published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

Falls among the elderly are a major health issue in Hong Kong. This problem has been worsening and has become a public concern for the aging population. In Hong Kong, over 30,000 community-dwelling older adults have needed hospital admission after falling, and billions of dollars are spent on the related medical costs. The prevalence of recurrent falls is high. However, a lack of concern in helping community-dwelling older adults to prevent recurrent falling currently persists in clinical field. A local study reported that most community-dwelling older adults have a fear of falling (FOF) after an accidental fall. Thus, reducing FOF can reduce the fall rate because FOF and falls are interdependent. A systematic review can show that multi-component psycho-therapeutic intervention is effective in reducing FOF. Therefore, the establishment of a standardized evidence-based practice (EBP) guideline to reduce FOF among community-dwelling older adults via multi-component psycho-therapeutic intervention is necessary. This thesis aims to develop an EBP guideline to reduce FOF among community-dwelling older adults via multi-component psycho-therapeutic intervention. Seven related studies were reviewed and appraised as having a high level of evidence. These studies also reported to have significantly positive effects on the clients. The transferability and feasibility of the proposed program in Hospital A were examined, and the results show that the transferability and feasibility of the proposed program were high. An EBP guideline and an implementation plan were then developed. A pilot test was proposed to determine and solve the difficulties in the implementation process. Then, the guideline was refined. A comprehensive evaluation plan of the proposed program is included in the final chapter. The standardized EBP guideline, which is an evidence-based approach, provides a clear pathway for practitioners to educate community-dwelling older adults in reducing FOF via multi-component psycho-therapeutic intervention. This method contributes to the reduction in the recurrent fall rate and the decrease in related medical costs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

According to the World Health Organisation, hip fracture among elderly people is a global public health problem, with 1.7 million cases worldwide in 1991, a figure due to the aging population and believed likely to increase. Post-operative delirium is a common complication following hip-fracture surgery, and occurs in 25% to 65% of cases (Gustafson 1988). It not only affects the rehabilitation progress of the elderly, but also prolongs hospitalisation, which in turn increases the financial burden on the government. There are different ways of managing post-operative delirium among the elderly, including pharmacological and multifactorial interventions and education programmes. However, there is no standard nursing management of post-operative delirium in Hong Kong, and this affects both patient care and nursing standards. According to the National Institute for Health and Clinical Excellence (2011), multifactorial intervention is cost-effective and an effective method of reducing postoperative delirium, where nurses play an important role as gatekeepers, and thus allow such intervention to be introduced into the clinical setting. With this in mind, translational nursing research was performed by a review of four studies, to introduce the concept of multifactorial intervention to nurses, to formulate the implementation for the intervention, and finally to obtain feedback from colleagues. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Falls are one of the most common and serious problems facing the elderly and are known to be associated with significant mortality, morbidity, decreased functioning and premature institutionalization. In Hong Kong, the prevalence of falls among community-dwelling older adults is 19.3%. Moreover, the incidence of falls among older people in institutions is almost three times the fall rates for the community-dwelling elderly. Institutional falls are regarded as common adverse events in hospitalized older patients. Significant mortality, morbidity and healthcare costs associated with institutional falls led institutions to recognize falls as a high-priority safety risk for hospitalized patients. This demonstrated the significance of providing the health care providers with an evidenced-based practice guideline of an effective multifactorial fall prevention programme in order to prevent in-patient falls. Objectives: The objectives of the study are to systematically review and present the best evidence for the effectiveness of multifactorial fall prevention interventions in reducing falls in hospitals, to translate the reviewed evidence and to develop evidence-based practice guidelines for the multifactorial fall prevention programme as well as to develop a plan for implementing and evaluating the multifactorial fall prevention programme. Methods: The relevant literature was searched by several electronic databases. The related literature was then retrieved, reviewed and synthesized. The quality assessment of the studies was performed according to the methodological checklist for controlled trials designed by the Scottish intercollegiate Guideline Network (SIGN). Evidenced-based practice guidelines for the multifactorial fall prevention programme were then synthesized according to the findings of the reviewed literature, while the implementation potential being assessed in terms of transferability, feasibility and the cost-benefit ratio. Results: Five studies were identified according to the inclusion and exclusion criteria set. “Evidence-based guidelines of fall prevention programme for hospitalized older patients” were formulated based on the review of the selected studies. Fourteen recommendations of the evidence-based guidelines are formulated and graded according to the grading system of Scottish Intercollegiate Guidelines Network (SIGN). The evidence-based recommendations can offer nurses and other health care professionals the standards and strategies required for implementing multifactorial fall risk assessment and multifactorial fall prevention interventions, including environmental modifications, knowledge, medication reviews and exercise. A communication plan for various parties in hospitals including a pilot test for determining the feasibility of the innovation and an evaluation plan to determine the effectiveness of the fall prevention programme were subsequently developed. Conclusion: This study reviewed evidence for the effectiveness of the multifactorial fall prevention programme in reducing the incidence of falls, translated the reviewed evidence and developed evidence-based guidelines for a multifactorial fall prevention programme, which can provide the health care practitioners with an evidence-based approach in fall risk assessment and management so as to prevent in-patient falls. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Deteriorations in cognitive functioning and sleep are the inevitable parts of the ageing process, and they are two very common complaints among the elderly population. Given their high relevance and great impact on daily functioning, many studies have attempted to address the associations of sleep problems and cognitive functioning with ageing, yet the direction of associations remained unclear. Several recent studies suggested that caffeine, a common psychostimulant present in coffee and tea, might have a beneficial effect on agerelated decline in cognitive functioning. Nonetheless, the dose-dependent effect of caffeine intake on specific domains of cognitive functioning, and the potential cost of compromised nocturnal sleep at high dose of caffeine remained to be investigated. In view of the lack of study on identifying the correlation and interaction between sleep, cognitive functioning, caffeine consumption habit, and age, this thesis reported two studies that clarified these relationships in the elderly population. Furthermore, the studies explored the possibility to utilize sleep and caffeine as a regimen to improve daytime cognitive functioning in the older population. Study 1 was a retrospective study that aimed to examine the relationship between sleep, habitual caffeine consumption, cognitive functioning, and mood in the two different age groups, the young adult and the elderly. Eighty-nine healthy elderly and forty-three healthy young adults participated in this study and completed a battery of neuropsychological assessment and a set of questionnaires. Findings revealed changes in multiple domains of sleep and cognitive functioning upon ageing. The age-related differences in sleep and cognitive functioning were correlated. Moreover, result suggested that regular caffeine consumption has a dose-dependent beneficial effect on cognitive functioning, but the effect was only observed in female. Study 2 was built on the relationship between sleep, cognitive functioning, and caffeine as found in Study 1. It aimed to investigate the effect of caffeine and daytime nap on the cognitive functioning in the healthy elderly adopting a repeated measure, double-blind, placebo-controlled design. Twenty-four healthy elderly were recruited for this study, and each of them were required to attend four experimental sessions with a one-week intersession interval. In each session, participants were required to take a rest or take a nap with or without a certain dosage of caffeine in the afternoon. Comparisons on their cognitive performance before and after the rest/ nap revealed an effect of nap and caffeine on improving subjective feeling of sleepiness and fatigue. Behavioural measurements revealed no effect on daytime nap on cognitive functioning, yet specific sleep stage and certain sleep oscillations were associated with post-nap changes in cognitive functioning. In summary, the present studies demonstrated the associations of sleep and caffeine consumption with cognitive functioning in the elderly. Habitual caffeine consumption was associated with a female-specific beneficial effect on cognitive functioning. Furthermore, daytime nap combined with the use of acute dose of caffeine might not enhance cognitive functioning, but could improve mood and well-being in the elderly. Findings from present studies suggested that further research could explore ways to maximise the benefit of napping in the elderly. / published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

China has 9 million elderly individuals with dementia, which places it first in the world. Although family care remains the major source of support for people with dementia, residential care has become an indispensable choice in recent years. The biggest concern is the quality of life of the elderly with cognitive impairment or dementia (QOL-ECI) in residential care facilities (RCFs). Previous studies have explored many individual-level factors associated with QOL-ECI; however, less discussion has been conducted on how to improve it from an organizational-level perspective. China serves as a good research setting for this issue. The present study aims to establish an organizational-level framework to investigate QOL-ECI in RCFs. The Person-centered Care (PCC) Approach serves as an organizational strategy, and the High Commitment Work System (HCWS) is used as a human resource management practice. The study exposes the QOL-ECI status of RCFs in Xi’an China; and examines the relationship between PCC/HCWS and QOL-ECI respectively and jointly. A quantitative research method, survey in particular has been designed to achieve the research objectives, and has been conducted in two phases. Phase one of the study aims to validate a Chinese Version of the Person-centered care Assessment Tool (P-CATC), which is designed to measure the extent to which formal caregivers rate their facility as being person-centered. The resulting 24-item P-CAT-C is validated among a sample of full-time employees (n=330) in all 34 RCFs in urban Xi’an, a city in China. Phase two is a survey conducted among the same 34 RCFs. Full-time employees (n=330) evaluated the HCWS level for each RCF; residents with cognitive impairment (n=307) and their respective personal care workers (n=207) were invited to evaluate QOL-ECI. Hierarchical Linear Modeling (HLM) has been adopted to test the hypothesis. In phase one study, Confirmatory Factor Analysis (CFA) shows that a three-factor 15-item solution of the P-CAT-C provided adequate fit indices to the data (χ2 = 145.69, df = 81, p< 0.001, CFI = 0.93, TLI=0.91; RMSEA = 0.05). The internal consistency coefficient (Cronbach’s α=0.68) is satisfactory. The inter scale correlation shows good construct validity. The result of Phase two study shows that the total mean patient-rated QOL-ECI score is 36.06 (SD=8.16) and the caregiver-rated score is 34.09 (SD=6.88). Using caregiver-rated QOL-ECI as the dependent variable, the HLM regression analysis shows that PCC and HCWS are statistically significant with QOL-ECI respectively, and that the HCWS has a positive moderate effect on the relationship between PCC and QOL-ECI. Using patient-rated QOL-ECI as the dependent variable, the hypotheses are partially supported. This study is among the first to report the QOL-ECI status of RCFs in China. It initially demonstrates that PCC and HCWS are positively associated with QOL-ECI both respectively and jointly. It also primarily establishes an organizational-level framework to examine QOL-ECI. This will generate valuable implications and insight into research, practice and policy-making. Finally, this study further develops the PCC theory from an organizational perspective, and contributes to both management and social work literature by first adopting the HCWS for service organizations for the elderly. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

To understand how falls occur during walking in older adults, we need to understand how the nervous system maintains stability, and how aging affects walking. Four studies were conducted to better understand the effect of age on gait. Older adults display higher gait variability compared to young adults, possibly because of their slower walking. We compared gait stability at multiple controlled walking speeds. Greater gait variability in healthy elderly existed independent of slower walking. Their diminished strength and flexibility partly explained this difference. To explain slower walking in the elderly, some have suggested that muscle weakness and stiffness may force people to walk slower. Others have suggested that people choose to walk slower to be more stable. We compared dynamic stability of gait at multiple speeds. Healthy older adults also exhibited more stability at slower speeds, yet walked at speeds comparable to young adults despite the lower strength and flexibility. Therefore, weakness and stiffness may not force healthy older adults to walk slower. The goal of the nervous system during walking may be to maintain stability of superior segments. We tested whether superior segments are more stable than inferior segments during walking. Superior segments exhibited less orbital stability during preferred walking speed, in contrast to previous suggestions. This highlighted the importance of trunk control during gait. The effects of aging on the fluctuations in the muscle activity during gait are not well understood. We quantified the stride-to-stride fluctuations of EMG as a measure of muscle activation patterns in state-space. Variability increased with speed except in the gastrocnemius. Orbital stability was less in older adults, suggesting that deviations in the EMG amplitude pattern were not readily corrected. Less local stability was seen in older adults, suggesting that older adults were more sensitive to perturbations. Together, these findings suggest that trunk control is important during gait. Strength and flexibility deficits help explain higher variability and lower stability in older adults. Future work will need to address the effect of strength interventions, neurophysiological decline on gait stability and fall risk.

published_or_final_version / Architecture / Master / Master of Architecture

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / Politics and Public Administration / Master / Master of Philosophy