Traditional Chinese Medicine Use and Health in Community-Dwelling Chinese-American Older Adults in Chicago

The long-term trend in utilization of traditional Chinese medicine and associated factors among older people in Taiwan

BACKGROUND

Both the size of the older population and the use of complementary and alternative medicine are increasing worldwide. This study evaluated the long-term trend in utilization of traditional Chinese medicine (TCM) and associated factors among older people in Taiwan.

METHODS

Using the database of population-based interview surveys, we evaluated the one-month prevalence of TCM use among 13,945 older people aged over 65 years from 2001-2017. The sociodemographic status and medical comorbidities of older people who did and did not use TCM were compared by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in the multiple logistic regressions.

RESULTS

The one-month prevalence of TCM use increased from 5.5% in 2001 to 9.1% in 2017 among older people in Taiwan. Overall, 7.3% of older people had used TCM within the previous month. People with a history of heart disease (OR 1.62, 95% CI 1.24-2.12), use of folk therapy (OR 3.16, 95% CI 2.00-4.99), and purchase of non-prescribed Chinese herbal medicine (OR 2.08, 95% CI 1.48-2.91) were more likely to use TCM than the comparison group. However, age ≥80 years (OR 0.48, 95% CI 0.31-0.72) and previous hospitalization (OR 0.59, 95% CI 0.41-0.85) were associated with the reduced use of TCM.

CONCLUSION

From 2001-2017, the use of TCM increased in the older population in Taiwan. The use of folk medicine and purchase of non-prescribed Chinese herbal medicine were significant predictors for the use of TCM.

Trust in physicians, health insurance, and health care utilization among Chinese older immigrants

OBJECTIVE

Trust in physicians (TIP) plays a critical role in the health care utilization (HCU) of minority older adults and older immigrants. Although previous studies suggested that TIP was positively associated with primary care visits, negatively associated with Emergency Room (ER) visits and hospitalization among African Americans in the United States (U.S.), it is unclear whether and how TIP influences various types of HCU among Chinese older immigrants, a fast-growing group of minority older immigrants in the U.S. Furthermore, despite the important role insurance plays in HCU and health disparities, few studies have tested whether TIP influences the HCU of the insured and uninsured Chinese older immigrants differently. Therefore, this study aims to examine the role of TIP in three types of HCU (physician visits, ER visits, and hospitalization) among Chinese older immigrants and whether the associations differ by insurance status.

DESIGN

The data were derived from the Population Study of ChINese Elderly in Chicago (PINE), N = 3,157. The sample is representative of Chinese older immigrants (60+ years) in Chicago. Guided by Andersen's behavioral model, hierarchical regression analyses examined the role of TIP in physician visits, ER visits, and hospitalization among Chinese older immigrants. An interaction term was added to examine whether the aforementioned associations differed by insurance status.

RESULTS

TIP was positively associated with the likelihood of physician visits (Odds Ratio [OR] = 1.07, p < 0.001) but not with ER (OR = 1.02, p = 0.054) or hospitalization (OR = 1.01, p = 0.13). The results of the moderation analyses further showed that TIP was more positively associated with ER visits (OR=0.94, p=0.006) and hospitalization (OR = 0.93, p = 0.004) among the uninsured population, compared to those insured.

CONCLUSIONS

TIP played an important role in facilitating primary care visits among Chinese older immigrants regardless of insurance status. Additionally, TIP facilitated the ER visit and hospitalization among uninsured Chinese older immigrants.

Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature

Background

There are over seven million older adult immigrants in the United States, and that number is expected to increase. Older adult immigrants in the United States have unique factors that influence their health.

Methods

In this integrative review, we systematically review 20 years of peer-reviewed literature on the barriers (i.e. isolation, lack of English Language Proficiency, low health literacy, lack of SES resources, discrimination) and facilitators (i.e. English Language Proficiency and maintaining ones native language, social support, culturally sensitive providers, healthcare access) of health among older adult immigrants in the United States.

Results

We found differing uses of the term ‘older adult’, emphasis on the lack of homogeneity among older adult immigrants, social support and isolation as significant barriers and facilitators of older adult immigrant health, and inconsistencies in uses and definitions of acculturation. We also examined relevant theories in the literature. Based on the literature review, focusing on Acculturation Theory, Social Cognitive Theory, and Successful Aging Theory, combining these three theories with findings from the literature to create the Older Adult Immigrant Adapted Model for Health Promotion.

Conclusions

Public health strives to promote health and prevent adverse health outcomes. Our integrative review not only systematically and thoroughly explicates 20 years of literature, but the Older Adult Immigrant Adapted Model for Health Promotion, provides guidance for future research and interventions.

Development and validation of a predictive index of elder self-neglect risk among a Chinese population

OBJECTIVE

To develop a predictive index that estimates the individual risk of incident self-neglect onset among the US Chinese older adults.

METHODS

The study used two waves of longitudinal data from 2713 participants of the Population Study of Chinese Elderly (PINE). Data were collected during 2011-2015 in Chicago, Illinois, with approximately 2-year follow-up intervals. The main outcomes are incident self-neglect cases. Variables in 14 potential predictive domains were considered, which are (1) sociodemographic/socioeconomic, (2) neighborhood/community, (3) immigration and acculturation, (4) adverse events, (5) culture, (6) general wellbeing, (7) health behavior, (8) medical health, (9) health care, (10) physical function, (11) cognitive function, (12) social wellbeing, (13) violence, and (14) psychological wellbeing. Stepwise selection in multivariable logistical regression models and bootstrapping were used to develop and validate the predictive index.

RESULTS

The 2-year self-neglect incidence rate was 237 (8.7%). A 19-item predictive model (with a c-statistic of 0.74) was developed. After correcting for overfitting by validating in 100 bootstrapping samples, the model demonstrated moderate predictive accuracy by a c-statistic of 0.68. A point-based risk index was developed and has an area under the receiver operating characteristic curve of 0.73.

DISCUSSION

The study developed an efficient index with a moderate-to-good predictive ability of self-neglect. With further external validation, modification, and impact studies, the index could be a culturally relevant tool for practitioners to quantify the risk of self-neglect among the US Chinese older population.

Anxiety Symptoms, Depressive Symptoms, and Traditional Chinese Medicine Use in U.S. Chinese Older Adults

This study examined the association between anxiety symptoms, depressive symptoms, and Traditional Chinese Medicine (TCM) use among U.S. Chinese older adults. Data was obtained from the Population Study of Chinese Elderly in Chicago (N = 3157; mean age = 72.8). Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS-A). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9). TCM modalities included herbal products, acupuncture, massage therapy, Taichi, and other types of TCM. Although not significant, there was a trend indicating that higher levels of anxiety symptoms showed a higher rate of acupuncture use and massage therapy. Older Chinese Americans with depressive symptoms were more likely to use acupuncture and massage therapy; and they were less likely to use other TCM. Future research is needed to identify reasons for TCM use; and how these factors mediate or moderate the relationship between psychiatric symptoms and TCM use.

Transition in Older Parent-Adult Child Relations in U.S. Chinese Immigrant Families

BACKGROUND AND OBJECTIVES

The family fundamentally underpins the immigration and acculturation processes. But most existing research on acculturation focuses on individual instead of family experience. Guided by Berry's acculturation theory and Intergenerational Solidarity Theory, this study examined continuity and changes in parent-adult child relations of older Chinese immigrants over a 2-year period, and their implications for older adults' depression and quality of life (QoL).

RESEARCH DESIGN AND METHODS

Participants included 2,605 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago (PINE). Latent Transition Analysis (LTA) was used to identify transitions in multidimensional parent-child relations over time. Negative binomial and logistic regressions were used to examine the influence of family transitions on depression and QoL, respectively.

RESULTS

LTA revealed five types of family relations: traditional, modified traditional, coresiding-unobligated, independent, and detached. Over 40% of the respondents shifted to a different relation type, with more families classified as modified traditional or independent over time. Transitioning into modified traditional relations or out of detached relations was associated with fewer depressive symptoms and better QoL at the follow-up. Transitioning into independent relation was associated with more depressive symptoms over time.

DISCUSSION AND IMPLICATIONS

Parent-child relations among Chinese older immigrants demonstrate significant complexity, including both heterogeneity and fluidity. Better well-being of these older adults seems to stem from the optimal combination of retaining the supportive heritage culture and embracing the host society's instrumental cultural elements. Services to this population need to include the family context in assessment and interventions.

Self-evaluation by community older adults on the applicability of the healthy beat acupunch exercise program

Objectives To evaluate the applicability of the Healthy Beat Acupunch (HBA) exercise program for older adults at community care centers and to explore their perceived impacts and suggestions for program protocol after six months of HBA exercises. Design & setting This prospective and descriptive study recruited 113 older adults from four community care centers. Intervention The HBA exercises were conducted 3 times a week, 40 min per session, for six months. Main outcome measures The program evaluation focused on four criteria: simplicity, safety, suitability, and helpfulness of the three phases of the HBA program using a 10-point ladder scale. The semi-structured interviews were focused on the participants' exercise experiences, perceived impacts on their health, and suggestions for the HBA program protocol. Results The average scores of the four criteria in each phase of the program ranged between 9.59 and 9.98 points. Participants reported an increase in their limb flexibility (n = 31) and that they were more relaxed (n = 26) and more energetic (n = 26) after engaging in the HBA exercises. Most of the participants suggested that the HBA program should be offered three times a week, 40 min per session, with 30 people in a group, and led by instructors who were professional, hardworking, easygoing, and enthusiastic, regardless of gender and age. Conclusions The HBA program was rated at a high level of simplicity, safety, suitability, and helpfulness by community older adults, which indicated that the program was considered as appropriate and applicable for the older population.

Characterizing Beliefs about Stroke and Walking for Exercise among Seniors from Four Racial/Ethnic Minority Communities

We described and compared seniors' stroke-related health beliefs among four racial/ethnic communities to inform a culturally-tailored stroke prevention walking intervention. Specific attention was paid to how seniors combined pathophysiology-based biomedical beliefs with non-biomedical beliefs. We conducted twelve language-concordant, structured focus groups with African American, Chinese American, Korean American, and Latino seniors aged 60 years and older with a history of hypertension (n = 132) to assess stroke-related health beliefs. Participants were asked their beliefs about stroke mechanism and prevention strategies in addition to questions corresponding to four constructs from the Health Belief Model: perceived susceptibility, perceived severity, and benefits and barriers to walking for exercise. Using thematic analysis, we iteratively reviewed and coded focus group transcripts to identify recurrent themes within and between racial/ethnic groups. Participants across all four racial/ethnic groups believed that blockages in brain arteries caused strokes. Factors believed to increase susceptibility to stroke were often similar to biomedical risk factors across racial/ethnic groups, but participants also endorsed non-biomedical factors such as strong emotions. The majority of participants perceived stroke as a serious condition requiring urgent medical attention, fearing paralysis or death, but few mentioned severe disability as a stroke consequence. Participants largely believed stroke to be preventable through physical activity, dietary changes, and medication adherence. Perceived benefits of walking for exercise included improved physical health, decreased bodily pain, and ease of participation. Perceived barriers to walking included limited mobility due to chronic medical conditions, increased bodily pain, and low motivation. While seniors' stroke-related health beliefs were often similar to biomedical beliefs across racial/ethnic groups, we also identified several non-biomedical beliefs that were shared across groups. These non-biomedical beliefs regarding perceived stroke susceptibility and severity may warrant further discussion in stroke education interventions. Patterns in non-biomedical beliefs that vary between groups may reflect cultural differences. Stroke education could potentially increase cultural relevancy and impact by addressing such differences in health beliefs as well as perceived benefits and barriers to walking for exercise that vary between different racial/ethnic groups.

The Association Between Musculoskeletal Symptoms and Traditional Chinese Medicine Use Among Chinese Older Adults in the Greater Chicago Area

Older adults disproportionately experience musculoskeletal symptoms, which are associated with morbidity and mortality. Traditional Chinese medicine (TCM) is an important part of Chinese culture and for millennia have been used to maintain health. This article aims to examine the association between musculoskeletal symptoms and different subtypes of TCM usage. Data were collected through the Population Study of Chinese Elderly in Chicago (PINE) study, a community-engaged, epidemiological study of a U.S. Chinese population. Review of systems was used to measure musculoskeletal symptoms. TCM use was measured by using a 5-point scale. Logistic regression analyses were conducted to control for potential confounding factors. Of 3,157 Chinese, older adults aged 60 and older, the mean age was 72.8 (SD = 8.3) and 58.9% were female. Older adults with any musculoskeletal symptoms had greater utilization of overall TCM use (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.76, 2.52]), especially massage therapy (OR = 3.41, 95% CI = [2.51, 4.63]), herbal (OR = 2.68, 95% CI = [2.28, 3.14]), and acupuncture (OR = 2.49, 95% CI = [1.87, 3.32]). However, there was no statistically significant association between the presence of musculoskeletal symptoms and Tai-Chi (OR = 1.18, 95% CI = [0.93, 1.50]). This study demonstrated that musculoskeletal symptoms among Chinese older adults were strongly associated with the use of TCM. Future research is needed to examine the effectiveness of TCM in treating musculoskeletal symptoms.

Association Between Social Engagement and Cancer Screening Utilization in a Community-Dwelling Chinese American Older Population

Objectives: This study aims to examine the association between social engagement and cancer screening utilization among a Chinese American older population. Method: Data were drawn from the Population Study of Chinese Elderly (PINE). In total, 3,157 Chinese older adults enrolled in this study. Cancer screening utilization was assessed by asking whether participants had utilized cancer screenings. Social engagement was measured with 16 questions. Results: After controlling for potential confounders, a higher level of social engagement was associated with increased utilization in blood stool test (OR 1.03, [1.02, 1.05]), colonoscopy (OR 1.02, [1.01, 1.03]), mammography (OR 1.06, [1.05, 1.08]), Pap test (OR 1.04, [1.03, 1.06]), and prostate specific antigen (PSA) test (OR 1.03, [1.01, 1.05]). Compared with those with low levels of social engagement, older adults with high levels of social engagement were more likely to have utilized a blood stool test (OR 1.85, [1.46, 2.35]), a colonoscopy (OR 1.37, [1.09, 1.72]), a mammography (OR 3.05, [2.25, 4.14]), and a Pap test (OR 1.99, [1.49, 2.66]), but not more likely to have utilized a PSA test (OR 1.40, [0.97, 2.03]). Conclusion: This study underscores the association between active social engagement and increased utilization of cancer screening among a Chinese American older population. Improving social engagement could be helpful in promoting cancer screening utilization.

Association Between Cancer and Utilization of Traditional Chinese Medicine in U.S. Chinese Women: Findings From the PINE Study

Objective: To examine U.S. Chinese older women and the association between their cancer screening behaviors and self-reported cancers with Traditional Chinese Medicine (TCM) use across sociodemographic characteristics. Method: Through the Population Study of Chinese Elderly in Chicago (PINE), 1,830 Chinese older women self-reported history of cancer screening, presence of women’s cancers, and TCM use according to type. Analyses were performed using multivariate regression models. Results: Chinese older women who underwent breast cancer screening are more likely to use herbal TCM (rate ratio [RR] = 1.15, 95% confidence interval [CI] = [1.03, 1.29]), acupuncture (RR = 1.62, CI = [1.21, 2.15]), massage therapy (RR = 2.05, CI = [1.46, 2.88]), and tai chi (RR = 1.86, CI = [1.28, 2.69]). Those who had cervical cancer screening are more likely to use herbal TCM (RR = 1.32, CI = [1.17, 1.48]), acupuncture (RR = 1.66, CI = [1.27, 2.18]), massage therapy (RR = 1.61, CI = [1.17, 2.21]), tai chi (RR = 1.69, CI = [1.19, 2.40]), and other forms of TCM (RR = 1.36, CI = [1.04, 1.79]). Those with cervical cancer are less likely to use herbal TCM (RR = 0.42, CI = [0.19, 0.93]). Conclusion: Contrary to previous studies, our results suggest that U.S. Chinese older women who have engaged in cancer screening use TCM while those with self-reported cancer did not use TCM at a higher rate. This warrants further research on TCM utilization to identify reasons of use in this population and encourage patient-centered care.

Treating people with arthritis with traditional Chinese medicine (TCM): an examination of the perception of TCM practitioners

INTRODUCTION

Emerging evidence has shown that traditional Chinese medicine (TCM) has a positive effect on arthritis. This research provides the first critical, systematic examination of TCM practitioners' perceptions of TCM use for people with arthritis.

METHODS

An online survey was distributed to all TCM professionals including acupuncturists and Chinese herbal medicine practitioners registered with the Practitioner Research and Collaborate Initiative (PRACI) practitioner database. The survey questions focus on practitioner characteristics, practice characteristics and clinical management approaches regarding arthritis care.

RESULTS

The survey attracted a response rate of 53% (n=52). The average age of the respondents was 49.9 years, more than half were female, and the majority held a bachelor degree or higher qualification. More than two thirds of TCM practitioners in our study worked with other health professionals, while they had a high level of referral relationships with a wide range of conventional, allied health and complementary and alternative medicine (CAM) providers. Most of the TCM practitioners reported that their patients with arthritis used other treatments alongside TCM and a large number of the TCM practitioners who participated believed that TCM was effective for treating arthritis.

CONCLUSIONS

The TCM profession represents a substantial component of the healthcare field in Australia, and treating patients with arthritis appears to be an important area of TCM practice, among others. Further detailed research is needed to help ensure effective, safe patient care for those with arthritis who may be utilising TCM alongside a broader range of conventional medicine, allied health, and other CAM treatments.