Self-Reported Discrimination, Resilience, and Oral Health-Related Quality of Life Among Older Chinese Americans

There is a lack of empirical evidence on self-reported discrimination and oral health-related quality of life (OHRQoL). Further, the mechanism linking the two constructs is not well understood. This study aimed to examine the relationship between self-reported discrimination and OHRQoL and investigate resilience as a mediator in such a relationship among foreign-born older Chinese Americans. Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3,054 foreign-born Chinese Americans (60+ years of age). Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL. Self-reported discrimination was directly and indirectly associated with poorer OHRQoL. Resilience mediated the relationship between self-reported discrimination and OHRQoL. Specifically, individuals experienced discrimination reported weaker resilience, and subsequently, reported poorer OHRQoL. Findings illustrate the importance of studying self-reported discrimination in relation to OHRQoL and further identify resilience as an intermediary pathway to promote OHRQoL.

Social Isolation, Resilience, and Psychological Well-Being in Older Chinese Americans

Using data collected in 2018 on 398 older Chinese Americans aged 55+ residing in Hawaii, we examined the associations of social isolation with psychological well-being and the mediating role of resilience. Social isolation was measured by their marital status, living arrangement, contact with children/family/friends, and participation in social activities. Psychological well-being was measured by psychological distress, life satisfaction, and happiness. Results from multivariate linear regressions and ordered logistic regressions showed social isolation was positively associated with psychological distress (β=0.017, p<0.05), and negatively associated with life satisfaction (β=-0.220, p<0.001) and happiness (β=-0.086, p<0.05) . By contrast, resilience was associated with lower psychological distress and higher life satisfaction and happiness. Moreover, mediation analysis showed that resilience contributed to 32% of the association between social isolation and psychological distress, 24.9% of the association between social isolation and life satisfaction, and 16.3% of the association between social isolation and happiness.

Family Conflict and Older Chinese Americans’ Self-Efficacy in End-of-Life Care Planning: The Role of Acculturation

Family involvement in end-of-life (EOL) care is critical to ensure older adults’ health and quality of life. Older adults’ self-efficacy in discussing EOL care plans with family members can facilitate family involvement in EOL care planning. Research shows that family relationships are associated with self-efficacy in discussing EOL care with family members among older Chinese Americans. However, the roles of family conflict and acculturation remain unknown. This study examines the association between family conflict and self-efficacy in discussing EOL care with family members and whether such an association differs by acculturation levels among older Chinese Americans. Data were collected from 207 Chinese Americans aged 65-102 in two metropolitan areas in 2017. Ordinary least squares regression was conducted to examine the association between family conflict, acculturation, and self-efficacy in discussing EOL care with family. Family conflict was negatively associated with older adults’ self-efficacy in discussing EOL care with family. More specifically, the negative association between family conflict and self-efficacy in discussing EOL care with family members was more pronounced for those with higher levels of acculturation. Findings highlighted differential effects of family conflict on self-efficacy of EOL care plan discussion for older adults with different acculturation levels. Those with higher acculturation may be more independent in their EOL care planning and aware of the possible negative effects of family conflict in their EOL care planning discussions. Acculturation needs to be considered by geriatric health providers to develop family-centered interventions in improving end-of-life care planning for this population.

Preferences and Determinants of End-of-Life Care Among Older Chinese Americans

End-of-life (EOL) care awareness and practice remain particularly low among older Chinese Americans. More empirical evidence regarding EOL is needed to develop culturally-relevant interventions to promote EOL engagement in this minority population. Using population-specific data, this study investigates preferences and associated sociodemographic and health determinants related to EOL among older Chinese Americans. Data were from the Population-based Study of Chinese Elderly in Chicago (collected 2017-2019, N=3,124). Linear and logistic regressions were conducted. Of the sample, 46.1% considered EOL care planning as important or somewhat import. Nearly 22% had EOL discussions with families. The most preferred EOL locations were home (43.7%), hospital (35.5%), nursing home (10.1%), and hospice (4.3%). Overall, 47.1% perceived EOL care as family decisions, 39.6% regarded EOL care as personal decisions, 7.5% preferred children to make EOL decisions, and 3.3% preferred a spouse to make EOL decisions. Chinese older adults who were female (B=0.10, p<0.01), married (B=0.11, p<0.01), had higher education (B=0.02, p<0.001), acculturation level (B=0.02, p<0.001), and religiosity (B=0.12, p<0.001), and more chronic conditions (B=0.05, p<0.001) were more likely to consider EOL as important. Those with older age [Odds Ratio (OR)=1.02, 95% Confidence Interval (CI)=1.01-1.03], female gender (OR=1.44, 95% CI=1.18-1.77), higher levels of education (OR=1.02, 95% CI=1.01-1.04), acculturation (OR=1.04, 95% CI=1.01-1.06), and religiosity (OR=1.11, 95% CI=1.02-1.21), longer U.S. residence (OR=1.02, 95% CI=1.01-1.03), and more chronic conditions (OR=1.13, 95% CI=1.06-1.21) were more likely to have discussed EOL preferences with their families. Study findings underscore low engagement in EOL planning in this population and the need for culturally-appropriate interventions.

Dementia literacy and worry among older Chinese Americans in Arizona: a comparison between 2013 and 2017

Objectives: This study examined the change in dementia literacy and dementia worry over a 5-year span among older Chinese Americans living in Arizona. Design, setting, participants, and measurement: This study used survey data collected among a purposive sample of 703 community-dwelling Chinese Americans aged 55 years or older living in the metropolitan areas of Phoenix, Arizona, from 2013 to 2017. The average age of participants was 73.1 (SD = 8.7) and 64.2% were female. Dementia literacy was measured by dementia knowledge (knowledge about Alzheimer’s disease and related dementia) and dementia beliefs (biased attitude toward dementia). Dementia worry was measured by assessing participants’ fear toward and concerns of developing dementia. Results: Regression analyses found dementia knowledge decreased (p < 0.05) and dementia beliefs remained unchanged (p > 0.05) from 2013 to 2017 among participants. Dementia worry only increased among those who lived alone. Significant correlates of dementia worry included low formal education level, depressive symptoms, and family conflict. Conclusions: Public health education targeting older Chinese Americans should aim to enhance dementia knowledge and to rectify their biased attitudes toward dementia. Psychosocial education or counseling should be available to older Chinese Americans who present dementia worry, particularly for those who live alone. More studies using diverse study designs, such as a longitudinal design, are needed to examine change in dementia literacy and worry among this population.