[Show abstract][Hide abstract] ABSTRACT: Objectives.Although domestic helpers increasingly play a role in elder care in many societies, there is a lack of research on their influence on caregiver distress. This study aimed to examine the influence of domestic helpers on the relationship between stressors (the care needs of frail elders and spousal provision of care) and spousal caregivers' psychological distress.Method.This study was a secondary analysis of cross-sectional data collected between 2007 and 2009 from 6,442 Hong Kong adults aged 60 or older who were applying for government-subsidized long-term care services and whose spouses were their primary caregivers. Among the spousal caregivers, 73.04% were women, 44.16% felt distressed, and 5.73% were assisted by domestic helpers.
According to logistic regression analysis, spousal caregivers who provided personal care related to activities of daily living were more likely to be distressed if they were not assisted by domestic helpers.Discussion.The findings suggest that domestic help may moderate the effect of stressors on spousal caregivers. Domestic helpers provide support not just to frail older adults but also to spousal caregivers. Further studies are recommended to explore the precise effect of domestic help on family caregivers, care receivers, and the caregiving process.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 04/2014; · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: Depression and pain often coexist in terminally ill patients, but few studies have examined their relationship among larger samples. Other psychosocial factors experienced by patients may become barriers to pain management and affect the relationship between depression and pain. Objective: This study aims to examine the relationship between depression and pain in terminally ill Chinese elders in Hong Kong and explore the moderating effect of psychosocial factors such as loneliness, communication, and being at ease interacting with others. Methods: A secondary data analysis was conducted on a large cohort of community-dwelling Chinese elders applying for long-term care service in Hong Kong between 2004 and 2009. A total of 312 elders who had a prognosis of less than 6 months were included. Results: Depression was associated positively and significantly with pain. However, loneliness moderated this relationship, and for participants who felt lonely, depression and pain were no longer significantly associated. Conclusions: Findings support the positive relationship between depression and pain in terminally ill elders. Feeling lonely may affect the tendency to report pain. To ensure optimal pain management for patients in palliative and end-of-life care, assessment and intervention should focus on the impact of psychosocial factors such as loneliness, and how they may affect elders' reporting of pain.
Journal of palliative medicine 04/2014; · 1.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective: The purpose of this study was to determine the reliability and validity of the Chinese interRAI Mental Health among people with psychiatric illness. Methods: Study participants were 157 individuals with psychiatric illness living in a psychiatric long-term care facility or half-way house in Hong Kong. The authors prepared the Chinese interRAI MH. A panel of bilingual healthcare professionals examined the quality of the translation. The reliability of the 6 scales embedded in the instrument was examined using Cronbach's alphas, intraclass correlations, and Kappa coefficients. Pearson's product moment correlations, Spearman's order correlations, and independent t-tests were used to determine the concurrent and construct validity of the scales. Results and Conclusions: Internal consistency values (α = .66 to .95) and test-retest reliability coefficients (ICC = .76 to .97; κ = .75 to 1.00) of the scales were found to be satisfactory. All 6 scales correlated significantly with the criterion measures. As expected, 3 scales relating to cognition, activities of daily living, and instrumental activities of daily living discriminated among individuals living in two types of residential setting. interRAI MH was found to be a valid and reliable tool for use by clinicians in Hong Kong.
International Journal of Psychiatry in Clinical Practice 03/2014; · 0.45 Impact Factor
[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.
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
[Show abstract][Hide abstract] ABSTRACT: Objectives
This study aims to describe the prevalence of chewing problems and oral dryness when eating and examine their risk factors among Chinese community-dwelling older adults. Background
Chewing problems and oral dryness are two common oral health complaints in older people. A number of factors associated with these two oral health problems in older people have been reported, but information regarding Chinese older adults is scarce. Materials and methodsSecondary analysis was conducted on the data collected from 3422 Hong Kong adults aged ≥60 who had completed a screening instrument for long-term care services for the first time. ResultsAmong the respondents, 15.3% reported having chewing problems and 3.5% reported having oral dryness when eating. More dependence on instrumental activities of daily living (IADL, OR = 1.06, p < 0.001) was associated with a greater likelihood of chewing problems, while more negative mood (OR = 1.19, p < 0.001) was associated with a greater likelihood of oral dryness when eating, after adjusting for the effects of socio-demographic characteristics and medical conditions. Informal care support, poor nutrition status and difficulty in brushing teeth/dentures were positively and significantly associated with these two perceived oral health problems. Conclusions
The prevalence of both chewing problems and oral dryness was low in Hong Kong older Chinese adults. IADL was related to chewing problems, while negative mood was related to oral dryness independently and significantly, which provide a knowledge base upon which to develop strategic programs of oral health promotion among older Chinese adults.
[Show abstract][Hide abstract] ABSTRACT: Purpose of the Study: This study examined associations between the availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders.
A sample of 8,087 assessments using the validated Chinese version of the Minimum Data Set-Home Care of individuals applying for government-subsidized long-term care services from 2006 to 2009 in Hong Kong were selected based on inclusion criteria.
More than 70% of primary caregivers had secondary caregivers; the rate was slightly lower for those caring for moderately or severely cognitively impaired spouses. More than half of the primary spousal caregivers had secondary caregivers who provided both emotional and instrumental support. Emotional support provided by secondary caregivers had a negative association with primary caregivers' psychological distress when their care recipients were cognitively intact. When secondary caregivers provided both instrumental and emotional support, primary caregivers had a higher likelihood of psychological distress when care recipients had greater negative mood symptoms as compared to those who had less negative mood symptoms.
This is the first study that examined the association between availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. The findings suggest a need to provide services that enhance the provision of emotional support from both secondary and primary caregivers to cognitively intact elders and support primary spousal caregivers to seek appropriate help according to the mood of care recipients.
[Show abstract][Hide abstract] ABSTRACT: This study aims to develop and test the psychometric properties of the Chinese Health Literacy Scale for Chronic Care (CHLCC). This is a methodological study with a sample of 262 patients 65 years of age and older who had chronic illnesses. Pearson's correlation, independent sample t tests, and analyses of variance were used. The CHLCC showed a significant positive correlation with Chinese literacy levels (r = 0.80; p < .001) but was negatively correlated with age (r =-0.31; p <.001). Respondents who were male (t =4.34; p <.001) and who had reached Grade 12 or higher in school (F = 51.80; p <.001) had higher CHLCC scores than did their counterparts. Individuals with high levels of health literacy had fewer hospitalizations than did their counterparts (β =-0.31; incidence rate ratio = 0.73; p <.05). The CHLCC also displayed good internal reliability (Cronbach'sα =0.91) and good test-retest reliability (intraclass correlation coefficient = 0.77; p <.01). The CHLCC is a valid and reliable measure for assessing health literacy among Chinese patients with chronic illness. The scale could be used by practitioners before implementing health promotion and education.
Journal of Health Communication 12/2013; 18(sup1):205-222. · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose of the Study: This study examined whether participating in productive activities was associated with better health outcomes among older adults in urban China, including analysis of potential gender differences.
Using a sample of 10,016 urban Chinese adults aged 60 years or older from the 2006 Sample Survey of the Aged Population in Urban/Rural China, we regressed measures of self-rated health, functional health, and depression on productive activities (paid employment, helping with family, and volunteering), controlling for sociodemographic variables.
Those who provided assistance to family members or volunteered had significantly lower levels of depression and better functional and self-rated health than their counterparts. Older adults with paid job, providing family assistance, or volunteering reported significantly lower levels of depression and better functional and self-rated health than those without those activities. However, only older men with paid employment reported significantly less depression, and the effect of family assistance on functional health also differed by gender.
As research increasingly demonstrates the role of productive activities in maintaining health among older adults, our findings can help practitioners or policy makers strategically select or develop health programs to promote productive activities among older adults in urban China.
[Show abstract][Hide abstract] ABSTRACT: Objectives.This study tested the relationship between grandparent-grandchild family capital and self-rated health of older rural Chinese adults and the mediating role of the grandparent-parent relationship in terms of grandparent-grandchild family capital and self-rated health. METHODS: Data were derived from a random sample of 1,027 adults aged 60 and older who were interviewed in the rural Chaohu region in 2009. Structural equation modeling was used to examine the direct effect of grandparent-grandchild family capital in terms of relations with the first child's family on self-rated health among respondents, as well as the mediating effect of the grandparent-parent relationship. RESULTS: The results showed the direct effect of grandparent-grandchild family capital on self-rated health of older rural Chinese adults. The grandparent-parent relationship had a partial mediation effect on the relationship between grandparent-grandchild family capital and self-rated health of respondents.Discussion.Grandparent-grandchild family capital had a unique direct effect on the self-rated health of older rural Chinese adults, enriching our theoretical understanding of sources of family capital and their impacts in a collectivist cultural context that emphasizes intergenerational interaction and exchange. The findings also highlighted the mediation effects of grandparent-parent relationships on the relationship between grandparent-grandchild family capital and self-rated health of older rural Chinese adults, supporting the "grandchild-as-linkage" hypothesis in understanding the social determination of self-rated health in China.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 06/2013; · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Guided by the socio-environmental theoretical framework, this study examined factors associated with life satisfaction experienced by older Chinese adults living in rural communities. The data used in this study were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted by the China Research Center on Aging in 2000. This study included 10,084 rural older adults in mainland China. In this study 60.2 % of rural older adults were satisfied with their lives. Results from a multinomial logistic regression analysis showed that life satisfaction reported by rural older Chinese adults was significantly related to education, financial resources, self-rated health, financial support from children, satisfaction with children's support, house sitting for their children, visiting neighbors, and being invited to dinner by neighbors. Research and policy implications of these findings are also discussed.
[Show abstract][Hide abstract] ABSTRACT: Objectives. Relying on the concept of sociological ambivalence, this study investigated the sources of intergenerational ambivalence in rural China, a traditional society that undergoes dramatic demographic, economic, and social changes. METHODS: Data were derived from a survey of 1,162 older adults and their 4,396 children in rural Anhui province. Two-level mixed-effects model was carried out to predict ambivalent feelings reported by the older parents toward their adult children. RESULTS: The findings yielded both similar and distinctive predictors of intergenerational ambivalence among the Chinese elderly population compared with their Western counterparts. The Chinese elderly population reported greater ambivalence toward sons than toward daughters. Adult children's higher socioeconomic status, represented by a more prestigious job and an urban household registry status (hukou), was associated with reduced ambivalence among parents. Parents' monetary support to children and assistance with childcare, which is common in rural China due to the massive out-migration, were also associated with higher levels of ambivalent feelings. Discussion. We interpreted the findings in the larger social context of strong son preference, large-scale rural-to-urban migration, and rigid rural-urban division in China due to the household registration system. Our findings demonstrate that individual feelings of ambivalence are culturally structured and are determined within complex social environment.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 05/2013; 68(3):420-430. · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: Depression has been reported as common among older rural Chinese adults, who often face limited access to healthcare services and resources. Empirical studies conducted in the West have shown beneficial effects of productive engagement on psychological well-being. However, the mechanisms by which engagement in productive activities leads to and results from improved mental health remain unclear. Method: Utilizing role enhancement and social resource theories, the present study investigated the relationship between productive role occupancy and depression among older Chinese adults in rural areas over 8 years. Using four waves of data from the Well-Being of Elderly in Anhui Province of China study, we employed bivariate latent different score analysis to examine the temporal sequence of productive role occupancy and depression among 1696 older adults. Results: Findings indicated that trajectories of productive role occupancy and depression rose across the four waves. There is evidence for self-feedback effects in productive role occupancy and depression. Depression had a significant effect on subsequent changes in productive role occupancy (β = -0.042, p = 0.000), whereas productive role occupancy had no significant effect on subsequent changes in depression. Conclusion: The mental well-being of participants worsened over time. Engaging in productive activities had no effect on mental health status, and rural older adults with poor mental health were less likely to engage in productive activities over time. Findings suggest that psychological well-being as a personal resource significantly affects how productively Chinese adults age in late life.
Aging and Mental Health 02/2013; · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: This study examined the frequency and predictors of hospitalization and emergency room (ER) use among residents with Alzheimer's disease at admission and after 1 year in a long-term care facility. Method: This secondary analysis used data collected with the Chinese version of the Residential Assessment Instrument Minimum Data Set 2.0 during the Hong Kong Longitudinal Study on Long-Term Care Facility Residents. Results: A sample of 169 residents with Alzheimer's disease who were newly admitted between 2005 and 2010 was included in the analysis. Mixed-effects modeling was adopted to assess the associations between risk factors and the frequency of hospitalization and ER use. At admission, 27 (15.98%) respondents had been hospitalized and 19 (11.24%) required ER services during the previous 90 days. At admission, polypharmacy (β = .081, p < .01) and use of psychotropic drugs (β = ‑.506, p < .05) were significantly associated with frequency of hospitalization. At 1-year follow-up, cognitive impairment (β = .088, p < .05) and polypharmacy (β = .058, p < .001) had significant positive associations with frequency of hospitalization, as well as use of ER services (β = .084, p < .01; β = .077, p < .001, respectively). Use of psychotropic drugs had a negative association with frequency of ER use at both time points. Conclusion: Practitioners should periodically observe cognitive ability, polypharmacy, and use of psychotropic drugs among long-term care residents with Alzheimer's disease.
Aging and Mental Health 02/2013; · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Immigration is a stressful experience. Social support from and negative interaction with relatives or friends play important roles in the health and well-being of immigrants. Data for this study came from the National Latino and Asian American Study, the first nationally representative household epidemiological survey of its kind (n = 1,639). Hierarchical regression models and structural equation modeling were used to test the direct, moderating, and mediating functions of social support and negative interaction on the effect of acculturative stress on depressive symptoms among Asian immigrants. The findings indicate that acculturative stress was significantly associated with depressive symptoms after controlling other variables. Social support had a direct beneficial effect and negative interaction had a direct harmful impact on depressive symptoms among Asian immigrants. In addition, negative interaction moderated and social support partially mediated the effect of acculturative stress on depressive symptoms. This finding suggests that Asian immigrants in the United States are vulnerable to psychological distress in the form of depressive symptoms while adjusting to a new culture. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Asian American Journal of Psychology. 01/2013; 4(3):217.
[Show abstract][Hide abstract] ABSTRACT: AIMS AND OBJECTIVES: To develop and to test the psychometric properties of the Chinese Health Literacy Scale for Diabetes. BACKGROUND: Patients with diabetes encounter many challenges when making health decisions in their daily lives, as they have access to many different kinds of health information. Health literacy issues are new topics in Chinese society. Without a valid and reliable instrument in Chinese, it is difficult to measure the level of health literacy and promote the concept of health literacy in Chinese societies. DESIGN: A methodological study with a sample of 137 patients with type 2 diabetes aged 65 years or older. METHOD: Chinese Health Literacy Scale for Diabetes was developed with reference to the revised Bloom's taxonomy model. Psychometric tests (content validity, item analysis, construct validity, discriminative ability and test-retest reliability) were conducted. Correlations between Chinese Health Literacy Scale for Diabetes and four relevant measures were tested. Cronbach's alpha and alpha if item deleted were calculated to assess internal consistency. RESULTS: Cronbach's alpha for Chinese Health Literacy Scale for Diabetes and its four subscales (remembering, understanding, applying and analysing) were 0·884, 0·885, 0·667, 0·654 and 0·717, respectively. The Chinese Health Literacy Scale for Diabetes was significantly correlated with the Diabetic Knowledge Scale (r = 0·398, p < 0·001), the Diabetic Management Self-Efficacy Scale (r = 0·257, p < 0·001), the Preschool and Primary Chinese Literacy Scale (r = 0·822, p < 0·001) and the Chinese Value of Learning Scale (r = 0·303, p < 0·001). It took an average of seven minutes to complete this 34-item instrument. CONCLUSION: The findings of this study support the Chinese Health Literacy Scale for Diabetes as a reliable and valid instrument for measuring the health literacy of Chinese patients with diabetes. RELEVANCE TO CLINICAL PRACTICE: We recommend that clinicians use this tool to assess patients' health literacy before conducting any kind of health promotion.
Journal of Clinical Nursing 11/2012; · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: although social engagement and depressive symptoms are important concerns for long-term care facility residents, the dynamic relationship between them has not been adequately studied. OBJECTIVE: this study examines the relationship between social engagement and depressive symptoms and changes in social engagement and depressive symptoms among Chinese residents of long-term care facilities over 6 years.Design and methods: a latent growth model was used to analyse six waves of data collected using the Resident Assessment Instrument Minimum Data Set 2.0 in the Hong Kong Longitudinal Study on Long-Term Care Facility Residents. Ten residential facilities with a total of 1,184 eligible older adults at baseline were included in the study. RESULTS: after controlling for demographic variables at baseline, a higher level of social engagement was associated with fewer depressive symptoms. Trajectories of social engagement were significantly related to trajectories of depressive symptoms. Participants who recorded positive social engagement growth reported reduction in depressive symptoms. CONCLUSION: the findings of our study extend previous research by showing that increased social engagement is associated with decreased depressive symptoms over time. In long-term residential care settings, it is important for services to engage residents in meaningful social activities in order to reduce depressive symptoms.
[Show abstract][Hide abstract] ABSTRACT: Most existing typology studies of intergenerational relations have used samples in North America and Europe. The present study expands on previous research by determining whether similar family relation typologies could be found using a sample of Chinese rural elders. The data were derived from a survey of 1,224 older adults in China's rural Anhui province in 2009. Latent class analysis revealed 5 types of intergenerational relations in rural Chinese families: (a) tight‐knit, (b) nearby but discordant, (c) distant discordant, (d) distant reciprocal, and (e) distant ascending. The authors argue that the distant ascending ties reflect the strong filial obligations that Chinese adult children have toward their parents and that the distant reciprocal ties reflect collaborative and mutually beneficial parent–child relations in rural China in the context of massive rural‐to‐urban migration. The findings of this study demonstrate how family relations in contemporary China are shaped by the larger economic, geographic, and cultural contexts.
Journal of Marriage and Family 10/2012; · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined how life satisfaction and grandparent caregiving intensity changed over time among rural Chinese older adults, and whether there was a leading predictor between grandparent caregiving intensity and life satisfaction. Using 4 waves of data from the Well-being of Elderly in Anhui Province of China (N = 1704), we applied latent difference score analysis to explore this relationship. Results indicated that grandparent caregiving intensity decreased and life satisfaction increased over time. There was a lagged effect between grandparent caregiving intensity and life satisfaction, and life satisfaction demonstrated a leading prediction role between these 2 variables. This study confirmed the potentially rewarding aspect of grandparent caregiving, which may lead to greater life satisfaction. The results also revealed that psychological well-being among grandparents is very important for performing activities, such as caregiving.
Family & community health 10/2012; 35(4):287-99. · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the present article was to systematically review the effectiveness of tai chi for reducing depressive symptoms among older adults. Electronic databases were searched through January 2011. Reference lists of systematic reviews and identified studies from the search strategy were also screened. Randomized controlled trials of tai chi compared with waiting list controls in older adults with depressive symptoms measured by a self-report depression rating scale were included. Two authors independently identified eligible studies, extracted data and assessed the included studies for risk of bias. Estimates of depressive symptoms reduction used a random effects model, and the I(2) statistic was applied to examine heterogeneity. Four trials with a total of 253 participants met the inclusion criteria. Two studies were assessed as being of high quality; the remaining two studies were rated as moderate quality. All four studies compared tai chi with a waiting list control group. The pooled standard mean difference for these studies was -0.27 (95% CI -0.52 to -0.02, P = 0.03). Tai chi appeared to have a significant impact on reducing depressive symptoms compared with the waiting list control groups. Further research is recommended with larger sample sizes, more clarity on trial design and the intervention, longer-term follow up, and concomitant economic evaluations. Geriatr Gerontol Int 2012; ••: ••-••.