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

Eating preferences and behaviors of older immigrants in Oslo: A qualitative study

Norway's population of older, first-generation immigrants is expected to almost triple by the year 2060 due to decreased mortality and continued immigration. Studies indicate that older immigrants in Norway have a higher rate of non-communicable disease than older non-immigrants. Eating a health-supporting diet is important for reducing disease risk and maintaining independence in older adults. The purpose of this study was to increase understanding of the eating preferences and behaviors of older, home-dwelling, first-generation immigrants in Oslo, and to identify influences on their eating preferences and behaviors. This qualitative study took a phenomenological approach to understand older immigrants' shared experience of changing eating behaviors with aging. Fourteen home-dwelling, older immigrants were recruited using a combination of purposeful random sampling and snowball sampling. In-depth interviews were conducted then analyzed according to reflexive thematic analysis. Study findings indicate that older immigrants eat a bi-cultural diet pattern. In addition, they seek out information about nutrition, and incorporate many health-supporting eating habits for disease management and prevention. In this way, older immigrants in Oslo share much in common with older non-immigrants. Hopes and worries for the future motivate older immigrants to eat more healthfully in order to maintain independence and cultural identity as long as possible. These results can be useful for designing culturally tailored programs which support eating habits for health maintenance and disease prevention among older immigrants.

What Does It Mean to "Age Well" Among British and Javanese Older Adults? A Cross-Cultural Qualitative Study

OBJECTIVES

This study aimed to investigate perceptions of what it means to "age well" and to explore similarities and differences between a Western and non-Western culture (Britain and Java).

METHODS

Qualitative interviews explored how Javanese and British older adults defined aging well, establishing the similarities and differences between cultures. Javanese (n = 14) and British (n = 15) adults aged 61-80 (mean age = 68) participated. The data were analyzed using reflexive thematic analysis and organized with NVivo.

RESULTS

Four themes were identified that captured what it means to age well across cultures: (a) good health is a springboard for aging well; (b) holding a positive outlook is a decisive factor in aging well; (c) "having enough" and "feeling safe" provide peace of mind; and (d) spirituality and religiosity provide tranquility. Although both cultures mentioned similar factors, there were variations in the interpretations and emphasis within themes. For example, Javanese participants emphasized the importance of the social environment whereas British participants highlighted the physical environment.

DISCUSSION

Differences between cultures are important for understanding how best to support people as they age. For example, in Java, aging well may be best supported by providing a vibrant social environment. For people in Britain, having a safe and secure physical environment may be more important.

Factors that affect the health of immigrants: Qualitative meta synthesis

BACKGROUND

Migration has challenged society. Most people who move do so for economic reasons, but others move for more tragic reasons. The proportion of female migrants was slightly higher than that of male migrants, partly due to the longer life expectancy of women and the higher demand for female migrants in care-related Jobs. The process may affect migrants' health, particularly in countries where healthcare is associated with high economic costs or insurance availability. A global systematic review of qualitative studies with meta-synthesis was conducted. The results can be used to support health policy and clinical practice.

OBJECTIVE

To describe how migrants perceive and experience the process of migrating and how it affects their health.

SEARCH STRATEGY

Databases consulted were Medline, PsychInfo, Cuiden, Cinahl, WOS, Scopus, Social Science Database, and Epistemonikos. Thirty-four articles were selected for final meta-synthesis.

INCLUSION CRITERIA

All qualitative primary studies were included that describe the experiences or perceptions of migrants and refugees over 18 years that talk about their migration process and the impact on their health; written in English or Spanish between 2016 and 2021. Articles referring to second generations and those dealing with pathologies that pre-date the migration process were excluded.

DATA EXTRACTION AND SYNTHESIS

The COREQ and JBI templates were used as quality criteria. Studies mostly used a phenomenological methodology and in-depth interviews, both individual and group, were used for data collection and narrative synthesis.

MAIN RESULTS

Uncertainty emerges as a main category. Three other interrelated themes have a direct impact on migrants' health: Language, Social Networks and Work. There are several conditions in each of these that have a positive or negative impact on health. The gender condition appears in both work and social networks, positively and negatively.

DISCUSSION AND CONCLUSIONS

Health would be improved by having a stable job, which would facilitate access to health resources. Social networks and language are facilitators of access to a better job, but not the only condition. From a gender perspective, social networks can become a source of health problems, especially for women. The process of migration places women in a position of vulnerability due to the difficulties of reconciling family and work life. Job insecurity, workload, loss of family life or social isolation increase hopelessness and anxiety, leading to health problems.

PUBLIC OR PATIENT CONTRIBUTION

As an academic review study, no patient contribution was required, and this study serves as a theoretical framework for more in-depth research that will work with migrant populations. As a public contribution, this work provides evidence of the need to improve access to health for some populations, in line with the Sustainable Development Goals (SDGs) set for 2030.

Gender Differences in Social Embeddedness Determinants of Loneliness Among Moroccan and Turkish Older Migrants

OBJECTIVES

Moroccan and Turkish migrants residing in Northwestern Europe have high loneliness levels. This study examines gender differences in loneliness within this migrant population. The migrants have gender-segregated social roles at home and in public, which might lead to gender differences in what aspects of social relationships can explain variation in loneliness.

METHODS

Respondents are from the Longitudinal Aging Study Amsterdam with 446 first-generation Moroccan and Turkish migrants in the Netherlands, aged between 55 and 66 years. We use interaction effects to test for gender differences in determinants of loneliness.

RESULTS

Men and women have a similar, moderate level of loneliness. Having a spouse and receiving care from children are more strongly related with lower loneliness levels in men than in women. Coethnic ties play an equally important role for men and women. In men, frequent mosque attendance is related with greater loneliness, but not in women.

DISCUSSION

Family ties are more protective against loneliness for older men than for older women, possibly indicating that migrant women's expectations regarding family go above and beyond having a spouse, receiving intergenerational care, or having frequent contact with children. In addition, migrant older men's higher expectations regarding a public social life could make their social life in the Netherlands less fulfilling, resulting in greater loneliness.

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.

The sex difference in self-rated health among older Turkish and Moroccan migrants in the Netherlands: an exploratory study of contributing determinants

BACKGROUND

Although being a woman and having a migration background are strong predictors of poor self-rated health among (older) adults, research on the sex difference in self-rated health among (older) migrants remains limited. This study therefore aims to investigate this topic and explore the contributing role of determinants of self-rated health.

METHODS

Cross-sectional data from 360 Turkish-Dutch and Moroccan-Dutch adults aged 55-65 as part of the Longitudinal Aging Study Amsterdam (LASA) were used. Self-rated health (good versus poor) was measured by a single item question. Univariate age-adjusted logistic regression analysis was used to investigate the sex difference in self-rated health and the contribution of sex differences in sensitivity (strength of the association) and/or exposure (prevalence) to socio-demographic, social, lifestyle or health-related determinants of self-rated health.

RESULTS

Women had a 0.53 times lower odds (95%CI:0.40-0.82, p = 0.004) on good self-rated health compared to men. Women more often having a lower education level, living alone and having a higher prevalence of depressive symptoms, chronic diseases and especially functional limitations contributed to the lower self-rated health among women. In contrast, men were more sensitive to the impact of memory complaints, depressive symptoms, visual difficulties and functional limitations.

CONCLUSIONS

Older Turkish-Dutch and Moroccan-Dutch women have a significant lower self-rated health compared to men. Women having a higher exposure to both socio-demographic and health-related determinants of self-rated health, which contributed to the sex difference. Future research should take these differences in self-rated health and determinants between women and men into account when investigating health among older migrants.

"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.

A Mixed-Method Social Network Analysis of Low-Income Diverse Older Volunteers

Although volunteering has been associated with numerous social benefits for diverse older adults, there is little information on how they establish relationships within a multicultural volunteering program outside of their co-ethnic communities. This convergent mixed-method social network study adopts the bonding and bridging social capital theory to explore the structures and dynamics of social interactions within a multicultural volunteer program. Low-income Russian, Khmer, Somali, Nepali, and English-speaking older volunteers in the Senior Companions Program (SCP) in a Midwest metropolitan (N = 83) participated in the surveys and focus groups. Homophily coefficients (r) show that the SCP volunteers mostly interacted with people who identified with the same nationality (r = .86), race (r = .87), and gender (r = .50). Qualitative results suggested that volunteers strengthened their social networks through within-cultural social bonding while appreciating opportunities for cross-cultural social bridging. Compared with within-cultural social bonding, cross-cultural social bridging in multicultural volunteer programs require intentional facilitation, resources, and organizational commitment.

Perspectives of older women in the Netherlands: identifying motivators and barriers for healthy lifestyles and determinants of healthy aging

BACKGROUND

Women have a higher life expectancy than men but experience more years with physical disabilities in daily life at older ages, especially women with a migration background. This pinpoints older women as an important target group for strategies that stimulate healthy lifestyle, which benefits healthy aging. Our study investigates motivators and barriers for healthy lifestyles and perspectives on determinants of healthy aging of older women. This provides essential information for developing targeted strategies.

METHODS

Data was collected by semi-structured digital interviews from February till June 2021. Women aged 55 years and older living in the Netherlands (n = 34) with a native Dutch (n = 24), Turkish (n = 6) or Moroccan (n = 4) migration background were included. Two main subjects were investigated: (1) motivators and barriers on their current lifestyles regarding smoking, alcohol consumption, physical activity, diet and sleep and (2) perspectives on determinants of healthy aging. Interviews were analyzed using Krueger's framework.

RESULTS

Personal health was the most common motivator for a healthy lifestyle. In addition, peer pressure and being outdoors were specific motivators for physical activity. Bad weather conditions and personal dislike to be active were specific barriers. The social environment, personal preferences and personal belief to compensate with other healthy lifestyle behaviors were barriers for low alcohol consumption. Personal preferences (liking unhealthy food and not making time) were the main barriers for a healthy diet. Sleep was not perceived as a form of lifestyle behavior, but rather as a personal trait. Since there were no smokers, specific barriers were not mentioned. For Turkish-Dutch and Moroccan-Dutch women, additional barriers and motivators were culture and religion. These were strong motivators to abstain from alcohol consumption and smoking, but a barrier for a healthy diet. With regard to perspectives on determinants of healthy aging, positive views on aging and being physically active were perceived as most important. Women often wanted to increase their physical activity or healthy diet to stimulate healthy aging. Among Turkish-Dutch and Moroccan-Dutch women, healthy aging was also perceived as something in the hands of God.

CONCLUSIONS

Although motivators and barriers for a healthy lifestyle and perspectives on healthy aging vary for distinct lifestyles, personal health is a common motivator across all lifestyles. Having a migration background added culture and religion as distinct barriers and motivations. Strategies to improve lifestyle among older women should therefore have a tailored, culture sensitive approach (if applicable) for distinct lifestyle factors.

Conducting Empirical Research with Older Migrants: Methodological and Ethical Issues

This special section brings together a set of four articles containing novel quantitative and qualitative research on older migrants in Europe. Detailed reporting and reflection is presented on fieldwork decisions and how certain challenges were tackled, and their implications. This introductory article aims to lay the groundwork for a better understanding and awareness of methodological and ethical challenges researchers face when designing and conducting empirical studies involving older migrants. Highlighted are the main methodological issues and ethical dilemmas we observe in studying older migrants, which can serve as a wake-up call for researchers to be more critical throughout the process. We end with a plea for more collaboration between researchers in the field of older migrants, by sharing their data despite potential methodological and ethical problems.

Social Inequalities and Health among Older Immigrant Women in the Nordic Countries: An Integrative Review

Introduction

The Nordic countries have a surprisingly strong relative socioeconomic health inequality. Immigrants seem to be disproportionately affected due to their social economic position in the host countries. Healthcare professionals, including nurses, have a professional obligation to adhere to fairness and social equity in healthcare. The aim of this review was to identify and synthesize research on health status and the impact of social inequalities in older immigrant women in the Nordic countries.

Methods

We conducted an integrative review guided by the Whittemore and Knafl integrative review method. We searched multiple research databases using the keywords immigrant, older, women, socioeconomic inequality, health inequality, and Nordic countries. The results were limited to research published between 1990 and 2021. The retrieved articles were screened and assessed by two independent reviewers.

Results

Based on the few studies on older immigrant women in the Nordic countries, the review findings indicate that they fare worse in many health indicators compared to immigrant men and the majority population. These differences are related to various health issues, such as anxiety, depression, diabetes, multimorbidity, sedentary lifestyle, and quality of life. Lower participation in cancer screening programs is also a distinctive feature among immigrant women, which could be related to the immigrant women's help-seeking behavior. Transnational family obligations and responsibilities locally leave little room for prioritizing self-care, but differing views of health conditions might also contribute to avoidance of healthcare services.

Conclusion

This integrative review shows that there is a paucity of studies on the impact of social inequalities on the health status of older immigrant women in the Nordic countries. There is a need for not only research focused on the experiences of health status and inequality but also larger studies mapping the connection between older immigrant women's economic and health status and access to healthcare services.

Perspectives on ageing: a qualitative study of the expectations, priorities, needs and values of older people from two Canadian provinces

BACKGROUND

Understanding the needs and values of older people is vital to build responsive policies, services and research agendas in this time of demographic transition. Older peoples' expectations and priorities for ageing, as well as their beliefs regarding challenges facing ageing societies, are multi-faceted and require regular updates as populations' age.

OBJECTIVE

To develop an understanding of self-perceptions of ageing and societal ageing among Canadian retirees of the education sector to define a meaningful health research agenda.

METHODS

We conducted four qualitative focus groups among 27 members of a Canadian retired educators' organisation. Data were analysed using an inductive thematic approach.

RESULTS

We identified four overarching themes: (1) vulnerability to health challenges despite a healthier generation, (2) maintaining health and social connection for optimal ageing, (3) strengthening person-centred healthcare for ageing societies and (4) mobilising a critical mass to enact change. Participants' preconceptions of ageing differed from their personal experiences. They prioritised maintaining health and social connections and felt that current healthcare practices disempowered them to manage and optimise their health. Although the sheer size of their demographic instilled optimism of their potential to garner positive change, participants felt they lacked mechanisms to contribute to developing solutions to address this transition.

CONCLUSION

Our findings suggest a need for health research that improves perceptions of ageing and supports health system transformations to deliver person-centred care. Opportunities exist to harness their activism to engage older people as partners in shaping solution-oriented research that can support planning for an ageing society.

Whose migration matters? The role of migration in social networks and mental health among rural older adults in China

The dual demographic changes in massive rural-to-urban labour migration and population ageing have significantly impacted the lives of older adults, who have either been left behind in rural regions or migrated to urban areas. While many extant studies on migration and wellbeing of older adults have focused on either migrating or left-behind older adults, a very limited number of studies have directly compared these two groups. Utilising data from the China Longitudinal Ageing Social Survey, this study examines the impacts of different migration patterns (i.e. migrating older adults, left-behind older adults and non-migrating older adults) on the social networks and mental health of older adults in rural China. Structural equation modelling results showed that older adults who have been left behind reported weaker family ties and poorer mental health than the other older adults. Moreover, weakened family ties increased older adults’ risk of developing mental health problems. Older migrants reported the lowest level of depressive symptoms among the three groups of older adults. However, migration may be associated with poorer mental health among the older migrants due to the shrinking/weakening of family/friendship ties.

Finding the Silver Lining: Aging Well Amongst Older Brazilian Women in the Post-Migration Context

STUDY BACKGROUND

The aging population in Canada has been increasing steadily over the past 40 years, however, there is limited information about the meaning of aging well amongst older Brazilian women in Canada.

METHODS

A Heideggerian interpretive phenomenology study was conducted to understand the meaning of aging well amongst older Brazilian women in the post-migration context living in the Greater Toronto Area (GTA) in Ontario, Canada.

RESULTS

Eight older Brazilian women residing in the GTA were recruited through purposive and snowball sampling and participated in individual face-to-face interviews. Through data analysis and the incorporation of Heidegger's four existentials of human existence, the themes that emerged were (a) Embracing being part of a mosaic, (b) Aging with grace, (c) Chasing your dreams and (d) Being a bridge and not a fence. The overarching theme was: Finding the silver lining: Aging well.

CONCLUSION

This study informs nursing practice, research and policy development to advance the health of older immigrant adults in Canada.

Positive and negative ageing perceptions account for health differences between older immigrant and native populations in the Netherlands

BACKGROUND

This study assessed the extent to which persistent differences in self-rated health (SRH) between older immigrants and natives are attributable to negative and positive ageing perceptions.

METHODS

The study was conducted with three population groups in Rotterdam, the Netherlands: native Dutch people aged ≥70 years (n = 1150), Turkish immigrants aged ≥65 years (n = 680) and Moroccan immigrants aged ≥65 years (n = 292). To assess participants' internal ageing representations, we used the short Aging Perceptions Questionnaire, which distinguishes negative (consequences, chronic and cyclical timeline awareness, and emotional representations) and positive (positive consequences, positive and negative control) dimensions and has been validated in native and immigrant populations. We analysed differences in ageing perceptions between immigrants and natives and the associations of ageing perceptions with SRH. We used Karlson-Holm-Breen decomposition to assess ageing perceptions' mediation of the relationship between migration background and SRH.

RESULTS

Older immigrants had stronger negative and weaker positive ageing perceptions (excepting the positive consequences of ageing) than did Dutch natives. Ageing perceptions mediated the relationship between migration background and SRH. SRH differences between Turkish immigrants and native Dutch older persons were explained mainly by differences in negative consequences and cyclical timeline awareness. SRH differences between Moroccan immigrants and native Dutch older persons were attributable mainly to differences in negative consequences and positive control.

CONCLUSIONS

Differences in positive and negative ageing perceptions between older immigrants and natives in the Netherlands largely explained SRH differences between these population groups.

What Does "Successful Aging" Mean to you? - Systematic Review and Cross-Cultural Comparison of Lay Perspectives of Older Adults in 13 Countries, 2010-2020

Successful aging is a concept that has gained popularity and relevance internationally among gerontologists in recent decades. Examining lay older adults' perspectives on successful aging can enhance our understanding of what successful aging means. We conducted a systematic review of peer reviewed studies from multiple countries published in 2010-2020 that contained qualitative responses of lay older adults to open-ended questions such as "What does successful aging mean to you?" We identified 23 studies conducted in 13 countries across North America, Western Europe, the Middle East, Asia, and Oceania. We identified no studies meeting our criteria in Africa, South America, Eastern Europe, North Asia, or Pacific Islands. Across all regions represented in our review, older adults most commonly referred to themes of social engagement and positive attitude in their own lay definitions of successful aging. Older adults also commonly identified themes of independence and physical health. Least mentioned were themes of cognitive health and spirituality. Lay definitions of successful aging varied by country and culture. Our findings suggest that gerontology professionals in fields including healthcare, health psychology, and public health may best serve older adults by providing services that align with older adults' priority of maintaining strong social engagement as they age. Lay perspectives on successful aging acknowledge the importance of positive attitude, independence, and spirituality, in addition to physical and cognitive functioning.