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Ageism is a global challenge and a public health concern that the recent COVID-19 pandemic has further exacerbated. Existing research has mainly focused on individual factors, overlooking the association between the neighborhood-built environment and ageism. This study examined this association and whether its effect varied among areas possessing different socioeconomic characteristics. We conducted a cross-sectional survey of 1278 older people in Hong Kong and merged this with the built environment factors derived from geographical information system data. We used multivariable linear regression to examine the association. Findings revealed that more parks were significantly associated with a lower level of ageism, an impact that remained significant in low-income or low-education areas. Conversely, more libraries in high-income areas were associated with a lower level of ageism. Our findings provide urban planners and policymakers insight into planning for the built environment that reduces ageism enabling older people to achieve a better life.

Previous studies have found negative ageing narratives in the media during the COVID-19 pandemic. However, few have focused on compassionate ageism and how the news responded to the progression of the COVID-19 pandemic. We investigated (a) media themes of negative and compassionate ageism and (b) their relationships with COVID-19 parameters and the public health response. The sample included 1,197 articles relevant to COVID-19 and older people in Hong Kong published between January and December 2020. We used thematic analysis to identify themes from the news articles and structural equation modelling to explore these themes' relationship with the number of older people infected, effective reproduction number, number of COVID-19 deaths and public health response parallel in time. Pandemic-related variables were lagged for a day – the time needed to be reflected in the news. Two negative ageism themes portrayed older people as vulnerable to COVID-19 but counterproductive in combating the pandemic. Two compassionate ageism themes depicted older people as a homogenous group of passive assistance recipients. The theme blaming older people was associated with the number of confirmed infections (β = 0.418, p = 0.002) but vulnerability of older people was not associated with pandemic-related variables. The theme helping older people was negatively associated with the percentage of older people in confirmed infections (β = −0.155, p = 0.019). The theme resources available was negatively associated with confirmed infections (β = −0.342, p < 0.001) but positively associated with the Containment and Health Index (β = 0.217, p = 0.005). Findings suggested that negative and compassionate ageism were translated into narratives about older people in the media as the pandemic evolved but did not address the actual risk they faced. Media professionals should be aware of the potential negative and compassionate ageism prompted by the news agenda and promote adequate health behaviours and responses.

Background and Objectives Internalized ageism and stigma of mental illness may disempower older people and impede help-seeking among those at risk of depression. Arts are deemed enjoyable, stigma-free, and conducive to mental health, and a participatory approach can engage and empower potential service users. This study aimed to co-design a cultural art program and test its feasibility in empowering older Chinese people in Hong Kong and preventing depression. Research Design and Methods Adopting a participatory approach and guided by the Knowledge-to-Action (KTA) framework, we co-designed a 9-session group art program using Chinese calligraphy as the channel for gaining emotional awareness and facilitating expression. The iterative participatory co-design process engaged 10 older people, 3 researchers, 3 art therapists, and 2 social workers through multiple workshops and interviews. We tested the program’s acceptability and feasibility in 15 community-dwelling older people at risk of depression (mean age = 71.6). Mixed methods were used, including pre- and post-intervention questionnaires, observation, and focus groups. Results Qualitative findings suggest the feasibility of the program, and quantitative findings indicated its effects in increasing empowerment (t(14)=2.82, p < .05), but not in other mental health-related measurements. Participants reflected that active participation and learning new art skills were fun and empowering, arts enabled them to gain insight into and express deeper feelings, and groups with peers made them feel relatable and accepted. Discussion and Implications Culturally appropriate participatory arts groups can effectively promote empowerment in older people, and future research should balance eliciting meaningful personal experiences and measurable changes.

Studies have documented the impact of childhood socioeconomic status (SES) on cognition. However, research that simultaneously considers SES in varied life stages, the multidimensional mechanisms, and racial differences is relatively understudied. This study examines the intersectionality across age, SES, and race and its impact on cognitive trajectories.Using 8376 respondents aged 65+ from the 1998-2016 Health and Retirement Study, we used latent growth curve modeling to examine the effects of four life course models (latency, pathway, accumulation, and mobility) on 18-year trajectories of mental status and episodic memory. We further tested for differences in the links between SES and cognitive trajectories between black and white respondents.Cognitive function declines with age and is interrelated with SES and race. Adulthood has a stronger effect on cognitive performance than childhood. However, linked positive childhood and adulthood SES contributes to positive cognition. Accumulated SES disadvantages were associated with lower cognition. Older adults with downward mobility and low SES throughout their lifespans had the lowest cognition scores. Life course models operated differently on trajectories of cognitive decline, yet the effects were particularly evident among older black respondents. Overall, those with socioeconomic advantages tended to have a slower decline in cognition, while a faster decline occurred for those with accrued disadvantages.Cognitive performance is a complex, longitudinal process intertwined with socioeconomic conditions and population heterogeneity shaped by life course contexts. Policies that facilitate healthy cognitive performance and address SES inequality could equalize health opportunities and address racial cognitive disparities later in life.

BACKGROUND Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an “infodemic” of overabundant and questionable information that has affected older adults’ mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization’s Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults. OBJECTIVE This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media. METHODS Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district–based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions. RESULTS Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=–0.39, P=.002) and AFC-Communication Technology (b=–1.06, PP=.002) and AFC-Communication Technology (b=–0.05, PP=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=–0.65, PPP=.003). CONCLUSIONS Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults.

Built environment can influence physical conditions of older adults (e.g. osteoporosis). However, traditional methods using 2-dimensional circular buffer as a spatial structure to measure neighbourhood effect may create bias in health estimation, especially for the hilly and compact environment across low-income neighbourhoods (e.g. public housing estates).We evaluated the environmental influences on self-reported osteoporosis among "old residents" (age≥65) in Hong Kong (n = 2077). Twelve public housing estates across hilly neighbourhoods in Hong Kong were selected as study sites. A cross-validated approach was developed to evaluate four spatial structures (2D circular, 2D service area, 3D circular, 3D service area). To determine problems of spatial uncertainty, we compared odds ratios (OR) and differences in effect sizes from models using different spatial structures. When all adjusted models achieve significant results based on 95% confidence intervals (CI) and with all positive/negative ORs, this study reported to have reached "a result with consistency". Results from the 3D service area were then used to explain the environment-health relationship.Different spatial structures can yield different results. Particularly, circular buffers overestimated environmental effects on self-reported osteoporosis. Overestimated measures were related to walkability and accessibility but not greenery. Specifically, results from the 3D service area showed that more public space and health facilities within a walkable distance (500 m) from a location of subject's residence were negatively associated with self-reported osteoporosis (adjusted ORs: 0.44 [0.29, 0.66]; 0.94 [0.90, 0.99]). However, more major transport facilities at the immediate distance from residence (200 m) was positively associated with self-reported osteoporosis (adjusted OR: 1.11 [1.01, 1.23]).Physical conditions (e.g. osteoporosis) of older adults living in a hilly neighbourhood could be driven by walking behaviours. It is necessary to include local terrain and road network to define a walkable neighbourhood for environment-health estimations to minimize spatial bias.

BACKGROUND COVID-19-related information on social media is overabundant and sometimes questionable, resulting in an “infodemic” during the pandemic. While previous studies suggest social media usage increases the risk of developing anxiety symptoms, how induced anxiety affects attitudes and behaviors is less discussed, let alone during a global pandemic. Little is known about the relationship between older adults using social media during a pandemic and their anxiety, their attitudes toward social trust in information, and behaviors to avoid contracting COVID-19. OBJECTIVE The goal of this study was to investigate the associations between using social media for COVID-19-related information and anxiety symptoms as well as the mediation effect of anxiety symptoms on social trust in information and COVID-safe behaviors among older adults. METHODS A cross-sectional telephone survey was conducted in Hong Kong between May and August 2020. A rapid warm-call protocol was developed to train social workers and volunteers from participant nongovernmental organizations to conduct the telephone surveys. Questions related to COVID-safe behaviors, social trust in information, social media use, anxiety and depressive symptoms, and sociodemographic information were asked. The number of confirmed COVID-19 cases at the community level was used to account for the risk of contracting COVID-19. Ordinary least squares regressions examined the associations between social media use and anxiety symptoms, and how they were associated with social trust in information and COVID-safe behaviors. Structural equation modeling further mapped out these relationships to identify the mediation effects of anxiety symptoms. RESULTS This study collected information regarding 3421 adults aged 60 years and older. Use of social media for COVID-19-related information was associated with more anxiety symptoms and lower social trust in information but had no significant relationship with COVID-safe behaviors. Anxiety symptoms predicted lower social trust in information and higher COVID-safe behaviors. Lower social trust in information was predicted by using social media for COVID-19 information, mediated by anxiety symptoms, while no mediation effect was found for COVID-safe behaviors. CONCLUSIONS Older adults who rely on social media for COVID-19-related information exhibited more anxiety symptoms, while showing mixed effects on attitudes and behaviors. Social trust in information may be challenged by unverified and contradictory information online. The negligible impact on COVID-safe behaviors suggested that social media may have caused more confusion than consolidating a consistent effort against the pandemic. Media literacy education is recommended to promote critical evaluation of COVID-19-related information and responsible sharing among older adults.

BACKGROUND Stroke has profound impacts on families. Often, family members, including stroke survivors and the person who takes up the role of the primary caregiver, would encounter demands on finances, rehabilitation arrangement, and even conflicts. Hence, a family-oriented intervention is expected to enable families to rebuild internal and external resources to achieve optimal rehabilitation and community reintegration. OBJECTIVE This study aims to describe a design of a two-tier family-oriented care management intervention for enhancing the family functioning and care capacity of the caregivers of stroke survivors. METHODS The two-tier care management intervention was guided by a standardized protocol conducted by trained professional care managers (first tier) with the support of trained volunteers (second tier), which lasted for 8-12 weeks. Participants were recruited through collaborating hospitals according to inclusion and exclusion criteria. In order to examine the effectiveness and cost-effectiveness of the two-tier care management intervention, a two-arm randomization multicenter study was designed, including an active comparison group, which was guided by a standardized protocol conducted by trained volunteers. Dyadic participants, including both stroke survivors and their primary caregivers for both groups, were invited to participate in a questionnaire survey using standardized and purposefully developed measures 3 times: before the intervention, immediately after the intervention, and 2 months after the intervention. The primary outcome was family functioning measured by the Family Role Performance Scale and Family Assessment Device-General Functioning Scale. The secondary outcomes included caregiving burden, depressive symptoms, care management strategies, and the incremental cost-effectiveness ratio. RESULTS Recruitment began in January 2017 and was completed at the end of April 2019. Data collection was completed at the end of March 2020. As of March 2020, enrollment has been completed (n=264 stroke caregivers). A total of 200 participants completed the baseline questionnaires. We aim to publish the results by mid-2021. CONCLUSIONS This study successfully developed a two-tier care management protocol that aims to enhance the family functioning of the caregivers of stroke survivors. Guided by a standardized protocol, this family-oriented two-tier intervention protocol was found to be feasible among Chinese families. CLINICALTRIAL ClinicalTrials.gov NCT03034330; https://ichgcp.net/clinical-trials-registry/NCT03034330 INTERNATIONAL REGISTERED REPORT RR1-10.2196/16703

There is little understanding about how rapid urban development has affected the extent to which communities are able to optimize health and participation opportunities for older adults in Hong Kong. Our objective was to examine what older residents perceive to be the shortcomings of their communities in meeting their psychosocial and physical needs as they age.In reference to the WHO Age-Friendly Cities Project Methodology: Vancouver Protocol, we conducted nine focus groups comprising 65 participants for an Age-Friendly City baseline assessment in two districts in Hong Kong, China. Participants were asked to share their views on their respective district of residence, and identify aspects of the city they found unfriendly. Data generated from interviews were analyzed using thematic analysis.Five of the following key themes were identified: the failure of public transportation to cater to the needs of older adults; a lack of public space for recreation and socializing; diminishing human interactions in welfare services; physical and financial challenges relating to housing; and workplace discrimination against older adults.These findings underscore the importance of prioritizing the social welfare of older adults in building a more inclusive and age-friendly city. They also highlight the difficulties in fostering an inclusive environment while ensuring efficiency and profit maximization.

Caregiving can be stressful, potentially creating physical and psychological strain. Substantial evidence has shown that family caregivers suffer from significant health problems arising from the demands of caregiving. Although there are programs supporting caregivers, there is little evidence regarding their effectiveness. Acupressure is an ancient Chinese healing method designed to restore the flow of Qi (vital energy) by applying external pressure to acupoints. A randomized, wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress (primary objective) and stress-related symptoms of fatigue, insomnia, depression, and health-related quality of life (secondary objectives) in Chinese caregivers of older family members. Two hundred Chinese participants, aged ≥ 21 years, who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong. Subjects will be randomized to receive either an immediate treatment condition (self-administered acupressure intervention) or a wait-list control condition. The self-administered acupressure intervention will include (i) an individual learning and practice session twice a week for 2 weeks, (ii) a home follow-up visit once a week for 2 weeks, and (iii) 15-min self-practice twice a day for 6 weeks. The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention. We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress, fatigue, insomnia, depression, and higher health-related quality of life after completion of the intervention than participants in the wait-list control group. This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue, insomnia, depression, and health-related quality of life in Chinese family caregivers. The findings will inform the design of interventions to relieve negative health effects of caregiving. Furthermore, the results can raise community awareness and serve as a basis for policymaking, planning, and allocation of resources regarding empowerment of family caregivers for self-care. Current Controlled Trials NCT02526446 . Registered August 10, 2015.

The public discourse on productive aging as a research and policy initiative has just begun in greater China. Two conferences in Mainland China in 2009 and 2011 and subsequent conferences in Taiwan and Hong Kong in 2012 have set it in motion. Because applied social science research has just started in greater China, researchers in Chinese societies will benefit from the experience and rich literature accumulated over the last three decades in the West. In this paper, I review and reflect on the research methods used in productive aging research in both Chinese societies and in the West. I believe that to advance productive aging research in greater China, we need to (1) discuss and agree upon a definition of productive aging, (2) identify and differentiate outputs and outcomes of productive aging activities in greater China, (3) develop precise measures for productive aging involvement, (4) focus on institutional (program and public policy) factors that promote productive aging involvement, (5) use a strong research design (such as a quasi-experimental design) to establish the internal validity of productive aging programs, and (6) be theory-driven. Lastly, productive aging should be seen as a choice, not an obligation for older people; otherwise, the productive aging agenda will be seen as exploiting older people. It is important that Chinese researchers and policy-makers have this in mind when they are advocating productive engagement of older people in China., published_or_final_version