The influence of income on morbidity, mortality and dependency in elderly Hong Kong Chinese

The association between income and mortality, morbidity and dependency is examined in a 3-year prospective follow-up study of 2032 subjects aged 70 years and above in the Hong Kong Special Administrative Region, China. Subjects were recruited using stratified disproportional random sampling of the Old Age and Disability Allowance Schemes, covering over 90% of the population. Subjects were interviewed at baseline and after 36 months. Presence or absence of disease was based on self-report of doctor diagnosis together with a check of medication taken. Functional status was measured using the Barthel Index. For the disease analysis, subjects with the disease being analyzed at baseline were excluded; similarly for the dependency analysis, subjects who were dependent at baseline were excluded. Chi-square test, univariate and multiple logistic regression were used to examine the association between income and mortality, development of new disease, and dependency. There was no association between income and mortality, or with development of new disease. Development of dependency was associated with lower income at baseline. An income of less than 1000 HK dollars per month increased the risk of dependency by 1.8-fold (95%CI 1.1-2.9). However, this association disappeared after adjustment for age and sex. Absolute income is not an important factor contributing to mortality, morbidity and dependency in elderly Chinese aged 70 years and above. A freely accessible health and social service at low or no cost, the survivor effect, or other factors may account for the lack of association with income, contrary to findings from studies of whole populations worldwide. Therefore manipulating income alone is unlikely to affect these outcomes in the elderly.     

Cultural specificity of socioemotional selectivity: age differences in social network composition among Germans and Hong Kong Chinese

We examined age differences in social network composition among 330 Germans and 330 Hong Kong Chinese, aged 20 to 91 years. We measured social network composition with the Social Convoy Questionnaire. In both cultures, older age was associated with the same number of close social partners and fewer peripheral social partners than was younger age. However, the patterns of age differences in specific relationships differed across cultures: Age was negatively associated with the proportion of nuclear family members among Germans but the association was positive among Hong Kong Chinese. Age was positively associated with the proportion of acquaintances among Germans but the association was negative among Hong Kong Chinese. We discuss the findings in terms of whether the socioemotional selectivity theory holds in both cultures.     

Community attitudes toward living arrangements between the elderly and their adult children in Hong Kong

For hundreds of years, Chinese societies have been living in extended family settings. However, the import of Western cultures and values are challenging the traditional Chinese practices in Hong Kong. This study assesses the community attitudes to living arrangements between elderly and their adult children in Hong Kong and to identify the factors which influence these attitudes. A random sample of 888 adult Hong Kong residents were telephone-interviewed. They were asked about their attitudes to living arrangements when they turned 60, if disabled and non-disabled. The relationship between these attitudes and the social and demographic characteristics of the respondents was also analyzed. Nearly 59% of the respondents preferred to live with their children if non-disabled. However, 43.5% of the respondents would be unlikely to want to live with their children if disabled. If non-disabled at 60, females, professionals or those who had lived overseas before preferred not to live with their children. Females also preferred not to live with their children if disabled at 60. Other factors, such as age, social class, education level and experience in living with elderly or looking after elderly had no effect on the respondents' preference. This study provides important information on the community attitudes to living arrangements between the elderly and their adult children in Hong Kong. These attitudes will shed light on the provision of housing and institutional care to elderly, as well as the family relationship and care pattern of the elderly in the future decades in Hong Kong and other communities which are undergoing rapid growth and 'Westernization'.     

Perforated peptic ulcer in Hong Kong and New South Wales

Direct comparisons of ulcer perforation rates and trends between countries have not been made in the past. Data on hospital admissions for perforated peptic ulcer during 1 January 1979 to 31 December 1985 were collected in Hong Kong (5868 perforations) and New South Wales, Australia (1669 perforations). Age and sex specific rates per 100,000 population were calculated. In Hong Kong, annual duodenal ulcer and gastric ulcer perforation rates were 13-16 and under two per 100,000 population respectively. In New South Wales, the corresponding rates were between three and four and under two per 100,000 population, respectively. The male:female ratios for duodenal ulcer perforation were consistently about 5:1 in Hong Kong and 2:1 in New South Wales, and for gastric ulcer perforation about 2:1 and 1:1, respectively. The incidence of perforation increased with age, and there was a statistically significant rise, over time, in duodenal but not gastric ulcer perforation rates in persons aged over 60 years in New South Wales; similar trends were seen in Hong Kong. Thus duodenal ulcer perforation occurs five times more commonly in Hong Kong than in New South Wales and this is largely accountable for by the higher rates of duodenal ulcer perforation in Chinese than in Australian males. Such geographical differences can best be explained by the occurrence of multiple aetiological mechanisms in ulcer perforation. Furthermore, there appears to be an increased susceptibility and an appreciable rising trend for duodenal ulcer perforation to occur in the elderly.     

Tuberculosis in the elderly in Hong Kong.

BACKGROUND: The rate of tuberculosis in Hong Kong has declined dramatically since the 1950s, but has remained high during the past decade, at around 110/100,000. The reason for the persistent high rate is not clear. OBJECTIVES: To study the trend of tuberculosis in Hong Kong during the past decade (1989 to 1998) and the clinical characteristics of tuberculosis patients > or = 60 years of age, and compare them with those of the younger age groups. METHODS: Notification rates of tuberculosis from 1989 to 1998 were obtained from the Hong Kong Government Tuberculosis and Chest Service (Chest Service), Department of Health, Hong Kong. In addition, all patients registered at the Chest Service for treatment of tuberculosis in 1996 were studied. RESULTS: During the past decade, the notification rate of tuberculosis, which included both bacteriologically confirmed and clinically active but bacteriologically not confirmed cases, decreased in those under 60, remained unchanged in those between 60-69, and increased in those > or = 70 years of age. An increase in the rate of bacteriologically confirmed cases (sputum smear or culture positive for Mycobacterium tuberculosis) in the older age groups was observed during the same period. In 1989, 31.9% of tuberculosis cases were over the age of 60 years; this proportion increased to 45.4% in 1998. The increase in the number of cases in those > or = 60 years could almost account for the total increase in number of cases during the last decade. Patients in the older age groups had more advanced disease at the time of diagnosis, and a higher proportion had comorbid illnesses. They also had significantly higher mortality compared with the younger age groups. CONCLUSION: The increasing longevity of the population and the high rate of tuberculosis in the elderly are important factors contributing to the persistent high rate of tuberculosis in Hong Kong in the past decade.     

An actuarial analysis of long-term care demand in Hong Kong

Hong Kong is a fast-aging society. More than 775 000 citizens (around 11% of the total population) in Hong Kong were aged 65 or above in 2002, and it is expected the figure will increase to 2.2 million (or 24% of the total) in 2031. In this paper, an actuarial projection of the demand of long-term care (LTC) services in Hong Kong using the US National Long-Term Care Surveys (NLTCS) data, is provided. The need for LTC in Hong Kong will be growing drastically for older ages in the next few years; around 10% for elderly aged between 65 and 74 and the proportion would mount to 60% for the elderly at age 85 or above. Using a Markov Chain model, an individual's (age–gender specific) future LTC expenditures in Hong Kong have been projected. The net actuarial present values of total future LTC costs are expected to be HK$83 000 and HK$160 000 for males aged 65 and females aged 65, respectively. Alternative funding strategies for these liabilities are discussed. A simple private insurance scheme is chosen to illustrate the actuarial calculations. The results could be useful for funding and planning LTC services in Hong Kong.     

Assessing life expectancies of institutionalized older persons in Hong Kong

BACKGROUND: In Hong Kong, it has been projected that, by the year 2010, there will be 0.86 million persons aged 65 or older. The demand for residential care places continues to rise. Information on the survival of older persons will allow better management of care in institutional settings. OBJECTIVE: The Weibull model was developed to predict the 18-month survival of a group of Chinese nursing home residents. METHODS: In this prospective cohort study, 590 older residents from four nursing homes with different levels of care were enrolled. The main outcome measure was survival at 18 months. Information on subject demographics, clinical data and disability levels as measured by the Patient Assessment Instrument (PAI) was collected at baseline. Life expectancies were derived from accelerated failure time models. RESULTS: Independent predictors of decreased survival derived from the Weibull model included increased age, male gender, diagnosis of cancer, presence of malnutrition and functional dependence. Significant interaction was observed between male gender and PAI score. The goodness of fit of the model was satisfactory. CONCLUSIONS: From this study, the model for predicting life expectancy in nursing home residents can assist policy makers in planning long-term care. It can also guide clinicians to make more appropriate management decisions for their older patients.     

Factors Affecting the Maintenance Stable Warfarin Dosage in Hong Kong Chinese Patients

Background: Multiple factors can affect the anticoagulation effect of warfarin. The objective of this study was to determine the relationship between different clinical factors and outcomes of warfarin therapy in Hong Kong Chinese patients.Methods: The study was conducted at the anticoagulation clinic of the Prince of Wales Hospital from 1 April to 31 December 2003. Clinical data collected included demographics, indications of warfarin, dietary vitamin K consumption, and drug-drug interactions. Blood samples were obtained for the genetic polymorphism analysis of CYP 2C9. Linear and multiple regression analysis were used for statistical analysis to determine the correlation between variables and the importance of various factors as the determinants of warfarin dosage requirement.Results: A total of 63 patients were recruited. The mean warfarin dosage was 3.30 ± 2.23 mg/day. The warfarin dosage ranged from 0.75 to 12 mg/day. The mean age was 59 ± 14 years old. Age, dietary vitamin K consumption, chronic heart failure, atrial fibrillation, hypertension, smoking and drinking status were found to be factors statistically significant affecting warfarin dosage. We detected no single nucleotide polymorphism in CYP 2C9 exon 4.Conclusion: Age, dietary vitamin K consumption, warfarin indication for atrial fibrillation, co-morbid with CHF, smoking and drinking status were found to be the factors that affected the warfarin requirement in Hong Kong Chinese patients. However, the genetic polymorphism in exon 4 of CYP 2C9 may not be associated with the warfarin sensitivity in this patient population.     

Examination of the Philadelphia Geriatric Morale Scale as a subjective quality-of-life measure in elderly Hong Kong Chinese

PURPOSE: We examine the psychometric properties of the Philadelphia Geriatric Morale Scale (PGMS) in an elderly Chinese population in Hong Kong. DESIGN AND METHODS: The study consisted of two cohorts: (a) 759 participants aged 70 years and older living in the community who were recruited as part of a territory-wide health survey and interviewed in 1993-1994; and (b) 388 participants living in long-term-care institutions in 1995-1996. Participants who were cognitively impaired (Abbreviated Mental Test score less than 7) or who could not answer questions for other reasons were excluded. The 15-item PGMS was administered. The Rasch dichotomous model was used to assess the validity of the PGMS, and the 15-item Geriatric Depression Scale, previously validated in Chinese, was also administered to examine the concurrent validity. RESULTS: A confirmatory factor analysis identified three underlying factors similar to findings among Caucasians; however, not all the goodness-of-fit indices were acceptable. An exploratory factor analysis using principal axis factoring and promax rotation revealed two underlying factors that explained 35% of the total variance: reconciled aging and unstrained affect. Some items were redundant when applied to the institutional sample. Concurrent validity was demonstrated by the good correlation between the reconciled aging and unstrained affect domains and the Geriatric Depression Scale (r = -0.72 and r = -0.56 respectively). Female gender, older age, and residence in institutions were associated with lower morale. IMPLICATIONS: The PGMS is a valid quality-of-life measure in elderly Hong Kong Chinese persons, but its psychometric properties are slightly different from those for Caucasians.     

Determinants of elderly residential mobility in Southern China: Exploration and implications

It is a widely accepted observation that many older Hong Kong residents have lived periodically on the Chinese mainland since the relaxation of restrictions on cross-border mobility and the closer connection between Hong Kong and the mainland. This paper explores and compares the determinants of various modes of residential mobility by Hong Kong retirees to the Pearl River Delta based on the data of two samples—one from Hong Kong and the other from the mainland. The findings support those of studies in Western societies that the decision of elderly residential mobility can be effectively predicted by the personal attributes, place ties, and person ties of the retirees, and that the effects of these factors vary with different modes of retiree mobility. The implications of these findings for the formulation of migration and housing policies for the older population and the economic development of amenity communities are discussed. He is also a Research Associate at the Joint Centre of Excellence for Research on Immigration and Settlement in Toronto, Canada. His research interests are elderly residential mobility, gerontology and geriatrics education, and the help-seeking behavior of older people. Dr. Ma’s latest study concerns the utilization and accessibility of human services for older residents in Hong Kong. He is also a reviewer of several international journals. Dr. Chow’s research interests are social security policies and practice, social policies and services for older people, and family support. The focus of his latest research project is the service needs of new immigrants to Hong Kong.     

Prevalence of tuberculous infection and active tuberculosis in old age homes in Hong Kong

OBJECTIVES: To assess the prevalence of tuberculous infection and active tuberculosis (TB) in old age homes in Hong Kong and to determine whether there is institutional transmission in these homes. DESIGN: Cross-sectional. SETTING: Old age homes. PARTICIPANTS: Total of 2,243 residents, representing 84.6% of all residents in 15 old age homes; 1,698 were women, and 545 were men, with an average age of 82. MEASUREMENTS: All residents had a questionnaire-based interview, medical record review, two-stage tuberculin testing using two units purified protein derivative-RT23, and a chest x-ray. Those with radiological abnormalities had sputum examined for acid-fast bacilli. RESULTS: The estimated prevalence rate of active TB in this population was 669 per 100,000, significantly higher in men than in women (1,101 per 100,000 vs 530 per 100,000). The proportion with positive tuberculin reactivity (> or =10 mm induration) after two-stage testing was 68.6%, significantly higher in men than in women. There was no evidence of active transmission of disease in these old age homes, with restriction fragment length polymorphism (RFLP) analysis performed on five cases of active pulmonary TB in the home with the highest rate of TB showing unique RFLP patterns. CONCLUSION: The rate of active TB and TB infection in old age homes in Hong Kong is still high. Because treatment for latent TB carries a high risk for liver dysfunction in this population, clinicians and other healthcare workers need a high index of suspicion and to diagnose and treat this disease as early as possible to prevent transmission.     

Research: Influence of different health‐care systems on health of older adults: A comparison of Hong Kong,Beijing urban and rural cohorts aged 70 years and older

Objective: To explore the hypothesis that better health status of elderly populations is primarily determined by the provision of freely accessible health service at low or no cost to the user and a social welfare system. Method: Information was collected by questionnaire from surveys of three cohorts of elderly (70 years and older) Chinese. Data from two health‐care systems were compared: the low‐cost or free government‐subsidised system in Hong Kong, and the market‐orientated user‐pays system in urban (Beijing), and rural China. Results: The Beijing rural cohort had the best health profile, whereas the Hong Kong cohort had the worst, despite the better lifestyle practices in the Hong Kong and Beijing urban cohorts compared with the Beijing rural cohort, and higher socioeconomic status in the Beijing urban and Hong Kong cohorts. However, the Beijing rural cohort had the highest prevalence of functional limitations. Conclusion: While health‐care systems may affect life expectancy at birth, psychosocial, lifestyle and socioeconomic factors influence subsequent health status of elderly people in a complex manner.     

Social support exchange among elderly Chinese people and their family members in Hong Kong: a longitudinal study

This study examines the pattern of social support exchange between the elderly and their family members, focusing on financial aid and household care (both instrumental and emotional). The second objective of this study is to identify resource capacity factors (including education, physical health, and size of social network) that generate differences in the exchange of financial aid and household care between elderly people and their family members. The respondents were 213 people who had family members living in Hong Kong aged 70-years-old or older from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, we found that the elderly subjects who received more household care from their family members were likely to provide more household care to their family members three years later, even after controlling for the impact of resource capacities; and the elderly subjects who provided more household care to their family members were more likely to receive more household care from their family members three years later. In assessing the impact of the resource variables on support exchange, functional disability and the number of close relatives were significantly associated with the amount of household care the old people provided, whereas the number of close family members were significantly associated with the amount of household care the old people received. Policy implications of the findings in this study were discussed.     

Group B streptococcal meningitis in adults: recent increase in Southeast Asia

Background : Meningitis caused by Streptococcus agalactiae (Group B Streptococcus) is rare in adults and usually affects patients with predisposing conditions.
Aims : To describe an increase in adult group B streptococcal meningitis occurring in parallel in Hong Kong and Singapore.
Methods : All cases of bacterial meningitis admitted to the Prince of Wales Hospital, Hong Kong and Singapore General Hospital in 1998, aged 15 years or above, were reviewed. Medical records for the previous ten years were searched for previous cases of adult group B streptococcal meningitis.
Results : In 1998, 29 adult patients with bacterial meningitis were admitted to the two hospitals. S. agalactiae was isolated in 11 cases, Streptococcus pneumoniae in three cases, Klebsiella pneumoniae in two cases, and Pseudomonas pseudomallei in one case. In 11 cases no bacteriological diagnosis could be made. Two patients with adult group B streptococcal meningitis had predisposing conditions for infection. One patient died before a definite diagnosis could be established. A ten year review of records revealed one previous case of adult group B streptococcal meningitis in a patient with multiple risk factors.
Conclusions : An increase of group B streptococcal meningitis has occurred among adults admitted to two major hospitals in two Southeast Asian cities. In the majority of cases there were no identifiable predisposing conditions. The cause of this increase of group B streptococcal remains unclear.     

Chronic illness and depressive symptoms among Chinese older adults: a longitudinal study

Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the impact of a series of chronic illnesses on change in depressive symptoms among the older people. The respondents were 260 people aged 70 years or older from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that, of six chronic illnesses examined, only arthritis was associated with depressive symptoms three years later, even after controlling socio-demographic, functional impairment, and social support variables were applied. Service and policy implications of the findings are discussed.     

Successful aging among the young-old,old-old,and oldest-old Chinese

In this study, successful aging was defined by four dimensions including functional status, affective status, cognitive status, and productive involvement status. This study examined successful aging among Hong Kong Chinese old people in three different age cohorts: young-old, old-old, and oldest-old. The respondents were 1106 people aged 60 years or older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong. We found modest associations between four dimensions of successful aging, indicating the relative independence of these four criteria for successful aging. Using multiple regression models, we found that age, gender, years of education, number of close relatives, frequency of contact with friends, financial strain, number of chronic illnesses, self-rated health, hearing impairment, and life satisfaction were associated with the successful aging indicator.     

Later life learning experience among Chinese elderly in Hong Kong

In a world with increasing numbers of older adults and a world wide emphasis placed on lifelong learning, it is crucial to examine and formulate appropriate policy for learning in later life (LLL). Hong Kong has a rapidly aging population, which is projected to double within the next 25 years. However, lifelong learning for the elderly has yet to be fully developed. This article reports the findings of 2 surveys: one on the LLL experience among 190 Chinese elderly in Hong Kong and another on the experiences of 9 center directors in running courses for the elderly. We found that Chinese older persons generally learn for expressive motivation rather than instrumental motivation, although those with higher educational attainment take LLL for both instrumental and expressive motivation. This finding is consistent with those obtained with American populations. Practical courses such as languages and health-related topics were found to be the most popular; and Nearly a quarter (27%) of the respondents (in particular those who are well educated) expressed interest in peer teaching. The findings are important to understand LLL in the Chinese population and assist in the formulation of an appropriate LLL policy in Hong Kong. These findings also serve as a comparison for other countries trying to provide continuing education opportunities for its older citizens.     

Social networks, institutionalization, and mortality among elderly people in the United States.

This study focuses on the effect of social networks on institutionalization and mortality among elderly people in the United States. Data are from the Longitudinal Study of Aging (LSOA), which incorporates a baseline interview in 1984 and a follow-up interview two years later. The study population consists of a sample of 5,151 noninstitutionalized elderly people who were 70 years of age or older in 1984. Multivariate analyses using logistic regression revealed that social networks are negatively related to the likelihood of institutionalization and mortality when controlling for sociodemographic characteristics and baseline health status. Elderly people who participated in some form of social activity decreased their risk of institutionalization by almost one-half, whereas living alone increased the likelihood of institutionalization. Participating in social activities and visiting or talking with friends or relatives was negatively related to the likelihood of mortality.     

Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization

STUDY OBJECTIVES: The accuracy of reference values of lung function is important for assessment of severity and functional impairment of respiratory diseases. The aim of the study was to establish updated prediction formulae of spirometric parameters for Hong Kong Chinese and to compare the reference values with those derived from other studies in white and Chinese subjects. DESIGN: Cross-sectional multicenter study. SETTING: Lung function laboratories of eight regional hospitals in Hong Kong. PARTICIPANTS: Subjects were recruited by random-digit dialing. One thousand one hundred seventy-six subjects who fulfilled recruitment criteria underwent spirometry. MEASUREMENTS: Spirometry was performed according to American Thoracic Society recommendations, and the technique was standardized among the eight participating lung function laboratories. RESULTS: Evaluable data of 1,089 (494 men and 595 women) healthy nonsmokers aged 18 to 80 years were analyzed. Age and height were found to be the major determinants of FEV1 and FVC, with a linear decline of height-adjusted values with age in both sexes. Spirometric values of this population have increased compared to Chinese populations of similar sex, age, and height two decades ago. Reference values derived from white populations were higher than our values by 5 to 19%, and the degree of overestimation varied with age, sex, and lung function parameter. We also demonstrated that the blanket application of correction factors for Asian populations may not be appropriate. In this study cohort, the distribution-free estimation of age-related centiles was more appropriate for the determination of lower limits of normal. CONCLUSIONS: Our findings underscore the need to use reference values based on updated data derived from local populations or those matched for ethnicity and other sociodemographic characteristics.