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

Validation of the Perceived Community Support Questionnaire for Older Chinese

BACKGROUND AND OBJECTIVES

Community support has a profound positive impact on older people's health and plays a crucial role in facilitating aging in place. This impact is particularly significant in the Chinese context, where community support can alleviate the pressure on traditional family caregiving. This study translated, adapted, and validated the perceived community support questionnaire (PCSQ) for use with older Chinese.

RESEARCH DESIGN AND METHODS

Data for this validation study were collected from a cross-sectional survey of 1,064 Chinese aged 65 years and above. Following the cultural adaptation of the PCSQ-14, confirmatory factor analysis (CFA) was conducted to examine its factor structure. Criterion validity, convergent and discriminant validity, internal consistency reliability, and test-retest reliability of the scale were also assessed.

RESULTS

Based on the CFA results, the adapted PCSQ-14 was found to have a 3-factor solution for community integration, community participation, and community organizations. The criterion-related validity was supported by its significant correlation with depression. Convergent and discriminant validity were established, with the internal consistency of the scale being 0.90. The test-retest reliability intraclass correlation coefficient for the scale was 0.78.

DISCUSSION AND IMPLICATIONS

The adapted version of the PCSQ-14 demonstrated promising psychometric properties in assessing perceived community support in older Chinese. The adapted PCSQ-14 could assist researchers in determining older Chinese adults' perceptions of community support, and could also assist practitioners and policymakers in developing targeted services for older people and allocating resources more effectively.

Intimate networks of care: Perceptions of intergenerational family care and experiences of ageing among Chinese midlife and older lesbians and gay men

This article examines how lesbians and gay men imagine and build their 'intimate networks of care' and negotiate moral expectations towards intergenerational family care as they age. To date, little is known about the strength and complexities of different intimate ties or the role of intergenerational dynamics in shaping ageing sexual minority people's care needs and choices. Based on narrative interviews with ageing Chinese lesbians and gay men, the findings reveal their experiences of constantly juggling their ties with families of origin, moral values around intergenerational care and the urge to receive support from and offer support to chosen networks of people. Participants exercised agency in expanding their networks of care by building friendship and (online and offline) community networks for mutual care and support in later life. Nevertheless, as evidenced by the centrality of ageing with(out) children, and the moral obligation of caring for parents in participants' narratives, participants experienced tensions between enacting what was considered morally right/wrong and developing networks of care that were perceived as emotionally intimate. Linking relational sociology with the sociology of morality, we discuss the conceptual utility of 'intimate networks of care' for sociological theorising of the linkages between sexuality, care and relational lives.

From Sheltered in Place to Thriving in Place: Pandemic Places of Aging

BACKGROUND AND OBJECTIVES

Response to the coronavirus disease 2019 pandemic required rapid changes to physical, social, and technological environments. There is a need to understand how independent-living older adults are adapting to pandemic-borne transformations of place and how environmental factors may shape experiences of aging well in the context of a public health emergency response.

RESEARCH DESIGN AND METHODS

We conducted a photovoice study to examine the characteristics associated with aging in place. Our study investigated how independent-living older adults characterized aging in a "right" place approximately 1 year after the onset of the pandemic.

RESULTS

Six themes categorized into 2 groups capture how older adults describe a "right" place to age. The first category, "places as enactors of identity and belonging," describes the significance of places contributing to intimate relationships, social connections, and a sense of personal continuity. The second category, "places as facilitators of activities and values," recognizes environments that promote health, hobbies, goals, and belief systems. Participants reported modifying their daily living environments with increased use of technology and more time outdoors.

DISCUSSION AND IMPLICATIONS

Our findings emphasize older adults' active engagement with place and strategies used to maintain healthy aging despite public health restrictions. The results also identify place-based characteristics that may help overcome stressful circumstances from older adults' perspectives. These findings inform pathways to pursue to facilitate resiliency for aging in place.

Reflexive Planning for Later Life: Minority Stress and Aging Challenges among Midlife Chinese Lesbians and Gay Men

This study examines how Chinese lesbians and gay men make sense of the prospect of growing old and plan for later life in Hong Kong, where same-sex relationships are yet to be legally recognized. Drawing on in-depth narrative interviews, the results show that lesbians and gay men in midlife reported a range of previous, current, and anticipated challenges associated with the stigma attached to homosexuality. These, in turn, shaped their ways of perceiving and planning for later life. Three forms of reflexivity in response to minority stress and the prospect of aging were identified: coping with fears of aging alone, striving for self-mastery, and planning ahead with feelings of wariness. Participants' concerns and plans around aging demonstrated differing degrees of reflexivity, through which they attempted to navigate family norms and structural constraints and find ways to accumulate resources for later life. Meanwhile, their heightened sense of uncertainty and insecurity showed that their perceptions and experiences of aging were influenced by minority stress and material, familial, and socio-political circumstances. This article builds a constructive dialogue between sexuality and aging studies by unraveling both the aging insecurity and capacities for reflexive planning among an oft-neglected group of sexual minority people in midlife.

Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study

BACKGROUND

Deprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients' and doctors' perspectives regarding the deprescribing of medications in older persons, particularly from developing countries. This study aimed to explore the necessities and concerns of deprescribing in older persons among older ambulatory patients and primary care trainees.

METHODS

A qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data.

RESULTS

Twenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges.

CONCLUSION

Deprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they 'didn't want to rock the boat'. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications.

Rethinking the residual policy response: Lessons from Hong Kong older women's responses to the COVID-19 pandemic

This article examines older women's experiences of searching for face masks and handling mask-related issues during COVID-19. Set within the context of the Hong Kong government's policy reaction to the shortage of masks in early 2020, the article draws on interviews with 40 older women in Hong Kong to identify their various forms of vulnerability to welfare threats and their active and diverse responses in times of crisis. The findings reveal the implications of the government's residual policy response for people's vulnerability to welfare threats. They also carry practical implications for the support that social workers can provide.

The Influence of Parent- and Adult Child-level Factors on Intergenerational Relationship Quality: A Study of Chinese Families with Multiple Children in Hong Kong

Intergenerational relationships have become increasingly crucial for maintaining well-being in aging families. Under a changing sociocultural background, families in Hong Kong increasingly exhibit diverse intergenerational relationships and functioning. Focusing on families with mutiple children, this study investigated how the characteristics of parents and their adult children jointly affect different domains of intergenerational relationship quality. A two-stage stratified random sampling design was adopted. Face-to-face questionnaire interviews were conducted between November 2016 and March 2017 with 1,001 Hong Kong residents aged ≥ 50 years. Data of 612 parents and 1,745 adult children were included for analysis. Hierarchical linear modeling was performed to examine child- and parent-level correlates of intergenerational relationship quality. Parents who were female, were married, had higher self-perceived economic status, owned a house, and had fewer depressive symptoms, exhibited higher intergenerational relationship quality. Parents' age was positively related to affectual closeness, whereas their educational level was negatively related to both affectual closeness and conflict. More favorable intergenerational relationships were reported by aging parents whose adult children were younger, female, and married. Children with higher educational levels exhibited higher levels of both affectual closeness and conflict with their parents. Moreover, affectual closeness was found to be transmitted between generations. The findings can help improve awareness of the factors affecting the different domains of intergenerational relationships, thus informing the development of targeted services and interventions to promote family relationships and well-being.

Public–private partnership in care provision for ageing‐in‐place: A comparative study in Guangdong, China

OBJECTIVE

This paper investigates how the public-private partnership (PPP) functions in the care provision for older people in Guangdong, China, particularly for ageing-in-place programs.

METHODS

Three cities with diversified PPP forms of care provision for older people were chosen as case studies. Focus groups were conducted in these cities for the local authorities and care homes involved in the partnerships.

RESULTS

Three forms of PPP, including private sector involvement for the ownership, construction, and operation of the facilities delivering care services, were identified. The public-private co-constructed and privately run model with greater private sector involvement may lead to higher quality care in one specific program. The publicly constructed and privately run program is widely used in many cities, advancing the expansion of ageing-in-place programs in more communities. These PPPs reflect flexible and practical collaboration between the public and private sectors at the local level in the Chinese context.

CONCLUSIONS

PPP have accelerated the development of a better care system for older people, mainly in terms of more affordable and higher-quality care options for the public. They are also a feasible solution for the local government due to more cost-effective and sustainable care provisions than previous publicly provided programs. The specific forms adopted are primarily associated with the scale of home care provision for ageing-in-place and the local government's financial capacity. Despite increasing private sector involvement, the public sector retains its crucial role in delivering care services targeting ageing in China.

Depression among poor older adults: The role of social support

RATIONALE

Depression should be investigated not only as a psychiatric symptom but also as a social issue. This research responds to recent calls and contributes to an understanding of the role played by social factors in the route toward the development of depressive symptoms.

OBJECTIVE

Our aim was to elaborate on the impact of poverty on depressive symptoms among Hong Kong's older people. To do this, we examined the potential of social support to both mediate and moderate the effect of poverty on symptoms of depression.

METHODS

Three waves of data were collected from a sample of Hong Kong's older adults (N = 563). Poverty was assessed as being either income-poor, expenditure-poor, asset-poor, or as experiencing material deprivation. Social support was measured in terms of instrumental support, financial support, and informational support.

RESULTS

When moderation and mediation were compared in the same model, only the role of moderation was identified as being significant. Instrumental support mitigated the effect of material deprivation on depression, while all three types of social support buffered the impact of expenditure-based poverty on depression.

CONCLUSIONS

Social support involves supplying coping resources to weaken the negative impacts of poverty rather than supplying social capital that the poor are deprived of. By its nature, the social support offered to the poor does not aim to provide them with the resources enjoyed by the rich, but to equip them with appropriate tools by which they can handle their own problems.

The filial piety paradox: Receiving social support from children can be negatively associated with quality of life

RATIONALE

Despite strong norms of filial obligation in Asian countries, little is known about whether child-provided support promotes older adults' well-being.

OBJECTIVE

This study sought to examine whether and how the source (e.g., child/non-child providers) and the form (e.g., financial, instrumental) of received social support are associated with older adults' quality of life.

METHODS

Data are from two waves of a longitudinal survey of older adults in Singapore (N = 2887). Two-wave mediation analyses were conducted to determine associations of the source and form of received social support with quality of life, and the extent to which personal mastery mediated these associations.

RESULTS

We find that, although receiving financial assistance from more children promotes older men's quality of life, older women's quality of life is eroded when receiving housework help from more children. These relationships are partially mediated through increase (for men) or decline (for women) in personal mastery.

CONCLUSIONS

The findings suggest that both the form and source of help provided to older adults matter. Receiving social support from children may not always benefit older adults - more attention is needed on how best to support older adults while giving them sufficient control to maintain a high quality of life.

Older Adults' Demand for Integrated Care and Its Influencing Factors: A Scoping Review

Introduction:

Integration has become a major concern for governments, healthcare and aged care systems in many countries. However, the research on and implementation of integrated care in China started relatively late, and there is no review on the needs of older adults with regard to integrated care and the influencing factors. Therefore, this paper aims to provide a scoping review by searching, evaluating, and summarizing the Chinese and international literature on the need for and the factors influencing integrated care for older people. In addition, this review highlights evidence of the gap between China and the world in integrated care.

Methods:

Using a framework proposed by Arksey and O’Malley, a systematic search of 12 domestic and international databases was conducted. Of the 890 original studies retrieved, those that met the established inclusion criteria were screened and scored using the Ekman quality assessment tool. The qualitative description method was used to summarize the demand for integrated care for older adults and the influencing factors.

Results:

A total of 49 papers were included. These studies were from eleven countries on five continents (most commonly China and the US) and were mostly cross-sectional quantitative studies that surveyed the integrated care needs of older people living in homes/communities or long-term care facilities. The analysis shows that existing research on the integrated care needs of older people in China adopts a single perspective and is inadequate and unsystematic in its assessment; the integrated care needs of older adults and the factors influencing them are multifaceted; and both in China and internationally, the community-home care scenario most consistently meets the needs and expectations of older adults.

Conclusion:

Although there is no uniform definition of integrated care in China or abroad and each country has its own national definition and system of integrated care, there are certain commonalities regarding the needs of older adults and the factors that influence them across countries. Our research reveals a gap between China and the international community in terms of integrated care.

Widowhood and Health Status Among Chinese Older Adults: The Mediation Effects of Different Types of Support

Although many studies have suggested that widowhood is related to worse health conditions among older adults, few have examined the mediation effects of social support between widowhood and health. Employing mediation analysis to a sample of data from the 2014 wave of China Longitudinal Aging Social Survey (CLASS), this study examined the mediation effects of social support, including emotional support, instrumental support, and companionship, in the widowhood-health association among older adults. The results indicated that the negative effect of widowhood on older adults' health was in part attributable to decreased emotional support and companionship. Specifically, emotional support exerted a significant role in the widowhood-mental health association, and companionship exerted a significant role in widowhood-physical health and widowhood-mental health associations. In the subsample analysis, the mediation effects were only significant among female older adults, and among rural older adults. Our findings highlight the importance of emotional support and companionship in maintaining health among widowed older adults and strategies should pay more attention to female and rural widowed older adults.

Societal Narratives on Caregivers in Asia

Although there has been an increase in awareness of the struggles experienced by caregivers, discourse on caregiving remains confined mostly to academia, policy circles or the family unit. There have been suggestions that public discourse on informal caregiving dwells overwhelmingly on the outsize toll it takes on the health of caregivers. However, few studies have examined societal narratives on caregivers-a gap our study aims to fill. We leveraged an online media database of 12 billion words collated from over 30 million articles to explore societal narratives on caregivers in six Asian countries. Computational linguistics and statistical analysis were applied to study the content of narratives on caregivers. The prevalence of societal narratives on caregivers was highest in Singapore-five times higher than Sri Lanka, which evidenced the lowest prevalence. Findings reveal that the inadequacies of institutional care as well as the need to train and empower caregivers are pressing issues that need to be prioritized on the policy agenda in Asia. Of broader significance, the diverse capabilities across Asia present opportunities for cross-country learning and capacity-building.

Adaptation and Validation of the Preparation for Future Care Needs Scale for Chinese Older Adults in Hong Kong

Background and Objectives

Care planning can protect against or offset potential stressors in the caregiving stage and mitigate their detrimental effects. This study aimed to translate, adapt, and validate 2 short forms of the multidimensional, theory-guided scale measuring preparation for future care needs (PFCN) among Chinese older adults in Hong Kong.

Research Design and Methods

Data were derived from a cross-sectional survey of 862 community-dwelling individuals aged 60 years and older. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to assess the structural validity of the scales. Criterion-related validity, known-groups validity, and internal consistency were also examined.

Results

EFA yielded a 14-item 4-factor (awareness, avoidance, decision making, and concrete planning) model, which was supported by CFA and explained 68.9% of the total variance. CFA also supported the structural validity of the 5-item scale. Criterion-related validity of the 2 scales was supported by their significant and positive correlations with domain-specific planning behaviors for retirement. Known-groups validity of the 2 scales was demonstrated by significant differences in scores between male and female older adults and scores between different educational levels and socioeconomic status. Cronbach’s alphas for the internal consistency of the 14-item and 5-item scales were 0.889 and 0.774, respectively.

Discussion and Implications

PFCN scales enable researchers and service practitioners to accurately understand and assess older adults’ processes and efforts in care planning, facilitate the identification of individuals at risk from inadequate planning, and inform the development of interventions to enhance care preparation in target domains.

Association between Personal Social Capital and Loneliness among Widowed Older People

To explore the association between the personal social capital and loneliness among the widowed older adults in China. Data from 1497 widowed older adults were extracted from China's Health-Related Quality of Life Survey for Older Adults 2018. The Chinese version of the Personal Social Capital Scale (PSCS-16) was used to evaluate the participants' status of bonding and bridging social capital (BOC and BRC). Loneliness was assessed by the short-form UCLA Loneliness Scale (ULS-8). Multiple linear regression models were established to examine the relationship between social capital and loneliness. The BOC and BRC of rural widowed older people were significantly lower than those of widowed older people in urban areas, while loneliness of rural widowed older people was higher than that of widowed older people in urban areas. The result of the final model showed that loneliness of rural participants was significantly associated with both BOC (B = 0.141, p = 0.001) and BRC (B = -0.116, p = 0.003). The loneliness of the urban widowed sample had no association with both BOC and BRC (p > 0.05). These findings suggested that more social support and compassionate care should be provided to enrich the personal social capital and thus to reduce loneliness of widowed older adults, especially those in rural areas.