“What If I Die and No One Notices?” A Qualitative Study Exploring How Living Alone and in Poverty Impacts the Health and Well-Being of Older People in Hong Kong
Abstract
:1. Background
1.1. Older People Living Alone
1.2. Old Age Poverty
1.3. Older People Living Alone and in Poverty: The Intersection
1.4. Research Aim
2. Methods
Participant Recruitment and Characteristics
3. Findings
3.1. Common Challenges
3.1.1. Key Theme 1: Social Isolation and Loneliness: “What If I Die and No One Notices?”
I live alone. Who will know if something bad happened to me? If nothing happens, that’s great. But if SOMETHING happens… it would be pathetic. Sometimes I go home from the hospital, and I feel extremely tired, but I still need to cook for myself. We older people who live alone worry about many things.(Female, 74)
What I am saying is I have diabetes, and if I fainted no one would know, and I will probably die. I am all alone. At times I think to myself: I will die, and no one will know. Everyone has their life, and no one would bother to care about me. I’m happy, but two things I fear are the house [referring to the possibility of losing public housing] and dying alone.(Male, 69)
Living alone, you can’t even find someone to chat with. If something happens, even mundane things like my scratching an itch on my back, no one can help you with that and you can’t help yourself, either. Earlier I got the shingles, I ha[d] to beg a few times before someone would help me to apply medicine to my back.(Male, 65)
3.1.2. Key Theme 2: Self-Esteem and Self-Efficacy
3.1.3. Key Themes 4: Declining Mobility, Health, and Activity Levels
In recent years, my knees started to hurt a lot and my relative suggested [I] go to a nursing home. She told me to apply when the situation is not that bad because it takes a few years of being on the waiting list. It’s hard to tell when it [her knees] would deteriorate. I am worried about that, so I applied.(Female, 80)
I seldom go out. I want to, but I can’t. Many things hinder me. I can’t walk fast. My knees make me have trouble in walking up stairs. I am scared of the stairs, so I don’t dare do many things. If you can still walk, you can find someone who can help you. If you want to talk to somebody, you can go out and find someone. How could this be achieved if you can’t walk?(Male, 71)
I joined as a volunteer with the church to do some home visits with other older adults, but it is difficult for me to walk, I feel exhausted when I go upstairs and downstairs. I want to prevent further damage on my joints, as there is wear and tear on them. There is no other way but to have a joint replacement. I am not willing to receive the replacement, so I stopped joining those activities.(Female, 77)
3.1.4. Key Themes 4: High Medical Expenses
Normally manageable [referring to his living expenses], but if I am sick or need to go to the hospital I don’t have spare money for that. It’s a minimum of 500 dollars each time. I need to keep watching my budget for that.(Male, 89)
I have the Health Care Vouchers, but I have used all of them. Now I pay for it myself. It costs around 300 dollars each time I visit the doctor. It is expensive. Sometimes I just stick a band-aid on instead of seeing a doctor. It can’t eliminate the pain completely, but I will feel more comfortable.(Female, 70)
3.1.5. Key Themes 5: Age Discrimination and Long Wait Times for Medical Health Services
He [the doctor] said it was because of degeneration. This is what the public hospital doctors do: old people come to them for knee pain, and they say it is untreatable degeneration.… they did not even assess me. They said the degeneration is irreversible!(Female, 80)
But for the x-ray, I need to wait for 5 years because I am 75 years old now. I am too old. I still did not have the scan even now. This is a long-term knee pain, I don’t have the knowledge of what to do, so I just tolerate the pain.(Female, 75)
I am most concerned about my nose. I cannot sleep when I have a stuffy nose, but no doctor helps me …. I have waited for 3 years. Is it reasonable?(Female, 74)
3.1.6. Key Theme 6: Age Discrimination, Retirement, and Wanting Part-Time Employment
It was not “retirement.” It was because I can’t walk fast. My knees are sore. I can’t work efficiently like others—what could I do when I only closed three deals as others closed five deals? [I was] sixty-something. I can’t work efficiently. Gradually, I had conflicts with my colleagues. They felt it was unfair when everyone took the same salary while I did less. The head [of staff] also complained to me. So, I was half-retired at that time.(Male, 71)
I was the chief writer of [name of newspaper]. The boss was rubbish. We could not get along. When I was first recruited, he promised that I would have my share. After the newspaper became well-known, he bought himself an industrial building. Once I reached 65 years old, he kicked me out and hired people who just graduated from university so he could pay less. Sneaky rubbish.(Male, 90)
3.2. Challenges Unique to Some Participants
3.2.1. Unique Theme 1: Not Enough Gender-Specific Social Participation Activities
3.2.2. Unique Theme 2: Housing Insecurity
Sometimes I can’t sleep, thinking about this [referring to his housing insecurity]. Yeah, sometimes I drink one can of beer to sleep. I used to not drink. But I have some beers in my fridge, and I’ll open one when I can’t sleep. I will not take sleeping pills.(Male, 69)
Yeah, a lot better [referring to public housing estates]. Subdivided units are a lot different from public estates. It’s much narrower and constraining. You enter a flat and it’s divided up to ten units. My life right now, to be frank, living in a subdivided unit, there’s a lot of bed bugs. They are in all the rooms. We have to spray insecticide all the time. Also, they usually come out at night. They wait for you to fall asleep for your blood. So, I write calligraphy till late, often until dawn before I sleep, and when I see a bed bug I catch it. I catch them all before I go to bed.(Male, 78)
… more bugs in these two years, especially this year! I cannot sleep well. People keep moving in and out, but I cannot. I don’t know where I can go. There is a lift in this building, I cannot walk up and down the stairs due to my knees. My friend introduced this flat to me because there is a lift, I don’t need to walk stairs.(Female, 74)
3.3. Common Strengths
3.3.1. Key Theme 1: An “I Have Enough” Mindset
I never ask too much. Living a mundane life: healthy, enough food, enough money. I don’t spend on luxurious things. So far, that’s it. Now I wait for nothing. I need nothing. The future? Not much. ‘Come quietly and leave peacefully’, I guess. [laughs] I am eighty and I am on the way to the “end of road.”(Male, 83)
The condition back then was not good, and my grandpa was part of the “Five Black Categories” [during the Cultural Revolution, there were five groups that were persecuted: landlords, rich farmers, counter-revolutionaries, bad influencers, and right-wingers [37]]. We have suffered many hardships, so I cherish my current life. Happiness consists in contentment; it is very important for everyone. Even having weak tea and scanty meals, I am satisfied with them.(Female, 73)
Everyone lived very poor in the past. We didn’t get to go to yum cha all the time like now. You had to be very wealthy with a house to enjoy the luxury of going to yum cha. We didn’t have three meals a day. Two meals a day is already lucky. One meal at 9 am, and another at 4 pm. Who gets three meals a day? I am over 80, I’ve seen everything. The Japanese invading, and Cultural Revolution. Now, now is the most peaceful time.(Female, 86)
3.3.2. Key Theme 2: Strong Formal Social Support
The district councillor––He was quite nice. He recommended me to sweep the floor [referring to her cleaning job]. When I encounter difficulties, I can seek advice from him. I don’t know words well and he helped me to fill the form to apply for the Consumption Voucher Scheme [a government subsidy during the pandemic]. Their office is on the 3rd floor below us. Everyone treats me well.(Female, 70)
3.3.3. Key Theme 3: Contributing to the Community and Others
I offer help whenever it is within my power to. Like the one downstairs. She asks me to go to the hospital with her, so I accompany her. Once she had a surgery, I bought food for her for three months. I help out.(Female, 74)
There is one who just got into [name] Hospital. He is 84 years old, living in the [name] building. He has chronic illnesses. Last year, I was walking out[side] the building and saw him having shortness of breath, so I took him to the hospital. After he was hospitalized, I got a call saying he had a stroke. He was in a coma for over ten days, and he woke up. He had no one to turn to, so he could only call me. I do what I can do. It took about two months for him to recover. The period before he was discharged, he cried a lot to me, saying he doesn’t know what to do, whether he should go to a nursing home or not. I had no idea of what to do, so I sought help from a doctor from the place [where] I do volunteer work, in [Name] Hospital. Then [Name of Social Worker] recommended him to a nursing home. He was lucky having me to help him—of course [name of social worker] also helped a lot.(Female, 74)
3.4. Strengths Unique to Some Participants
Unique Theme 1: “Most of Us Like to Be Alone”
I don’t feel so sad. Right now, I feel good being alone. I have way less burden. Except if you really have someone you really love who you want to spend your life with. Or else I really don’t want to become others’ burden. There’s nothing wrong about being alone, we all come here on our own, you brought nothing, so you don’t need to bring anything away with you either when you leave, right?(Male, 78)
I think it’s more freedom for myself. No one to make me angry, nothing to see, right? If I have friends over we can drink tea if we want to drink tea, watch a movie if we want. Walk around if we want. I think it’s freedom.(Female, 74)
4. Discussion
5. Conclusions and Study Limitations
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Interview Guide
- We invited you to the interview because we want to hear your personal life story and history. We think that your stories will provide useful information for us to learn more about and support older people who live alone and are low-income, because we are finding that increasingly more older people are living alone in Hong Kong.
- Before we start the interview, I want to:
- o
- Introduce myself and my own interest in working on this project [interviewer to share].
- o
- Let you know that the interview will take approximately 1 to 1.5 h, and that you can share whatever you want, and if you do not want to answer any questions you don’t have to—you can just say “pass.”
- o
- Let you know that you are in control of the interview and you can take breaks whenever you need—you can always just interrupt me and let me know when you need a break.
- o
- Let you know that the interview will be audiorecorded, but that is only so that we can transcribe the interview later, and we will not include any identifying information; you will remain anonymous.
- o
- Ask if you have any questions for me. If not, we can begin, and I will start recording.
- 1.
- Before we get into your life history, I hope you will share with us your present living situation.
- o
- How long have you [lived alone]?
- o
- How would you describe your current living situation?
- -
- What positive aspects do you like about your current situation?
- -
- What are some challenges/problems in your current situation?
- -
- What do you think is the most important thing that others (service providers, researchers, etc.) should know about older people in situations like yours?
- 2.
- Let’s start with when you first became an older adult (65+). Can you tell me: At this stage of your life, what were some of the most significant life events that impacted your well-being?
- -
- How did each of these life events impact you—positively and/or negatively?
- -
- Of all of the life events that you shared, what event had the most significant impact on you?
- 3.
- Next, I am interested in hearing about your working adulthood life years (about 30–64 years of age). Can you tell me: At this stage of your life, what were some of the most significant life events that impacted your well-being?
- -
- How did each of these life events impact you—positively and/or negatively?
- -
- Of all of the life events that you shared, what event had the most significant impact on you?
- 4.
- Next, I am interested in hearing about your young adulthood life years (about 18–30 years of age). Can you tell me: At this stage of your life, what were some of the most significant life events that impacted your well-being?
- -
- How did each of these life events impact you—positively and/or negatively?
- -
- Of all of the life events that you shared, what event had the most significant impact on you?
- -
- For someone who is at my stage of life now [referring to the young interviewer], what would be your biggest advice to me?
- 5.
- Finally, I am interested in hearing about your childhood years (0–17). Can you tell me: At this stage of your life, what were some of the most significant life events that impacted your well-being?
- -
- How did each of these life events impact you—positively and/or negatively?
- -
- Of all of the life events you shared, what event had the most significant impact on you?
- 6.
- Collect the following demographic information (if it has not already been collected in the course of the interview)
- Age
- Gender
- Place of birth
- Length of residency in Hong Kong
- Length of residency in the current community/neighborhood (________)
- Type of housing
- Languages spoken
- Marital status
- Family size (number of adult children)
- 7.
- We have covered a lot over the past hour or so. How are you feeling right now about the interview?
- 8.
- If anything comes up from this interview or you want to check-in, please call this number ####-#### during Monday–Friday, 10 a.m.–6 p.m. If there is no answer, leave a voice mail with a number where I can reach you.
- 9.
- We appreciate your time in sharing your story, so we want to give you a $100 supermarket voucher. (If the interview is done on the phone, please ask: “Can you tell us an address where we should send it?”)
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Characteristic | Participants (n = 47) |
---|---|
Gender | |
Female | 37 |
Male | 10 |
Age | |
Young-old individuals (age 65–74 years) | 5 |
Middle-old individuals (age 75–84 years) | 23 |
Old-old individuals (age 85+ years) | 19 |
Place of birth | |
Hong Kong | 10 |
China (Mainland) | 32 |
Other 1 | 5 |
Length of time living in Hong Kong | |
Less than 10 years | 2 |
11–20 years | 2 |
21–30 years | 6 |
31–40 years | 7 |
41–50 years | 5 |
50+ years | 25 |
Language spoken | |
Cantonese | 44 |
Mandarin | 3 |
Marital status | |
Divorced | 9 |
Never Married | 3 |
Married 2 | 4 |
Widowed | 31 |
Housing type | |
Private flat (rental) | 1 |
Subdivided flat | 4 |
Subsidized public housing | 37 |
Village house | 5 |
Age of receiving public housing | |
Adulthood (up to age 44 years) | 6 |
Late middle age (age 45–64 years) | 16 |
Older adulthood (age 70–79 years) | 14 |
Not applicable | 11 |
Family members | |
No children | 9 |
1 child | 9 |
2 children | 13 |
3 children | 8 |
4 children | 3 |
5 or more children | 5 |
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Kwan, C.; Tam, H.C. “What If I Die and No One Notices?” A Qualitative Study Exploring How Living Alone and in Poverty Impacts the Health and Well-Being of Older People in Hong Kong. Int. J. Environ. Res. Public Health 2022, 19, 15856. https://doi.org/10.3390/ijerph192315856
Kwan C, Tam HC. “What If I Die and No One Notices?” A Qualitative Study Exploring How Living Alone and in Poverty Impacts the Health and Well-Being of Older People in Hong Kong. International Journal of Environmental Research and Public Health. 2022; 19(23):15856. https://doi.org/10.3390/ijerph192315856
Chicago/Turabian StyleKwan, Crystal, and Ho Chung Tam. 2022. "“What If I Die and No One Notices?” A Qualitative Study Exploring How Living Alone and in Poverty Impacts the Health and Well-Being of Older People in Hong Kong" International Journal of Environmental Research and Public Health 19, no. 23: 15856. https://doi.org/10.3390/ijerph192315856