Iris Chi

University of Southern California, Los Ángeles, California, United States

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Publications (211)320.99 Total impact

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    ABSTRACT: Using 8-year panel data for 1,355 older adults in rural Anhui province, China, this study examined the trajectories and determinants of elder care provided by adult children to their older parents. The results of two-level latent variable growth models showed that trajectories of elder care differed by the gender of children, with an increase in care from sons but a decrease in care from daughters over time. Children's life stages influenced their care provision but differed by gender. Functional impairment of parents and care provided by siblings in the family also affected the care provided by each child. The findings reflect the patrilineal nature of Chinese family systems and demonstrate the linkages between critical life events and caregiving behaviors of adult children. Findings of this study can inform the formulation of elder care policies that meet the needs of families with different structures and at different life stages. © The Author(s) 2015.
    06/2015; DOI:10.1177/0164027515593346
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    Journal of Clinical Nursing 06/2015; DOI:10.1111/jocn.12885 · 1.23 Impact Factor
  • Hong Li, Ling Xu, Iris Chi
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    ABSTRACT: Guided by the biopsychosocial framework and empirical evidence, this study examined protective and risk factors of older adults' suicidal thoughts and attempts during the previous month, 12 months, and 5 years. The data used in this study were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted in 2006, which included 15,957 older adults from mainland China. Multiple penalized logistic regressions were used to conduct the analyses. During the previous month, 12 months, and 5 years, 5.1‰, 10.0‰, and 17.7‰ of older adults indicated that they thought about suicide, whereas 2.2‰, 3.5‰, and 6.3‰ reported suicidal attempts, respectively. Older adults' age, financial strain, functional limitations, depression, children's filial piety, social network, loneliness, and urban residence were significantly related to suicidal thoughts during the different time periods. In addition, older adults' religious affiliation, depression, loneliness, and urban residence were significantly related to suicidal attempts during the different time periods. Older adults' suicidal thoughts and attempts need to be assessed by mental health care professionals and primary care doctors. Programs addressing these important protective and risk factors may help reduce older adults' suicidal thoughts and attempts.
    Aging and Mental Health 04/2015; DOI:10.1080/13607863.2015.1037242 · 1.75 Impact Factor
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    ABSTRACT: Although the prevalence of depressive disorders among North Korean (NK) refugees living in South Korea has been reported to be twice the rate of their South Korean counterparts, little is known about the correlates of depressive symptoms among this population. Despite their escape from a politically and economically repressive setting, NK refugees continue to face multidimensional hardships during their adaptation process in South Korea, which can adversely affect their mental health. However, to our knowledge, no empirical research exists to date on depressive symptoms in the context of adaptation or perceived discrimination among NK refugees. To fill this gap, this study used a sample of 261 NK refugees in South Korea from the 2010 National Survey on Family Violence to examine associations between sociocultural adaptation, perceived discrimination, and depressive symptoms, as well as the moderation effect of discrimination on adaptation to depressive symptoms. We found that poor sociocultural adaptation and perception of discrimination were associated with increased levels of depressive symptoms. Perception of discrimination attenuated the association between better adaptation and fewer depressive symptoms, when compared to no perception of discrimination. These findings highlight the need to improve NK refugees' adaptation and integration as well as their psychological well-being in a culturally sensitive and comprehensive manner. They also underscore the importance of educating South Koreans to become accepting hosts who value diversity, yet in a homogeneous society. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Social Science & Medicine 02/2015; 131:107-113. DOI:10.1016/j.socscimed.2015.02.039 · 2.56 Impact Factor
  • Yura Lee, Iris Chi
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    ABSTRACT: Objectives: Increasing demand for early detection and prevention of dementia has shifted recent attention toward cognitive impairment with no dementia (CIND), which is often considered a possible risk path to dementia. Education and cognitive leisure activities are major predictors featured in dementia studies. However, the definition of cognitive leisure activities often has been inconsistent and diverse. This study explored different domains of these activities and their moderating roles on the relationship between education and cognition. Method: A sample of 704 participants aged 70 or older was drawn from the national Aging, Demographics, and Memory Study. Exploratory factor analysis was conducted to assess two domains from cognitive leisure activities: literacy and visuospatial activities. Multinomial logistic regression tested the main and moderating roles of each domain on cognition categorized as no impairment, CIND, and dementia. Results: Individuals with greater engagement in both literacy and visuospatial activities were more likely to have no cognitive impairment than CIND. Individuals with greater engagement in literacy activities were less likely to have dementia compared to CIND. Literacy activities and education years had a significant interaction effect. Individuals with higher education seem to benefit more by engaging in literacy activities, as evidenced by decreased odds of having dementia. Conclusion: Engagement in cognitive leisure activities for both cognitively intact and impaired older adults is suggested, with more focus on literacy activities for cognitively impaired and highly educated older adults.
    Aging and Mental Health 02/2015; DOI:10.1080/13607863.2015.1011081 · 1.75 Impact Factor
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    ABSTRACT: Some evidence from previous randomized controlled trials and systematic reviews has demonstrated a positive association between hypertension and transcendental meditation (TM). However, other trials and reviews showed the effect of TM on blood pressure (BP) was unclear but did not use subgroup analysis to rigorously investigate this relationship. The American Heart Association has stated that TM is potentially beneficial but did not give a standard indication. The present study explored several subgroup analyses in systematic reviews to investigate the effect of TM on BP. Medline, Embase, Cochrane Library, Web of Science and Chinese BioMedical Literature Database were searched through August 2014. Randomized controlled trials of TM as a primary intervention for BP were included. Two reviewers independently used the Cochrane Collaboration's quality assessment tool to assess each study's quality. Twelve studies with 996 participants indicated an approximate reduction of systolic and diastolic BP of -4.26 mm Hg (95% CI=-6.06, -2.23) and -2.33 mm Hg (95% CI=-3.70, -0.97), respectively, in TM groups compared with control groups. Results from subgroup analysis suggested that TM had a greater effect on systolic BP among older participants, those with higher initial BP levels, and women, respectively. In terms of diastolic BP, it appears that TM might be more efficient in a short-term intervention and with individuals experiencing higher BP levels. However, some biases may have influenced the results, primarily a lack of information about study design and methods of BP measurement in primary studies.Journal of Human Hypertension advance online publication, 12 February 2015; doi:10.1038/jhh.2015.6.
    Journal of Human Hypertension 02/2015; DOI:10.1038/jhh.2015.6 · 2.69 Impact Factor
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    ABSTRACT: Abstract Objectives: Mental health providers are the major resource families rely on when experiencing the effects of dementia. However, mental health resources and manpower are inadequate and unevenly distributed between cities and towns in China. The present study was conducted to examine similarities and differences in knowledge, attitudes, and clinical practices concerning dementia and working with family caregivers from mental health providers' perspectives in city versus town settings. Method: Data were collected during focus group discussions with 40 mental health providers in the Xicheng (city) and Daxing (town) districts in Beijing, China in 2011. Results: Regional disparities between providers' knowledge of early diagnosis of dementia and related counseling skills were identified. Regional similarities included training needs, dementia-related stigma, and low awareness of dementia among family caregivers. Conclusion: Culturally sensitive education specific to dementia for mental health providers and a specialized dementia care model for people with dementia and their family caregivers are urgently needed. Implications for geriatric practitioners and educators are discussed.
    Gerontology & Geriatrics Education 01/2015; DOI:10.1080/02701960.2014.990152
  • Yura Lee, Iris Chi
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    ABSTRACT: Objectives: Based on the cognitive reserve theory, relationships among education, employment status, and cognition have been found in many studies. However, there are only few studies specifically investigating the influence of late-life verbal activities (reading, writing, and discussing) on cognition, comparing those who are yet impaired with cognition vs. who are already in the process of cognitive deterioration. This study aims to examine aforementioned predictors on cognition; categorized into normal, cognitively impaired not demented (CIND) and demented given by the expert consensus panel. Methods: The study employed a national sample of American older adults (70+) from the ‘Aging, Demographics, and Memory Study’. 702 respondents (Normal: 270, CIND: 190, Demented: 242) were included in the final analysis using multinomial logistic regression, controlling for age, sex, race, employment status, depression, perceived health, and ApoE genotype. CIND was treated as a reference group. Results: Results showed that longer education years (OR=1.10, CI=1.02-1.17), current employment (OR=4.30, CI=1.55-11.94), and more engagement in verbal activities (OR=1.20, CI=1.11-1.31) increased the odds to be diagnosed with normal cognition than with CIND. On the other hand, education years and employment status were not significant predictor when comparing CIND vs. demented group. Only engagement in verbal activities decreased the odds (OR=0.70, CI=0.64-0.76) to be diagnosed with dementia than with CIND. Conclusions: Findings suggest that late-life verbal activities are important for both normal and cognitively impaired group to prevent any or further deterioration while education and employment status were only significant for normal vs. CIND group. Different approaches will be required for implementation purposes on two groups.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: To investigate why first-generation Chinese immigrants with diabetes have difficulty obtaining, processing and understanding diabetes related information despite the existence of translated materials and translators. This qualitative study employed purposive sampling. Six focus groups and two individual interviews were conducted. Each group discussion lasted approximately 90 min and was guided by semistructured and open-ended questions. Data were collected in two community health centres and one elderly retirement village in Los Angeles, California. 29 Chinese immigrants aged ≥45 years and diagnosed with type 2 diabetes for at least 1 year. Eight key themes were found to potentially affect Chinese immigrants' capacity to obtain, communicate, process and understand diabetes related health information and consequently alter their decision making in self-care. Among the themes, three major categories emerged: cultural factors, structural barriers, and personal barriers. Findings highlight the importance of cultural sensitivity when working with first-generation Chinese immigrants with diabetes. Implications for health professionals, local community centres and other potential service providers are discussed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 11/2014; 4(11):e005294. DOI:10.1136/bmjopen-2014-005294 · 2.06 Impact Factor
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    ABSTRACT: ABSTRACT This study examined correlates of caregiving at the end of life provided by adult children to their older parents and the role of gender of adult children in family caregiving in rural China. Data came from five waves of the Longitudinal Study of Rural Elder's Well-Being in Anhui Province, China, over 12 years and from a post-mortality survey. Hierarchical linear modeling was used. Findings demonstrated that the birth order of adult children, prior geographic distance, and prior intergenerational support exchange were significantly associated with family caregiving at the end of life. Eldest children, compared to other siblings, provided the most end-of-life caregiving to their parents. Children cohabitating with older parents before death provided the most caregiving, compared to other siblings. Adult children who had previously exchanged instrumental support with older parents before death, especially sons, tended to provide the most caregiving, compared with that by others, at end of life.
    Canadian journal on aging = La revue canadienne du vieillissement 10/2014; 33(04):1-14. DOI:10.1017/S0714980814000373 · 0.92 Impact Factor
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    ABSTRACT: We tested how health literacy (HL) was associated with sunlight exposure behavior.•Doctor recommendations were not sufficient to affect health behavior.•HL was directly and indirectly associated with sunlight exposure behavior.•Training individuals health literacy skills increase the chance of sunlight exposure.
    Archives of Gerontology and Geriatrics 10/2014; DOI:10.1016/j.archger.2014.10.005 · 1.53 Impact Factor
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    ABSTRACT: Objectives: This study examined the relationship between depression and pain, and the moderating effect of communication difficulty on this relationship, among community-dwelling older adults in Hong Kong. Method: We used logistic regression to analyze secondary data regarding 12,402 Chinese older adults applying for long-term care service in Hong Kong in 2012. Results: Approximately 30% of participants were depressed and 37% experienced communication difficulty. Depression was associated with increased pain. Communication difficulty was found to moderate the relationship between depression and pain. Pain scores increased more when individuals who experienced communication difficulty reported being depressed, compared to those who did not experience communication difficulty. Conclusion: The moderating effect of communication difficulty may be explained by the interaction between depression and communication difficulty. Participants who were depressed and concurrently experienced communication difficulty may be more likely to catastrophize their pain and may tend to report or experience more pain. Health care professionals need to be aware of the different effects of communication difficulty on the pain experiences of older adults. Psychosocial intervention may be provided to minimize older adults' communication barriers to pain management.
    Aging and Mental Health 10/2014; 19(9):1-6. DOI:10.1080/13607863.2014.967172 · 1.75 Impact Factor
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    ABSTRACT: AimThe aim of present study was to describe the prevalence of medication adherence, and to examine its risk factors among Chinese community-dwelling older adults with chronic diseases.Methods Secondary analysis was carried out on the data collected from 3167 Hong Kong adults aged ≥60 years who lived in their private home, had at least one type of chronic disease and had completed a screening instrument for long-term care services for the first time in 2006. The outcome variable was the self- or caregiver-reported medication adherence.ResultsAmong the respondents, 90.8% reported having good medication adherence in the past 7 days. More dependence on activities of daily living (P < 0.001), stroke (P = 0.003) or diabetes (P = 0.036), had medication review by physicians (P < 0.001) and received more informal care support (P = 0.005) were positively associated with medication adherence, whereas more cognitive impaired (P = 0.008), more negative mood (P = 0.071) and perceived poor health (P < 0.001) were negatively associated with medication adherence.Conclusions The prevalence of self-reported medication adherence was high in Hong Kong Chinese community-dwelling older adults. A number of modifiable factors associated with medication adherence were identified, which provides specific targets for interventions. Geriatr Gerontol Int 2014; ●●: ●●–●●.
    Geriatrics & Gerontology International 10/2014; 15(6). DOI:10.1111/ggi.12342 · 1.58 Impact Factor
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    ABSTRACT: The mechanisms underlying the relations among health literacy, perceived capacity for communication, diabetes knowledge, and diabetes self-care are unclear. This study tested this relation using structural equation modeling with a sample of 137 Chinese patients 65 years of age or older with type 2 diabetes. The model showed that health literacy, knowledge, communication capacity, and diabetes self-care formed complex relations. After adjusting for age, education, and Chinese cultural influence, health literacy affected diabetes self-care indirectly through perceived capacity for communication (standardized estimate coefficient = .641, p < .001) but not diabetes knowledge. To enhance self-care, interventions should be tailored to increase patient health literacy and perceived capacity for communication with health care providers. Training should be provided to patients to enhance their communication abilities.
    Journal of Health Communication 10/2014; 19 Suppl 2:161-72. DOI:10.1080/10810730.2014.940475 · 1.61 Impact Factor
  • Journal of Intergenerational Relationships 08/2014; 12(3):226-240. DOI:10.1080/15350770.2014.929936
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    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; 69(6). DOI:10.1093/geronb/gbu034 · 2.85 Impact Factor
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    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; 17(5). DOI:10.1089/jpm.2013.0555 · 2.06 Impact Factor
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    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; 18(3). DOI:10.3109/13651501.2014.902070 · 1.31 Impact Factor
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    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; 15(5). DOI:10.1016/j.jamda.2013.12.081 · 4.78 Impact Factor
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    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.
    Gerodontology 02/2014; DOI:10.1111/ger.12116 · 0.81 Impact Factor

Publication Stats

3k Citations
320.99 Total Impact Points


  • 2004–2015
    • University of Southern California
      • School of Social Work
      Los Ángeles, California, United States
  • 1989–2014
    • The University of Hong Kong
      • • Sau Po Centre on Aging
      • • Department of Psychology
      • • Department of Nursing Studies
      • • Department of Social Work and Social Administration
      Hong Kong, Hong Kong
  • 1988–2014
    • University of California, Los Angeles
      • • Department of Community Health Sciences
      • • Department of Social Welfare
      Los Ángeles, California, United States
  • 2013
    • National Taiwan University
      T’ai-pei, Taipei, Taiwan
    • University of Iowa
      • School of Social Work
      Iowa City, IA, United States
  • 2007
    • The Ohio State University
      • College of Social Work
      Columbus, Ohio, United States
  • 2001
    • University of Macau
      • Faculty of Social Sciences and Humanities
      Macao, Macau, Macao
  • 1999
    • Prince of Wales Hospital, Hong Kong
      Chiu-lung, Kowloon City, Hong Kong