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Biomedical subjects

Iris Chi

Publications and source records attributed to Iris Chi.

At least 19 recordsLinked to original sources
PubMed2006

Impact of falls on the balance, gait, and activities of daily living functioning in community-dwelling Chinese older adults.

OBJECTIVE: The objective of the present study was to investigate the impact of incident falls on the balance, gait, and Activities of Daily Living functioning in community-dwelling older adults. METHODS: This was a population-based, 1-year prospective cohort study in older adults. We performed baseline assessment of potential predictors, the 1-year occurrence of falls, and then 1-year reassessment of the following outcome measures: the Barthel Index (BI), Lawton's Instrumental Activities of Daily Living (IADL) scale, gait speed, and Tinetti Balance and Gait Evaluation's total mobility score (TMS). At 1 year of follow-up, participants who had declined by > or = 1 standard deviation (SD) below the baseline mean value of each outcome measure were classified as "decliners." RESULTS: Of the 1517 participants, 93.5% (n = 1419) completed the 1-year follow-up reassessment of BI and IADL. For gait speed and TMS, respectively, 88.2% (n = 1338) and 88.3% (n = 1339) completed the 1-year outcome assessment. Fallers, particularly recurrent fallers, experienced significantly greater 1-year declines in the four functional measures. Multivariate logistic regression analyses showed that an incident fall was a significant independent predictor for decliners in the BI, Lawton's IADL score, gait speed, and TMS after adjustment of all significant confounding factors. The relative risks of an incident fall as an independent predictor for decliners in the BI, IADL score, gait speed, and TMS were 2.4 (95% confidence interval [CI], 1.4-4.0; p =.01), 2.9 (95% CI, 1.7-5.2; p <.001), 2.4 (95% CI, 1.5-3.8; p <.001), and 4.6 (95% CI, 2.7-7.8; p <.001), respectively. CONCLUSIONS: Incident falls have a significant negative impact on the balance, gait, and Activities of Daily Living functioning in community-dwelling older adults.

Accidental Falls↗
PubMed2005

Prevalence and correlates of depression in Chinese oldest-old.

BACKGROUND: In Hong Kong, the aged population will be increased rapidly in the coming three decades and the oldest-old (aged 80 and above) is the fastest growing age group. In this paper, we examined the prevalence rate and the correlates of depression for the oldest-old. METHOD: This article analyzes cross-sectional data collected from a representative community sample of 1 903 Chinese elderly people aged 60 or above in Hong Kong. Respondents were interviewed in face-to-face format with structural questionnaire. RESULT: Using 8 as the cut-off point for the 15-item Geriatric Depression Scale, we found that the prevalence rate was greater for the oldest-old (31.1% +/- 9.7%) than for the young-old (aged between 60 and 69; 19.1% +/- 2.8%) and the old-old (aged 70 and 79; 22.4% +/- 4.2%) groups. Logistic regression analyses revealed that financial strain, poor self-rated health, loneliness, and heart disease were significantly and positively related to depression in the oldest-old after gender, marital status, education, living arrangement, functional disability, sensory impairment, cognitive ability, and the presence of eight medical conditions were controlled. Interestingly, financial strain, self-rated health, and loneliness were found to be significant correlates of depression in the young-old and the old-old groups, too. CONCLUSION: Depression is a serious problem for the oldest-old but a number of correlates are consistently identified in the oldest-old, as well as the two other age groups in the elderly population. Therefore, aged care service practitioners must take these correlates into consideration in their prevention and treatment for depression for all different age groups in the aged.

Age Distribution↗
PubMed2005

Prevalence of depression among elderly Chinese with diabetes.

BACKGROUND: To examine the association between diabetes and depression among older Chinese and to determine the extent to which depression is mediated by physical disability and diabetes-related comorbid conditions. METHOD: Cross-sectional analysis of data from a population-based study composed of a representative sample of 2003 non-institutionalized older adults aged 60 and older living in Hong Kong who agreed to participate in the study. We examined the relation between diabetes and depression (measured with the Geriatric Depression Scale). RESULT: 12% of the older adults reported physician-diagnosed diabetes and amongst these older persons with diabetes, 26% of them reported elated level of depressive symptoms. Logistic regression analyses revealed that diabetes was significantly related to depression even when controlling for age, gender, marital status, and education. More importantly, adjusted for self-reported disability in three domains including self-care, mobility, and higher functioning did not attenuate this association but the association disappeared after we adjusted for four diabetes-related complications including heart disease, high blood pressure, stroke, and vision problems. CONCLUSION: Diabetes is associated with depression and this association appears to be mediated by prevalent diabetes complications. This is of particular clinical important because although depression is often overlooked in the aged population, effective treatment is available and can result in improved medical outcomes.

Aged↗
PubMed2005

Reciprocal relationship between pain and depression in elderly Chinese primary care patients.

BACKGROUND: Pain and depression are common in old age but the reciprocal relationship between pain and depression has not been established in a single study. Moreover, few studies have addressed this issue in a primary care setting. The purposes of this study were to examine the reciprocal relationship between pain and depression and to identify whether social support, functional disability or social functioning mediated the link between pain and depression among Hong Kong Chinese elderly primary care patients. METHOD: Subjects were 318 patients assessed by a trained assessor with MDS-HC at baseline and these subjects were randomly selected from attendants of three randomly selected elderly health centers in Hong Kong. These patients were re-assessed one year after baseline evaluation. RESULTS: Multiple regression analyses revealed that pain at baseline significantly predicted depression at 12-month follow-up assessment when age, gender, martial status, education, and depression at baseline were adjusted for, but depression at baseline was not associated with pain at 12-months after baseline measure while controlling for age, gender, martial status, education, and pain at baseline. However, depression did predict the onset of pain. Moreover, social support, physical disability or social functioning did not mediate the impact of pain on depression. CONCLUSIONS: These data suggest that pain is an important predictor of depression in elderly primary care patients. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.

Activities of Daily Living↗
PubMed2005

Training nurses and social workers in smoking cessation counseling: a population needs assessment in Hong Kong.

BACKGROUND: To achieve greater coverage of elderly smokers and to shift entire populations toward cessation, the provider-client interface could be broadened beyond physicians to include nurses and social workers, who can be formally trained to provide such services. We carried out a population-based training needs assessment of the latter two groups in Hong Kong. METHODS: Three thousand seven hundred eligible hospital-based nurses and 2,258 social workers who had elderly clients in Hong Kong were recruited in a knowledge, attitude, and practice (KAP) cross-sectional survey. We used multivariable logistic regression to identify predictors for two key outcomes-"initiation and advice" (ask and advise) and "follow-through" (assess, assist and arrange), based on the U.S. Agency for Health Care Policy Research framework. RESULTS: One thousand eight hundred forty-three (49.8%) nurses and 1,499 (66.4%) social workers responded. Nurses reported a much higher level of engagement in smoking cessation activities than social workers in all five steps of the AHCPR framework (P<0.001). Nurses (mean score=2.99+/-0.40 on a 4-point Likert scale) had more positive attitudes to tobacco control and smoking cessation counseling compared to social workers (mean score=2.79+/-0.41; P<0.001), whereas the latter group perceived themselves as more competent in handling such practice (mean score(nurses)=2.36+/-0.52, mean score(social workers)=2.51+/-0.39; P<0.001). Both attitudinal and self-perceived competence scores predicted incremental gains in the likelihood of offering "follow-through" interventions in addition to those observed for "initiation and advice" actions. CONCLUSION: Our findings highlight a large degree of unmet need in Hong Kong's hospital-based nurses and social workers who work with the elderly regarding smoking cessation service provision and training. Future research should focus on developing and evaluating programs that encourage nurses and social workers to provide cessation interventions to exert a much greater collective impact than doctors can alone.

Adult↗
PubMed2005

Prevalence of depression and its correlates in Hong Kong's Chinese older adults.

OBJECTIVE: Because of the rapid aging of the population and inconsistent findings of previous epidemiological studies in Hong Kong, a prevalence study of depression among older adults was timely. The authors assessed the prevalence of depression among older adults and identified factors associated with it. METHODS: The authors interviewed a random representative sample of 917 community-dwelling Chinese adults age 60 and over. The 15-item Chinese Geriatric Depression Scale with a cutoff of > or = 8 was used to identify clinically significant depression in the older adults. RESULTS: The authors found that 11.0% and 14.5% of older Chinese men and women, respectively, scored above the cutoff, a prevalence rate similar to those found in other countries, including the United States, England, and Finland. Factors that were associated with an increased likelihood of depression among older adults included poor self-rated health, long-term pain, vision problems, higher level of impairment in activities of daily living, residing in Hong Kong less than 20 years, financial strain, and having less social support. CONCLUSIONS: The prevalence rate of depression among older Chinese adults in Hong Kong is more or less similar to rates found in Western countries. The data suggest that older adults who receive less social support are more likely to be depressed.

Aged↗
PubMed2005

Attempted suicide in elderly Chinese persons: a multi-group, controlled study.

OBJECTIVE: Attempted suicide in later life is under-researched despite its public health significance. In this study, the authors delineated the characteristics of elderly suicide attempters in a representative Chinese sample by comparing them with suicide completers and comparison subjects age 65 years or over who were randomly selected from the community. METHODS: There were 224 subjects in this study: 66 suicide attempters, 67 suicide completers, and 91 comparison subjects from the community. Using a case-control design and standardized measuring instruments, authors examined the risk and protective factors associated with attempted suicide, making direct comparisons with the community-comparison subjects and suicide completers. RESULTS: A current diagnosis of major depression was associated with a nearly 60-fold increased risk for attempted suicide, and a population attributable risk (PAR) of 67%. Other risk factors included past suicide attempts, poorer function of self-care, arthritis, and specific personality dispositions, particularly low Conscientiousness. Co-residence with children decreased risk. Although the profiles of suicide attempters and completers were similar, they could be distinguished by suicide intent, recent life events (particularly hospitalization), functional competence, religious denomination, and personality characteristics. CONCLUSIONS: A high degree of clinical vigilance and multidisciplinary collaboration are required in the management of elderly suicide attempters. The treatment of depression should form a crucial part of the prevention program. Features that distinguish suicide completers from suicide attempters may also carry implications for the secondary prevention of suicide in elderly persons.

Aged↗
PubMed2005

Later life learning experience among Chinese elderly in Hong Kong.

In a world with increasing numbers of older adults and a world wide emphasis placed on lifelong learning, it is crucial to examine and formulate appropriate policy for learning in later life (LLL). Hong Kong has a rapidly aging population, which is projected to double within the next 25 years. However, lifelong learning for the elderly has yet to be fully developed. This article reports the findings of 2 surveys: one on the LLL experience among 190 Chinese elderly in Hong Kong and another on the experiences of 9 center directors in running courses for the elderly. We found that Chinese older persons generally learn for expressive motivation rather than instrumental motivation, although those with higher educational attainment take LLL for both instrumental and expressive motivation. This finding is consistent with those obtained with American populations. Practical courses such as languages and health-related topics were found to be the most popular; and Nearly a quarter (27%) of the respondents (in particular those who are well educated) expressed interest in peer teaching. The findings are important to understand LLL in the Chinese population and assist in the formulation of an appropriate LLL policy in Hong Kong. These findings also serve as a comparison for other countries trying to provide continuing education opportunities for its older citizens.

Adult↗
PubMed2005

A proposal for a voucher system for long-term care in Hong Kong.

Over the next three decades, due to a rapidly aging population coupled with the recent economic downturn, Hong Kong society will face severe challenges in establishing a sustainable aged care system. We identify four principles: the encouragement of family care, service integration, a mixed mode of financing, as well as a "small government and large market" approach to guide the development of aged care services. After a brief description of existing Hong Kong long-term care services for the elderly, we evaluate this service according to these principles. We examine how a proposed voucher system could tackle problems in the current system of long-term care. Finally, we propose solutions to alleviate the possible negative consequences of the voucher system and describe the essential preconditions for the full implementation of the system.

Aged↗
PubMed2004

Childlessness and psychological well-being in Chinese older adults.

BACKGROUND: Childless older adults will increase rapidly in the coming future due to delayed marriage, infertility, and high divorce rate. We examined whether childlessness is significantly related to loneliness and depression and whether the effect of childlessness persisted even when other factors including gender, marital status, age, education, self-rated health status and financial strain were controlled for. METHOD: This article analyzes cross-sectional data collected from a representative community sample of 2003 Chinese elderly people aged 60 or above in Hong Kong. Respondents were interviewed in face-to-face format and data including socio-demographic variables, health indicators, loneliness and depression were obtained. RESULT: Logistic regression analyses revealed that childlessness was significantly related to loneliness and depression even after marital status, gender, age, education, self-reported health status, and financial strain were controlled for. CONCLUSION: The impact of childlessness on psychological well-being among elderly Chinese is more robust than that found in older Americans. Moreover, consistent with the findings of previous studies, we found that the effect of childlessness on psychological well-being has to be investigated in the context of marital status. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.

Aged↗
PubMed2004

Combined effect of vision and hearing impairment on depression in elderly Chinese.

BACKGROUND: Sensory impairment and depression are common in old age and the relation between depression and vision as well as hearing impairment have been established. However, few studies have directly compared their effects and examined the impact of dual sensory loss. The purpose of this study is to compare impacts of self-reported hearing and vision loss as well as the effect of double sensory impairment on depression. METHOD: This article analyzes cross-sectional data collected from a representative community sample of 2,003 Chinese elderly people aged 60 or above in Hong Kong. Respondents were interviewed in a face-to-face format and data including vision and hearing impairment, socio-demographic variables, health indicators, family support, and depression were obtained. RESULTS: Logistic regression analyses revealed that visual impairment was significantly related to depression even after age, gender, marital status, education, self-reported health status, the presence of 11 diseases, functional limitation and family support were controlled but hearing loss was not. Hearing impairment did not add to the likelihood of depression where visual impairment was already present. CONCLUSION: The impact of visual impairment on psychological well-being among elderly Chinese is more robust than hearing loss. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.

Age Distribution↗
PubMed2004

A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia.

BACKGROUND: To date, no firm conclusions can be reached regarding the effectiveness of reminiscence for dementia. Researchers have emphasized that there is an urgent need for more systematic research in the area. OBJECTIVE AND METHOD: A single-blinded, parallel-groups (one intervention, one comparison, and one no-intervention group) randomized controlled trial (RCT) was adopted to investigate whether a specific reminiscence program leads to higher levels of psychosocial well-being in nursing home residents with dementia. The intervention adopted a life-story approach, while the comparison group provided friendly discussions to control for any changes in outcome as a result of social contacts and attention. The Social Engagement Scale (SES) and Well-being/Ill-being Scale (WIB) were the outcome measures used. The outcomes of the groups were examined with reference to the baseline (T0), immediately (T1), and six weeks (T2) after intervention. The final sample had 101 subjects (control group: n=30; comparison group: n=35; intervention group: n = 36). Using multivariate analysis with repeated measures, no significant differences in outcome were found between groups at either T1 or T2. Wilcoxon signed rank tests were performed for each group comparing outcomes between T1 and T0, T2 and T1, and T2 and T0. Significant differences were observed in the intervention group when comparing T1 and T0 WIB (p = .014), but not for the other groups. CONCLUSION: Although the intervention did not lead to significant differences between the three groups over time, there was a significant improvement in psychosocial well-being for the intervention group.

Aged↗
PubMed2004

Reducing utilisation of hospital services by case management: a randomised controlled trial.

A 12-month randomised controlled trial was conducted in Hong Kong to evaluate the effectiveness of case management provided to a group of home-dwelling, frail elderly patients (control group: n = 47; intervention group: n = 45) in terms of utilisation of hospital services by these patients. Significant reductions (significance at P </= 0.05) in mean total number of hospital bed-days (P < 0.001), mean total episodes of hospital admissions (P < 0.001), and mean total number of attendances at the outpatient department (P < 0.05) were observed when the baseline and post-intervention differences between the intervention and control groups were compared. The study demonstrated that utilisation of hospital services could be significantly reduced when a group of elderly patients and their caregivers received timely interventions and appropriate services through case management services.

Caregivers↗
PubMed2004

Preventing economic hardship among Chinese elderly in Hong Kong.

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.

Aged↗
PubMed2003

A prevalence study of suicide ideation among older adults in Hong Kong SAR.

OBJECTIVE: The objective of this paper is to ascertain estimates of the prevalence, and associated risk factors for, suicidal ideation among community-dwelling older adults in Hong Kong. METHOD: The study was conducted as part of the General Household Survey (GHS), using face to face interviews of ethnic Chinese people aged 60 or above living in the community. Elders living in institutions or elderly homes were excluded from the study. RESULTS: Six percent of the sample was found to have ever had suicide ideation. The results showed that poor physical health, including poor vision, hearing problems, and a greater number of diseases; and poor mental health, especially in the form of depression, are predictors of suicidal ideation in the elderly population. Also, statistical analysis by linking individual factors to depression showed that financial and relationship problems are significant risk factors as well. Older adults who engaged in active coping, that is, those who actively seek to manage or control the negative events in their lives, fare better with lower levels of suicidal ideation than those who use passive coping styles. CONCLUSIONS: The prevalence of suicidal ideation is similar among elders in Hong Kong and western countries. Factors that contribute to risk for suicidal ideation span physical and mental health, social, and psychological domains. Although the association of suicidal ideation to self-destructive acts remains to be determined, these findings indicate a variety of potential foci for late life suicide prevention efforts.

Adaptation, Psychological↗