The Role of Social Isolation on Mediating Depression and Anxiety among Primary Family Caregivers of Older Adults: A Two-Wave Mediation Analysis

BACKGROUND

Primary family caregivers of older people with chronic care conditions are highly vulnerable to social isolation and psychological strains such as depression and anxiety due to their demanding responsibilities. This study examines how social isolation mediates the relationship between caregiving stress and mental health symptoms of primary family caregivers.

METHODS

The analytic sample included 881 primary caregivers of older adults from the 2015 and 2017 National Study of Caregiving (NSOC). Social isolation was measured using a composite structure that includes objective social disconnectedness and subjective loneliness. Two-wave mediation models were estimated to examine longitudinally if social isolation mediated the relationship between caregiving stress (subjective & objective stress) and mental health symptoms (depression & anxiety) of primary caregivers.

RESULTS

The study findings indicate that both subjective (β = 0.32, p < 0.001) and objective stress (β = 0.21, p = 0.003) have direct effects on depression among primary caregivers. Social isolation was found to only mediate the relationship between objective stress and depression (β = 0.18, p < 0.001). In contrast, no significant direct and indirect pathway was found in the anxiety model.

CONCLUSIONS

The study demonstrates the internal mechanism where objective strains of caregiving make family caregivers socially isolated, which in turn leads to increased symptoms of depression. Future interventions and practices aimed at improving the psychological well-being of family caregivers should prioritize strategies aimed at increasing social engagement, particularly for those with heavy caregiver burdens.

Utilization of Traditional Complementary and Alternative Medicine Across Ethnically Diverse Asian Americans

We conducted an analysis to identify factors influencing the use of traditional complementary and alternative medicine (TCAM), with a particular emphasis on ethnic variations. Using the 2015 Asian American Quality of Life survey (N = 2,609), logistic regression analyses were performed, considering acculturation, health status, healthcare accessibility/utilization, and socio-demographic factors. Ethnicity, specifically being Chinese or Korean Americans, having chronic medical conditions, experiencing unmet healthcare needs, and having regular check-ups were significant predictors of TCAM use among Asian Americans as a whole. However, when we delved into sub-ethnic groups, different patterns were found. Among Vietnamese and Filipino Americans, having unmet healthcare needs emerged as the most prominent predictor of TCAM use. Furthermore, acculturation level and English proficiency were significant in predicting Vietnamese and Filipino Americans' TCAM use, with the direction varying by sub-ethnicity. Being old emerged as a predictor of TCAM use for Chinese, Indian, Korean, and 'other' Americans. Our findings underscore the importance of adopting an ethnically sensitive approach when addressing the healthcare needs of diverse Asian American populations.

Perceived Anxiousness About COVID-19 and Preventive Behaviors Among Dyads of Older Adults and Family Caregivers

BACKGROUND AND OBJECTIVES

Adopting preventive behaviors is crucial to avoiding coronavirus disease 2019 (COVID-19) infection, and perceived anxiousness may influence such behaviors among older adults and their caregivers. This study investigated the relationships between perceived anxiousness about COVID-19 and preventive behaviors in older adult-caregiver dyads.

RESEARCH DESIGN AND METHODS

A cross-sectional study was conducted using 1,565 older adult-caregiver dyads from the 2020 National Health and Aging Trend Study (NHATS)/National Study of Caregiving (NSOC) COVID-19 Supplements data. Actor-partner interdependence models were estimated to examine the associations between older adults' and family caregivers' perceived anxiousness about COVID-19 and their engagement in personal (e.g., wearing masks, washing hands) and social (e.g., avoiding contact with friends, limiting grocery shopping) preventive behaviors. Separate models were estimated based on older adults' dementia status.

RESULTS

We found significant actor effects of anxiousness about COVID-19 on preventive behaviors of both older adults and caregivers in nondementia dyads. The anxiousness about COVID-19 of older adults had significant partner effects on both personal and social preventive behaviors of caregivers, whereas caregivers' anxiousness about COVID-19 only had a significant partner effect on social preventive behaviors of older adults. No significant partner effect was found in dementia dyads.

DISCUSSION AND IMPLICATIONS

Our findings highlight the critical role of caregivers in promoting older adults' health behaviors during the COVID-19 pandemic and maintaining mental well-being of older adults. The study also implies future efforts to explore the dyadic relationship of dementia care dyads in promoting health behaviors and mental health.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Intervention to promote preventive dental care for older Korean-American Medi-Cal enrollees in Los Angeles

BACKGROUND

In California, preventive dental care is covered by Medi-Cal (California's Medicaid program). However, many beneficiaries do not use their dental benefits. Given that a lack of knowledge about oral health and insurance coverage contributes to this underutilization, promoting the use of dental benefits among eligible individuals via an educational program is imperative. Responding to the particular needs of older immigrants with limited English proficiency, we developed a digital oral health intervention for older Korean-American Medi-Cal enrollees in Los Angeles. This educational intervention is designed to be delivered via computers and the Internet. It consists of a 15-min self-running PowerPoint presentation narrated in Korean with links to additional information on the Internet. The slides contain information about the basic etiology of oral diseases, oral hygiene, common myths about oral health and dental care, Medi-Cal coverage of preventive dental care, and how to find a dental clinic.

METHODS

We pilot tested the intervention with 12 participants to examine its feasibility and acceptability. We also obtained participants' qualitative feedback about the intervention.

RESULTS

A post-intervention quantitative assessment yielded high participant satisfaction and improved oral health and dental care knowledge. Participant responses to the intervention yielded four themes: (1) content and structure, (2) linguistic and cultural aspects, (3) delivery mode, and (4) additional concerns and suggestions.

CONCLUSIONS

Our findings confirm the intervention's feasibility and acceptability and suggest further refinement.

Relationship of Living and Eating Arrangements to Mental Distress Among Older Korean Immigrants: Gender Difference in the Mediating Role of Loneliness

This study examined how different living/eating arrangements were associated with loneliness and depressive symptoms among older Korean immigrants. We examined gender differences considering: (1) patterns of living/eating arrangements and their relations with loneliness and mental distress and (2) indirect effect of living/eating arrangements on mental distress through feeling lonely. Data were drawn from the Study of Older Korean Americans that surveyed older; Korean immigrants during 2017-2018 (N = 2150). Living/eating arrangements were classified in the combination of four categores. Using the PROCESS macro, we tested gender differences in the mediation effect of loneliness on the relationship between living/eating arrangements and mental distress while controlling for background/health characteristics and social connectedness-related variables. The mediating role of loneliness was manifested differentially between men and women. By administering simple measures of living/eating arrangements, practitioners could potentially identify key targets to improve social and mental well-being, particularly among older immigrants with limited resources.

Examining cultural adaptations of the savvy caregiver program for Korean American caregivers using the framework for reporting adaptations and modifications-enhanced (FRAME)

BACKGROUND

The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) is a tool that systematically guides decision-making and reporting of adaptations made to evidence-based interventions. Using FRAME, we documented the process and outcomes of adapting the Savvy Caregiver Program (SCP) for Korean American dementia caregivers.

METHODS

Sequential adaptation was initiated with linguistic attunement, followed by pilot implementation and full adaptation. Our data-driven adaptation with multiple data sources and a feedback loop among multiple stakeholders yielded a total of 32 modifications, and each was coded according to the eight domains of FRAME: (1) what was modified, (2) who participated in recommending and deciding the modification to be made, (3) when the modification occurred, (4) whether the modification was planned, (5) whether the modification was fidelity-consistent, (6) whether the modification was temporary, (7) at what level of delivery, the modification was made, and (8) why the modification was made.

RESULTS

The areas of adaptation were evenly distributed across context (37.5%), content (31.2%), and training (31.2%). The primary reasons for modification were for engagement (62.5%), followed by fit with recipients (43.8%) and outcome improvement (31.1%). About 66% of the modifications were applied to the entire target group, and all modifications were fidelity-consistent.

CONCLUSIONS

The FRAME categorization provided a detailed understanding of the process and nature of adapting the SCP and served as a foundation for further implementation and scale-up. FRAME not only serves as a guide for adapting evidence-based interventions but also promotes their replicability and scalability.

Access to Primary Healthcare and Discussion of Memory Loss with a Healthcare Provider in Adults with Subjective Cognitive Decline: Does Race/Ethnicity Matter?

Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, p < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting.

Safety Concerns for Persons with Dementia in Senior Housing: A Qualitative Study with Korean American Caregivers in Los Angeles

Subsidized senior housing helps many socioeconomically disadvantaged older adults pursue independent living and aging in place. However, cognitive impairment or dementia poses a critical challenge to many residents' ability to live independently and safely. Focusing on Korean American dementia caregivers, a group known to be vulnerable to caregiving burden but understudied, we explored the safety of persons with dementia in senior housing from the perspectives of caregivers. Qualitative data from nine caregivers whose care recipients were current or former residents of subsidized senior housing in Los Angeles were analyzed by the constant comparative method. Major concerns emerged were: (1) fire risks, (2) wandering, (3) physical injury (e.g., self-harm, falls), and (4) potential neglect. Caregivers also mentioned errors in the self-administration of medications, potential financial exploitation, and interpersonal conflicts. These concerns provide implications for services and programs for the safety of persons with dementia who live in senior housing.

Mental Health of Asian American Caregivers of Family Members With Severe Mental Illness

Within the general population, caregivers of individuals with severe mental illness experience considerable mental health burdens. Less is known about these burdens among Asian Americans, who frequently serve as primary caregivers of family members in accordance with cultural values of familism and interdependence. Asian American caregivers experience severe stigma regarding mental health issues as well as other barriers to care, often resulting in decreased help-seeking behaviors and poorer mental health. Given a paucity of research, the authors systematically reviewed the literature on mental health outcomes among Asian American caregivers. This column offers policy and practice suggestions for supporting the mental health of Asian American families affected by severe mental illness.

Changes in Depressive Symptoms of Korean American Dementia Caregivers After Attending the Savvy Caregiver Program: Preliminary Findings with a Pilot Sample

OBJECTIVES

Language accommodation is indispensable in making evidence-based interventions available and accessible to ethnic minorities with limited English proficiency. As part of the larger effort to culturally adapt the Savvy Caregiver Program for Korean American dementia caregivers, we first conducted linguistic adaptation, and the present study reports the preliminary findings on participants' changes in depressive Symptoms.

METHODS

The linguistically adapted program was delivered to two small groups of Korean American dementia caregivers (total n = 13) by two Savvy-certified Korean-speaking trainers. Participants' depressive symptoms were assessed at three time points (pre-intervention, immediate post-intervention, and 6-month follow-up).

RESULTS

Following the intervention, participants exhibited lowered depressive symptoms (t = 8.64, p < .001, Cohen's d = .89). This benefit was sustained at 6-month follow-up.

CONCLUSIONS

Findings suggest that the therapeutic benefit of the Savvy Caregiver Program could potentially be shared with linguistic minorities when delivered in their native language.

CLINICAL IMPLICATIONS

Although limited in its scope and nature, the pilot study with linguistic adaptation sheds light on efforts to close the gap in the evidence-based intervention delivery.

COVID-19 health information sources and their associations with preventive behaviors: A typological study with older residents in Seoul, South Korea

Considering that individuals' health information can enable their adoption of health behaviors, we examined the use of health information sources related to COVID-19 and its association with preventive behaviors in a sample of older residents in Seoul, South Korea (N = 400, M age = 76.1 years). Latent profile analysis of 12 sources of health information representing conventional media, online sources, interpersonal networks, and health professionals or authorities yielded a 4-group typology: limited, moderate/traditional, moderate/digital, and diverse. In a multivariate model with the diverse group as a reference, the limited group (B = -4.48, SE = 1.14, p < .001) and the moderate/digital group (B = -2.73, SE = 0.76, p < .001) were associated with lower adherence to COVID-19 preventive behaviors. Our findings support the heterogeneity in the use of health information sources and the hypothesis that groups with restricted sources of health information would report less desirable behaviors. The findings also underscored the importance of proper use of digital health information. Efforts should be made not only to help older adults with low education access diverse sources of health information, including digital sources, but also to empower them to build digital and health literacy.

The Role of Ethnic Community Social Capital in the Association between Acculturation and Psychological Distress among Older Korean Americans

Guided by the theories of social capital and stress-buffering, we examined how the association between low acculturation and poor mental health among older immigrants would be modified by social capital in ethnic communities (social cohesion, social engagement, perceived ethnic density, and the quality of social interaction). Using data from the Study of Older Korean Americans (N = 2,150, Mean age = 73.4), direct and interactive effect models were examined. Lower acculturation was associated with a greater level of psychological distress, and their link was modified by social cohesion (β = .19, p < .01) and negative social interactions (β =  - .97, p < .01). Findings suggest that the mental health risk associated with low acculturation could be intensified when older immigrants perceive low sense of cohesion in their ethnic communities or have negative interactions with ethnic community members.

Factors Associated With Dietary Risks in Older Korean Americans

Given the importance of healthy eating in the later years of life, the present study examined factors associated with dietary risks in older Korean Americans. We hypothesized that dietary risks would be associated with sociodemographic disadvantages, adverse health conditions, and limited sociocultural resources. Dietary risks were assessed with a scale covering five behavioral and situational risk factors (eating alone, skipping meals, functional challenges, oral health problems, and financial difficulties). Analyses of the data from the Study of Older Korean Americans (N = 2,150) showed that the sample on average had 1.13 risks (SD = 1.31), eating alone having the highest frequency (35.6%). Supporting the hypothesis, higher levels of dietary risks were found in individuals with sociodemographic disadvantages, poorer physical and mental health status, smaller social networks, and lower acculturation. Findings suggest concerted efforts to promote dietary behaviors and call attention to older immigrants who are socially and culturally isolated.

The Relationship Between Multimorbidity and Types of Chronic Diseases and Self-Rated Memory

This study explores the impact of multimorbidity and types of chronic diseases on self-rated memory in older adults in the United States. Data were drawn from the 2011 wave of the National Health and Aging Trends Study (NHATS, N = 6,481). Logistic regressions were used to examine the associations between multimorbidity and types of chronic diseases and fair/poor self-rated memory. Compared to respondents with no or one chronic disease, respondents with multimorbidity showed 35% higher odds of reporting fair/poor self-rated memory. Also, stroke, osteoporosis, and arthritis were identified as increasing the odds of reporting fair/poor self-rated memory by 41%, 20%, and 30%, respectively. Demonstrating the importance of both multimorbidity and types of chronic diseases in self-reporting of memory, our findings suggest the need to educate older adults with multimorbidity and certain types of diseases regarding negative self-rated memory and its consequences.

The Mental Health Benefit of Friend Networks in Older Korean Americans: The Conditioning Effect of Family Type

OBJECTIVES

We identified types of family relationships of older Korean Americans and examined how the mental health benefit of friend networks might be conditioned by family type.

METHODS

Data were from 2,070 participants in the Study of Older Korean Americans, a multistate survey of Korean immigrants aged 60 and older (Mage = 73.3, standard deviation [SD] = 8.01). To identify family types, latent profile analysis (LPA) was performed with marital status, living arrangement, family network, positive and negative interactions with family members, and family mistreatment. Linear regression models examined how mental distress was associated with friend networks and family types, as well as their interactions.

RESULTS

LPA identified 5 family types: close-knit, intimate but distant, detached, connected but dysfunctional, and dysfunctional. Greater distress was associated with smaller friend networks and belonging to the detached, connected but dysfunctional, and dysfunctional family types in comparison to the close-knit type. The interaction model showed that people in the connected but dysfunctional and dysfunctional groups had a stronger association between friend networks and mental distress than the counterparts in the close-knit group.

DISCUSSION

We not only confirmed the health-promoting role of friend networks and the value of a close-knit family but also found that the benefit of friend networks was pronounced when quality of the family relationship was impaired. Our findings called renewed attention to older immigrants' social convoys of family and friends, suggesting that the enhancement of friend networks could be particularly advantageous for older immigrants with dysfunctional family relationships.

Perceived racial discrimination and mental distress in older Korean Americans: the moderating role of ethnic resources

OBJECTIVES

To examine associations among perceived racial discrimination, ethnic resources, and mental distress in older Korean Americans. Ethnic resources included ethnic identity (how closely individuals identify themselves with other members of the same ethnic background) and sense of community (individuals' feelings of belonging to their ethnic group). We examined the direct effect of perceived racial discrimination and these ethnic resources, as well as their interactions, hypothesizing that mental distress associated with perceived racial discrimination would be reduced by ethnic resources.

DESIGN

Using survey data from the Study of Older Korean Americans (N = 2,150), linear regression models of mental distress were examined for direct and interactive roles of perceived racial discrimination and ethnic resources.

RESULTS

Mental distress was directly associated with perceived racial discrimination (B = 1.90, SE = .20, p < .001), ethnic identity (B = -.41, SE = .13, p < .01), and sense of community (B = -.45, SE = .12, p < .001). Perceived racial discrimination interacted significantly with sense of community (B = -1.86, SE = .28, p < .001). Subgroup analyses suggested that in the context of experiencing racial discrimination, a high sense of community can serve as a buffer against mental distress.

CONCLUSIONS

Ethnic resources are a benefit in coping with experiences of discrimination. The moderating role of sense of community suggests the value of fostering social capital in ethnic communities to protect and promote older immigrants' mental health.

The Use of Preventive Health Care in Asian Americans: The Cross-level Interactions between Individual and Neighborhood Factors in the United States

The present study explored how individual- and neighborhood-level factors contribute to predicting the use of preventive health care in a sample of Asian Americans. The cross-level interaction between individual- and neighborhood-level factors was also examined. We found a significant interaction between individual-level health insurance coverage and neighborhood health care providers' availability. Those who were uninsured and living in areas with limited health care provider availability (bottom 20%) were the most disadvantaged. This study adds to the growing literature on the effect of neighborhood-level factors on health care as sources of disparities. For health care policy, identifying individuals without health insurance coverage and living in a neighborhood with limited health care providers should be a priority to diminish disparities in access to care.

Older Korean Americans' Perceived Burdensomeness to Their Healthcare Partners: An Egocentric Network Assessment

Objectives: The objective is to examine how older Korean Americans' perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants (egos) and their healthcare partners (alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of burdensomeness, the study suggests strategies to promote their health and healthcare use.

Political Participation Among Middle-Aged and Older Asian Americans

Political civic participation is an important dimension of engagement in adulthood, but low rates are often reported among middle-aged and older Asian American immigrants. Acculturation to American culture has been associated with more civic participation, yet little is understood about how informal social contexts may play an additional role in these relationships. Using data from the 2015 Asian American Quality of Life survey, this study examined how political civic participation was associated with acculturation and social contexts in a diverse sample of Asian Americans aged 40 and above in Central Texas. Negative binomial regression results indicated that years lived in the U.S. familiarity with American culture, and friend network size were associated with more political participation. Furthermore, social contexts such as larger friend networks exhibited potential to shape how one's adjustment to life in the U.S. is related to their political participation.

HEALTHCARE-SEEKING BEHAVIORS AMONG OLDER AMERICANS WITH SUBJECTIVE COGNITIVE DECLINE

Subjective cognitive decline (SCD) in older adults is increasingly recognized as a harbinger of dementia. However, since SCD is, by definition, based on self-reports, it is unclear whether those who experience memory loss discuss these issues with physicians. Access to regular healthcare can be a catalyst for early detection of SCD because asymptomatic cognitive changes may not be apparent unless directly addressed with primary care physicians (PCP). Further, given the widely-known racial/ethnic disparities in healthcare access, minority adults might be further disadvantaged in healthcare seeking for SCD. Using a large national dataset, Behavioral Risk Factor Surveillance System (BRFSS) in 2019, the goals of the study are to a) examine the link between having a PCP and discussing memory issues with physicians and b) examine how race and ethnicity and the availability of PCPs are associated with discussion of SCD. The sample included 7,900 individuals 50 and older who reported SCD in the past year. We conducted a logistic regression adjusting for BRFSS survey weights, missing data, state-level clustering, and a set of covariates. Among those with SCD, those with a PCP were almost twice as likely to discuss their cognitive decline (OR=1.98, p&lt;.001). There was also a significant interaction between Hispanic ethnicity and having a PCP (OR=0.25, p&lt;.05, F=4.65, p=.03). Surprisingly, Hispanics with a PCP were less likely to discuss memory issues compared to Hispanics without one. The findings highlight the significance of routine healthcare service utilization for adults with SCD while providing a nuanced understanding of ethnic differences.

COMMUNITY TYPOLOGY IN OLDER KOREAN AMERICANS: IMPLICATIONS FOR MENTAL/COGNITIVE HEALTH

The purposes of this study were to: (1) identify community typology in older Korean Americans; and (2) examine the associations of typology with loneliness, mental distress, and cognitive health. Guided by social capital conceptualization, we hypothesized that distinct community groups would be identified and that they would be differentially associated with sociodemographic, immigration-related, health, and social characteristics and mental/cognitive health. Data were drawn from a survey with older Korean Americans aged 60 and older, collected during 2017−2018 in diverse locations (n=2,138). To identify community typology, a series of latent profile analysis (LPA) were conducted using 15 community-related variables in three domains (neighborhood characteristics, social cohesion, ethnic attachment). After examining characteristics of the identified groups in relations with study variables, hierarchical multiple regression models of loneliness, mental distress, and self-rated cognitive health were estimated. Based on several model evaluation criteria, LPA model with five community groups was identified as best-fit (BIC=64,619, Entropy=.94). The five groups were identified as “a. high safety/cohesion/ethnic attachment” (10%), “b. high safety/low cohesion/ethnic attachment” (10%), “c. moderate neighborhood/low ethnic attachment/cohesion” (38%), “d. moderate neighborhood/high cohesion/ethnic attachment” (31%), and “e. low safety/moderate cohesion/ethnic attachment” (11%). In reference to the group with high on all three domains (a), group with low ethnic attachment/cohesion in moderate neighborhood (c) and group in unsafe environment with moderate cohesion/ethnic attachment (e) were consistently associated with elevated loneliness/mental distress and poor rating of cognitive health. The results suggest the need to understand profiles of community characteristics and their relationships with health/well-being among older immigrants.

NEIGHBORHOOD ADVERSITY AND COGNITIVE HEALTH: THE MODIFYING ROLE OF SELF-PERCEPTIONS OF AGING

Research has documented the increased risk of cognitive impairment among older adults living in socioeconomically disadvantaged neighborhoods. Much less is known about the factors that moderate this risk. We conceptualized self-perception of aging (SPA) as a potential moderator because it reflects core beliefs about the self at older ages but is also closely linked to late-life health. Guided by the diathesis-stress model that postulates the interactive roles of cognitive styles and stressors in shaping health outcomes, we hypothesized that more positive SPA would buffer the effects of neighborhood adversity on cognitive function. Using data from the Health and Retirement Study (2008–2016), the analytic sample consisted of adults aged 54 and older (N=5,902). Cognitive function was assessed by the Telephone Interview for Cognitive Status. The neighborhood indicators included 1) poverty rates at the census tract level, 2) perceived neighborhood social cohesion, and 3) perceived neighborhood disorder. Three-level growth curve models were separately estimated for each neighborhood indicator’s effect as well as its interaction with SPA on the 8-year cognitive function trajectories. Findings showed that higher poverty rates, more disorder, and less cohesion were associated with lower initial levels of cognitive function but slower rates of cognitive decline. SPA partially moderated the linkage between neighborhood adversity and the level of cognitive function. More positive SPA was associated with reduced negative effects of living in neighborhoods with higher poverty rates and more physical disorder. These findings highlight the intersection of an individual-level psychological factor and a contextual-level factor in shaping late-life cognition.

MENTAL HEALTH IMPACT OF DISCRIMINATION: THE PROTECTIVE FUNCTION OF SOCIAL CAPITAL IN DIVERSE GROUPS OF OLDER ADULTS

Discrimination occurs in complex social contexts leading to various levels and types of outcomes. Although the negative health impact of discrimination is well-documented, there is a need to investigate patterns among discrimination, social factors, and health outcomes in diverse racial/ethnic groups of older adults to inform interventions. For example, social capital, such as social cohesion, social ties, and safety, is anticipated to be directly associated with mental health and also to modify the impact of discrimination. In the present study, we examined (1) racial/ethnic differences in perceived discrimination, social capital, and depressive symptoms and (2) the direct effect of perceived discrimination and social capital, as well as their interactions, on depressive symptoms among different racial/ethnic groups. Data were drawn from the National Social Life, Health, and Aging Project (NSHAP) Round 3 (2,988 non-Hispanic Whites, 719 non-Hispanic Blacks, and 499 Hispanics; 68 mean age). Compared to non-Hispanic Whites, non-Hispanic Blacks had a significantly higher level of perceived discrimination, lower social capital, and more depressive symptoms. Findings from multivariate linear regression models demonstrated that, in all racial/ethnic groups, frequent experiences of discrimination and low levels of social capital were associated with increased symptoms of depression. A significant interaction between discrimination and social cohesion was observed in non-Hispanic Whites and Hispanics. In both groups, the negative impact of discrimination was lower among those with higher levels of social cohesion. Our findings support efforts such as improving well-being for older adults by promoting age-friendly communities to build greater social cohesion.

ASSOCIATIONS BETWEEN COVID-19 PERCEPTIONS AND PREVENTIVE BEHAVIORS IN DEMENTIA CAREGIVING DYADS

This study adopted a dyadic perspective to examine how the perceptions of COVID-19 (i.e., anxiousness & hopefulness) of dementia caregiving dyads are associated with their engagement in personal (e.g., washing hands, wearing mask) and social (e.g., avoiding physical contact and going restaurants/bars) preventive behaviors. Multiple cross-sectional Actor-Partner Interdependence Models (APIMs) were estimated using data from the 2020 NHATS/NSOC COVID-19 Supplements (N=1565). In the anxiousness models, participants’ own feeling of anxiousness was associated with their own engagement in personal preventive behaviors (actor effects), and the perceived anxiousness of PLWD was associated with personal preventive behaviors of caregivers (partner effect). In the model on social preventive behaviors, both actor and partner effects were found on dementia caregiving dyads. No effect was found in the models on hopefulness. Our findings extend understandings of mutual influence within the caregiving dyads and demonstrate the possibility of developing interventions for caregivers to promote PLWD’s health behaviors.

THE MENTAL HEALTH BENEFIT OF FRIEND NETWORKS IN OLDER KOREAN AMERICANS: THE CONDITIONING EFFECT OF FAMILY TYPE

Building on the importance of family and friends as sources of social connectedness in later years of life, we conducted a contextual examination of their independent and interactive roles in predicting mental health, using a compensatory social convoy model. In a sample of older Korean Americans, we anticipated that friend networks would be a more important predictor of mental distress when strong family relationships were absent. Data were from 2,140 participants in the Study of Older Korean Americans, a multi-state survey of Korean immigrants age 60 and older (Mage = 73.4, SD = 7.97). To identify family types, latent profile analysis (LPA) was performed with 17 variables assessing family networks, positive and negative interactions with family members, and incidence of mistreatment by family. Linear regression models of mental distress then examined the direct effects of family type and networks of friends, as well as their interactions. LPA on family-related items identified three family types: close-knit, mixed, and dysfunctional. Membership in the close-knit group and a larger network of friends were associated with lower levels of mental distress. In addition, a significant interaction was found between dysfunctional family type and friend network (B = −.35, SE = .08, p < .001), where the positive effect of friend networks was most pronounced in the context of dysfunctional family relationships. These findings support the use of a compensatory social convoy model. Substituting for family resources, friend networks yielded compensatory mental health protection for those with dysfunctional family relations.

ACCULTURATION ON PSYCHOLOGICAL DISTRESS AMONG OLDER KOREAN AMERICANS: DOES ETHNIC COMMUNITY SOCIAL CAPITAL MATTER?

Responding to the rapid growth of the older immigrant population and building upon the literature on the critical role of acculturation in older immigrants’ health and well-being, we focused on the role of ethnic community social capital (social cohesion, social engagement, safety, and negative interactions in ethnic communities) in older Korean Americans. Guided by social capital and stress-buffering theories, we examined the direct effect of acculturation and ethnic community social capital on psychological distress, as well as their interactions. We hypothesized that the negative impact of low acculturation on mental health would be lowered by positive perceptions of and experiences in ethnic communities. Using data from 2,150 participants in the Study of Older Korean Americans (Age range = 60-99, M [SD] = 73.4 [7.97]), the direct and interactive effect models were examined. Results showed that low acculturation posed a significant risk to mental health and all four types of ethnic community social capital had a significant direct effect. Furthermore, significance was observed in the interaction of acculturation with social cohesion (B [SE] = .01 [.01]. p < .05) and with negative interaction (B [SE] = -.01 [.01]. p < .01). The negative impact of low acculturation was attenuated among those with a high sense of ethnic community social cohesion but intensified among those with frequent experiences of negative interactions with ethnic community members. Our findings highlight the importance of social capital that forms within ethnic communities and provide implications for programs and services to promote older immigrants’ mental well-being.

Cultural adaptation of the savvy caregiver program for Korean Americans with limited English proficiency: a feasibility and acceptability study

Background

Limited English proficiency (LEP) of dementia caregivers poses a critical barrier to these caregivers’ access to evidence-based interventions. In an effort to make such interventions available and accessible to dementia caregivers with LEP, in the present study we use Barrera and colleagues’ (2011) three-step model of cultural adaptation: (1) information gathering, (2) preliminary adaptation, and (3) full adaptation. Selecting Korean Americans as a target group and the Savvy Caregiver Program (SCP) as a target intervention, we demonstrate the sequential process of cultural adaption and report the outcomes on feasibility and acceptability.

Methods

Preliminary adaptation with linguistic attunement was conducted by translating the SCP manual into Korean and certifying two lay individuals who were bilingual in English and Korean as Savvy trainers. The 6-week online SCP program was delivered by the two trainers in Korean with six to seven caregiver participants per trainer (N = 13). Feasibility and acceptability of the SCP for both caregiver participants and trainers were assessed using mixed methods, and their data then informed full adaptation.

Results

Findings not only showed the initial efficacy of the linguistically attuned SCP but also suggested areas for further modification. Data-driven assessment yielded a list of recommended changes for full adaptation, which was reviewed by the SCP developer to ensure fidelity and by community and research partners to confirm contextual and cultural relevance.

Conclusions

The adopted changes are broadly summarized as representing logistical, technical, and cultural issues. Given our refined set of educational materials and implementation guidelines, we discuss future directions for research and development.

Relationship of social isolation with mental distress among older Korean Americans: The moderating role of social cohesion

Social isolation has been associated with poor mental health outcomes, particularly for older immigrants who do not have a protective social environment. The purpose of this study was to investigate the relationship of social isolation (living alone, marginal family ties and marginal friend ties) with mental distress and to examine the moderating role of social cohesion (family cohesion and community cohesion). We hypothesised that social isolation and social cohesion would be directly associated with mental distress and that social cohesion would buffer the influence of social isolation on mental distress. Data were drawn from the Study of Older Korean Americans (SOKA), which included 2150 older Korean Americans aged 60 or over in multiple areas, collected during 2017-2018. A series of hierarchical regression models of mental distress examined the direct and interactive role of social isolation and social cohesion. Approximately one-third of the sample lived alone, 20% had marginal family ties and 27% had marginal friend ties. All three indicators of social isolation had a significant direct effect on mental health; however, living alone lost its statistical significance with the inclusion of social cohesion variables. Both indicators of family and community cohesion were significantly associated with lower levels of mental distress. In addition, family cohesion buffered the negative effects of marginal ties to family and friends on mental distress. The significant role of a positive social environment must be considered when addressing the needs of older immigrants who are socially isolated.

Linguistic Adaptation and Cognitive Function in Older Chinese and Korean Immigrants in the United States: A Cross-Sectional Study

OBJECTIVES

To examine the cross-sectional association of linguistic adaptation with cognitive function, as well as its interactions with sociodemographic and health profiles in older Chinese and Korean immigrants in the U.S.

METHODS

Using harmonized data (N = 5063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we examined between- and within-group differences in the role of linguistic adaptation (English use in older Chinese Americans and English proficiency in older Korean Americans) in cognitive function.

RESULTS

The positive association between linguistic adaptation and cognitive function was common in both groups. We also found that the relationship was pronounced among subgroups with the underlying linguistic and cognitive vulnerabilities (i.e., the very old, women, those with low education, and newly immigrated individuals).

DISCUSSION

Findings show the importance of linguistic adaptation in older immigrants' cognitive health and suggest a need for targeted interventions for high-risk groups.

Social isolation in Asian Americans: risks associated with socio-demographic, health, and immigration factors

OBJECTIVES

The present study examined the factors associated with social isolation in Asian Americans. Three types of social isolation (social isolation from family, social isolation from friends, and overall social isolation), identified by the Lubben Social Network Scale-6, were examined with a sample of Asian Americans representing diverse ethnic groups (Chinese, Asian Indian, Korean, Vietnamese, Filipino, and other Asians) and a broad age range (18-98).

DESIGN

Using data from the 2015 Asian American Quality of Life Survey (N = 2609), logistic regression models examined how each type of social isolation was predicted by sociodemographic (age, gender, ethnic origin, marital status, education, and perceived financial status), health-related (chronic medical conditions and self-rated health), and immigration-related (proportion of life in the United States and English proficiency) variables.

RESULTS

The percentage of the sample that fell into the category of social isolation from family, social isolation from friends, and overall isolation ranged from 18.2% to 19.3%. At 36% in the friend category and 33% in the overall category, the Vietnamese sample showed a heightened risk of social isolation. Regression analyses indicated that, for both family and friend categories, individuals who were in the middle-aged group (40-59 years old) and who had limited English proficiency demonstrated higher odds of being isolated. Reflecting relational differences in family and friend networks, the risk associated with unmarried status was specific to social isolation from family, whereas having unmet financial needs was only associated with social isolation from friends.

CONCLUSIONS

The study findings expand our understanding of the multiple domains of social isolation in an understudied population and emphasize the importance of developing prevention and intervention programs to foster social connectedness among Asian Americans. Our findings on risk factors and ethnic variations help identify the groups to be prioritized in intervention efforts and suggest ways to approach them.

Chronic Conditions and Psychological Distress in Older Asian Americans: The Mediating Role of Subjective Health Perception

Given the importance of understanding the connection between physical and mental health in old age, the study examined the mediating role of subjective health perception in the relationship between chronic conditions and psychological distress among older Asian Americans. Using data from 533 Asian Americans aged 60 and over in the 2016 Asian American Quality of Life Study, the direct and indirect effect models were tested with multivariate linear regressions and the PROCESS macro. Results show that chronic conditions pose significant risks to psychological distress and that subjective health perception mediates their association. The observed role of subjective health perception as an intervening step between physical and mental health offers implications for gerontological social work research and practice by highlighting the importance of positive self-appraisals for the health and well-being in later years of life.

Longitudinal links between behavioral activation coping strategies and depressive symptoms of U.S. adults living alone during the COVID-19 pandemic

The COVID-19 pandemic and related physical distancing measures have posed a significant threat to the mental health of adults, particularly those living alone. Accordingly, the World Health Organization implemented the #HealthyAtHome program, encouraging people to keep in regular contact with loved ones, stay physically active, and keep a regular routine. The current study aims to examine a micro-longitudinal link between behavioral activation coping strategies (exercise, meditation, relaxation, and social connection) and depressive symptoms among adults who lived alone during the COVID-19 pandemic. We used 21 biweekly waves of longitudinal data from the Understanding America Study (UAS) collected between April 2020 and February 2021 (N = 1,280). The multilevel models with correlated random effects were estimated to examine lagged effects of coping strategies (t-1) on depressive symptoms (t). The results showed that exercise was predictive of lower depressive symptoms even after controlling for time-invariant and time-varying covariates. The results showed that modifiable lifestyle factors, such as taking time to exercise, may be beneficial for the mental health of Americans living in single-person households.

The Effect of Support from Secondary Caregiver Network on Primary Caregiver Burden: Do Men and Women, Blacks and Whites Differ?

OBJECTIVES

Many older adults receive informal care from multiple caregivers, including support from a primary caregiver and a secondary caregiver network (SCN). This study examined the association between SCN support and primary caregiver burden, and whether the association varies across women and men, Black and White.

METHODS

Data came from the 2015 National Health and Aging Trend Study (NHATS) and the National Study of Caregiving (NSOC), including non-Hispanic White and Black men and women who were identified as primary caregivers (n = 967) and their secondary caregivers (n = 2,253). SCN support was indicated by (a) care domain overlap, and (b) proportion of caregiving by SCN. Multiple regression models were estimated for the analyses.

RESULTS

Both SCN support variables were found to reduce primary caregiver burden, and the effect of proportion of caregiving by SCN was found to vary by gender-race groups. With the increase of the proportion of caregiving by SCN, both Black and White women caregivers tend to experience faster decrease in caregiver burden than Black men.

DISCUSSION

Our findings support the role of SCN in reducing primary caregiver burden and demonstrate that the benefit of SCN support varies across the four gender-race groups. The results indicate that it is imperative to further examine caregiving experience and protective mechanisms of SCN support using an intersectional perspective.

Racial/Ethnic Differences in Correspondence Between Subjective Cognitive Ratings and Cognitive Impairment

OBJECTIVES

Responding to racial/ethnic disparities in dementia diagnosis and care, we examined the role of race/ethnicity in the correspondence between subjective and objective ratings of cognitive impairment. Our examination focused on the two types of discordance: (1) positive ratings in the presence of cognitive impairment and (2) negative ratings in the absence of cognitive impairment.

DESIGN AND PARTICIPANTS

A cross-sectional assessment was conducted using the data from the Harmonized Cognitive Assessment Protocol project, a sub-study of the Health and Retirement Study. Our analytic sample included 3,096 participants: 2,257 non-Hispanic Whites, 498 Blacks, and 341 Hispanics.

MEASUREMENTS

Discordant groups were identified based on self-ratings of cognition (positive versus negative) and the Langa-Weir classification of cognitive impairment (normal versus impaired).

RESULTS

Blacks and Hispanics were more prone to falsely positive perceptions of their cognitive function in the presence of cognitive impairment than non-Hispanic Whites. On the other hand, non-Hispanic Whites were more likely to manifest negative ratings even in the absence of cognitive impairment.

CONCLUSION

Our findings demonstrate the critical role of race/ethnicity in determining discordance between subjective and objective measures of cognition and highlight the importance of a tailored effort to promote dementia diagnosis and care.

Loneliness as a Mediator in the Association Between Social Isolation and Psychological Distress: A Cross-Sectional Study With Older Korean Immigrants in the United States

The present study explored the role of loneliness in the association between social isolation and psychological distress, using a cross-sectional sample of older Korean immigrants in the U.S. Considering structural (unmarried and living alone) and relational (isolation from family and friends) social isolation, we hypothesized that (1) both types of social isolation would be associated with loneliness and psychological distress and (2) their effect on psychological distress would be mediated through loneliness. Data came from the Study of Older Korean Americans (SOKA), a multisite survey of Korean immigrants aged 60 and older (n = 2,150). The multivariate analyses demonstrated that older individuals with structural and relational isolation reported higher levels of loneliness and psychological distress. Loneliness was found to mediate the effect of both types of social isolation on psychological distress. The intervening role of loneliness suggests strategies to alleviate the mental health consequences of social isolation in older immigrants.

Racial and ethnic differences in cognitive health appraisals: a comparison of non-Hispanic White, non-Hispanic Black, and Hispanic older adults

OBJECTIVES

To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables.

METHOD

The sample (N = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016-2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE).

RESULTS

The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed.

CONCLUSION

Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.

Racial and Ethnic Diversities in Cognitive Health Appraisals: Findings from the HCAP

Using data from NHATS Round 9, the present study examines the relationships between environmental factors and self-reported health among older adults with dementia, mild cognitive impairment (MCI), and normal cognition. Based on neighborhood stress process theory, we investigate the following questions: 1) Are there associations between dwelling safety hazards and neighborhood environments and self-reported health? 2) Is cognitive status a moderator between the relationship? 3) How do these associations differ between older adults with varying cognitive status (i.e., dementia, MCI, and normal cognition)? A hierarchical linear regression analyses are conducted. Results indicate that better quality of sidewalk surface and neighborhood social cohesion are associated with better self-reported health, after taking into account sociodemographic, health, and social factors. Interaction terms are then used to examine the moderating effects of cognitive status on the associations; four interactions terms are found to be statistically significant. Lastly, separate linear regression analyses are implemented for the dementia, MCI, and normal cognition groups. Findings show that the predicting power of environmental factors vary by cognitive status of older adults. For individuals with dementia, tripping hazards, cluttered home, and community disconnectedness are associated with poor self-reported health. However, no significant relationship was found for older adults with MCI. For older adults with normal cognition, better quality of sidewalk surface and neighborhood social cohesion predict better self-rated health scores. Findings of this study illuminate the important role of a hazard-free home, community walkability, and socially cohesive neighborhood environments in predicting better health status of older adults.

Differences in Self-Rated Memory by Race/Ethnicity

Self-rated memory is an important dimension of well-being among older adults that has also been linked to cognitive impairment over the long term. However, few studies based on nationally-representative samples have examined differences in self-rated memory by race/ethnicity. This study explores differences in self-rated memory across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States. Data were drawn from the 2011 wave of the National Health and Aging Trends Study (NHATS). The sample consisted of older adults aged 65 and older (N=4,753 non-Hispanic Whites, N=1,442 non-Hispanic Blacks, and N=388 Hispanics). Logistic regression was used to examine the association between having poor/fair self-rated memory and race/ethnicity, controlling for socio-demographic characteristics (age, gender, education level, income, and marital status), chronic conditions (heart attack, hypertension, diabetes, stroke, and depressive symptoms), objective memory status, functional limitations (activities of daily living and instrumental activities of daily living), and other social and cultural factors (economic vulnerability, religious practice, and limited English proficiency). I find that non-Hispanic Blacks and Hispanics have significantly higher odds of reporting poor/fair self-rated memory than non-Hispanic Whites. Compared to non-Hispanic Whites, Blacks and Hispanics had 33% and 56% higher odds of reporting poor/fair self-rated memory, respectively, controlling for sociodemographic characteristics, chronic conditions, objective memory status, functional limitations, and social and cultural factors. These results provide evidence that understanding differences in self-rated memory across racial/ethnic groups may have important implications for health professionals, particularly in relation to conducting and interpreting cognitive screening assessments.

Health Risks Posed by Social and Linguistic Isolation in Older Korean Americans

Guided by the double jeopardy hypothesis, the present study examined the health risks posed by the coexistence of social and linguistic isolation in older Korean Americans. Using data from the Study of Older Korean Americans (SOKA, n = 2,032), comparisons of four isolation typologies (no isolation, social isolation only, linguistic isolation only, and dual isolation) were made, and their impacts on physical (self-rated health), mental (mental distress), and cognitive health (cognitive performance) were examined. The ‘dual isolation’ group exhibited greater sociodemographic and health disadvantages. The odds of having fair/poor health, mental distress, and cognitive impairment were 2.21-3.17 times higher in the ‘dual isolation’ group than those in the group with no isolation. Our findings confirm that both social relationships and language proficiency are key elements for older immigrants’ social connectedness and integration, deprivation of which puts them at risk in multidimensions of health.

Living/Eating Arrangement, Loneliness, and Mental Distress among Older Korean Immigrants: Gender Difference

Structural isolation such as living alone poses a mental health risk in diverse groups of older adults, including older immigrants. Given that those living with others might also be disengaged, the present investigation included eating alone as another source of isolation and examined the impact of the combination of living and eating alone. The proposes of the study were to examine (1) how living and/or eating alone would impact mental distress, (2) whether the impact would be mediated by feelings of loneliness, and (3) if there would be gender differences in the mediation effect. The data were drawn from the Study of Older Korean Americans (SOKA), which surveyed older Korean immigrants in five states during 2017−2018. The living/eating arrangement was classified into four-groups: living/eating with others (57%), living with others/eating alone (12.4%), living alone/eating with others (7.3%), and living/eating alone (23.1%). Using the PROCESS macro, we tested the mediation effect of loneliness and the moderation effect of gender in the relationship between the typology and mental distress controlling for background/health characteristics and social capital related variables. Two groups (living with others/eating alone and living/eating alone) had sociodemographic, health, and social capital disadvantages. Analyses demonstrated that mental distress was linked with living with others/eating alone and living/eating alone, of which relationships were mediated by loneliness only among women. Findings suggest that not only structural isolation (e.g., living alone) but also disengagement with others (e.g., eating alone) need to be considered to understand emotional well-being in older immigrant population and gender difference.

Longitudinal Effects of Coping Strategies on Mental Health of Older Adults Living Alone During the COVID-19 Pandemic

The COVID-19 pandemic and related social distancing measures have posed a significant threat to the mental health of older adults, particularly those living alone. Accordingly, the World Health Organization implemented the #HealthyAtHome program, encouraging people to keep in regular contact with loved ones, stay physically active, and keep a regular routine. The current study aims to examine a micro-longitudinal link between positive coping strategies (e.g., exercise, meditation, relaxation, and virtual social contacts) and depressive symptoms among older adults who live alone during the COVID-19 pandemic. We used 21 biweekly waves of longitudinal data from the Understanding America Study (UAS) collected between April 2020 and February 2021 (N=839, observation= 16,256). The multilevel models with correlated random effects were estimated to examine lagged effects of coping strategies (t-1) on depressive symptoms (t). The analysis used the xthybrid command with clustered standard errors in Stata 15.1. The results show that exercise (b=-.10, p=0.02), relaxation (b=-02, p=0.01), and virtual social contacts (b=-.01, p=0.01) were predictive of lower depressive symptoms even after controlling for time-invariant and time-varying covariates. Meditation, however, was associated with higher depressive symptoms (b=.01, p=0.02). The results show that modifiable lifestyle factors, such as taking time to exercise or relax, may enhance mental health and well-being for older adults living alone. Virtual social contacts such as video calls could be an effective way to keep older adults socially connected and emotionally healthy.

"Better be dead than grow older:" A qualitative study on subjective aging among older Koreans

While a large body of evidence suggests potential cultural variations in the experiences of subjective aging, very little is known about how members of Asian cultures feel about their aging. This study aims to acquire an in-depth understanding of subjective aging and its cultural/societal contexts among older Korean adults. In-depth face-to-face interviews were conducted with 20 community-dwelling Korean adults over age 65. Guided by the Stereotype Embodiment Theory, open-ended questions were asked to address how exposure to cultural/societal views about older adults relate to individuals' subjective aging. Data were analyzed using the constant comparative method. Seven categories were identified, which were grouped into three primary themes: 1) exposure to negative views on aging/older persons; 2) salience gain from self-relevance; and 3) influence on older adults' subjective aging. Most participants were generally not satisfied with their aging, felt they were a burden, and were prone to experience intergenerational conflicts. This may be attributed in part to their exposure to widespread negative age stereotypes and disrespect for older adults. Awareness of age-related changes and experience of age discrimination appear to be triggers through which the negative cultural/societal views on aging/older persons influence one's subjective perceptions and experience of aging. This in-depth data from an understudied population contributes to the existing literature by suggesting that the dominant-negative experience of aging among older Koreans may be better understood from socio-cultural contexts. Our findings can inform culture-specific intervention strategies to promote positive subjective aging.