Health of the Chinese elderly in America

Ageing well in a foreign land as a process of successful social identity change

PURPOSE

Over and above the risks associated with ageing, older migrants are also at risk of social isolation. The social identity approach, and the Social Identity Model of Identity Change (SIMIC) in particular, provides a theoretical basis from which to understand the factors contributing to social isolation and how this then impacts on older migrants' capacity to age well in a foreign land. Building on the recognition that migration involves a major life change, we explore this transition qualitatively focusing specifically on social connectedness and adjustment.

METHODS

In semi-structured interviews with 29 older migrants in Australia, we examined participants' experiences of migration and perceptions of identity and identity change. We also considered in more detail experiences of the most and least socially isolated individuals to understand adjustment trajectories.

RESULTS

We found evidence supporting the key processes described in SIMIC (relating to social identity continuity, social identity gain, and perceived identity compatibility), suggesting that where adjustment was positive it was experienced as a process of successfully adapting to identity change.

CONCLUSION

We emphasise the importance of identity resources as substantial and concrete assets that can enhance the well-being among older adults aging in a foreign land.

Social Engagement and Sense of Loneliness and Hopelessness: Findings From the PINE Study

Among older Chinese adults in the United States, depression is a common health problem. Using data from the first population-based survey of older Chinese Americans (N = 2,929) and applying negative binomial and ordinary least squares regression models, this study examines the relationship between social engagement (including cognitive activity and social activity) and sense of loneliness and hopelessness. Findings reveal that social engagement is significantly and negatively related to both loneliness and hopelessness after controlling for sociodemographic characteristics and health status. In addition, it is found that different aspects of social engagement present differential associations with sense of loneliness and hopelessness: Social activity is significantly associated with lower rate ratios of loneliness, whereas cognitive activity is significantly related to reduced levels of hopelessness. Our findings address the importance of engaging in cognitively stimulating and socially integrating activities in promoting psychological well-being for U.S. Chinese older adults.

Breast cancer experience and survivorship among Asian Americans: a systematic review

INTRODUCTION

Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship.

METHODS

A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion.

RESULTS

Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups.

CONCLUSIONS

Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included.

IMPLICATIONS FOR CANCER SURVIVORS

The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.

Perception and negative effect of loneliness in a Chicago Chinese population of older adults

This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased healthcare utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults.

Depression Among the Elderly Chinese in Canada

Cette recherche examine la prévalence de la dépression chez les Chinois(es) aîné(e)s du Canada. On a interrogé 96 Chinois(es) aîné(e)s choisi(e)s au hasard et vivant à Calgary. On a utilisé vine version chinoise en 15 points du Geriatric Depression Scale (échelle de l'évaluation de l'état dépressif des aîné(e)s) comme instrument de mesure. Les résultats indiquent que 9,4 pour 100 des personnes interrogées étaient légèrement déprimées et que 11,5 pour 100 étaient moyennement ou gravement déprimées. Le taux de prévalence général chez les Chinois(es) aîné(e)s est plus élevé que celui de l'ensemble de la population aînée du Canada et plus faible que celui des Chinois(es) aîné(e)s des États-Unis. Les résultats de l'analyse de régression font ressortir les principaux prédicteurs de la dépression de ce groupe de la population: la maladie, le fait d'habiter le Canada depuis longtemps, ne pas connaître l'anglais, être plus jeune, et avoir une mauvaise santé physique. Les résultats soulignent également les besoins du groupe sur le plan de la santé mentale. La recherche présente de plus d'autres éléments et les répercussions pratiques des résultats.

Relationships between culture and health status: a multi-site study of the older Chinese in Canada

This study examined the relationships between culture and the health status of older Chinese in Canada. Data were collected through face-to-face interviews with a cross-sectional, randomly selected sample of 2,272 older Chinese between 55 and 101 years of age in seven Canadian cities. Health status was assessed by the number of chronic illnesses, by limitations in ADL and IADL, and by information on the Medical Outcome Study Short Form SF-36. Although cultural variables explained only a small proportion of variance in health status, having a stronger level of identification with traditional Chinese health beliefs was significant in predicting physical health, number of illnesses, and limitations on IADL. Other cultural variables, including religion, country of origin, and length of residence in Canada, were also significant in predicting some health variables. Interventions to improve health should focus on strategies to enhance cultural compatibility between users and the health delivery system.

Symptoms, self-care, and quality of life of Chinese American patients with cancer

PURPOSE/OBJECTIVES

To explore the cancer symptom experience, self-care strategies, and quality of life (QOL) among Chinese Americans during outpatient chemotherapy.

DESIGN

Descriptive, exploratory cohort study.

SETTING

An outpatient infusion unit at a public urban county medical center.

SAMPLE

25 Chinese-speaking patients with cancer completed the study. Participants were first-generation immigrants with low levels of acculturation; 88% could not read English; 64% had an annual household income of less than $20,000.

METHODS

Participants completed a basic demographics data sheet, the Suinn-Lew Acculturation Scale, the Memorial Symptom Assessment Scale and Self-Care Diary weekly for three weeks, and the Multidimensional QOL Scale-Cancer and Short-Form 36 Health Survey at the start and end of one chemotherapy cycle. Study instruments were translated into Chinese.

MAIN RESEARCH VARIABLES

Symptoms, self-care, QOL, and acculturation.

FINDINGS

Participants reported experiencing about 14 symptoms weekly. Lack of energy, hair loss, dry mouth, sleep difficulty, and loss of appetite were reported most frequently. On average, about two self-care strategies per symptom were reported and were low to moderate in effectiveness. About 20% of the sample listed Chinese medicine as part of their self-care strategies. A moderate level of QOL was reported.

CONCLUSIONS

Using translated standardized questionnaires can be a feasible method of data collection in studies with non-English-speaking patients. However, having well-trained, bilingual data collectors is important. More attention to long-term cancer self-management in minority patients with cancer is needed.

IMPLICATIONS FOR NURSING

Further research is needed with larger samples, more efficient community-based recruitment strategies, and the development and testing of culturally sensitive interventions.

Prevalence and correlates of depressive symptoms in older Taiwanese immigrants in Canada

BACKGROUND

There is a lack of research regarding depression in older Taiwanese immigrants in North American countries. This study in Canada therefore examined the prevalence of depressive symptoms among older immigrants from Taiwan, and psychosocial factors as predictors of depressive symptoms reported by older Taiwanese immigrants.

METHODS

Ninety-eight migrants (aged > or = 55 years) from Taiwan to Canada, who were part of a multi-site study of health and well-being in a total of 2,272 older ethnic Chinese individuals in community dwellings, completed a face-to-face interview and answered questions in an orally administrated questionnaire. Depressive symptoms were measured by a Chinese version of the Geriatric Depression Scale.

RESULTS

Of the 98 migrants from Taiwan, 21.5% reported at least a mild level of depression. Predictive factors for depressive symptoms were a negative attitude towards aging, poor general physical health, single marital status, barriers in terms of gaining access to health care services, poor financial status, lower level of identification with Chinese health beliefs, and low income.

CONCLUSION

The prevalence of depressive symptoms in older Taiwanese immigrants in Canada was higher than that reported by older adults in the general Canadian population. Thus, implications for the delivery of health care services, and possible strategies to enhance the mental well-being of older Taiwanese immigrants, are discussed.

Impact of culture on depressive symptoms of elderly Chinese immigrants

OBJECTIVES

The impact of culture on mental health has been inadequately researched. This study examines the effect of cultural factors on the depressive symptoms reported by elderly Chinese immigrants in Canada.

METHOD

Data from 1537 elderly Chinese immigrants who took part in a cross-sectional multisite survey on the health and well-being of older Chinese-Canadians were used. Participants were identified through telephone screening of randomly selected telephone numbers listed with Chinese surnames. A structured questionnaire was used to conduct face-to-face interviews. A Chinese version of the 15-item Geriatric Depression Scale was used to assess depressive symptoms.

RESULTS

Close to one-quarter of the elderly Chinese immigrants reported having at least a mild level of depressive symptoms. Having more cultural barriers and a higher level of identification with Chinese cultural values resulted in a higher probability of being depressive.

CONCLUSIONS

The importance of the sociocultural determinants of mental health is demonstrated. The health delivery system should be more sensitive to the unique ethnic and cultural differences of older immigrants.

Health status of older Chinese in Canada: findings from the SF-36 health survey

BACKGROUND

Despite the fact that the Chinese belong to the largest visible minority group in Canada, there is little research findings on their health status, particularly the aging adults. This research aimed at bridging the knowledge gap by examining the health status of this population and comparing the health status between the Chinese aging population and the general aging population in Canada.

METHODS

Secondary data analysis of data obtained from a multi-site study, Health and Well Being of Older Chinese in Canada, and from the Medical Outcomes Study 36-item Short Form (SF-36). The SF-36 published scores obtained from the same age cohorts in the Canadian Multicentre Osteoporosis Study were used for comparison purposes. Independent samples t-tests were used to compare the statistical significance of the two groups.

RESULTS

Overall, older Chinese-Canadians reported better physical health than all older adults in the Canadian population. However, the older Chinese in all age and gender groups scored lower in the mental component summary (MCS). Despite the age differences, Chinese women reported statistically poorer health than the Chinese men in all of the 8 health domains.

CONCLUSION

The data are useful for forming baselines for monitoring the effectiveness of future health interventions for this population. Efforts by service providers to address the health needs of older Chinese-Canadian women, the most vulnerable subgroup in this study, are essential. Interventions are also needed to address the poor mental health status in this ethnic minority group.

Measuring depression of elderly Chinese Americans: a replication study

Research findings aimed at understanding depression in ethnic elderly Chinese are lacking. Using a revised version of the Chinese Geriatric Depression Scale, this replication study measures the prevalence of depression and its related explanatory factors in a community sample of elderly Chinese. One in five respondents was found to be depressed. Reliability and validity of the instrument support the applicability of the Chinese GDS in measuring depression in elderly Chinese. The practice implications of serving the elderly Chinese population are also discussed.

Depression in older Chinese migrants to Auckland

OBJECTIVE

This study was conducted to identify risk factors for depressive symptomatology among older Chinese migrants.

METHOD

One hundred and sixty-two Chinese migrants aged 55 years or older, living in the community and recruited via Chinese community organizations and general practitioners, were interviewed using a Chinese version of the Geriatric Depression Scale and measures of stressful life events, morbid conditions, self-rated health, acculturation, social support and service utilization.

RESULT

Twenty-six percent of participants met the criteria for depressive symptomatology. No recent migrants showed symptoms of depression. Multiple logistic regression analysis showed that lower emotional support, greater number of visits to a doctor, difficulties in accessing health services and low New Zealand cultural orientation increased the risk of showing symptoms of depression.

CONCLUSION

Significant numbers of older Chinese migrants appear to be depressed or at risk for depression and, while participants with depressive symptoms consulted general practitioners more than their counterparts without such symptoms, they reported greater difficulty in accessing health services. The findings point to the need for further epidemiological study of this growing sector of the population and investigation of the nature of its engagement with health services. Social support and aspects of acculturation may play a significant role in preventing depression. This also requires further investigation.

Sociodemographic and health characteristics of older Chinese on admission to a nursing home: a cross-racial/ethnic study

OBJECTIVES

To investigate sociodemographic characteristics (SDCs) and health status of older Chinese newly admitted to a nursing home (NH) and to compare them with the characteristics of residents from other racial/ethnic groups.

DESIGN

Secondary analysis of the admission Minimum Data Set Plus (MDS+).

SETTING

A New York City municipal NH near Chinatown.

PARTICIPANTS

Two hundred fifty-eight (125 Chinese, 57 white, 53 Hispanic, and 23 black) of 292 residents consecutively admitted from November 1992 to May 1997 were selected after excluding those younger than 60 or transferred from another NH.

MEASUREMENTS

SDCs, health status parameters (cognitive performance, physical functioning, mood/behavior patterns, and psychosocial well-being), and morbidity information (most-frequent diagnoses/conditions and medication use) documented in or generated from the MDS+.

RESULTS

The majority of these Chinese were first-generation immigrants and spoke primarily Cantonese or Mandarin Chinese. Compared with whites, they were more likely to be married, less likely to have lived alone, more likely to be using Medicaid, less likely to make medical decision alone, and more likely to depend on family members for decision-making. Nearly three-quarters of Chinese had cognitive impairment. There was an underdiagnosis of dementia in the Chinese subjects on admission. Severe dependence in activity of daily living was identified in more than one-third of Chinese. Fewer Chinese were using psychotropic medications on admission than the whites. Similar to other groups, many of the Chinese subjects were incontinent of bowel and bladder and had chewing or swallowing problems, hypertension, anemia, and stroke.

CONCLUSION

This is the first systematic report of the SDCs and health status of a group of newly admitted older Chinese to an urban NH in the United States using the Minimum Data Set database. These findings suggest that Chinese residents are as frail as other racial/ethnic residents on admission. NHs caring for older Chinese need to be sensitive to the presence of dementia, and require a staff that can speak Cantonese and Mandarin Chinese and is comfortable negotiating with families who are more likely to be the designated decision makers.

Translation and psychometric evaluation of a Chinese version of the SF-36 Health Survey in the United States

Outcome measures are rapidly becoming standard tools in the assessment of clinical effectiveness and in the measurement of health status in populations. In this article we document the development of a self-administered Chinese version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and report the results of psychometric testing among 156 adult Chinese Americans in Boston, Massachusetts. Following the standard guidelines, a Chinese version of the SF-36 was developed through forward-backward translation techniques and committee review. We used psychometric methods to test assumptions underlying construction and scoring of scales and to evaluate the reliability and validity of the Chinese SF-36 as a measure of health status. The preliminary results indicated that missing value rates for the 36 items were consistently low. Item-discriminant validity was high (over 90% scaling successes) for six of the eight scales (Physical Functioning, Role-Physical, Bodily Pain, General Health, Role-Emotional, and Mental Health). Cronbach's alpha coefficient was above 0.70 criterion for all scales except Social Functioning. Reliability estimates also appeared to vary by sample characteristics. We discuss the implications of these findings and identify where further work will be required.

Evaluating health status of elderly Chinese in Boston

There is increasing demand for measurement tools to assess health related quality of life among the Chinese elderly population in the United States. Health services questionnaires, developed largely in English, often under-represent Chinese Americans. Based on conventional mortality statistics, the public mistakenly views Chinese Americans as a "model" minority with no health problems. This general perception has masked the serious health problems among the elderly Chinese Americans. Using the newly developed Chinese version of the MOS SF-36, we aim to explore how elderly Chinese perceive their own health. Based on 219 elderly Chinese recruited in Boston, the study provided mixed results with regard to the perception of a healthy minority model. While the study subjects perceived similar or better physical health to the U.S. norm, they reported worse mental health than the U.S. norm. We explored possible explanations for this discrepancy and discussed the implications as well as directions for future research.

US National Health Data on Asian Americans and Pacific Islanders: a research agenda for the 1990s

OBJECTIVES

In spite of over 30 years of periodic nationwide surveys, we have thus far only the most rudimentary estimates of the determinants of the health of Asian Americans and Pacific Islanders. This paper explores ways to improve the capability of the National Center for Health Statistics (NCHS) to collect national health data on these populations.

METHODS

The NCHS "race" coding practices are reviewed, their limitations stated, ways to improve the numerator and denominator data discussed, and a research agenda presented.

RESULTS

Resources can be intensified to produce better denominator data, and to improve the collection of detailed ethnicity information for the numerators, in at least the three states (California, New York, and Hawaii) where the majority of Asian/Pacific Islanders lived in 1990. Subsequently, these efforts should be extended to the 10 states where 79% of these individuals reside or to the top 15 metropolitan areas where they are concentrated.

CONCLUSIONS

If the recommendations are implemented, several coordinated multisite, multiwave epidemiologic surveys can be conducted using standardized interview instruments and data collection procedures that will capitalize on the geographic distribution of Asian/Pacific Islanders.

Perspectives on nursing care of Chinese Americans

Chinese population growth in the United States is expected to accelerate more rapidly than that of any other Asian group in the coming decades. As a result, nurses will be encountering members of this diverse and rich cultural group more frequently. A better understanding of the cultural beliefs, customs, and health care practices of Chinese Americans can only improve the quality of nursing care provided for these clients. Awareness of the barriers to health care that confront many Chinese Americans will be useful in designing appropriate nursing interventions. Knowledge of the positive and negative effects of some traditional Chinese health care practices can be incorporated into individualized client teaching plans.

Changing demographics in the United States. Implications for health professionals

The coming decade will bring dramatic changes in the composition of the American population. Changes in immigration laws, illegal and legal immigration into this country, and the aging of the "baby boomers" will all result in profound changes in the demographics of this country. These demographic changes will necessitate alterations in all aspects of the health care system. This article focuses on the projected changes that will occur in relation to the elderly, Hispanics, Asian Americans, and the economically disadvantaged, and on the related implications for health care professionals. The cancer incidence and mortality rates for each discussed minority group differ from the rates presently reported for white Americans. Thus, health professionals will have to be aware of the differences among these groups and tailor their primary and secondary prevention efforts accordingly. The future task for all health care providers serving minorities and the elderly will be to familiarize themselves with the special health problems of the population with whom they work and with the ethnocultural barriers that deter proper use and delivery of health services.