Perceptions of health and use of ambulatory care: differences between Korean and White elderly

"I can wait until I return home": healthcare utilization among Korean international students in the U.S

ObjectiveThis study aimed to understand healthcare utilization behavior among Korean international students in the U.S. Participants and methods: Seventeen Korean international students in New York City participated in in-depth personal interviews. Results: The participants passively utilized U.S. healthcare by minimizing, avoiding, or delaying needed healthcare. However, they actively utilized transnational healthcare (in Korea) as an alternative strategy. Participants' negative perception of the U.S. healthcare system (as a predisposing factor) influenced healthcare utilization in the U.S. The enabling transnational factors influenced their transnational healthcare utilization. Low perceived need for healthcare (as a need factor) determined the country where they utilized healthcare. Conclusion: Andersen's healthcare utilization model is applicable in explaining healthcare utilization behavior among Korean international students, who could be considered a nontraditional vulnerable population. On-campus health education and promotion may help international students receive timely healthcare, especially those who do not return to their home country routinely.

Enoch Senior's College for Korean Immigrant Seniors: Quality of Life Effects

ABSTRACTA community-based program is increasingly recognized as promoting health and active social participation in one's life, yet information is lacking about the use and impact of such programs among immigrant visible minority seniors. This mixed-method research evaluated the impact of a cultural community program for Korean immigrant seniors by examining participants' health-related quality of life (HR-QOL) benefits and overall well-being. In this study, 79 participants completed the SF-36v2 questionnaire twice to assess the impact of Canada Enoch Senior's College (CESC) program on their HR-QOL and well-being. Statistically significant improvement in physical and mental health domains was observed: bodily pain and role limitations due to emotional problems. Qualitative data from participants' interviews supported the survey findings with positive contributions in health and social arenas of seniors' lives. These results suggest that the CESC program contributes to quality of life and well-being of Korean senior participants and supports similar community-based cultural programs.

Social relationships and physician utilization among older adults-A systematic review

Background

In older age health needs and demand for health services utilization increase. Individual’s social relationships can play a decisive role regarding the utilization of outpatient health care services. This systematic review examines the associations of structural and functional dimensions of social relationships with outpatient health services use of older adults.

Methods

The databases PubMed, CINAHL, SocINDEX, PsycINFO, International Bibliography of the Social Sciences (IBSS), Sociological Abstracts, and Applied Social Sciences Index and Abstracts (ASSIA) were searched in February 2016. The methodological and reporting quality of the articles was assessed and the results were synthesized descriptively and systematically.

Results

Out of 1.392 hits, 36 articles (35 studies) were included in the systematic review. The methodological and reporting quality of the included articles was reasonable. Various structural and functional characteristics of social relationships were associated with the use (yes/no) and the frequency of using outpatient care among older adults. The majority of the associations between structural dimensions of social relationships and the use of physicians were positive and moderate in strength. The associations between functional dimensions of social relationships and the probability of using physician services were inconsistent and varied in strength. For the most part, social relationship variables assigned to the structural dimension were positively and weakly to moderately associated with the frequency of physician visits. Functional aspects of social relationships also tended to have positive associations with the frequency of physician utilization. The associations were weak to moderate in strength.

Conclusions

Measuring social relationships and their influence on health services use is a challenging methodological endeavor indicated by the inconclusive results. The results suggest that the outpatient care utilization behavior of older individuals being structurally and functionally integrated in social relationships is different to older adults being socially isolated or having no social support. All in all, the current status of quantitative data was insufficient. Future health services research should accentuate social ties in more detail, especially according to quality aspects of social relationships.

Racial Disparities in Health Service Utilization Among Medicare Fee-for-Service Beneficiaries Adjusting for Multiple Chronic Conditions

OBJECTIVE

To examine racial disparities in health services utilization in Hawaii among Medicare fee-for-service beneficiaries aged 65 years and above.

METHOD

All-cause utilization of inpatient, outpatient, emergency, home health agency, and skilled nursing facility admissions were investigated using 2012 Medicare data. For each type of service, multivariable logistic regression model was used to investigate racial disparities adjusting for sociodemographic factors and multiple chronic conditions.

RESULTS

Of the 84,212 beneficiaries, 27.8% were White, 27.4% were Asian, 27.3% were Pacific Islanders; 70.3% had two or more chronic conditions and 10.5% had six or more. Compared with Whites, all racial groups experienced underutilization across all types of services. As the number of chronic conditions increased, the utilization of inpatient, home health care, and skilled nursing facility dramatically increased.

DISCUSSION

Disparities persist among Asians and Pacific Islanders who encounter the problem of underutilization of various health services compared with Whites.

Correlates of Sense of Control among Older Korean-American Immigrants: Financial Status, Physical Health Constraints, and Environmental Challenges

Responding to the need for more research on minority older populations, the present study assessed sense of control among older Korean-American immigrants. The association of sense of control with financial status, physical health constraints, and environmental challenges was examined with a sample of 230 older Korean-Americans (Mage = 69.8, range = 60–92) in Florida. In a hierarchical regression analysis, financial limitations (poorer perceived financial status and receipt of financial support from adult children), physical health constraints (greater functional disability), and environmental challenges (lower acculturation and greater difficulty with transportation) were identified as significant risk factors for a diminished sense of control. Findings are discussed in a cultural context, and ways to promote sense of control among immigrant older populations are suggested.

Korean Immigrant Women’s Health Care Utilization in the United States

A systematic literature review was performed to review empirical evidence, published between 1946 and 2015, regarding Korean immigrant women’s health care utilization and factors affecting their health care utilization in the United States. Andersen’s behavioral model of health services utilization was used as a framework and was expanded to analyze the pattern of health services utilization and to identify characteristics of access to health care. A total of 32 reports were included. Variables were categorized into 1 of 5 individual determinants: cultural, enabling, predisposing, need, and reinforcing factor. A total of 423 relationships were found between individual determinants and health care utilization. All reinforcing variables were effective in increasing Korean immigrant women’s health care utilization in a positive way. Interventions targeting multiple factors were strongly effective in encouraging Korean immigrant women to utilize health services for cancer screening. However, these studies yielded inconsistent findings related to outcome measures due to the variability of measurement criteria.

Factors associated to medical consultations by elderly adults in southern Brazil: a population based study

OBJECTIVE

To analyze the prevalence of medical consultations in the last three months among elderly adults and associated factors.

METHODS

A cross-sectional, population-based study was carried out with 1,705 elderly adults (60+ years of age) in the urban region of Florianópolis, Santa Catarina, Brazil, in 2009 and 2010. The sampling selection was performed in two stages. The sample was complex, with census tracts as primary and households as secondary sampling units. For association analysis, Poisson regression was performed using predisposing factors, enabling factors and need as independent variables, according to Andersen's theoretical model.

RESULTS

The response rate was 89.2%. The prevalence of medical appointments by elderly adults was 70.4% (95%CI 67.5 - 73.4). Factors associated with higher prevalence of medical consultations in the crude analysis were female gender, accumulation of chronic diseases, negative self-perception of health, and report of chronic pain. The multivariate analysis showed that having at least one chronic disease and negative self-perception of health was positively associated with the outcome.

CONCLUSION

Only variables from the need dimension were associated with medical consultations, indicating an equal use of this service.

Acculturation and perceived mental health need among older Asian immigrants

The demographic landscape of the United States is changing as the general population ages and the size of racial/ethnic minority groups grows. Most prior studies on mental health service use among Asians in America have overlooked older adults. A deeper understanding of the way acculturation factors impact help-seeking behaviors among older Asian Americans will inform behavioral health practice and program planners as they address the disparities affecting a diverse racial group. The California Health Interview Survey was used to examine the correlates of perceived mental health need among 980 older Asian immigrants. The study found that English proficiency and other covariates affected how Asian Americans perceived mental health need. Implications for understanding the help-seeking behaviors of older Asian immigrants are discussed.

Physician contact by older Asian Americans: the effects of perceived mental health need

OBJECTIVE

The use of physicians is more common than of behavioral specialists, especially in underserved Asian American communities. Despite a rapidly aging Asian American population, research has overlooked older people. This study examines the way mental health need affects the number of physician contacts by older Asian Americans.

METHOD

This study uses data on self-identified Asian Americans aged over age 50 years derived from the 2001 California Health Interview Survey. A total of 1191 Asian Americans from Chinese, Filipino, Korean, and Vietnamese backgrounds were studied. Replicate weights were applied to account for the survey's complex sampling methods. Linear regression was used to identify the number of physician contacts.

RESULTS

Overall, respondents had seen a doctor an average of five times in the previous 12 months; 7% perceived that they had a mental health need. Perceiving a mental health need was associated with a decreased number of physician contacts for Filipino and Korean Americans.

CONCLUSION

This study revealed interethnic differences among older Asian Americans' contact with physicians. As older Filipino and Korean Americans who perceive a mental health need have fewer contacts with their physician, correctly identifying mental health needs in the health care system for these groups is crucial. Health and mental health professionals can work toward reducing mental health disparities by accounting for older Asian Americans' help-seeking patterns when designing evidence-based interventions.

Longitudinal changes in access to health care by immigrant status among older adults: the importance of health insurance as a mediator

PURPOSE

This longitudinal study examined the role of health insurance in access to health care among older immigrants.

DESIGN AND METHODS

Using data from the Second Longitudinal Study of Aging, the longitudinal trajectories of having a usual source of care were compared between 3 groups (all 70+ years): (a) late-life immigrants with less than 15 years of residence in the United States ("recent immigrants"; n = 133), (b) "earlier immigrants" (15 years or longer in the United States, n = 672), and (c) U.S. born (n = 8,642). A series of hierarchical generalized linear models were run to test the mediating relationship of health insurance between immigrant status and having a usual source of care.

RESULTS

Although the probabilities of having a usual source of care increased over time across all three groups, recent immigrants were less likely to have Medicare and private insurance over time; this in turn was related to lower probabilities of having a usual source of care (indirect relationship). There was no direct relationship between immigrant status and having a usual source of care.

IMPLICATIONS

To prevent the use of more expensive forms of care in the long run, policy efforts should expand late-life immigrants' health insurance coverage by increasing affordable health insurance options.

Ethnic differences in internal medicine referrals and diagnosis in the Netherlands

BACKGROUND

As in other Western countries, the number of immigrants in the Netherlands is growing rapidly. In 1980 non-western immigrants constituted about 3% of the population, in 1990 it was 6% and currently it is more than 10%. Nearly half of the migrant population lives in the four major cities. In the municipality of Rotterdam 34% of the inhabitants are migrants. Health policy is based on the ideal that all inhabitants should have equal access to health care and this requires an efficient planning of health care resources, like staff and required time per patient. The aim of this study is to examine ethnic differences in the use of internal medicine outpatient care, specifically to examine ethnic differences in the reason for referral and diagnosis.

METHODS

We conducted a study with an open cohort design. We registered the ethnicity, sex, age, referral reasons, diagnosis and living area of all new patients that visited the internal medicine outpatient clinic of the Erasmus Medical Centre in Rotterdam (Erasmus MC) for one year (March 2002-2003). Additionally, we coded referrals according to the International Classification of Primary Care (ICPC) and categorised diagnosis according to the Diagnosis Treatment Combination (DTC). We analysed data by using Poisson regression and logistic regression.

RESULTS

All ethnic minority groups (Surinam, Turkish, Moroccan, Antillean/Aruban and Cape Verdean immigrants) living in Rotterdam municipality, make significantly more use of the outpatient clinic than native Dutch people (relative risk versus native Dutch people was 1.83, 1.97, 1.79, 1.65 and 1.88, respectively). Immigrant patients are more likely to be referred for analysis and treatment of 'gastro-intestinal signs & symptoms' and were less often referred for 'indefinite, general signs'. Ethnic minorities were more frequently diagnosed with 'Liver diseases', and less often with 'Analysis without diagnosis'. The increased use of the outpatient facilities seems to be restricted to first-generation immigrants, and is mainly based on a higher risk of being referred with 'gastro-intestinal signs & symptoms'.

CONCLUSION

These findings demonstrate substantial ethnic differences in the use of the outpatient care facilities. Ethnic differences may decrease in the future when the proportion of first-generation immigrants decreases. The increased use of outpatient health care seems to be related to ethnic background and the generation of the immigrants rather than to socio-economic status. Further study is needed to establish this.

Linguistic disparities in health care access and health status among older adults

BACKGROUND

English proficiency may be important in explaining disparities in health and health care access among older adults.

SUBJECTS

Population-based representative sample (N=18,659) of adults age 55 and older from the 2001 California Health Interview Survey.

METHODS

We examined whether health care access and health status vary among older adults who have limited English proficiency (LEP), who are proficient in English but also speak another language at home (EP), and who speak English only (EO). Weighted bivariate and multivariate survey logit analyses were conducted to examine the role of language ability on 2 aspects of access to care (not having a usual source of care, delays in getting care) and 2 indicators of health status (self-rated general health and emotional health).

RESULTS

Limited-English proficient adults were significantly worse off (1.68 to 2.49 times higher risk) than EO older adults in 3 of our 4 measures of access to care and health status. Limited-English proficient older adults had significantly worse access to care and health status than EP older adults except delays in care. English proficient adults had 52% increased risk of reporting poorer emotional health compared with EO speakers.

CONCLUSIONS

Provision of language assistance services to patients and training of providers in cultural competence are 2 means by which health care systems could reduce linguistic barriers, improve access to care, and ultimately improve health status for these vulnerable populations.

Insurance, acculturation, and health service utilization among Korean-Americans

This study describes the pattern and predictors of ambulatory care utilization among Korean Americans (KAs) living in Los Angeles. Data were gathered via a mail survey. Analysis employed a two-part model: logit model for factors affecting any health care use and truncated negative binomial model for frequency of use given one visit. Use of ambulatory care among KAs was low (2.80 visits during prior 12 months), compared to their counterparts in South Korea and the U.S. population. Variables associated with higher utilization included old age, health needs, and health insurance. Income had a positive effect on health care utilization decisions among the uninsured. Acculturation appeared to be neither a strong nor consistent predictor of ambulatory care utilization among KAs. Of particular concern is the finding that KAs suffer from inadequate access to care due to lack of employment-based health insurance.

Health care and social service use among Chinese Immigrant elders

We explored patterns and reasons for health and social service use among Chinese immigrant elders. Interviews were conducted with 27 Chinese immigrant elders, 11 adult care giving children, and 12 health and social service providers. Content analysis of these data indicated that participants across groups agreed that Chinese elders under-utilize services because of problems related to language, transportation, cost, long waits for appointments, and because of cultural norms/values related to need for care, preference for self-over professional care, fear, and distrust of western biomedicine, and the obligation to refrain from using formal services. These problems are complicated by geographical dispersion and dialect differences in the local Chinese immigrant community.

Pathways to care for Alzheimer's disease among Korean Americans

Little is known about how Korean Americans make decisions whether to seek help when, experiencing symptoms that might signal dementia. In Study 1, patient registry data for 60 Korean and 212 non-Korean Alzheimer's disease patients revealed that both groups waited 3-4 years before seeking help and sought help when memory decline was accompanied by other problems. Among Korean Americans, those living with family were more impaired than those living alone, suggesting greater, delay in seeking help. In Study 2, 109 Korean Americans ages 18-73 were surveyed concerning acculturation, knowledge, and help-seeking attitudes. Those more familiar with dementia symptoms indicated they would seek help, supporting the value of public education.

Race and productivity outcome after traumatic brain injury: influence of confounding factors

OBJECTIVE

Investigate the impact of race on productivity outcome after traumatic brain injury (TBI) and evaluate the influence of confounding factors on this relationship.

DESIGN

Inception cohort of 1083 adults with TBI for whom 1-year productivity follow-up data were available.

RESULTS

Univariable logistic regression indicated that race was a significant predictor of productivity outcome after TBI. African Americans were 2.76 times more likely to be nonproductive than whites and other racial minorities were 1.92 times more likely to be nonproductive than whites. Multivariable logistic regression analyses revealed that the effect of race on employability was influenced by confounds with preinjury productivity, education level, and cause of injury. After adjustment for other predictors, African Americans were 2.00 times more likely to be nonproductive than whites and other racial minorities were 2.08 times more likely to be nonproductive than whites. The multivariable logistic regression model with all predictors except race accounted for 39% of the variability in productivity outcome (R2-Nagelkerke=0.39), whereas the full logistic regression model including race accounted for 41% of the variability in productivity outcome (R2-Nagelkerke=0.41); a difference of only 2%.

CONCLUSION

Any effect of race on productivity is significantly influenced by confounding with preinjury productivity, education level, and cause of injury.

A comparison of correlates of self-rated health and functional disability of older persons in the Far East: Japan and Korea

Self-rated health and physical functioning are recognized as important indicators of health in older persons. Rarely, however, there have been studies done which examine cross-cultural differences in the health of older people using these measures, especially among non-Western countries. The objective of this study was to examine patterns of association of self-rated health and functional disability of Japanese and Korean elderly people living in the community, using nationwide surveys of persons aged 60 years or over. There were striking similarities in the general pattern of associations with covariates. In the multivariate analysis, age, work status, comorbidity, depressive symptoms, life satisfaction, hospitalization, and functional disability were strongly associated with self-rated health in both populations. For functional disability, older age, female, low social contact, depressive symptoms, poor life satisfaction, and poor self-rated health were found to be significantly associated. Some differences in the structure of associations with self-rated health, however, were noted. Women tended to assess their health more favorably than men in Korea, but in the Japanese elderly gender differences disappeared when other variables were taken into account. Health-related variables tended to be more closely associated with functional disability in the Japanese sample. An overall similarity, however, in the pattern of associations of these measures supports their utility in assessing and comparing the health of older populations in this region.