). Rates of hospital admissions for primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore. Br J Ophthalmol, 84:990-992.
[30] Wong TY (2001). Cataract extraction rates among Chinese, Malays, and Indians in Singapore: a population-based analysis. Arch Ophthalmol, 119:727-732.
[31] Rosman M, Wong TY, Ong SG, Ang CL (2001). Retinal detachment in Chinese, Malay and Indian residents in Singapore: a comparative study on risk factors, clinical presentation and surgical outcomes. Int Ophthalmol, 24:101-106.
[32] Cheng GH, Chan A, Ostbye T, Malhotra R (2019). Productive engagement patterns and their association with depressive symptomatology, loneliness, and cognitive function among older adults. Aging Ment Health:1-9.
[33] Saw SM, Foster PJ, Gazzard G, Seah S (2004). Causes of blindness, low vision, and questionnaire-assessed poor visual function in Singaporean Chinese adults: The Tanjong Pagar Survey. Ophthalmology, 111:1161-1168.
[34] Wood JM, Anstey KJ, Kerr GK, Lacherez PF, Lord S (2008). A multidomain approach for predicting older driver safety under in-traffic road conditions. J Am Geriatr Soc, 56:986-993.
[35] Frisby JP, Davis H, McMorrow K (1996). An improved training procedure as a precursor to testing young children with the Frisby Stereotest. Eye (Lond), 10(Pt 2):286-290.
[36] Owsley C, Ball K, McGwin G, Sloane ME, Roenker DL, White MF, et al. (1998). Visual processing impairment and risk of motor vehicle crash among older adults. Journal of the American Medical Association, 279:1083-1088.
[37] Ball KK, Roenker DL, Wadley VG, Edwards JD, Roth DL, McGwin G Jr, et al. (2006). Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? J Am Geriatr Soc, 54:77-84.
[38] Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. (2014). Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc, 15:95-101.
[39] McGinnis RS, Mahadevan N, Moon Y, Seagers K, Sheth N, Wright JA Jr, et al. (2017). A machine learning approach for gait speed estimation using skin-mounted wearable sensors: From healthy controls to individuals with multiple sclerosis. PLoS One, 12:e0178366.
[40] Hamacher D, Singh NB, Van Dieen JH, Heller MO, Taylor WR (2011). Kinematic measures for assessing gait stability in elderly individuals: a systematic review. J R Soc Interface, 8:1682-1698.
[41] Konig N, Taylor WR, Baumann CR, Wenderoth N, Singh NB (2016). Revealing the quality of movement: A meta-analysis review to quantify the thresholds to pathological variability during standing and walking. Neurosci Biobehav Rev, 68:111-119.
[42] Konig N, Singh NB, Baumann CR, Taylor WR (2016). Can Gait Signatures Provide Quantitative Measures for Aiding Clinical Decision-Making? A Systematic Meta-Analysis of Gait Variability Behavior in Patients with Parkinson's Disease. Front Hum Neurosci, 10:319.
[43] Chen KL, Xu Y, Chu AQ, Ding D, Liang XN, Nasreddine ZS, et al. (2016). Validation of the Chinese version of Montreal Cognitive Assessment basic for screening mild cognitive impairment. Journal of the American Geriatrics Society, 64.
[44] Yu X, Tam WW, Wong PT, Lam TH, Stewart SM (2012). The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Comprehensive psychiatry, 53:95-102.
[45] Mary Elizabeth H, Linda JW, Louise CH, John TC (2004). A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies. Research on Aging, 26:655-672.
[46] Schwarzer R, Jerusalem M1995. Generalized Self-Efficacy Scale. WeinmanJ, WrightS, and JohnsonM (eds.) Measures in health psychology: A user's portfolio, Causal and control beliefs, editor. Windsor England: NFER-NELSON. 35-37.
[47] Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J (2008). The brief resilience scale: assessing the ability to bounce back. Int J Behav Med, 15:194-200.
[48] Rabin R, Charro Fd (2001). EQ-SD: a measure of health status from the EuroQol Group. Annals of medicine, 33:337-343.
[49] Lamoureux EL, Pallant JF, Pesudovs K, Hassell JB, Keeffe JE (2006). The Impact of Vision Impairment Questionnaire: an evaluation of its measurement properties using Rasch analysis. Investigative ophthalmology & visual science, 47:4732-4741.
[50] Jupiter T, Palagonia CL (2001). The Hearing Handicap Inventory for the Elderly screening version adapted for use with elderly Chinese American individuals. American Journal of Audiology, 10:99-103.
[51] Collin C, Wade DT, Davies S, Horne V (1988). The Barthel ADL Index: A reliability study. International Disability Studies, 10:61-63.
[52] Lawton MP, Brody EM (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9:179-186.
[53] Ng TP, Feng L, Nyunt MSZ, Larbi A, Yap KB (2014). Frailty in older persons: multisystem risk factors and the Frailty Risk Index (FRI). Journal of the American Medical Directors Association, 15:635-642.
[54] Neelakantan N, Whitton C, Seah S, Koh H, Rebello SA, Lim JY, et al. (2016). Development of a Semi-Quantitative Food Frequency Questionnaire to Assess the Dietary Intake of a Multi-Ethnic Urban Asian Population. Nutrients, 8.
[55] Strawbridge WJ, Wallhagen MI, Shema SJ (2007). Impact of spouse vision impairment on partner health and well-being: A longitudinal analysis of couples. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62:S315-S322.
[56] Lempers JD, Clark-Lempers D, Simons RL (1989). Economic hardship, parenting, and distress in adolescence. Child development:25-39.
[57] Nair R, Tsakos G, Yee Ting Fai R (2016). Testing reliability and validity of oral impacts on daily performances for Chinese-speaking elderly Singaporeans. Gerodontology, 33:499-505.
[58] Elwick H, JosephS, BeckerS & BeckerF (2010). Manual for the Adult Carer Quality of Life Questionnaire (AC-QoL). London: The Princess Royal Trust for Carers.
[59] Ng A, Chew I, Narasimhalu K, Kandiah N (2013). Effectiveness of Montreal Cognitive Assessment for the diagnosis of mild cognitive impairment and mild Alzheimer's disease in Singapore. Singapore Med J, 54:616-619.
[60] Sung SC, Low CC, Fung DS, Chan YH (2013). Screening for major and minor depression in a multiethnic sample of Asian primary care patients: a comparison of the nine-item Patient Health Questionnaire (PHQ-9) and the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ). Asia Pac Psychiatry, 5:249-258.
[61] Chan KM, Pang WS, Ee CH, Ding YY, Choo P (1999). Functional status of the elderly in Singapore. Singapore Med J, 40:635-638.
[62] Ng TP, Niti M, Chiam PC, Kua EH (2006). Physical and cognitive domains of the Instrumental Activities of Daily Living: validation in a multiethnic population of Asian older adults. J Gerontol A Biol Sci Med Sci, 61:726-735.
[63] Ge L, Yap CW, Ong R, Heng BH (2017). Social isolation, loneliness and their relationships with depressive symptoms: A population-based study. PLoS One, 12:e0182145.
[64] Fenwick EK, Man RE, Rees G, Keeffe J, Wong TY, Lamoureux EL (2017). Reducing respondent burden: validation of the Brief Impact of Vision Impairment questionnaire. Qual Life Res, 26:479-488.
[65] Luo N, Chew LH, Fong KY, Koh DR, Ng SC, Yoon KH, et al. (2003). Validity and reliability of the EQ-5D self-report questionnaire in English-speaking Asian patients with rheumatic diseases in Singapore. Qual Life Res, 12:87-92.
[66] Wee HL, Loke WC, Li SC, Fong KY, Cheung YB, Machin D, et al. (2007). Cross-cultural adaptation and validation of Singapore Malay and Tamil versions of the EQ-5D. Ann Acad Med Singapore, 36:403-408.
[67] Tan ML, Wee HL, Salim A, Lee J, Ma S, Heng D, et al. (2016). Validity of a Revised Short Form-12 Health Survey Version 2 in Different Ethnic Populations. Ann Acad Med Singapore, 45:228-236.
[68] Tham YC, Lim SH, Shi Y, Chee ML, Zheng YF, Chua J, et al. (2018). Trends of Visual Impairment and Blindness in the Singapore Chinese Population over a Decade. Sci Rep, 8:12224.
[69] Zheng Y, Lavanya R, Wu R, Wong WL, Wang JJ, Mitchell P, et al. (2011). Prevalence and causes of visual impairment and blindness in an urban Indian population: the Singapore Indian Eye Study. Ophthalmology, 118:1798-1804.
[70] Rubin GS, West SK, Munoz B, Bandeen-Roche K, Zeger S, Schein O, et al. (1997). A comprehensive assessment of visual impairment in a population of older Americans. The SEE Study. Salisbury Eye Evaluation Project. Invest Ophthalmol Vis Sci, 38:557-568.
[71] Swenor BK, Simonsick EM, Ferrucci L, Newman AB, Rubin S, Wilson V (2015). Visual impairment and incident mobility limitations: the health, aging and body composition study. J Am Geriatr Soc, 63:46-54.
[72] West SK, Rubin GS, Broman AT, Munoz B, Bandeen-Roche K, Turano K (2002). How does visual impairment affect performance on tasks of everyday life? The SEE Project. Salisbury Eye Evaluation. Arch Ophthalmol, 120:774-780.
[73] Samper-Ternent R, Al Snih S (2012). Obesity in Older Adults: Epidemiology and Implications for Disability and Disease. Rev Clin Gerontol, 22:10-34.
[74] Lim KH, Jasvindar K, Cheong SM, Ho BK, Lim HL, Teh CH, et al. (2016). Prevalence of smoking and its associated factors with smoking among elderly smokers in Malaysia: findings from a nationwide population-based study. Tob Induc Dis, 14:8.
[75] (2000). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 894:i-xii, 1-253.
[76] Misra A, Vikram NK, Gupta R, Pandey RM, Wasir JS, Gupta VP (2006). Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity. Int J Obes (Lond), 30:106-111.
[77] Manolio TA, Fishel SC, Beattie C, Torres J, Christopherson R, Merritt WT, et al. (1988). Evaluation of the Dinamap continuous blood pressure monitor. Am J Hypertens, 1:161s-167s.
[78] Sun C, Liew G, Wang JJ, Mitchell P, Saw SM, Aung T, et al. (2008). Retinal vascular caliber, blood pressure, and cardiovascular risk factors in an Asian population: the Singapore Malay Eye Study. Invest Ophthalmol Vis Sci, 49:1784-1790.
[79] Wong TY, Cheung N, Tay WT, Wang JJ, Aung T, Saw SM, et al. (2008). Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. Ophthalmology, 115:1869-1875.
[80] (2002). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 39:S1-266.
[81] Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. (2009). A new equation to estimate glomerular filtration rate. Ann Intern Med, 150:604-612.
[82] Bowie CR, Harvey PD (2006). Administration and interpretation of the Trail Making Test. Nat Protoc, 1:2277-2281.
[83] Foster PJ, Oen FT, Machin D, Ng TP, Devereux JG, Johnson GJ, et al. (2000). The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol, 118:1105-1111.
[84] Baskaran M, Foo RC, Cheng CY, Narayanaswamy AK, Zheng YF, Wu R, et al. (2015). The Prevalence and Types of Glaucoma in an Urban Chinese Population: The Singapore Chinese Eye Study. JAMA Ophthalmol, 133:874-880.
[85] Foster PJ, Buhrmann R, Quigley HA, Johnson GJ (2002). The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol, 86:238-242.
[86] Spaeth GL (1971). The normal development of the human anterior chamber angle: a new system of descriptive grading. Trans Ophthalmol Soc U K, 91:709-739.
[87] Scheie HG (1957). Width and pigmentation of the angle of the anterior chamber; a system of grading by gonioscopy. AMA Arch Ophthalmol, 58:510-512.
[88] (1991). Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology, 98:786-806.
[89] Klein R, Davis MD, Magli YL, Segal P, Klein BE, Hubbard L (1991). The Wisconsin age-related maculopathy grading system. Ophthalmology, 98:1128-1134.
[90] Chylack LT Jr, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, et al. (1993). The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol, 111:831-836.
[91] (1994). Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser, 843:1-129.
[92] Ong HL, Abdin E, Chua BY, Zhang Y, Seow E, Vaingankar JA, et al. (2017). Hand-grip strength among older adults in Singapore: a comparison with international norms and associative factors. BMC Geriatr, 17:176.
[93] Mathers C, Smith A, Concha M (2000). Global burden of hearing loss in the year 2000. Global burden of Disease, 18:1-30.
[94] Rumeau C, Nguyen DT, Jankowski R (2016). How to assess olfactory performance with the Sniffin' Sticks test((R)). Eur Ann Otorhinolaryngol Head Neck Dis, 133:203-206.
[95] Schimmel M, Christou P, Miyazaki H, Halazonetis D, Herrmann FR, Muller F (2015). A novel colourimetric technique to assess chewing function using two-coloured specimens: Validation and application. J Dent, 43:955-964.
[96] Lang NP, Adler R, Joss A, Nyman S (1990). Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol, 17:714-721.
[97] Wang X, Lamoureux E, Zheng Y, Ang M, Wong TY, Luo N (2014). Health burden associated with visual impairment in Singapore: the Singapore epidemiology of eye disease study. Ophthalmology, 121:1837-1842.
[98] Stalvey BT, Owsley C, Sloane ME, Ball K (1999). The Life Space Questionnaire: A measure of the extent of mobility of older adults. Journal of Applied Gerontology, 18:460-478.
[99] Chiu CT, Malhotra R, Tan SM, Lim J, Chan A, Teoh KH, et al. (2017). Dental health status of community-dwelling older Singaporeans: findings from a nationally representative survey. Gerodontology, 34:57-67.
[100] Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA (2001). Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys, 50:695-704.
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[11] Tian Li,Nan Mu,Yue Yin,Lu Yu,Heng Ma. Targeting AMP-Activated Protein Kinase in Aging-Related Cardiovascular Diseases[J]. Aging and disease, 2020, 11(4): 967-977.
[12] Asish K Ghosh. p300 in Cardiac Development and Accelerated Cardiac Aging[J]. Aging and disease, 2020, 11(4): 916-926.
[13] Alan R Hipkiss. COVID-19 and Senotherapeutics: Any Role for the Naturally-occurring Dipeptide Carnosine?[J]. Aging and disease, 2020, 11(4): 737-741.
[14] Nir Barzilai, James C Appleby, Steven N Austad, Ana Maria Cuervo, Matt Kaeberlein, Christian Gonzalez-Billault, Stephanie Lederman, Ilia Stambler, Felipe Sierra. Geroscience in the Age of COVID-19[J]. Aging and disease, 2020, 11(4): 725-729.
[15] Janina Tiemann, Thomas Wagner, Olivier M Vanakker, Matthias van Gils, José-Luis Bueno Cabrera, Bettina Ibold, Isabel Faust, Cornelius Knabbe, Doris Hendig. Cellular and Molecular Biomarkers Indicate Premature Aging in Pseudoxanthoma Elasticum Patients[J]. Aging and disease, 2020, 11(3): 536-546.
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