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This study explored the longitudinal association between overall and individual sources of social support and global cognitive function in older adults.There was no significant association between perceived overall social support and global cognitive function over time (Our findings highlight the importance of examining perceived social support from specific elements of one's social networks, rather than in an aggregated variable. Although the positive effect of perceived support from children may be small to moderate, the findings could provide a target for interventions to protect the cognitive function of older adults.

Acculturation to the mainstream culture and the settlement contexts could shape cognitive function of older immigrants. Guided by ecological theory, this study examines the interaction effect between individual acculturation and ecology of family on cognitive function among older Chinese Americans.Data were derived from the Population Study of Chinese Elderly in Chicago (Older adults in the commanding-conflicted type had the lowest cognitive function. After controlling confounding variables, higher levels of acculturation (Acculturation to the dominant culture is identified as a cultural asset for cognitive function in older Chinese Americans. Social services could protect cognitive function of older immigrants in the commanding-conflicted type through enhancing cultural participation. Future research could test how affective and cognitive aspects of acculturation affect health.

PURPOSE: This study aimed to examine the associations between perceived social support and help-seeking among U.S. Chinese older adults who reported elder mistreatment (EM). METHODS: Data were from the Population Study of Chinese Elderly in Chicago. Perceived social support and informal/formal help-seeking intentions and behaviors were measured. Descriptive statistics, multiple linear regressions, and multinominal logistic regression analyses were performed. RESULTS: A total of 450 participants reported EM. Mean age of the sample was 72.73 ± 8.03 years old. Perceived social support was associated with an increase in intentions of seeking help from informal sources. Compared with not seeking help, older Chinese-American adults with any EM who perceived social support were more likely to seek help from informal and formal sources. CONCLUSION/IMPLICATION: The potential role of social support in increasing help-seeking was highlighted. Culturally tailored interventions that provide social support might promote help-seeking among U.S. Chinese elder immigrants who experienced EM.

Objectives Previous research focused on the individual risk factors of mortality, while little is known about how family environment could influence mortality in later life. This study aims to examine mortality risks in different family types and what family type may increase mortality risk for older adults with medical comorbidities or functional impairment. Methods Data were derived from the Population Study of Chinese Elderly (PINE) in Chicago. The baseline interview was conducted from 2011 to 2013. The outcome was 6-year all-cause mortality. Family typology included tight-knit, unobligated-ambivalent, commanding-conflicted, and detached types. Cox proportional hazards models were used. Results The study sample consisted of 3,019 older adults and 372 participants passed away during 6 years follow-up. Older adults in the detached type had higher risks of mortality than those in the tight-knit type (hazard ratio: 1.45 [95% confidence interval, 1.02–2.07]). Regarding the interaction effect between family typology and functional impairment, older adults with higher levels of physical impairment (1.29 [1.07–1.56]) and cognitive impairment (1.07 [1.01–1.14]) nested in the commanding-conflicted type had higher mortality risks than their counterparts nested in the tight-knit type. Discussion In this longitudinal cohort study with a 6-year follow-up, older adults nested in the detached family type had higher 6-year mortality risks than those nested in the tight-knit family type. Living in the commanding-conflicted family increased the 6-year mortality risks for older adults with physical impairment or cognitive impairment compared with their counterparts residing in the tight-knit family type.

Background and Objectives Studies have shown that neighborhood environment shapes older Americans’ aging experience and health. However, it remains largely unknown whether and how neighborhood environment influences the well-being of older Asian Immigrants. Guided by the neighborhood stress process model, this study aims to investigate (a) the associations between neighborhood environmental stressors and depression among Chinese older immigrants and (b) the potential mediation effects of intrapersonal (sense of mastery and sense of hopefulness) and interpersonal coping (social engagement) resources in such associations. Research Design and Methods This study analyzed data collected from 2,801 Chinese older immigrants in the greater Chicago area. Structural equation modeling with bootstrap resampling was used to fit path models on neighborhood environmental stressor, intra- and interpersonal coping resources, and depression. Results Findings showed that neighborhood social disintegration and physical disorder were associated with more depressive symptoms directly and indirectly via lower intra- and interpersonal coping resources. Specifically, older immigrants living in neighborhoods with greater social disintegration reported lower sense of mastery and social engagement, which in turn were associated with more depressive symptoms (partial mediation). Older immigrants living in neighborhoods with greater physical disorder reported lower sense of hopefulness and mastery, which subsequently were associated with more depressive symptoms (full mediation). Discussion and Implications The findings showed that neighborhood environmental stressors are risk factors for mental health of Chinese older immigrants, and coping resources may serve as pathways of the associations. The implications for future research and practice were discussed.

Objectives To examine the cross-sectional association of linguistic adaptation with cognitive function, as well as its interactions with sociodemographic and health profiles in older Chinese and Korean immigrants in the U.S. Methods Using harmonized data ( N = 5063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we examined between- and within-group differences in the role of linguistic adaptation (English use in older Chinese Americans and English proficiency in older Korean Americans) in cognitive function. Results The positive association between linguistic adaptation and cognitive function was common in both groups. We also found that the relationship was pronounced among subgroups with the underlying linguistic and cognitive vulnerabilities (i.e., the very old, women, those with low education, and newly immigrated individuals). Discussion Findings show the importance of linguistic adaptation in older immigrants’ cognitive health and suggest a need for targeted interventions for high-risk groups.

This study aims to examine the associations between gambling participation, problem gambling, and cognition. Data were derived from the PINE study. Gambling participation was measured by Modified South Oaks Gambling Screen. Problem gambling was assessed with Problem Gambling Severity Index. Cognition was measured by East Boston Memory Test, Digit Span Backward, Symbol Digit Modalities Test, and Mini-Mental State Examination. Of all participants, 41.940% were male. Higher gambling participation was significantly associated with higher global cognition ( b = .008, SE = .003, p < .05), executive function ( b = .118, SE = .049, p < .05), and episodic memory ( b = .009, SE = .004, p < .05). Higher problem gambling was significantly related to lower Mini-Mental State Examination ( b = -.105, SE = .031, p < .001). Guiding older adults’ gambling behaviors and intervening in problem gambling timely might be crucial for their cognitive function.

Trust in physicians (TIP) plays a critical role in the health care utilization (HCU) of minority older adults and older immigrants. Although previous studies suggested that TIP was positively associated with primary care visits, negatively associated with Emergency Room (ER) visits and hospitalization among African Americans in the United States (U.S.), it is unclear whether and how TIP influences various types of HCU among Chinese older immigrants, a fast-growing group of minority older immigrants in the U.S. Furthermore, despite the important role insurance plays in HCU and health disparities, few studies have tested whether TIP influences the HCU of the insured and uninsured Chinese older immigrants differently. Therefore, this study aims to examine the role of TIP in three types of HCU (physician visits, ER visits, and hospitalization) among Chinese older immigrants and whether the associations differ by insurance status.The data were derived from theTIP was positively associated with the likelihood of physician visits (Odds Ratio [TIP played an important role in facilitating primary care visits among Chinese older immigrants regardless of insurance status. Additionally, TIP facilitated the ER visit and hospitalization among uninsured Chinese older immigrants.

It is well-established that racial discrimination influences quality of life, but there is scarce evidence about how racial discrimination affects oral health-related quality of life (OHRQoL). Furthermore, the pathways linking racial discrimination and OHRQoL remain unknown. Guided by the integrative framework of immigration, ageing, and oral health, psychosocial stressors and resources exert influences on OHRQoL. In addition, according to the compensatory model of resilience, resilient resources could counteract risk exposures to stressors given specific outcomes. Hence, this study examined the relationship between experiences of discrimination and OHRQoL and investigated resilience as a mediator in such a relationship among older Chinese immigrants.Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3054 foreign-born older Chinese Americans aged 60 years or older. OHRQoL was measured by seven items from the Geriatric Oral Health Assessment Index. Experiences of discrimination (yes or no) were measured by the 9-item Experiences of Discrimination instrument. Resilience was measured by the 10-item Connor Davidson Resilience Scale. Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL.Experiences of discrimination were directly associated with poorer OHRQoL (b = -0.98, P .05). Resilience partially mediated the relationship between discrimination experiences and OHRQoL. Specifically, discrimination experiences were associated with weaker resilience (b = -1.58, P .05), and weaker resilience was associated with poorer OHRQoL (b = 0.06, P .05).Findings illustrate the importance of studying racial discrimination and resilience in OHRQoL. Interventions need to consider individuals' discrimination experiences and stress coping abilities to promote OHRQoL.

Background and Objectives Ethnic enclaves provide pivotal coping resources for immigrants, having important implications for cognitive health. This study examined the association between living in an ethnic enclave (i.e., Chinatown) and cognition, and potential moderating effect of education on such an association among Chinese older immigrants in the United States. We further examined subgroup differences based on preferred language (Mandarin, Cantonese, and Taishanese). Research Designs and Methods Data were derived from the Population Study of Chinese Elderly in Chicago (N = 3,105, mean age = 73). Global cognition, assessed by a battery including Mini-Mental State Examination, working memory, episodic memory, and executive function, was compared between those who lived in Chinatown (n = 1,870) and those who did not (n = 1,235). Linear regressions with interaction terms were performed in the entire sample and subsamples with different language preferences. Results Chinatown residents had significantly poorer cognition than non-Chinatown residents. Regression results identified both protective and risk factors for cognition associated with living in Chinatown. Among them, education (β = 0.072, p < .001) played a salient role in explaining the cognitive disadvantage of Chinatown residents. Education also moderated the influence of Chinatown residence on cognition, but only among Mandarin speakers (β = −0.027, p = .04). Discussion and Implications Living in an ethnic enclave may be a risk factor for poor cognition for Chinese immigrants. Neighborhood-specific health assessment may facilitate early identification and prevention of cognitive impairment in this population. Studies need to examine divergent aging experiences of immigrants within single ethnic groups.

Studies of family relations have not kept pace with the acceleration of international migration. To address this gap, this study relied on a survey of 545 Chinese immigrants in Chicago who reported information of 869 older parents to examine the sources of intergenerational conflict in five domains: norms/values, relationship itself, money, health, and parenting. The results of logistic regression showed that maintaining one’s traditional culture, in the form of endorsing a sense of filial obligation, was a significant protective factor against all types of conflict. Immigrants with a higher level of acculturation were more likely to report conflict regarding norms/values and relationship itself, but not more so regarding practical issues such as health, money, and parenting. Helping parents with ADLs, not IADLs, was associated with more conflict regarding monetary and health issues. Immigrants’ greater sense of mastery was associated with a lower chance of reporting norm/value-related intergenerational conflict.

The present study aimed to examine the role of acculturation in mitigating the negative impact of perceived stress on depressive symptoms among U.S. Chinese older adults. Data of 3,159 Chinese adults over 60 years old were drawn from the Population Study of Chinese Elderly in Chicago (PINE). In addition to socio-demographic variables, participants’ acculturation levels, perceived stress, and depressive symptoms were assessed. Perceived stress was positively related to depressive symptoms among Chinese older adults. However, no significant association was found between acculturation level and depressive symptoms. Regression analysis supported the moderation hypothesis of acculturation level on the relationship between perceived stress on depressive symptoms. The negative impact of perceived stress on depressive symptoms was mitigated for Chinese older adults who had higher levels of acculturation than for those who had lower levels of acculturation. The findings have implications in minority aging and mental health policies during the on-going pandemic era.

Objectives: Depression has become one major mental health concern among Asian older adults. Yet, less is known about the role of social support on depression help-seeking among this population. This study examined the association between positive (i.e., open up to, rely on) and negative (i.e., too many demands, criticism) social support and depression help-seeking among U.S. Chinese older adults. Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (PINE). Study sample consisted of 994 U.S. Chinese older adults with depressive symptoms. Results: Stepwise logistic regression results indicated that greater positive social support was associated with increased likelihood of both formal and informal help-seeking behaviors, whereas negative support was not a significant predictor. Discussion: Findings highlight the key role of positive social support in influencing U.S. Chinese older adults’ depression help-seeking behaviors. Tailored strategies are recommended to better meet the mental health needs of this vulnerable population.

Engaging in leisure activities that are cognitively simulating and enjoyable may be protective against cognitive decline in older adults; yet, few studies have examined this topic. We used two waves of data from the Population Study of Chinese Elderly and ran mixed-effects regression models to examine the relationship between baseline art activity attendance (including attending museum, musical arts, or both) and change in cognitive function (global, episodic memory, working memory, and executive function) among 2,703 older U.S. Chinese adults. We found that compared with older adults who did not attend any art activities, those who reported attending both art activities experienced a slower rate of change in episodic memory (estimate = −0.07; SE = 0.03; p = .01) and executive function (estimate = −0.06; SE = .03; p = .04). Our study findings point to the importance of attending art-based culture events among U.S. Chinese older adults.

Objectives: This study addressed two questions: (1) Is age at migration associated with cognitive function among Chinese older immigrants? and (2) what personal and environmental factors confound the above relationship? Methods: Data were derived from the Population Study of Chinese Elderly ( N = 2957). Quantile and linear regressions were used to examine the associations between age at migration and Mini-Mental State Examination (MMSE) and global cognitive function, respectively. Results: Migration in late middle age (50–64) or late adulthood (65 or older) was associated with lower MMSE scores. Global cognition did not vary by age at migration. Associations between age at migration and MMSE were stronger among individuals with lower education or social engagement. Discussion: Migrating late in one’s life has important implications for cognitive health over the life course. Findings are helpful to identify vulnerable older immigrant segments and provide tailored interventions to promote their cognitive health.

BACKGROUND/OBJECTIVES To better understand the role of sensory loss as a potentially modifiable risk factor for cognitive decline, this study examined cognitive decline in relation to single modality hearing or vision loss and dual sensory loss. DESIGN Longitudinal secondary data analysis. SETTING The Health and Retirement Study (HRS) and its supplement: The Aging, Demographics, and Memory Study (ADAMS). PARTICIPANTS Individuals aged 73 and older (N = 295). MEASUREMENTS Hearing loss was defined by an inability to hear sounds of 25 dB at frequencies between 0.5 and 4.0 kHz in either ear. Vision loss was defined as having corrected binocular vision worse than 20/40. Dual sensory loss was defined as having both hearing and vision loss. We used one time point of hearing and vision data objectively measured in ADAMS Wave C (June 2006-May 2008) and five waves of cognitive function data measured by the HRS version of the Telephone Interview for Cognitive Status in HRS (2006-2014). Multilevel mixed models were used. RESULTS Among the participants, 271 completed a hearing assessment and 120 had hearing loss; 292 completed a vision assessment and 115 had vision loss; 52 had dual sensory loss. Older adults with hearing loss had a significantly faster rate of cognitive decline as they aged compared to those with normal hearing (β = -0.16, P

Despite significant scientific and medical discoveries, the genetics of novel infectious diseases like COVID-19 remains far from understanding. SARS-CoV-2 is a single-stranded RNA respiratory virus that causes COVID-19 by binding to the ACE2 receptor in the lung and other organs. Understanding its clinical presentation and metabolomic and genetic profile will lead to the discovery of diagnostic, prognostic and predictive biomarkers, which may lead to more effective medical therapy. It is important to investigate correlations and overlap between reported diagnoses of a patient with COVID-19 in clinical data with identified germline and somatic mutations, and highly expressed genes from genomics data analysis. Timely model clinical, genomics and metabolomics data to find statistical patterns across millions of features to identify underlying biological pathways, modifiable risk factors and actionable information that supports early detection and prevention of COVID-19, and development of new therapies for better patient care. Next, ensuring security reconcile noise, need to build and train machine learning prognostic models to find actionable information that supports early detection and prevention of COVID-19. Based on the myriad data, applying appropriate machine learning algorithms to stratify patients, understand scenarios, optimise decision-making, identify high-risk rare variants (including ACE2, TMPRSS2) and making medically relevant predictions. Innovative and intelligent solutions are required to improve the traditional symptom-driven practice, and allow earlier interventions using predictive diagnostics and tailor better personalised treatments, when confronted with the challenges of pandemic situations.

ObjectiveGiven a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples.MethodParticipants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants’ cognitive status and PC needs.ResultsOur results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08.Significance of resultsThis study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.

Face-saving represents a unique culturally salient construct among Chinese. However, our understanding regarding its relationship with psychological distress in this population remains limited. The objective of this cross-sectional study is to examine (1) the relationship between face-saving and depressive symptoms among U.S. Chinese older adults; and (2) whether face-saving mediates the relationship between acculturation and depressive symptoms. Data were from the Population Study of Chinese Elderly in Chicago (N = 3132), the largest epidemiologic study of Chinese older adults in Western countries. The relationship between face-saving and self-reported depressive symptoms was investigated by step-wise multivariable linear regression models. The Sobel test was used to test the mediating effect of face-saving. U.S. Chinese older adults with higher face-saving values experienced greater levels of depressive symptoms (B = 0.05, p < 0.001) than those with lower face-saving values, even after sociodemographic factors, health characteristics, and social support were accounted for. The mediation effect of face-saving was not statistically significant. The study findings underscore the significance of a unique cultural factor, specifically face-saving, in understanding U.S. Chinese older adults’ experience of depressive symptoms. Depression screening and treatment programs should pay attention to face-saving issues among U.S. Chinese older adults. Future studies need to incorporate cultural factors in mental health research in diverse populations.

Background Suicide is a large and growing public health problem. Little is known about the attributes of suicidal ideation (SI) in the contexts of immigration. This qualitative study aims to explore immigration- and acculturation-related attributes of SI among older immigrants. Methods A qualitative semi-structured interview design. Interview were conducted with 57 older Chinese immigrants in Chicago with self-reported SI in the past month. Results In addition to attributes of SI which have been well documented in the literature, we identified immigration- and acculturation-related attributes, including linguistic and cultural barriers of being integrated to the receiving communities, acculturation gaps in intergenerational support, and uselessness. Conclusions Findings of the study highlight the intersectionality of race, culture, and aging regarding SI, which are essential to improve recognition and understanding of SI among immigrant populations.

Background The only way to systematically screen for self-neglect among older adults is through in-home observations, which are often difficult and unfeasible for healthcare providers. To fill this gap, we need a robust and efficient prognostication tool to better treat and prevent self-neglect among older adults. Objectives To develop a predictive index that can be used to assess risk prognostication of the onset of self-neglect among community-dwelling older populations. Design Two waves of longitudinal data from the Chicago Health and Aging Project (CHAP), collected during 2008 to 2012 with approximately 3-year follow-up intervals. Setting Non-Hispanic black or non-Hispanic white community-dwelling older adults in three adjacent neighborhoods in Chicago, IL. Participants A total of 2885 individuals who were participants of the CHAP study. Measurements The main outcomes are incident self-neglect cases. A total of 86 potential predictors were considered in the domains of sociodemographic and socioeconomic, general well-being, health behavior, medical health, medicine/healthcare, cognitive function, physical well-being, social well-being, and psychological well-being. Results The 3-year self-neglect incidence rate is 241 (8.4%). A 10-item predictive model (with a c-statistic of 0.76) was developed using stepwise selection in multivariable logistical regression models. After corrections of overfitting by validating in 100 bootstrapping samples, the predictive accuracy of the model dropped to 0.71, suggesting at least moderate overfitting. A point-based risk index was developed based on parameter estimates of each predictive factor in the final logistic model. The index has an area under the receiver operating characteristic curve of 0.76. Conclusion The study developed an efficient index with good predictive ability of self-neglect. Further external validation and impact studies are necessary before practitioners can apply this index to determine risk of self-neglect among other community aging populations. J Am Geriatr Soc 68:809-816, 2020.

Purpose Older immigrant adults are reported to be more tolerant of abusive situations and less likely to seek help. This study aimed to examine the associations between social networks and help-seeking among U.S. Chinese older adults reported elder mistreatment (EM). Methods Data were from the Population Study of Chinese Elderly in Chicago (PINE). Social networks were assessed with network size, volume of contact, emotional closeness, proportion kin, proportion female, and proportion coresident. Informal/formal help-seeking (intentions and actual behaviors) were measured. Descriptive statistics and regression analyses were performed. Results A total of 450 participants reported EM. Participants had a mean age of 72.73 ± 8.03 years old (range 60-97). Participants had a mean of 3.29 (SD ± 1.31) network members, a mean of 3.24 (SD ± 0.67) emotional closeness, and average contacts of 6.62 (SD ± 1.10) times per year with network members. Smaller network size (p = .00) and less emotional closeness (p = .03) were associated with an increase in intentions of seeking help from formal sources. Compared to not seeking help, smaller network size (p = .04) and more emotional closes (p = .03) were associated with a higher likelihood to seek help from informal sources among U.S. Chinese older adults who reported any EM. Conclusion/implication: This study highlights the dynamic nature of social networks of help-seeking among this underserved population. Culturally tailored interventions are suggested to promote help-seeking through increasing strong ties and improving the quality of social networks for U.S. Chinese older immigrants with EM.

Regular dental care utilization is instrumental to good oral health. This study aimed to examine how positive and negative aspects of social relationships jointly exert influences towards dental care use among foreign-born older Chinese Americans. Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019 (n = 3,000). Dental care utilization was dichotomized into “no dental visit” versus “any dental visit” in the past two years (including dental visit overseas). Social support and strain were measured by the Health and Retirement Study’s scale from spouse, other family members, and friends (1= having any support/no strain). In stepwise logistic regression, accounting for chronic conditions, oral health problems, and sociodemographics, spousal support remained to be significantly associated with a lower likelihood of having any dental visit. Findings illustrate the importance of understanding how different aspects of social relationships might play a role in dental care use.

Purpose Elder mistreatment (EM) in immigrants with cognitive decline is an understudied public health problem. Cognitive function plays an important role in individuals’ ability to seek help. This study aimed to examine the associations between cognitive function and help-seeking among U.S. Chinese older adults reported EM. Methods Data were from the Population Study of Chinese Elderly in Chicago (PINE). Five instruments were used to measure cognitive function, including the Mini-Mental State Examination, East Boston Memory Test Immediate Recall and Delayed Recall, Digit Span Backwards, and Symbol Digit Modalities Test. Informal/formal help-seeking intentions and behaviors were measured. Descriptive statistics, linear regression, and logistic regression were performed. Results A total of 450 participants reported EM. Most victims sought help from informal sources (53.48%), followed by any sources (11.42%) and formal sources (3.34%). About one-third of participants did not seek any help. Higher episodic memory was associated with an increase in help-seeking intentions among Chinese older adults with financial mistreatment (p < .05) and poly-victimization (p < .01). Lower working memory was associated with an increase in help-seeking intentions among those with caregiver neglect (p < .001). Compared to not seeking help, higher executive function was associated with a higher likelihood to seek help from any sources among Chinese older adults with psychological mistreatment (p < .05). Conclusion/implication: This study highlights the associations between cognitive function and help-seeking among this underserved population. Culturally tailored interventions are suggested to promote help-seeking for different types of cognitive impairment among Chinese older adults with EM.

OBJECTIVES The purpose of this study was to determine the relationship between discrimination in healthcare settings and psychological distress. METHOD This study utilized a retrospective cross-sectional study design. The dataset was obtained from 2015-2017 California Health Interview Survey (CHIS). Healthcare discrimination experience (yes, no) was measured using the following question "Over your entire lifetime, how often have you been treated unfairly when getting medical care (never, rarely, sometimes, often)?". Psychological distress was the study outcome and was measured using the Kessler Psychological Distress Scale. A composite score (0-24) was created for psychological distress for the prior 30 days and for the worse most in the past 12 months. A hierarchical multivariate linear regression was conducted to examine the influence of healthcare discrimination experience on psychological distress after adjusting for other covariates. RESULTS Study participants (weighted N = 1,360,487) had a mean age of 64.35 years (SD = 0.61), were primarily female (54.93%), heterosexual (96.61%), and married or living with a partner (73.37%). About 10.00% of older Asian Americans ever perceived healthcare discrimination over their entire lifetime. Perceived discrimination was associated with higher levels of psychological distress for the past 30 days (beta= 2.107, SE = 0.662, p

Focusing on a less studied aspect of friendship and an overlooked type of loss, this study examined associations between loss of friends and psychological well-being among older Chinese immigrants and whether such associations are moderated by age, gender, marital status, and social connection.This study used baseline data from the Population Study of Chinese Elderly in Chicago. Linear and logistic regressions tested whether the loss of friends was associated depressive symptoms, loneliness, and quality of life . Interaction terms were created to test the moderating effects .Losing friends was associated with a greater sense of loneliness but also a higher chance of reporting good quality of life. The association between the loss of friends and loneliness was stronger among married and young-old (59-69) participants . The association between the loss of friends and quality of life was stronger among young-old and old-old (70-79) participants and the participants with the high level of social connection.Findings shed light on the importance of the loss of friends in shaping psychological well-being among older immigrants. More research is needed to understand the needs of older friend survivors and develop relevant interventions.

Background and Objectives The family fundamentally underpins the immigration and acculturation processes. But most existing research on acculturation focuses on individual instead of family experience. Guided by Berry’s acculturation theory and Intergenerational Solidarity Theory, this study examined continuity and changes in parent–adult child relations of older Chinese immigrants over a 2-year period, and their implications for older adults’ depression and quality of life (QoL). Research Design and Methods Participants included 2,605 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago (PINE). Latent Transition Analysis (LTA) was used to identify transitions in multidimensional parent–child relations over time. Negative binomial and logistic regressions were used to examine the influence of family transitions on depression and QoL, respectively. Results LTA revealed five types of family relations: traditional, modified traditional, coresiding-unobligated, independent, and detached. Over 40% of the respondents shifted to a different relation type, with more families classified as modified traditional or independent over time. Transitioning into modified traditional relations or out of detached relations was associated with fewer depressive symptoms and better QoL at the follow-up. Transitioning into independent relation was associated with more depressive symptoms over time. Discussion and Implications Parent–child relations among Chinese older immigrants demonstrate significant complexity, including both heterogeneity and fluidity. Better well-being of these older adults seems to stem from the optimal combination of retaining the supportive heritage culture and embracing the host society’s instrumental cultural elements. Services to this population need to include the family context in assessment and interventions.

Background Misclassification of Medicare beneficiaries' race/ethnicity in administrative data sources is frequently overlooked and a limitation in health disparities research. Objective To compare the validity of 2 race/ethnicity variables found in Medicare administrative data [enrollment database (EDB) and Research Triangle Institute (RTI) race] against a gold-standard source also available in the Medicare data warehouse: the self-reported race/ethnicity variable on the home health Outcome and Assessment Information Set (OASIS). Subjects Medicare beneficiaries over the age of 18 who received home health care in 2015 (N=4,243,090). Measures Percent agreement, sensitivity, specificity, positive predictive value, and Cohen κ coefficient. Results The EDB and RTI race variable have high validity for black race and low validity for American Indian/Alaskan Native race. Although the RTI race variable has better validity than the EDB race variable for other races, κ values suggest room for future improvements in classification of whites (0.90), Hispanics (0.87), Asian/Pacific Islanders (0.77), and American Indian/Alaskan Natives (0.44). Discussion The status quo of using "good-enough for government" race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data, available in the Medicare data warehouse. Health services and policy researchers should critically examine the source of race/ethnicity variables used in minority health and health disparities research. Future work to improve the accuracy of Medicare beneficiaries' race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.

To examine associations between social support and negative social interaction with past suicidal ideation (SI) at multiple time intervals. The study used cross-sectional data collected from 3157 US Chinese older adults in Chicago to assess past 2-week, 1-month, 1-year, and lifetime SI. Self-perceived social support and negative social interaction were measured. Multiple logistic regression analyses were used to examine the associations. People perceived more social support and less negative social interaction were 17-19% less likely to have SI. People perceived more social support were 14-20% less likely to have SI. Meanwhile, people perceived more negative social interaction were 28-37% more likely to have SI. The independent associations between different social interaction and SI are significant regardless of the time intervals. Research should pay attention not only to bolstering perceptions of social support, but also to strategies that help individuals cope with the influence of negative social interactions.

OBJECTIVES: Adult children play a significant role in ageing parents’ health and well-being. However, the evidence is mixed regarding whether the parent-child relations will affect older adults’ longevity. This study aims to investigate the relationship between filial discrepancy and mortality risk. METHOD: Data were derived from a prospective cohort study from 2011 to 2017 of US Chinese older adults aged 60 and above in the greater Chicago area, with a median of follow-up of 5.28 years. Filial discrepancy was assessed by the gap between filial expectation and receipt, including six domains (discrepancy in respect, greet, care, obey, make happy, and financial support). Mortality ascertained during follow-up. Cox proportional hazards models were used. RESULTS: Among 3,021 participants, care expectation was least fulfilled while financial expectation was better fulfilled compared with other filial discrepancy domains. Compared with no respect discrepancy, older adults with respect expectation above receipt had higher risk of mortality (HR, 1.44; 95%CI, 1.07-1.94). Older adults with higher greet expectation than receipt experienced greater risk of mortality (HR, 1.56; 95%CI, 1.16-2.09) than those with no greet discrepancy. Older adults with care receipt above expectation had lower risk of mortality (HR, 0.75; 95%CI, 0.56-1.00). CONCLUSION: This study extends the relative standards model to investigate mortality outcomes. The findings add new insights to the association between parent-child relations and mortality risk. It is suggested that educational programs should focus on fostering young immigrants’ attitude and behavior to provide more respect and greeting for aging parents to strengthen the family protection role.

OBJECTIVES: This study aims to investigate the relationship between quantity, quality, and composition of social networks and depressive symptoms among U.S. Chinese older adults. METHODS: Data were derived from the Population Study of Chinese Elderly (PINE) (N = 3,157), a study of Chinese older adults aged 60 and above in Chicago. We assessed quantitative (network size and volume of contact), qualitative (emotional closeness), and composition (proportion kin, proportion female and proportion coresident) aspects of social networks. Depressive symptoms were measured by the Patient Health Questionnaire-9. Negative binomial and logistic regressions were conducted. RESULTS: Older adults who had three to five network members with strong ties, a medium level of contact, and a high level of emotional closeness were less likely to experience depression than their counterparts. Quantitative and qualitative dimensions of social networks have stronger protective effects than the composition dimension. CONCLUSIONS: U.S. Chinese older immigrants with different levels of social network characteristics have different risks of depression, suggesting targeted subpopulation assessments to facilitate the delivery of more appropriate and effective treatment to those most in need. CLINICAL IMPLICATIONS: Health-care professionals and social service agencies are suggested to develop intervention programs to promote mental health through increasing strong ties and improving the quality of social networks for U.S. Chinese older immigrants.

Objectives This study aims to identify (a) different types of parent–child relations among Chinese older immigrants, (b) predictors of each relation type, and (c) the most “optimal” type that is associated with better psychological well-being of the older adults. Methods Data were derived from 3,109 Chinese elderly adults in Chicago. Latent Class Analysis was used to identify structures of parent–child relations based on eight indicators of family solidarity. Logistic regressions were used to predict the relation types. Negative binomial and logistic regressions were used to examine the associations between the relation types and depression and quality of life (QoL). Results Four types of parent–child relations emerged: unobligated ambivalent (44.77%), tight-knit (40.11%), detached (10.28%), and commanding conflicted (4.84%). Older adults’ age, gender, marital status, health status, and immigration/acculturation experience were related to their relation types. While tight-knit relation was associated with the fewest depressive symptoms, older adults with unobligated ambivalent relations were the least likely to report good QoL. Discussion The study illustrates the diverse and complex ways in which Chinese older immigrants and their children are connected. The findings suggest that a departure from the traditional norm of filial piety may present a risk factor for this population’s mental health.

Objectives: To investigate the relationship between acculturation and subsequent oral health problems in older Chinese Americans and to further test the moderating role of neighborhood disorder in such a relationship. Methods: The working sample included 2,706 foreign-born community-dwelling older Chinese Americans aged 60 years or older who participated in the Population Study of Chinese Elderly in Chicago at baseline between 2011 and 2013 and the 2-year follow-up between 2013 and 2015. Stepwise Poisson regressions with lagged dependent variable were conducted. Results: Behavioral acculturation was protective against subsequent oral health problems, and the protective role was stronger among individuals reporting lower levels of neighborhood disorder. Residence in Chinatown was associated with an increase in the risk of subsequent oral health problems. Discussion: To reduce oral health symptoms and related burdens, it is important to consider, in practice and policy, the role of acculturation and the neighborhood on subsequent oral health outcomes.

This study investigated sociodemographic factors for immunization care use and the relationship between trust in physician (TIP) and immunization service use in older Chinese Americans. Data were collected through the Population Study of Chinese Elderly, including survey information of 3,157 older adults in the Greater Chicago area. Regression results showed that the odds of getting vaccinated were higher for those who were older, female, and had higher education and income. After adjusting for the covariates, higher TIP was associated with greater immunization service use. The highest tertile of TIP was associated with higher odds of using immunization service ( OR 2.19, 95% CI [1.76, 2.72]), especially for flu and pneumonia vaccines. Findings suggests that immunization service use may be increased by improving TIP and promoting targeted health care management plans for racial/ethnic minorities, which is highly relevant to increase the vaccination rate and contain the pandemic as the COVID-19 vaccine is available.

Introduction: Guided by the intergenerational solidarity theory, this study examined how different dimension of intergenerational solidarity of adult children associated with their choice of being a primary caregiver for aging parents in the Chinese American families. Methodology: Secondary data from PIETY study were used. Logistic regressions were conducted to examine the relationships between each dimension of intergenerational solidarity and the likelihood of being a primary caregiver to mother or father. Results: Associational solidarity (odds ratio [ OR] = 1.31, for father, OR = 1.27, for mother), normative solidarity ( OR = 1.06, for both father and mother), and structural solidarity ( OR = 0.95, for father, OR = 0.64, for mother) were significant associates of high chances of being primary caregivers for older parents. Discussion: Results from this study confirmed the importance of cultural construct of solidarity in caregiving choice. Practice implications for health care professionals, in particular the nurses were discussed.

Objectives: Elder mistreatment (EM) is associated with worse physical health and psychological well-being, but little is known regarding its cognitive consequences. Methods: Data were derived from the T1–T2 PINE ( n = 2713). EM was measured by psychological, physical, and sexual mistreatment; financial exploitation; and caregiver neglect. Cognitive function was evaluated by global cognition, episodic memory, working memory, processing speed, and Mini-Mental State Examination. Linear regression was used. Results: At baseline, physical mistreatment and caregiver neglect were associated with lower global cognition and cognitive domains, while psychological mistreatment was associated with higher cognitive function. Older adults with incident psychological mistreatment, physical mistreatment, and caregiver neglect had a faster decrease in global cognition and cognitive domains over 2 years. Discussion: This study is among the first to examine the association between different forms of EM and cognitive change. These findings provide a basis for engaging ethnic minorities with EM to maintain cognitive health.

BACKGROUND AND AIM. The World Health Organization has identified child abuse, intimate partner violence (IPV), and elder abuse (EA) as common types of interpersonal violence. Research showed individuals exposed to interpersonal violence in one life stage were at higher risks of exposure to interpersonal violence in other life stages. This study aims to examine the relationship between cumulative interpersonal violence and cognitive function. METHODS. Data were derived from the PINE Study in which 3,157 Chinese older adults aged 60 and above received interviews in Chicago. We used a 56-item modified Conflict Tactics Scale to evaluate EA. Abuse history was defined as exposure to child abuse (before age 18) and/or IPV (age 18–59) measured respectively by the Extended Hurt, Insult, Threaten, Scream scale. We divided participants into four groups: EA and abuse history (n=204), EA only (n=439, reference group), abuse history only (n=310), and no interpersonal violence (n=2,181). Global cognition was evaluated by episodic memory, working memory, processing speed, and MMSE. Linear regression was used. RESULTS. Older adults with EA and abuse history (b=0.147, SE=0.052, p

In the present study, we examined self-rated health as a mediator between physical health conditions (chronic diseases and functional disability) and depressive symptoms in older Chinese and Korean Americans. Using harmonized data (N = 5,063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we tested direct and indirect effect models. In both groups, chronic diseases and functional disability were closely associated with negative ratings of health and symptoms of depression. Analyses with the PROCESS macro showed that the effect of chronic diseases and functional disability on depressive symptoms was mediated by self-rated health in both groups; the indirect effect was greater in the Korean American sample than in the Chinese American sample. These findings contribute to the understanding of the psychological mechanisms that underlie the mind–body connection and highlight the potential importance of subjective health assessment as a useful tool for health promotion.

Objectives Physical function impairment can cause great stress to older adults. The purpose of the study is to investigate the association between self-reported and directly-observed physical function on perceived stress among U.S. Chinese older adults. Methods Data were from the Population Study of Chinese Elderly in Chicago (PINE) of 3,157 Chinese older adults who were 60 and above in the Greater Chicago Area. Self-reported and directly-observed physical function measures, and Perceived Stress Scale were used. Results Participants had a mean age of 72.8 ± 8.3 years old (range 60–105). Higher scores of Katz activities of daily living impairments (odds ratio [OR]=1.77), Lawton instrumental activities of daily living impartments (OR=1.10, p

A broad literature has explored racial disparities in cognitive aging. Research incorporating sociocultural factors would provide a more comprehensive understanding of minority aging. This study aims to investigate the role of family typology in cognition among U.S. Chinese immigrants. Data were derived from the Population Study of Chinese Elderly in Chicago (PINE). Family typology included tight-knit, unobligated ambivalent, commanding conflicted, and detached typologies. Cognition was evaluated by global cognition, episodic memory, working memory, executive function, and mini-mental state examination (MMSE). Linear and quantile regressions were used. Older adults with detached and commanding conflicted typologies reported lower global cognition than those with unobligated ambivalent typology. Detached, commanding conflicted, and tight-knit typologies were associated with poorer performance in episodic memory, working memory and MMSE than unobligated ambivalent typology, respectively. Social service providers could be aware of multifaceted family relationships when developing interventions for cognitive function and understand family typology as a whole.

Elder abuse is a pervasive public health issue. The relationship between personality traits and elder abuse remains unclear. This study aims to examine the associations between neuroticism, conscientiousness, and elder abuse. Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged study of 3,157 US Chinese older adults in the greater Chicago area from 2011-2013. Elder abuse included psychological, physical, and sexual abuse, financial exploitation, and caregiver neglect. The assessments of neuroticism and conscientiousness were derived from the NEO Five-Factor Inventory. Logistic regression was used. Higher neuroticism (score range: 6-30, OR = 1.14, CI = 1.11-1.18) and lower conscientiousness (score range: 16-60, OR = 0.97, CI = 0.96-0.99) were associated with a higher risk of elder abuse. With respect to different forms of elder abuse, higher neuroticism was associated with an increased risk of psychological abuse (OR = 1.14, CI = 1.10-1.17), financial exploitation (OR = 1.03, CI = 1.00-1.07), and caregiver neglect (OR = 1.06, CI = 1.03-1.09). Higher conscientiousness was associated with a higher risk of financial exploitation (OR = 1.02, CI = 1.00-1.05). Intervention programs could reduce neuroticism and raise conscientiousness of elder abuse victims.

The aim was to examine the prevalence of and risk factors for lower urinary tract symptoms (LUTS) in a community-dwelling cohort of older Chinese American women. We performed a secondary analysis of a prospective cross-sectional population-based survey of community-dwelling Chinese Americans aged 60 and older in English, Mandarin, Cantonese, Taishanese, or Teochew between 2011 and 2013. A clinical Review of Systems (ROS) was used to assess LUTS, which included urinary frequency, urgency, burning or pain, blood in urine, and urinary incontinence. Of the 1,829 women queried, 28.6% reported LUTS. The cohort of women who reported LUTS had a mean ± SD age of 74.7 ± 8.7 years, with a BMI of 23.4 ± 3.7 kg/m2 and had lived in the USA for 21.5 ± 13.1 years. Nearly 90% earned less than $10,000 a year, 50% were married, and 50% used traditional Chinese medicine (TCM) once monthly or more. In comparison with women without LUTS, women with LUTS had significantly higher rates of medical comorbidities and a poorer perception of their general health and quality of life. In multivariate regression analysis, any LUTS were significantly associated with older age (aOR 1.03, 95% CI 1.01–1.04), TCM use (aOR 1.67, 95% CI 1.34–2.07), anxiety (aOR 1.45, 95% CI 1.02–2.06), depression (aOR 2.00, 95% CI 1.53–2.61), and a history of stroke (aOR 1.90, 95% CI 1.19–3.02). Lower urinary tract symptoms are common among older Chinese American women, particularly in those who are older, use TCM regularly, or report a history of anxiety, depression, or stroke.

This study examined the relationship of kinship bereavement with the psychological well-being of Chinese American older women and men. Data from the Population Study of ChINese Elderly were used. Respondents were asked if their spouse, children/grandchildren, siblings, close relatives, and friends had died. Widowhood was associated with more loneliness for both genders. For women, close relative/friend loss was associated with more stress, and children/grandchildren loss was linked to stronger anxiety. Only coefficients for close relative in the stress model were significantly different between genders. The variation in patterns of kinship bereavement may be attributed to Chinese cultural attitudes toward death.

This study investigates the differential associations of activity engagement and perceived neighborhood characteristics (i.e., cohesion, disorder, sense of community) with cognitive measures. Using data of 2,713 Chinese older adults in Chicago, who completed two interviews between 2011 and 2015, we identified three activity domains: reading, social, and games. In general, engagement in more reading and social activities was associated with better baseline cognitive function, but the positive effects tapered off over time in some cases. Neighborhood cohesion had both direct and indirect effects on cognitive function. Engagement in social activities mediated the neighborhood cohesion effects, that is, living in a cohesive neighborhood promoted social activities and consequently benefited cognitive function. Findings speak to the importance of activity engagement and neighborhood cohesion for cognition among the U.S. Chinese older adults. Future research is needed to investigate the longitudinal relationships of activity engagement and environmental factors with cognitive change.