Perspectives on ageing, later life and ethnicity: ageing research in ethnic minority contexts

Doing old(er) age in a translocal context: Turkish-born women's experiences of ageing, care and post-mortem care practices

This article elaborates on how Turkish-born women in Sweden do old age in relation to gender and migrancy and aims to understand the fluid process of doing over their life course. It draws upon 20 in-depth and semi-structured interviews with Turkish-born women aged 60-78 and aims to address the tensions between agency and intersecting power positions. Theoretically, the article relies on critical feminist gerontology and doing old age to address the negotiations and performances of the interviewed women. The findings show that there are several ambivalences and dilemmas in how the women do old age in a transnational setting. Intergenerational and gendered old age care comes to fore as a significant negotiation site. The women negotiate identity categories with both imagined others and the social actors in their lives (such as their children) over their life course, which implies the situated and relational aspect of doing old age.

"Think positive and don't die alone" - Foreign-born, South Asian older adults' perceptions on healthy aging

South Asians are the largest and fastest-growing racialized group in Canada, yet there are limited data on various aspects of health and well-being within this population. This includes the South Asian older adults' ethnoculturally informed perceptions of ageing. The study aimed to understand how social and cultural forces impact the meaning assigned to healthy ageing amongst older South Asians in Canada. We recruited with purposeful and snowball sampling strategies in Southern Ontario. We conducted in-depth focus group and individual interviews (n = 19) in five South Asian languages, employing a multilingual and cross-cultural qualitative approach. In our analysis, we identified three central themes: (a) taking care of body (b) taking care of mind and heart and (c) healthy ageing through the integration of mind and body. Our study demonstrates that older immigrants are a diverse and heterogeneous population and that their conception of healthy ageing is strongly influenced by their country of origin. This study also demonstrates how racialized foreign-born older adults might provide distinctive perspectives on the ageing process and on social theories of ageing due to their simultaneous immersion in and belonging to global majority and global minority cultures. This research also adds to the limited body of literature on the theories of ageing, despite migration trends, still has a white-centric lens.

Migration and health: exploring healthy ageing of immigrants in European societies

AIM

The aim is to identify important factors for immigrants' health and well-being and for their use (or non-use) of primary health care (PHC) and other non-specialised services, and for possible ways that PHC can support healthy ageing of immigrants.

BACKGROUND

Older persons are an increasing share of the immigrant population in the global north, frequently in contact with various forms of health services, (PHC services most of all. Consequently, PHC services are in a particularly unique position to support healthy ageing of immigrants.

METHODS

The position paper builds on five international, multi-professional and cross-disciplinary small group discussions as well as an international workshop early summer. During the discussions and the workshop, topics were arrived at as to factors related to the health situation of older immigrants, their needs, and health-seeking behaviour, and to how PHC professionals could support healthy ageing in immigrants. Those main topics in turn guided search for relevant research literature and informed the selection of the main research questions of this paper.

FINDINGS

Several factors, in addition to culture and cultural differences, are important to for PHC professionals and decision-makers to take into consideration in encounters with older immigrants. The socio-economic position of the older immigrant and close relatives, inter-generational relationships within the immigrant communities, country-specific factors in the host country like health care expenditure, and communication skills in health professionals are all examples of factors playing an important role regarding the health and health-seeking behaviour of older immigrants.

The Happy Home: Ageing, Migration, and Housing in Relation to Older Migrants' Subjective Wellbeing

(1) Background: With an increasingly diversifying ageing population, it is important to understand what 'ageing well' means to older adults with a migration background. Given older adults' preference to age in place and declining mobility, housing is a significant place in later life. Therefore, this paper explores the influence of housing, migration, and age on older migrants' subjective wellbeing, with attention to immaterial aspects such as a sense of home as well. (2) Methods: In-depth interviews with older migrants from various ethnicities (N = 22) were conducted. The data collection and analysis were led by an inductive and deductive approach through thematic analysis. (3) Results: The results point to the dynamic nature of age(ing) and the role of migration background in the subjective wellbeing of older migrants. The need for preserving one's housing situation and environmental mastery in later life is highlighted. Furthermore, the relation and mutual influence of subjective wellbeing and sense of home is uncovered. (4) Conclusions: This study highlights the intersection of age, migration, and housing to the subjective wellbeing and sense of home of older migrants. In addition, influences on older migrants' subjective wellbeing concern both a material (i.e., housing) and immaterial (i.e., sense of home, age, migration) base.

Pathways of aging in migration and their association with the quality of life

This study adopted a life course approach in exploring the quality of life of old migrants based on the experiences of Korean Australians aged 60 years and over. Pathways of aging were considered as related to the aging progress in migration, and three different groups were identified: aged with a migrant background (those who migrated when they were younger and had grown old in the destination country), family migrants (those who accompanied/were invited by their children), and retirement migrants (those who chose to migrate in later life independent of their children). The study identified elements of quality of life particularly meaningful to specific groups. The findings of this study may help in broadening the knowledge base of the diverse aging experiences of migrants and to inform policy and the development of programs to support elderly migrants.

Behaviour change interventions to promote health and well-being among older migrants: A systematic review

Background

Whether behaviour change interventions are effective for the maintenance of older migrants’ health and well-being is uncertain. A systematic review was conducted to assess evidence for the capacity of behaviour change techniques (BCTs) to promote the health and well-being of older migrants.

Methods

Electronic databases (Cochrane CENTRAL, Embase, Ovid MEDLINE and Web of Science) were searched systematically to identify relevant randomised controlled trials, pre–post studies and quasi-experimental studies published before March 2021. Additional articles were identified through citation tracking. Studies examining BCTs used to promote the health and/or well-being of older migrants were eligible. Two independent reviewers used the Behaviour Change Technique Taxonomy version 1 to extract data on BCTs. Data on intervention functions (IFs) and cultural adaption strategies were also extracted. Intervention contents (BCTs, IFs, culture adaption strategies) were compared across effective and ineffective interventions according to health and well-being outcome clusters (anthropometrics, health behaviour, physical functioning, mental health and cognitive functioning, social functioning and generic health and well-being).

Results

Forty-three studies (23 randomised controlled trials, 13 pre–post studies and 7 quasi-experimental studies) reporting on 39 interventions met the inclusion criteria. Thirteen BCTs were identified as promising for at least one outcome cluster: goal-setting (behaviour), problem-solving, behavioural contract, self-monitoring of behaviour, social support (unspecified), instruction on how to perform the behaviour, information about health consequences, information about social and environmental consequences, demonstration of the behaviour, social comparison, behavioural practice/rehearsal, generalisation of a target behaviour and addition of objects to the environment. Three BCTs (instruction on how to perform the behaviour, demonstration of the behaviour, and social comparison) and two IFs (modelling and training) were identified as promising for all outcome clusters.

Conclusions

Thirteen distinct BCTs are promising for use in future interventions to optimise health and well-being among older migrants. Future research should focus on the effectiveness of these BCTs (combinations) in various contexts and among different subgroups of older migrants, as well as the mechanisms through which they act. Given the scarcity of interventions in which cultural adaption has been taken into account, future behavioural change interventions should consider cultural appropriateness for various older migrant (sub)groups.

Trial registration

PROSPERO CRD42018112859.

Social position of older immigrants in the Netherlands: where do immigrants perceive themselves on the societal ladder?

Older Turkish and Moroccan immigrants are often ascribed a low social position based on their relatively unfavourable educational level, occupational status and income. Yet immigrants emigrated to improve their social position and came from contexts where determinants of social position might be based on different socio-cultural circumstances than those used in the country of settlement. In order to understand immigrants' own perception of their social position, we interviewed 23 60-68 year old immigrants from Turkish and Moroccan origin in the Netherlands. Using a ten rung ladder, participants were asked to position themselves in the societal hierarchy before migration, after settlement and currently. Most participants positioned themselves at a middle or high position on the societal ladder. Circumstances used for positioning were related to socioeconomic indicators, but also to social affirmation, family, social integration, physical, mental health, happiness and complying to religious prescriptions. When these circumstances were deemed favourable, participants tended to position themselves higher. Our findings also show that the circumstances that participants used for positioning themselves varied across the life course. These findings complement the picture of the often low objective low socioeconomic position of older immigrants and show that immigrants' perception of their subjective social position reflects a broader set of circumstances than just socioeconomic ones.

Exploring Dementia Care Systems Across the African Caribbean Diaspora: A Scoping Review and Consultation Exercise

BACKGROUND AND OBJECTIVES

Understanding the influences of marginalized cultural and social identities as experienced by the African Caribbean diaspora within the context of dementia care is essential to minimize the gaps in current practice and policy in the health care setting. This study explores the impact of marginalized identities upon the meaning-making process, access to services and experience of care provisions through a scoping review and consultancy exercises with key stakeholders.

RESEARCH DESIGN

Fourteen databases were searched using key terms. Primary studies in English, any year, study design, and country of origin were eligible. Titles, abstracts, and full texts were screened for inclusion and data were extracted in stages. Thematic analysis was performed and the findings were discussed in a series of consultation meetings with people with dementia, carers, and health care professionals in Manchester (United Kingdom) and Jamaica.

RESULTS

The scoping review retrieved n = 1,989 research articles. Nineteen were included, most were qualitative (n = 14), 3 quantitative, and 2 mixed-method. The findings revealed limited insight into cultural and multiple individual identities in explaining conceptualization and service access. Consultation meetings confirmed these findings and highlighted differences in health care services and systems in the United Kingdom and Jamaica.

DISCUSSION AND IMPLICATIONS

This study suggests there is a complex interaction of sociocultural processes that marginalize African Caribbean persons in and across various national settings within the context of dementia care. The study highlights the importance of acknowledging and addressing how prevalent racialized- and class-based divides and related marginalized social locations are reflected in inequities in access to and use of dementia services.

Targeting preventive home visits to older adults in disadvantaged communities: Perspectives of professionals

This study explored the implementation of multidimensional preventive home visits targeted to older adults living in a disadvantaged community in Denmark. The intervention was adapted to include the following key components: involvement of community members in recruitment processes; a combination of individual and group-based dissemination; adaptation of materials to overcome language barriers; and diversity-sensitivity training for professionals. The study took place over 12 months between August 2016 and August 2017 and used various data sources: registry-based data, participant observations, combined with individual and focus group interviews with the target population (n = 22) and relevant health care professionals (n = 8). Here, we report on findings pertaining to implementation barriers and facilitators as seen from the perspective of professionals. Socioeconomic vulnerability was prominent, and uptake of health care services was low, indicating under-utilisation. Implementation facilitators and barriers were identified including potentials in nurturing local partnerships and proximity during recruitment; overcoming language barriers; offering diversity-sensitivity training for professionals; and a need for a more multidisciplinary, comprehensive scope of preventive visits for diverse older adults in disadvantaged communities. Thus, more focus on participatory, comprehensive and community-based health promotion are needed to ensure healthy ageing in the context of social inequality and ethnic diversity.

Unpacking the Complexity of Migrated Older Adults' Lives in the UK through an Intersectional Lens: A Qualitative Systematic Review

BACKGROUND AND OBJECTIVES

The intersection of population ageing and international migration increases the ethnic and cultural diversity of the UK's older population, which has significant implications for health and care services and requires social inclusion and equal access to welfare. This review aimed to explore the complexity of migrated older adults' lives and analyse how their multiple identity markers interweave and affect their lived experiences.

RESEARCH DESIGN AND METHODS

This review is a qualitative systematic review. Intersectionality was applied as a theoretical scaffold to inform the qualitative thematic synthesis of the data.

RESULTS

A total of 29 studies in the period 2000-2020 were included. Three themes- language barriers, racism and discrimination, negotiating cultural influences, were identified as common challenges faced by migrated older adults. However, the degree of these challenges and the resources to buffer their effects vary dramatically given the significant differences in older migrated adults' gender, socio-economic status (SES), cultural backgrounds and migration pathways.

DISCUSSION AND IMPLICATIONS

Rather than focusing on any single factor, it is required to consider the intersection of age, race, ethnicity, gender, SES, and migration status when understand and address inequality not only between migrated older adults and native older adults, among different migrated older adult groups but also within any certain group. This review calls for the acknowledgment and awareness of policymakers, care and service practitioners and academics on the heterogeneity of migrated older adults.

Knowing, Being and Co-Constructing an Age-Friendly Tāmaki Makaurau Auckland

A third of Aotearoa New Zealand’s increasingly ageing population resides in Tāmaki Makaurau Auckland. This most populous cosmopolitan urban area in the country is also home to the largest Polynesian population of any global city. Sprawling across a North Island isthmus inclusive of Hauraki Gulf islands, 70% of the city region is rural, whilst almost 90% of the ethnically diverse residents live in urban areas. Members of Auckland Council’s Seniors Advisory Panel (SAP) advocated for, and in 2018 secured unanimous support from the governing body to resource an Age-friendly City (AFC) Project. This case study inquiry applied bricolage methodology to provide diverse contextual perspectives of this unique Polynesian setting, prior to exploring interview narratives of three SAP members who served two consecutive terms (six years) as AFC advocates. Weaving insights gleaned from their interview transcripts responding to relational leadership prompts about their age-friendly advocacy with the findings from the council’s AFC Community Engagement report highlighted the achievements and challenges of the evolving AFC Project. Service-learning recommendations include co-developing: (1) A sustainable co-governance framework for an independent steering group that embodies the values and principles of Te Tiriti o Waitangi to enable empowered active ageing for all residents; (2) A succession plan that enables the timely transfer of knowledge and skills to empower incoming SAP members.

Doing research on the intersection of ethnicity and old age: Key insights from decolonial frameworks

Population aging and international migration are two of the most critical social trends shaping the world today. As a result, scholars across the globe have begun to investigate how to better incorporate ethnicity into gerontological research. The integration of insights from life-course theory, post-colonial, and feminist theories have resulted in valuable attempts to tackle issues related to ethnicity and old age. Inspired by these bodies of research, this paper explores how decolonial perspectives can strengthen social gerontological research at the intersection of ethnicity and old age. This theoretical paper advances four key insights drawn from decolonial perspectives that expose some current blind spots in gerontological research at the intersection of aging and ethnicity. Through a process of awareness and resistance decolonial perspectives reveal that: 1) colonial thinking is deeply embedded in research; 2) critical reflection about who is considered the "knower" in research is warranted; 3) alternative ways to generate, analyze, and publish knowledge exist; and 4) the places and systems of knowledge production are not neutral. To address these issues empirically, decolonial frameworks call us to actions that include decolonizing the conceptual underpinnings of the research enterprise, scholars themselves, research-in-action (through "epistemic disobedience"), and current knowledge systems and structures that reflect and reinforce colonialism. Potential applications of these insights are explored, but acknowledged as an essential first step on a nascent path. This paper concludes by arguing that decolonial perspectives offer a more genuine gaze by demanding nuanced reflections of contemporary realities aging persons embodying the intersection of aging and ethnicity, like racialized older migrants and ethnic minorities, while simultaneously revealing how historically-rooted power hierarchies that are often invisible constrain their aging experiences.

From an aging person to an elegant senior: a humanistic approach to viewing older adults

The continuing growth in the number of adults aged 60-plus has raised global alertness of population restructuring. This demographic change, on the one hand, reduces productivity and increases public expenditure due to aging, resulting in prejudice, bias, misrepresentation, and discrimination against them. On the other hand, it develops a specific consumer market segment and extends the availability and accessibility of the elderly through employment, volunteering, or grandparenting. This study argues against the stigmatization of this age group from a functional perspective that damages social cohesion. It advocates a humanistic view toward seniors to eradicate marginalization and promotes the manageability of the senior population. With the aid of advanced technology and health equity, senior adults can retain everyday competence for self-care with dignity, as well as gracefully attain physical and psychological health, autonomy, and well-being in their later life. All these considerations give medical and nursing professionals insight into how to take care of the elderly.

'An invisible human rights crisis': The marginalization of older adults during the COVID-19 pandemic - An advocacy review

The world has endured over six months of the Coronavirus disease 2019 (COVID-19). Older adults are at disproportionate risk of severe infection and mortality. They are also vulnerable to loneliness and social exclusion during the pandemic. Age and ageism both can act as significant risk factors during this pandemic, increasing the physical as well as psychosocial burden on the elderly. A review was performed in relation to the psychosocial vulnerabilities of the older adults during the pandemic, with insights from the similar biological disasters in the past. Besides the physiological risk, morbidities, polypharmacy and increased case fatality rates, various social factors like lack of security, loneliness, isolation, ageism, sexism, dependency, stigma, abuse and restriction to health care access were identified as crucial in pandemic situation. Frailty, cognitive and sensory impairments added to the burden. Marginalization and human rights deprivation emerged as a common pathway of suffering for the elderly during COVID-19. The implications of the emergent themes are discussed in light of psychosocial wellbeing and impact on the quality of life. The authors suggest potential recommendations to mitigate this marginalization on lines of the World Health Organization (WHO)'s concept of Healthy Ageing and the United Nations (U.N.) Sustainable Development Goals.

The Aging Experiences of LGBTQ Ethnic Minority Elders: A Systematic Review

BACKGROUND AND OBJECTIVES

In gerontological research and practice, an increasing amount of attention is being paid to lesbian, gay, bisexual, transgender and queer (LGBTQ) older people and how their experiences differ from their heterosexual and cisgender counterparts. However, LGBTQ elders themselves are not a homogenous group. Moreover, as the immigrant populations in industrialized nations age, the number of LGBTQ elders from ethnic minority backgrounds will only grow. This systematic review hence investigates the experiences of LGBTQ ethnic minority elders.

RESEARCH DESIGN AND METHODS

Following the PRISMA guidelines, we conducted a systematic search in five databases for English peer-reviewed studies. The retrieved articles were coded and analyzed inductively using an intersectional framework to tease out the varying influences of ethnicity, age, gender and sexual identity on the LGBTQ ethnic minority elders' experiences.

RESULTS

A total of 30 articles across 17 studies (13 qualitative, seven quantitative and one mixed methods) were identified. Six key themes emerged from the studies: stigma and discrimination; isolation, support and belonging, interactions with services and institutions, self-acceptance, resilience and agency; mental health and wellbeing; and uncertain futures.

DISCUSSION AND IMPLICATIONS

The experiences of LGBTQ ethnic minority elders echo those of LGBTQ ethnic majority elders when they are shaped by gender and sexual identity factors. Nevertheless, significant differences in experiences -both positive and negative-emerge when cultural and ethnicity-related factors come to the fore. These findings emphasize the need for intersectional aging policies and services that go beyond catering for LGBTQ elders to include the diversity within this sub-population.

Persons With a Migration Background Caring for a Family Member With Dementia: Challenges to Shared Care

Background and Objectives

By shedding light on the reasons why persons with a migration background (PwM) may take up the role of family caregiver of a person with dementia, and how this relates to gender norms, we aim to elucidate cultural and social dynamics that impede care sharing.

Research Design and Methods

A qualitative study of 12 PwM who provide care, or have recently provided care, for a family member with dementia was conducted through semi-structured interviews. Identified themes and patterns were analyzed with the help of Hochschild’s interpretive framework of framing and feeling rules.

Findings

Our findings illuminate how motivations to provide care are framed through two moral framing rules, reciprocal love and filial responsibility, and how these framing rules are accompanied by the feeling rule of moral superiority over non-caregiving family members. We show how shared dementia care is impeded though these moral framing and feeling rules, and how gender norms impact on an unequal distribution of care-tasks.

Implications

Healthcare practitioners should identify the moral dialectics of caregiving. This means that, on the one hand, they should be aware that moral framing rules may pressure women into exclusive caregiving, and that this can lead to health problems in the long term. On the other, healthcare practitioners should recognize that providing care can create a deep sense of pride and moral superiority. Therefore, showing acknowledgement of the caregiver contribution is a crucial step in creating trust between the caregiver and healthcare practitioner. Furthermore, asking for support should be normalized. Governmental advertisements on care–support can achieve this.

The Experience of Aging and Perceptions of "Aging Well" Among Older Migrants in the Netherlands

BACKGROUND AND OBJECTIVES

In this study, we examine the experience of aging and subjective views of what it means to age well among older adults with a migrant background in the Netherlands. We embed the study within the successful aging debate and tackle two of its most persistent critiques: the failure to adequately include subjective views in the definition of aging well and the failure to recognize that the process of aging is culturally determined.

RESEARCH DESIGN AND METHODS

The research draws on qualitative data collected through eight focus-group discussions with the six largest migrant groups in the Netherlands, namely Indo-Dutch and Moluccans, and migrants with Western, Surinamese, Antillean, Turkish, and Moroccan background.

RESULTS

The study findings show that in general older migrants experience aging more positively than commonly assumed. Nevertheless, some negative aspects of aging were also mentioned. These together with fears about the future underpin participants' perceptions about aging well. Key aspects of successful aging include remaining healthy, independent, and engaged. Differences between and within groups exist in the meaning given to these concepts and the extent to which other specific aging-related wishes were mentioned. These differences are rooted in participants' experiences of the migration event, employment history, and their current socioeconomic conditions.

DISCUSSION AND IMPLICATIONS

We conclude that the life course perspective is essential in understanding migrants' aging process and their views on successful aging, and suggest that policies and interventions which promote disease prevention and tackle social exclusion will be beneficial for older adults with a migration background.

Caring for migrant older Moroccans with dementia in Belgium as a complex and dynamic transnational network of informal and professional care: A qualitative study

BACKGROUND

Due to its labour migration history, Belgium is confronted with an increasingly older population of people of Moroccan background who have been diagnosed with dementia. These migrants came to the country during the labour migration wave of the nineteen-sixties and seventies to work in mines and other industries and they are now ageing. Yet little is known about how dementia care is provided to this older population.

OBJECTIVES

This study explores how dementia care is provided to these Moroccan older people with dementia, and what challenges do caregivers face in providing care.

METHODS

A qualitative study including 31 informal caregivers of older Moroccan migrants with dementia and professional caregivers in the field of dementia care in several Belgian cities was conducted. After an initial focus group including 6 informal and professional caregivers, individual in-depth interviews were held with 12 informal caregivers of Moroccan decent and 13 professional caregivers. In order to be included in the study, informal caregivers had to have a recent experience in caring for an older family member with dementia. The professional caregivers had to be active in the field of dementia care (General Practitioners, nurses, psychologists,…) and have experience with older migrants with dementia.

RESULTS

Analyses of the collected data reveal that current dementia care is a challenging, complex and dynamic search process. This process is shaped by (1) multiple factors reflecting the changing care needs of the care recipient during the course of the dementia, (2) the individual (transnational) recourses of the informal caregivers and the (3) current (lack of) accessibility of professional dementia care (driven by the absence of an accessible migration-, culture- and religion-sensitive professional care). The limited professional service-use is predominantly compensated through the search for transnational external helpers. The limited migration, cultural and religious sensitivity of current dementia care is often overlooked by professional caregivers.

CONCLUSION

The study provides a better understanding of the complex reality of dementia care for older migrants in which these different aspects intersect. This understanding enable health professionals and policy makers to develop a better suited care for older migrants with dementia.

Social Support and Life Satisfaction of Ethnic Minority Elderly in China

Previous studies indicate that Han and ethnic minority groups in China are not homogeneous. However, little research has examined potential heterogeneity in the association between social support and life satisfaction across Han and ethnic minority elderly. Based on data from the 2014 China Longitudinal Aging Social Survey, this study uses ordered logit models with interaction terms to examine the relationship between social support and the life satisfaction of ethnic minority elderly and of elderly Han Chinese. We find that support from families and friends has a stronger association with the life satisfaction of ethnic minority elderly than their Han peers. For ethnic minority elderly, the patterns of family support varied according to rural or urban residence, with family support being less important to the life satisfaction of ethnic minority elderly living in urban communities than in rural areas. Our findings suggest that social policy should take this heterogeneity between ethnic groups into account.

Successful Aging in Individuals From Less Advantaged, Marginalized, and Stigmatized Backgrounds

Health and well-being in later life are heavily influenced by behaviors across the life course, which in turn are influenced by a variety of wider contextual, social, economic, and organizational factors. There is considerable potential for inequalities in health-promoting behaviors and health outcomes, arising from poverty, social, and environmental factors. This suggests that individuals from disadvantaged backgrounds and circumstances may have more exposure to (chronic) stressors, coupled with reduced access to resources, and increased susceptibility to risk factors for ill-health and mental disorders in later life. This drastically decreases the likelihood for successful aging in individuals from less advantaged backgrounds. Nevertheless, despite these adverse circumstances, some high-risk, disadvantaged individuals have been shown to achieve and maintain good health and well-being into later life.

This scientific update provides an overview of recently published research with samples that, against expectations, demonstrate successful aging.

Favorable personality traits, cognitive strategies, and a high-level of intrinsic motivation, paired with a supportive social environment, have been found to build a prosperous basis for successful aging and positive health outcomes in later life for individuals living in aversive environmental circumstances.

For clinical psychologists, the movement towards the investigation of underlying mechanisms of successful aging from a psychological perspective, particularly in disadvantaged individuals, may be a critical step towards understanding the vast heterogeneity in aging.

Successful aging is possible in disadvantaged individuals.

Psychological and social resilience resources may compensate for the impact of disadvantage.

The application of multi-level resilience models can aid future research on successful aging.

Older migrants reflecting on aging through attachment to and identification with places

With increasing numbers of older migrants adopting a transnational lifestyle or returning to their country of origin following retirement, the sense of attachment to and identification with the places they inhabit remains an under explored field of enquiry. Through an ethnographic approach, this paper seeks to raise awareness of the diversity within a group of older migrants, given the heterogeneity of affective bonds established with places. By highlighting the perspective of older Italian migrants living in Newcastle upon Tyne, UK, this paper illustrates the role of a sense of identification with the context of migration in later life. In referring to migration as a process of transformation, some older Italians re-define their identities, as these become interwoven with the characteristics of the places in which they grow older. However, older migrants' sense of attachment to places also reveals the complexity of aging in the context of migration, when a sense of identification with these is never fully achieved in older age. This paper argues that the notion of aging that these older Italian migrants uphold is not only altered by their experience of migration, but also shaped through their identification with the places they inhabit, given formal and informal practices of identification. Thus, by addressing the determinants for a positive experience of aging in the context of migration, this paper challenges the ways in which older migrant groups are conceptualized in gerontological scholarship.

Changes in Left Ventricular Mass and Geometry in the Older Adults: Role of Body Mass and Central Obesity

BACKGROUND

Left ventricular (LV) hypertrophy is an independent risk factor for cardiovascular outcomes. There are limited data about modifiable factors associated with progression of LV hypertrophy in older adults. Our objective is to describe the changes in LV mass and geometry over time in a predominantly older multiethnic cohort and to identify possible predictors of changes over time.

METHODS

We analyzed data from participants in the Northern Manhattan Study who underwent serial echocardiographic studies, comparing the baseline and the most recent echocardiograms. We recorded changes in LV mass and geometry and correlated them with baseline characteristics using linear regression models.

RESULTS

There were 826 participants (mean age, 64.2 ± 8.0 years) included in the analysis (time between measurements, 8.5 ± 2.7 years). Overall, LV mass index increased from 45.0 ± 12.7 to 50.3 ± 14.6 g/m^2.7 (P < .001). There were 548 participants (66.3%) with LV mass increase; 258 individuals (31.2%) showed worsening LV geometry. Multivariable analysis showed that change in LV mass index was independently associated with baseline LV mass index (β estimate, -17.000 [standard error, 1.508]; P < .001), hypertension (2.094 [0.816], P = .011), body mass index (0.503 [0.088], P < .001), and waist-to-hip ratio (1.031 [0.385], P = .008). Both waist-to-hip ratio and waist-to-height ratio remained significantly associated with LV mass increase even after adjusting for body mass index (P = .008 and P = .036, respectively).

CONCLUSIONS

Regardless of race/ethnicity, LV mass progressed over time in older adults. We also observed that worsening geometry was frequent. Assessment of central obesity in the older population is important because indicators of central obesity add prognostic value over body mass index for the risk of LV mass increase.

Do religious activities among young-old immigrants act as a buffer against the effect of a lack of resources on well-being?

OBJECTIVES

Despite a large body of sociological and psychological literature suggesting that religious activities may mitigate the effects of stress, few studies have investigated the beneficial effects of religious activities among immigrants. Immigrants in particular may stand to benefit from these activities because they often report a religious affiliation and often occupy disadvantaged positions. This study investigates whether private and public religious activities reduce the negative effects of a lack of physical, social, and socio-economic resources on wellbeing among Turkish and Moroccan young-old immigrants in the Netherlands.

METHOD

Using data from the Longitudinal Study Amsterdam, cluster analysis revealed three patterns of absence of resources: physically disadvantaged, multiple disadvantages, and relatively advantaged. Linear regression analysis assessed associations between patterns of resources, religious activities and wellbeing.

RESULTS

Persons who are physically disadvantaged or have multiple disadvantages have a lower level of wellbeing compared to persons who are relatively advantaged.  More engagement in private religious activities was associated with higher wellbeing. Among those with multiple disadvantages, however, more engagement in private religious activities was associated with lower wellbeing. Public religious activities were not associated with wellbeing in the disadvantaged group.

CONCLUSION

Private religious activities are positively related to wellbeing among Turkish and Moroccan immigrants. In situations where resources are lacking, however, the relation between private religious activities and wellbeing is negative. The study's results highlight the importance of context, disadvantage and type of religious activity for wellbeing.

Bibliometric networks and analytics on gerontology research

Purpose

The purpose of this paper is to bibliometrically analyze the gerontology-related research articles for a comprehensive understanding of the gerontology literature.

Design/methodology/approach

This study employed the approach of visual analytics on 32 journals with a total of 99,204 articles published after 2000 to identify the main subfields, keywords, and growth trend. The investigated journals are either open access online or listed in the Social Sciences Citation Index. In addition, the 200 most frequently cited papers were analyzed through bibliographic coupling, co-word, and co-citation analysis.

Findings

The selected most cited papers were mostly published before 2007, and psychiatry and psychology were the top research subfields. Dementia, older adult, and Alzheimer’s disease were the three most frequently occurring keywords, both in Author Keywords and KeyWords Plus. While coupling analysis yielded 12 research groups, co-word analysis classified the most frequently used 20 Author Keywords into two categories. Four research clusters were identified by the co-citation analysis.

Originality/value

This research provides a comprehensive view of the gerontology research as well as an understanding of the subfields and their interrelations. It also provides government departments with directions for formulating and executing policies affecting older people not only in setting academic and professional priorities but also in understanding the key topics related to older people.

Immigrants Coping with Transnational Deaths and Bereavement: The Influence of Migratory Loss and Anticipatory Grief

This study examines immigrants' experiences of bereavement and coping with the deaths of family members in a transnational context. Data were collected through in-depth personal interviews with middle-aged and older immigrants from different countries of origin, who have been living in the United States for a majority of their adult lives. Thematic analysis of participants' narratives showed that immigrants' geographic distance from family complicated caregiving circumstances and rituals surrounding burial, and impacted the grieving process. At the same time, this distance also served as an emotional barrier and provided protection from prolonged grief. Immigrants' U.S.-based family and work responsibilities served as buffers from prolonged grief. Over time, immigrants became Americanized in their attitudes toward coping with death and favored a fast return to productive activities. Finally, immigrants' experience of migratory loss and anticipatory grief early in immigration, along with their personal growth and resilience developed over time, impacted their bereavement experiences later in life. Considering the limitations and the exploratory nature of the present study, further research is needed to investigate the specifics of coping with loss and bereavement among immigrants.

Evidence-Based Practice Guideline: Secondary Prevention of Late-Life Suicide

Suicide is a tragic, traumatic loss, and one of the most emotionally devastating events families, friends, and communities experience. Suicide claims more than 800,000 lives every year, and some of the highest rates of suicide in the United States and globally are among older adults. The purpose of this evidence-based guideline is to help health care providers recognize those at risk for suicide and recommend appropriate and effective secondary suicide prevention interventions. The information in this guideline is intended for health care providers who work in a variety of settings, including hospitals, nursing homes, rehabilitation centers, out-patient clinics, mental health clinics, home health care, and other long-term care facilities. Assessment and preventive treatment strategies were derived by exhaustive literature review and synthesis of the current evidence on secondary prevention of late-life suicide across practice settings. [Journal of Gerontological Nursing, 44(11), 20-32.].

Exploring health care workers’ perceptions and experiences of communication with ethnic minority elders

Purpose

There is a recognition in Europe and in the western world of a demographic shift in the ageing population. While the overall ageing of the general population is growing, the numbers of immigrants getting old in their host countries is also increasing, thereby increasing the racial and ethnic proportion of older people in these countries. This changing landscape calls for understanding of issues related to health care provision, policy and research regarding ethnic minorities. Communication is seen as a key factor in understanding the needs of ethnic minority elders (EMEs). The purpose of this paper is to explore health care workers’ (HCWs) perceptions and experiences of communication with EMEs. In this paper the term HCW includes qualified nurses and health care assistants.

Design/methodology/approach

A descriptive qualitative study design using semi-structured interviews was employed. Ten HCWs, who had ethnic minorities in their care were individually interviewed to explore their perceptions and experiences of communication when caring for EMEs.

Findings

Analysis of data revealed that in common with all older people, EMEs experience stereotyped attitudes and difficulties in communication. However, EMEs face particular challenges, including cultural differences, different language and stereotyping of care based on misunderstood needs of EMEs. Facilitators of communication included appropriate training of HCWs and appropriate use of interpreters.

Research limitations/implications

Only homes willing to take part in the study gave permission for their staff to be interviewed. In addition, the HCWs came from various settings. Therefore, views of staff in homes who did not give permission may not be represented.

Practical implications

The diversity of older people needing care in nursing homes and the community calls for training in culturally competent communication for effective provision care provision for EMEs.

Originality/value

Training of health care staff in culturally appropriate communication requires effective practice.

Dementia and Migration: Family Care Patterns Merging With Public Care Services

This article focuses on cognitive impairment and dementia in the context of transnational migration. Based on data from focus group discussions and interviews, we conclude that to adjust to the needs of care within ethnic-minority communities, it is important to consider not only the availability of household and kin members but also the present understanding of obligation and reciprocity underlying the perception of care. Another important issue to realize is that caregivers, women in particular, might feel obliged to conform to a traditional caregiver role, but without the support from a wider extended family, and in the context of other pressing roles and duties. Consequently, health personnel should be wary of stereotyping and generalizing groups through "othering" ideologies and rather try to explore, understand, and adjust to the present and often fluctuating set of needs, as well as be aware of how and by whom these needs are articulated.

The Missing Link in the Chain

As the migrant workers of the 1960s and 1970s age in place, many countries are facing caring for increasing numbers of older migrants, many of whom have complex health and social care needs. By applying a qualitative case study approach, of a grassroots disability resource center that works with older migrants, this article critically explores the social policy debates that are focused on older migrants in the Black and Minority Ethnic community. A number of themes have emerged, including the impact of changing family structure, difficulties with accessing services, and increased isolation. In addition, there are also examples of older migrants activtly engaged in building communities and supporting others, defying the stereotypes of vulnerable older migrants being a burden on the state. This article argues for politicians and social policy makers to refocus on the new challenges that are emerging in the older migrants of the Black and Minority Ethnic community.

Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada

Background

Canada depends on Temporary Foreign Workers (TFWs), also known as migrant workers, to fill labour shortage in agriculture, hospitality, construction, child/senior care, and other low-skilled occupations. Evidence shows that TFWs, especially women live-in caregivers (LC), constitute a vulnerable population. Their health is compromised by the precarious and harsh working and living conditions they encounter. There is a paucity of research on the mental health of LCs, their support systems and access to mental health services.

Method

In this community-based exploratory study, we used mixed methods of survey and focus groups to explore the work related experiences and mental health of migrant live-in caregivers in the Greater Toronto Area in Ontario, Canada. Convenience and snowball sampling were used to recruit participants. The inclusion criteria were: being 18 years or older, initially migrated to Canada as TFWs under LC program, resided in the Greater Toronto Area, and able to understand and converse in English based on self-report. This paper reports on the focus group results derived from inductive thematic analysis.

Results

A total of 30 women LCs participated in the study. Most of them were from the Philippines. A number of key themes emerged from the participants’ narratives: (1) precarious migration-employment status (re)produces exploitation; (2) deskilling and downward social mobility reinforce alienation; (3) endurance of hardship for family back home; (4) double lives of public cheerfulness and private anguish; and (4) unrecognized mental health needs. The study results reflected gross injustices experienced by these women.

Conclusion

A multi-faceted approach is required to improve the working and living conditions of this vulnerable group and ultimately their health outcomes. We recommend the following: government inspection to ensure employer compliance with the labour standards and provision of safe working and living conditions; change immigration policy to allow migrant caregivers to apply for permanent residence upon arrival; the TFWs Program to establish fair wages and subsidized housing so that caregivers can truly access the live-out option; and local ethno-specific, settlement and faith organizations be leveraged to provide TFWs with social support as well as information about their rights and how to access health and social care.

Ethnic inequality in retirement income: a comparative analysis of immigrant–native gaps in Western Europe

Previous research unequivocally shows that immigrants are less successful in the labour market than the native-born population. However, little is known about whether ethnic inequality persists after retirement. We use data on 16 Western European countries from the European Union Statistics on Income and Living Conditions (EU-SILC, 2004–2013) to provide the first comparative study of ethnic inequalities among the population aged 65 and older. We focus on the retirement income gap (RIG) between immigrants from non-European Union countries and relate its magnitude to country differences in welfare state arrangements. Ethnic inequality after retirement is substantial: after adjusting for key characteristics including age, education and occupational status, the average immigrant penalty across the 16 countries is 28 per cent for men and 29 per cent for women. Country-level regressions show that income gaps are smaller in countries where the pension system is more redistributive. We also find that easy access to long-term residence is associated with larger RIGs, at least for men. There is no clear evidence that immigrants’ access to social security programmes, welfare state transfers to working-age households or the strictness of employment protection legislation affect the size of the RIG.

Aging and health among migrants in a European perspective

Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe. Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age. Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity. In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs.

Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist. These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life. Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups. Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified. Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern.

In conclusion, there is a need for attention to migration alongside other determinants of healthy aging. The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging. This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age.

Social exclusion of older persons: a scoping review and conceptual framework

As a concept, social exclusion has considerable potential to explain and respond to disadvantage in later life. However, in the context of ageing populations, the construct remains ambiguous. A disjointed evidence-base, spread across disparate disciplines, compounds the challenge of developing a coherent understanding of exclusion in older age. This article addresses this research deficit by presenting the findings of a two-stage scoping review encompassing seven separate reviews of the international literature pertaining to old-age social exclusion. Stage one involved a review of conceptual frameworks on old-age exclusion, identifying conceptual understandings and key domains of later-life exclusion. Stage two involved scoping reviews on each domain (six in all). Stage one identified six conceptual frameworks on old-age exclusion and six common domains across these frameworks: neighbourhood and community; services, amenities and mobility; social relations; material and financial resources; socio-cultural aspects; and civic participation. International literature concentrated on the first four domains, but indicated a general lack of research knowledge and of theoretical development. Drawing on all seven scoping reviews and a knowledge synthesis, the article presents a new definition and conceptual framework relating to old-age exclusion.