Assessing the Health Needs of Chinese Older Adults: Findings from a Community-Based Participatory Research Study in Chicago's Chinatown

The Threefold Path to Equity: Approaches for Health and Aging Researchers

The authors present a model for pursuing equity in research on health and aging, in terms of: (a) community-driven research governance, with reference to examples inside and outside of the United States, (b) a focus on policy change, where policy is defined broadly in terms of all legislative and regulatory change, and (c) equity-focused research practices, at the level of measurement, analysis, and study design. The model is visualized as a "threefold path" that researchers may walk, to achieve changes within our field, and changes in how we interface with other fields, and communities.

Asian Cohort for Alzheimer's Disease (ACAD) pilot study on genetic and non-genetic risk factors for Alzheimer's disease among Asian Americans and Canadians

INTRODUCTION

Clinical research in Alzheimer's disease (AD) lacks cohort diversity despite being a global health crisis. The Asian Cohort for Alzheimer's Disease (ACAD) was formed to address underrepresentation of Asians in research, and limited understanding of how genetics and non-genetic/lifestyle factors impact this multi-ethnic population.

METHODS

The ACAD started fully recruiting in October 2021 with one central coordination site, eight recruitment sites, and two analysis sites. We developed a comprehensive study protocol for outreach and recruitment, an extensive data collection packet, and a centralized data management system, in English, Chinese, Korean, and Vietnamese.

RESULTS

ACAD has recruited 606 participants with an additional 900 expressing interest in enrollment since program inception.

DISCUSSION

ACAD's traction indicates the feasibility of recruiting Asians for clinical research to enhance understanding of AD risk factors. ACAD will recruit > 5000 participants to identify genetic and non-genetic/lifestyle AD risk factors, establish blood biomarker levels for AD diagnosis, and facilitate clinical trial readiness.

HIGHLIGHTS

The Asian Cohort for Alzheimer's Disease (ACAD) promotes awareness of under-investment in clinical research for Asians. We are recruiting Asian Americans and Canadians for novel insights into Alzheimer's disease. We describe culturally appropriate recruitment strategies and data collection protocol. ACAD addresses challenges of recruitment from heterogeneous Asian subcommunities. We aim to implement a successful recruitment program that enrolls across three Asian subcommunities.

Social Support and Unmet Needs for Personal Assistance Among Community-Dwelling U.S. Chinese Older Adults: Does the Source of Support Matter?

This study examines the relationship between social support sources and unmet needs among U.S. Chinese older adults. Data were from the Population Study of Chinese Elderly in Chicago. Unmet needs were assessed by indexes of activities of daily living (ADL) and instrumental activities of daily living (IADL). Three specific sources of social support (spouse, family members, and friends) were included. Multivariable logistic regression models were conducted. Approximately 17% of the 3,157 respondents reported having unmet ADL/IADL needs. U.S. Chinese older adults with less overall social support were more likely to have unmet ADL needs (odds ratio [OR]=0.91, 95% CI=0.83-0.99) and IADL needs (OR=0.84, 95% CI=0.81-0.88). Family and friend support were associated with a lower likelihood of having unmet ADL needs. Support from spouse, family, and friends was associated with a lower likelihood of having unmet IADL needs. The findings highlight the importance of informal social support in addressing unmet needs        .

A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

BACKGROUND

Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment.

METHODS

We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021.

RESULTS

A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the  United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process.

CONCLUSION

Our findings highlight the need for having holistic approaches to assess community's health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal-assessment of the community health needs assessment impacts.

Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care

Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients. Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening. Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions. Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.

Prevalence of Psychological Symptoms in Community-Dwelling Chinese American Patients with Chronic Cancer Pain

Cancer is common among older Chinese American immigrants. Psychological distress may be associated with cancer pain, yet prior studies have not examined this relationship. We conducted a secondary analysis of 514 Chinese Americans with cancer-related pain. Patients completed validated questionnaires, including the Chinese Health Questionnaire-12 (CHQ-12). Analyses evaluated associations among sociodemographics, acculturation, psychological distress, and pain variables. Most patients had low acculturation and socioeconomic levels. Overall, 51.9% of patients reported moderate-severe psychological distress, 35.8% reported worst pain intensity ≥7/10 over the previous week and 41.2% had high pain-related distress. Higher CHQ-12 scores were associated with younger age (β = -0.13); lower educational level (β = -0.12); birthplace in China (β = -0.18); lack of a caregiver (β = -0.10); higher worst pain intensity (β = 0.15); and higher pain-related distress (β = 0.28; all p < 0.05; R² = 0.23). Chinese American cancer patients with chronic pain experience high psychological distress, which is associated with pain characteristics and other social factors.

Lower urinary tract symptoms in older Chinese American women: prevalence and risk factors

INTRODUCTION AND HYPOTHESIS

The aim was to examine the prevalence of and risk factors for lower urinary tract symptoms (LUTS) in a community-dwelling cohort of older Chinese American women.

METHODS

We performed a secondary analysis of a prospective cross-sectional population-based survey of community-dwelling Chinese Americans aged 60 and older in English, Mandarin, Cantonese, Taishanese, or Teochew between 2011 and 2013. A clinical Review of Systems (ROS) was used to assess LUTS, which included urinary frequency, urgency, burning or pain, blood in urine, and urinary incontinence.

RESULTS

Of the 1,829 women queried, 28.6% reported LUTS. The cohort of women who reported LUTS had a mean ± SD age of 74.7 ± 8.7 years, with a BMI of 23.4 ± 3.7 kg/m² and had lived in the USA for 21.5 ± 13.1 years. Nearly 90% earned less than $10,000 a year, 50% were married, and 50% used traditional Chinese medicine (TCM) once monthly or more. In comparison with women without LUTS, women with LUTS had significantly higher rates of medical comorbidities and a poorer perception of their general health and quality of life. In multivariate regression analysis, any LUTS were significantly associated with older age (aOR 1.03, 95% CI 1.01-1.04), TCM use (aOR 1.67, 95% CI 1.34-2.07), anxiety (aOR 1.45, 95% CI 1.02-2.06), depression (aOR 2.00, 95% CI 1.53-2.61), and a history of stroke (aOR 1.90, 95% CI 1.19-3.02).

CONCLUSIONS

Lower urinary tract symptoms are common among older Chinese American women, particularly in those who are older, use TCM regularly, or report a history of anxiety, depression, or stroke.

Attitudes and Beliefs Toward Advance Care Planning Among Underserved Chinese-American Immigrants

CONTEXT

Many in the rapidly growing Chinese-American population are non-English-speaking and medically underserved, and few engage in advance care planning (ACP). Evaluating culturally-determined factors that may inhibit ACP can inform programs designed to increase ACP engagement.

OBJECTIVES

To describe attitudes and beliefs concerning ACP in older, non-English-speaking Chinese Americans in a medically-underserved urban region.

METHODS

Patients were consecutively recruited from a primary care practice in New York City to participate in a cross-sectional survey. Attitudes and beliefs were measured using an ACP Survey Tool and the validated Traditional Chinese Death Beliefs measure. Exploratory analyses evaluated associations between these two measures and between each measure and sociodemographics, primary dialect, acculturation (using the Suinn-Lew Asian Self Identity Acculturation Scale), and health status (using the Short Form-8 Health Survey).

RESULTS

Patients (n = 179) were 68.2 years on average; 55.9% were women, and 81.0% were non-English speaking (42.8% Cantonese, 15.2% Mandarin, 19.3% Toisanese, and 19.3% Fuzhounese). Most had low acculturation (mean 1.7/5.0) and highly-rated physical and mental health (mean 70.1/100 and 81.5/100, respectively). Few patients (15.1%) had an advance directive and 56.8% were unfamiliar with any type; 74.4% were willing to complete one in the future. Thirty-two percent "agreed" that "talking about death in the presence of a dying person would accelerate death". The analyses revealed no significant associations.

CONCLUSION

These Chinese-American older adults had low acculturation and very limited knowledge of, or engagement in, ACP. Factors that may predict culturally-determined attitudes and beliefs about ACP were not identified. Further research can inform efforts to improve ACP engagement in this population.

Healthy aging through the lens of community-based practitioners: a focus group study

Background

Nearly one in every seven Americans is 65 years and older, facing day-to-day challenge of aging. Although interest in healthy aging is growing, most of the efforts are directed towards understanding the perceptions of older adults. Little is known about the perspectives of community-based practitioners who work with older adults and deliver programs to promote healthy aging. The purpose of this project was to expand knowledge on healthy aging by exploring the perspectives of community-based practitioners working directly with older adults.

Methods

We purposively sampled community-based practitioners (n = 12, including nurses, physician, social workers, and other community services professionals) working with older adults, who then participated in one of three in-depth focus group discussions conducted between March and June 2016. Each focus group discussion lasted for about 2 h. Verbatim transcript data were analyzed in Atlas.ti 7 using a conventional content analysis with an inductive approach, and consensual validation of coding was achieved.

Results

Three core categories of healthy aging were identified: (1) characteristics of healthy aging; (2) healthy aging attainment; and (3) programs and activities for healthy aging. Practitioners identified a number of characteristics of healthy aging under person-specific (physiological, basic, psych-emotional, and cognitive needs), social aspects (creating community and contributing to the community), and spiritual dimensions (cultural views and beliefs) of healthy aging. Healthy aging attainment was represented as facilitators and barriers both with respect to care recipients and care providers, and programs and activities through promoting fitness and wellness.

Conclusions

The rapidly changing demographics and aging population in the United States and their various needs suggest the implications for recognizing opportunities and developing and implementing programs to promote healthy aging. Although practitioners’ perspectives had some overlap with traditional research and medical views on healthy aging, the unique and holistic conceptual framework derived in the study might provide a more refined foundation for delivering appropriate health care services to the American aging population.

Prioritizing the health education needs based on community participation: AHP method

INTRODUCTION

The identification of health education needs through the community results in targeted services and health promotion. Prioritizing these needs, in addition to identifying the desired health system based on the needs of the community, is required for the optimal allocation of resources. Therefore, this study was conducted with the aim prioritizing the health educational needs of Sabzevar-Iran community.

MATERIALS AND METHODS

This study was a two-step mix study. In the first stage, the qualitative method of the main themes of health educational needs of Sabzevar society was determined. Then, the questionnaire was prepared by a paired scale (36 questions) and quantitative method was used to prioritize the main themes with Analytic Hierarchy Process (AHP) software. The random sampling method was used in this study and data analysis was performed using Expert Choice software using AHP method.

RESULTS

Social problems with 0.206, contagious diseases with 0.205, nutrition with 0.161, and public health with 0.132 were in the first to fourth grades of health educational needs in Sabzevar city and environmental health, health management, noncontagion diseases, elderly, and occupational health were in the fifth to ninth grades. The consistency index in this study was 0.08, although the adjustment index is <0.1 good and acceptable.

CONCLUSION

Social problems are the first priority of Sabzevar society, which require appropriate training.

Chinese Immigrant Women's Attitudes and Beliefs About Family Involvement in Women's Health and Healthcare: A Qualitative Study in Chicago's Chinatown

Purpose: Healthcare utilization and health-seeking behaviors of Chinese American immigrant women may be influenced by longstanding cultural perspectives of family roles and relationships. An understanding of Chinese immigrant women's perceptions of family social support in health and how these beliefs manifest in healthcare utilization and help-seeking behaviors is critical to the development of culturally appropriate health interventions. Focusing on a sample of Chinese women in Chicago's Chinatown, this qualitative study seeks to describe women's attitudes and beliefs about spouse and adult children's involvement in women's health and healthcare.

Methods: We conducted six focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014. Focus groups were transcribed, coded, and analyzed for emergent themes.

Results: Women reported that their adult children supported their health and healthcare utilization by helping them overcome language and transportation barriers, making and supporting decisions, and providing informational and instrumental support related to diet and nutrition. Women viewed these supports with mixed expectations of filial piety, alongside preferences to limit dependency and help-seeking because of concern and emotional distress regarding burdening adult children. Women's expectations of the spouse involvement in their healthcare were low and were shaped by avoidance of family conflict.

Conclusion: Findings inform opportunities for the development of culturally appropriate interventions to enhance Chinese immigrant women's health and healthcare. These include patient navigation/community health worker programs to promote self-management of healthcare and family-centered strategies for enhancing family social support structures and reducing family conflict.

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

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

Acculturation and Activity Engagement Among Older Chinese Americans

Using data from the Population Study of Chinese Elderly in Chicago (PINE) conducted from 2011 to 2013, this study aims to examine the role of acculturation in engagement in cognitive, social, and religious activities among older Chinese Americans. Activity engagement and acculturation levels were relatively low in the study sample. Multivariate regression analyses showed that high levels of acculturation in general, and particularly media use (e.g., TV and radio) and ethnic social relations (i.e., preferred ethnicity of those with whom one interacts) were associated with more engagement in cognitive and social activities, respectively. High levels of acculturation in general and ethnic social relation in particular increased the likelihood of engaging in religious activities. Language use was not related to engagement in any activity, probably because only 2% of the PINE participants preferred to speak English. Findings indicate that acculturation can promote activity engagement probably through media use and social relations, whereby older adults may acquire information about opportunities for various activities. Active participation with life may improve older adults’ well-being and help address the widening health disparities among minority older populations in American society.

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

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

Breast Cancer Screening Beliefs Among Older Chinese Women in Chicago's Chinatown

Background

Chicago's Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago's Chinatown to inform strategies for future interventions.

Methods

We conducted six focus groups among Chinese-speaking adult women aged 45 and older. Focus groups were transcribed, coded, and analyzed for emergent themes.

Results

Forty-seven women participated in focus groups; 10 (21%) had received a breast cancer diagnosis in their lifetime, all participants were foreign-born, and 80% have resided in the United States for over 10 years. Participants expressed a range of breast cancer beliefs, attitudes toward screening, barriers encountered, and facilitators. Some differences were noted between women with cancer and those without. Barriers described include language, time, not wanting to burden their adult children, and transportation. Navigation services and physician recommendation were suggested facilitators to screening.

Conclusions

Our findings have important implications for development of interventions and policies to bolster breast cancer screening among Chinese women. We highlight the need to connect Chinese older adults with resources to navigate the health care system and present opportunities for community stakeholders, researchers, health professionals, and policy makers to improve the health of Chinese Americans.

Social Support, Social Strain, and Cognitive Function Among Community-Dwelling U.S. Chinese Older Adults

Background

Limited research is available on the relationship between social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. This study aims to examine the associations between social support/strain and cognitive outcomes.

Methods

Data were drawn from the Population-Based Study of Chinese Elderly (N = 3,159). Cognitive function was measured by a battery of tests including the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Social support and strain were measured by the scales drawn from the Health and Retirement study. Multiple regression analyses were conducted.

Results

Social support was significantly associated with global cognitive function (β = .11, SE = .02, p < .001), episodic memory (β = .11, SE = .03, p < .001), working memory (β = .18, SE = .08, p < .05), and executive function (β = 1.44, SE = .37, p < .001). Social strain was significantly associated with global cognitive function (β = .23, SE = .05, p < .001), episodic memory (β = .27, SE = .07, p < .001), working memory (β = .34, SE = .17, p < .05), and executive function (β = 2.75, SE = .85, p < .01). In terms of sources of social support/strain, higher support from friends was significantly associated with higher global cognitive function (β = .04, SE = .02, p < .05), higher episodic memory (β = .05, SE = .02, p < .05), and higher executive function (β = .71, SE = .29, p < .05). Higher strain from spouse was significantly associated with higher global cognitive function (β = .10, SE = .03, p < .01), higher episodic memory (β = .11, SE = .04, p < .01), and higher executive function (β = 1.28, SE = .49, p < .01). Higher strain from friends was significantly associated with higher executive function (β = 3.59, SE = 1.17, p < .01).

Conclusions

Social support and strain were associated with cognitive outcomes. Future longitudinal studies should be conducted.

The Association Between Filial Discrepancy and Depressive Symptoms: Findings From a Community-Dwelling Chinese Aging Population

Background

The relationship between filial piety and depressive symptoms has been widely discussed, but limited research focused on the gap between filial expectations and filial receipt. This study aims to investigate the association between filial discrepancy and depressive symptoms.

Methods

Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged, population-based epidemiological study of U.S. Chinese older adults aged 60 and older in the greater Chicago area. Depressive symptoms were measured by the Patient Health Questionnaire-9. Overall filial discrepancy was evaluated by filial receipt minus expectations. Levels of overall filial discrepancy divided older adults into four groups based on the medium value of filial expectations and receipt. Logistic regression analyses were performed.

Results

Older adults with greater filial receipt than expectations were more likely to have lower risk of depressive symptoms (odds ratio [OR], 0.95 [0.92-0.97]). The group with high expectations and low receipt has the highest risk of depressive symptoms among the four groups (OR, 1.51 [1.07-2.13]). Greater receipt than expectations in care (OR, 0.83 [0.76-0.92]), make happy (OR, 0.77 [0.69-0.86]), greet (OR, 0.88 [0.79-0.97]), obey (OR, 0.76 [0.68-0.86]), and financial support (OR, 0.80 [0.71-0.89]) was associated with lower risk of depressive symptoms.

Conclusions

This study goes beyond previous research by examining the association between filial discrepancy domains and depressive symptoms. Cultural relevancy of health interventions is important in the context of Chinese communities. Health care professionals are suggested to be aware of the depressive symptoms of U.S. Chinese older adults with high filial expectations and low receipt.

Incidence of Elder Abuse in a U.S. Chinese Population: Findings From the Longitudinal Cohort PINE Study

BACKGROUND

Elder abuse (EA) is a global public health issue. However, no prior longitudinal research has quantified the incidence of EA, which is critical to understand risk factors and future prevention strategies.

METHODS

The study is based on a longitudinal cohort design. We followed 2,713 U.S. Chinese older adults who agreed to participate in the study within 2011 to 2015. A structured questionnaire was used to collect data regarding the 2-year incidence of EA and its subtypes. We employed multiple logistic regression analyses to examine the associations between the sociodemographic characteristics and incident EA.

RESULTS

The incidence of overall EA was 8.8% with 4.8% for psychological, 2.9% for financial, 0.5% for physical, 0.1% for sexual abuse, and 1.1% for caregiver neglect. Age, gender, duration of residence, language preference and health status change were associated with incident EA. Self-perceived worsened health was positively associated with overall EA (odds ratio [OR] 1.28 (1.01, 1.62). Women (OR 2.98 [1.10, 8.11]) and older individuals (OR 1.06 [1.00, 1.13]) had an increased risk of caregiver neglect. Older adults who have lived in the U.S. longer had a higher risk of financial exploitation (OR 1.02 [1.00, 1.05]). Individuals who prefer to speak Mandarin or English were more likely to experience EA (OR 2.08 [1.21, 3.58]) and sexual or physical abuse (OR 3.91 [1.01, 15.17]). No significant association was observed between education, income, marital status, number of children, country of origin, overall health, life quality, and incident EA.

CONCLUSION

This study presents the first illustration of EA incidence in a longitudinal cohort study, the findings of which verify and challenge prior fundamental assumptions of risk factors associated with EA, and are relevant to future prevention strategies.

Knowledge and Beliefs About Biospecimen Research Among Chinese Older Women in Chicago's Chinatown

BACKGROUND

Enhancing the participation of Chinese older women in biobanking efforts is important for precision medicine efforts, as underrepresented groups risk benefiting less than others from medical advancements in individualized therapies. Focusing on a sample of Chinese older women in Chicago's Chinatown, this qualitative study seeks to describe attitudes toward, and barriers and facilitators of, participation in biospecimen research.

METHOD

We conducted six focus groups among Chinese-speaking adult women age 45 and above. Focus groups were transcribed, coded, and analyzed for emergent themes.

RESULTS

Forty-seven women participated in focus groups, the majority (66.0%) were age 66 and over and half (50.1%) had less than a high school education. Participants expressed predominantly positive attitudes toward biospecimen research, but also identified multifaceted barriers to participation that included cultural beliefs of the body, perceived physical and privacy risks, as well as perceptions related to aging. Use of minimally invasive biospecimen collection and education to promote awareness of biospecimen research were suggested facilitators to increasing biospecimen research participation.

CONCLUSIONS

Culturally and linguistically isolated populations like Chinese older women are at risk of exclusion from advancements in precision medicine. Our findings provide cultural insights for tailoring interventions for Chinese older women to increase knowledge, change attitudes, and increase intention and participation in biospecimen research. We also highlight the need for individual, family, and community level interventions to promote healthy aging among Chinese older women.

Using community-based participatory research to address Chinese older women's health needs: Toward sustainability

Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study—a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population.

Religiosity among U.S Chinese Older Adults in Greater Chicago Area-Findings from the PINE Study

BACKGROUND

Religiosity influences health and well-being. We assessed religiosity among U.S. Chinese older adults.

METHODS

Data were drawn from the PINE study based on 3,159 community-dwelling U.S. Chinese older adults aged 60+ in the greater Chicago area. Two items retrieved from Duke University Religion Index (DUREL) were used to assess the frequency of participating in religious activities, and a separate item was used to assess the importance of religion.

RESULTS

Overall, 35.4% of participants perceived religion to be important. This study correlated the higher frequency of participation in religious observances with older age groups of the sample, being female, having a higher income, being unmarried, longer duration of residency in the U.S., and not having been born in Mainland China. Higher frequency of participating in organized religious services was correlated with better quality of life.

CONCLUSIONS

Religion is important among U.S Chinese older adults. Future longitudinal research is needed to explore aging and religiosity.

Caregiver Abuse of Chicago Chinese Older Adults in a Community-Dwelling Population

OBJECTIVES

This study aimed to examine the prevalence and correlates of elder abuse reported by adult children among U.S Chinese populations.

METHOD

A community-based participatory research approach was implemented. A total of 548 Chinese adult children aged 21 years and over participated in this study. Elder abuse reported by adult children was assessed using Caregiver Abuse Screen (CASE).

RESULTS

This study found a prevalence of 59.8%for elder abuse among 548 adult children. Younger age (r = -0.10, p < .05), higher level of education (r = 0.20, p < .001), higher income (r = 0.14, p < .01), more years in the U.S. (r = 0.12, p < .05), not born in Mainland China (r = -0.13, p < .01), and English-speaking (r = 0.16, p < .001) were positively correlated with elder abuse reported by adult children.

DISCUSSION

Elder abuse by adult children is prevalent among U.S. Chinese populations. It is necessary for researchers, health care providers and policy makers to put more attention on elder abuse by adult children. Longitudinal research is needed to explore the risk factors associated with elder abuse by adult children. Health care providers should improve detection of elder abuse and support at-risk caregivers. Policy makers may consider cultural sensitive approaches to address elder abuse.

Parent–child relationships among older Chinese immigrants: the influence of co-residence, frequent contact, intergenerational support and sense of children's deference

Immigration disrupts the bonding process in families. Maintaining close relationships with adult children can be an important protective factor for older immigrants' health and wellbeing. Quantitative research explaining such close relationships is rare. This study examined factors associated with close parent–child relationships in a purposive sample of 236 older Chinese immigrants in Los Angeles who provided information regarding 365 children. Two-level regression models were estimated to investigate factors contributing to cohesive parent–child relationships among these older adults. The findings showed that co-residence, a characteristic that distinguishes immigrant families from most non-immigrant families, was associated with lower parent–child relationship quality. Frequent contact was associated with closer relationships. While receiving instrumental and monetary support from children was associated with favourable ratings of relationships with children, providing such support to children was not related to parents' assessment of relationship quality. Parental perceptions of children being respectful was also associated with better relationship quality ratings. Overall, the findings demonstrate how family-related changes in the immigration context shape parent–child relationships in later life. Implications for future research and practice are provided.

Risk Factors for Social Isolation in Older Korean Americans

OBJECTIVE

Given the importance of social ties and connectedness in the lives of older ethnic immigrants, the present study examined the prevalence of social isolation and its risk factors in older Korean Americans.

METHOD

Using survey data from 1,301 participants (Mage = 70.5, SD = 7.24), risk groups for marginal social ties with family and friends were identified and predictors of each type of social isolation explored.

RESULTS

Male gender and poorer rating of health were identified as common risk factors for marginal ties to both family and friends. Findings also present specific risk factors for each type of social isolation. For example, an increased risk of having marginal ties with friends was observed among individuals with perceived financial strain, greater functional impairment, and a shorter stay in the United States.

DISCUSSION

The common and specific risk factors should be incorporated in programs to reduce social isolation in older immigrant populations.

Physical function assessment in a community-dwelling population of U.S. Chinese older adults

BACKGROUND

This report describes the levels of physical function in U.S. Chinese older adults utilizing self-reported and performance-based measures, and examines the association between sociodemographic characteristics and physical function.

METHODS

The Population Study of Chinese Elderly in Chicago enrolled an epidemiological cohort of 3,159 community-dwelling Chinese older adults aged 60 and older. We collected self-reported physical function using Katz activities of daily living and Lawton instrumental activities of daily living items, the Index of Mobility scale, and the Index of Basic Physical Activities scale. Participants were also asked to perform tasks in chair stand, tandem stand, and timed walk. We computed Pearson and Spearman correlation coefficients to examine the correlation between sociodemographic and physical function variables.

RESULTS

A total of 7.8% of study participants experienced activities of daily living impairment, and 50.2% experienced instrumental activities of daily living impairment. With respect to physical performance testing, 11.4% of the participants were not able to complete chair stand for five times, 8.5% of the participants were unable to do chair stands at all. Older age, female gender, lower education level, being unmarried, living with fewer people in the same household, having fewer children, living fewer years in the United States, living fewer years in the community, and worsening health status were significantly correlated with lower levels of physical function.

CONCLUSIONS

Utilizing self-reported and performance-based measures of physical function in a large population-based study of U.S. Chinese older adults, our findings expand current understanding of minority older adults' functional status.

A battery of tests for assessing cognitive function in U.S. Chinese older adults--findings from the PINE Study

BACKGROUND

Existing methodological challenges in aging research has dampened our assessment of cognitive function among minority older adults. We aim to report the composite scores of five cognitive function tests among U.S. Chinese older adults, and examine the association between cognitive function and key sociodemographic characteristics.

METHODS

The Population Study of Chinese Elderly in Chicago Study enrolled an epidemiological cohort of 3,159 community-dwelling Chinese older adults. We administered five cognitive function tests, including the Chinese Mini-Mental State Examination, the immediate and delayed recall of the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. We used Spearman correlation coefficients to examine the correlation between cognitive function and sociodemographic variables. Linear regression models were used to report the effect of sociodemographic and health variables including age, sex, education on cognitive function.

RESULTS

Our multivariate analysis suggested that performance in each domain of cognitive function was inversely associated with age and positively related to education. With respect to sex, after adjusted for age, education and all key variables presented in the model, being male was positively related to global cognitive score and working memory. Being married, having fewer children, having been in the United States for fewer years, having been in the community for fewer years, and better self-reported health were positively correlated with all cognitive function domains.

CONCLUSIONS

This population-based study of U.S. Chinese older adults is among the first to examine a battery of five cognitive function tests, which in aggregate enables researchers to capture a wide range of cognitive performance.

The prevalence of cardiopulmonary symptoms among Chinese older adults in the Greater Chicago area

BACKGROUND

Cardiovascular and pulmonary symptoms influence health and well-being among older adults. However, minority aging populations are often underrepresented in most studies on cardiovascular and pulmonary symptoms. This study aims to examine the prevalence of cardiovascular and pulmonary symptoms among U.S. Chinese older adults.

METHODS

Data were drawn from the Population Study of Chinese Elderly study, a population-based survey of U.S. Chinese older adults in the Greater Chicago area. Guided by a community-based participatory research approach, a total of 3,159 Chinese older adults aged 60 and above were surveyed. Clinical Review of Systems was used to assess participants' perceptions of their cardiovascular and pulmonary symptoms.

RESULTS

Cardiovascular symptoms (31.6%) and pulmonary symptoms (42.2%) were commonly experienced by U.S. Chinese older adults. Symptoms such as cough (27.4%), sputum production (22.7%), chest pain or discomfort (16.3%), shortness of breath at rest (15.1%), and shortness of breath with activity (12.9%) were commonly reported. Older age, lower income, fewer years residing in the community, poorer self-perceived health status and quality of life, and worsened health over the last year were associated with report of any cardiovascular or pulmonary symptom.

CONCLUSIONS

Cardiovascular and pulmonary symptoms are common among Chinese older adults in the U.S. Future longitudinal research is needed to examine changes in Chinese older adults' burden of cardiopulmonary symptoms and their health and well-being.

Social engagement among U.S. Chinese older adults--findings from the PINE Study

BACKGROUND

Social engagement is a key indicator of older adults' later life quality and health status, but few studies have comprehensively examined social engagement patterns of U.S. Chinese older adults. This study assesses social engagement patterns among U.S. Chinese older adults.

METHODS

Data were collected by the Population Study of Chinese Elderly project, a cross-sectional population-based study of 3,159 U.S. Chinese older adults aged 60 and older in the greater Chicago area. Social engagement patterns were examined with a list of 16 social engagement activity related questions. Analysis of variance and Pearson or Spearman correlation coefficients were used to examine correlations between sociodemographic and health characteristics and social engagement.

RESULTS

Age was negatively associated with social engagement actives for Chinese older adults. Although education had a significant positive correlation on older adults' participation in social engagement activities, income did not show any significant correlation. Perceived health status and quality of life were also positively correlated with social engagement. Chinese older adults were more likely to visit community centers than any other social or cultural venues.

CONCLUSIONS

This study highlights the important role community centers play in the lives of Chinese older adults. Further, longitudinal studies are also necessary to understand the predictors and outcomes of social engagement levels among Chinese older adults.

Experience of discrimination among U.S. Chinese older adults

BACKGROUND

Experiences of discrimination are detrimental to health and well-being. This study aimed to examine experiences of discrimination and responses to unfair treatment among community-dwelling U.S. Chinese older adults.

METHOD

Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults aged 60 years and older in the Greater Chicago area were interviewed in person between 2011 and 2013.

RESULTS

Of the 3,159 participants interviewed, 58.9% were women and the mean age was 72.8 years. A total of 671 (21.3%) participants reported having experienced discrimination and 1,454 (48.2%) reported passive response to unfair treatment. Older adults living in Chicago's Chinatown had the lowest prevalence of perceived discrimination compared with those living in other areas. Younger age, higher education, higher income, fewer children, more years in the United States, more years in the community, poorer health status, lower quality of life, and worsening health over the last year were associated with higher frequency of discrimination reported. Younger age, higher education, higher income, being married, living with more people, having fewer children, more years in the United States, and better health over the past year were associated with engaged responses to unfair treatment.

CONCLUSION

U.S. Chinese older adults suffered considerable discrimination, but tended to have passive responses to unfair treatment. Future longitudinal studies are needed to improve our understanding of the risk factors and outcomes associated with discrimination among U.S. Chinese older adults.

Anxiety among community-dwelling U.S. Chinese older adults

BACKGROUND

This study aimed to explore the prevalence and correlates of anxiety disorders and any anxiety symptoms among community-dwelling U.S. Chinese older adults.

METHODS

Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person between 2011 and 2013.

RESULTS

Of 3,159 older adults surveyed, 8.5% had anxiety disorders and 65.0% reported having any anxiety symptoms. Being female, unmarried, poorer health status, lower quality of life, and worsening health over the past year were positively correlated with anxiety disorders and any anxiety symptoms. Living with fewer people and having fewer children were only correlated with any anxiety symptoms and lower income was only correlated with anxiety disorders.

CONCLUSIONS

This study emphasizes that interventions for anxiety among Chinese older adults should give special attention to older women, those who are unmarried, with impaired health status, and poorer quality of life. Further longitudinal studies should be conducted to better understand risk factors and outcomes associated with anxiety among U.S. Chinese older adults.

Trust in physicians among U.S. chinese older adults

BACKGROUND

Trust in physicians influences the health and well-being of older adults and is an important indicator to assess the quality of medical care. However, Asian aging populations are often underrepresented in studies of patient trust in physicians. This study aims to examine the level of trust in physicians among Chinese older adults in a community-dwelling Chinese aging population.

METHODS

Data were drawn from the Population Study of Chinese Elderly, a population-based survey of U.S. Chinese older adults in the Greater Chicago area. Guided by a community-based participatory research approach, a total of 3,159 Chinese older adults aged 60 and above were surveyed. An 11-item scale was used to measure participants' trust in physicians.

RESULTS

On a scale of 11-55, the level of trust in physician among U.S. Chinese older adults was 42.0 (SD = 6.3). Items related to confidence in physicians' knowledge and skills were most commonly endorsed, including trusting physicians' judgment on medical care (84.8%), trusting physicians' advice (84.2%), and trusting physicians' words that something is so and must be true (81.2%). Younger age, male gender, higher educational level, fewer years of residing in the United States and in the community, poorer self-reported health status, and poorer quality of life were associated with lower level of trust in physicians.

CONCLUSIONS

Trust in physician is commonly endorsed among U.S. Chinese older adults. However, future longitudinal studies are needed to improve our understanding of risk factors and outcomes associated with trust in physicians among U.S. Chinese older adults.

The prevalence of medical conditions among U.S. Chinese community-dwelling older adults

BACKGROUND

The burden of medical conditions is increasing among U.S. older adults, yet we have very limited knowledge about medical conditions among Chinese older adults in the United States. This study aimed to examine the prevalence of medical conditions and its sociodemographic and health-related correlates within the context of a population-based cohort study of U.S. Chinese older adults.

METHOD

Using a community-based participatory research approach, community-dwelling Chinese older adults aged 60 years and older in the Greater Chicago area were interviewed between 2011 and 2013.

RESULTS

Of the 3,159 participants interviewed, 58.9% were female and the mean age was 72.8 years. In total, 84.3% of older adults had one or more medical condition, 24.6% reported two conditions, 19.5% had three conditions, and 17.0% reported four or more conditions. A sizeable percentage of older adults had never been screened for dyslipidemia (24.4%) or had never been screened for diabetes mellitus (35.7%).For those who reported high cholesterol, 73.0% were taking medications when compared with 76.1% of those who reported having diabetes and 88.3% of those who reported having high blood pressure. Various sociodemographic and health-related characteristics were correlated with medical conditions.

CONCLUSION

Medical conditions were common among U.S. Chinese older adults, yet screening and treatment rates were fairly low. Future longitudinal studies should be conducted to better understand the risk and protective factors associated with medical conditions.

Demographic characteristics of U.S. Chinese older adults in the Greater Chicago area: assessing the representativeness of the PINE study

OBJECTIVE

We aimed to assess the representativeness of the demographic characteristics of the PINE study to the Chinese aging population in the Greater Chicago area.

METHOD

The PINE study is a population-based study of Chinese older adults aged 60 and over in the Greater Chicago area. In preparation of the PINE study, we conducted a random block census study in Chicago. Demographic characteristics of the PINE study were compared with the data drawn from U.S. Census 2010 and random block census study using chi-square tests.

RESULTS

The PINE study is representative of the Chinese aging population in the Greater Chicago area. No significant difference was found in key attributes including age, sex, income, education, number of children, and country of origin.

DISCUSSION

Our report is critical in understanding the vast socio-demographic diversity of U.S. Chinese older adults. Rigorous studies are needed to explore the heterogeneity among the diverse aging populations.

A psychometric assessment of the psychological and social well-being indicators in the PINE study

OBJECTIVE

This report aims to establish the reliability and validity of five psychological and social well-being indictors in their applications to a U.S. Chinese aging population.

METHOD

The Population Study of Chinese Elderly in Chicago (PINE) is a population-based epidemiological study of Chinese older adults in the Greater Chicago area. Internal consistency reliability was assessed by determining the coefficient alpha and inter-item correlation coefficients. Content validity was assessed by bilingual and bicultural study researchers and community leaders.

RESULTS

The reliability and validity analysis supported the use of the Chinese version of the psychological and social well-being indicators in the PINE study. The value of Cronbach's alpha for fives scales ranged from .64 to .82, indicating reasonable internal consistency. Content validity was established through intensive review by a panel of experts.

DISCUSSION

The instruments discussed in this report are reliable and valid measures to assess key dimensions of psychological and social distress of Chinese older adults.

Suicidal ideation in an older U.S. Chinese population

OBJECTIVE

This study examined the prevalence and correlates of suicidal ideation among U.S. Chinese older adults.

METHOD

Guided by the community-participatory research approach, the PINE (Population Study of Chinese Elderly in Chicago) study is a population-based epidemiological study conducted from 2011 to 2013 of 3,159 community-dwelling Chinese adults aged 60 years and above in the Greater Chicago area.

RESULTS

The 2-week prevalence of suicidal ideation, 12-month prevalence of suicidal ideation, and lifetime suicidal ideation were 3.5%, 4.8%, and 9.4%, respectively. Age, sex, marital status, education, income, living arrangement, country of origin, years in the United States, overall health status, quality of life, and health changes over the past year were significantly correlated with suicidal ideation.

DISCUSSION

Suicidal ideation was common among U.S. Chinese older adults in the Greater Chicago area. Further longitudinal studies should be conducted to explore the risk and protective factors associated with suicidal ideation.

Lost in translation: to our Chinese patient, Alzheimer's meant 'crazy and catatonic'

When cultural perceptions get in the way, a Chinese geriatrician and his colleagues find a way to care for a patient newly diagnosed with dementia.

Simon M. The prevalence of suicide attempts among community-dwelling US Chinese older adults – findings from the PINE study

Purpose

– The purpose of this paper is to examine the prevalence of suicide attempts and explore the suicide methods among community-dwelling Chinese older adults.

Design/methodology/approach

– Data were drawn from the Population Study of Chinese Elderly in Chicago (PINE) study, a population-based epidemiological study of Chinese older adults aged 60 years and above in the greater Chicago area. Guided by the community-based participatory research (CBPR) approach, the study enrolled 3,159 community-dwelling Chinese older adults from 2011 to 2013.

Findings

– The lifetime prevalence of suicide attempts is 791 per 100,000 and the past 12-month prevalence of suicide attempts is 285 per 100,000. Medication overdose is the most common suicide method both in the group of lifetime suicide attempts and 12-month suicide attempts. Lower income is positively correlated with lifetime suicide attempts and 12-month suicide attempts. Living with fewer household members is positively correlated with lifetime suicide attempts but not with 12-month suicide attempts.

Research limitations/implications

– The findings emphasize the needs for improved understanding of suicidal behavior among minority older adults and to develop culturally and linguistically sensitive prevention and intervention strategies.

Practical implications

– Community stakeholders should improve the accessibility and availability of culturally sensitive mental health services and extend timely and effective suicide interventions in the Chinese community.

Originality/value

– This study represents the first and largest population-based epidemiological study to investigate the suicide attempts and methods among US Chinese older adults. In addition, the implementation of the CBPR approach allows us to minimize the cultural barriers associated with suicide investigation. The study emphasizes the need for improved understanding on suicidal behavior among minority older adults to inform culturally and linguistically sensitive prevention and intervention strategies.

Investigating the myth of the "model minority": a participatory community health assessment of Chinese and Vietnamese adults

Despite the persistent belief that Asians are the "model minority" there is accumulating evidence of health concerns within Asian subgroups. In this study, we implemented a cross-sectional participatory community health assessment in an urban city in Massachusetts, to understand differences and similarities in demographics, health and healthcare access in Chinese and Vietnamese adults. We gathered qualitative data from community stakeholders to inform the development of a community health assessment tool. The tool elicited information on healthcare access, health status, behavioral health and chronic disease history and treatment. Healthcare access issues and poor health status, particularly among Chinese participants and mental health symptomotology in both groups were areas of concern. These findings revealed important health concerns in two Asian ethnic groups. Studies are needed to better understand these concerns and inform programs and policies to improve health outcomes in these Asian ethnic groups.

Worries of independent older people regarding health and daily life: a survey of residents of a rural town in Japan

The purpose of the study was to analyze the worries of independent older people regarding health and daily life. We collected data from 259 people who responded to the free descriptive questionnaire and analyzed it qualitatively and inductively. Thirteen categories derived from the results were classified into 6 types of worries: health worries, life function worries, daily life worries, long-term care worries, family relationship worries, and future life worries. Promoting the prevention of "long-term care status," the need for physical nursing care, in a super aging society, where the population of 65 years or older is more than 21% of all of the population, requires consideration of not only measures to deal with physical symptoms, but also measures to deal with psychological aspects, and social aspects.

The perceptions, social determinants, and negative health outcomes associated with depressive symptoms among U.S. Chinese older adults

PURPOSE OF THE STUDY

Recent demographic growth of the U.S. Chinese aging population calls for comprehensive understanding of their unique health needs. The objective of this study is to examine the perceptions, social determinants of depressive symptoms as well as their impact on health and well-being in a community-dwelling U.S. Chinese aging population in Chicago.

DESIGN AND METHODS

A community-based participatory research approach was implemented to partner with the Chicago Chinatown population in a geographically defined community. Data were collected from questionnaires and semistructured focus group interviews with 78 community-dwelling Chinese older adults.

RESULTS

Our findings suggest that the depressive symptoms were common among older adults. It was frequently identified through feelings of helplessness, feelings of dissatisfaction with life, feelings of getting bored, loss of interests in activities, suicidal ideation, and feelings of worthlessness. Societal conflicts, family conflicts, financial constraints, personality, and worsening physical health may be associated with greater depressive symptoms. In addition, depressive symptoms may be detrimental to the overall health and well-being of Chinese older adults.

IMPLICATIONS

This study has wide implications for health care professionals, social services agencies, and policy makers. Our results call for improved public health education and awareness programs to highlight the health impact of depressive symptoms on Chinese older adults. Future prospective studies are needed to investigate the prevalence of depressive symptoms among U.S. Chinese older adults. Longitudinal research is needed to quantify the risk and protective factors of depressive symptoms.

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.