Enhancing Engagement With Socially Disadvantaged Older People in Organized Physical Activity Programs.

BACKGROUND AND OBJECTIVES: Participation in physical activity (PA) is low among older adults in developed nations and even lower among several socially disadvantaged groups. This study aimed to identify the actions that can be taken in the promotion, design, and implementation of organized PA programs to improve engagement with socially disadvantaged and underrepresented older people. Research design and methods: Semistructured interviews were conducted with 30 community service providers and 5 focus groups with 42 older participants in existing PA programs. Data were analyzed thematically, and the PRECEDE-PROCEED model for program planning was used to broadly categorize themes. Results: Helpful strategies for addressing predisposing factors such as social anxiety and lack of confidence included user-centered program design and sensitive, informative messaging and promotion. Key enabling strategies were transport assistance and minimizing fees. Facilitating gentle entry to groups and fostering inclusion and safety were identified as valuable reinforcing strategies. Providers regarded organizational networks as beneficial for facilitating referral and addressing resource constraints. Discussion and implications: A multifactorial approach addressing a range of predisposing, reinforcing, and enabling factors is likely to be necessary to enhance engagement in organized PA by socially disadvantaged and underrepresented older people. Key factors relate to creating a positive sociocultural environment, identifying activities of interest, and enhancing ease of access.

"I feel like a caged pig in here": Language, Race, and Ethnic Identity in a Case Study Hmong Nursing Home Resident Quality of Life.

Racial disparities in nursing home (NH) quality of life (QOL) are well established, yet, little is understood about actual experiences shaping QOL for Black, indigenous, and people of color (BIPOC) residents in NHs. This gap extends to BIPOC residents with limited English proficiency (LEP). Drawing on Kane's (2001) and Zubristky's (2013) QOL frameworks, this case study examined QOL experiences for Hmong NH residents, an ethnic and refugee group from Southeast Asia, in a NH with a high proportion of BIPOC residents. Methods include four months of observation, interviews with eight Hmong residents and five NH staff, and one community focus group. Thematic analysis revealed significant challenges in QOL. Exacerbated by language barriers and racism, many residents reported neglect, limited relationships, lack of meaningful activities, and dissatisfaction with food. These experiences fostered a sense of resignation and diminished QOL among Hmong residents, highlighting the need for additional supports for this group.

Performance of the Modified Caregiver Strain Index in a Sample of Black and White Persons Living With Dementia and Their Caregivers.

BACKGROUND AND OBJECTIVES: This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia. RESEARCH DESIGN AND METHODS: Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and wellbeing. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups. RESULTS: Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a 3-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, although personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p = .003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r = 0.67, Black: r = 0.54) and the GAD-2 (White: r = 0.47, Black: r = 0.4), and negatively correlated with self-efficacy ratings (White: r = -0.54, Black: r = -0.55), with a p < .001 for all validity analysis. DISCUSSION AND IMPLICATIONS: The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Researchers results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.

Understanding Challenges and Coping Strategies Experienced by Chinese American Family Caregivers of Persons with Dementia.

The purpose of this study was to explore the caregiving experience of Chinese American family caregivers of persons with dementia with a focus on challenges and coping strategies. Using a qualitative study design, we conducted semi-structured interviews with 26 Chinese American family caregivers and analyzed the data using thematic analysis. We also identified their caregiving experience specific to the COVID-19 pandemic. First, four themes were discovered: (1) filial obligations, (2) preference for utilizing home- and community-based supports, (3) relying on primary care doctors, and (4) helping behaviors. Two additional COVID-19-related themes were identified: (1) social isolation and (2) perceived discrimination. We suggested interventions at the individual, community, and societal level not only to support various challenges experienced by this ethnic group but also to promote their coping strategies.

Access and Use of Services by Caregivers of Older Adults: A Scoping Review of Cultural and Linguistic Diversity.

Westernized countries are home to an increasingly culturally and linguistically diverse (CLD) older adult population. Informal caregivers of CLD older adults face unique challenges accessing and using home- and community-based services (HCBS). This scoping review sought to identify facilitators and barriers to access and use of HCBS for informal caregivers of CLD older adults. Arksey and O'Malley's framework guided a systematic search of five electronic databases. The search strategy retrieved 5979 unique articles. Forty-two studies met the inclusion criteria and informed this review. Facilitators and barriers were identified at three stages of using services: knowledge, access, and use of services. Findings concerning access to HCBS were subdivided into willingness and ability to access HCBS. Results emphasize the need for changes in healthcare systems, organizations, and providers to provide culturally appropriate care and improve the accessibility and acceptability of HCBS for informal caregivers of CLD older adults.

Life Space and Activity Space Measurement: Making 'Room' for Structural Racism.

As we age, the ability to move is foundational to health. Life space is one measure of a person's ability to move and engage in activity beyond the home. A separate but related concept is activity space, a measurement of a person's spatial behaviors and visited locations that include social networks, neighborhoods, and institutions. In this article, we integrate the literature on life space and activity space discussing how physical function is not only determined by individual capabilities, but also by the surrounding social and environmental factors which may limit their agency. We show how structural racism contributes to inequities within this paradigm linking related concepts of movement, agency, belonging, and timing. We also explore implications for research and theory for mobility, social connection, and activity.

Modifiable Risk Factors and Change in Cognition of Maori and Non-Maori in Advanced Age: LiLACS NZ.

OBJECTIVE: This study investigated whether previously identified modifiable risk factors for dementia were associated with cognitive change in Maori (indigenous people of New Zealand) and non-Maori octogenarians of LiLACS NZ (Life and Living in Advanced Age; a Cohort Study in New Zealand), a longitudinal study. METHOD: Multivariable repeated-measure mixed effect regression models were used to assess the association between modifiable risk factors and sociodemographic variables at baseline, and cognitive change over 6 years, with p values of <.05 regarded as statistically significant. RESULTS: Modifiable factors associated with cognitive change differed between ethnic groups. Depression was a negative factor in Maori only, secondary education in non-Maori was protective, and obesity predicted better cognition over time for Maori. Diabetes was associated with decreased cognition for both Maori and non-Maori. CONCLUSION: Our results begin to address gaps in the literature and increase understanding of disparities in dementia risk by ethnicity. These findings have implications for evaluating the type and application of culturally appropriate methods to improve cognition.

Is Living in an Ethnic Enclave Associated With Cognitive Function? Results From the Population Study of Chinese Elderly (PINE) in Chicago.

BACKGROUND AND OBJECTIVES: Ethnic enclaves provide pivotal coping resources for immigrants, having important implications for cognitive health. This study examined the association between living in an ethnic enclave (i.e., Chinatown) and cognition, and potential moderating effect of education on such an association among Chinese older immigrants in the United States. We further examined subgroup differences based on preferred language (Mandarin, Cantonese, and Taishanese). RESEARCH DESIGNS AND METHODS: Data were derived from the Population Study of Chinese Elderly in Chicago (N = 3,105, mean age = 73). Global cognition, assessed by a battery including Mini-Mental State Examination, working memory, episodic memory, and executive function, was compared between those who lived in Chinatown (n = 1,870) and those who did not (n = 1,235). Linear regressions with interaction terms were performed in the entire sample and subsamples with different language preferences. RESULTS: Chinatown residents had significantly poorer cognition than non-Chinatown residents. Regression results identified both protective and risk factors for cognition associated with living in Chinatown. Among them, education (ß = 0.072, p < .001) played a salient role in explaining the cognitive disadvantage of Chinatown residents. Education also moderated the influence of Chinatown residence on cognition, but only among Mandarin speakers (ß = -0.027, p = .04). DISCUSSION AND IMPLICATIONS: Living in an ethnic enclave may be a risk factor for poor cognition for Chinese immigrants. Neighborhood-specific health assessment may facilitate early identification and prevention of cognitive impairment in this population. Studies need to examine divergent aging experiences of immigrants within single ethnic groups.

Help-Seeking Behaviors Among Older Adults: A Scoping Review.

Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O'Malley's scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults' help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.

Traversing the Aging Research and Health Equity Divide: Toward Intersectional Frameworks of Research Justice and Participation.

Meaningful reductions in racial and ethnic inequities in chronic diseases of aging remain unlikely without major advancements in the inclusion of minoritized populations in aging research. While sparse, studies investigating research participation disparities have predominantly focused on individual-level factors and behavioral change, overlooking the influence of study design, structural factors, and social determinants of health on participation. This is also reflected in conventional practices that consistently fail to address established participation barriers, such as study requirements that impose financial, transportation, linguistic, and/or logistical barriers that disproportionately burden participants belonging to minoritized populations. These shortcomings not only risk exacerbating distrust toward research and researchers, but also introduce significant selection biases, diminishing our ability to detect differential mechanisms of risk, resilience, and response to interventions across subpopulations. This forum article examines the intersecting factors that drive both health inequities in aging and disparate participation in aging research among minoritized populations. Using an intersectional, social justice, and emancipatory lens, we characterize the role of social determinants, historical contexts, and contemporaneous structures in shaping research accessibility and inclusion. We also introduce frameworks to accelerate transformative theoretical approaches to fostering equitable inclusion of minoritized populations in aging research.

Mortality From Forces of Nature Among Older Adults by Race/Ethnicity and Gender.

Older adults are especially vulnerable to disasters due to high rates of chronic illness, disability, and social isolation. Limited research examines how gender, race/ethnicity, and forces of nature-defined here as different types of natural hazards, such as storms and earthquakes-intersect to shape older adults' disaster-related mortality risk. We compare mortality rates among older adults (60+ years) in the United States across gender, race/ethnicity, and hazard type using the Centers for Disease Control and Prevention's Wonder database. Our results demonstrate that older adult males have higher mortality rates than females. American Indian/Alaska Native (AI/AN) males have the highest mortality and are particularly impacted by excessive cold. Mortality is also high among Black males, especially due to cataclysmic storms. To address disparities, messaging and programs targeting the dangers of excessive cold should be emphasized for AI/AN older adult males, whereas efforts to reduce harm from cataclysmic storms should target Black older adult males.

Variations Between Adult Day Services Centers in the United States by the Racial and Ethnic Case-Mix of Center Participants.

This is the first nationally representative study to identify differences between adult day services centers, a unique home- and community-based service, by racial/ethnic case-mix: Centers were classified as having a majority of participants who were Hispanic, non-Hispanic Black, or non-Hispanic other race/ethnicities and non-Hispanic White. The associations between racial/ethnic case-mix and geographic and operational characteristics of centers and health and functioning needs of participants were assessed using multivariate regression analyses, using the 2014 National Study of Long-term Care Providers' survey of 2,432 centers. Half of all adult day centers predominantly served racial/ethnic minorities, which were more likely to be for-profit, had lower percentages of self-pay revenue, more commonly provided transportation services, and had higher percentages of participants with diabetes, compared with predominantly non-Hispanic White centers. Findings show differences by racial/ethnic case-mix, which are important when considering the long-term care needs of a diverse population of older adults.

Research Priorities in Family Caregiving: Process and Outcomes of a Conference on Family-Centered Care Across the Trajectory of Serious Illness.

The number of older adults living with functional decline and serious illness is growing exponentially at a time when availability of both family and professional caregivers is strained. Achieving optimal outcomes for this vulnerable population involves advancing the knowledge needed to improve the quality of care delivered by families, health professionals, and community programs. Recent reports from National Institute of Health and the National Academy of Science, Engineering and Medicine have called for the identification of gaps in key areas of family caregiving intervention research. In March 2018, the Family Caregiving Institute at UC Davis convened an invitational meeting of over 50 thought leaders in family caregiving-representing service agencies, funding organizations, and academia-to participate in the Research Priorities in Caregiving Summit: Advancing Family-Centered Care across the Trajectory of Serious Illness. Using an iterative process, attendees identified the top 10 research priorities and created research priority statements that incorporated a definition of the priority topic, rationale for the priority; problem(s) to address; priority population(s); and example research topics. The research priority statements serve as a roadmap for research development that will address the most significant gaps in the caregiving field.

Life in Limbo: Old-Age Transnationalism.

BACKGROUND AND OBJECTIVES: Transnationalism, defined as migrants having ties to the country of origin and the destination country, is mostly explored with qualitative data. Quantitative studies only use a small number of indicators. This is one of only a few studies to examine transnationalism based on multiple indicators and elaborate classes of transnationalism. The research questions are: What are the forms of transnationalism in which older migrants engage? And how do age, gender, income, and country of origin affect these forms? RESEARCH DESIGN AND METHODS: The paper used the Vivre/Leben/Vivere (2011/2012) subsample of migrants in Switzerland, aged 65-82 years. Transnationalism was measured using 11 indicators, including nationality, having family abroad, and sending remittances. Latent class analysis was used to distinguish between several forms of transnationalism. Latent class regression models subsequently explore the effect of age, gender, income and country of origin on these transnationalism forms. RESULTS: Four different forms of transnationalism were found among older migrants: least transnational, distant transnational, active transnational, and returning transnational. The models suggest that country of origin and income are important predictors, while age is less important and gender has no effect on falling in these transnationalism classes. DISCUSSION AND IMPLICATIONS: The results confirm that our measure of transnationalism is an innovative approach toward exploring the different forms older migrants engage in. The method has several advantages over usual methods and can be used in future studies to analyze, for example, how different forms of transnationalism emerge as a consequence of policies relevant for older migrants, like care arrangements and pensions.

Growing Old as a Member of an Ethnic Minority in Hong Kong: Implications for an Inclusive Long-Term Care Policy Framework.

Hong Kong is experiencing significant demographic changes as a result of rapid population aging and immigration. Anecdotal evidence suggests that ethnic minorities, in particular aged members of South Asian ethnic minorities, face significant and diverse obstacles in accessing services important to their general welfare. This study is the first systematic attempt to explore the long-term care needs of Nepalese older adults in Hong Kong and the barriers they face in accessing long-term care services. Data were obtained through semi-structured interviews with 30 Nepalese older adults. We found that Nepalese older adults have similar physical and psychosocial needs as those of their local Chinese counterparts. However, participants face a range of structural, knowledge, and attitudinal barriers that together deter them from accessing long-term care services, despite their right to do so. Policy recommendations to mitigate these barriers are given, with reference to the World Health Organization's Age-Friendly Cities Framework.

A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes.

Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity.

BACKGROUND AND OBJECTIVES: This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development. RESEARCH DESIGN AND METHODS: Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138). RESULTS: Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91). DISCUSSION AND IMPLICATIONS: PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.

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.

Bilingual Text With or Without Pictograms Improves Elderly Singaporeans' Understanding of Prescription Medication Labels.

BACKGROUND AND OBJECTIVES: In Singapore, primarily English-language prescription medication labels challenge elderly Singaporeans, many of whom are unable to read English. We investigated whether bilingual text and pictograms can help them understand prescription medication labels. RESEARCH DESIGN AND METHODS: We randomized 1,414 elderly respondents of a national survey into four prescription medication labels: English-text; English-text-and-pictograms; Bilingual-text; and Bilingual-text-and-pictograms, which were similar except for the addition of another language and/or pictograms (International Pharmaceutical Federation, FIP). Respondents answered 16 label-related questions; an expert panel rated answers for correctness. Outcomes were (1) complete understanding (16 correct); (2) any understanding (≥1 correct); and (3) number of incorrect answers among those with any understanding. We evaluated associations of each prescription medication label (vs. English-text) with outcomes (1), (2), and (3) using logistic and negative binomial regression, respectively. RESULTS: The elderly respondents were similar across the four prescription medication labels (English-text, English-text-and-pictograms, Bilingual-text, Bilingual-text-and-pictograms), for which the proportions with outcomes (1) and (2) were (17.9%, 25.6%, 36.9%, 40.1%) and (50.4%, 62.6%, 75.9%, 76.5%), respectively. We observed statistically significant higher odds of outcomes (1) and (2) among those assigned the three labels (vs. English-text): English-text-and-pictograms, 1.96 and 2.51; Bilingual-text, 3.54 and 6.73; and Bilingual-text-and-pictograms, 4.51 and 7.93. Those assigned the three labels also had 0.94, 1.98, and 2.12 fewer outcome (3) on average (vs. English-text). DISCUSSION AND IMPLICATIONS: Adding bilingual text with or without pictograms on prescription medication labels considerably improved elderly Singaporeans' understanding of the labels, strongly suggesting its application in practice. Other issues in prescription medication labels design and content, including adapting FIP pictograms for elderly Singaporeans, warrant further investigation.

Will My Soul Go to Heaven If They Take My Brain? Beliefs and Worries About Brain Donation Among Four Ethnic Groups.

Purpose of the Study: Studying the brain through autopsy is an essential component of Alzheimer's disease research. Racial and ethnic minorities are underrepresented in Alzheimer's research generally and, in particular, in the number of completed brain autopsies. We explored beliefs about and attitudes toward brain donation among African American, Chinese, Caucasian, and Latino research subjects and their family members through focus groups at 4 NIH-funded Alzheimer's Disease Centers. Design and Methods: Eighteen focus groups were conducted with 61 research subjects and 34 family members. Because the primary purpose of the focus groups was to identify the range of considerations that may influence the decision to participate in brain donation, data from focus groups were pooled and then analyzed. Results: We found that many of the concerns, attitudes, and beliefs about brain donation were similar across the 4 ethnic groups. Concerns and attitudes fell into 3 categories: (a) concerns and misconceptions about brain research and the process of brain removal, (b) religious beliefs, and (c) the role of the family. Implications: Our findings suggest that interventions to enhance enrollment in brain donation that target factors identified in this study are likely to be relevant to people from a broad range of backgrounds and ethnicities. Nonetheless, we observed some potential differences among racial/ethnic groups that may affect how research volunteers and their families approach a decision about donating their brain for research. Further study is warranted to explore these and other possible culturally distinct attitudes and beliefs about brain donation.