Helen Bartlett

Ageing and aged care in the People's Republic of China: national and local issues and perspectives

Chinas population is rapidly ageing at a time when former socialist collective provision and provision by the state in all sectors, especially in social welfare, is being radically reduced because of economic reform and financial stringency. The traditional Chinese approach to family care for elderly members is being encouraged but may be difficult because of smaller family sizes and the disruption of migration. This paper discusses some urban responses to pressures for change in care of elderly people, drawing on the example of Guangzhou (Canton) in southern China, which typifies many of the problems of caring for elderly people in times of social and economic change. It notes the development of homes and facilities for elderly people and the emergence of some prestige homes, often occupied by the better off, which have received both local and international investment. By contrast, the bulk of elderly people will not be adequately provided for by a declining public/collective sector. The dilemmas faced by the Chinese authorities attempting to stimulate local provision for all elderly people are identified.

Aging trends-Hong Kong

Aspects of demographic aging in Hong Kong are examined in this study. By regional standards, many of Hong Kongs 1992 population of 5.9 million have a good standard of living and adequate housing. However, there are considerable discrepancies in wealth and well-being; elderly people are not always financially secure, and there are growing difficulties in maintaining the oft-cited mode of family care for elderly members. Hong Kong is a rapidly aging society and it is essential to see this process in the context of local and regional socioeconomic change and the future political linkages of the territory with China.

Policy issues in the private health sector: Examples from long-term care in the U.K

The international trend towards private markets in health care can be illustrated very clearly by developments over the last decade in the U.K., where the balance of health care provision has shifted from a predominantly free, public and comprehensive system to more of a mixed economy model. The shift can be attributed to a variety of factors, and not government policy alone. The relationship between the private and NHS sectors of health care is not a simple one and there are both positive and negative implications of the public-private mix. The growth of private hospitals and acute beds has dominated debates about private health care, but further policy issues have emerged in relation to the significant growth in private residential and nursing home care. This paper briefly reviews developments in private health care and then explores the key policy issues associated with this development. Secondly, an analysis of developments in the private residential care sector is undertaken highlighting the relationship between the public and private sectors of care provision. Policy issues pertaining to the long-term care sector of private health care are raised, including the regulation of residential care, regulatory models, enforcement and quality, and standards of care. Lessons for the regulation of private health care generally are considered and the implications for the private sector of a growing trend towards market deregulation are explored. Future models of long-term care are discussed and the likely balance between the public and private sectors explored.

An evaluation of a walking scheme based in primary care: the participants' perspective

Exercise promotion schemes often fail to keep people exercising after the first few months. However, schemes that promote walking have been associated with longer-term adherence to exercise. Health Walks is a community-based exercise programme that emphasizes brisk walking activity. In the first year of an important new scheme in the Thames Valley, over 700 people took part. A survey was designed to determine the motivation of the participants and the benefits of the scheme. It was mailed to all of the participants in the scheme, of whom 48% replied. The evaluation found that 90% of participants said that they would continue walking on the scheme. In addition to physical fitness, the countryside and the social aspects of the walks were important motivating factors. The majority of the participants were women, in higher social classes and over 50 years of age, indicating the efficacy of this type of activity for older participants. The average number of walks taken each month was only three, yet participants perceived that there were health benefits. This may be due to the additional exercise which participants engaged in outside the organized scheme. Over half of the participants said that they were doing more walking, in addition to the Health Walks, and relied on their car less for short journeys. Primary care groups and trusts only need to provide minimal support to develop and co-ordinate walking schemes, in contrast to traditional exercise prescription schemes. Further research is needed to examine whether ‘walking for health’ schemes encourage people to adopt healthy lifestyles.

Regulating Residential Aged Care Homes in Hong Kong: Issues for the Asia-Pacific Region

Many countries in the Asia-Pacific Region, most notably Hong Kong, are experiencing rapid demographic ageing. Such trends in other parts of the world have created an inexorable demand for formal residential care and support services. In the UK, the private sector has responded rapidly to these demands and become an important provider of such care. A similar trend is already evident in Hong Kong. This article examines the development of residential aged care in Hong Kong and considers how approaches have been devised to safeguard standards and quality of care in such homes, whether in the public or private sector. The legislation introduced in 1994 to regulate all sectors of residential aged care in Hong Kong is discussed and some of the potential implementation problems are identified. Questions are raised about the costs for home owners, staff recruitment, the operation of inspection, and the extent to which regulation can improve the quality of care. If residential accommodation for older people grows n...

Residents' Views and Quality Improvement in Homes for Older People

Taking the views of the residents of homes into account is an important objective in the context of community care reforms. This article describes the development in Australia of a systematic, credible approach to realising that objective and recommends a similar application in the UK.

Is health-related quality of life a suitable outcome measure for evaluating health promotion programmes?:

This study describes results from a double blind randomised controlled trial which examined the efficacy of a primary care-based exercise promotion programme (the Health Walks Scheme). Quality of life data from the SF-36 questionnaire are presented from 260 previously sedentary participants randomly selected from a large GP practice (data are available for 72% at the 12-month follow-up). After 12 months, only 61% of participants in the health walks group were still classified as sedentary, compared with 73% in the control group who were simply given advice regarding exercise (p=0.05). There were no significant changes in the dimensions of the SF-36 questionnaire at 12 months. Those people who actually completed a health walk showed larger improvements in dimensions of the SF-36 (although these were also not significant). The appropriateness of quality of life outcome measures in health promotion trials is discussed in the light of the findings.

The profile, motivations and challenges for volunteers on health walks schemes based in primary care

Objective Volunteers are often needed to be employed in community- based health projects to ensure the viability of such schemes. This paper describes their important role in an exercise promotion scheme Health Walks, where they lead community walks. The aim of the study is to determine why people volunteer as walk leaders, what challenges they face, why they are committed to the scheme and whether they fit a particular demographic profile. This information will be useful in order for future schemes to understand and support their work. Design The research design consisted of a simple questionnaire, sent to all the volunteers who were part of the walking programme. Setting Community based. Method The survey was mailed to all 29 walk leaders. A prepaid response envelope was included along with a covering letter informing them of the project aims and a request to take part in the study. A total of 22 people (76 per cent) completed the survey. Results Similarities were found between the traditional volunteer demographic profile and those of the walk leaders, who were middle- aged and previously worked in managerial or professional occupations. However, the motivations of the leaders were more related to self-interest or enjoyment than altruism. Conclusion In order to maintain volunteers commitment to the scheme, future walking programmes must support their efforts, by showing appreciation and by giving them opportunities for ownership. Key words: walking, volunteers, leaders, health walks

Community health policy and provision in Hong Kong: challenges for 1997 and beyond

Abstract As 1997 approaches, and Hong Kong faces reunification with China, the need for a clearly defined health policy that addresses Hong Kongs community health concerns is increasingly apparent. The health consequences of rapid industrialization have highlighted the importance of shifting the present biomedical emphasis in health care towards a primary health care approach. However, unless government responsibility for new policy concerns such as community health is better defined by the current administration, priorities are likely to change after 1997. Analysis of community health policy and provision in the short period remaining before handover is therefore important to chart progress and identify the issues yet to be addressed. By drawing on the experiences of one established community health programme in the non-government sector, attempts to meet the changing health needs of Hong Kongs population are discussed and issues that have implications for the effective delivery of community health programmes in newly industrialized countries are identified.