The effect of the Ambulatory Integration of the Medical and Social (AIMS) model on health risk and depression.

Social needs are factors for health risk and depression that may negatively impact health outcomes and costly services use. Care management addresses social needs that can reduce health risk and depression. An exploratory study of the 5-step Ambulatory Integration of the Medical and Social Model (AIMS) was conducted to examine the effect of steps completed as part of AIMS on patients' depression and health risk outcomes at 6-months. Results reveal steps central to AIMS are significantly related to lower depression and health risk, suggesting AIMS is a valuable intervention for reducing health risk and depression.

The Effects of Religious Participation and Familial Assistance on Mental Health among Older Chinese and Korean Immigrants: Multiple Mediator Analyses.

Older Asian immigrants are one of the fastest growing segments of the U.S. population and a growing number of them reside in non-traditional destination cities. However, there is a paucity of research on older Asian immigrants living in these non-traditional destination cities, and how this residential choice impacts their stress and mental health. In the current study, we examined how stressors and social support contribute to the overall mental health of older Asian immigrants who lack access to culturally responsive formal social support services. Using a convenience sample of older Chinese (n = 120) and Korean (n = 118) immigrants living in Arizona, we conducted multiple mediator analyses, focusing specifically on how ethnicity would differentially influence mediating effects of religious participation and familial assistance in the relationships between physical/acculturative stressors and mental health outcomes. The results showed that among older Chinese immigrants, religious participation significantly mediated the relationships between both physical/acculturative stressors and mental health, while there was no significant mediation effect detected among older Korean immigrants. Although Asian Americans are often perceived as a monolithic homogeneous group, the multiple mediator models suggest significant differences in the use of cultural/information resources in coping with life stressors and their impact on mental health outcomes between the older Chinese and Korean immigrants in our study. The study findings suggest a need for developing and strengthening formal social services in non-traditional destination cities that are culturally and linguistically responsive to those older Asian immigrants.

The role of social workers in addressing nonmedical needs in primary health care.

Nonmedical needs are intricately linked to health. Unaddressed nonmedical needs often result in poorer health and increased healthcare costs. Although social workers are well positioned to address nonmedical needs, their role in healthcare environments to address nonmedical needs is limited. The limited role relates to a lack of reimbursement streams, which stems from poor articulation about their unique contributions. An analysis of a case study in which a social worker using AIMS, a protocolized care coordination model, was undertaken to highlight specific activities performed by social workers. Implications for patient health outcomes and healthcare costs are discussed.

Attachment-focused integrative reminiscence with older African Americans: a randomized controlled intervention study.

OBJECTIVES: Prior integrative reminiscence interventions have had a limited focus on attachment themes. The attachment-focused integrative reminiscence (AFIR) intervention differs from these in its central emphasis on attachment themes. The wide range of health benefits resulting from integrative reminiscence may be due in part to reminiscing about, mourning, and integrating unresolved attachment experiences. METHOD: Participants were randomized into treatment and wait-list control conditions, completed a pre-test, met for eight consecutive weekly two-hour sessions of largely attachment-focused reminiscence, then completed post-tests immediately following the intervention and again six months later. RESULTS: Results show treatment effects for depression (p = .01 and .05 at eight weeks and six months), perceived stress (p = .01 and .04), and emergency room (ER) visits at six months (p = .04), with the intervention group showing lower depression and stress and fewer ER visits. CONCLUSION: Integrative reminiscence interventions are cost effective, have rapid impact, and carry a certain appeal to older adults. Augmenting such interventions with a focus on attachment experiences may reduce perceived stress, an important health risk factor. Wider application of AFIRs may further reduce health disparities among US older adults.

Depression among Korean immigrant elders living in Canada and the United States: a comparative study.

Korean immigrant elders in North America experience a high level of depression. This study explored the correlates of depression among a sample of 245 Korean immigrant elders living in metropolitan cities in Canada (n = 128) and a southwestern state in the United States (n = 117), using a stress-coping framework. Results revealed discrepancies between the 2 subgroups. Years since immigration and number of health concerns were positively associated, and English proficiency was negatively associated with depressive symptoms among Korean immigrant elders in the United States; only health status was significant among Korean immigrant elders in Canada. Implications of the study are presented.

Racial/ethnic differences in the association between symptoms of depression and self-rated mental health among older adults.

The study examined racial/ethnic differences in the association between symptoms of depression and self-rated mental health among older adults. Data came from the first wave of the National Social Life, Health, and Aging Project, a population-based study of non-institutionalized older adults aged 57 to 85. The sample consisted of non-Hispanic Whites (n = 2,110), Blacks (n = 509), and Hispanics (n = 304). The association between symptoms of depression and self-rated mental health was weaker among minority groups than that among non-Hispanic Whites. Tests of interaction effects showed that the predictability of depressive symptoms to self-rated mental health was substantially weakened among Blacks of advanced ages and Hispanics with multiple chronic conditions. The study explored potential sources of racial/ethnic differences in subjective reports of mental health and called attention to older minorities with advanced ages and cormorbid conditions in mental health services and interventions.

Older adults' online activities and cognition: Investigating the psychological mechanisms and age and gender differences.

OBJECTIVES: This study aimed to investigate psychological mechanisms underlying the association between older adults' Internet use and cognition and examine potential age and gender group differences. METHODS: 2064 older participants were extracted from the Waves 2012, 2013, and 2016 Health and Retirement Study. Internet use was measured by two sets of variables: Internet access and different types of online activities (i.e., informational use, social use, online shopping, and online banking). Path analyses were applied to test the proposed mechanisms via three mediators (i.e., loneliness, depressive symptoms, and perceived control). Multi-group analyses were conducted to examine the potential group differences. RESULTS: Internet use was positively associated with cognition. Despite the large direct effect, small but significant indirect effects via depressive symptoms and perceived control were identified across all online activities. Multi-group analyses revealed age-group differences in the mechanisms: depressive symptoms mediated the effects of all online activities on cognition among young-old adults, while perceived control mediated all the effects among old-old adults. Gender group differences were also identified: depressive symptoms mediated the effects of all online activities on cognition among older women and most online activities among older men, whereas perceived control mediated the associations between informational and instrumental (i.e., online shopping and banking) use and cognition among older men. DISCUSSION: This study highlights the mediating effect of depressive symptoms and perceived control and age and gender differences regarding the Internet use-cognition association. Internet-based cognitive interventions should consider these psychological mediators and age and gender differences for the best results.

Contributing factors of depressive symptoms among elderly Korean immigrants in Texas.

This study examined various life stresses associated with relocation that may contribute to depressive symptoms among Korean immigrant elders in Texas. A sample of 120 elders was assessed using the Geriatric Depression Scale-Short Form and a 90-min face-to-face interview. Over 1/3 of respondents (37.5%) had symptoms of depression. Regression analyses (R(2) = .331) indicate that self-rated health, stressful life events, English language proficiency, satisfaction of visiting one's birth place, and watching TV were correlates of depressive symptoms among them. The findings of this observational study may be used as a baseline for designing service program for this population.

English language proficiency and lifetime mental health service utilization in a national representative sample of Asian Americans in the USA.

BACKGROUND: US Department of Health and Human Services reported that the lack of English language proficiency and the shortage of providers who possessed appropriate language skills were identified as major barriers to mental health service use for approximately half of the population of Asians and Pacific Islanders. The aim of this study was to examine the predictors of lifetime mental health service use in relation to English language proficiency among Asian Americans. METHODS: Data from 2095 Asian participants from the National Latino and Asian American Study were analyzed using logistic regression. RESULTS: Respondents with better English language proficiency and with a mental health diagnosis were more inclined to use mental health services. Participants who were born in the USA, who were widowed, separated or divorced, who sought comfort from religion, who reported worse physical and mental health self-ratings were more likely to use mental health services. The lack of health insurance coverage was not a significant predictor. CONCLUSIONS: The public health implications for behavioral health include the need to educate health-care providers working with Asian Americans regarding the benefits derived from seeking services and making interpreter services available in a culturally sensitive environment.

Time Contribution of Social Workers in Care Management: Value for Older Adults.

PURPOSE OF THE STUDY: The purpose of this study was to examine the time contribution of social workers in delivering AIMS (Ambulatory Integration of the Medical and Social), a care management protocol designed to address patients' nonmedical needs, and the association of time contribution with patients' depression outcomes. PRIMARY PRACTICE SETTING: The study was conducted in 6 primary care provider clinics housed in a large, urban academic medical center located in the Midwestern United States. METHODOLOGY AND SAMPLE: A longitudinal, quasi-experimental study employing survey procedures and a retrospective review of patient records was conducted. The study included 340 patients 50 years and older with unmet nonmedical needs. Half of the patients received AIMS, which was delivered by social workers. The other half received usual care (UC), which was delivered by other health care providers. RESULTS: Chi-square analysis and independent-samples t tests were performed to compare time spent addressing nonmedical needs with differences in patients' depression levels at 6 months postenrollment. The findings reveal that social workers spend significantly more time with patients than UC providers addressing patients' nonmedical needs (p < .0001). At 6 months postintervention, reduced levels of depression were observed for AIMS patients when compared with UC patients (p = .026). IMPLICATIONS FOR CARE MANAGEMENT PRACTICE: Including social workers as part of health care teams is valuable. Time spent with patients and engaging in care management activities to support patients' needs is linked with positive health outcomes. Given the benefits of care management, opportunities for reimbursement are enhanced.

Differential Patterns of Healthcare Service Use Among Chinese and Korean Immigrant Elders.

Previous studies of healthcare service use among Asian immigrant elders have been conducted in major metropolitan areas with established ethnic enclaves. The factors that affect levels of utilization by Asian immigrant elders who live in places where systematic support from an ethnic community is not readily available are unknown. This study employed the Andersen-Newman healthcare service utilization model to examine unique correlates of healthcare service use among Chinese and Korean immigrant elders. Between 2005 and 2007, we used a snowball sampling method to collect data from Chinese (n = 116) and Korean (n = 101) immigrant elders living in Arizona. We then performed two negative binomial regressions based on ethnic background to identify factors associated with the number of annual physician visits. The results indicated that the number of medical conditions they experienced was positively associated with an increased likelihood of healthcare service utilization for both subgroups. However, the results indicated that each ethnic group had distinctive predisposing (sex and length of US stay for Chinese; marital status for Korean), enabling (English proficiency and cultural gap; insurance status), and need factors (depressive symptoms; self-reported health status) for predicting healthcare service utilization. Asian immigrant elders in this study experienced unique barriers and facilitators based on their ethnic backgrounds. Communicating with these two different groups in their native languages and better understanding their cultural backgrounds are imperative to understanding the factors related to their healthcare service utilization. Thus, rather than viewing Asians as a homogeneous population, the differences found in heterogeneous ethnic groups, such as language and cultural variations, should be taken into account when planning and implementing approaches to intervention.

Ethnic enclave resources and predictors of depression among Arizona's Korean immigrant elders.

This is the first study examining predictors of depression among Arizona's Korean immigrant elders not residing in ethnic enclaves. A snowball sample of 120 elders, aged 64 and over, completed the study interview. The proportion of respondents reporting depression was 38.1%, higher than the incidence reported among counterparts in New York City's immigrant ethnic enclaves. Multiple regression analyses (R2=.44) indicate that English language proficiency had the most powerful effect on explaining depression. Discussion centers on why programs aimed at reducing language barriers among socially isolated immigrant elders need to be a first priority in service provision.

English language proficiency and health-related quality of life among Chinese and Korean immigrant elders.

This study examined the association between English language proficiency and health outcomes in a regional probability sample (n = 205) of elderly Chinese and Korean immigrants. Data support that these two Asian ethnic subgroups differ in English proficiency and health-related quality of life. Chinese and Korean elders had poorer health than the national norms, and poor English proficiency was associated with poorer outcomes for six of eight health outcomes measures. Implications for health care delivery and social work are discussed.

Predictors of emotional strain among spouse and adult child caregivers.

This study used data from the 1999 National Long Term Care Survey to examine predictors of emotional strain between spouse and adult child caregivers using the frameworks of role theory and the stress process model. Secondary data analysis examined if and how emotional strain differed between the groups and what the predictors of emotional strain were for each group. Common group predictors of emotional strain were elder's disruptive behaviors, caregiver's perceived overload, family disagreement, limitations on the caregiver's life, and utilization of personal coping strategies by the caregiver. There were predictors unique to spouse's emotional strain but elders' race and respite availability were unique predictors of adult child caregiver's emotional strain. Ways in which predictors of emotional strain can be used to design effective and efficient social work interventions are discussed.

Acculturation stress and depression among Asian immigrant elders.

This study examines the association between acculturation stress and depressive symptoms in a regional probability sample (n = 407) of six groups of Asian immigrant elders (Chinese, Korean, Indian, Filipino,Vietnamese, and Japanese). Findings suggest that about 40 percent of the sample were depressed, indicating higher depression rates than found in other studies of older American or Asian elderly samples in the United States and Asia. Multiple regression analyses indicated that acculturation stress caused by elders' perception of a cultural gap between themselves and their adult children was associated with high depression levels. Other predictors of depression were poor perceived health, stressful life events, religiosity, proximity of children, assistance received from adult children, and longer residence in the United States. Data suggest that depression is prevalent among urban Asian immigrant elders and that there is great heterogeneity among Asian ethnic subgroups. Implications for social work practice are discussed.

Reliability of the Geriatric Depression Scale for use among elderly Asian immigrants in the USA.

The increasing numbers of Asian and other immigrants in the United States have resulted in greater demands for research methodology sensitive to cross-cultural issues. A regional probability sample (n = 407) of Asian elderly immigrants of different nationalities (Chinese, Korean, Indian, Filipino, Vietnamese, or Japanese) residing in New York City was used to examine the reliability of the Geriatric Depression Scale (GDS). Using the 30-item GDS, about 40% of this representative sample of Asian elderly immigrants was considered to be depressed, indicating higher depression rates than in the previous studies of other Asian elderly samples in the US and in Asia. Results also showed that the 30-item GDS and 15-item GDS Short Forms were reliable measures to assess depression in community-dwelling Asian immigrant elders. Data strongly suggest that Asian elderly immigrants in the US are at risk of depression, indicating a need for the design of culturally sensitive mental health programs.