Research to inspire new ideas and promote the sustainable development of dementia care

JCCPA is at the forefront of promoting advanced development for dementia care. We believe that resources and research must be applied to understand the effectiveness of different care solutions and to support a sustained improvement in services in step with the needs of those with dementia. JCCPA’s research team applies its rich experience to conduct studies on dementia, with professionalism and focus, to achieve the goal of discovering innovative care models that can be implemented across industry based on forward-looking research results.


Since 2005, JCCPA has completed more than 30 surveys and research studies, exploring diverse topics such as: public misconceptions about dementia; relieving stress for dementia services’ frontline workers; the benefits of minimal constraints on people with dementia; how to avoid dementia patients living in the community getting lost; the efficacy of day care services for people with dementia; the efficacy of cognitive training, psychological education support by phone, acupuncture and others. The research findings supported the argument for promoting quality care services for people with dementia and shaped the future direction of service development.

Current Research

iSupport for Dementia (iSupport) is an online education and skill training programme for informal carers developed by the World Health Organization (WHO). It includes five learning modules: (1) general information about dementia; (2) information related to being a carer; (3) self-care; (4) providing care for the person with dementia; and (5) addressing symptoms of dementia. JCCPA will collaborate with Flinders University, College of Nursing & Health Sciences to conduct a study in Hong Kong with an aim to (1) investigate the opinions of family carers and care workers about the ease of access the iSupport, user-friendly level and potential problems when they use the iSupport, and (2) investigate the effects of iSupport for family carers. In Phase 1 of the study, we will conduct online focus groups to find out the views of family carers and care workers on the revision and implementation of the generic web-based Chinese iSupport for Dementia program. In Phase 2 of the study, we will conduct a randomized controlled trial to find out whether the iSupport for Dementia program has positive effects on health and wellbeing for family carers and for those they care for.

Funded by the Knowledge Transfer Project Fund of CUHK, JCCPA developed a chronic disease self-management programme for people with mild neurocognitive disorder (MNCD) to facilitate them to delay further deterioration by helping them better manage their lives physically, psychologically, and socially. A quasi-experimental study was conducted to evaluate the effectiveness of this intervention on enhancing the cognitive functioning, mental-welling, and perceived social support. 13 centers with N=141 elderly with cognitive impairment participated in this study, and assessment were taken at three time-points: baseline, upon completion of intervention, and one year after intervention. The findings of pretest-posttest comparison showed that participants had improved cognitive functioning after the intervention, while the long-term effect of the intervention is under investigation. Continue to read the 《健康由我管─輕度認知障礙自我管理課程計劃小冊子》(Chinese version only)
JCCPA initiates the Jockey Club Caring Communities for Dementia Campaign in collaboration with Saint James’ Settlement and Hong Kong University of Science and Technology with the aim to assist in finding people with dementia who get lost using the Bluetooth crowd-sourcing technology and promote the concept of dementia-friendly community through public education. The evaluation of the campaign focuses on two areas, firstly, to examine the effectiveness of the technology in lowering caregivers’ anxiety towards getting lost, secondly, to investigate if the public education could enhance knowledge of dementia and promote positive attitude towards dementia in the general public. The primary caregivers of people with dementia using the Bluetooth crowd-sourcing technology who participate in our study would complete a structured questionnaire when beginning to use the technology, half year, and one year after the usage. The questionnaire measures the anxiety of caregivers when care recipients are getting lost, details of the getting lost episode of care recipients before and during the technology usage, and the technology’s usability. Attendees in public education talks will be invited to complete a questionnaire to measure the change of knowledge and attitude on dementia and motivation to help elderly with dementia who get lost after they attend the public education programmes.

In Hong Kong, the prevalence of restraints in long-term care institutions is high compared to other places. Restraint is usually a preferred option of staff to control residents, and people with dementia are more likely to be restrained than other residents. Studies have identified a range of negative physiological and psychological outcomes associated with the use of restraint, including strangulation, fall, anger, and feeling of humiliation. JCCPA attempts to establish a protocol to promote restraint reduction in local settings by introducing a multi-disciplinary restraint reduction programme in two residential care homes. Before and after the restraint reduction programme, staff would self-complete questionnaires about their usage, knowledge, and attitude on restraint, and their competency in dementia care. In addition, the changes in physical restraint and fall of the elder service users throughout the programme will be recorded to examine how the programme would help on reducing physical restraint.

To facilitate the service provision of staff of the elderly settings to people with dementia, JCCPA initiates an outreach training offered by our training consultant to the staff in dementia and elderly units. The training includes the knowledge and caring techniques on dementia in the actual working context, workplace environmental design assessment and suggestion, etc. The outcome measures for the evaluation of the staff training include knowledge on dementia, attitude and feeling on dementia and dementia care, dementia care competence, and satisfaction on programme. The staff attending the training would self-complete the assessment at two time-points: before they attend the training, and when they complete the training. In addition, the center in-charges would be invited to provide their views on how the training brings changes to the dementia care service provision of their units, and their satisfaction on the programme.

Funded by The Hong Kong Club Charities Trust, JCCPA launches a variety of training and support to both the family caregivers and to local citizens on helping people with dementia in neighbourhood, and city-wide public education to facilitate the general public to understand more about dementia and how everyone in the community can do to help people with dementia in daily lives. The evaluation of this community project will focus on the change of behavior, attitude, condition, and knowledge of the participants after attending our training and programmes, and their satisfaction towards this project.

Research shows that unfamiliar and noisy environment and use of restraint during hospitalization may result in the confusion and decondition of people with dementia. Family caregivers may find it difficult to manage these acute changes incurred from hospital stay, resulting in the care recipients being transferred to nursing home after hospital discharge. Funded by The Hong Kong Club Charities Trust, JCCPA launches a 12-week post discharge service model to facilitate the rehabilitation and long-term ageing in place of people with dementia discharged from hospitals. An evaluation is conducted on measuring the effectiveness of the programme on improving the functional status of people with dementia and psychological wellbeing of caregivers. Ninety people with dementia discharged from hospitals and their caregivers are targeted in this evaluation and are assessed at baseline, programme discharge, 3 months and 6 months after the programme on mobility, cognitive functioning, nutritional level, and mental wellbeing of care recipients, as well as caregivers’ caregiving burden. In collaboration with the Nethersole School of Nursing of CUHK, cost-effectiveness and social impact of the programme is also being evaluated.

Services of day care centers for the elderly have been suspended from late January 2020 due to the outbreak of COVID-19. JCCPA initiates a study to investigate how the suspension of day care service influences the users with dementia and their family caregivers. People with dementia of two day care centers, JCCPA and Jockey Club CADENZA Hub, who have taken leave during the COVID-19 pandemic and their family caregivers are recruited to participate in this research. The cognition, psychological well-being and physical mobility of users, and the caregiving burden of carers will be collected in three time points: Latest assessment record before service suspension, when users resume the service, and three months after the resumption.

Family caregivers of people with dementia may encounter multiple crises during their caregiving, e.g., caregivers do not know how to effectively handle the symptoms of dementia, or decide whether their relative need to go to a nursing home, these crises cause both physical and emotional stress to caregivers. As such, JCCPA has implemented a consultation service provided by a healthcare professional to assist family caregivers of people with dementia in their caregiving.

The evaluation study of this intervention showed that caregivers reported emotional stress from the uncertainty of the diagnosis and progression of dementia as well as from the deteriorating health of care recipients. Notably, many caregivers did not have community support. To address caregivers’ concerns, the healthcare professional offered information about dementia and future care planning, and practical and customised solutions to caregiving difficulties.

Caregivers were satisfied with the consultation service. The service facilitated caregivers to arrange a diagnostic consultation for the care recipients and led caregivers to feel more motivated and knowledgeable to seek community support after the consultation.

Research Report

During the outbreak of the COVID-19 pandemic, the Social Welfare Department of HKSAR suspended services of day-care centres for older adults as an infection control measure in early 2020. In this time, it was likely that family caregivers were the only source of care to the older adults. JCCPA investigated the impact of day-care service cessation on the caregiving experience of family caregivers of people with dementia. In collaboration with ten day-care centres in Hong Kong, N=152 family caregivers completed our survey through phone interview or self-completion. Our findings revealed that caregivers of people with dementia experienced increased caregiving stress during day-care service cessation. Caregiving stress was likely to be greater when the caregivers were older, when the people with dementia experienced greater emotional or communication issues, or when the caregivers spent more time with the people with dementia. More than one-third of the participants preferred day-care services to continue during the pandemic so as to prevent further deterioration of care recipients’ mobility, cognition, and mood, as well as provide respite for caregivers. Therefore, while infection control measures are important, interventions to improve the wellbeing of and support people with dementia and their caregivers should also be prioritised.
The study evaluated the benefits of using toys and games onto various stakeholders including day care or residential service users with dementia, family caregivers, and staff (paid and voluntary). JCCPA conducted staff surveys and qualitative interviews to dyads of caregivers, elderly care recipients and volunteers.

Our findings revealed that care recipients and caregivers were satisfied with the programme. Care recipients’ social engagement, self-esteem, and sense of competency increased when they independently completed the games. Caregivers reported improvement in care recipients’ physical and cognitive functioning and emotional wellbeing, and that the programme offered respite and reduced caregiving burden. Staff viewed the programme favourably as the programme strengthened staff’s dementia caregiving skills.

Overall, this service model was feasible, acceptable, and effective to provide quality dementia care to people with dementia, respite to family caregivers, and professional development to staff. We suggest that (1) NGOs should regularise this intervention and (2) family caregivers should encourage their family members with dementia to participate in this programme.
Literature has shown that calligraphy is beneficial to cognitive function and quality of life in the general public and in clinical populations. In this study, we found that regular calligraphy practice preserves cognitive ability (e.g. orientation) among older adults. Publication Kwok T, Bai X, Kao H, Li J, Ho F. Cognitive Effects of Calligraphy Therapy for Older People: A Randomized Controlled Trial in Hong Kong. Clinical Interventions in Aging. 2011;6:269. Conference Yip E, Yuen K, Li J, Ho F, Lam S, Kao S, Kwok T. Effectiveness of Calligraphy Groups in Retaining Cognitive Function During Ageing. Paper Presentation at the 16th Annual Congress of Gerontology; November 2008; Hong Kong.
Research shows that the physical and emotional burden of dementia caregiving may initiate grief of the family caregivers. With the support of the Knowledge Transfer Fund of the Chinese University of Hong Kong (CUHK), the Department of Medicine & Therapeutics of CUHK, the Department of Social Work of CUHK, and the Jockey Club Centre for Positive Ageing conducted a research about the "grief and loss" experienced by the family caregivers of people with dementia to facilitate better grief detection and management. Continue to read the Self-help Booklet of Grief in Dementia Caregiving for Family Caregivers (Chinese version only) Publication Chan W, Wong B, Kwok T, Ho F. Assessing Grief of Family Caregivers of People with Dementia: Validation of the Chinese Version of the Marwit–Meuser Caregiver Grief Inventory. Health & Social Work. 2017;42(3):151-158.
Self-constructed questions were used to assess dementia knowledge and treatment seeking tendency of Hong Kong residents. Findings showed that respondents had a variety of misconceptions about dementia and its symptoms. Respondents who had more misconceptions about dementia were less willing to seek for treatment options. We suggested to strengthen fellow citizen's understanding of dementia by organizing public educational programs. The result would assist departments and organizations concerned in determining their course of action. Publication Yan E, Wong A, Chan W, Kwok T. Misconceptions about Dementia and Its Implication for Willingness to Seek Treatment and Knowledge in Dementia Related Information. Hong Kong Practitioner. 2006;28(3):108-113. Conference Yan E, Kwok T, Ho F, Li J. Misconception about Dementia and its Effects on Treatment Seeking Tendency. Paper presented at the 13th Annual Congress of Gerontology; November 2005; Hong Kong.
This study evaluated the effectiveness of case management to mobilise resources within families and dementia patients in the community. The result showed that case management for Chinese outpatients with mild dementia did not show significant effects in reducing caregiver burden but encouraged family caregivers to seek external support. Publication Lam LC, Lee JS, Chung JC, Lau A, Woo J, Kwok TC. A Randomized Controlled Trial to Examine the Effectiveness of Case Management Model for Community Dwelling Older Persons with Mild Dementia in Hong Kong. International Journal of Geriatric Psychiatry.
Leaving decisions to family members is common among elderly people with dementia. However, surrogate decision makers often lack the necessary knowledge to decide on life-sustaining treatment (LST) options for patient. This study examined attitudes toward LST in family caregivers. They displayed poor knowledge about LST. Most were reluctant to forgo treatments. More dialogue and education are needed about end-of-life care in the early phase of dementia Publication Kwok T, Twinn S, Yan E. The Attitudes of Chinese Family Caregivers of Older People with Dementia towards Life Sustaining Treatments. Journal of Advanced Nursing. 2007;58(3):256-262.
This study aimed to determine the prevalence of restraint use in hospital medical wards in Hong Kong. The results showed that more than two-thirds of nursing staff reported using restraint or force in the past three months. To reduce restraint use in patient care, steps must be taken to reduce burnout and to foster social support among nurses. Publication Yan E, Kwok T, Lee D, Tang C. The Prevalence and Correlates of the Use of Restraint and Force on Hospitalised Older People. Journal of Nursing and Healthcare of Chronic Illness. 2009;1(2):147-155. Conference Yan E, Kwok T, Ho F, Li J. Nurses' Attitudes towards Restraint-use among Dementia Elderly Patients. Oral presentation at the 14th Annual Congress of Gerontology; November 2006; Hong Kong.
Difficulties in finding one's way, disorientation and getting lost in the community are symptoms of dementia. Phone interviews were conducted with caregivers of persons aged 60 to 85 with suspected or diagnosed dementia. Results showed that the rate of getting lost exceeded 30% among elderly people with dementia. A higher risk of getting lost occurred among people with greater cognitive decline but maintained mobility. The experience of people getting lost had brought significant distress to more than 40% of the families involved. Publication Kwok T, Yuen K, Ho F, Chan W. Getting Lost in the Community: a Phone Survey on the Community‐dwelling Demented People in Hong Kong. International Journal of Geriatric Psychiatry. 2010;25(4):427-432. Conference Yuen K, Kwok T, Ho F, Li J. Getting Lost in the Community: A Phone Survey on the Aged Population in Hong Kong. Oral presentation at the 15th Annual Congress of Gerontology; November 2007; Hong Kong.
This study examined the overall life satisfaction of personal care workers (PCWs) delivering dementia care in elderly daycare centres in Hong Kong. Results demonstrated that perceived adequacy of training and self-efficacy in dementia care are robust predictors for PCWs' work satisfaction. Publication Yan E, Ho F, Kwok T, Tang C. Factors Associated with Life Satisfaction of Personal Care Workers Delivering Dementia Care in Day Care Centers. Social Work in Health Care. 2007;46(1):37-45.
This research focused on concurrent cognitive training and its effects in memory training. Findings suggested that older persons without concurrent cognitive stimulation were able to benefit from memory training in the form of improved initiation and memory functioning. On the other hand, regular concurrent cognitive training leveled off the effect of memory exercises. Publication Kwok T, Chau WW, Yuen K, et al. Who Would Benefit from Memory Training? A Pilot Study Examining the Ceiling Effect of Concurrent Cognitive Stimulation. Clinical Interventions in Aging. 2011;6:83.
Previous studies showed that physical exercise may stimulate cognitive processing. As such, this study explored the effect of coordination exercise training in older adults. The results showed that coordination exercise can improve older adults' cognitive functioning. Findings indicated that exercise in general may be useful in retaining elderly cognitive functioning. Publication Kwok T, Wong A, Chan G, et al. Effectiveness of Cognitive Training for Chinese Elderly in Hong Kong. Clinical Interventions in Aging. 2013;8:213. Conference Ting K, Yuen K, Chung E, Li J, Ho F, Kwok T. Effectiveness of Physical Exercise in the Ageing Population. Oral presentation at the 16th Annual Congress of Gerontology; November 2008; Hong Kong.
This study explored the effect of drama therapy on individuals with early stage dementia in alleviating emotional problems and facilitating acceptance. A 10-session drama program was provided to patients at the JCCPA. No significant change in their self-efficacy score was found.
Although animal-assisted therapy is a popular non-drug treatment in dementia-related behavioural problems, empirical data is scarce. As such, we conducted a study to evaluate the therapeutic effect of animal-assisted therapy on older people with dementia. After eight to 12 therapy sessions, participants showed higher levels of activity, higher frequency of pleasant emotions and social interactions. In line with previous studies, our findings suggest that animal-assisted therapy may be useful in alleviating behavioural problems and symptoms among elderly dementia patients.
This study investigated the effect of music therapy in mitigating depressive symptoms among older people with dementia. Qualitative analysis on individual behavior during treatment sessions was performed. Findings suggested that individuals with previous experience of music or musical instruments may benefit from music therapy.
There is a widespread concern about whether pre-licensure health and social care professionals receive adequate training before serving the population with dementia. This study assessed the knowledge of dementia among undergraduates in health and social care in Hong Kong. The results showed that the students were generally poor in knowledge of dementia. We suggest that adequate knowledge of dementia could be achieved among future professionals by strengthening their self-efficacy in dementia care and increasing the hours of dementia education. Publication Kwok T, Lam K, Yip A, Ho F. Knowledge of Dementia among Undergraduates in the Health and Social Care Professions in Hong Kong. Social Work in Mental Health. 2011;9(4):287-301. Conference Lam K, Yip A, Kwok T, Ho, F. Knowledge of Dementia Among Undergraduates in the Health and Social Care Professions in Hong Kong. Paper Presented at the 17th Annual Congress of Gerontology; November 2009; Hong Kong.
With the ageing population, day care services are in great demand in Hong Kong. A survey was conducted to investigate the usage pattern of elderly day care centers for the elderly by demented clients and the difficulties perceived by staff in caring for them. 55 of the 59 in-charge persons of government day care centers in Hong Kong filled out a self-administered questionnaire about the composition of day care users and the difficulties perceived by staff in caring for demented clients. 98.0% of the respondents reported that demented clients with good mobility were very or quite difficult to take care of. The main perceived hindrances were manpower shortage (54.5%) and insufficient space (20.0%). Publication Kwok T, Ho D, Chan G, Ip I, Wong B, Ho F. Evaluation of Day Care Services for Demented Clients in Hong Kong. Asian J Gerontol Geriatr. 2014;9:5-9. Conference Lam KC, Hui E, Yip A, Kwok T, Ho, F. Usage of Day Care Service by Persons with Dementia in Hong Kong. Poster presented at the 18th Annual Congress of Gerontology; 2010; Hong Kong.
Day care services are reported to be effective in maintaining the cognitive ability of people with dementia and in improving their behavioral and psychological symptoms. In this study, JCCPA further examined the role of day care services in reducing caregivers' stress and in facilitating nutrition level and quality of life. 27 men and 63 women with dementia newly admitted to JCCPA were assessed at baseline, month 6, and month 12. The caregivers' stress decreased significantly at month 12. The cognitive function and the quality of life were maintained at months 6 and 12. The nutrition level improved significantly at month 6. However, there was a significant deterioration in the score for daily living ability and the score for mobility at month 12. The score for behavioral and psychological problems also increased significantly at month 6. Publication Kwok T, Young D, Yip A, Ho F. Effectiveness of Day Care Services for Dementia Patients and Their Caregivers. Asian J Gerontol Geriatr. 2013;8:9-15. Conference Yip A, Kwok T, Ho F, Li J. The Effectiveness of Day Care for People with Dementia and Their Family Caregivers: The JCCPA Experience. Paper Presented at the 17th Annual Congress of Gerontology; November 2009; Hong Kong.
This study evaluated the effectiveness of the Active Mind cognitive-training program in improving the cognitive function and quality of life (QoL) for local community-dwelling older adults. A total of 200 subjects were recruited from 20 different district elderly community centers, which were randomly assigned into either the intervention group or control group. The intervention group underwent eight 1-hour sessions of cognitive training, while the control group was included in the usual group activities provided by the centers. A total of 176 subjects completed the study. The intervention group showed greater improvement in the cognitive function and QoL. Subjects with lower education level were associated with better cognitive response to the cognitive-training program. Publication Kwok T, Wong A, Chan G, et al. Effectiveness of Cognitive Training for Chinese Elderly in Hong Kong. Clinical Interventions in Aging. 2013;8:213.
The job satisfaction of live-in foreign domestic helpers (FDHs) may influence their caring motivation and the quality of care they provide, which may in turn affect the health status of care recipients. This study identified the factors affecting job satisfaction of FDHs caring for people with dementia in Hong Kong, focusing especially on the role of FDHs' adaptation status, job self-efficacy and care recipients' situation. A total of 152 FDHs taking care of people with dementia were recruited from 6 day care centers where they attended with their care recipients. The results showed that longer stay in Hong Kong, better fluency in Cantonese (local dialect), greater satisfaction in living conditions, higher caregiving self-efficacy, and less disruptive behavior of care recipients were independently associated with stronger job satisfaction in FDHs looking after people with dementia. On the basis of these findings, we would suggest that employers should consider helpers who have been in Hong Kong for a longer period of time and speak fluent Cantonese, and have previous experience of taking care of people with dementia. In addition, FDHs caring for people with dementia may benefit from carer training which improves their self-efficacy in dementia care. Publication Bai X, Kwok T, Chan N, Ho F. Determinants of Job Satisfaction in Foreign Domestic Helpers Caring for People with Dementia in Hong Kong. Health & Social Care in the Community. 2013;21(5):472-479.
Older adults with dementia are often afflicted with sleep problems. Recent studies have suggested that acupuncture may be a feasible alternative to traditional sleep medicine for treating sleep disturbance. This study investigated the effectiveness of acupuncture on sleep quality of older adults with dementia. Nineteen people with dementia were followed through a control period and an acupuncture treatment period, each lasting 6 weeks. The subjects gained significantly more resting time and total sleep time in the treatment period than in the control period. A non-significant trend for improvement in sleep efficiency was observed. Publication Kwok T, Leung PC, Wing YK, et al. The Effectiveness of Acupuncture on the Sleep Quality of Elderly with Dementia: a Within-subjects Trial. Clinical Interventions in Aging. 2013;8:923.
Many family caregivers of persons with dementia are unable to participate in community center-based caregiver support services because of logistical constraints. Due to the constraints, JCCPA offered a telephone-delivered psychoeducational intervention for family caregivers to alleviating caregiver burden and enhancing caregiving self-efficacy. In a single-blinded randomized controlled trial, 38 family caregivers were randomly allocated into an intervention group or a control group. The intervention group received psycho-education from a registered social worker over the phone for 12 sessions. Caregivers in the control group were given a DVD containing educational information about dementia caregiving. The level of burden of caregivers in the intervention group reduced significantly compared with caregivers in the control group. Caregivers in the intervention group also reported significantly more gain in self-efficacy in obtaining respite than the control group. Publication Kwok T, Wong B, Ip I, Chui K, Young D, Ho F. Telephone-delivered Psychoeducational Intervention for Hong Kong Chinese Dementia Caregivers: a Single-blinded Randomized Controlled Trial. Clinical Interventions in Aging. 2013;8:1191.
This study examined the short-term and long-term effects of a cognitive training program in enhancing cognitive function of older people with subjective memory complaints. In the trial, 223 older participants were randomly assigned to either the intervention group or the health related educational control group. The intervention group received cognitive training led by an occupational therapist once a week for 12 weeks, while the control group attended a series of health-related educational lectures in small groups led by the same occupational therapist. Results indicated that cognitive training was effective in enhancing the overall cognitive function of less educated older adults. The positive effect was durable for at least nine months in conceptualization and memory. Publication Kwok T, Bai X, Li J, Ho F, Lee T. Effectiveness of Cognitive Training in Chinese Older People with Subjective Cognitive Complaints: a Randomized Placebo‐controlled Trial. International Journal of Geriatric Psychiatry. 2013;28(2):208-215. Conference Kwok T, Yip A, Cheng S, Ho F. The Effects of Cognitive Training in Older Adults: A Randomized Controlled Trial. Presented at the 25th International Conference of Alzheimer's Disease International; March 2010; Thessaloniki, Greece.
JCCPA was commissioned by Hong Kong Lutheran Social Service (HKLSS) to conduct a randomized controlled trial that evaluated the effectiveness of toy intervention on people with mild cognitive impairment (MCI) on enhancing their cognition and mental wellbeing. 119 people with MCI, recruited from four HKLSS centers, participated in a 12-week research. Both intervention and control groups demonstrated improvement in psychological wellbeing, overall quality of life, and cognitive functioning after participating in intervention or control activities. The intervention group showed statistically significant improvement in psychological wellbeing and overall quality of life; while participants from the intervention group who were more cognitively impaired yielded statistically significant improvement in cognitive functioning. The manuscript of the study is in progress.
In both acute care and residential care settings, physical restraints are frequently used in the management of older people. Building on the reported negative outcomes of physical restraint use, JCCPA examined the effects of the nursing practice on patients' length of stay (LOS) in hospitals. Medical records of 910 older patients aged 60 years or above and admitted to one Hong Kong public hospital in 2007 were randomly selected and recorded during July to September 2011. The results indicated that older patients' general health status, physical, and cognitive function were important factors affecting their LOS. However, independent of these factors, the physical restraint use was still significantly predictive of longer LOS. Publication Bai X, Kwok T, Ip I, Woo J, Chui M, Ho F. Physical Restraint Use and Older Patients' Length of Hospital Stay. Health Psychology and Behavioral Medicine. 2014;2(1):160-170. Kwok T, Bai X, Chui M, et al. Effect of Physical Restraint Reduction on Older Patients' Hospital Length of Stay. Journal of the American Medical Directors Association. 2012;13(7):645-650
Previous research conducted by JCCPA has suggested that an online support system lowered caregivers' stress and burden. This study further evaluated the effectiveness of the online intervention for family caregivers in improving their self-efficacy in managing behavioral and psychological symptoms of dementia (BPSD), and their emotion well-being. A total of 36 family caregivers of people with dementia participated in a 9-week online intervention based on the cognitive behavioral therapy model. The severity of BPSD of people with dementia and BPSD-related distress in family caregivers showed a statistically significant reduction after the intervention. Subgroup analysis showed self-efficacy in controlling upsetting thoughts significantly improved in caregivers of PWD at moderate to severe stages. Publication Kwok T, Au A, Wong B, Ip I, Mak V, Ho F. Effectiveness of Online Cognitive Behavioral Therapy on Family Caregivers of People with Dementia. Clinical Interventions in Aging. 2014;9:631.
JCCPA was commissioned by the Hong Chi Association to evaluate the effectiveness of life story work (LSW) on enhancing mood, socialization and quality of life for ageing people with mild to moderate levels of intellectual disabilities. Research findings from 60 older adults aged 50 to 90 and with mild to moderate intellectual disabilities indicated that LSW was useful for elderly people with intellectual disabilities by enhancing their quality of life and preventing deterioration in mood. It also helped improve participants' social skills. Through the activity, staff and family caregivers were benefited by seeing their clients or family members with ID as unique individuals. Publication Bai X, Ho D, Fung K, et al. Effectiveness of a Life Story Work Program on Older Adults with Intellectual Disabilities. Clinical Interventions in Aging. 2014;9:1865.
This study evaluated the effectiveness of the training offered to the staff about dementia care on improving their knowledge of dementia and sense of competence of dementia care. The findings showed that the trainees had improved knowledge on dementia, and the professional staff had improved competency towards dementia care after the training. The trainees are in general satisfied with the training.
A randomized controlled trial with a waitlist control design was conducted to evaluate the effectiveness of a game intervention on enhancing the quality of life and cognitive functioning of the elderly with dementia who join day care centres. Assessment was taken at baseline, upon completion of intervention, and three months post-intervention. N=83 subjects were included in the analysis. The quality of life and cognitive functioning of intervention group increased significantly after intervention, while those of control group yielded an insignificant improvement of mean score. The difference of the change of quality of life and cognitive functioning between intervention group and control group was not significant. As for the evaluation of public education, over 80% of subjects indicated that they had good knowledge and positive attitude towards dementia after the education talks.
This study examined the effectiveness of a game porgramme and a music porgramme offered by secondary school students to people with dementia. N=36 elderly with dementia joining the game porgramme, N=8 elderly with dementia joining the music porgramme, and N=25 secondary school students leading these porgrammes participated in this evaluation. The findings showed that the elderly were satisfied with the porgrammes, the elderly participating of the game porgramme commented that they enjoyed playing games with younger generation and activity with young generation would attract them to go to the elderly centres. The participants of the music porgrammes also enjoyed playing with the younger generation and they felt happy joining the porgrammes. The secondary school students were satisfied with the porgrammes, and they recognized the strengths of the elderly and felt more confident communicating with the elderly after the porgrammes. They were also more willing to help the elderly and participating in activities with the elderly after these porgrammes.
JCCPA launched a training programme for the domestic helpers to enhance their knowledge about dementia, and their skills taking care of people with dementia. N=297 domestic helpers self-completed a questionnaire after the training to evaluate the effectiveness of the training. 99% of the participants commented that the training enhanced their knowledge about dementia, and improved their understanding towards the needs of people with dementia as well as confidence about communicating with people with dementia. 98% of the participants felt more confident offering help to people with dementia after the training.
CCPA collaborated with the Dementia Services Development Centre of the University of Stirling to localize its Best Practice Training Dementia Care ("Best Practice Training") to Hong Kong workers. Different from the traditional classroom learning, the Best Practice Training adopts the "train-the-trainer" model, in which the professional staff ("facilitators") in elderly settings attended a three-day workshop, then the facilitators taught their frontline colleagues ("learners") during the 12 two-hour coaching sessions. The evaluation of the programme measured the improvement of staff on providing dementia care after the programme. Before the programme and 12-month after the enrolment, all the participants completed questionnaires measuring the following variables: Knowledge (learners only), attitude, and perceived competence (learners only) in dementia care, and job satisfaction. Fifty reflective writings were randomly selected to validate the results of the questionnaires. In total, 1,264 participants, including 195 facilitators and 1,069 learners, from 70 elderly settings were included. Results showed that participants improved significantly in all variables after the training. Publication Chan H, Ho F, Chui K, et al. Capacity Building for Dementia Care in Community Care Services: A Mixed Methods Approach. BMC Geriatrics. 2020;20:1-10.
This study evaluated the effectiveness of an expanded cognitive stimulation therapy (CST) model combining CST and tai chi on improving the cognitive ability of community-dwelling elderly with mild stage dementia. The research findings showed that the intervention group was significantly more effective than the control group in improving the cognitive functioning of the participants and the improvement maintained after four months. Publication Young D, Ng P, Kwok T, et al. The Effects of an Expanded Cognitive Stimulation Therapy Model on the Improvement of Cognitive Ability of Elderly with Mild Stage Dementia Living in a Community—a Randomized Waitlist Controlled Trial. Aging & Mental Health. 2019;23(7):855-862. Young D, Ng P, Cheng D, et al. Outcomes of Expanded Cognitive Stimulation Therapy Group for Mild-Stage Dementia: Four-Month Follow-Up. Research on Social Work Practice. 2019:1049731519859432.
Dementia has an effect on the entire family system because family members are usually the main caregivers of the patients, and the caregiving tasks are ever-changing to accommodate the needs of different stages of the disorder. However, the individual model of dementia continues to be the dominant theoretical perspective in dementia care. This qualitative study explored themes that described families taking care of elderly relatives with dementia in Chinese society. Five themes were drawn from 20 family therapy sessions which elevated our understanding of family context in the provision of care to an elderly person with dementia: positive affection as coping strategies, power and control in the caregiving relationship, adult children's involvement in caregiving, sibling rivalry, and intergenerational conflicts. Publication Wong OL, Kwong PS, Ho C, et al. Living With Dementia: An Exploratory Study of Caregiving in a Chinese Family Context. Social Work in Health Care. 2015;54(8):758-776.

Dementia Research In-focus

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Coconut oil has a prominent position in the food and medical tradition, especially in places where palms are cultivated, such as South America and Southeast Asia. In recent decades, however, health concerns about the risk saturated fats have on cardiovascular diseases, along with the high amount of saturated fats in coconut oil, have made many hesitate to consume the oil. This review examines the existing evidence on the nutritional value of coconut oil, in particular the effects it has on the risk management of Alzheimer's disease. Continue to full text.
Wandering is a behaviour that may be exhibited by some people with dementia. There may be various factors associated with wandering, such as cognitive decline, unmet needs of people with dementia, or the environment. Wandering may put people with dementia at higher risk of getting lost, while the use of assistive technology and a dementia-friendly community may facilitate people with dementia to live in the community more safely and independently.Continue to full text.
Maintaining good psychological health in elderly is one of the important factors in reducing the risk of dementia. This article will detail the association between depression, anxiety and cognitive function, and the way mindfulness activities can assist participants to enhance psychological flexibility. By encouraging self-compassion and resilience, older adults might be more capable of dealing with ongoing challenges in life, as well as reducing the risk of cognitive decline. Continue to full text.
Family caregivers of people with dementia may experience grief in advance of the death of their care recipients, which is termed anticipatory grief. It involves stages of coping from mourning to psychosocial reorganization incurred by the anticipation of the loss of a loved one in the near future1. For dementia caregivers, in particular, this sense of loss can entail the losses of companionship, personal freedom, control, well-being, and personhood for the care recipient. The grieving process is often characterized by anticipation and ambiguity about the future as well as a wide range of negative emotions, such as anger, frustration and guilt2. Studies from the western countries estimated that around 47% to 71% of the caregivers experience anticipatory grief3,4, and close to 10% may be at risk of severe grief reactions needing professional help5. Continue to full text.
The concept of dementia specialized care unit was developed in America in the seventies, in the aim to provide better care to people with dementia. There are no concrete standards on how a dementia specialized care unit should equip itself, while the units claim measures specifically designed for people with dementia such as physical design, program, staff training etc. 1 Previous studies comparing benefits of specialized care units on people with dementia versus integrated care setting resulted in discrepancies in benefits or effectiveness, while the major trend of published studies skew towards confirming that specialized care units benefit some cohorts of people with dementia in some areas. This literature review documented some previous studies in the recent decade examining the advantages of specialized care unit and added views on what an integrated care setting has been investigated to help people with dementia. Continue to full text.
A review on the subjective needs of PWD revealed that people at the early to moderate stage of dementia valued well-being and coping needs over functional, instrumental supports. What they regarded as their top concerns were social supports and ways to compensate for their cognitive deficits that would help ease their grief and frustrations 1 . A study investigating the needs of institutionalized elderly PWD found that environmental and physical needs of the old people were usually taken care of, yet mental health care and social needs were usually unmet. The study reported that PWD, in general, lacked stimulating daytime activities, that their depression and anxiety were often left untreated, and that many revealed to have no company 2 . The service gap, therefore, mirrored the claim made by O'Connor, Ames, Gardner, King 3 , which demonstrated that human attention and enjoyable interaction in some studies (while treated as control activities) yielded comparable results as interventions such as validation therapy and progressive muscle relaxation training, providing evidence on the notion that intervention to people with dementia should take human attention or social interaction into consideration.Continue to full text.
Caregiving is a stressful experience, but when it comes to dementia caregiving, the stress could become more intense. Research has shown that caregivers of people with dementia engage in a greater intensity of work and face more problems. The high caregiving hours and degree of daily activity assistance are reported to associate directly with stress 1. The effect of chronic stress extends beyond psychology to physical wellbeing. Studies have related dementia caregiving to heart disease risk 2 , wound healing performance 3 , and other immune functions. For example, a study comparing 49 spousal caregivers of persons with dementia and 67 healthy non-caregivers of the same age reported a lower cell-mediated immunity and an elevated level of salivary cortisol, a stress indicator, among dementia caregivers 4 Continue to full text.
With the notion that "if exercise could be packed into a pill, it would be the single most widely prescribed and beneficial medicine in the nation", it has long been proposed that an active lifestyle is the medicine for frail adults. This issue's Dementia Research in Focus outlines the therapeutic effects of physical exercise and the importance to engage in a long term active lifestyle.Continue to full text.
Although dementia has no known cure at the moment, it is suggested that preventable causes account for 1/3 to 1/2 of the disease cases. This research review will focus on the risk factors of dementia and subsequent lifestyle changes.Continue to full text.
Research shows that trans fat is associated with cardiovascular diseases and diabetes, it may also heighten the risk of cognitive damage and dementia. Both local and international governmental bodies have issued guidelines about the consumption of trans fat. As a continuation of the preventive measures on dementia, the Research In-focus of this quarter further illustrates the effects dietary habit has on cognition.Continue to full text.
Currently, dementia affects around 9% of Hong Kong elderly aged over 70. It is estimated that in 2036, there will be 230,000 community-dwelling senior citizens with dementia. Studying the prevalence as well as the risk factors of dementia would help understand what we can do to alleviate the demented population.Continue to full text
Recent studies have introduced the MIND diet to promote brain health. Moderating two established dietary patterns based on current evidence of large-scale observational studies, researchers believe that the MIND diet might point to a more accurate eating guideline to slower age-related cognitive decline.Continue to full text.
The needs of people with dementia change over time and staging. With appropriate training, staff members in elderly services may provide demetnia care with better sense of competence and self-efficacy. Continue to full text.
As technology advances, computer-based cognitive interventions might become more disseminative than traditional interventions, and could even be a solution to the current service gap. This article will describe the potential improvements the computer interventions might achieve, and provide information of the current trend of technology usage among the local elderly.Continue to full text.
Restraints may come in the form of physical restraint or chemical restraint. Despite the lack of evidence of restraint use as an effective therapeutic measure, restraint use is prevalent among long term care facilities in Hong Kong. Dementia and cognitive impairment may be associated with increased likelihood of being restrained. Academic studies have suggested various potential adverse outcomes of restraint use such as fall, poorer cognitive outcomes, increased dependence in walking and death. Restraint reduction program is proven beneficial to the hospitalized elderly with cognitive impairment; in long term it is suggested to promote restraint reduction in elderly settings in order to provide better elderly care in Hong Kong.Continue to full text.
Caregivers of people with dementia (PwD) often find themselves in a difficult position to make proxy decisions for the care recipients if the care recipients have not expressed their care wishes before their cognitive ability declined. The decision making is even harder when there is family disagreement at times of healthcare crises. There is some evidence in dementia-related literature pointing to the effectiveness of ACP in minimizing inappropriate hospital admissions, death of PwD and increased use of hospice. Therefore, to maintain care in accordance with the PwD's wishes, a discussion about future care should be made when the PwD is still in the early stageContinue to full text