Ageing and Health

Objective: To evaluate the effectiveness of a Dyadic pain management program (DPM) in reducing pain and psychological health symptoms, improving pain self-efficacy, quality of life, and physical function in older adults.

Hypothesis: DPM is more effective in reducing pain and psychological health symptoms,  improving pain self-efficacy, quality of life, and physical function among older adults than the usual care, upon completion of the DPM (week 8) and over time (week 16).

Design and subjects: Clustered randomized controlled trial with neighborhood elderly centers (NEC) as cluster; 150 dyads (one older adults and his/her caregiver as one dyad) will be recruited from 22 NEC clusters. Each NEC will be randomly allocated to experimental group (receive DPM), control group (receive usual care and pain management pamphlet).

Study instruments: Brief Pain Inventory; Pain Self-Efficacy Questionnaire; Short Form Health Survey-12; Depression, anxiety & stress; Caregiver Burden Inventory; 6-minute walk test and process evaluation.

Intervention: DPM, each session includes exercise, interactive pain management education, practices on non-drug techniques and using a WhatsApp group to encourage home-based exercise and practice of non-drug methods.    

Outcome measures: Pain intensity, pain self-efficacy, perceived health-related quality of life and experience in participating DPM, to be collected at baseline (T0), week 8 (T1), and week 16 (T2).

Data analysis: Multilevel regression and/or Generalized Estimating Equation will be used for within-group and between- group comparisons.

Expected results: Significant reduction in pain and enhancement in pain-related parameters, enforcing dyadic pain management models in elderly care.

This study aims to develop and validate a health literacy scale for family caregivers of older people. This study contains two parts. The first part is about developing a conceptual model of health literacy in the family caregivers of older people. To develop the model, concept mapping will be adopted to identify and organize ideas related to the health literacy of family caregivers of older people. The second part is about developing and validating a health literacy scale for family caregivers of older people. A validity-driven approach will be employed to develop the scale based on the conceptual model developed in part one. The instrument can be used to identify caregivers with insufficient health literacy, allowing nurses to provide timely interventions to support them.

The World Health Organization and Centers for Disease Control and Prevention recommend the use of N95 respirators (masks) as a precaution against respiratory pathogens. The effectiveness of respiratory protection heavily relies on filtering materials, fit testing and usability, particularly for those newly developed N95 respirators. However, these parameters are not available for most of newly developed respirators. This study aims to assess the filtering materials of two newly developed respirators (V8380+ and V9580+) as well as the fit rate and usability of these model among healthcare professionals.

According to the benefit of “masking” as a public health intervention, mass masking would probably intercept the transmission link of COVID-19 when facing this novel epidemic with limited alternatives in the community setting. Hong Kong people started a mass surge of surgical masks locally and nationally. This gives a golden opportunity to thousands of fake masks and protective gears flocking in markets ever since the pandemic. This project aims to develop and establish a testing laboratory based on the ASTM F2100-19 standard for checking the quality of filtering facemasks in phase 1. And phase 2 will be a repeated cross-sectional study, which aims to routinely take samples of the filtering facemask available from the market to investigate the trends of that quality for 12 months. The project team share the same passion to improve the quality of face mask in Hong Kong. Hence, the establishment of testing laboratory, and repeated cross-sectional investigation of masks in the market will inform general public, policy maker and government on the quality control of face masks. This is game changing project and it will benefit to most of Hong Kong people.

According to the benefit of “masking” as a public health intervention, mass masking would probably intercept the transmission link of COVID-19 when facing this novel epidemic with limited alternatives in the community setting. However, the critical shortage of face mask still forced many people to disinfect and reuse their used masks in their own ways. The guidelines for the disinfection methods were greatly unclear. The study results will provide solid evidence to inform the society on the reuse of face mask, which is beneficial to mankind.

Happiness index survey has conducted by the HK.WeCare, Wofoo Social Enterprises since 2015. This survey aims to assess and monitor the trends of happiness level annually and explore the factors contributing to happiness. With the academic inputs for sharpening its reliability and validity of questions and results, the understanding about happiness in Hong Kong is enriched. The project leader has reported those previous results through news and media, which have attracted more than 100 news reports. Besides, we have submitted policy consultation report to the Government for the policy address. Although this survey is important and worthwhile to keep, the results of past three years appears to be descriptive, which can explain only a little on the contributing factors of happiness level. With this collaborative project, the research team will be involved in happiness index survey (available to retrieve those previous data), explore the happiness related mental health issues e.g., depression, and consolidate the model through advanced statistics. It is time to explore deeply and consolidate the understanding of happiness in establishing an exploratory model for Hong Kong people.

Aims

The study aims to compare the effects of a nurse-led support programme using a mobile application versus telephone advice on clients at risk of coronary heart disease .

Methods
A multi-centre, single-blinded, randomized controlled trial will be conducted. 60 clients diagnosed as being at risk of CHD, able to use a smart phone will be randomized into the App Support Programme (ASP) group or the Telephone Support (TS) group. All participants will receive usual medical treatment as prescribed by doctors . The ASP group will receive an app whereas the TS group will receive telephone support provided by the nurse for 20 minutes bi-weekly. The self-developed mobile app will support clients in managing their health problems and lifestyle. It is comprised of: (1) a knowledge health platform, (2) a membership area for individual health measures and exercise records, (3) a Chest Pain – Things to Do List, and (4) an individual reminder and measure feedback system.

Health outcomes will be collected at baseline (T0), 1 months (T1), 3 months (T2). The primary outcome is: Self-efficacy and self-management behaviour. Secondary outcomes are: (i) ED and hospitalization frequency; (ii) Physiological health profile and cardiovascular functional endurance; (3) total amount of exercise; (4) perceived stress level; and (6) quality of life.

Data analysis: A Generalized Estimating Equations model will be used to assess differential changes in all outcome variables.
Significance:
Coronary heart disease (CHD) is a major chronic disease around the world and in Hong Kong, and secondary prevention is important to reduce the impact of CHD and to slow its progression via early detection and treatment. Strategies to improve secondary care and support have become a priority of government health policies and healthcare strategies in Hong Kong and many other countries.
This pilot study will examine the feasibility of the main RCT study by using the app; identify any recruitment, implementation of intervention and logistic issues arising from the recruitment, intervention and follow-ups. It can also provide the preliminary finding for sample size calculation for the main RCT.

Happiness index survey has been conducted and supported by some local non-government organizations since 2015. This survey aims to assess and monitor the trends of happiness level annually and explore the factors contributing to happiness level. The conference reporting the result of happiness level attracts many press attentions and news annually in Hong Kong, which serves as reference/indicator for policy makers on public health and resources utilization. With the academic inputs for sharpening its reliability and validity of questions and results, the understanding about happiness in Hong Kong is enriched. However, there is no such standard measurement in the Greater Bay Area, where covers the country’s most open and economically vibrant region (Cheung, 2019). It is time to investigate and consolidate the understanding of happiness in the Greater Bay Area. This is a 3-phase project with different research design and population investigated. This proposal aims to describe the phase 1 study, which is a large-scale survey to explore and compare happiness level among five regions of the Greater Bay Area (i.e., Hong Kong, Macau, ChuHai, Shenzhen and Guangzhou). This study is coordinated by the Psychosocial Health Research Team, Nursing Alliance of Research and Knowledge Transfer. Data from five regions of the Greater Bay Area will be grouped to develop norm-based happiness indicator. The data collection of each region will be responsible by the respective researcher(s).

Introduction
Cognitive frailty is an at-risk state of dementia. Motor-cognitive training is effective to promote cognitive and physical function. However, the ecological validity of conventional motor-cognitive training is questionable. Virtual reality (VR) aims to increase the extent of effect transfer from a lab setting to the daily living settings. However, the effect and ecological validity of the virtual reality-based motor-cognitive training in older people with cognitive frailty is unknown.

Objectives
The objectives of this study are to examine the effects of the VR motor-cognitive training on:
1. cognitive function,
2. frailty syndrome,
3. physical activity level in daily living, and
4. life-space in daily living

Methods
A wait-list multi-centred randomized controlled trial will be employed. Subjects will be randomized into either the intervention group or control group in 1:1 ratio. Subjects will be recruited in the community settings in the elderly community centres. Eligibility criteria include 1) age ≥ 60 years, 2) community-dwelling, 3) cognitive frailty, 4) no dementia, & 5) functional level at outdoor walker level. In the intervention group, the subjects receive VR motor-cognitive training which lasts for eight weeks, provides two sessions per week, and provides 30 minutes per session. In the control group, the subjects receive usual care provided by the elderly community centres (e.g., unsupervised ergometer cycling, board games). Outcome measures include 1) cognitive function as measured by Montreal Cognitive Assessment, 2) frailty as measured by Fried Frailty Phenotype scale, 3) physical activity as measured by actigraph, and 4) life-space as measured by GPS lodger. We aim to recruit 648 subjects in not-less-than six community elderly centres. Data collection will be conducted at baseline (T0) and the week immediately after the intervention (T1). Data will be analysed by using IBM SPSS version 25.0. ANOVA will be used to estimate the interaction-group, between-group, and within-group effects on the outcomes. Principle of intention-to-treat analysis will be adopted to interpret the results. Missing data will be replaced by the last observed values.
Significance
If the intervention is effective, there is going to be a brand new community-based training for community-dwelling older people with cognitive frailty to reduce their cognitive frailty, so as their risk of dementia.

Aims The study aims to compare the effect of a lifestyle intervention programme (LIP) using mobile application (MetS app) vs using booklet for MetS adults living in the community.

Methods A multi-site randomized controlled trial (RCT) with three arms, namely, MetS app group (Group A), booklet group (Group B), and control group (group C). Two hundred and sixty four subjects will be recruited from community centers and randomized into either one arm. Inclusion criteria are those MetS adult, able to use a smart phone. Group a participants will receive a 30-minute educational session and a MetS app while Group B will receive same educational session and a MetS booklet and the control group receive a placebo booklet only. The MetS app or booklet, has been well developed by the team with the support of internal grant, aims to support MetS individual’s self- monitoring and record of health measures (body weight, blood pressure, waist circumference) and exercise. The primary outcomes of this study include the body weight and total physical exercise (GSLTPAQ). The secondary outcomes include cardiometablolic risk factors, cardiovascular endurance, self-efficacy for exercise (SEE) and stress level (PSS-10). Data will be collected at baseline (T1), 4 week (T2) and week 12 (T3) and week 20 (T4). SPSS and Generalized Estimating equations (GEE) model will be employed for data analysis.

Significance This study will provide empirical evidence and inform about the effective way to enhance patient’s self-management of MetS, exercise sustainability that will be beneficial to clients’ health.

Objective: To evaluate the efficacy of a peer-led pain management program (PAP) in improving pain self-efficacy, reduce pain, enhancing use of drugs and non-drug methods and quality of life among nursing home residents Hypothesis: PAP lead by peer volunteer (PV) is more effective than receive usual care and pain management pamphlet, in reducing pain intensity, enhancing pain self-efficacy, use of drugs and non-drug methods, health-related quality of life upon completion of the PAP (week 12) and over time (week 24). Design and subjects: Clustered randomized controlled trial with nursing homes as cluster; 288 residents will be recruited from 12 nursing homes. Each nursing home will be randomly allocated to experimental group (PV led PAP), control group (receive usual care and pain management pamphlet). Study instruments: Brief Pain Inventory, Pain Self-Efficacy Questionnaire, Use of drugs and non-drug methods log book, Short Form Health Survey-12 and process evaluation. Intervention: 12-week PAP (one 1-hour session per week). Each session includes 20-minute exercise, 30-minute interactive pain management education, practices on non-drug management techniques, and portfolio entry for activities of the day. Outcome measures: Pain intensity, pain self-efficacy, use of non-drug pain relief methods, perceived health-related quality of life and experience in participating PAP, to be collected at baseline (T0), week 12 (T1), and week 24 (T2). Data analysis: Multilevel regression and/or Generalized Estimating Equation will be used for within-group and betweengroup comparisons. Expected results: Significant reduction in pain and enhancement in pain-related parameters, making peers support models in elderly care.

The family caregivers of people with dementia experience high level of stress resulting in different physical and psychological comorbidities. Mindfulness-based cognitive therapy (MBCT) has been found to be effective at improving a few main psychological symptoms which may help the family caregivers in stress reduction and maintain their sustainability in providing daily care for the PWD for a longer period of time. This study aims to explore the feasibility, acceptability and preliminary effects of the modified MBCT in reducing stress in the family caregivers of people with dementia. If significant benefits are found, the MBCT can be used as a standard supportive intervention for the family caregivers of people with dementia.

Numerous RCTs and systematic reviews have shown that music intervention is useful in alleviating depressive and anxiety symptoms of people with dementia. A 12-week caregiver-delivered, home-based music-with-movement intervention protocol was developed for people with dementia, and found effective in reducing the anxiety level of people with dementia, and the qualitative findings showed that caregivers have better understanding on the people with dementia and maintain a closer relationship. However, some of the participating family caregivers reported that they have difficulties in grasping the skills at the beginning, and sometimes too busy in following the recommended frequency. Implementation strategies were discussed with different stakeholders, and this study aims at evaluating the actual implementation process of the music intervention and the efficacy on the psychosocial wellbeing outcomes of the dyads. This study is a multi-centre, cluster randomized controlled effectiveness-implementation hybrid trial. People with early dementia or mild cognitive impairment who are living at home, and their family caregivers are the target population. They will be recruited from non-government organizations (NGOs) in partnership. The outcomes to be assessed at baseline (T0), immediate post-intervention (T1, i.e. 12th week), and 3 months post intervention (T2, i.e. 24th week) include the anxiety and depressive symptoms of people with early dementia or mild cognitive impairment; perceived stress and positive aspects of caregiving of the caregivers; and the quality of the caregiver-care recipient relationship. The implementation will be continuously observed in the trial period, and stakeholders (staff members, caregivers, and volunteers) will be interviewed in the following aspects: acceptability of the whole programme; appropriateness of the strategies; feasibility of the center to adopt the programme as regular approach for the other members of their centers; penetration of the programme in the participating centers; sustainability of the programme in the centers; and sustainability of the intervention on the dyads.

General fatigue with non-specific causes is prevalent among frail older people. Although the evidence suggests that general fatigue is a strong indicator of rapid ageing, leading to frailty and disability, general fatigue is under-recognized and under-treated in gerontological care. Exercise and Behavioural Change Enhancement (BCE) have been shown to be effective at improving disease-induced fatigue, but their effect on general fatigue among frail older people is not known. This project aims to investigate the effects of an individualized exercise programme with and without BCE strategies for community-dwelling frail older people with general fatigue, so as to reduce their fatigue and improve their physical endurance, exercise self-efficacy, and habitual physical activity, while reducing their symptoms of frailty. In this three-arm, single-blinded, cluster-randomized controlled trial, 285 community dwelling older people with general fatigue will be recruited from twelve district community health centres. Each centre will be randomized to one of the three study groups: the combined (COMB) group, receiving the 16-week combined intervention consisting of individualized exercise training and BCE programmes plus two booster sessions at 2 and 6 months after the programme; the exercise (EXER) group, receiving exercise training and health talks only; or the control group, receiving health talks only. Participants from each centre will be placed in their centre’s corresponding group to avoid ‘contamination’ effects across participants. We hypothesize that the COMB group will achieve a significantly greater reduction in fatigue and a greater improvement in their physical endurance, exercise self-efficacy, and habitual physical activity, and a significantly greater reduction in their frailty symptoms, when compared with the EXER and control groups at 1 week and 6 and 12 months after completing the interventions. Semi-structured focus group interviews with 30 COMB participants (4-6 per group) will be conducted after the first post-test. Content analysis of the interview data will be used to identify the participants' perceptions of the benefits, weaknesses, and difficulties of participation/adherence in the combed intervention, and the therapeutic components of the combined interventions. Based on the intention-to-treat principle, A mixed-effects modelling technique will be used to compare changes in all of outcome variables at the three post-tests between the three groups, followed by the Helmert contrasts test (if any outcome results are found to be significant). This study will be a pioneering interventional study on how general fatigue among frail older people can be managed and how fatigue-related frailty can be prevented.

Objectives: This project is the extension of the previous study (MAHL). It aims to compare the effect of verbal advice with the effect of comic books on medication adherence and health literacy among older residents in the 15 public estates in Hong Kong, and to develop a protocol for home-based nursing counselling in medication adherence and assess its implementation.

Methods: This is a three-phase multi-site study with pre-and-post measures. Phase 1 consists of two 45-minute home visits to each older resident by Mediation Use Supportive Team (MUST) team members. A designated protocol will be developed to guide the MUST team members’ action/health education. Phase 2 consists of another two 45-minute home visits in which health literacy skills training and clarification of the misunderstanding of drug labels, appointment sheets and use of common drugs will be included. A comic book will used. Phase 3 consists of 3-hour contacts (two 1-hour home visits, phone counselling and whatsapp messaging) by an experienced nurse. We will reach 300-350 older residents in Phase 1 and Phase 2 respectively, while 25 older residents in Phase 3. Measures include medication knowledge and compliance scale (MKCS) and Chinese Health Literacy Scale for Chronic Care (CHLCC).

Significance of the study: This study provides evidence of the use of verbal advice, comic books, and home-based nursing counselling in medication compliance and health literacy.

Background: Many older adults experience loneliness and depression but they do not often express their feelings, particularly in Chinese population.

Aim: This project aims to promote older adults’ mental well-being and develop their capacity to seek for mental health advices. Design: This is a community-based participatory project encouraging older participants to take photos to share and express their feelings. Their mental health issues will be explored and discussed in meetings with their community workers. These older adults will then be supported to seek for advices on mental health promotion.

Subjects: A total of 460 older adults will be guided by 46 community workers to take photos in the neighbourhood and share their feelings.

Significance: This project contributes to better understanding of mental health issues in older adults, enhancing psychosocial support and health seeking for promotion of mental health/well-being. Participants’ quality of life will be assessed to evaluate its effect.

Objectives: This study aims to validate genetic variants in APOE gene that are associated with the risk of late-onset Alzheimer’s disease in Hong Kong, perform whole-exome search for genetic variants that are associated with the risk of late-onset Alzheimer’s disease in Hong Kong, and identify factors or lifestyle associated with genetic variants.

Method: We will recruit 300 local Chinese persons, 100 with clinically diagnosed with AD, 100 with mild cognitive impairment and 100 with normal cognition. A comprehensive health survey will be conducted by trained research assistants. The environmental and psychosocial factors associated with AD and cognitive frailty will be included in the survey. Buccal swab samples will be collected and DNA will be extracted.

Significance of the study: The findings of the study will inform us the genetic variants in persons with late-onset of Alzheimer’s disease and the factors associated with these genetic variants.

Objectives: This project aims to assess the effect of comic books on medication adherence and health literacy among older residents in the 15 public estates in Hong Kong.

Methods: This is a multi-site study with pre-and-post measures. Phase 1 consists of two 45-minute home visits to each older resident by Mediation Use Supportive Team (MUST) team members. Phase 2 consists of another two 45-minute home visits in which health literacy skills training and clarification of the misunderstanding of drug labels, appointment sheets and use of common drugs will be made via a comic book. Measures include medication knowledge and compliance scale (MKCS) and Chinese Health Literacy Scale for Chronic Care (CHLCC).

Significance of the study: This study provides evidence of the use of comic books in medication compliance and health literacy.

Background: Aging is a worldwide issue. Higher prevalence of pain and frailty are found in ageing population while pain and frailty may negatively influence the psychosocial well-being of older adults. However, few studies explore the association between pain, frailty and psychosocial well-being of older adults in Hong Kong.

Aim and objective: To investigate pain and pain-related situations among frail older adults, and to explore the relationship between pain, frailty and psychosocial well-being among older adults.

Design: Cross-sectional study.

Setting: Hospital and Geriatric Day Rehabilitation Center.

Sample: 360 participants will be recruited based on convenience sampling.

Measurements: Abbreviated Mental Test 10 will be used to assess the cognitive status of participants for screening. The pain situation and psychosocial well-being will be measured by Brief Pain Inventory - Chinese version and The World Health Organization Quality ofLife-BREF (WHOQOL-BREF) for cognitive intact participants while Abbey Pain Scale and The Quality of Life-Alzheimer's Disease (QOL-AD) are for cognitive impaired participants or those who cannot verbalize. A questionnaire about demographic data and pain-related situations, Fried Frailty Index and FRAIL scale for measuring frailty, and Subjective Happiness Scale - Chinese version for measuring psychological well-being will be adopted for all participants.

Data analysis: Kruskal-Wallis ANOVA will be used to test the differences in pain sitnations of participants who arc divided into three groups of frailty, robust, pre-frail and frail. Linear correlation will be analysed using Chi-square for QOL-AD and pain, and Pearson test for WHOQOL-BREF and pain. To compare the psychosocial well-being of three groups of frailty, ANOVA will be used for Snbjeetive Happiness Scale, Chi-square for QOL-AD, and Kruskal-Wallis ANOVA for WHOQOL-BREF.

Expected outcome: Positive association between pain and frailty, negative associations between pain and psychosocial well-being, and between frailty and psychosocial well-being of older adults are expected. Significance of study: The findings will lay the foundation for designing more effective rehabilitation programme for older adults in Hong Kong.

Background: Mobile application has been proven to be a valuable method to increase adults’ health awareness.

Aim: This project aims to promote diabetes risk self-assessment and lifestyle modification with the use of electronic devices.

Design: A longitudinal design with a 3-month intervention for the high-risk persons of diabetes.

Subjects: A total of 2,500 persons aged 40 to 70 will be approached and invited to use the HKU Diabetes Risk Score (HKU DRS) app. Among these, 300 high-risk persons will be invited to join the 3-month phone intervention. Mobile applications will be used to record participants’ lifestyle. Graphs shown in the app (such as diabetes risk level, energy consumption per day) and health advices in the app and phone calls will serve as facilitators to lifestyle change.

Significance: This project contributes to empower individuals to change lifestyle with the support of electronic technology and reduce the chance the progression to diabetes.

Background: In the specifications in the Call for Tender, the Social Service Department of the Yuen Yuen Institute (YYI) indicated three main practice issues that were to be examined. Consequently, this study focus on these three special aspects of long-term residential care, namely falls and fall prevention, restraint reduction, and infection control practice review.

The objectives of this study included: (i) To review the YYI’S existing practices in the YYH and YYC&A in the following three aspects of care: (a) Prevention of falls (b) Restraint policy (Least Restraint Policy), and (c) Infection control practices (ii) To propose recommendations for the standardization of existing policies for the two subvented homes.

The study is aimed to provide health education to community-dwelling older adults in terms of healthy diet and healthy eating habits, drug knowledge and fall prevention. It is a pre-post experimental design. The target population is community dwelling older people, aged 65 or above and members of the Pentecostal Church of Hong Kong. The sample size will be 120 participants. The targeted participants will be recruited from the community elderly centers by convenience sampling. The Center in-charge will put up poster in their centers to invite their center members to participate. Also, they will make announcement in their regular meetings and phone calls to remind their center members regarding the HLP; and the responses rate has always been satisfaction. The research team will screen the participants, those who fit the inclusion criteria (aged 60 or above; >1 in frailty score, able to communicate and understand Cantonese) will be invited to join the study. 1. Phase 1: demographic data & baseline data will be data collection 40 participants in each center, i.e. 120 for 3 centers; 2. Phase 2: participants in each center will be invited to join a 6 week HLP; 3. Phase 3: Post data collection for all participants upon completion of the HLP in each center. The study will collect information on community dwelling older people on their knowledge towards drug management, fall and nutrition. It is foreseen that the study can enhance the self-care abilities through health management for the elderly.

Horticultural therapy (HT) has been found to be of benefit to different patient populations but its use in people with frail older people has not been examined, Clinical experience of horticultural therapists revealed that HT can benefit older people in terms of their mood, affect, self-efficacy and sense of wellbeing, thereby enhancing their quality of life, This is a mixed methods study with the quantitative arm being the main study paradigm, The quantitative arm is a randomized controlled trial to investigate the effect of HT on frail older persons in residential care as compared with a control group, An HT group program consists of 8 weekly sessions will be delivered by a HT internist supervised by a Registered Horticultural Therapist The control condition is an activity group that is similar in design except in the content (Le" HT activities), The outcome measures that will be used include those that measure general self-efficacy, mood and affect (depression, loneliness, happiness), social interaction (network and engagement), wellbeing, and quality of life. There will be three measurement points - baseline (TO), immediately post-intervention (Tl), and a follow-up assessment at 12 weeks post-intervention (T2). The qualitative arm of the study employs observational methods. The HT internist and assistants (e.g., volunteers) will document participants' responses. Trained research personnel will join the HT sessions for taking field notes as non-participants. Unstructured interviews will be conducted for all subjects at Tl. Both the quantitative and qualitative outcomes will be triangulated to inform the researchers about the effects of HT for this particular population. The knowledge gained from this study will inform clinicians and researchers alike how best to further explore HT as a therapeutic modality.

Background: Persons with early dementia (PWeD) often encounter anxiety and sleep problems, which often also increases the stress felt by their primary caregivers. Support for the PWeD and their families is therefore needed to help them both. Music intervention has been found to be useful in managing anxiety and sleep disturbances in different populations, including people with dementia. Regrettably, music intervention in the community is not readily available in Hong Kong. Even when it is, no home-based approach is offered. Aim: The aim of this project was to design and test a caregiver-delivered, home-based, music-with-movement (MWM) intervention protocol that would be suitable for PWeD in Hong Kong. Through the new intervention, we hoped to reduce the anxiety and sleep disturbances of PWeD as well as that of their family caregivers, thereby promoting their wellbeing and quality of life and reducing the burden of the family caregivers.

The study aims to examine the effectiveness of implementing advance care in caregivers. 25 patients were recruited to answer quality of life and patient satisfaction questionnaire, while 14 caregivers were recruited to answer quality of care and quality of death questionnaire. Collected data was analyzed both in quantitative and qualitative way. Result showed no statistical significant effect on psychological and physical improvement of patients and caregivers across three prognostic windows (days, weeks, months). However, the case-based analysis could reveal the gradual improvement of patients and caregivers in various aspects, thus brought out the importance of advance care planning implementation to end of life care.

PRACTICE IMPLICATION: Eight workshops were conducted for staffs training nursing students learning. Advance care planning was introduced through presenting research finding, discussing cases, and practicing the use of instruments. One evidence-based practice guideline was also completed for staffs to facilitate the initiation of sensitive conversations in the future work.

Systematic use of observational pain tools has been advocated as a means to improve pain management for care home residents with dementia. Pain experts suggest that any observational pain tool should be used as part of a comprehensive pain management protocol, which should include score interpretation and verification as well as suggestions regarding appropriate pain treatment according to the pain score. The Observational Pain Management Protocol (Protocol) was therefore developed. A pre and post study design was used to evaluate the effectiveness of the Protocol in managing pain among 30 residents with diagnoses of dementia and pain. Preliminary results suggest that the Protocol can improve pain management practice in a care home. Therefore, a 2-group randomized controlled trial with a larger sample size is proposed to examine the effect of the Protocol on improving pain management as compared to a control condition of usual pain management practice in long-term care homes. The aim of this study is to investigate whether regular use of the Protocol can improve the management of pain for residents with dementia as manifested by the increased use of pharmacological and non-pharmacological pain treatments. As a consequence, pain scores will be lower due to better pain management. 126 care home residents will be recruited based on the sample selection criteria from 6 care homes. A similar number of participants from each home will be randomized to the control or experimental condition. Participants from the same care home will be placed in their home’s corresponding condition to avoid a “contamination” effect. This study will take 16 weeks (i.e. baseline assessment X 4 weeks and Protocol implementation X 12 weeks). After the training for care home staff in the experimental condition, the Protocol will guide the pain management of the participants for 12 weeks. Meanwhile, the control care homes will continue their usual pain management strategies. Intervention effects will be measured weekly and compared with the baseline measurements as well as between the experimental and control conditions. Research assistants, who will be blinded to the study hypothesis and group allocation, will be responsible for all subject assessment measures. The effectiveness of the Protocol will be evaluated by a) the use of pharmacological pain treatments, measured by the Medication Quantification Scale III; b) the use of all non-pharmacological pain treatments; and c) pain-related behaviours exhibited by participants, assessed by an observational pain tool, the Chinese-Pain Assessment IN Advanced Dementia (CPAINAD).

Horticultural therapy (HT) has been found to be of benefit to different patient populations but its use in people with mental handicap has not been examined. Clinical experience of horticnltural therapists revealed that HT can benefit people with mental handicap in terms of self-efficacy and social skills, thereby enhancing their quality of life. This mixed methods exploration study adopts a single group pre- and post-test design to investigate the effect of HT on adults who are mentally handicapped and live in a managed hostel setting. An HT group program consists of 12 weekly sessions will be delivered by a HT internist supervised by a Registered Horticultural Therapist. The outcome measures that will be used include, (i) Glasgow Social Self-Efficacy Scale, (ii) Chinese Quality of Life Questionnaire- Intellectual Disability, (iii) N on-pharmacolo gical therapy Experience Scale, and (iv) 園藝治療效益量表, an assessment tool specifically designed for HT outcomes. There will be three measurement points - baseline (TO), immediately post-intervention (Tl), and a follow-np assessment at 12 weeks post-intervention (T2). Throughout the 12 sessions, trained research personnel will join the group for taking field notes as non-participants. Unstructured interviews will be conducted for all subjects at Tl. Both the quantitative and qualitative outcomes will inform the researchers about the effects of HT for this particular population. The knowledge gained from this study will inform clinicians and researchers alike how best to further explore HT as a therapeutic modality.

The purpose of the study is to examine the spending habits of the middle age and older adults, particularly on health-related products and communications products. It is a cross-sectional survey study. Our target population is community-dwelling older adults, age of 50 and above. The sample size will be 609; based on the data from Census and Statistics Department in 2011, the total population of Hong Kong is 7,070,338, in which 35.4% (n = 2,501,105) are aged 50 or above. By setting alpha = 0.01 and 5% of margin of error, the estimated sample size is 609. By using proportional sampling, the sample size for HK, KLN and NT are 118, 193 and 298 respectively. The target population will be approached individually in the elderly community centers, housing estates and parks, and they will be invited to join our study by answering the questionnaire administered by the research team. The estimated time to complete the questionnaire is around 10 minutes. It is hoped that the project could collect information from middle and older adults regarding their spending habits on health-related products and communications products, so that, more tailor-made market strategies can be developed for this group of persons.

Subject population: The agitated nursing home residents with dementia.

Research design: Quasi-experimental: time series design with multiple groups. Instruments: Cohen-Mansfield Agitation Inventory (CMAI) for agitation, enzyme-link immunosorbent assay (ELIZA) for salivary cortisol (as a marker of stress).

Procedure: 24 participants will be sampled from the target population by convenience sampling. Samples will be evenly assigned into eight groups which consist of two dosage factors of the intervention (ie. frequency and duration). Subjects in each group will receive acupressure at various dosages as specified by the study group. For example, in group G1-2, the subject will receive the acupressure once a day for two week. The outcomes (ie. agitation and stress) will be measured repeatedly over time (maximally eight weeks) at a fixed interval until the stability of the outcomes resume, which indicates that the acupressure effect is weaned off. For the agitation, it will be measured by CMAI weekly from the commencement day of the acupressure until the agitation level resumes stability after the completion of the acupressure. For the stress, it will be measured by salivary cortisol every three days. The measurement will start 6 days before the commencement day of acupressure until the salivary cortisol level resumes stability after the completion of the acupressure.