Chinese Immigrant Caregivers: Understanding Their Unmet Needs and the Co-Design of an mHealth App.

BACKGROUND: Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials. OBJECTIVE: This study employed a design thinking framework to examine Chinese immigrant caregivers' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs. METHODS: Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases. FINDINGS: Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens. DISCUSSION: The co-design process appears to be beneficial in having participants voice both barriers and preferences.

Validating interRAI Chinese self-reported carer needs (SCaN) assessment and predicting caregiving distress among informal Chinese caregivers of older adults.

BACKGROUND: This study aims to (1) determine the reliability and validity of the interRAI Chinese Self-reported Carer Needs (SCaN) assessment among informal Chinese caregivers of older adults, (2) identify predictors of caregiving distress in Asian regions with long-standing Confucian values of filial piety and family responsibility. METHODS: This cross-sectional study recruited 531 informal Chinese caregivers of older adults in Hong Kong, Shanghai, Taiwan, and Singapore. The scale reliability was examined using Cronbach's alphas (α) and McDonald's omega coefficient (ω). The concurrent validity and discriminant validity were assessed using Spearman rank correlations (rho). To examine the predictors of caregiving distress among informal caregivers of older adults, we employed hierarchical linear regression analyses informed by the Model of Carer Stress and Burden and categorized the predictors into six domains. RESULTS: Results revealed good internal consistency reliability (α = 0.83-0.96) and concurrent validity (rho = 0.45-0.74) of the interRAI Chinese SCaN assessment. Hierarchical linear regression analysis revealed that entering the background factors, primary stressors, secondary stressors, appraisal, and exacerbating factors all significantly enhanced the model's predictability, indicating that the source of caregiving distress is multidimensional. In the full model, caregivers with longer informal care time, lack of support from family and friends, have unmet needs, experience role overload, have sleep problems, and low IADL functioning are at a higher risk of caregiving distress. CONCLUSIONS: The interRAI Chinese SCaN Assessment was found to be a reliable and valid tool among the Chinese informal caregivers of older adults. It would be useful for determining family caregivers' strengths, needs, and challenges, and tailoring interventions that address the potentially modifiable factors associated with caregiving distress and maximize support. Healthcare providers working in home and community settings should be aware of the early identification of caregiving distress and routine assessment of their needs and empower them to continue taking care of their needs and providing adequate care to the care recipient.

"Do Your Best to Avoid it": Appraisals and Coping with Discrimination-Related Stress Among Older Chinese Immigrants in Affordable Senior Housings During the COVID-19 Pandemic.

This study investigated how older Chinese immigrants in affordable senior housing facilities (ASHs) appraise and cope with anti-Asian discrimination and related stress during the COVID-19 pandemic. Qualitative interviews were conducted with 26 participants aged over 65, analyzing verbatim transcripts and field notes using thematic analysis. Four major domains were identified: (1) discriminatory experience, (2) appraisals of discrimination stress, (3) coping strategies, and (4) rationales behind coping. Among the participants, 11 (42%) reported experiencing discrimination either personally or by someone they know. Participants' appraisals of discrimination stress varied, and most of them opted for disengagement coping strategies (e.g., avoidance, rationalization) attributing them to health concerns, individual characteristics, environmental and societal factors, and low acculturation. The findings suggest the need for more social and community resources to enhance coping capacity and resilience in this vulnerable population.

Technology-Based Interventions to Address Social Isolation and Loneliness Among Informal Dementia Caregivers: A Scoping Review.

OBJECTIVE: Social isolation and loneliness are major public health concerns. Informal dementia caregivers are particularly vulnerable, as many are older adults themselves and at elevated risk of adverse mental and physical health outcomes. Technology-based interventions could offer accessible, affordable, and convenient solutions. A previous review included Internet-based supportive interventions for informal dementia caregivers published up to 2013; however, new publications, technological advances, and targeted outcomes justify conducting this scoping review. Here, we identified and synthesized recent technology-based interventions that addressed social isolation and loneliness among informal dementia caregivers. DESIGN: Scoping review. SETTING AND PARTICIPANTS: Informal dementia caregivers in the community. METHODS: Following Arksey and O'Malley's scoping review framework, we conducted a systematic search of peer-reviewed studies across 6 databases within the last 11 years, including identifying research questions, selecting relevant studies, charting data, and summarizing results. RESULTS: From the 2937 articles identified, 10 eligible studies were included in this review. The intervention type, format, and duration varied widely. Three categories of interventions to address social isolation and loneliness among informal dementia caregivers included technology-assisted peer support, newly developed Web-based multicomponent psychoeducational programs and platforms, and virtual adaptation and modification of existing programs. Predominantly qualitative evidence suggests that technology-based interventions have the potential to reduce feelings of loneliness and improve caregiver well-being. Quantitative evidence tends to be preliminary and inconclusive. CONCLUSIONS AND IMPLICATIONS: The findings offer preliminary evidence for technology-based interventions to reduce or prevent social isolation and loneliness in informal dementia caregivers. Technology-based interventions addressing social isolation and loneliness in informal dementia caregivers have the potential to overcome barriers to low uptake of services and withdrawal from interventions and improve the sustainability of the interventions. In the long run, by reducing or preventing social isolation and loneliness in informal dementia caregivers, the transition from home care to facility-based care might be delayed.

Intergenerational Reminiscence Approach in Improving Emotional Well-Being of Older Asian Americans in Early-Stage Dementia Using Virtual Reality: Protocol for an Explanatory Sequential Mixed Methods Study.

BACKGROUND: After a dementia diagnosis, Asian Americans experience anxiety, feelings of shame, and other negative effects. Emotional well-being is not only an important aspect of mental health, but also a quality of resilience that helps people bounce back faster from difficulties. However, few studies have addressed issues in developing, implementing, and testing intervention strategies to promote emotional well-being among older adults. Intergenerational solidarity between grandparents and grandchildren has been emphasized in Asian families and is beneficial for the health of persons with dementia. Reminiscence and life review have been identified as potentially effective intervention strategies for helping depression and emotional well-being for older adults. OBJECTIVE: This proposed study aims to develop and implement an intergenerational reminiscence approach and evaluate its potential feasibility and effectiveness in improving the emotional well-being of older Asian American adults who have a recent dementia diagnosis. METHODS: An explanatory sequential mixed methods design will be used in which quantitative data will first be collected and analyzed to identify subsamples of participants who report the greatest and least change in emotional well-being; then, these subsamples will be interviewed to further understand why or why not this intervention works for them. Older adults will receive 6 sessions of life review with grandchildren in virtual reality (VR; 1-1.5 hours each week for 6 weeks), aided by pictures and virtually traveling to important places in their life using Google Earth to look around at those places and remember important times. Quantitative survey data will be collected pre- and postintervention and at a 3-month follow-up. Qualitative interviews with selected participants will also be integrated into the study design. The quantitative data from the surveys will be entered into SPSS (IBM Corp) and analyzed using descriptive analyses, Pearson chi-square tests, nonparametric Friedman tests, or nonparametric Wilcox signed-rank tests (2-tailed). The qualitative data will be transcribed by research assistants, coded by the investigators independently, and analyzed with guidance from content analysis software (Atlas.ti; Atlas.ti Scientific Software Development GmbH). RESULTS: The project was delayed due to the COVID-19 pandemic. Data collection started in late 2021, and 26 participants were recruited as of December 2022. While we are still cleaning and analyzing the quantitative data, the qualitative interviews showed promising results of this intergenerational reminiscence approach in improving emotional well-being among older Asian American adults who have cognitive impairment. CONCLUSIONS: Intergenerational reminiscence provided by grandchildren is promising in improving the emotional well-being of grandparents. VR technology is likely to be accepted by older adults. Future research may consider scaling up this pilot into a trackable, replicable model that includes more participants and develops a more rigorous study design with control groups to test the effectiveness of this intervention for older adults with dementia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48927.

Social network and mental health of Chinese immigrants in affordable senior housing during the COVID-19 pandemic: a mixed-methods study.

OBJECTIVE: Chinese immigrant older adults who live in affordable housing are at high risk of experiencing social isolation during the COVID-19 pandemic, which can affect their mental health. Using a triangulation mixed-methods approach, this study describes Chinese immigrant older adults' social network, mental health status, and their associations during the pandemic. METHODS: Semi-structured in-depth interviews were conducted with 26 Chinese immigrant older adults from June to August 2021. The structure and characteristics of participants' social networks were assessed with a name-generating approach. Mental health status was self-reported with Geriatric Depression Scale and UCLA loneliness scale. RESULTS: This sample (mean age = 78.12, 69.23% female), on average, had 5.08 social ties in their network, and 58% were family ties. Participants reported decreased social contact, family and friends interaction patterns specific to immigrants, and constantly being in a low mood and bored. Having closer relationships with others and maintaining the same or higher contact frequency after COVID-19 onset was associated with fewer depressive symptoms. Resilience from religious beliefs, neighbors as role models, and wisdom learned from past experiences were reported. CONCLUSION: Knowledge built in this study can inform respondence to future crises like the COVID-19 pandemic in affordable housing settings serving older immigrant populations.

Impacts of Caregiving on Health of New Spousal Caregivers to Older Adults in the United States: A Coarsened Exact Matching Analysis.

OBJECTIVES: Spousal caregivers of older adults, especially new spousal caregivers, face increased risks of negative health outcomes due to the demands of caregiving and their own health decline. Estimating the impacts of caregiving on health without controlling for caregivers' own aging-related health decline could exaggerate the negative health consequences of caregiving, while focusing solely on caregivers could result in selection bias where healthier individuals enter and/or remain in caregiving. This study aims to estimate the impacts of caregiving on health of new spousal caregivers while controlling for observable confounders. METHODS: We utilized coarsened exact matching analysis to compare health outcomes between new spousal caregivers and spousal noncaregivers using pooled panel data from 2006 to 2018 in the Health and Retirement Study. We analyzed 242,123 person-wave observations from 42,180 unique individuals, among whom 3,927 were new spousal caregivers. Variables used for matching were classified into 3 categories: care needs, willingness to provide care, and ability to provide care. Two-year outcomes assessed are spouse's self-rated health, depressive symptoms, and cognitive functioning. RESULTS: A total of 3,417 (87.01%) new spousal caregivers were matched with 129,798 observations of spousal noncaregivers. Regression analysis indicated being a new spousal caregiver was associated with a 0.18- (standard error = 0.05) unit increase in number of depressive symptoms. No statistically significant results were identified for self-rated health and cognitive functioning. DISCUSSION: Our results highlighted the needs to address mental health among new spousal caregivers and emphasized the importance of addressing mental health in long-term care programs and policies.

Life review on psychospiritual outcomes among older adults with life-threatening illnesses: A systematic review and meta-analysis.

Background: At the intersection of old age and illness, older adults with life-threatening illnesses (LTI) are a group who often show resilience and seek validation of life, acceptance, and integration of past and now, even under the fear of loss, suffering, and dying evoked by life adversities. Life review has been widely conducted to help older adults enhance well-being and cope with burdens. Spirituality is an important part of an older adult' overall well-being, especially for those with LTI. However, few review studies examined the effectiveness of life review interventions on psychospiritual outcomes among this population. The aim of the study was to examine the effectiveness of life review on psychospiritual well-being among older adults with LTI. Methods: A systematic review with meta-analysis following the recommendations of the Cochrane Collaboration was conducted. Database searches included PubMed, PsycINFO, the Cochrane Library, the Campbell Library, EBSCO, CNKI, and the Airiti Library up to March 2020. Gray literature and reference lists from relevant articles were also searched and reviewed. Results: In total, 34 studies were included in the systematic review and the meta-analysis for outcomes of depression (n = 24), quality-of-life (QOL) (n = 10), anxiety (n = 5), life satisfaction (n = 3), mood (n = 3), apathy (n = 2), and general well-being (n = 2). Other psychospiritual outcome measures included spirituality, self-esteem, meaning in life, hope, and some multi-dimensional instruments. The studies greatly varied in program design, content, format, length, and more. Although with high heterogeneity, meta-analysis results demonstrated standardized mean differences in favor of life review in decreasing depression, anxiety, negative mood, and increasing positive mood and QOL compared with the control group. Conclusion: This review calls for including more psycho-spiritual well-being measures among interventions for older adults with LTI, as well as studies with rigorous designs in future research.

Exploration of Social Exclusion among Older Chinese Immigrants in the USA.

BACKGROUND: Older adults are vulnerable to social exclusion and its detrimental health outcomes. However, few existing studies focus on the social exclusion of older adults as immigrants and ethnic-minority individuals. To fill the gap, drawing on the conceptual framework of old-age vulnerability, this study explored the multi-dimensional experience of social exclusion for older Chinese immigrants in the U.S. and investigated how old age and immigration exacerbated older adults' experiences of social exclusion. METHOD: The study included 24 in-depth face-to-face individual interviews in Los Angeles and employed thematic analysis on the qualitative data. Themes were identified until consensus was reached among the research-team members. Triangulation of multiple analysts was used to avoid analytic bias. FINDINGS: Findings showed that older Chinese immigrants experienced social exclusion in the following dimensions: basic services; material and financial resources; social relations and activities; socio-cultural aspects; and neighborhood/territory/community. In addition to age-related factors, immigration-related factors, including changes in physical and socio-cultural environments and legal status, also contributed to older immigrants' extra vulnerabilities to social exclusion. CONCLUSIONS: This study provides useful information and strategies for human and healthcare service providers to find ways to overcome social exclusion and enhance older Chinese immigrants' social inclusion in the U.S.

Experiences of discrimination and oral health-related quality of life among foreign-born older Chinese Americans: Does resilience play a mediating role?

OBJECTIVES: It is well-established that racial discrimination influences quality of life, but there is scarce evidence about how racial discrimination affects oral health-related quality of life (OHRQoL). Furthermore, the pathways linking racial discrimination and OHRQoL remain unknown. Guided by the integrative framework of immigration, ageing, and oral health, psychosocial stressors and resources exert influences on OHRQoL. In addition, according to the compensatory model of resilience, resilient resources could counteract risk exposures to stressors given specific outcomes. Hence, this study examined the relationship between experiences of discrimination and OHRQoL and investigated resilience as a mediator in such a relationship among older Chinese immigrants. METHODS: Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3054 foreign-born older Chinese Americans aged 60 years or older. OHRQoL was measured by seven items from the Geriatric Oral Health Assessment Index. Experiences of discrimination (yes or no) were measured by the 9-item Experiences of Discrimination instrument. Resilience was measured by the 10-item Connor Davidson Resilience Scale. Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL. RESULTS: Experiences of discrimination were directly associated with poorer OHRQoL (b = -0.98, P < .05). Resilience partially mediated the relationship between discrimination experiences and OHRQoL. Specifically, discrimination experiences were associated with weaker resilience (b = -1.58, P < .05), and weaker resilience was associated with poorer OHRQoL (b = 0.06, P < .05). CONCLUSIONS: Findings illustrate the importance of studying racial discrimination and resilience in OHRQoL. Interventions need to consider individuals' discrimination experiences and stress coping abilities to promote OHRQoL.

A Social-Ecological Approach to Understanding Activity Engagement Patterns Among Older Chinese Immigrants.

Few studies have focused on activity engagement among older immigrants. We aim to map the patterns of activity engagement and examine the associations with social-ecological factors in a sample of older Chinese immigrants. Participants were from the Population Study of Chinese Elderly in Chicago (PINE). Four patterns of activity engagement were identified through latent class analysis: restricted, diverse, informal social, and community-based social. Intrapersonal, interpersonal, cultural, and environmental factors distinguished latent classes of activity engagement. In particular, acculturation and family-oriented immigration differentiated the restricted from the diverse class membership. Positive attributes of social environment such as social network size, positive social support, and neighborhood cohesion were associated with the likelihood of categorization in the diverse, informal social, and community-based social groups relative to the restricted group. Findings point to the importance of positive attributes of social environment in enhancing engagement with life among older Chinese immigrants.

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.

Immigration Experience and Cognitive Function Trajectories Among Older Chinese Immigrants.

OBJECTIVES: Although a number of studies have documented cognitive health among older immigrants in the United States, little is known about how the life-course immigration experiences are associated with cognitive trajectories among older Chinese immigrants. We assess patterns of cognitive functioning and change over time and examine whether age at migration, reasons for migration, acculturation, perceived discrimination, and preferred dialects are related to cognitive trajectories. METHODS: The sample comprised 2,075 participants from the Population Study of Chinese Elderly (PINE), who completed a battery of cognitive tests at four time points (2011-2019). Latent class growth analysis and multinomial logistic regression were utilized. RESULTS: Three latent classes of cognitive trajectories were identified: the low functioning with the fastest decline (LCF, 12%), the moderate functioning with a medium decline rate (MCF, 39%), and the high functioning with the slowest decline (HCF, 48%). Perceiving more discrimination reduced, whereas speaking Taishanese increased the odds of being in the LCF and MCF. High acculturation only distinguished MCF from HCF after controlling for the known factors of cognitive health such as age, education, and social engagement. DISCUSSION: This study identifies a group of older Chinese immigrants who are especially vulnerable to cognitive impairment and indicates that the risk of cognitive decline appears to be elevated with lower levels of acculturation and unidentified racial discrimination. More research is needed to fully understand the underlying mechanisms that link the life-course immigration experiences to cognitive health outcomes in later life.

A Systematic Review of Randomized Controlled Trials on Interventions Adopting Body-Mind-Spirit (BMS) Model on Holistic Well-Being.

BACKGROUND: This systematic review aims to examine existing randomized controlled trials on interventions adopting Body-Mind-Spirit (BMS) model and evaluated the effectiveness of holistic well-being outcomes. Following three key concepts of the BMS model, our review questions included (1) How was BMS defined? (2) What activities were included, and how were they related to BMS dimensions? (3) What were interventionists' backgrounds, and whether they received BMS training? (4) What were holistic outcomes? and (5) What were the effectiveness and qualities of studies? METHODS: Searches were performed using nine databases for the studies published through August 2020. The process follows PRISMA protocol, and the "risk of bias" tool from the Cochrane Handbook was utilized to determine the quality of included studies. RESULTS: Across 20 included studies, 18 (90%) presented a BMS definition, but only seven (35%) included all three key concepts of the BMS model. Eight studies (40%) offered detailed descriptions of body, mind, and spirit sections, and 12 (60%) mentioned cultural factors. Only five (25%) specified the body, mind, and spirit activities, and only three (15%) reported the BMS training in detail. Seven studies (35%) showed effectiveness in holistic outcomes. Only three (15%) were considered as high quality. CONCLUSION: A unified definition of the BMS model and the guideline to apply the BMS model to design and implement interventions are highly recommended to provide a standard framework for researchers to conduct future studies. The reason for low quality is because the lack of adequate allocation concealment and blindings.

The Effect of Support From Secondary Caregiver Network on Primary Caregiver Burden: Do Men and Women, Blacks and Whites Differ?

OBJECTIVES: Many older adults receive informal care from multiple caregivers, including support from a primary caregiver and a secondary caregiver network (SCN). This study examined the association between SCN support and primary caregiver burden, and whether the association varies across women and men, Black and White. METHODS: Data came from the 2015 National Health and Aging Trend Study and the National Study of Caregiving, including non-Hispanic White and Black men and women who were identified as primary caregivers (n = 967) and their secondary caregivers (n = 2,253). SCN support was indicated by (a) care domain overlap and (b) proportion of caregiving by SCN. Multiple regression models were estimated for the analyses. RESULTS: Both SCN support variables were found to reduce primary caregiver burden, and the effect of proportion of caregiving by SCN was found to vary by gender-race groups. With the increase of the proportion of caregiving by SCN, both Black and White women caregivers tend to experience faster decrease in caregiver burden than Black men. DISCUSSION: Our findings support the role of SCN in reducing primary caregiver burden and demonstrate that the benefit of SCN support varies across the 4 gender-race groups. The results indicate that it is imperative to further examine caregiving experience and protective mechanisms of SCN support using an intersectional perspective.

Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents.

BACKGROUND: Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids. METHODS: Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses. RESULTS: Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline. CONCLUSION: In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.

Use of Home and Community Based Services in Urban China: Experiences of Older Adults with Disabilities.

This study examined the factors related to the use of home and community based services (HCBS) by urban Chinese older adults with disabilities. The study used data from the 2006 Sample Survey on Aged Population in Urban/Rural China. A total of 3,920 older adults who experienced at least one disability were included in this sample. Of the study participants, 13.9% used housekeeping services and 12.2% used doctor/nurse home visit services. Results from logistic regression tests showed that older adults' gender, educational attainment, financial strain, family support, and number of chronic illnesses were significantly related to their use of housekeeping services. Additionally, older adults' levels of disability were significantly related to doctor/nurse home visit services. Findings underscore the importance of service needs in Chinese older adults' use of HCBS and also reveal that factors related to service use vary depending on specific services.

Factors Associated with Development of New Joint Contractures in Long-Term Care Residents.

OBJECTIVE: Limb contractures are associated with poor outcomes and quality of life in long-term care (LTC) residents. This study examined the rate of developing new joint contracture in the LTC residents and associated risk factors to formulate effective interventions in this critical but understudied area. DESIGN: This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTC Residents between 2005 and 2016. SETTING AND PARTICIPANTS: Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) to collect the data of the residents from 9 residential LTC facilities. MEASURES: Limb contractures were defined as a functional limitation in the range of motion involving the upper or lower limbs. Primary outcomes included annual prevalence of joint contractures and factors that were associated with the development of new joint contractures. RESULTS: We analyzed the data for 1914 older residents (674 males, mean age 83.4 years). During the first 5 years since admission, the annual prevalence of upper limb contractures increased from 29.8% to 36.5%, and lower limb contractures increased from 41.5% to 57.4%. Overall, the increment of the prevalence rate of joint contractures per year ranged from 0.7% to 3.2% for the upper limbs and 0.3% to 6.0% per year for the lower limbs. Impaired mobility, presence of neurologic diseases, and older age were the leading independent risk factors for the development of new joint contractures. CONCLUSIONS AND IMPLICATIONS: Joint contractures are highly prevalent among residents admitted to the LTC facilities, and many residents develop new contractures during the first 5 years of their admission. Immobility appears to be the main modifiable risk factor. Further studies are needed to identify potential strategies to prevent new contractures in this vulnerable group.

Performance of an Abbreviated Lubben Social Network Scale (LSNS-6) in Three Ethnic Groups of Older Asian Americans.

BACKGROUND AND OBJECTIVES: The present study examined the measurement quality and performance of an abbreviated Lubben Social Network Scale (LSNS-6) in three ethnic groups (Chinese, Koreans, and Vietnamese) of older Asian Americans, addressing both within- and cross-group validations. RESEARCH DESIGN AND METHODS: We selected 605 participants aged 50 or older (242 Chinese, 150 Koreans, and 213 Vietnamese) from the 2015 Asian American Quality of Life survey, conducted with self-identified Asian Americans aged 18 or above living in central Texas. We analyzed LSNS-6 data on measurement qualities (internal consistency and corrected item-total correlation), dimensionality (exploratory and confirmatory factor analyses), and correlations with other indicators. RESULTS: LSNS-6 showed very good internal consistency in each ethnic group, and the two-factor structure of family and friends were invariant across the groups. The items on friends demonstrated greater homogeneity than those on family and emerged as a first factor. Both subscale and total scores of LSNS-6 were associated in expected directions with the social and health indicators considered. DISCUSSION AND IMPLICATIONS: The findings confirm the measurement qualities of LSNS-6 within each group and provide support for measurement invariance across the groups. While the observed difference in family and friend networks warrants further investigation, LSNS-6 serves as a viable option for the assessment of social networks. When using LSNS-6 with older Asian Americans, it is highly recommended to use the family/friend subscales in consideration of cultural and immigration contexts.