Research Review

Asian-Americans Face Barriers to Healthy Aging

Rutgers population epidemiologist provides insights into the wellbeing of aging Asian-Americans

Older Asian-American immigrants are healthier and happier if they are socially active, connected to their families and communities, and able to maintain their cultural values while adapting to western culture, according to a new Rutgers study.

The research appears in the current issue of the journal Gerontology and Geriatric Medicine.

XinQi Dong, director of Rutgers University's Institute for Health, Health Care Policy and Aging Research and the lead researcher of the Population Study of Chinese Elderly in Chicago (PINE), published 20 articles based primarily on his teams' examination of the health and wellbeing of Chinese older adults globally. For the study, researchers interviewed more than 3,000 Chinese Americans between 60 and 105 over a two-year period to explore their psychological wellbeing, involvement in their community and neighborhood, quality of life, acculturation, and use of traditional Chinese medicine.

"Aging Asian-Americans are underrepresented in the discussion of health disparity issues in the United States," says Dong, who guest-edited the special issue focusing on Asian-American health. "This journal compilation is the first substantive step in trying to understand the health of this population."

The research challenges the pervasive "model minority myth"—the belief that U.S. Asian populations have fared better than other ethnic groups in socioeconomic status, social relationships, and health. The Chinese-Americans in the studies reflect the overall Asian-American population, which face a high prevalence of psychological distress and disorders, dementia, and cancer, especially in advanced age. "These conditions usually go untreated for multiple reasons, such as a desire to 'save face' and a lack of culturally and linguistically appropriate treatment and prevention methods," Dong says.

The articles address a gap in understanding health equity issues in the Asian community—in the United States and globally—and offers insight on how health care professionals and policymakers can provide support through understanding cultural values, such as filial piety, collectivism, individualism, and sense of harmony in families.

Six of the papers examine the risk factors and impact of psychological distress among global Chinese populations. The researchers found that while depression and loneliness may negatively impact cognitive function, those effects may be buffered by individual, social, and family resources. "We found the more older adults talked about their concerns, the lower the likelihood they experienced depressive symptoms," Dong says. "Individuals who were frequently demanded upon or criticized were more likely to experience depressive symptoms."

The studies show that a well-connected community, active social life, and high acculturation are essential to improving older Chinese adults' health and lowering depression. Actively social individuals were found to participate more in preventative health screenings for diseases like cancer, while negative neighborhood conditions, such as crime or decrepit buildings, was shown to potentially increase the risk of self-neglect. "We also found that immigrants who had been in the United States longer were at higher risk of tooth symptoms, which shows that more studies are needed to better understand the relationship between acculturation and oral health in Chinese-American populations," Dong says.

Individuals who were employed and those who lived in rural areas reported a higher quality of life than those who did not work or lived in urban settings. The studies revealed that a higher perceived gap in acculturation between grandparents and grandchildren negatively impacted their relationships, which in turn could undermine the health and wellbeing of the older generation. "This tells us that acculturation should be looked at on a family level as well as an individual level," Dong says.

Family relationships and cultural backgrounds also factor in to end-of-life care, a complex concept in the Asian-American community, Dong says. "Our research indicates that a comprehensive end-of-life care plan should include cultural considerations and traditional family values in addition to physical, psychosocial and spiritual needs," he notes.

The studies revealed that traditional Chinese medicine is still widely used among Chinese older adults in the United States in conjunction with non-Western and Western forms of health care, especially with respect to preventive care.

"Health is multifaceted," Dong says. "These studies reinforce the idea that we cannot just look at the individual, but must take into account the person's social, community, national, and cultural contexts. More systematic and integrated approaches are needed to generate and translate knowledge in Asian populations in order to move the needle on health equity in our increasing diverse populations."

Source: Rutgers University-New Brunswick

PINE Study: Introduction
• "Achieving Health Equity in Asian Populations"

PINE Study: Psychological Wellbeing
• "The Association Between Filial Piety and Depressive Symptoms Among U.S. Chinese Older Adults"

• "The Association Between Personality and Loneliness: Findings From a Community-Dwelling Chinese Aging Population"

• "Support From Migrant Children and Depressive Symptoms Among Chinese Older Adults in Transnational Families"

• "Association Between Perceived Social Support and Depressive Symptoms Among Community-Dwelling Older Chinese Americans"

• "Loneliness, Depressive Symptoms, and Cognitive Functioning Among U.S. Chinese Older Adults"

• "Perceived Stress and Cognitive Functions Among Chinese Older Adults: The Moderating Role of Health Status"

PINE Study: Quality of Life
• "Defining Successful Aging: Perceptions From Elderly Chinese in Hawai'I"

• "What Matters Most at the End-of-Life for Chinese Americans?"

• "Employment and Life Satisfaction Among Middle- and Old-Aged Adults in China"

PINE Study: Community and Neighborhood
• "Exploring Relationships of Psychological Sense of Community With Self-Rated Health and Depressive Symptoms Among Older Chinese Americans"

• "Neighborhood Disorder Is Associated With Greater Risk for Self-Neglect Among Chinese American Older Adults: Findings From PINE Study"

PINE Study: Social Engagement
• "Activity Engagement and Cognitive Function: Findings From a Community-Dwelling U.S. Chinese Aging Population Study"

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

• "Social Engagement and Sense of Loneliness and Hopelessness: Findings From the PINE Study"

• "Acculturation and Activity Engagement Among Older Chinese Americans"

PINE Study: Acculturation
• "The Influence of Health Literacy and Acculturation on Cancer Screening Behaviors Among Older Chinese Americans"

• "Grandparent–Grandchild Relationships in Chinese Immigrant Families in Los Angeles: Roles of Acculturation and the Middle Generation"

• "Associations Between Acculturation and Oral Health Among Older Chinese Immigrants in the United States"

PINE Study: Traditional Chinese Medicine
• "The Association Between Musculoskeletal Symptoms and Traditional Chinese Medicine Use Among Chinese Older Adults in the Greater Chicago Area"

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