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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.
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.
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.
One of the major aspects of successful ageing is active engagement in later life. Retirement and widowhood are two significant life transitions that may largely influence leisure engagement patterns among older adults. Limited findings exist regarding the impact of life transitions on leisure activity engagement due to the scarcity of longitudinal data with repeated measurement of older individuals’ leisure engagement. This study longitudinally examined changes in leisure activity engagement as influenced by retirement and widowhood using five waves of national panel data from the Health and Retirement Study and its supplementary Consumption and Activities Mail Survey. Multi-level modelling was conducted with retirement and widowhood status as time-varying variables. Socio-economic status, depressive symptoms, cognitive function, self-rated health and functional limitations were also included as time-varying and time-invariant covariates. Findings show that engagement in mental, physical, social and household activities significantly decreased during an eight-year period. Moreover, transition from working to retired status was associated with increased engagement in mental, social and household activities but decreased engagement in physical activities among men only. Transition from married to widowhood status was associated with decreased engagement in household activities among women only. Encouraging active leisure engagement among individuals who experience either or both life transitions may help maintain their health after transition.
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.
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.
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.
Culturally, sensitive education and specific trainings for formal and informal dementia caregivers are urgently needed in China. Policy and program implications are discussed.
This study examined how financial strain, worry about having no care-giver and social engagement modify the association between widowhood and depressive symptoms among older adults in China. Using national representative data from older adults in China in 2006, we ran structural equation models and ordinary least square regressions to investigate the mediating and moderating effects of financial strain, worry about having no care-giver and social engagement on the association between widowhood and depressive symptoms. All three variables significantly mediated the association between widowhood and depressive symptoms. Compared to their married counterparts, widowed older adults showed more worry about having no care-giver, increased financial strain and lower social engagement, which were significantly associated with depressive symptoms. Higher level of worry about having no care-giver and lower social engagement significantly exacerbated the adverse effects of widowhood on depressive symptoms in the moderation analyses. Our finding of mediating effects suggests that widowhood is negatively related to psychological wellbeing via financial strain, social engagement and care resources. The results regarding moderating effects suggest that alleviating worry about having no care-giver and increasing social engagement may buffer the deleterious effect of widowhood on psychological wellbeing in later life.
This study examined engagement in leisure activities among older adults, specifically focusing on how life transition factors in later life, including retirement and marital status, are associated with leisure activity engagement using a national sample of older American men and women. We conducted multiple regression analyses with a sample of 5,405 individuals (2,318 men; 3,087 women) from the Consumption and Activities Mail Survey, a supplementary sample of the Health and Retirement Study. We analysed activity engagement in each of four domains of leisure activities: mental, physical, social and religious. Retirement status was categorised into three groups: working (referent), completely retired and partly retired. Marital status was categorised into four groups: married (referent), divorced or separated, widowed and never married. We found an overall trend of a positive relationship between retirement and leisure activity engagement, which suggests that retirement provides a chance for older adults to participate in leisure activities after withdrawal from the labour force. The overall trend of a negative relationship between non-married status and leisure activity engagement suggests that the loss or absence of a spouse may serve as a barrier to participate in leisure activities. Nevertheless, variation among retirees and non-married individuals suggests future studies should compare completely and partly retired individuals or those who are widowed, divorced or separated, or never married to elucidate distinguishable leisure activity profiles.
Using four-wave panel data of 1,327 older adults in rural China, this study examined potential gender and marital status differences in the relationships between three forms of intergenerational support (monetary, instrumental and emotional support) and the level of depression of the older adults. Results from a pooled time-series fixed-effects model showed that receiving and providing monetary support had a comparable beneficial effect on mothers and fathers, but mothers benefited more psychologically than fathers from closer relationships with their children. Exchanges in instrumental support was not related to either mothers' or fathers' level of depression. Widowhood further affected the gendered relationships between support and depression in that recently widowed fathers had a significantly higher level of depression when they received more monetary support from their children. In contrast, providing monetary support to children was associated with a significantly higher level of depression among recently widowed mothers. We explained the findings in the context of familial and gender norms in the Chinese culture and temporal needs for family support that link with bereavement coping stages among older adults. We argued that the gender and marital status patterns observed in this study are attributive to more fundamental differences in men's and women's social positions in the Chinese society.
Immigration disrupts the bonding process in families. Maintaining close relationships with adult children can be an important protective factor for older immigrants' health and wellbeing. Quantitative research explaining such close relationships is rare. This study examined factors associated with close parent–child relationships in a purposive sample of 236 older Chinese immigrants in Los Angeles who provided information regarding 365 children. Two-level regression models were estimated to investigate factors contributing to cohesive parent–child relationships among these older adults. The findings showed that co-residence, a characteristic that distinguishes immigrant families from most non-immigrant families, was associated with lower parent–child relationship quality. Frequent contact was associated with closer relationships. While receiving instrumental and monetary support from children was associated with favourable ratings of relationships with children, providing such support to children was not related to parents' assessment of relationship quality. Parental perceptions of children being respectful was also associated with better relationship quality ratings. Overall, the findings demonstrate how family-related changes in the immigration context shape parent–child relationships in later life. Implications for future research and practice are provided.
This study examined correlates of caregiving at the end of life provided by adult children to their older parents and the role of gender of adult children in family caregiving in rural China. Data came from five waves of the Longitudinal Study of Rural Elder’s Well-Being in Anhui Province, China, over 12 years and from a post-mortality survey. Hierarchical linear modeling was used. Findings demonstrated that the birth order of adult children, prior geographic distance, and prior intergenerational support exchange were significantly associated with family caregiving at the end of life. Eldest children, compared to other siblings, provided the most end-of-life caregiving to their parents. Children cohabitating with older parents before death provided the most caregiving, compared to other siblings. Adult children who had previously exchanged instrumental support with older parents before death, especially sons, tended to provide the most caregiving, compared with that by others, at end of life.
To determine the prevalence, risk factors, and molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) colonization at the time of admission to acute medical units and to develop a cost-effective screening strategy.
Nasal and groin screening cultures were performed for patients at admission to 15 acute medical units in all 7 catchment regions in Hong Kong. All MRSA isolates were subjected to spa typing.
The overall carriage rate of MRSA was 14.3% (95% confidence interval [CI], 13.5–15.1). MRSA history within the past 12 months (adjusted odds ratio [OR], 4.60 [95% CI, 3.28–6.44]), old age home residence (adjusted OR, 3.32 [95% CI, 2.78–3.98]), and bedbound state (adjusted OR, 2.19 [95% CI, 1.75–2.74]) were risk factors selected as MRSA screening criteria that provided reasonable sensitivity (67.4%) and specificity (81.8%), with an affordable burden (25.2%). spa typing showed that 89.5% (848/948) of the isolates were clustered into the 4 spa clonal complexes (CCs): spa CC1081, spa CC032, spa CC002, and spa CC4677. Patients colonized with MRSA spa types t1081 (OR, 1.77 [95% CI, 1.49–2.09]) and t4677 (OR, 3.09 [95% CI, 1.54–6.02]) were more likely to be old age home residents.
MRSA carriage at admission to acute medical units was prevalent in Hong Kong. Our results suggest that targeted screening is a pragmatic approach to increase the detection of the MRSA reservoir. Molecular typing suggests that old age homes are epicenters in amplifying the MRSA burden in acute hospitals. Enhancement of infection control measures in old age homes is important for the control of MRSA in hospitals.
Cross-cultural research in the behavioural and social sciences uses data from several societies or distinct cultural groups to describe the diversity of human behaviour and test hypotheses about behaviour and culture. This paper reviews the historical development and current state of cross-cultural research in the social sciences and gerontology. Cross-cultural research in gerontology is important because the social processes of ageing vary. It aims to distinguish universal from culturally-specific processes and determine how cultural factors influence individual and population ageing. It has to overcome many challenges: how to design an equivalent and unbiased study, how to access different cultures, how to contextualise these cultures, and how to ensure that questions are meaningful for different cultures. Appropriate strategies include using an international multicultural research team, becoming familiar with the local culture, maintaining good relationships with community leaders, studying only those aspects of behaviour that are functionally equivalent while avoiding the idiosyncratic, using appropriate measures, and encouraging equal partnership and open communication among colleagues. Cross-cultural research has been growing and has become a basis for globally-relevant social gerontology. To highlight the complexity of cross-cultural research and lessons learnt from such research experience, this paper describes an example study of long-term care that involved researchers from more than 30 countries and from many disciplines.
Resource Utilization Groups III (RUG-III) is a case-mix system developed in the United States for categorization of nursing home residents and the financing of residential care services. In Hong Kong, RUG-III is based on several board groups of residents. The aim of this study was to examine the reliability and validity of the RUG-III in Hong Kong nursing homes. A cross-sectional survey was conducted in seven residential facilities operated by one agency. Residents (N=1,127) were assessed by the Minimum Data Set (MDS) and nursing as well as auxiliary staff care times were recorded within 2 weeks before or after the completion of MDS assessment. Forty-five out 1,127 residents were re-interviewed by an independent assessor to assess the inter-rater reliability. The inter-rater reliability of MDS assessment was excellent (κ=0.76) and the original RUG-III accounted for about 30 per cent of nursing staff time. Results provide preliminary evidence to support that RUG-III is a reliable and valid case-mix system for Hong Kong nursing homes, but future studies must be explored to reduce the variance of resource use explained by this case-mix system.
Although the association between falls and fear-of-falling has been established by previous studies, the temporal ordering of the two is uncertain. Moreover, the common and unique risk factors that contribute to falls and to fear-of-falling have not been investigated in either primary health-care settings or Asian societies. The aims of this study were to examine the temporal sequencing of fear-of-falling and a fall, and to identify the risk factors associated with the two. A prospective cohort study with three six-month measurement waves was conducted in primary-care settings in Hong Kong. The sample was derived from the waiting list control group of a randomised clinical trial, and 321 respondents participated in the three waves. They were evaluated with the Minimum Data Set for Home Care. It was found that falls and fear-of-falling at baseline were not independent predictors of respectively developing a fear-of-falling and becoming a faller, but that age was a common independent predictor for falls and the onset of a fear-of-falling. Individuals with a fear-of-falling were at risk of both falling and a fear-of-falling at 12 months. The good news is that no vicious cycle of falls and fear-of-falling was found, and modifiable risk factors, including IADL limitations, environmental hazards, and fear-of-falling were identified, so that effective prevention programmes for falls and for fear-of-falling can be designed.
Gerontologists have recognised the important influence of leisure activity on the mental and physical health of older adults. To date, however, there have been few studies of the patterns of participation in leisure activity among older adults in Hong Kong. This study examines a large representative sample of Hong Kong older adults and the associations between their socio-economic and health characteristics and their leisure activities. The data are from a cross-sectional survey of 2,180 respondents aged 60 or more years, conducted in 2000 by the Hong Kong Census and Statistics Department. There were full records for 2,144 respondents. Among the participation rates in the seven categories of leisure activities, watching television or listening to radio was the highest, while the lowest was for playing mahjong or cards. The characteristics that significantly correlated with the level of participation differed by the activity. Although no consistent pattern emerged, gender, education, employment status, receiving welfare benefits, self-rated health and functional impairment were the strongest correlates for most types of leisure activity. The paper is concluded by comparing the results with previous findings, and by discussing the service implications of the findings, the limitations of the study, and directions for future research.
Background: To date, no firm conclusions can be reached regarding the effectiveness of reminiscence for dementia. Researchers have emphasized that there is an urgent need for more systematic research in the area.
Objective and Method: A single-blinded, parallel-groups (one intervention, one comparison, and one no-intervention group) randomized controlled trial (RCT) was adopted to investigate whether a specific reminiscence program leads to higher levels of psychosocial well-being in nursing home residents with dementia. The intervention adopted a life-story approach, while the comparison group provided friendly discussions to control for any changes in outcome as a result of social contacts and attention. The Social Engagement Scale (SES) and Well-being/Ill-being Scale (WIB) were the outcome measures used. The outcomes of the groups were examined with reference to the baseline (T0), immediately (T1), and six weeks (T2) after intervention. The final sample had 101 subjects (control group: n=30; comparison group: n=35; intervention group: n=36). Using multivariate analysis with repeated measures, no significant differences in outcome were found between groups at either T1 or T2. Wilcoxon signed rank tests were performed for each group comparing outcomes between T1 and T0, T2 and T1, and T2 and T0. Significant differences were observed in the intervention group when comparing T1 and T0 WIB (p=.014), but not for the other groups.
Conclusion: Although the intervention did not lead to significant differences between the three groups over time, there was a significant improvement in psychosocial well-being for the intervention group.