Do you respect older people?

Do you respect older people? Why? Do you respect older people because of their age? Or for other reasons? If it is because of their age, why so?

Chinese societies are very much into respecting elderly people, with few explanations as to why this should be. I used to wonder why such “wisdom” is passed through generations without being challenged. I have to say that I don’t respect seniors just because of their age. Respect has to be earned.

Just as I don’t disrespect children because of their age, I don’t respect seniors because of their age. Age per se is not a good argument for me. To me, we should respect life, respect people as individuals, having a rightful place on this planet. Seniors don’t get extra respect for the mere reason of being older. There are some young people who put me in awe, and many more who deserve my admiration and respect. And there are a lot of older people whom I don’t respect.
But, of course, there are other qualities that come with age that I appreciate–the ability to withstand adversity, worldly wisdom gained out of a lifetime of experience, and so on. But age is never a good enough argument for me.

As a gero nurse, I advocate for the well-being and health of seniors, not because they are a respectable group because of their advanced age, not because of their growing numbers and looming “grey power.” As a gero nurse, I am cognizant of the right of every member of our society to receive the same respect, irrespective of power, wealth and class. Only when groups live in harmony and recognize each other as having equal rights can we start to build a better world.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Development of people-friendly cities: Observations of a gero nurse

Hong Kong is probably not on the list of the top 10 most habitable cities in the world. Although my view is coloured by having been born and brought up here, my bias is not unfounded when I say that it is a reasonably good city to live in—apart probably from the air, sound and light pollution problems we have. (We can do something about the air pollution, but won’t be able to solve the problem entirely because of all the factory smoke that is blown from across the border.)

There are certain prerequisites required to survive in Hong Kong. One, of course, is having strong nerves to tolerate sharing 1,095 square kilometers (423 square miles) with seven million others. This means that one should have the ability to withstand crowdedness, noise, a very fast pace of life and a sense of urgency in everything we do.

Although a “developed” city, Hong Kong is not as “civilized” as cities in Japan. But civility comes with a price—a very high cost of living—because its habitants are paying a lot for the basic infrastructure. As a developed city, we share many ills and strange phenomena with others. Our city may be advanced, but it is not quite a senior-friendly city. With the present trend toward cool structures and minimalism in design, there are just too many glassy reflective surfaces, mirrors and glistening facades of massive buildings and shopping malls around us.

These are not good for aging eyes when glare becomes a problem. The many mirrors and glass structures are traps for seniors who have less-efficient depth perception to differentiate subtle changes in tone between surfaces; without such perception you cannot know whether it is a passage or a mirrored wall. Marble floors, a symbol of luxury, pave most new and recently renovated shopping malls. Even though designers claim that these floors are non-slippery, try walking on them on a rainy day. They are essentially traps for seniors in a modern city.

I have not yet mentioned the problem of finding your way. These modern, massive structures are not simple. You need to learn the language and have a different set of orientation skills than what you learnt a couple of decades ago. First of all, you need to learn how to perform a methodical 3D scan of a large space—I mean 360 degrees front to back, and from the tall ceiling to the ground you are walking on. Often, the signage is hanging high up in the air. (Try to recall a large airport you have visited).

What is more, special signs and utilities are designed to be artistic and blend into the physical space surrounding us. The philosophy of modern design is to make transition of space inconspicuous, blending man’s architecture with natural scenes. Thus, you will need to learn to decode the signs or symbols, making sure you are heading toward your destination.

And finally, you need the energy and ability to cover that long distance to find the bathroom or information counter. It is not always a breeze getting into a building and quickly identifying how to get where you want to go. It is a whole new language that the older generation needs to embrace and understand.

There is still a long way to go before Hong Kong can become a people-friendly city.

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For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

"Cardboard box" men and women

There is an occupation or informal kind of work in Hong Kong that I haven’t seen in other cities of the developed world. Older men and women who do this work are self-employed. They work both outdoors (on the streets) and indoors (in shopping malls). They have flexible working hours but most work at the beginning and end of a business day. They deal with material and not people.

These are the men and women who pick up cardboard boxes. Hong Kong is a highly commercialized city, so the turnover of material goods is huge. We make, import and dispose of staggering quantities of cardboard boxes. Seniors who want to make a few dollars go around collecting cardboard boxes from shops, if the shopkeepers let them. Then, they take the folded boxes to the recycling dealers and sell them for a meager sum of money.

I think of these seniors as highly industrious, but I have seen with my own eyes some sneaky ones who sprayed the boxes with water, making them heavier when placed on the scales. I have also read about heartless dealers who cheat with their scales so they can pay less.

Of course, there is no such thing as a perfectly honest occupation. Nevertheless, I am impressed by the industrious spirit of these seniors. They don’t want to idly waste their time away; they are doing something useful and making a few dollars at the same time. I am particularly impressed by the old lady who, although both of her lower limbs are amputated above the knee, drives her motorized wheelchair around to visit stalls and collect cardboard boxes. I admire her spirit.


For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Life after cancer

Readers of my blog may wonder what I am up to in my life after cancer. Well, life goes on as usual.

When I first went back to work, I felt fine. I was able to keep my cool and maintain a fairly good balance between work and rest. As time goes by, I find myself increasingly drawn to more and more work, and needing to stay up later and later into the night. This is not a good sign. I am still trying to find a new and healthy balance.

One important impact of cancer on my life is that I have started to exercise regularly. No, not exercising three times a week for half an hour each time, but hiking weekly. Above the village behind the housing estate where I live, there is a path that, after a 45-minute walk up and down the hill, converges with the MacLehose Trail, a country-park hiking trail. Every Saturday or Sunday, I make an effort to hike this path. Sometimes, when I don’t feel like going, I tell myself that it is a medicine that I must take, given the Hong Kong-based evidence that shows a positive association between exercise (or lack of it) and occurrence of breast cancer. Sometimes, when I miss my weekend hike, I try to make it up in the middle of the following week.

Those who hike will know that it is not easy to find a hiking partner. Everyone walks at a different tempo, some fast, some slow and some in-between. So I usually hike by myself. Hiking on my home trail—I call it my home trail now—has opened my eyes to the world of nature. I have seen how a snail flips its body trying to shake a bug from its shell. I have seen wild pigs running down the hill, snakes slither across a path and into the grass again, and sometimes, more alarmingly, wild dogs. I always take a hiking stick with me, not for hiking, but to frighten away menacing dogs. I have become much more aware that I am close to nature, observing different flowers that blossom at different times of the year, or fruit trees that I never noticed before. Hong Kong has 7 million people, and it is hard to find a spot where you don’t run into anyone. But, sometimes, I do not run into anyone up on the hill, and it is as if I have all that nature to myself. Such beauty and tranquility!

Occasionally, when I am alone, I ask myself what cancer means to me. There is also a slight fear that I may have forgotten something important about surviving cancer. Sometimes I feel I don’t know what the important lesson was, while, at other times, I believe the key lesson is that I should remember that a good life is about loving and forgiving. Essentially, life goes on as usual after cancer. And that is already very comforting.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

If you were a senior in Hong Kong

If you were a senior in Hong Kong, I would say you could be pretty sure that your later life would be well covered. Well, of course, you would have to make a noise first of all and get into the system, i.e., register with the Social Services Department, and then take it from there.

Hong Kong has universal health coverage. For a nominal fee—really nominal—you will be seen by doctors in public clinics and hospitals. You will also get the drugs you need, without paying anything further. Some really novel and expensive drugs are not covered, but there are always alternative drugs that the doctor can prescribe free of charge. If you consult a specialist within the public system, then you will only pay HK$10 (US$1.28) per drug item. You only pay HK$100 for a day in a public hospital, which is just US$12.80. If you need surgery (even heart bypass or brain surgery), chemo, anything, it is all covered.

Of course, before getting treatment, you will need to wait in line. There can be a long wait for specialist appointments, ranging from a few months—rarely—to a couple of years. People in Hong Kong need to wait for three years for cataract operations within the public system.

There is also low-cost housing. Although Hong Kong does not have an official poverty line, there is a reasonable social security net. You won’t get overly comfortable if you are on social security, but you will be covered one way or another.

There are home-care services, and all kinds of in-home support to enable you to live at home and out of long-term residential care. If you applied for residential care with the Social Services Department, you and/or your family will have to wait for 3-plus years. There are also day hospitals and daycare services. But there are always long queues to get into these.

The worst is probably dental care. But isn’t it the same in other parts of the world?

Many seniors may have their roots in the Chinese mainland. Therefore, they may go back to their hometown to spend the rest of their lives. The cost of living is considerably cheaper and, also, they are with their relatives. You may lose your social security benefits if you leave Hong Kong for more than six months. However, recently there has been litigation against this policy, claiming that it is against Hong Kong’s “Basic Law.” The results are not yet known.

There are, of course, problems in our elderly services. But, in general, I appreciate all these things that society and the government are doing for seniors in Hong Kong. As a nurse, it is especially hard for me, knowing that just across the border in the Chinese mainland, health care is not a right for all.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Going green and care of older adults

Looking after my mother, age 82, has given me new insights into what it means to be environmentally aware when we look after older adults. It is not so straightforward.

My mother has been very conscious about turning off the lights (and thereby saving electricity) since she was young. But now, when I find her fiddling around in dim light in her room, I am concerned, fearing she might trip on something and hurt herself.

On occasions when I am burning the midnight oil, I notice my mother getting up to go to the bathroom, again finding her way in darkness and not turning on any lights. Though there is a night light in her room, it is dark in the bathroom. It is hard to convince her it would be better to turn on the lights in the bathroom. Fearing she may trip over something, we usually keep a lot of lights on to make a brighter environment for Mom.

That water conservation is an issue in caregiving is something else I didn’t realize before. You are less likely to conserve water if you are caring for a senior. While, in the past, Mom could turn off the tap in a second, now it takes considerably longer. With failing eyesight and less dexterity, it has become more frequent that my mother fails to fully turn off the tap. The tap can run for a long while before someone at home discovers it.

Even when someone is around, trying to reduce water use is not always easy. Mom moves slowly. Everything is always ready for her bath but she takes her time to undress, to check whether she has all her clothes and other items she needs, such as a face cloth. And so the tap keeps running to add hot water to the tub until she finally gets in and washes herself.

Increasing age leads to less efficient adaptation to environmental temperatures. My mother often complains of feeling too warm or too cold. To provide a more stable ambient temperature that makes her feel more comfortable, it becomes necessary to use a lot of air conditioning and heating.

Living with Mom for the last five months has made me realize that, as one who is environmentally conscious, use of sensing technology is very important in looking after seniors. The problem is that people who have lived in their own home for many years cannot always readily switch to using technological devices.

To me, the challenges ahead for gerotechnologists are twofold: developing innovative technologies that are readily adaptable to existing home settings and making these gadgets affordable.

Going green is good, of course. It is something that every responsible citizen should consider and in which they should become involved. However, there are concerns other than higher water and electricity bills. Not long ago, the Hong Kong government passed legislation that vehicles not in motion must have their engines turned off.

Hong Kong, however, lies in the subtropics. In the subtropical sun, the temperature can be significantly higher inside a vehicle. In yesterday’s news, it was reported that an 81-year-old minibus driver had been found unconscious in the driver’s seat. The air conditioning had been turned off while he was waiting in line to pick up passengers. He passed away the next day.
It is not so easy to draw the line between saving our planet and staying safe at the same time.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

About active ageing

My brother and I visited the Fujian Tulou (also called Earthen House) in southern Fujian Province, China, at the end of June. The tulou is an unusual type of Chinese rural dwelling. In 2008, UNESCO (United Nations Educational, Scientific and Cultural Organization) designated the Fujian Tulou as part of the cultural heritage of humankind. I had wanted to visit the place since I saw a commercial featuring a tulou a few years back.

There is an interesting story about the tulou. Reportedly, during the Reagan Administration, the CIA mistook them for nuclear devices and sent an undercover team, in the guise of a cultural tour, to check out the facts.

Tulou are mostly found in the southwestern part of rural Fujian. The area is hilly, full of terraced fields for growing tea and vegetables. Most of the people who live there seem to be engaged in farming or farm-related industries.

Well, this entry is not really about tulou, but about active ageing. One of the images that remains in my mind from my trip is seniors who were busy working in the fields or selling things on the road. They always had something to do. They didn’t seem to be worried or sad. They seemed contented and had a sense of purpose. It made me wonder whether city life has turned us into beings who are far too structured, where there is a time for everything, including retirement from work. There is no retirement in rural living. What better illustration could we have for active ageing than this?


For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.