Jacky Chak Pui Choy

Objectives: Aligned with the World Health Organization's call for enhanced dementia research to inform national strategies, this systematic mapping review identifies critical gaps in the evidence base for Chinese populations. Representing over 20% of people living with dementia globally, this group remains underrepresented in the Western‐centric research that currently guides best practices. This is the first study that comprehensively reviews evidence on dementia‐related interventions trialled among participants identified as Chinese worldwide across both Chinese and English literature. It addresses critical gaps in previous Anglo‐centric reviews by capturing culturally specific interventions and assessing the evolving evidence landscape for Chinese population. Methods: Following PRISMA guidelines, we systematically searched two widely used Chinese databases (China National Knowledge Infrastructure, Wanfang Data) and 12 English bibliographical databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit, Cochrane Database of Systematic Reviews) to identify randomised controlled trials (RCTs) published between 2008 and 2020 (registered on PROSPERO: CRD42019134135). Dual‐language teams employed culturally sensitive strategies to maximise coverage of regionally prevalent interventions. Risk of bias was assessed using version two of the Cochrane risk‐of‐bias tool for randomised trials. A narrative approach was used to review and assess the current landscape of dementia intervention research in Chinese communities. Results: We identified 183,277 records across Chinese and English databases and included 525 unique RCTs for synthesis (93% published in Chinese). The most commonly studied interventions were multicomponent interventions (35.2%), followed by pharmacological (29.5%), non‐pharmacological (18.3%), and traditional Chinese medicine (TCM; 14.5%) interventions. 62.7% of multicomponent RCTs were those combining TCM with Western drugs. Cognitive outcomes were measured in 86.9% of RCTs and functional outcomes in 60.2%, while only 3% evaluated quality of life (QoL) and 1% carer‐related outcomes. Most trials (91.8%) were hospital‐based. Over 80% of included RCTs were assessed as having overall ‘some concerns’. Conclusions: Despite rapid growth of dementia intervention research in Chinese communities, evidence remains skewed towards hospital‐based trials conducted predominantly in mainland China, with a focus on cognitive and functional outcome. High‐quality evidence is urgently needed to rebalance research priorities and address critical knowledge gaps in improving QoL, carer support, and community‐based interventions. Our finding that most trials were published in Chinese involving TCM illustrates the value of integrating non‐English literature in global evidence synthesis, especially for identifying culturally specific interventions common in lower‐ and middle‐income countries.

Background and objectives: Most people with dementia are undiagnosed and rely heavily on long-term care. Little is known about the relationship between dementia diagnosis and care costs, and inconsistent evidence exists on the cost implications of cognitive impairment severity. We examined how formal and informal care costs are associated with a dementia diagnosis and cognitive impairment levels across care settings. Research design and methods: We used representative data from publicly funded long-term care recipients in residential care settings and community care settings in Hong Kong (n = 1,603). Staff time measurement was used to capture service utilization of both formal and informal care. Generalized linear model (log-link and gamma distribution) was used to estimate long-term care costs, controlling for covariates. Results: A dementia diagnosis is associated with an additional 13% and 23% care costs in residential and community care settings, respectively. People with more severe cognitive impairment incur greater long-term care costs; the highest difference (a 189% increase) was found in informal care costs in community care settings among those with moderate-to-severe cognitive impairment. In community care settings, formal care costs were insensitive to cognition status but were consistently higher with a dementia diagnosis; in contrast, informal care costs were less associated with a diagnosis but increased with cognitive impairment severity. Discussion and Implications: Having a diagnosis of dementia and poorer cognition are associated with higher long-term care costs in both residential and community care settings. A dementia diagnosis is potentially a more important driver of formal care costs than cognitive impairment levels within the current care system, in contrast to what is observed with informal care costs. Practitioners and policymakers need to ensure that individuals with cognitive impairment without a dementia diagnosis receive the appropriate level of care.

Family caregivers of older adults are at risk of high care burden and reduced quality of life. Existing research and practices had primarily focused on the caregiving dyad. However, it is often observed that multiple family members are involved in caregiving for older adults. We applied family stress theory to understand family caregiving and examined how care demands, resources, and perceptions are associated with and predict caregiver well‐being. Participants in this study were low‐income family caregivers who received caregiver allowance and provided care for an older adult with care needs in the community in Hong Kong. Two waves of data, including baseline data from 358 caregivers and 2‐year follow‐up data from a subsample of 93 caregivers, were collected. We used hierarchical regression to predict care burden and quality of life at baseline and follow‐up, respectively, by care demands, resources, and perceptions after controlling for the context of care. Results show that additional caregiving roles, quality of relationship with the older adult, and satisfaction with family support were associated with care burden and quality of life at baseline. Predictors of lower care burden at 2‐year follow‐up were discontinuation of additional caregiving roles, increase in size of caregiving family, and the use of domestic helper. Applying family stress theory to understand the caregiving process reveals the significance of additional caregiving roles, the involvement of multiple caregivers, and caregivers' perceptions about family support in enhancing caregiver well‐being, underscoring the need to focus on these factors when designing and implementing caregiver support services.

Dementia is a growing health challenge that demands better public preparedness. Persons with dementia often lack the capacity to make and execute plans such that family involvement in care preparation becomes necessary. It is commonly observed in Chinese societies that there are more than one family members involved in the taking care of the person with dementia. The current qualitative study aims to understand preparedness for dementia caregiving of a family as unit in a Chinese society. In-depth interviews with 10 family units of dementia caregivers were conducted. Participants (4 spousal caregivers; 44 to 80 years old; mean years of caregiving: 3.3) reflected on how prepared their families were before the caregiving began. Thematic analysis was applied to examine the family preparedness and the family dynamics throughout the caregiving journey. As opposed to a crisis-driven involvement, involvement of more family members before crisis was helpful for reducing the damage brought to the family. Furthermore, families that could align their expectation and understanding of the situation, share knowledge and resources, negotiate the allocation of caregiving duties, and provide emotional support among family members were more likely to provide proper care with minimal sacrifice in family wellbeing. Chinese families often worked as a caregiving team, yet, with uneven distribution of caregiving duties and a lack of proper communication to sustain their caregiving role healthily. Timing and quality of family involvement were more influential factors than family resources to successful adaptation to caregiving.

This study aimed to examine of the type and intensity of activities of an ageing-in-place (AIP) Scheme that might contribute to the positive outcomes of elders. Method: A cohort of 2,081 elders from 11 AIP housing estates and 1 control estate were randomly selected within each age stratum: 65–74 years, 75–84 years, and 85 years. Elders were interviewed face-to-face at baseline and 1 year and their participation in the AIP Scheme activities was recorded. Results: Structured small group intervention and activities that improved the frailty states, mood, and cognitive function increased the likelihood of elder tenants’ to age in place. Implications: Group activities that promote physical, psychological and cognitive outcome all contribute to the positive change in elders’ preference for aging-in-place. Promotion of positive social interaction is crucial in the development of an AIP program.

Objectives: To investigate the predictive value of symptoms of dementia that the person or an informant noticed spontaneously in determining the clinical severity of dementia. Design: Cross‐sectional. Setting: Community‐based open‐referral dementia assessment service in Hong Kong between 2005 and 2013. Participants: Help‐seekers for dementia assessment service and their informants (N = 965 dyads). Measurements: Participants underwent a clinical dementia interview based on the Clinical Dementia Rating. Spontaneous complaints that the person and the informant made that had prompted their help‐seeking of groups with interview results suggestive of no impairment, mild cognitive impairment, and dementia were compared. Logistic regression was used to evaluate the predictive value of spontaneous complaints for clinical severity. Independent raters blinded to clinical results coded spontaneously reported symptoms into theoretical themes: memory, executive function, language, time and place orientation, neuropsychiatric, mood, and avolition. Results: Memory problems were the most frequently reported complaints for participants (87.7%) and their informants (95.5%), followed by self‐reported language (33.0%) and informant‐reported orientation (33.0%) difficulties. Informant‐reported but not self‐reported symptoms predicted clinical severity. Compared with the persons themselves, informants reported more pervasive symptoms corresponding to clinical severity. Persons with dementia self‐reported fewer types of symptoms than their healthy or mildly impaired counterparts. Spontaneously reported language and orientation symptoms by the informant distinguished persons with mild or worse dementia ( P < .001, Nagelkerke coefficient of determination = 29.7%, percentage correct 85.6%). Conclusion: The type and pervasiveness of symptoms spontaneously that informants reported predicted clinical severity. This may provide a quick reference for triage.

Objectives: Intact cognition is a key determinant of quality of life. Here, we investigated the relative contribution of age and physical frailty to global and everyday cognition in older adults. Methods: Data came from 1396 community-dwelling, healthy Chinese older adults aged 65 or above. We measured their global cognition using the Cantonese Chinese Montreal Cognitive Assessment, everyday cognition with the short Chinese Lawton Instrumental Activities Daily Living scale, and physical frailty using the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight Scale and grip strength. Multiple regression analysis was used to evaluate the comparative roles of age and physical frailty. Results: In the global cognition model, age explained 12% and physical frailty explained 8% of the unique variance. This pattern was only evident in women, while the reverse (physical frailty explains a greater extent of variance) was evident in men. In the everyday cognition model, physical frailty explained 18% and chronological age explained 9% of the unique variance, with similar results across both genders. Conclusion: Physical frailty is a stronger indicator than age for everyday cognition in both genders and for global cognition in men. Our findings suggest that there are alternative indexes of cognitive aging than chronological age.

PREDICTIVE POWER OF SUBJECTIVE COMPLAINT DOMAINS FOR SUSPECTED MCI AND DEMENTIA