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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]

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]

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]

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]

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]

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]

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 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]

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]

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]

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]