Alignment or struggle? Exploring socio-demographic correlates of individual modernity in Chinese older people

"Participation Is Fun and Empowering": A Participatory Approach to Co-Design a Cultural Art Program for Older Chinese at Risk of Depression in Hong Kong

Background and Objectives

Internalized ageism and stigma of mental illness may disempower older people and impede help-seeking among those at risk of depression. Arts are deemed enjoyable, stigma-free, and conducive to mental health, and a participatory approach can engage and empower potential service users. This study aimed to co-design a cultural art program and test its feasibility in empowering older Chinese people in Hong Kong and preventing depression.

Research Design and Methods

Adopting a participatory approach and guided by the Knowledge-to-Action framework, we co-designed a 9-session group art program using Chinese calligraphy as the channel for gaining emotional awareness and facilitating expression. The iterative participatory co-design process engaged 10 older people, 3 researchers, 3 art therapists, and 2 social workers through multiple workshops and interviews. We tested the program's acceptability and feasibility in 15 community-dwelling older people at risk of depression (mean age = 71.6). Mixed methods were used, including pre- and postintervention questionnaires, observation, and focus groups.

Results

Qualitative findings suggest the feasibility of the program, and quantitative findings indicated its effects in increasing empowerment (t(14) = 2.82, p < .05), but not in other mental health-related measurements. Participants reflected that active participation and learning new art skills were fun and empowering, arts enabled them to gain insight into and express deeper feelings, and groups with peers made them feel relatable and accepted.

Discussion and Implications

Culturally appropriate participatory arts groups can effectively promote empowerment in older people, and future research should balance eliciting meaningful personal experiences and measurable changes.

Influence of intergenerational relationships on depressive symptoms in ageing Chinese adults in Hong Kong: Mediating effects of sense of loneliness

Background

Mental health of older adults could be positively predicted by harmonious parent–adult children relationships, although the mechanism has not been sufficiently demonstrated. This study employed sense of loneliness as mediator to examine the influence of multiple domains of intergenerational relationships on depressive symptoms in ageing Chinese adults.

Methods

Data was extracted from a representative survey in Hong Kong among Chinese adults aged over 50 with at least one adult child (n = 801). Four key domains (structural–associational, consensual–normative, affectual closeness, and intergenerational conflict) were adopted to measure the intergenerational relationship quality. Depressive symptoms were assessed using the five-item Geriatric Depression Scale. The mediating role of sense of loneliness in the association between intergenerational relationships and depressive symptoms were tested by the PROCESS macro in SPSS.

Results

The influence of overall intergenerational relationship quality and its four subdomains on depressive symptoms were significantly mediated by sense of loneliness. Among the four domains, affectual closeness presented the strongest association with older people’s depressive symptoms. The effect of intergenerational conflict on depressive symptoms was completely mediated by sense of loneliness, and the effects of remaining three domains were partially mediated. The domain of consensual–normative solidarity received the lowest rating by Chinese older adults.

Conclusion

The psychological pathway that loneliness links intergenerational relationships and depressive symptoms was supported in this study. With respect to improving intergenerational relationships, enhancing affectual connection between older parents and adult children was essential to prevent mental problems. This study calls for more attention to the protective role of diverse social relationships in improving mental health through multiple pathways.

Classifying and characterizing the development of self-reported overall quality of life among the Chinese elderly: a twelve-year longitudinal study

Background

To promote healthy aging, the information about the development of quality of life (QoL) is of great importance. However, the explorations of the heterogeneity in the change of QoL under the Chinese context were limited. This study aimed to identify potential different development patterns of QoL and the influential factors using a longitudinal, nationally representative sample of the Chinese elderly.

Methods

We adopted a five-wave longitudinal dataset from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and a total of 1645 elderly were obtained. The sample had a mean age of 72.7 years (SD = 6.64) and was 47.2% male. Overall QoL was measured through self-report during the longitudinal process. We utilized the conditional growth mixture model (GMM) with time-invariant covariates (TICs) to explore various development patterns and associated factors.

Results

Three distinct trajectories of self-reported overall QoL were identified: the High-level Steady Group (17.08%), the Mid-level Steady Group (63.10%), and the Low-level Growth Group (19.82%). Results also indicated that several factors predicted distinct trajectories of self-reported overall QoL. Those elderly who received enough financial resources, had adequate nutrition, did not exhibit any disability, engaged in leisure activities, and did less physical labor or housework at the baseline were more likely to report a higher level of overall QoL over time.

Conclusions

There existed three development patterns of self-reported overall QoL in elders, and the findings provided valuable implications for the maintenance and improvement of QoL among the Chinese elderly. Future studies could examine the influence of other confounding factors.

Attitudes of Chinese College Students Toward Aging and Living Independently in the Context of China's Modernization: A Qualitative Study

Modernization in China is accompanied by some specific features: aging, individualization, the emergence of the nuclear family, and changing filial piety. While young Chinese people are still the main caregivers for older adults, understanding the attitudes of young Chinese people toward aging and living independently in the context of modernization is important because it relates to future elderly care problems in China. By using in-depth interviews and qualitative methods, 45 participants were enrolled in the study, 38 (84.44%) were women and 37 (82.22%) had no siblings. The ages ranged from 17 to 25 years (mean age = 19.28, SD = 1.74). Results revealed that participants held diverse attitudes about older adults, but the general attitudes were that older adults are lonely, financially disadvantaged, have poor social support, lack hobbies, and care about their children more than themselves. Chinese college students were affected both by traditional filial piety and individualism; however, of the two, they seemed put greater value on independence. Moreover, traditional filial piety is changing in a modern direction, affected by Western ideas of individualism: the status of the senior is diminishing, and living with one's parents is no longer regarded as a necessary component. Implications concerning age stereotypes, elderly care policies, and strategies are discussed.

Intergenerational relationships and depressive symptoms among older adults in urban China: The roles of loneliness and insomnia symptoms

The prevalence of depressive symptoms in older Chinese adults has increased recently. Intergenerational relationships play an important role in the mental health conditions of older adults, especially in Chinese culture. Therefore, this study aims to unravel the complex connection between intergenerational relationships and depression, and to explore the potential mediating roles of loneliness and nighttime insomnia symptoms within that connection. A cross-sectional household survey was conducted in China with 2038 participants aged 65 years or above. Variables were measured using the Center for Epidemiologic Studies Short Depression Scale, the Intergenerational Relationship Quality Scale for Aging Chinese Parents (IRQS-AP), three nighttime insomnia symptoms extracted from the Insomnia Severity Index and the De Jong Gierveld Six-Item Loneliness Scale. The IRQS-AP includes four subdimensions: consensual-normative solidarity, structural-associational solidarity, affectual closeness and intergenerational conflicts. Path analyses were performed in Mplus to investigate regression coefficients and mediating effects. Results showed that three general intergenerational relationships (consensual-normative solidarity, affectual closeness and intergenerational conflicts) were significantly correlated with all mental health outcomes, including their symptoms of loneliness, insomnia and depression. A serial mediation model suggested that loneliness mediated the connection between those constructs of intergenerational relationships and depression, with an independent path to insomnia symptoms via loneliness. The proposed mediators fully mediated the effects of affectual closeness on depression. Nighttime insomnia symptoms alone mediated only the relationship between intergenerational conflicts and depression independently from paths involving depression. Removal of sleep item from CES-D did not affect the results of paths. Our findings highlight the importance of intergenerational relationships for mental health, especially for the mediating effects of loneliness and nighttime insomnia symptoms on the relationship between intergenerational relationships and depression. Effective mental health services for older adults can address their feelings of loneliness and sleep problems, especially for those who have a poor relationship with their adult children.

Personal care expectations: Photovoices of Chinese ageing adults in Hong Kong

The increasing ageing population contributes to growing demands for personal care that fulfils ageing adults' preferences and expectations. This study explored Chinese ageing adults' expected forms and sources of future personal care and the factors influencing care expectations. A qualitative photovoice research method - which integrated photography, interviews and group discussions - was used for data collection between January and April 2016. Through purposive sampling, 36 community-residing participants aged 51-80 years took photographs that captured personal care preferences or expectations within individual, familial and societal contexts. Participants described feelings of worry, uncertainty and unpreparedness for future care needs and arrangements. They preferred practicing self-care for as long as possible and remaining in their homes and communities ("ageing in place") through support from assistive technologies, family members or home-based and community services. Institutional care was regarded as the last resort. The findings reflected discrepancies between ageing adults' care preferences and realities and their ambivalent attitudes towards filial care when switching between roles. Confronted with the increasingly unreliable family care, financial resources and insufficient community services, participants anticipated receiving institutional care that would be less satisfying or that they would dislike. As caregivers, ageing adults displayed strong commitment to filial obligations, whereas when perceiving themselves as care receivers they felt that they could not expect care from their children because of practical considerations. By understanding preferred care forms and sources, actors can devote resources, policies and interventions to support self-care through proactive planning and technological advancement, foster "ageing in place" through family and community care, and improve institutional care to enable ageing with dignity.

Development and Validation of a Multidimensional Intergenerational Relationship Quality Scale for Aging Chinese Parents

Background and Objectives

The quality of intergenerational relationships is crucial for maintaining the well-being of parents and adult children. This study developed and validated an Intergenerational Relationship Quality Scale for Aging Chinese Parents (IRQS-AP) based on the solidarity, conflict, and ambivalence models.

Research Design and Methods

The data were derived from a cross-sectional study in Hong Kong which included a random sample of 1,001 community-dwelling individuals aged ≥50 years. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure of the scale. The internal consistency reliability and convergent validity of the scale were also assessed.

Results

EFA resulted in a 13-item four-factor (i.e., consensual-normative solidarity, structural-associational solidarity, affectual closeness, and intergenerational conflict) model, which was supported by the CFA and explained 70.7% of the total variance. The reliability of the scale measured using Cronbach's alpha was .776. The convergent validity of the IRQS-AP was established by its significant correlation with depressive symptoms (r = -.385), sense of loneliness (r = -.449), and self-image (r = .384).

Discussion and Implications

The IRQS-AP as a reliable and valid scale can enable researchers and service practitioners to measure the relationship quality between older people and their adult children accurately, inform the development of interventions to strengthen intergenerational relationships in target domains, and evaluate the effectiveness of related services.

Whom should I rely on for my future care? Patterns of care expectations and intergenerational correlates among ageing Chinese adults in Hong Kong

This study examined ageing parents' care expectations across multiple care domains (financial and material, emotional, personal and informational) towards filial and formal sources and identified intergenerational correlates of care expectation patterns using a proposed care expectation model. Data of 780 eligible ageing parents were drawn from a representative household survey of ageing adults (≥50 years) conducted in 2016-2017. Latent class analysis was used to examine the typological structure underlying ageing parents' care expectations. Four patterns of care expectations were discovered: mixed-maximal, filial-modest, formal-modest and neither-minimal. Multinomial logistic regression analysis was conducted to validate the newly proposed care expectation model. In addition to certain predisposing factors (participants' age, sex and education), parental enabling resources (economic status), health characteristics (physical, mental and functional health status), children-related enabling characteristics (number of sons and marital status of children), and intergenerational enabling circumstances (intergenerational relationships and caregiving to their own parents) were introduced into the model and found to be associated with ageing parents' care expectations. The findings can inform policy and programmes that effectively respond to ageing adults' diverse care expectations in Hong Kong and have implications for other Asian societies facing rapid population ageing and increasing care demands.

Hong Kong Chinese aging adults voice financial care expectations in changing family and sociocultural contexts: implications for policy and services

Despite being one of the world's wealthiest cities, approximately one-third of Hong Kong older adults live below the poverty line. Innovatively using the Photovoice research method, this study invited 36 Hong Kong Chinese aging adults to photograph images and voice their concerns and expectations regarding financial care. Insufficient government support, diminishing family support, insecurity and fear regarding future finances, and strong desire for self-sufficiency through early preparation and bridge employment were recurring themes observed in the participants' photographs and narratives. The shifting of the participants' financial care expectations from informal to formal sources in changing family and sociocultural contexts indicated that older people are in urgent need of policy reform from a needs-based to rights-based approach to foster empowerment and fulfill older people's rights of financial security, dignity and participation. Improving the retirement protection system should go hand in hand with encouraging family support and caregiving and creating age-friendly working environment for older residents. The findings of this study may have crucial policy implications for Hong Kong and other aging societies, especially those that share similar filial piety values and have seemingly ungenerous welfare systems.

Self-image and intergenerational relationships as correlates of life satisfaction in Chinese older adults: will gender make a difference?

Promoting life satisfaction in later life has long been both a policy and practice challenge. This study examined the association between older adults' self-image and life satisfaction, and that between their intergenerational relationships and life satisfaction. Given that sources of wellbeing for older men and women may vary due to socially constructed realities in early life, gender differences were also investigated in the correlates of life satisfaction. A face-to-face questionnaire survey was conducted in 2014 with a sample of 1,099 older adults aged 60 years and over from four cities in China. Findings of this study showed that older adults’ self-image and intergenerational relationships were significantly associated with their life satisfaction after controlling for certain socio-demographic characteristics, and health and self-care ability. The correlates of life satisfaction were shown to differ between older men and women. Programmes and Services should be developed for older adults to explore and identify positive aspects of themselves, to improve their relationships with their adult children, and to foster a more positive image of ageing in wider society. In addition, service providers should take gender differences in correlates of life satisfaction into account in service and intervention programme development.

Self-perceived uselessness is associated with lower likelihood of successful aging among older adults in China

BACKGROUND

Plenty of evidence has shown that self-perceived uselessness among older adults is negatively associated with successful aging in terms of good health in Western societies. It is unclear whether these findings are valid in China where living into older age is more selective due to high mortality at younger ages.

METHODS

Using five waves (2000, 2002, 2005, 2008/2009 and 2011/2012) of a large nationally representative survey in China with 29,954 observations from 19,070 older adults aged 65 and older, this study aimed to investigate the association between self-perceived uselessness and successful aging. Self-perceived uselessness was measured by a single item "with age, do you feel more useless?" with six answers: always, often, sometimes, seldom, never, and unable to answer. Successful aging was measured by independence in activities of daily living (ADL), independence in instrumental activities of daily living (IADL), unimpaired cognition, good life satisfaction, and good self-rated health. Logistic regression models were applied to each successful aging indicator after controlling for a rich set of covariates that included demographics, socioeconomic status, family/social support, and health practices. The models also adjusted for intraperson correlations across waves.

RESULTS

We found that self-perceived uselessness was negatively associated with successful aging among older adults aged 65 or older. Specifically, compared to never having self-perceived uselessness, always having such a perception was associated with 16-42 % lower odds of being ADL independent, IADL independent, cognitively unimpaired, and having good life satisfaction and good self-rated health. Often or sometimes having such a perception also reduced odds of aging successfully, although such reductions were less pronounced. The associations were similar among the oldest-old aged 80 or older with one exception for the case of IADL independence.

CONCLUSIONS

Self-perceived uselessness is negatively associated with successful aging among Chinese older adults as well as among the oldest-old. Our findings could be informative for China in the development of public health programs that aim to improve self-perceptions about aging and promote successful aging.

The role of travel in enhancing life satisfaction among Chinese older adults in Hong Kong

Life satisfaction is an important indicator of wellbeing and successful ageing, while boosting life satisfaction in later life has long been a policy and service challenge. Based on a questionnaire survey with 415 Chinese older adults aged 60 years and over in Hong Kong, this study examined how older adults' travel motivations influenced their travel actions and how the travel affected their life satisfaction using structural equation modelling. A proposed ‘travel motivation–action–life satisfaction’ model showed an acceptable fit with the data. It was found that travel motivations stimulated older adults' travel actions, while their travels further contributed to greater life satisfaction. The findings of this study indicated the need for improved knowledge and understanding of older adults' travel preferences and requirements, and highlight the importance of enhancing awareness among professionals and service providers about the benefit of travelling in enhancing life satisfaction of older adults.