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Li, Chien-Ching, Alicia Matthews, and XinQi Dong. "Psychological Distress Among Older LGBT and Non-LGBT Asian Americans: The Influence of Minority Stress." Innovation in Aging 4, Supplement_1 (December 1, 2020): 624. http://dx.doi.org/10.1093/geroni/igaa057.2125.
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Abstract Emerging data from epidemiological studies have confirmed elevated prevalence rates for mental health conditions among the lesbian, gay, bisexual and transgender (LGBT) populations. An estimated 2.8% of Asian Americans identify as LGBT and 26% of Asian LGBT are 40 years or older. This study analyzed the California Health Interview Survey to examine differences in psychological distress between LGBT and non-LGBT older Asian Americans, and further evaluated the role of discrimination in medical care and intimate violence on psychological distress. Regression results showed older LGBT Asians had a higher psychological distress score compared to non-LGBT Asians. After adjusting for discrimination or violence, this association no longer existed. Experiencing discrimination in medical care and intimate violence were associated with higher levels of psychological stress. This study increases our knowledge of mental health among older Asian LGBT, enhancing our ability to design culturally-targeted and trauma-informed psychosocial interventions to improve outcomes in this population.
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Dong, XinQi, Melissa Simon, and Bei Wu. "Stress, Trauma, and Resilience Among U.S. Asian Older Adults: Findings From the Rutgers Asian RCMAR." Innovation in Aging 4, Supplement_1 (December 1, 2020): 623–24. http://dx.doi.org/10.1093/geroni/igaa057.2124.
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Abstract U.S. Asians are the fastest growing group of older adults in the nation, increasing by 68% from 2000-2018. However, research on the psychological wellbeing of this population is limited. Drawing on the research of Rutgers Asian RCMAR Scientists, this symposium will address the impacts of stress, trauma and resilience on the psychological wellbeing of diverse groups of U.S. Asian older adults. Session 1 will assess the prevalence of psychological distress among older LGBT and non-LGBT U.S. Asian older adults, and the role of discrimination in medical care and intimate violence on psychological distress. Session 2 will take a mixed-methods approach to examining caregiver burden and depressive symptoms of Chinese American spouses and adult-children who provided care for their spouse or parents with dementia. Session 3 will explore the risk and protective factors for the mental health of sexual minority U.S. Asian older adults using data from the Research Program on Genes, Environment and Health. Session 4 will identify different patterns of coping repertoires of older immigrants, based on a combination of individual, family, and community coping resources, and the optimal coping repertoire that is associated with the best psychological outcomes. In summation, this symposium describes the psychological wellbeing of diverse groups of U.S. Asian older adults, including sexual minority, caregiver and immigrant groups. The symposium addresses both risk factors and the protective factors and coping mechanisms that mediate and mitigate psychological wellbeing and aims to inform interventions to improve psychological wellbeing outcomes in U.S. Asian older adults.
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Enger, Shelley M., Soe Soe Thwin, Diana S. M. Buist, Terry Field, Floyd Frost, Ann M. Geiger, Timothy L. Lash, et al. "Breast Cancer Treatment of Older Women in Integrated Health Care Settings." Journal of Clinical Oncology 24, no. 27 (September 20, 2006): 4377–83. http://dx.doi.org/10.1200/jco.2006.06.3065.
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Purpose A substantial literature describes age-dependent variations in breast cancer treatment, showing that older women are less likely to receive standard treatment than younger women. We sought to identify patient and tumor characteristics associated with the nonreceipt of standard primary tumor and systemic adjuvant therapies. Patients and Methods We studied 1,859 women age 65 years or older with stage I and II breast cancer diagnosed between 1990 and 1994 who were cared for in six geographically dispersed community-based health care systems. We collected demographic, tumor, treatment, and comorbidity data from electronic data sources, including cancer registry, administrative, and clinical databases, and from subjects' medical records. Results Women 75 years of age or older and women with higher comorbidity indices were more likely to receive nonstandard primary tumor therapy, to not receive axillary lymph node dissection, and to not receive radiation therapy after breast-conserving surgery (BCS). Asian women were less likely to receive BCS, and African American women were less likely to be prescribed tamoxifen. Although nonreceipt of most therapies was associated with a lower baseline risk of recurrence, an important minority of high-risk women (16% to 30%) did not receive guideline therapies. Conclusion Age is an independent risk factor for nonreceipt of effective cancer therapies, even when comorbidity and risk of recurrence are taken into account. Information regarding treatment effectiveness in this age group and tools that allow physicians and patients to estimate the benefits versus the risks of therapies, taking into account age and comorbidity burden, are critically needed.
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Reibling, Ellen T., Brian Distelberg, Mindi Guptill, and Barbara Couden Hernandez. "Intimate Partner Violence Experienced by Physicians." Journal of Primary Care & Community Health 11 (January 2020): 215013272096507. http://dx.doi.org/10.1177/2150132720965077.
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Purpose: World Health Organization (WHO) defines intimate partner violence (IPV) as physical, sexual or psychological harm caused by an intimate partner or ex-partner. There are few studies describing interpersonal violence (IPV) among physicians. Our study describes IPV experienced by U.S. physicians. Methods: This was a multicenter survey administered to 4 physician groups in 2015 to 2016. In total 400 respondents returned survey results. Measures included current IPV, childhood abuse, mental health, professional role, and demographics. Results: IPV was reported by 24% of respondents. The most frequent abuses reported were: verbal (15%), physical (8%) followed by sexual abuse (4%) and stalking (4%). Logistic regression model found that IPV was more likely to be reported by older participants (aged 66–89), those who experienced childhood abuse, working less than full time, and had been diagnosed with a personality disorder. Women and Asian Americans reported slightly higher IPV rates. Conclusions: Our study has implications for both medical education and intervention development. Universal screening and education that addresses clinical implications when treating peers who experience IPV are needed. Workplace interventions that consider unique physician characteristics and experiences are needed, as well as programs that support sustained recovery. This is the first survey to our knowledge that confirms that physicians experience IPV at a rate consistent or higher than the national level. We developed a standardized instrument to assess IPV in male and female physicians at various career stages. We also identified significant predictors that should be included in IPV screening of potential physician victims.
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Boucher, Nathan, and Kimberly S. Johnson. "CULTURAL COMPETENCE TRAINING FOR HOSPICE STAFF: FINDINGS FROM A NATIONAL HOSPICE SURVEY." Innovation in Aging 3, Supplement_1 (November 2019): S6. http://dx.doi.org/10.1093/geroni/igz038.019.
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Abstract Compared to whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce these disparities. We conducted a national survey of hospices’ practices to promote CC. A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census over 100 (53%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 54% held it annually. Most trainings were one hour (60%); content was delivered via web (58%) and/or lecture (57%). While over 90% of staff (i.e., nurses, social workers, and chaplains) completed CCT, a smaller proportion of medical directors (63%), senior leaders (70%) and board members (23%) did so. Most common (>70%) topics were: cross-cultural communication, death and illness beliefs, and spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (61%)—the most common U.S. minority groups. Almost 30% reported no assessment of effectiveness of CCT while 45% reported a quiz at the end. In this study, most hospices offered some CCT. CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.
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Boucher, Nathan A., and Kimberly S. Johnson. "Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?" American Journal of Hospice and Palliative Medicine® 38, no. 2 (July 31, 2020): 169–74. http://dx.doi.org/10.1177/1049909120946729.
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Background: Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities. Objective: To describe the state of CC training across hospices. Design: National survey of hospices’ practices to promote CC. Results: A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were: cross-cultural communication, death/illness beliefs, spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)—the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT. Conclusions: CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.
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Jang, Y., H. Yoon, N. S. Park, and D. A. Chiriboga. "ORAL HEALTH AND DENTAL CARE IN OLDER ASIAN AMERICANS." Innovation in Aging 1, suppl_1 (June 30, 2017): 119. http://dx.doi.org/10.1093/geroni/igx004.490.
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Suresh, Suraj, Jinyu Zhang, Abdelwahab Ahmed, Mouhanna Abu Ghanimeh, Ahmed Elbanna, Randeep Kaur, Mahmoud Isseh, et al. "Risk factors associated with adenoma recurrence following cold snare endoscopic mucosal resection of polyps ≥ 20 mm: a retrospective chart review." Endoscopy International Open 09, no. 06 (May 27, 2021): E867—E873. http://dx.doi.org/10.1055/a-1399-8398.
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Abstract Background and study aims Cold snare endoscopic mucosal resection (EMR) is being increasingly utilized for non-pedunculated polyps ≥ 20 mm due to adverse events associated with use of cautery. Larger studies evaluating adenoma recurrence rate (ARR) and risk factors for recurrence following cold snare EMR of large polyps are lacking. The aim of this study was to define ARR for polyps ≥ 20 mm removed by cold snare EMR and to identify risk factors for recurrence. Patients and methods A retrospective chart review of colon cold snare EMR procedures performed between January 2015 and July 2019 at a tertiary care medical center was performed. During this period, 310 non-pedunculated polyps ≥ 20 mm were excised using cold snare EMR with follow-up surveillance colonoscopy. Patient demographic data as well as polyp characteristics at the time of index and surveillance colonoscopy were collected and analyzed. Results A total of 108 of 310 polyps (34.8 %) demonstrated adenoma recurrence at follow-up colonoscopy. Patients with a higher ARR were older (P = 0.008), had endoscopic clips placed at index procedure (P = 0.017), and were more likely to be Asian and African American (P = 0.02). ARR was higher in larger polyps (P < 0.001), tubulovillous adenomas (P < 0.001), and polyps with high-grade dysplasia (P = 0.003). Conclusions Although cold snare EMR remains a feasible alternative to hot snare polypectomy for resection of non-pedunculated polyps ≥ 20 mm, endoscopists must also carefully consider factors associated with increased ARR when utilizing this technique.
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Au, Clement. "Cultural factors in preventive care: Asian-Americans." Primary Care: Clinics in Office Practice 29, no. 3 (September 2002): 495–502. http://dx.doi.org/10.1016/s0095-4543(02)00011-8.
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Min, Jong, Siyon Rhee, Phu Phan, Jessica Rhee, and Thanh Tran. "Health of Older Asian Americans in California: Findings from the California Health Interview Survey." Aging 6, no. 2 (2008): 17–44. http://dx.doi.org/10.36650/nexus6.2_17-44_wonetal.
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Health studies on older Asian Americans based on national and statewide representative data are scarce. This study examined subgroup differences in demographic, socioeconomic and general health status, health conditions, and access to health care services among five groups of Asian Americans aged 60 or older (Chinese, Filipino, Japanese, Korean, and Vietnamese), using data from the 2001 California Health Interview Survey. Significant differences in demographic and socioeconomic characteristics, health status, chronic conditions, and coverage and use of health care services were found in the five groups, indicating the complexity, diversity, and heterogeneity of older Asian American populations. Practice and research implications are discussed.
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Rhee, Min Kyoung, Yuri Jang, Mona Liu, William E. Haley, and Susan Enguidanos. "UNDERSTANDING BARRIERS TO PALLIATIVE CARE USE AMONG ASIAN AMERICANS: A SYSTEMATIC REVIEW." Innovation in Aging 3, Supplement_1 (November 2019): S977—S978. http://dx.doi.org/10.1093/geroni/igz038.3542.
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Abstract Despite the well-documented clinical and public health impacts of palliative care on older patients’ end of life experiences, racial and ethnic disparities in palliative care use still remain. However, empirical evidence on the sources of disparities is lacking, particularly for Asian Americans. Given the rapid growth and increasing cultural diversity of the older Asian population in the United States, a systematic review was conducted to provide a comprehensive overview of the best available evidence on the barriers to palliative care use among Asian Americans. Search was conducted using six electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, Cochrane Library, and Google Scholar), and all procedures of the study have been guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). A total of 23 studies published in the U.S. since 1998 were included. Individual level barriers to palliative care service use among Asian Americans identified by the study included lack of palliative care knowledge, lack of insurance, cultural beliefs, language barrier, attitude toward death, family centered decision-making. Provider level barriers included lack of training and experience about palliative care, patient-provider discordance in language and culture, and absence of policy or guidance for providers. Although racial disparities in palliative care for Asian Americans were evident, Asian Americans were underrepresented in palliative research. Future research effort should be directed toward the development of culturally sensitive palliative care services and policies that reduce racial and ethnic specific barriers.
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Jang, Yuri, Hyunwoo Yoon, Nan Sook Park, and David A. Chiriboga. "Oral Health and Dental Care in Older Asian Americans in Central Texas." Journal of the American Geriatrics Society 65, no. 7 (May 26, 2017): 1554–58. http://dx.doi.org/10.1111/jgs.14832.
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Nguyen, Duy. "The Effects of Sociocultural Factors on Older Asian Americans' Access to Care." Journal of Gerontological Social Work 55, no. 1 (January 2012): 55–71. http://dx.doi.org/10.1080/01634372.2011.618525.
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Li, Yawen, Dennis Kao, and Tam Q. Dinh. "Correlates of Neighborhood Environment With Walking Among Older Asian Americans." Journal of Aging and Health 27, no. 1 (June 17, 2014): 17–34. http://dx.doi.org/10.1177/0898264314535636.
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Pei, Yaolin, Wei Zhang, and Bei Wu. "Advance Care Planning Engagement and End-of-Life Preference Among Older Chinese Americans." Innovation in Aging 4, Supplement_1 (December 1, 2020): 750–51. http://dx.doi.org/10.1093/geroni/igaa057.2704.
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Abstract The study aimed to examine how immigrant status and family relationships are associated with advanced care planning (ACP) engagement and end-of-life (EOL) preference over burial plan among older Chinese Americans, the largest subgroup of Asian Americans. Logistic regressions were used to analyze data from a survey of 430 older Chinese Americans aged 55 and older living in a Honolulu, Hawai’i. Results show that U.S.-born Chinese Americans were more likely to engage in ACP, including willingness thought of EOL care, and discussion about EOL care, and having preference over burial plan, than the foreign-born Chinese American. Family cohesion was not associated with ACP engagement and EOL preference over burial plan. Family conflict increased the possibility of ACP engagement, indicated by willingness thought of ACP, willingness discussion on ACP, and EOL preference over burial plan. The culturally sensitive educational intervention is needed to increase ACP engagement among older Chinese Americans.
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Yoon, Hyunwoo, Hyunwoo Yoon, Yuri Jang, and Kwangyul Choi. "FACTORS ASSOCIATED WITH UNMET HEALTHCARE NEEDS IN OLDER ASIAN AMERICANS." Innovation in Aging 3, Supplement_1 (November 2019): S31. http://dx.doi.org/10.1093/geroni/igz038.120.
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Abstract Older Asian Americans are the fast-growing but understudied population in health disparities research. Using a sample that reflects cultural/linguistic diversity, the present study explored general (health insurance, usual place for care, income) and immigrant-specific (nativity, length of stay in the US, English proficiency, acculturation) risk factors of unmet healthcare needs in older Asian Americans. Data were drawn from the Asian American Quality of Life survey (N = 533). With the inclusion of a considerable number of non-English-speaking individuals, the present sample presented a high rate of unmet healthcare needs. Those with a shorter stay in the US, limited English proficiency, and lower level of acculturation had increased odds of having unmet healthcare needs than their counterparts after controlling for background characteristics. Challenging the myth of model minority, findings highlight the importance of immigrant-specific factors in identifying risk groups of unmet healthcare needs and demonstrate vulnerability in access to healthcare.
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Lee, Minsun, Wenyue Lu, Tyrell Mann-Barnes, Jin-Hyeok Nam, Julie Nelson, and Grace X. Ma. "Mental Health Screening Needs and Preference in Treatment Types and Providers in African American and Asian American Older Adults." Brain Sciences 11, no. 5 (May 5, 2021): 597. http://dx.doi.org/10.3390/brainsci11050597.
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Older African Americans and Asian Americans in the U.S. underuse mental health services, despite their vulnerability to diverse mental health problems. This study examined their perspectives on the importance of various mental health problems, mental health treatment, and provider type preference. A total of 243 participants residing in Philadelphia were recruited through community-based organizations. Chi-square, ANOVA, and logistic regression were conducted to examine ethnic differences in demographic characteristics, mental health screening needs, and treatment preferences. African Americans were more likely to endorse the screening needs for depression (AOR: 3.77; 95% CI: 1.19–11.93, p < 0.05) and less likely to endorse the screening needs for suicide (AOR: 0.24; 95% CI: 0.08–0.76, p < 0.05) compared to Asian Americans. For treatment preferences, African Americans were more likely to seek help from primary care physicians (AOR: 8.26; 95% CI: 1.71–32.86, p < 0.01) and less likely to prefer medication as a treatment option (AOR: 0.36; 95% CI: 0.09–0.79, p < 0.05) than Asian Americans. African Americans and Asian Americans prioritized mental health screening needs differently and had different treatment preferences, indicating that matching community needs and preferences regarding mental health services is critical to improve mental service utilization rates in the targeted populations.
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Nguyen, Duy D. "Older Asian Americans' Primary Care Use: Examining the Effect of Perceived Mental Health Need." Social Work in Mental Health 10, no. 2 (March 2012): 89–103. http://dx.doi.org/10.1080/15332985.2011.597312.
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Villatoro, Alice P., Vickie M. Mays, Ninez A. Ponce, and Carol S. Aneshensel. "Perceived Need for Mental Health Care: The Intersection of Race, Ethnicity, Gender, and Socioeconomic Status." Society and Mental Health 8, no. 1 (August 1, 2017): 1–24. http://dx.doi.org/10.1177/2156869317718889.
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Racial/ethnic minority populations underutilize mental health services, even relative to psychiatric disorder, and differences in perceived need may contribute to these disparities. Using the Collaborative Psychiatric Epidemiology Surveys, we assessed how the intersections of race/ethnicity, gender, and socioeconomic status affect perceived need. We analyzed a nationally representative sample of U.S. adults (18years or older; N= 14,906), including non-Latino whites, Asian Americans, Latinos, African Americans, and Afro-Caribbeans. Logistic regressions were estimated for the total sample, a clinical need subsample (meets lifetime diagnostic criteria for a psychiatric disorder), and a no disorder subsample. Perceived need varies by gender and nativity, but these patterns are conditional on race/ethnicity. Men are less likely than women to have a perceived need, but only among non-Latino whites and African Americans. Foreign-born immigrants have lower perceived need than U.S.-born persons, but only among Asian Americans. Intersectional approaches to understanding perceived need may help uncover social processes that lead to disparities in mental health care.
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Rhee, Min-Kyoung, and Yuri Jang. "Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors." International Journal of Aging and Human Development 91, no. 1 (May 6, 2019): 21–36. http://dx.doi.org/10.1177/0091415019848211.
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The present study examined the prevalence of and factors associated with the designation of a substitute decision-maker (SDM) in a sample of older Asian Americans. Particular emphasis was placed on cultural factors (ethnicity, time in the United States, English proficiency, acculturation, and cultural belief) that might influence on one’s attitudes toward death and dying or end-of-life decision-making. Data were drawn from the 499 participants aged 60 years and older using the 2015 Asian American Quality of Life survey. Twenty-two percent of the sample had completed a legal document identifying a SDM. Results of a hierarchical logistic regression indicated that ethnicity, time in the United States, English proficiency, and acculturation were significant predictors. By examining the role of cultural factors in predicting SDM designation, the present study provided implications for culturally tailored strategies to help older Asian Americans plan their end-of-life care.
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Park, Nan Sook, David Chiriboga, and Barbara Yee. "Understanding Mental Health, Vulnerabilities, and Coping in Older Koreans and Older Korean Americans." Innovation in Aging 4, Supplement_1 (December 1, 2020): 633. http://dx.doi.org/10.1093/geroni/igaa057.2167.
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Abstract Although significant progress has been made in understanding mental health issues, racial/ethnic minorities are disadvantaged in terms of knowledge, attitude/stigma toward mental illness, and access to treatment. Older Koreans and Korean Americans are high-risk groups with great prevalence of stigma and limited access to mental services. The two groups share similarities as well as differences. For example, Older Korean Americans, a first-generation immigrant group, tend to share traditional values and beliefs with older Koreans. However, differences in social and cultural contexts, availability of social networks and resources, and access to health care systems present unique challenges and strategies. The purpose of this symposium is to enhance the understanding of critical issues in mental health among older Koreans and Korean Americans and identify challenges and strategies to promote mental health and well-being. Five studies conducted in Korea and the US will explore a variety of personal, social, and cultural factors related with mental health, based on quantitative and qualitative approaches. The diverse topics cover the mediating role of self-esteem in the relationship of stigma to emotional well-being, the effect of stress and coping on well-being, loneliness and negative family interactions, the relationship of life stressors and social capital on mental distress among older Korean Americans compared with other older Asian Americans, and community leaders’ attitude toward depression. The issues of vulnerabilities and resources will be discussed from the cultural perspectives as well as implications for future research and practice.
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Arnsberger, Pamela. "Best Practices in Care Management for Asian American Elders: The Case of Alzheimer’s Disease." Care Management Journals 6, no. 4 (December 2005): 171–77. http://dx.doi.org/10.1891/cmaj.6.4.171.
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This article addresses practice concerns and special issues for professionals doing case management for older Asian Americans using Alzheimer’s disease as the case example. Highlighted are cross-cultural issues in assessment for depression in this population, as well as caregiving and community service utilization issues. The research is based on the author’s own work and the literature, as well as results from a population-based study of caregivers of the elderly in California.
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MCBRIDE, MELEN R., and RENE D. LEWIS. "African American and Asian American Elders: An Ethnogeriatric Perspective." Annual Review of Nursing Research 22, no. 1 (January 2004): 161–214. http://dx.doi.org/10.1891/0739-6686.22.1.161.
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By 2030, ethnic minority elders are expected to increase by 12%. Research about this highly diverse population is gaining momentum. This chapter summarizes selected research articles published after 1996 on access and utilization of services and resources by African American and Asian American elders. Computerized searches were made using PubMed and CINAHL (Cumulative Index of Nursing and Allied Health Literature) with the following terms used individually or combined: health care, aging, older adults, ethnicity, access, disparities, chronic illness, community health care, health beliefs, health practices, and ethnogeriatrics. Citations for 456 articles on two ethnic groups were retrieved; 155 were reviewed, and 84 citations were used for this chapter. The publications focus on African Americans (45%), Asian Americans (41%), and both groups (14%). Descriptive, exploratory, cross-sectional studies dominate the research effort, identifying unmet needs, and a limited number are on culturally appropriate and acceptable interventions. Results are discussed in the context of ethnogeriatrics, and recommendations for future studies are proposed.
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Jang, Yuri, Min-Kyoung Rhee, Jeong Chung Hyeon, Eun Young Choi, Juyoung Park, and Nan Sook Park. "Oral Health and Dental Care in Older Korean Immigrants: A Qualitative Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 336. http://dx.doi.org/10.1093/geroni/igaa057.1079.
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Abstract Many segments of the U.S. population continue to experience a disproportionate burden of oral disease and inequities in dental care, and older Asian immigrant populations are among those at high risk. Responding to the needs to attend to ethnic and geographic variations among older Asian Americans and to better understand contextual factors that shape their experiences of oral health and dental care, the present study conducted in-depth interviews with eighteen older Korean immigrants in the Los Angeles Greater area. The qualitative inquiries were theoretically guided by the three core categories of the Andersen’s (1968, 1997) health service model: oral health needs, service barriers, and service outcomes. Using the constant comparison method, themes and sub-themes within each category were derived. The eight themes emerged from the qualitative data were: (1) oral health problems, (2) perceived need, (3) insurance and finance, (4) language barriers, (5) social support, (6) knowledge and belief, (7) satisfaction with service, and (8) areas of improvement. The findings demonstrated varied experiences associated with oral health and dental care of older Korean immigrants and informed the development of services and programs responsive to the identified needs and barriers.
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Shive, Steven E., Grace X. Ma, Yin Tan, Jamil I. Toubbeh, Lalitha Parameswaran, and Joseph Halowich. "Health Information and Cancer Screening Differences for Asian Americans." Californian Journal of Health Promotion 4, no. 1 (March 1, 2006): 1–11. http://dx.doi.org/10.32398/cjhp.v4i1.727.
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This study examined differences between Asian and non-Asian Americans in sources of health information and cancer screening. A nationally representative sample of 6,722 adults in the US, including those who speak, Spanish, Chinese, Vietnamese and Korean was selected. Questionnaire items included demographic variables, health status, cancer screening, health care experiences, health information sources, and use of an interpreter in the patient-provider interaction. Asians used the internet more for health information, preferred a physician from their own race, had friends or relatives and staff persons serve as interpreters, and less likely to call a health care provider and pharmacist, to need an interpreter, have had a complete physical exam, pap test, mammogram, and colorectal exam, within the last two years, than non-Asian Americans. Difficulty speaking with a physician led to 2.2 times greater risk of never getting a physical exam and 4.3 times greater risk of never getting a prostate exam. Development of sources of health information relevant to Asian Americans may enhance their decision making prior to and in conjunction with receiving medical care services.
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Fuchs, Victor R., and Sarah Rosen Frank. "Air Pollution And Medical Care Use By Older Americans: A Cross-Area Analysis." Health Affairs 21, no. 6 (November 2002): 207–14. http://dx.doi.org/10.1377/hlthaff.21.6.207.
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Yeh, Angelica, and Marie Mayen-Cho. "Facing the Journey Together: Using Digital Media to Support Dementia Care Among Asian Americans." Innovation in Aging 4, Supplement_1 (December 1, 2020): 542. http://dx.doi.org/10.1093/geroni/igaa057.1762.
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Abstract Asians and Pacific Islanders (APIs) in the United States have limited access to dementia care information that is linguistically and culturally appropriate. Alzheimer’s Los Angeles created “Faces of Caregiving”, a video project available with English/Japanese subtitles, documenting in-depth interviews with 7 Japanese/Japanese-American familial care partners of individuals living with dementia. It touched on the personal yet universal aspects of each journey embedded in a particular family context. The 5 video profiles were subsequently shown at 3 community sites to attendees comprised of mostly older-adult APIs. Among 85 attendee responses, approximately 90% stated they were more likely to seek out information on and support for Alzheimer’s disease, felt more open to talking about the disease, and were more likely to advocate and raise awareness for the disease. This program could be replicated for other API communities, allowing individuals to learn more effectively from a peer-to-peer experience in a culturally familiar setting. Part of a symposium sponsored by the Aging Among Asians Interest Group.
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Sorkin, Dara H., and Quyen Ngo-Metzger. "The Unique Health Status and Health Care Experiences of Older Asian Americans: Research Findings and Treatment Recommendations." Clinical Gerontologist 37, no. 1 (November 27, 2013): 18–32. http://dx.doi.org/10.1080/07317115.2013.847513.
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Kwon, Simona, Jazmine Wong, Janet Pan, Andrew Rosenberg, Germaine Cuff, and Myint Aye. "SOCIOCULTURAL DETERMINANTS IN PAIN PERCEPTION AND MANAGEMENT AMONG OLDER CHINESE AMERICANS." Innovation in Aging 3, Supplement_1 (November 2019): S713—S714. http://dx.doi.org/10.1093/geroni/igz038.2619.
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Abstract Background: Chinese Americans make up the largest Asian American subgroup in the US. Data from a large health system indicate that older Chinese Americans experience lower satisfaction in pain management after surgery compared to all other racial/ethnic groups. Objective: To understand pain experience among older Chinese American patients to improve pain satisfaction strategies Methods: A mixed methods study was conducted, including: 1. A scoping review of the peer-reviewed published literature; 2) face-to-face survey; and 3) qualitative interviews. 14 Chinese American postsurgical patients >65 years of age were recruited for the survey and interview with a trained bilingual Community Health Worker. Questions from the Survey on Disparities in Quality of Healthcare and Kleinman’s Explanatory Model of Illness guided the data collection tools. Results: The 31 studies identified in the review were largely observational; none assessed pain control or management interventions for older Chinese Americans. Most participants reported experiencing a language barrier that hindered healthcare staff communication during hospital stay. Even with an interpreter, limited English proficient patients reported lower understanding of health information compared to those who did not need interpretation. Ideas of “pushing through” pain, perceiving physicians as “busy people,” and mismatch in pain assessment tools contributed to pain attendance delay. Facilitators to care included family support, culturally and linguistically-tailored tools, and availability of cultural remedies. Conclusions: This mixed-methods study identified key themes including socio-cultural barriers and facilitators to effective pain care and management. Findings will inform tools and resources to better capture and address pain management in Chinese Americans.
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Nolan, Lila Wahidi, Yilin Yoshida, Emily Coberly, and Bindu Kanathezhath Sathi. "Hemolytic, Vaso-Occlusive and Renal Complications of SCD: Report from the Central Missouri Cohort." Blood 132, Supplement 1 (November 29, 2018): 1091. http://dx.doi.org/10.1182/blood-2018-99-113723.
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Abstract Background The clinical phenotype and complications of sickle cell disease (SCD) are heterogeneous and disease outcomes are influenced by both genetic and non-genetic factors, including geography, socioeconomic and educational status and access to health care. These factors serve a role in the quality of life and overall survival in the SCD population. Prior studies have sought to characterize the genotype-phenotype relationship and geographic clustering of SCD with distinct clinical differences found between the African and Asian SCD subtypes. The Central Missouri SCD Cohort (MU-SCD Cohort) has a heterogeneous population of SCD patients who seek medical care from University of Missouri. The clinical characteristics and frequency of SCD-related complications in this group have not yet been defined. This is a retrospective cohort analysis of patients HbSS, HbSC, and HbS/b-thalassemia in central Missouri, ranging in age from the first through the sixth decade of life. We hypothesize that SCD patients from central Missouri, with its mix of African American, Congolese, Nigerian, Kenyan, Southeast Asian and other refugee populations, will have clinical complications distinct from the previously described North American Sickle Cell Disease series and needs further characterization. Objective To survey the SCD phenotype by evaluating complications of patients in the MU-Sickle Cell Disease Cohort. Methods We retrospectively reviewed clinical and laboratory data for pediatric and adult SCD patients who were treated at the University of Missouri between 2002 to 2018. Prevalence of major vaso-occlusive, hemolytic and renal complications by decade was estimated. Results A total of 81 patients were reviewed, with five excluded due to insufficient clinical data. The sample size for prevalence estimation was 76, 61, 30, 14 and 8 for first to fifth decade, respectively. In this cohort, 60.5% were male with average age of 21.2 years. Genotypes represented included 52.6% HbSS, 38.2% HbSC, and 7.9% HbS/b-thalassemia. A total of 94.7% of patients identified as African American. Clinical features of vaso-occlusive complications predominated in the first two decades of life. The frequency of acute chest syndrome for patients ages ≤10 years and 11-20 years of age were 23.7% and 21.3%, respectively (Table 1). Seven children (9.2%) developed overt stroke by age 10 years. Greater than one vaso-occlusive pain crisis occurred in 46% of patients in the first decade of life and thereafter declined with age (Figure 1). In contrast, the MU-SCD Cohort exhibited increasing frequency of hemolytic complications with advancing age. The peak prevalence of pulmonary hypertension occurred between the ages of 21-30 years (13.3%). In congruence, only 4% of patients aged ≤10 years were diagnosed with gallstones requiring cholecystectomy, which increased to 57.1% at age 31-40 years. Reticulocytopenia was noted in the fourth decade with further decline in the fifth decade of life (Figure 2). Renal evaluation revealed an average estimated glomerular filtration rate (eGFR) of 149.9 ± 43 in patients ≤10 years, with progressive decline to 117.3 ± 25 in SCD patients aged 41-50 years (Figure 3). The average serum creatinine demonstrated an increasing trend with advancing age. There was a prevalence of persistent proteinuria in patients older than 11 years. Disease modifying agents were assessed, in which only 21% of patients ≤10 years, 25% of patients aged 11-20 years, and 15.8% of patients aged 21-30 years received therapy with hydroxyurea (Table 1). The use of exchange transfusion or packed red blood cell (pRBC) transfusion for anemia was predominant in SCD patients aged ≤20 years. Conclusions This is the first report describing prevalence of SCD-related complications in the MU-SCD Cohort. We identified this population to have an increasing frequency of hemolytic complications and sickle cell nephropathy with advancing age. Onset of persistent proteinuria occurred in the second decade of life, followed by renal insufficiency or end stage renal disease in subsequent decades. As previously demonstrated in the Cooperative Study of Sickle Cell Disease and the Jamaican SCD Cohort study, renal insufficiency was a significant risk factor for early mortality. Further studies are required for identification of biomarkers and institution of early intervention strategies to prevent end-organ damage and decrease mortality in SCD. Disclosures No relevant conflicts of interest to declare.
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Nguyen, Peter, Rosalie Corona, Matthew Peter DeCarlo, Anna Yaros, Anh Thuy Le, and Kimberly Compton. "Help Seeking Behavior in a Diverse Sample of Asian American Adults." Journal of Ethnic and Cultural Studies 5, no. 2 (December 9, 2018): 1. http://dx.doi.org/10.29333/ejecs/124.
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We sought to characterize the help-seeking behavior of Asian Americans living in a Southeastern community in the U.S. by examining different types of services sought, help-seeking preferences, and how demographic characteristics and mental health problems (including domestic violence) predicted these behaviors. 610 Asian Americans (mean age = 39.43 years; 59.6% female; 75% immigrants) completed an anonymous, community survey that included measures of different types of help-seeking behaviors and preferences, mental health symptoms, and exposure to domestic violence. The two most-frequently help-seeking behaviors included seeking advice from friends, family members, or relatives (66.7%), and visiting a medical doctor (46.4%). In logistic regression models, older age, sex, immigrant status and symptomatic depression predicted different types of help-seeking behaviors and preferences. Neither domestic violence experience or symptomatic anxiety significantly predicted help-seeking.
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Li, Mengting, Man Guo, Meredith Stensland, and XinQi Dong. "ASSOCIATION BETWEEN FAMILY TYPOLOGY AND COGNITIVE FUNCTION AMONG OLDER ADULTS IN THE US? FINDINGS FROM THE PINE STUDY." Innovation in Aging 3, Supplement_1 (November 2019): S377. http://dx.doi.org/10.1093/geroni/igz038.1384.
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Abstract A broad literature has explored racial and ethnic disadvantages in cognitive aging. Migration and acculturation created additional challenges on cognitive aging of minority older immigrants. Asian Americans are the fastest growing minority group in the United States. Chinese Americans constitute the largest segment of Asian Americans. Family is a core social value in Chinese culture. Less is known regarding the impact of family relationship on cognitive function for US Chinese older immigrants. Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged, population-based epidemiological study of 3,157 US Chinese older adults aged 60 and above in the greater Chicago area from 2011-2013. A typology approach is a useful tool to operationalize multifaceted family relationships. Our prior study used Latent Class Analysis to cluster family typologies, evaluating structural, associational, affectual, functional and normative aspects of family relationship. Cognitive function was evaluated by global cognition, episodic memory, executive function, working memory, and Chinese Mini-Mental State Examination (C-MMSE). Linear regression and quantile regression were used. The findings showed detached and commanding conflicted typologies were associated with lower global cognitive function compared with unobligated ambivalent typology. Wish respect to cognitive domains, detached, commanding conflicted, and tight-knit typologies were associated with lower episodic memory, working memory, and C-MMSE than unobligated ambivalent typology, respectively. Commanding conflicted typology, featured by high intergenerational conflicts, was associated with lowest cognitive function among all typologies. Health care professionals and social service providers should focus on older adults with commanding conflicted typology and prevent them from cognitive impairment.
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Lange Maia, Brittney S., Emily Laflamme, Fernando DeMaio, and Raj C. Shah. "OLDER ADULT HEALTH IN THE CITY OF CHICAGO." Innovation in Aging 3, Supplement_1 (November 2019): S246—S247. http://dx.doi.org/10.1093/geroni/igz038.925.
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Abstract In 2012, Chicago was designated as an Age Friendly City. However, city-wide data on the health and health disparities experienced by older adults have been scarce. In order to address this knowledge gap, the Chicago Department of Public Health (CDPH) partnered with the Center for Community Health Equity at Rush and DePaul Universities to create a report describing health status among adults age 65+. Data were from the Healthy Chicago Survey—a population-based health survey conducted by CDPH, the American Community Survey, Hospital Discharge Data, and State Vital Records. The report highlights considerable racial/ethnic diversity in Chicago, as 38% of older adults are white, 37% black, 18% Latinx, and 7% are Asian. Encouraging results exist regarding healthcare access; 96% have a personal health care provider and 89% report being able to get care needed through their health plan. Several areas of improvement are needed regarding root causes of health. More older adults live below the federal poverty level (15.9%) compared to the overall U.S (9.3%), and 45.8% would be unable to pay for an unexpected $400 expense. Disparities were evident as life expectancy at age 65 is 2.5 years longer for Latinx and white older adults (age 85) compared to African Americans (age 82.4). African American and Latinx older adults had higher rates of preventable hospitalizations per 10,000 (801.1 and 678.9, respectively) compared to white (492.4) and Asian (374.1) older adults. Findings from this report will spur Chicago’s continued progress as an Age-Friendly City for all its residents.
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Harman, Jeffrey S., Mark J. Edlund, John C. Fortney, and Henrique Kallas. "The Influence of Comorbid Chronic Medical Conditions on the Adequacy of Depression Care for Older Americans." Journal of the American Geriatrics Society 53, no. 12 (December 2005): 2178–83. http://dx.doi.org/10.1111/j.1532-5415.2005.00511.x.
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Lin, Richard J., Smita Joshi, Michelle M. Le Beau, Howard Weiner, Peggy Green, Theodore Karrison, and Richard A. Larson. "Therapy-Related Myeloid Neoplasms (t-MN) in 71 Patients Following Radiation Therapy (RT) Only,." Blood 118, no. 21 (November 18, 2011): 3522. http://dx.doi.org/10.1182/blood.v118.21.3522.3522.
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Abstract Abstract 3522 Exposure to ionizing radiation has long been associated with the development of secondary malignant neoplasms including therapy-related myeloid neoplasms (t-MNs). We examined the clinical, epidemiologic, and cytogenetic characteristics of 71 consecutive cases of t-MN presenting to the University of Chicago between 1972–2011 in patients (pts) who received radiation therapy (RT) alone for a malignant or non-malignant disease; one-third had been treated for their primary disease at our institution. No subsequent chemotherapy had been given for the primary disease. 64 (90%) pts had had a primary solid tumor, 5 had had a primary hematologic malignancy (4 Hodgkin lymphoma), and 2 had received RT for non-malignant disorders (acne; hydatiform mole). Prostate and testicular cancers were the predominant primary tumors (n=27; 38%). Breast (n=15; 21%) and gynecological cancers (n=13; 18%, including ovarian, cervical, endometrial, and vaginal cancers) were also common. There were 36 women and 35 men; 50 white (70%), 10 African American (14%), 1 Asian American (1%), and 10 with unrecorded race/ethnicity. The median age at primary diagnosis was 64 years (range, 0–83 yrs). Pts with solid tumors were older at primary diagnosis (median, 66 yrs; range, 0–83) compared to pts with primary hematologic malignancies (median, 48 yrs; range, 32–67) or no malignancy (median, 22 yrs) (p= 0.01). Median latency from RT to the first confirmed diagnosis of t-MN overall was 67 months (interquartile range (IQR), 27–120 mos). Patients with a hematologic malignancy had shorter latency intervals (median, 25 mos; IQR, 18–50) compared to pts with solid tumors (median, 68 mos; IQR, 31–117) (p=0.017, Kruskal-Wallis test). Younger age at primary diagnosis correlated with longer latency intervals (p=0.0013, Spearman's rank correlation test). However, this apparent association may be attributed in part to competing risk factors such as medical comorbidities and death in older pts prior to the development of t-MN. Gender was not associated with latency intervals. 59 pts had one or more clonal cytogenetic abnormality (83%) at diagnosis of t-MN; 12 (17%) had no detectable abnormality. Most common (38 pts, 54%) were translocation, loss, or deletion of chromosome 5 (n=19), 7 (n=8), or both (n=11). Ten patients (14%) had recurring balanced translocations previously reported in t-MN; 4 with inv(16) or t(16;16), 4 with t(15;17), and 2 with t(21q22). Eleven pts (15%) had other clonal abnormalities. No significant correlations were found between cytogenetics and age or type of primary diagnosis. Only 6 pts currently remain alive: 2 with inv(16), 1 with t(16;16), 1 with t(15;17), 1 with independent -7 and del(11q) clones, and 1 with a normal karyotype. The median time from diagnosis of t-MN to death was 10 months (95% confidence interval (CI), 7–14 mos). Pts with normal cytogenetics or recurring balanced translocations survived longer (log rank, p=0.0009). t-MN with clonal abnormalities of chromosome 5, 7, or both had a poor median survival of 7 mos (95% CI, 3–12 mos) compared to other cytogenetic groups. There was no association between age at diagnosis of t-MN and overall survival. Treatments given after the development of t-MN were individualized and variable, ranging from supportive care only to intensive chemotherapy and subsequent hematopoietic cell transplantation. We reviewed treatment records for 38 pts: 18 received low intensity treatment with best supportive care or participated in a phase I clinical trial; 20 underwent high intensity induction chemotherapy with or without hematopoietic cell transplantation. Pts in the low intensity treatment group had a median survival of 8 mos (95% CI, 3–11 mos) compared to pts in the high intensity treatment group who had a median survival of 14 mos (95% CI, 5–30 mos) (log rank, p=0.12). We conclude that t-MN following RT alone bears striking clinical and cytogenetic similarities to alkylator-associated t-MN with frequent clonal abnormalities of chromosomes 5 and 7, relatively long latency, and poor outcomes even with intensive therapy. However, some pts who develop t-MN after RT alone have recurring, balanced chromosomal translocations or normal karyotypes, and they have a better response to anti-leukemia treatment and longer survival. Disclosures: No relevant conflicts of interest to declare.
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Chubb, Racheal, and Janet Wilmoth. "Assessing the Impact of Older Americans Act–Funded Services on Caregiver Stress." Innovation in Aging 4, Supplement_1 (December 1, 2020): 356. http://dx.doi.org/10.1093/geroni/igaa057.1145.
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Abstract Funding for OAA programs that support caregivers and care recipients has steeply declined since 2010. This is potentially problematic given these programs provide services that may reduce caregiver stress. To better understand what and for whom caregiving services reduces stress, we used data from the National Survey of Older Americans Act Participants (NSOAAP) to estimate logistic regression models predicting caregiver stress. These models include the following measures: services provided to the care recipient, services received by the caregiver, and caregiver satisfaction with services received; caregiver health, age, race, and gender; and care recipient health, age, gender, relationship to the caregiver, and coresidence with the caregiver. The results indicate that caregivers who were satisfied with services were less likely to be stressed compared to those who are not satisfied with services. Those who received respite care and counseling services were less likely to be stressed than those who attended classes and training. Consistent with the literature, caregivers who reported better health or cared for someone in better health were less likely to be stressed. Caregivers were also more likely to be stressed if they provided help with medical care compared to ADLs or if they lived with the care recipient. Overall, the results underscore the importance of continued, and possibly expanded, OAA funding for caregiver support services, especially those that provide respite and counseling to individuals who are providing care to frail and co-residential older adults.
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Wiltshire, Jacqueline, Barbara Orban, Kyaien Conner, Edlin Garcia Colato, Erica Anderson, and Iraida Carrion. "Healthcare Affordability and Associated Concerns Among Older Adults in Florida." Innovation in Aging 4, Supplement_1 (December 1, 2020): 97. http://dx.doi.org/10.1093/geroni/igaa057.321.
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Abstract Rising healthcare costs create significant financial burden for Americans and is a threat to the well-being of our growing, racially/ethnically diverse, older population. In a mixed method study, we assessed ability to afford care and ascertain concerns about healthcare cost in a racially diverse sample of Floridians ages ≥ 65. We surveyed 170 adults (40.4% White, 27.6% African Americans/Black and 31.8% Latino/Hispanic) and conducted three race-stratified focus groups (n=27). Most participants had Medicare coverage (97.1%) and 27% also had Medicaid. Approximately 11.6% of Whites had problems paying medical bills in the past 12 months versus 14.9% of African Americans/Blacks and 24.1% of Latino/Hispanics. Additionally, 13% of Whites, 19.2% of African Americans/Blacks and 20.4% of Hispanics reported not getting needed prescription drugs because they could not afford them. Approximately 45.7% either perceived that their doctor “never” takes into account costs for treatment or did not know whether costs were considered. Multiple regression analyses showed no statistically significant racial/ethnic differences in affordability problems. From the focus groups, healthcare cost concerns most frequently identified by participants were the high cost of prescriptions drug, rising co-pays and out of pocket expenses, and medical billing. Participants’ concerns about medical billing included understanding their bills, transparency in billing, timely posting of charges, and uncertainty about who to talk to about billing problems. Our findings suggest that routine discussions about healthcare costs with doctors or designated healthcare personnel should help ease financial burden and healthcare costs concerns among older adults.
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Le, Thomas, Gilbert Gee, Lorraine Dean, Hee-Soon Juon, and Som Saha. "57963 The Impact of Asian American Perceived Discrimination on Health Utilization." Journal of Clinical and Translational Science 5, s1 (March 2021): 86. http://dx.doi.org/10.1017/cts.2021.623.
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ABSTRACT IMPACT: Understanding how perceived discrimination affects Asian Americans can help stakeholders target subgroups that are at highest risk of discrimination-related behaviors and design culturally appropriate interventions to ensure equitable access to healthcare. OBJECTIVES/GOALS: The COVID-19 pandemic has exposed longstanding anti-Asian racism in the US. Yet, effects of discrimination on Asian American health are unknown, partly because diverse Asian American populations are analyzed in aggregate. We aim to understand how perceived discrimination affects healthcare utilization among different Asian American subgroups. METHODS/STUDY POPULATION: We examine the association of perceived discrimination with healthcare utilization using the California Health Interview Survey (CHIS). In the CHIS, respondents reported whether they would’ve gotten better medical care if they belonged to a different race. We examine the association between these responses and physician visits within the past year, in the survey years 2003, 2004 and 2016-2017. We adjust for covariates based on the Andersen Health Behavior model. Subsequent modeling examines potential mediating and moderating factors such as limited English proficiency, immigration status, income, and survey year. Asian American subgroups analyzed include Asian Indian, Korean, Chinese, Filipino, Vietnamese, Japanese, and other Asian. RESULTS/ANTICIPATED RESULTS: Results will highlight how perceived discrimination incentivizes or disincentivizes certain Asian subgroups to utilize healthcare. Asian American subgroups have differing and diverse experiences with discrimination due to their historical and cultural differences; results will elucidate how discrimination affects these subgroups. Results will be compared to non-Hispanic Whites, who represent the racial group least likely to experience discrimination in the US. Mediation and moderation analysis will help understand how traditionally cited factors for healthcare utilization interact with perceived discrimination on Asian Americans. DISCUSSION/SIGNIFICANCE OF FINDINGS: Asian American subgroups are understudied, despite Asian Americans being one of the fastest growing racial groups in the US. Understanding how perceived discrimination affects Asian Americans can help stakeholders target subgroups that are at highest risk of discrimination-related behaviors and design culturally appropriate interventions.
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Aranda, María P., Laura A. Ray, Soham Al Snih, Kenneth J. Ottenbacher, and Kyriakos S. Markides. "The Protective Effect of Neighborhood Composition on Increasing Frailty Among Older Mexican Americans." Journal of Aging and Health 23, no. 7 (September 23, 2011): 1189–217. http://dx.doi.org/10.1177/0898264311421961.
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Objective: Little is known about the nature of the frailty syndrome in older Hispanics who are projected to be the largest minority older population by 2050. The authors examine prospectively the relationship between medical, psychosocial, and neighborhood factors and increasing frailty in a community-dwelling sample of Mexican Americans older than 75 years. Method: Based on a modified version of the Cardiovascular Health Study Frailty Index, the authors examine 2-year follow-up data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) to ascertain the rates and determinants of increasing frailty among 2,069 Mexican American adults 75+ years of age at baseline. Results: Respondents at risk of increasing frailty live in a less ethnically dense Mexican-American neighborhood, are older, do not have private insurance or Medicare, have higher levels of medical conditions, have lower levels of cognitive functioning, and report less positive affect. Discussion: Personal as well as neighborhood characteristics confer protective effects on individual health in this representative, well-characterized sample of older Mexican Americans. Potential mechanisms that may be implicated in the protective effect of ethnically homogenous communities are discussed.
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Sadarangani, Tina, Chau Trinh-Shevrin, and Abraham Brody. "BARRIERS AND FACILITATORS TO DELIVERING PERSON-CENTERED NUTRITION FOR ASIAN AMERICANS IN ADULT DAY HEALTH SETTINGS." Innovation in Aging 3, Supplement_1 (November 2019): S227. http://dx.doi.org/10.1093/geroni/igz038.835.
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Abstract Malnutrition is a growing problem in community-based long-term care settings. Delivering person-centered nutrition is particularly important in congregate settings serving ethnically diverse older adults who have strong culturally-derived preferences around food. We conducted in-depth semi-structured multi-stakeholder interviews (N = 13) in an adult day health center (ADHC) serving Asian immigrants to explore the ADHC’s capacity to deliver person-centered nutrition interventions. Thematic analysis showed ADHCs successfully promoted social interaction at meal-time. However, participants had limited choice and restrictions on additives, like sodium, making it difficult to honor participants’ cultural preferences. Lack of flavor, limited choice, and rushed mealtimes, driven by center policies and procedures, disproportionately affected persons with dementia. Among those with dementia, clinicians disagreed whether nutrition should be used to manage chronic illness or whether a more palliative approach was warranted. One potential way to address this challenge would be to enable greater choice within a supportive ADHC mealtime environment.
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Kaiser, R., C. M. Cleveland, and L. A. Criswell. "Risk and protective factors for thrombosis in systemic lupus erythematosus: results from a large, multi-ethnic cohort." Annals of the Rheumatic Diseases 68, no. 2 (September 9, 2008): 238–41. http://dx.doi.org/10.1136/ard.2008.093013.
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Objectives:Few studies have examined thrombosis in systemic lupus erythematosus (SLE), none have included Asian-Americans, and most have had small sample sizes. We analysed risk factors for thrombosis in a large, multi-ethnic SLE cohort.Methods:We studied 1930 SLE subjects, including Caucasians, African-Americans, Asian-Americans and Hispanics. Data were derived from questionnaires and medical records. Documented history of thrombosis was the primary outcome. Explanatory variables included age at SLE diagnosis, gender, ethnicity, disease duration, smoking, antiphospholipid antibody (aPL) status, nephritis and specific medications.Results:Smoking (OR 1.26, p = 0.011), longer disease duration (OR 1.26 per 5 years p = 0.027×10−7), nephritis (OR 1.35, p = 0.036), aPL positivity (OR 3.22, p<10−9) and immunomodulating medication use (OR 1.40, p = 0.011) were statistically significant risk factors for thrombosis. Younger age at SLE onset was protective (OR 0.52 for age ⩽20, p = 0.001). After adjusting for disease severity and incorporating propensity scores, hydroxychloroquine use remained significantly protective for thrombosis (OR 0.62, p = 4.91×10−4).Conclusions:This study confirms that older age at onset, longer disease duration, smoking, aPL positivity, history of nephritis and immunomodulating medication use are risk factors for thrombosis in SLE. These data are the first to confirm in a large and ethnically diverse SLE cohort that hydroxychloroquine use is protective for thrombosis.
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Shon, En-Jung, and Anjanette Wells. "Effects of Patient-Centered Communication on Influenza Vaccination and Self-Reported General Health Status among Asian Americans: A Comparison Model for Young/Middle-Aged and Older Adults." Journal of Aging and Health 32, no. 10 (June 4, 2020): 1409–18. http://dx.doi.org/10.1177/0898264320930888.
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Objectives: Asian American subgroups’ influenza vaccination is still below the US standards. This study examined the effects of patient-centered communication (PCC) on influenza vaccination and the general health (GH) of Chinese, Vietnamese, and Korean Americans. A group difference between younger and older adults was investigated. Methods: The 2014–2016 California Health Interview Surveys were merged (Chinese [ N = 1,680], Korean [ N = 514], and Vietnamese [ N = 644]; age 18+; younger = 1,629 and older = 1,209). Two path models (PCC [measured by physicians’ careful listening], vaccination, and GH; PCC [measured by physicians’ clear explanation], vaccination, and GH) were evaluated. Regression maximum likelihood was applied for missing values. Results: Both the first and second models showed good model fit scores (comparative fit index [CFI] = .95, root mean square error of approximation [RMSEA] = .04, and standardized root mean residual [SRMR] = .03; CFI = .93, RMSEA = .04, and SRMR = .03). There were direct effects of PCC on vaccination among younger adults. PCC directly influenced GH for both age-groups. Discussion: A PCC manual for physicians in local or community health centers could enhance both younger and older adults’ influenza vaccination.
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Finn, J. W., P. Nelson, M. Yassine, K. Presby, J. Towns, and S. Affholter. "Cancer outcomes at end-of-life in Michigan." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 8575. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.8575.
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8575 Background: End-of-life care (EOLC) is an important focus of comprehensive cancer control, yet little data is formally collected and no central repository exists across all cancer sites. Collaboration by the MI Department of Community Health, the MI Public Health Institute, and the Institute for Public Policy and Social Responsibility (IPPSR) in 2004 produced an end-of-life module, which was added to a caregiver survey designed to track cancer screening already in use: the Michigan Special Cancer Behavioral Risk Factor Survey (MSCBRFS). Methods: A population-based sample of caregivers, age 40 and older, including minorities, were contacted by trained IPPSR staff (bilingual) using computer-assisted telephone interviews. Results: 761 respondents constituted the sample size of caregivers who reported having cared for a family member or friend who died of cancer in the preceding 5 years, including 196 African Americans, 92 American Indians, 51 Hispanic Americans, 49 Arab Americans and 73 Asian Americans. The average pain level in the final 3 months was severe to excruciating for 44.7%. Pain medications had been prescribed for 93.5%; however, not used as directed for 30.3%. The most frequent reason given for this was fear of addiction/side effects (32.7%). The proportion who died at home was 44.3%. In general terms, Caucasians tended to die outside the hospital, whereas African and Asian Americans tended to die in the hospital and Native and Hispanic Americans at home. 68.2% of cancer decedents died with the support of hospice care (no racial variance). The median length of stay on hospice was short, 17.5 days (2003 MHPCO data). The main reason given why hospice was not chosen was that death occured before hospice enrollment (55.2%). Conclusions: Cancer outcomes data at end-of-life is an important part of state-wide comprehensive cancer control. Specific progress markers are presently established for the Michigan Cancer Consortium. Baselines measurements include the prevalence of severe pain in the final 3 months (44.7%), proportion of those who died at home (44.3%), percent of those who used hospice services (68.2%) and median hospice length of stay (17.5 days). These outcome measures will be trended over the next five years for purposes of cancer care quality improvement, public and professional education and system change. No significant financial relationships to disclose.
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Chao, Ying-Yu, Jin Young Seo, Mei-Lan Chen, and Peijia Zha. "Factors Associated With Depressive Symptoms Among U.S. Older Chinese Immigrants." Innovation in Aging 4, Supplement_1 (December 1, 2020): 167–68. http://dx.doi.org/10.1093/geroni/igaa057.542.
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Abstract Purpose: Chinese Americans represent the largest Asian ethnic subgroup in the United States. Depression is the most common mental health problem among older adults. However, we have a limited understanding of depressive symptoms among older Chinese immigrants. The study aimed to examine the potential factors associated with depressive symptoms among older Chinese immigrants in U.S. Methods: We recruited participants from psychiatric clinics who sought professional help in New York City. Inclusion criteria were Chinese immigrants from Asian countries 50 years or older; able to speak and understand either Mandarin or Cantonese; and had a diagnosis with major depressive disorder. Depressive symptoms were measured with Quick Inventory of Depressive Symptomatology; cognitive function was measured with Montreal cognitive assessment; sleep quality was measured with Pittsburgh Sleep Quality Index, and physical activity was measured with International Physical Activity Questionnaire. Descriptive statistics and multiple regression were performed. Results: Participants were ninety-nine Chinese older immigrants (mean age: 60.69 ± 7.62 years). Participants who had more children (p < .05), poor health status (p < .01), poor quality of life (p < .01), less social support (p < .01), and need help with activities of daily living (p < .05) had more depressive symptoms. Cognitive function, sleep quality, and physical activity were significantly associated with depressive symptoms. Conclusions & Implications: Poor cognitive function, poor sleep quality, and less physical activity were associated with depressive symptoms. Our results provide knowledge for developing culturally tailored self-management interventions for older Chinese immigrants with depressive disorder in managed care settings.
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Mittal, Nupur, Mario Martinez, Johnathan Davidson, Paul Kent, Lisa Giordano, Dipti Dighe, Daniel K. Choi, et al. "Improving Accrual of Adolescents and Young Adults and Underrepresented Minorities with Leukemia to Children's Oncology Group Clinical Trials: A Novel Collaborative Approach to Address Disparities in Leukemia." Blood 128, no. 22 (December 2, 2016): 845. http://dx.doi.org/10.1182/blood.v128.22.845.845.
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Abstract Background: It is accepted that the dramatic historical decrease in mortality from ALL and AML in children and more recently AYAs is directly related to improved participation in NCI sponsored COG clinical trials. It is also known that African-American (AA) and Hispanic children, Hispanic females, and particularly AYAs 15 to 39 years are under-represented in COG clinical trials and may benefit from targeted attention. AA and Hispanic children with ALL and AML have worse survival than white and Asian children even with modern therapy where cure rates have improved drastically. Access to standard accepted chemotherapy for leukemia, socio-economic status and insurance status, differences in disease phenotype and pharmacogenetic variations play a role in these racial and ethnic disparities. AYAs with leukemia have experienced variable improvement in survival over the past two decades due partly to insufficient cancer clinical trial enrollment. Uninsured, older patients and those treated by non-pediatric oncologists were less likely to enroll onto clinical trials. Multiple studies of ALL in North America and Europe have shown AYA patients treated with pediatric "inspired" protocols have better outcomes than AYA patients treated with protocols designed for adults. Enhancing access to quality cancer care in a timely manner in these underrepresented populations (AYA, non white, or under-insured) has emerged as a priority area in oncology. In 2008, to improve access to this largely underserved population, two COG institutions (University of Illinois at Chicago (UIC) and Rush University) and a non-member hospital (John H Stroger Hospital of Cook County) created a unified COG program utilizing one lead IRB and one research team. This study assesses the impact that the collaborative UIC/Rush/Stroger COG program had on clinical trial enrollment for minority underserved and AYA patients with leukemia (ALL and AML). Methods: A retrospective comparative analyses of COG enrollment data from 2002-2008 and 2008-2014 (pre vs. post-merger) for all patients with ALL and AML by race/ethnicity, age at diagnosis, gender, insurance status, clinical trial type (biology, registry, therapeutic) , and leukemia type was completed. Information regarding the number of COG clinical trials available to enrolment and primary oncologists of enrollees' pre and post merger was collected. Results: The comparison of the number of patients enrolled pre-merger and post-merger by various variables is shown in table 1. A total of 40 enrolments with 9 being for therapeutic trials occurred at Stroger Hospital, a site with no access to COG trials prior to the merger. A total of 13 ALL patients and 5 AML patients were enrolled at Stroger Hospital, 7 of whom were uninsured (39%). Nine Pediatric Oncologists, 6 Medical Oncologists and 3 Pediatric nurse practitioners (18 total providers) were engaged in post-merger COG enrollments compared to 6 Pediatric and only 1 Medical Oncologist (7 total providers) engaged pre-merger across the three institutions. Conclusions: Significant increase in COG leukemia trial availability and enrollment especially for under-represented (non-white, underinsured) minorities and AYAs was a direct result of the creation of the novel UIC/Rush/Stroger COG Clinical Trials program. Cancer clinical trial participation has directly led to improved disease free survival and lower cancer death rates. Collaboration between institutions and Medical and Pediatric Oncologists is critical to participation of AYA's with leukemia in NCI sponsored clinical trials. Improving access to these clinical trials is essential to addressing current disparities in leukemia survival. The UIC/Rush/Stroger COG Program serves as a model for improved collaboration between competing institutions and specialists within institutions to increase access to current clinical trials for minority and AYA patients with leukemia. Disclosures No relevant conflicts of interest to declare.
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Alex, Deepa, Yatinesh Kumari, and Amudha Kadirvelu. "An Experiential Aged Care Module for First-Year Undergraduate Medical Students." Education Sciences 11, no. 10 (September 22, 2021): 565. http://dx.doi.org/10.3390/educsci11100565.
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A rapid demographic transition to aging populations is imminent over the next decade, especially in Southeast Asian countries. An aging population presents a host of medical challenges, such as multimorbidity; chronic illnesses; and geriatric syndromes, such as frailty, falls, dementia, and incontinence. In order to tackle such issues efficiently, there is an urgent need to train future doctors in geriatric medicine. Aged care is a specialty in medicine that was not traditionally part of the undergraduate medical curriculum. With the changing demographic, aged care content needs to be integrated into the existing curriculum for undergraduate medical students. In this paper, we present an introductory novice level geriatric module that was developed for first-year medical undergraduate students in Monash University, Malaysia. The module consisted of collaborative active learning sessions on healthy aging, interaction with older adults from the community, and a simulated experiential activity. Feedback was collected from students on module completion. The immediate impact of the module was positive from the student responses. The findings from this study will be useful to inform the development and implementation of future educational interventions for aged care, as well as to support the establishment of a vertically integrated aged care curriculum, in order to prepare future doctors to provide healthcare for the ageing Asian population.
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Han, Areum, and Tae Hui Kim. "A Simulation-Based Empathy Enhancement Program for Non-Medical Care Providers of Older Adults: A Mixed-Methods Study." Psychiatry Investigation 18, no. 2 (February 25, 2021): 132–39. http://dx.doi.org/10.30773/pi.2020.0290.
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Objective Studies using simulation-based programs for empathy enhancement have been conducted mostly for health profession students and medical care providers in Western countries. No empirical research has been conducted for non-medical care providers of older adults in community settings in Asian countries. The purposes of this mixed-methods study were: to explore experiences and perceived usability of non-medical care providers of older adults in a simulation-based empathy enhancement program; and to examine if the program is effective in improving empathy and relevant outcomes.Methods 104 non-medical care providers of older adults in South Korea participated in a simulation-based empathy enhancement program in 2018. Data were collected using self-reported questionnaires for effectiveness testing, a program evaluation questionnaire, and individual interviews and analyzed using statistical tests and thematic analysis.Results Care providers showed higher levels of empathy and lower levels of stress and burnout after the program participation (p<0.05). Qualitative findings supported the improved attitude and care strategies, increased empathy towards older adults, preparing for their own aging, and restoration of emotional stability through the participation in the program.Conclusion This study suggests that the simulation-based program is useful in promoting empathic responses of non-medical care providers working with older adults.
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Silva, Analiza M., Jack Wang, Richard N. Pierson, ZiMian Wang, Steven B. Heymsfield, Luis B. Sardinha, and Stanley Heshka. "Extracellular water: greater expansion with age in African Americans." Journal of Applied Physiology 99, no. 1 (July 2005): 261–67. http://dx.doi.org/10.1152/japplphysiol.01317.2004.
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Aging is associated with the onset of chronic diseases that lead to pathological expansion of the extracellular water (ECW) compartment. Healthy aging, in the absence of disease, is also reportedly accompanied by a relative expansion of the ECW compartment, although the studies on which this observation is based are few in number, applied different ECW measurement methods, included small ethnically homogeneous subject samples, and failed to adjust ECW for non-age-related influencing factors. The aim of the current study was to examine, in a large ( n = 1,538) ethnically diverse [African American (AA), Asian, Caucasian, Hispanic] subject group the cross-sectional relationships between ECW and age after controlling first for other potential factors that may influence fluid distribution. ECW and intracellular water (ICW) were derived from measured total body water (isotope dilution) and potassium (40K whole body counting). The cross-sectional relationships between ECW, ICW, and ECW/ICW (E/I), and age were developed using multiple regression modelling methods. Body weight, weight squared, height, age, sex, race, and interactions were all significant ECW predictors. The slope of the observed race × age interaction was significantly greater in AA (β = 0.0005, P = 0.005) than in the three other race groups. Race, sex, and age differences in fluid distribution persisted after adjusting for body composition in a subgroup ( n = 994) with dual-energy X-ray absorptiometry lean soft tissue and fat measurements. A relative ECW expansion (i.e., E/I) was present with greater age in most sex-race groups, although the effect was not significantly larger in AA males ( P > 0.05) compared with the other race groups, except Asians ( P < 0.05). For females, a larger E/I-age effect was found in AA compared with the other race groups, but only the comparison against Hispanics was significant ( P < 0.05). The ECW compartment and E/I are thus variably larger, according to race, in healthy older subjects independent of sex, lean soft tissue, and fat mass.
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Steffens, David C. "In our hands: responding to the IOM report on workforce needs for older adults with mental health and substance use disorders." International Psychogeriatrics 25, no. 7 (May 2, 2013): 1039–40. http://dx.doi.org/10.1017/s1041610213000641.
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In the United States, there are signs that we are coming to terms with the growing healthcare needs of older Americans. Over the past decade, exploding Medicare costs and the federal budget deficit have forced medical professionals, policy-makers, and other stakeholders to consider the consequences of an aging population. The US Congress commissioned a report from the Institute of Medicine (IOM) on the physical healthcare needs of the elderly adults and the geriatric healthcare workforce required to meet them, resulting in the 2008 IOM report Retooling for an Aging America: Building the Health Care Workforce (IOM, 2008). Following this report, Congress recognized that the work was not finished and that more information was needed about mental health and substance use (MH/SU) disorders in older Americans. The IOM was commissioned by Congress to convene a committee to study and report on the workforce needed to care for this group. In 2012, the IOM released The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? (IOM, 2012).
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Artnak, Kathryn E., Richard M. McGraw, and Vayden F. Stanley. "Health Care Accessibility for Chronic Illness Management and End-of-Life Care: A View from Rural America." Journal of Law, Medicine & Ethics 39, no. 2 (2011): 140–55. http://dx.doi.org/10.1111/j.1748-720x.2011.00584.x.
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The Institute of Medicine (IOM) reporting on the quality of health care in America recommends six aims for achieving the health care system we could have. Together with the Institute for Healthcare Improvement (IHI) Triple Aim initiative, a framework has emerged to challenge providers, educators, and policymakers to remake the health care system according to specific objectives: to provide care that is safe, effective, patient-centered, timely, efficient, and equitable to more people at a price we can afford. Complicating this mission of better prevention and better care at a lower cost is a daunting demographic: January of 2011 marked the month and year that the first of the baby boomers turned 65. The U.S. Census Bureau in May 2010 projected the number of Americans of this age and over to reach 88 million by 2050, more than double the current figure of 40.2 million. Parekh and Barton forecast in stark detail what it will be like to address these burgeoning numbers of older Americans with comorbidities, including the fact that over 20% of the population currently experiences at least two chronic medical conditions.