Coping repertoires and psychological well-being of Chinese older immigrants in the United States.

OBJECTIVES: This study examines (1) the overall structures of multifaceted coping resources, that is, coping repertoires, among Chinese older immigrants in the United States, (2) the optimal coping repertoire that is associated with best psychological outcomes of these older immigrants, and (3) the most effective coping repertoire in different adversities. METHOD: Using data from 2,923 Chinese older immigrants in Chicago, Latent Class Analysis (LCA) was performed to identify the overall coping repertoires of U.S. Chinese older adults. Negative binomial and logistic regressions were used to examine associations between coping repertoires and depression and Quality of Life (QoL), respectively. We further tested whether coping repertories moderate the relationships between adversities in health, economic, and social domains, and the two psychological outcomes. RESULTS: LCA revealed four types of coping repertories: low-resource (43%), spouse-oriented (32%), community-oriented (15%), and multi-source coping (10%). Overall, Chinese older immigrants who had the multi-source coping repertoire reported the best psychological outcomes. The community-oriented and multi-source coping repertories had significantly stronger buffering effects on psychological well-being among individuals with IADL difficulties or low acculturation. However, spouse-oriented coping intensified the association between ADL difficulties and depression, and community-oriented coping intensified the association between poorer subjective health and lower quality of life. CONCLUSION: This study revealed overall low coping repertories of Chinese older immigrants, suggesting the most optimal coping repertories should consist of both intrinsic and extrinsic coping sources. The findings further show that relying on limited sources might be harmful to older immigrants' mental health.

Managing the Incurable: Older Pain Clinic Patients' Experiences of Managing Treatment-Resistant Chronic Low Back Pain.

Chronic low back pain (CLBP) is a highly prevalent disabling condition among older adults, and treatment remains a challenge. Limited research has qualitatively examined late-life CLBP and its management. Study objective was to examine how older adults experience pain management approaches for CLBP. Guided by van Manen's phenomenological method, 21 pain clinic patients (66-83) completed semi-structured interviews. Under the main theme "Managing the incurable," four subthemes emerged: (a) A quest for relief; (b) Spinal procedures offer temporary relief yet ongoing disappointment; (c) The apprehension of medication (d) Making things work for me. Social work practice implications are discussed.

A systematic review of correlates of depression among older Chinese and Korean immigrants: what we know and do not know.

OBJECTIVES: Guided by the stress and coping theory, this study provides a systematic review of existing research on acculutration, family support, and social support related correlates of depression among older Chinese and Korean immigrants in the United States. METHOD: A comprehensive literature search was conducted in CINAHL Plus, Abstracts in Social Gerontology, AgeLine, Social Work Abstracts, PubMed, PsychINFO, and Social Science Citation Index databases to identify relevant articles that presented multivariate analysis results. RESULTS: A total of 55 articles were identified, with the vast majority focusing on older Korean immigrants. The overall evidence showed that length of residence was largely unrelated to depression, and poor Enligsh proficiency also had a weak correlation with depression. However, a low level of acculturation measured by multidimensional scales was consistently associated with more depressive symptoms. Overall, living arrangements and the size and frequency of contact of both kin and non-kin networks were weak correlates of depression. In contrast, negative family and social interactions seem to be more consequential for depression in the two groups than positive relations and support. CONCLUSION: The findings show that established acculturation instruments are useful tools to identify at-risk older Chinese and Korean immigrants. Future studies need to further examine which aspects of acculturation experience are more influential for immigrants' mental health. Although often conceptualized as important coping resources, family and social networks could present significant stressors for older immigrants. Future research and services could focus on these contexts to improve the mental health of these two rapidly increasing Asian populations.

Living a Life Full of Pain: Older Pain Clinic Patients' Experience of Living With Chronic Low Back Pain.

Chronic low back pain (CLBP) is older adults' most common pain complaint and is associated with many physical and psychosocial consequences, which have been quantitatively examined. However, little research has qualitatively examined the experience itself of CLBP in later life. Study objective was to understand older adults' lived CLBP experience. Guided by van Manen's phenomenological method, 21 pain clinic patients aged 66 to 83 completed semistructured interviews. Under the main theme "living a life full of pain," results are reflected in four existential subthemes: (a) Corporeality: The pain is relentless and constantly monitored, (b) Temporality: To live with pain is to live by pacing day and night, (c) Relationality: Pain creates limits that can be tested or obeyed, and (d) Spatiality: Manipulating the space around me to accommodate the pain. Findings improve understanding of the patient experience of late life CLBP and highlights the importance of empathy and patient-centeredness when treating older adults.

Agency behind bars: Advance care planning with aging and dying offenders.

Aging and terminally ill individuals in U.S. prisons are increasing, making critical the need for appropriate end-of-life (EOL) care and advance care planning (ACP). Applying Bandura's agentic perspective, the authors examined 20 aging/dying offenders' EOL preferences and ACP. Findings include 6 themes: decisions in the shadow of the past, what works best for me, feeling blessed, what is really going on, can anyone be trusted, and turning agency over to someone else. This study provides critical information that will assist professionals who work with dying offenders, as it presents a vivid illustration of their dying process.

"It has changed my whole life": The systemic implications of chronic low back pain among older adults.

Chronic low back pain (CLBP) is the most common pain complaint among older adults. Despite its prevalence, very little research has qualitatively examined the diverse consequences of living with CLBP in later life. As part of a larger study aiming to understand the experience of CLBP among older adults, the objective of this manuscript is to understand how older adults experience CLBP and its impacts on the functioning of older adults. Guided by van Manen's phenomenological method, 23 semi-structured interviews with 21 pain clinic patients aged 66-83 were conducted. Through an iterative process assisted by NVivo 11 software, researchers used line-by-line thematic coding to identify main impacts of CLBP. Under the main theme "It has changed my whole life," results are reflected in six subthemes: (a) Pain damages sense of self; (b) trapped in a body that doesn't work anymore; (c) me, my partner, and my pain; (d) pain complicates family relationships; (e) painfully employed; and (f) feeling socially and recreationally repressed. This study improves our understanding of older pain clinic patients' experience of living with debilitating CLBP and offers direction for social work intervention in the context of multidisciplinary pain management.

Burnout Among Iowa Hospice Workers: A Test of the Job Demands-Resources Model.

Burnout is a critical problem for hospice care system, particularly given the potential increase in hospice utilization because of the increasing older adult population. Hospice care requires social workers and other professionals to work in interdisciplinary settings under conditions of prolonged stress. Guided by the Job Demands-Resources (JDR) model, this study sought to: (1) understand Iowa hospice workers' level of burnout, indicated by emotional exhaustion (EE); (2) identify organizational and personal determinants of EE. This web-based study used a cross-sectional survey administered to hospice staff across Iowa. Seventeen hospice organizations participated as study sites, and 244 out of 825 employees, consisting of interdisciplinary clinical workers and administrative personnel, completed the survey. Descriptive, correlational, and regression statistics were used to test study hypotheses. Regarding EE levels, 59% of participants were experiencing low EE, while the other 41% had moderate or high EE. Those lacking empathy, working full-time, and working for larger hospice organizations had greater EE. While findings largely support the JDR model, interactions between demands and resources offer only partial support. Results indicate the importance of hospices fostering supportive work environments and providing employee education about emotional benefits of respect, strategies for displaying workplace respect, and evaluation of respect-related initiatives.

Detained and Dying: Ethical Issues Surrounding End-of-Life Care in Prison.

Prisons are increasingly being called upon to provide end-of-life (EOL) care within the restrictive correctional environment. Several relatively recent phenomena have brought medical ethics to the forefront of prison EOL care-including aging behind bars, a paradigm shift in prison culture, the increasing rate of in-prison deaths, and the corresponding prison hospice movement. This article examines prominent ethical issues that emerge for prison personnel who are tasked with providing care to terminally ill offenders by presenting three offender composite characters that exemplify dying offenders and emergent ethical issues surrounding their care. Identification and critical analysis of these ethical issues demonstrate the need for strong commitment to ethical practice and highlights specific issues for prisons to examine in their own EOL care practice.

End-of-life care as a field of practice in the social work curriculum.

Attention to end-of-life care in social work education and practice is growing. With funding from the Project on Death in America, in 2001, the University of Iowa, School of Social Work developed and implemented an End-of-Life Field of Practice. Unlike a concentration, a Field of Practice is a set of integrated courses focused on one specific area of focus. This article describes the Field of Practice, the community-based partnerships, and the curriculum that serves as a basis for training the students enrolled in this area. Strategies for other social work programs interested in developing a similar Field of Practice or specialty area in their MSW curricula are provided. These include faculty committed to the content area, comprehensive course offerings to encompass all aspects of end-of-life care, and field sites willing to help train students.

Barriers associated with the implementation of an advance care planning program in a prison setting.

Advance care planning is considered a best practice within health care. However, the extent to which planning occurs within prison settings is unknown. Through the course of implementing an advance care planning (ACP) program for aging and dying offenders at a medical classification center, multiple barriers were identified that need to be addressed systemically to ensure the medical wishes of offenders were known and honored. This article will outline the barriers and the steps that were taken to create systems change to promote and sustain advance care planning.

Use of animal-assisted interventions in relieving pain in healthcare settings: A systematic review.

BACKGROUND AND OBJECTIVE: Therapeutic interaction with animals for patients coping with physical and mental health conditions is a growing interest among healthcare providers and researchers. We aimed to comprehensively summarize and evaluate the current state of evidence examining the use of animal-assisted interventions [AAI] for pain relief in healthcare settings. DESIGN: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. METHODS: Two researchers independently assessed publications dated before February 5, 2021 in OVID Medline, CINAHL, and PsychINFO databases, and used the Delphi list to evaluate the quality of the evidence. RESULTS: Of the 109 studies screened, a total of 24 studies totaling 1,950 participants were ultimately included. Studies varied in design, including single group trials (8), controlled trials with at least two groups (6), and randomized controlled trials (10). The most common form of pain measurement was the visual or numeric rating scale. For the 18 studies that reported data on changes in pain severity from pre-to-post-test, 13 reported a significant reduction; using the converted common metric we created, these reductions ranged from 0.20 to 3.33 points on a 10-point numeric rating scale. CONCLUSIONS: AAI may be considered a promising approach in need of further, more rigorous research. Available evidence supporting AAI remains weak due to issues of study quality and design, thereby impeding our ability to draw reliable conclusions on the utility of AAI in relieving pain. Given the rapidly increasing availability of these interventions in hospitals, it is important to better understand its effectiveness.

"If You Don't Keep Going, You're Gonna Die": Helplessness and Perseverance Among Older Adults Living With Chronic Low Back Pain.

BACKGROUND AND OBJECTIVES: Chronic low back pain (CLBP) is the leading cause of disability worldwide and the most common pain complaint among the rapidly growing older adult population. As part of a larger qualitative study examining the lived experience of CLBP among older adults, the objective of the present study is to understand how older pain clinic patients experience helplessness and also how they foster perseverance amid treatment-resistant CLBP. RESEARCH DESIGN AND METHODS: Using van Manen's phenomenological method, semistructured, in-depth, one-on-one interviews were conducted with 21 older pain clinic patients (aged 66-83) living with CLBP. Data were iteratively analyzed via line-by-line thematic coding. RESULTS: Findings dually illustrate how participants were living a battle between helplessness and perseverance; the final thematic structure revealed 5 subthemes: (a) Feeling helpless because nothing works; (b) Feeling down and depressed; (c) Distantly wishing for an end; (d) Accepting the reality of my pain; and (e) The pain stays, I keep going. DISCUSSION AND IMPLICATIONS: This study contributes a vivid illustration of older adults' CLBP illness experiences that are substantially underpinned by helplessness, depression, and a drive to continue thriving in old age. Practice implications include the need for clinic-based mood and suicide assessment.

Family Relationships and Cognitive Function Among Community-Dwelling U.S. Chinese Older Adults.

A broad literature has explored racial disparities in cognitive aging. Research incorporating sociocultural factors would provide a more comprehensive understanding of minority aging. This study aims to investigate the role of family typology in cognition among U.S. Chinese immigrants. Data were derived from the Population Study of Chinese Elderly in Chicago (PINE). Family typology included tight-knit, unobligated ambivalent, commanding conflicted, and detached typologies. Cognition was evaluated by global cognition, episodic memory, working memory, executive function, and mini-mental state examination (MMSE). Linear and quantile regressions were used. Older adults with detached and commanding conflicted typologies reported lower global cognition than those with unobligated ambivalent typology. Detached, commanding conflicted, and tight-knit typologies were associated with poorer performance in episodic memory, working memory and MMSE than unobligated ambivalent typology, respectively. Social service providers could be aware of multifaceted family relationships when developing interventions for cognitive function and understand family typology as a whole.

Age at Migration and Cognitive Health Among Chinese Older Immigrants in the United States.

Objectives: This study addressed two questions: (1) Is age at migration associated with cognitive function among Chinese older immigrants? and (2) what personal and environmental factors confound the above relationship? Methods: Data were derived from the Population Study of Chinese Elderly (N = 2957). Quantile and linear regressions were used to examine the associations between age at migration and Mini-Mental State Examination (MMSE) and global cognitive function, respectively. Results: Migration in late middle age (50-64) or late adulthood (65 or older) was associated with lower MMSE scores. Global cognition did not vary by age at migration. Associations between age at migration and MMSE were stronger among individuals with lower education or social engagement. Discussion: Migrating late in one's life has important implications for cognitive health over the life course. Findings are helpful to identify vulnerable older immigrant segments and provide tailored interventions to promote their cognitive health.

Parent-Adult Child Relations of Chinese Older Immigrants in the United States: Is There an Optimal Type?

OBJECTIVES: This study aims to identify (a) different types of parent-child relations among Chinese older immigrants, (b) predictors of each relation type, and (c) the most "optimal" type that is associated with better psychological well-being of the older adults. METHODS: Data were derived from 3,109 Chinese elderly adults in Chicago. Latent Class Analysis was used to identify structures of parent-child relations based on eight indicators of family solidarity. Logistic regressions were used to predict the relation types. Negative binomial and logistic regressions were used to examine the associations between the relation types and depression and quality of life (QoL). RESULTS: Four types of parent-child relations emerged: unobligated ambivalent (44.77%), tight-knit (40.11%), detached (10.28%), and commanding conflicted (4.84%). Older adults' age, gender, marital status, health status, and immigration/acculturation experience were related to their relation types. While tight-knit relation was associated with the fewest depressive symptoms, older adults with unobligated ambivalent relations were the least likely to report good QoL. DISCUSSION: The study illustrates the diverse and complex ways in which Chinese older immigrants and their children are connected. The findings suggest that a departure from the traditional norm of filial piety may present a risk factor for this population's mental health.

Transition in Older Parent-Adult Child Relations in U.S. Chinese Immigrant Families.

BACKGROUND AND OBJECTIVES: The family fundamentally underpins the immigration and acculturation processes. But most existing research on acculturation focuses on individual instead of family experience. Guided by Berry's acculturation theory and Intergenerational Solidarity Theory, this study examined continuity and changes in parent-adult child relations of older Chinese immigrants over a 2-year period, and their implications for older adults' depression and quality of life (QoL). RESEARCH DESIGN AND METHODS: Participants included 2,605 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago (PINE). Latent Transition Analysis (LTA) was used to identify transitions in multidimensional parent-child relations over time. Negative binomial and logistic regressions were used to examine the influence of family transitions on depression and QoL, respectively. RESULTS: LTA revealed five types of family relations: traditional, modified traditional, coresiding-unobligated, independent, and detached. Over 40% of the respondents shifted to a different relation type, with more families classified as modified traditional or independent over time. Transitioning into modified traditional relations or out of detached relations was associated with fewer depressive symptoms and better QoL at the follow-up. Transitioning into independent relation was associated with more depressive symptoms over time. DISCUSSION AND IMPLICATIONS: Parent-child relations among Chinese older immigrants demonstrate significant complexity, including both heterogeneity and fluidity. Better well-being of these older adults seems to stem from the optimal combination of retaining the supportive heritage culture and embracing the host society's instrumental cultural elements. Services to this population need to include the family context in assessment and interventions.

Is Migration at Older Age Associated With Poorer Psychological Well-Being? Evidence from Chinese Older Immigrants in the United States.

BACKGROUND AND OBJECTIVES: The migrating age of an individual has far-reaching implications for their acculturation experience, social integration, and well-being. This study addressed two questions: Is migrating at older age associated with poorer psychological well-being? If so, what factors account for such differences? RESEARCH DESIGN AND METHODS: Using data of 3,138 Chinese elderly people in Chicago, we compared the levels of depression and quality of life among individuals who migrated in young adulthood (before 35), adulthood (35-49), midlife (50-64), and later life (65+). Negative binominal and logistic regressions were performed to examine the associations between age at migration and the two outcomes, controlling for demographics and four sets of explanatory variables (socioeconomic status, health status, acculturation level, and family/social relations). RESULTS: The findings revealed mixed results. Migrating in later life was associated with more depressive symptoms, but also a higher chance of reporting good quality of life. Late-life immigrants' greater depression was partially contributed to their low income, lack of access to health care, poor physical health, and weak social relations. In contrast, regardless of the explanatory variables, migrating at middle age was associated with lower quality of life. DISCUSSION AND IMPLICATIONS: Acknowledging that the older immigrant population is segmented with unique susceptibilities improves understanding of heterogeneity among the older immigrant populations and allows for targeted intervention. Gerontological practitioners should include migration history during their intakes and more actively screen for depression with socially isolated Chinese older immigrants who migrated at a later age.

Typology of Family Relationship and Elder Mistreatment in a US Chinese Population.

OBJECTIVES: To examine the associations between typology of family relationship and risk of elder mistreatment (EM). DESIGN: Population-based epidemiological cross-sectional study. SETTING: Community-dwelling older adults in the greater Chicago area. PARTICIPANTS: A total of 3157 US older Chinese immigrants. MEASUREMENTS: EM was measured by a brief screening tool. Latent class analysis was used to construct typologies of family relationship from eight indicators, evaluating the structural, associational, functional, affectual, and normative aspects of family relationship. Logistic regression models were used to test the associations between typology of family relationship and EM. RESULTS: Unobligated ambivalent type (44.77%) was the most common family type among US older Chinese immigrants. The prevalence of EM was around 15%, with 475 participants reporting experience of EM. Unobligated ambivalent (odds ratio [OR] = 1.90; 95% confidence interval [CI] = 1.54-2.34) and detached (OR = 1.78; 95% CI = 1.32-2.42) family types were associated with greater risk of EM; tight-knit (OR = .34; 95% CI = .27-.44) family type was associated with lower risk of EM. The relationship between commanding conflicted family type and EM was not significant. CONCLUSION: Unobligated ambivalent family type, featured by high emotional closeness and high family conflict, was prevalent among US Chinese families and associated with EM consequences. Culturally customized social services are suggested to reduce intergenerational ambivalence and promote family harmony for immigrant families. J Am Geriatr Soc 67:S493-S498, 2019.

Preparing to Die Behind Bars: The Journey of Male Inmates With Terminal Health Conditions.

The prison population is graying as more individuals are receiving longer sentences without opportunities for parole or release for health-related reasons. While research has expanded on end-of-life care in and out of prison settings, to date there has been little research conducted on how inmates experience dying behind bars. Through collecting data during observation of facilitated advance care planning sessions, this qualitative study revealed four main themes: (1) losing a piece of everything, (2) not sure what to feel, (3) where will I die, and (4) finding purpose in the midst of purposelessness. These themes characterize the central issues discussed by inmates as they considered death behind bars. As we seek to improve health care in prison settings, this study provides insight into how inmates view their dying process.

Not So Golden After All: The Complexities of Chronic Low Back Pain in Older Adulthood.

Background and Objectives: The study objective was to understand how Chronic low back pain (CLBP) impacts key aging concepts such as retirement, housing, health, and independence. Research Design and Methods: Twenty-one pain clinic patients (66-83 years old) with CLBP engaged in 23 in-depth semistructured interviews, which were audio-recorded and transcribed verbatim. Guided by van Manen's phenomenological method, researchers used line-by-line thematic coding to analyze data through an iterative process. Results: Participants' accounts illustrate the interplay between aging and living with CLBP. Under the larger theme "Not so golden after all," results are reflected in five subthemes: (a) Falling apart; (b) Pain stigmatizes aging; (c) Hurting slowly, aging quickly; (d) Pain threatens independence; (e) The reality of unrealized futures. Discussion and Implications: This study improves our understanding of how CLBP complicates growing older with regard to tarnished retirements and stigmatization. Findings highlight the importance of coordinated care and recognition of pain-related loss.