Dim sum and family: Prescription for blessing

Chinese seniors are easy to please. Traditional older-Chinese folks’ idea of a blessing is simple—having dim sum with the family. Better still, doing so on a regular basis. Going for dim sum in a Chinese teahouse or restaurant is such a deeply rooted cultural behavior that, even to date, it has not gone out of fashion. Young and old alike, we all go for dim sum every now and then—sometimes for morning tea, sometimes for brunch, lunch or even afternoon tea, probably because we Chinese from the southern part of Canton, China, love food.

To a Chinese senior, having dim sum with one’s children and grandchildren is the symbol of a complete family, of being blessed in old age. It is something to boast about if a family can have five generations, all dining together. It is also a source of great delight to the elders.

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

Reverse ageism

Some of our students participated in a volunteer project, visiting seniors we believed to be “hidden” from society. They either lived alone or without adequate social support.

I went with one of the students to visit an elderly woman in her 80s. She was a nice, pleasantly plump woman who manages very well on her own. She can walk around independently, albeit slowly, and she can go shopping and attend medical follow-ups without assistance. She says she likes staying home, and hardly ever goes out. We tried to encourage her to join the nearby social center, which is why my student was sent to visit her. But she was clearly in possession of all her faculties, and knew what she wanted. She said she didn’t feel bored spending her time at home. She had worked as a maid/nanny her entire life. Although she lived alone, the children of her former employer, whom she had served for many years, would call and visit her every now and then. She had brought them up and was like family to them. It was clear that she was not depressed and was very much in control of her own affairs.

After speaking with her for a while, I came to realize that she was not in need of any external help. She did not like to join trips organized by the center because she didn’t want to make others wait for her. She did not want to spend more of her time at the center because she was the kind of person who didn’t like to be in lots of group activities. She was not what we would call a role model of active ageing, but she was self-sufficient. She was leading the kind of life she wanted and was not making any intentional efforts to isolate herself from others. She was not “hidden” from social services. She had limited social contacts, but this was, indeed, the way of life she intended to lead. Who are we to say that she needed more social contact?

With the hype about healthy living and active ageing in recent years, we have formulated notions about living and ageing, what active ageing means and how to go about ageing in an active manner. We have a stereotype for those we think have aged successfully.

During our 45-minute visit with this woman, I reminded myself once more that I must not let reverse ageism cloud my lens, that I should respect people’s choices of how they live their lives and that I must not impose what I believe is right on people who have experienced living a lot longer than I have.

I do believe there are multiple models of successful ageing. Active ageing is but one of them.

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

Seniors and fast food

As a Hong Kong Chinese, I did not associate seniors with fast food until about 10 years ago, when I moved into an apartment from which, if I needed to get to the train station fast, I had to take a short cut through a McDonald’s.

Every morning I made that trip, the scene never failed to amaze me—lots of seniors having breakfast at McDonald’s. Maybe it is a myth, after all, that Chinese people are particular about food. My—or our, if I can claim that I represent a certain segment of our society—belief used to be that Chinese seniors would not like fast food. They preferred congee to burgers, jasmine tea to coffee. But, obviously, I learnt something new when I moved into that apartment.

When I was taking a course for my doctoral program, my professor told me that she had been to Hong Kong and that both she and her husband were totally surprised to see that McDonald’s was such a favorite spot for children in an Asian city. She predicted that this generation of Hong Kong youngsters would have the same kind of cardiovascular problems as those in her country, the United States.

When I saw the large number of seniors having breakfast at McDonald’s, I remembered what she had said and thought, not only will we have a generation of young people with cardiovascular problems, we will also have a generation of seniors with those problems, as in Western countries.

I remarked about this to a friend, and she suggested it could be the free coffee refill that attracts seniors. This may be one of the reasons, but probably only one. To this day, although not so amazed as before, I am still puzzled. Maybe one day, I will do a survey on this, trying to find out seniors’ perceptions of fast food, and why they patronize these restaurants.

My speculation is that fast-food restaurants treat everybody the same. Our seniors enjoy the same kind of “freedom” as anyone else. They can sit for as long as they like, in spite of buying little, and not be driven away or given strange looks by waiters and waitresses. They don’t have to abide by the rules of a regular restaurant. This, then, is a good aspect of fast-food chain restaurants. They are a place for any age group; there is no age discrimination.

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

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.

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.