Ethnographic Study of Living Alone Elderly with Mild Cognitive Impairment in Hong Kong: A Pilot Study
Authors: Alex Pui-Yuk King, Kin Wai Michael Siu
Abstract: 1. IntroductionA report by the United Nations has revealed the number of older adults in the world is projected to reach 1.4 billion by 2030, and this number is expected to increase to 2.1 billion by 2050. This development will place enormous pressure on current healthcare and social protection systems. If life expectancy continues to rise while fertility constantly declines over many years. the ageing of the population will continue to throughout the world. The gigantic numbers of elderly people will place significant pressure on current systems of social protection and global health care. By 2024, it is expected to have nearly 400,000 people over the age of 80 in Hong Kong —a 24.8% increase over the figure recorded in 2014. 2. Problem StatementLike in other Asian cities, the population of Hong Kong exhibits a continuous ageing trend.The change in the population structure will need an improved housing policy and health care system and infrastructure in order to tackle these resulting social problems. The more older adults are living in the city, the greater the numbers of people who are living with dementia. 3. Older Adults Living with Mild Cognitive ImpairmentDementia is characterised by the loss of mental abilities,and by further degeneration over time.This condition is not inevitable, as the hallmark symptoms of cognitive deterioration are not considered to be a normal part of ageing. It is a typical biomedical disease that might appear when the brain is affected by some specific diseases, such as a series of small strokes damage the brain and cause confusion, speech problems and progressive loss of memory and cognition. This gradual decline in cognitive functions causes people to need extra support for daily living. A person who is having slightly problems with planning, reasoning and also remembering may be classified as having mild cognitive impairment (MCI). 4. Universal DesignUD (universal design) is classified as the practice of making things in ways that involve almost no extra cost, but offer attractive yet functional styles that are fulfilling all people, regardless of each individual’s ability or disability. UD addresses the complete span of functionality through making each element and space accessible to its deepest extent by careful planning at all different stages of a project. 5. Participant Observation An interpretive approach is adopted as a research paradigm for understanding the meanings that human beings attach to their experiences. For this study, a centre manager of the well-established Yan Oi Tong Elderly Community Centre recruited three older adults to participate for nine months. These people were living with MCI in a rural district. Prior to this study, these three elders engaged in a participative design workshop that was organised by the same researcher. The workshop had two sessions, and explored the participants’ latent needs concerning home decoration and product design for public housing.Observational visits were conducted with each participant every two weeks for a nine-month period. The participants are referred to as CH, CP and SK, and they were aged between 79 and 85 years old.6. DiscussionTheme 1: Fear of being alone.The participants described their experiences of facing loneliness. Although they felt that their memories were getting worse, they could still express how loneliness was one of the most difficult challenges that they had to face day-by-day. SK said that ‘I want to do my preferred activities,and don’t want to stay at home all the time!’ Theme 2: Recognition of incompetence.The older persons suffering from MCI believed that they were, to varying degrees, incompetent in dealing with day-to-day activities. As CP explained, ‘I have become useless and cannot remember things recently…’ Theme 3: Lack of neighbourhood spirit. For older people living alone in public housing, neighbours become the most reliable people after their families. Older participants reported that they commonly displaced their house keys due to their gradual memory loss. They had to make duplicate front door keys, and gave them to neighbours who they trusted.To deal with such problems, a product design or system could be pre-installed in housing facilities that would enable better communication or connection between neighbours, and allow older residents to become closer to others.7. ConclusionThis ethnographic study has investigated the latent, unfulfilled needs of older persons living with MCI. Building rapport with these older participants was an important step at the beginning of the study.This finding of “Fear of being alone”, “Lack of neighbourhood spirit”also revealed that regular visits by community centre staff and local social workers should be organised to provide older community members and stakeholders with more attention regarding their day-to-day activities and their relations to society as a whole in order to eliminate “Recognition of incompetence”.
Keywords: mild cognitive impairment, dementia, universal design, participant observation, day-to-day activity
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