Mental Health Impact of Bullying by Ethnic Peers in Senior Housing: A Study with Older Korean American Residents in the Greater Los Angeles Area.

Using data from Korean-American residents (N = 343) in subsidized senior housing in the Los Angeles area, we examined the effect of peer bullying on mental health. About 18% of the sample had been a target of bullying, and over 31% had witnessed someone being bullied. Being a target of bullying was a significant predictor for both depressive symptoms and anxiety, whereas witnessing other residents being bullied was a significant predictor for anxiety only. Findings shed light on the adverse mental health impacts of peer bullying among ethnic minority older residents in senior housing.

The Role of Sensory Impairment in Cognitive Health Appraisal: A Study of Older Korean Americans Living in Subsidized Senior Housing.

OBJECTIVES: We examined how the association between cognitive performance and cognitive health appraisal would be moderated by vision and/or hearing impairment. METHODS: Data were collected from 315 older Korean-American residents in subsidized senior housing in Los Angeles (M age = 79.4 years). Linear regression models examined the direct and interactive effects of cognitive performance, vision impairment, and hearing impairment on cognitive health appraisal. RESULTS: Negative appraisal of cognitive health was associated with lower cognitive performance and poorer ratings for vision and hearing. Moreover, we found a significant interaction between cognitive performance and hearing impairment (ß = .13, p < .05), as well as a three-way interaction among cognitive performance, vision impairment, and hearing impairment (ß = .12, p < .05). DISCUSSION: The association between objective and subjective measures of cognition was weakened when hearing was impaired. Such a pattern was further evident when both vision and hearing were impaired.

Intervention to promote preventive dental care for older Korean-American Medi-Cal enrollees in Los Angeles.

BACKGROUND: In California, preventive dental care is covered by Medi-Cal (California's Medicaid program). However, many beneficiaries do not use their dental benefits. Given that a lack of knowledge about oral health and insurance coverage contributes to this underutilization, promoting the use of dental benefits among eligible individuals via an educational program is imperative. Responding to the particular needs of older immigrants with limited English proficiency, we developed a digital oral health intervention for older Korean-American Medi-Cal enrollees in Los Angeles. This educational intervention is designed to be delivered via computers and the Internet. It consists of a 15-min self-running PowerPoint presentation narrated in Korean with links to additional information on the Internet. The slides contain information about the basic etiology of oral diseases, oral hygiene, common myths about oral health and dental care, Medi-Cal coverage of preventive dental care, and how to find a dental clinic. METHODS: We pilot tested the intervention with 12 participants to examine its feasibility and acceptability. We also obtained participants' qualitative feedback about the intervention. RESULTS: A post-intervention quantitative assessment yielded high participant satisfaction and improved oral health and dental care knowledge. Participant responses to the intervention yielded four themes: (1) content and structure, (2) linguistic and cultural aspects, (3) delivery mode, and (4) additional concerns and suggestions. CONCLUSIONS: Our findings confirm the intervention's feasibility and acceptability and suggest further refinement.

Relationship of Living and Eating Arrangements to Mental Distress Among Older Korean Immigrants: Gender Difference in the Mediating Role of Loneliness.

This study examined how different living/eating arrangements were associated with loneliness and depressive symptoms among older Korean immigrants. We examined gender differences considering: (1) patterns of living/eating arrangements and their relations with loneliness and mental distress and (2) indirect effect of living/eating arrangements on mental distress through feeling lonely. Data were drawn from the Study of Older Korean Americans that surveyed older; Korean immigrants during 2017-2018 (N = 2150). Living/eating arrangements were classified in the combination of four categores. Using the PROCESS macro, we tested gender differences in the mediation effect of loneliness on the relationship between living/eating arrangements and mental distress while controlling for background/health characteristics and social connectedness-related variables. The mediating role of loneliness was manifested differentially between men and women. By administering simple measures of living/eating arrangements, practitioners could potentially identify key targets to improve social and mental well-being, particularly among older immigrants with limited resources.

The effect of digital literacy on depressive symptoms among older Korean women: a mediation analysis focusing on the role of social support.

PURPOSE: The purpose of this study was to investigate the relationship between digital literacy and depressive symptoms, as well as the mediating role of social support in this relationship, among older women (60 years and older) in Korea. METHODS: This study analyzed data from the User Experience Evaluation Survey, which was conducted by the Ewha Institute for Age Integration Research to improve the accessibility of digital information for older adults research from May to September 2020. Survey data on depressive symptoms, digital literacy, and social support were analyzed using descriptive statistics, Pearson correlation coefficients, and multiple regression. RESULTS: The factors influencing depressive symptoms among older women included work status (B=-.19, p=.01), social support (B=-.17, p<.001), self-rated health (B=-.13, p=.003), and digital literacy (B=-.10, p=.005), which had an explanatory power of 33%. In addition, social support played a mediating role in the relationship between digital literacy and depressive symptoms (B= -.05, SE=.02; 95% CI, -.09 to -.02). CONCLUSION: The findings of this study support the need to develop and apply interventions that promote digital literacy among older women to mitigate depressive symptoms by increasing social support.

E-health literacy and associated factors among Korean adults during the COVID-19 pandemic: age-group differences.

The purpose of this study was to compare the mean scores of e-health literacy, health information, social relationships, and psychological status between younger, middle-aged, and older Korean adults during the COVID-19 pandemic and to identify the factors associated with e-health literacy as well as the moderating effect of age on the association between health information factors and e-health literacy. We used a cross-sectional survey of 2400 Korean adults aged 20 years or older residing in Seoul. Descriptive statistics, ANOVA, chi-square test, and hierarchical multiple regression analyses were used to analyze the data. Findings demonstrated an age-group difference in the mean score of e-health literacy with the older group having lower e-health literacy than the other groups. Health information, social support, and COVID-19-related anxiety were associated with e-health literacy and a moderating effect of age on the association between sources of health information and e-health literacy was also identified among the three age subgroups. This study emphasizes the importance of identifying e-health-related risk factors leading to health disparities between age groups.

COVID-19 health information sources and their associations with preventive behaviors: A typological study with older residents in Seoul, South Korea.

Considering that individuals' health information can enable their adoption of health behaviors, we examined the use of health information sources related to COVID-19 and its association with preventive behaviors in a sample of older residents in Seoul, South Korea (N = 400, M age = 76.1 years). Latent profile analysis of 12 sources of health information representing conventional media, online sources, interpersonal networks, and health professionals or authorities yielded a 4-group typology: limited, moderate/traditional, moderate/digital, and diverse. In a multivariate model with the diverse group as a reference, the limited group (B = -4.48, SE = 1.14, p < .001) and the moderate/digital group (B = -2.73, SE = 0.76, p < .001) were associated with lower adherence to COVID-19 preventive behaviors. Our findings support the heterogeneity in the use of health information sources and the hypothesis that groups with restricted sources of health information would report less desirable behaviors. The findings also underscored the importance of proper use of digital health information. Efforts should be made not only to help older adults with low education access diverse sources of health information, including digital sources, but also to empower them to build digital and health literacy.

Safety Concerns for Persons with Dementia in Senior Housing: A Qualitative Study with Korean American Caregivers in Los Angeles.

Subsidized senior housing helps many socioeconomically disadvantaged older adults pursue independent living and aging in place. However, cognitive impairment or dementia poses a critical challenge to many residents' ability to live independently and safely. Focusing on Korean American dementia caregivers, a group known to be vulnerable to caregiving burden but understudied, we explored the safety of persons with dementia in senior housing from the perspectives of caregivers. Qualitative data from nine caregivers whose care recipients were current or former residents of subsidized senior housing in Los Angeles were analyzed by the constant comparative method. Major concerns emerged were: (1) fire risks, (2) wandering, (3) physical injury (e.g., self-harm, falls), and (4) potential neglect. Caregivers also mentioned errors in the self-administration of medications, potential financial exploitation, and interpersonal conflicts. These concerns provide implications for services and programs for the safety of persons with dementia who live in senior housing.

Age-friendly environment, social support, sense of community, and loneliness among middle-aged and older adults in Korea.

OBJECTIVES: The purpose of this research is to explore the relationship between age-friendly environment, social support, sense of community, and loneliness of Korean adults aged 45 and above. METHODS: A total of 590 participants from a cross-sectional and secondary data from an age integration survey conducted in 2018 was used for analysis. Structural equation modelling and bootstrapping method were applied to examine the mediating role of social support and sense of community on the relationship between age-friendly environment and loneliness. RESULTS: Age-friendly environment was positively associated with social support (ß=.310, p<.001) and sense of community (ß=.479, p<.001). Social support was negatively associated with loneliness (ß=-.190, p<.001). Full mediation effect of social support was observed in the pathway from age-friendly environment to loneliness (95% CI: -0.135 to -0.036). CONCLUSION: Social support was fundamental in lowering loneliness in an age-friendly environment. There was no significant association linking age-friendly environment, sense of community, and loneliness. The results support the adoption of AFE to protect people at risk of loneliness with social support mediating this relationship.

Relationship of social isolation with mental distress among older Korean Americans: The moderating role of social cohesion.

Social isolation has been associated with poor mental health outcomes, particularly for older immigrants who do not have a protective social environment. The purpose of this study was to investigate the relationship of social isolation (living alone, marginal family ties and marginal friend ties) with mental distress and to examine the moderating role of social cohesion (family cohesion and community cohesion). We hypothesised that social isolation and social cohesion would be directly associated with mental distress and that social cohesion would buffer the influence of social isolation on mental distress. Data were drawn from the Study of Older Korean Americans (SOKA), which included 2150 older Korean Americans aged 60 or over in multiple areas, collected during 2017-2018. A series of hierarchical regression models of mental distress examined the direct and interactive role of social isolation and social cohesion. Approximately one-third of the sample lived alone, 20% had marginal family ties and 27% had marginal friend ties. All three indicators of social isolation had a significant direct effect on mental health; however, living alone lost its statistical significance with the inclusion of social cohesion variables. Both indicators of family and community cohesion were significantly associated with lower levels of mental distress. In addition, family cohesion buffered the negative effects of marginal ties to family and friends on mental distress. The significant role of a positive social environment must be considered when addressing the needs of older immigrants who are socially isolated.

Self-esteem as a mediator in the relationship between perceived age stigma and emotional well-being among Korean older adults: the moderation effect of marital status.

OBJECTIVES: This study examined whether self-esteem mediates the association between perceived age stigma and emotional well-being (loneliness and emotional isolation) among Korean older adults and how these processes differ by marital status. METHODS: Using the 2018 Age Integration and Generation Integration Survey, a cross-sectional national survey of Korean adults, we analyzed data from 266 adults aged 60 and older. RESULTS: Older adults who perceived greater age stigma reported higher levels of loneliness and emotional isolation. Self-esteem played a significant indirect role in the association between perceived age stigma and the two emotional well-being outcomes. Moderated mediation analyses further revealed significant differences by marital status: self-esteem was a more powerful mechanism among unmarried older adults relative to their married counterparts. CONCLUSIONS: The findings suggest that efforts to minimize public and internalized stigmatization of older adults and improve their self-esteem may be critical for their emotional well-being.

The Relations of Social Network Types With Mental Distress Among Older Korean Americans: The Interactive Role of Living Arrangement.

The purpose of this study is to identify social network types in older Korean Americans and to examine their direct associations, as well as interactions with living arrangement, on mental distress. Drawn from the Study of Older Korean Americans (SOKA), participants were aged 60 or over and lived in five states. Analyses included 2,140 cases surveyed during 2017-2018. To identify social network types, latent profile analyses were conducted using 10 network-related criterion variables. A model with five social network types was identified as best fit. The groups were labeled as diverse, moderately diverse, family deficit, friend deficit, and restricted. As hypothesized, greater mental distress was associated with belonging to more deprived networks such as family deficit and restricted groups. Interaction effects also suggest that members of the restricted group were more distressed when they lived alone than when they lived with others. Implications based on the results are discussed.

WHO's Global Age-Friendly Cities Guide: Its Implications of a Discussion on Social Exclusion among Older Adults.

This study analyzed the World Health Organization's (WHO) Global Age-Friendly Cities Guide to observe its role in embodying social inclusion of older adults in attempts to prevent social exclusion. Social exclusion refers to the marginalization of individuals and groups from important economic and social opportunities in the society. Many aging societies are implementing social inclusion of older adults as one of their key policy agendas to create a more sustainable and healthy society, in recognition that age functions as one of the essential factors accelerating social exclusion and declining physical and mental health of those affected. In order to explore the pertinence of the WHO guidelines to social inclusion of older adults, content analysis was conducted on each checklist item in the WHO guideline to identify its relation to the four dimensions of social exclusion, which are social interaction, production, consumption, and political engagement. The results showed comprehensive coverage of each dimension by the guideline, although the relative importance of each dimension was unequal. Additional insights were suggested to promote further social inclusion of older adults in the context of an age-friendly environment.

Age-friendly environments and depressive symptoms among Korean adults: The mediating effects of loneliness.

OBJECTIVES: In this study, we examined (1) group differences with regard to age-friendly environments (AFE), loneliness, and depressive symptoms among younger, middle-aged, and older Korean adults; (2) the relationship of AFE to loneliness and depressive symptoms; and (3) the mediating effect of loneliness on the relationship between AFE and depressive symptoms among three Korean adult groups. METHOD: We used a cross-sectional survey design featuring multistage quota sampling. Study participants were 1,017 Korean adults aged 18 years or older. Multi-group structural equation modeling was used for data analysis. RESULTS: Statistically significant age group differences were found in the mean values of loneliness and depressive symptoms, but no significant age group differences in the mean values of AFE were observed. Older adults showed a significant relationship between AFE and loneliness, while their younger counterparts demonstrated a significant relationship between AFE and depressive symptoms. The mediating effect of loneliness on the association between AFE and depressive symptoms was found only for the older age group. CONCLUSION: The results of the study contribute to the existing understanding of AFE and mental health among Korean adults, while providing service providers and policy makers with fundamental background information on alleviating depression.

The Role of Social Networks on Depressive Symptoms: A Comparison of Older Koreans in Three Geographic Areas.

The purpose of this study was to examine the correlates of depressive symptoms among older Korean adults in three geographic locations with varying densities of the Korean population: mainland Korea (mostly Koreans), New York metropolitan area (high Korean density), and west central Florida (low Korean density). The study focused on the role of family and friend networks. Data were drawn from three sources: (1) a multistage national sample of Koreans in South Korea (n = 403); (2) a survey conducted in the western/central Florida area that used a variety of culturally sensitive sampling strategies (n = 672); and (3) a survey in the New York metropolitan area (n = 420) that replicated the Florida study. For those living in Korea, living alone and lower perceived financial status were independently associated with higher levels of depressive symptoms. For the New York and Florida samples, fair or poor self-rating of health, lower levels of acculturation, and weaker ties with family were related to higher levels of depressive symptoms. Similar to the older Korean sample, lower perceived financial status was linked with greater depressive symptoms in the New York sample. The overall results suggest that it is important to consider the interplay of the social network, personal, and cultural resources when working with older adults in diverse contexts. Intervention efforts should address mental health issues tailored to cultural and social settings.

The Comparative Macro-Level Ageism Index: An International Comparison.

Ageism, socially constructed discrimination against seniors, influences the quality of life of older adults. This study aimed to compare ageism in 15 Organization for Economic Cooperation and Development (OECD) countries using the scientifically developed Comparative Macro-Level Ageism Index (CMAI). We developed the CMAI by reviewing previous index research on the life of older people and conducting expert interviews using a Delphi method. We identified five domains, economic status, health, employment, environment, and social participation, and 17 indicators of ageism. Standardized ageism scores were compared across 15 OECD countries. The results indicated that the overall ageism score was highest in Turkey and lowest in Japan. Turkey was the most likely while South Korea was the least likely to practice age discrimination in the workplace. Yet, South Korea had the highest score for discriminating against seniors based on economic status while Spain had the lowest score in this domain. Japan had favorable conditions for economic status, health status, and social participation for older adults. Implications of this study and suggestions for further studies on developing an objective indicator of structural age discrimination are discussed.

Health Literacy in Korean Adults and Korean American Immigrants: Implications for Achieving Health Equity.

Health literacy is necessary to understand health information and make appropriate decisions regarding one's health. This study aims to investigate (1) the health literacy level of Korean citizens and Korean American (KA) immigrants in the United States and (2) factors that influence health literacy across three age groups. A quota sampling method was used to collect cross-sectional survey data from 404 Korean participants and 404 KA immigrants. Andersen's behavioral model was used as the theoretical framework for this study. Overall, Korean participants had a higher mean score on health literacy than did the KA immigrants. Only one of predisposing and enabling factors were significant variables influencing health literacy in KA immigrants, while several predisposing, enabling and need factors were significantly associated with health literacy in Korean adults. Our findings indicate that both countries need to have a community-based health literacy educational program that is tailored to each age group.

Profiles of Social Engagement and Their Association With Loneliness and Self-Rated Health Among Older Korean Immigrants.

The purposes of this study were to (1) develop a typology of social engagement in older Korean immigrants in the United States and (2) compare the groups in the typology regarding their level of loneliness and self-rated health. Data were drawn from the Study of Older Korean Americans covering the five geographic locations (N = 2,149). Using eight criterion variables concerning the type and frequency of activities, latent profile analysis identified a six-group model as the most optimal with the following groups: diverse, active, moderately social, structured, sedentary, and restricted. When the restricted group was used as the reference, the groups that were more socially engaged were found to have lower levels of loneliness. Additionally, being a member of the active or moderately social group was associated with more favorable self-ratings of health. These findings hold implications for understanding the variability of social engagement and how it relates to health and well-being.

A Typology of Social Networks and Its Relationship to Psychological Well-Being in Korean Adults.

The purposes of this study were to (a) develop an empirical typology of the social networks in Korean adults aged 18 years or older and (b) examine the relation of network types on depressive symptoms and satisfaction with life. Data for this study were drawn from the survey with 1,017 community-dwelling adults aged 18 years or older in South Korea representing three life stages: young adults, middle-aged adults, and older adults. Latent profile analysis was conducted based on eight social network-related variables: marital status, living arrangement, number of family confidants, number of friend confidants, frequency of contact with friends using phone or social media, frequency of participation in social groups, frequency of conversation with neighbors, and perceived closeness of family. The identified typologies were then regressed on depressive symptoms and satisfaction with life. A model with four network types was identified as being the most optimal, and the groups were labeled as: diverse-family, diverse-friend, solo-restricted, and coresident-restricted. Regression analyses showed that in comparison with the coresident-restricted group referent, diverse-friend and solo-restricted groups exhibited elevated levels of depressive symptoms; diverse-family and diverse-friend type had higher levels of satisfaction with life. Implications of the study findings were discussed in line with current research and intervention efforts.

Loneliness as a mediator in the relationship between social engagement and depressive symptoms: Age differences among community-dwelling Korean adults.

The purpose of this study was to examine whether loneliness mediates the relationship between social engagement and depressive symptoms and to determine how age moderates the mediation effect. Data for this study came from the survey with community-dwelling adults aged 18 and older in South Korea, from March to April 2017. The total of 1,017 respondents were drawn from three age groups (18-44, 45-64, or 65 and older). The mediating effect of loneliness was tested between each of three social engagement-related variables (family network, friend network, and perceived community support) and depressive symptoms. The results showed age differences in mediation: the effect was most pronounced in the relationship of family network with loneliness for the older group, whereas the size of friend network significantly predicted loneliness for younger adults. Both younger and older groups felt less lonely when they had a higher level of perceived community support; the middle age group remained uninfluenced by the mediation effects. Our findings confirm that loneliness is one of the mechanisms by which social engagement exerts its effect on depressive symptoms. As the Korean society embraces its growing proportions of older adults, the results of the study provide implications for adaptive strategies for changing social engagement need and mental health associated with ageing.