Validating interRAI Chinese self-reported carer needs (SCaN) assessment and predicting caregiving distress among informal Chinese caregivers of older adults.

BACKGROUND: This study aims to (1) determine the reliability and validity of the interRAI Chinese Self-reported Carer Needs (SCaN) assessment among informal Chinese caregivers of older adults, (2) identify predictors of caregiving distress in Asian regions with long-standing Confucian values of filial piety and family responsibility. METHODS: This cross-sectional study recruited 531 informal Chinese caregivers of older adults in Hong Kong, Shanghai, Taiwan, and Singapore. The scale reliability was examined using Cronbach's alphas (α) and McDonald's omega coefficient (ω). The concurrent validity and discriminant validity were assessed using Spearman rank correlations (rho). To examine the predictors of caregiving distress among informal caregivers of older adults, we employed hierarchical linear regression analyses informed by the Model of Carer Stress and Burden and categorized the predictors into six domains. RESULTS: Results revealed good internal consistency reliability (α = 0.83-0.96) and concurrent validity (rho = 0.45-0.74) of the interRAI Chinese SCaN assessment. Hierarchical linear regression analysis revealed that entering the background factors, primary stressors, secondary stressors, appraisal, and exacerbating factors all significantly enhanced the model's predictability, indicating that the source of caregiving distress is multidimensional. In the full model, caregivers with longer informal care time, lack of support from family and friends, have unmet needs, experience role overload, have sleep problems, and low IADL functioning are at a higher risk of caregiving distress. CONCLUSIONS: The interRAI Chinese SCaN Assessment was found to be a reliable and valid tool among the Chinese informal caregivers of older adults. It would be useful for determining family caregivers' strengths, needs, and challenges, and tailoring interventions that address the potentially modifiable factors associated with caregiving distress and maximize support. Healthcare providers working in home and community settings should be aware of the early identification of caregiving distress and routine assessment of their needs and empower them to continue taking care of their needs and providing adequate care to the care recipient.

"Do Your Best to Avoid it": Appraisals and Coping with Discrimination-Related Stress Among Older Chinese Immigrants in Affordable Senior Housings During the COVID-19 Pandemic.

This study investigated how older Chinese immigrants in affordable senior housing facilities (ASHs) appraise and cope with anti-Asian discrimination and related stress during the COVID-19 pandemic. Qualitative interviews were conducted with 26 participants aged over 65, analyzing verbatim transcripts and field notes using thematic analysis. Four major domains were identified: (1) discriminatory experience, (2) appraisals of discrimination stress, (3) coping strategies, and (4) rationales behind coping. Among the participants, 11 (42%) reported experiencing discrimination either personally or by someone they know. Participants' appraisals of discrimination stress varied, and most of them opted for disengagement coping strategies (e.g., avoidance, rationalization) attributing them to health concerns, individual characteristics, environmental and societal factors, and low acculturation. The findings suggest the need for more social and community resources to enhance coping capacity and resilience in this vulnerable population.

Social network and mental health of Chinese immigrants in affordable senior housing during the COVID-19 pandemic: a mixed-methods study.

OBJECTIVE: Chinese immigrant older adults who live in affordable housing are at high risk of experiencing social isolation during the COVID-19 pandemic, which can affect their mental health. Using a triangulation mixed-methods approach, this study describes Chinese immigrant older adults' social network, mental health status, and their associations during the pandemic. METHODS: Semi-structured in-depth interviews were conducted with 26 Chinese immigrant older adults from June to August 2021. The structure and characteristics of participants' social networks were assessed with a name-generating approach. Mental health status was self-reported with Geriatric Depression Scale and UCLA loneliness scale. RESULTS: This sample (mean age = 78.12, 69.23% female), on average, had 5.08 social ties in their network, and 58% were family ties. Participants reported decreased social contact, family and friends interaction patterns specific to immigrants, and constantly being in a low mood and bored. Having closer relationships with others and maintaining the same or higher contact frequency after COVID-19 onset was associated with fewer depressive symptoms. Resilience from religious beliefs, neighbors as role models, and wisdom learned from past experiences were reported. CONCLUSION: Knowledge built in this study can inform respondence to future crises like the COVID-19 pandemic in affordable housing settings serving older immigrant populations.

A Social-Ecological Approach to Understanding Activity Engagement Patterns Among Older Chinese Immigrants.

Few studies have focused on activity engagement among older immigrants. We aim to map the patterns of activity engagement and examine the associations with social-ecological factors in a sample of older Chinese immigrants. Participants were from the Population Study of Chinese Elderly in Chicago (PINE). Four patterns of activity engagement were identified through latent class analysis: restricted, diverse, informal social, and community-based social. Intrapersonal, interpersonal, cultural, and environmental factors distinguished latent classes of activity engagement. In particular, acculturation and family-oriented immigration differentiated the restricted from the diverse class membership. Positive attributes of social environment such as social network size, positive social support, and neighborhood cohesion were associated with the likelihood of categorization in the diverse, informal social, and community-based social groups relative to the restricted group. Findings point to the importance of positive attributes of social environment in enhancing engagement with life among older Chinese immigrants.

Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents.

BACKGROUND: Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids. METHODS: Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses. RESULTS: Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline. CONCLUSION: In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.

Use of Home and Community Based Services in Urban China: Experiences of Older Adults with Disabilities.

This study examined the factors related to the use of home and community based services (HCBS) by urban Chinese older adults with disabilities. The study used data from the 2006 Sample Survey on Aged Population in Urban/Rural China. A total of 3,920 older adults who experienced at least one disability were included in this sample. Of the study participants, 13.9% used housekeeping services and 12.2% used doctor/nurse home visit services. Results from logistic regression tests showed that older adults' gender, educational attainment, financial strain, family support, and number of chronic illnesses were significantly related to their use of housekeeping services. Additionally, older adults' levels of disability were significantly related to doctor/nurse home visit services. Findings underscore the importance of service needs in Chinese older adults' use of HCBS and also reveal that factors related to service use vary depending on specific services.

Loss of friends and psychological well-being of older Chinese immigrants.

BACKGROUND AND OBJECTIVES: Focusing on a less studied aspect of friendship and an overlooked type of loss, this study examined associations between loss of friends and psychological well-being among older Chinese immigrants and whether such associations are moderated by age, gender, marital status, and social connection. RESEARCH METHODS: This study used baseline data from the Population Study of Chinese Elderly in Chicago. Linear and logistic regressions tested whether the loss of friends was associated depressive symptoms, loneliness, and quality of life . Interaction terms were created to test the moderating effects . RESULTS: Losing friends was associated with a greater sense of loneliness but also a higher chance of reporting good quality of life. The association between the loss of friends and loneliness was stronger among married and young-old (59-69) participants . The association between the loss of friends and quality of life was stronger among young-old and old-old (70-79) participants and the participants with the high level of social connection. DISCUSSION AND IMPLICATIONS: Findings shed light on the importance of the loss of friends in shaping psychological well-being among older immigrants. More research is needed to understand the needs of older friend survivors and develop relevant interventions.

Validation of the Quality of Dying and Death Questionnaire among the Chinese populations.

OBJECTIVE: This study reports the evaluation of the original 31-item Quality of Dying and Death Questionnaire (QODD) using a sample of caregivers of recently deceased older adults in China, and the validation of a shortened version (QODD-C) derived from the original scale. METHODS: The translation was performed using a forward and back method. The full scale was tested with 212 caregivers of decedents in four regions of China. Confirmatory factor analysis tested the model fit between the full Chinese version and the original conceptual model and generated the QODD-C. The psychometric analysis was performed to evaluate the QODD-C's internal consistency, content validity, construct validity, and discriminant validity. RESULTS: A five-domain, 18-item QODD-C was identified with excellent internal consistency reliability (Cronbach's α = 0.933; split-half Pearson's value = 0.855). The QODD-C total score was significantly associated with constructs related to five domains. The caregiver's relationship with the decedent, the decedent's age at death, death reason, and death place was significantly associated with the QODD-C total score. SIGNIFICANCE OF RESULTS: The QODD-C is a valid and reliable instrument for assessing the quality of dying and death among the Chinese populations.

Acculturation and health behaviors among older Chinese immigrants in the United States: A qualitative descriptive study.

Older immigrants tend to experience rapid deterioration in health after immigration. Changes in health behaviors over the course of acculturation are considered attributable factors. However, much remains unknown when it comes to acculturation experiences and health behaviors among older immigrants. This study explored acculturation in three domains (behavioral, cognitive, and identificational) and described how each domain of acculturation could influence various health behaviors among community-dwelling older Chinese immigrants in the United States. In this qualitative descriptive study, trained bilingual interviewers conducted in-depth individual interviews with 24 participants in the greater Los Angeles area. Acculturation experiences emerged from qualitative content analysis, such as high dependence on Chinese behavioral patterns and intraethnic networks and limited intergroup interactions (behavioral acculturation), strong maintenance of Chinese cultural values and some American cultural learning (cognitive acculturation), and strong identification with Chinese ethnicity (identificational acculturation). Behavioral acculturation and cognitive acculturation may influence various health behaviors, including eating/diet, exercise, chronic disease, and mental health management. By recognizing the unique acculturation experiences, interventions could be developed to promote healthy behaviors in achieving optimal health in this population.

Beyond Just Giving Care: Exploring the Role of Culture in Chinese American Personal Care Aides' Work.

As the number of older Chinese Americans with immigration background increases, there is a growing need for Chinese American personal care aides (CA-PCAs) to assist them with aging at home by providing culturally congruent and linguistically competent service. However, little is known about how culture factors into the caregiving process and influences CA-PCAs' well-being. In this study, two focus groups were conducted with ten immigrant CA-PCAs and conventional content analysis was used to analyze the qualitative data. Seven cultural themes were identified, including guanxi (relationship), renqing (favor), mianzi/lian (face), hierarchy and authority, communication, harmony, and elder respect. By drawing attention to the idiosyncratic cultural landscape and entailed challenges faced by underrepresented CA-PCAs, the investigators corroborate the importance of cultural sensitivity for working with ethnic minority non-familial caregivers. The findings shed light on cultural factors that can be targeted by culturally sensitive direct practices, programs, and policies.

Seasonal pattern of single falls and recurrent falls amongst community-dwelling older adults first applying for long-term care services in Hong Kong.

BACKGROUND: few studies had investigated seasonal pattern of recurrent falls. OBJECTIVE: to examine seasonal pattern of both single and recurrent falls amongst community-dwelling older adults first applying for long-term care (LTC) services. METHODS: a cohort of 89,100 community-dwelling Hong Kong older adults aged 65 and over first applying for LTC services from 2005 to 2014 was obtained. Logistic regression models were used to examine seasonal pattern in single and recurrent falls, whilst controlling for gender, age and year. RESULTS: amongst 89,100 older adults, about 32% fell in past 90 days. Amongst the fallers, 34% fell recurrently. In 2014, the incidences of all fall, single fall and recurrent fall were 1.95, 0.80 and 1.15 per person-years, respectively. For single falls, the 90-day fall risk was highest during November to February with an odds ratio (OR) of 1.29 (95% confidence interval [CI] 1.19-1.41), compared with the lowest one during July to October. For recurrent falls, the highest OR for 90-day risk was highest during November to February (1.46, 95% CI 1.31-1.64) as well. CONCLUSIONS: single and recurrent falls both peaked during winter months. Interventions, such as implementing educational publicity and sending reminder to older adults in fall season, may be considered.

Widowhood, leisure activity engagement, and cognitive function among older adults.

OBJECTIVES: Maintaining cognitive function is an essential aspect of successful aging. Widowhood is a salient life transition that can affect older adults' cognitive function. Leisure engagement has received increasing attention because it is still modifiable in later life to help prevent cognitive decline. Nonetheless, limited longitudinal studies have examined how widowhood influences cognitive function, and even fewer studies have tested the role of leisure activities in this relationship. METHOD: This study delineated the mechanism of widowhood, leisure activity engagement, and cognitive function among older adults using a national longitudinal dataset, the Health and Retirement Study, and its supplementary dataset, the Consumption and Activities Mail Survey, which repeatedly measured individuals' leisure activity engagement. RESULTS: Findings showed no significant association between widowhood and cognitive function during a 4-year period. However, engagement in mental activities moderated the impact of widowhood on cognitive function. Specifically, the benefit of mental activity engagement on cognition was more pronounced among individuals who were recently widowed compared to those who were married. This implies a protective role of mental activities in the relationship between widowhood and cognitive function. CONCLUSION: Interventions with mentally stimulating activities at the community level to retain cognition among individuals in early phase widowhoodare suggested. Future studies are necessary to explore whether other factors such as changes in physical and mental health and intergenerational support from adult children during widowhood may further influence this mechanism among widowhood, leisure activities, and cognitive function.

Geographical proximity and depressive symptoms among adult child caregivers: social support as a moderator.

OBJECTIVES: This study examined whether geographical proximity is a predictor of depressive symptoms, and whether family and friend support can moderate the relationship between geographical proximity and depressive symptoms. METHOD: A survey of 557 adult child primary caregivers was conducted in Shanghai, China in 2013. Geographical proximity was measured as a categorical variable: coresidence, short distance (less than 30 minutes' travel time), and long distance (more than 30 minutes' travel time). Family and friend support were assessed using the Multidimensional Scale of Perceived Social Support. Depressive symptoms were evaluated using the Center on Epidemiologic Studies Depression Scale. Multiple regression analyses and interaction terms were used to test the moderating roles of family and friend support. RESULTS: Adult child caregivers who live more than 30 minutes away from care recipients experienced higher depressive symptoms than coresiding caregivers (ß = .114, p < .01). Family support (ß = -.408, p < .05) and friend support (ß = -.235, p < .05) were protective factors that lessened depressive symptoms for long-distance adult child caregivers. CONCLUSION: This study adds spatial dimension to caregiving literature and extends stress process theory. These findings have important implications for service planning and social support for adult child caregivers.

Art therapy for anxiety, depression, and fatigue in females with breast cancer: A systematic review.

This systematic review employed a meta-analysis to examine the effectiveness of art therapy for treating anxiety, depression, and fatigue in female patients with breast cancer, the most prevalent cancer and the most common cause of cancer-related mortality among women worldwide. The review included nine original studies and analyzed data from a total of 754 patients. Data extraction and quality assessment were conducted by two independent reviewers. In total, 1,466 articles were retrieved. We excluded studies in which the participant, interventions, and study design did not satisfy the inclusion criteria, leaving nine articles for analysis, The Cochrane risk of bias assessment tools were used for quality evaluation. The analysis revealed a significant difference in treatment outcomes between patients who received art therapy and those who did not (SMD = -0.48, 95%CI [-0.75, -0.21, p = 0.0005]). The review provides initial evidence to suggest that art therapy benefits female breast cancer patients with respect to the treatment of anxiety, depression, and fatigue. However, additional and better-quality studies must be conducted, particularly with larger sample sizes, greater specificity of the design of trials and interventions, and a longer follow-up duration.

Developmental regulation of lifelong dental experiences and beliefs in Guangzhou and Hong Kong.

AIMS: The aim of this study was to explain through the life-course and life-span perspectives of developmental regulation theory the controls on dental experiences and beliefs throughout the lives of older people in Guangzhou and Hong Kong. BACKGROUND: Dental diseases and disabilities among older people are serious public health concerns in China. METHODS: A facilitator conducted eight focus groups, three in Hong Kong and five in Guangzhou, involving a total of 51 participants. She encouraged discussions about lifetime events to explain dental experiences and beliefs. Transcripts were coded and analysed using a constant comparative approach to identify themes that explained the regulators of dental experiences throughout the participants' lives. RESULTS: Participants explained the influence of culture and history through critical events, and how external and internal factors regulated their current oral health status and beliefs. They emphasised the role of Traditional Chinese Medicine and family, and the stress of social upheaval compounded by a scarcity of dental services. They revealed also how current choice of dental services and health promotional programs, helped by personal food choice, self-reliance, and scepticism, helped them to adjust and cope with dental diseases and disabilities and the commercialisation of dental services. CONCLUSIONS: Dental experiences and beliefs of older people living in Guangzhou and Hong Kong were regulated strongly during personal development by culture and history during critical events, and by various controlling factors, such as health promotion and choice of services supplemented by food choice, nutritional balance, self-reliance, scepticism and social adjustments.

Training needs for dementia care in China from the perspectives of mental health providers: who, what, and how.

ABSTRACTBackground:Acknowledging increasing demand of dementia care for patients in China, this paper aims to understand the training needs of dementia care from the perspectives of mental health providers by examining who should be the trainees, what should be the contents of training, and how to deliver the training in China. METHODS: Using purposive sampling, data were gathered via four focus group discussions with 40 mental health providers in Beijing, China, in 2011. Data were transcribed by independent investigators and then translated into English. Researchers used content analysis to separately identify themes and codes. Discrepancies were discussed until final agreement achieved. RESULTS: To improve the quality of dementia care, all participants agreed there is a significant need to train both formal or professional (physicians, nurses, hospital administrators, community workers) and informal caregivers (family, friends, or non-kin hired caregivers). For formal or professional caregivers, suggested training content included clinical knowledge of dementia (i.e. pathogenesis, approaches for preventing dementia deterioration) and clinical practice skills (i.e. diagnostic, treatment, caregiving, counseling, communicating skills). For informal caregivers, basic dementia knowledge and home-based caregiving skills such as safety, restorative, stress management, and communication were identified as key training contents. Multilevel support from the government and community centers were considered crucial factors to delivering the training and educating the public to enhance awareness of dementia. CONCLUSIONS: Culturally, sensitive education and specific trainings for formal and informal dementia caregivers are urgently needed in China. Policy and program implications are discussed.

Challenges and resilience related to aging in the United States among older Chinese immigrants.

OBJECTIVES: This study sought to identify challenges and protective factors for resilience related to the process of aging among older Chinese immigrants in the United States. METHODS: This study used qualitative methods and involved 24 in-depth interviews with Chinese immigrants aged 65 or older in Los Angeles. Content analysis was employed to analyze qualitative data. RESULTS: Three major themes emerged regarding challenges older Chinese immigrants encountered in aging in the United States: language barriers, loneliness and social isolation, and insufficient use of social services. Four themes were identified regarding resilience protective factors: acceptance and optimism; independence and autonomy; informal social support; and use of the formal social welfare system. CONCLUSION: This study provides several implications for future human services to build relational and societal resilience and enhance Chinese older immigrants' personal resilience. Cultural strengths should be taken into consideration by practitioners and policy makers.

Intergenerational relationships and the trajectory of depressive symptoms among older Chinese adults in rural migrant families.

OBJECTIVES: This study examined the trajectory patterns of depressive symptoms of older rural Chinese adults in migrant families and the role of intergenerational relationships in predicting trajectory class memberships. METHOD: Data were derived from the 2001, 2003, 2006, and 2009 waves of a longitudinal survey titled The Well-being of Older People in Anhui Province. The sample featured 486 respondents who had at least one migrant adult children at all four waves. Growth mixture modeling was used to investigate the trajectory classifications of depressive symptoms from 2001 to 2009 and antecedents in differentiating among class memberships. RESULTS: The findings suggested a two-class model to interpret depressive symptom trajectory patterns: persistently high symptoms and low but increasing symptoms. Older adults who had better intergenerational relationships at baseline were more likely to have low but increasing depressive symptoms after controlling for other covariates. DISCUSSION: The findings suggest that intergenerational relationships have long-term impacts on depressive symptom trajectory classes. Policy and intervention implications are discussed.

Worry about not having a caregiver and depressive symptoms among widowed older adults in China: the role of family support.

OBJECTIVES: Using the stress-coping framework, this study examined whether worry about not having a caregiver in old age was associated with depressive symptoms among widowed Chinese older adults, including the moderating effects of self-perceived family support. METHOD: Using a sample of 5331 widowed adults aged 60 years old or older from the 2006 National Sample Survey of the Aged Population in Urban/Rural China, we regressed measures of depressive symptoms on worry about not having a caregiver. We also tested moderation effects of family support. RESULTS: Individuals who were worried about not having a caregiver reported significantly higher levels of depressive symptoms. Feeling that their children are filial, having instrumental support from children, and having only daughters moderated the effects of worry about not having a caregiver on depressive symptoms. CONCLUSION: Our findings indicate the detrimental effects of worry about not having a caregiver on the psychological well-being of widowed older adults. This study also highlights some forms of family support that may help reduce such negative effects of widowhood.

Can domestic helpers moderate distress of offspring caregivers of cognitively impaired older adults?

OBJECTIVE: This study examined the moderating effect of domestic helpers on distress of offspring caring for parents with cognitive impairments and with or without behavioural problems. METHOD: This secondary analysis of data involved 5086 Hong Kong Chinese adults aged 60 or older applying for public long-term care services from 2010 to 2012. All variables were measured using the mandatory Hong Kong version of the Minimum Data Set-Home Care 2.0. RESULTS: Regarding taking care of parents with cognitive impairments, 10.7% of offspring primary caregivers were aided by domestic helpers, 55.54% reported distress, and 75.70% lived with their parents. Assistance from domestic helpers reduced offspring caregiver distress if the offspring provided psychological support to parents (ratio of OR = 0.655, p < .05) and were not living with parents (ratio of OR = 1.183, p < .01). CONCLUSION: These findings might suggest: a) the positive effects of audience on psychological responses to stress; b) caregiving is usually less stressful for informal caregivers not residing with care recipients. Conversely, having a domestic helper could add to caregiving distress if offspring caregivers live with their parents, most likely because offspring may witness difficulties that domestic helpers face in providing dementia care.