Thesis (M. Med. Sc.)--University of Hong Kong, 2006.

Thesis (Ph. D.)--Open University. BLDSC no. DX87034.

Thesis--PlanA (M.S.)--University of Wisconsin--Stout, 2000. / Includes bibliographical references.

published_or_final_version / Medicine / Master / Master of Medical Sciences

Introduction: Cognitive impairment (CI) in older adults refers to impairment in cognition function beyond normal aging. Previous studies have reported the effect of dietary antioxidants, especially flavonoids on cognitive function in older adults, suggesting that high dietary flavonoids intake may reduce the risk of cognitive impairment. However, most of these studies were reported in Caucasian older populations in Western countries. Moreover, some studies were positive, which others were negative studies. There was no previous study regarding dietary flavonoids and cognitive impairment among Chinese older adults. Objectives: The objectives of this study were to explore the association between dietary intake flavonoids and the risk of cognitive impairment in Chinese older adults, and to identify the independent factors associated with the risk of cognitive impairment in Chinese older adults. Method: This study was a retrospective cross-sectional study, 200 patients who fulfilled the inclusion and exclusion criteria and gave written informed consent were recruited from the Geriatric clinics in Queen Mary Hospital, Hong Kong, from 11th July to 31st October 2011. All recruited subjects were invited to attend face-to-face interviews. Brief cognitive assessments by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were done for all subjects. Every subject also answered a detailed questionnaire on socio-demographic, type and frequency of diet items (food frequency questionnaire) and co-morbid diseases. Main outcome measure: The primary outcome measure was cognitive function, using an education-adjusted MMSE cut-off s to categorize the subjects into two groups (i.e. normal cognitive group and cognitively impaired group). Results: 200 subjects were recruited, 104 participants (37 males and 67 females) were in the normal cognitive group and 96 subjects (22 males and 74 females) were in the cognitively impaired group. The mean amount of dietary flavonoids intake of the cognitively normal group was higher than that of the cognitively impaired group (i.e. 291.84 grams/day and 240.92 grams/day respectively; p=0.006 Mann-Whitney U test). Other common dietary nutrients were also compared between the two groups. The dietary carbohydrate (p<0.001), total sugar (p<0.001), vitamin C (p=0.001) and folic acid (p<0.001) intakes were significantly related to cognitive impairment (using chi-square statistics). After adjustment for age, gender, education, exercise pattern, the dietary flavonoids intake was not independently associated with cognitive impairment. However, after adjustment for age, education level, exercise pattern and BMI, the higher to highest quartile of dietary carbohydrate intake (184.184-1176.703g/d), high total sugar intake (0.166-35.102g/d), highest quartile of vitamin C intake (139.803-900.952mg/d), the third and fourth quartiles of folic acid intake (208.899-1544.418mcg/d) were significantly associated with reduced risks of cognitive impairment. Older adults who had regular exercise (both less and more than 30 minutes per day) had lower risk of cognitive impairment than those who never did exercise (OR= 0.361, 95% confidence interval=0.167-0.784 for less than 30 minutes/d; OR=0.137, 95% confidence interval=0.048-0.396 for more than 30 minutes/d). We also found high BMI was associated with a reduced risk of cognitive impairment with an OR of 0.897 (95% confidence interval=0.816-0.987). Besides, the increasing age was also associated with cognitive impairment (OR=1.059, 95% confidence interval=1.007-1.115). Conclusion: In summary, the present study demonstrated that the dietary flavonoids intake was not significantly associated with the risk of cognitive impairment in Chinese older adults in Hong Kong. / published_or_final_version / Medicine / Master / Master of Medical Sciences

Cataract is one of the most common causes of visual impairment (VI) and blindness in the elderly population. In Hong Kong, the total population and the number of people over the age of 65 has been increasing over the past 10 years. The number of people suffered from cataract has also increased due to population growth and limited availability of medical resources. The waiting time for cataract surgery is long. Patients’ visual acuity (VA) continues to deteriorate while they are waiting for the surgery. Therefore, it is important for healthcare providers to explore the impact of VI on the quality of life (QOL) of cataract patients, and develop strategies to help patients overcome their difficulties. Patients who were on the cataract surgery waiting list with no cognitive impairment were recruited from the Department of Ophthalmology, Queen Mary Hospital, Hong Kong. A purposive sampling method was used. 24 patients were recruited based on their age and VA. Each group contained the same number of male and female patients. Informed consent was obtained before the start of the interview. Patients’ demographics and clinical data were extracted from their medical records. A mix of qualitative and quantitative approaches was adopted. Data were collected through semi-structural interviews (qualitative) and the administration of the Chinese version of the 25-Item National Eye Institute Visual Function Questionnaire (CHI-VFQ-25) (quantitative). Our results suggested that patients had poor knowledge regarding the definition and symptoms of cataract. In-depth interviews revealed that patients were having troubles in various ADLs, including cooking and dining, reading and writing, housekeeping, grooming and watching television (TV). Difficulties with mobility and transportation, together with the inability to recognize faces, were found to affect patients’ social lives. The fear of future deterioration in VA and the loss of abilities resulted in a range of negative feelings, such as sadness, frustration, irritation, insecurity and feeling of burden to others. Strategies used to tackle the difficulties in ADLs and patients’ adjustments to their negative emotions were also described. Certain comorbid diseases, for example stroke, arthritis and hearing impairment, further complicated patients’ QOL. Quantitative analyses showed that patients had suboptimal scores in all subscales of CHI-VFQ-25, except for ocular pain and peripheral vision. In general, the CHI-VFQ-25 composite scores reflected that patients had little to moderate difficulties in their ADLs. Working status also affected the CHI-VFQ-25 scores. Patients who were working had lower scores in almost all subscales (except general health, ocular pain, colour vision and peripheral vision) than retired patients. Intergroup comparison suggested that patients who were older and had lower VA scored worst in the CHI-VFQ-25. In conclusion, although our patients have been suffered from cataract for years, they had poor knowledge about this common eye disease. Both qualitative and quantitative analyses showed that patients experienced a lot of difficulties in their ADLs, which eventually led to a variety of negative impacts on their emotional and psychosocial wellbeing. / published_or_final_version / Anatomy / Master / Master of Philosophy

Depression has become a medical condition that affects more and more of the aged Hong Kong population, yet this condition is often overlooked. Depression is a treatable condition. Nevertheless, the current practice in Hong Kong relies heavily on medication and cognitive-behavioural therapy. The effectiveness of these two types of therapy is limited by the side-effects of the medications and the accessibility to medical facilities for cognitive-behavioural therapy. Physical activity is suggested by many studies to be effective in managing depressive symptoms in the population. Physical exercise is a relatively economic and convenient activity that can be self-administered for health. Some studies have suggested that physical activity is effective for managing depression, yet the number of theses on this topic for the aged population is limited. In this thesis, studies related to the effectiveness of physical activity on depressive symptoms alleviation among older adults were reviewed and critically appraised. The potential to apply the findings of these studies to the aged Chinese population in Hong Kong is discussed and presented. Studies were searched using the databases Pubmed and CINAHL, and a total of 15 relevant studies were found. The 15 studies were analyzed and listed as tables of evidence and appraised with the SIGN checklist for their quality. The results of these studies and the quality of the papers were summarized. Regarding the physical activity types examined in these studies, aerobic exercise involving controlled-breathing or deep-breathing (e.g. TaiChi) and activities to promote posture including flexibility and balance (e.g. Yoga) were found to be effective for alleviating depressive symptoms among the aged population. The feasibility and transferability of the desired intervention to the target population and setting were discussed. An evidence-based guideline with 8 recommendations was also developed. Finally, a plan for communication with different parties (e.g., administrators, users and staff) to administer the intervention was devised. A pilot test was also planned, with and evaluation plan for the pilot test to allow for adjustments to the intervention. This thesis discussed an alternative to treatment of depressive symptoms among the aged population. With the practice of physical activity effective in managing depressive symptoms in this population, it gave rise to the possibility that to promote the innovation to all of this population. / published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

Falls risk factor assessment is the first step in the development of appropriate intervention strategies for the prevention of falls. However, few multifactorial, validated falls risk assessments exist which are suitable for use in busy clinical settings. This project aimed to develop a reliable and valid falls risk assessment that was feasible for use in various clinical settings. The QuickScreen Clinical Falls Risk Assessment was developed and evaluated via four methods; a) the test-retest reliability of the measures was assessed with 30 community-dwelling older people, b) the concurrent validity of the measures was assessed by comparison with performance in the Physiological Profile Assessment, c) the predictive validity of the measures was assessed by comparison of performance with prospective falls in two studies involving large samples of community dwelling older people and d) the feasibility of the assessment was evaluated with 40 clinicians who trialled the assessment with their patients. The QuickScreen clinical falls risk assessment consists of eight measures, including previous falls, total medications, psychoactive medications, visual acuity, touch sensation, the sit to stand test, the near tandem stand test and the alternate step test. The test-retest reliability of the assessment measures was acceptable (intraclass correlation coefficients ranged from 0.56 to 0.89) and the assessment measures discriminated between multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.5. The clinicians that trialled the assessment reported that it was quick and easy to administer and that it assisted in the management of their elderly patients. These results show that the QuickScreen Clinical Falls Risk Assessment has proven validity, test-retest reliability and is practical for use in a variety of clinical settings.

Falls risk factor assessment is the first step in the development of appropriate intervention strategies for the prevention of falls. However, few multifactorial, validated falls risk assessments exist which are suitable for use in busy clinical settings. This project aimed to develop a reliable and valid falls risk assessment that was feasible for use in various clinical settings. The QuickScreen Clinical Falls Risk Assessment was developed and evaluated via four methods; a) the test-retest reliability of the measures was assessed with 30 community-dwelling older people, b) the concurrent validity of the measures was assessed by comparison with performance in the Physiological Profile Assessment, c) the predictive validity of the measures was assessed by comparison of performance with prospective falls in two studies involving large samples of community dwelling older people and d) the feasibility of the assessment was evaluated with 40 clinicians who trialled the assessment with their patients. The QuickScreen clinical falls risk assessment consists of eight measures, including previous falls, total medications, psychoactive medications, visual acuity, touch sensation, the sit to stand test, the near tandem stand test and the alternate step test. The test-retest reliability of the assessment measures was acceptable (intraclass correlation coefficients ranged from 0.56 to 0.89) and the assessment measures discriminated between multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.5. The clinicians that trialled the assessment reported that it was quick and easy to administer and that it assisted in the management of their elderly patients. These results show that the QuickScreen Clinical Falls Risk Assessment has proven validity, test-retest reliability and is practical for use in a variety of clinical settings.