Older Korean Americans Research Articles

A perceived community typology in older Korean Americans: implications for mental health.

The aims of this study were to identify a community typology in older Korean Americans and to examine how the typology is associated with feelings of loneliness and mental distress. We hypothesized that distinct community groups would be identified and that they would be differentially associated with mental health and background characteristics. Data were drawn from a survey with older Korean Americans aged 60 and older, collected during 2017-2018 in diverse locations (n = 2138). To identify a community typology, a series of latent profile analyses (LPA) were conducted using 15 community-related variables in three domains (neighbourhood characteristics, social cohesion, ethnic attachment). Based on model evaluation criteria, an LPA model with five community groups was identified as the best fit. The five groups were identified as "safe/integrated" (10%), "safe/distant" (10%), "moderate integration" (38%), "marginal" (31%), and "vulnerable" (11%). After examining descriptive characteristics of the identified groups, regression models of loneliness and mental distress were estimated. Using the safe/integrated group as reference, the marginal and vulnerable groups were consistently associated with elevated feelings of loneliness and mental distress. The results suggest the need to understand community profiles and their relationships with health/well-being among older immigrants.

Health risks associated with urinary incontinence among older Korean Americans living in subsidized senior housing.

We examined the association of urinary incontinence (UI) with physical, mental, and social health among older Korean Americans living in subsidized senior housing. Data were obtained from surveys conducted in 2023 with older Korean Americans residing in subsidized senior housing in the Los Angeles area (n = 313). UI was measured using a question about the frequency of involuntary urine loss. Physical, mental, and social health risks were assessed with a single item for self-rated health (fair/poor rating), the Patient Health Questionnaire-9 (probable depression), and the Lubben Social Network Scale-6 (isolation from family and friends). Over half of the sample reported UI, with 46.3% experiencing it infrequently (i.e. seldom) and 10.3% frequently (i.e. sometimes or often). UI was significantly associated with physical and mental health indicators; the odds of reporting fair or poor health and having probable depression were 1.94-7.32 times higher among those with either infrequent or frequent UI compared to those without UI. While family isolation was not associated with UI, the odds of being isolated from friends were 2.85 times greater among those with frequent UI compared to those without UI. Our findings confirm the adverse impact of UI on physical and mental health and highlight its unique role in social health. UI-associated social isolation was significant only in relationships with friends, providing new insights into the distinction between isolation from family and friends. These findings enhance our understanding of the health risks associated with UI and inform strategies for health management and promotion within the senior housing context.

Falls as a mental health risk among Korean-American residents in subsidized senior housing: mediating effect of fall-related self-efficacy

Objectives The study examined the mediating role of fall-related self-efficacy in the association between falls and mental health among older Korean Americans living in subsidized senior housing in the greater Los Angeles area. We focused on serious fall incidents (i.e. multiple falls or any fall with a fracture) and used symptoms of depression and anxiety as indicators of mental health. Method Survey data from 315 participants (M age = 79.4 years) were used to examine the direct effects of serious fall incidents on mental health symptoms, as well as indirect effects through fall-related self-efficacy. Results The mediating effect of fall-related self-efficacy was found to be significant in both models for depressive symptoms (B [SE] = 0.15 [0.07], bias-corrected 95% CI = [0.03, 0.31]) and anxiety symptoms (B [SE] = 0.11 [0.05], bias-corrected 95% CI = [0.02, 0.23]). Conclusion The mental health impact of serious fall incidents was shaped by older individuals’ perceived concerns about falls and confidence in performance. The findings highlight the importance of addressing fall-related psychological responses in preventing falls and promoting mental health among senior housing residents.

Risk Factors for Elder Mistreatment Among Older Korean Americans.

Using data from a sample of older Korean Americans (n = 2,150), we examined the prevalence and associated factors of physical, emotional, and financial mistreatment. Given the importance of contextual factors, we examined the effect of immigration-related (years in the U.S. and acculturation) and interpersonal/community-related (family solidarity, social network, and ethnic community social cohesion) factors in addition to sociodemographic and health-related characteristics. The rate of experiencing physical, emotional, and financial mistreatment during the past year was 3%, 37.9%, and 16.1%, respectively. Younger age and lower family solidarity were common risk factors for emotional and financial mistreatment. The experience of emotional mistreatment was also more likely among females and those with higher level of acculturation, smaller social networks, and lower ethnic community social cohesion. Chronic disease was an additional risk factor for financial mistreatment. The findings suggest targeted prevention and intervention strategies for elder mistreatment.

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

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

Mental Health Impact of Bullying by Ethnic Peers in Senior Housing: A Study with Older Korean American Residents in the Greater Los Angeles Area

ABSTRACT Using data from Korean-American residents (N = 343) in subsidized senior housing in the Los Angeles area, we examined the effect of peer bullying on mental health. About 18% of the sample had been a target of bullying, and over 31% had witnessed someone being bullied. Being a target of bullying was a significant predictor for both depressive symptoms and anxiety, whereas witnessing other residents being bullied was a significant predictor for anxiety only. Findings shed light on the adverse mental health impacts of peer bullying among ethnic minority older residents in senior housing.

ANTI-ASIAN RACISM AMONG OLDER KOREAN AMERICANS DURING THE COVID-19 PANDEMIC

Abstract Background Hate crimes in the U.S. targeting adults of Asian descent have sharply increased during the COVID-19 pandemic. Korean Americans experience the highest level of everyday racism (37.5%), followed by Chinese (15.2%) and Vietnamese during the pandemic (Jung et al., 2021). Moreover, perceived discrimination in older Korean Americans is significantly related to a greater risk for poor mental health (Chau et al., 2018). However, older Korean Americans were likely to experience barriers to mental healthcare services. With this concern in mind, this study explored how older Korean Americans perceived discrimination related to ethnicity/race and coped with adverse mental health during the pandemic. Methods Our study used the thematic analysis of textual data to reconstruct and categorize, engaging in six steps: 1) familiarizing the qualitative data, 2) generating initial codes, 3) searching for themes, 4) reviewing themes, 5) defining and naming themes, and 6) producing a final report. Results This study identified that older Korean Americans (N=18) experienced direct and vicarious racism during the pandemic but felt barriers (limited English proficiency and a lack of accessible resources) to mental healthcare services. Active religious activities ameliorated discrimination-related stress. Some participants tried to solve the stress through wrong behaviors that criticized Chinese Americans. As a result, barriers to mental healthcare were likely to cause secondary discrimination and prejudice against Chinese Americans. Discussion To ameliorate adverse mental health and prevent secondary discrimination, it is essential to identify well-accepted, well-timed, sustainable, and cost-effective therapeutic strategies to alleviate the adverse mental health associated with discrimination-related stress.

A DYADIC ASSESSMENT OF COGNITIVE RESOURCES AND COGNITIVE FUNCTION AMONG OLDER KOREAN AMERICAN COUPLES

Abstract Individuals’ health and well-being are often shaped by significant others in their lives in that spousal relationships are particularly important. In dyadic studies among older couples, few studies have examined cognitive health as an outcome variable. Considering the lack of couple research on cognition especially among older immigrant population, the purpose of this study was to examine the cognitive function of community-dwelling older Korean American couples in the U.S. Data were drawn from a survey with older Korean Americans aged 60 and older, collected during 2017−2018 in multiple locations. Using a subset of 252 couples of the survey (individual N = 504), we examined the extent to which one’s cognitive function was associated with the cognitive resources (education, acculturation, friend network, and activity participation) of their own and of their spouse. The analyses with the Actor-Partner Interdependence Model showed the differences in the actor- and partner-effects between spouses. For husbands, acculturation was the only significant actor-level predictor to cognitive function. Wives’ cognitive function was associated with a wider array of their own cognitive resources, including education, friend network, and activity participation. The partner effect was only observed in education for husbands, indicating that wives’ higher education was beneficial for their husbands’ cognitive function. Further, the cognitive benefit of higher education was found to be maximized for husbands who also had greater levels of acculturation or activity participation. For practice implications, cognitive resources both in individual and spousal levels could help promote the cognitive health and well-being of older married couples.

TRANSCENDING BOUNDARIES AND BARRIERS: END-OF-LIFE CARE AND QUALITY OF LIFE FOR ASIAN POPULATIONS

Abstract End-of-life care and quality of life are critical issues for older Asian populations, as they face unique cultural, linguistic, and health-related challenges. This symposium will bring together scholars in this field to discuss the latest research and practices for improving end-of-life care planning and quality of life for older Asian populations. The symposium consists of four papers that focus on different Asian ethnic groups. Zhang and colleagues will use survey data to examine the barriers and sociocultural factors of advance care planning among older Chinese Americans. Xu will present a systematic review on non-medical factors that affect quality of life in the last year among older Chinese. Wang will compare the completion of advance directives and examine its psychosocial factors among older Vietnamese, Filipino, and Indonesian Americans. Using a case study of Somang Society, Lee will discuss how non-profit organizations can navigate social media to provide education and volunteer training to promote advance care planning and healthy aging for older Korean Americans. Collectively, these four papers compare the values, barriers, and resources related to end-of-life care between these groups and propose effective strategies for enhancing end-of-life care planning and quality of life for Asian communities. Findings will inform the development and adaptation of culturally sensitive interventions to promote end-of-life health outcomes for diverse Asian populations. Carrion, the discussant, will address the strengths and limitations of these papers and discuss their contribution to theories, practices, policies, and future research on end-of-life care for minority aging populations.

FACTORS INFLUENCING OLDER KOREAN AMERICAN IMMIGRANTS’ FRAILTY: A QUALITATIVE STUDY

Abstract The older immigrant population, characterized by unique attributes such as diverse cultural backgrounds, health beliefs, health behaviors, language barriers, and low health literacy, requires a specific focus on identifying factors that influence frailty. This study aims to explore the influencing factors of frailty among older Korean American immigrants (OKAIs) residing in suburban areas with limited Korean healthcare infrastructure. Semi-structured interviews were conducted with 9 OKAIs residing in Lee County, Alabama, focusing on four factors associated with frailty: health literacy, physical activity, diet, and mental health. Qualitative content analysis was employed to analyze the data. Validated assessment tools for frailty, health literacy, physical activity, nutrition, depression, and cognitive impairment were also used to gather participant characteristics and complement the qualitative findings. Participants exhibited significant differences in health literacy scores between the Korean and English versions. Content analysis yielded seven categories and twenty-two sub-categories were derived from the eighty identified codes. In addition to typical age-related changes observed among older adults in general, their social activities, health behaviors, and healthcare visits were constrained by different environments/healthcare systems compared to Korea, as well as limited English proficiency and healthcare resources. Participants expressed a need for Korean healthcare providers or interpreters during their healthcare visits and emphasized their preference for Korean food and sought ways to maintain vitality. To prevent and manage frailty among OKAIs, interventions need to consider their unique characteristics, facilitators, and barriers. This approach may also benefit other ethnic minority populations facing similar challenges, thus enhancing healthcare for these communities.

CLIMATE CHANGE, AIR POLLUTION, AND MENTAL HEALTH AMONG OLDER KOREAN AMERICAN RESIDENTS IN LOW-INCOME SENIOR HOUSING

Abstract Given the impact of climate change and air pollution on human health, the present study examined how older individuals’ perceived disruption by extreme weather and air pollution would be linked with mental health. We focused on older Korean Americans living in low-income senior housing and selected anxiety as an indicator of mental health. Data came from surveys with Korean American residents in five low-income senior housing facilities located in the Greater Los Angeles area (n=343, Mean age = 78.4). Anxiety, measured with the GAD-7, averaged 3.38 (SD = 3.77). Perceived levels of disruption caused by extreme weather and air pollution averaged 1.71 (SD = .69) and 1.75 (SD = .72), respectively, out of a range from 1 (not at all) and 4 (very much). Individuals who reported greater disruptions by extreme weather and air pollution had a higher level of anxiety. Given the high correlation between the two types of disruption (r = .56, p &amp;lt; .001), we tested separate regression models of anxiety. Each variable of the perceived disruption by extreme weather (β = .18, p &amp;lt; .001) and air pollution (β = .18, p &amp;lt; .001) was found to have a significant impact on anxiety. Although limited by the use of a small sample of convenience restricted to one ethnic group in one geographic location, our findings suggest the potential mental health impact of climate change and air pollution and call attention to intervention strategies.

MENTAL HEALTH RISKS SIGNIFIED BY THE CO-EXPERIENCE OF ELDER MISTREATMENT AND SOCIAL ISOLATION

Abstract Both elder mistreatment (EM) and social isolation are widely known to pose a significant risk to mental health of older individuals. Despite the general agreement that EM should be addressed in consideration of social contexts, there has been limited attention to the potential harm of the co-experience of EM and social isolation. The issue is of particular concern in older Asian immigrants. Using a sample of older Korean Americans (N = 2,150, Mean age = 73.4), we examined the direct and interactive effect of EM and social isolation on mental distress. In a measure including psychological, physical, and financial mistreatment, 32% reported a single EM exposure and 12% multiple EM exposure in the past year. The rate of social isolation, measured with Lubben Social Network Scale-6, was 24%. About 30% were in the category of mental distress measured with Kessler 6. The direct effects of a single EM or multiple EM exposure in reference to no EM and social isolation were significant. In addition, the interaction between multiple EM exposure and social isolation was significant. The odds of mental distress associated with multiple EM exposure were substantially higher when experienced in social isolation (OR = 7.23, [CI: 3.65, 14.3]) than in non-isolation (OR = 2.68, [CI: 1.66, 4.32]). Findings suggest the signified mental health risk of the co-experience of EM and social isolation and call attention to those who might silently suffer from EM in isolation. Comprehensive interventions that encompass both preventive measures and targeted support systems are in need.

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.

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

Abstract 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.

UNDERSTANDING SOCIAL AND CULTURAL DIVERSITIES AND AGING FOR HEALTH AND WELL-BEING IN KOREAN AND KOREAN AMERICANS

Abstract Guided by the socio-ecological model and the cultural diversity perspective, this symposium aims to enhance the understanding of critical issues in health and well-being among Koreans and Korean Americans with three primary focuses: aging, social-ecological and multilevel factors, and identifying social and cultural contexts. Five studies examined multilevel factors—individual, relational/interpersonal, community, and societal—that are associated with health and well-being, conducted in Korea as well as in the United States. Study 1 examined psychological well-being among older Koreans, specifically its association with intergenerational relationships and social support using longitudinal multilevel modeling to estimate depression trajectories. Study 2 examined childhood experiences and midlife cultural engagement associations among middle-aged Korean couples, considering the influences of their spouses’ experiences and cultural resources. Study 3 explored the experiences of the nature-based virtual reality program among older Korean Americans, using in-depth interviews and providing an innovative approach using technology as a therapeutic tool. Study 4 examined social determinants of health associated with Korean American immigrants’ willingness for end-of-life discussions and the factors affecting willingness (awareness of hospice, communication with family/doctors, and social isolation). Study 5 examined health insurance coverage and its association with immigration-related factors (English proficiency, generational status, and age at immigration) among Korean Americans using national data. The various health, mental health, and well-being issues in Koreans and Korean Americans will be discussed from contextually responsive approaches. This symposium will provide implications for practices, education, research, and policy to promote health, mental health, and well-being in the Korean and Korean American populations.

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

Abstract 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 &amp;lt; .05) and with negative interaction (B [SE] = -.01 [.01]. p &amp;lt; .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.

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

Abstract 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 &amp;lt; .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.

MOBILE-BASED MULTIDOMAIN LIFESTYLE INTERVENTION AND HEALTH PROMOTION IN OLDER KOREAN AMERICANS

Abstract Prior studies have suggested that the nature-based virtual reality (VR) program serves as a therapeutic tool to increase health and wellbeing among older adults. While much research on virtual reality indicates their health benefits among older adults, there are research gaps in the current literature on the nature-based VR experiences of older Korean Americans. The objective of this study was to gather preliminary information on the health outcomes of the program as well as challenges to participation. Based on in-depth interviews with five participants, three main salient themes as positive outcomes emerged: (a) enjoyment, (b) stress reduction, and (c) cognitive function. On the other hand, there were three main challenges that participants experienced: (a) challenges in the immersion experience itself, (b) difficulties with the controllers, and (c) cybersickness. This finding suggests that the nature-based virtual reality program can serve older immigrant population as a therapeutic tool to increase their mental and cognitive health.

INTEGRATION OF DIGITAL TECHNOLOGY IN RESEARCH INVOLVING OLDER ADULTS: LESSONS FROM COMMUNITY-BASED TRIALS

Abstract Working with study participants in community-based clinical trials during COVID-19 pandemic has created diverse challenges to study teams. Globally, COVID-related restrictions were implemented including country-wide lockdowns and social distancing, and study teams had to quickly adjust their study protocols to work in a virtual environment. Meeting virtually for recruitment activities or intervention delivery may be particularly challenging when the target group is older adults—one of the vulnerable populations to experience the digital divide due to limited digital access and limited digital literacyThis symposium covers the lessons learned related to use of digital technology in participant recruitment and intervention delivery across a range of populations, including community-dwelling Korean American older adults to African American older women living with pain and low mood, caregivers of persons living with heart failure, and low-income cancer survivors with multiple chronic conditions. The discussion will include 1) findings from screening over 1,000 older Korean Americans to enroll them into a multi-site community-based trial, 2) lessons in diversifying intervention delivery methods to African American older women, 3) the integration of virtual modality into a self-care and social support intervention for caregivers of persons with heart failure, and 4) the deployment of mHealth to deliver a home-based exercise program to ethnically diverse low-income cancer survivors with co-morbid conditions in the setting of the COVID-19 pandemic. This symposium seeks to build the evidence related to recruitment and intervention delivery targeting diverse groups of older adults in community settings using technology by sharing common challenges, experiences, and opportunities.

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.