A peer mentoring program for Chinese American dementia caregivers: a pilot randomized controlled trial.

OBJECTIVES: A large gap exists in the development of culturally sensitive interventions to reduce stress related to dementia care among Chinese Americans, one of the fastest growing minority populations in the United States. We developed and pilot tested the feasibility and preliminary efficacy of a peer mentoring program for Chinese American dementia caregivers. METHOD: A pilot randomized controlled trial was conducted among 38 Chinese American caregivers in New York City. Four outcome variables-caregiving competence, loneliness, caregiver burden, and depressive symptoms-were measured at baseline and 3-month and 9-month follow-ups. The study protocol and preliminary results are available at clinicltrial.gov [NCT04346745]. RESULTS: The feasibility of the intervention was high, as indicated by an acceptable retention rate, fidelity, and positive feedback from caregivers and mentors. Compared with the control group, the intervention group had greater reductions in scores for loneliness at 3-month follow-up and for caregiver burden and depressive symptoms at 9-month follow-up. We did not find significant differences in caregiving competence between the two groups. CONCLUSION: The results indicated the high feasibility and potential efficacy of empowering existing human resources of experienced caregivers in the same ethnic community to improve the mental health of Chinese caregivers. Further research is needed to test the efficacy in a larger sample of this population.

Social Participation Patterns Among Community-Dwelling Older Adults Before and During the COVID-19 Pandemic: Roles of Community Social Cohesion and Health.

The objectives of this study were to investigate groupwide variations in social participation among older adults before and during the COVID-19 pandemic and how such variations were associated with their community social cohesion and health. Data were from the National Health and Aging Trends Study (2019-2020; n = 2,597 adults aged 65 or older). Latent class analysis was used to identify groupwide variations in social participation. These variations were then incorporated into adjusted regressions to test relationships with social cohesion and health. Four participation patterns emerged: active, selective independent, occasional, and selective religious participants. Selective independent and occasional participants were likely to live in less socially cohesive communities. During the pandemic, active participants were likely to report better self-rated health and lower risks of depressive and anxiety symptoms and dementia. Findings highlight directions for policy and intervention design that can enhance social participation and support healthy aging.

Associations Between Deaf/Hard of Hearing and Social Participation Among Older Americans.

This study investigated the associations between self-reported deaf or hard of hearing (D/HH) and informal and formal social participation among Americans aged 65 or older and how their family resources, health, and community social capital may partially account for these associations. Using cross-sectional data from the National Health and Aging Trends Study, multiple logistic regressions were conducted to test the research questions. Results revealed that older adults who were D/HH had significantly lower odds of attending recreational and clubs and organized activities. Family resources and health significantly explained the disparity for all types of social participation, whereas community social capital contributed more to the disparity in religious service attendance. Findings provide important intervention directions to reduce the disparity in late-life social participation as a result of experiencing D/HH.

The Association between Residential Environment and Self-Rated Mental Health among Older Canadians: The Moderating Effects of Education and Gender.

This study examined the associations between residential environment and self-rated mental health (SRMH) among Canadians aged 65 or older (n = 16,304) and whether education and gender moderated the associations. Data came from the 2018 Canadian Housing Survey. Hierarchical multiple regressions were conducted to test the associations. Analyses revealed that increased dwelling size was associated with better SRMH among older women with high school education. Older adults with higher satisfaction with their dwelling design were more likely to report better SRMH, except for women with some college education. Feeling safer in the community was uniquely associated with better SRMH for men with high school education and women with a university degree. Results confirmed significant associations between specific home and residential environment features and SRMH for each gender-by-education group. Environmental programs designed to improve SRMH for older adult populations should consider within- and between-group diversity.

Neighborhood Gentrification and Food Insecurity Among Urban Older Adults: Evidence From New York City.

BACKGROUND AND OBJECTIVES: Gentrification is a prevalent neighborhood development process in urban areas across the United States. Prior studies have identified the influence of gentrification on late-life health and quality of life, yet little is known about its relationship with food insecurity, an important public health issue for older adult populations. Using New York City as a case study, this study investigated associations between living in a gentrifying neighborhood and food insecurity, as well as the mediating roles of neighborhood environment factors-social cohesion, public transportation, and food environment. RESEARCH DESIGN AND METHODS: This study adopted 2 waves of annual data from the Poverty Tracker Study (2015-2016; N = 703) merged with American Community Survey and spatial data sets to measure gentrification and neighborhood factors. Adjusted logistic regressions were used to examine the associations between gentrification and food insecurity. Further mediation analyses were conducted to test the mechanisms of such associations. RESULTS: Older adults in gentrifying neighborhoods were more likely to have food insecurity than those in moderate- to high-income neighborhoods. Compared to low-income neighborhoods, older adults in gentrifying neighborhoods had a lower likelihood of reporting food insecurity. Two significant mediators were found when comparing gentrification with moderate- to high-income neighborhoods: social cohesion and healthy food outlets. DISCUSSION AND IMPLICATIONS: This study highlights the importance of gentrification in determining late-life food insecurity and identifies possible mechanisms with policy and social service implications to reduce the risk of food insecurity in urban areas.

Moderating Role of Neighborhood Environment in the Associations Between Hearing Loss and Cognitive Challenges Among Older Adults: Evidence From US National Study.

This study examined the associations between hearing loss and cognitive challenges among community-dwelling older adults and whether neighborhood characteristics (physical disorder and low social cohesion) moderated the associations. Cross-sectional national data from Round 11 of the National Health and Aging Trends Study were adopted (N = 2,515). Multinomial logistic regressions were used to examine associations among variables and interactive analyses were conducted to examine moderating effects. Results indicated significant relationships between the experience of hearing loss and possible dementia and between severe or profound hearing loss and probable dementia. Interactive models suggested that residing in neighborhoods with physical disorder and low social cohesion were negatively associated with possible dementia among older adults with moderate and severe or profound hearing loss, respectively, compared to those without hearing loss. Findings underscore the necessity of environmental and social interventions to enhance cognitive health among older adults with varying degrees of hearing challenges.

Beyond Dichotomy and Stability: ICT Use Among Asian American Older Adults During the COVID-19 Pandemic.

This study examined the effect of the COVID-19 pandemic on information and communications technology (ICT) use and the typology of ICT users among older Chinese and Korean Americans. Survey data were collected from 513 Chinese and Korean older adults in New York City. We measured ICT use for social contact, grocery shopping, health care, and COVID-19 information seeking. In the study sample, ICT use for online shopping with others, contact with doctors, and telehealth significantly increased during the pandemic. Three groups of ICT users were identified: limited, users, expanding users, and active users. Older Chinese Americans and those with better English proficiency were more likely to be expanding and active ICT users. The patterns and heterogeneity of ICT use among older Asian Americans are multifaceted and dynamic beyond dichotomy and stability. The findings of this study offer helpful guidance for future development of ICT-based interventions for older Asian Americans.

Gender Variation and Late-life Depression: Findings from a National Survey in the USA.

Based on the Wave 3 National Social Life, Health, and Aging Project (2015-2016), this study has extensive breadth in examining the roles of multiple stressors (i.e., health-related, social relationship, community) and coping resources (i.e., social participation and social support from family and friends) in explaining depressive symptomatology among a recent cohort of the U.S. national sample of community-dwelling older men (n = 1,431) and women (n = 1,673). Statistical additive and interactive models were tested. Results from this pre-COVID study serve as a baseline, and show that gender had significant independent and joint effects on stress and coping factors in explaining depressive symptoms. Parallel regression analyses were conducted for each group. Findings suggest that significantly more women (26.9%) reported depressive symptoms than men (19.9%) (CESD-11 score ≥ 9). Multivariate analyses show that unique predictors for older men's depression include less support from friends, more cognitive challenges, and feeling less control in life. For women, less social participation, less emotional support from spouse, greater IADL impairment, and family disharmony were more significantly associated with their depressive symptoms than men's. Contrary to the literature, community factors were not statistically significant in predicting depressive symptoms. Findings suggest that correlates of depressive symptoms impact older women and men differently. Results point to the need for gender-sensitive mental health services and programs to protect community-dwelling older adults in USA against depression, especially in light of the recent COVID era social proximity restrictions.

Do Home and Community Environments Explain Self-Rated Health Among Older Canadians? Evidence From the 2018 Canadian Housing Survey.

OBJECTIVES: This study examined the associations between home and community environmental factors and self-rated health (SRH) among older Canadians and how these associations vary by gender and living arrangements. Background: In social gerontology research, the psychosocial determinants of SRH have been widely investigated. Based on the environmental gerontology framework, this study examined the home and community environmental correlates of SRH. METHOD: The sample (aged 60 or older) was drawn from the 2018 Canadian Housing Survey (4,086 men living alone; 6,471 men living with others; 9,170 women living alone; 4,876 women living with others). Multiple regression analyses were used to examine the relationships between SRH and potential environmental correlates in a hierarchical model. RESULTS: Findings show that older men and women living alone reported lower levels of SRH than those living with others. Regression findings show common and unique home and community environmental predictors of SRH by group. Common predictors of higher SRH were private housing residence, larger living space, satisfaction with dwelling, volunteering, no perceived need for community services, and community safety. Home maintenance needs predicted lower SRH among older men and women living with others; uninhabitable conditions predicted poor SRH among older men living with others and older women living alone. CONCLUSION: Results support the important effects of place in terms of home and community environments for older adults' SRH, and associations differed by gender and living arrangements.

Use of tangible, educational and psychological support services among Chinese American dementia caregivers.

BACKGROUND AND OBJECTIVES: Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans in this field. Guided by Andersen's behavioral model of health services use, we aimed to understand what factors were associated with utilizing multiple types of services among Chinese American dementia caregivers. RESEARCH DESIGN AND METHODS: We collected survey data from 134 Chinese dementia caregivers in New York City. Logistic regression models were conducted to test the associations between predisposing, enabling, and need factors and the likelihood of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) support services. RESULTS: Several variables conceptualized by Andersen's model, including caregiver's knowledge about services, caring tasks, length of care and burden, and care recipient's physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services. Three sociocultural factors-residing in Chinatown, availability of alternative family caregivers, and diagnosis of cognitive deterioration-were also associated with higher likelihood of using educational or psychological services. DISCUSSION AND IMPLICATIONS: The findings extend the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and considering sociocultural factors in future research and practice.