Cw Kwan

Elderly suicide in Hong Kong – a case‐controlled psychological autopsy study

Objective:  To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case‐controlled psychological autopsy approach.

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.

Assessing local influence for specific restricted likelihood: Application to factor analysis

In restricted statistical models, since the first derivatives of the likelihood displacement are often nonzero, the commonly adopted formulation for local influence analysis is not appropriate. However, there are two kinds of model restrictions in which the first derivatives of the likelihood displacement are still zero. General formulas for assessing local influence under these restrictions are derived and applied to factor analysis as the usually used restriction in factor analysis satisfies the conditions. Various influence schemes are introduced and a comparison to the influence function approach is discussed. It is also shown that local influence for factor analysis is invariant to the scale of the data and is independent of the rotation of the factor loadings.

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.

Reference values for change in body mass index from birth to 18 years of age

Body mass index (BMI) has become the measure of choice for determination of nutritional status during the paediatric years, as in adults. Recently, several cross‐sectional BMI childhood reference values standards have been published. In order precisely to evaluate childhood nutritional interventions, reference values allowing for the evaluation of changes in BMI values are also needed. For the first time, such reference values can be presented based on 3650 longitudinally followed healthy Swedish children born full term. The reference values for the change in BMI are given as the change in BMI standard deviation scores. The reference values are given as means of mathematical functions adjusting for gender, age of the child and the length of the interval between two measurements for interval lengths of 0.25 to 1.0 y before 2y of age and of 1 to 5 y between birth and 18 y. The usefulness of the reference values is proved by a graph that forms a part of a clinical computer program; the ‐2 to +2 standard deviation range of the predicted change in BMI can be computed for an individual child and drawn in the graph as an extended support for clinical decision‐making.

Use of the Minimum Data Set—Home Care: A cluster randomized controlled trial among the Chinese older adults

The objective of this study was to test whether the utilization of Minimum Data Set—Home Care (MDS-HC) as a case finding instrument for Chinese attenders of elderly health centres in Hong Kong had a beneficial impact on the physical and mental health status of those older clients. The dependent variables were 13 outcome variables measuring different dimensions of participants’ physical and mental health status. Using a cluster randomized controlled trial design, we assigned three of six participating elderly health centres to the experimental group and the other three to the control group. The respondents were 925 (472 in the experimental group and 453 in the control group) elderly health centre attenders aged 65 years or above. They were assessed by MDS-HC and 734 (382 in the experimental group and 352 in the control group) of them were re-assessed one year later. In the experimental group, the medical doctors had been given their patients’ profile of potential problem areas identified by MDS-HC before they treated their patients whereas in the control, the medical doctors treated their patients with their usual practice. We found that older attenders in the experimental group improved more than the ones in the control group in only two out of 13 areas. Surprisingly, the patients in the experimental group deteriorated even more than the ones in the control group in terms of bowel incontinence. Our results indicated that the function of the MDS-HC in case finding or screening is limited in the Hong Kong primary medical care setting.

Sensitivity analysis in factor analysis: Difference between using covariance and correlation matrices

Influence curves of some parameters under various methods of factor analysis have been given in the literature. These influence curves depend on the influence curves for either the covariance or the correlation matrix used in the analysis. The differences between the influence curves based on the covariance and the correlation matrices are derived in this paper. Simple formulas for the differences of the influence curves, based on the two matrices, for the unique variance matrix, factor loadings and some other parameter are obtained under scale-invariant estimation methods, though the influence curves themselves are in complex forms.

Use of the Sign Test for the Median in the Presence of Ties

The sign test was developed to examine the median difference of paired samples. Ignorance of ties—that is, zero differences—in the sign test can substantially inflate the Type I error rate. A uniformly most powerful test has been developed to test for the symmetry of the positive and negative differences but little attention has been given about inferences concerning the median difference when ties are abundant. This article examines a simple modified sign test which can be implemented in most computer packages and a likelihood ratio test.

Residents with Alzheimer's disease in long-term care facilities in Hong Kong: patterns of hospitalization and emergency room use

Objectives: This study examined the frequency and predictors of hospitalization and emergency room (ER) use among residents with Alzheimers disease at admission and after 1 year in a long-term care facility. Method: This secondary analysis used data collected with the Chinese version of the Residential Assessment Instrument Minimum Data Set 2.0 during the Hong Kong Longitudinal Study on Long-Term Care Facility Residents. Results: A sample of 169 residents with Alzheimers disease who were newly admitted between 2005 and 2010 was included in the analysis. Mixed-effects modeling was adopted to assess the associations between risk factors and the frequency of hospitalization and ER use. At admission, 27 (15.98%) respondents had been hospitalized and 19 (11.24%) required ER services during the previous 90 days. At admission, polypharmacy (β = .081, p < .01) and use of psychotropic drugs (β = ‑.506, p < .05) were significantly associated with frequency of hospitalization. At 1-year follow-up, cognitive impairment (β = .088, p < .05) and polypharmacy (β = .058, p < .001) had significant positive associations with frequency of hospitalization, as well as use of ER services (β = .084, p < .01; β = .077, p < .001, respectively). Use of psychotropic drugs had a negative association with frequency of ER use at both time points. Conclusion: Practitioners should periodically observe cognitive ability, polypharmacy, and use of psychotropic drugs among long-term care residents with Alzheimers disease.

Can domestic helpers moderate distress of offspring caregivers of cognitively impaired older adults

ABSTRACT 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.