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.

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.

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.

Moderating effect of communication difficulty on the relationship between depression and pain: a study on community-dwelling older adults in Hong Kong.

OBJECTIVES: This study examined the relationship between depression and pain, and the moderating effect of communication difficulty on this relationship, among community-dwelling older adults in Hong Kong. METHOD: We used logistic regression to analyze secondary data regarding 12,402 Chinese older adults applying for long-term care service in Hong Kong in 2012. RESULTS: Approximately 30% of participants were depressed and 37% experienced communication difficulty. Depression was associated with increased pain. Communication difficulty was found to moderate the relationship between depression and pain. Pain scores increased more when individuals who experienced communication difficulty reported being depressed, compared to those who did not experience communication difficulty. CONCLUSION: The moderating effect of communication difficulty may be explained by the interaction between depression and communication difficulty. Participants who were depressed and concurrently experienced communication difficulty may be more likely to catastrophize their pain and may tend to report or experience more pain. Health care professionals need to be aware of the different effects of communication difficulty on the pain experiences of older adults. Psychosocial intervention may be provided to minimize older adults' communication barriers to pain management.

Secondary School Students' Views on Sexuality and Sexual Health Education.

Objective: This study examined the views of secondary school students on sexuality and sexual health education in Hong Kong, China. Methods: A total of 818 secondary school students (mean age = 15.3 years, SD = 1.6) participated in this study by completing a questionnaire consisted of items on sociodemographic characteristics, sexual attitudes, and other measuring scales. Results: Students were slightly permissive in sexual attitudes and supported sexual health education. However, students who were male, highly liberal in sexual attitudes, and low in religiosity and spirituality were less supportive. Conclusions: Educators may need to address these deterring factors of sexual health education before teaching specific sexual health topics.

Secondary school students in Hong Kong show liberal sexual attitudes. Liberal sexual attitudes may lead to risky sexual behaviors which may deleteriously affect students' physical and psychological health. To promote students' sexual health, school-based SHE should foster positive sexual attitudes among students, particularly students who are male, older, higher in year of study, or non-religious affiliated. Our data on students' responses to items of ATSS provide useful information on sexual topics that need to be addressed. School authorities may consider conducting intervention or workshops in schools to disseminate information about exogenous factors of liberal sexual attitudes and their associations with risky sexual behaviors. Students may be informed of the protective measures of sexual activities and forewarned about the negative health consequences of risky sexual behaviors. Although majority of the students are supportive of school-based SHE, students who are male, liberal in sexual attitudes, low in religiosity and spirituality showed negative attitudes toward school-based SHE. To facilitate effective implementation of school-based SHE, educators may need to spend special effort on students who are less supportive of school-based SHE. Negative influence on attitudes toward SHE may be addressed before teaching specific sexual health topics.

Trajectories of social engagement and depressive symptoms among long-term care facility residents in Hong Kong.

BACKGROUND: although social engagement and depressive symptoms are important concerns for long-term care facility residents, the dynamic relationship between them has not been adequately studied. OBJECTIVE: this study examines the relationship between social engagement and depressive symptoms and changes in social engagement and depressive symptoms among Chinese residents of long-term care facilities over 6 years. DESIGN AND METHODS: a latent growth model was used to analyse six waves of data collected using the Resident Assessment Instrument Minimum Data Set 2.0 in the Hong Kong Longitudinal Study on Long-Term Care Facility Residents. Ten residential facilities with a total of 1,184 eligible older adults at baseline were included in the study. RESULTS: after controlling for demographic variables at baseline, a higher level of social engagement was associated with fewer depressive symptoms. Trajectories of social engagement were significantly related to trajectories of depressive symptoms. Participants who recorded positive social engagement growth reported reduction in depressive symptoms. CONCLUSION: the findings of our study extend previous research by showing that increased social engagement is associated with decreased depressive symptoms over time. In long-term residential care settings, it is important for services to engage residents in meaningful social activities in order to reduce depressive symptoms.

Factors Associated with Development of New Joint Contractures in Long-Term Care Residents.

OBJECTIVE: Limb contractures are associated with poor outcomes and quality of life in long-term care (LTC) residents. This study examined the rate of developing new joint contracture in the LTC residents and associated risk factors to formulate effective interventions in this critical but understudied area. DESIGN: This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTC Residents between 2005 and 2016. SETTING AND PARTICIPANTS: Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) to collect the data of the residents from 9 residential LTC facilities. MEASURES: Limb contractures were defined as a functional limitation in the range of motion involving the upper or lower limbs. Primary outcomes included annual prevalence of joint contractures and factors that were associated with the development of new joint contractures. RESULTS: We analyzed the data for 1914 older residents (674 males, mean age 83.4 years). During the first 5 years since admission, the annual prevalence of upper limb contractures increased from 29.8% to 36.5%, and lower limb contractures increased from 41.5% to 57.4%. Overall, the increment of the prevalence rate of joint contractures per year ranged from 0.7% to 3.2% for the upper limbs and 0.3% to 6.0% per year for the lower limbs. Impaired mobility, presence of neurologic diseases, and older age were the leading independent risk factors for the development of new joint contractures. CONCLUSIONS AND IMPLICATIONS: Joint contractures are highly prevalent among residents admitted to the LTC facilities, and many residents develop new contractures during the first 5 years of their admission. Immobility appears to be the main modifiable risk factor. Further studies are needed to identify potential strategies to prevent new contractures in this vulnerable group.

Sexual Self-Concept and Psychological Functioning of Women With a History of Childhood Sexual Abuse in Hong Kong.

Sexual self-concept (SSC) is an important component of health that is closely associated with the well-being of survivors of child sexual abuse (CSA). Compared with non-CSA respondents, SSC of CSA survivors was deleteriously affected, resulting in ineffective psychological functioning (negative self-evaluation, psychological ill-health, and difficulties in interpersonal relationships). Negative SSC (sexual anxiety, sexual depression, and sexual fear) played a significant role in mediating the adverse effects of CSA on psychological functioning. Future studies may recruit a sample with greater variation in CSA characteristics and use externalizing problems as outcome measures to cross-validate findings of this study.

Psychological distress among Chinese adult-child caregivers: the effects of behavioral and cognitive components of care.

This study examined the effects of behavioral and cognitive components of care on caregivers' psychological distress among adult children who were the primary caregivers of frail older adults living in the community in Hong Kong. The sample was drawn from a 2008 data set that was used to determine the eligibility for long-term care in Hong Kong. Logistic regressions evaluated the association between caregiver psychological distress and the behavioral and cognitive components of care with a range of covariates. About 35% of the caregivers showed signs of psychological distress. Caregivers who provided more care for instrumental activities of daily living (IADLs), demonstrated a greater intensity of care, lived with the care recipient, or became dissatisfied with the amount of support received from other family members and friends were more likely to express psychological distress. Providing emotional support to the care recipient and being unable to continue providing care were negatively associated with psychological distress, after controlling for the sociodemographic status and health status of the care recipient.

Doctors' personal health care choices: a cross-sectional survey in a mixed public/private setting.

BACKGROUND: Among Western countries, it has been found that physicians tend to manage their own illnesses and tend not have their own independent family physicians. This is recognized as a significant issue for both physicians and, by extension, the patients under their care, resulting in initiatives seeking to address this. Physicians' personal health care practices in Asia have yet to be documented. METHODS: An anonymous cross-sectional postal questionnaire survey was conducted in Hong Kong, China. All 9570 medical practitioners in Hong Kong registered with the Hong Kong Medical Council in 2003 were surveyed. Chi-square tests and logistic regression models were applied. RESULTS: There were 4198 respondents to the survey; a response rate of 44%. Two-thirds of respondents took care of themselves when they were last ill, with 62% of these self-medicating with prescription medication. Physicians who were graduates of Hong Kong medical schools, those working in general practice and non-members of the Hong Kong College of Family Physicians were more likely to do so. Physician specialty was found to be the most influential reason in the choice of caregiver by those who had ever consulted another medical practitioner. Only 14% chose consultation with a FM/GP with younger physicians and non-Hong Kong medical graduates having a higher likelihood of doing so. Seventy percent of all respondents believed that having their own personal physician was unnecessary. CONCLUSION: Similar to the practice of colleagues in other countries, a large proportion of Hong Kong physicians self-manage their illnesses, take self-obtained prescription drugs and believe they do not need a personal physician. Future strategies to benefit the medical care of Hong Kong physicians will have to take these practices and beliefs into consideration.

Severe Spastic Contractures and Diabetes Mellitus Independently Predict Subsequent Minimal Trauma Fractures Among Long-Term Care Residents.

OBJECTIVE: The study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents. DESIGN: This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. SETTING: A 300-bed long-term care hospital in Hong Kong. PARTICIPANTS: All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. MEASUREMENTS: Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. RESULTS: Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8-56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3-12.7). CONCLUSIONS: Severe spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.

Associations Between Secondary Caregivers' Supportive Behavior and Psychological Distress of Primary Spousal Caregivers of Cognitively Intact and Impaired Elders.

PURPOSE OF THE STUDY: This study examined associations between the availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. DESIGN AND METHODS: A sample of 8,087 assessments using the validated Chinese version of the Minimum Data Set-Home Care of individuals applying for government-subsidized long-term care services from 2006 to 2009 in Hong Kong were selected based on inclusion criteria. RESULTS: More than 70% of primary caregivers had secondary caregivers; the rate was slightly lower for those caring for moderately or severely cognitively impaired spouses. More than half of the primary spousal caregivers had secondary caregivers who provided both emotional and instrumental support. Emotional support provided by secondary caregivers had a negative association with primary caregivers' psychological distress when their care recipients were cognitively intact. When secondary caregivers provided both instrumental and emotional support, primary caregivers had a higher likelihood of psychological distress when care recipients had greater negative mood symptoms as compared to those who had less negative mood symptoms. IMPLICATIONS: This is the first study that examined the association between availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. The findings suggest a need to provide services that enhance the provision of emotional support from both secondary and primary caregivers to cognitively intact elders and support primary spousal caregivers to seek appropriate help according to the mood of care recipients.

Early spontaneous catch-up growth.

We explored factors related to early catch-up growth in healthy children in Göteborg, Sweden. Most (82.9%) infants born small for gestational age (SGA) showed catch-up growth during their first 6 months, and 94.3% reached a final height within the normal range. At 6 months, 21 SGA children remained short and 45 non-SGA babies fell below the -2 SDS cutoff in height. Of these 66 short infants, 10 (15.2%) remained short into adulthood and 56 showed spontaneous catch-up growth. Fetal growth should be defined by body size at 6 months of age rather than at birth because most SGA infants catch up before 6 months, and furthermore, fetal growth regulatory mechanisms, such as insulin-like growth factor-I and -II, are the primary growth-promoting factors until 6 months of age.

The impact of loneliness on the relationship between depression and pain of Hong Kong Chinese terminally ill patients.

BACKGROUND: Depression and pain often coexist in terminally ill patients, but few studies have examined their relationship among larger samples. Other psychosocial factors experienced by patients may become barriers to pain management and affect the relationship between depression and pain. OBJECTIVE: This study aims to examine the relationship between depression and pain in terminally ill Chinese elders in Hong Kong and explore the moderating effect of psychosocial factors such as loneliness, communication, and being at ease interacting with others. METHODS: A secondary data analysis was conducted on a large cohort of community-dwelling Chinese elders applying for long-term care service in Hong Kong between 2004 and 2009. A total of 312 elders who had a prognosis of less than 6 months were included. RESULTS: Depression was associated positively and significantly with pain. However, loneliness moderated this relationship, and for participants who felt lonely, depression and pain were no longer significantly associated. CONCLUSIONS: Findings support the positive relationship between depression and pain in terminally ill elders. Feeling lonely may affect the tendency to report pain. To ensure optimal pain management for patients in palliative and end-of-life care, assessment and intervention should focus on the impact of psychosocial factors such as loneliness, and how they may affect elders' reporting of pain.

Domestic helpers as moderators of spousal caregiver distress.

OBJECTIVES: Although domestic helpers increasingly play a role in elder care in many societies, there is a lack of research on their influence on caregiver distress. This study aimed to examine the influence of domestic helpers on the relationship between stressors (the care needs of frail elders and spousal provision of care) and spousal caregivers' psychological distress. METHOD: This study was a secondary analysis of cross-sectional data collected between 2007 and 2009 from 6,442 Hong Kong adults aged 60 or older who were applying for government-subsidized long-term care services and whose spouses were their primary caregivers. Among the spousal caregivers, 73.04% were women, 44.16% felt distressed, and 5.73% were assisted by domestic helpers. RESULTS: According to logistic regression analysis, spousal caregivers who provided personal care related to activities of daily living were more likely to be distressed if they were not assisted by domestic helpers. DISCUSSION: The findings suggest that domestic help may moderate the effect of stressors on spousal caregivers. Domestic helpers provide support not just to frail older adults but also to spousal caregivers. Further studies are recommended to explore the precise effect of domestic help on family caregivers, care receivers, and the caregiving process.

Prevalence of depression and its correlates in Hong Kong's Chinese older adults.

OBJECTIVE: Because of the rapid aging of the population and inconsistent findings of previous epidemiological studies in Hong Kong, a prevalence study of depression among older adults was timely. The authors assessed the prevalence of depression among older adults and identified factors associated with it. METHODS: The authors interviewed a random representative sample of 917 community-dwelling Chinese adults age 60 and over. The 15-item Chinese Geriatric Depression Scale with a cutoff of > or = 8 was used to identify clinically significant depression in the older adults. RESULTS: The authors found that 11.0% and 14.5% of older Chinese men and women, respectively, scored above the cutoff, a prevalence rate similar to those found in other countries, including the United States, England, and Finland. Factors that were associated with an increased likelihood of depression among older adults included poor self-rated health, long-term pain, vision problems, higher level of impairment in activities of daily living, residing in Hong Kong less than 20 years, financial strain, and having less social support. CONCLUSIONS: The prevalence rate of depression among older Chinese adults in Hong Kong is more or less similar to rates found in Western countries. The data suggest that older adults who receive less social support are more likely to be depressed.

Pubertal growth assessment.

Almost all available sets of height growth reference values are constructed in a cross-sectional manner, except for a few studies in which longitudinal sampling was used. Such reference values are, however, flawed because of considerable individual variation in the timing of puberty, especially among children with early or late pubertal maturation. An additional complicating factor is that the magnitude of the total pubertal growth spurt is significantly larger among those individuals with early pubertal maturation, compared with late maturation. Based on the growth records of 145 healthy Swedish children followed longitudinally, this study introduces a pre-pubertal standard for the assessment of pre-pubertal height for children with late onset of puberty. By plotting the height values of a child in a chart containing pre-pubertal reference values, the onset of the pubertal growth spurt can be identified by a change in the pre-pubertal height standard deviation score values of 0.3 standard deviations or more over a period of 1 year. Once the pubertal onset is established, a highly accurate final height prediction method can be applied to the data, as described in this article, in which height and age at pubertal onset are the only two measures required. The r(2) value of the prediction model was over 0.80 for both sexes. Finally, a method for assessing total pubertal height gain is presented. The method adjusts for the timing of puberty and is based on the height and age at pubertal onset, plus the observed final height.