published_or_final_version / Public Administration / Master / Master of Social Sciences

published_or_final_version / Social Work / Master / Master of Social Sciences

貧窮既是一種客觀況，又是一種主觀心感受。既有的研究很少關注老年人自身關於貧窮的經驗，特別是缺乏華人社會背景下貧窮老人主觀經驗的研究。本研究試圖從個體的層面考察貧窮對於中國城市老人多重面向的負面影響，以及他們如何回應這些負面影響，在此基礎上為改善與貧窮老人有關的社會政策提出適切的建議。 / 基於這一研究目的，本研究從批判老年學和抗逆力的理論視角出發，採取建構主義範式和生命故事的研究取向，以中國北京的城市貧窮老人為例，選取17位城市貧窮老人為研究物件，深入研究中國城市貧窮老人的各種壓力，以及抗逆力的內外保護性因素回應這些壓力的機制及其所起到的作用。 / 研究發現，中國城市貧窮老人面臨經濟壓力、疾病與老化的壓力、逆反哺與照顧配偶的壓力，以及貧窮恥感的壓力。貧窮在城市老人的主觀經驗裡意味著多重壓力的相迭，這從主觀經驗的角度揭示了中國城市貧窮老人的多重弱勢。 / 作為抗逆力外在保護性因素的社會支持，它的實現機制因其類型的不同而相異。代際支持對提升抗逆力的作用受到代際團結和代際張力的共同影響；其他非正式支持對提升抗逆力的作用受到互惠關係的影響；社會政策的支持對提升抗逆力的作用受到人情倫理的雙重性和代群差異的影響。這些機制共同決定了貧窮老人的非正式支援日趨弱化，而社會政策和專業服務提供的正式支援有待加強。 / 作為貧窮老人抗逆力的內在保護性因素，工具性策略由獨立性的要求所驅動，意義創造遵循追尋自我價值和重構貧窮經驗這兩條路徑。意義創造在貧窮老人的內在保護性因素中發揮著更為根本性的作用。內外保護性因素的比較有助於我們識別城市貧窮老人中更脆弱的次群體。 / 基於這一研究發現，本研究在原有研究框架的基礎上，補充了貧窮老人的多重壓力和保護性因素的實現機制，擴展了貧窮老人抗逆力研究的研究框架。文章的最後提出了社會政策的具體建議。 / Poverty is both an objective condition and a kind of subjective psychological feeling. However, existing studies pay little attention to older people’s own experience of poverty, especially lacking of studies on subjective experience of the aged poor in the Chinese context. This research attempts to explore from the individual level, the multi-dimensional negative effects of poverty on the aged poor in urban China and how they respond to these impacts. On this basis, appropriate social policies were proposed to improve the living conditions of the aged poor. / Taking the constructivist position and life story approach, this study was conducted from the perspectives of resilience theory and critical gerontology and used the urban aged poor in Beijing, China as an example. Seventeen urban aged poor were selected as the sample for in-depth interview and their multiple stresses, and the mechanisms of internal and external protective factors of resilience in response to their stresses and their functions were investigated. / Research findings show that China’s urban aged poor suffer stresses from economic pressure, diseases and aging, taking care of their spouses, inverse nurturing, and shamefulness of poverty. Poverty means a combination of multiple stresses in the subjective experience of the urban poor elderly. This perspective reveals the multiple disadvantages of the Chinese urban aged poor. / Social support as the external protective factor of resilience, its implementation mechanisms are different by its types. The intergenational support in enhancing the function of resilience is influenced by intergenational solidarity and intergenational tension. Other informal social support in enhancing the function of resilience is affected by reciprocal relationship. Formal support from social policy in enhancing the function of resilience is influenced by the dual nature of interpersonal ethics as well as cohort differentiation. These mechanisms together determine that informal social support of the urban aged poor is gradually weakened. As a result, formal social support coming from social policy and professional social service has to be strengthened. / As one of the internal protective factors of resilience of the aged poor, the instrumental strategies are driven by the demands of independence. The other one of the internal protective factors, the creation of meaningfulness, develops towards two paths, one of which is in search of self-worthiness and the other reconstruction of experience of poverty. The significance of creation of meaningfulness in the internal protective factors of the aged poor exerts a more fundamental function. A combination of the internal and external protective factors can help us differentiate the more disadvantaged sub-group among the urban aged poor. / Based on the findings of the study, the original conceptual framework is reconstructed by supplementing the multiple stresses and the operating mechanisms of protective factors. This has expanded the research framework of studying resilience of the aged poor. Finally, some specific recommendations of social policy are provided. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 陳岩燕. / Thesis subitted: December 2012. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 456-499) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Chen Yanyan. / Chapter 第一章 --- 緒論 --- p.1 / Chapter 第一節 --- 研究背景 --- p.1 / Chapter 第二節 --- 研究目的與研究意義 --- p.11 / Chapter 第三節 --- 本文的結構 --- p.13 / Chapter 第二章 --- 文獻回顧 --- p.14 / Chapter 第一節 --- 貧窮老人研究的回顧 --- p.14 / Chapter 第二節 --- 與老年貧窮相關的社會政策與研究發現 --- p.49 / Chapter 第三節 --- 與貧窮老人相關的理論解釋 --- p.80 / Chapter 第四節 --- 現有研究的不足 --- p.125 / Chapter 第三章 --- 研究設計 --- p.132 / Chapter 第一節 --- 概念框架 --- p.132 / Chapter 第二節 --- 研究方法 --- p.143 / Chapter 第四章 --- 中国城市貧窮老人的多重壓力 --- p.183 / Chapter 第一節 --- 經濟壓力 --- p.183 / Chapter 第二節 --- 老化和疾病的壓力 --- p.187 / Chapter 第三節 --- 逆反哺和照顧配偶的壓力 --- p.202 / Chapter 第四節 --- 貧窮恥感的壓力 --- p.226 / Chapter 第五節 --- 多重壓力相疊 --- p.237 / Chapter 第五章 --- 貧窮老人與非正式社會支持 --- p.240 / Chapter 第一节 --- 貧窮老人與代際支持 --- p.240 / Chapter 第二節 --- 貧窮老人與擴展家庭的支持 --- p.259 / Chapter 第三節 --- 貧窮老人與鄰里支持 --- p.271 / Chapter 第四節 --- 貧窮老人與其他非正式支持 --- p.291 / Chapter 第六章 --- 貧窮老人與正式社會支持 --- p.297 / Chapter 第一節 --- 貧窮老人與社會政策的支持 --- p.297 / Chapter 第二節 --- 貧窮老人對待社會政策支持的例外個案 --- p.319 / Chapter 第三節 --- 社會政策基層執行者的支持 --- p.325 / Chapter 第四節 --- 其他的正式社會支持 --- p.336 / Chapter 第七章 --- 貧窮老人的工具性策略與意義創造 --- p.347 / Chapter 第一節 --- 貧窮老人的工具性策略 --- p.348 / Chapter 第二節 --- 貧窮老人的意義創造 --- p.372 / Chapter 第八章 --- 討論 --- p.410 / Chapter 第一節 --- 多重壓力：中國城市貧窮老人的多重弱勢 --- p.411 / Chapter 第二節 --- 外在保護性因素：社會支持的再審視 --- p.414 / Chapter 第三節 --- 內在保護性因素 --- p.435 / Chapter 第四節 --- 對貧窮老人抗逆力理論框架的補充 --- p.441 / Chapter 第九章 --- 社會政策的啟示 --- p.445 / Chapter 一、 --- 優勢為本的社會政策 --- p.445 / Chapter 二、 --- 支持家庭的社會政策 --- p.446 / Chapter 三、 --- 雙重權利系統的社會政策 --- p.447 / Chapter 四、 --- 適度普惠的社會政策 --- p.448 / Chapter 第十章 --- 總結 --- p.450 / Chapter 第一節 --- 總結 --- p.450 / Chapter 第二節 --- 本研究的貢獻與局限 --- p.453 / p.456 / 附錄 --- p.500 / Chapter 附錄1： --- 200-2050年中國各年齡段男、女性人口增長趨勢 --- p.500 / Chapter 附錄2： --- 北京市歷年社會保障相關標準（1994-2011） --- p.501 / Chapter 附錄3： --- 受訪者的訪談時間與合計訪談時長 --- p.502 / Chapter 附錄4： --- 2009年11月第一次訪談大綱 --- p.504 / Chapter 附錄5： --- 2010年9月第二次訪談大綱 --- p.507

伴隨著改革開放開始的中國醫療改革由於受到過度市場化的影響，一直在質疑聲中前行。進入21世紀，社會醫療保障制度改革標誌著中國醫改「健康公平」之路的回歸。然而，在公平正義不斷被強調的口號背後，對「健康公平」的理論界定與實證研究仍然相對匱乏。 / 本研究從「弱者優先」的社會公義理論出發，重新將「健康公平」理論界定為「基於社會公義的健康平等」。研究員立於足后實證主義研究範式，綜合運用質化與量化研究方法，結合一手與二手數據分析，以浙江省為研究場域，探索以社會醫療保險改革為核心的醫療福利制度改革，對老年人「健康公平」所造成的影響。最終，確立了「底層健康公平」的價值選擇，並發展了多元健康公平的理論框架。 / 透過量化研究的主要發現，研究員的結論是要將健康公平問題從「機會公平」視角轉換為健康「結果公平」。另一重要的結論是不要單一關注社會醫療保險改革覆蓋面的擴大，更應關注不同保險項目之間福利待遇的公平性。透過多元線性回歸分析，研究員發現了醫療保險改革之後影響老年人健康水平的顯著因素：微觀層面的社會經濟地位與慢性病特徵，宏觀層面的保險因素與中觀層面的社會支持網絡。質化研究的採用將「健康公平」的討論從關注客觀的「健康結果」擴展為利益相關者主觀的公平性體驗。質化研究補充了政策制定者、基層醫生與弱勢老年人各自對「健康公平」的理解，進一步回答了「什麽是健康公平」，確立了本研究的底層視角。 / 混合研究進一步回答了社會醫療保險改革對老人「健康公平」的影響：雖然醫療保險改革提高了老人的「機會公平」，但這只是形式公平，改革在推動「過程公平」與「結果公平」這些實質公平的維度尚待探索。在醫療保險改革之後，進一步的路徑分析評估了「醫療服務使用」作為mediator的作用，呈現了與「健康水平」之間的負向因果關係。交互作用分析表明，如若改變弱勢老年人社群在「健康公平」中的弱勢地位，就需要社會醫療保險改革調節「醫療服務使用」與「健康水平」的關係；且澄清了不同社會醫療保險項目作為moderator的差別：城鎮職工基本醫療保險可以改善使用較多醫療服務的老人的健康水平，而新型農村合作醫療則起到相反的作用。在這些變量之間的關係背後，站在「弱者優先」的底層立場上，深入的質化研究補充了社會醫療保險改革對弱勢老人接受醫療服務與享受醫療福利待遇「過程公平」的缺失與「結果公平」的不足。 / 結合以上量化與質化研究發現，本研究識別出了「健康公平」多維度的影響因素（經濟地位、健康地位、社會關係網絡、身份地位、福利地位），建立了包括機會、結果和過程公平在內的多元的健康公平理論框架。並且綜合討論了「健康公平」理論的反思與重構，混合研究方法在評價醫療保障改革公平性實證研究中運用的可行性，並且倡導在政策制定中改變福利觀念，提出了如何進行公平的「全民醫保」政策改革，以及如何實現「以社區為中心的綜合健康服務與長期照顧體系」的政策創新。 / Along with the reform and opening up, the health reform in China had been continously challenged due to its excessive marketization. As the pioneer of a new round of health reform since 21st century, social health insurance reform reiterated ‘health equity’. Nevertheless, neither theoretical nor empirical studies were abundant behind the slogans for the advancement of equity and justice. / This thesis began with theory of social justice based on ‘give priority to the disadvantaged group’, redefining the concept of ‘health equity’ by ‘health equality on the basis of social justice’. Adopting of the paradigm of post-positivism, researcher chose quantitative-and-qualitative mixed method, and combined analysis of primary data and secondary data. This study has been located in Zhejiang province, intending to explore the impacts of health insurance reform along with health welfare system changes on health equity among the elderly. Researcher finally adopted the value choice of health equity for vulnerable groups, and developed a multi-dimension theoretical framework of ‘health equity’. / From the quantitative research findings, researcher modified the theory of health equity from concerning ‘equal opportunity’ to ‘equal outcome’. This research also contributed to a transition of health insurance studies from emphasis on expansion of ‘insurance coverage’ to the concerns with unequal benefit packages between different social insurance schemes. Multiple linear regression demonstrated significant predictors of older adults’ health outcome after health insurance reform, composing of socio-economic status and chronic disease in the micro-level, health insurance in the macro-level, and social support in the meso-level. Simultaneously, qualitative research explained diversive understandings of ‘health equity’ among policymakers, doctors who provide primary care and vulnerable older adults. The crucial question of ‘what is health equity’ has been answered, and that the ‘give priority to the disadvantaged group’ standpoint being reaffirmed. / Mixed method study further answered the research question of ‘what is impacts of health insurance reform on the health equity among the elderly’: Although health reform improved ‘opportunity equity’ for older adults as a kind of ‘form fairness’, it was still expected to explore other dimensions of ‘essential fairness’, such as ‘process equity’ and ‘result equity’. After health insurance reform, researcher employed path analysis to test mediator effects of ‘healthcare utilization’, which demonstrated negative causal relations with ‘health outcome’. Interaction effect analysis manifested a moderating effect of health insurance reform adjusting the relationship between ‘healthcare utilization’ and ‘health outcome’ with an attempt to improve social status for disadvantaged older groups. Interaction effects of different insurance schemes have been clarified as well: The Basic Medical Insurance for Urban Employees could improve health outcome of the elderly who use more health care services, whereas the New Rural Cooperative Medical Scheme played an opposite function. Under the background of these relations between variables, being standfast in vulnerabe groups’ stand, researcher adopted qualitative data to complement quantitative findings: The lack of ‘process equity’ and the short of ‘outcome equity’ during the process of interpreting accessibility to health care services and utilization. / In this dissertation, researcher also synthetically combined findings in quantitative and qualitative research, identified multiple predict factors of ‘health equity’ (economic status, health status, social networks, identity status and welfare status). All of above mentioned factors jointly composed and enriched multi-dimensional ‘health equity’ theoretical framework (including equitable opportunity, outcome and process). It also profoundly rethought and reconstructed ‘health equity’ theory, and evaluated efficiency and effectiveness of health insurance reform by using mixed research methods. Researcher advocated a transition of welfare ideology in the process of policy making, and recommended an ‘universal health insurance’ reform based on health equity, then initiated a ‘home and community based comprehensive health and long-term care service’ system. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 劉曉婷. / "2013年3月". / "2013 nian 3 yue". / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 386-422). / Abstract in Chinese and English. / Liu Xiaoting. / 論文摘要 --- p.I / Abstract --- p.III / 致謝 --- p.VI / Chapter 第一部份 --- 研究背景 --- p.1 / Chapter 第一章 --- 導論 --- p.2 / Chapter 第一節 --- 研究的緣起 --- p.2 / Chapter 一、 --- 醫療改革中的公平性失守 --- p.3 / Chapter 二、 --- 醫改糾偏：重建社會公平的改革共識 --- p.6 / Chapter 三、 --- 聚焦老年人：醫療保障改革中的弱勢社群 --- p.10 / Chapter 四、 --- 研究場域：浙江醫改之路 --- p.12 / Chapter 第二節 --- 研究問題的提出 --- p.16 / Chapter 第三節 --- 研究的目標 --- p.19 / Chapter 一、 --- 從理論上對「健康公平」的界定與發展 --- p.19 / Chapter 二、 --- 從實證研究中識別「弱勢老年人」的社會結構、關係網絡與疾病風險特徵 --- p.20 / Chapter 三、 --- 通過混合研究方法探索醫療保險改革與老人健康公平的因果關係 --- p.21 / Chapter 四、 --- 探索建立「健康公平」研究的理論框架 --- p.21 / Chapter 第四節 --- 本文的結構 --- p.24 / Chapter 第二部份 --- 研究準備 --- p.27 / Chapter 第二章 --- 文獻回顧 --- p.28 / Chapter 第一節 --- 平等與公平 --- p.28 / Chapter 一、 --- 平等的主體與客體 --- p.29 / Chapter 二、 --- 公平的價值選擇 --- p.35 / Chapter 第二節 --- 基於社會公義的健康公平 --- p.41 / Chapter 一、 --- 健康公平的界定 --- p.41 / Chapter 二、 --- 健康公平的實現 --- p.48 / Chapter 三、 --- 底線公平 --- p.53 / Chapter 第三節 --- 醫療保險、醫療服務使用與健康水平的關係 --- p.58 / Chapter 一、 --- 文獻回顧與批評 --- p.58 / Chapter 二、 --- 對老年人健康水平認識的發展 --- p.64 / Chapter 第四節 --- 影響健康公平的社會決定因素 --- p.69 / Chapter 一、 --- 社會結構因素 --- p.69 / Chapter 二、 --- 社會網絡因素 --- p.78 / Chapter 第五節 --- 中國社會醫療保險制度改革 --- p.87 / Chapter 一、 --- 中國傳統醫療保障制度及其缺陷 --- p.87 / Chapter 二、 --- 社會醫療保險的道路選擇與發展 --- p.91 / Chapter 三、 --- 醫療保障制度改革對弱勢社群的排斥 --- p.102 / 本章小結 --- p.107 / Chapter 第三章 --- 方法論與反思 --- p.109 / Chapter 第一節 --- 研究範式：對後實證主義的理解 --- p.109 / Chapter 一、 --- 範式與範式轉移 --- p.109 / Chapter 二、 --- 證偽與後實證主義的運用 --- p.112 / Chapter 三、 --- 研究方法的層次與後實證主義的適用性 --- p.116 / Chapter 第二節 --- 混合研究方法 --- p.118 / Chapter 一、 --- 量化與質化研究各自的優缺點 --- p.118 / Chapter 二、 --- 選擇混合研究方法的理由 --- p.121 / Chapter 第三節 --- 分析單位：結構與能動者 --- p.124 / Chapter 一、 --- 結構與能動者 --- p.124 / Chapter 二、 --- 本研究的分析單位 --- p.128 / Chapter 第四節 --- 研究員的自我反省 --- p.130 / Chapter 一、 --- 對研究員個人社會特徵與經歷的反思 --- p.131 / Chapter 二、 --- 對研究員在學術場域中的位置的反思 --- p.135 / Chapter 三、 --- 對整個研究過程和研究方法的反思 --- p.137 / 本章小結 --- p.141 / Chapter 第四章 --- 研究框架與研究設計 --- p.142 / Chapter 第一節 --- 研究框架 --- p.142 / Chapter 第二節 --- 基本概念界定 --- p.146 / Chapter 一、 --- 社會醫療保險 --- p.146 / Chapter 二、 --- 弱勢老年人 --- p.148 / Chapter 三、 --- 醫療服務使用 --- p.149 / Chapter 四、 --- 健康水平 --- p.150 / Chapter 五、 --- 健康公平 --- p.151 / Chapter 第三節 --- 量化研究設計 --- p.153 / Chapter 一、 --- 研究假設 --- p.153 / Chapter 二、 --- 抽樣方法、問卷調查與二手數據分析 --- p.157 / Chapter 三、 --- 測量問題與分析模型 --- p.165 / Chapter 第四節 --- 質化研究設計 --- p.171 / Chapter 一、 --- 研究假設 --- p.171 / Chapter 二、 --- 樣本選擇與獲得進入 --- p.173 / Chapter 三、 --- 資料收集策略與分析方法 --- p.183 / Chapter 第五節 --- 研究的質素 --- p.190 / Chapter 一、 --- 量化與質化研究方法各自的信效度 --- p.190 / Chapter 二、 --- 混合研究方法的信效度：三角互證法 --- p.192 / 本章小結 --- p.197 / Chapter 第三部份 --- 研究發現 --- p.198 / Chapter 第五章 --- 量化研究發現 --- p.199 / Chapter 第一節 --- 改革前後被訪老人社會特徵的變化 --- p.199 / Chapter 一、 --- 基本特徵 --- p.200 / Chapter 二、 --- 社會經濟地位 --- p.204 / Chapter 三、 --- 社會支持網絡 --- p.208 / Chapter 第二節 --- 被訪老年人的健康水平與醫療服務使用情況 --- p.210 / Chapter 一、 --- 健康水平 --- p.210 / Chapter 二、 --- 醫療服務可及性及使用 --- p.220 / Chapter 第三節 --- 各保險項目參保老年人的健康不平等 --- p.227 / Chapter 一、 --- 各保險項目參保老年人的基本特徵 --- p.228 / Chapter 二、 --- 醫療保險類型與老年人的醫療服務使用 --- p.230 / Chapter 三、 --- 醫療保險類型與老年人的健康水平 --- p.233 / Chapter 第四節 --- 多元線性回歸分析：對健康水平的預測 --- p.236 / Chapter 一、 --- 建立多元線性回歸模型 --- p.239 / Chapter 二、 --- 多元線性回歸分析的結果 --- p.242 / 本章小結 --- p.248 / Chapter 第六章 --- 質化研究發現 --- p.250 / Chapter 第一節 --- 政策制定者：對形式公平與個人責任的強調 --- p.250 / Chapter 第二節 --- 基層醫生：因醫患矛盾和「付出-回報失衡」而產生的弱勢感 --- p.255 / Chapter 第三節 --- 弱勢老人：建立在「比較」基礎上的不公平感 --- p.259 / Chapter 一、 --- 農村老人與城鎮老人比較：社會福利不公平與弱勢地位的惡化 --- p.261 / Chapter 二、 --- 普通老人與離退休干部比較：身份地位差別引發的醫療服務不公平 --- p.264 / Chapter 三、 --- 只享受醫療保險的老人與低保對象比較：究竟誰更加弱勢？ --- p.266 / 本章小結：基於弱者優先的底線公平 --- p.271 / Chapter 第七章 --- 混合研究發現：醫療保險改革如何影響弱勢老人的健康公平 --- p.274 / Chapter 第一節 --- 浙江省社會醫療保障的改革實踐：機會公平 --- p.275 / Chapter 第二節 --- 路徑分析：醫療服務使用與健康水平的關係 --- p.279 / Chapter 一、 --- 醫療服務使用與健康水平的相關分析 --- p.280 / Chapter 二、 --- 路徑模型的建立、修正及結果 --- p.282 / Chapter 三、 --- 戶口-醫療服務使用-健康水平（最終的路徑模型） --- p.294 / Chapter 第三節 --- 交互作用分析：醫療保險的調節作用 --- p.299 / Chapter 一、 --- 「城鎮職工基本醫療保險」作為moderator --- p.299 / Chapter 二、 --- 「新型農村合作醫療」作為moderator --- p.302 / Chapter 第四節 --- 醫療保障制度改革中的過程公平與結果公平 --- p.306 / Chapter 一、 --- 過程公平：部門利益爭奪中「看病貴」問題喜憂參半的改革 --- p.306 / Chapter 二、 --- 結果公平：弱勢老人未被滿足的需要與不足夠的保障 --- p.310 / 本章小結 --- p.316 / Chapter 第四部份 --- 討論與結論 --- p.318 / Chapter 第八章 --- 討論 --- p.319 / Chapter 第一節 --- 「公平性」理論的反思與重構 --- p.319 / Chapter 一、 --- 反思醫療福利改革的理論基礎：對社會公義理論的發展 --- p.320 / Chapter 二、 --- 分析「底層健康公平」的理論機制：階層化身份地位差別的形成與變遷 --- p.325 / Chapter 第二節 --- 傳統微觀影響因素的再認識 --- p.332 / Chapter 一、 --- 健康水平：疾病風險變化與健康水平測量的發展 --- p.332 / Chapter 二、 --- 社會經濟地位：從關注收入轉向關注疾病的經濟負擔 --- p.334 / Chapter 三、 --- 戶籍狀況：影響的消除還是持續？ --- p.336 / Chapter 第三節 --- 結果公平的全民醫療保險制度改革 --- p.339 / Chapter 一、 --- 全民醫療保險的角色反思：從機會公平到結果公平 --- p.339 / Chapter 二、 --- 從醫療服務使用到健康結果：全民醫療保險的新路徑倡導 --- p.341 / Chapter 三、 --- 醫療保險改革與醫藥體制改革的互動 --- p.344 / Chapter 第四節 --- 以社區為中心的綜合健康服務與長期照顧體系初探 --- p.349 / Chapter 一、 --- 社會支持網絡：擴展的視角 --- p.349 / Chapter 二、 --- 美國社區健康中心與長期照顧服務的啟示 --- p.351 / Chapter 三、 --- 對中國建立社區綜合健康服務與長期照顧體系的啟示 --- p.355 / 本章小結 --- p.357 / Chapter 第九章 --- 結論與建議 --- p.359 / Chapter 第一節 --- 結論 --- p.359 / Chapter 一、 --- 「底層健康公平」價值選擇的特殊意涵 --- p.360 / Chapter 二、 --- 混合研究發現「過程公平」與「主觀公平」的重要性 --- p.362 / Chapter 三、 --- 健康公平社會影響因素的新變化與新發現 --- p.363 / Chapter 四、 --- 改革中醫療保險對健康公平的調節作用 --- p.364 / Chapter 第二節 --- 建議 --- p.367 / Chapter 一、 --- 醫療保障政策建議 --- p.367 / Chapter 二、 --- 醫療與醫藥政策的配合：推動「過程公平」的需要 --- p.371 / Chapter 三、 --- 社會醫療保險改革對醫療服務發展的啟示 --- p.373 / Chapter 第三節 --- 貢獻、局限與研究展望 --- p.375 / Chapter 一、 --- 本研究的貢獻 --- p.375 / Chapter 二、 --- 本研究的局限 --- p.379 / Chapter 三、 --- 未來的研究方向 --- p.381 / 結束語 --- p.384 / 參考文獻 --- p.386 / 附錄 --- p.423 / Chapter 附錄1. --- 調查問卷 --- p.423 / Chapter 附錄2. --- 數據使用協議 --- p.441 / Chapter 附錄3. --- 知情同意書 --- p.442 / Chapter 附錄4. --- 訪談提綱 --- p.443

心肺功能是其中一項體能特質，而對於進行較長時間的中至高劇烈程度運動十分重要，也會影響日常活動和健康。但是，還沒有研究香港華裔長者心肺功能水平及其與體能活動參與程度和健康的關條。 / 招募對象是從現有的兩個追蹤研究來的[男女骨折研究(n=998 和884 )和頸動脈粥樣硬化研究( 191 名婦女)， 70 - 79 歲年長男士最大攝氧量的參考範圖為22.3-23.0 毫升/分鐘/公斤(95%信賴區間) , 80 歲以上為19.2-20.2 毫升/分鐘/公斤。80 歲以上女性的參考範園為17.0-18.3 毫升/公斤/分鐘， 70-79 歲為19.3-20.0毫升/公斤/分鐘， 60-69 歲為2 1. 7-23.0 毫升/公斤/分鐘和年齡55-59 歲為22 .1 -23.8毫升/公斤/分鐘。男性的心肺功能與腰圍有相關性。<.0001) ，而女性的相關性還要加上體重(p<.02) ，與年齡有關的最大攝氧量衰退在男性為0.368 毫升/公斤/分鐘/年，而女性為0 .238 毫升/公斤/分鐘/年。 / 70 - 79 歲年長男士6 分鐘步行距離的參考範圍為453.3-466 公尺， 80 歲以上為382.6-403.3 公尺。80 歲以上女性的參考範圍為333.9-357.2公尺和年齡70-79 歲為396.1-406.8 公尺。6 分鐘步行距離與腰圍、身高和學歷有相關性(p:S:.05) ，與年齡有關的6 分鐘步行距離衰退在男性為9.06 公尺/年，而女性為7.35 公尺/年。從長者活動評估量表得出的體能活動參與程度被認為是與最大攝氧量成正相關(男性:r=.241，'女性:r=.214 )和6 分鐘步行距離(男性: r=.257，女性:r=.1 84) 。長者日常步行時間越長最大攝氧量和6 分鐘步行距離較佳(p≤01) ，進行劇烈運動的女性有正常最大攝氧量的機會較高(p=.041) 。男性能符合美國運動醫學學院或香港衛生署指引的明顯比不能達到指引的有較好的心肺功能。能達到指引的男性有1. 68 倍的概率有正常的心肺功能。回溯性研究追查過去的PASE 分數與現在最大攝氧量的相關性，反應出過去的體能活動參與程度對現在的心肺功能影響隨時間減少(男性由目前回到7 年前: r=0.241、0.168、0.120; 女性: r= .214、0.106、0.069 )。 / 患有高血壓男性的最大攝氧量和6 分鐘步行距離較差(p=.014) ，曾患有心肌硬塞或心絞痛男性和糖尿病女性的6 分鐘步行距離較差(p<.04) 。最大攝氧量分別與由社區認知篩選工具評估的男性認知水平（r=.107)和男女長者憂鬱量表分數男性:r=-.112 ，女性: r=-.123) 有相關性。另一方面， 6 分鐘步行距離被發現分別與簡易智能狀態測驗p<.02) 、男性的社區認知篩選工具(p=.046)的認知級別和男女長者憂鬱量表的抑鬱狀態p<.04)有差別。 / 最大攝氧量和6分鐘步行距離的年齡調整相關性連中高程度(男性:R=.459、女性: R=.425) 。除了與最大攝氧量有滿意的相關性，6分鐘步行距離與精神健康有比較密切的相關性。6分鐘步行距離可作為香港華裔長者最大攝氧量的體能代表值。 / Cardiorespiratory fitness (CRF) is one of the main attributes which is important toper form moderate-to-high intensity exercise for prolonged periods which affects daily activities as well as health. However, there are no studies among HK Chinese Elders' CRF and the relationship between this important parameter of physical fitness, PA participation and health outcomes. / By recruiting subjects from two existing cohort studies, the Osteoporetic Fractures in Men & Women Study (n=998 & 884 respectively) and the Carotid Atherosclerosis Study (191 women), the reference ranges of VO₂ peak for men were 22.3-23.0ml/min/kg (95% C.I.) at age 70-79y, and 19.2-20.2 ml/min/kg at age ≥80y. Forwomen, the reference range at age ≥80y was 17.0-18.3 ml/kg/min, 70-79y was19.3-20.0 ml/kg/min, 60-69y was 21.7-23.0 ml/kg/min and for age 55-59y was22.1-23.8 ml/kg/min. Men's VO₂ peak was associated with waist circumference(WC, p<.000l) while women's VO₂ peak additionally associated with weight (p<.02).There was an age-related decline in VO₂ peak at 0.368 ml/kg/minly in men and 0.238ml/kg/minly in women. / The reference ranges of 6MWD for men were 453.3-466.6m (95% C.I.) at age 70-79y, and 382.6-403.3m at age ≥80y. For women, the reference range at age 80≥y was 333.9-357.2m and for age 70-79y was 396.1-406.8 ml/kg/min. 6MWD was associated with WC, height and education (p≤.05). There was an age-related decline in 6MWD at 9.06m/y in men and 7.35m/y in women. / Elders' participation in PA assessed by the Physical Activity Scale for Elderly (PASE), was positively correlated with VO₂ peak (r=.241 in men, r=.214 in women) and 6MWD (r=.257 in men, r=.184 in women). Elderly walked more everyday have better VO₂peak and longer 6MWD (p≤ .0l). Women did more strenuous sport had higher chance of having normal CRF (p=.041). Men who met the guidelines by American College of Sports Medicine (ACSM) & Department of Health (DH), HK had better VO₂ peak than those who failed to meet that guidelines (p<.005). By following the PA guidelines, men had a 1.68-fold probability having normal CRF. A novel approach to retrospectively explore the correlation between the past PASE score and the present VO₂ peak revealed that the effect of past PA participation diminished with time (correlations for men from present, 4y and 7y ago: r=.241, .168, .120; for women r=.214, .106, .069). / Men with hypertension had significantly lower V02 peak and shorter 6MWD (p<.03). Men with history of myocardial infarction and angina also walked shorter in 6MWT while women only with diabetes had shorter 6MWD (p<.04). CRF was found to be correlated with cognitive level in men estimated by CSI-D (p<.0001) and GDS-15 score in both genders (r=-.112 in men, r=-.123 in women). On the other hand, 6MWD was found to be different across cognitive status estimated by MMSE (p<.02) & CSI-D (p=.046 in men only), and depression status estimated by GDS-15 (p<.04) in both genders. / Age-adjusted correlation between VO₂ peak & 6MWD was moderately high (R=.459 in men; R=.425 in women). In addition to the satisfactory correlation with VO₂ peak, stronger associations were found 6MWD, cognitive and mental health. It was suggested 6MWD might be a feasible surrogate for VO₂ peak as a physical fitness measure among HK Chinese elderly. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Yau, Chung Fai Forrest. / "December 2011." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 215-237). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendix in Chinese. / ABSTRACT (IN ENGLISH) --- p.I / ABSTRACT (IN CHINESE) --- p.IV / ACKNOWLEDGEMENT --- p.VI / LIST OF CONTENTS --- p.VII / LIST OF TABLES --- p.XII / SELECTED ABBREVIATIONS --- p.XV / Chapter 1 --- BACKGROUND & OBJECTIVES --- p.1 / Chapter 1.1 --- INTRODUCTION --- p.1 / Chapter 1.2 --- OBJECTIVES OF THE STUDY --- p.3 / Chapter 1.3 --- OUTLINES OF THE THESIS --- p.4 / Chapter 2 --- LITERATURE REVIEW --- p.6 / Chapter 2.1 --- ELDERLY POPULATIONS --- p.6 / Chapter 2.1.1 --- Health --- p.6 / Chapter 2.1.1.1 --- Hypertension, Coronary Heart Disease & Stoke --- p.8 / Chapter 2.1.1.2 --- Diabetes --- p.10 / Chapter 2.1.1.3 --- Chronic Obstructive Pulmonary Disease --- p.11 / Chapter 2.1.1.4 --- Cognitive Function --- p.12 / Chapter 2.1.1.5 --- Depression --- p.13 / Chapter 2.2 --- THE RELATIONSHIP BETWEEN PA & HEALTH --- p.15 / Chapter 2.2.1 --- Participation in PA --- p.22 / Chapter 2.2.1.1 --- PA Recommendation --- p.24 / Chapter 2.2.2 --- Indirect Estimation ofPA Participation --- p.25 / Chapter 2.2.2.1 --- Physical Activity Scale for Elderly. --- p.26 / Chapter 2.3. --- PHYSICAL FITNESS & HEALTH. --- p.28 / Chapter 2.3.1 --- Definition of Physical Fitness. --- p.28 / Chapter 2.3.1.1 --- Cardiorespiratory Fitness --- p.30 / Chapter 2.3.2 --- Direct Assessment of Physical Fitness --- p.33 / Chapter 2.3.2.1 --- Cardiopulmonary Exercise Test --- p.33 / Chapter 2.3.2.1.1 --- Affordable Device for CPET --- p.35 / Chapter 2.3.2.2 --- Six Minutes Walk Test --- p.36 / Chapter 3 --- MATERIALS & METHODS --- p.39 / Chapter 3.1 --- SUBJECTS --- p.39 / Chapter 3.1.1 --- Subjects Source --- p.39 / Chapter 3.1.1.1 --- The Osteoporetic Fractures in Men & Women Study --- p.39 / Chapter 3.1.1.2 --- Carotid Atherosclerosis Study --- p.40 / Chapter 3.1.2 --- Follow up Situation --- p.40 / Chapter 3.1.3 --- Ethical Consideration --- p.41 / Chapter 3.2 --- INSTRUMENTATION --- p.41 / Chapter 3.2.1 --- Questionnaire --- p.41 / Chapter 3.2.1.1 --- Medical History --- p.41 / Chapter 3.2.1.2 --- Smoking Habit --- p.41 / Chapter 3.2.1.3 --- Cognitive & Mental Health --- p.42 / Chapter 3.2.1.3.1 --- Cantonese Mini Mental State Examination & Community Screening Instrument for Dementia --- p.42 / Chapter 3.2.1.3.2 --- Geriatric Depression Scale-15 --- p.42 / Chapter 3.2.1.4 --- Physical Activity Scale for Elderly --- p.43 / Chapter 3.2.1.5 --- Veteran Specific Activity Questionnaire --- p.44 / Chapter 3.2.2 --- Physical Measurements --- p.45 / Chapter 3.2.2.1 --- Height, Weight & Fat Percentage --- p.45 / Chapter 3.2.2.2 --- Waist, Hip Circumferences & WHR --- p.45 / Chapter 3.2.2.3 --- Blood Pressure --- p.45 / Chapter 3.2.2.4 --- Electrocardiograph --- p.46 / Chapter 3.2.3. --- Fitness Tests --- p.46 / Chapter 3.2.3.1 --- Cardiopuhuonary Exercise Test --- p.46 / Chapter 3.2.3.1.1 --- Exclusion Criteria --- p.46 / Chapter 3.2.3.1.2 --- PreTest Consideration --- p.47 / Chapter 3.2.3.1.3 --- Test Sequence & Measures --- p.48 / Chapter 3.2.3.1.4 --- Test Tennination Criteria --- p.49 / Chapter 3.2.3.2 --- Six Minutes Walk Test --- p.50 / Chapter 3.2.3.2.1 --- Six Minute Walk Test Sequence --- p.50 / Chapter 3.3 --- STATISTICS --- p.52 / Chapter 3.3.1 --- Description of Variables --- p.52 / Chapter 3.3.2 --- General Statistical Method --- p.53 / Chapter 3.3.3 --- Comparison between VO₂ peak & 6MWD Relationship with other Variables --- p.54 / Chapter 4 --- RESULTS --- p.56 / Chapter 4.1 --- RESPONSE & PARTICIPATION OF SUBJECTS --- p.56 / Chapter 4.2 --- DEMOGRAPHIC PROPERTIES --- p.63 / Chapter 4.2.1 --- Men --- p.63 / Chapter 4.2.2 --- Women --- p.68 / Chapter 4.2.3 --- Sample Representativeness --- p.71 / Chapter 4.2.4 --- Physical Measurements --- p.75 / Chapter 4.2.4.1 --- Peak Oxygen Uptake --- p.75 / Chapter 4.2.4.2 --- Correlations with Demographic Properties --- p.82 / Chapter 4.2.4.2.1 --- Mean VO₂ peak in Different WC Status --- p.83 / Chapter 4.2.4.2.2 --- Reference Range across Age Groups 98 --- p.84 / Chapter 4.2.4.2.3 --- Mllltivariat Analysis of VO₂ peak --- p.86 / Chapter 4.2.4.3 --- Six Minutes Walk Test --- p.88 / Chapter 4.2.4.3.1 --- UnivariateAnalysis with Demographic Properties --- p.90 / Chapter 4.2.4.3.2 --- Mean 6MWD by WC Status --- p.92 / Chapter 4.2.4.3.3 --- Reference Range by Age Groups --- p.92 / Chapter 4.2.4.3.4 --- Multivariate analysis of 6MWD --- p.94 / Chapter 4.2.5 --- Physical Activity Scale for Elderly --- p.96 / Chapter 4.2.5.1 --- Univariate Analysis with Demographic Properties --- p.97 / Chapter 4.2.5.2 --- Reference Range across Age Groups --- p.98 / Chapter 4.2.5.3 --- Reference Range of PASE --- p.99 / Chapter 4.2.5.4 --- Multivariate Analysis of PASE --- p.100 / Chapter 4.2.6 --- Cognitive & Mental Scores --- p.101 / Chapter 4.2.6.1 --- Community Screening Instrument for Dementia --- p.101 / Chapter 4.2.6.2 --- Mini-Mental State Examination --- p.102 / Chapter 4.2.6.3 --- Geriatric Depression Scale-15 --- p.103 / Chapter 4.3 --- CORRELATIONS OF CRF TESTS --- p.104 / Chapter 4.3.1.1 --- Relationship between 6MWD & VO₂ peak --- p.104 / Chapter 4.3.1.1.1 --- Pearson Correlation between 6MWD & VO₂ peak --- p.104 / Chapter 4.4 --- CRF & LIFESTYLES --- p.106 / Chapter 4.4.1 --- How PA correlates with CRF --- p.107 / Chapter 4.4.1.1 --- Relationship between PASE& VO₂ Peak --- p.107 / Chapter 4.4.1.1.1 --- Pearson Correlation between PASE & V02 peak. --- p.107 / Chapter 4.4.1.1.2 --- Mean VO₂ peak by Quartiles of PASE --- p.109 / Chapter 4.4.1.1.3 --- Mean PASE scores by VO₂ peak status --- p.110 / Chapter 4.4.1.1.4 --- Relationship between PASE leisure activities & VO₂ peak --- p.111 / Chapter 4.4.1.1.5 --- Time spent daily on PASE leisure activities by VO₂ peak status --- p.113 / Chapter 4.4.1.2 --- Relationship between PASE & 6MWD --- p.116 / Chapter 4.4.1.2.1 --- Mean 6MWD by Quartiles of PASE --- p.118 / Chapter 4.4.2 --- Relationship between CRF & Recommended PA Guidelines --- p.119 / Chapter 4.4.2.1 --- ACSM Guidelines --- p.119 / Chapter 4.4.2.2 --- HKDH Guidelines --- p.121 / Chapter 4.4.3 --- Does PASE in the Past Predict Present Maximal Oxygen Uptake --- p.122 / Chapter 4.4.3.1 --- Pearson Correlation between PASE at 3y before & Present VO₂ peak --- p.122 / Chapter 4.4.3.2 --- Pearson Correlation between PASE at 7y before & Present VO₂ peak --- p.124 / Chapter 4.5 --- CRF & HEALTH --- p.126 / Chapter 4.5.1 --- CRF & Physical Health --- p.126 / Chapter 4.5.1.1 --- Relationship between VO₂ peak & Medical History --- p.126 / Chapter 4.5.1.2 --- Relationship between 6MWD and medical history --- p.129 / Chapter 4.5.1.2.1 --- Mean 6MWD of men by chronic diseases --- p.130 / Chapter 4.5.1.2.2 --- Mean 6MWD of women by diabetes --- p.134 / Chapter 4.5.1.3 --- Comparison between VO₂ peak & 6MWD relationship with medical history --- p.135 / Chapter 4.5.2 --- CRF & Cognitive Function --- p.137 / Chapter 4.5.2.1 --- Relationship between MMSE& VO₂ Peak --- p.137 / Chapter 4.5.2.1.1 --- Pearson Correlation betweenMMSE & VO₂ peak --- p.137 / Chapter 4.5.2.1.2 --- Mean VO₂ peak by MMSE Status --- p.139 / Chapter 4.5.2.2 --- Relationship between MMSE & 6MWD --- p.141 / Chapter 4.5.2.2.1. --- Pearson Correlation between MMSE & 6MWD --- p.141 / Chapter 4.5.2.2.2 --- Mean 6MWD by MMSE category --- p.143 / Chapter 4.5.2.3 --- Relationship between CSID & VO₂ peak --- p.144 / Chapter 4.5.2.3.1 --- Pearson Correlation between CSID & VO₂ peak --- p.144 / Chapter 4.5.2.3.2 --- Mean VO₂ peak by CSID Classification --- p.146 / Chapter 4.5.2.4 --- Relationship between CSID & 6MWD --- p.147 / Chapter 4.5.2.4.1 --- Pearson Correlation between CSID & 6MWD --- p.147 / Chapter 4.5.2.4.2 --- Mean 6MWD by CSID Classification --- p.149 / Chapter 4.5.2.5 --- Comparison between VO₂ peak & 6MWD relationship with Cognitive Function --- p.150 / Chapter 4.5.2.5.1 --- Pearson Correlation between MMSE & 6MWD --- p.151 / Chapter 4.5.2.5.2 --- Mean 6MWD by MMSE category --- p.151 / Chapter 4.5.2.5.3 --- Pearson Correlation between CSID & 6MWD --- p.152 / Chapter 4.5.2.5.4 --- Mean 6MWD by CSID Classification --- p.153 / Chapter 4.5.3 --- CRF & Depression --- p.154 / Chapter 4.5.3.1 --- Relationship between GDS & VO₂ peak --- p.154 / Chapter 4.5.3.1.1 --- Speannan Correlation between GDS & VO₂ peak --- p.154 / Chapter 4.5.3.1.2 --- Logistic Regression Analysis --- p.154 / Chapter 4.5.3.2. --- Relationship between GDS & 6MWD --- p.156 / Chapter 4.5.3.2.1. --- Spearman Correlation between GDS & 6MWD --- p.156 / Chapter 4.5.3.2.2. --- Mean 6MWD by depression status. --- p.156 / Chapter 4.5.3.3. --- Comparison between VO₂ peak & 6MWD relationship with GDS --- p.158 / Chapter 4.5.3.3.1. --- Pears on Correlation between GDS & 6MWD --- p.158 / Chapter 4.5.3.3.2. --- Mean 6MWD by depression status --- p.158 / Chapter 5 --- DISCUSSION --- p.160 / Chapter 5.1 --- INTERPRETATION OF RESULTS --- p.160 / Chapter 5.1.1 --- Physical Fitness --- p.160 / Chapter 5.1.1.1 --- Cardiorespiratory Fitness --- p.160 / Chapter 5.1.1.1.1 --- Mode for CPET --- p.160 / Chapter 5.1.1.1.2 --- Criteria for VO₂ peak --- p.161 / Chapter 5.1.1.1.3 --- Reference Range of VO₂ peak among HK elderly --- p.164 / Chapter 5.1.1.1.4 --- Age Related Decline in VO₂ peak --- p.169 / Chapter 5.1.1.1.5 --- Repeatability of Measurements using FitMate[superscript TM] Pro --- p.170 / Chapter 5.1.1.1.6 --- Smoking --- p.170 / Chapter 5.1.1.2 --- Six Minutes Walk Test --- p.171 / Chapter 5.1.1.2.1 --- Reference Range of 6MWD among HK Elderly --- p.172 / Chapter 5.1.2 --- How Estimated PA Level Correlated to CRF --- p.173 / Chapter 5.1.2.1 --- CRF &PA --- p.174 / Chapter 5.1.2.2 --- CRF & Leisure Activities --- p.176 / Chapter 5.1.3 --- Elderly CRF of those who met Recommended PA Guidelines --- p.177 / Chapter 5.1.4 --- Could Past PA Participation Predict Present CRF --- p.180 / Chapter 5.1.5 --- Health --- p.181 / Chapter 5.1.5.1 --- Physical Health --- p.181 / Chapter 5.1.5.2 --- Dementia --- p.185 / Chapter 5.1.5.2.1 --- Community Screening Instrument for Dementia --- p.186 / Chapter 5.1.5.2.2 --- Mini-Mental State Examination --- p.188 / Chapter 5.1.5.2.3 --- Possible Mechanisms of Cognitive Decline & Benefits ofPA --- p.191 / Chapter 5.1.5.3. --- Depression --- p.193 / Chapter 5.1.5.3.1 --- Possible Mechanism of Depression & Benefits of PA --- p.197 / Chapter 5.1.6 --- 6MWD, a Better Physical Fitness Surrogate than VO₂ peak --- p.200 / Chapter 5.2 --- LIMITATIONS AND STRENGTH --- p.205 / Chapter 5.3 --- FUTURE STUDIES --- p.210 / Chapter 6 --- CONCLUSION --- p.211 / Chapter 7 --- REFERENCES --- p.215 / APPENDIX --- p.238

Alzheimer's disease (AD) is the most common form of dementia. As the prevalence of AD increases with age, population aging will inevitably lead to an exponential increase in the proportion of older persons suffering from this disease. According to 2005 WHO estimate, 26.6 million people (approximately 0.55% of the general population) suffered from this disease. AD not only affects intellectual and functional abilities, it is also associated with significant neuropsychiatric disturbances. The pathogenesis of AD is characterized by widespread cerebral atrophy, abnormal deposition of amyloid plaques and tau protein in the central nervous system. While the classical histopathological features of AD are well recognized, exact physiological mechanisms that initiate the cascade of neural degeneration are still under active investigation. / As mentioned, the telomere length studies focused on ethically Chinese subjects recruited from two independent samples. The first clinical sample consisted of 411 older people and the other sample from healthy aging study, 976 community dwelling men were recruited. All subjects were assessed with the Cantonese version of the Mini-mental State Examination (CMMSE) for global cognitive function. Genomic DNA of the subjects was extracted from the peripheral whole blood sample. Lengths of the telomere were measured with Quantitative Real-Time PCR and the Ct ratio of the telomere and a control gene (36B4) of each sample was compared with the standard curve constructed with 4 selected sample's telomere lengths measured previously by Southern blotting. / For the first association study of the cell cycle checkpoint genes and AD, sample was recruited from a prospective study of cognitive function and risk factors for development of AD. 701 elderly were clinically evaluated for diagnosis of AD by psychiatrists. For this sample, genotyping of tagging SNPs of the 10 cell-cycle checkpoint genes were carried out by Restriction Fragment Length Polymorphism (RFLP) analysis. All tagging SNPs were selected from HapMap database and 5000bp upstream and downstream regions of each gene was also included. / For the results, the association study with cell cycle checkpoint genes, there was no SNPs found to be associated with diagnosis of clinical AD. We also found out that telomere length was associated with age in both two healthy aging men and clinical samples. There was no association between education and telomere lengths. For subjects in the healthy aging study, participants with CMMSE scores fell into the lowest 25% were found to have shorter telomere lengths. Similar result was found in the clinical AD sample. / In the study, telomere lengths were negatively associated with age. As the telomere will be shortened for each cell cycle, this finding correlated with physiological function at a cellular level. Statistical analysis also showed that shorter telomere lengths were found in subjects with poorer cognitive function. However, as age is a major determinant for cognitive impairments, further studies are recommended to evaluate the interaction effects of age in this association. Telomere shortening will cause cell senescence, and may be associated with faster neuronal degeneration, thus affecting cognitive function. Further studies should be conducted to examine its usefulness as an adjuvant biomarker for risk stratification of AD intervention trials. / Recent researches begin to unfold the physiological significance of telomere. A telomere is a repetitive region at the end of a chromosome. Basic functions of telomeres are involved with protection of the chromosome during replication and preventing chromosomal rearrangement or fusion. Abnormal telomere lengthening may be related to cancerous conditions. At a cellular level, telomere may also be related to aging and limitation in cell lifespan. In my study, I aimed to evaluate the association between the lengths of telomere and global cognitive function in community dwelling Chinese older persons in Hong Kong. As the length of telomere is also determined by the turnover rates of cells, apart from association study of telomere lengths and cognitive function, I also tried to study the association of genes related to cell cycles and AD. Polymorphisms of ten cell-cycle checkpoint genes, i.e. RB1, CDKN1A, CDK5R1, CDK2AP1, CDKN2A, CDKN2C, MDM2, P53, GSK3B, TPND1 and CDKN1B genes, were chosen in my project. / The thesis comprised of three studies. The first study was an association study of cell cycle checkpoint gene single nucleotide polymorphisms (SNPs) with clinical diagnosis of AD. The second study was an association study of telomere lengths and clinical diagnosis of AD in a clinical sample of patients suffering from the disease. The third study was an association study of the telomere lengths and global cognitive status in a group of active community dwelling older men who participated in a healthy aging study. / Lau, San Shing. / Adviser: Linda C.W. Lam. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 101-124). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Tam Pui Ching, Maria. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 67-73). / Questionnaire also in Chinese. / Chapter Chapter One: --- Introduction --- p.1 / Chapter Chapter Two: --- Literature Review --- p.5 / Cultivation Theory --- p.5 / Stereotypes and Attitudes toward the Elderly --- p.8 / Factors Affecting Stereotypes --- p.9 / Media Influence on Attitudes toward the Elderly --- p.12 / Cultural Values of Family and Ageing --- p.15 / Chapter Chapter Three: --- Rationale and Hypotheses --- p.20 / Rationale --- p.20 / Hypotheses --- p.23 / Chapter Chapter Four: --- Methodology --- p.29 / Sample --- p.29 / Measurement of Chinese Cultural Values --- p.30 / Measurement of Attitudes toward the Elderly --- p.33 / Measurement of Stereotypes about the Elderly --- p.37 / Media Exposure --- p.39 / Chapter Chapter Five: --- Findings --- p.41 / Testing Hypothesis H1 --- p.46 / Testing Hypothesis H2 --- p.47 / Testing Hypothesis H3 --- p.47 / Testing Hypothesis H4 --- p.48 / Testing Hypothesis H5 --- p.48 / Testing Hypothesis H6 --- p.49 / Testing Hypothesis H7 --- p.50 / Chapter Chapter Six: --- Discussion and Conclusion --- p.52 / Appendix1 --- p.62 / References --- p.67

by Chan Yuen Yee, Irene, Chung Wing Sze. / Thesis (M.B.A.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 64-65). / Questionnaire also in Chinese. / ABSTRACT --- p.ii / ACKNOWLEDGEMENT --- p.v / TABLE OF CONTENTS --- p.vi / LIST OF TABLES --- p.ix / Chapter / Chapter I. --- INTRODUCTION --- p.1 / Background --- p.1 / Elderly People and the Living Environment --- p.2 / The Role of the Living Environment to Elderly People --- p.2 / The Housing and Environment Needs of Elderly People --- p.3 / Physical Aspects --- p.4 / Social Aspects --- p.4 / Objectives --- p.5 / Chapter II. --- SCOPE OF STUDY --- p.6 / Marco Environment --- p.6 / The Changing Profile and Characteristics of Elderly People in Hong Kong --- p.6 / Ageing population --- p.6 / Education Level --- p.8 / Earlier Retirement and Retirement Population --- p.8 / Economics --- p.9 / Policy and Regulations --- p.10 / Age of Retirement and Pension Scheme --- p.10 / Tax Allowance for Maintaining Dependents --- p.11 / Old Age Allowances and Senior Citizen Cards --- p.11 / Public Medical Service --- p.11 / Financial Assistance to the Aged --- p.12 / Increasing Needs of Personal Financial Planning --- p.12 / Staying Period for Hong Kong Citizens in China --- p.13 / Social Cultures --- p.13 / Self-financing and Living Independently at Old Ages --- p.13 / More Life & Health Conscious --- p.13 / Better Perception on the Living Quality in China --- p.14 / Trend of Cross-boundary Traveling Between Hong Kong and China --- p.14 / Micro Environment --- p.15 / Demand for Residential Service for Hong Kong Elderly in China --- p.15 / Increasing Market Size --- p.15 / Market Potentials --- p.15 / Needs of Community Development for the Elderly --- p.16 / Demand on Residential Service in China --- p.17 / Limitations of living in China --- p.17 / Supply of Elderly Accommodation Service in Hong Kong --- p.17 / Private Housing --- p.17 / Public Housing --- p.18 / Residential Care House --- p.18 / Supply of Elderly Accommodation Service in China --- p.19 / Residential Care Homes --- p.19 / Private Housing --- p.19 / Product Features --- p.20 / Price --- p.21 / Location --- p.21 / Promotion --- p.21 / Chapter III. --- METHODOLOGY --- p.23 / Primary Data --- p.23 / Survey Objectives --- p.23 / Sampling Population --- p.24 / Sampling Method --- p.24 / Process of Survey --- p.24 / Limitations --- p.25 / Data Analysis --- p.25 / Secondary Data --- p.25 / Chapter IV --- SURVEY RESULTS AND DISCUSSION --- p.26 / Profile of the Respondents --- p.26 / Lifestyle and Consumption Behavior after Retirement --- p.27 / Living Arrangement after Retirement --- p.27 / Daily Activities after Retirement --- p.28 / All Respondents --- p.28 / Difference between Retired and Non-Retired People --- p.28 / Demographic Factors --- p.29 / Average Monthly Expenditure after Retirement --- p.30 / Proportion of Different Expenses on Monthly Spending after Retirement --- p.31 / All Respondents --- p.31 / Difference between Retired and Non-Retired People --- p.31 / Correlation between Monthly Expenditure and Percentages of Different Expenses --- p.32 / Correlation between Different Expenses and Likelihood of Retirement in China --- p.32 / Demographic Factors --- p.32 / Retirement Plan in China --- p.33 / Reasons for Retirement in China --- p.35 / Reasons for not to retire in China --- p.36 / Buying Property in China --- p.38 / Ideal Dwelling for Retirement in China --- p.39 / Chapter V --- RECOMMENDATIONS --- p.43 / Market Size --- p.43 / Target Customers --- p.44 / Expected Expenditure --- p.44 / Product --- p.45 / Interior Design --- p.46 / Supplementary Property Management Service --- p.46 / Supplementary Community Facilities --- p.47 / Place --- p.48 / Price --- p.49 / Promotion --- p.49 / Chapter VI --- CONCLUSION --- p.51 / APPENDIX --- p.53 / BIBLIOGRAPHY --- p.64

published_or_final_version / Social Work / Master / Master of Social Sciences