Spilling over Strain between Elders and Their Caregivers in Hong Kong

Should Cash Subsidy Be Offered to Family Caregivers for the Elderly? The Case of Hong Kong

Hong Kong's Covid-19 epidemic circumstances have given us a valuable opportunity to reflect on Hong Kong's elderly care policies. This essay argues that Hong Kong should learn from the West and provide a subsidy to family caregivers for proper elderly care. We rebut the social and moralistic reasons for not introducing such a subsidy in Hong Kong. We indicate that providing cash subsidy to family caregivers does not monetize or tarnish Confucian filial obligation to take care of elderly people, but enable adult children from low-income families to undertake this obligation effectively. In addition, we contend that providing such a subsidy would not significantly affect the job market in Hong Kong and that incurred financial and manpower costs for monitoring family care are controllable.

Physical exercise for individuals with dementia: potential benefits perceived by formal caregivers

Background

The social and economic impact of dementia for the development of accessible and sustainable care for individuals with dementia (IwD). Physical exercise has been seen as a beneficial non-pharmacological therapy in the prevention and management of dementia, and possible benefits may not only impact on participants, but also indirectly on their caregivers. Thus, this quasi-experimental non-randomized study aimed to analyze the effects of an exercise intervention on functional capacity, behavioural and psychological symptoms in dementia (BPSD) and quality of life of institutionalized older adults with dementia, perceived by their formal caregivers.

Methods

Sixty-four institutionalized older adults (from both genders, aged 65–93 yrs. old), clinically diagnosed with dementia, were divided into two groups: control group (CG, continued with usual care, n = 26) and exercise group (EG, 6-month supervised multicomponent exercise intervention, n = 38). Nine caregivers (female, aged 28–47 yrs. old) from nine different nursing homes, reported about their distress related to BPSD and proxy-reported about participants’ functional capacity (Katz index), quality of life (QoL-AD), BPSD (NPI) before and after 6 months of an exercise intervention (aerobic, muscular resistance, flexibility and postural exercises).

Results

A two-way ANOVA, with repeated measures, revealed significant group and time interactions on Total Katz index and QoL-AD. The CG’s performance functional capacity and quality of life score worsen over time while in EG maintains these values after the exercise intervention. Moreover, formal caregiver’s distress triggered by apathy and disinhibition increased in CG while after 6 months of an exercise intervention no alterations were seen regarding these distress causes in EG. No significant main effects were observed for total NPI score or NPI distress.

Conclusions

Overall results show that after the exercise intervention, IwD from the EG, was capable of preserving the functional capacity, quality of life and neuropsychiatric symptoms were attenuate, contributing to a lower load of distress for the caregivers.

Trial registration

clinicaltrials.gov, NCT04095962. Retrospectively registered on 19 September 2019

Towards Ethically and Medically Sustainable Care for the Elderly: The Case of China

An enormous challenge facing China is how to provide sustainable care for its rapidly-increasing elderly population. Its recent policy directives include three medical forms-the institution-cooperation-form, the institution-medical-form, and the family-physician-form-to integrate medical care into ordinary care for the elderly. This essay indicates that China will not be able to maintain sustainable elderly care unless it places emphasis on the family-physician-form that focuses on family physicians and the use of primary care services. The essay constructs arguments for this policy suggestion based on China's long-standing Confucian ethical resources of filial piety and family-based concerns for elderly care.

Stigma, the medical model and dementia care: Psychological growth in senior health professionals through moral and professional integrity

Minimal research explores the impact of a career in dementia care on senior health professionals. This study sought positive and negative subjective interpretations from seven senior health professionals regarding their experiences in dementia care. Data from semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). One superordinate theme, Honouring stigmatised self, overarched four sub-themes: Systemic stigma, Invalidated, Self-respect and Moral integrity and Growth. Stigma was interpreted as systemically entrenched minimisation of aged care and the aged-care workforce, including poor remuneration and training. Participants experienced peer invalidation particularly when attempting to resolve complex professional and moral challenges in dementia care. These often occurred in the context of efforts to individualise care, constrained within a medical model. Paradoxically, external invalidation motivated a search for redefining ‘self’ and moral integrity. By wisely acknowledging career experience, growthful domains of self-respect, optimism, humility and innovation defined professional practice and personal choices. Implications are discussed.

Shame, hope, intimacy and growth: Dementia distress and growth in families from the perspective of senior aged care professionals

Minimal research explores the impact of dementia and a dementia diagnosis on families from the unique vantage of senior health professionals. The participants of this study, eight senior aged care professionals, provided unique interpretative insights into family dynamics and sense-making on the journey with dementia, and their own role in that journey. Both positive and negative perspectives were sought. Data from semi-structured interviews were analysed using Interpretative Phenomenological Analysis (IPA). One superordinate theme, Dementia naiveté; redefined intimacy, overarched Embarrassed shame; Maintaining hope; Redefining a model of intimacy; and Redefined relational intimacy and growth. Within these themes, the participants shed light on hurtful embarrassment and shame experienced by families associated with the diagnostic label given to a loved one. This label was perceived to either trigger separation, hurt and immobility through ignorance, or precipitate a frenzy of naive yet hopeful energy for seeking that elusive cure. The participants saw their role as one of enacting a new way of connecting what was with what could be. Thus, they modelled advocacy, integral care and relational intimacy. Validation came in witnessing a redefining of intimacy in many families who were able to embrace that holistic and empathic approach to the shifting presentation of dementia. Psychological well-being was observed to occur when families embraced growthful domains, e.g. acceptance, hope, relational closeness and altruistic concern for other families. Implications for future care models are discussed.

Motor and multisensory care-based approach in dementia: long-term effects of a pilot study

This study examined the short-, mid-, and long-term effects of a motor and multisensory care-based approach on (i) the behavior of institutionalized residents with dementia and (ii) care practices according to staff perspective. In all, 6 residents with moderate to severe dementia (mean age 80.83 ± 10.87 years) and 6 staff members (40 ± 10.87 years old) were recruited. Motor and multisensory stimulation strategies were implemented in residents' morning care. Data were collected with video recordings and focus-group interviews before, immediately after, at 3 months and 6 months after the intervention. The frequency and duration of each resident's behavior were analyzed. Content analysis was also performed. Results showed short-term improvements in residents' communication and engagement, followed by a sustained decline over time. Staff reported to change their practices; however, difficulties related to the institution organization were identified. There is a need to implement long-term strategies and involve institutions at different organizational levels to sustain the results.

The relationship between psychological resources, social resources, and depression: results from older spousal caregivers in Hong Kong

OBJECTIVES

The rapidly ageing population in Hong Kong has led to a major concern in providing care for the elderly. Due to the current social changes in Hong Kong, such as smaller family size, longer life spans, and increasing employment demands, spouses increasingly serve as the primary caregivers for older adults. To explore the mental health of older spousal caregivers, this study investigated the relationships between psychological resources, social resources, and depression.

METHOD

One hundred fifty-eight spousal caregivers aged 55 and above were recruited from 13 caregiver resource centres in Hong Kong. Data were collected using structured questionnaires.

RESULTS

Hierarchical regression analysis revealed that the number of duties and psychological resources including purpose in life, caregiver burden, and personal wellbeing explained 56% of the variance in depression. Logistic regression analysis further indicated that purpose in life predicted the likelihood of depression reported by caregivers. Social resources did not significantly predict depression.

CONCLUSION

Results suggest that mental health enhancement programs should be developed for Chinese spousal caregivers with a focus on purpose in life, burden, and personal wellbeing.

Strain in nursing care of people with dementia: nurses' experience in Australia, Sweden and United Kingdom

OBJECTIVES

The aim of this study was to explore nurses' experience of strain in dementia care.

METHOD

Focus groups were held with 35 nurses in Sweden, Australia and UK, who care for people with dementia. The discussions were tape-recorded and analysed using qualitative content analysis.

RESULTS

The nurses described the complexity of their situation and referred to environmental factors such as 'the system', community attitudes, other staff, residents' family members and also their own family. With regard to caring for people with dementia, three main sources of strain could be identified: Being unable to reach; Trying to protect; and Having to balance competing needs.

CONCLUSION

The nurses' experience could be understood as a desire to do the best for the people in their care by trying to alleviate their suffering and enhance their quality of life. When they did not have the resources, opportunity or ability to do this, it caused strain.