Isolation East & West

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Isolation East & West 隔離東西方

Institution vs. ageing in place: Examining the difference in societal attitude towards the elderly in Chinese and Irish culture.

機構與就地老化:

考察東西方文化中社會對老年人的態度差異。




隔離東西方

機構與就地老化:

考察東西方文化中社會對老年人的態度差異。


Isolation East & West

Institution vs. ageing in place: Examining the difference in societal attitude towards the elderly in Chinese and Irish culture.


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The research in this booklet highlights the contrasting attitudes towards the elderly in eastern and western culture. It will highlight the benefits that can be found with ageing in place which is favored in Chinese culture. This will be contrasted by as the problems which arise from institutionalised ageing found in Irish culture as highlighted by the pandemic and the issues surrounding isolated ageing which rose from it.

Isolation East & West 隔離東西方


Isolation east & west The WHO Has outlined that Given the large and expanding proportion of the global population

living longer than 65 years, a focus on sustainable

healthy ageing is fundamental to a healthy planet.

An Examination Into Elderly Care in Ireland 愛爾蘭老年護理調查

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Contents 內容 Isolated Ageing: Implications for Sustainability

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WHO goal #3

18

Ageing populations and sustainability

25

Ensuring not only survival, but that the elderly thrive

30

Isolation East & West 隔離東西方

Background: Isolation and Elderly Care Studies: health risks surrounding isolation

36

Effects of lockdown

48

What family connection means to the elderly

62


Elderly Care : East & West

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Ageing population in Ireland

39

Ageing population in China

48

Institutionalized ageing in Ireland

55

61 Covid in Wuhan Nursing homes

66

Relevance of filial piety today

72

A conversation with Sheila

102

A conversation with Hao

108

An Examination Into Elderly Care Contents in Ireland 愛爾蘭老年護理調查


Isolated Ageing: Implications for Sustainability

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Isolation East & West 隔離東西方


對 可 持 續 性 的 影 響

孤 立 老 化:

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Isolated An Examination Ageing: Implications Into ElderlyforCare Sustainability in Ireland 愛爾蘭老年護理調查


The WHO Has outlined that given the large and expanding proportion of the global population living longer than 65 years, a focus on sustainable healthy ageing is fundamental to a healthy planet.

12 十二

Isolation East & West 隔離東西方


Sustainable ageing

To fully understand the impact of population

ageing and action approaches that achieve global

sustainability, we need to examine their intersection.

Isolated An Examination Ageing: Implications Into ElderlyforCare Sustainability in Ireland 愛爾蘭老年護理調查

13 十三


The WHO Has outlined that given the large and expanding proportion of the global population living longer than 65 years, a focus on sustainable healthy ageing is fundamental to a healthy planet.

14 十四

Isolation East & West 隔離東西方


Worldwide in 2018, for the first time in history, people aged 65 years and older outnumbered children younger than 5 years.

Sustainable ageing

To fully understand the impact of population

ageing and action approaches that achieve global

sustainability, we need to examine their intersection.

Isolated An Examination Ageing: Implications Into ElderlyforCare Sustainability in Ireland 愛爾蘭老年護理調查

15 十五


The WHO Has outlined that given the large and expanding proportion of the global population living longer than 65 years, a focus on sustainable healthy ageing is fundamental to a healthy planet.

年在全球範圍內歷史 上第一次歲及以上的人 人數超過兒童 小於 歲。

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Isolation East & West 隔離東西方


Sustainable ageing

To fully understand the impact of population

ageing and action approaches that achieve global

sustainability, we need to examine their intersection.

Isolated An Examination Ageing: Implications Into ElderlyforCare Sustainability in Ireland 愛爾蘭老年護理調查

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WHO Goal #3: Good health and wellbeing, ensure healthy lives and promote well-being for all ages

18

確 保 健 康 的 生 活 並 促 進 所 有 年 齡 段 的

良 好 的 健 康 和 福 祉

Isolation East & West 隔離東西方

世 衛 組 織 目 標 三:


History 歷史 The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. At its heart are the 17 Sustainable Development Goals (SDGs), which are an urgent call for action by all countries - developed and developing - in a global partnership. They recognize that ending poverty and other deprivations must go hand-inhand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests. The SDGs build on decades of work by countries and the UN, including the UN Department of Economic and Social Affairs The global community is at a critical moment in its pursuit of the Sustainable Development Goals (SDGs). More than a year into the global pandemic, millions of lives have been lost, the human and economic toll has been unprecedented, and recovery efforts so far have been uneven, inequitable and insufficiently geared towards achieving sustainable development. Regrettably, the WHO goals were already off track even before COVID-19 emerged. The current crisis is threatening decades of development gains, further delaying the urgent transition to greener, more inclusive economies, and throwing progress on the SDGs even further off track. Had the paradigm shift envisioned by the 2030 Agenda for Sustainable Development been fully embraced over the past six years, the world would have been better prepared to face this crisis – with stronger health systems, expanded social protection coverage, the resilience that comes from more equal societies, and a healthier natural environment.

An Examination Into Elderly Care WHOinGoal Ireland #3 愛爾蘭老年護理調查

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Sustainable Development Goals 可持續發展目標 Progress had been made in poverty reduction, maternal and child health, access to electricity, and gender equality, but not enough to achieve the Goals by 2030. In other vital areas, including reducing inequality, lowering carbon emissions and tackling hunger, progress had either stalled or reversed. As the pandemic continues to unfold, The Sustainable Development Goals Report 2021 outlines some significant impacts in many areas that are already apparent. The global extreme poverty rate rose for the first time in over 20 years, and 124 million people were pushed back into extreme poverty in 2020.

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1: World Health

Organization. (2011).

Global health and aging.

Isolation East & West 隔離東西方

There is a risk of a generational catastrophe regarding schooling, where an additional 101 million children have fallen below the minimum reading proficiency level, potentially wiping out two decades of education gains. The COVID-19 crisis demonstrated inspiring community resilience, highlighted the Herculean work by essential workers in myriad fields and facilitated the rapid expansion of social protection, the acceleration of digital transformation and unprecedented worldwide collaboration on the development of vaccines. A brighter future is possible. We must use the crisis to transform our world, deliver on the 2030 Agenda and keep our promise to current and future generations. Building on the Millennium Development Goals (MDGs), the SDG agenda demonstrates unprecedented scope and ambition. Poverty eradication, health, education, and food security and nutrition remain priorities, but the 17 SDGs also encompass a broad range of economic, social and environmental objectives, as well as the promise of more peaceful and inclusive societies.1 But much remains to be done. Reports of global progress have often masked discrepancies in progress between and within countries. There is a recognition of the need to focus not only on ensuring that people survive, but that they thrive as well. It has also become clear that the world would be a healthier place if there were global targets for a much wider range of issues. Importantly, the new goal includes targets for tackling


noncommunicable diseases. It also covers health security; reproductive, maternal, newborn, child and adolescent health; infectious diseases and universal health coverage. WHO looks forward to collaborating with partners to meet all these targets, and particularly welcomes the inclusion of universal health coverage. Universal health coverage expresses the very spirit of the new development agenda, with its emphasis on equity and social inclusion that leaves no one behind. Increases in life expectancy and subsequent population growth will fundamentally affect sustainable development efforts to eradicate poverty In terms of both scale and impact, population ageing has far-reaching implications for our planet, not least as a major driver of population growth and consequent ever-increasing human demands on natural resources and ecosystems. Worldwide in 2018, for the first time in history, people aged 65 years and older outnumbered children younger than 5 years, with two-thirds of the world's older population now living in low-income and middle-income countries. Increases in life expectancy and subsequent population growth will fundamentally affect sustainable development efforts to eradicate poverty, achieve food security, ensure sustainable water supplies, build inclusive and resilient communities, and ensure sustainable consumption. Yet to fully understand the impact of population ageing and action approaches that achieve global sustainability, we need to critically examine their intersection. In WHO Goal 3, health is also presented as an input to other goals, and a reliable measure of how well sustainable development is progressing in general.

An Examination Into Elderly Care WHOinGoal Ireland #3 愛爾蘭老年護理調查

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Worldwide in 2018, for the first time in history, people aged 65 years and older outnumbered children younger than 5 years.

6,000

22

millions

3,000

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2000

1990

1980

1960

1950

1,000


Global Ageing by group:

Ages 0-14

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Ages 15-59

2050

2040

2030

2020

2010

Ages 60+

An Examination Ageing populations Into Elderly andCare sustainability in Ireland 愛爾蘭老年護理調查


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The WHO Global Network for Age-friendly Cities and aims to embed “concrete actions to make communities better places to grow old” across global communities. The focus of these actions is to include participation to promote ageing in place.

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Sustainable agendas for healthy ageing 健康老齡化的可持續議程

Although the link to the SDGs is fundamental, no explicit alignments between the health of older people, the effects of climate change, and environmental sustainability are made in the WHO report. These alignments are similarly absent in the current WHO Global Strategy and Action Plan on Ageing and Health. Beard and colleagues highlight SDG 3—to ensure healthy lives and promote wellbeing for all at all ages—as the main intersect between older people and sustainability; yet global ageing will determine sustainable development across the UN 2030 Agenda for Sustainable Development. Initiatives that offer opportunities for synergistic action and mutual benefit, such as the WHO Global Network for Age-friendly Cities and Communities, present a range of approaches.2 The Network aims to embed “concrete actions to make communities better places to grow old” across global communities. These actions include accessible transport, quality housing, well designed outdoor spaces and buildings, and social inclusion and participation to promote ageing in place. Yet advocates are asserting the need for healthy ageing to go beyond current parameters and take in climate change, pollution, and environmental change. This more integrated approach is a tangible opportunity that aligns well with current sustainability initiatives to design and build sustainable cities of the future. For example, synergistic action on promoting universally accessible public transportation and active travel increases physical activity, which can reduce morbidity and mortality from non-communicable diseases, increase social capital, and reduce air pollution.6, 78In parallel, healthy diets sourced from sustainable food production could promote both planetary and human health and contribute meaningfully towards ageing well. 2: Angelique Mavrodaris (2021).

Healthy ageing for a healthy planet: do sustainable solutions exist? 128, 76–86.

An Examination Ageing populations Into Elderly andCare sustainability in Ireland 愛爾蘭老年護理調查

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Isolation East & West 隔離東西方


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An Examination Ageing populations Into Elderly andCare sustainability in Ireland 愛爾蘭老年護理調查


The WHO World Report on Ageing and Health attributed the insufficient progress in global healthy ageing to a lack of consideration of the health and wellbeing of older people in the context of other global public health agendas, including the Sustainable Development Goals.

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In other vital areas, including reducing inequality, lowering carbon emissions and tackling hunger, progress had either stalled or reversed. As the pandemic continues to unfold, The Sustainable Development Goals Report 2021 outlines some significant impacts in many areas that are already apparent. The global extreme poverty rate rose for the first time in over 20 years, and 119 to 124 million people were pushed back into extreme poverty in 2020. There is a risk of a generational catastrophe regarding schooling, where an additional 101 million children have fallen below the minimum reading proficiency level, potentially wiping out two decades of education gains.3

3: UNICEF. (1997)

Children at risk in

Central and Eastern Europe: Perils and promises.

Isolation East & West 隔離東西方

The COVID-19 crisis demonstrated inspiring community resilience, highlighted the Herculean work by essential workers in myriad fields and facilitated the rapid expansion of social protection, the acceleration of digital transformation and unprecedented worldwide collaboration on the development of vaccines. A brighter future is possible. We must use the crisis to transform our world, deliver on the 2030 Agenda and keep our promise to current and future


generations. Building on the Millennium Development Goals (MDGs), the SDG agenda demonstrates unprecedented scope and ambition. Poverty eradication, health, education, and food security and nutrition remain priorities, but the 17 SDGs also encompass a broad range of economic, social and environmental objectives, as well as the promise of more peaceful and inclusive societies. But much remains to be done. Reports of global progress have often masked discrepancies in progress between and within countries. There is a recognition of the need to focus not only on ensuring that people survive, but that they thrive as well. It has also become clear that the world would be a healthier place if there were global targets for a much wider range of issues. Importantly, the new goal includes targets for tackling noncommunicable diseases. It also covers health security; reproductive, maternal, newborn, child and adolescent health; infectious diseases and universal health coverage. WHO looks forward to collaborating with partners to meet all these targets, and particularly welcomes the inclusion of universal health coverage. Universal health coverage is the very spirit of the new development agenda, with its emphasis on equity and social inclusion that leaves no one behind. Not only does poorer health drive the consumption of health-care resources, whether appropriate or not, but it also affects efforts to address poverty, which is experienced differently by older people relative to other age groups. In terms of both scale and impact, population ageing has far-reaching implications for our planet, not least as a major driver of population growth and consequent ever-increasing human demands on natural resources and ecosystems.

An Examination Ageing populations Into Elderly andCare sustainability in Ireland 愛爾蘭老年護理調查

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“There is a recognition of the need to focus not only on ensuring that people survive...

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Isolation East & West 隔離東西方


but that they thrive as well.”

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Angelique Mavrodaris (2021).

Healthy ageing for a healthy planet: do sustainable solutions exist? 128, 76–86.

An Examination Into Ensuring Elderlynot Care onlyinsurvival Ireland 愛爾蘭老年護理調查


Worldwide in 2018, for the first time in history, people aged 65 years and older outnumbered children younger than 5 years, with two-thirds of the world's older population now living in low-income and middle-income countries. Increases in life expectancy and subsequent population growth will fundamentally affect sustainable development efforts to eradicate poverty, achieve food security, ensure sustainable water supplies, build inclusive and resilient communities, and ensure sustainable consumption. Yet to fully understand the impact of population ageing and action approaches that achieve global sustainability, we need to critically examine their intersection.4 Although the link to the SDGs is fundamental, no explicit alignments between the health of older people, the effects of climate change, and environmental sustainability are made in the WHO report. These alignments are similarly absent in the current WHO Global Strategy and Action Plan on Ageing and Health. Beard and colleagues highlight SDG 3—to ensure healthy lives and promote wellbeing for all at all ages—as the main intersect between older people and sustainability; yet global ageing will determine sustainable development across the UN 2030 Agenda for Sustainable Development.

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4: Global Council on Brain Health. (2017). The brain and social connectedness: GCBH recommendations on social engagement and brain health .

Isolation East & West 隔離東西方


By emphasising the link between sustainability and ageing, stakeholders across multiple disciplines can work to reinforce and secure an approach that meets basic human needs while protecting our natural environment.

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This approach is a necessary paradigm shift but cannot be done in isolation; it will depend on ingenuity and consistent commitment from all to achieve a shared vision of the kind of planet we all want to age well and thrive on.

An Examination Into Ensuring Elderlynot Care onlyinsurvival Ireland 愛爾蘭老年護理調查


Isolation and Elderly Care

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Isolation East & West 隔離東西方

Studies: health risks surrounding isolation

36

Effects of lockdown

48

Importance of family connection

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隔 離 與 養 老

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An Examination Into Ensuring Elderlynot Care onlyinsurvival Ireland 愛爾蘭老年護理調查


The effects of covid isolation may be particularly acute among older adults in long-term care facilities. Feelings of loneliness, abandonment, despair and fear among residents– and their toll on physical and neurological health– are pushing the pandemic’s death toll higher.

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Isolation

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Being socially connected significantly reduces

risk for premature mortality, while being socially unconnected significantly increases risk.

An Studies: Examination health Into risksElderly surrounding Care inisolation Ireland 愛爾蘭老年護理調查


The effects of covid isolation may be particularly acute among older adults in long-term care facilities. Feelings of loneliness, abandonment, despair and fear among residents– and their toll on physical and neurological health– are pushing the pandemic’s death toll higher.

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Isolation East & West 隔離東西方


Since the pandemic began, older people all across society have struggled with the absence of relatives and their visits.

Isolation

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Being socially connected significantly reduces

risk for premature mortality, while being socially unconnected significantly increases risk.

An Studies: Examination health Into risksElderly surrounding Care inisolation Ireland 愛爾蘭老年護理調查


The effects of covid isolation may be particularly acute among older adults in long-term care facilities. Feelings of loneliness, abandonment, despair and fear among residents– and their toll on physical and neurological health– are pushing the pandemic’s death toll higher.

自疫情爆發以來, 大多數年長的社會成員都在 為缺席而苦苦掙扎親戚和他 們的訪問。

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Isolation East & West 隔離東西方


Isolation

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Being socially connected significantly reduces

risk for premature mortality, while being socially unconnected significantly increases risk.

An Studies: Examination health Into risksElderly surrounding Care inisolation Ireland 愛爾蘭老年護理調查


Social Isolation and Loneliness: Prevalence, Epidemiology, and Risk Factors.

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患 社 病 會 率、 孤 流 立 行 和 病 孤 學 獨: 和 風 險 因 素。

Isolation East & West 隔離東西方


Effects on Physical and Mental Health 對身心健康的影響

The effects of social isolation vary from individual to individual and social isolation doesn’t always lead to loneliness. Some older individuals without many social or community connections feel content, while others with many connections and lots of family support may feel a profound sense of loneliness. While social relationships are widely considered crucial to emotional well-being, social isolation and loneliness can also have a negative impact on physical health. A 2018 study on potential health risk factors of social isolation and loneliness, in which the author concluded that being socially connected significantly reduces risk for premature mortality, while being socially unconnected significantly increases risk. Moreover, these social isolation factors have a larger impact on mortality than factors that currently receive substantial public health attention such as obesity, physical inactivity and air pollution. The effects of COVID isolation may be particularly acute among older adults in long-term care (LTC) facilities, as outlined in an AARP report that suggests feelings of loneliness, abandonment, despair and fear among residents – and their toll on physical and neurological health – are pushing the pandemic’s death toll higher.5

5: Holt-Lunstad, J., Robles, T.F., & Sbarra, D.A . (2017). Advancing social connection as a public health priority in the United

States. The American Psychologist, 72(6 )

An Studies: Examination health Into risksElderly surrounding Care inisolation Ireland 愛爾蘭老年護理調查

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An Studies: Examination health Into risksElderly surrounding Care inisolation Ireland 愛爾蘭老年護理調查

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This 2018 study from the National Council of Ageing presented evidence that social isolation increases risk for depression, cognitive decline, and dementia, and directly influences medication/treatment adherence, blood pressure, immune functioning and inflammation, as well as the ability to conduct activities of daily living (ADL). 46 六

6: DiMatteo, M.R .

(2004a). Social support and patient adherence

to medical treatment: A meta-analysis. Health Psychology, 23(2 )

Isolation East & West 隔離東西方

“Before the pandemic, individuals in LTC facilities could benefit from the social connections and mental stimulation provided by visiting friends and family,” According to Kathleen Zuke, MPH, senior program manager, Center for Healthy Aging, National Council on Aging (NCOA).. “Now, while staff members can try to provide interactions, they also have other tasks they need to focus on, making it impossible for them to be the sole source of interaction. Fortunately, restrictions are easing up somewhat.” Zuke urged older adults and their families to stay connected as much as possible while waiting for restrictions to be lifted. She suggested setting a regular time on a weekly basis – make it a new habit – to connect with loved ones via phone, email or video chat. Before the pandemic, many older adults turned to community organizations and senior centers for social connections, meals, transportation and other services. Once the pandemic struck, those organizations had to pivot from in-person to online services. Some of them have struggled, according to Zuke, who added that the NCOA has worked hard throughout the pandemic to support community organizations and share best practices among them.6


Our social relationships are widely considered crucial to emotional well-being; however, the possibility that social connection may be a biological need, vital to physical well-being and even survival, is commonly unrecognized.

The NCOA surveyed senior-focused community organizations three times throughout 2020 (April, July and October) to understand the pandemic’s impact. The most recent survey (October) found that several months in, the pandemic was continuing to impact organizations’ resources, with just under half losing funding and having to reduce staff. About a third of organizations were making plans to reopen following local health guidelines, while many continued to expand their virtual, phone and home delivery services including meals, caregiver support and benefits counselling. “One of the biggest takeaways was the switch from providing in-person meals to home-delivered meals,” said Zuke. “That switch created volume and process problems, especially in the beginning, as organizations scrambled for logistical support and faced staffing issues among their largely older volunteer base.”Technology access and skills also have impacted community organizations supporting older adults, from the perspectives of both organization staff/volunteers and clients. The NCOA’s July survey found that only 38 percent of older adults feel comfortable using the internet and just under half have broadband access.

Still, extreme examples clearly illustrate infants in custodial care who lack human contact fail to thrive and often die.

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An Examination Into Elderly Effects Care of lockdown in Ireland 愛爾蘭老年護理調查


Risk Factors 風險因素 Can we identify those who are at greatest risk? It is important to note that the overall effect of lacking social connection on risk for mortality can be applied quite broadly: robust effects were found across age, gender, health status, and cause of death (Holt-Lunstad et al., 2010). Further, the protective effect of social connection—or, conversely, the risk of disconnection—appears to be continuous: there is evidence of a dose-response effect such that for every level of increase in isolation there is an increase in risk (Yang et al., 2016). This dose-response effect held across indicators of structural, functional, and quality of relationships. Thus, it is important to acknowledge data supports treating this as a continuous issue, not a dichotomous issue. Nevertheless, there are factors that may contribute to increased risk.

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There is evidence that social connection influences a variety of mental and physical health outcomes.

Living alone, being unmarried (single, divorced, widowed), no participation in social groups, fewer friends, and strained relationships are not only all risk factors for premature mortality (Holt-Lunstad et al., 2010), but also increase risk for loneliness. Retirement and physical impairments (e.g., mobility, hearing loss) may also increase risk for social isolation (AARP, n.d.). Although few studies examined multiple components of social connection in the same sample, measures of complex social integration were the strongest predictors of mortality; thus, presumably those who lack connection on more than one indicator would carry greater risk. Social isolation and loneliness may be particularly important among older adults. Chronic exposure to either protective or risk factors will be more pronounced as individuals age. For example, the effects of social disconnection (neglect, strain, isolation) or connection (supportive, stable family environment) that

Isolation East & West 隔離東西方


occurred earlier in life will become more apparent later in life. Further, there are a number of important life transitions among older adults that may result in disruptions or decreases in social connection (e.g., retirement, widowhood, children leaving home, age-related health problems). A growing body of research shows that health problems in adulthood and older age stem from conditions earlier in life, suggesting the importance of preventative efforts (World Health Organization). For example, those who are isolated are at increased risk for depression, cognitive decline, and dementia

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There is now substantial evidence documenting that being socially connected significantly reduces risk for premature mortality, and lacking social connection significantly increases risk, even more than the risks associated with many factors that currently receive substantial public health attention and resources (e.g., obesity, physical inactivity, air pollution). Further, social isolation influences a significant portion of the U.S. adult population and there is evidence the prevalence rates are increasing. With an increasing aging population, the effect on public health is only anticipated to increase. While many U.S. health organizations have been slow to recognize this, the World Health Organization (n.d.) explicitly recognizes the importance of social connections. Indeed, many nations around the world now suggest we are facing a loneliness epidemic. The challenge we face now is what can be done about it. Sustained efforts, attention, and resources are needed to adequately address this important issue.

These social isolation factors have a larger impact on mortality than factors that currently receive substantial public health attention such as obesity, physical inactivity and air pollution.

An Examination Into Elderly Effects Care of lockdown in Ireland 愛爾蘭老年護理調查


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53 八 Kathleen Zuke, MPH, senior program manager, Center for Healthy Aging, National Council on Aging (NCOA).

An Examination Into Elderly Effects Care of lockdown in Ireland 愛爾蘭老年護理調查


A collaborative report published by researchers at the Irish Longitudinal Study on Ageing (TILDA) and ALONE examines issues of loneliness and social isolation in older adults. The report offers fresh insight into the experiences of those over 70 who were advised to ‘cocoon’ as part of public health measures to curtail the spread of the COVID-19 virus. New data from ALONE which documents increased feelings of loneliness, anxiety and isolation in older adults throughout the pandemic, is compared with experiences of loneliness and isolation in older adults before the COVID-19 outbreak.

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55% of callers to the ALONE support service were from the over 70s, the cohort advised to ‘cocoon’.

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The rise of loneliness in a pandemic 大流行中孤獨感的增加 Previous research into this area has shown that strong social ties may protect people from emotional distress, cognitive decline, and physical disability, while loneliness and social isolation can cause harm to physical and psychological wellbeing. Both loneliness and social isolation have been strongly associated with poorer quality of life and other measures of well-being. The TILDA study offers unique insights into the health, habits and experiences of older adults living in Ireland through its longitudinal research, examining a variety of key areas that affect older adults such as physical and mental health as well as economic and social factors. Research from TILDA highlights the prevalence of loneliness and social isolation in its nationally representative survey of participants which gives clear insight into the experiences of older people. Both studies combined aim to help and support health systems and policymakers to strengthen and improve the national response to Covid-19 in the longer term. Measures introduced to curb the spread of the COVID-19 virus, including physical distancing, and self-isolation particularly affected those over 70 who were ‘cocooning’; disrupting daily routines and social interactions with friends and family. Following the outbreak of the virus, ALONE’s Support and Telephone Befriending service continued remotely with volunteers calling and sending regular texts to older people with health and well-being tips and practical supports.

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Callers have most often requested support for their physical health, befriending, and emotional and mental health needs.

An Examination Into Elderly Effects Care of lockdown in Ireland 愛爾蘭老年護理調查


Professor Rose Anne Kenny, Principal Investigator of TILDA: “This collaborative report between ALONE and TILDA offers a unique perspective into how older adults have been affected by the COVID-19 pandemic. TILDA research shows that most older adults are not often lonely and highlights the resilience of older adults as they adapt to an ever-changing world. The world has witnessed how older adults have been disproportionately affected by the pandemic. ALONE’s research provides front- line evidence that shows the true toll public health measures have had on older people with increased feelings of loneliness, anxiety and isolation. The impact of the pandemic is now being studied in the TILDA cohort and will be reported later this year. This will more precisely inform the impact of COVID-19 on loneliness and social isolation, and areas for policy intervention.”

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Sean Moynihan, Chief Executive Officer of ALONE:

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“ALONE’s coordinated National Response to the COVID19 pandemic allowed us to respond with immediacy to the concerns newly emerging, and existing issues being elevated from older people. We worked to keep all our services operative through adaptation of their structures. The presence of this virus in society has further solidified existing issues while further alienating some older people, as we have seen extensive increases in loneliness through the isolation experienced from cocooning. Society needs to understand that loneliness can happen to anyone and can damage both your physical and mental health. It is distressing and we want to work towards breaking down this stigma.”

An Examination Into Elderly Effects Care of lockdown in Ireland 愛爾蘭老年護理調查


The ALONE national support line has received 26,174 calls during the period: March 9th to July 5th, 2020.

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55% of callers were from the over 70s, the cohort advised to ‘cocoon’.

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75% of callers to the helpline were living alone.

“We must remember that there are several thousands of older people behind every percentage.”

An Examination Into Elderly Effects Care of lockdown in Ireland 愛爾蘭老年護理調查


The role of the family in old age: The importance of ability to participate in family life.

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參 與 家 庭 生 活 的 能 力 的 重 要

家 庭 在 老 年 中 的 作 用:

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Family 家庭 The family is the best environment to meet the needs of each senior. Nowadays, when life expectancy got extended and retired people are in full possession of their faculties and physical strengths, they are people with considerable needs, wishing to retain contacts with the environment, the stereotype of old age being associated with diseases, dependency on others, the decline of the needs and opportunities, lost its topicality and validity. Family life sometimes imposes the situations of inevitable necessity, such as caring for a sick family member who is devoid of self-service capabilities, caring for the seriously ill or an infant.7 However, it happens that a family obligation is permeated with satisfaction of freedom, that is, voluntary commitments. Grandma is pleased to look after her grandson, left in her care, unless the care is too lengthy or too exhausting. Similarly, grandfather happily fulfills the tasks undertaken for the sake of his children’s family if these tasks are appropriate to his forces and capabilities.

7: Pielkowa J.A., Nowe podejcie do starszego

pokolenia, Maeństwo i Rodzina, nr 3(11), s. 11-12. 2004

The role of elderly people may be performing educational functions as well as maintaining family traditions. Performing the function of education in the family stems from the fact that parents, due to the fast pace of life, do not have a sufficient amount of time to fulfill this task. This need is additionally deepened by the increasing number of mothers who are actively employed, and by obligation of heart, which makes the majority of elderly people take care of their grandchildren, not so much out of duty, but for the satisfaction that it gives them. The functions performed by the elderly have an impact on their social position, give them a sense of social usefulness. First and foremost, family members are expected to support an elderly person when he or she is in the adverse situations of life. The need for respect, security and belonging is felt by the elderly more strongly than in the previous periods of life. Meanwhile, family attitudes towards them are dominated by the desire to restrict independent decision-making, to take over their roles, or to replace them in the activities that they can successfully perform themselves. What An Examination family connection Into Elderly meansCare to the in Ireland elderly 愛爾蘭老年護理調查

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What An Examination family connection Into Elderly meansCare to the in Ireland elderly 愛爾蘭老年護理調查


Staying close to each other or living together and maintaining frequent contacts, the elderly and their children provide vitally important services and support for one another. For the elderly, they are not only of financial matter, but also of high emotional value, including the expression of memory, intimacy, respect and cordiality. 66 六

For an elderly person family is the most important social group to which he or she is usually tied by a strong emotional bond and mutual exchange of benefits.

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Leaving seniors to their own devices is, among the middle generation, the manifestation of the desire to remove the image of old age from the children’s and grandchildren’s life, as if it was a disadvantage. Mean-while, the elderly need acceptance, support, empathy and love from their families. In the old age the social circle tightens mainly to relationships with family, especially with the spouse, children, grandchildren, or siblings, because these relations are of great importance to the quality of life and its assessment. In popular opinion, all of it used to and could be ensured by the traditional big family, especially peasant or largely artisanal which was unified by the source of income formed by family-run workshops. Individualization accompanying industrialization broke typical for family traditional community of production and consumption.

The ability to participate in family life, even regular family meetings, A deeper study of family, especially carried out in the fifties and sixties of the twentieth century by gerontologists1 in the United States and Europe, including Poland, showed the coexistence of different family types, from small to traditional, big ones in different environments. In Poland, in the past few decades deep socio-economic, political and cultural transformations have been made that have left their mark on the changes in the family in the direction of its nuclearization.

gives the older person not only direct satisfaction that comes from meeting the need for warmth or kindness,

What An Examination family connection Into Elderly meansCare to the in Ireland elderly 愛爾蘭老年護理調查

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Isolation East & West

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What An Examination family connection Into Elderly meansCare to the in Ireland elderly 愛爾蘭老年護理調查


Elderly care: east & west

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Institutionalized ageing in Ireland

70

Covid in Wuhan: How the elderly

90

coped during lockdown.

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A conversation with Sheila

102

A conversation with Hao

108


東 養 西 老 方 服 務 東 西 方

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An Examination Into Elderly Elderly care: Care east in &Ireland west 愛爾蘭老年護理調查


This section will examine the differences in attitudes towards ageing between eastern and western culture and what we as a culture can learn from the Confucian ideal of respect for the elderly known as "filial piety".

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Institution vs. ageing in place

The pandemic highlighted the issues which

institutionalised ageing presents in Ireland. A

focus on family assisted ageing in place may be the solutuion, which is facilitated in Chinese culture.

An Examination Into Elderly Elderly care: Care east in &Ireland west 愛爾蘭老年護理調查

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This section will examine the differences in attitudes towards ageing between eastern and western culture and what we as a culture can learn from the Confucian ideal of respect for the elderly known as "filial piety".

74

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In China, long term care facilities are treated as a last resort. In Ireland, such facilities have been major sources of infection and despair.

Institution vs. ageing in place

The pandemic highlighted the issues which

institutionalised ageing presents in Ireland. A

focus on family assisted ageing in place may be the solutuion, which is facilitated in Chinese culture.

An Examination Into Elderly Elderly care: Care east in &Ireland west 愛爾蘭老年護理調查

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This section will examine the differences in attitudes towards ageing between eastern and western culture and what we as a culture can learn from the Confucian ideal of respect for the elderly known as "filial piety".

在中國,長期護理 設施 被視為最後採取。在愛爾蘭, 此類設施一直是感染和絕 望的主要來源。

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Institution vs. ageing in place

The pandemic highlighted the issues which

institutionalised ageing presents in Ireland. A

focus on family assisted ageing in place may be the solutuion, which is facilitated in Chinese culture.

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Institutionalised ageing in Ireland: The impact of the coronavirus.

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居 冠 民 狀 心 病 理 毒 健 大 康 流 的 行 影 對 響。 愛 爾 蘭 老 年 療 養 院

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愛 爾 蘭 老 年 護 理 服 務 的 不 足:


Nursing homes and the pandemic 療養院和流行病 The mental health impact of the pandemic on nursing home residents is characterised by various dynamics. Loneliness may have been a problem for some nursing home residents prior to the COVID-19 pandemic; however, the ban on visits during the pandemic has exacerbated the problem and extended its impact to all nursing home residents. Residents struggle with the absence of relatives and their visits. An attempt has been made to replace direct contacts with the use of technology; however, such provision has limited effectiveness on residents with dementia who need social contact or a nearby voice. In some cases, serious discomfort manifests itself as delirium superimposed on dementia; in particular, a hypokinetic type, with consequent refusal of food and difficulty getting out of bed.Older residents who are cognitively intact also breathe the atmosphere of anxiety and anguish7 .

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Loneliness may have been a problem for some nursing home residents prior to the COVID-19 pandemic; however, the ban on visits during the pandemic has exacerbated the problem and extended its impact to all nursing home residents. Residents struggle with the absence of relatives and their visits

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In an ageing country that will undergo a profound demographic shift in coming decades these are questions that will be asked again and again as people live longer. Although the Irish are still young by European standards, there will soon be substantially more older people. The eldercare system was already creaking before the onset of Covid-19 exposed serious deficiencies in nursing-home care, raising questions about the treatment of some of our most vulnerable people. Ensuring that system is fit for purpose in the future will be a key challenge for society as Ireland emerges from a pandemic that still poses a grave threat to public health. Such changes are no different to what is happening in developed countries around the world, albeit a little later in Ireland’s case than countries with older populations like Germany and Italy. But looking after the needs of these people is shaping up to be a defining test for the State. The thrust of public policy into the future will be to provide more care for older people in their own home for as long as possible – the homecare option. This has been cast as the best way forward for decades but has proved exceedingly difficult to achieve in Ireland.

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“All the evidence is that people want to remain in their own homes.”

“All the evidence is that people want to remain in their own homes. We’ve had a policy which is good on rhetoric and not so good in terms of delivering on the pursuit of homecare that we all aspire to. When we did try to initiate policy change … we tended to focus on residential care. We tended to neglect homecare. Now that has changed in the last number of years a little bit as we have I think begun to shape a clearer understanding of what’s required in regard to homecare. Ireland has significant under-provision of public services for [long-term care] and therefore high unmet need. The homecare sector in particular has not kept up with demand, and Ireland is still trying to undo the effects of the cutbacks that were made as a response to the 2008 recession.” Celine Clarke, head of advocacy for Age Action Ireland, which campaigns for the rights of older people, says the current homecare services are underfunded and undersupplied. says Eamon O’Shea, economics professor at NUI Galway, a specialist on ageing issues. “Pre-pandemic figures show over 7,000 people on the wait-list for homecare supports.”

In the programme for government last year, the Fianna FáilFine Gael-Green Coalition promised a statutory homecare scheme. The lack of such a scheme means there is no regulation on the provision of homecare services or indeed on the quality of homecare. A spokeswoman for Mary Butler, Minister of State for Older People, said work is “ongoing” on a statutory scheme with a pilot programme to reform the service due to start later this year. Colette Kelleher, a former independent senator who was chief of the Alzheimer Society of Ireland, says a statutory scheme ranks among the most important steps for the future. “That’s been talked about for a very long time. It was postponed and postponed,” she says.

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In a statutory regime the service would expand. It would also subject providers to independent regulation for the first time and become eligible for funding under the Fair Deal scheme, currently limited to nursing homes, in which a portion of the value of a person’s home would be used to pay for their care. Huge public spending on nursing homes was still not sufficient to avert the crisis in the sector when the pandemic struck in February 2020. Data shows that 985 nursing-home residents had died by October, 56 per cent of all deaths in the State by that time. The Oireachtas special committee on the response to Covid-19 said in a report last year that it was “unable to get satisfactory answers” as to why that happened, despite devoting more time to the question than any other.

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The committee said the number of deaths was “totally disproportionate for a group comprising of 0.65 per cent of the population who were unique in terms of frailty and vulnerability”. Kelleher, a former senator, notes the lack of laws to protect nursing-home residents “in the way that we have safeguarding legislation for children”. As a result, a social worker who receives a complaint from a resident has no right of entry into a nursing home to investigate. “All of that was very heightened during the pandemic when you had very large numbers of people dying.” She supports calls for a public inquiry into the nursing home response to Covid-19, as does Clarke of Age Action. Butler’s office said the Government accepts the need for longer-term reform of elder and nursing homecare. Nursing Homes Ireland, the lobby group for the sector, says smaller operators believe the current financial model has left smaller operators under acute strain. Although large international nursing-home groups have increased their presence in Ireland, 23 homes closed last year. “This is a very significant number,”

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Cases in long-term care facilities in December 2020

50

100

150

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Data shows that 985 nursing-home residents had died by October, 56 percent of all deaths in the State by that time.

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An Examination Institutionalised Into Elderly ageing Care in Ireland 愛爾蘭老年護理調查


International guidance 國際指導 Older adults, especially in isolation and those with cognitive decline or dementia, may become more anxious, angry, stressed, agitated and withdrawn during the outbreak or while in quarantine. Provide practical and emotional support through informal networks [families] and health professionals. Share simple facts about what is going on and give clear information about how to reduce risk of infection in words older people with or without cognitive impairment can understand. Repeat the information whenever necessary. Instructions need to be communicated in a clear, concise, respectful and patient way. It may also be helpful for information to be displayed in writing or pictures. Engage family members and other support networks in providing information and helping people to practise prevention measures.9

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(2020) Mental 9: World Health Organization health and psychosocial considerations during the COVID-19 outbreak

Older adults, especially those with cognitive decline and/or dementia, may become more anxious, angry, stressed, agitated and withdrawn, particularly if they are in isolation or quarantine. Management of visitors to facilities and provision of face masks and introduction of IPC measures will possibly add a substantial additional burden and impact the time available to HCWs for care tasks. Ethical considerations regarding longterm isolation and restriction of visits to residents have to be balanced against the impact of the infection on residents and staff. 10

10: European Centre for Disease Prevention and Control (2020) Surveillance of

COVID-19 at long-term care facilities in the EU/EEA 19 May 2020[iii]

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11: Van Order et al (2020) Strategies to Promote Social Connections Among Older Adults

During‘Social Distancing’Restrictions[iv]

Older age and medical comorbidity are factors associated with more severe illness and risk of death due to COVID19 infection. Social distancing is an important public health strategy for controlling the spread of the virus and minimizing its impact on the older adult population; however, social distancing comes at a cost. Loneliness is associated with myriad adverse health outcomes including impaired immune functioning which adds greater risk of coronavirus infection, complications and death. Older adults are at compound risk and the effective management of loneliness and social isolation is a high priority target for preventive intervention. The authors describe a cognitive behavioral framework for social connectedness including evidenceinformed strategies clinicians can use to help patients develop a ‘connections plan’ to promote social, mental and physical health during social distancing restrictions.11 12: Gordon et al (2020) [Commentary]

COVID in Care Homes-Challenges and Dilemmas in Healthcare Delivery[v]

Social isolation and loneliness have been associated with an increased prevalence of vascular and neurological diseases and premature mortality. Additionally, it is well known that social exclusion is significantly associated with higher risks of cognitive impairment which in turn increases the risk of Alzheimer’s disease and accelerates disease progression of existing conditions. Emotional distress aggravated by the current pandemic is another risk factor for premature death since anxiety is known to predict all-cause death and is especially detrimental in persons aged 75 and older. Apart from the psychological burden of isolation, reduced opportunities for physical activity represent an additional health-damaging burden in the long run. This applies not only to home residents, but also to older people living alone. Eventually, the impoverished environment and lack

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An Examination Institutionalised Into Elderly ageing Care in Ireland 愛爾蘭老年護理調查


Another 5,000 people live in public nursing homes.

Despite the push for more homecare, thousands of additional nursing-home places will still be needed as the ageing of the population intensifies.

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Economic & Social Research Institute projections point to the need for 15,600 new places by 2030 above 2015 levels, when there were some 22,340 spaces in private homes.

Prof O’Shea, the NUI Galway academic, says homecare will never replace residential care.

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R

The big challenge is to really make sure that we accelerate this shift to ageing in place, 91 八

which for many people is in their own homes but there are many variations...

Before you go into residential care there’s housing with care, for example, where people may have to shift out of their home but not into residential care.

There’s also technology which potentially has at least some capability in terms of allowing us to remain in our own homes for longer.”

An Examination Institutionalised Into Elderly ageing Care in Ireland 愛爾蘭老年護理調查


Ageism reached a new level with the hashtag #BoomerRemover. This vulgar concept highlights two prevalent ageist attitudes in the COVID-19 pandemic response:

Older adults are vulnerable and helpless against COVID-19. High mortality rates amongst older adults are considered an inevitable and normal outcome of the pandemic. Healthy younger adults may perceive themselves as invulnerable to COVID-19 and, as a result, may not realize the importance of following public health advice and policies on infection prevention.

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Conclusion 療養院和流行病 Over 20 international researchers in the field of aging have contributed to this document. The commentary discusses how older people are misrepresented and undervalued in the current public discourse surrounding the pandemic; it points to issues in documenting the deaths of older adults, the lack of preparation for such a crisis in long-term care homes, how some protective policies can be considered patronizing and how the initial perception of the public was that the virus was really an older adult problem. The authors also call attention to important intergenerational solidarity that has occurred during the crisis to ensure support and social-inclusion of older adults, even at a distance. 93 八

The eldercare system was already creaking before the onset of Covid-19 exposed serious deficiencies in nursing-home care, raising questions about the treatment of some of our most vulnerable people.

An Examination Institutionalised Into Elderly ageing Care in Ireland 愛爾蘭老年護理調查


Covid in Wuhan: How the elderly coped during lockdown.

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封 武 城 漢 期 的 間 新 老 冠 年 肺 人 炎: 如 何 應 對。

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Wuhan is a city of 11 million people, 1.33 million of whom are aged above 65, accounting for 14.74% of the total population Wuhan, Hubei, China, the first epicentre of the COVID 19 pandemic, has experienced outbreaks and stringent lockdown (social distancing, traffic restriction, strict stay at home policy) (National Health Commission of the People's Republic China [NHC], 2020). Located in central China, Wuhan serves as a major transportation hub. When the epidemic happened, it was just several days ahead of the spring festival, when millions of Chinese people would travel across the country to celebrate with relatives, especially those older adults staying in the hometown, bringing them more risks. To control the epidemic, Chinese government has made much effort. ‘Upholding life first’ and ‘leaving no one unattended’ policy were adopted on the country level. Medical services were reorganized and 42,000 healthcare workers were dispatched to help Wuhan. The government also undertook all medical expenses for COVID 19 treatment to relieve the financial worries of patients infected with COVID 19. Moreover, communities in Wuhan have taken much responsibility during the lockdown. The community system in China is the basic unit that provides residents with living services.12 Social workers in the community have the responsibility to integrate resources and coordinate social relations in the community and help those in need. And communities enforced the quarantine policy and supported every resident in the face of COVID 19 as all residential communities in Wuhan were locked down.

12:Dong Y, Mo X, Hu Y et al.

Epidemiology of COVID-19 among

children in China. Pediatrics 2020; 145

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“Only 3% of China’s elderly population live in care homes,

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whereas in several western countries, such facilities have been major sources of infection.”

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98

This study explored the experiences of community dwelling older adults in Wuhan during the COVID 19 lockdown. Although being challenged in every aspect of daily lives, older adults in our study showed amazing resilience and adapted to the situation. We believe that the ‘family culture’ helped them and other Wuhan citizens to look out for each other and get through difficult times.

The results of the study suggest that certain social dynamics and individual behaviours helped the elderly to better cope with the stressful quarantine period. The findings of the study not only help to better understand the experiences of older adults but also provide guidelines on how to reduce the negative effects on the older adults during the COVID 19 pandemic and enlighten studies concerning the well being of older adults or other vulnerable people in future crises.

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Family and community support 家庭和社區支持 Family was the most important source of support for most participants. N12 said: ‘My children brought back food.’ N16 said: ‘Our kids bought us new phones so that we can use the QR (quick response) code.’ Some reported increased contact with family members. N15 said: ‘We had more time together.’ For participants infected with COVID 19, family members helped them get medical treatment and provided support. N6 said: ‘I asked my son in law to take me to the hospital.’ N3 said: ‘When I was sick, my daughter encouraged me to stay positive and receive treatment.’ Almost all participants have received help from communities. N2 said: ‘Community worker called us once or twice a day and delivered food to us. And if we need any help, we could call them.’ Also, community workers monitored the condition of the residents and released timely information. N11 said: ‘Community workers sent masks to us and monitored our body temperature.’ The government dispatched medical teams to help Wuhan. Many participants were proud and thankful. N2 said: ‘The whole country was supporting us. We praise the country and express our gratitude.’ And N16 said: ‘I think COVID 19 is controlled by the government. If the country did not cover the expenses for the treatment, more people would die.’ “Family” is a unique concept in Chinese culture. The Chinese believed that family members should take care of each other, and the government is obligated to take care of their people. A Chinese proverb says that the home is the smallest country and the country is the largest home, which means for Chinese people, they not only have the small families but also are members of the big family (China). ‘Harmony in the family brings prosperity’ is widely embraced in China, and Chinese people value collectivism more than individualism. Facing this epidemic, the Chinese hold the value that when disaster strikes, all members of the big family and small family should help. An Examination Into ElderlyCovid Care in in Wuhan Ireland 愛爾蘭老年護理調查

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‘Fam is a unique Chinese culture believed that family take care of each othe is obligated to take care o proverb says that the hom and the country is the large Chinese people, they not onl also are members of the bi in the family brings prospe China, and Chinese peopl than individualism. Fac Chinese hold the valu strikes, all member and small fa he

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mily’ concept in e. The Chinese y members should er, and the government of their people. A Chinese me is the smallest country est home, which means for ly have the small families but ig family (China). ‘Harmony erity’ is widely embraced in le value collectivism more cing this epidemic, the ue that when disaster rs of the big family amily should elp.

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Filial Piety 療養院和流行病 Children raised with the concept of filial piety grow up understanding that their elders should receive excellent care as they get older. For many, filial piety is not just a responsibility, but a solemn religious duty. Filial piety is the honor and respect children show their parents, grandparents, and elderly relatives. For example. when children demonstrate filial piety in China, they are viewed as trustworthy and respectable. Children who don’t show respect to the elderly in their lives are viewed as shameful and of a bad character. While respect shown to all older adults can be viewed as a form of filial piety, the deepest dedication is to be given to parents alone. Filial piety is seen in many Eastern cultures through submission to the wishes of parents. They must help the elderly by making them happy and comfortable during the final years of their lives. As opposed to Western culture, where adult children leave home and many never return, in Eastern culture, thanks to filial piety, adult children view it as their responsibility to take care of their parents until they die. Filial piety is a Confucian philosophy. Parents raise their children, clothe them, feed them, bathe them, and make sure that the first half of their lives are lived in peace, comfort, and harmony. Confucian philosophy says that for the second half of their lives, adult children will take care of, feed, clothe, honor, respect, and serve their parents.

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8: Czerniawska O.,

Style ycia w staroci,

Wydawnictwo ód 1998.

The concept of filial piety can be found throughout the Asian world by cultures heavily influenced by Confucianism and Buddhism. While it may not be called by the same name, the In both Chinese and Indian Buddhism, filial piety played an important role in both cultures. Karma, the idea that your actions will come back to you for good or for bad, was fundamental in creating a system of filial piety. According to some scholars, filial piety was not just part of karma but was the best thing you could do to produce good karma in your life.

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In Buddhist teachings, the Buddha said that children were to honor parents as though they were honoring Brahma (God), support and respect their parents to pay back the debt of childhood, and perform extra good deeds for their parents to accumulate merit and beneficial karma. While the concept of filial piety is connected to Chinese culture, it can be seen in many parts of the world today from East to West. In many parts of the world, once parents finish raising their children and adult children get married, roles start to reverse. As parents become older, parents will move in with one of their married children. In most Eastern cultures, parents move in with a son. The son, daughter-in-law, and grandchildren then support the parents. All their needs are met and they are provided with shelter, food, clothing, and comfort.

According to Confucian philosophy, filial piety is considered to be the greatest of all virtues and should be demonstrated to both the living and the dead. At its core, filial piety deals with the level of respect and obedience a child must show their parents. This concept of bestowing honor and respect became so ingrained into Chinese culture that laws were built around filial customs.

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Filial piety is seen in every part of Chinese culture and much of the Asian world. It is demonstrated by showing respect toward parents, the elderly, and even the deceased. Regardless of how this concept is demonstrated, filial piety is a manner of honoring the life of one’s parents and honoring their legacy. The concept of filial piety has adapted over time, where living with family members may be in need of care giving isn't possible, lending a hand and checking in as much as possible can make all the difference to an elderly family member.

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Respect, Honor, and Virtue 尊重、榮譽和美德 In the West, in America and Europe, a single child might choose to move in with their older parents. The son or daughter will care for them, cook, and supply their basic needs. In some cases, if the single caretaker child gets married, they will continue to live with the parents. Some children choose to purchase the family home and continue living with their parents until they pass instead of placing them in a facility. In Chinese culture, and many countries around the world, filial piety can be seen in the way children honor parents when they pass away. Death in different cultures will be responded to uniquely, however, many similar concepts 105 八 are shared. While a dedicated mourning of period is not typical in most of America, many places and cultures around the world reserve specific time set aside to properly mourn parents. If the mourning period is broken, it appears shocking, scandalous, and sends a message that the child does not respect the parent who has passed. In some locations, children are expected to host elaborate funerals and hire professional mourners to demonstrate their filial piety. Without the outward display of loss, the community might view the children with shame because they did not demonstrate that they loved their parents. Children honor deceased parents (remembrance) In addition to honoring a deceased parent during the funeral, there are numerous opportunities for children to honor their parents afterward. Placing incense, food, and other offerings for their parents on altars during different festivals is one way filial piety is demonstrated. In Korea, they honor their deceased relatives through the Jesa ceremony. They believe the spirits of departed relatives stay on earth and care for their families for several generations. During the Jesa ceremony, Korean children will honor deceased ancestors by placing food and drink in a shrine and cleaning tombstones of dirt and grass.

An Examination Into ElderlyCovid Care in in Wuhan Ireland 愛爾蘭老年護理調查


A conversation with Sheila: Bridging the gap with family created by the pandemic.

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彌 合 與 家 人 的 差 距 疫 情 造 成 的

與 希 拉 的 對 話:

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“My name is Sheila, I'm 81 years old and have lived in my home in Dublin all my life. I have 4 children and 5 grandchildren and have found it difficult to keep up with them since the beginning of the pandemic.”

What for you was the toughest part of the initial lockdown in march 2020?

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“Now, that feeling of imprisonment, that is not easy. My husband, as a joke, told me “even prisoners need an hour of yard time”. Yes, even prisoners have the right to an hour of yard time. I don’t know to what extent you can force people to stay at home. What sense does it make when you are not even able to see a family member? I mean, it is the saddest thing not to have the comfort of having your family next to you, to be really alone. I also understand the doctors who are dealing with this situation, it must not be easy for them. Finding yourself alone and not being able to even meet a friend.”

As restrictions were being put in place, were you glad to be protected or did you feel marginalized?

“I did not feel like a group to be protected, that is my personal opinion. But if I think about all the rest, I think it was right. However, I felt a bit deprived of my freedom. I mean, being considered at risk kind of bothers me. I understand why they did that, but it did bother me.” An Examination AInto conversation Elderly Carewith in Ireland Sheila 愛爾蘭老年護理調查


So, do you feel that people are going out of their way to help you or do you think they are they avoiding you out of fear? “Honestly, I have not yet understood if we are seen as the lepers or individuals to be protected, considering their attitude towards us… I meet, for example, a girl pushing a pram on the footpath, she gets off the footpath, which is a good thing. I would have done the same! Then she walks towards the middle of the street… I did not understand well—she was not wearing a mask either—if they are afraid that we are infected, or they do it out of respect towards us.”

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What have you found to be the attitude of younger people towards the elderly in the pandemic?

“Younger people seemed not to care; it seemed that they did not give it importance. What I perceived was “They are old, anyway”. Not “Who cares?” but many young people say “Let’s go out and let’s do this and that, only old people will die”. These were the first things that you heard.”

Do you think there's a lack of respect in Irish culture for the elderly compared to other societies?

“The other day I run into a lady who was wearing neither gloves nor mask, while I was wearing both. I stepped off the footpath and she—I think she was younger than me— she carried on her way. Because someone does not respect the rules, we are all affected.”

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An Examination AInto conversation Elderly Carewith in Ireland Sheila 愛爾蘭老年護理調查


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“For me, the hardest part has b distance that lockdown after lo has created between me and t We’ve all gotten used to spend apart to protect each other an when restrictions lift,

the d pand

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been the ockdown the family. ding time nd I find that 111 八

distance created by the demic is still there.”

An Examination AInto conversation Elderly Carewith in Ireland Sheila 愛爾蘭老年護理調查


A conversation with Hao: My children got me through the toughest parts of the pandemic.

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大 我 流 的 行 孩 最 子 艱 們 難 讓 的 我 部 度 分。 過 了 難 關

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與 郝 的 對 話:


“My name is Hao, I'm 79 years old and moved to Dublin from Beijing in 1965. I have 2 children who did next to everything for me during the last two years when my age group was forced to isolate.”

How do you feel going into our third year living with lockdowns and isolation?

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“[I hope] we can go back to normality soon, with the hope that all this will make us better than we are and that we can finally understand the importance of life and friendship. We are all a bit worried because we do not know what the future will be like. Will it change? Totally! And everyone will have to change their mind. Maybe we will appreciate each other a little more. I hope that the community has learned something… specially to help others more, to be more available, to smile more, to be happy with what we have and to defend it.”

What do you think is the most important lesson we have learned from the pandemic? “I really want to live, and I hope it will end soon, for the good of all the people of the world… and I hope that we will start over, this time in a more responsible way. We will be much more responsible even with respect to the world that we have destroyed, the environment that we have polluted. We will do that at least at the beginning. Then maybe we will forget with time, but I think we will carry something heavy for a while.”

An Examination Into A conversation Elderly Care in with Ireland Hao 愛爾蘭老年護理調查


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Did your children contact you regularly while you were “cocooning”?

“Our daughter wants to know if we are in good health. They, both our son and daughter, check on us every day. “How are you?”, they say, and then tell us a few words like this and that to comfort us.”

Did you find a difference in attitude between younger generations in China and Ireland?

“Most of these young people, where I visit in China, they are at home all day long. And I think they study, and read, and do other things, then they go shopping for us elders. We have younger neighbors who go shopping for us and this is actually done by many. That is why I was saying to other older people “We have to stay at home, we have to stay at home quietly, and we have all the help that we need to be able to stay at home”.

Can you tell me what it felt like to “cocoon”?

“I was locked inside my house afraid to go out. Those who were over 65 couldn't even go out to buy their shopping. Here at home, I didn’t see anyone. Subconsciously, I had a mental block. It’s a kind of fear of that insidious stranger… And I no longer felt like going out, even for a short walk in the forest. I didn’t feel like it and I only felt good if I stayed at home.”

An Examination Into A conversation Elderly Care in with Ireland Hao 愛爾蘭老年護理調查

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“‘Coco was very difficu and I feel very sa I know that didn’t ha around to help them have gotten thr my family

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ooning’ ult for everyone, ad for the people ave younger people m, I know I couldn't rough it without y’s help.”

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An Examination Into A conversation Elderly Care in with Ireland Hao 愛爾蘭老年護理調查


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Conclusion 療養院和流行病 The goal of this commentary is to highlight the ageism that has emerged during the COVID-19 pandemic. The commentary discusses how older people are misrepresented and undervalued in the current public discourse surrounding the pandemic; it points to issues in documenting the deaths of older adults, the lack of preparation for such a crisis in long-term care homes, how some protective policies can be considered patronizing and how the initial perception of the public was that the virus was really an older adult problem. The authors also call attention to important intergenerational solidarity that has occurred during the crisis to ensure support and social-inclusion of older adults, even at a distance. It highlights the contrasting the treatment and attitudes towards the elderly in Irish and Chinese culture and asks the question, what we as a society can learn from the values of filial piety?

An Examination Into A conversation Elderly Care in with Ireland Hao 愛爾蘭老年護理調查

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All rrights reserved. No part of this publication may be repoduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage or retrieval system, without prior permission in writing from the publisher.

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Published in 2022 by Laurence King Publishing Ltd 331–373 City Road London EC1V 1LR United Kingdom Tel: + 44 20 7841 6900 Fax: + 44 20 7841 6910 email: enquiries@laurenceking.com www.laurenceking.com Copyright © Eoin Cantwell

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An Examination Into A conversation Elderly Care in with Ireland Hao 愛爾蘭老年護理調查


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