1. Cadenza Symposium 2008 - Successful Ageing

2. Well-being Indicators: How Does Hong Kong Compare with Other Countries
Patsy Pui-hing CHAU
Research Assistant Professor
CADENZA: A Jockey Club Initiative for Seniors
11 October 2008

3. Active Ageing Framework
Introduced by World Health Organization (WHO) in 2002
Policy makers & service providers address the health, social, economic & spiritual needs of seniors to facilitate healthy ageing

4. Well-being Indicators
Adopt a positive outlook along the lines of the active ageing framework
Highlight aspects that contribute to successful & productive ageing such as healthy lifestyle & active social engagement

5. Well-being Indicators (con’t)
Nutrition & Health-related Lifestyle
Demographic Profile
Well-being
Social Networking & Engagement
Health Status
Functional Status

6. Benchmarking
Compare with economically developed countries in both the East & the West
Reflect how well seniors in Hong Kong are doing with reference to these countries

7. Data Sources
Surveys or the population censuses conducted by the government officials/departments
Surveys/studies conducted by the universities, individual researchers or non-government agencies
Owing to space limit, citation of these sources is omitted from this presentation; interested parties could refer to our publication for the full list of references (Chau and Woo, 2008)
Reference: Chau PH and Woo J. (2008). How Well Are Seniors in Hong Kong Doing? An
International Comparison. Hong Kong: The Hong Kong Jockey Club.

8. Interpretation of Statistics
Due to the possible differences in conceptualization & compilation methods, the international comparisons presented can only be interpreted in a broad sense

9. Demographic Profile

10. Demographic Profile
People age in unique ways, depending on a large variety of factors, including demographic factors
To address different needs of the ageing population, policy-makers & service providers should understand the profile of the senior population

11. Life Expectancy
Commonly used to quantify the longevity of a population

12. Health-Adjusted Life Expectancy (HALE)
Describe the life expectancy with an adjustment for time spent in poor health

13. Mortality
One of the contributing factors to longer life expectancy is the decline in the mortality rates at all ages

14. Mortality (con’t)

15. Proportion of Seniors
The proportion of seniors is increasing at a faster rate than any other age groups in the population
In 2007, about 11% (about 705 million) of the world's population is aged 60+
By 2050, it is projected that about 22% (2 billion) of the world's population will be aged 60+

16. Proportion of Seniors (con’t)

17. Summary
The life expectancy at birth of the Hong Kong population is among the highest in the world
While Japan has been facing ageing issues for many years, Hong Kong will soon catch up

18. Nutrition & Health-related Lifestyle

19. Nutrition and Health-related Lifestyle
Healthy diets & regular, adequate physical activity are major factors in the promotion & maintenance of good health, especially in the prevention of chronic diseases
More importantly, diet & physical activity are modifiable factors in the well-being of seniors

20. Dietary Habits
It is commonly believed that seniors have to avoid consumption of certain high risk food in order to maintain good health
It seems there is a lack of emphasis on encouraging seniors to consume adequate amounts of nutritious food

21. Dietary Habits of People Aged 65+ in Hong Kong, 2003-2004
Ate fish at least once a day: 48%
Ate ≥2 servings of vegetables a day: 78%
Ate ≥2 servings of fruits a day: 30%
Ate meat at least once a day: 53%
Removed all the fat from their food when eating: %
Drank
milk at
least once
a day: 27%
Did not eat high fat food or ate high fat food less than once a week: 69%

22. Physical Activity and Exercise
Appropriate amount of physical activity & exercise is important for all ages, including seniors, to maintain good physical & mental health

23. Proportion of Seniors having Physical Activities and Exercises, 2004
U.S. 22% of people aged 65+ reported engaging in regular leisure time physical activity
Hong Kong
73% of people aged
60+ reported having
the habit of doing
exercises regularly
Japan
38% of people
aged 65+ reported having the habit
of doing exercises regularly
Australia
25% of people aged 65+ reported moderate or high
exercise levels in the two weeks preceding the survey
Singapore
28% of
people aged exercised regularly

24. Underweight and Overweight
Being underweight (BMI< 18.5 kg/m2) is a reflection of insufficient nutrition & also makes people more vulnerable to diseases because of their weakened immune systems
Being overweight (BMI ≥25 kg/m2) is well-known for its association with a higher risk of disease, especially cardiovascular diseases
For seniors, the risks of being underweight or overweight are equally important

25. Underweight and Overweight (con’t)

26. Smoking
Smoking is hazardous to health

27. Summary
The consumption of vegetables & avoidance of high fat food followed the recommended pattern fairly well. However, fruit consumption should be encouraged
Most seniors in Hong Kong had a habit of doing exercise regularly
The prevalence of being overweight among seniors in Hong Kong was lower than that of the other countries, whilst the prevalence of being underweight was higher
Hong Kong had a lower prevalence of female smokers than the other countries. However, the prevalence of male smokers was high

28. Social Networking & Engagement

29. Social Networking and Engagement
A healthy social life plays an important part in the well-being of individuals
A healthy social life can be sought actively by social participation
Alternatively, social support can be provided by family, friends & other people through day-to-day interactions

30. Social Participation
Seniors have a number of opportunities to actively participate in various work or activities which enable them to interact with people in the community

31. Participation in Formal Employment

32. Participation in Voluntary Works

33. Care Provided by the Seniors
Hong Kong (2000)
22% of people aged 60+ took care of other family members
Australia (2003)
19% of people aged 65+ were carers to older people & people with disabilities
England & Wales (2001)
11% of the population aged 65+ provided unpaid care to family members, friends, neighbours or others

34. Participation in Social Activities
Hong Kong ( )
63% of people aged 65+ had participated in some kind of social activity during the 3 months preceding the survey
England (2003)
65% of people aged & 47% of people aged 75+ attended arts activities in the 12 months preceding the survey
Australia (2006)
61% of people aged 65+ actively participated in a social or support group in the 12 months preceding the survey

35. Lifelong Learning Japan (2001)
27% of people aged participated in "studies or research"
Hong Kong (2005)
12% of people aged participated in continuing education
England & Wales (2002)
51% of people aged reported some learning
Australia ( )
20% of people aged participated in structured, taught learning in institutions & organizations
U.S. (1999)
20% of people aged took at least one adult education class in the year preceding the survey

36. Care and Support
Care & support is important to seniors, regardless of their physical condition & health status
Caregivers not only provide support in instrumental activities & personal care, but also emotional support to seniors

37. Care and Support (con’t)
Hong Kong (2004)
Among people aged 60+ who had caregivers, 37% & 27% had their children & spouse as the major caregivers respectively
Australia (2003)
Among people aged 65+ and receiving assistance, 18% received assistance from partners and 26%-29% from children

38. Oldest Old Support Ratio
As most of the informal caregivers are aged 50-74, recent research suggested using the oldest old support ratio (the ratio of people aged to those aged 85+) to provide information on the number of potential carers per person aged 85+

39. Oldest Old Support Ratio (con’t)

40. Summary
While the participation of seniors in formal employment, voluntary work & lifelong learning was relatively low in Hong Kong, the participation of seniors in care giving & social activities was comparable to other countries
It was common that the informal caregivers to seniors were their spouse & children
According to the oldest old support ratio, Hong Kong has the largest potential in developing informal caregivers when compared with other countries, except Singapore

41. Functional Status

42. Functional Status
While functional decline is commonly misbelieved to be an unavoidable part of ageing, it actually can be prevented or slowed down at any age
Given mild levels of disabilities or impairment, seniors are still able to live independently

43. Seeing and Hearing
During the ageing process, some people might experience deterioration in seeing and/or hearing abilities

44. Proportion of Seniors with Visual Impairment
Australia ( )
3% of people aged 65+ reported complete or partial blindness
Hong Kong (2000)
6% of people aged 60+ had problems with vision
U.S. (2004)
17% of people aged 65+ reported trouble seeing (with or without glasses/contact lenses)
U.K. (2001)
28% of people aged 65+ reported difficulties with their eyesight

45. Proportion of Seniors with Hearing Difficulties
Hong Kong (2000)
4% of people aged
60+ had hearing
difficulties
Australia ( )
33% of people aged
65+ reported complete
or partial
deafness
U.S. (2004)
40% of people aged
65+ reported trouble
hearing
(without a
hearing aid)
U.K. (2001)
32% of people aged
65+ reported difficulties
with their hearing
(with or
without a
hearing aid)

46. Activities of Daily Living (ADL)
The ability of seniors to perform daily activities independently is largely affected by the level of functional status
As suggested by the WHO, disability & functioning are outcomes of interaction between health conditions & contextual factors
The basic ADL are widely used to measure the ability of seniors to perform basic daily tasks independently

47. Proportion of Seniors without any ADL Limitations
Hong Kong (2004)
94% of people aged 60+ could perform all 6 tasks (transferring between a bed & a chair, mobility, dressing, eating, toileting & bathing) independently
Japan (2002)
84% of people aged 66+ reported the ability to perform all 6 tasks (bathing, dressing, eating, getting out of bed or up from or sitting down in a chair, going outside & toileting) independently

48. Instrumental Activities of Daily Living (IADL)
While basic ADL focuses on fundamental functioning, IADL focuses on more complicated tasks, such as cooking & communicating, which integrate proper physical & mental functioning

49. Proportion of Seniors without any IADL Limitations
Hong Kong (2004)
79% of people aged 60+ could perform all 7 tasks (meal preparation, ordinary house work, managing finance, managing medications, phone use, shopping & transportation) independently
Singapore (2004)
62% of people aged 60+ did not have any limitations in performing all 8 tasks (doing laundry, doing housework, grocery shopping, preparing meals, getting to places outside the house, managing money, taking medications & using a telephone)

50. Summary
Vision & hearing problems among seniors in Hong Kong might be less prominent than the other countries studied
The proportion of the senior population who could perform ADL & IADL tasks independently appeared to be higher than Japan & Singapore respectively

51. Health Status

52. Health Status
Maintaining a good health status is an important component in an active ageing framework
While some conditions are associated with the ageing process, many illnesses & conditions can be largely prevented by living a healthy lifestyle throughout the course of life

53. Self-rated Health Status
Self-rated health status is a commonly used subjective measure to describe the general health & well-being of an individual
It is a complex combination of many factors, including observed morbidity, health expectations as well as social & cultural context

54. Self-rated Health Status (con’t)

55. Chronic Illnesses
An important effect of chronic diseases is limitation in functional abilities, which in turn affects one's independence & autonomy
Prevention & postponement of chronic illnesses is an essential part of active ageing
In cases where some chronic illnesses are already present, the aim of active ageing is to reduce or minimize the disabilities caused by these illnesses

56. Chronic Illnesses (con’t)

57. Prevalence of Heart Diseases
Hong Kong (2004)
11% of people aged 60+
U.S. (2006)
31% of people aged 65+
Japan (1999)
12% of people aged 65+
U.K. (2003)
15% of people aged 65+ had coronary heart disease

58. Mortality from Common Chronic Illness
Some chronic illnesses & conditions only lead to functional disability, but some might lead to more serious adverse effects or even death

59. Leading Causes of Death among the Population Aged 65+
Malignant
neoplasma
(964/ 100,000
population)
Hong Kong (2006)
Diseases of heart
(569/ 100,000
Pneumonia
(463/ 100,000
Cerebrovascular
diseases
(340/ 100,000
Malignant
neoplasma
(976/ 100,000
population)
Japan (2005)
Diseases of heart
(585/ 100,000
Pneumonia
(400/ 100,000
Cerebrovascular
diseases
(456/ 100,000
Malignant
neoplasma
(1,056/ 100,000
population)
Australia (2005)
Ischaemic heart
disease
(771/ 100,000
Influenza &
Pneumonia
(65/ 100,000
Cerebrovascular
diseases
(403/ 100,000
Malignant
neoplasma
(1,056/ 100,000
population)
U.S. (2005)
Diseases of heart
(1,443/ 100,000
Pneumonia
(146/ 100,000
Cerebrovascular
diseases
(337/ 100,000
Malignant
neoplasma
(1,223/ 100,000
population)
U.K. (2004)
Ischaemic heart
disease
(958/ 100,000
Pneumonia
(336/ 100,000
Cerebrovascular
diseases
(586/ 100,000

60. Depression
There is growing concern over the psychological health status of seniors
Good psychological health is one of the key components in positive ageing
Poor psychological health may be a life-threatening condition

61. Prevalence of Depression
Hong Kong: 13%
(GDS≥8, aged 65+, 2000)
Singapore: 5%
(Geriatric Mental State Schedule, aged 60+, )
U.S.: 15%
(CES-D, aged 65+, 2002)
Japan: 30%
(GDS≥6, aged 65+, 2002)
U.K.: 3%
(GDS≥8, aged 75+, )

62. Summary Many seniors had a positive view of their health status
Similar to other countries, hypertension was one of the most prevalent chronic illnesses in Hong Kong
Cancer was the leading cause of death among seniors in Hong Kong, Japan, Australia & the United Kingdom
Differences in the prevalence of depression were observed in different countries, which might be due partly to differences in assessment tools & definitions

63. Conclusion
The seniors in Hong Kong generally live a healthy & active life
The seniors’ well-being in physical, social & economical terms is of a comparable level to other well developed economies
For characteristics that are relatively less favourable in Hong Kong compared to other countries, more effort should be invested to improve the current situation
For characteristics that compare favourably with other countries, they should be maintained & even taken to a higher standard

64. No matter how well the seniors in Hong Kong are doing at present, our society can always find ways to help
Celebrate their
Accomplishments and
Discover their
Effervescence and
Never-ending
Zest as they
Age