• What is the impact of the integrated care to the frail elderly in the community in Hong Kong?
• Table of Contents
• Abstract4
• Chapter1. 5
• Introduction. 5
• Chapter 2. 10
• Background. 10
• Chapter 3. 16
• Methodology. 16
• Explanatory phase. 17
• Search strategy inclusion and exclusion criteria. 18
• Electronic search. 19
• Critiquing methods. 20
• Ways of analyzing other people works. 21
• Critical analyses. 22
• Thematic analysis. 22
• Ethical issues. 23
• Chapter 4. 24
• Method. 24
• How the literature reviewed was done. 24
• Database used. 25
• Search terms. 25
• Critiquing framework. 27
• Data analysis method. 28
• Chapter 5. 28
• Reviews. 28
• Chapter 6. 39
• Analysis. 39
• Chapter 7. 47
• Discussion. 47
• What do they themes identified above mean. 47
• Implication of the practice. 48
• Using the findings in practice. 48
• Benefits of the research to patients, their families, professionals and theorganization. 49
• How themes that emerged relates to the background. 50
• Need for further research. 50
• Ethical implications of the study. 51
• Limitation of the study. 51
• What I have leant regarding the topic. 52
• Chapter 8. 53
• Conclusion. 53
• Recommendation. 54
• Reference
• . 56
•             Hong Kong is one of the cities is faced with a considerable high number of aging populations. This paper analysis how integrated care can be used to help solve some of the problems facing the frail elderly in the society. The background of this research paper indicates that the elderly people in Hong Kong are faced with various problems mainly related to the plans of the government to upgrade the city. This paper adopts the literature review as the main methodology in order to analyze the topic. In relation to this the paper uses the critical appraisal and thematic analysis in order the content of various article analyzed. Various inclusion and exclusion criteria search criteria were included in the methodology to help determine the materials to be included in the study.
•             The findings of the research indicated that with the increase of frail elderly persons in the society, remain vulnerable especially to health problems. Lack of financial support is another aspect evident from the research whereby the frail elderly are not in a position to access high quality services due to lack of enough funds and these services are expensive for them. Majority of the articles reviewed are proposing that the government should intervene to ensure that the frail elderly have access to high quality services. The recommendation for the research is that more integrated care management facilities need to be established in the community in order to ensure that the elderly are transferred to these facilities to get quality services. The care managers as well as nurses facilitating care management to the elderly also need to be trained to ensure that they deliver quality services.
•             Hong Kong like many other countries in the world is also faced with the problems of dealing with the aging populations in the country. According to the census and statistics department in the year 2007 the country had over 874,400-citizen aged 65 and above (Leung, et al., 2009). There has also been an increase in life expectancy in the country from about 75.3 to about 85.4. Increase in the number of the elderly people in the society has in turn led to an increase in the number of the residential caring facilities in the country. The lack of space is also another major factor that makes the young people in Hong Kong to opt to take their elderly parent or grandparents to the residential caring facilities. According to Leung, et al., (2009) relocation of the elderly people to the residential caring center is also known to cause distress among these groups. The elderly people when taken to the residential caring centers are not only confronted with a change in the physical location but also changes in the living standard (Chui, 2008). In addition when the elderly people are relocated into these care centers they may also experience decreased psychological functioning as well as the decreased life expectancy (Lee, 1997). Due to the problem that the elderly people in the society face, integrations of health and social care therefore becomes important in such situation.
•             The term integrations as used in the healthcare refers to the various set of integrated care technique and different organizational model that are designed to help ensure that the care services are connected with other health services. The goal of the integrated care among the frail elderly is to help in enhancing the quality of life and care that is accorded to these groups of people (Lee, 1999). The range of the community services that are accorded to the frail elderly people in most cases are also meant to help ensure that these older people are able to live long in the community as possible. This paper analyses some of the impact of integrated care to the frail elderly in Hong Kong. In relation to this the paper tries to explore some of the mechanism that have been put in place to help in providing care and support to the frail old in the country.
•                         Considering the various health and medical care services in Hong Kong it is evident that the government and the various nongovernmental organizations have committed efforts towards improving the life of the elderly people in the society. In this case the various community Geriatric Assessment teams have helped to provide elderly people in the society with the specialized support in form of nursing and rehabilitation services (Y. F., 2000). Other team such as the pychogeriatric outreach teams have also helped to provide visits to the residential homes and provide early assessment and for the elderly in the society. This paper will also help to assess the impact of various services that are offered to the elderly people in the society.
• The elderly people who have been recently discharged from hospital in Hong Kong are exposed to high risks of unplanned readmission resulting to the occurrence revolving door syndrome (Leung, 2006). A believe in many countries including America and Hong Kong is that integrated care strategies provide the potential to enhance service coordination, quality outcomes as well as efficiency in these healthcare sector.   However, the major dilemma of understating the performance as well as the results of a fully integrated care is the failure to comprehend the application of the analytical model (Capitman, 2000). Analytical paradigms in this case are the concepts that support communication, understanding as well as policy formulation and program development (Patton, 1990).
• Integration as Luetz et al (1985) explains has three sections which include linkage, coordination, and full integration whereby these levels are explained s a continuum and linkage is the aspect located at the end of the continuum. Linkage is explained as a minimalist least change approach to integrated care that operates within the context of existing and fragmented systems. Full integration embody the complete overhaul and consolidation of all or majority of the responsibilities and funding for patient management or care for a certain population (Kane et al, 1992). The frail older persons suffer in the gap between healthcare or hospitals and the community care systems and this increases the level of victimization (Coleman, 2003). In such a case, repeated admissions of such patients lead to consumption of huge resources as well as blocking beds in the acute hospital whereby this has been a predominant problem in Hong Kong (Bound & Gardiner 2002).
• In contrast, the United States and the United Kingdom have more hospital based healthcare systems. A survey conducted by Woo &Cheung (1993) of older medical patients discharged from the hospital indicated a read transmission rate of approximately 11% in one month which increased to 30% in 6 months. Kwok et al (1999) carried out a research in 1999 in1204 hospitals for the patients with 70 years above where he found out that 38% had a readmission in every six months while 18% were readmitted in every 28 days. Majority of the frail elderly people in need of long term care (LTC) are generally victims of chronic diseases and they are in need of medical care.
• When in adequate medical care is provided to the Long term care (LTC) or when quality of medicine is rated unsatisfactory, many of the elderly become frequent users of acute medical services (Leung, 2006). The latter phenomenon in this case therefore accounts to the high number of hospital readmissions as well as high occupancy of medical and geriatric wards and apart from having a great impact on the health of the elderly it also poses a great burden on the medical sector (Bound & Gardiner 2002). Naylor et al. (1994) conducted a in Philadelphia where he found out that advanced nursing practices that acted like case managers care coordination, discharge planning and follow ups.
• (Leung, 2006) explains that care management for the patients discharged from hospital comprises of both long term and short term components whereby the short term management is initially used to facilitate transition of patients from hospitalization. In this case, once the patient is discharged, he/she is under the care management of a nurse or social work staff for about one to possibly three months. Short term management on the other hand is applied in a case whereby the frail elderly persons and the disabled receive care management from care managers for prolonged periods possibly two or more years (Long term care for the frail elders, 2001). The care manager is generally responsible of resource allocation as well as patient advocacy. Hong Kong generally does not have many cases of local care management and the majorly known is the case management study that was initiated by the HA (Case management pilot scheme in community nursing service, 1995).
• Older persons having different healthcare levels and functional impairment need different cases of management intervention and the psychosocial support as well as empowerment of the frail older persons and other care givers are essential aspects that instill tolerance and coping capacity at home and in care management interventions (Long term care for the frail elders, 2001). For those elderly persons being discharged from the hospital and are exposed to the social risks, it is more cost effective to have this person being under care of the care manager in order to be supported with short term care services in the in-patients units and this is the most effective and cost effective method. Leung, (2006) explains that case management is a predominant tool that can be incorporated for ensuring continuity as well as integration for the frail elderly patients in transition from the hospital to the community and its application in the case of Hong Kong was proved encouraging since it bridged the gap between the healthcare and social service. Nevertheless, the care management alone cannot facilitate the required support a fragmented care system for the elderly unless the intervention of system integration and a mechanism for facilitating pooling of health as well as social care budget.
• The aim of the study in this case is to facilitate an investigation of the importance of integrated care management to frail elderly in terms of social and health care, case study related to Hong Kong. The objectives of the study will be to determine the significance of integrated care management to the frail elderly people in Hong Kong. The other objective that the research aims to fulfill is to investigate how the society in Hong Kong perceives integrated healthcare to the elderly and how they support the programs. The other objective is research on the strategies that can be incorporated in order to improve the programs facilitated to support integrated care management for the elderly in Hong Kong as well as in other regions. However, the research may not be tied to the case of the frail elderly people only but will also touch on the effect of the care management programs on other people with special needs such as the impaired although it will majorly focus on the frail elderly people.
•             This paper is structured in such a way that the aims and objectives are discussed in the first chapters, which is the introduction. The second chapter of this paper is the background of study, which mainly describes the body knowledge of the topic and at the same time, tries to justify why it is important to study the topic related to the impact of integrated care to the frail elderly in Hong Kong. Chapter three of this paper is the methodology, which indicates what the literature says regarding the topic. The methodology chapter also tries to justify why the literature review method is the most appropriate method to study the topic. Moreover, the methodology chapter also discusses the various ways of analyzing other people research finding and the different ethical implications of the literature review.
•             Methods comprise the chapter four of this paper, and it mainly explains how the searching of the information presented in this paper was done. In addition the critical appraisal and the thematic analysis are also provided in this chapter. The method chapter therefore helps to provide a brief analysis of ‘how’ and ‘what’ regarding the various issues presented in the paper. The review chapter is the sixth chapter of this paper that describes the number of articles that were used in the survey and why they were used. Chapter six of this paper also provides critics of some of the article that were used in the study. On the other hand chapter seven of this paper provides analysis of the various themes that emerged in the course of the study. Discussion is provided in chapter seven of this paper and helps to relate the various themes and issues indentified in the paper. Conclusions and recommendations form chapter eight of this paper. The chapter eight of this paper provides some of the possible factors that need to be implemented in order to ensure that the integrated care provided to the frail elderly has a positive impact on the quality of their lives.
• Chapter 2
• Background
•             Honk Kong has enjoyed a substantial economic development since 1970s. It has managed to achieve an admirable per capital gross domestic product of about $23579. Despite the booming economic development in the city it is important to note that the elderly people in the society are disadvantage since they are unable to participate actively in the development of the city. The city is also known to have a high percentage of the elderly people in the society where it is estimated that over 15% of people in the city are above age of 60 years.   The annual growth rate of the elderly people in the according Chui (2001) is expected to at rate of about 2.5%. Amongst the elderly people in the country it is important to note that a considerable high percentage is poor. These high poverty levels among the elderly can be linked to the capitalist system adopted in the china. This unfavorable financial condition among the elderly people in Hong Kong in most cases render the elderly people in the society unable to satisfy their housing need where most of them end up depending on the upon government subsidized public housing. During the census that was carried out in 2001 it had been estimated that 47% of the elderly people in the country were living in government rental houses while the 30.8% were living in the territory singleton and the rest were living with their relative or friends (Chui,2001).
•             Besides being faced with the housing problems the elderly people in Hong Kong are also faced with the lack of viable family and the necessary social support. Lack of proper provisions of care among the elderly people in the city can be linked to the changes in the Chinese traditional value of respecting elders especially among the young generations. The urban development in residential is another factor that has contributed to the housing problems faced in the city. This is because in most cases the elderly people in the country have been dislocated from their original residential houses. Chui (2001) notes that the elderly people in the city have been forced to relocate from their original residential houses to pave way for the construction of new buildings. Displacement of the elderly people from their original residential home is also known to have an impact on the disrupting the various social networks leading to increased dependency. In addition the relocation of the elderly people also has an impact on the psychological health of the elderly since in most cases they are unable to cope up with the new environment. Furthermore it is also evident that when the elderly are removed from the houses involuntary and in most cases they may be deprived environmental resource such as the peers. In view with these problems related to relocation of the elderly people to pave ways for economic development this papers argues that the government should also factor in social status of people when carrying out such development. This can help to ensure the relocated elderly people in Hong Kong are able to continue with their normal life.
•             Elderly people are faced with several risks, which justify the need to develop integrated care systems. In this case the term risks relates to the probability that an event that unfavorable event within a specified period of time or before. Most of the elderly people are faced with the problems related to body impairments. The body impairment among the elderly is mainly due to the loss of sensory functions where the peripheral nervous system becomes worn out. Body impairment among the elderly may also occur due to the vision impairment. Numbers of the somatic disorders are also associated with the frail elderly people in the society. Most of the somatic disorder found among the frail elderly people is related to the neurological disorders leading to diseases such as the stroke, vestibular pathology among others. According to Bergland(2012 ) about 22 to 73% of the elderly people in the society have stroke emotional health problems among the frail old in the society is also another possible factor that contributes to the physical health of these groups. In this case the cognitive impairment causes problems to these frail elderly since most them end up losing their memory, which greatly affect the quality of their life. Medication, which is common among the frail old in the society, is another factor that is known to affect the quality of life of these groups of people. Taking too many drugs is known to be dangerous since it may lead to detrimental drug interactions. In addition the inability of the frail elderly in the society to perform basic activities of daily living is also known to increases chances of the old in the society experiencing falls. Social isolations experienced by the frail elderly in the society is also another major source of problems experienced by the groups.
•             Moreover the integrated care approach is important since most of frail elderly in the society are subjected to neglect and abandonment. In this case the neglect and abandonment can either be intentional or unintentional on the part of the health care provider. Neglect is evidence when the relative or the person meant to care for the old withholds affections or lacks interest in the older person well being. Neglected frail elderly in the society do not have the required nutrition, hygiene physical and emotional health. In some cases the integrated among is important since some frail elderly in the society are subjected to physical abuses by the same people who are meant to provide care and support to them. Physical abuse among the frail elderly include acts such injury or infliction of any form of pain. According to Melby,and Ryan (2005). Due to the old age most people in the society become physically and mentally dependant, which in turn increases their chances of being subjected to different form of abuse.  
•             Provision of social support to the frail old in the society in most cases has positive relations with life satisfaction. According to Abley (2012) a study conducted to establish the effect of the social support on the life satisfactions among the frail elderly in the society the study showed that those who perceived their social status to be poor also had poor life satisfaction. Social support in most cases is known to enhance physical health or buffer an individual from some stressful situation that can cause low satisfactions levels. In relation to this some scholar argue that being old in some cases is the state of mind and hence the social support play a critical role in determining the fate of the frail old in the society. Social support is also deemed important since most of the frail elderly in the society since most of them suffer from bereavement of their loved ones, which greatly affect the quality of their life. Social support in cases of bereavement can help to ensure that these people are able to move on with their life. Wilkinson (2011) notes that one of the most important fact that determines the quality of life among the frail old in the society is the physical health. Most of the old people in the society do not fear getting old but in most cases fear becoming isolated by their ill health hence the need to have an integrated care approach
• Case management has been advocated as criteria for coordinating heath together with social care for the frail elderly people as well as reduce the increased hospital admissions (Graffy & Grande, 2008). This has been pressurized by the growing number of the elderly people in Hong Kong and other parts of the world thus increasing the demand for long term care services. As Lee, (2004) remarks, strategies have underway to meet these challenges through balancing residential care as well as communal care for the frail elderly ad especially to Community Care Services (CCS) that helped the elderly people to lead independent lives in the community. However, this initiative not only reaches for facilitating independent lives for the elderly but it also helps overcome the issue of cost increment since majority of the frail elderly have been admitted to hospitals where they get long term care for both health and social services, an aspect that is really expensive to cope with.
• As Lee, (2004) remark, in order to have a sustainable long term care (LTC) policy in Hong Kong the strategies need to prove of their appropriateness and effectiveness by responding to the factors affecting individual choices among various communities or residential LTC services including changing demography, social norms in accordance to elderly care, gender and cultural tradition as well as the contemporary development regarding to welfare regime. Andersen, (1995) proposed a model that aimed at healthcare service utilization which perceived that the people choosing to utilize certain care services are generally influenced by three factors which include predisposing, enabling and need factors. Predisposing factors encompass factors such as demographic variables, enabling factors include aspects such as financial concerns, availability of caregivers, together with the sustainable strategies involving both the care giver and the care receiver and finally the need factors include such aspects as healthy status, dependency level together with care giver’s burden and care giving intensity (Andersen, 1995).
• The model is widely incorporated to study the factors that affect the long term care services and their utilization in Hong Kong elderly by many researchers including (Lee, 2004) whereby some of the results indicated that despite of the fact that elderly people in Hong Kong supported the virtues associated with cultural traditions, they consider and agree with the reality of the long term care facilitated to them. Hong Kong saw the initiation of the Hospital Authority (HA) that saw the public hospital system in the city being reorganized into seven clusters whereby a population based model is greatly applied in resource allocation to the clusters (Leung, 2006). According to Leung, (2006) this need to encourage further expansion of outreach community geriatric services including the Geriatric Day Hospital, Community Nursing Service and the Community rehabilitation services among others.
• The Hospital Authority (HA) is the policy of healthcare in Hong Kong which has influenced the change in hospital care whereby the elderly patients in the hospital are required to identify themselves with a care network in the community and this reduces the number of patients in the hospitals thus making hospital bed available for other services and reducing cost of healthcare (Leung, 2006). The social Welfare Department (SWD) in Hong Kong is the major department that funded and oversees the social service delivery and this has recently been reviewed and re-organized into 13 districts. The SWD and the non-governmental organizations dealing with issues of the care management for the elderly have undergone changes in resource allocation following the implementation of a lump-sum grant-funding model in the region of which the latter are major operators of community based as well as residential care services for the elderly in Hong Kong (Leung, 2006).
• The social deliver system for the elderly people has now gained more concerns, it has shifted emphasis, and supporting services together with district based coordination through the District Elderly Community Centers while the traditional home help services have been re-organized and further strengthened following the introduction of more basic nursing as well as rehabilitation elements to form the improved home thus giving the frail older persons easy access to someone (Leung, 2006). Different authors also contributed to the increased campaign to change the healthcare system under care management of the elderly people whereby they emphasized for the need to train the case managers who were carrying out the task of facilitating the health and social services to the elderly and this covered comprehensive geriatric assessment. The training was also focused on facilitating skills as well as clinical care planning and increase the ability of the care managers to provide integrated care (Landi et al. 2000).
• Following a research conducted by Lee, (2004) there was no significant relation or association was seen consensual solidarity (inclination to family tradition and filial piety) and the utilisation of community care service and this generally signified the altitude towards family tradition filial piety was somehow de-linked with altitude towards concrete behaviours or rather the long term care arrangement. The research by Lee, (2004) also indicated that the existing policy in Hong Kong had a great impact to personal or family decisions following the long term arrangements and the people who had comparatively more financial support would stay in the community while those who had comparatively in adequate financial support were likely to shift to residential facilities. The care facilities found in the local regions in Hong Kong are generally subsidized by the government. For instance, in the year 2008 to 2009, the government subsidized HK$ 6000 and HK$ 8000per month to the private homes which were participating in Enhanced Bought Scheme and care attention homes supporting the elderly respectively (Landi et al. 2000).
• The intervention of the government in this case implicates that it is devoted in supporting the frail elderly persons in Hong Kong through facilitating easily accessible health and social services in order to help reduce the expenses incurred in dealing with the elderly patients as well as free hospital beds through having the elderly being taken care of in communal health and social facilities. This will help the elderly lead independent lives and ensure that they get the comfort they deserve since they are still important to the society.
• In America for instance, the PACE model is a prepaid, capitated managed care program that supports comprehensive primary, long term as well as acute care generally provided the non-profit and public organizations (Wieland, 2001). This plan focused in enabling the frail elderly and the disabled patients to get the care they needed from the community setting in an appropriate manner and prolonged period as required. The Onlok Senior Service in San Francisco initially developed the innovation as a demonstration project and it aimed at addressing the geriatric long term care needs in the Chinatown (Bodenheimer, 1999). The model has been replicated in 25 demonstration sites in the United States and has the eligibility of funding from both the Federal and the state government.
• The PACE model entails an innovative comprehensive long term as well as social services and has a strong motivation for supporting and preserving the older person’s family unit since it comprises of special characteristics such as targeting the older persons who reside in older geographical regions (Rich, 1999). The model is also an initiative of improving health and social care for the elderly since it provides comprehensive as well as integrated care through an interdisciplinary team and intensive case management (Rich, 1999). The case management systems which have incorporated the PACE model get to support case management which is supported and provided by the interdisciplinary team and meets once or twice in a week with the social workers since the case nurse managers initially act as the liaison persons with the older persons and their family caregivers (Rich, 1999).
• On a different context, Hong Kong is not the only region being faced with increased numbers of the elderly population and Australia is another case where the government recognizes the significance of the elderly in the society. In this case, the Australian government is fully committed in encouraging as well as supporting the elderly in the region to live full, active and independent lives through taking part in the aging and aged programs facilitated by the government (Australian Government, 2008). The Australian government has initiated a social inclusion Agenda that focuses on creating opportunities for individuals not only to participate in economic activities but also the civic and social life as per the culture and standards of the region (Australian Government, 2008). This ensures that the elderly can be involved in such activities as social life thus the elderly feel supported by the society. The agenda also focuses on recognizing the multifaceted and distinct barriers that obstruct participation as well as the impact this has on the community and the individuals especially the elderly (Australian Government, 2008). This agenda also implicates on the need for early intervention, prevention and treatment strategies that facilitate pathways to inclusion and a continuum of care (Australian Government, 2008).
• Case of care management is also considered in the United Kingdom and the past decade saw the region committed for search of more coordinated care for the elderly people through linking the health and social service system (Wieland, 2001). The evaluation of pilot programs in this region indicated a varied degree of success and the programs implicated that there was need to differentiate the level of case management responses in accordance to the needs, target appropriately, devolvement of budgets together with ensuring continuity of case manager with service user involvement and provide appropriate links with healthcare expertise (Leung, 2006).
• In this case, the application of the case management tool is now proving as a convenient tool that has instilled continuity as well as integration and effectiveness in dealing with the increased problem of lack of space in hospitals and increased costs (Leung, 2006). The developed nations for instance have realized the importance of connecting the social and health services for the elderly through establishing care management facilities in the community and supporting the caregivers in providing quality services to the elderly in an appropriate manner (Leung, 2006). However, due to the indication of increment of the elderly population in the near future, the developed nations are also faced by the challenge of health and social care policy involving the elderly including Hong Kong. This is because, despite the fact that medication seems to have made a greater progress in dealing with different diseases, frailty is a price of longevity. This has been a solution to many countries whereby the establishment of community care plan has seen many of elderly persons access the healthcare and social services from the community and not hospitals thus saving Medicare costs.
• Chapter 3
• Methodology
•             This chapter explains how the literature review was conducted in this paper. In relation to this the chapters also justify why the literature review was taken as research methodology. This chapter will therefore outline the critical appraisal and thematic analysis of the literature. Most importantly the chapter will also help to discus in details the different databases that were used to search for the required information.
• Explanatory phase
•             Literature review as used in this paper has helped to provide an overview of the various research that have been conducted with regard to the impact of integrated care for the frail elderly in the community. According to Gildberg et al., (2010) literature review plays a critical role in helping to distinguish what has been done from what needs to be done. In this case the literature provided in this papers will help to establish some of the possible impact of applications of integrated care among the frail elder in Hong Kong. Through establishing the current system used to provide integrated care present in the city this paper will also propose some of the ways that can help to enhance its impact. The literature review will also help to discover the relevant variables regarding the topic in addition the literature review will also help in relating ideas and different theory that relate to the subject.
•             This paper will therefore use the systematic review of the literature to present some of the impact of the integrated care in enhancing the quality of life of the frail elderly in the society. According to Gildberg et al., (2010) systematic review of the literature is the best practice based research synthesis. In order to ensure that the research presented is credible comprehensive, transparent and unbiased literature review will be conducted. The process of integrating the various finding across many studies is one of the ideal steps that help towards according legitimate scholarly research. In order to help minimize bias in the literature review this papers will also include the grey literature, which include unpublished research papers, census finding among other. Using the systematic reviews will also help to provide a focused cross discipline search and hence help to provide the necessary information required.
•             Moreover this paper will also use the integrated review method to conduct the literature reviews. According to Gao et al., (2013) integrated review refers to a method of analyzing the relevant literature for the purpose drawing conclusion and providing a, more comprehensive understanding of the subject. In order to carry out a comprehensive literature review the entire eligible primary source will be grouped together for extracting information in an organized manner. Organizing all the sources related to the topic of study will help to ensure accurate information is collected from sources. In relation to this the integrated review will be conducted in way that it will help to cover the various research questions that are proposed in this study.
• Search strategy inclusion and exclusion criteria
•             In order to gain the necessary information required to complete the topic several search engine will be used. The criteria for selecting the article will be based on the on the following factors that will determine inclusion and exclusion criteria.
• Inclusion criteria
• Exclusion criteria
• Material that are not related to the topic of study
• Materials that are published in any other language apart from English.
• Material published prior 2000 unless it has relevant information that can be used in the topic of study
• Material that do not in any way relate to the topic of study
• Study that does not focus on the aged populations in the community
• In some case the article with no empirical data will not be put into consideration
•             In this case the article publish in English will be considered since it is the main my main language of communication. Accessing mainly the article that were published from 2000 to 2013 will help to ensure that the paper present some of the possible recent studies that have been done with regard to the topic. The search in this paper will involve approximately 300 to 400 articles that relate to the topic of the study. Selection of the article to be in the study will first include a brief analysis of the abstracts of the paper in order to establish the main concept presented in the paper. The final inclusion screening of information was based on the assessment of how the article relates to the topic of study.
•             The various sources of article will be selected from the various category of materials in this case the first priority will be given to the primary sources which contain information where the author report his or her original research. The secondary source that include the various articles that are written by another person apart from the original author will also be considered. In relation the papers concerned with the description of the theories and concept related to the topic will be considered in the study. With regard to the primary sources the type of study setting and the data collection methods will be considered as well as the possible recommendation that the author presents. For the case of the secondary sources the review boundaries and the synthesis criteria will be put into consideration.
•             Moreover the selection criteria used for the study will be based on the assessment of how the article indentifies a particular context of the study. This is to help ensure that the information collected relates to the topic of study. In relations to this the articles selected should help to show some of the possible impact of using integrated care among the frail elderly in Hong Kong. Finally the article will be organized based on the relevance of the information contained in them. The information that will be collected to each article includes the authors name year of publication of the article as well as the major concept present in the paper that relates to the topic of study. This information collected from the various sources will be incorporated in this paper accordingly.
• Electronic search
•             One of the electronic databases that will be used in this paper is the ebscohost in order to access the necessary academic article needed. The major advantage of the ebscoshost is the fact that all the articles are organized in a consistence manner. Through this simple arrangement of the data one can therefore be able to retrieve all the necessary information that one requires with ease. The organization of the database also allows elimination of the unnecessary data hence ensuring that one is able to filter only the relevant information. In addition the database is also organized in a way that it can allow one to retrieve information using the mobile phone since in this case the site is optimized for use in the mobile platform such as the adroid and apple phone models. In relation to this the site is also flexible and therefore allow one to access all the popular sites containing books summary, leading medical databases, nursing reference center among others. The presence of these other sites in the database can allow one to get information access from a wide range of sources.
•             Moreover the database of the ebscohost also has simpler queries which allow easy navigation while searching the information. Another major advantage of the use of the ebscohost is the fact that the database is well maintained which makes it reliable source of information. In relation to this the database also contains the most recent research that has been approved related to the topic of study. Using the most recent publication to collect information will help to ensure that this paper present the most possible recent impact of integrated care on the frail elderly in Hong Kong. It is also important to note that other database may also be used to in the paper provided they contain the relevant information.
• Critiquing methods
•             According to Miller, et al., (2006) critiquing can be referred to as an objective analysis that aims at establishing whether the author has supported his main point with reasonable argument and the different applicable facts. Critiquing of the article is an important method since it helps one to gain an incite of the various arguments that are proposed in the study. This paper will adopt the following critiquing methods in order to analyses the information that is related to the topic of study.

Abstract

Chapter1

Introduction

Materials related to integrated care for the frail elderly in Hong Kong.
Publications of material in English language
Primary materials that are published from 2000 up to date
Study focused on the nursing care and nursing intervention situations
Study that focus on the frail elderly in the society
Article that provide empirical data will be put into consideration

1. Simple argument perspective

•             Critiquing of the article using this method mainly require one to evaluate the argument presented in the article and the various supporting evidence that the author presents in the paper. In order to indentify the major argument presented in the article the first step is to analyze the abstract or the introduction in order to establish the major argument presented by the author (Ryan, Coughlan, & Cronin, 2007). The background part and the acknowledgement part can help in assisting one to get the main argument that is presented in the article. In order to assess whether the author has establish enough evidence to support his argument there this papers will also assess whether the author has managed to successfully defined all the key words in the essay. In relation to this use of this method also requires one to evaluate whether the authors have demonstrated their expertise in the presentation of information. Using the simple argumentative perspective it is also important for one to establish whether the author has presented some of the counter argument with regard to the topic presented in the article

1. Picturing perspective

•             This approach of critiquing an article involves first drawing a picture in the mind with regard to the topic presented by the author of the article. In order to use this method one requires to establish the major problem that is presented in the article. Through establishing the major problem presented in the article one is able to have a clear picture of develop the possible perspectives that the author uses in the article. Using this method one is also required to depict all the possible relationships presented in the article. Most importantly using the method can help one to establish whether the various relationship presented in the article agrees to each other. In this case applying this method to study this topic will help to ensure that through analyzing the introduction of the papers one is able to establish the relationship of the paper with the main topic of study.

1. Concern perspective

•             The concern perspective is an integrative approach that requires one to investigate the various ideas presented in papers from how they are perceived. In order to use this perspective one first requires establishing the main object under consideration in the article. After considering the main object under consideration one is also supposed to establish the purpose and the connection of different idea in the paper. In addition one is also required to establish the perspective with regard to the object under study. Using this it is therefore possible to argue that one can be able to all the necessary information related to the topic under study.
• Ways of analyzing other people works
• This paper will analyze the data from other people in order to establish the impact of integrated care approach on the frail elderly in Hong Kong. The following are some of the methods that will be used
• Critical analyses
• The critical analyses will also be used the information presented in the article. In order to conducts an effective critical analysis of the article the main argument of the author will first be established through the analysis of the abstract as well as the introduction of the article. The critical analysis will also include the analyses of the evidence that the author presents in order to support the main argument. The assessment of the evident will include establishing the data presented in presented in the article. Moreover the reliability of the information presented in the article will also be evaluated through indentifying the various primary sources that are used to gather the information presented in the article. In addition the degree of persuasiveness of the information presented in the article will also be accessed.   In relation to this the discussion presented in the article will also be assessed to establish whether the author has indentified the strength and the weakness of the topic of study. Finally the conclusion presented in the article will also be assessed to establish whether the conclusion is supported by the results indentify.
• Thematic analysis
•             Thematic analysis refers to one of the simplest method of categorizing the qualitative data. Thematic analysis can be used for data interpretation and hence help one to draw the necessary interpretation (Adapa, 2013). Using this method one can be able to identify the various variable that are presented in the different articles. This is because in most case the thematic analysis is not only involved in the analysis of the various words and phrases used in the articles but also the ideas and the themes presented in the article. It is also evident that the methods can also allow one to deduce the various relationships that are presented in the article. Moreover thematic analysis can allow one to study two different phased data presented in the article (Gildberg et al.,2013) In this case it allows one to study the pre-collected data as well as the post-collected data. Analyzing the data presented in the article using the thematic approach can help one to establish the association of the data presented and the major argument of the author. Most important using the thematic analyses one can be able to categorize the data and the themes presented in the article (Gao, Chan, & Cheng, 2012). In order to perform an effective thematic analysis the following procedure will be put into considerations.
•             The meta-synthesis technique will also be used to integrate and evaluate the finding presented in various articles. Using the meta-synthesis technique it is possible for enhance the understanding presented in the article by different author relating to the topic of study. In order to carry out a successful meta-synthesis this paper will draw the different conclusion presented by different authors in order to establish common themes presented in the article. The following are some of the proposed procedure that will be adopted in thematic analysis
• Preparing the analysis
• This step involves gathering all the necessary materials required to perform an effective thematic analysis.
• Reading the text
• After all the necessary materials are collected the next step will involve reading the collected materials in order to indentify the main argument present in the article. In order to carry out a comprehensive reading the important points will be noted somewhere, which relates to the topic of study. In this case noting the major point presented can help one establish the depth into which the author of the article analyses the themes in the article.
• Sorting items of interest
• After careful reading of all the materials presented in the article the next step involves sorting of various items of interest presented in the article. The idea taken from the article should help to contribute to the information related to the study topic. However it is important to note that all the information collected from various sources will be properly cited in this paper.
• Ethical issues
•             In order to carry out a comprehensive literature review several ethical issues must also be put into consideration. Plagiarism is one of the ethical principle that will be put into consideration . According to McMaugh, et al., (2006) plagiarism refers to the act of theft of an intellectual property rights. Being an academic paper the rules of plagiarism must be adhered. This is because failure to adhere with the rules of plagiarism in most cases leads to loss of academic reputations, which may in turn destroy professional career of an individual. In relation to this failure to adhere with the rule of plagiarism may lead to legal persecution due to the breach of the copyright law. Considering that the topic of study involves assessing the impact of the integrated care then failure to observe the rules of plagiarism can therefore lead to publication of wrong information.
•             In order to avoid plagiarism this paper will paraphrase work from different authors and at the same time cites the source. However it is important to note that this paper will paraphrase materials without necessary losing the original idea presented by the article. Another ways that this paper will avoid plagiarisms is through ensuring that only a small proportion of the material used in the paper is directly copied from the sources. All the materials that will be copied directly will be cited and the copied information presented with quotation marks. Most important a clear reference list will be provided at the end of this paper to indicate the various sources that have used in the paper. The information provided in the reference list will therefore include the author’s name, date of publication and the title of the journal.
•             Moreover being nursing related research accuracy would be maintained in the collection of information in this paper. The paper will therefore report precisely the information related to the impact of the integrated care on the frail elderly in Hong Kong. In this case the paper will therefore not omit, add or even exaggerate the original information.   According to Meltzoff (2005) exaggerating or falsifying case facts violates fabrication of research data. In addition the papers will also avoid the selection bias when compiling of information from different sources.
• Chapter 4
• Method
• How the literature reviewed was done
• I incorporated research from a diversity of resources in order to ensure that I covered a comprehensive literature review. The literature review was from different peer reviewed articles which are related to the research I have conducted. I developed a research question that helped me achieving through analyzing the journals that had been published on research carried out by different research in regard to the topic I am studying. The search included all the health areas that relate to the topic under study. Initially, articles published from date 2000 and lately will be incorporated since they contain the most recent researches done by different researchers. However, the electronic search might not facilitate all the information required due to issue of indexing and this will require that manual search be incorporated to ensure that all the possible relevant information is exhausted. In my research, I will incorporate the comparison of data from the findings of the researches performed by different authors in different region on how the elderly are provided with long-term care as well as the strategies that the different governments have put in place in order to ensure that the elderly are well catered for. I will incorporate the opinion of how people in these regions perceive about the elderly care and the efforts that the governments of different countries need to put in place in dealing with the care for the elderly. Manual search requires that one is conversant with the publishers of the journals or articles that are related to the field of study.
• Database used
•             The major search will include electronic journal from the EBESCO-host whereby the most recent peer reviewed articles will be evaluated and the findings analyzed to provide the key points to facilitate the support of the research. However, the research will not only be depended on the EBSCO-host as the only electronic site for the research material but I will also incorporate search in other databases such as PubMed. The reason for using EBESCO-host is because it encompasses a great diversity of articles from the health sector as well as from other fields.   The other reason why I chose the EBESCO host database is because of the fact that the search will not require exact Boolean expression for the search but inputting a similar expression to the field of study provides numerous results of journals of health. EBESCO-host has been widely used in research following the fact that it has rich composition of articles from different institutions and research sites.
• Search terms
• In searching for the relevant articles to enable me in providing a comprehensive literature review, I incorporated some search terms which were more relevant to the anticipated results. The following tables show the search terms used in searching the articles.
• Care
• or
• Case
• And
• Management
• and
• or
• Elderly
• or
• Old people
• or
• Aging
• Aged
• Integrated
• Or
• Long-term
• And
• Care
• Healthcare
• And
• Or
• Aged
• or
• Old
• or
• Aging
• or
• Elderly
• Reasons
• Or
• Effectiveness
• Or
• Importance
• And
• Or
• Integrated
• And
• Care
• Or
• Healthcare
• Or
• Social-care
• Or
• Acute medical care
• Or nursing home
  • Or
  • Acute geriatric care
• Frail
• Inclusion and exclusion criteria
•             The first major inclusion and the exclusion a criterion was based on the whether the material used were related to the topic of study. In this case all the material related to the study was included in the search while the unrelated materials were excluded. Another major factor considered in the study was the year of publication where the materials published from years 2000 were given priority in the study. The materials that were related to the frail elderly in Hong Kong were also given priority during selection. Various articles that provided empirical data were consider first over the article that did not have any empirical data. In relation to this various studies that focused on the nursing care and nursing interventions were also given priorities. Most importantly only the articles that were published in English were included in the study. In this case the articles published in English were given priority since it is the main writing language that is used to write up this paper.
• Critiquing framework
•             Several critiquing framework have been adopted in the papers in order to analyze the impact of integrated care on the frails elderly in Hong Kong. One of the critiquing method that was used in this paper is the simple argument perspective where the abstract of the different articles that were the indemnities in the using the search criteria were studied. This was to help indentifying the main point presented in the paper. The counter arguments present in the study was also established using this perspective. Another critiquing frameworks adopted in this paper is the picturing perspective where the major problems issue discuses by the author of the article was first identified. Application of the picturing perspective also helped to establish whether the author has managed to explain the various relationships with regard to the main topic. In addition the concern perspective was adopted in order to establish the various ideas that are presented in the article.
• Data analysis method
•             This paper adopted two data analysis method the critical analysis and the thematic analysis. With regard to the critical analysis the main idea presented in the article was first established through the analysis of the abstract and the introduction of the paper. Using the critical analysis this paper established the reliability of the information presented in the article through indentifying the primary source used in the articles. However it is important to note the main method that was used to analyze the data was the thematic analysis. This paper relied on the thematic analysis since it allows one to study the various themes and ideas presented in the article. In relation to this using the method it was possible to establish the association of the data presented and the major argument of the author. In this case after careful reading of the article the items of interest were sort and noted somewhere. The various themes analyzed in different articles were later used to write the topic presented in this paper.
• Chapter 5
• Reviews
•             The review included a critic of ten articles that are associated to heath issues especially in majoring the issues that have effect on the care for the elderly. The critic for each article is indicated in appendix 1.1 while the summary of the critic is indicated as follows
• Ka ching et al., (2006)
• Focus
• The title of the article ‘characteristic associate with the fear of falling in Hong Kong Chinese elderly residing in care attention home’ provides clear reasonable explanation regarding what the author aims to present in his study. However it could have been made shorter for easiness in understanding
• Background
• The author of the article has managed to provide a good background regarding the topic of study. This background help to give the reader the insight of the topic to be discussed in the article
• Terms of reference
• The authors aims at providing some of the possible causes of the fear of fearing among the elderly
• Study design
• A quantitative methodology was adopted where the semi-structured   questionnaire were used to collect data
• Finding
• The study showed that the fear of falling among the frail elderly was associated with the chronic injury and the body balance.
• Applicability of the study
• The fear of falling is normally related to the lack of proper counseling. There is need for the policy maker to ensure care provided to the frail elderly incorporate aspect of method of preventing falls.
• Siu Lun Chow et al., (2004
• Focus
• The title of the article ‘The prevalence of depressive symptoms among elderly Chinese private nursing home residents in Hong Kong’ is able to give the reader an important message regarding what is discussed in the article. However it is possible to argue that the authors do not bring out all the issues covered in their article. In this case the title of the article is somehow not sufficient to represent the information provided in the article.
• Background
• In the background the authors of the article have managed to bring out all the necessary information related to the topic of study. In this case the authors have managed to present some data from various studies that were done related to their topic of study. Through giving this   background the authors have managed to explain some important issues regarding the topic of study
• Terms of reference
• The author of the article mainly sort to   explore some of the factors causing high risk incident among the elderly people living in the private nursing homes
• Study design
• The quantitative technique was used to collect data where t all the resident above age 65 residing in these private nursing homes were recruited in the study.
• Finding
• The result of the study indicated that most of elderly people taken in the private nursing homes in most case undergo depression. This depression was mainly due to poor condition of these private nursing homes and lack of enough facilities to cater for both their physical and mental health.
• Applicability of the study
• This research is important since it helps to present some of the possible challenges that the elderly taken in the private nursing homes undergo while in these centre.
• Kee-Lee, C., & Chi, I. (2005
• Focus
• The title of the article ‘Reciprocal relationship between pain and depression in elderly Chinese primary care patients’ is a bit complex where one may not be able to get any idea of what to expect   in the article. Being a journal in nursing there was the need for the authors to ensure that the title is simple and does not include mathematical terms.
• Background
• Analysis of the background presented in the article it is evident to that the authors do not show this reciprocal relationship. Failure of the authors to provide a background of the study is one of the factors that make it hard for one to understand the concept present in the article.
• Terms of reference
• The authors of the article sort to establish the relationship between the pain and depressions. In addition the authors also sort to establish whether the social factors had any effects on causing depressions among the elderly people living in the institutions.
• Study design
• The qualitative technique was used in the study. In order to establish the relations between pain and depressions the authors of the article decided to carry out the study for a period of one year.   The participant recruited in the study were aged 65 and above. In relation to this study bias was eliminated through the random selection of the participants a well as the institutions involved in the study
• Finding
• From the finding the researcher was able to establish that there was a reciprocal relationship between pain and depressions. However it is important to note that it was not possible for reader to establish this relationship from the data presented. It is therefore evident that the authors did not present good data to support his finding
• Applicability of the study
• Despite lack of enough evidence to support it is evident from argument that pain cause depressions. This imply that there is need for the care provider to ensure that the minimize incidents that may cause pain to the elderly people in the society to helps reduce cases of depressions.
• Chan, C., & Chui, E. (2011).
• Focus
• The focus of this article ‘Association between cultural factors and the care-giving burden for Chinese spousal caregivers of frail elderly in Hong Kong’ is good since it helps to explain to the reader what he might expect from the article. It therefore evident the title of the article helps gives the reader an sight of what to expect in the article regarding some of the factors that hinder provision of care to the elderly in Hong Kong
• Background
• The background of the article is also good since it help to explain some history regarding the Chinese culture. This explanation helps to give the reader the insight of what to expect in the study
• Terms of reference
• The author of the article sort to find some of the possible culture aspect that hinder care delivery to the frail elderly in the society
• Study design
• The study was based on one time cross sectional   and the data in the article collected using the structured interview
• Finding
• The author of the article was able to establish that some of the Chinese cultures interfere with the care provision with regard to the elderly people.
• Applicability of the study
• The study has significance since it helps to bring out some of the Chinese culture that need to be addressed in order to enhance provisions of care to the elderly
• Focus
• The title of the article ‘Transition to residential care: experiences of elderly Chinese people in Hong Kong’ is good one since it helps to give the reader an insight of what to expect in the article.
• Background
• The author of the article has managed to provide a good background regarding the topic of study
• Terms of reference
• The author of this article sort to indentify some of the experiences that the elderly people face when they are moved in the residential institutions
• Study design
• Quantitative data technique was used where the audience were radio taped during the interviews
• Finding
• The authors of the article have provided a good finding where they have been able to establish that the elderly people face a lot of challenges when moving into the residential care.
• Implication of the study
• This study is important since it helps to present some of the challenges that the elderly people face when they move to these residential care.
• Abley, C. (2012)
• Focus
• The title ‘Responding to vulnerability in old age: patient-centered care’ is clear on what the research is all about but it could be clear.
• Background
• The author has presented his/her background in brief thus failing to give the detailed part of the research and this may lead the reader not being able to understand clearly the context.
• Terms of reference
• The abstract of the article contained the research question that the research aimed to justify/answer although the researcher did not make it more clear and concise
• Methodology
• The author has incorporated a review of peer reviewed article including journals that cover similar topic
• Tool of data collection
• The researcher incorporated interview, which collected the responses of the participants in regard to the field under study.
• Ethical considerations
• The research only considered some but not the major ethical issues that need to be considered when conducting a research. The ethical issues included in the research were closely reviewed and a conclusion was draw that the research did not consider the important aspects for ethics in dealing with research.
• Data representation
• The results of the data were only discussed and no representations were done although it remains an essential component of the data analysis
• Recommendations
• The key reason for taking research is to suggest what improvements can be done and how they can be done although the article has not facilitated enough recommendations.
• Bergland, A. (2012)
• Background
• A close review of the article indicated that the researcher did not address the paper as per the region under study.
• Terms of reference
• After analysis of the terms of reference incorporated in the research, it is clear that the researcher has only indicated the reason for the research but has not provided the major research question.
• Study design
• The research has incorporated some of the major research questions to guide in the research but has left more questions which would be important too. This is because the design of the study should predict of the appropriate criteria to ensure that all the important information has been covered in the research.
• Data collection
• The researcher did not incorporate questionnaires or interviews and relied completely on the research conducted by other authors and this would be the option he had to use.
• Data representation
• The research did not have any data represented in charts or graphs since the researcher did not necessarily rely on the common methods such as qualitative or quantitative methods in collecting data
• Conclusion
• Although it is important o ensure that the findings as well as recommendations are reflected in the abstract and conclusion, in this research the author has not presented the points in a concise manner as required for a conclusion
• Readability
• The article would impress the reader but is more important to incorporate a format that would impress the reader more and make them understand the research from a glance
• Implications of practice
• The research addressed on the issues concerning the elderly in the community but is essential for a comprehensive research was carried out to determine the most effective strategies that need to be applied to deal with these problems
• Chui, E. (2001)
• Title
• The title ‘Doomed Elderly People in a Booming City: Urban Redevelopment and Housing Problems of Elderly People in Hong Kong’ can be rectified to be concise and to the point.
• Background
• The author has incorporated a well structured background that provides the reader with an idea of what the article is all about. Nevertheless, he/she would have been more accurate by incorporating major points on the place the research is based on.
• Methodology
• The methodology of the article does not appropriately connect with the literature review of the paper. This would have been more comprehensive and the link between the two being more evident
• Design
• Researches that present valid arguments need to ensure that the goals/aims of the research have been achieved, a case that has been totally been objected in this study
• Data representation
• The research is not qualitative or quantitative but it is essential for the author to incorporate graphs since the reader will be determined to have a summary of findings in figures.
• Recommendations
• The author has offered some of the strategies that can be incorporated in order to ease the effect of the case. However, this could have been improved since recommendation is amongst the key parts of the research.
• Readability
• The article has a clear format that the reader can enjoy when reading although the author would have done better
• Implications of research
• Future research needs to be incorporated to base on the care management for the elderly in society
• Melby, V., & Ryan, A. (2005).
• Title
• The title ‘Caring for older people in pre-hospital emergency care: can nurses make a difference?’ would be somehow confusing to the reader.
• Background
• The author has presented different issues and the weight of the discussion needs to be more on the major issue being discussed while the others remain as additional information
• Design
• The major questions as presented by the author are substantial to facilitate a research of the key issues, although there should also be a question that need to research for manner in which the service can be improved
• Methodology
• The author has combined both interviews and questionnaires and this would facilitate in acquiring the best results for the research. However, the issue of having multi-design method is also appropriate but this might confuse the study
• Data representation
• The best thing that the author has reached for the graphical representation is through incorporating the demographical features of the participants in a table but failed to represent the results of the research too.
• Conclusion and recommendation
• The conclusion is fine but the author has failed to incorporate the effectiveness of the recommendations provided in the study.
• Readability
• The author has incorporated an appropriate format for the article depending on the available options.
• Implications of research
• Although the author has presented some effective strategies that can be incorporated in some cases, more on the recommendations need to be covered since some of them have already been applied and the institutions are looking for better alternatives.
• Gao, L., Chan, S., & Cheng, B. (2012)
• Background
• The article has a clear background of the place that the study aims and the issues being investigated and this is essential to the reader
• Study design
• The design of the research presents an appropriate aspect under investigation and there is clear connection between these issues and the literature review.
• Methodology
• A thematic analysis and narrative synthesis were incorporated in the research methodology of the research whereby this means that no qualitative or quantitative research was performed.
• Data analysis
• In analyzing the data, the researcher needs to incorporate a strong method in order to reach for the appropriate themes revealed throughout the research. The author did not incorporate the analysis of the articles that presented the best argument and research.
• Data representation
• No data representation was carried out in the research and this could have been reached through a table indicating comparison, critic and support to the arguments presented in the articles reviewed.
• Conclusion and recommendation
• Despite the fact that the paper presents the issues evident in the research, the author did not come up with substantial recommendation to help on what actions need to be undertaken in dealing with these issues.
• Limitation of research
• The article did not present adequate information on the challenges that faced him/her during the research and this is equally essential to the other researcher who would like to conduct a similar research in future.
• Readability
• The article has an appropriate format whereby in the abstract, the author has indicated the key aspects such as background, design, methodology, findings and recommendations.
• Chapter 6
• Analysis
• The themes evident from the review of different article are as below;
• Impact of Chinese culture on care management of the frail elderly in the society
• Transitional to residential care centers
• Pain management in elderly Chinese care centers
• Importance of managing falls among the frail elderly
• Alternative long care means for the frail elderly
• Intervention of government to elderly care
• Linking social and healthcare for the elderly
• Training of nurses in care management
• Fishbone diagram
• Theme 1. Training of nurses in care management
•             Training of nurses or the care managers was one of the key themes evident when reviewing articles. In this case majority of the articles have discussed on updating the knowledge of the nurses through training in order to ensure that the quality of service provided to the elderly people. A higher percent 46% of the articles reviews carried out suggested that training was amongst the strategies that need to be incorporated in care of the elderly to ensure that they acquired quality services. Melby, & Ryan, (2005) explain that the services offered to the elderly in many regions are of low quality and can be improved if measures are put in place to ensure that those offering these services understand the health as well as social requirements of the elderly. The issue of having trained nurses as perceived in the review undertaken from different journals is a major emphasis from different authors or rather researchers who have studied the services offered to the frail elderly in the society and their recommendations is how well the health department can reach for this initiative. Gao, Chan, & Cheng, (2012), are other authors who remarked that the healthcare sector has greatly improved and the elderly should be provided with the quality of care they need. The recommendation of these authors is that the government needs to intervene and ensure that training programs are facilitated to the nurses with responsibilities of taking care for the frail elderly in the society. In accordance to the views of the authors of these articles, training the frail elderly will ensure that the nurses or the care managers understand the actions they are supposed to take when the health condition of the elderly person worsens as well as to determine the improvement of the old people. In addition, the care managers need to distinguish on the social requirements that the elderly people and be in a position to facilitate these requirements in an appropriate manner.
• Theme 2. Alternative long care means for the elderly
•             Fifteen percent of the articles reviewed in this research indicated that the frail elderly people require long term care since they remain to be vulnerable and the only mans being facilitated for taking care of them is through hospital units which prove to be more costly. Melby, & Ryan, (2005) for instance explain that the elderly people may be easily infected with certain ailment and be subjected to malfunctioning of a particular organ and this requires that they are closely mastered and taken care of. As majority of the authors of these articles reviewed in the research suggest, the current initiative of the elderly being taken care of in hospital units remains to be expensive and there are other alternatives that can be applied to care for the elderly in the society. Integrated care managing in the community facility was the most proposed alternative that was suggested to ensure that the elderly access high quality care at lower costs. The effectiveness of this strategy as Abley, (2012) explains is that the method is cost effective and it ensures that the frail elderly are well catered for when it comes to delivering both social and health care services. The communal care facilities will ensure that the problems of the frail elderly people are well catered for and that they feel that they are part of the community and not being secluded by others. This follows the fact that the government is also working on the initiative to develop the urban regions such as Hong Kong and the elderly are amongst the poor whom houses are being demolished to develop the region maybe offered with a solution of providing them with integrated health care. In addition, other authors also suggested that the alternative of stabling more homecare and supporting the existing care provided in homes to ensure that the elderly receive quality health and social services. All these alternatives offered in the articles reviewed have the key advantage of reduced expenses or costs and the fact that the elderly will feel more close to the other members of the community than being in hospital units where they feel separated from the rest of the community members.
• Theme 3. Intervention of government to elderly care
•             Out the articles reviewed, a good percent of these articles indicated that the government has a great influence on the provision of care to the frail elderly in the community whereby Bergland, (2012) explained that the elderly people in the community are also vulnerable if they do not get quality services and the government is the only department that can ensure that the services provided to the elderly are upgraded. The authors of the articles propose that the government need to ensure that the elderly are out of any risks through providing support in terms of resources and funding thus ensuring that the facilities that provide these services to the elderly people are developed. For instance, Melby, & Ryan, (2005) remark that the government need to ensure that training for the care managers is implemented to facilitate the required skills in handling the special cases of the elderly people. In this case, the recommendations from seventy percent of the articles involved the government in the responsibility of facilitating adequate and easily accessible services to the elderly as well as supporting the healthcare institutions focused in offering these services to the elderly. The effectiveness of this recommendation is that once the government sets focus towards improving the social and healthcare services provided to the elderly people, then majority of the elderly being taken care of in hospital units will be transferred to homecare or integrated care management services in the community thus ensuring that the hospital beds occupied by these elderly in hospitals are freed. Numerous articles also suggested the fact that it is through the intervention of the government that the homecare or communal facilities established for the frail elderly in the community follow the required protocol and legal requirements thus instilling high standard of service to the elderly. Moreover, without the government financing the institutions offering the healthcare and social services to the elderly, the facilities will lack the expertise and technology (standard of development) required to facilitate the provision of quality services.
• Theme 4. Linking social and healthcare for the elderly
•             A greater percent defined and explained care for the frail elderly in the society as not only incorporating healthcare services but also social services. For instance, Abley, (2012), explains that the elderly people in the society are in need of the social care whereby they need the comfort and encouragement from the other members of the society. Healthcare services are a requirement to the frail elderly whereby they need to be taken care of following their deteriorating health. The elderly may provided with high quality healthcare services but without the social care form the community, they feel that they are not satisfied. In other cases, some of the articles reviewed acknowledge the fact that the elderly in the community have great importance and they have to be in a position to access quality health and social services. In this case, the authors of different articles explain that the role of care manager is primarily to ensure that the elderly are provided with adequate and high quality services and taking care of their social needs. Gao, Chan, & Cheng, (2012) discussed that the persons taking care of the elderly people need to be trained on how to take care of the elderly in order to ensure that they have reduced risk rate and this can only be facilitated through appropriately determining and linking both services to ensure that they satisfy the patients. Some of the articles reviewed and especially journals indicated that a great gap existed between the social and health services whereby either of the two services are not provided to satisfaction and failure to ensure the balance results to low quality services to the elderly. The ability of the elderly being in a position to enjoy social services reduces the chance of developing health complications such as depression and falls and this explains the reason why social care is greatly enhanced in care management facilities. Majority of the frail elderly are in medication and the care manager should ensure that the patient takes the medication as prescribed by physician or doctor and failure to follow the appropriate procedure might lead to health complications to the patient.
• Theme 5. Impact of Chinese culture on care management of the frail elderly in the society
•             Some of the Chinese cultural aspects were identified by 20% of the study to be some of the factors that hinder provision of care among the frail elderly in the society. The act of giving care in the society in most cases tends to be bound firmly on the different cultural point of view. According to the Chinese culture women mainly do the responsibility of giving care to the elderly. Some of the study indicated that the women in most cases the women experienced poor physical and psychological health. The various compelling cultural factors in most cases make the women continue with the role of the caregivers and at same time create stress among the women. Most of the men in the Chinese culture do not take the responsibility of providing care to the frail in the society. According to Chan and Chui, (2011) most of the men are more likely to take their frail elderly to the care providing institution than their female counterpart. Moreover the marital satisfaction is another factor that can affect care giving among the frail elderly in the society. In this case a good marital relationship leads to commitment to care provision. In addition a good quality care among the Chinese elderly is also related to the love that exists between the couple. However it is important to note that the provision of care to the frail elderly in the society should not be related to the culture. There is therefore need for the Chinese people to be educated on the importance of abandoning some of the retrogressive culture aspect that hinder provisions of care to the frail elderly in the society.
• Theme 6. Managing transitional to the residential care centers
•             The issue of managing the translational to the residential centers is another major issue that came up in the study of the articles. According to the Kee-Lee (2005) most of the Chinese currently prefer to take their elderly people in the residential centers. In relation to this it is estimated that over 40,000 elderly people were residing in over 400 centers (Lee, 1999). Moving to the residential centre has been described as one the difficult problems facing these elderly people. Admission to the elderly centers has been known to evoke a feeling of abdomen and stress among the elderly. In relation to this most of the Chinese elderly people regard the admissions to the residential centers as sense of parental failure and loss of respect. This is because according to the Chinese traditional value primary care and basic support should be part of the family care. Relocation to the residential care centers causes decreased physical and social satisfactions, depressions and in some cases suicidal risk   among others (Lee, 1999). Due to the various problems that these elderly people when they moved to these residential centers there need the healthcare providers to ensure that they implement measure to help these people to deal with these problems. In this case there is need for heath care provider to ensure that they help these elderly people to establish relationship upon admission to these residential care centers. This is because most of the newly admitted elderly people in the residential centers preferred to stay alone most of the time. In addition most of the elderly people residing in the residential care centers also complain of being harassed by the nurse the staff in these centers. This implying that there is need to ensure that the staff improve communication with these frail elderly.   It is therefore possible to argue that there is need for the Chinese government to ensure that they develop measure to assist the elderly people going into these residential centre cope up with this new environment.
• Theme 7. Pain management among the frail elderly in Chinese centers
•             Most of the article argues that the pain is one of the factors the major problems that the frails elderly in the society undergo. According to Kee-Lee (2005) pain in most case is related to depressions where the elderly people have a decreased interest in the participation in the daily activity. Pain in the old age is often accompanied by withdraw from social activity. However it is important to note that participation in the social activity is crucial for the maintenance of the psychological well being of an individual. Reduction from the social activities also causes lead to detrimental effect related to depression. Siu Lun Chow et al., (2004) notes that pain among the frail elderly in the society is one of the predictor of depression that an individual is going through.
•             Reducing the amount of pain among the frail elderly in the society can help to improve the quality of life of these people. In order to help to these elderly people deal with this problem there is need for the care provider to assert to these groups of people that the pain is normal part of aging and must be tolerated. There is also need for the caregivers to concentrate on the indentifying the physical and psychological risk factors that cause pain   on these frail elderly in the society. In addition there is also need for care providers to ensure that they assess all the possible causes of pain so that any serious problem can be treated early enough. Since from the study it has been demonstrated that pain and depression are related therefore need for the care givers to ensure that they implement measures to ensure to help deal with these two major problem facing the frail elderly in the residential centers.
• Theme 8. Importance of managing falls among frail elderly
•             Many of the article also insist that fear of falling is another major condition that affect the aged populations in the society. Fear of falling has been established to range between 25% to 50 % of all the elderly people especially in the residential care centers (Kuzuya, et al., 2006). The fear of falling in the old age is also often accompanied by withdraw from the various social activities. Reduction in the social activity is known to affect the psychological well being of an individual especially later in life. In relation to this fear of falling has also been known to cause depression among the frail elderly in the society, which further affect their quality of life of these groups of people.
•             Order people who have suffered falls are at risk of suffering falls again in the course of their lives. According to study done by Ka ching et al., (2006) 325 elderly people who were admitted due to falls indicated that they had experienced falls at least once in their lives. It has also been established that the older people admitted to hospital due to illness experienced falls after being discharged from the hospitals. Most of the elderly people with the cognitive impairment and other neurological condition are also reported to have high incident falls. In addition the risks of falls among the elderly people are also increased in the incidents of nutritional deficiencies. In this case it has been established that lack of vitamin D is another major cause of increased falls among the frail elderly in the society. Various environmental factors also increase the risk of falls among the frail elderly living in the community. The environmental factors affect these old people since most of them have problem related to sight and lack of body balance. With regard to the environmental hazard such poor lighting, slippery floor are known to increase chances of falls. Some of the footwear and clothing also increase chance of falls among the elderly people (Sihvonen, et al., 2004).
•             Moreover lack of appropriate assisting devices also increases incident of falls among the frail elderly in the society. Considering the various risk that causes falls among the elderly people there is therefore need for the care givers to ensure that they implement measure to help reduce these incidence of falls. One of the possible intervention measure is through ensuring that these elderly people provided both physical and health support to enable them deal with the challenge. In addition the group based exercise and nutrition supplement can help the frail elderly to deal with this challenge.
• Explain what all your articles tell you when you pull the theme together
•             Considering the above indentified themes then it is evident that there is need for care givers to ensure that they adopt integrated care in order to helps these frail elderly in the society. In relations to this there is need for the Chinese government to implement measure to ensure that the frail elderly in the country are provided with the necessary care and support to help them deal with the challenges that come with the old age.
• Chapter 7
• Discussion
• What do they themes identified above mean
•             Majority of the articles reviewed and discussed have similar themes in accordance to the care that the elderly need to be provided with as well as the problems that face frail elderly in the society. In this case, most of the themes are upon the risks and causes that the frail elderly are subjected to in the society. Poor healthcare and social services are some of the factors that lead to increment of these risks whereby the frail elderly are seen to require more attention than any other population in the society. The health issues facing the frail elderly in the community include such aspects as depression, falls resulting to injuries due to lack of an appropriate care for these persons. The responsibility of the government in this case is inevitable considering the fact that it is supposed to fully support programs implemented for ensuring that the elderly have unlimited access to the services they need, whether in private or public organizations. The themes as implicated in the articles also address on the issue of cost of these services and as well as the manner which hospitals have been pre-occupied by the frail elderly due to lack of proper care back in the society. This implies without developing or implementing alternative measures of dealing with the increasing population of the frail elderly people in the community will lead to hospitals and other healthcare facilities being overwhelmed by the increased elderly people seeking for care in the hospital units.
• Implication of the practice
•             The implications of practice in this case address the steps that need to be undertaken to improve the quality of care provided to the elderly in the community. In this case, the role of each individual or department is clearly identified in ensuring that the frail elderly do not suffer and that they feel secure, protected, and well cared for by the entire community. The suggestions in this case implicate how more community facilities should be set up to deal with this issue as well as ensure that hospitals are lessened the burden of caring for the frail elderly whereas this can be effectively performed through setting or increasing integrated care management homes for the elderly. Moreover, the expertise required in facilitating the level of care for the elderly is also an issues being addressed whereby it would be essential for the care managers as well as healthcare practitioners to ensure that they have the right level of knowledge to facilitate or provide high quality services to the elderly. Healthcare policy is also essential in facilitating the environment for improving the standards of operations to improve the quality of services offered to the frail elderly in the community. Community members should also ensure that they visit as well as involve the elderly in the social activities for them to feel that they are highly valued, accepted, and supported by the community not just seeing them as dependants. The process of government developing rural and urban regions which includes destroying the old structures especially the homes of the elderly should be practiced through first ensuring that it will not affect the elderly negatively.
•             The findings from the research have advanced knowledge and skills in understanding the requirements of the frail elderly and gaining more understanding on how the elderly can be taken care of without causing any health related problems. The community is full of the elderly people and the knowledge from the findings has implicated the different strategies that can be incorporated to ensure that the elderly are satisfied with the services they get. Old age is not a choice but a situation that every person is subjected to and as a practitioner in the healthcare sector it is important to boost the campaigns to increase the concern of the government as well as for each individual in the society on how well they can help the elderly lead happy life with reduced risks. The major risks that the elderly are exposed to due to lack of quality healthcare and social services are health problems since both social and healthcare concerns are essential and failure to provide either of them might lead to these problems. The needs of the frail elderly are similar and distinct as compared to those of the other persons since they require more attention and close supervision. This is because the mental strength of the elderly reduces as they continue to age and they have to be led on how to perform certain activities. Their needs also increase as they continue to age and especially the healthcare needs. The effectiveness of setting up and effectively managing care management facilities in the community is also evident in ensuring the services required by frail elderly persons are easily accessible.
• Benefits of the research to patients, their families, professionals and theorganization
•             The benefits of the research findings to the patients are generally the concern to campaign on the improvement of service quality and ensure that their needs are properly addressed. The patients in this case are the frail elderly in the community and this research will only provide a call for intervention of the government as well as other private organization in ensuring that the needs of these patients are clearly addressed in order to keep their health in shape. The research is also essential to the professionals in the healthcare sector as well as others in the departments concerned with the issues of elderly people in the community. The research educates them on the different vulnerabilities as well as the need to take care of the elderly in a special way through incorporating initiatives such as integrated care management with qualified managers. As for the healthcare organizations or any organization offering care to the elderly such as home cares and hospitals, the research emphasizes on the need to ensure that they clearly understand the needs that the elderly have both social and healthcare needs. Both the professionals and the organizations involved in providing care services to the elderly will clearly understand the strategies to apply in order to ensure that that the elderly have easily accessible services at subsidized costs through working with the government and campaigning for more concern to be channeled to the frail elderly in order to reduce the health risks.
•             The theme emerged relate to the background in several ways. First in the background it was indentified that the elderly people are faced with various problems in Hong Kong today. This is because most of these people are forced to relocate from their old building to pave was for the city development. One of the themes that relate to this problem is the lack of family support on these frail elderly. From the background it was indentified that the elderly people are deprived environmental support where most of them are not given a chance to interact with their peer. In this case the theme of managing fear of falls relates to this factor since it is evident lack of proper social support is one of the major causes of falls among the frail elderly.
•             Moreover in the background chapter, this paper had indentified that the elderly people in Hong Kong are faced with several risks hence the need for care system to be adopted. In this case one of the themes that have been indentified that relate to this issue is the need for the various institutions to implement measures to help the frail elderly adapt residential care homes. This can be linked to the fact that most of the elderly people who are taken in the residential care homes are faced with the challenge of coping with this new environment. Most importantly the background of this paper relates to themes since it bring out the importance of the integrated care among the frail elderly. Incorporation of the integrated care can help to ensure that these frail elderly are able to deal with the challenge associated with aging.
•             The research has only incorporated the risks that the frail elderly are exposed to when they are not facilitated with high quality health and social care as well as the need to ensure that the elderly are well catered for. In this case, further research is essential especially in determining how effectively the recommendation facilitated in the research as well as in other researches by certain professionals can be implemented without any problem or with few problems. Despite the fact that the research has studied and analyzed on the essential requirements of frail elderly in the community, poor implementation of the strategies proposed might lead t other problems instead of facilitating solution to the impending dilemmas. More research on the effectiveness of the proposed strategies is also essential in educating the society as well as earning support from the government on how well the issue of care for the elderly can be handled in the society. A clear comparison of each strategy and the current strategies is also important in this case. Further research to be carried out should include a review of whether the proposed strategies already incorporated in the care institutions are proving effective and worthy for the practice.
• Ethical implications of the study
•             From what has been identified in the study it is evident that some of the Chinese cultures are unethical since they do not promote access to quality care among the frails elderly in the society. According to the Chinese culture it is the role of women to provide care and support to the frail elderly in the society. However this is unethical since the men also need to take part in caring of these friar elderly in the society. Overburdening the women in the society with the role of providing care to the elderly causes psychological distress and may lead to stress. Failure to provide care to the frail elderly as evident among the youth is unethical issue since it is even against human rights. There is need for the young people to be taught on the importance of providing care and support to these frails elderly members of   the society. This can help to ensure that the frail members are provided with the necessary care and support.
•             Moreover from the study it is evident that it is unethical for the relative to take the elderly to the residential care centers without subjecting them through counseling. This is because from what has been identified in the study when the elderly people are taken in the residential care centers most of them are faced with the challenge of adopting to this new environment. In addition lack of the Chinese government to have proper mechanism to help care for the frail elderly in the society may also been seen to be unethical. Considering the various role that the elderly people play in the society it is there possible to argue that there is need for all the stakeholder to ensure that the these elderly people are accorded the respect they deserve.
• Limitation of the study
•             One of the limitations of the methodology adopted in this study is complete overreliance on the previously published material. This overreliance on the already published material affected the depth of this research since it was not possible to come with new data apart from what is there. The search criteria indentify on the methodology also limited the depth of research since it was not possible to search for the material outside the search criteria outlined in the methodology. In this case some of the studies on sociology were excluded from the study since they did not meet the search criteria. Another major limitations of the methodology adopted in this study is the fact that it was not possible to understand some of the concept provided in some articles. For instance on the article ‘Reciprocal relationship between pain and depression in elderly Chinese primary care patient’ (Kee-Lee & Chi, 2005) it was not possible to establish the reciprocal relationship that the author was trying to present in his argument. However the article was included in the study since it helps to bring out the theme of importance of pain management among the frail elderly in the society.
•             Another major limitation of this study is the fact it was not possible to test the claim presented in this paper on the importance on the role of integrated care among the frail elderly in the society through an experimental research. Failure of some of the article to provide sufficient information regarding the topic of study is another major challenge that was experienced while conducting the research. This can be linked to the fact that very few articles talked on the care of frail elderly in the society rather most of them only argued on the care for the elderly only. In addition it is evident that it was not possible for one to understand some of the vocabulary used by some authors, which further limited the scope of this study.
• What I have leant regarding the topic
•             This study has helped me to understand some of the challenges that the frail elderly people undergo in the society. In this case I have been able to learn that the current young generations in Hong Kong have in way neglected the frail elderly in the society where many of them opt to take them to residential homes. When the elderly people are taken in the residential homes many of them take a lot of time to adapt. I have also learnt there is need for the elderly people to be given both social and health supports to enable them cope up with the various challenges. Moreover I have also learnt that falls is one of the common occurrences among the elderly people in the society. Most of the frail elderly suffer from fear of falls and hence the need to implement measure to help them cope up with these challenges. Pain is also part of aging hence the need to convince these elderly people that it is normal. However there is also need for the care provider to commit effort to help reduce the pain among the frail elder. I have also leant that some of the Chinese culture undermine provision of care and support to these frail elderly in the society. Finally I have also leant there is need for the care providers to ensure that they minimize incidences that might cause depression among the frail elderly in the society.
•             Moreover I have also been able to increase my research skills. In this case I have been able to increase my knowledge on the most effective method of carrying out research. The research skills I have gained in this study will help to further my studies more especially with regard to the provision of integrated care among the frail elderly in the society. Most importantly the finding presented in this study will help to explain the need for having an integrated care.
• Chapter 8
• Conclusion
•             Care for the frail elderly is an aspect that has been neglected in some regions or countries and the fact that the elderly require to be provided with both social and health services remains an issue that has not yet been properly addressed. In Hong Kong for instance, the elderly population is increasing at a high rate similar to other big cities and countries such as in Australia, Europe, and America. In Hong Kong the developments being carried out by the government are affecting the stay of the elderly people in urban cities since the old house are being brought down to facilitate space to build newly developed models. The elderly are among the poor and the dependent in the society and this makes them lack the financial support to access the services they need. Research carried out by different authors indicate that the frail elderly are subjected to the risk of developing health problems such as depression and falls which cause injuries due to the fact that they do not have access to high quality services from both healthcare and social dimensions. The most effective and recommended strategy that can ensure that the frail elderly in the community are well cared for is through the government facilitating initiatives to support the development of care management facilities in the community. This will ensure that the elderly people in the society can join the communal facility and have access to the services they need. This is also a solution to the congested hospitals following the fact that the frail elderly taken care of in hospital units can now be transferred to the care management homes where they can be well taken care of since the managers in this case have only one obligation of ensuring that these elderly persons get the services they need. Hong Kong has not yet fully incorporated this intuitive and this has led to the elderly people being in risk of health problems. The government of the region is obligated to intervene in the care management for the elderly through providing financial support as well as ensuring that the care managers are well trained to handle the cases of elderly people. The government should also implement a healthcare policy that governs and ensures that the elderly people in the society are well taken care of and that the other members of the community recognize that the elderly are still members of the community who need the care from every member. Through incorporating care management facilities in the government ensures that the elderly reduce dependency from other members of the community since the care facility can facilitate to fulfill the needs of the elderly people. Having the issue of increased frail elderly people in the community who lack proper care is a problem that is not only facing the developing countries but also majority of the developed countries are subjected to this problem. Therefore, as per the results or findings of the research, the only alternative that can be incorporated to deal with this problem is through establishing the integrated care management homes for the frail elderly.
• Recommendation
•             Considering the above raised themes there is therefore need for the healthcare providers to adopt an integrated care for the frail elderly in the society. Adopting an integrated care can help to ensure that the frail elderly are provided with the necessary social support they require. Providing these elderly people with the necessary social care and support can help to minimize incidence of depression, which are common among these groups. In relation to this paper argues that there need for the care providers to ensure that they convince these frail elderly that pain part of aging and therefore they need to accept this fact. However there is also need for the care providers to ensure that they implement measure to help minimize the incidences that can cause pain among these groups.
•             During transition to residential care centre there is need for the care providers to ensure that the provide the frail elderly with the necessary counseling to enable them cope up with this new environment. Providing counseling to the frail elderly who have been transferred to the residential care centre can help to eliminate the feeling of being abraded. In relation to this providing counseling to the frail elderly who have been transferred to the residential care centers can help to ensure that they are able to make new peer. While at the residential care centers there is need for the care providers to encourage the frail elderly to participate in social activities in order to keep their body health.
•             From the above it was also evident that most of the young generations in Hong Kong have not committed effort toward providing care and support to these frail elderly. There is therefore need for the government to develop measure to convince the youth on the importance of providing care to these frail elderly in the society. It is also evident that most of the private residential care centers do not provide the necessary care and support to the frail elderly. This implies that the Chinese governments need to implement measure to ensure that the elderly people in the private residential homes are provided with the necessary care and support.
•             Traditional Chinese culture is also another fact that is indentified in this paper to be one of the factors that hinder provision of quality care to the elderly. There is therefore need for the government and the different stakeholders to commit effort towards ensuring that they discourage this retrogressive culture aspect that hinder provision of quality. In addition this paper also suggests that there is need for all caregiver involved in provision of care to the frail elderly in the society to be well trained on the principles of integrated care. This can help to ensure that all the frail elderly are provided with the necessary support they need. Finally, this paper suggests that there is need for more research to be done with regard to the provision of care to the elderly to help in developing long-term solutions to this issue.
• Abley, C. (2012). Responding to vulnerability in old age: patient-centred care. Nursing Standard,             27(9), 42-46.
• Adapa, S. (2013). Circumstances Probing Internet Banking Users to Use Alternative Channels:    Thematic Matrix Display Analysis. Information Management & Business Review, 5(1),          1-12.
• Andersen, R. M (1995). Revisiting the behavioural model and access to medical care: does it        matter? J Health Soc Behav; 36:1-10.
• Australian Government. (2008). Ageing and Aged Care In Australia. Department of Health          and Ageing :             http://www.health.gov.au/internet/main/publishing.nsf/Content/BFE46F21A3241ECB            CA2574BE001A6E06/$File/Ageing_and_Aged_Care.pdf
• Bergland, A. (2012). Fall risk factors in community-dwelling elderly people. Norsk            Epidemiologi, 22(2), 151-164
• Bodenheimer T. (1999). Long-term care for frail elderly people—the On Lok model. N Eng J       Med; 341:1324-8
• Bound, J & Gardiner, P (2002). Hospital readmissions. Return to sender. Health Serv        J;112:26-7.
• Capitman J. (2000). Effective co-ordination of medical and supportive services.     Commissioned Paper for the Home Care Research Initiative at the Visiting Nurse             Service            of New York, in progress.
• Case management pilot scheme in community nursing service (1995). Revised CBNS S/C             paper 1/6/95. Hong Kong SAR: Hospital Authority.
• Chan, C., & Chui, E. (2011). Association between cultural factors and the care-giving burden for             Chinese spousal caregivers of frail elderly in Hong Kong . Aging & Mental Health,             15(4), 500-509
• Chui, E. (2001). Doomed Elderly People in a Booming City: Urban Redevelopment and Housing             Problems of Elderly People in Hong Kong. Housing, Theory & Society, 18(3/4), 158-166
• Chui, E. (2008). Introduction to Special Issue on ‘Ageing in Place’. Ageing International, 32(3),   165-166.
• Coleman, E.A. (2003). Falling through the cracks: challenges and opportunities for            improving transitional care for persons with continuous complex care needs. J Am         Geriatr Soc.51:549-55.
• Gao, L., Chan, S., & Cheng, B. (2012). The past, present and future of nursing education in the    People's Republic of China: a discussion paper. Journal Of Advanced Nursing, 68(6), 1429-1438
• Gildberg, F. A., Elverdam, B. B., & Hounsgaard, L. L. (2010). Forensic psychiatric nursing: a      literature review and thematic analysis of staff–patient interaction. Journal Of Psychiatric    & Mental Health Nursing, 17(4), 359-368
• Graffy, J& Grande, M. (2008). Case management for elderly patients at risk of hospital     admission: a team approach. Primary Health Care Research & Development 2008; 9: 7–13doi: 10.1017/S1463423607000564
• Ka Ching Yeung, F., Kee-Lee, C., & Wong, E. H. (2006). Characteristics Associate with Fear of Falling in Hong Kong Chinese Elderly Residing in Care and Attention Homes. Clinical       Gerontologist, 29(3), 83-98.
• Kane, R.L, Illston, L.H &Miller, N.A. (1992). Qualitative analysis of the program of all-   inclusive care for the elderly (PACE) The Gerontologist.32(6):771–80
• Kee-Lee, C., & Chi, I. (2005). Reciprocal relationship between pain and depression in elderly       Chinese primary care patients. International Journal Of Geriatric Psychiatry, 20(10),             945-95
• Kuzuya, M., Masuda, Y., Hirakawa, Y., Iwata, M., Enoki, H., Hasegawa, J., & ... Iguchi, A.        (2006). Falls of the elderly are associated with burden of caregivers in the community. International Journal Of Geriatric Psychiatry
• Kwok T, Lau E, Woo J, Luk JK, Wong E, Sham A, et al (1999). Hospital readmission among       older medical patients in Hong Kong. J R Coll Physicians London.33:153-6.
• Landi, F, Gambassi, G, Carbonin, P. U & Bernabei, R. (2000). Nurse case management of           frail older people. J Am Geriatr Soc.; 48:596-7.
• Lee, D. (1997). Residential care placement: perceptions among elderly Chinese people in Hong     Kong. Journal Of Advanced Nursing, 26(3), 602-607.
• Lee, D. (1999). Transition to residential care: experiences of elderly Chinese people in Hong         Kong. Journal Of Advanced Nursing, 30(5), 1118-1126.
• Lee, D. F. (1999). Transition to residential care: experiences of elderly Chinese people in Hong Kong. Journal Of Advanced Nursing, 30(5), 1118-1126.
• Lee, W. K (2004). Living arrangements and informal support for the elderly: alteration to intergenerational relationships in Hong Kong. J Interge-ner Relatsh; 2:27-49.
• Leung, A. (2006). Case management for at-risk elderly patients: a review. Asian J Gerontol           Geriatr 2006; 1: 150–6
• Leung, B. L., Ma, T. W., & Ng, C. M. (2009). Linking Elderly to Holistic Care Services through Integrated Communication Technology: The Personal Emergency Link Service Rendered       by the Senior Citizen Home Safety Association in Hong Kong. Journal Of Technology   In Human Services, 27(1), 34-43.
• Leutz, W.N, Greenberg JN, Abrahams R, Prottas J, Diamond L & Gruenberg L. (1985).    Changing health care for an aging society: planning for the social health maintenance             organization. Lexington, MA: Lexington Books.
• Long term care for the frail elders (2001). EC/D/5-01:Restricted paper. Hong Kong SAR:             Elderly Commission.
• McMaugh, A., Sumsion, J., Symes, C., & Saltmarsh, D. (2006, March). From Ethics in Research   to Ethics in Writing: Not entirely separate matters. Asia-Pacific Journal of Teacher        Education. pp. 1-3.
• Melby, V., & Ryan, A. (2005). Caring for older people in prehospital emergency care: can nurses make a difference?. Journal Of Clinical Nursing, 14(9), 1141-1150       
• Meltzoff, J. (2005). Ethics in publication. Journal Of Aggression, Maltreatment & Trauma,            11(3), 337-355.
• Miller, J. E., Patterson, E. S., & Woods, D. D. (2006). Elicitation by critiquing as a cognitive        task analysis methodology. Cognition, Technology & Work, 8(2), 90-102.           
• Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M &Pauly M. (1994).   Comprehensive discharge planning for the hospitalized elderly. A randomized clinical             trial. Ann Intern Med; 120:999-1006.
• Patton, M.Q. (1990). Qualitative evaluation and research methods. Second Edition. Newbury       Park, London and New Delhi: Sage Publications.
• Rich, M. L. (1999). The PACE model: description and impressions of a capitated model of           long-term care for the elderly. Care Manag J; 1:62-70
• Ryan, F., Coughlan, M., & Cronin, P. (2007). Step-by-step guide to critiquing research. Part 2:     qualitative research. British Journal Of Nursing, 16(12), 738-744
• Sihvonen, S., Sipilä, S., Taskinen, S., & Era, P. (2004). Fall incidence in frail older women after    individualized visual feedback-based balance training. Gerontology, 50(6), 411-416.
• Siu Lun Chow, E., Ming Hei Kong, B., Tak Po Wong, M., Draper, B., Ka Leung, L., Ho, S., &    Chun Por, W. (2004). The prevalence of depressive symptoms among elderly Chinese       private nursing home residents in Hong Kong. International Journal Of Geriatric       Psychiatry, 19(8), 734-740
• Wieland, D. (2001). Program of All-inclusive Care for the Elderly (PACE). In: Mezey MD,          editor. Encyclopedia of elderly care: the comprehensive resource on geriatric and social   care. New York: Springer; 531-3.
• Wilkinson, K. (2011). An age-old problem: care of older people undergoing surgery. British                      Journal Of Hospital Medicine (London, England: 2005), 72(3), 126-127.
• Woo J &Cheung A. (1993). A survey of elderly people discharged form hospital. J Hong Kong   Med Assoc.45:291-7.
• Y. F., H. (2000). The Case In Hong Kong. Ageing International, 25(4), 47.
• Appendix 1.0: Critique of different articles 1-10

Using the findings in practice

How themes that emerged relates to the background

Need for further research

 

Reference

1. Ka Ching Yeung, F., Kee-Lee, C., & Wong, E. H. (2006). Characteristics Associate with Fear of Falling in Hong Kong Chinese Elderly Residing in Care and Attention Homes. Clinical Gerontologist, 29(3), 83-98.
2. Aim

The aim of the study was to indentify the correlation between that the fear of falling in Hong Kong Chinese elderly residing in care and attention homes. According to the author of the article it is evident that the fear of falling has impact on the physical and the psychological well being of an individual especially in the later life.

Background Ka ching et al., (2006) indicates that about 22% of the community-dwelling elderly people aged 65 and above fall once in their lifetime. Falls in Hong Kong had been identified as one of the leading causes of accident in acute care setting. Moreover the author notes that the rates of falling is high for institutionalized elderly people than the community dwelling. In relation to this it has also been established that the fear of falling is common even older persons who have not experienced falls

Methodology A quantitative methodology was adopted in the study. All the participants recruited in this study were taken from the selected care and attention home. The residents included in the study were aged 60 and above who were not suffering from any infectious diseases. In order to ensure that each resident had the required comfort each of the elderly people were provided with a private room a bed and cabinet

Research design College student were recruited in order to conduct face-to-face interview with the respondent using a structured questionnaires. The questions used were close-ended questions. The fear of falling was measured on how the respondent answered the questions

Ethical consideration The ethical consideration was also made since the interviewee in this case was human being. Each of the respondents in the study was first informed on the aim of the study and what is required from them. The research showed that the fear of falling was significantly associated with the self-related health insight, chronic injury, sight and the body balance. The authors of the article note that the age, sight, and injury are the most recent causes of fall among the elderly people in Hong Kong. In addition, the authors of the article also notes that fear of falling some cases causes the elderly people in the society to stay indoors. Finally according to Ka ching et al., (2006) the overall result demonstrates that the fear of falling is linked to the social demographic and the health related factors.                                                                                       From the recommendation presented in the article it is evident that there is need for the planners to implement policies to help in providing counseling services to the frail elderly in the society.   This can   help to reduce the fear related to falls. In relation to there is also need for the health care providers to incorporate counseling programs to the elderly who experience accidents. The author of the study aimed at determining the prevalence of the significance depressive symptoms among the a group of Chinese people who were living in the private nursing home The depressive symptoms are common among the elderly people in Japan where it is estimated that the conditions affects 29% of men and 41.1% women. Local data in Hong Kong also indicate that the institutionalized care is the most leading cause of the risk of depression. According to Siu Lun Chow et al., (2004) most of the public care institutions are well funded by the government and therefore they are able to deliver quality services to their clients compared to the private nursing home Terms of reference refers to the statement that the researcher was trying to answer through carrying out the study. In this case the author aimed at establishing the possible factors that were responsible in causing high incident of the risk factors among the elderly people living in private nursing home. The researcher used the qualitative data collection methods where inclusion and exclusion criteria was first established. The Chinese Abbreviated Mental Test Score was used as one of the screening tools. In relation to this all the resident below the age of 65 were excluded from the study. All the participants of the research were first informed on the detailed of the study, in addition all the interviewee were also guaranteed that the information they would give would be kept private and confidential. The research presented the result in a table format where the risk factors, number of depression cases were recorded. The probability of the depression value on the elderly admitted in these private nursing homes was also established. The result from the article indicated that the depressive symptoms were common among the elderly living in the private nursing homes. The physical disabilities as well as the social economic factors were identified as the most leading factors that cause depression among the frail elderly.   The researchers concludes that there is need for the government to commit effort toward ensuring that they continue to fund even the private nursing to ensure that these eldery people are given quality care Analyses of the information presented in the article it is evident that the article has a considerable high readability which allows the reader to understand the information presented in the article 9. implication of the study This study helps in highlighting the importance of the government ensuring that the elderly people in the society. this is because failure of the government to supervise services offered to the elderly living in the   private nursing homes The author of the article aimed at establishing whether there is any relationship between pain and depression mediated by the social support, functional capacity or withdrawal from the social activities. Another major aim of the author was to establish the link between depression among Hong Kong Chinese elderly primary care patient. Pain and depression is common among the elderly people living either institution or home based care setting. Various study have managed to show that the relationships between pain and depression among the elderly people in the society. Pain in the old age is often accompanied with withdrawal from the social activities. According to chin and Kee-Lee (2005) the social activities are significant in maintaining well being of an individual. Qualitative technique was used in this study. In this case a longitudinal study was conducted for a period of year where the data was collected from the control groups The ethics and research committees of Hong Kong university approved the study design. In relations to this researcher also informed the entire participant their role before commencing with the data collection. In addition the interviewers were also guaranteed that their personal detailed would be held confidential. In order to investigate the relationship between the pain and depressions mediated by the social support the 18 health care centers in Hong Kong were included in the study. The participant in the study were selected randomly in order to avoid data bias during data collection Various statistical data analysis method was applied in order to obtain relationship between the factors under the study. Application of the different statistical technique is one the factor that shows that the study was done in consistent with the scientific procedures. From the study the researchers was able to establish that there is a reciprocal relationship between the pain and depression. From the study it was evident that the impact of pain on depression was statistically significant even adjustment of the age, gender, marital status and the educations levels of an individual. The study also indicated that the participants who were indicated to have pain in most case also had depressions The researchers in this article indicate that there is a considerable relationship between the pain and depression among the elderly people in the society. in this case the author of the article argue that the there   is need for the care providers to ensure that they provide social to care to the elderly in the community to prevent any form of pain which may lead to depression One of the significance of this study is the fact that it help to raise the importance of providing social care and ensuring that the frail elderly in the society are not subjected to inform of pain. This can help to lower the depressions cases among the frail elderly. The objective of this study was to explore the relationships between the cultural factors and the care-giving burden among the Chinese spouse caregivers who provided care to the frail elderly. Therefore this article can help to indicate some of the possible factors that need to be addressed in order to ensure that the frail elderly in the society are given proper care. The authors of article have managed to bring out some of the Chinese culture that interferes with the provision of care to the frail elderly in the society. In relation to this the author has managed to bring out the issue that the division of labor in the family is one of the major factor that hinder provision of quality care to the   frail elderly in the society. The research was based on one time cross-sectional and the data collected through the personal structured interview The authors of the article developed effective tools of collecting data where they has managed to use the traditional Chinese family value to collect information from the care givers in the country. The authors have managed to use the various statistical techniques to analyze their data.   Through their analysis they have been able to demonstrate the normality and skweness of the data. Through their discussion the author has managed to establish that the various cultural factors among the Chinese people interferes with the provision of care to the frail elderly in the community The authors of the article have managed to give good recommendation where they have recommended that there is need for the government to ensure that they educate the young people in the society the need to care for the frail elderly Significance of the study This study is important since it helps to raise some of the negative impact of the Chinese culture in the caring of the frail elderly in the society. Lee, D. (1999). Transition to residential care: experiences of elderly Chinese people in Hong Kong. Journal Of Advanced Nursing, 30(5), 1118-1126. Focus The title of the article was a good indicator since it allowed one to establish some expectation about the research. Background The author has managed to provide good background of the study where he has managed to explore the various types of relocations and some of the possible impact of these relocation Terms of reference The goal of the study was to establish the experience that these elderly people face when they move to the residential care centers. Study design The quantitative data collection technique was used where the participants were audio taped during the interview. However it is important to note that the researcher has not provided some brief background of the study design Ethical consideration The researcher has managed to put into consideration the some ethical issues while conducting the study. In this case researcher informed all the participants their   role before collecting data from them Data presentations From article it is evident that the author has not managed to present the data well since he has not provided any table or charts indicating how the data was collected. Main finding The author has managed to present a good finding where he indicates that when the elderly people move to the residential home in most case they are faced with the challenge of adapting to this new environment. Readability The paper is easy to read and understands especially due to the use of some case studies. Implication of the study The study has managed to bring the fact that there is need for health care provider to ensure that they provide social care to the elderly   who move to the residential care centers Article 6 Abley, C. (2012). Responding to vulnerability in old age: patient-centered care. Nursing Standard, 27(9), 42-46 Focus The title clearly defines that focus of the research. From the beginning, the reader can understand what to expect and what the author of the article had covered. Despite the fact that the title is clear, the author could have been more concise on what major vulnerability that the old age is facing. Background The background of an article should provide an explanation as to what led the author to choose the topic under study. The author should as well explain the importance and to whom the article is expected to benefit. In this case the author of the article has not provided substantial background in regard the aspects covered in the article. However, the author has incorporated research from local regions thus ensuring that some issues expected to be covered were comprehensively addressed. Terms of reference This entails the criteria for guiding the research focus. It generally the research question that the results and conclusion should provide a concise answer. The abstract of the article contained the research question that the research aimed to justify/answer although the researcher did not make it more clear and concise Methodology Methodology explains the criteria or techniques that the author incorporated in research. In this case, the author has incorporated a review of peer reviewed article including journals that cover similar topic. Although this method facilitates a broader coverage, the researcher also needs to get clearly align the literature review with the overall   design of methodology Tool of data collection The researcher incorporated interview which collected the responses of the participants in regard to the field under study. In this case, his method of data collection could not facilitate much result. Ethical considerations Ethical considerations are concerned with aspects that would apply during the data collection process and it generally defines how the researcher ensured the participants were safe and his/her relation with them. The researcher did not consider all the issues such as protecting participants. Data representation After the collection of data, the researcher is required to summaries the results in table and graphs in order to facilitate for a clear comparison. The researcher in this case has not represented all the results in table or graphs Recommendations Although the research is not much problem oriented, the research is supposed to offer his/her thought in terms of recommendations on the appropriate strategies that need to incorporate to improve the situation. Article 7 Bergland, A. (2012). Fall risk factors in community-dwelling elderly people. Norsk      Epidemiologi, 22(2), 151-164 Background The author has presented a comprehensive background to support the purpose of the paper. However, the author has only presented the purpose of the research but has not specified a certain region affected by the problem under study. Terms of reference As in many studies, the researchers generally incorporate an overall question that will guide him/her throughout the study however in this case, the researcher has only indicated the reason for the research but has not provided the major research question. Study design Numerous methods exist that can be incorporated in the collection and analysis of data. The researcher in this case has majored on the research conducted by other researchers and in this case, he has appropriately incorporated the reviews although lacks opinions from people in that particular field relating to the topic. Data collection In data collection, the researcher needs to choose the appropriate approach to ensure that he/she collects enough data to facilitate for the required facts to prove the research topic. In this case, the researcher did not incorporate questionnaires or interviews and relied completely on the research conducted by other authors. Data representation Due to the fact that the researcher did not collect any data in the field, there were not graphical representations to give the summary of results. Therefore, even if the researcher used reviews of other articles, he/she should have critics and reasons why they think the data from the article reviewed is correct. Conclusion In the conclusion, the researcher should tie up the themes evident from the research in accordance to the topic under study. However, in this research the author has not presented the points in a concise manner as required for a conclusion. Readability The paper is easy to read and understand only the fact that in the methodology part is complicated sine it does not clearly explain how the data from the sources being reviewed was collected to justify the results. Implications of practice It is clear that the research aimed at analyzing the risk factors facing the elderly in the community but it is more important if a comprehensive research was carried out to determine the most effective strategies that need to be applied to deal with these problems. Article 8 Chui, E. (2001). Doomed Elderly People in a Booming City: Urban Redevelopment and Housing Problems of Elderly People in Hong Kong. Housing, Theory & Society, 18(3/4), 158-166 Title The title of the research should provide the reader with the idea of what to expect after going through the research. Background The background of the study is well presented and this helps the reader to understand the context of the research as well as where the research is taking place. However, the researcher has not incorporated sufficient background for the place where the study is based. Methodology The researcher has incorporated case study as the methodology for the study, and this may not facilitate the right results due to the fact that there is no clear link between the literature review and the methodology. Study design The research has not considered incorporating a major question that would facilitate the guide throughout the research and yet this is an essential aspect in research. Researches that present valid arguments need to ensure that the goals/aims of the research have been achieved Data representation Although the researcher did not collect any data, it is essential to ensure that he/she incorporates some graphs or figures to implicate the summary of the research results. This would make it easier for the reader to get into the point without having to struggle much. Recommendations Despite the fact that every research addressing a certain problem should offer the most appropriate recommendations following the implications of the research, the author of the article has tried to offer some recommendations. However, the effectiveness of the strategies proposed has not been explained. Readability The article has a clear format that the reader can enjoy when reading. However, the author has not considered creating a clear connection between the methodological and the literature review part Implication of research The research has important aspects that can be considered when dealing with the issue of the care of elderly people in the society. However, a future research needs to be incorporated to base on the care management for the elderly in society. Article 9 Melby, V., & Ryan, A. (2005). Caring for older people in prehospital emergency care: can nurses make a difference?. Journal Of Clinical Nursing, 14(9), 1141-1150 Title A title needs to be simple and directly aim to the major investigation that the research is all about. The problem with the title of this article is that it is basing on care for the elder people yet it researches on the efficiency and effectiveness of nurses in the care management service for the elderly. Background The background is well presented but it has equally reviewed on the two sides, effectiveness of the service offered and the problems that the elderly face. The paper should provide more background on the major issue that the article investigate. Study design The article clearly presents the principle questions that aid in the research in an appropriate manner. However, there should also be a question that need to research for manner in which the service can be improved. Methodology The researcher has appropriately incorporated qualitative techniques of data collection including the interviews and questionnaires. The issue of having multi-design method is also appropriate but this might confuse the study. Data representation The idea of data representation has only been incorporated in this study to indicate the demographic features of the participants, thus an important aspect, but not in representing the results which is an essential requirement. Conclusion and recommendation The recommendation provided in the article provides quality ideas that can be incorporated to ease the problem and the effectiveness of the ideas have been discussed. The conclusion does not provide a clear provision of the findings Readability The article has an abstract that presents alignment of each chapter addressed in the article. However, all the major topics should be different from the subtitles Implications of research The research determines the effectiveness of nurses in providing services to the elderly people. More on the recommendations need to be covered since some of them have already been applied and the institutions are looking for more. Article 10 Gao, L., Chan, S., & Cheng, B. (2012). The past, present and future of nursing education in the People's Republic of China: a discussion paper. Journal Of Advanced Nursing, 68(6), 1429-1438 Background The author has presented a clear background of the place that the study aims and the issues being investigated. However, there is no clear connection of how these factors are to be discussed in the investigation. There should be clear connection on how these factors lead to one another Study design The article has incorporated the major research questions that will facilitate an appropriate investigation of the issues under study. However, it is important for the research to have enough investigations performed. The research has also incorporate review of relevant articles. Methodology The methodology incorporated in the research is thematic analysis and narrative synthesis whereby this means that no qualitative or quantitative research was performed. The research needs to incorporate its own data collection to view the opinion of the participants since it is reviewing both the past and present cases. Data analysis Data analysis requires that the researcher incorporate strong methods. This facilitates appropriate information to be retrieved from the responses of the participants. The researcher in this case has not incorporated strong data analysis tools despite the fact that the methodology is built on article reviews Data representation Graphs and table would be essential to explain more about the results of the research and incase where trends of aspects are being investigated, the graphs initially indicate the variance or movement of that trend aspect. The article has not incorporated any of the graphs to indicate the results. Conclusion and recommendation The paper has clearly presented the conclusion through tying the major findings of the research. It is clear that there were issues faced during the research but the paper has not offered adequate recommendations on how these issues can be appropriately dealt with. Limitation of research In research the researcher faced with some challenges either during the process of collecting data. In this case, it is essential to provide the challenges that one faces during the research in order to for other be aware of the challenges and prepare to overcome them. Readability The article is well arranged following the appropriate format. In the abstract for instance, the author have incorporated the title as well as the background, results, method and conclusion. The reader is in a position to know what the research coverage is all about, however, without incorporating graphics and pictures, the article lacks essential component.

Finding from the research

Discussions and recommendation

Value of the research

2. Siu Lun Chow, E., Ming Hei Kong, B., Tak Po Wong, M., Draper, B., Ka Leung, L., Ho, S., & Chun Por, W. (2004). The prevalence of depressive symptoms among elderly Chinese private nursing home residents in Hong Kong. International Journal Of Geriatric Psychiatry, 19(8), 734-740

Focus

Background

Term of reference

Methodology

Ethical consideration

Data presentations

Discussion and conclusions

Readability

3. Kee-Lee, C., & Chi, I. (2005). Reciprocal relationship between pain and depression in elderly Chinese primary care patients. International Journal Of Geriatric Psychiatry, 20(10), 945-95

Focus

Background

Study design

Ethics

Sampling

Data analysis

Results

Discussions and conclusion

Significance of the study

4. Chan, C., & Chui, E. (2011). Association between cultural factors and the care-giving burden for Chinese spousal caregivers of frail elderly in Hong Kong . Aging & Mental Health, 15(4), 500-509

Focus

Back ground

Method

Data collection

Data analysis

Discussion

Recommendation