During her first field placement as an undergraduate social work student in Hong Kong, Iris Chi encountered what she expected to be a very depressing situation.

One of her clients was a woman in her 70s who had applied for housing assistance. Her husband and children had died during World War II, she had no other close relatives, and she had worked as a maid her entire life.

“At the beginning, I thought this was a very sad case, that this was just a helpless old lady,” Chi said. “She lived on her own and the living environment was terrible.”

Contrary to her expectations, however, the woman was far from depressed or negative about her circumstances.

“She had nothing, but she was very positive and she still wanted to help other people,” Chi said. “I was very surprised to see how resilient an older person can be. That one case really got me to think more about what is important in old age, and what quality of life means to older people.”

That initial spark of interest evolved into a lifelong passion for Chi, who has held the Chinese–American Golden Age Association/Frances Wu Chair for the Chinese Elderly at the USC School  of Social Work since 2004. Her extensive research on health and issues of aging, particularly among older Asian groups, has garnered accolades from government officials and brought increased attention to an often marginalized population.

Innate interest

Born in Taiwan and raised in Hong Kong, Chi was exposed to social work at a young age, as her mother cared for children with mental disabilities. Chi said she was initially very jealous of the attention that the other children received.

“The older I got, the more I understood her work and it helped my interest in social work,” she said.

Her mother’s career inspired Chi to study sociology at Chinese University of Hong Kong for two years, after which she switched her major to social work to pursue a more active and practice-based approach of social care. Her experiences during her field placement prompted her to travel to the United States to attend San Diego State University, where she was among a handful of students in a new concentration program on aging.

Gerontology was just emerging as a field of study, and many of Chi’s classmates were older practitioners returning to school for more training. They seemed surprised to see a young Asian woman in the program, she said, but Chi was confident in her choice.

“What amazed me the most was that when you looked at the population projections, you pretty much knew what was going to happen 30 or 50 years later,” she said. “I would joke with my classmates and say, I think I’ll have a pretty good career.”

After earning her master’s degree in San Diego, Chi completed a doctorate in social work at UCLA in 1985, where she shifted her focus from a practice-based career to academia. Due to a diverse group of mentors, her interests broadened to include public health and psychology.

Breaking new ground

After several years of postdoctoral work, Chi returned to Hong Kong and took a position at the University of Hong Kong, where she taught for 17 years, established a research center on aging, and oversaw postgraduate research.

She also led a handful of groundbreaking studies exploring health issues among older adults. Her initial research project involved conducting the first health survey of aging populations in Hong Kong.
“It was something to educate myself, to understand this population better,” Chi said. “Before, there was no data on aging at all.”

She followed up that baseline survey with a 6-year study on health promotion in Hong Kong. Chi found that although the city had one of the best child health programs in the world, little funding was being directed to older adults.

“People have this misconception that they are getting old, it’s too late to do anything, it’s just a waste of money, that older people don’t even want to participate,” she said. “But that study really showed all those myths are wrong. Older people are very concerned about their health, it’s just they don’t know how to take care of themselves.”

Her results inspired the government to develop a health promotion program for older adults, and sparked interest in the issue among nongovernmental groups and the private sector. Chi parlayed that research into another innovative study on suicide rates among the aging population of Hong Kong.

Newspaper articles on teenage suicides always attracted significant attention, she said, but stories on suicides among older people were typically very brief and buried deep in the newspaper, and always attributed the deaths to chronic illness. Her baseline study found intriguing results; although suicides were indeed linked to chronic illness, other significant factors were at play.

“It wasn’t the disease per se, it was the type of disease,” Chi said.

Health conditions that caused pain, such as cancer and arthritis, were associated with suicide. Other physical issues, such as chronic obstructive pulmonary disease, that induced a sense of uselessness or inhibited the ability to perform daily activities as simple as walking or completing household chores were also linked with self-inflicted deaths among elderly groups.

“This really provided useful information for social workers or practitioners,” she said. “You don’t just treat all older people with illnesses like they are going to commit suicide. You focus on specific types of disease that would create this type of effect.”

Drawing attention

In recognition of her significant contributions to public health in Hong Kong, government officials honored Chi with the Bronze Bauhinia Star in 2004. By that time, she had drawn the attention of Marilyn Flynn, dean of the USC School of Social Work, who attempted to recruit Chi for a relatively new endowed chair with a combined focus on social work, gerontology, and older Chinese adults.

The position seemed tailor-made for Chi, who was among very few experienced scholars in the world with a strong background in all three areas, and she accepted the position in 2004.

Chi quickly set about gaining a greater understanding of the issues faced by aging groups in her new surroundings, launching a comparative study of older adults in urban areas of Los Angeles. But she also became increasingly intrigued by issues in rural areas of China, where the majority of older Chinese people reside.

“In rural China, the government hasn’t been able to provide much assistance,” she said. “People are still very traditional and rely on families for support.”

Despite being told that local customs and wariness about outsiders would prevent her from conducting a successful study in rural communities, she joined forces with a colleague at the USC Davis School of Gerontology, Merril Silverstein, who was already attempting to establish a research foothold in Anhui province.

“That became a major study,” Chi said. “This is the first longitudinal study in rural China, and we are very proud of our product.”

Many doctoral students mentored by Chi have relied on the data for their dissertations, and the study results have provided fodder for numerous articles. Among the most significant findings has been the unique nature of support exchange across generations.

As middle-aged Chinese people flood urban areas looking for employment, children are frequently left with their grandparents in rural villages. Gaining a better understanding of the complex interactions in these new family structures—such as the health benefits related to a sense of purpose older adults develop by caring for their grandchildren and maintaining the household—has offered guidance to social workers and others looking for ways to strengthen the health and longevity of older Chinese populations.

Compare and contrast

In recent years, Chi has shifted her focus back to cross-cultural characteristics of older adults in China and the United States. She sees parallels and differences between the two countries in terms of how they approach issues of aging.

“In the United States, we already have the infrastructure, Social Security and Medicare, but the problem is to make sure these programs are sustainable,” she said. “All this has become very political, but the problem is quite clear. These programs are just not going to be able to continue in the same way.”

In China, the opposite is true. There are relatively few large-scale programs in place to support older adults.

“They need to build it as soon as possible,” Chi said, citing the nation’s rapidly aging population. “They need to understand that this program is not just for the next 10 years; you really need to have a long-term vision.”

She is hopeful that her ongoing research will help guide policy makers as they develop and adapt programs for aging groups. One critical issue is the need for a renewed focus on family support. Despite spending large sums of money on different programs in the United States, Chi said 85 percent of care for older adults is provided by family members.

“Both China and the United States need to understand the family dynamics, how family can continue to provide care to older people under increasing stress,” she said. “I hope this is something the two countries can build together and learn from each other.”