Health Services Utilization Among Older Asian Americans

Older Asian Americans (OAAs) represent one of the largest and the fastest growing older minority populations nationwide. The striking growth and intra-group diversity of OAA underline the urgency for an improved understanding of ethnic Asian groups\u27 health care access and service utilization patterns. This dissertation therefore examines health seeking and utilization behaviors among OAAs. It consists of two studies. The first study used secondary data from the 2011-2012 California Health Interview Survey (CHIS) to explore health service utilization (HSU) patterns among OAAs. Bivariate and multivariate regression analyses were conducted to examine the significant factors associated with physician visits, emergency department (ED) visits, and hospitalization, focusing on psychological distress as the key independent variable. The study findings suggest that psychological distress was associated with the utilization of ED services among older Korean and Chinese Americans. Other significant factors associated with HSU included self-reported health, length of residence in the U.S., and English proficiency. ED encounters may therefore represent opportunities to identify older Korean and Chinese Americans with psychological distress and initiate appropriate treatment. The second study is a qualitative study that examined culturally-informed perceptions of dementia and barriers/facilitators in accessing/providing dementia-related services from the perspectives of older Korean and Chinese immigrants, their family caregivers, and home care providers. In-depth face-to-face interviewers were conducted with 12 older Asian immigrants and 12 family caregivers. Three semi-structured focus group sessions were conducted with home care professionals and ethnic home health aides. Data were analyzed using the conventional content analysis approach. Six themes emerged: perceptions and attributions of dementia, delayed help-seeking, perceived barriers in accessing care, caregiving burdens, barriers in providing care, and service needs. The findings underscore the importance of culture in shaping perceptions of dementia and related help-seeking behaviors. Culturally and linguistically appropriate training and educational programs should be developed to enhance awareness and knowledge of dementia in the Asian community to facilitate timely help-seeking. Culturally and linguistically appropriate social services are imperative to address the emotional and social needs of older Asian immigrants and their family caregivers

My bitterness is deeper than the ocean : understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers.

Background: It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers. Methods: We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma of Mental Illness Scale and Affiliated Stigma Scale. Scores from the two scales and number of text fragments were compared to identify consistency of responses using the two methods. Profiles from three family-dyads were analyzed to highlight the interactive aspect of stigma in a dyadic relationship. Results: Our analyses suggested that persons with schizophrenia and their caregivers both internalized negative valuation from their social networks and reduced engagement in the community. Participants with schizophrenia expressed a sense of shame and inferiority, spoke about being a burden to their family, and expressed self-disappointment as a result of having a psychiatric diagnosis. Caregivers expressed high level of emotional distress because of mental illness in the family. Family dyads varied in the extent that internalized stigma were experienced by patients and caregivers. Conclusions: Family plays a central role in caring for persons with mental illness in China. Given the increasingly community-based nature of mental health services delivery, understanding internalized stigma as a family unit is important to guide the development of cultural-informed treatments. This pilot study provides a method that can be used to collect data that take into consideration the cultural nuances of Chinese societies

Analysis of the status quo of solar heating under the background of carbon neutrality

Since 2020, under the market trend of the "carbon peak" and "post-coal reform" era, clean energy heating has ushered in development opportunities. This article mainly introduces the current status of solar combined heat pump, biomass energy, electricity, photovoltaic and other heating methods, compares the differences of various types of energy heating, analyzes the advantages and limitations of solar heating, and puts forward reasonable suggestions

Identifying Distinct Risk Profiles to Predict Adverse Events among Community-Dwelling Older Adults

Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p \u3c 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults

Health Services Utilization Among Older Asian Americans

Older Asian Americans (OAAs) represent one of the largest and the fastest growing older minority populations nationwide. The striking growth and intra-group diversity of OAA underline the urgency for an improved understanding of ethnic Asian groups\u27 health care access and service utilization patterns. This dissertation therefore examines health seeking and utilization behaviors among OAAs. It consists of two studies. The first study used secondary data from the 2011-2012 California Health Interview Survey (CHIS) to explore health service utilization (HSU) patterns among OAAs. Bivariate and multivariate regression analyses were conducted to examine the significant factors associated with physician visits, emergency department (ED) visits, and hospitalization, focusing on psychological distress as the key independent variable. The study findings suggest that psychological distress was associated with the utilization of ED services among older Korean and Chinese Americans. Other significant factors associated with HSU included self-reported health, length of residence in the U.S., and English proficiency. ED encounters may therefore represent opportunities to identify older Korean and Chinese Americans with psychological distress and initiate appropriate treatment. ^ The second study is a qualitative study that examined culturally-informed perceptions of dementia and barriers/facilitators in accessing/providing dementia-related services from the perspectives of older Korean and Chinese immigrants, their family caregivers, and home care providers. In-depth face-to-face interviewers were conducted with 12 older Asian immigrants and 12 family caregivers. Three semi-structured focus group sessions were conducted with home care professionals and ethnic home health aides. Data were analyzed using the conventional content analysis approach. Six themes emerged: perceptions and attributions of dementia, delayed help-seeking, perceived barriers in accessing care, caregiving burdens, barriers in providing care, and service needs. The findings underscore the importance of culture in shaping perceptions of dementia and related help-seeking behaviors. Culturally and linguistically appropriate training and educational programs should be developed to enhance awareness and knowledge of dementia in the Asian community to facilitate timely help-seeking. Culturally and linguistically appropriate social services are imperative to address the emotional and social needs of older Asian immigrants and their family caregivers.

Health Services Utilization Among Older Asian Americans

Older Asian Americans (OAAs) represent one of the largest and the fastest growing older minority populations nationwide. The striking growth and intra-group diversity of OAA underline the urgency for an improved understanding of ethnic Asian groups\u27 health care access and service utilization patterns. This dissertation therefore examines health seeking and utilization behaviors among OAAs. It consists of two studies. The first study used secondary data from the 2011-2012 California Health Interview Survey (CHIS) to explore health service utilization (HSU) patterns among OAAs. Bivariate and multivariate regression analyses were conducted to examine the significant factors associated with physician visits, emergency department (ED) visits, and hospitalization, focusing on psychological distress as the key independent variable. The study findings suggest that psychological distress was associated with the utilization of ED services among older Korean and Chinese Americans. Other significant factors associated with HSU included self-reported health, length of residence in the U.S., and English proficiency. ED encounters may therefore represent opportunities to identify older Korean and Chinese Americans with psychological distress and initiate appropriate treatment. The second study is a qualitative study that examined culturally-informed perceptions of dementia and barriers/facilitators in accessing/providing dementia-related services from the perspectives of older Korean and Chinese immigrants, their family caregivers, and home care providers. In-depth face-to-face interviewers were conducted with 12 older Asian immigrants and 12 family caregivers. Three semi-structured focus group sessions were conducted with home care professionals and ethnic home health aides. Data were analyzed using the conventional content analysis approach. Six themes emerged: perceptions and attributions of dementia, delayed help-seeking, perceived barriers in accessing care, caregiving burdens, barriers in providing care, and service needs. The findings underscore the importance of culture in shaping perceptions of dementia and related help-seeking behaviors. Culturally and linguistically appropriate training and educational programs should be developed to enhance awareness and knowledge of dementia in the Asian community to facilitate timely help-seeking. Culturally and linguistically appropriate social services are imperative to address the emotional and social needs of older Asian immigrants and their family caregivers

Health Services Utilization Among Older Asian Americans

Older Asian Americans (OAAs) represent one of the largest and the fastest growing older minority populations nationwide. The striking growth and intra-group diversity of OAA underline the urgency for an improved understanding of ethnic Asian groups\u27 health care access and service utilization patterns. This dissertation therefore examines health seeking and utilization behaviors among OAAs. It consists of two studies. The first study used secondary data from the 2011-2012 California Health Interview Survey (CHIS) to explore health service utilization (HSU) patterns among OAAs. Bivariate and multivariate regression analyses were conducted to examine the significant factors associated with physician visits, emergency department (ED) visits, and hospitalization, focusing on psychological distress as the key independent variable. The study findings suggest that psychological distress was associated with the utilization of ED services among older Korean and Chinese Americans. Other significant factors associated with HSU included self-reported health, length of residence in the U.S., and English proficiency. ED encounters may therefore represent opportunities to identify older Korean and Chinese Americans with psychological distress and initiate appropriate treatment. ^ The second study is a qualitative study that examined culturally-informed perceptions of dementia and barriers/facilitators in accessing/providing dementia-related services from the perspectives of older Korean and Chinese immigrants, their family caregivers, and home care providers. In-depth face-to-face interviewers were conducted with 12 older Asian immigrants and 12 family caregivers. Three semi-structured focus group sessions were conducted with home care professionals and ethnic home health aides. Data were analyzed using the conventional content analysis approach. Six themes emerged: perceptions and attributions of dementia, delayed help-seeking, perceived barriers in accessing care, caregiving burdens, barriers in providing care, and service needs. The findings underscore the importance of culture in shaping perceptions of dementia and related help-seeking behaviors. Culturally and linguistically appropriate training and educational programs should be developed to enhance awareness and knowledge of dementia in the Asian community to facilitate timely help-seeking. Culturally and linguistically appropriate social services are imperative to address the emotional and social needs of older Asian immigrants and their family caregivers.

Advance Directives Completion among Older American Couples: A Dyadic Perspective on the Role of Cognitive Function and Other Factors

Objective: Dyadic perspective is scarce in existing advance directive (AD) literature. Particularly, the significance of one’s own and/or one’s partner’s cognitive function on AD remains unknown. This study investigates the relationship of cognitive function and other factors with AD completion within the spousal context. Methods: Data from the Health and Retirement Study (2014-2015) were used. Older heterosexual couples (age ≥65) married for 10+ years were asked if they had a living will and/or appointed a durable power of attorney for healthcare (DPAHC). Structural Equation Models examined the actor and partner effects of sociodemographic, health, and couple-level characteristics on wife’s and husband’s AD, respectively. Results: Moderate spousal interdependence was observed in living will (Kappa coefficient, k =0.60) and DPAHC (k=0.53). Older age and higher education were related to both spouses having AD. Less household wealth and being racial/ethnic minority were associated with a lower probability of having AD. Notable gender contrasts in actor and partner effects were found. Wife’s higher level of cognitive function was associated with husband’s AD completion. Contrarily, husband’s lower level of cognitive function was associated with wife’s AD completion. Retirement status had primarily actor effects for both husbands and wives. More chronic conditions were linked to husband’s AD completion. Discussion: The spousal interdependence of AD warrants practitioner efforts to facilitate family-oriented end-of-life planning. Wives and husbands may have different thoughts regarding their spouse’s cognitive capacity to surrogate. Facilitating couple-based discussions may be a feasible approach to promote engagement with AD among older adults.This is a manuscript of an article published as Lu, Peiyi, Dexia Kong, Jeongeun Lee, and Mack Shelley. "Advance Directives Completion among Older American Couples: A Dyadic Perspective on the Role of Cognitive Function and Other Factors." The Journals of Gerontology: Series B (2021). DOI: 10.1093/geronb/gbab077. Posted with permission.</p

“My bitterness is deeper than the ocean”: understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers

Abstract Background It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers. Methods We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma of Mental Illness Scale and Affiliated Stigma Scale. Scores from the two scales and number of text fragments were compared to identify consistency of responses using the two methods. Profiles from three family-dyads were analyzed to highlight the interactive aspect of stigma in a dyadic relationship. Results Our analyses suggested that persons with schizophrenia and their caregivers both internalized negative valuation from their social networks and reduced engagement in the community. Participants with schizophrenia expressed a sense of shame and inferiority, spoke about being a burden to their family, and expressed self-disappointment as a result of having a psychiatric diagnosis. Caregivers expressed high level of emotional distress because of mental illness in the family. Family dyads varied in the extent that internalized stigma were experienced by patients and caregivers. Conclusions Family plays a central role in caring for persons with mental illness in China. Given the increasingly community-based nature of mental health services delivery, understanding internalized stigma as a family unit is important to guide the development of cultural-informed treatments. This pilot study provides a method that can be used to collect data that take into consideration the cultural nuances of Chinese societies