Social Determinants of Health among Older Korean Immigrants in the United States: A Systematic Review

The visible impact of the SDoHs on health and behavioral health as well as health disparities among minority populations is heightened due to COVID-19. One group about which little is known in relation to SDoHs is the older Korean immigrant population in the U.S. To examine the impact of SDoHs on the health, mental health, and health care utilization, a systematic review of studies focused on SDoHs for this population was conducted. Using multiple indexing terms, databases were searched for articles published in English between January 1, 2011 and December 2020. Articles were included in the search if they examined social determinants of health of older Korean immigrants defined as foreign-born Koreans aged 60 or older who live in the United States regardless of citizenship or legal immigration status. A total of 1090 articles were identified in the search. A review of abstracts for inclusion criteria resulted in 118 articles for review. Seventy-one articles were excluded during the review process. A total of 47 articles met inclusion criteria and were evaluated. The review revealed that SDoHs, including education level, financial resources, access to health insurance, level of acculturation and level of social support, influenced cognitive status, depressive symptoms, health status and quality of life. These findings validate the need for interventions to address the social care needs of older Korean immigrants and can be used to identify the role of social workers in addressing the SDoHs that result in health disparities for older Korean immigrants.

Living/Eating Arrangement, Loneliness, and Mental Distress among Older Korean Immigrants: Gender Difference

Structural isolation such as living alone poses a mental health risk in diverse groups of older adults, including older immigrants. Given that those living with others might also be disengaged, the present investigation included eating alone as another source of isolation and examined the impact of the combination of living and eating alone. The proposes of the study were to examine (1) how living and/or eating alone would impact mental distress, (2) whether the impact would be mediated by feelings of loneliness, and (3) if there would be gender differences in the mediation effect. The data were drawn from the Study of Older Korean Americans (SOKA), which surveyed older Korean immigrants in five states during 2017−2018. The living/eating arrangement was classified into four-groups: living/eating with others (57%), living with others/eating alone (12.4%), living alone/eating with others (7.3%), and living/eating alone (23.1%). Using the PROCESS macro, we tested the mediation effect of loneliness and the moderation effect of gender in the relationship between the typology and mental distress controlling for background/health characteristics and social capital related variables. Two groups (living with others/eating alone and living/eating alone) had sociodemographic, health, and social capital disadvantages. Analyses demonstrated that mental distress was linked with living with others/eating alone and living/eating alone, of which relationships were mediated by loneliness only among women. Findings suggest that not only structural isolation (e.g., living alone) but also disengagement with others (e.g., eating alone) need to be considered to understand emotional well-being in older immigrant population and gender difference.

Sleep Disturbance Among Older Korean Immigrants

Little is known about sleep disturbance among older Korean immigrants living in the United States. In this exploratory study, we conducted focus groups with 6 and phone interviews with 22 older Korean immigrants to explore and understand their sleep experiences. Three members of the research team fluent in Korean independently coded each focus group and phone interview transcript to identify underlying themes. The following themes emerged: Daytime naps were acceptable behaviors, particularly among those who were retired or not employed. Many reported worry and anxiety rumination behaviors that interfered with their sleep. In addition, praying, reading the bible, and singing hymns often occurred while in bed, and smartphone or tablet use was a frequent activity as well. Drinking alcohol and taking sleeping pills were used as a last resort to help with sleep, particularly among those who lived alone. Internal (e.g., biological urge, snoring, medical conditions) and external distractions (e.g., noise) contributed to nighttime awakenings. Living alone and worrying about the future made it difficult for some to return to sleep after awakening. Seeking advice from peers was a common behavior but did not seem to help with sleep. Calming activities such as reading a book, taking a shower, watch television, or writing a diary were routinely performed before bedtime. These findings are consistent with unhealthy sleep behaviors shown in other racial/ethnic minority older adults with poor sleep. Sleep education programs in Korean-speaking churches may be used to target those who are socially isolated and may benefit older Korean immigrants.

Pathways among Frailty, Health Literacy, Acculturation, and Social Support of Middle-Aged and Older Korean Immigrants in the USA

Culturally and linguistically different immigrants in the U.S. are considered populations with low health literacy in general, thereby having a high risk of negative health outcomes such as frailty. The purpose of this study is to identify the effects of social support and acculturation on the relationship between health literacy and frailty of Korean immigrants in existing models of health literacy. A total of 244 Korean immigrants aged 50 years and older residing in Southern United States (Alabama and Georgia) were recruited. Path analysis was used to examine the pathways among variables, and the indirect effects of health literacy were analyzed. The results revealed that health literacy and social support directly influenced frailty; social support and acculturation were identified to influence health literacy. Health literacy had a partial mediating effect in the relationship between social support and frailty and a complete mediating effect in the relationship between acculturation and frailty. Therefore, to prevent frailty, it is necessary to consider enhancing immigrants’ health literacy by elevating acculturation and social supports.

Oral Health and Dental Care in Older Korean Immigrants: A Qualitative Study

Many segments of the U.S. population continue to experience a disproportionate burden of oral disease and inequities in dental care, and older Asian immigrant populations are among those at high risk. Responding to the needs to attend to ethnic and geographic variations among older Asian Americans and to better understand contextual factors that shape their experiences of oral health and dental care, the present study conducted in-depth interviews with eighteen older Korean immigrants in the Los Angeles Greater area. The qualitative inquiries were theoretically guided by the three core categories of the Andersen’s (1968, 1997) health service model: oral health needs, service barriers, and service outcomes. Using the constant comparison method, themes and sub-themes within each category were derived. The eight themes emerged from the qualitative data were: (1) oral health problems, (2) perceived need, (3) insurance and finance, (4) language barriers, (5) social support, (6) knowledge and belief, (7) satisfaction with service, and (8) areas of improvement. The findings demonstrated varied experiences associated with oral health and dental care of older Korean immigrants and informed the development of services and programs responsive to the identified needs and barriers.

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.

Mediating role of resilience between successful aging and acculturation among older Korean immigrants In the United States

Background: This study was to investigate how acculturative stress affects older Korean immigrants' successful aging and whether resilience can play a mediator's role to the sample population's successful aging or not. The research design was a cross-sectional survey using three valid and reliable scales such as Successful Aging Scale, Acculturative Stress Scale, and Resilience Scale. A research shows that there is no or minimum correlation between acculturative stress and successful aging (Choi & Thomas, 2009). However, it was hypothesized that although there was a weak correlation between acculturative stress and successful aging, once the resilience involved as a mediator, the correlation would be stronger. Methods: The study was designed as a self-administered survey research using the scales mentioned above. One hundred and two (N=102) older Koreans who currently enrolled in Adult Health Care Centers in Los Angeles, CA, participated in this study. Multiple Regression, Correlation, ANOVA, and t-test was administered to analyze the collected data. Results: The results indicated that there was a positive but weak correlation between acculturative stress and the sample population's successful aging rate (r = .252, p<.05). Interestingly, when resilience intervened as a mediator, the correlation between acculturation and successful aging was increased to (r = .622, p<.05). Therefore, the study discovered that the resilience was able to play a mediator's role between acculturative stress and successful aging among the older Korean immigrants. Implications: The findings can be directed to social work researchers and practitioners to help educate the ethnic older adults in the community on the social and behavioral importance of the positive aspects of aging such as successful aging and healthy aging to increase the chance of community member's longevity. Future research will include other ethnic and immigrant older populations in the community to show internal and external validity of the study related to successful aging, acculturative stress, and resilience.