Elderly Chinese Americans Research Articles

"At the End I Have a Say": Engaging the Chinese Community in Advance Care Planning.

Despite the association of advance care planning (ACP) with improved patient and caregiver outcomes, Chinese American elders have low rates of ACP. Assess ACP facilitators/barriers in the San Francisco (SF) Chinese community and codesign, implement, and test community-based ACP-promoting pilot events. A Chinese Community Committee (N=19 community-based organization leaders, health system representatives, community members) conducted focus groups in Cantonese and English with Chinese older adults (age ≥55), caregivers, and community leaders. The Committee designed and implemented pilot events in-person and online. We analyzed focus group data using thematic analysis; assessed pre-to-post-event readiness to engage in ACP (validated survey; 14 scale, 4=most ready); and assessed event acceptability. A total of 34 people participated in six focus groups. Themes described Chinese community-specific importance of ACP (e.g., reduces family burden), barriers (e.g., younger generations lack tools to discuss ACP with elders and vice versa), and facilitators (e.g., intergenerational events, culturally/linguistically appropriate materials). Based on focus groups findings, the Committee developed a novel ACP tool and designed intergenerational events. A total of 195 participants attended 10 events; 95% were Chinese, 90% spoke Chinese languages, 80% were women. ACP readiness increased significantly (1.66 [SD 0.84] vs. 2.03 [SD 0.85]; P < 0.001); 94% of participants were comfortable attending and 96% would recommend events. Community-developed intergenerational events that highlight the value of ACP and address barriers are acceptable and increase ACP engagement in the Chinese community.

Financial Maltreatment of Chinese American Elders: An Inquiry through a Cultural Lens

ABSTRACT This study examined financial maltreatment from the perspectives of Chinese American elders via a mixed method approach. Three focus groups of Chinese American elders and one group of service professionals recruited from Phoenix metropolitan areas shared their insights of financial maltreatment and contributed to the refinement of questions in the followed survey that included 325 elders (Mage = 75.6, SD = 7.00). Two types of financial maltreatment: Financial exploitation and financial neglect were identified from focus group discussions. About 9.2% experienced financial exploitation and 1.5% experienced financial neglect. Both financial exploitation and neglect were related to higher vulnerability scores for abuse assessed using the H-S/EAST elder abuse screening scale. Financial maltreatment needs to be understood in legal, cultural, and family contexts, incorporating the perspectives of older adults. Prevention of financial maltreatment hinges on increased awareness and knowledge of this issue among elders, families and service professionals, and the collaborative efforts of stakeholders from ethnic communities.

Grandparenting and the Receipt of Filial Piety From Adult Children in Chinese American Families

The current study explores the association between grandparent caregiving by Chinese American elders and their perceived receipt of filial support from their adult children, called filial piety (xiao). Many studies find a correlation between grandparent caregiving and filial behaviors from their adult children, which is notably higher among minority families, especially among Asians than among white families, stimulated by the norm of reciprocity, familism, and extended kinship. Drawing from the theory of intergenerational relationships, social exchange theory, and the role theory, this study questions whether a more active engagement in grandparenting renders higher levels of filial piety returns from adult children. It uses the PINE data, a survey on the wellbeing of Chinese American elders in Chicago. The results show that more hours of grandparent caregiving relate to higher returns of filial piety perceived by older parents. Correspondingly, though with a marginal significance, more pressures to take care of a grandchild from adult children reduce the elders’ perception of filial piety receipt. No interaction effect is found between the grandparenting hours and the pressure from adult children. Additionally, Chinese American elders possessing higher levels of education, mastery, and longer stays in the US perceive lower levels of filial piety receipt from adult children. Discussion will focus on how grandparent caregiving can be mutually beneficial and strengthen intergenerational relationships among Chinese American families.

Symptoms and Management Strategies for Older Chinese Adults with End Stage Renal Disease (ESRD) and Other Chronic Conditions (GP792)

• Name common, bothersome symptoms symptoms in adult Chinese-American ESRD patients.• Identify strategies reported by adult Chinese-American ESRD patients to ameliorate the identified symptoms. Over $50 billion is spent on elderly patients with chronic kidney disease in the United States; with 1.5 times higher incidence of end stage renal disease (ESRD) in Asian Americans compared to Caucasians, there is a dire need to improve self-care and symptom management studies for this population. ESRD patients typically have a very short life expectancy and do not qualify for hospice benefits while they remain on dialysis or transplant lists. There are calls to strengthen palliative care for ESRD patients to help decrease distressing symptoms. Chinese-American patients have low use of both hospice and palliative care and may withdraw from hospice even when enrolled, resulting in few Chinese-American patients receiving the benefits of palliative care. To identify common, bothersome symptoms and strategies used to ameliorate these symptoms in adult Chinese-American ESRD patients. Using purposive sampling, elderly Chinese-Americans were surveyed for commonly occurring symptoms using standardized instruments and open-ended questions to identify strategies used to ameliorate those symptoms. Thirty Chinese-American participants were recruited with an average age of 80 (SD =13.08). They scored higher-than-average for constipation and lower than average for quality of life (QoL) measures. There were statistically significant higher levels of nausea and vomiting in those with ESRD and diabetes (p = 0.042), pruritus in those who also had heart disease and ESRD (p = 0.002), and fatigue for those with ESRD and arthritis compared to those without (p = 0.048). Strategies were reported for 8 common symptoms: fatigue, pain, sleep disturbance, dyspnea, anxiety, nausea and vomiting, constipation and pruritus. On average, participants reported fewer symptoms compared to the general population but scored lower for QoL. Further exploration is needed to understand this phenomenon and to validate the reported amelioration strategies.

Perceived threat of Alzheimer's disease and related dementias among older Chinese Americans in subsidized housing: Through a cultural lens.

Low socioeconomic status and limited social support may put older residents in subsidized housing at high risk for developing fears of Alzheimer's disease or related dementias. This study examined the perceived threat of Alzheimer's disease or related dementias among older Chinese Americans in subsidized housing facilities in Phoenix, Arizona of the United States, and focused on the effect of cultural beliefs (i.e., beliefs toward Alzheimer's disease or related dementias, and beliefs toward intergenerational support) on the perceived threat of Alzheimer's disease or related dementias. Analyses were based upon a survey of 207 Chinese American older adults (Mage = 75.37, SD = 7.47) living in subsidized housing facilities in the Phoenix metropolitan area. Standardized survey questionnaires were delivered through face-to-face interviews. Multivariate analyses suggest that fatalism related beliefs about Alzheimer's disease or related dementias, rather than stigmatization, were related to higher levels of concerns for developing Alzheimer's disease or related dementias, while beliefs in intergenerational support were related to lower levels of perceived threat of Alzheimer's disease or related dementias. However, the protective effect of beliefs in intergenerational support tended to diminish in those living with higher levels of depressive symptoms. Cultural beliefs can entail both risks and strengths when low-income Chinese American elders attempt to comprehend the implications of Alzheimer's disease or related dementias. Health education or intervention programs need to address their fatalism beliefs toward Alzheimer's disease or related dementias, and facilitate the accessibility of intergenerational support for this group.

Cognitive test battery for evaluating elderly Chinese Americans.

Data from a pilot study at the Mount Sinai Alzheimer's Disease Research Center was examined. All participants were &gt; 65 years old, primarily Chinese speaking, with adequate sensorimotor capacity to complete cognitive tests. A research diagnosis of normal mild cognitive impairment (MCI) or Alzheimer's disease (AD) was assigned to each participant in consensus conference. Composite scores were created to summarize test performance on overall cognition, memory, attention executive function, and language. Multivariable logistic regression models were used to assess the sensitivity of each cognitive domain for discriminating three diagnostic categories. Adjustment was made for demographic variables (i. e., age, gender, education, primary language, and years living in the USA). The sample included 67 normal, 37 MCI, and 12 AD participants. Performance in overall cognition, memory, and attention executive function was significantly worse in AD than in MCI, and performance in MCI was worse than in normal controls. Language performance followed a similar pattern, but differences did not achieve statistical significance among the three diagnostic groups. This study highlights the need for cognitive assessment in elderly Chinese immigrants.

Caring for Chinese-American Home Care Patients.

Chinese-Americans are the largest group of Asian Americans. Home care providers in the United States will encounter patients with various levels of traditional Chinese lifestyles, cultural expressions, and health practices. A description of how to prepare for and conduct a home care visit with a patient from China is described. This article integrates recent research about Chinese-American elders and basics of Chinese culture to assist healthcare clinicians in providing supportive, culturally sensitive home care for Chinese patients and developing rapport and trust with them.

BEIJING VERSION OF THE MONTREAL COGNITIVE ASSESSMENT FOR ELDERLY CHINESE AMERICANS

The Beijing version of Montreal Cognitive Assessment (B-MoCA) was originally developed for Mandarin speakers but can also be used for Cantonese speakers. Our study aimed to evaluate the capability of B-MoCA in identifying elderly U.S. Chinese participants with Mild Cognitive Impairment (MCI) or dementia. We administered the B-MoCA test to 86 elderly Chinese Americans during a standard dementia evaluation as part of a clinical study at the Mount Sinai Alzheimer’s Disease Research Center (MSADRC). All participants were primarily Chinese speaking and ≥ 65 years old. Clinical diagnoses of Normal Control (NC), MCI, and dementia were made by clinicians, who were blinded to the B-MoCA scores, using criterion sheets developed at the MSADRC. The effects of diagnostic categories (NC, MCI, and dementia) and education levels (I: 0-8 years, II: 9-12 years, and III: 13-20 years) on the total B-MoCA scores were investigated by analysis of covariance (ANCOVA); age was treated as a covariate. The sensitivity and specificity of B-MoCA were assessed for detection of MCI or dementia. Our study recruited 52 Mandarin-speaking and 34 Cantonese-speaking participants, with average age of 73.70±6.16 years old and education of 12.92±4.65 years. 48 participants were diagnosed as NC, 27 with MCI, and 11 with dementia. The mean ages were comparable between three groups. Participants in the NC group tended to have higher education than participants in other two diagnostic groups. The B-MoCA scores for the NC, MCI, and dementia groups were 24.58±3.221, 20.04±3.579, and 15.11±5.840, respectively. The average age for participants in level I education group was older than the other two levels (II and III), and the mean B-MoCA score of participants in level I education group was 3.21 and 5.45 lower than those in level II and II groups, respectively. The ANCOVA showed that education and diagnostic categories had a major impact on the B-MoCA scores, even after adjusted for age. With a cut-off score of 26, the B-MoCA can detect MCI or dementia with a sensitivity of 47.9%, and a specificity of 97.2%. The B-MoCA is a useful neuropsychological tool for identifying elderly Chinese Americans with MCI or dementia.

Association between recognizing dementia as a mental illness and dementia knowledge among elderly Chinese Americans.

To investigate whether older Chinese Americans perceive dementia as a mental illness and the relationship between such perception and their general understanding of dementia remains unclear. Our study aims to understand this relationship and its future implication on improving dementia literacy among ethnic minorities. Elderly Chinese American participants from the Greater Los Angeles were asked to complete an 11-item dementia questionnaire, following a community health seminar. Cross-sectional survey data was analyzed using standard statistical methods. The questionnaire received an 88.3% response rate. Among 316 responders, only 28.8% (n = 91) of elderly Chinese Americans identified dementia as a mental illness, and 71.2% (n = 225) did not recognize its mental disease origin. Furthermore, in comparison between these two groups, the first group demonstrated significantly higher level of baseline knowledge of the disease. This study reveals that only approximately 1 out of 4 older Chinese Americans recognized dementia as a mental illness, consistent with previous studies on Asian Americans. Our study however showed that when dementia was being perceived as a mental illness, such perception was associated with a higher level of baseline dementia understanding. The current study suggested the potential of improving older Chinese Americans dementia literacy by increasing awareness of its mental illness origin.

Knowledge of advance directive and perceptions of end-of-life care in Chinese-American elders: The role of acculturation.

This study aimed to describe knowledge of an advance directive (AD) and preferences regarding end-of-life (EoL) care communication, decision making, and designation of surrogates in Chinese-American elders and to examine the role of acculturation variables in AD awareness. Survey data were collected through face-to-face interviews on a sample of 385 Chinese-American elders aged 55 or above living in the Phoenix metropolitan area. The choice of language (Mandarin, Cantonese, or English) and place of interview (senior apartments, Chinese senior centers, or homes) was at the respondent's preference. Hierarchical logistic regression analysis was employed to examine the influence of acculturation variables on AD awareness. Some 21% of participants had heard about ADs, and only 10% had completed one. Elders with higher acculturation levels (OR = 1.04, p < 0.10) and those residing more than 20 years in the United States (OR = 6.87, p < 0.01) were more likely to be aware of ADs after controlling for the effects of demographics, health, and experiences of EoL care. The majority preferred physicians to initiate AD discussions (84.9%) and identified burdens on families as the most important factor in making EoL decisions (89.3%). About 55.1 % considered daughters as the preferred healthcare surrogate. Acculturation levels influence awareness of an AD, and family values are crucial in EoL care decision making. Cultural factors should be considered in designing and delivering appropriate programs to promote knowledge of EoL care among Chinese-American elders and their families.

Levels and correlates of knowledge about Alzheimer's disease among older Chinese Americans.

This study examined knowledge of Alzheimer's disease (AD) and correlates of AD knowledge in a sample of Chinese American older adults living in the Phoenix metropolitan area of the United States. Survey data were collected from 385 Chinese Americans age 55 or older (M = 72.43, SD = 8.67) recruited from various settings not limited to senior housing facilities, senior clubs, senior centers and church groups. Participants responded to a 24-item true/false AD knowledge scale with 73 % accuracy. Multivariate regression analyses found that participants who held more traditional Chinese cultural beliefs of AD tended to have less AD knowledge. Older women had more knowledge of AD than men when educational differences were controlled. Participants who used media to acquire AD information had more AD knowledge than those did not. AD educational programs should target domains (e.g., risk factors, symptoms, and caregiving) about which Chinese American elders tend to have less knowledge; AD information should be disseminated through appropriate media to outreach Chinese American elders more effectively. Addressing the biases in elders' cultural beliefs of AD should be incorporated in AD educational programs.

The evaluation of a culturally appropriate, community-based lifestyle intervention program for elderly Chinese immigrants with chronic diseases: a pilot study

The 'Healthy Habits Program' is a 6-month community-based program, which offers exercise facilities, training and weekly health education group to underserved elderly Chinese Americans with chronic medical diseases in their native languages. This pilot study evaluates the acceptability and the health effects of the 'Healthy Habits Program'. Ninety-nine subjects participated in the 'Healthy Habits Program' in 2011. Before and after the program, the participants were assessed in their physical and mental health using various fitness tests as well as measures of disability and psychological functioning. Participants provided overwhelmingly positive feedback on the program, which was associated with significant improvements in physical and mental health including a significant decrease in body mass index (BMI), blood pressure and increase in stamina. The participants reported lower mean scores on the Patient Health Questionnaire-9 item Scale (PHQ-9), indicating improved psychological well-being. These promising pilot study results from this lifestyle intervention program for elderly Chinese American immigrants with chronic diseases inform the design of a more definitive trial using a randomized design and larger sample size.

Honoring the Patient and the Family: When the Family Refuses DNR

As a house call doctor in New York City caring for homebound, frail Chinese elders,1 I've had the opportunity of getting to know patients in the context of their homes and establish long-term relationships with them. Naturally, because elder care in the Chinese culture is often a family responsibility, I also work closely with family members and hired caregivers. But what I found most rewarding was being able to bring my Chinese patients and their families closer together through a series of conversations relating to the patients' goals of care and end-of-life wishes. Despite the common belief that bringing up taboo topics such as and dying could spell trouble, I have found that such exploratory conversations are often welcomed by both parties. When the health care provider initiates such conversations, patients are given permission formally to share their wishes. For family members, such conversations have helped to reduce the emotional burden related to knowing what their elder would have wanted. Knowing the patient's wishes can thus help to minimize conflict within the family. Experience has taught me that many elders, including Chinese elders, are often not afraid to discuss their end-of-life wishes. Many chronically ill elders have already begun to focus on different goals of care, that is, to focus more on improving quality of life (e.g., improving home safety, mobility, nutrition, pain control), and to focus less on prolonging life (e.g., cancer screening, and curative treatments for cancer). In one study, Chinese American elders were more likely than non-Chinese American elders to have no fear in discussing attitudes concerning death (92% vs. 78%; Crain, 1996). In a Hong Kong study involving nursing home elders, six out of eight declined cardiopulmonary resuscitation (CPR). Elders who declined CPR refused it because they had achieved a good age, wanted to avoid suffering, wanted to avoid burdening the family, and accepted their fate. One Chinese elder expressed that the discussion with the doctor relieved burden (Chu & Woo, 2004). Medical training has taught me the importance of patient autonomy-all patients have the right to make their medical decisions, including advance directives. Working with patients of different ethnic backgrounds, however, has taught me that there is more than one approach to such discussions. In the traditional Chinese culture, caregiving of elders is considered a family responsibility and a moral obligation. The term filial piety refers to the concept where the elder parents are protected from harm. For this reason, family members have legitimate decision-making authority even if the patient is fully competent. As health care providers, we are naturally patient advocates; but we must be advocates in the context of culture. MR. CHAN One of my more challenging discussions regarding advance directives involved Mr. Chan (not his real name), a 90-year-old Chinese man living in a 5-floor walk-up apartment in Chinatown, New York City. Mr. Chan had emigrated from Hong Kong in the 1960s with his wife and three sons. He worked as a chef until retirement. Mr. Chan had many chronic medical conditions, including hearing loss and near blindness because of cataracts. He had been living in the same apartment for more than 40 years and had been living alone since his wife's death 15 years ago. When I first met Mr. Chan in 2004, he had already been homebound for a year because of generalized weakness and poor vision. He had a home attendant (Medicaid-funded) who was available for only 3 hours daily to tend to his needs. Mr. Chan was found to have high blood pressure, chronic cough, and was significantly underweight. At 5 feet 8 inches, he only weighed 110 lb. Having smoked cigarettes for many years, I was concerned that he had cancer. Mr. Chan didn't mind getting a chest X-ray at home and willingly took blood pressure medications. He happily accepted more home attendant hours and an order of Ensure drinks. …

The Influence of Eastern Philosophy on Elder Care by Chinese Americans

Chinese philosophy has been a major cornerstone of Chinese culture for millennia and has bestowed on the world traditions such as Taoism, Yin and Yang, and filial piety. Although these beliefs have remained steadfast over thousands of years, their ability to survive unchanged in the future is uncertain. As the world forges ahead into the 21st century, several pertinent questions arise: Will age-old axioms, primarily those concerning elderly Chinese and their relationship with their children, survive? When ancient, traditional beliefs conflict with newer, Western ideas, which system of thought is likely to be the victor? Moreover, will elderly Chinese Americans and their perceptions concerning long-term care facilities cause problems with the traditional familial unit? This article will discuss these issues in detail.

Gender, Widowhood, and Living Arrangement among Non-married Chinese Elders in the United States

This article examines the effects of gender and widowhood on the living arrangements of older Chinese American men and women. This study uses data from the 2006 American Community Survey (ACS). Combining the individual and household ASC files, 1,022 non-married Chinese American elders age 65 and older were included in the study. A multinomial logistic regression model was tested, stratified by gender. Widowhood was associated with differential living patterns for men and women. Spoken English ability, financial resources, health condition age resulted in divergent living arrangement patterns by gender. The findings suggest that older unmarried Chinese Americans are subject to a host of health and psychosocial risks that are compounded by their marital status, and point to the importance of identifying vulnerable elders who are in need of psychosocial services and to mediate physical and mental health risks among this population.

Body Mass Index and Cultural Food Practices Predicting Dietary Adequacy of Elderly Chinese Americans in South Florida Using Structural Equation Modeling

Body Mass Index and Cultural Food Practices Predicting Dietary Adequacy of Elderly Chinese Americans in South Florida Using Structural Equation Modeling

Antihypertensive Medication Adherence Among Elderly Chinese Americans

This study explored the level of antihypertensive medication adherence and examined certain demographic attributes and influential factors in relation to antihypertensive medication nonadherence among Chinese American elders using a descriptive cross-sectional survey design. Findings revealed that 52% of the elderly Chinese Americans adhered to their antihypertensive medications. Gender, education, years of residency in the United States, years of diagnosed hypertension, and perceived safety of taking antihypertensive medications did not contribute to the differences in medication adherence. Forgetfulness, medication adverse effects, language difficulties, and cultural barriers were the influential factors that hinder antihypertensive medication adherence. Developing effective and culturally appropriate strategies for Chinese American elders is recommended.

Increasing mental health awareness and appropriate service use in older Chinese Americans: A pilot intervention

Objective This study evaluated the effectiveness of a community intervention in increasing awareness of mental health issues and available resources among elderly Chinese Americans. Methods Twenty-seven members of a community church received a 1-h didactic presentation, in English and Mandarin, and completed surveys regarding their help-seeking preferences before and after the intervention. Results were analyzed using a series of Wilcoxon matched-pair signed rank tests and comparing pre- and post-test scores. Results Findings indicated an increase ( p < .05) in intention to consult a mental health professional for psychiatric symptoms at post-test. A significant increase also was found in preference for consulting a physician for physical symptoms. Conclusion The pilot educational intervention increased awareness of mental health and treatment issues and the role of mental health professionals, lending support to evaluate the intervention on a larger scale. Practice implications Greater awareness of mental health among Chinese Americans can be promoted via education forums provided through faith-based organizations. Stigma of mental illness leads many Chinese individuals to seek help for psychiatric problems from primary care physicians. Integrating mental health practitioners in primary care settings may help decrease stigma and encourage appropriate help-seeking behavior.

The effects of age, gender, obesity, health habits, and vegetable consumption frequency on hypertension in elderly Chinese Americans

The purpose of this study was to assess the effects of age, gender, obesity, consumption frequency of selected vegetables, alcohol consumption, cigarette smoking, and tea consumption on the prevalence rate (PR) of hypertension in elderly Chinese Americans. Hypertension is defined as having a systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥140 mm Hg and ≥90 mm Hg, respectively. A total of 205 subjects were recruited in the Chinatown section of Los Angeles, CA. Hypertension was more prevalent in the oldest age groups for both sexes (45.1%), and the percentage of hypertension for men was lower than those of female counterparts (47% vs. 53%, respectively). The percentage of lean (body mass index [BMI] < 25 kg/m 2) hypertensive subjects was higher than those of obese (BMI > 27 kg/m 2) hypertensive subjects in group 1 (50-64 years), group 2 (65-74 years), and group 3 (≥75 years) (32%, 24%, and 26%; vs. 3%, 11%, and 13%, respectively). The overall percentage of obese hypertensive subjects was higher in women than those of their male counterparts (13% vs. 6%, respectively) and increased substantially with age as well. In conclusion, age and gender (particularly in lean men and obese women), were the greater risk factors for the development of hypertension.

Health-seeking behaviors of elderly Chinese Americans: shifts in expectations.

This study reported a qualitative analysis of health-seeking behaviors of community-dwelling elderly Chinese Americans on the influences of family network, cultural values, and immigrant experience in their use of health resources. Barriers to health care, pathway of health care, and adaptation of health care by use of self-treatment and Eastern and Western medicines were also examined. The investigators used content analysis to obtain themes and key points of focus group interview data (N = 25) to explore the elderly participants' attitudes, values, and practices in their use of health resources. Survey questionnaires in Chinese were used to compile demographic data. Findings suggested a shift from traditional expectations of filial piety to more dependence on neighbors and friends, and a genuine adaptability to combining Eastern and Western health care modalities. Immigration was not proposed by these Chinese elders as an explanation of shifts in expectations for family support or values. This study has implications for research, service delivery, and policy making for health care of ethnic elderly persons, particularly in addressing structural and cultural issues in access and compliance.