Chinese late-life immigrants' loneliness and social isolation in host countries: An integrative review.

AIMS AND OBJECTIVE: To synthesise current international empirical evidence on loneliness and social isolation in Chinese late-life immigrants. BACKGROUND: Loneliness causes adverse health consequences in Chinese late-life immigrants leading to increased utilisation of often increasingly limited healthcare resources. However, little is known about how Chinese late-life immigrants perceive and experience loneliness and social isolation in their host countries. DESIGN: An integrative review methodology. METHODS: Using a systematic search strategy, Google scholar and databases, such as Scopus, Web of Science, PubMed, CHNAHL, Medline and open access Theses were searched. No limitation was placed on publication date. Peer-reviewed studies published from the database inception to May 6, 2021 in the English language were included. The review process is reported according to PRISMA. RESULTS: Eight articles met the criteria and were included in this review. Two themes resulting from the data synthesis process were identified. Firstly, 'disrupted social relations after late-life immigration' and secondly 'moving away from filial expectations'. CONCLUSION: Loneliness and social isolation are commonly experienced by Chinese late-life immigrants when residing in host countries. Understanding and identification of the sources of loneliness and social isolation among late-life immigrants are essential prompts for healthcare professionals, particularly nurses, to engage sensitively with Chinese late-life immigrants. Nurses culturally relevant care delivery in a variety of settings may best serve recipients' social and health related needs. RELEVANCE TO CLINICAL PRACTICE: This integrated review informs the planning of health and social services for addressing Chinese late-life immigrants' experiences of loneliness and social isolation. Focused attention on cultural responsiveness is an important component of providing quality and safe nursing care. This review of the recent evidence on socially-rooted health concerns affected by both immigration and ageing will help advance nursing practice in providing culturally responsive care interventions.

Impacts of older people's patient and public involvement in health and social care research: a systematic review.

Background: patient and public involvement (PPI) in research has been linked with numerous beneficial impacts, however, evidence for older people's involvement is limited. Objectives: to evaluate the impacts of involving older people in health and social care research on older co-researchers, academic researchers, and research processes and outcomes. A secondary aim was to explore critical success factors and future considerations for PPI. Design: systematic review. Methods: six databases were searched for English language articles published between 2006 and 2017. A supplementary search was conducted. Two authors independently retrieved articles using standardised inclusion criteria and data extraction forms. Articles reporting formal evaluation of older people's involvement were included. Results: nine articles, all using qualitative methodology, were included. Benefits for older co-researchers included psychological and social benefits, new learning, and activism and career opportunities, while challenging impacts comprised demanding workloads, difficult relationships and dissatisfaction with level of involvement. Benefits for academic researchers entailed new learning and shared workloads; challenges related to demanding workloads and difficult relationships. Both positive and negative effects on research quality and impact were observed. Benefits for participants and the community were demonstrated. Building relationships, facilitating communication and breaking down barriers to participation were identified as critical success factors. Conclusions: evidence for the impacts of older people's involvement is mixed although benefits appear to outweigh the challenges. Future considerations for PPI include matching older people's skills and motivations to the project and level of involvement, and establishing an iterative research process in which evaluation is embedded.

Strengthening Community: Older Asian Immigrants' Contributions to New Zealand Society.

This study sought to uncover the process through which older Chinese, Indian and Korean immigrants residing in Auckland, New Zealand contribute to, and participate in, local community. There is a paucity of literature addressing the everyday activities of older Asian immigrants living in New Zealand. The few studies that do exist focus solely on one ethnic group with little discussion of how community participation occurs. Grounded theory methodology was employed. Focus groups and individual interviews with 76 Chinese, Indian or Korean older immigrants were recorded, transcribed, translated, and analysed using grounded theory methods of dimensional analysis to develop a theory of participation. Older Asian immigrants contribute to society through a process of Strengthening Community; comprising three perspectives: Advancing Cultural Connectedness, Giving Service and Caring for Family. Each perspective is mediated by conditions and strategies that facilitate when and how participants engage in their chosen activities. Older Asian immigrants are active social contributors to New Zealand communities. Although they encounter barriers to participation, they constantly seek ways to work individually and in community groups to effectively contribute to civic society. In doing so, they take pride in giving back to their host country.

Ethnic and Gender Differences in Preferred Activities among Maori and non-Maori of Advanced age in New Zealand.

This study explored active aging for older Maori and non-Maori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Maori aged 80 to 90 and non-Maori aged 85 were recruited. Of the 937 participants enrolled, 649 answered an open question about their three most important activities. Responses were coded under the World Health Organization's International Classification of Functioning, Disability and Health (ICF), Activities and Participation domains. Data were analyzed by ethnicity and gender for first in importance, and all important activities. Activity preferences for Maori featured gardening, reading, walking, cleaning the home, organized religious activities, sports, extended family relationships, and watching television. Gendered differences were evident with walking and fitness being of primary importance for Maori men, and gardening for Maori women. Somewhat similar, activity preferences for non-Maori featured gardening, reading, and sports. Again, gendered differences showed for non-Maori, with sports being of first importance to men, and reading to women. Factor analysis was used to examine the latent structural fit with the ICF and whether it differed for Maori and non-Maori. For Maori, leisure and household activities, spiritual activities and interpersonal interactions, and communicating with others and doing domestic activities were revealed as underlying structure; compared to self-care, sleep and singing, leisure and work, and domestic activities and learning for non-Maori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.

The lived experience of physically active older prostate cancer survivors on androgen deprivation therapy.

This study sought to explore the lived experiences of physically active prostate cancer survivors on androgen deprivation therapy (ADT), who exercise individually. Three older men (74-88 years old) with prostate cancer, using ADT continuously for at least 12 months and regularly exercising for at least 6 months, participated in this qualitative pilot study, informed by interpretive phenomenology. Data were gathered using individual semi-structured interviews, audio recorded and transcribed verbatim. Coherent stories were drawn from each transcript and analyzed using iterative and interpretive methods. van Manen's lifeworld existentials provided a framework for interpreting across the research text. Three notions emerged: Getting started, Having a routine and Being with music. Together they reveal what drew the participants to exercising regularly despite the challenges associated with their cancer and treatments. This study provides insights into the benefits of, and what it means for, older men with prostate cancer to regularly exercise individually. These findings may assist cancer clinicians and other allied health professionals to be more attuned to prostate cancer survivors' lived experiences when undergoing ADT, allowing clinicians to better promote regular exercise to their patients as a foundational component of living well.

Community integration after traumatic brain injury: a systematic review of the clinical implications of measurement and service provision for older adults.

OBJECTIVE: To explore the scope, reliability, and validity of community integration measures for older adults after traumatic brain injury (TBI). DATA SOURCES: A search of peer-reviewed articles in English from 1990 to April 2011 was conducted using the EBSCO Health and Scopus databases. Search terms included were community integration, traumatic brain injury or TBI, 65 plus or older adults, and assessment. STUDY SELECTION: Forty-three eligible articles were identified, with 11 selected for full review using a standardized critical review method. DATA EXTRACTION: Common community integration measures were identified and ranked for relevance and psychometric properties. Of the 43 eligible articles, studies reporting community integration outcomes post-TBI were identified and critically reviewed. Older adults' community integration needs post-TBI from high quality studies were summarized. DATA SYNTHESIS: There is a relative lack of evidence pertaining to older adults post-TBI, but indicators are that older adults have poorer outcomes than their younger counterparts. The Community Integration Questionnaire (CIQ) is the most widely used community integration measurement tool used in research for people with TBI. Because of some limitations, many studies have used the CIQ in conjunction with other measures to better quantify and/or monitor changes in community integration. CONCLUSIONS: Enhancing integration of older adults after TBI into their community of choice, with particular emphasis on social integration and quality of life, should be a primary rehabilitation goal. However, more research is needed to inform best practice guidelines to meet the needs of this growing TBI population. It is recommended that subjective tools, such as quality of life measures, are used in conjunction with well-established community integration measures, such as the CIQ, during the assessment process.

Cross-cultural understandings of festival food-related activities for older women in Chiang Mai, Thailand, Eastern Kentucky, USA and Auckland, New Zealand.

This cross-country, cross-cultural study explored the meaning of older women's food-related activities for the annual festivals of Songkran (Thai New Year) in Chiang Mai, Thailand; and Christmas in Richmond, Kentucky, USA; and Auckland, New Zealand. A derived etic method was used. The community-dwelling participants were 33 Thai women, aged 60 and older, and 16 New Zealand and 23 eastern Kentucky women, aged 65 and older. This article focuses on the final cross-cultural analysis of the data. Emic, or within-country, findings are presented, followed by the derived etic, or cross-cultural, interpretations for two themes of meaning; older women's 'protecting what matters' and 'leading the way'. Applying derived etic methods helped reveal how, despite the highly different food-related practices, preparing and sharing celebratory foods at Songkran or Christmas held related meanings for older women in Thailand, Kentucky USA, and New Zealand.

Feeling a deep sense of loneliness: Chinese late-life immigrants in New Zealand.

OBJECTIVES: To explore Chinese late-life immigrants' perceptions of loneliness and social isolation. METHODS: A qualitative descriptive methodology underpinned this study. In-depth individual interviews were conducted in Mandarin with purposively recruited participants. The twenty-three participants in the study had all emigrated from China, were 65-80 years old on arrival and had lived in New Zealand for between 2.5 and 16 years. An inductive thematic analytic process was undertaken. The COREQ checklist was followed to ensure study rigour. RESULTS: Three themes, 'high value placed on meeting family obligations', 'feeling a deep sense of imbalanced intergenerational reciprocity' and 'moving away from filial expectations', were identified. Confucianist values of 'women's domestic duty of caring for grandchildren', 'filial piety', and 'saving face' to be accepted and respected by others negatively attributed to participants' understandings and experiences of loneliness. To plan for increasing frailty and to avoid family conflict while ameliorating potential loneliness, some participants reluctantly discarded prior customary filial piety expectations in favour of formal aged care options. CONCLUSIONS: Participants' profound sense of loneliness was seen to be attributed to their deeply rooted cultural values and backgrounds from having lived for a significant period of time in China. Loneliness occurred as a result of the resettlement process in later life. These experiences highlight the importance of using cultural framing that takes into account beliefs and adaptations to host societies anticipated during the process of late-life immigration.

Prevalence of Loneliness and Its Association With General and Health-Related Measures of Subjective Well-Being in a Longitudinal Bicultural Cohort of Older Adults in Advanced Age Living in New Zealand: LiLACS NZ.

OBJECTIVES: There is evidence that loneliness is detrimental to the subjective well-being of older adults. However, little is known on this topic for the cohort of those in advanced age (80 years or older), which today is the fastest-growing age group in the New Zealand population. We examined the relationships between loneliness and selected subjective well-being outcomes over 5 years. METHODS: We used a regional, bicultural sample of those in advanced age from 2010 to 2015 (Life and Living in Advanced Age: a Cohort Study in New Zealand). The first wave enrolled 937 people (92% of whom were living in the community): 421 Maori (Indigenous New Zealanders aged 80-90 years) and 516 non-Maori aged 85 years. We applied standard regression techniques to baseline data and mixed-effects models to longitudinal data, while adjusting for sociodemographic factors. RESULTS: For both Maori and non-Maori, strong negative associations between loneliness and subjective well-being were found at baseline. In longitudinal analyses, we found that loneliness was negatively associated with life satisfaction as well as with mental health-related quality of life. DISCUSSION: Our findings of adverse impacts on subjective well-being corroborate other evidence, highlighting loneliness as a prime candidate for intervention-appropriate to cultural context-to improve well-being for adults in advanced age.

Doing everyday occupations both conceals and reveals the phenomenon of being aged.

BACKGROUND/AIM: The phenomenon of ageing is so commonplace that it is ordinarily taken-for-granted, with little call to question its meaning. Of importance to occupational therapists is the recent appeal to understand older adults' ordinary ways of everyday living. The aim of this interpretive phenomenological study was to understand the meaning of 'being aged' through the everyday experiences of those who are long-lived. METHODS: The writings of two philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study's design and research methods. Being aged in the context of everyday living was the phenomenon of interest. Individual interviews were conducted with 15 community-dwelling New Zealand elders: four Maori aged 71-93 years and 11 non-Maori aged 80-97 years. Stories of going about daily occupations and particular moments in the day were elicited during conversational-style interviews. Hermeneutic methods and phenomenological reflection were used to analyse the data. RESULTS: Two overarching notions were illuminated. The ordinary ways of 'being in the every day', such as having a routine and a familiar purposefulness, conceal being aged. In contrast, 'experiencing the unaccustomed', such as suddenly noticing an unaccustomed weakness or oldness, in the midst of doing deeply familiar occupations is an announcing of being aged. CONCLUSIONS and SIGNIFICANCE OF THE STUDY: As such, engaging in everyday, familiar occupations holds the potential to both conceal and reveal the phenomenon of being aged. These results point to the importance of illuminating the lived experience of occupational engagement as a fruitful way of informing occupation-focussed practice.

Influence of Purposeful Activities on Upper Extremity Motor Performance: A Systematic Review.

Following upper extremity injury, exercise-approaches are commonly used to address motor impairments. Occupation-based approaches are also used but less widely promoted and their mechanisms of action not well-understood. Movement performed during purposeful activities and occupations may yield better motor performance than during nonpurposeful tasks. This review investigated the influence of engagement in purposeful activities and occupations on upper extremity motor performance in healthy and musculoskeletal populations. Databases were searched for studies in healthy or upper extremity musculoskeletal-injured adults that compared motor performance during purposeful activities against nonpurposeful movements. Twenty-one studies of moderate quality, conducted predominantly in healthy populations, were included. Upper extremity movement quantity and quality were enhanced when performed during purposeful conditions. Purposeful activities have potential to be used following injury to enhance movement and address motor impairments to a greater extent than is currently promoted. Research in musculoskeletal populations is required.

Integrative review of older adult loneliness and social isolation in Aotearoa/New Zealand.

OBJECTIVE: To conduct an integrative review of empirical studies of loneliness for older people in Aotearoa/New Zealand. Loneliness is a risk factor for older people's poor physical and cognitive health, serious illness and mortality. A national survey showed loneliness rates vary by gender and ethnicity. METHODS: A systematic search of health and social science databases was conducted. Of 21 scrutinised articles, nine were eligible for inclusion and subjected to independent quality appraisal. One qualitative and eight quantitative research articles were selected. RESULTS: Reported levels and rates of loneliness vary across age cohorts. Loneliness was significantly related to social isolation, living alone, depression, suicidal ideation, being female, being Maori and having a visual impairment. Qualitatively, older Korean immigrants experienced loneliness and social isolation, along with language and cultural differences. CONCLUSION: Amongst older New Zealanders loneliness is commonly experienced by particular ethnic groups, highlighting a priority for targetted health and social services.

Narratives in research: story as 'showing' the eminently ordinary experience of ageing.

AIM: To offer a perspective when research narratives about how ageing is lived in everyday life are the primary data. METHODS: A literature search explored the garnering of narratives about everyday life in advanced age in qualitative research. Narrative examples from the authors' research, and supervised student research, are drawn on to illustrate the experiences of ageing when going about an ordinary day. RESULTS: Stories show the lived experience of ageing is both ordinary and complex. Notions revealed are: age as constructed, as assumed by others, as being engaged every day, and as living the day my way. CONCLUSION: Understanding what it means to be older is in part shaped by which stories are told, who tells the stories and what sense is made of them. In gerontology research, 'story telling' can be a potent means of knowing what it means to be 'older' and of being worthy to self and others.

Doing what's important: valued activities for older New Zealand Maori and non-Maori.

AIM: This project explored the usability of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) for describing older Maori and non-Maori people's self-nominated important activities. METHOD: Within a feasibility-for-cohort study, 112 participants, 33 Maori, aged 75-79 years, and 79 non-Maori, aged 85 years, nominated their three most important activities. Verbatim responses were coded using the ICF classifications and described using non-parametric statistics. RESULTS: Men and women mostly named domestic life, interpersonal relationships and recreation and leisure activities. While Maori frequently named extended family relationship activities as being most important, non-Maori named more recreation and leisure activities. CONCLUSIONS: The ICF is useful for classifying older New Zealanders' important activities, although some activities of older Maori were not specified in the original version used. While important activity patterns were similar for men and women, those related to ancestral connectivity and community collectivity were most important for Maori.