Journey to inpatient hospice care: A qualitative study on the decision-making process of Chinese family caregivers of persons with terminal cancer.

OBJECTIVE: To understand family caregivers' decision-making process to place their family members with terminal cancer in inpatient hospice care, especially in the social-cultural contexts whereby the caregivers have a dominant say about the care of their seriously ill family members. METHODS: A qualitative study with a phenomenological approach was undertaken to understand the lived experience of caregivers of persons with terminal cancer in the decision-making process. Semi-structured qualitative interviews were conducted with a purposive sample of 17 caregivers in Shanghai, China. Thematic analysis was used to analyze the data. RESULTS: The caregivers underwent a winding and socioculturally mediated four-stage process. The stages are (i) trigger for alternatives: lost hope for a cure, (ii) meandering the see-saw process, (iii) the last straws: physical limitations and witnessing unbearable suffering, and (iv) the aftermath: acceptance versus lingering hope. Caregivers' attitudes towards death and their family members with advanced cancer expressed care wishes influence the state of the aftermath. CONCLUSIONS: Chinese sociocultural values and beliefs about caregiving and death provide insightful explanations for the observed process. PRACTICAL IMPLICATIONS: Training healthcare professionals in cultural competence, developing an effective hospice referral system, and delivering socioculturally acceptable death education are critical interventions to facilitate better decision-making experiences.

Safeguarding health equality for the disadvantaged during the COVID-19 pandemic: Lessons learned for the social work profession.

An evaluation of the role played by the social work profession during the outbreak of COVID-19 is necessary. Although social workers have made efforts to address people's needs during the pandemic, it is worth examining the role they have played in safeguarding health equality. Focusing on the case of Hong Kong, we found that the profession was generally ill-prepared for the outbreak, and in particular, for confronting the attendant social inequalities. We identified three possible reasons for these findings: 1) non-governmental organizations were caught off-guard by the outbreak, 2) there was no clearly articulated intervention agenda to inform practitioners of the roles they should play in such a large-scale crisis, and 3) having become more formalized and standardized, social work services may have become less flexible in responding to emerging community needs. We conclude this article by suggesting three directions that could allow the profession to better pursue its mission during large-scale crises.

Determinants of Patterns of Need for Home and Community-Based Care Services Among Community-Dwelling Older People in Urban China: The Role of Living Arrangement and Filial Piety.

This study aims to identify older people's home- and community-based care (HCBC) service need patterns and explore the role of living arrangement and filial piety in affecting such patterns. A total of 556 older people were selected in Beijing, China. Latent class analysis and multinomial logistic regression were adopted to identify the service need patterns and the influencing factors. A three-class model of service need patterns was explored (high-needs group, moderate-needs group, and low-needs group). Living arrangement was related to HCBC service need patterns. Compared with the high-needs group, those living with at least two family members were more likely to express low needs or moderate needs. Living arrangement was a moderator for the effect of filial piety on HCBC needs. Greater recognition of the effects of living arrangement and filial piety should enrich the Andersen model and provide a robust stimulus for long-term care policy development and for service delivery and social work.

Self-Perceptions of Aging and Control of Life in Late Adulthood: Between-Person and Within-Person Associations.

Objectives: This study aimed to examine the longitudinal relationship between two central concepts in aging research-self-perceptions of aging (SPA) and perceived control of life (COL). Method: The data came from three measurement points over a 9-year period in the Health and Retirement Study (HRS). A random intercepts cross-lagged panel model (RI-CLPM) was estimated. Results: The covariations between SPA and COL across 9 years were evident at both the between-person level and the within-person within-time level. The results revealed a reciprocal relationship between SPA and COL: Higher than usual negative SPA predicted within-person decreases in COL 4 years later, and lower than usual COL predicted future within-person increases in negative SPA. Furthermore, SPA were found to have a somewhat larger effect on COL than the corresponding influence of COL on SPA. Discussion: This study enriches the stereotype embodiment theory and the practice by documenting a reciprocal interrelationship between SPA and COL.

The Longitudinal Associations between Physical Health and Mental Health among Older Adults.

OBJECTIVES: This study examines the lead-lag relationship between physical and mental health among older adults. METHOD: Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated. RESULTS: Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health. CONCLUSION: This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems.

An exploration of older Hong Kong residents' willingness to make copayments toward vouchers for community care.

Because of its rapidly aging population, Hong Kong faces great challenges in the provision and financing of long-term care (LTC) and needs to explore sustainable funding mechanisms. However, there is a paucity of research on older people's willingness to pay (WTP) for LTC services in Hong Kong. This study utilizes data collected in Hong Kong in 2011 (N = 536) to investigate older people's receptivity to this financing mode by assessing their co-payments for a community care service voucher scheme and then testing how potential factors affect respondents' amount of co-payment. Results show that respondents' WTP was positively associated with family financial support, financial condition, and positive attitudes toward this novel policy and negatively associated with family caregiving support. Direct and moderating effects of family financial support on WTP were found. The policy-related implications of LTC financing to improve older people's acceptance of co-payment mechanisms, financial condition, and shared responsibility of care are discussed.

Factors associated with older people's long-term care needs: a case study adopting the expanded version of the Anderson Model in China.

BACKGROUND: Alongside changes in society and the economy, the family's function of taking care of older people is weakening and the formal care mode is becoming more accepted. Older Chinese people are facing diverse choices of long-term care (LTC) modes. Acknowledging this situation, to optimize older people's arrangements for LTC services and improve quality of later life, this study sets out to explore and make theoretical sense of older people's LTC needs and to identify the factors influencing their LTC needs. METHODS: Questionnaire data were collected from 1090 participants in four Chinese cities in 2014. A conceptual framework was established based on the Anderson Model (i.e., predisposing factors, enabling factors, and need factors), and further strengthened by adding several psychosocial factors (i.e. intergenerational relationships, unmet care service needs, and self-image). Multinomial logistic regression was adopted to explore the influencing factors of LTC needs. Participants choosing home-and-community-based care were regarded as the reference group. RESULTS: After controlling for predisposing, enabling, and need factors, those with better self-image (OR = 1.027, p = 0.021) and fewer unmet care service needs (OR = 0.936, p = 0.009) were identified as being more likely to choose family care; those with less close intergenerational relationships (OR = 0.676, p = 0.019), fewer unmet care service needs (OR = 0.912, p = 0.027), and better self-image (OR = 1.044, p = 0.026) were more likely to choose institutional care. Gender- and age-related differences in the determinants of LTC needs were observed. CONCLUSIONS: The findings of this study suggest that professionals and service providers should pay more attention to the important role of psychosocial factors in affecting older people's LTC needs and be more sensitive to gender- and age-related differences. Effective efforts to improve intergenerational relationships, to further develop care services for older people, and to foster a more positive image of aging should be emphasized.

An alternative discourse of productive aging: A self-restrained approach in older Chinese people in Hong Kong.

While Western discourses regarding productive aging emphasize individuals' contributions to economic productivity, the Confucian cultural heritage of the Chinese community may provide an alternative perspective. This qualitative study explores interpretations of what constitutes productive aging, based on a series of in-depth interviews with older Chinese people in Hong Kong. It shows that some of these individuals adopted a passive and indirect interpretation of productive aging, distinct from that found in Western countries. The Confucianism-based, collectivist, normative order underpinning Hong Kong society disposed these older people to adopting a self-restrained attitude with the aim of avoiding becoming a burden to others, especially family members. Such a tendency toward self-restraint or avoidance also encompassed a compromise between ideals and reality, with the older people opting to compromise their expectations of the younger generation as a whole, their adult children in particular, in terms of respect and reciprocity.

Long-term care policy in Hong Kong: challenges and future directions.

In comparison to residential care services, home and community care services in Hong Kong remain underfunded and underdeveloped. The government's long-term care policies have resulted in an overreliance on subsidized long-term care services in the form of institutional care services. The quality of services offered by private residential care facilities is a cause for concern. Population aging, evolving family structures, and changes in residential living patterns are expected to continue to put a strain on resources for services for the elderly in the near future. This article provides an overview of the many issues surrounding long-term care in Hong Kong and offers potential directions for the future development of long-term care services.