International Journal of Clinical Research

The Hong Kong Special Administration Region(HKSAR) of China’s rapidly aging population, particularly those with sight and memory loss in long-term care facilities, faces significant occupational dysfunction and psychosocial challenges. This article explores the application of the Kawa Model, a culturally responsive occupational therapy framework originating from Japan, which employs the metaphor of a river to conceptualize life flow, obstacles, and environmental influences. Emphasizing harmony and collective cultural values, the model aligns with traditional Chinese philosophies, making it particularly relevant for elderly clients in Hong Kong. A case study of a 90-year-old woman with visual impairment and anxiety ("Living in the Darkness") demonstrates the model’s utility. Through collaborative narrative exploration, her "life river" was mapped, identifying obstacles (e.g., unresolved trauma, sleep disturbances) and strengths (e.g., faith, social engagement). Interventions integrated adaptive coping strategies, occupational re-engagement (e.g., cooking groups), and cultural elements such as Zen principles and Chinese idioms (e.g., "海纳百川" [Figure 1]— inclusivity). Outcomes highlighted enhanced occupational balance, self-efficacy, and reduced anxiety, underscoring client empowerment through culturally resonant metaphors. The discussion posits that the Kawa Model’s flexibility and emphasis on client-therapist collaboration foster therapeutic relationships while bridging Western clinical practices with Eastern cultural values. By incorporating Chinese philosophical concepts, the model offers a holistic, person-centered approach to address the complex needs of elderly individuals with sensory and cognitive impairments. This study advocates for culturally adapted models in occupational therapy to improve well-being in aging populations within multicultural contexts.

Occupational therapy; Older adult; Visual impairment; Kawa Model; Ethical practice