Jockey Club JoyAge: Holistic Support Project for Elderly Mental Wellness
Phase: NA
Conditions: Depressive Symptoms
Sponsor: The University of Hong Kong

 
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Jockey Club JoyAge: Holistic Support Project for Elderly Mental 
Wellness 
Date of the document: 20th March, 2020  
INVESTIGATORS 
Terry YS Lum (Principal Investigator) 
Department of Social Work and Social Administration, HKU 
Gloria HY Wong (Co-Principal Investigator) 
Department of Social Work and Social Administration, HKU 
Wai Chi Chan 
Department of Psychiatry, HKU 
Jennifer YM Tang 
Sau Po Centre on Ageing, HKU 
Samson Tse 
Department of Social Work and Social Administration, HKU 
Daniel FK Wong 
Department of Social Work and Social Administration, HKU 
Paul WC Wong 
Department of Social Work and Social Administration, HKU 
Siuman Ng 
Department of Social Work and Social Administration, HKU 
Vivian Lou 
Sau Po Centre on Ageing, HKU 
Department of Social Work and Social Administration, HKU 
Ricky Kwok 
Department of Electrical and Electronic Engineering, HKU 
Zvi Gellis 
School of Social Policy & Practice, University of Pennsylvania 
Martin Knapp 
Department of Health Policy, London School of Economics and Political Science  
PARTNERING ORGANIZATIONS  
Caritas Hong Kong 
Christian Family Service Centre 
Haven of Hope Christian Service 
Hong Kong Sheng Kung Hui Lady MacLehose Centre Mental Health Association of Hong 
Kong 
New Life Psychiatric Rehabilitation Association  
 
 

 
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BACKGROUND  
To develop a viable and sustainable best practice model to promote elderly mental wellness 
and prevent elderly depression for Hong Kong, the Hong Kong Jockey Club Charities Trust 
has initiated a pilot holistic support project entitled “JC JoyAge: Holistic Support Project for 
Elderly Mental Wellness”. This project aims to develop and implement a collaborative stepped 
care and peer support programme for effective outreach, engagement, and prevention of 
depression among older people in four pilot districts in Hong Kong, namely Kwun Tong, Sham 
Shui Po, Kwai Chung, and Tseung Kwan O.  
Objectives  
1. To evaluate the effectiveness of a collaborative stepped care and peer support 
programme in engaging older people at-risk of or with depression.  
2. To evaluate the efficacy of the programme in reducing symptoms/risks and promoting 
wellbeing in older people at-risk of or with depression.  
3. To investigate the impact of the programme on care resources utilization in these older 
adults.  
Methods  
Design  
This study adopts quasi-experimental design and compares older adults at-risk of or with 
depression receiving the stepped collaborative care (intervention group) versus those receiving 
standard care (control group).  
Participants  
1. Intervention Group: older people at-risk of having depression (n=1,600) and those with 
clinically significant depressive symptoms (n=400) recruited from NGOs providing the 
intervention in four pilot districts in Hong Kong  
2. Control Group: older people at-risk of having depression (n=400) and those with 
clinically significant depressive symptoms (n=100) referred by different NGOs in Hong 
Kong and recruited through open recruitment  
The inclusion criteria are:  

 
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• 
age 60 years or above; and  
• 
residing in Kwun Tong, Kwai Chung, Tseung Kwan O, or Sham Shui Po; and  
• 
have one or more known risk factor(s) for developing depression; and/or  
• 
have depressive symptoms of mild level or above; and  
• 
able to give informed consent to participate  
The exclusion criteria are:  
• 
known history of autism, intellectual disability, schizophrenia-spectrum disorder,  
• 
bipolar disorder, Parkinson’s disease, or dementia  
• 
(temporary exclusion criteria) imminent suicidal risk;  
• 
and difficulty in communication  
Assessment Procedures  
After basic screening, assessments will be conducted by trained social services staff and peer 
supporters employed by NGOs for the intervention group, and by trained research assistants 
employed by the University of Hong Kong for the control group.  
For the intervention group, assessments will be conducted at baseline (T0/Intake), completion 
of intervention (4 weeks to 6 months, depending on individual condition) or drop-out (T1/Exit), 
and follow-up at 12 months (T2/FU). For control group, assessment would be conducted at T0 
and T2.  
Assessment for those with clinically significant depressive symptoms will last for about 90 
minutes, and assessment for those at-risk of depression will last for around 60 minutes.  
Interventions  
The intervention group will receive a collaborative stepped care programme provided by 
registered social workers and trained peer supporters from elderly or mental health service units 
(NGOs) according to level of risks, symptom severity, and intervention response. Home visits 
or other format of contact will be delivered by trained peer supporters employed by NGOs to 
detect and engage hidden cases.  

 
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For “at-risk” group, 4 weeks of “selective prevention” group sessions will be provided at the 
elderly service level by trained peer supporters with registered social worker supervision, on 
wellness topics tailored to the person’s concern as entry point, packaged with mental health 
information, followed by a review. If the review shows no significant improvement, a further 
2-4 weeks of group plus individual casework sessions will be provided.  
For people with depressive symptoms, we further divide them to “mild” and “moderate” groups. 
For mild group, 6-8 weeks of indicated prevention with psychoeducation or low-intensity 
psychotherapy would be provided. For moderate group, 6-8 weeks high- intensity cognitive 
behavioral therapy (CBT) would be provided. All intervention for depressed elderly would be 
conducted by registered social workers who are trained by this project and employed by the 
NGOs. The trained peer supporters will be matched to individual older adults to walk them 
through the process.  
The control group will receive treatment as usual, which will be determined by the responsible 
worker from NGO units.  
Measurements  
1. Basic demographics: age, gender, marital status, education (years and highest 
attainment), and work experience.  
2. Risk flowchart: a customized questionnaire for quick screening of the following known 
risk factors for late-life depression: recent spousal death; widowed; disability; living 
alone; pain & sleep complaints.  
3. The Patient Health Questionnaire (PHQ-9) (Kroenke, Spitzer, & Williams, 2001): a 9-
item instrument that incorporates depression diagnostic criteria with other leading 
major depressive symptoms, and rates the frequency of the symptoms which factors 
into the scoring severity index. PHQ-9 scores of 5-9, 10-14, 15-19, 20 and above 
represent mild, moderate, moderately severe, and severe depression.  
4. Self-harm risk assessment: assessment by social service staff on participant’s risk of 
self-harm (yes or no answers to 10 items) and harm to others (yes or no answers to 4 
items), and in the end social service staff will give an overall evaluation of suicidal risk 
score ranging from 0-No to 3-High.  

 
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5. Generalized Anxiety Disorder scale (GAD-7; Spitzer, Kroenke, Williams, & Lowe, 
2006): a 7-item scale, responses to each item are rated on a 4-point Likert scale and 
range from 0 to 3. The following guidelines are recommended for the interpretation: 5-
9 for mild anxiety, 10-14 for moderate anxiety, and 15-21 for severe anxiety.  
6. Hong Kong Montreal Cognitive Assessment 5-Minute Protocol (HK-MoCA 5-Min) 
(Wong et al., 2015): a validated and reliable cognitive screen for stroke and transient 
ischemic attack, brief and highly feasible for telephone administration. It includes four 
items examining attention, verbal learning and memory, executive functions/language, 
and orientation extracted from the MoCA.  
7. Name generator: asking participants to list out names of people who they would turn to 
when they feel down, and when they need help for trivial things.  
8. UCLA loneliness scale (UCLA-3) (Hughes, Waite, Hawkley, & Cacioppo, 2004): a 3-
item self-report measuring individual’s perceived loneliness. Each item is evaluated 
with scores ranging from 0 (never) to 3 (often), total score is the sum of all items, and 
higher score indicates higher level of perceived loneliness.  
9. EQ-5D-5L (Herdman et al., 2011): a measure of health-related quality of life at five 
dimensions (5D), each with five levels (5L) of problems, and the five dimensions are: 
mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The 
traditional Chinese version for Hong Kong developed by EuroQol Group would be used.  
10. Lifeengagement:asemi-structuredinterviewaskingclientsabouttheirtypicalday activities 
in three domains, physical, social, and mental. A combination of being active in at least 
two domains would be used as one of the exit criteria.  
11. Client Service Receipt Inventory (CSRI) (Chisholm et al., 2000): to collect the current 
types and level of services which comprise the care package of each participant, and a 
locally adapted short version would be developed for this purpose.  
Data Analysis  
We will generate descriptive statistics of the demographic and clinical variables at the baseline 
(T0/Intake) assessment. The independent sample t-test will be used to compare the means of 
continuous variables in the intervention and control groups; the chi-square test will be used to 
compare categorical variables; and Fisher exact test will be used for variables with low cell 
counts (n < 5). For the majority of clinical scales that are ordinal in nature, the independent 
samples Mann–Whitney U-test will be used to examine whether the same distributions could 

 
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be assumed across groups. As observations at two /three time points are nested within 
individuals and individuals are nested within clusters (centers), changes in outcome measures, 
including PHQ-9 and GAD-7 scores, will be assessed by a three-level linear mixed model. 
Because the number of clusters is small, degree-of-freedom correction using the Satterthwaite 
method will be applied to the mixed models to maintain the desired type I error rate (Leyrat, 
Morgan, Leurent, & Kahan, 2017). We will use STATA 14.1 (StataCorp, 2015) for data 
analysis. For all the tests, the statistical significance level was set at .05. 
 
To investigate engagement in the intervention versus control group, the following analyses will 
be conducted: (1) Cox proportional hazard regression analysis of the time to the primary 
endpoint of voluntary withdrawal from service; (2) Chi-square test of initial refusal of service 
by eligible participants after screening. 
 
 
 
 

 
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