Biomedical subjects

I Chi

Publications and source records attributed to I Chi.

At least 19 recordsLinked to original sources

PubMed2006

Use of the Minimum Data Set--Home Care: a cluster randomized controlled trial among the Chinese older adults.

The objective of this study was to test whether the utilization of Minimum Data Set-Home Care (MDS-HC) as a case finding instrument for Chinese attenders of elderly health centres in Hong Kong had a beneficial impact on the physical and mental health status of those older clients. The dependent variables were 13 outcome variables measuring different dimensions of participants' physical and mental health status. Using a cluster randomized controlled trial design, we assigned three of six participating elderly health centres to the experimental group and the other three to the control group. The respondents were 925 (472 in the experimental group and 453 in the control group) elderly health centre attenders aged 65 years or above. They were assessed by MDS-HC and 734 (382 in the experimental group and 352 in the control group) of them were re-assessed one year later. In the experimental group, the medical doctors had been given their patients' profile of potential problem areas identified by MDS-HC before they treated their patients whereas in the control, the medical doctors treated their patients with their usual practice. We found that older attenders in the experimental group improved more than the ones in the control group in only two out of 13 areas. Surprisingly, the patients in the experimental group deteriorated even more than the ones in the control group in terms of bowel incontinence. Our results indicated that the function of the MDS-HC in case finding or screening is limited in the Hong Kong primary medical care setting.

Aged↗

PubMed2006

Relationship between adherence to tradition and depression in Chinese elders in China.

This study examined the relationship between adherence to tradition and depression in a large sample (N = 1502) of Chinese elders living in the People's Republic of China. In Chinese traditional culture, an elder's purpose, meaning and self-worth are derived, in large, from their social roles within the family and community. As the traditional culture declines so do these familiar roles, supports, and ways of coping. This constitutes a major loss which can have a variety of psychosocial consequences, one of which could be depression. The elders in our study responded to a nine-item measure of traditional mutual aid and intergenerational exchange. Depression was measured by the Center for Epidemiological Studies Depression Scale. Regression analysis found a significant and negative relationship between tradition and depression which suggests that adherence to tradition may have protective benefits. These findings have application with elders in China as well as with those who are immigrants to other societies.

Aged↗

PubMed2006

Ageing and psychological response during the post-SARS period.

We studied the psychological impact of the outbreak of Severe Acute Respiratory Syndrome (SARS) to understand if age and residential location were risk factors associated with post-traumatic disturbance, namely intrusion, avoidance, and hyperarousal. One hundred and forty-six volunteers belonging to four groups classified along the dimensions of age (middle-aged versus older-aged) and location (high SARS-prevalent regions versus low SARS-prevalent regions), participated in this study. After controlling for depression, residents in high SARS-prevalent regions, regardless of age, consistently developed more intense post-traumatic disturbance than residents in low SARS-prevalent regions. Furthermore, the prevalence of probable post-traumatic stress disorder (PTSD) cases was significantly higher in older people and in residents of SARS-prevalent regions. Our findings suggest the importance of mental health aftercare in the post-epidemic period of disease epidemics.

Adaptation, Psychological↗

PubMed2006

Living alone and depression in Chinese older adults.

Western literature has repeatedly indicated a strong relationship between living alone and depression among the aged population, however, studies among the Chinese population are scarce. In this paper, we examine whether the association between living alone and depression is independent of health status, social support and financial strain among Chinese older adults, and subsequently assess whether such association persists after adjusting these variables. Cross-sectional data drawn from the Hong Kong Population Census consisting of 2,003 Chinese elderly people aged 60 or over were analyzed. Chi-square tests and logistic regression analyses revealed that living alone results in higher levels of depressive symptoms for older women but not for older men. This relationship remained significant even when socio-demographic variables, health indicators, social support, and financial strains were adjusted; yet, the impact of living alone with depression disappeared when all variables were controlled. In summary, this paper is the first to report that living alone is an independent risk factor contributing to depression among Chinese older women, as well as identifying certain significant factors including social support and health indicators that can affect and explain the link between living alone and depression. Preventive measures and related issues were discussed.

Activities of Daily Living↗

PubMed2005

Low staffing level is associated with malnutrition in long-term residential care homes.

OBJECTIVE: To determine if staffing level is associated with poor nutrition in the long-term residential care setting, adjusting for other confounding factors. DESIGN: Cross-sectional survey. SETTING: 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. SUBJECTS: 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. INTERVENTION: 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. RESULTS: 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. CONCLUSION: 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. SPONSORSHIP: SK Yee Memorial Fund.

Age Factors↗

PubMed2005

Assessing Chinese older adults' suicidal ideation: Chinese version of the Geriatric Suicide Ideation Scale.

The psychometric properties of the Chinese version of the Geriatric Suicide Ideation Scale (GSIS-C) were investigated in a sample of 154 Hong Kong Chinese older adults. The internal consistency, test-retest reliability, face validity, convergent and divergent validities of the GSIS-C were assessed and all of them were well above acceptable levels. The GSIS-C demonstrated excellent internal consistency including the four subscales and the test-retest reliability of the GSIS-C was also good. In terms of convergent validity, the GSIS-C correlated significantly and positively with depression (assessed by CES-D), loneliness (assessed by Revised UCLA Loneliness Scale), and hopelessness (assessed by Beck 'Hop'elessness Scale). The divergent validity of the GSIS-C was demonstrated by the negative but significant, association between the GSIS-C and two variables including self-rated health status and life satisfaction (assessed by Life Satisfaction Inventory--Version A).

Adult↗

PubMed2005

Incidence and predictors of falls in the chinese elderly.

INTRODUCTION: This is the first prospective longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls. MATERIALS AND METHODS: This is a population-based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method. Baseline data on demographic, comorbid diseases, drugs, Activities of Daily Living (ADL) [Barthel Index and Lawton's Instrumental Activities of Daily Living (IADL)], Geriatric Depression Scale (GDS-15), cognitive assessment by the Abbreviated Mental Test (AMT), fear of falling, self-perceived mobility problem, hand grip strength, lower limb power, balance and gait tests were performed. Every subject was followed up for 1 year. RESULTS: Four hundred and one falls occurred in 294 fallers (19.3%) over 1 year of follow-up. The prevalence of falls and recurrent falls were 19.3% and 4.75%, respectively. The incidences of falls (i.e., the fall events) were 220, 324 and 270 per 1000 person-years for men, women and both gender, respectively. The independent predictors of falls were previous history of falls, advancing age, Parkinson's disease, knee extension power and gait speed. The independent predictors of recurrent falls were previous history of falls, self-perceived mobility problem, the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation. CONCLUSIONS: The incidence of falls in the Chinese elderly was 270 per 1000 person-years. History of falls, old age, Parkinson's disease, decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly. Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia.

Accidental Falls↗

PubMed2004

Differential age-related change of prose memory in older Hong Kong Chinese of higher and lower education.

BACKGROUND: Memory difficulty is one of the most common complaints of older people, with or without psychiatric conditions. It is therefore of utmost important to understand how normal ageing process impacts upon prose memory so as to gain insight into ways to differentiate pathological vs normal age-related changes of the recall of prose observed among older people. OBJECTIVES: To understand the differential age-related change of prose memory in older Hong Kong Chinese of higher and lower education. METHOD: Forty-eight normal, healthy Cantonese-speaking Chinese were recruited. Seventeen of them were younger, highly educated participants. Among the 31 older people recruited, 19 of them received education comparable with the younger participants and 12 were older people of low education. A prose passage was constructed to measure the different processes of prose memory, including learning efficiency, rate of forgetting, recall accuracy, accuracy of temporal sequence of information recalled, distortions, and recognition memory. RESULTS: As expected, ageing affected all the processes of prose memory measured, except the rate of forgetting. Apart from learning efficiency and rate of forgetting, education was observed to modify the effect of ageing on all the processes studied. CONCLUSIONS: Changes of prose memory associated with ageing and the differential effect of education on prose recall among older people were discussed. The findings seem to suggest that prose memory is a multifaceted construct.

Adult↗

PubMed2004

Factors associated with the use of publicly funded services by Hong Kong Chinese older adults.

This article analyzes cross-sectional data collected from a representative community sample of 2003 Chinese elderly people aged 60 or above in Hong Kong. We examined whether the use of publicly funded health services by older adults is equitable under the framework of Andersen model. A number of predisposing, enabling, and need factors were assessed as predictors of utilization in four categories of services including hospital admission, emergency room, general outpatient clinics, and specialist outpatient clinics. It was found that utilization of these four health services was consistently correlated with need factors. Specifically, self-rated health status and particular types of chronic illness were consistently and significantly related to utilization for all four of services in Hong Kong. On the other hand, age and family support were related to hospital admission whereas functional impairment was associated with the use of emergency room and general outpatient clinics. Findings suggest that publicly funded health services in Hong Kong are used equitably by elderly people.

Activities of Daily Living↗

PubMed2004

Elderly suicide in Hong Kong--a case-controlled psychological autopsy study.

OBJECTIVE: To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case-controlled psychological autopsy approach. METHOD: Informants of 70 subjects aged 60 or above who had committed suicide as well as a community sample of 100 elderly controls were interviewed. Subjects and controls were assessed for the presence of mental illness, history of suicide attempt and data on health care utilization. RESULTS: Eighty-six per cent of suicide subjects suffered from a psychiatric problem before committing suicide, compared with 9% of control subjects. Among the psychiatric problems, major depression was the commonest diagnosis. Seventy-seven per cent of suicide subjects had consulted a doctor within 1 month of suicide. One-third of suicide subjects had a history of suicide attempt. Rates of current psychiatric diagnosis, rates of medical consultation and history of suicide attempt are all significantly higher in suicide subjects than controls. CONCLUSION: Our findings support the view that depressive disorders and a past history of suicide attempt are risk factors of late-life suicide in the Chinese population of Hong Kong, similar to findings in western studies.

Age Factors↗

PubMed2004

Sources of income and depression in elderly Hong Kong Chinese: mediating and moderating effects of social support and financial strain.

This study examines the relationship between major source of income (i.e., adult children, financial independence and government welfare) and depression among elderly Hong Kong people. We also assessed the mediating and moderating effects of family social support and financial strain in the linkage between source of income and depression. The data came from a cross-sectional survey of a representative community sample of 1106 elderly respondents in Hong Kong. Using multiple regression models, data revealed that there was a differential impact of major sources of income on depression. Welfare participation and financial independence contributed to a higher level of depressive symptoms whereas people whose source of income was their adult children were more likely to report a lower level of depression than the others who were not. We also found that family social support was either a complete mediator or partial mediator in the relationship between different major sources of income and depression but it was not a significant moderator in the linkage between different major sources of income and depression. In contrast, financial strain was a significant moderator in the link between different major sources of income and depression. Specific and effective interventions must be developed for those who are financially independent or on welfare.

Aged↗

PubMed2003

Reciprocal relationship between social support and depressive symptoms among Chinese elderly.

For many Hong Kong Chinese elderly, depression is a quite common occurrence. This study examines the reciprocal relationship between social support and depressive symptoms. The data came from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that elderly persons who reported depressive symptoms more frequently were likely to receive higher levels of social support from family members living with elders, but lower levels of social support from friends three years later, even after controlling for socio-demographic and physical health status variables. In addition, elderly people who received more social support from family members not living with elders reported fewer depressive symptoms three years later.

Aged↗

PubMed2003

The economics of Alzheimer disease.

Economic assessments of health and healthcare have become an integral part of policy decisions in the last decade. Increasingly, this trend is extending to medical decision-making in day-to-day patient-provider interactions. Alzheimer disease (AD) offers a potent example of the clinical and economic issues at stake with its diagnostic techniques, pharmacotherapies, and public health and policy implications. This review introduces basic economic concepts in examining the impact of AD and related care. It presents a summary of the latest economics research on cost estimates of AD and on economic evaluations of diagnostic and management interventions in terms of cost-of-illness and cost-effectiveness studies respectively. Empirical and conceptual issues about the interpretation of costs and the uses of evaluative methods are also discussed. We found that the economic costs attributable to AD care is highly variable mostly due to non-standardised methodologies and geographical variations in care patterns. There is, however, little doubt that the impact is substantial and is expected to worsen with the demographic, epidemiologic, technologic and economic transitions worldwide. There are comparatively fewer studies on the cost-effectiveness of interventions in AD. Most of the published work revolves around pharmacotherapeutics while relatively little has been done on diagnostics, patient care programmes and programmes for caregivers. We conclude that there are significant opportunities to strengthen research on standardised cost-of-illness analyses and new cost-effectiveness studies on a broader range of AD interventions.

Alzheimer Disease↗

PubMed2002

Self-rated economic condition and the health of elderly persons in Hong Kong.

Studies have documented that health and income are important variables affecting the quality of life in old age. However, there is little knowledge about whether perceived financial sufficiency affects the health of elderly persons. Recent research has documented that in addition to material and behavioural determinants, psychosocial pathways also have an influence on health inequalities. This is the first paper to examine the relation between self-rated economic condition (measured with a single item question) and reported health conditions (i.e., somatic complaints, diagnosed physical diseases, functional health (Activities of Daily Living), self-rated health, and mental health status (General Health Questionnaire-30 [GHQ-30]) among elderly persons in Hong Kong. The respondents of the study were persons aged 65 and over residing in public housing estates in the Southern District of Hong Kong Island. Four hundred and fifty respondents were interviewed in 1995 by means of a structured questionnaire. The study found that although it did not record the actual income levels of the respondents, the subjective measure vividly demonstrated the health differentials among the elderly respondents. Multiple regression analyses suggested that self-rated economic condition was a significant predictor of the number of somatic complaints and physical illnesses reported, as well as of functional health, self-rated health, and mental health status (controlling for socio-demographic variables). However, the measure explained a higher proportion of variance in models related to psychological health than those related to physical health. The findings substantiated the role of psychosocial processes in understanding perceived health and illness and health inequalities in particular.

Activities of Daily Living↗

PubMed2002

Financial strain and life satisfaction in Hong Kong elderly Chinese: moderating effect of life management strategies including selection, optimization, and compensation.

For many Hong Kong Chinese elderly, financial strain is quite a common occurrence. This study examines the moderating effect of life management strategies including selection, optimization, and compensation in the relationship between financial strain on life satisfaction. The data came from a survey of a representative community sample of 421 elderly respondents in Hong Kong. Using multiple regression models, the authors found that selection and optimization of life management strategies moderated the linkage between financial strain and life satisfaction even after controlling socio-demographic variables, but sense of control over finances did not. Findings suggest that life management strategies should be enhanced to protect older people under chronic financial strain from low level of life satisfaction

Aged↗

PubMed2001

The construction and validation of a scale for consumer satisfaction of residential care in Hong Kong.

Consumer satisfaction has been adopted by many service industries as an outcome measure of service quality. This paper reports and discusses the construction of validation of a set of quality indicators that have been used to measure the domains of satisfaction among residents of old age homes in Hong King. The quality indicators were firstly constructed through residents' focus group discussions in Hong Kong and through reference to theories of social gerontology. A team of multi-disciplinary professionals, including social workers, nurses and social gerontology researchers, then reviewed the indicators. Residents' views and reactions to the indicators were also solicited through face-to-face interviews with 20 residents. The 55-item scale was then validated and modified to 35 items after a pilot study of 98 residents. Finally, the indicators were used in a study of 405 residents selected by stratified random sampling. A 28-item scale representing nine quality indicators for the residential home service was finally validated. The paper concludes with recommendations on the use of this set of quality indicators to promote service quality in residential care.

Aged↗

PubMed2001

Financial strain and depressive symptoms in Hong Kong elderly Chinese: the moderating or mediating effect of sense of control.

For many Hong Kong Chinese elderly, depression and financial strain are quite a common occurrence. This study examines the mediating and moderating effect of sense of control in the relationship between financial strain and depressive symptoms. The data came from a survey of a representative community sample of 411 elderly respondents in Hong Kong. Using multiple regression models, the authors found that generalized sense of control mediated and moderated the linkage between financial strain and depressive symptoms even after controlling socio-demographic variables but sense of control over finances did not. Findings suggest that generalized sense of control should be enhanced to protect older people under chronic financial strain from depression.

Aged↗

PubMed2001

Social comparison in Chinese older adults.

Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the role of social comparison in the relationship between depressive symptoms and four key life domains including: physical health, financial situation, relationships with adult children, and social support from friends. The respondents were 411 people aged 60 years or older from a survey of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that social comparison mediated the effect of support from friends on depressive symptoms and social comparison was the partial mediator in the linkage between financial strain and depressive symptoms. Moreover, social comparison also moderated the effect of physical health and support from friends on depressive symptoms. Lastly, we found that self-efficacy and self-esteem were moderators in the relationship between depressive symptoms and all four key life domains including physical health, financial situation, relationship with adult children, and social support from friends, whereas sense of control over physical health and sense of control over support from friends moderated the effect of social comparison on physical health and support from friends, respectively, on depressive symptoms.

Activities of Daily Living↗