This pilot study will investigate the bio-psycho-social mechanisms of the relationship between widowhood (trauma) and cognitive function (health outcome) among U.S. Asian older adults in comparison to non-Asian older adults in general (e.g., White, Black, Hispanics) using the two secondary datasets, Health and Retirement Study (HRS), and Population Study of Chinese Elderly in Chicago Study (PINE). To that end, this study will first examine the bio-psycho-social factors (e.g., chronic conditions, functional limitations, perceived loneliness, depressive symptoms) as potential mediators to explain the pathways between widowhood and cognitive function. Second, this study will explore the moderating effects of resilience factors, such as leisure activity engagement (e.g., physical, cognitive, and social activities), social support (e.g., support received from and provided to children, family, and friends), and the level of acculturation in this relationship. Understanding the mechanisms of widowhood and cognitive function will help identify the specific mediating and/or moderating factors that may attenuate the negative impact of widowhood on cognitive function among U.S. Asian older adults. Cognitive function is measured in three domains: 1) episodic memory (e.g., immediate and delayed word recall), 2) working memory (e.g., serial 7’s, digit span backwards), and 3) perceptual/processing speed (e.g., counting backwards, symbol digit modalities test). Raw scores of these cognitive tests will be converted to z-scores to measure global cognition. Eventually, this study aims to guide researchers and practitioners to design and deliver interventions that may prevent risk factors and promote resilience factors among U.S. Asian older adults who experience widowhood.
Older Asian Americans (AAs) are one of the fastest growing populations of older adults in the US, and approximately 85% of aging AAs aged 65 or above are foreign-born. Trauma is significantly associated with negative psychological outcomes among older adults, such as posttraumatic stress disorder (PTSD), depression, and complicated grief. Resilience is defined as a dynamic process in which psychological, social, environmental, and biological factors interact to enable an individual to develop, maintain, or regain their mental health in the face of adversity. The literature has indicated that resilience is an important protective factor that enables ethnic groups of immigrants to recover from distressing traumatic stressors and maintain positive mental health status. Specifically, some resilience factors, including social support, self-esteem, optimism, religion, are significantly associated with positive mental health status among Asian Americans. However, these existing studies exclusively target a specific Asian ethnic group (e.g., Koreans, South Asians, or Iraqis) or female immigrants using qualitative methods or a small sample size. An extremely limited number of studies explored the psychopathology, resilience factors, and professional healthcare services use among a national, ethnically diverse groups of immigrants. The findings on trauma, resilience-promoting factors, and the context of mental health and access and utilization of professional healthcare services among older Asian immigrants who have experienced traumatic events are far scarcer. The positive deviance approach is defined as a process of social and behavioral change that highlights uncommon social practices. This approach is based on the premise that some individuals can overcome constraints and attain better health outcomes than their peers who are in a similar situation.9 The positive deviants (PDs) are the individuals who exhibit positive deviance behaviors in the presence of an unfavorable environment or negative experience. Non-positive deviants (non-PDs) are individuals who share a cultural background, environment, or negative experience similar to that of PDs, but did not have a positive health outcome or exhibit desired health behaviors. The positive deviance approach is a quick, cost-saving, and culturally appropriate method to identify uncommon practices that can be used to encourage others in similar situations to adapt the same healthy strategies and practice. This approach has been effective in addressing a broad array of intractable health problems (e.g., improving diabetes patients’ care, the quality of care, breastfeeding, and decreasing cancer risk). The findings from our preliminary studies have suggested that the positive deviance approach can be applied to identify resilience-promoting factors associated with the access and utilization of professional mental health services among older Asian female immigrants with diagnosed lifetime mental disorder using a national secondary database. Specifically, the PDs in this proposed project are older Asian immigrants aged 60+ in the US who were exposed to one or more traumatic events and developed an onset of any sequent psychiatric disorders (e.g., PTSD, depression, anxiety, suicide ideation) or substance disorders (e.g., alcohol, drug use or tobacco), but successfully accessed and utilized routine and specialty mental health services or substance abuse treatment. Correspondingly, the non-PDs are AAs aged 60+ who experienced traumatic events and developed an onset of any sequent psychiatric disorders or substance abuse but did not access or utilize any mental health services as expected.
There is strong evidence linking oral health with over-all health in older adults.1 Poor oral health has been associated with decreased quality of life, a variety of non-communicable diseases, and mortality. The is also evidence that older adult immigrants and those who had been in the US for less than 5 years are more likely to have periodontitis, a serious gum disease and a common oral health condition. The results of a study by Wu et al. using a large national data set showed that middle-aged and older Filipino immigrants had the highest rate of edentulism or total loss of teeth among Chinese, Asian Indians, Other Asians, Hispanics, Blacks and Caucasians. Despite this evidence, there is a paucity of studies on oral health among Filipino older adults, especially those that investigate the influence of acculturation, immigration-related trauma (acculturative stress) and resilience on oral health and dental care service use among Filipino older adult immigrants. To address this significant knowledge gap, we will use a mixed-methods convergent study design to obtain a comprehensive and nuanced understanding of the cultural- and immigration-related factors that influence oral health and dental care practices among Filipino older adult immigrants, including those factors that facilitate and hinder their access to dental care services.
The US older adult population continues to grow and with this growth an increased need for assistance with Activities of Daily Living (ADL). Age is a robust predictor of Alzheimer’s Disease and related dementia (ADRD). Asian Americans (AA) are the fastest growing racial group in the country and research on ADRD among AA is needed. Caregiving burden of family members with ADRD, characterized by depression, health deterioration, and role captivity, is potentially traumatic to the well-being of the caregiver. Studies on caregivers’ needs have been psychologically oriented and frame caregiving as a form of stress, but caregivers may also require tangible needs that include financial, medical, and ADL care and support. It has also been difficult to recruit patient-caregiver dyads (pairs) for research studies. Secondary traumatic stress and burnout have been discussed identified as outcomes of compassion fatigue. Studies on caregiver compassion fatigue of ADRD patients have proposed that this framework, which includes exposure to traumatizing experiences for the caregiver, may also apply to the informal family caregiver because of the existing emotional relationship. Though caregiver burden of family members with ADRD has been researched, its relationship with compassion fatigue has been recommended for further studies. Including compassion fatigue in studying informal caregiver experiences of family members with ADRD will contribute to a model on how trauma may be related to the caregiver experience. A growing proportion of AA, especially women, will serve as (informal) caregivers to elder family members with ADRD8. AA typically have stronger filial support and family networks than White Americans; thus, AA caregivers may demonstrate resiliency and perceive the experience differently compared to White Americans (burdensome). Filipinos are much more likely to describe caregivers as good or saintly, to value harmony over conflict and have a strong Catholic faith. Informal social support significantly reduced the perception of caregiving-related stressors among Korean American caregivers. As the need for family caregiving among elders with ADRD increases, especially among AAs, understanding caregiving roles and how it affects the AA caregivers’ health will help in supporting their family members’ with ADRD and related physical, social, and emotional well-being. Qualitative research studies in Asia (e.g., Hong Kong, Singapore) have examined cultural values, beliefs, practices, and family systems on experiences of the caregiver role of family members with ADRD. Caregivers of family members with ADRD may provide different help with more ADLs. US based studies have yet to be published quantifying measurable health outcomes for the AA caregiver of family members with ADRD. These measures would include caregiver QOL, health status, and assistance with ADLs. Furthermore population-based cohort studies have been recommended to examine the prevalence of ADRD in AAs including subgroup differences. There are also vast differences in the estimated numbers of family caregivers nationally, which depend on the type of survey method used, and specifically on AA caregivers.
Biological evidence insufficiently account for differences in physical and behavioral health outcomes for Asians in the United States and Canada. Although Asians have established communities in North America since the 19th century, major waves of migration began after the 1960s. Asians are largely a foreign-born population in North America, and the majority of Asian older adults are immigrants. A substantive body of research has identified epigenetic factors in the social environment related to acculturation which can be protective or lead to increased risk for poor health for Asians throughout the lifecourse. Although Asian Americans may have similar biological influences compared to Asian immigrants to other countries such as Canada, differences in social and environmental influences can result in divergent health outcomes. Asian Americans are the most economically divided race group in the US (Pew Research Center, 2018), and encounter different environmental influences compared to Asian Canadians across the lifespan. These different influences, many of which are impacted by acculturation, can have implications on their health and well-being over the lifecourse. Risk factors such as exposure to discrimination can increase the negative effects of trauma on health outcomes, and protective factors such as social supports can bolster their resilience during their acculturation process. As a health disparities scholar, my goal is to investigate the association of acculturation with trauma (specifically perceived discrimination), resilience and health outcomes for Asians across the lifespan and make a meaningful impact towards better care for the growing Asian population in the US and Canada.
