Age at Migration and Cognitive Health Among Chinese Older Immigrants in the United States

The Role of Sensory Impairment in Cognitive Health Appraisal: A Study of Older Korean Americans Living in Subsidized Senior Housing

OBJECTIVES

We examined how the association between cognitive performance and cognitive health appraisal would be moderated by vision and/or hearing impairment.

METHODS

Data were collected from 315 older Korean-American residents in subsidized senior housing in Los Angeles (M age = 79.4 years). Linear regression models examined the direct and interactive effects of cognitive performance, vision impairment, and hearing impairment on cognitive health appraisal.

RESULTS

Negative appraisal of cognitive health was associated with lower cognitive performance and poorer ratings for vision and hearing. Moreover, we found a significant interaction between cognitive performance and hearing impairment (β = .13, p < .05), as well as a three-way interaction among cognitive performance, vision impairment, and hearing impairment (β = .12, p < .05).

DISCUSSION

The association between objective and subjective measures of cognition was weakened when hearing was impaired. Such a pattern was further evident when both vision and hearing were impaired.

Immigration, Racialization, and Asian American Older Adults' Cognitive Difficulties

OBJECTIVES

The sociohistorical experiences of Asian American older adults (AAOA) vary, but limited research has examined how immigration status operates as social determinants. This study builds on an existing framework to examine the relationship among social determinants and the differential effects of immigration status on cognitive difficulties among AAOA.

METHODS

Using 5-year estimate data from the 2019 American Community Survey, the study sample consisted of AAOA aged 65 years and older identifying as Chinese, Filipino, Indian, Japanese, Korean, or Vietnamese (N = 100,584). AAOA were categorized as noncitizens, naturalized, or U.S. born for their immigration status. Participants who indicated having difficulty concentrating, remembering, or making decisions were categorized as having cognitive difficulties.

RESULTS

Chinese were the most prevalent ethnic group (30%). Over 70% were naturalized citizens. About 8% endorsed having cognitive difficulties. According to bivariate analyses, there were considerable differences in AAOA's characteristics (e.g., age, gender, marital status, medical insurance, employment status) by their immigration status. The results from the logistic regressions showed that immigration status was independently associated with poor cognitive difficulties. By AAOA's immigration status, unique protective and risk factors were presented for cognitive difficulties.

DISCUSSION

The differential pattern of cognitive difficulties among AAOA reveals a fuller picture of variations within AAOA by immigration status. The results imply that more research is needed to develop culturally sensitive practices that account for the racialized differences by AAOA's immigration status. Further research into the interplay between structural determinants is necessary to formulate practice and policy interventions to address better successful aging for AAOA.

Family surrogate decision-makers' perspectives in decision-making of patients with disorders of consciousness

To explore and describe the experience of decision-making for patients with disorders of consciousness (DOC) from the perspectives of family surrogate decision-makers. A total of 21 face-to-face interviews with family surrogate decision-makers from a tertiary hospital in Shanghai, China were conducted from January 2021 to February 2021. Thematic analysis was used for data analysis. Four main themes were identified and were included in this study: (1) a tough choice between life and dignity, (2) a major responsibility for patient's voice, (3) complex considerations between ethics and morals, and (4) the importance of realistic basis. The surrogate decision-making of DOC patients in China has been affected by the Chinese cultural context and several practical roots. And the family surrogate decision-makers shared their experiences of trade-offs during the decision-making process. Moreover, family surrogate decision-makers realized their serious responsibility to make a decision that would be in the best interest of DOC patients.

Effectiveness of mental health interventions for older adults in South Asia: A scoping review

OBJECTIVE

Mental health problems among older adults are becoming a growing public health concern in South Asia due to continued changes in population dynamics caused by declining fertility rates and increasing life expectancy. This scoping review aimed to explore and summarize evidence about mental health interventions and their impacts on geriatric mental health and highlight gaps and areas for future research.

METHODS

We searched six electronic databases and additional sources for experimental/non-experimental studies evaluating the effectiveness of geriatric mental health interventions in eight countries in the South Asia region from the date of inception of each database up to August 5, 2022. Following the preliminary screening, we extracted data from the eligible articles using a Microsoft Excel data extraction worksheet. We followed Joanna Briggs Institute (JBI) guidelines for this scoping review and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

RESULTS

From a total of 3432 potential articles retrieved, 19 were included in this review following pre-determined eligibility criteria. Across studies, mental health interventions can be broadly categorized into the following types- 1) traditional Yoga, Tai chi, or other meditative movements; 2) behavioral, occupational, or learning-based interventions; 3) tech-based interventions; 4) music therapy; and 5) new healthcare model. The evidence was predominantly based on India (n = 16), whereas three articles were identified from Pakistan. No article was found from six other South Asian countries. Depression and anxiety were the most frequent mental health outcomes, followed by quality of life, cognitive function, self-esteem, physical performance, and many more.

CONCLUSION

Although limited, this review found various interventions that have varying effects on different geriatric mental health outcomes. A handful of evidence on mental health intervention in South Asia indicates a lack of acknowledgment that may develop a serious paucity of geriatric mental health practice. Therefore, future researchers are encouraged to conduct empirical studies to understand disease burden, including associated factors of geriatric mental health, which may help to construct contextually appropriate mental health interventions in this region.

Caregiving for Foreign-Born Older Adults With Dementia

OBJECTIVES

This study examines how nativity, dementia classification, and age of migration (AOM) of older foreign-born (FB) adults are associated with caregiver psychological well-being and care burden.

METHODS

We used linked data from Round 1 and Round 5 of the National Health and Aging Trends Study and Round 5 of the National Study of Caregiving for a sample of nondementia caregivers (n = 941), dementia caregivers (n = 533), and matched care recipients. Ordinary least squares regression models were estimated, adjusting for caregiver characteristics.

RESULTS

Relative to nondementia caregivers, dementia caregivers were more likely to provide care for an older FB adult (8.69% vs. 26.70%), reported more assistance with caregiving activities, worse quality of relationship with care recipients, and higher care burden than nondementia caregivers. In adjusted models, interactions of nativity status × dementia and AOM × dementia revealed that overall, caregivers of older FB adults with dementia who migrated in late life (50+) reported lower psychological well-being than those caring for older FB older adults who migrated at (20-49 years) and (0-19 years). Moderating effects of AOM on the link between dementia caregiving and care burden were not observed.

DISCUSSION

Age of migration of older FB adults with probable dementia may have unique effects on the caregiver's psychological well-being. Our results underscore the importance of considering sociocultural factors of FB adults beyond nativity and the need for research to develop culturally appropriate interventions to enhance psychological well-being and reduce the care burden among dementia caregivers.

Immigration Experience and Cognitive Function Trajectories Among Older Chinese Immigrants

OBJECTIVES

Although a number of studies have documented cognitive health among older immigrants in the United States, little is known about how the life-course immigration experiences are associated with cognitive trajectories among older Chinese immigrants. We assess patterns of cognitive functioning and change over time and examine whether age at migration, reasons for migration, acculturation, perceived discrimination, and preferred dialects are related to cognitive trajectories.

METHODS

The sample comprised 2,075 participants from the Population Study of Chinese Elderly (PINE), who completed a battery of cognitive tests at four time points (2011-2019). Latent class growth analysis and multinomial logistic regression were utilized.

RESULTS

Three latent classes of cognitive trajectories were identified: the low functioning with the fastest decline (LCF, 12%), the moderate functioning with a medium decline rate (MCF, 39%), and the high functioning with the slowest decline (HCF, 48%). Perceiving more discrimination reduced, whereas speaking Taishanese increased the odds of being in the LCF and MCF. High acculturation only distinguished MCF from HCF after controlling for the known factors of cognitive health such as age, education, and social engagement.

DISCUSSION

This study identifies a group of older Chinese immigrants who are especially vulnerable to cognitive impairment and indicates that the risk of cognitive decline appears to be elevated with lower levels of acculturation and unidentified racial discrimination. More research is needed to fully understand the underlying mechanisms that link the life-course immigration experiences to cognitive health outcomes in later life.

The Fading of Protective Roots: A Multivariate Analysis of the Risk of Hypertension among Hispanics by Nativity

OBJECTIVE

To examine the effects of Hispanic nativity on the risk and severity of hypertension relative to US-born non-Hispanic whites.

METHODS

The analytic sample (n = 34,007) was comprised of cross-sectional data drawn from twenty years of the National Health and Nutrition Examination Survey, 1999-2018.

RESULTS

Foreign-born Hispanics aged 65 years and older had a greater risk of severe hypertension compared to non-Hispanic Whites. When examined by length of residency in the US, elderly foreign-born Hispanics with less than 10 years of residency were at greater risk of hypertension and severe hypertension, while those with 20 or more years of residency had similar risks compared to non-Hispanic Whites.

CONCLUSION

The "Hispanic Paradox" of better health despite lower socioeconomic status, was not observed in foreign-born or US-born Hispanics aged 65 years and older. Among elderly immigrants, those with fewer years of residency had the greatest hypertensive risk.

Psychological resilience, activities of daily living, and cognitive functioning among older male Tekun adults in rural long-term care facilities in China

Most of the rural long-term care (LTC) facilities in China are ill-equipped to manage the physical and psychological needs of older residents with dementia. These facilities mostly consist of older male Tekun (socially and economically vulnerable) adults. Preventing or delaying the onset of dementia is especially crucial for these older Tekun adults. A sample of 711 older male Tekun adults from rural LTC facilities in the Anhui province of China was used to investigate the association between psychological resilience and cognitive functioning, and to examine the moderating effect of activities of daily living (ADLs) on that association. Linear and quantile regression found that resilience was positively associated with cognitive functioning for the total sample, with a greater effect among those with a lower level of cognitive functioning. The benefit of resilience on cognitive functioning was observed only in participants with disability in ADLs. Our findings present evidence in support of interventions to foster psychological resilience and potentially improve cognitive functioning among vulnerable older adults. Resilience-promoting intervention is a strength-based approach that aligns with social work values and can be used in practice. The implications for social work practice were discussed.

Loneliness, age at immigration, family relationships, and depression among older immigrants: A moderated relationship

Guided by a convoy model of social relations, this study explores the complex relationships between loneliness, age at immigration, familial relationships, and depressive symptoms among older immigrants. This study used 2010 Health and Retirement Study data from a sample of 575 immigrants (52% female, age range 65-99 years). Ordinary least squares regression models were estimated. The findings indicate that for older immigrants who came to the United States at age 45 or older, loneliness was significantly positively associated with depressive symptoms. Further, perceived negative strain and hours spent helping family moderated this relationship such that the effect of loneliness on depressive symptoms was stronger among respondents who perceived more negative family strain and spent fewer hours helping family. Familial relationships are crucial for the psychological well-being of older immigrants because they can be a source of either stress or support. The results have implications for how research and practices can support the immigrant families.

Immigration and the Life Course: Contextualizing and Understanding Healthcare Access and Health of Older Adult Immigrants

OBJECTIVE

Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country.

METHODS

We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972-2000" and 2015-2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties.

RESULTS

Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country.

DISCUSSION/IMPLICATIONS

Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging.