Vivian Lou
Description: Vivian Lou is a Professor in the Department of Social Work and Social Administration at The University of Hong Kong, serving as the Director of the Sau Po Centre on Ageing. Her research looks into the social impacts of aging, from family caregiving to mental health of caregivers and age targeted crimes. In this episode we talk about the importance of holistic care solutions for the elderly as family dynamics evolve with urbanization and how prioritizing elderly care benefits an entire society. Professor Lou sheds light on the importance of spiritual wellbeing as a coping for the realities of aging and the significance of intergenerational relationships in creating harmony with an aging population.
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Show Notes:
[0:00] Introduction and Background
[1:24] Interest in Gerontology and Cultural Characteristics
[4:01] Impact of One-Child Policy and Urban-Rural Disparities
[4:55] Challenges of Multi-generational Care in Urban Areas
[7:03] Transition from Traditional Family Care to Shared Care
[7:24] Distancing Caregiving and Challenges Faced
[10:42] Leveraging Technology for Elder Care
[17:23] Daily Stressors Faced by Older Adults
[20:06] Rising Mental Illness and Cognitive Decline
[21:20] Spiritual Well-being and Meaning of Life
[23:30] Importance of Harmony with Environment
[25:56] Value of Intergenerational Relationships
[27:15] Impact of Technology on Generational Divides
[28:39] Impact of Young Children on Older Adults
[32:29] Cultural Legacy and Intergenerational Learning
[44:18] Exoskeleton Technology for Mobility Enhancement
[48:20] Challenges and Support for Caregivers
[51:51] Care Support Centers for Caregivers
[53:31] Challenges and Opportunities in a Super Aging Society
Unedited AI Generated Transcript:
Brent:
[0:01] Welcome, Professor Vivian Lou. Thank you for coming on today.
Vivian:
[0:04] Thank you. Good morning. Nice meeting you.
Keller:
[0:08] We'd love to start off by hearing a little bit more about your story. What got you interested in gerontology and how you got to the University of Hong Kong?
Vivian:
[0:14] Yeah, I think that is really inspired by my mentor at my master's degree. She is a professor, is a social psychologist in my master's degree university that is East China Normal University. So at that moment, she's very keen to study the social determinants of health for older adults back to the 80s. And then I followed her footprints and then started to be interested in aging issues. And then she has a collaboration with a professor that is my PhD supervisor in future at the University of Hong Kong. So during their collaborations, I have the privilege to visit Hong Kong U for one month. And then during that month of time, I learned a lot. Oh, there's a PhD program that I can further pursue. And also the collaborator in Hong Kong U encouraged me to apply for that PhD program.
Vivian:
[1:21] So that's the start for my career.
Brent:
[1:24] And, What would you say are some unique characteristics of the Asian Chinese population, especially when you're looking at the culture and some of the other impacts on self-worth?
Vivian:
[1:39] Yeah, that is a very interesting question because I started my very early career development. My supervisors always ask me a question. So why you study this? Why you study Chinese older adults? So what are the uniqueness? Then I came out to understand, oh, there's a cultural dimension in terms of understanding the aging process, in particularly the collectiveness versus the individualist. So if you ask me the question about the uniqueness of Chinese culture, maybe I think this is at the higher level. That means we are more collectivist as a whole. So, of course, there's individual differences.
Vivian:
[2:26] But the point is we are more, first of all, it's more family based and then social oriented. These are all features of the collectivist. And of course, in the modern China, we actually have two more unique characteristics. One is that we have implemented the one-child policy from the late of the 70s to the 2010s. So during that period of time, we have a very special family structure, and then that has imparted dependency because all these families, they are now entering into aging families. So they will have a very special family structure that will have the impact on the intergenerational exchange and the support. And then another issue, I think that is very obvious in all the less developed countries, is the differences between the urban and the rural.
Vivian:
[3:31] Even though we have developed universal pension and also try to develop a universal health care insurance system, but still there's a huge discrepancy between the urban and the rural. So whenever we try to understand aging in China, we cannot say there's only one group of people. We have to understand that kind of differences. And also the cohort means the one child family cohort. That is quite unique.
Keller:
[4:01] So you'd say that those two are the main reasons why there's a shift in the culture and how the younger generation relates with the older generation?
Vivian:
[4:10] Yeah, yeah. Because structurally or historically, we are actually fond of family. And also we have this intergenerational exchange and support that has been nurtured for thousands of years. But now when the family structure is kind of changed, And then we must change. We must adapt to the new family structure in terms of the living arrangement and also the availability of support and care and also the affordability of support and care. So I think that's why also the government chipped in to develop this universal
Vivian:
[4:48] pension, health care, and even some of the housing solutions for the deprived population.
Brent:
[4:55] Population yeah because it seems like as china really starts to urbanize that there's going to be less space for it to have like large multi-generational housing and also now like one kid or has to take care of two parents or like four grandparents so where do you think like the best like solutions are especially in places like hong kong where it's space is very Yeah.
Vivian:
[5:22] I think one of the things is that, first of all, we must continue to emphasize the importance of family because based on my experiences of communicating with older adults and doing a lot of study among our older adults, they're still very yearning for the support from their children and grandchildren. Children, they feel very joyful to have that kind of opportunities. But at the same time, we have to recognize that the family's function, I mean, the instrumental function or in terms of taking care of failed older adults, for example, to provide them escort services, meal services, cleaning services, all these would be shrinking to a certain degree so that.
Vivian:
[6:11] Shared partner care must be in place. That means the family has to engage, for example, the volunteer support, or maybe in Hong Kong we have the domestic helper support, and then the formal support supported by the government. Moment, the formal care, the in-home care, the daycare, the residential care, you know, all these we have to understand and recognize their roles, different roles by different parties so that we can have this shared. But this is not easy because some of the older adults, they still believe, oh, taking care of me or family members are the responsibility of my family. So they don't want to engage with external parties. But I think that is an adapting and educational process.
Brent:
[7:03] Yeah. So that's, would you say, the biggest difference between more traditional views and the way we have to adapt in modern times is getting away from the idea that the family has to be the sole provider for care when you age?
Vivian:
[7:15] Yes.
Brent:
[7:15] Okay.
Vivian:
[7:16] We must go for multi-sector and multi-professionals and also multi-partners shared care.
Brent:
[7:25] Yeah. And then as children, especially, leave rural areas, do you think most of that migration out of the rural area to work in a city has happened? And when people do that, do they bring their parents with them? Because I could imagine a lot more difficulties for children working in, say, Hong Kong, but their family is in a rural area far away, how do they support them?
Vivian:
[7:49] Oh, yeah, this would be a future challenge. We call it a distancing caregiving. So I have a collaborative project with a scholar from Germany to study this phenomenon. So it's not only happened, I think, in China, but also in European countries. Because also there's a lot of migration in European countries. Young people mobile a lot. So we call it distancing family caregiving. But I think there's two things we have to really take into consideration. First of all, when their parents are still health and mobile, most of the time their parents can move towards the children and even help them to do grandparenting. So during that stage, that would be a kind of scenario that the parents become a resource for the younger generations so that they can take care of their grandchildren and also support the children to become career-focused or be more focused on their work and their job or career development. But at a later stage, when their parents move into old age, that means they might suffer from chronic diseases and maybe fail tea that need a lot of instrumental care.
Vivian:
[9:10] In that circumstances, we must understand, you know, how distancing caregiving can work or what are the things that doesn't work at this moment. I think there's a few things that it still does not work very smoothly. First of all is the portable health care insurance, because if you move to another city, that the health care might not be that smooth, or that takes extra steps for you to get all the things settled. And then it is about the long-term care, because nowadays China is working on long-term care insurance, all these things, but how portability of these insurances are still a question. So there's still a time or gap in terms of that. And then it is about how we can leverage our technology.
Vivian:
[10:05] We all understand nowadays we have technology, so that there might be worthwhile to study. That's also why I started to study on this, how technology can be leveraged, and we can tap the advantage of all these technologies so that the distance in caregiving can be worked. Because this is something, you know, technology is the extension of our eyes and our vision, you know, and our space, our time, you know, how this can be a future solution.
Keller:
[10:42] So how is technology, in particular the internet, helping with elder care in terms of especially their self-determination and understanding their place in this very changing world?
Vivian:
[10:51] Yeah, I think specifically, I think under the COVID, we all understand COVID is very challenging. There's a lot of negative impact. But I think one of the positive impacts of COVID is that we really convinced the older generation or the generation who are not that digital competency to learn how to use digital. And then they understand, you know, wow, during that very extreme circumstances, digital is the only solution that they can use. So that's why, you know, they learn how to use these video calls and also use the apps to order food and also use the apps. I think in China, they use the apps to book an appointment, to download the reports of the medical examinations and all these or that. And also use the digitals to do medication delivery and all these things. Even in Hong Kong, we have this kind of services. So that people started to... Fully embrace the advantage that can bring through the digital revolution.
Keller:
[11:57] Have you looked at all into, I guess, social media for elder care? Because I would imagine that some of the reasons that social media is very bad for the younger generation might actually be beneficial for the older generation.
Vivian:
[12:09] I would say I did a little bit of analysis using the existing or secondary data in China. And also I collect a few, some small sample data in Hong Kong, we find it's actually digital as two sides of a sword. On the positive side, they really, you know, empower the older adults to be more independent. So if they can really, you know, use the digital to communicate with children, grandchildren, and also to communicate with friends, That is really very, very empowering. But at the negative side, we found, actually, first of all, if there's a young old couple, and it seems like that the digital sometimes become a barrier for them, even to communicate, you know, like the young generations. They actually are just the tags or, you know, when they are togetherness, and then they still are on their digital world. so that they forgot to communicate. And then the other thing is, of course, nowadays it's about the digital crime that's really targeting the old generation. You know, in our police's report, every two reports of this digital crime, one is associated with the older adults in Hong Kong.
Vivian:
[13:39] So it's a very serious problem.
Brent:
[13:40] So are those phone calls that they're getting, like, hey, what do those digital crimes look like?
Vivian:
[13:49] Many of the times it's related to a threatening message that asks you to transfer money or to pay something or to pay somebody or to transfer some money so that you can avoid some kind of trouble. Or there's various kind of messages from the digital crime area, but basically it is about financial issues.
Brent:
[14:16] And then how often would you say that people are getting these calls or messages?
Vivian:
[14:22] Oh, I think from my own experiences, I received every day. So nowadays I install an app and the app will tell me, you know, whether this phone number is skeptical or not, you know. So that when I look at the phone, oh, this is a financial company's call. It's called from a person I don't know. I would not pick up. So we will be educated to learn these new things.
Brent:
[14:54] My grandma back home has dealt with very similar things.
Vivian:
[14:57] Yeah.
Brent:
[14:57] I think it's a problem worldwide.
Keller:
[14:59] Yeah. Yeah.
Vivian:
[15:01] So because, you know, because old people, I mean, the old generation, most of them, they're retired. They have time. So they become the primary target for this crime.
Brent:
[15:13] Yeah. And I know it's getting even scarier now with AI voices. Oh, yes. They might be able to replicate family members.
Vivian:
[15:21] Yeah, it's exactly the same. And also they can have videos.
Brent:
[15:25] Yeah.
Keller:
[15:26] Yeah.
Vivian:
[15:26] Yeah.
Brent:
[15:27] Has the population seen those things? Because I know we've seen them on movies, TV shows. But are people here experiencing video scams?
Vivian:
[15:36] Yeah.
Brent:
[15:36] Scams?
Vivian:
[15:37] Yes.
Brent:
[15:37] Wow.
Vivian:
[15:38] Video, voice, and also video scams. Because in Hong Kong, we have the special relationship with the mainland China. So a lot of message is about, oh, there's something wrong for your family members in the mainland. land so that you must send some money to save his or her life and this and that. So usually they use this as an excuse to trap the older adults because they're really concerned and care and love their family members. So they don't want them to be in a threat or at risk of anything. So they actually just do it.
Keller:
[16:26] Yeah. And I want to dwell on this for too much longer, but do we know if that crime is coming from within China or if it's coming from other like states?
Vivian:
[16:34] Oh that is very very difficult. Actually I'm one of the advisor for the senior police cops and then it is very difficult to tell because of this IP address usually they will direct to different countries already. So many of the times, you just cannot establish the case. That's why our Hong Kong SAR government has just established a joint task force. Tackle this issue.
Brent:
[17:07] Yeah so that is definitely a big stress i'm sure for a lot of the older adults yeah what are some other like just daily stressors besides like those negative phone calls or messages that people are dealing with it especially younger kids
Brent:
[17:22] like people might not be aware of.
Vivian:
[17:23] Um i believe um from you know if if you think about you know the uh the old age uh start from 65 years old, then we have almost 30 years of life after this six or 65. And then one of the things we really have to understand or be aware of is we call it stressful life events.
Vivian:
[17:51] So that means anything happened, not only the negative things, but sometimes positive things happen to the older person, him or herself, and also his or her family members and the close friends. For example, at the top level is the pass away of the spouse, of course. And then lower down, it can be the marriage of their children, having a grandchildren. All these are very stressful. And also about their financial stability and also about the crime because we found that the crime rate for older adults is kind of increasing, you know. I had a pilot project with one of the NGOs collaborate with the police is to support those older adults who commit crime. We found out that some of them, they might have mental ill health so that their crime behavior is kind of associated with that. And some of them, they have early cognitive decline so that they don't know that actually they are committing a crime.
Brent:
[19:04] These are the older, like the aging population committing crimes. Yeah.
Vivian:
[19:08] Okay. Yeah. So sometimes there's shoplifting because they just forget to pay the money because of their cognitive decline. So that is the reason that there's an increasing trend of crime committed by older adults. And then they have very scaring feelings because they don't want to let their family know, oh, I actually committed a crime. So this is something also very, very stressful. And also is the health issues, you know, because start from 65 and then to the 70s, 80s, 90s, you might experience deterioration of your health, physical health, mental health, social isolation threats. And all these are the daily stresses that the older adults are facing.
Brent:
[20:00] And then as people, you're saying like the mental deterioration is increasing.
Brent:
[20:06] Would you say this day and age, our generation now is facing more mental illnesses or like dementia, other cognitive declines than previous generations?
Vivian:
[20:19] I wouldn't say in that way I think one thing that we should celebrate is our longevity But, you know, along with the longevity We have to live with all these risks For example, if back to the 100 years ago So our life expectancy may be only 60 something So you don't have the chances to experience all these cognitive decline or comorbidities, you know, and then all these. But now, when we can live until, for example, in Hong Kong, for women, we can live until 88, and then for men, it's 81 or 82, so that you have much more chances to experience these kind of diseases or health deterioration. So as compared to the previous generation, we would observe more of these experiences.
Brent:
[21:19] Yeah, that makes sense.
Keller:
[21:21] And when it comes to managing all these different stressors, is that where the concept of spiritual well-being comes into play?
Vivian:
[21:26] Yeah, I would say that. Because if you look at the changes of the lifespan or life course, you can see that our physical strength would deteriorate no matter how well we try to maintain it. Because this naturally happens, for example, our muscle percentage will decline and all these things. But one of the things that will increase along our lifespan is our spirituality and in a non- religious context, for example, in China and also in Hong Kong, I would say meaning of life or purpose becomes a very important concept. That's why I studied this concept together with an NGO that is Donghua Group of Hospitals in Hong Kong. We try to figure out what are the meaning-making process of our older adults if they don't have a religious affiliation.
Brent:
[22:31] What were the results of that?
Vivian:
[22:33] I found that actually, if we don't focus on religion, that the most important things for our Chinese older adults are the relationship perspective. That means we have to establish very comfortable and harmonized relationship with, first of all, with ourself, and then with our families, and with our significant others, and then with the environment. That is very important because from our Chinese cultural perspective, human and environment must be harmonized. We cannot live in an environment that really gives us a lot of threats, so that it's a kind of harmonized relationship with self, with people around, and also with our natural environment.
Keller:
[23:28] Can that harmony with the environment be attained anywhere? Could you achieve harmony with an urban environment, or is it more so going to... The elderly are better off in environments that are more conducive more rural environments more spacious environments.
Vivian:
[23:42] No it's not exactly about the um you know the, wealth and assets that attach to the environment it it is about the uh you know how individual can create or adapt to the environment so that he or she feels that I feel very comfortable in that kind of environment. So it doesn't matter whether you live in a very wealth community or a poor community. Even if you live in a poor community, you can have your room that is clean and decent, and then you can have things that are arranged in a way that you feel very comfortable. This is the thing we call environment. So this is a very, you know, start from a very close environment that maybe your bedroom or maybe a wider environment that is about your community, whether you feel your community is safe or you can have a peace of mind in maybe in a small park or maybe in the community centers that are all very good. That means you have to, every older adult, you have to find out a place that you really feel that you are very comfortable, you can actually have a peace of mind.
Brent:
[25:07] Yeah. And then is there a standard practice, especially for like houses or like more like your personal spaces, is there a standard practice for how they should be designed or is it? I myself, this is the way I like to do it. I'm now comfortable in my environment.
Vivian:
[25:24] Yeah, I would say the autonomy is important. There's no guideline on how you should or you must design your environment. But I think everybody should think about that. If your environment is messy, we all understand that, or you even don't have a place to sit down, then that will be very problematic.
Brent:
[25:49] Yeah.
Keller:
[25:49] And then within the community, is there a difference in the types of relationships
Keller:
[25:54] in terms of their impact on the elderly? I thought we had seen one paper that mentioned that grandchildren in particular, there's a special value in that support to the grandparents. Could you speak on that?
Vivian:
[26:04] Yeah, I think we must take into consideration of the cohort differences in terms of generations. I think nowadays, you know, grandchildren's generation, children's generation, grandparents' generation, they have very different views in terms of what is the best for me and for you. So sometimes we really have to sit down and communicate. And also, we would like to encourage or advocate that in the community, we have to create opportunities for different generations to mix up with each other and to talk. And just to, you know, communicate or observe what happened to the next generation or the parent generation or the grandparent. So we have to, first of all, to observe, to understand. Then we can have communications and the support to happen.
Vivian:
[27:11] Otherwise, there's a lot of misunderstandings between each other, I think.
Brent:
[27:16] Do you think we're more divided now than ever with technology and separation and confined housing?
Vivian:
[27:22] Yeah.
Brent:
[27:23] Yeah.
Vivian:
[27:23] I believe so. Yeah.
Keller:
[27:26] Is that where the community centers come into play?
Vivian:
[27:30] Yeah, I would say in that sense, our community centers has a role to bring generations together. So that in Hong Kong, we have a trial in terms of how the community centers can bring intergenerational activities so that we invite the older adults and also invite the young people there. They can learn with each other. So we have this elderly academy in Hong Kong so that the primary school or the secondary school, they will open their classrooms or their campus to the older adults so they can learn in that places. And recently, we have some very innovative trial that to mix up people, older people with maybe a starting sign of cognitive decline with young children so that the children can have their after class activities together with these older adults.
Vivian:
[28:35] So they can mingle with each other and then they can communicate.
Brent:
[28:39] Do you think there will be evidence showing that these young children help keep the older people young?
Vivian:
[28:46] Oh, that... I haven't studied that. But based on my literature understanding that if older adults have a very... Have a perception that I'm still young or I'm not old at least, then have positive impacts on their health consequences.
Brent:
[29:12] And then do you think that the grandparents here, when they're taking care of the grandchildren, they feel less of a sense of responsibility because it's not like their direct child. So that allows them to have a lot more fun and just joy with their grandchild. Because there's not the direct stress of, oh, I need to take care of it. It's more of like, I can have fun. This is like my grandchild.
Vivian:
[29:38] This depends on the roles and also the perceived responsibility. I would say if you are the, we call it surrogate parents or surrogate grandparents role, and then it is very stressful.
Brent:
[29:55] True.
Vivian:
[29:56] Because you take the responsibility and then you have to make decisions. And sometimes the grandparents may also consider that, oh, even though this is my responsibility to make that decision, for example, if the kid has a fever, should I go to see a doctor? Or if the kid doesn't take in food, what should I do? and they might want to consult the children. But many of the times the children can only be maybe online or take a telephone. It's very difficult to explain. So they feel very stressful. But if the grandparents, we call it fun or leisure or Sunday or weekend grandparents, many of the times they have a lot of fun.
Keller:
[30:44] You just mentioned it with the difference between the phone. Have you guys been able to see, I guess, like value differences in the impact of family with elderly in terms of if you were to just call them or FaceTime them or do a Zoom, how much that improves their happiness, their well-being versus the ability to actually be there in person?
Vivian:
[31:02] I would say if you are a grandparent that's really taking care of your grandchildren, we find a U-shaped curve. That means there's a ceiling effect. I mean, the turn-around effect. So that means if you spend a huge amount of time taking care of your grandchildren, your health would be negatively impacted. But it's just optimized in that sense, just to give a little bit of time, but you still have your own time to pursue your own life, that you would have your optimized happiness, meaning, and also you can pursue your own autonomy for your own life. So there must be a balance in terms of how much time you would devote to this role. So my observation or based on my study, I would say a balance is always very important not to overcome it.
Keller:
[32:07] And then within the meaning that the elderly are able to derive in their later years, is there anything that can be taken for the younger generation in terms of how they should approach getting meaning in their life? Because I think when you're younger, it tends to be more career-focused. But at the end of the day, that's not going to necessarily lead to happiness. Have you been able to find anything with that?
Vivian:
[32:30] You're right. Right. Is there any cultural legacy that the older generation can pass to the younger artists? I think, yes. For an older generation, if you interview them and ask them, they have a lot to share with the youngsters. But I would also share that many of our older generations, they found that our younger generations, they don't want to listen. Or sometimes they really wish to take a risk and then to bear their own consequences. So in our Chinese say, we said, okay, if you don't hit the wall, you don't know the consequences. So it is better for you to hit the wall by yourself, even though our older generation would like to share, oh, you don't go that way because if you go, there's no way beyond the wall. But I would say there's always a point that maybe the younger generation can have insight or saying that, okay, oh, yeah, yeah, yeah. At that certain point of time, my grandparents shared this with me or my teacher said this to me. So I think there's no immediate impact on that. But maybe, you know, we cannot say if there's no immediate impact, the older generation should give up. We should stop.
Vivian:
[33:59] Continues to encourage the older generations to do. So under that circumstances, actually, I have developed a campus project that I train the older adults to be an ambassador and then try to bring them to universities so that they join my classes and they give feedback to the students on their projects, on their papers, you know, and to see, you know, and our youngsters, Linguisters, they treasure it a lot. They say, oh, you know, I cannot learn from the textbook. I cannot learn from a lecture. But the older adults would share with them, ah, this does not work. You know, you cannot think in that way. And then, ah, there might be alternative thoughts beyond that point. They actually mingled each other very well. And so that one of my friends who is a generalist, she established and trained a group of older adults.
Vivian:
[35:03] She has a project called Old Ginger. The Old Ginger. And she trained these young old people to tell stories. And then she is now lead this group of old people to join university classes and also the media interviews and a lot of, you know, advocating activities to really try to bridge the young and old.
Brent:
[35:32] What type of stories would they be telling?
Vivian:
[35:35] They actually would tailor their stories according to the context. So if you're in a medical classroom, they will tell about health and disease. If it's social work, they tell about emotion and social relationships. And she's very good at writing. Mentor uh the older adults to tell their own stories not a very lengthy storytelling but they're very sharp and also just to the point yeah.
Brent:
[36:08] And then could you speak more a bit on like uh older people's like mental health.
Vivian:
[36:12] And especially.
Brent:
[36:13] How that might be changing nowadays.
Vivian:
[36:15] Yeah i think nowadays uh the international world or the global aging world is really worried about the uh the social isolation, especially after the COVID. I think before COVID, social isolation has already been noticed or recognized by the academia, but nowadays it is much more recognized by the policymakers and also the community stakeholders in terms of, you know, how the whole society can actually mobilize, be mobilized to encourage all the adults to participate.
Vivian:
[36:54] And provide them opportunities to participate in a societal level, you know, civic level, community level, neighborhood level, and family level. But of course, on top of that, we have the old or established mental health threats, that is depression, and also maybe anxiety, you know, and also maybe some lifelong mental ill problems. Because, you know, the current generations, during their life courses, they might have already suffered from mental ill health problems. For example, they might have some anxiety disorders, personality issues, or maybe some stress adjustment issues, maybe some depression in their previous life course. So that when they move into the old adults, when they suffer from other stressful life events, for example, the loss of their independent competencies and maybe their own diseases, and then these will trigger the new episode or new experiences of mental ill health.
Keller:
[38:10] And are there differences in the way that those mental illnesses manifest themselves in the elderly? Like let's say you had depression. Does that, I guess, look differently for elderly than it does for youth?
Vivian:
[38:23] Theoretically, it is. For example, in terms of depression, the older adults would have less, I would say, emotion, vibrations, or their sadness may not be that strong.
Vivian:
[38:43] Strong. Their emotion is, comparatively speaking, is more flat. That means it seems like they are actually indifference, and then they're not really interested in anything. And the things in their old age, many of them, they don't have a full-time job or very stressful job demand, so that people are not aware of that. Because if you are young, you have a very high demand job, And then you must perform. If you cannot perform, you would seek some help from the professionals. But for older adults, they might not be enabled or being really very, very sensitive to that kind of change, right? And also, there's many times all these depressive mood is kind of parallelized with physical declination. So many times you might not be really aware. Is it because of my stroke or I suffered from Parkinson's or I have a cancer, I'm a cancer survivor, and then I have that kind of emotion? Is it normal just because I have all these physical deterioration? So that is kind of a little bit different as compared to the young generation.
Keller:
[40:08] Yeah. And then you mentioned the jobs. After the age of retirement, have you seen any benefit to working, let's say, a part-time job or some kind of job more just for the sake of feeling like a contributing member of society on the mental health of older generations?
Vivian:
[40:22] Yeah, yeah. Yeah, definitely. Definitely. there today.
Brent:
[40:25] Do you think they're going to start doing more virtual jobs?
Vivian:
[40:29] Um, virtual jobs, I'm not sure. I think in real scenario, I think having jobs or part-time or project-based or consulting is kind of beneficial.
Brent:
[40:46] You still get the in-person interaction.
Vivian:
[40:49] Yes. And also keep them engaged in various of ways. Because actually job is not only relates to earning a salary, it gives you a sense of meaning and a purpose and also gives you some kind of colleagues, social relationships and also provide you an opportunity to experience a certain level of stress. We understand that, you know, our human beings, if we are under a moderate level of stress, that becomes a general motivation.
Vivian:
[41:24] That is a positive side. If you are totally not under a demand, then you will feel very bored and that you don't have any purpose. So this is the one side of that. And also for our society, I think it is also very good because we do move into an historical era that we don't have enough labor force in the coming decades. But in terms of virtual, I would say maybe our old generation, at this moment, we are still lack of a lot of opportunities to get used to this virtual world. We still need a little bit more time to enhance our digital literacy and also to reduce the digital divide so that we can enjoy more about the virtual reality.
Brent:
[42:22] And then you were talking earlier about the negative mental health effects of not feeling included. And I think we've touched on the... Internet allowing for more virtual communications and more inclusion that way. But physical deterioration also plays a huge role in being able to do certain activities. And we saw that you did some work on exoskeletons.
Vivian:
[42:44] Oh, yeah.
Brent:
[42:45] Is there any evidence showing that exoskeletons can help these older populations get more active, physically active, and be able to do more activities?
Vivian:
[42:53] Oh, this is our purpose, our mission. So because we actually see a lot of time, one of the key threats for older people to become less active or less participatory, it is because their mobility level decreased to a certain degree so that they don't want to go out or going out becomes a burden for them. And so from that perspective, we are kind of look at the high potential for us to develop new technology to compensate their mobility abilities. So that is our mission and our heart for wish to achieve that so that I have a close collaboration with Professor Ning Shi from the engineering department to work out soft robotic solutions. Because the existing technology for the Xcode selectors are very heavy and not really for daily life. Because if you wear this, it looks like you are a robot, not looks like a human. So that's why we use new technology, new materials to work out some new kind of robots. It's not in a robot that you imagine, it's like.
Vivian:
[44:18] It's like the Iron Man or things like that, you know? So we work at a robotic solution that will look like soft clothes.
Brent:
[44:30] Yeah.
Vivian:
[44:30] It's just like that.
Brent:
[44:31] So it might be like a pair of pants that help you stand up a little bit easier.
Vivian:
[44:35] Yeah, that's true. That's true.
Brent:
[44:36] That's true.
Vivian:
[44:36] We are now in the prototype stage, and hopefully, you know, I can share later more on this.
Brent:
[44:43] That'd be really cool.
Keller:
[44:44] Yeah. You mentioned the threshold of mobility. Are there particular movements that are key markers to use for, you know, elderly care that, you know, let's say it's sitting up or getting down? Are there key areas that elderly should be looking at in terms of this is where we need to be putting our maintenance efforts?
Vivian:
[44:59] Oh, yeah. We have this sit to stand test. We have the four meters or six meters walking test. That means you have to work to a certain speed. And also we have a kind of, if you put it in layman's perspective, it is you have to be able to walk the steps for maybe 15 steps without any support. That means you have to just walk by yourself. If you can pass that threshold, that means that you are still maintaining a very reasonable or constructive mobility level.
Brent:
[45:39] Yeah. And then are there any other technologies that you think are going to really help elder care? Because I know, I think we saw some stuff on like wearable technologies and other like tracking biomarkers. Do you think that's the future of health care for the older generation?
Vivian:
[45:54] I think for the old generations to be really concerned, one is about physical health, one is about mental health, and one is about the brain health. So all these three kinds of health, I think there's different kinds of technology that can be very helpful in terms of the physical health. We understand maybe that's reminders for your activity level and also some new technologies that can...
Vivian:
[46:24] Detect different kind of activity because we don't want to just commit to one kind of activity because we need various kinds of activities that could be very helpful because in our daily life if you are just go to work you you have different kinds of physical movement that will be engaged that would also apply to the old adults and then it's the social activity or so i think to use the social media or maybe video course or other technology. I think in some of the countries, if my memory is correct, I couldn't remember which country, you can actually use your voice to control your TV at home so that you can get everything there. You can talk to your friends. You can turn on Netflix or YouTube or maybe some WeChat calls, WhatsApp calls, you know. That would be very important. We don't need a new app. We need something to be integrated to our older adults' lives that they can easily use it. The usefulness and ease of use are very important. And in terms of brain activities.
Vivian:
[47:41] I think work is the best brain activity that older adults can pursue. So work, learning something new, and also doing volunteers, they're all brain activities. But if you don't do and also do the family choice, you know, going to shopping and pay a bill and all these are very good brain activities. So, if you are not engaged in all these, maybe you need some computer-based games to keep your brain active. So that's all about choices, but technology can definitely help you.
Brent:
[48:20] Yeah.
Keller:
[48:20] And then we've covered a good amount of the issues and obviously solutions that are involved with the care recipients. We're wondering if you could shift more towards the caregivers and particularly any challenges they may face. Let's say if you're a caregiver for an elderly that has dementia or other mental issues where there's some communication barriers between the two that are difficult to deal with.
Vivian:
[48:40] Yeah, I think for dementia caregivers, they are the group of people that really deserve our concern. First of all, we have to give full recognition for their contributions, because they actually take a lot of time taking care of all the adults every day, maybe sometimes on a 24-hour base. So they really deserve a break in terms of that. Respite services are very, very important to be designed in a way and also become very accessible and affordable for the caregivers who are taking care of people with dementia. And then next, but not the least, is about the financial support, because taking care of a person with dementia, sometimes you have to quit your job or you shift from a full-time to a part-time. How we can take a life course perspective, not only provide financial support for their current daily life, but also think about their retirement, you know, how we can protect their health care needs, their retirement protection needs are also very important from a policy perspective.
Vivian:
[49:52] Then it is about information, because all these caregivers, they are important. Required to navigate throughout the healthcare system, the social care system, the neighborhood, you know, they need a lot of information that can support them to make decisions. And also they need the literacy that can empower them to make the right decision. These are all very, very challenging tasks, not only during a time that they have to make decision whether I should go to see a doctor and do an operation and also move into institutional care and also relates to the end-of-life care decision. For example, should I go for comfort spoon feeding or should I go for the tube feeding? These are all very, very difficult decisions for family caregivers. So without professional support or professional guided or coached decision-making processes, I believe the family members as a lay person, they might have challenges to make an appropriate decision. So that's why we need further and extensive research so that we can develop easy-to-understand and easy-to-implement tools that can support the caregivers to make that kind of decisions.
Brent:
[51:17] And then when you're saying caregivers, are you taking, are you thinking more about the family members who don't have professional training and trying to inform them on the best like standard of care?
Vivian:
[51:29] Yes.
Brent:
[51:29] Yeah. That makes sense. If you told me to take care of someone with dementia, I wouldn't know remotely how to do it.
Vivian:
[51:36] That's true.
Brent:
[51:37] Are there centers opening up? Is there anything tangible now for people to look towards to learn more about how to take care of their parents, grandparents with dementia?
Vivian:
[51:52] Supported by the Hong Kong Joglet Club Charity Trust. And I'm now leading a project that are going to set up these care support centers. So in the coming future times, we'll have nine open in Hong Kong in different areas so that the caregivers, they can visit their centers so that the center staff would guide them to establish all these competencies and also literacy to understand that caregiving roles. And also, of course, to encourage them or to facilitate them to take some rest.
Keller:
[52:29] Are those centers specifically for dementia? Are they for any kind of caregiving?
Vivian:
[52:35] Yeah, we do have dementia-specific centers, but there are only a few of them. So now we wish to actually scale up the caregiver centers so that they can become more power to reach out to diversified caregivers, of course, including the caregivers who are taking care of people with dementia.
Brent:
[52:57] So this would be like consultation services, correct?
Vivian:
[53:01] Navigating services. We call it carer space so that you can get respite care, you can have information. And also if you identified as high risk of mental ill health or other kind of risks, based on a screening tool developed by my team. And we will recommend you to do some counseling services as well.
Vivian:
[53:26] And then empower you to navigate in the whole caregiver journey.
Keller:
[53:32] Yeah. And then as we start to wrap up here, what are some of the challenges and also opportunities that Hong Kong faces as it enters as a super aging society?
Vivian:
[53:40] Oh, yeah. I think one of the opportunities that we can become a model city to set up our caregiver support model in the whole long-term care map.
Vivian:
[53:58] But another opportunity we have is that we can try out different technologies because nowadays we really have advanced technology that we can tap on and our government has put in 2 billion of budget that's supporting the organizations to implement technology to support older adults and their family caregivers. But the threats or the challenges is here because when we move into super aged, we understand dementia is one of the highest threats for the whole society. So that's why nowadays we are actually promoting more to develop the, we call it the dementia-friendly community so that we can mobilize the sector's resources, not only the sectors from the non-government organizations, but also, for example, the property management, the retail, the bus drivers and the taxi drivers, and also maybe the market shops, small shops in the market, they all have to be mobilized so that we can make our community more dementia-friendly.
Vivian:
[55:26] At the same time, I would say we have to be very, very mindful about promoting a high-quality end-of-life care services. Services and under that arm i also engaged in this jockey club trust supported the end of life community project and under that project we try to promote the idea of compassionate community and we want everybody to understand that when you move into the last stage of your life we want everyone to be very care and support and also be loving. Because in Hong Kong, we have a myth about if a person dies in that particular apartment, and then that apartment is kind of curved so that people don't want to move in, or it becomes less valued in terms of the property price. You know but this is all uh i would say it's kind of a mess you know we must break down that one and then to promote a very loving and secure community so that people can peacefully die uh in in the place that they preferred yeah.
Brent:
[56:49] That exists back home too that there's always i think there might be even like a legal requirement if someone died in your home like you have to like state that to sell the house. So it's the same back home. It's a little weird, but it's definitely the most comfortable place for so many people to- That's true. To have their final days.
Vivian:
[57:10] Yeah.
Brent:
[57:10] Is there anything else you want to share before we sign off here?
Vivian:
[57:14] Yeah, I really appreciate your efforts to conduct this interview and hope that all the youngsters, if you really wish to be a researcher in future, or even though you don't want to be a researcher and understand what does it mean research and how research can have a role in the aging society, would be really beneficial to the whole society. Thank you very much.
Brent:
[57:40] Thank you.
Keller:
[57:41] Thank you.