Felix Chan

The Chinese University of Hong Kong, Hong Kong, Hong Kong

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Publications (10)55.12 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Weight loss has been considered predictive of early mortality in nursing home residents. Lower body mass index, irrespective of weight loss, has also been considered detrimental for survival in community-dwelling older persons. We examined which of the 2 is more important for survival in nursing home residents and at what body mass index (BMI) cut-offs survival benefits are gained or lost. Prospective study. Nursing homes. One thousand six-hundred fourteen nursing home residents. Minimum Data Set at baseline and mortality status assessed at 6 months, 1, 2, 4, and 9 years later. Relationship between mortality and significant weight loss (≥5% over 30 days or ≥10% over 180 days), and BMI, was studied by Cox regression with both variables in the same model, adjusted for age, sex, medical conditions (cancer, renal failure, heart disease, dementia, hip fracture, diabetes mellitus), tube-feeding, 25% food left uneaten, swallowing problem, and the activities of daily living hierarchy scale. One thousand six-hundred fourteen residents (69.5% female) with mean age 83.7 ± 8.4 years and mean BMI 21.7 ± 4.8 were studied. Mortality rates were 6.3% (6-month), 14.3% (1-year), 27.1% (2-year), 47.3% (4-year), and 78.1% (9-year). Significant weight loss was not associated with higher mortality at all follow-up durations, whereas higher BMI was significantly protective: mortality reduction per 1 unit increase in BMI were 9% at 6 months, 10% at 1 year, 9% at 2 years, 7% at 4 years, and 5% at 9 years, all at P < .001. Having ≥25% of food left uneaten (51.2% of participants) had no relationship to survival at all follow-up durations. At 9 years, compared with those with BMI < 18.5kg/m(2), the normal weight (BMI 18.5-22.9 kg/m(2), Asia Pacific cut-off), overweight (BMI 23-25 kg/m(2), Asia Pacific cut-off) and obese (BMI > 25 kg/m(2), Asia Pacific cut-off) had significantly lower mortality (hazard ratio 0.65, 0.62, and 0.47, respectively, all P < .001). Significant weight loss as defined by the Minimum Data Set was not associated with short- or long-term survival in Chinese nursing home residents. BMI, however, is predictive of short- and long-term survival irrespective of weight loss in this population. Low BMI, detectable at a single point of time, may be another readily available alternative trigger point for possible interventions in reducing mortality risk. Obese residents had the lowest mortality compared with those with normal weight.
    Journal of the American Medical Directors Association 02/2014; · 5.30 Impact Factor
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    ABSTRACT: To estimate the 12-month institutionalization rate and to identify the associated predictors among functionally impaired elders with or without cognitive impairment. A cohort of Hong Kong community-dwelling elders aged 65 or older with functional and/or cognitive impairments was recruited and interviewed from 2007 to 2008. Twelve months after the baseline interview, the family caregivers or elders were interviewed to update the residence status of the elders. Logistic regressions were used to examine the association between institutionalization and the baseline variables. Eighty elders (of 749 respondents) had been institutionalized within 12 months from baseline. The institutionalization rates were 6.2% (95% confidence interval (CI): 4.0%-8.5%) for elders with functional impairment only and 17.3% (95% CI: 13.0%-21.6%) for elders with both functional and cognitive impairments. Stepwise multiple logistic regressions found that more usage of community services was the single predictor to institutionalization in 1 year for the elders with functional impairment only. The risk was doubled (odd ratio = 2.166, 95% CI: 1.286-3.647) for usage in 1 more community service. For elders with both functional and cognitive impairments, the institutionalization risk was reduced by about 70% with employment of a domestic helper (odd ratio = 0.268, 95% CI: 0.120-0.598), despite increased risk being associated with advancing age of caregiver, caregiver being male, and deteriorating functional status of the elder. Among the functionally impaired elders, more usage of community services predicted increased institutionalization, whereas among the functionally and cognitively impaired elders, employment of a domestic helper predicted reduced institutionalization. Innovative services and care models are needed to prevent unnecessary institutionalization and to postpone premature institutionalization. Further research needs to be conducted to investigate the long term care needs of the elders from the perspective of both the elders and their caregivers.
    Journal of the American Medical Directors Association 10/2010; 13(2):169-75. · 5.30 Impact Factor
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    ABSTRACT: This study determined factors associated with increased use of emergency room (ER) and hospitalization of Chinese nursing home residents. A cross-sectional study. The setting was 14 nursing homes in Hong Kong. Participants were 1820 Chinese nursing home residents. Data on facility factors and resident factors were collected. Resident factors were mainly collected by the Minimum Data Set-Resident Assessment Instrument 2.0 (MDS-RAI 2.0). Residing in a for-profit home (OR=6.51), having less than one third of time spent in activities (OR=1.84), having had recent fall (OR=3.81), having renal failure (OR=3.17), having had recent initiation of new medications (OR=1.42), and having had recent physician visit (OR=1.67) were factors associated with increased use of ER. Male gender (OR=1.49), having a body mass index (BMI) less than 18.5 kg/m(2) (OR=1.51), being more functionally dependent (OR=1.18 per 1-point increment in the ADL Hierarchy Scale), having higher burden of illness (OR=1.29 per 1-point increment in the CHESS score), having a feeding tube (OR=3.07), having an indwelling urinary catheter (OR=2.75), having had recent fall (OR=1.94), having respiratory tract infection (OR=2.05), having Parkinson's disease (OR=1.55), having anemia (OR=1.70), having had recent initiation of new medications (OR=2.08), and having had recent physician visit (OR=1.83) were factors associated with increased risk of hospitalization. Although some of the associated factors reflect frailty characteristics of residents, differences in association between for-profit and not-for-profit institutions provide evidence of overreliance on the ER, perhaps as a result of inadequate primary care support.
    Journal of the American Medical Directors Association 06/2010; 11(5):325-32. · 5.30 Impact Factor
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    ABSTRACT: This study examined the predictive factors of preference for residential care in cognitively intact and impaired elders and their family caregivers. It was hypothesized that disagreement in preference for residential care between the elders and their caregivers was greater in the cognitively impaired. A cross-sectional survey was conducted during June 2007 to March 2008 in Hong Kong, and 707 community-dwelling elders aged 65 and above and 705 family caregivers were interviewed. Cognitively impaired elders were over-sampled to give reliable estimates for that sub-group. A structural questionnaire was used to collect data on preference for residential care and potential factors. Logistic regression was used to identify the predictors. More cognitively impaired elder-caregiver dyads (37.4%) had disagreement in preference for residential care than cognitively intact elder-caregiver dyads (20.5%) (p < .001). From the elders' perspective, less preference for residential care was associated with cognitive impairment, whereas greater preference was associated with depression (for cognitively intact elders), more usage of community service and functional impairment. From the caregivers' perspective, greater preference for residential care was associated with greater caregiver burden, or care-recipients having cognitive or functional impairment, or more usage of community services. Cognitively intact elders were more likely to indicate preference for residential care than cognitively impaired elders. Elders, both cognitively intact and impaired, were less likely than their caregivers to indicate preference for residential care. Disagreement in preference for residential care between the elders and their caregivers was larger for the cognitively impaired group than the cognitively intact group.
    International Journal of Geriatric Psychiatry 06/2009; 25(1):46-54. · 2.98 Impact Factor
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    ABSTRACT: With the intention to aid planning for elderly focused public health and residential care needs in rapidly aging societies, a simple model using only age, gender and three Minimum Data Set (MDS) subscales (MDS-ADL Self-Performance Hierarchy, MDS-Cognitive Performance and the MDS-Changes in Health, End-stage disease and Symptoms and Signs scales) was used to estimate long-term survival of older people moving into nursing homes. A total of 1820 nursing home residents were assessed by the MDS 2.0 and their mortality status 5 years later was used to develop a survival prediction model. In December 2006, 54.2% of subjects were dead. Older age at nursing home admission (HR = 1.036 per 1-year increment, 95% CI 1.028-1.045), men (HR = 1.895, 95% CI 1.651-2.175), higher impairment level according to the MDS-ADL (HR = 1.135 per 1-unit increment, 95% CI 1.099-1.173) and MDS-CPS (HR = 1.077 per 1-unit increment, 95% CI 1.033-1.123), and more frail on the MDS-CHESS (HR = 1.150 per 1-unit increment, 95% CI 1.042-1.268), were all independent predictors of shorter survival after nursing home admission in multivariate analysis. Survival function was derived from the fitted Cox regression model. Survival time of nursing home residents with different combinations of risk factors were estimated through the survival function. The MDS-ADL, MDS-CPS and MDS-CHESS scales, in addition to age and gender, provide prognostic information in terms of survival time after institutionalization. The model may be useful for health care and residential care planning in an ageing community.
    The European Journal of Public Health 03/2009; 19(3):308-12. · 2.52 Impact Factor
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    ABSTRACT: To identify factors associated with falls in non-bedridden nursing home residents in Hong Kong, and to examine whether restraints are protective against falls. Cross-sectional survey of 1710 nursing home residents, examining factors associated with falls and use of restraints, as documented in the RAI questionnaire. Vision impairment is highly associated with falls (OR 1.75, 95% CI 1.29-2.34), whereas older age (OR 1.03, 95% CI 1.01-1.05), dementia (OR 1.46, 95% CI 1.05-2.04), and intake of psychotropics (OR 1.52, 95% CI 1.06-2.17) were moderately associated. Women were less likely to fall (OR 0.65, 95% CI 0.48-0.90). Walking with aids and taking more medications were not associated with falls in this population. Restraints were used in 68%. The use of any type of restraint was marginally associated with fewer falls (OR 0.73, 95% CI 0.53-1.00). Men, those with impaired vision, dementia or taking psychotropic drugs were more likely to fall. Restraints are very commonly used in Hong Kong nursing homes. Although their use was associated with fewer falls, their effect on preventing falls could not be established in this cross-sectional study.
    Aging clinical and experimental research 11/2008; 20(5):447-53. · 1.01 Impact Factor
  • Source
    J Woo, I Chi, E Hui, F Chan, A Sham
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    ABSTRACT: To determine if staffing level is associated with poor nutrition in the long-term residential care setting, adjusting for other confounding factors. Cross-sectional survey. In total, 14 residential care facilities in Hong Kong, stratified by nature (government subvention or for-profit) to reflect the overall proportion in Hong Kong. A total of 1914 subjects were assessed, using the Resident Assessment Instrument (RAI) 2.0. The response rate was 95% (1820 subjects), of which 1699 subjects had complete nutritional information. Body mass index (BMI) was calculated by weighing and height measurement, and arm span was used if the subject could not stand. Subjects who were receiving parenteral or enteral nutrition via nasogastric of enterostomy tubes were excluded. A history of weight loss of 5% in the past month or 10% in the past 6 months, leaving 25% of food uneaten, and BMI < 18.5 kg/m(2) were examined as nutritional indicators. Association with age, gender, functional disability, oral problems, taste problems, presence of physical diseases and psychological well-being was examined using chi(2)-test, and multiple logistic regression. In all, 26% of residents had a BMI < 18.5 kg/m(2), with a higher prevalence in the for-profit homes. History of weight loss and the record that 25% of food was left uneaten were poor indicators of low BMI. Multivariate analysis showed that having chronic obstructive airways disease, requiring help with feeding, being female, older age, were factors associated with an increased risk of poor nutrition, while being independent in activities of daily living and higher staff levels were associated with a reduced risk. Poor nutrition is a persistent problem in the long-term care setting, and inadequate staffing levels may be a reversible cause. However, resource limitations may render efforts at improvement difficult. SK Yee Memorial Fund.
    European Journal of Clinical Nutrition 05/2005; 59(4):474-9. · 2.76 Impact Factor
  • The Journals of Gerontology Series A Biological Sciences and Medical Sciences 10/2004; 59(9):M921. · 4.31 Impact Factor
  • Gastroenterology 01/2001; 120(5). · 12.82 Impact Factor
  • Gastroenterology 01/2001; 120(5). · 12.82 Impact Factor