"My wife made me": motivations for body and beauty work among older Korean and Chinese migrant adults in Australia

This article examines how older Korean and Chinese migrants living in Perth, Australia, engage in various beauty, grooming and fitness practices to negotiate "successful ageing" in transnational contexts. Drawing on semi-structured interviews with 30 men and women aged between 60 and 89, we examine what social meanings are attached to these practices, and how the transnational context of living in Australia has influenced the participants' perceptions of ageing and presentation of self in later life. Migration in later life is often considered in relation to the 'host' countries values and social practices, which can make it difficult for individuals to settle and feel a sense of belonging especially in later life. In this article, we will illustrate how gender, class, and cultural dispositions intersect and link with possibilities for defining and redefining successful ageing in migrant contexts. This study illustrates how successful ageing emerges as a malleable concept that draws on ideas of an ideal ageing body from the cultural values of the 'home' country, rather than the 'host' country. The findings illustrate how in everyday lived experience, the transnational habitus does not always necessarily result in a 'divided habitus' where the values of the 'home' country and that of the 'host' country are in conflict - even when the migration experience is relatively recent. Quite the contrary, the way the participants utilise everyday beauty, fitness and grooming practices to maintain a future-focused self in the context of 'home' country's age-appropriate body ideals to perform signifiers of 'successful migrant living' point to the positive aspects that appearance management can have on an individual in later life, particularly in migrant contexts.

"What's your accent, where are you from?": Language and belonging among older immigrants

Researchers have identified immigration and marginalization as two processes that impact older immigrants' experience of aging in the U.S. Our paper draws on 42 interviews with a diverse group of older American immigrants to center issues of language, accent, and Othering. We argue that the importance of language extends beyond communication for older immigrants, as English proficiency and accent are important boundaries determining inclusion and recognition as an American. Accents are a racialized characteristic that can prompt microaggressions and exclusion. We identified a racial pattern in reported reactions to accents among the participants in our study. White immigrants generally described positive appraisals of their accent, and typically had a choice whether to emphasize their national origins. While white immigrants were viewed as "Acceptable Outsiders," many immigrants of color described microaggressions, ridicule, and discrimination related to their accented speech. We contend that these experiences of Othering can have a profound impact on sense of belonging, as many of the older immigrants of color in our study expressed a persistent sense of exclusion and even alienation. We advance the concept of "aging off center" to describe how repeated experiences of Othering and exclusion shape aging experiences for immigrants of color who are long-term residents of the United States.

Aging Out-of-Place: Perceptions of Successful Aging Among Aging Burundian Refugees in the United States

BACKGROUND AND OBJECTIVES

Refugees flee their home countries due to life-threatening situations and are resettled in countries such as the United States. For older refugees, their cultural background and forced migration experience may affect how they perceive successful aging in their host countries. As such, it is important to understand how aging refugees perceive aging well to enhance their well-being in the host communities. Thus, the present study explores perceptions of successful aging among refugees in the United States.

RESEARCH DESIGN AND METHODS

Twenty-one Burundian refugees, aged 50-67, were recruited from an upper Midwest community to participate in interviews on their perceptions of successful aging. The qualitative interviews were analyzed using thematic content analysis.

RESULTS

Emergent themes showed that aging refugees' perceptions of successful aging were in some ways consistent with perceptions among other nonrefugee aging populations, such as perceptions related to physical functioning and health. Yet, in many ways, refugees' unique background and experiences seemed to lead to unique aging perceptions, such as perceiving an earlier onset of aging and expressing surprise and appreciation to experience old age.

DISCUSSION AND IMPLICATIONS

Study findings suggest important future directions and potential implications for refugee host regions and communities on how they can better support aging refugees as well as develop effective interventions to promote well-being.

Older adult Cubans moving to the Canary Islands (Spain): Migrants' strategies in later life

The research on migration to Spain of Cuban citizens in later life proposes to overcome the lack of academic knowledge from these analytical perspectives: migrations of older adult people beyond the issue of lifestyle mobility; the transnational diasporic nexus favoring migrations; and the Cuban community residing abroad, outside the United States of America. The combination of these elements in this case study shows the agency of older adult Cuban citizens who move to the Canary Islands, trying to achieve a greater level of material well-being and taking advantage of the diasporic ties between the Canary Islands and Cuba; but this is a process that brings out, simultaneously, feelings of dislocation and nostalgia in the stage of old age. The development of a mixed methodology and the focus on the life course of migrants offer an opportunity to reflect on the cultural and social construction of ageing in migration studies. Consequently, this research allows a deepening of knowledge on human mobility from the perspective of ageing in a counter-diasporic migration, showing the relationship between emigration and life cycle and demonstrating the strength and spirit of achievement of those individuals who decide to emigrate despite their advanced age.

Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study

Objectives

Neighborhood disadvantage may increase the risk of adverse health outcomes among older refugees. Yet few studies rigorously estimate the effects of place-based factors on later-life health, particularly dementia and mortality. Evidence about refugees is especially sparse.

Methods

This study leveraged a natural experiment in the form of a Danish policy (1986-1998) that dispersed refugees quasi-randomly across neighborhoods upon arrival. We used longitudinal registers allowing 30 years of follow-up among refugees aged 40+ years upon arrival in Denmark (N = 9,854). Cox models assessed the association between neighborhood disadvantage and risk of dementia and mortality. We examined heterogeneous effects by sex, age, and family size. We also examined associations among non-refugee immigrants and native-born Danes.

Results

Neighborhood disadvantage was not associated with dementia in any group. One unit increase in neighborhood disadvantage index (ranges -8 to 5.7) was associated with greater mortality risk among non-refugee immigrants (HR 1.06, 95%CI: 1.02, 1.10) and native-born Danes (HR 1.11, 95%CI: 1.06, 1.17). In contrast, neighborhood disadvantage was associated with lower mortality risk among refugees (HR 0.96, 95%CI: 0.93, 0.99). Neighborhood disadvantage remained negatively associated with mortality risk in subgroups: refugees who are female (on moderate-disadvantage compared to low-disadvantage), aged 60+, and who arrived with families.

Discussion

While neighborhood disadvantage was associated with lower mortality risk among refugees, it was associated with greater mortality risk among non-refugee immigrants and native-born Danes, perhaps due to confounding in the latter groups or different place-based experiences by immigration status. Future research is warranted to explain the reasons for contrasting findings.

Taking Refuge in Religion: Buddhist-Oriented Coping following Late-Life Immigration

Despite a recognition of religion as a resource for coping in later life, few studies have examined how religion is summoned to cope with the stressors of late-life immigration. Drawing upon data generated in a phenomenological study of the aging-out-place experience, this article presents a hermeneutic analysis of textual extracts addressing 10 Sri Lankan-born late-life immigrants' Buddhist beliefs and practices, and how these beliefs and practices contributed to coping with immigration stressors. Four shared experiences facilitated through religious engagement were revealed: religious engagement as a source of purpose, making meaning of suffering and experiencing hope, non-attachment, and connecting to the past and the ethnoreligious community. Late-life immigrants drew on religious engagement to remain resolute amidst adversities, thus reinforcing the importance of culturally responsive milieus and services to support religion-focused coping. Findings are interpreted in relation to Pargament's (1997) theory of religious coping.

Aging in Chinatowns: the Meaning of Place and Aging Experience for Older Immigrants

The concept of "Aging in place" has not been fully validated among older immigrant groups living in diverse cultures. The study used a qualitative research approach and interviewed Chinese immigrant older adults across three Chinese enclave communities in New York City to identify whether Chinatowns are a place for Chinese immigrants to age and explore their experience of aging in Chinatowns. The findings showed that Chinese immigrants did consider Chinatown as the place, which conveyed practical, linguistic, social, emotional and cultural meaning. Aging in Chinatown, older adults sought independence, security, and autonomy through various social resources. However, older adults, especially newly arrived immigrants, have faced obstacles that undermine their aging experience. Older immigrants' unique aging experience has provided profound insight in understanding migration and AIP, which help develop proper policies and programs to support the AIP initiative.

Successful Aging among Immigrant and Canadian-Born Older Adults: Findings from the Canadian Longitudinal Study on Aging (CLSA)

BACKGROUND

Few studies in Canada have focused on the relationship between immigrant status and successful aging. The concept of successful aging used in this study includes the ability to accomplish both activities of daily living (ADLs) and instrumental activities of daily living (IADLs), freedom from mental illness, memory problems and disabling chronic pain, adequate social support and older adults' self-reported happiness and subjective perception of their physical health, mental health and aging process as good.

METHODS

The present study analyzed the first two waves of data from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). The sample includes 7651 respondents aged 60+ at time 2, of whom 1446 respondents were immigrants. Bivariate and multivariable binary logistic regression analyses were conducted.

RESULTS

Canadian-born older adults had a slightly higher prevalence and age-sex adjusted odds of achieving successful aging than their immigrant counterparts (aOR = 1.18, 95% CI: 1.04, 1.34, p < 0.001). After adjusting for 18 additional factors, immigrant status remained statistically significant (aOR = 1.24, 95% CI: 1.09, 1.41, p < 0.001). Significant baseline factors associated with successful aging among immigrants included being younger, having higher income, being married, not being obese, never smoking, engaging in moderate or strenuous physical activities, not having sleeping problems and being free of heart disease or arthritis.

CONCLUSIONS

Immigrant older adults had a lower prevalence of successful aging than their Canadian-born peers. Further research could investigate whether policies and interventions supporting older immigrants and promoting a healthy lifestyle enhance older adults achieve successful aging in later life.

Developing the Person-Place Fit Measure for Older Adults: Broadening Place Domains

BACKGROUND AND OBJECTIVES

Literature calls for larger studies with empirically tested instruments about the meaning of place for older adults-studies that include a broader range of domains and neighborhood characteristics. Although rich narrative and qualitative data for small groups of older individuals exist, a measure with valid and reliable scores that includes the new, multiple domains about aging in place does not.

RESEARCH DESIGN AND METHODS

Findings are reported from a two-phase, nine-step, exploratory sequential mixed-methods process of measurement development for the Person-Place Fit Measure for Older Adults (PPFM-OA). In Phase I, a focus group (n = 8) and qualitative interviews (n = 77) with persons 65 and older were used to develop emerging domains of aging in place. Qualitative data about concepts and language informed the development of a quantitative item pool for the Mechanical Turk-distributed survey. Phase II included a Delphi process reducing the number of items in the PPFM-OA. Exploratory factor analysis (EFA) and reliability analysis further reduced the number of potential measure items.

RESULTS

Five factors emerged from the EFA. They were primary or basic needs/necessities (α = .84), neighborhood changes and moving (α = .88), identity and place attachment (α = .86), community value (α = .89), and services and resources (α = .78).

DISCUSSION AND IMPLICATIONS

The development of a measure, such as the PPFM-OA, is crucial as more programs and services are created to address aging in place but uniform data for planning and evaluation are lacking. These initial quantitative analyses are informative for the next step, a larger-scale, quantitative evaluation.

Using the Social Ecological Model to Identify Drivers of Nutrition Risk in Adult Day Settings Serving East Asian Older Adults

Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke's six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users' nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population. [Research in Gerontological Nursing, 13(3), 146-157.].

A new conceptual model of experiences of aging in place in the United States: Results of a systematic review and meta-ethnography of qualitative studies

OBJECTIVES

The purpose of this systematic review was to synthesize the evidence on experiences of aging in place in the United States.

DESIGN

Systematic review and meta-ethnography of qualitative studies.

DATA SOURCES

We searched six bibliographic databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, Sociological Abstracts), with no limits on publication date. Eligible studies reported peer-reviewed qualitative research on experiences of aging in place in the United States with full-text available in English.

REVIEW METHODS

Three reviewers independently used Covidence software to screen titles and abstracts followed by full texts. We assessed quality and risk of bias using a modified version of the Joanna Briggs Institute Checklist for Qualitative Research. Qualitative data analysis was conducted using meta-ethnography, following Noblit and Hare's seven-step method of translation and synthesis to generate a novel conceptual model.

RESULTS

Of 2659 papers screened, 37 unique studies were eligible for inclusion, reported in 38 publications. The studies were conducted in 16 states and published between 1994 and 2018. The included samples represented 1199 participants in total, with mean ages ranging from 48 to 91 years. The gender of the samples ranged from 20% to 100% female, with a median of 77%. One-third of the included studies did not report participants' race/ethnicity, and half of the remaining study samples were at least 90% white; however, 20% of the studies focused exclusively on experiences of racial/ethnic minority older adults. Using meta-ethnography, we developed a new conceptual model of aging in place in the United States as a dynamic process of balancing threats and agency in relation to experiences of identity, connectedness, and place. We found that people aging in place were engaged in significant work to cope with unpredictable needs and challenges by changing their mindset, adapting their home environment to accommodate new needs, and finding different ways to connect with important people in their lives. Agency was shaped by resources and restrictions on choice, and where threats to aging in place outweighed an individual's sense of agency, the consequences included feelings of uncertainty, isolation, and dislocation.

CONCLUSIONS

To the best of our knowledge, this is the first systematic review of qualitative studies to evaluate experiences of aging in place in the United States. The findings of our meta-ethnographic synthesis led to the development of a new conceptual model of aging in place highlighting the dynamic tensions involved in balancing threats and agency.

Racial Disparities in Nutritional Risk among Community-Dwelling Older Adults in Adult Day Health Care

Information regarding nutritional risk among users of American adult day health centers (ADHCs), 60% of whom are racial minorities, is scant. This study examined nutritional risk and associated factors in a diverse sample ADHC users aged 50+ using secondary cross-sectional analysis of data collected between 2013 and 2017. Risk was assessed using the DETERMINE checklist, and results were stratified by race. The majority of the sample (N = 188) was at moderate (45.2%) or high (38.5%) nutritional risk, with statistically significant racial differences. Blacks were at greater risk than any other group: 65% had high nutritional risk; 76.5% ate <5 servings of fruits, vegetables, or milk daily; 21% ate <2 meals daily, 48.5% reported involuntary weight loss/gain, and 41.2% had tooth loss/mouth pain. Older adults in ADHCs are at elevated risk of malnutrition, disproportionately so amongst blacks. Both routine nutrition screening and population-specific approaches are needed to attenuate risk.

"Living happily despite having an illness": Perceptions of healthy aging among Korean American, Vietnamese American, and Latino older adults

BACKGROUND/OBJECTIVE

The growingly diverse aging population presents a challenge for the geriatric workforce, particularly its capacity to effectively respond to the sociocultural and linguistic needs of ethnic minority older adults. Informed by research on the importance of culturally-competent care in reducing racial and ethnic health disparities, this study sought to understand the meaning of healthy aging from the perspectives of Korean American, Vietnamese American, and Latino older adults.

METHODS

Interviews were conducted with 30 participants recruited from community-based organizations in Southern California.

RESULTS

Several dimensions emerged in the participants' understanding of healthy aging: (1) having good physical and mental health (2) optimism and acceptance; (3) social connectedness; (4) taking charge of one's health; and (5) independence and self-worth.

CONCLUSIONS

Results could inform the development of a culturally-responsive geriatric healthcare system that takes into account older adults' beliefs, preferences, and needs to promote successful aging.

Disparities in the Prevalence and Correlates of Disability in Older Immigrants in the USA: a Systematic Review of the Literature

BACKGROUND

Disability in older adults leads to poor quality of life, is costly for the health system, and is a risk for mortality. Little is known about disability in older immigrants to the USA.

OBJECTIVE

To synthesize the evidence on the prevalence and factors associated with disability in older adult immigrants.

METHODS

We conducted searches in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. Disability was defined as difficulty in performing basic or instrumental activities of daily living. Older adult was defined as 65 years and older. Immigrant status was defined as someone born outside of the USA.

RESULTS

Eighteen articles met the inclusion criteria. Seven studied Hispanic/Latino immigrants, six studied Asian immigrants, four studied diverse older immigrant samples, and one studied European immigrants. Prevalence of disability ranged from 2 to 49% in Asians and 3 to 58.1% in Hispanic/Latinos. In a diverse sample of immigrants, the prevalence of disability was 19.3%. Correlates of disability included female gender, low income, limited education, single status, migration in late adulthood, obesity, arthritis, and diabetes. Factors protective against disability in older adult immigrants were acculturation, migrating at a younger age, exercise, alcohol intake, and church attendance.

CONCLUSION

Disability prevalence was generally lower in Asian immigrants compared to Hispanic/Latino immigrants. Identification of the precise rates and factors associated with disability in older immigrants can inform health interventions for this population.

Challenges and resilience related to aging in the United States among older Chinese immigrants

OBJECTIVES

This study sought to identify challenges and protective factors for resilience related to the process of aging among older Chinese immigrants in the United States.

METHODS

This study used qualitative methods and involved 24 in-depth interviews with Chinese immigrants aged 65 or older in Los Angeles. Content analysis was employed to analyze qualitative data.

RESULTS

Three major themes emerged regarding challenges older Chinese immigrants encountered in aging in the United States: language barriers, loneliness and social isolation, and insufficient use of social services. Four themes were identified regarding resilience protective factors: acceptance and optimism; independence and autonomy; informal social support; and use of the formal social welfare system.

CONCLUSION

This study provides several implications for future human services to build relational and societal resilience and enhance Chinese older immigrants' personal resilience. Cultural strengths should be taken into consideration by practitioners and policy makers.

“Caught in a Generation Gap”: A Generation Perspective on Refugees Getting Old in Denmark—A Qualitative Study

Purpose: Older non-Western migrants in Europe are a vulnerable population, due to old age and multiple disadvantages related to language barriers and different understandings of care, health, and disease. Our aim was to gain a better understanding and insight into the care needs of families with refugee background Method: The study was designed as a qualitative exploration using semistructured individual interviews and family group interviews. Results: The results illustrate how vulnerability can “transmit” from one family member to another. Discrepancies between the older person’s expectations and needs and society’s expectations trap family members in ethical and moral dilemmas. This divides and stresses the family and results in difficult decision making, increased stress, and vulnerability. Conclusion and Implication: Migration and displacement can lead to ambivalent feelings among younger relatives regarding their role in caring for older relatives. Health professionals need to address and acknowledge this to be able to provide culturally congruent health care.

Older migrants in exile: the past holding hands with the present - a qualitative study

The aim of this study was to explore the everyday life conditions experienced by older migrants and their reasons for specific age- and health-related behaviour during the conduct of everyday life. The study comprised 16 qualitative interviews with migrants aged 56-96 years from Palestine, Lebanon, Iraq and Somalia. The three themes that emerged from the conditions, meanings and reasons analysis illustrated that the older persons were trapped in various ways -without language, in fragmented families and in an unfamiliar structure. We identified these themes as The importance of the life history, Lost in language barriers and Having a national sense of belonging. The main findings emphasise the vulnerability of older migrants in a resettlement country. With an unclear national identity and without the local language, older migrants struggle to develop a clear vision of their role in a minority community in a foreign country. Besides language skills and the need for interpreters, health professionals need to consider issues such as life history, traumas and national belonging when their usual approaches to managing health-related topics have failed.

Ageing out of place: The meaning of home among hispanic older persons living in the United States

AIM

To explore the meaning of home among older Hispanic immigrants who are "aging out of place."

BACKGROUND

Emerging evidence supports the concept of older persons ageing in place. Nurse researchers have demonstrated that older person who age in place have better physical, psychological and cognitive outcomes. Less, however, is known about older persons who are "aging out of place," meaning out of their country of origin. With the growth of home health care, there is a need to understand the older immigrants' meaning of home when ageing out of their country of origin.

DESIGN AND METHOD

An inductive, qualitative descriptive research design was used. Seventeen Hispanic participants, ranging in age from 65 to 83 years were interviewed using a semi-structured interview protocol.

FINDINGS

Two major finding of the study focused on participants' descriptions of home in their country of origin and in the USA. The majority of participants described their home in their native country as the community, countryside or town (pueblo) and in the U.S.A. as family. The level of social isolation and loneliness among participants was evident.

CONCLUSIONS

Older Hispanic immigrants who are "aging out of place" integrate their past experiences of sense of place in their native country with their present experiences of home in the USA. The need to understand the role of the community and the family in the provision of nursing care in the home may be more important than the physical structure or setting in which it is delivered. Further intra- and cross-national studies are needed to provide a framework for understanding the issues of ageing and immigration globally.

IMPLICATIONS FOR PRACTICE

Gerontological nurses need to recognise the complexity of family relationships for older Hispanic persons who are ageing out of place of origin and their risk of depression, social isolation, and loneliness.

Bhutanese Older Adult Refugees Recently Resettled in the United States: A Better Life With Little Sorrows

PURPOSE

This study explores the experiences and adjustment process among older Bhutanese refugees resettled in the United States and identifies their unmet health and social service needs.

DESIGN

This phenomenological study design included the conduction of nine in-depth semistructured interviews in the respondents' native language. The researchers adhered to the steps outlined by Moustakas for data analysis.

RESULTS

The five identified themes included the following: a better life but with little sorrows, cultural tensions related to adaptation, language as a barrier to success in the United States, isolation and loneliness, and worries about citizenship and its impact on the future. Discussion/Implications for Practice: Psychological adjustment to life in the United States can have profound impact on the health of Bhutanese older adults. Nurses and health care providers should integrate culturally congruent health care, raise awareness of the unique needs, and advocate for policy changes that will benefit this group of older adult refugees whose lives have frequently been upended.

Revaluating aging in place: from traditional definitions to the continuum of care

Purpose

Traditional definitions of aging in place often define aging in place specifically as the ability to remain in one’s own home or community setting in later life. The purpose of this paper is to reframe aging in place and show how narrowly defined aging in place models can be potentially negative constructs that limit options for older adults. The authors propose a paradigm shift, or a re-framing of, the popularized idea of aging in place. The authors challenge mainstream and literature-based beliefs that are deeply rooted to the idea that aging in place ideally happens in the home in which a person has lived for many years.

Design/methodology/approach

The paper reviews common concepts and constructs associated with aging in place as well as gaps or exclusions, and US-based aging in place policy initiatives favoring the aging in place model.

Findings

An expanded definition of aging in place embraces heterogeneity in residence types and living options. A realistic assessment of person-environment fit, matching an older person’s capabilities to his or her environmental demands, allows for the development of additional aging in place options for those living across the continuum of care.

Social implications

Aging in place should be moved from the personal “success” or “failure” of an older individual to include the role of society and societal views and policies in facilitating or hindering aging in place options. The authors demonstrate that these options, in facilities within the continuum of care, can be thought of as appealing for older persons of all levels of physical and cognitive functioning.

Originality/value

Research about aging in place tends to stress the value of one place (one’s home) over other living settings. This limits the ability of people to age in place and curtails discussion of all the items necessary to maintain place.

Meeting the Needs of Older Adult Refugee Populations With Home Health Services

The United States resettles close to 70,000 refugees each year more than any other country in the world. Adult refugees are at risk for negative health outcomes and inefficient health resource use, and meeting the multiple health needs of this vulnerable population is a challenge. The purpose of this study was to assess the impact of a home health care (HHC) pilot project on meeting the needs of older adult refugee patients. A retrospective chart review of 40 refugee adult patients who participated in an HHC pilot was done to analyze their health outcomes using OASIS-C data. Participants’ pain level, anxiety level, medication management, and activities of daily living management all significantly improved over the course of their HHC episode. Results of this study indicate that HHC has great potential to improve the health of vulnerable refugee populations and assist the families involved in their care.