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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. [ABSTRACT FROM AUTHOR]

Family involvement is critical to end-of-life (EOL) care among older adults. This study aims to examine the association and pathways between family relationships and older Chinese Americans' attitude toward family involvement in EOL care discussions. Data were collected from 260 Chinese Americans aged 55 years and above. Structural equation modeling was used to examine the total and indirect effects of family relationships on attitude toward family involvement in discussing EOL care plans. Family relationships had a significant positive total effect on attitude toward family involvement in EOL care. Indirect effects of family relationships on attitude toward family involvement in EOL care through self-efficacy, perceived benefits, and perceived barriers of discussing EOL care with family members were all significant. Findings provide empirical evidence of how family relationships affect older Chinese Americans' attitude toward family involvement in EOL care and underline the need for family-centered EOL interventions for this population. [ABSTRACT FROM AUTHOR]

This research examined whether perceived receipt of filial piety from adult children and ethnic community engagement—two major ethnocultural resources—were associated with psychological wellbeing of older Chinese American immigrants. Analyses used data from the PINE study, a sample of older Chinese adults in Chicago. Tobit regression revealed that elders who received more filial piety and visited community centers experienced less loneliness and depression than their counterparts did. Tests of interactions showed that community center visits moderated the negative relationship between perceived filial piety and depression. Results suggest the importance of community engagement for diminishing depressive symptoms in older Chinese American immigrants, particularly those with culturally weak intergenerational ties. Discussion centers on how visiting community centers in ethnically dense neighborhoods compensates for unfulfilled filial piety expectations by protecting the mental health of minority elders within a rapidly growing and acculturating immigrant population. [ABSTRACT FROM AUTHOR]

Mahjong is considered a popular form of gambling in the Chinese culture, especially among older Chinese populations. However, there is a lack of research on mahjong playing among older Chinese immigrants and its impact on their lives. The current study explored the beliefs and experiences of mahjong through the lens of older Chinese immigrants residing in New York City. A total of 14 participants who played mahjong were included in the analysis. Thematic analysis revealed two major themes: The first theme, healthy mahjong, encompasses the positive roles and meaning of mahjong among older Chinese immigrants as it promotes social engagement and cognitive activity, and eliminates boredom. The second theme, little mahjong, focuses on the attitudes and behaviours used to keep their play under control, through small-scale betting, casual acceptance of winning and losing, and not making it a habit. Negative cases were also included to provide a full illustration of the participants' views. The findings suggest that, despite a low risk of problem gambling, there may be a need for an intervention in order to increase awareness to prevent health consequences contributed by long periods of time spent sitting to play mahjong. [ABSTRACT FROM AUTHOR]

OBJECTIVES To examine the associations between violence experiences including phenotypes (psychological, physical/sexual abuse, financial exploitation, caregiver neglect) of child maltreatment (CM), intimate partner violence (IPV), and elder abuse (EA). DESIGN Cross‐sectional data collected during 2011‐2013. SETTING US Chinese community in Chicago, Illinois. PARTICIPANTS A total of 3157 community‐dwelling older adults (aged ≥60 y). MEASUREMENTS Cases of CM, IPV, and EA. RESULTS: Prevalence of violence was 11.4% for CM (physical/sexual = 10.2%; psychological = 2.4%), 6.5% for IPV (psychological = 5.3%; physical/sexual = 2.8%), and 15.2% for EA (caregiver neglect = 11.2%; psychological = 9.8%; financial exploitation = 9.3%; physical/sexual = 1.2%). After adjusting for potential confounding variables, CM psychological was associated with increased risks for IPV psychological (odds ratio [OR] = 7.60; 95% confidence interval [CI] = 4.29‐13.45), IPV physical/sexual (OR = 4.06; CI = 1.71‐9.63), EA psychological (OR = 3.79; 95% CI = 2.20‐6.51), and EA financial exploitation (OR = 2.07; 95% CI = 1.12‐3.81). CM physical/sexual was associated with increased risks for IPV physical/sexual (OR = 1.86; 95% CI = 1.02‐3.38), EA psychological (OR = 1.70; 95% CI = 1.20‐2.42), and EA financial exploitation (OR = 2.38; 95% CI = 1.72‐3.30). IPV psychological and physical/sexual were associated with 5 to 8 times increased risks for EA psychological, 6 to 9 times increased risks for EA physical/sexual, and 3 times increased risks for EA financial exploitation. CONCLUSION: Healthcare professionals working with older adults should be informed that a history of violence might further predispose a person to different types of EA. The cumulative impact of violence should also be considered when providing services or care to violence victims. J Am Geriatr Soc 67:S486–S492, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/ OBJECTIVES Prior research has shown that social engagement is beneficial to older adults' health and well‐being. This study examined the association between environmental factors and social engagement of older Chinese immigrants in the United States. SAMPLE A cross‐sectional data set of Chinese immigrants in the greater Chicago, IL, area (Population Study of Chinese Elderly; n = 3159), was used in this study. DESIGN Multiple regression models were used to test the associations between older adults' engagement in cognitive and social activities and environmental factors, including financial difficulties, social support, neighborhood cohesion, neighborhood disorder, and sense of community. MEASUREMENT Eight questions measuring participants' engagement in cognitive and social activities, a single‐item question measuring financial difficulties, a 12‐item social support measurement, an eight‐item neighborhood cohesion measurement, and a six‐item neighborhood disorder and sense of community scale. RESULTS: Having fewer financial difficulties and a cohesive neighborhood is related to a higher level of engagement in both cognitive and social activities. More social support from family and friends and a sense of community are associated with higher levels of social activities engagement, but not cognitive activity engagement. Neighborhood cohesion has a stronger association with social engagement than other environmental factors and most individual‐level factors. Surprisingly, neighborhood disorder is positively related to social activity engagement, which needs further examination. The associations between environmental factors and social engagement showed no significant difference between healthy and unhealthy older adults. CONCLUSION: This study highlights the need for policies and programs to promote an active lifestyle among older immigrants by creating facilitative social and physical environments. J Am Geriatr Soc 67:S571–S576, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Among older adults, intergenerational support can help to improve well‐being. This study examines the correlation between intergenerational relationships and the subjective well‐being among older Chinese immigrants in the United States. DESIGN Hierarchical multiple regression analyses were applied to test the association between intergenerational relationships and self‐rated well‐being. The mediating effects of sense of control and the moderation effects of support from friends were also tested. SAMPLE A cross‐sectional sample of 2717 older Chinese immigrants, aged 60 years and older, with children and grandchildren was drawn from the Population Study of Chinese Elderly. MEASUREMENTS Study measures included four items concerning intergenerational relationships: the Pearlin Mastery Scale, two items on seeking support from friends, and single items measuring self‐rated health status and quality of life. RESULTS: Only the feeling of closeness with children was positively linked with subjective well‐being, while coresidence and frequency of talking were not. Support from friends moderated the association with self‐rated health status, while sense of control partially mediated the association between feeling of closeness and both self‐rated health status and quality of life. CONCLUSION: A stronger sense of closeness with children correlates to self‐rated health status and quality of life among older Chinese immigrants. The effects of sociocultural changes affecting Chinese American families, and potential implications for older adults' health, could be addressed through strategies to develop emotional closeness with their families and to support sense of control and well‐being among older Chinese adults. J Am Geriatr Soc 67:S557–S563, 2019. [ABSTRACT FROM AUTHOR]

OBJECTIVES To examine the associations between typology of family relationship and risk of elder mistreatment (EM). DESIGN Population‐based epidemiological cross‐sectional study. SETTING Community‐dwelling older adults in the greater Chicago area. PARTICIPANTS A total of 3157 US older Chinese immigrants. MEASUREMENTS EM was measured by a brief screening tool. Latent class analysis was used to construct typologies of family relationship from eight indicators, evaluating the structural, associational, functional, affectual, and normative aspects of family relationship. Logistic regression models were used to test the associations between typology of family relationship and EM. RESULTS: Unobligated ambivalent type (44.77%) was the most common family type among US older Chinese immigrants. The prevalence of EM was around 15%, with 475 participants reporting experience of EM. Unobligated ambivalent (odds ratio [OR] = 1.90; 95% confidence interval [CI] = 1.54‐2.34) and detached (OR = 1.78; 95% CI = 1.32‐2.42) family types were associated with greater risk of EM; tight‐knit (OR = .34; 95% CI = .27‐.44) family type was associated with lower risk of EM. The relationship between commanding conflicted family type and EM was not significant. CONCLUSION: Unobligated ambivalent family type, featured by high emotional closeness and high family conflict, was prevalent among US Chinese families and associated with EM consequences. Culturally customized social services are suggested to reduce intergenerational ambivalence and promote family harmony for immigrant families. J Am Geriatr Soc 67:S493–S498, 2019. [ABSTRACT FROM AUTHOR]

OBJECTIVES Dry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship. DESIGN Cross‐sectional analysis. SETTING Baseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults. PARTICIPANTS Individuals 60 years or older (N = 3157). MEASUREMENTS Perceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 ("never") to 4 ("very often"). Dry mouth was a binary self‐reported outcome variable (1 = "dry mouth"). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 ("hardly ever") to 2 ("often"). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms. RESULTS: Having higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support. CONCLUSION: Perceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019. [ABSTRACT FROM AUTHOR]

OBJECTIVE To examine the influence of smoking status on the health profiles of community‐dwelling older Chinese American men in the greater Chicago, IL, area. DESIGN This study utilized a cross‐sectional study design to analyze data obtained from the larger Population Study of Chinese Elderly in Chicago (PINE). SETTING A population‐based study conducted in Chicago. PARTICIPANTS Baseline data from Chinese American men who participated in PINE (N = 1492). MEASURES Demographic characteristics measured included age, education years, marital status, income, health insurance coverage, and smoking pack‐years. Self‐reported smoking status included never smoker, current smoker, and former smoker. Health profile indicators included perceived health status, past 12‐month changes in health, chronic medical conditions (heart diseases, stroke, cancer, diabetes, hypertension, high cholesterol, thyroid disease, and osteoarthritis), quality of life, and depression and anxiety. RESULTS: The mean age of the study sample was 72.5 years. Of the sample, 65% reported a smoking history, with 25.1% current smokers and 40.1% former smokers. Current smokers were younger, less educated, and uninsured. Former smokers had the poorest overall health profiles. Compared to former smokers, current smokers were less likely to have heart disease (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.39‐0.90), hypertension (OR = 0.54; 95% CI = 0.41‐0.72), high cholesterol (OR = 0.74; 95% CI = 0.56‐0.99), thyroid disease (OR = 0.44; 95% CI = 0.21‐0.90), depression (rate ratio [RR] = 0.76; 95% CI = 0.58‐0.99), and anxiety (RR = 0.72; 95% CI = 0.59‐0.89), and they had fewer overall chronic medical conditions (RR = 0.79; 95% CI = 0.70‐0.88) after controlling for demographic factors and smoking pack‐year history. Compared to never smokers, former and current smokers reported poorer self‐rated health (OR = 1.58; 95% CI = 1.11‐2.26) and lower perceived quality of life (OR = 2.11; 95% CI = 1.04‐4.29). CONCLUSIONS: Consistent with prior research, smoking rates were elevated among this sample of older Chinese men. Counter to study hypotheses, former smokers had worse overall health. Study findings suggest the need for health promotion interventions for both current and former smokers. J Am Geriatr Soc 67:S577–S583, 2019. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Research has examined the relationships between positive social support (PSS) and elder mistreatment (EM) but less is known regarding the negative aspect of social support (NSS), especially among minority groups in the United States. This study aimed to investigate the relationships between PSS/NSS from different sources and EM among US Chinese older adults. Design Population‐based cross‐sectional study. Setting Greater Chicago, IL, area. PARTICIPANTS: A representative sample of Chinese older adults aged 60 years or older (N = 3157) from the Population Study of ChINese Elderly in Chicago in 2011 to 2013. Measurements We applied a 10‐item widely used instrument to assess EM. PSS and NSS from spouse/family members/friends were measured by a 12‐item scale. Multivariate logistic regression analyses were conducted to examine the relationships. RESULTS: After adjusting for confounders, higher levels of overall PSS from all three sources, including spouse, family members, and friends (odds ratio [OR] = 0.88 [95% confidence interval {CI} = 0.85‐0.91]), were associated with lower risk of EM. But participants with a higher level of overall NSS from all three sources (OR = 1.51 [95% CI = 1.41‐1.61]) were more likely to experience EM. The results on the relationships between PSS from spouse (OR = 0.70 [95% CI = 0.64‐0.76]), PSS from family members (OR = 0.73 [95% CI = 0.68‐0.79]), and EM were similar to overall PSS. But PSS from friends had a nonsignificant association with EM. Greater levels of NSS from spouse (OR = 1.84 [95% CI = 1.64‐2.07]), family members (OR = 2.36 [95% CI = 2.03‐2.75]), and friends (OR = 1.69 [95% CI = 1.32‐2.17]) were associated with increased risks of EM. CONCLUSION: Higher levels of SS were not always associated with lower risks of EM among US Chinese older adults. NSS might have counter effects. Future qualitative or longitudinal research needs to explore detailed cultural explanations and casual relationships between SS and EM. J Am Geriatr Soc 67:S499–S505, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Limited research is available on the relationship between oral health symptoms and cognitive function among community‐dwelling US Chinese older adults. The purpose of this study was to examine the associations between tooth/gum symptoms and changes in cognitive function. DESIGN: Two‐wave epidemiological study. SETTING: Population Study of Chinese Elderly in Chicago (PINE). PARTICIPANTS: US Chinese older adults (N = 2713; mean age = 72.6 y; 58.4% women). MEASUREMENTS: We selected self‐reported oral (tooth and gum) symptoms as independent variables. To examine changes in cognitive function (wave 2: Baseline), we chose the following three domains: episodic memory (East Boston Memory Test); executive function (Symbol Digit Modalities Test); and working memory (Digit Span Backwards). In addition, we assessed global cognitive function by constructing a composite measure. RESULTS: At baseline, 1297 participants (47.8%) reported having teeth symptoms, and 513 participants (18.9%) reported having gum symptoms. Adjusting for sociodemographic and health‐related characteristics, participants who reported having teeth symptoms at baseline experienced their global cognition decrease by 0.07 units (estimate = −0.07; p =.003) and their episodic memory decrease by 0.07 units (estimate = −0.07; p =.026). Participants who reported having teeth symptoms at baseline experienced a faster rate of decline in global cognition for every additional year (estimate = 0.02; p =.047). However, this effect disappeared once we adjusted for all covariates (estimate = 0.02; p =.069). We found no significant relationship between baseline gum symptoms and change of cognitive function. CONCLUSION: Having teeth symptoms was associated with a decline in cognitive function among US Chinese older adults. Developing policy measures aimed at ameliorating health and improving cognition in this high‐risk fast‐growing population in the United States would need to include oral health preventive and dental care services. J Am Geriatr Soc 67:S532–S537, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Focusing on Chinese immigrants, this study examined (1) whether filial obligation, the core social norm in the Chinese culture, is related to caregiving burdens; and (2) whether level of acculturation of the caregivers moderates the above relationships. DESIGN Cross‐sectional. SETTING Chicago, Illinois. PARTICIPANTS A purposive sample of 393 Chinese adult immigrants who were primary caregivers of parents aged 60 years or older. MEASURES Sense of filial obligation was captured by felt responsibility toward parents in six domains (respect, make happy, care, greet, obey, and provide financial support). Caregiving burdens were measured by the Caregiver Burden Inventory. Acculturation was measured by 12 questions about respondents' language preference in different settings and ethnicity of individuals they interact with. RESULTS: A stronger sense of filial obligation was significantly associated with lower levels of developmental (β = −.15), emotional (β = −.18), social (β = −.20), and physical (β = −.10) burdens. For subjective burdens (developmental, social burdens), such a protective effect of filial obligation was stronger among caregivers with lower acculturation levels. For more objective burdens (time‐dependent, physical burdens), stronger filial obligation was actually associated with greater burdens among caregivers with higher acculturation levels. CONCLUSION: Programs focusing on celebrating the cultural heritage of immigrants and improving the relationship between the parents and children may be helpful to reduce caregiving burdens. Intervention programs that help Chinese immigrant caregivers to find the most appropriate way to balance traditional and new social norms are important to provide successful care to aging Chinese immigrants. J Am Geriatr Soc 67:S564–S570, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Somatization of depressive symptoms among Chinese American older adults remains understudied. This study aimed to identify whether the relationship between depressive symptoms and use of health services (ie, doctor visits, hospital, and emergency department) could be due to pain and whether acculturation played a role in the relations among depressive symptoms, pain, and health service use. DESIGN AND PARTICIPANTS Secondary data came from the Population Study of Chinese Elderly in Chicago that surveyed 3159 Chinese community‐dwelling older adults in the greater Chicago area. The average age was 76.3 years (standard deviation = 8.4); 57.95% were female). Negative binominal models were used to identify the effects of depression and pain on each type of health service use, controlling for sociodemographics and health‐related factors (eg, chronic illness). MEASUREMENTS Depressive symptoms were assessed using the Patient Health Questionnaire‐9; pain was assessed by self‐reported pain severity. Participants were classified into low, moderate, and high acculturation groups based on acculturation scores. RESULTS: Depressive symptoms and pain were positively related to health service use on the bivariate level. For groups with both low and high acculturation levels, depression and pain each independently predicted more health service use, whereas for the group with a moderate acculturation level, the effect of somatization was substantialized. CONCLUSION: Depression largely influenced health service use independently and partially through pain for older Chinese Americans. The somatization tended to be only salient for the moderate acculturation group, calling for more research attention to the complicated effect of acculturation. J Am Geriatr Soc 67:S584–S589, 2019. [ABSTRACT FROM AUTHOR]

Older Asian immigrants are one of the fastest growing segments of the U.S. population and a growing number of them reside in non-traditional destination cities. However, there is a paucity of research on older Asian immigrants living in these non-traditional destination cities, and how this residential choice impacts their stress and mental health. In the current study, we examined how stressors and social support contribute to the overall mental health of older Asian immigrants who lack access to culturally responsive formal social support services. Using a convenience sample of older Chinese (n = 120) and Korean (n = 118) immigrants living in Arizona, we conducted multiple mediator analyses, focusing specifically on how ethnicity would differentially influence mediating effects of religious participation and familial assistance in the relationships between physical/acculturative stressors and mental health outcomes. The results showed that among older Chinese immigrants, religious participation significantly mediated the relationships between both physical/acculturative stressors and mental health, while there was no significant mediation effect detected among older Korean immigrants. Although Asian Americans are often perceived as a monolithic homogeneous group, the multiple mediator models suggest significant differences in the use of cultural/information resources in coping with life stressors and their impact on mental health outcomes between the older Chinese and Korean immigrants in our study. The study findings suggest a need for developing and strengthening formal social services in non-traditional destination cities that are culturally and linguistically responsive to those older Asian immigrants. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the potential influence of coping resources at individual (sense of mastery), family (spousal and family support, children's filial piety), and community levels (community cohesion) on the mental health (depression, anxiety) of U.S. Chinese older adults. Methods: The data were derived from the Population Study of Chinese Elderly in Chicago (N= 3,159). Negative binomial regressions were performed to predict depression and anxiety, respectively, by entering the three sets of coping resources separately and jointly, controlling for socio-demographic and acculturation variables. Results: Stronger sense of mastery and greater perception of children's filial piety were associated with better mental health outcomes. Spousal support was not associated with any mental health outomes, and family support was actually assciated with greater depression and anxiety. Stronger community cohesion was associated with fewer depressive symptoms but greater anxiety. Conclusion: Older immigrants' sense of control and perception that children adhere to traditional family norms are important mental health protective factors. Whereas depending on families for support may compromise their well-being, community cohesion could be a double-edged sword for their mental health. Future studies shall further disentangle the associations among sense of mastery, reliance on family and ethnic enclaves for support, and older immigrants' well-being. [ABSTRACT FROM AUTHOR]

This paper explores discursive ways Chinese American older adults with type 2 diabetes mellitus (T2DM) take ownership of their health management. Fifteen patient stakeholders with T2DM took part in four focus group interviews. We used qualitiative discourse analysis to examine how participants used the phrase, “We (Tong) Chinese,” and variants, to index models of Chinese-living-in-the-U.S. personhoods, to incorporate “Chinese” and “western” ways of doing health management, to be Chinese American, and to interact with medical practitioners. We show how terms like “Tong” distinguish transnational boundaries and position participants in claiming “Chinese-in-America-ness” in relevant ways. Findings have implications for healthcare providers, health education, and intercultural communication. [ABSTRACT FROM AUTHOR]

Objectives: This study identified the prevalence of depression and tested the influence of acculturation and family dynamics on depressive symptoms, among a community sample of older Chinese Americans. Method: Data came from a survey of 385 Chinese Americans aged 55 and older (Mage = 72.4 years, SD = 8.7) living in a large metropolitan area in the American Southwest. The survey was administered in 2013 through face-to-face interviews. Depressive symptoms were assessed with the 12-item Center for Epidemiological Studies Depression scale. Results: Approximately 19.5% of the sample reported mild depressive symptoms and an additional 8.5% reported moderate depressive symptoms. Three-step hierarchical regression analyses indicated that smaller family support network size and more family conflict were risk factors for depressive symptoms. The effect of acculturation was not significantly associated with depressive symptoms after controlling for family dynamics. Discussion: Family support and conflict play a prominent role in explaining depressive symptoms among Chinese American older adults. The effect of acculturation is minimal when older adults have supportive families and good health. Interventions or services aimed at promoting family harmony for members of this population should be considered. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between neighborhood cohesion and risk of self-neglect in a community-dwelling Chinese-American older population. Setting Community. Participants Chinese-American older adults aged 60 and older interviewed from 2011 to 2013 (N = 3,159). Design Data were drawn from the Population Study of Chinese Elderly, a cross-sectional community-engaged study in the greater Chicago area. Measurements Self-neglect was assessed with systematic observations of a participant's personal and home environment. Neighborhood cohesion was measured using six questions. Results After controlling for potential confounders, greater neighborhood cohesion was significantly associated with lower risk of overall self-neglect (odds ratio ( OR) = 0.87, 95% confidence interval ( CI) = 0.77-0.98) and moderate to severe self-neglect ( OR = 0.70, 95% CI = 0.58-0.85) but not significantly associated with mild self-neglect ( OR = 0.94, 95% CI = 0.82-1.09). Regarding the phenotypes of self-neglect, greater neighborhood cohesion was significantly associated with lower risk of poor personal hygiene ( OR = 0.80, 95% CI = 0.67-0.96) and need for home repair ( OR = 0.70, 95% CI = 0.60-0.83) but not significantly for hoarding ( OR = 1.04, 95% CI = 0.89-1.21), unsanitary conditions ( OR = 0.88, 95% CI = 0.76-1.02), and inadequate utilities ( OR = 1.00, 95% CI = 0.77-1.31). Conclusion This study highlights the association between greater neighborhood cohesion and lower risk of overall self-neglect in Chinese-American older adults. Enhancing neighborhood cohesion may enhance elder self-neglect prevention and intervention. [ABSTRACT FROM AUTHOR]

Objective: This study examined the associations of neighborhood characteristics and living arrangements with physical and mental health among older Chinese Americans. Method: A sample of 3,159 community-dwelling Chinese older adults in the Greater Chicago area provided reports of health, socio-demographic characteristics, living arrangements, social cohesion, and neighborhood disorder. We used multinomial logistic, Poisson, and negative binominal regression analyses. Results: Neighborhood disorder was consistently associated with negative health indicators, including poor self-reported health, more chronic conditions, depressive symptoms, and anxiety symptoms. Findings about the relationships between social cohesion and health indicators were mixed. Social cohesion was more salient to mental health for those living with spouse, children, and/or grandchildren relative to those living with spouse only. Discussion: Policies and interventions are needed to improve the physical and social environments of neighborhoods and to promote healthy aging among Chinese older adults and in the general population as well. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the relationship of engagement in social and cognitive activities and social support with the sense of community (SOC) and its components among older Chinese Americans.Methods: The Sense of Community Index (SCI) was used to measure SOC and its four component factors: membership, influence, needs fulfillment, and emotional connection. Social engagement was assessed with 16 questions. Social support included positive support and negative strain. Principal component analysis was used to identify the SCI components. Linear regression analysis was used to detect the contribution of social engagement and social support to SOC and its components.Results: After controlling for sociodemographics and self-rated health, social activity engagement and positive social support were positively related to SOC and its components.Conclusions: This study points to the importance of social activity engagement and positive support from family and friends in increasing the sense of community. [ABSTRACT FROM AUTHOR]

Background: Social network research has become central to studies of health and aging. Its results may yield public health insights that are actionable and improve the quality of life of older adults. However, little is known about the social networks of older immigrant adults, whose social relationships often develop in the context of migration, compounded by cultural and linguistic barriers.Objectives: This report aims to describe the structure, composition, and emotional components of social networks in the Chinese aging population of the USA, and to explore ways in which their social networks may be critical to their health decision-making.Methods: Our data come from the PINE study, a population-based epidemiological study of community-dwelling older Chinese American adults, aged 60 years and above, in the greater Chicago area. We conducted individual interviews in participants' homes from 2011 until 2013. Based on sociodemographic and socioeconomic characteristics, this study computed descriptive statistics and trend tests for the social network measures adapted from the National Social Life, Health, and Aging Project study.Results: The findings show that older Chinese adults have a relatively small social network in comparison with their counterparts from other ethnic and racial backgrounds. Only 29.6% of the participants could name 5 close network members, and 2.2% could name 0 members. Their network composition was more heavily kin oriented (95.0%). Relationships with network members differed according to the older adults' sociodemographic and socioeconomic characteristics. Subgroup variations included the likelihood of discussing health-related issues with network members.Conclusion: This study highlights the dynamic nature of social networks in later-life Chinese immigrants. For healthcare practitioners, developing cost-effective strategies that can mobilize social network support remains a critical undertaking in health intervention. Longitudinal studies are needed to examine the causal impact of social networks on various domains of health. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor presents compiled 17 articles that examine the health and well-being of Chinese older adults through the Population Study of Chinese Elderly (PINE) and PIETY studies, the largest epidemiological cohort studies of Chinese older adults and Chinese adult children in the United States.

The rapid increase in grandparents caring for grandchildren has received growing attention, but little research has focused on Chinese-American grandparents and their caregiving experiences. Drawing on cross-sectional data from the Population Study of Chinese Elderly-a community-engaged, epidemiological study of Chinese-American adults aged 60 and older, the relationships between caregiving experiences and psychological well-being were examined. Of 2,365 older adults who answered the question about grandparent caregiving, 818 (35%) were designated as caregivers, spending an average of 12 hours a week on childcare. About one in five caregivers reported caregiving burden, pressure, or negative health effect of caregiving. Caregivers had better psychological well-being than noncaregivers, with significantly lower levels of depressive symptoms, anxiety, stress, and loneliness. For caregivers, higher levels of caregiving burden, pressure from adult children, and perceived negative effect were related to greater rates of psychological distress. With a strong cultural expectation of family care, grandparent caregiving is generally associated with positive psychological well-being, but it can also be stressful, especially when older adults feel pressured to provide childcare or that doing so is a burden. The study implies that cultural values and life transitions may shape grandparent caregiving experiences and well-being, indicating the importance of respecting cultural differences in family caregiving. Understanding positive and negative aspects of grandparent caregiving and the underlying mechanisms will help healthcare professionals identify caregivers at risk of psychological distress and provide proper interventions to attenuate negative outcomes while maximizing positive experiences for Chinese-American older adults. [ABSTRACT FROM AUTHOR]

Although advance care planning ( ACP) is associated with better care at the end of life, better quality of death, and less psychological distress in survivors, ethnic disparities in ACP completion rates have been documented and may be attributable to lack of knowledge about ACP or differences in cultural values and preferences. Despite rapid increases in the size of the Asian-American population, little is known about ACP preferences of Chinese Americans. The purpose of this study is to explore the knowledge, attitudes, and preferences of older Chinese Americans toward ACP. Focus groups with Chinese older adults (n = 34) were conducted in Mandarin, Cantonese, and English, and transcripts were analyzed using a grounded theory approach. Identified themes included knowledge and experience with ACP and end-of-life care options, health as a factor in timing of ACP and communication, and communication of end-of-life care preferences. Knowledge of and experience with ACP and end-of-life decision-making varied according to focus group, although few participants had an advance directive. Findings suggest that Chinese older adults prefer to use indirect communication strategies, such as commenting on the circumstances of others rather than directly stating their wishes, and informal contexts, such as during a family dinner rather than formal meeting, to convey their care preferences to loved ones and may employ similar tactics when communicating with clinicians. This is particularly important given the recent decision by the Centers for Medicare and Medicaid Services to provide reimbursement to physicians for engaging in advance care planning conversations. [ABSTRACT FROM AUTHOR]

The present study examined the factors associated with self-rated health (SRH) and self-rated mental health (SRMH) in a sample of 108 older Chinese Americans (MeanAge = 70.6,SD = 7.70). SRH and SRMH were highly associated with each other. In the multiple regression models, chronic conditions and functional disability emerged as significant predictors of poor SRH and SRMH. However, the significance of depressive symptoms was only obtained in the model of SRMH. The findings reflect the body–mind connection among older Chinese Americans and provide implications for integrative health promotion efforts. [ABSTRACT FROM PUBLISHER]

Background: Neurological symptoms influence health and well-being among older adults. However, Chinese older adults are underrepresented in most studies on neurological symptoms. This study aims to examine the prevalence of neurological symptoms among U.S. Chinese older adults. Methods: Data were drawn from the PINE study, a population-based survey of U.S Chinese older adults in the greater Chicago area. Guided by a community-based participatory research approach, a total of 3,159 Chinese older adults aged 60 and above were surveyed. Clinical review of system (ROS) was used to assess the presence of dizziness, syncope/fainting, fall, seizures, weakness, numbness, tingling, tremor, and stiffness. Results: Neurological symptoms were commonly experienced by U.S Chinese older adults (50.6%). Symptoms as dizziness (31.0%), numbness (19.0%), and falls (14.8%) were commonly reported. Participants were more likely to report any neurological symptom if they were older, female, with lower education, lower income, poorer self-perceived health status, poorer quality of life, and worsened health change over last year. Conclusions: Neurological symptoms are common among Chinese older adults in the U.S. Future longitudinal research is needed to examine risk factors and health outcomes associated with neurological symptoms. [ABSTRACT FROM AUTHOR]

Objective: This study examined knowledge of Alzheimer's disease (AD) and correlates of AD knowledge in a sample of Chinese American older adults living in the Phoenix metropolitan area of the United States. Methods: Survey data were collected from 385 Chinese Americans age 55 or older ( M = 72.43, SD = 8.67) recruited from various settings not limited to senior housing facilities, senior clubs, senior centers and church groups. Results: Participants responded to a 24-item true/false AD knowledge scale with 73 % accuracy. Multivariate regression analyses found that participants who held more traditional Chinese cultural beliefs of AD tended to have less AD knowledge. Older women had more knowledge of AD than men when educational differences were controlled. Participants who used media to acquire AD information had more AD knowledge than those did not. Conclusions: AD educational programs should target domains (e.g., risk factors, symptoms, and caregiving) about which Chinese American elders tend to have less knowledge; AD information should be disseminated through appropriate media to outreach Chinese American elders more effectively. Addressing the biases in elders' cultural beliefs of AD should be incorporated in AD educational programs. [ABSTRACT FROM AUTHOR]

The purpose of the study was to elicit the definitions of successful aging according to Chinese and Hmong elders living in Milwaukee, WI. In-depth semi-structured interviews were conducted with 44 elders (Hmong n = 21 and Chinese n = 23). Findings show some similarities in the Chinese and Hmong elders' definitions though specific cultural differences exist. Chinese elders emphasized physical health and mobility, mental health, positive attitudes, shedding responsibilities, positive family relationships, financial stability, social engagement, religious faith, and accomplishments and volunteer work. Hmong elders emphasized physical health and mobility, mental health, harmonious relationships, positive family relationships, tangible family support, financial stability, social engagement, and religious faith. Cross-cultural comparisons of the findings highlight the cultural heterogeneity between these two subgroups. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Researchers speculate that depression tends to be more prevalent among immigrant elders due to their lack of resources, acculturation stress, language problems, and social isolation. However, other characteristics of elderly immigrants, such as the healthy immigrant effect, may counteract these potential risk factors. This study examined whether depressive symptoms differed between Chinese immigrant elders and their counterparts in China and whether health conditions were similarly associated with depressive symptoms in these two samples. Methods: Depression and health information was collected from 177 Chinese immigrant elders in Boston, the US in 2000 and from 428 education and gender-matched elders in Shanghai, China in 2003. Results: Chinese immigrants had a significantly lower score on the modified Center for Epidemiologic Studies Depression Scale (CES-D) and its subscales: somatic symptoms and depressive affect. The association remained for the subscale depressive affect in multivariate analyses. Arthritis and back or neck problems were associated with a higher level of depressive symptoms among Chinese immigrants, while problems in walking were associated with depression among their counterparts in China. Pain was an underlying contributor to the association between depression and these health problems in both the groups. Conclusions: This study suggests that Chinese immigrant elders might be more resilient than their counterparts despite many challenges they face after moving abroad. With the growing number of older Chinese immigrants in the US, a better understanding of depressive symptoms is essential to provide culturally competent services to better serve this population. [ABSTRACT FROM AUTHOR]

Although recent scholarship focuses on the importance of religion to ethnic minorities and immigrants, relatively little attention has been given to how faith and spirituality help Asian immigrant elderly cope with life's challenges. This exploratory study was undertaken via in-depth interviews with 12 Chinese American older adults to further explore the meaning of suffering and faith as a coping mechanism for these challenges. Findings reveal that these respondents have developed particular adaptive strategies in managing their life challenges incorporating socio-emotional, cognitive, and instrumental aspects. Religious/spiritual coping was found to be embedded with respondents' values, faith, and cultural beliefs, and seem to be an important factor in developing effective coping strategies. Implications for the importance of culturally sensitive social work practice are discussed. [ABSTRACT FROM AUTHOR]

Mainland Chinese elders constitute a unique group in popular Christian participation and conversion. This work aims to explore the social contexts and cultural facets of Mainland Chinese elders' Christian practice in the United States. Based on face-to-face, in-depth interviews with 20 Mainland Chinese elders as well as participant observation at selected congregational settings, this study suggests that the existing theories on aging and religion as well as religious practice among immigrants are inadequate to explain Chinese elderly immigrants' participation in Christian congregations in the U.S. Instead, social isolation and lack of social support system resulting from immigration and aging process serve as the major drive for the elders to pursue social and cultural recognition from Chinese Christian gatherings. Besides religious services, social service functions of churches and opportunities for fellowship are other factors that explain Chinese elders' church involvement. In conclusion, we argue that social and cultural services are needed to particularly assist Chinese seniors to adjust and adapt to their elderly lives in the host country. [ABSTRACT FROM AUTHOR]

Older Chinese and Hispanic immigrants (mostly Dominican) reacted to 9/11 in distinct, culture bound ways, which helped them cope with this traumatic event. This paper compares the two groups in terms of how they reacted and coped with 9/11, how cultural factors influenced their responses, and discusses implications for social work education, policy and practice. For the Chinese, cultural values associated with social connections played an important role in coping with 9/11, while for Hispanics belief in destiny was significant. Data for the paper come from two independent qualitative studies conducted in 2002 with 31 Hispanic and 51 Chinese subjects. The challenge to social workers of finding ways to help older immigrant populations cope with major trauma will remain well into the future. [ABSTRACT FROM AUTHOR]

Objectives To examine the effectiveness of depression screening and the Engagement Interview Protocol (EIP) in identifying and engaging in treatment depressed Chinese Americans in a primary care setting. Methods Chinese American patients who attended a primary care clinic between 15 September, 2004 and 14 September, 2005 were screened for depression using the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9). Patients who screened positive (CB-PHQ-9 ≥ 15) were evaluated using the EIP to establish psychiatric diagnosis and to engage patients in treatment. Results Three thousand eight hundred and twelve patients completed the CB-PHQ-9, of which 113 (3.2%) screened positive for MDD. Among those screening positive, six (5.3%) had been receiving psychiatric treatment for depression, 57 (50%) declined to receive a psychiatric interview or were unable to be contacted, and 50 (44%) agreed to be interviewed with the EIP. Out of the 50 patients interviewed, 44 (88%) had their MDD diagnosis confirmed; among them, 41 (93%) agreed to receive treatment for depression and three (7%) declined intervention. Conclusions Under-recognition and under-treatment of depressed Chinese Americans in primary care settings continue to be prevalent. Recognition of depression can be enhanced by using the brief CB-PHQ-9 to screen for depression. Half of the Chinese Americans who screened positive for MDD declined evaluation by a mental health professional. Most of the depressed Chinese Americans who were evaluated agreed to receive treatment. Enhanced cultural sensitivity with the use of the EIP in psychiatric assessment may have contributed to the success in engaging depressed Chinese Americans in treatment. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The National Institutes of Health is making efforts to increase the representation of minority elders in aging research. While it is often noted that cultural barriers may make the recruitment of minority elders into research more difficult, relatively little empirical exists to support this claim. The purpose of this study was to identify sociocultural barriers to recruitment that emerged during a four-year study of dementia caregiving among Chinese families in the Boston area. More specifically, this paper examines how culturally shaped conceptions of health, aging, and dementia impacted the recruitment process. This paper is based on a qualitative analysis of interviews with 23 Chinese families and extensive fieldnotes generated by project ethnographers and interviewers. The following themes emerged in this analysis: 1) dementia-related changes were construed as a normal part of the aging process rather than a disease, making it more difficult to identify dementia-affected elders and to recruit families, 2) research participation was viewed as potentially harmful because it can lead to excessive worry 3) Alzheimer's disease carries a social stigma among Chinese, leading families to shun formal diagnosis and research participation, and 4) practitioners viewed research as an intrusion offering no direct benefit to participants. [ABSTRACT FROM AUTHOR]

This study explores the use of informal and formal social supports among ninety-three elderly Chinese immigrants residing in California. A historical and cultural overview of the Chinese immigrant experience is presented as a contextual framework. Results showed that family and kin were perceived as the most satisfying sources of support. Barriers to utilization of formal services and agencies were lack of knowledge of services, language differences and lack of transportation. The implications of these results within the changing dynamics of Chinese-American families are discussed. [ABSTRACT FROM AUTHOR]

Using data from the Population Study of Chinese Elderly in Chicago (PINE) conducted from 2011 to 2013, this study aims to examine the role of acculturation in engagement in cognitive, social, and religious activities among older Chinese Americans. Activity engagement and acculturation levels were relatively low in the study sample. Multivariate regression analyses showed that high levels of acculturation in general, and particularly media use (e.g., TV and radio) and ethnic social relations (i.e., preferred ethnicity of those with whom one interacts) were associated with more engagement in cognitive and social activities, respectively. High levels of acculturation in general and ethnic social relation in particular increased the likelihood of engaging in religious activities. Language use was not related to engagement in any activity, probably because only 2% of the PINE participants preferred to speak English. Findings indicate that acculturation can promote activity engagement probably through media use and social relations, whereby older adults may acquire information about opportunities for various activities. Active participation with life may improve older adults' well-being and help address the widening health disparities among minority older populations in American society. [ABSTRACT FROM AUTHOR]

This study examined the relationships of psychological sense of community (PSOC) with self-rated health and depressive symptoms among older Chinese Americans. The sample was taken from the Population Study of Chinese Elderly in Chicago (PINE), a population-based survey of 3,159 community-dwelling seniors. PSOC was measured through the Sense of Community Index (SCI). Factor analysis indicated a four-dimensional structure within the SCI; however, the SCI lacked dimensional consistency and items that composed four underlying factors were different than the proposed ones. After controlling for sociodemographics, binary and multinomial logistic regression analyses showed that a higher level of PSOC was related to a lower likelihood of self-reporting poor or fair health and of developing more depressive symptoms. The identified factors of influence and emotional connection were also significantly related to self-rated health and depressive symptoms. Future research need aim at improving the conceptualization process of the PSOC and cultural relevance in minority populations. [ABSTRACT FROM AUTHOR]

The article discusses research which found high self-reported visual impairment among Native Americans, Chinese Americans, Puerto Ricans, Dominicans and Central/South American individuals in the U.S. who were 45 years and older. It references a study which appeared in "Ophthalmic Epidemiology." It outlines the two questions given to patients that rated the prevalence of sight impairment.