Facilitating Volunteer Engagement Among Older Adults in Social Services: A Case Study of an Innovative Timebank Program in a Chinese Society

BACKGROUND AND OBJECTIVES

Exploring the roles of older adults as volunteers in social care settings has attracted wide attention to facilitate healthy aging and tackle care workforce constraints. However, there is little knowledge of the mechanism of engaging older adults as volunteers in the social care sector.

RESEARCH DESIGN AND METHODS

The study applies a case study to describe the features of an innovative timebank project, Good Hands, and explore the underlying mechanism of engaging older adults as volunteers in the social care sector. Three focus groups were conducted with 12 older adult volunteers and 6 advisory group members. Thematic analysis was applied to code and analyze the content of the focus group interviews.

RESULTS

Three emergent themes were identified as critical components: strong cross-sector collaboration, meaningfulness in voluntary work comprising 4 subthemes (including capacity optimization, care capacity enhancement, cultivating belonging, and value recognition), and a coproducing environment.

DISCUSSION AND IMPLICATIONS

Volunteer engagement of older adults in the provision of welfare for community-based care for frail peers is discussed, and practice implications are presented.

Understanding the life experiences of elderly in social isolation from the social systems perspective: using Hong Kong as an illustrating example

Aim

The elderly in social isolation often referred to as older people who experience social alienation with little social support from their family, peers, and community suffer from a poor quality of life and well-being. Since their life experiences are affected by a range of factors from different levels, this study seeks to investigate their current life situations and experiences from a social systems perspective.

Methods

A qualitative study was conducted to enrich the understanding of their current life situations and experiences and to generate corresponding practice implications. In this study, there were 13 elderly participants in social isolation, which were users of a social service agency in Hong Kong. They took part in a semi-structured individual interview, sharing their life stories about their daily lives, social relationships, and sense of well-being. Qualitative results were analyzed based on these dimensions.

Results

Results showed that the elderly participants in social isolation had a low level of social support and participation in social activities. Their life experiences and situations were affected by multiple levels of factors that were interrelated.

Conclusion

The results support the application of the social systems perspective in investigating the living conditions of the elderly in social isolation. The corresponding practice implications were also discussed.

Universities as Intermediary Organizations: Catalyzing the Construction of an Age-Friendly City in Hong Kong

Background and Objectives

The construction of an Age-Friendly City (AFC) requires active contribution from relevant interest groups including older adults, nonprofit organizations, and policy-makers. However, given that relevant interest groups may have limited resources, knowledge, and skills, as well as unique contextual factors, they often require help from intermediary organizations-actors that aim to build interest groups' capabilities. Our objectives were to examine the functions of universities, as an example of intermediary organizations, in facilitating the construction of an AFC, and identify critical factors that enable intermediary organizations to perform their functions.

Research Design and Methods

We conducted three focus groups and one individual interview with multiple interest groups including older adults and social workers from nonprofit organizations and local government involved in a 6-year citywide AFC project in Hong Kong. Participants were asked to share their views on the role of universities in relation to their own experiences and roles in the project. Data generated from the interviews were analyzed using thematic analysis.

Results

Four themes pertinent to the functions of universities in facilitating development were identified: facilitating cross-sector collaborations, knowledge diffusion, interest-group building, and mediating divergent interests. We also found that neutrality and reputability are key characteristics for intermediary organizations to wield sufficient legitimacy to perform their functions efficiently.

Discussion and Implications

Findings underscore the important yet overlooked role of intermediary organizations in bridging and mediating different interest groups to facilitate AFC development. We advance gerontological scholarship by providing insights into the theoretical mechanisms and practice implications for intermediary organizations in fostering an AFC.

Long-term trends in the incidence of depressive disorders in China, the United States, India and globally: A comparative study from 1990 to 2019

Background

Depressive disorders have become an increasingly significant public health issue. This study is intended to show the trend of the incidence of depressive disorders in China, the United States, India and the world from 1990 to 2019, as well as the impact of age, period and cohort on it.

Methods

Extracting incidence data from the Global Burden of Disease Study 2019, we determined trends in the age-standardized incidence rate (ASIR) using Joinpoint regression. An age-period-cohort analysis was implemented to describe the effects of age, period, and cohort, as well as the long-term tendencies.

Results

From 1990 to 2019, the ASIR of depressive disorders in China was lower than that in the United States; India is lower than the United States in the first 5 years, showing a downward trend. The incidence in India and the United States is higher than the global average. The ASIR of women in the three countries is higher than that of men. In China, the elderly, early period and people born around 1954 have a higher risk of depressive disorders. In the United States, young people born around 1999 have a higher risk of depressive disorders. India is similar to China.

Conclusion

From 1990 to 2019, the age effect of China as a whole increased, and the period became stable, and the cohort effect declined. The overall age and period effects of the United States reduced, while the cohort effect increased. The age effect in India increased, while the period and cohort effects decreased. Depressive disorders are becoming ever more serious worldwide, and we'd better take measures to reduce its incidence according to the cohort effect of each age group.

Impact of additional community services provision on dementia caregiver burden: an interrupted time-series analysis of 12-year interRAI assessments in Hong Kong

OBJECTIVES

To evaluate the impact of providing additional dementia caregiver support services on caregiver burden.

DESIGN

Interrupted time-series analysis using territory-wide panel data.

SETTINGS

All public-funded district elderly community centres in Hong Kong (HK).

PARTICIPANTS

Primary caregivers for older adults (age over 65 years) living with dementia assessed through International Residential Assessment in HK between 1 October 2004 and 31 September 2016. Paid caregivers were excluded.

INTERVENTIONS

In April 2014, US$280 million was allocated to provide additional psychological support, education and respite care for dementia caregivers in HK.

MAIN OUTCOME MEASURES

Caregiver burden was measured by two age-standardised rates: (1) caregivers in emotional distress; and (2) caregivers with long care time in a week (more than 20 hours a week). We fitted the two time-series into Autoregressive Integrated Moving Average models to evaluate intervention impacts, with follow-up analyses to consider a 6-month transition period of policy implementation. Segmented linear regressions and Holt-Winter exponential smoothening models were used as sensitivity analyses.

RESULTS

36 689 dementia caregivers were included in this study, of which 14.4% caregivers were distress and 31.9% were long-hours caregivers after the policy intervention in April 2014. Providing additional caregiver service significantly reduced standardised rates of caregivers in distress (β (95% CI)=-3.93 (-7.85 to -0.01), p<0.05), but the effect was not sustained (p=0.183). There was no significant impact on the level of age-standardised rates of caregiver with long care time (β (95 CI)=-4.25 (-9.61 to 1.10), p=0.120). Also, there was no significant delay of intervention impacts.

CONCLUSION

Our study finds that strengthening caregiver services provision could reduce distress rates among primary caregivers for older adults living with dementia. Expanding community services for caregiver could be a solution to the escalating burden of informal care for people living with dementia.

How working-age population education and health of older people shape the burden of population aging: A comparative study of Macau, Hong Kong, and Singapore

Macau, Hong Kong and Singapore are all facing increasing population aging. Those aged 65 and over make up the old-age population. The working-age population refers to the population aged 15 to 64. Conventionally, the burden of population aging is measured by the Old-Age Dependency Ratio, which is the ratio of the old-age population to the working-age population. As life expectancy rises, depending exclusively on age to calculate the burden of aging hinders the development of effective anti-aging strategies. The working-age population's education and the elderly's health affect the aging burden's support and generator, respectively. Including them in the calculation gives us a fuller view of the burden of aging.

Objective

To compare the population aging burden in Macau, Hong Kong, and Singapore by including working-age population education and elderly health.

Methods

The overall, working-age and old-age population and proportion, as well as the Old-Age Dependency Ratio of Macau, Hong Kong, and Singapore, were collected from the World Bank database. The life expectancy at 65 was extracted from the 2022 World Population Prospect. The tertiary education rate of the working-age population and the self-rated health status of the old-age population were retrieved from governments' statistical reports. We then calculated the Education-Health Adjusted Old-Age Dependency Ratio, a set of four equations showing the support of the working-age population on the old-age population, where OADRh_t and OADRuh_t represent the burden of healthy and unhealthy old-age population on the working-age population with tertiary education; similarly, OADRh_nt and OADRuh_nt indicate the burden placed on the working-age population without tertiary education by healthy and unhealthy old-age population. Lastly, for comparison with the conventional Old-Age Dependency Ratio, we generated the Weighted Education-Health Adjusted Old-Age Dependency Ratio.

Results

Hong Kong has the greatest old-age population proportion and Old-Age Dependency Ratio, yet its growth rates are moderate and stable, ranging from 0 to 4% and 0 to 6%, respectively. Macau and Singapore experienced sharper changes in old-age population proportion and the Old-Age Dependency Ratio, with Macau's Old-Age Dependency Ratio varying between -2.66 and 8.50% and Singapore's ranging from -1.53 to 9.70%. Three cities showed different patterns in four Education-Health Adjusted Old-Age Dependency Ratio indicators. In Macau, the OADRh_nt and OADRuh_nt increased by 0.4 and 6.2, while the OADRh_t and OADRuh_t decreased by 13.5 and 15.3 from 2004 to 2016. In Hong Kong, only the OADRuh_t fell by 9.4, and the other three increased from 2003 to 2015. In Singapore, the OADRh_nt and OADRh_t increased by 3.8 and 1.0, while OADRuh_nt and OADRuh_t decreased by 1.2 and 3.9 from 2007 to 2011. The Weighted Education-Health Adjusted Old-Age Dependency Ratios are all smaller than the conventional Old-Age Dependency Ratio in the three regions, particularly in Singapore. The Weighted Education-Health Adjusted Old-Age Dependency Ratio of Singapore was reduced by 9.5 to 30.5% compared with the conventional Old-Age Dependency Ratio, that of Hong Kong reduced by 6.2 to 22.5%, and that of Macau reduced by 4.4 to 16.1%.

Conclusion

This is the first study to compare the aging burden in Macau, Hong Kong, and Singapore in connection to working-age population education and elderly health. With the new assessment, the burden of population aging in three regions has been reduced, showing that improving the education of the working-age population and maintaining older people's wellbeing can assist authorities to deal with population aging, especially in Macau and Hong Kong.

Opportunities for organizational learning and innovation: A nonprofit case study during COVID-19 in Hong Kong

COVID-19 has created unprecedented challenges and uncertainty for the nonprofit sector. Drawing from a case study of a community-based service delivery nonprofit organization in Hong Kong, this research note examines the impact of COVID-19 on this organization's daily operations, identifies its organizational coping strategies in response to the challenges it faced, and outlines key organizational learning resulting from its experience of dealing with the pandemic. With reference to the narrative development process framework, this study found that the customary social service delivery model was inadequate in meeting the emergent needs identified in the community. This realization served as a catalyst for the organization to employ socially innovative coping strategies to continue safeguarding the well-being of vulnerable population groups. As a result, a new paradigm of service delivery leveraging on neighborhood support networks and cross-sector collaborations was developed. Factors that would enable nonprofits to enhance their adaptive capacity in the face of future public health crises are discussed, with particular attention drawn to the usefulness of adopting a narrative development process in guiding organizations' collective actions.

OUP accepted manuscript

There is no theoretical framework to guide society to enhance social capital among older adults in the Decade of Healthy Aging. This article aims to advance scholarship by providing a theoretical framework for promoting social capital for healthy aging using timebanking as a case illustration. We provide an integrated theoretical framework to enhance social capital for healthy aging by incorporating 3 core elements: (a) facilitating emotional meaningfulness via social participation for older adults, (b) incorporating older adults as coproducers in community development, and (c) nurturing an inclusive and equitable society. We further demonstrate the utility of the integrated theoretical framework for gerontologists by conceptualizing timebanking as an intervention for enhancing social capital in an aging society.

Scientometric Analysis of Global Scientific Literature on Aging in Place

The amount of literature reporting "aging-in-place" studies has increased sharply in recent decades. However, the studies have taken a global view of the range and scope of the research that has taken place. This study presents a bibliometric analysis of the current status of the aging in place research themes published as scientific articles between 1970 and 2021, using the Web of Science database. VOSviewer software was employed to map and visualize the 1331 items of bibliographic data retrieved. The findings reveal a continuous growing trend in the publication of aging in place research. Most productive institutions derive from the USA. The International Journal of Environmental Research and Public Health is the most preferred Journal. The most popular research hotspots or areas include; older adults, aging, housing, dementia, long-term care, and technology, and their associations with the field of "aging in place" field were elucidated. This study offers several valuable insights to scholars, research institutions, and policymakers, enabling a better understanding of the developments in the aging in place research domain.

Typology of pain coping and associations with physical health, mental health, and pain profiles in Hong Kong Chinese older adults

OBJECTIVES

To identify typology of pain coping in older adults and to see whether the coping types or patterns were associated with pain, physical health, and mental health outcomes.

METHODS

Six hundred and fifty six Chinese older adults were recruited on a convenience basis from social centers in Hong Kong. A 14-item Brief Pain Coping Scale (BPCS) was constructed on the basis of the Chronic Pain Coping Inventory. Outcome measures included pain intensity, pain disability, pain-related cognitions, depressive symptoms, health-related quality of life, and health and physical functioning (in terms of chronic illnesses, basic and instrumental activities of daily living, and self-rated health). Coping typology was identified using latent class analysis.

RESULTS

A 3-class solution based on BPCS provided the best fit to data. Class 1 used almost all coping strategies on a daily basis, Class 2 used the strategies less frequently, whereas Class 3 adopted few strategies. Yet, Class 3 was basically indistinguishable from Class 1 across the outcome variables, even though the participants had more chronic illnesses and poorer instrumental activities of daily living than those in Class 1. Class 2, however, had the poorest outcome profiles, reporting more pain, disability, depression, and health-related quality of life than the other two classes. The differences in coping could not be explained by the differential effectiveness of coping strategies across groups.

CONCLUSION

The way coping was used, and the way it was related to pain, mood, health and functioning outcomes, varied substantially across individuals. Implications for coping skills interventions are discussed.

Developing a Short Multidimensional Measure of Pain Self-efficacy: The Chronic Pain Self-efficacy Scale-Short Form

BACKGROUND AND OBJECTIVES

The 22-item Chronic Pain Self-efficacy Scale (CPSS) measures three domains of pain self-efficacy: pain management, physical functioning, and coping with symptoms. This study aims to develop a short form (CPSS-SF) that retains the multidimensional structure of the instrument.

RESEARCH DESIGN AND METHODS

Six hundred sixty-four community-dwelling Chinese older adults aged 60-95 years with chronic pain completed a survey. Confirmatory factor analysis (CFA) was conducted on the 22-item CPSS. Regression analyses were performed to examine the items' correlations with criterion variables. After CPSS-SF items were selected, the performance of CPSS-SF subscales in terms of accounting for pain-related outcomes was compared with the full version.

RESULTS

CFA supported a modified 3-factor model of the CPSS. On the basis of factor loadings on the 3 dimensions and the items' correlations with pain intensity and pain disability, 11 items were selected for the CPSS-SF, which correlated at .97 with the full version. Regression analyses showed that the associations of the CPSS-SF subscales with pain intensity, pain disability, depressive symptoms, instrumental activities of daily living, and physical and mental health-related quality of life, were indistinguishable from their full-version counterparts.

DISCUSSION AND IMPLICATIONS

The CPSS-SF is a valid instrument that can be used in lieu of the full scale. Its availability will facilitate the assessment of pain self-efficacy in research and clinical settings due to its brevity but strong psychometric properties. However, the current evidence is limited to Chinese older adults; more research is needed to ascertain its validity in other age and cultural groups.

Does exposure to information about dementia change stigma? An experimental study

Objectives: Educational programs on dementia may backfire, as recipients could feel more negatively about people with dementia after exposure to the alarming symptoms (e.g., behavioral and psychological symptoms of dementia, or BPSD). This study aimed to investigate whether such exposures had any effect on stigma.Methods: 200 adults aged 18-83 years were randomly assigned to three groups. The first group read vignettes describing fictitious older adults with memory impairment. The second group read the same vignettes that were expanded to include descriptions of BPSD (i.e., memory impairment cum BPSD). After reading the vignettes, both groups answered questions about stigma, while the third group directly responded to this questionnaire without reading any vignette (i.e., not exposed to experimental manipulation). ANOVA was performed to analyze the effect of experimental manipulation, as well as that of age, education, whether having relatives with dementia, and belief about treatability of dementia.Results: At posttest, the level of stigma was moderate and was comparable across the three groups, suggesting that exposures to information about cognitive and behavioral symptoms did not change people's stigmatizing attitude. The absence of group effect in stigma did not vary by age, education, whether having a relative with dementia, or belief about prognosis. Only the main effects of age and education were significant, where younger and least educated participants reported higher stigma.Conclusion: There was no evidence that stigma would be affected by exposure to information about symptoms of dementia, including the more disturbed ones (i.e., BPSD).

Integrated social and health care services among societies in transition: Insights from Turkey

Societies experiencing rapid demographic transition may expect to face challenges such as accelerated population aging and increasing care-related needs. Decentralization of welfare states and resultant fragmentation of services is gaining increasing attention. In this study, we offer suggestions of how developing countries might move from fragmentation to integration of social and health care services. Using the Health Survey of Turkey (HST-2012) data with 15,000 households of populations' age 15 and older, we explore challenges to integrating social and health care service strategies in Turkey. Findings include inequities in material and service accessibility between rural and urban settings. Increasing numbers of older widowed women, especially in rural environments, will require direct income assistance over the coming decades. Additional findings include the need for primary and preventative health care services for middle age groups and strategies to address both unemployment among younger generations and barriers to work force participation for women. In conclusion, among rapid transition societies, it will take time to resolve decentralization-related regional inequalities in social and health services. Therefore, information and communications technologies (ICT) should be employed from an intersectionality perspective to more quickly bridge the services integration - regional inequalities gap in Turkey and possibly other societies in transition.

Attitudes Toward Retirement Drive the Effects of Retirement Preparation on Psychological and Physical Well-Being of Hong Kong Chinese Retirees Over Time

Recent findings on retirement preparation found a positive impact on the psychological and physical well-being of retirees. However, the types of mental resources that are driving the relationship, such as attitudes toward retirement, only received limited attention. Reasoning from previous findings, we posit that attitudes toward retirement would explain the relationship between retirement preparation and well-being over time after retirement. A three-wave study was conducted in a sample of 130 Hong Kong Chinese retirees over a period of 1.5 years. Data were collected 6 months prior to retirement (T1) and 6 and 12 months after retirement (T2 and T3, respectively), in which preretirement preparation, attitudes toward retirement, and psychological and physical well-being were measured. The positive effect of T1 retirement planning on T3 physical and psychological well-being was partially mediated by T2 attitudes toward retirement. These results remain significant even after controlling for gender, education level, preretirement occupation, and well-being at T1. These findings reveal the role of attitudes toward retirement in driving postretirement adjustment over time.

The Effect of Negative Aging Self-Stereotypes on Satisfaction With Social Support

OBJECTIVES

Previous studies have demonstrated a relationship between negative age self-stereotypes and social support satisfaction. This study examined whether negative age stereotype plays a causal role, and whether health anxiety is a possible mediator, in this relationship.

METHODS

A total of 114 Chinese older persons were randomly assigned into three experimental conditions. In two of the conditions, participants were primed with either negative or positive age stereotypes using a sentence unscrambling task, before responding to measures of self-perception of aging, health anxiety, and satisfaction with family and nonfamily support. Those in the control condition responded to the same questions without priming.

RESULTS

Main effects of priming were found across the board except for satisfaction with nonfamily support. In general, participants primed with negative age stereotypes reported more negative self-perception of aging, higher health anxiety, and lower satisfaction with family support, compared with control or those primed with positive age stereotypes. However, the effect on family support satisfaction could not be explained by concomitant experimental effect on health anxiety.

DISCUSSION

The central role of the family as a support provider might be the reason why the activation of negative age stereotypes led to less satisfaction with family, but not nonfamily.

Barriers to dementia diagnosis and care in China

In China, the ageing population and the prevalence of dementia are projected to escalate significantly by 2050 resulting in a substantial increase in health and economic burden on caregivers, healthcare facilities, healthcare providers and communities. There is no published national dementia policy or strategy in China. This case report describes significant barriers contributing to diagnostic problems and inadequate care of dementia through the case of an older female in rural China, whose condition deteriorated due to neuropsychiatric and functional symptoms of undiagnosed dementia. Intersectoral collaboration between care organisations facilitated delivery of a non-pharmacological intervention programme which was associated with improvements in the patient's functional and neuropsychiatric symptoms. The case demonstrates that recruitment and training of a wider range of health and care professionals and caregivers in a systematic approach to non-pharmacological interventions could help overcome barriers to the specialised care needs of people with dementia where resources are lacking.

Growing Old as a Member of an Ethnic Minority in Hong Kong: Implications for an Inclusive Long-Term Care Policy Framework

Hong Kong is experiencing significant demographic changes as a result of rapid population aging and immigration. Anecdotal evidence suggests that ethnic minorities, in particular aged members of South Asian ethnic minorities, face significant and diverse obstacles in accessing services important to their general welfare. This study is the first systematic attempt to explore the long-term care needs of Nepalese older adults in Hong Kong and the barriers they face in accessing long-term care services. Data were obtained through semi-structured interviews with 30 Nepalese older adults. We found that Nepalese older adults have similar physical and psychosocial needs as those of their local Chinese counterparts. However, participants face a range of structural, knowledge, and attitudinal barriers that together deter them from accessing long-term care services, despite their right to do so. Policy recommendations to mitigate these barriers are given, with reference to the World Health Organization's Age-Friendly Cities Framework.

Fostering Civic Awareness and Participation Among Older Adults in Hong Kong: An Empowerment-Based Participatory Photo-Voice Training Model

Social and civic participation are important tenets for both the age-friendly city and active aging frameworks promoted by the World Health Organization. Yet older adults are often under-represented in civic affairs. This study examines the effects of using photo-voice as a method in facilitating older adults' civic participation. Specifically, an empowerment-based participatory photo-voice training model was implemented among older adults with limited formal education in Hong Kong. We conducted three focus groups comprising 12 older adults and one in-depth interview with a social worker. Findings revealed that photo-voice is an effective tool in capturing older adults' views that would have otherwise been difficult to articulate in words or in writing, and in enhancing older adults' ability and willingness to participate in community and civic affairs. These findings underscore the importance of using novel techniques to build a more inclusive society that incorporates the views of older adults.

Aging in Place

Aging is a function of time and is a natural and integral part of the life cycle. Aging process differs among individuals and brings all kinds of changes, affecting not just the physical body and its functions, but also to the social, psychological and financial situations to individuals. Aging in place (AIP) is a common preference among older people for remaining in their local community and maintaining their social networks throughout the aging process. Issues about appropriateness of aging in place, long-term care, and residential homes are discussed. Some models and recommendations are discussed, completed with thoughts on future studies.

Spatial Variability of Geriatric Depression Risk in a High-Density City: A Data-Driven Socio-Environmental Vulnerability Mapping Approach

Previous studies found a relationship between geriatric depression and social deprivation. However, most studies did not include environmental factors in the statistical models, introducing a bias to estimate geriatric depression risk because the urban environment was found to have significant associations with mental health. We developed a cross-sectional study with a binomial logistic regression to examine the geriatric depression risk of a high-density city based on five social vulnerability factors and four environmental measures. We constructed a socio-environmental vulnerability index by including the significant variables to map the geriatric depression risk in Hong Kong, a high-density city characterized by compact urban environment and high-rise buildings. Crude and adjusted odds ratios (ORs) of the variables were significantly different, indicating that both social and environmental variables should be included as confounding factors. For the comprehensive model controlled by all confounding factors, older adults who were of lower education had the highest geriatric depression risks (OR: 1.60 (1.21, 2.12)). Higher percentage of residential area and greater variation in building height within the neighborhood also contributed to geriatric depression risk in Hong Kong, while average building height had negative association with geriatric depression risk. In addition, the socio-environmental vulnerability index showed that higher scores were associated with higher geriatric depression risk at neighborhood scale. The results of mapping and cross-section model suggested that geriatric depression risk was associated with a compact living environment with low socio-economic conditions in historical urban areas in Hong Kong. In conclusion, our study found a significant difference in geriatric depression risk between unadjusted and adjusted models, suggesting the importance of including environmental factors in estimating geriatric depression risk. We also developed a framework to map geriatric depression risk across a city, which can be used for identifying neighborhoods with higher risk for public health surveillance and sustainable urban planning.

Changes in Prevalence, Outcomes, and Help-seeking Behavior of Chronic Pain in an Aging Population Over the Last Decade

BACKGROUND

Chronic pain is expected to increase as the population ages. This study aimed to investigate the changes in prevalence, patterns, and help-seeking behavior of chronic pain and prevalence of neuropathic pain of an aging population in Hong Kong.

METHODS

A cross-sectional, telephone interview with a structured questionnaire was conducted in a randomly selected sample of adults with acute or chronic pain of any kind in the general population to estimate the prevalence of chronic and neuropathic pain, and to describe sociodemographics and help-seeking behavior. Results were compared with a similar study conducted in 1999.

RESULTS

Totally, 1,570 people were interviewed. Chronic pain was experienced by 28.7% of all respondents, compared to 10.8% in 1999. Joint (45.5%), muscle (27.1%), and back (25.2%) pain were the most common, similar to findings in 1999. Of those with chronic pain, 83.1% reported pain in more than one body site (63.4% in 1999, P = 0.0023). More respondents reported their average pain as being intense (51.57% vs. 33.0% in 2013 and 1999, respectively, P = 0.0098). A downward trend of respondents taking medications for chronic pain (34.9% in 2013 vs. 47.6% in 1999, P = 0.019) was seen. Neuropathic pain was present in 9.03% of the population and 14.7% of chronic pain sufferers.

CONCLUSION

The prevalence of neuropathic pain in Hong Kong is high and is described here for the first time. The number of chronic pain sufferers has tripled in the past decade. Significant changes in the patterns and help- seeking behavior of chronic pain sufferers are also seen.

Better way to measure ageing in East Asia that takes life expectancy into account

AIM

The aim of the study was to improve the measurement of ageing taking into account characteristics of populations and in particular changes in life expectancy.

METHOD

Using projected life tables, we calculated prospective old age dependency ratios (POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy (RLE) for all countries of East Asia.

RESULTS

POADRs grow less rapidly than old age dependency ratios (OADRs). For example, in the Republic of Korea, the OADR is forecast to increase from around 0.1 in 1980 to around 0.8 in 2060, while the POADR is forecast to increase from around 0.1 to 0.4 over the same period.

CONCLUSION

Policy makers may wish to take into account the fact that the increases in measures of ageing will be slower when those measures are adjusted for changes in life expectancy.

Elderly people as "apocalyptic demography"? A study of the life stories of older people in Hong Kong born in the 1930s

In Hong Kong, the general view still follows the biomedical discourse to define aging. The government and leading gerontologists follow the prevailing representation of elderly and describe growing old as a process of becoming "frail, infirm, and vulnerable" (Fealy et al., 2012: 91). Discussions of demographic trends often focus on the drastic effects of an aging society on economic development. Our research indicates that Hong Kong's construction of aging is a product of its market-driven economy. Drawing from the life stories of eight participants born in the 1930s, we examine the meaning of aging and the formation of character in a specific historical context, adopting the life-course perspective. We wish to understand how larger movements in the social and political world shaped the experiences of the participants and the strategies they developed to maintain agency and control in life. The participants in our study struggled for survival through unprecedented political disasters and social turmoil in their youth. When they reached maturity in the 1960s and 1970s, they devoted themselves to bettering their lives and contributed to the economic boom of the city. We maintain that the biomedical model offers a reductive and unjust means of viewing the people in this cohort, who are often seen as a problem and a burden. Challenging the prevailing ageist attitude, we set the life stories of the participants against the dominant biomedical model of aging. Our work aims to establish a just description of the life experiences of Hong Kong people.

End-of-life care research in Hong Kong: A systematic review of peer-reviewed publications

Objective:

This systematic review aimed to examine end-of-life (EoL) care research undertaken in an Eastern cultural context—Hong Kong—with the hope of better informing EoL care professionals and policy makers and providing lessons for other countries or areas that share similar EoL care challenges.

Method:

Eight databases were searched from their respective inception through to August of 2014. All of the resulting studies conducted in Hong Kong and relevant to EoL care or palliative care were examined. The included studies were assessed with respect to study design, care settings, participants, research themes, and major findings.

Results:

Some 107 publications published between 1991 and 2014 were identified. These studies were undertaken at a range of places by different professionals. Of the total, 44 were led by physicians, 36 by nurses, 17 by social workers, and 10 by other professionals. Participants included both inpatients and outpatients with different illnesses, nursing home residents, older community-dwelling adults, deceased individuals, care staff, and informal caregivers. A total of 13 research themes were identified: (1) attitudes to or perceptions of death and dying; (2) utilization of healthcare services, (3) physical symptoms or medical problems; (4) death anxiety or mental health issues; (5) quality of life; (6) advance directives or advance care planning; (7) supportive care needs, (8) decision making; (9) spirituality; (10) cost-effectiveness or utility studies; (11) care professionals' education and training; (12) informal caregivers' perceptions and experience; and (13) scale development or validation.

Significance of results:

While there has been a wide and diverse range of research activities in Hong Kong, EoL care services at primary care settings should be strengthened. Some priority areas for further research are recommended.

Benefit-finding intervention for Alzheimer caregivers: conceptual framework, implementation issues, and preliminary efficacy

PURPOSE

To describe an intervention promoting benefit-finding in Alzheimer caregivers, to discuss key issues in implementation and ways to resolve them, and to examine whether the intervention reduced burden and depression in a small randomized trial.

DESIGN AND METHODS

Twenty-five caregivers were randomized into benefit-finding and psychoeducation groups. Both groups had eight weekly sessions. Outcome measures including role overload, Zarit Burden Interview, and Hamilton depression scale were collected at baseline and after treatment. Results were analyzed using analysis of covariance. Additionally, the challenges of implementing such interventions, some of which related to cultural issues, were analyzed qualitatively.

RESULTS

Controlling for pretest, the benefit-finding group had lower depression than the psychoeducation group at post-test, despite the fact that some caregivers found benefit-finding challenging. The two groups did not differ on overload and burden. However, within-group analysis suggested that both groups showed significant reductions in overload from pretest to post-test. In addition, we discussed participants' difficulties in grasping the technique of thought modification for benefit-finding, recording such exercises at home, and sharing their thoughts and experiences in groups. We described measures undertaken in the main trial to overcome these issues.

IMPLICATIONS

Cognitive approaches focusing on benefit-finding are feasible among Chinese caregivers, with preliminary evidence suggesting an effect on alleviating depression.