Objective and perceived service accessibility and mental health in older adults.

OBJECTIVES: Service accessibility plays a pivotal role in older adults' mental health. However, accessibility measures used in previous studies are either objective or perceived. This study aimed to integrate both objective and perceived measures of service accessibility to explore the relationship between environmental cognition on service accessibility and mental health in older adults and the pathways. METHODS: We used both questionnaire data collected from 2,317 older adults in Hong Kong and geographical data to explore the direct and indirect effect of environmental cognition (i.e. positive, negative, and matching evaluation) relating to service accessibility on mental health and two pathways (i.e. physical activity and sense of belonging) based on a structural equation model. RESULTS: Physical activity mediated the positive relationship between non-negative perceptions toward access to convenience stores, leisure facilities, clinics, community centers, places of worship and mental health. Sense of community can significantly mediate the positive relationships between non-negative perceptions toward all 10 types of services and mental health. CONCLUSION: This study provides an empirical contribution to environmental cognition theory and person-environment fit theory; its findings have implications for urban planning policy.

The findings from this study provide significant evidence that environmental cognition distortion, especially negative perception, can be significantly associated with lower mental health through physical activity and a sense of community. This suggests that policies focused on changing environmental cognitions could be a promising public health strategy. Environmental cognition theory suggests that improving awareness of setting could help improve the precision of cognitive mapping of environmental reality. This can be very important where it is difficult to change the objective environment due to the deep-rooted and long-standing urban structure.

Childhood emotional abuse and alcohol use disorders in a national Nepali women sample: The mediating role of borderline personality traits.

While many studies have found an association between childhood emotional abuse and alcohol use disorders (AUD) during adulthood, underlying psychological mechanisms linking the two remain inadequately understood. Drawing on the developmental psychopathology perspective, this study examined the relationship between childhood emotional abuse and AUD during adulthood with a national sample of women in Nepal (N = 1,100, M age = 37.73), focusing on the mediating role of borderline personality traits. Mediation analyses were performed using the Karlson-Holm-Breen (KHB) method and bootstrapping confidence intervals. Results indicated that Nepali women's borderline personality traits significantly mediated the relationship between childhood emotional abuse and AUD. Hence, emotional abuse in childhood increases the risk for AUD during adulthood for Nepali women by increasing the risk of borderline personality traits. Findings underscore the necessity of continued emphasis on developing and implementing early interventions for childhood emotional abuse and therapeutic interventions for borderline personality traits in reducing AUD among vulnerable women in Nepal.

Threats to personhood from within the family? A study of family caregivers of people with dementia in the Chinese context.

BACKGROUND AND OBJECTIVES: Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers' reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs. RESEARCH DESIGN AND METHODS: We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews. RESULTS: Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers' views, infantilization, treachery, and exclusion and imposition. DISCUSSION AND IMPLICATIONS: These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.

Universities as Intermediary Organizations: Catalyzing the Construction of an Age-Friendly City in Hong Kong.

Background and Objectives: The construction of an Age-Friendly City (AFC) requires active contribution from relevant interest groups including older adults, nonprofit organizations, and policy-makers. However, given that relevant interest groups may have limited resources, knowledge, and skills, as well as unique contextual factors, they often require help from intermediary organizations-actors that aim to build interest groups' capabilities. Our objectives were to examine the functions of universities, as an example of intermediary organizations, in facilitating the construction of an AFC, and identify critical factors that enable intermediary organizations to perform their functions. Research Design and Methods: We conducted three focus groups and one individual interview with multiple interest groups including older adults and social workers from nonprofit organizations and local government involved in a 6-year citywide AFC project in Hong Kong. Participants were asked to share their views on the role of universities in relation to their own experiences and roles in the project. Data generated from the interviews were analyzed using thematic analysis. Results: Four themes pertinent to the functions of universities in facilitating development were identified: facilitating cross-sector collaborations, knowledge diffusion, interest-group building, and mediating divergent interests. We also found that neutrality and reputability are key characteristics for intermediary organizations to wield sufficient legitimacy to perform their functions efficiently. Discussion and Implications: Findings underscore the important yet overlooked role of intermediary organizations in bridging and mediating different interest groups to facilitate AFC development. We advance gerontological scholarship by providing insights into the theoretical mechanisms and practice implications for intermediary organizations in fostering an AFC.

Neighborhood built environments and cognition in later life.

Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults' cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population.Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition.Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80.Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.

Opportunities for organizational learning and innovation: A nonprofit case study during COVID-19 in Hong Kong.

COVID-19 has created unprecedented challenges and uncertainty for the nonprofit sector. Drawing from a case study of a community-based service delivery nonprofit organization in Hong Kong, this research note examines the impact of COVID-19 on this organization's daily operations, identifies its organizational coping strategies in response to the challenges it faced, and outlines key organizational learning resulting from its experience of dealing with the pandemic. With reference to the narrative development process framework, this study found that the customary social service delivery model was inadequate in meeting the emergent needs identified in the community. This realization served as a catalyst for the organization to employ socially innovative coping strategies to continue safeguarding the well-being of vulnerable population groups. As a result, a new paradigm of service delivery leveraging on neighborhood support networks and cross-sector collaborations was developed. Factors that would enable nonprofits to enhance their adaptive capacity in the face of future public health crises are discussed, with particular attention drawn to the usefulness of adopting a narrative development process in guiding organizations' collective actions.

Depressive Symptoms and Coping Strategies in Community-Dwelling Older People Amidst the COVID-19 Pandemic: A Mixed-Method Study.

This study aimed to examine depressive symptoms of community-dwelling older people amidst COVID-19 and explore how naturally occurring coping strategies were associated with depression. A mixed-method cross-sectional telephone survey was conducted with 375 older people aged 60 years and above between March and May 2020 in Hong Kong. Trained social workers interviewed participants and assessed depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). Attribute coding and thematic analysis were adopted for qualitative data analyses. Generalized linear models (GLM) were used to examine the effects of demographics, self-reported risk factors and coping strategies on PHQ-9 scores. Participants' average PHQ-9 score was 1.9 (SD = 2.9), suggesting a low risk for depression in general. Over half of the participants reported adaptive coping strategies, including learning new things, staying physically, mentally, and socially active, and having a positive mind-set. GLM results indicated that living with family members (other than spouse) and/or others, maladaptive coping, and self-reported risk factors were significantly associated with higher PHQ-9 scores, while adaptive coping was significantly associated with lower PHQ-9 scores. Our study contributed to the growing literature on older people's resilience and adaptive coping during the pandemic, and the results may have implications for mental health promotion and community care.

Neighbourhood physical environment, intrinsic capacity, and 4-year late-life functional ability trajectories of low-income Chinese older population: A longitudinal study with the parallel process of latent growth curve modelling.

BACKGROUND: Knowledge of how intrinsic capacity (IC) and neighbourhood physical environment shape functional ability (FA) trajectories in later life remains understudied. We investigated four-year trajectories of IC and their impact on FA trajectories and the association between neighbourhood physical environment and FA trajectories among community-dwelling older adults in Hong Kong, China. METHODS: We conducted a four-wave longitudinal study from 2014 to 2017 in Hong Kong with 2,081 adults aged 65 and above. FA was assessed by The Chinese Lawton Instrumental Activities of Daily Living Scale. We used cognition, affect, locomotion, sensory capacity, and vitality to capture the multiple domains of IC. Neighbourhood physical environment attributes included green space, land use diversity, and availability of facilities, assessed within 200- and 500-meter buffers of respondents' homes. We used the parallel process of latent growth curve model. FINDINGS: IC (Unstandardized coefficient, ß = -0.02, p<0.001) and FA (ß = -0.20, p<0.001) each decreased significantly over time. Individuals with declines in IC experienced a faster decline in FA over time. Green space within a 200-meter buffer (ß = 1.15, p = 0.023), the number of leisure (ß = 0.03, p = .0.043) and public transport (ß = 0.08, p = .0.003) facilities within a 500-meter buffer slowed the rate of FA decline. INTERPRETATION: The level of FA decreased over time in later life. Changes in IC shaped FA trajectories. Increased residential green space and the number of leisure and public transport facilities in the neighbourhood may help slow FA decline over time. FUNDING: The Hong Kong Housing Society.

Longitudinal associations between neighbourhood physical environments and depressive symptoms of older adults in Hong Kong: The moderating effects of terrain slope and declining functional abilities.

Little is known about the accumulative impacts of neighbourhood physical environments on older adults' depressive symptoms over time. Based on a cohort study of 2081 older adults in Hong Kong, this study examined longitudinal relationships between neighbourhood physical environments and depressive symptoms among older adults, with a particular focus on the moderating effects of terrain slope and individual functional ability using latent growth curve modelling. Results indicated that the availability of community centres and passive leisure facilities reduced depressive symptoms over time. The protective effects of residential surrounding greenness on depressive symptoms among older adults differed by the terrain slope types. Longitudinal associations between neighbourhood physical environments and depressive symptoms varied between older adults with and without functional limitations. This study has implications for the Ecological Theory of Ageing by identifying the dynamic interplay of environment demands and individual functional ability. Planning policies for building age-friendly neighbourhoods are discussed.

Associations between Volunteering and Mental Health during COVID-19 among Chinese Older Adults.

Evidence about the association between volunteering and the mental health of older adults during COVID-19 remains underexplored. This study investigated (1) patterns of volunteering among older adults in Hong Kong during COVID-19; (2) associations between volunteering and mental health of older adults during COVID-19; and (3) associations between key psychological resources (e.g., self-efficacy and self-esteem) and volunteering among older adults during COVID-19. This study applied a cross-sectional design with data collected from 128 older adults in June 2020, who were trained as volunteers in a volunteer program that began before COVID-19. The study found that older adults continued to actively contribute to their communities by engaging in volunteering during COVID-19. The specific type of volunteering activities was linked to few depressive and anxiety symptoms. Older adults with increased self-esteem prior to COVID-19 were more likely to participate in volunteering activities related to COVID-19. Our study suggested that encouraging older adults to volunteer during the pandemic is a key pathway to maintain mental health. Social workers are encouraged to engage older adults in volunteerism regularly to offset the risk of depression and anxiety symptoms in times of crisis.

The mediating role of knowledge on the contact and stigma of mental illness in Hong Kong.

BACKGROUND: Although knowledge is a crucial component in contact theory delineating how prejudice changes toward out-groups with stigmatized conditions, little is known about the mediating role of knowledge on contact, stigmatizing attitudes, and behaviors toward mental illness. AIM: This study aimed to examine the mechanism underlie contact and stigma change by knowledge. METHODS: A total of 366 participants including family members (FM), mental health providers (MHP), and community residents (CR) recruited across communities in Hong Kong and completed measures of contact level, contact quantity, contact quality, mental health related knowledge, prejudice, and discriminatory behaviors. Structural equation modeling was adopted to test the association among the key variables. RESULTS: Higher level of contact was significantly correlated with better knowledge, less prejudice, and less discriminatory behaviors. Knowledge was directly and negatively correlated with prejudicial attitudes but was not significantly related to discriminatory behaviors. Furthermore, lower levels of prejudice were associated with less discriminatory behaviors. CONCLUSION: Enhancement of contact may increase understanding toward people with mental illness (PMI) and diminish stigmatizing attitudes and behaviors. Although prejudicial attitudes may be reduced by broadening mental health knowledge, increasing knowledge only might not ameliorate discriminatory behaviors. Future research should test mediators on contact and stigma by using longitudinal data.

Growing Old as a Member of an Ethnic Minority in Hong Kong: Implications for an Inclusive Long-Term Care Policy Framework.

Hong Kong is experiencing significant demographic changes as a result of rapid population aging and immigration. Anecdotal evidence suggests that ethnic minorities, in particular aged members of South Asian ethnic minorities, face significant and diverse obstacles in accessing services important to their general welfare. This study is the first systematic attempt to explore the long-term care needs of Nepalese older adults in Hong Kong and the barriers they face in accessing long-term care services. Data were obtained through semi-structured interviews with 30 Nepalese older adults. We found that Nepalese older adults have similar physical and psychosocial needs as those of their local Chinese counterparts. However, participants face a range of structural, knowledge, and attitudinal barriers that together deter them from accessing long-term care services, despite their right to do so. Policy recommendations to mitigate these barriers are given, with reference to the World Health Organization's Age-Friendly Cities Framework.

Fostering Civic Awareness and Participation Among Older Adults in Hong Kong: An Empowerment-Based Participatory Photo-Voice Training Model.

Social and civic participation are important tenets for both the age-friendly city and active aging frameworks promoted by the World Health Organization. Yet older adults are often under-represented in civic affairs. This study examines the effects of using photo-voice as a method in facilitating older adults' civic participation. Specifically, an empowerment-based participatory photo-voice training model was implemented among older adults with limited formal education in Hong Kong. We conducted three focus groups comprising 12 older adults and one in-depth interview with a social worker. Findings revealed that photo-voice is an effective tool in capturing older adults' views that would have otherwise been difficult to articulate in words or in writing, and in enhancing older adults' ability and willingness to participate in community and civic affairs. These findings underscore the importance of using novel techniques to build a more inclusive society that incorporates the views of older adults.

Older Adults' Perceptions of Age-friendliness in Hong Kong.

BACKGROUND AND OBJECTIVES: There is little understanding about how rapid urban development has affected the extent to which communities are able to optimize health and participation opportunities for older adults in Hong Kong. Our objective was to examine what older residents perceive to be the shortcomings of their communities in meeting their psychosocial and physical needs as they age. RESEARCH DESIGN AND METHODS: In reference to the WHO Age-Friendly Cities Project Methodology: Vancouver Protocol, we conducted nine focus groups comprising 65 participants for an Age-Friendly City baseline assessment in two districts in Hong Kong, China. Participants were asked to share their views on their respective district of residence, and identify aspects of the city they found unfriendly. Data generated from interviews were analyzed using thematic analysis. RESULTS: Five of the following key themes were identified: the failure of public transportation to cater to the needs of older adults; a lack of public space for recreation and socializing; diminishing human interactions in welfare services; physical and financial challenges relating to housing; and workplace discrimination against older adults. DISCUSSION AND IMPLICATIONS: These findings underscore the importance of prioritizing the social welfare of older adults in building a more inclusive and age-friendly city. They also highlight the difficulties in fostering an inclusive environment while ensuring efficiency and profit maximization.

Depression and its risk factors among pregnant women in 2008 Sichuan earthquake area and non-earthquake struck area in China.

BACKGROUND: On May 12, 2008, a powerful 8.0 magnitude earthquake struck China's Sichuan province. While some studies have assessed the mental and physical wellbeing of disaster victims, few have examined the long-term impact of natural disasters on pregnant women's mental health. As such, this study aims to assess whether the Sichuan earthquake continues to negatively affect women's mental health, 4 years since its occurrence. In addition, predictive and protective risk factors of depressive symptoms among pregnant women were also identified. METHODS: From June 2012 to October 2012, 520 pregnant women were interviewed, of whom 253 were from an earthquake struck area and 267 were from a non-earthquake struck area. Symptoms of antenatal depression were measured using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of≥10. RESULTS: The prevalence rate of depression among pregnant women in the earthquake area was 34.5% (95% CI, 28.9-40.6), while the rate in the non-earthquake area was 39.6% (95% CI, 33.9-45.5). The perceived stresses associated with pregnancy and social support from husbands are significantly correlated with antenatal depression. LIMITATIONS: Lack of diagnosis for antenatal depression and it is a self-report evaluation. CONCLUSIONS: This study found that the Sichuan earthquake does not necessarily have a long-lasting effect on pregnant women who were once victims of the disaster. It was found that pregnant women who experience high levels of pressures from the pregnancy and receive medium support from husbands are more susceptible to experience antenatal depression than pregnant women who perceive higher levels of support from husbands.

The relationship between Internet addiction and depression among migrant children and left-behind children in China.

With greater Internet availability, the pathological use of the Internet has become an emerging mental health issue among adolescents in China. The objective of this study was to examine the associations between Internet addiction and depression in migrant children (MC) and left-behind children (LBC). The present study was conducted using a cross-sectional design with 3,254 participants (8-17-years old), which included 1143 LBC, 574 MC, and 1287 nonleft-behind rural children (RC) from 12 schools. Young's 8-item Internet Addiction Scale was used to assess Internet dependency. The Children's Depression Inventory-Short Form was used to measure child depression. The results showed that the prevalence of depression was 10.9 percent among RC, 19.7 percent among MC, and 14.3 percent among LBC. The prevalence of Internet addiction was 3.7 percent among RC, and was 6.4 percent among MC and 3.2 percent among LBC. Depression was effected by the interaction between types of children and Internet addiction. LBC with Internet addiction (odds ratio [OR], 2.780; 95 percent confidence interval [CI], 1.237-6.248), MC with Internet addiction (OR, 2.922; 95 percent CI, 1.116-7.652), and MC with no Internet addiction (OR, 2.735; 95 percent CI, 1.974-3.789) had higher risks of depression than that for RC with no-Internet addiction. The results indicated that Internet addiction might be associated with an increased risk of depression in LBC, and migration was an important risk factor for child depression.