Jean Woo

The Chinese University of Hong Kong | CUHK · Department of Medicine and Therapeutics

Background Extreme hot weather events are happening with increasing frequency, intensity and duration in Hong Kong. Heat stress is related to higher risk of mortality and morbidity, with older adults being particularly vulnerable. It is not clear whether and how the older adults perceive the increasingly hot weather as a health threat, and whether...

Introduction: Although social isolation is associated with premature death and somatic and mental diseases, evidence of its long-term effect on sarcopenia is scarce. This study aimed to examine the longitudinal association between social isolation and possible sarcopenia. Methods: We extracted baseline and four-year follow-up data from the China...

Although integrated care has been considered a key strategy in reforming health systems around the world, it seems hard to realise in practice, particularly in the part of medical social integration. Worse still, little is known about the capacity of social care professionals who implement it, or their perceived roles and responsibilities, as well...

Objectives Intrinsic capacity (IC) declines progressively with age, thereby increasing the risk of disability. However, it is less known whether IC trajectories are associated with disability. This study aims to identify the different patterns of IC trajectories in older people, and examine their determinants and associations with Instrumental Acti...

Background: Non-diabetic overweight/obese metabolic dysfunction-associated fatty liver disease (MAFLD) represents the largest subgroup with heterogeneous liver fibrosis risk. Metabolic dysfunction promotes liver fibrosis. Here, we investigated whether incorporating additional metabolic risk factors into clinical evaluation improved liver fibrosis...

Methods The aim of this paper is to define terms commonly related to sarcopenia to enable standardization of these terms in research and clinical settings. The Global Leadership Initiative in Sarcopenia (GLIS) aims to bring together leading investigators in sarcopenia research to develop a single definition that can be utilized worldwide; work on a...

In many developed countries such as the UK and Australia, addressing socioeconomic inequalities in health is a priority in their policy agenda, with well-established practices and authorities to collect and link selected health and social indicators for long-term monitoring. Nonetheless, the monitoring of socioeconomic inequalities in health in Hon...

Background : Inflammation has been proposed to initiate the development of cachexia and is a driver of skeletal muscle loss. It raised the question of whether inflammation may also predict the age-related decline in muscle-related measures. This study explored the longitudinal association between high-sensitivity C-reactive protein (hsCRP) and musc...

(1) Background: Dietary protein intake might be beneficial in optimizing physical performance, yet whether this is dependent on protein source and sex is unclear. We examined the association between dietary protein intake and change in physical performance among Chinese community-dwelling older adults. (2) Methods: This prospective study included o...

The Hong Kong Grocery Shopping Dialog Task (HK-GSDT) is a short and easy-to-administer cognitive test developed for quickly screening neurocognitive disorders (NCDs). In the test, participants are instructed to do a hypothetical instrumental activity of daily living task of purchasing ingredients for a dish from a grocery store and verbally describ...

Despite continuous growth in dietary pattern research, the relative importance of each dietary component in the overall pattern and their joint effects on mortality risk have not been examined adequately. We explored the individual and joint associations of multiple food groups with all-cause and cause-specific mortality (cardiovascular disease (CV...

Background Population ageing and community care on older adults, as well as the marked social inequalities in health, have received growing concern by the government and the community. This study evaluated the medico-social integrated day care model of the Cadenza Hub for older adults with dementia. We also examined whether services subsidized by t...

This study examined the gender differences in the main and interactive effects of subjective social status and area deprivation on health among older adults in Hong Kong. Data for this study came from the baseline of MrOs and MsOs studies, including 4000 Chinese men and women ≥ 65 in Hong Kong. Subjective social status was assessed using the MacArt...

Background and objectives Longitudinal data with regard to the association between the intrinsic capacity (IC) and mortality is required for prevention efforts. We examined the association between IC and 10-year mortality among older people. Research design and methods We recruited a cohort of 2032 Chinese people aged 70 years and older, 1371 of t...

Introduction Telomere length (TL) is generally regarded as a biomarker of aging. TL, which is influenced by sociodemographic factors, has been shown to be inversely associated with morbidity. However, most studies were examined in the youngest old and whether the findings can be extended to the oldest old is less clear. This study examined TL and i...

Background: Literature reporting the association between heat stress defined by universal thermal climate index (UTCI) and emergency department visits is mainly conducted in Europe. This study aimed to investigate the association between heat stress, as defined by the UTCI, and visits to the accident and emergency department (AED) in Hong Kong, wh...

Objective: To determine the prevalence and distribution of intrinsic capacity (IC) impairments and examine their associations with health outcomes. Methods: Community-dwelling people aged 60 years and older were interviewed at baseline and followed up for one to three years. IC domains including cognitive, locomotor, vitality, sensory (vision, h...

Purpose Few studies have examined the variety in fruit and vegetable (FV) intake with cognitive impairment in older adults. This study examined the associations of variety in fruit, vegetable and combined FV with 4-year incident cognitive impairment in Chinese community-dwelling older adults. Methods Data was derived from a cohort study among Chin...

Constructing an Age-friendly City (AFC) has become a major public policy imperative in response to global population aging and urbanization. Yet there is a dearth of empirical evidence on how AFC initiatives can improve perceived age-friendliness among community-dwelling older adults, and on how such initiatives may differently affect older adults...

Background: Assessing motor function is a simple way to track cognitive impairment. We analysed the associations between cognitive and motor function and assessed the predictive value of two motor function measuring tools for cognitive impairment in older adults with multimorbidity in primary care settings. Methods: We conducted a prospective co...

Background Despite the adverse physical health impact of COVID-19 on older adults, whether they are psychosocially vulnerable under the pandemic remains debatable. In this mixed methods study, we examined the psychosocial vulnerability of older adults relative to their younger counterparts and explored how they coped with the pandemic. Methods Fro...

Osteoporosis is a major physical health issue in healthy ageing among urban populations. However, few studies have investigated how greenspace can influence osteoporosis, especially to those who lived in a compact city with high-density living environment. Furthermore, no studies have investigated how “planned greenspace” and “natural greenspace” c...

General muscle health declines with age, and in particular, sarcopenia—defined as progressive loss of muscle mass and strength/physical performance—is a growing issue in Asia with a rising population of community‐dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is cen...

Objectives: This study seeks to provide an understanding of the changing experiences in caregivers of end-of-life patients in Hong Kong through exploring their caregiving journey. Methods: Using longitudinal individual qualitative interviews, a total of 14 caregivers of community-dwelling elderly patients receiving end-of-life care were recruite...

Background: With reference to the medico-social integrated day care model of the Cadenza Hub for older people with dementia, we examined whether services subsidized by the publicly funded graded financial support of the Community Care Service Voucher for the Elderly (CCSV) could mitigate social inequalities in community care needs of older adults a...

Objectives: Few studies have investigated the link between diet and intrinsic capacity (IC), and the potential sex difference in such association. This study examined the association between dietary patterns and IC and its sub-domains in Chinese community-dwelling older adults. Design: Cross-sectional analysis using baseline data from the MrOs a...

Objectives To examine whether intrinsic capacity (IC) could predict frailty, whether declines in specific domains of IC could lead to frailty, and whether different combinations of domains could represent different risks of developing frailty.SettingCommunity.ParticipantsChinese people aged 65 years and older.MeasurementsUsing data from a prospecti...

One major limitation of prior studies regarding the associations between built environment (BE) and obesity has been the use of anthropometric indices (e.g., body mass index [BMI]) for assessing obesity status, and there has been limited evidence of associations between BE and body fat. This study aimed to explore the longitudinal association betwe...

The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in places with relatively well-controlled outbreaks such as Hong Kong. This study aimed to explore whether the socioeconomically disadvantaged fare worse via various types of worry in terms of their mental health and well-being. Between September and October 2020, 1067 adult...

Extending healthspan is a major public health challenge. Diet is one of the modifiable factors for preventing age-related diseases and preserving overall good health status during aging. Optimizing individuals’ intrinsic capacity, including domains in cognition, psychological, sensory function, vitality, and locomotion, has been proposed as a model...

Geographic variation in fracture risk may be due to divergent profiles of dietary, lifestyle, and other risk factors between populations. We investigated differences in fracture rates between two older-population cohorts: the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk cohort ( n = 7732) in the United Kingdom (UK), a...

Background/Purpose: There is a global movement towards integrated community care; yet this is difficult to implement in countries with well-established separate organizations for health and social care. Such a model requires navigation across rigid boundaries. With philanthropic support, a pilot model of self-financed integrated community care for...

The COVID-19 pandemic has substantially induced worries and affected individual mental health and subjective well-being. Nonetheless, a high level of social capital could potentially protect individuals who suffer from mental health problems and thus promote their subjective well-being, especially under the social distancing policies during the pan...

Introduction: Dietary protein intake and serum amino acids (AAs) are factors controlling the rate of muscle protein synthesis and catabolism. This study examined the association between serum AAs patterns and incident sarcopenia in community-dwelling older adults. Methods: Chinese older adults in Hong Kong aged ≥65 years attended a health check...

Background Social gradients of self-rated health (SRH) of elderly are evident in various settings. However, it is not clear whether improving elderly’s sense of community (SoC) could mitigate the social gradient. Methods Elderly aged 60+ in 5 residential districts of Hong Kong were sampled using multi-stage sampling (n = 1793). SoC was measured us...

Although coronavirus disease (COVID-19) outbreaks have been relatively well controlled in Hong Kong, containment remains challenging among socioeconomically disadvantaged persons. They are at higher risk for widespread COVID-19 transmission through sizable clustering, probably because of exposure to social settings in which existing mitigation poli...

Objectives It is inconsistent in the literature on whether inequalities of health in older age widen or narrow over time. We assessed the associations of socioeconomic status (SES), physical functioning, and mortality in an older age cohort in Hong Kong. Design Longitudinal cohort study. Setting and Participants We recruited 2032 older adults age...

Background & aims While the association between fatty pancreas and metabolic syndrome has been suggested in retrospective studies, long-term prospective data on the effect of fatty pancreas on various metabolic outcomes is lacking. We aimed to prospectively investigate the association between fatty pancreas and development of major metabolic outcom...

Disease-related malnutrition is prevalent among older adults; therefore, identifying the modifiable risk factors in the diet is essential for the prevention and management of disease-related malnutrition. The present study examined the cross-sectional association between dietary patterns and malnutrition in Chinese community-dwelling older adults a...

The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of COVID-19 severity and its effect modification with...

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e.,...

Background: Sarcopenia is a major health problem in older adults. Exercise and nutrient supplementation have been shown to be effective interventions but there are limited studies to investigate their effects on the management of sarcopenia and its possible underlying mechanisms. Here, we studied T cell gene expression responses to interventions i...

Background A large body of literature has reported positive effects of green space (GS) on various aspects of health and well-being, while no studies explore the role of GS in bone health. Objectives The present study aimed to investigate the associations of GS with bone mineral density (BMD) change and incident fracture in a prospective cohort of...

Objectives To investigate whether there were any socioeconomic disparities in utilisation of hospital care services during end of life in Hong Kong. Methods Secondary data analyses were conducted using frequency of the accident and emergency (A&E) department visits and hospital admissions during the last year of life in all public hospitals from 2...

Objectives We examined the structure and predictive ability of intrinsic capacity in a cohort of Chinese older adults.Methods We used data from the MrOS and MsOS (Hong Kong) study, which was designed to examine the determinants of osteoporotic fractures and health in older Chinese adults. We analysed baseline and the 7-year follow-up data using exp...

Objective This study examined sodium intake and identified the major food sources of sodium in healthy Chinese adults aged ≥50 years in Hong Kong. Design Participants who completed a baseline assessment of a randomized controlled trial assessing the effectiveness of exercise and nutrition supplementation on improving physical and cognitive functio...

(1) Objective: This study examined the effects of a combined intervention of Brainastic computerized cognitive training (CCT) preceded by physical exercise (PE) for improving frailty status and cognitive function in older adults. (2) Methods: Older adults aged 50 years or older attending elderly centers, without frailty/history of cognitive impairm...

Background Previous studies have focused on associations between individual built environment (BE) characteristics and mortality, and found the BE-mortality associations differed by socioeconomic status (SES). Different individual BE characteristics may have different impacts on health and thus could interact. Combinations of BE characteristics may...

Background Social gradients of self-rated health (SRH) of older people are evident in various settings. However, it is not clear whether improving older people’s sense of community (SoC) could mitigate the social gradient. Methods People aged above 60 in five residential districts of Hong Kong were sampled using multistage sampling (n = 1,793). So...

Background We examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence. Methods 752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factor...

The authors apologize for a typing error that occurred in the September 2020 article that changes the meaning of a sentence.

Objectives To assess the validity and acceptability of the online FRAIL scale in identifying frailty in community settings. Methods Frailty was assessed using the online FRAIL scale. A pilot sample of 65 persons aged 60 years or more were invited to complete the online FRAIL scale to explore the face validity of the instrument. Following minor rev...

Objectives The Global Leadership Initiative on Malnutrition (GLIM) has proposed a consensus scheme for classifying malnutrition. This study examined the prevalence of malnutrition according to GLIM criteria and evaluated if these criteria were associated with adverse outcomes in community-dwelling older adults. Design This was a prospective cohort...

Purpose: Environmental and lifestyle factors that affect oxidative stress and inflammation may influence telomere length (TL). There are limited data to relate dietary patterns with TL. This study examined the association of various dietary patterns with TL in Chinese older adults. Methods: We conducted a cross-sectional analysis and performed m...

(252 words) Background and Aims Recently, a group of hepatologists proposed to rename non-alcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) with modified diagnostic criteria. We aimed to study the impact of the new definition on the epidemiology of fatty liver disease. Methods We randomly selected 922 adult...

One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly....

Purpose of review: The aim of this study was to highlight recent evidence on protein requirement and physical activity recommendations in older adults and their interrelationship. Recent findings: Higher protein intake in older adults is beneficial for better physical function, reduced fracture risk, healthy ageing and lower mortality. However,...

Background: In response to population aging, there is a need for health systems to focus on care for chronic disease, specifically palliative care, while focusing on people-centered care. The objective of this study is to explore the healthcare system enablers and barriers to the provision of quality palliative and end-of-life care from the perspe...

Objectives We examined the relationship between absolute income, adequacy of disposable income, and self-rated health among participants aged 60 years and over.DesignCross sectional study.SettingCommunity living older people in Hong Kong.ParticipantsOlder people aged 60 years and over in five districts in Hong Kong.MeasurementsData from a cross sec...

Objective This study aimed to examine the prospective associations of general and abdominal obesity patterns with carotid plaque development among early postmenopausal Chinese women. Methods A total of 518 postmenopausal women aged 50 to 64 years were recruited between 2002 and 2004 and were followed up at 3 years and 5 years. Carotid plaque was m...

Background: Physicians often prescribe high numbers of medications for managing multiple cardiometabolic diseases. It is questionable whether polypharmacy (concurrent use of five or more medications) is beneficial or detrimental for older adults with cardiometabolic multimorbidity (co-occurrence of two or more diseases). Objective: To examine co...

Background. Hong Kong faces several public health problems including malnutrition and osteoporosis. Considering the typical Chinese diet and overall low physical activity levels of Chinese adults, timely interventions to improve nutritional status and bone health are needed. Objectives. We examined the effects of a nutrition plus exercise interven...

A large number of studies have focused on the associations between single built environment (BE) characteristics and physical activity (PA). Combinations of BE characteristics offer a more comprehensive approach to identify the BE–PA associations. We aimed to examine the BE–PA associations in a cohort of elderly Hong Kong Chinese. Between 2001 and...

Background: Advance care planning (ACP) facilitates identification and documentation of patients' treatment preferences. Its goal aligns with that of palliative care - optimizing quality of life of seriously ill patients. However, concepts of ACP and palliative care remain poorly recognized in Chinese population. This study aims at exploring barri...

Objectives: to evaluate the effect of an integrated care model for pre-frail and frail community-dwelling older people. Design: a quasi-experimental design. Setting and participants: we enrolled people aged ≥60 years from a community care project. An inclusion criterion was pre-frailty/frailty, as measured by a simple frailty questionnaire (FR...

There is a paucity of research on factors influencing long-term adherence to lifestyle modification. We conducted a mixed-method study to explore the psychological factors of dietary and physical activity (PA) adherence among Chinese adults with overweight and obesity at 10 months after enrollment of a community-based lifestyle modification program...

The coronavirus disease 2019 (COVID‐19) pandemic has casted a huge impact on global public health and economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attentions. To evaluate the impacts of COVID‐19 on older people, it is important to balance the successf...

Objectives Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance.DesignObservational study.SettingWe tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevale...

The prevalence of frailty varies among socioeconomic groups. However, longitudinal data for the association between subjective social status and frailty is limited. In this study, we examined whether subjective social status was associated with incident frailty. Data were obtained from a 14-year cohort of Chinese men and women (N = 694) aged 65 yea...

Background: Higher income and education and lower income inequality in a neighbourhood have been shown to be related to better mental health outcome in developed countries. However, it is not clear whether these factors would affect the subjective well-being of the elderly, especially in a setting with recent rapid economic development. Methods: Th...

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently...