Study of Adaptive Clothing in Hong Kong: Demands, Analysis and Future Direction

Aging population is substantively increased over last decade and they have specific clothing needs especially for the elderly with disabilities. Their clothing needs to cover functional and aesthetic requirements in order to improve their quality of life. Adaptive clothing is specially designed for the elderly and the disabled. However, there is no public policy to support such the elderly with disabilities in their clothing needs. In this paper, we aim to study the adaptive clothing and its significance, the problems encountered by the elderly with disabilities in adaptive clothing, analysis of public policy in Hong Kong for the elderly with disabilities in adaptive clothing over last decade, and implications and future directions for adaptive clothing in Hong Kong. In our findings, the demand of adaptive clothing in Hong Kong was substan-tially increased over last decade and the predicted demand will be twice of current demand after 50 years. However, the Government policy in Hong Kong has not yet fully supported their clothing needs, and the non-profit clothing services centre is set up to provide tailoring services to meet their needs. As the capacity of the centre is very limited, it is necessary to expand its capacity through assistive technology and to encourage non-government organizations (NGOs) to establish more social enterprises with Government’s support. Such findings would be beneficial to the Government for streng-thening such services for the elderly and the disabled as well as public awareness.


What Is Adaptive Clothing and Its Significance?
Adaptive clothing consists of garments and footwear designed for the elderly and people with disabilities (PWD), and is designed to eliminate, or at least reduce, the impact of functional limitations of its wearer's body [1], enabling them to go about their everyday lives with nonrestrictive comfort. In addition, it also allows caregivers and nurses to more easily provide assistance to those in need.
That adaptive clothing increases the wearer's sense of autonomy and control over their body means that they can more meaningfully participate in their community [2], increasing their engagement in occupations, as well as prospects for education and employment-all of which have a great impact on their quality of life [3]. As a means of lowering the barriers to social participation that the elderly and PWD encounter, adaptive clothing enables them to be more socially involved; thus, it plays a role in reducing the negative consequences of physical and mental problems, such as higher rates of coronary heart disease, stroke, depression, and cognitive decline [4], that arise from social isolation.
Clothing is fundamental to identity and self-image; it influences how one thinks, feels, and is perceived [5]. Therefore, aesthetic considerations figure just as much as functional considerations when it comes to adaptive clothing. In a society that privileges the needs and interests of the able-bodied, it comes as no surprise that the clothing choices of people with physical impairments are based on a desire to meet the dominant socio-cultural standards of appearance, so as to increase social acceptance and minimize differences from non-disabled peers [6] [7]. As such, fashionable adaptive clothing that fulfills its wearers' pursuit for style and image can positively influence wearers' self-concept, self-esteem, and body image, which in turn bolster cognitive functioning, mental health, and physical health [6].

Demands of Adaptive Clothing in Hong Kong from the Elderly and PWD
The need and demand for adaptive clothing will undoubtedly increase in the fu-  [9]. Given the projected increase in people aged 65, which also entails an increase in people with restricted body movement, the significance and need for accessible adaptive clothing ought to be considered just as much as other much-welcomed initiatives to improve the well-being of PWD and the elderly.

Current Government Policy for Supporting the Elderly and PWD in Hong Kong
Over the years, the Hong Kong government has demonstrated an awareness of the ways in which disabilities are very much social problems created and intensified by environmental barriers in society. In terms of policy, it has addressed the need to lower these environmental barriers, through measures such as the expansion of barrier-free and assistive transport and facilities [10].

Problems Encountered by the Elderly and PWD in Adaptive Clothing
Curiously, while there are measures to make the built environment more bar-

Setup of Non-Profit Servicing Centre and Social Enterprise for Adaptive Clothing
In the absence of policies to expand the provision of and access to adaptive The significance of adaptive clothing for the elderly and PWD should not be understated. It is just like assistive devices, such as wheelchairs and catheter bags, in that it fulfills the elderly and PWD's utilitarian need to better meet the demands of everyday life. Additionally, adaptive clothing fulfills the elderly and PWD's hedonic need for self-expression [7], should it be designed to be aesthetically pleasing, which is something that assistive devices cannot fulfill. Accordingly, any attempt by the government and the RAC to formulate a comprehensive plan for the rehabilitation and habilitation of the elderly and PWD needs to take into account the role of adaptive clothing in diminishing disablement and improving mental and physical well-being.

Facts Findings of Adaptive Clothing in Hong Kong over Last Decade
This section examines the data that the CAC has collected from 2007 to 2017 with regards to the adaptive clothing it has sold to its customers (see Table 1). Figure 1 illustrates the number of adaptive clothing items purchased from  Table   2), and the latter consisting of purchases made by individuals.
It can be seen that the individual purchases increase in a roughly linear man- There is no pattern to the institutional purchases throughout the decade, because these purchases are contingent upon whether institutions decide to purchase adaptive clothing items through Care Apparel Center. The purchase records show that all of the items that are usually purchased in bulk by these institutions are mass-produced ones that CAC sources from adaptive clothing suppliers. As such, institutions do not necessarily have to make their purchases through CAC, because there exist many suppliers in Hong Kong that offer mass-produced adaptive clothing items, such as non-slip socks and disability aid aprons, the top two most ordered items (see Table 3). This explains why no trend can be discerned from the bulk purchases throughout the decade. The nature of the most purchased items from individual purchases generally differs from the items purchased by various institutions (see Table 3). All of the adaptive clothing items that CAC sells to various institutions are mass-produced items that the center sources from various suppliers. Some of the items that individuals purchase are also mass-produced, such as non-slip socks, constraint mittens, and disability aid aprons. Many more are custom-made adaptive clothing items that are modified, tailored and manufactured to fit the specifications that individual customers require. For instance, the most ordered item from non-bulk purchases is a protective shirt, and customers who order a protective shirt from CAC experience a variety of physical impairments, many of which a pre-made protective shirt cannot address. A customer may require a special pocket to conceal the urine bag they carry with them, an attached arm sling on which to rest their arm, an enlarged zipper tab for those with finger dexterity impairments, and so on. CAC's two full-time tailors would have to take the measurements of these customers in order to manufacture a customized protective shirt for them. It also has to be noted that Table 3 only shows the most ordered

Implications and Further Actions for Adaptive Clothing in Hong Kong
Data from the CAC's records show that there is a high demand among the PWD and elderly for both mass-produced and customized adaptive clothing. The CAC does its best to meet this demand, but due to its small size, its ability to procure, manufacture, modify, and repair adaptive clothing items is limited. . Such an equipment center can feature a much larger center than the existing CAC. It could train and hire PWD for tailoring services, and it could offer its PWD and elderly clients customized adaptive clothing at a subsidized price, or even for free, to honor the notion that PWD is entitled to habilitation services as a basic human right.
In contrast, establishing more social enterprises that provide tailoring services for customers who want to buy customized adaptive clothing is less preferable, because of their need to earn a profit in order to be sustainable. The Fullness of Social Enterprises Society Report published in 2015 paints a bleak picture of the social enterprises' ability to sustain themselves-23% of SEs closed within 5 years, and the non-survival rate increased 55% within 10 years [17]. Given the low socio-economic background that PWD disproportionately belongs to, it does not seem appropriate for PWD customers to purchase customized clothing at a social enterprise. After all, the lack of competitive markets for adaptive clothing entails that the tailoring services offered for PWD customers, as well as the production of customized adaptive clothing, will be quite costly. Moreover, social enterprises need to maximize their profits in order to maintain and expand their operations-to profit off a marginalized group's need for adaptive clothing is not ideal. That said, elderly and PWD customers may not have to worry about the potentially high costs of customized adaptive clothing, given that many are fully subsidized by the government initiatives that grant them disability allowances and vouchers for these purchases. Even so, the fundamental problem remains: social enterprises like Home Care Apparel and non-profits like Care Apparel Center are too small to fulfill the burgeoning demand for customized adaptive clothing.
Lastly, to craft policies that are responsive to existing and rising demand for adaptive clothing, it may do well for the RAC and the Hong Kong Government to expand their conception of assistive technology and devices, so as to bring adaptive clothing within its fold. Browsing the information pages of programmes such as the Innovation and Technology Fund for Application in Elderly and Rehabilitation Care [18], as well as RPP's proposals of a Funding Scheme on Life-supporting and Assistive Devices, and Community Care Service Voucher for the Elderly [19], one gets the impression that assistive technology is mainly conceived as electronic devices and equipment such as wheelchairs and urine drainage bags. If assistive technology was defined as devices and equipment that maintain, increase, or improve the abilities of individuals with disabilities [1], then adaptive clothing belongs to this category, and should be perceived