Older Korean Americans Research Articles

Exploring Levels and Correlates of Depression Literacy Among Older Korean Immigrants.

Despite the high prevalence of depression among older Korean Americans (KAs), there has been very little research on depression literacy among older KAs. This study identified specific areas of improvement in depression literacy to address mental health promotion among KAs. Twenty-two items on the depression literacy scale were grouped under five key themes: incidence and prognosis, differential symptoms, symptom recognition, non-pharmacological effectiveness, and pharmacological knowledge. This study aimed to assess the level of understanding depression literacy based on five domains and identify factors associated with depression literacy and its domains among older KAs. A cross-sectional study with 178 KAs aged 60 years and older was conducted in the Washington DC Metro area. Interviewer and self-administered questionnaires were used to collect data. Multiple linear regression analyses were conducted to identify factors associated with depression literacy and its domains. Statistical significance was set at p < .05 for analyses. Knowledge pertaining to all 5 depression literacy domains was low, particularly on pharmacological treatment and differential symptoms were noticeably low. The majority of participants had misconceptions about antidepressants. 86% believed that antidepressants can have a rapid effect on symptoms, 82.6% believed people with depression should stop taking antidepressants as soon as they feel better, and 66.3% believed antidepressants were addictive. Misperception about depression and antidepressants may be associated with poor mental health outcomes among older KAs. Culturally-tailored education for older KAs with limited English proficiency could be beneficial in promoting depression literacy and reducing stigma or misconceptions regarding depression and treatments.

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

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. 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. 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. 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.

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.

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.

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.

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

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

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.

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

ABSTRACT 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.

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.

The Vertical and Horizontal Relations of Korean and Korean American Older Adults and Their Well-Being

Various relationships are important for the well-being of older adults. This session focuses on the vertical and horizontal relations of Korean and Korean American older adults and their well-being. The purpose of this session is to highlight the importance of intergenerational relations and social involvement of Korean and Korean American older adults. For vertical relations, two studies focus on intergenerational relationships and solidarity. The first study investigated whether intergenerational relationships and social support mediate the distressing consequences of life events, and how this improved the psychological well-being of Korean older adults. The second study developed a standardized measurement tool for intergenerational solidarity because intergenerational conflicts caused by rapid socioeconomic changes have highlighted the importance of strengthening intergenerational solidarity. The third and fourth studies focus on horizontal relations involving social isolation and social involvement. Guided by the double jeopardy hypothesis, the third study examined the health risks posed by the coexistence of social and linguistic isolation in older Korean Americans. As the opposite of social isolation, social involvement was an important factor of social integration of older adults. The fourth study examined volunteering as an example of social involvement by focusing on older adults’ volunteering on the social integration and role identity. Implications of this study suggest not only the importance of social involvement but also the intergenerational relationships on older adults’ well-being.

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.

Recruitment and Retention in Diverse Cohorts: Lessons From Community-Engaged Efforts

Effective behavioral interventions and associated trials reflect the complexity and context of the communities with which they are tailored and the behaviors they seek to address. Community-engaged methodology can serve to capture these complexities, particularly when focusing on health inequities. Significant health and healthcare disparities persist among racial/ethnic minorities and representation of racial/ethnic minorities is lacking within trials that reflects the diversity of the U.S. population. Novel approaches are needed to increase the diversity of participants within behavioral intervention research. This symposium covers the unique barriers and facilitators related to recruitment and retention across a range of populations, including African American and Hispanic/LatinX older adults with hearing loss to diverse dementia family caregivers and community-dwelling Korean American older adults. Beyond the challenges and opportunities, the symposium will focus on effective recruitment strategies. The discussion will include 1) findings from 10 years of recruiting older Korean Americans into community-based trials, 2) lessons in tailoring recruitment efforts to dementia family caregivers, 3) the integration of human-centered design into a community-engaged hearing care intervention targeting low-income and African American older adults, 4) successful recruitment and retention efforts in a community-based participatory research trial in a borderlands community, and 5) the deployment of strategies to recruit Latino, Asian, and African American older adults with depression and anxiety in the setting of the COVID-19 pandemic. This symposium seeks to build the evidence related to recruitment of older racial/ethnic minorities in diverse settings, which is fundamental to addressing health inequities through behavioral intervention research.

Community-Engaged Strategies for Recruitment of Korean Americans in Community-Based Research Studies

With increasing numbers of researchers targeting ethnic minorities to address health disparities, it is important to address the unique needs of Korean American (KA) older adults—a “hard to reach” yet one of the most rapidly increasing ethnic and age groups in the nation. The purpose of this paper is to describe the main barriers to research participation and to identify facilitators for recruitment of older KAs. We have analyzed recruitment data pertaining to more than 10 community-based KA research studies we have conducted for the last ten years. There were a number of unique recruitment challenges in regard to the culture, language, and sociodemographic characteristics of the participants. Examples of effective recruitment strategies included: aligning the research agenda with the priorities of the community; establishing collaboration with ethnic churches and ethnic media; recruiting and training bilingual volunteers and community health workers; and placing liaison research staff in the community.

Cognitive health risks posed by social isolation and loneliness in older Korean Americans

AbstractBackgroundThis study examines associations among social isolation, loneliness, and cognitive health risks in older Korean Americans, focusing on the mediating role of loneliness in the relationship between social isolation and objective and subjective measures of cognitive impairment.MethodData are from 2,061 participants in the Study of Older Korean Americans, a multi‐state survey of Korean immigrants age 60 and older (M age = 73.2, SD = 7.93). Social isolation was indexed with the Lubben Social Network Scale−6; loneliness, with the short‐form UCLA Loneliness Scale. Objective and subjective measures of cognitive impairment included the Mini‐Mental State Examination and a single‐item self‐rating of cognitive health.ResultIn the logistic regression model for objective cognitive impairment, social isolation was significantly associated, but loneliness was not. In the model for subjective cognitive impairment, both social isolation and loneliness were significant factors. However, the effect of social isolation became non‐significant when loneliness was considered, suggesting a potential mediating role of loneliness. The subsequent mediation analysis confirmed that the indirect effect of social isolation on subjective cognitive impairment through loneliness was significant (B = .33, SE = .04, 95% CI = .24, .42).ConclusionOur analyses provide evidence for the proposed mediating effect of loneliness in the relationship between social isolation and subjective cognitive impairment. Intervention efforts should focus on reducing feelings of loneliness experienced by older immigrants, possibly by engaging them in socially meaningful and cognitively stimulating activities.

Factors Influencing Smoking Decisions Among Older Korean American Men: A Qualitative Study.

Cigarette smoking is highly prevalent among Korean American men. Although the nationwide anti-smoking efforts and American individualism-oriented cultural system seem to help some Korean American men stop smoking, many of them still smoke. Thus, it is necessary to understand factors influencing decisions to continue smoking or stop smoking among older Korean American men. We recruited a convenience sample of 24 Korean American men (12 current smokers, 12 former smokers) who were aged 55-79 years to participate in this qualitative study. Five focus groups and nine individual interviews were conducted. Thematic content analysis was used to analyze the qualitative data. Participants were older (mean age = 69 years) and have lived in the United States an average of 26 years. Average duration of smoking was 41 years among current smokers and 31 years among former smokers. Key themes influencing continuous smoking include stress relief, fear of side effects, difficulty stopping, smoking peers, and misbeliefs about lung cancer and smoking, whereas key themes for decisions to stop smoking include present health issues, family/physician/media recommendation, and smoking-restricted environments. This study reinforces the importance of culturally and age-relevant smoking cessation programs targeting smokers and their families. Future quantitative studies in different geographic areas can validate the study findings.

A comparison of the influencing factors of chronic pain and quality of life between older Koreans and Korean\u2013Americans with chronic pain: a correlational study

BackgroundChronic pain is one of the most common health problems for older adults worldwide and is likely to result in lower quality of life. Living in a different culture may also influence chronic pain and quality of life in older adults. The purpose of this study was to explore how multifaceted elements affect chronic pain and quality of life in older Koreans living in Korea and in older Korean–Americans (KAs) living in the USA.MethodsWe conducted a secondary data analysis of data from 270 adults aged 65 years or over (138 Koreans and 132 KAs). We compared the effects of multifaceted elements on pain and quality of life by testing structural equation models (SEMs) for each group, using a maximum likelihood estimation and bootstrapping.ResultsSEMs for both Korean and KAs showed that age and depressive symptoms directly affected quality of life. The number of comorbidities and depressive symptoms had mediating effects on quality of life through chronic pain in both groups. In older Koreans only, perceived financial status directly affected quality of life. In older KAs only, sleep quality indirectly affected quality of life through chronic pain.ConclusionThe data showed that multimorbidity and depressive symptoms play critical roles for explaining chronic pain in older Koreans and KAs and ultimately negatively influence quality of life. Future intervention program to improve quality of life in older adults with chronic pain should consider the different cultural aspects affecting quality of life for Koreans and KAs.

Bridging Potential in Friend Networks and Cognitive Function in Older Korean Americans.

To examine the associates of bridging potential in networks of friends and its impact on cognitive function in older Korean Americans. Data came from 308 participants in Central Florida who were part of the Study of Older Korean Americans (SOKA). Using data from a name generator of three close friends in local Korean communities, non-overlapping networks were quantified for bridging potential. Linear regression models for bridging potential and cognitive function were examined. Bridging potential was greater among those with stronger social ties with friends in general and higher levels of activity engagement. The direct benefit of bridging potential on cognitive function was also confirmed. In addition, bridging potential was found to mediate the effect of social ties with friends on cognitive function. Findings underscore the interconnectedness of older immigrants' social and cognitive function and shed light on interventions.

Health risks posed by social and linguistic isolation in older Korean Americans.

Inspired by the notion of double jeopardy positing the dual disadvantage in the coexistence of different sources of vulnerability, the present study examined health risks posed by social and linguistic isolation in older Korean Americans. A cross-sectional study, using a four-cell classification to compare isolation types (no isolation, social isolation only, linguistic isolation only, and dual isolation) and to examine their impacts on physical (self-rated health), mental (mental distress), and cognitive (cognitive performance) health. Data are from the Study of Older Korean Americans survey of Korean immigrants aged 60 or older (n=2032), conducted in five states in the United States (California, New York, Texas, Hawaii, and Florida). Social isolation was indexed by the Lubben Social Network Scale-6; linguistic isolation, by a question on English-speaking ability. Physical, mental, and cognitive health were indicated by a single-item self-rating of health, the Kessler Psychological Distress Scale 6, and the Mini-Mental State Examination, respectively. The dual-isolation group exhibited notable 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 in the no-isolation group. Our findings confirm that both social relationships and language proficiency are key elements for older immigrants' social connectedness and integration, the deprivation of which puts them at heightened risk in multiple dimensions of health.

Community leaders’ perceptions of depression and the perceived barriers in seeking mental health services for older Korean Americans

ABSTRACT Objectives This study explored community leaders’ understanding of depression among older Korean Americans and barriers to seeking mental health services. Depression is prevalent among older Korean Americans, but they are less likely to seek help from professionals and prefer to use informal methods. Older Korean Americans strongly prefer to maintain their ethnic traditions and use community service agencies provided by their same ethnicity. In this regard, community leaders who provide services for older adults play a significant role in not only advocating for the population but also in developing services and programs for their communities. Design In this qualitative study, 12 Korean community leaders who provide services for older adults were interviewed. Data were analyzed thematically, and Nvivo 12 was used to organize the data and to detect relevant themes. Results Findings showed that community leaders had an in-depth understanding of the causes of depression from environmental and cultural contexts including isolation, losing independence, cultural factors, and lack of family support. However, although the leaders were aware of the severity of depression among older Korean Americans, they did not understand biologically-based factors; rather, they considered it a natural part of aging. Findings indicated that they were biased towards older adults like older Korean Americans, attributing depressive symptoms to personality issues. They also heavily rely on personal experiences to understand depression instead of on having educational training. Barriers to getting help for older adults include lack of the perceived need of older adults, lack of professionals, and a prevalent stigma against depression that encourages individuals to hide their illness. Conclusions The findings indicated that community-based educational training is necessary to increase understanding of depression not only for the community leaders but also for individuals and families.

Community agency directors’ attitudes on depression treatment among older Korean Americans and barriers to providing services

Objectives: The purpose of this study is to explore Korean agency directors’ attitudes about depression treatment and their current efforts and barriers to providing services for older Korean Americans. Methods: Interviews were conducted with 11 agency directors, providing services from ethnic community centers and health care agencies. A constant comparative approach was applied to detect emerging themes. Results: Findings revealed that the agency directors had a negative attitude about using antidepressants and counseling. Based on these beliefs, they were less likely to recommend individuals with depression to use medical treatment or counseling; instead, they recommended informal ways of treating depression, including reliance on peers, family, and religious activities. A lack of educational training, funding, collaboration, and Korean-speaking professionals were perceived to be barriers to providing services. Discussion: Findings indicate the importance of educational training to increase understanding of depression treatment and to support the agency directors in offering services for older Korean Americans.