Family networks are widely assumed to be a key source of support for older people in Indonesia and Southeast Asia more generally, although empirical study of their composition and functioning is in its infancy. This paper draws on ethnographic and survey data collected in longitudinal research of ageing in three rural Indonesian communities, in order to identify demographic and social factors limiting the size of elders’ networks. Gaps in networks commonly emerge as a result of childlessness, migration and alienation, but their implications for older people’s vulnerability are shaped by socio-economic status, reputation and cultural norms.
Adoption; Childlessness; Elderly; Migration; Networks; Socio-economic stratification; Vulnerability
This article describes the development of SHARE-Israel, the survey of persons aged 50 and older in Israel, and preliminary results from an early data release. The introduction of an HRS-inspired computer-based survey into a Middle East country required linguistic and cultural adaptations of the survey mechanisms that had not been previously experienced in other countries. Preliminary findings showed that the majority group of veteran Jewish-Israelis aged 50 and over is in a favorable position in terms of health, employment status and household income compared to Arab-Israelis and to new immigrants to Israel from the Former Soviet Union. Arab-Israelis aged 50 and over are at greater risk due to greater disability and lower incomes. Recent immigrants from the former Soviet Union are at greatest risk. They report having the highest degree of depression, long term problems and activity limitation, the fewest children, low rates of home ownership and low incomes. Comparing the older Israeli population with their European counterparts revealed that Israelis are more depressed; more Israeli women are employed, and fewer Israeli men are retired; and household income in Israel is lower, but rises relatively when correcting for purchasing power parity. These trends point to several areas that will require attention in the formulation of public policy on behalf of the aging population in Israel.
SHARE; HRS; Israel; 50 and older; Survey
Researchers at the South African Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit (Agincourt) fieldsite in rural South Africa consider Mozambican residents more vulnerable than others in the local population. These self-settled refugees, many of whom are still not South African citizens, primarily came to South Africa in the 1980s during the Mozambican Civil War. This perceived economic vulnerability is rooted in their difficulties in accessing social grants, until recently legally available only to those with South African citizenship documentation. This paper focuses on semi-structured interviews with 30 ‘older’ women of Mozambican-descent living in the Agincourt area. These interviews highlight three important aspects of vulnerability; the respondents: (1) perceive a risk of deportation despite their having lived in the country for 20 years, (2) are unable to easily access social grants, namely the state-funded old-age pension, and (3) struggle to make ends meet when faced with daily needs and crisis situations. All three of these vulnerabilities were mediated to some extent by these women’s resourcefulness. They generated ties to South Africa through obtaining identification-documents, used these documents to access pensions, and used the pensions to help them sustain their multigenerational households.
Aging; Refugees; Social grants; South Africa; Vulnerability
Forty people over 60 years of age took part in longitudinal research over the course of a year on the impact of the HIV epidemic in southern Uganda. In this paper we focus mainly on the data from 26 of the 40 who were HIV-positive. While we observed that feelings of depression were frequently experienced by many of the people in our study, the state of ‘being depressed’ was not constant. Participants regularly expressed economic frustration (because of a lack of money to buy food and other commodities including sugar and soap); medical problems (including those related to HIV) as well as old age, the burden of dependents (including concerns about school fees for grandchildren), feelings of sadness and isolation, and a lack of support from others, as well as stigma, whether real or perceived. However, while worries, sorrow and despondent thoughts were reported in many of the interviews across the study, moods fluctuated moving from happiness and hope, to sadness and despair, from month to month. Concerns regarding the psychological wellbeing amongst older people, including those living with HIV and older carers in Uganda deserve greater attention.
Despondence; Depression; HIV and AIDS; Hope; Social isolation; Uganda
In Canada’s multicultural society, ethnic identity is important to the elderly and can influence areas such as access to services, health promotion and care. Often, the complex nature of ethnic identity is underestimated when looking at cultural groups. This study aims to: (a) validate the factor structure of a Chinese ethnic identity measure for older Chinese in Canada, (b) examine the level of ethnic identity of the participants, and (c) examine the correlates of ethnic identity in these older individuals. Using data from a large, national research project on the elderly Chinese in Canada, this study analyzed the results gathered from a total of 2,272 participants. Principal component analysis, maximum-likelihood confirmatory factor analysis, and multiple regression analysis were performed. The results indicated that ethnic identity of the older Chinese is a multi-dimensional construct made up of three factors: (a) culture related activities, (b) community ties, (c) linkage with country of origin, and (d) cultural identification. The findings have provided a better understanding of how ethnic identity can be measured among the aging Chinese population in Canada.
Chinese elderly; Immigrants; Ethnic identity
Abstract In recent years, a vast literature has accumulated on the negative effects on family caregivers of providing care to elders, while relatively little research has explored caregiving as a positive experience. Only a handful of studies have examined any aspect of informal caregiving among American Indians. This mixed methods study explores the negative and positive aspects of providing elder care among 19 northern plains American Indian family members. These caregivers described low levels of burden and high levels of reward, attributable to cultural attitudes toward elders and caregiving, collective care provision, strong reciprocal relationships with elders, enjoyment of elders, and relatively low levels of care provision. Caregiving manifested as part of a complex exchange of assistance rather than a unidirectional provision of assistance from the family member to the elder. That caregiving emerged as such an overwhelmingly positive experience in a community faced with poverty, alcohol disorders, trauma, and cultural traumatization is testimony to the important roles that elders often continue to play in these communities.
American Indian; Caregiving; Elders; Family; Positive valuation of elders; Caregiving reward
Osteoarthritis is a prevalent disease in older patients of all racial groups, and it is known to cause significant pain and functional disability. Racial differences in how patients cope with the chronic pain of knee or hip osteoarthritis may have implications for utilization of treatment modalities such as joint replacement. Therefore, we examined the relationships between patient race and pain coping strategies (diverting attention, reinterpreting pain, catastrophizing, ignoring sensations, hoping and praying, coping self-statements, and increasing behavior activities) for hip and knee osteoarthritis. This is a cross-sectional survey of 939 veterans 50 to 79 years old with chronic hip or knee osteoarthritis pain recruited from VA primary care clinics in Philadelphia and Pittsburgh. Patients had to have moderate to severe hip or knee osteoarthritis symptoms as measured by the WOMAC index. Standard, validated instruments were used to obtain information on attitudes and use of prayer, pain coping strategies, and arthritis self-efficacy. Analysis included separate multivariable models adjusting for demographic and clinical characteristics. Attitudes on prayer differed, with African Americans being more likely to perceive prayer as helpful (adjusted OR=3.38, 95% CI 2.35 to 4.86) and to have tried prayer (adjusted OR=2.28, 95% 1.66 to 3.13) to manage their osteoarthritis pain. Upon evaluating the coping strategies, we found that, compared to whites, African Americans had greater use of the hoping and praying method (β=0.74, 95% CI 0.50 to 0.99). Race was not associated with arthritis pain self-efficacy, arthritis function self-efficacy, or any other coping strategies. This increased use of the hoping and praying coping strategy by African Americans may play a role in the decreased utilization of total joint arthroplasty among African Americans compared to whites. Further investigation of the role this coping strategy has on the decision making process for total joint arthroplasty should be explored.
Coping strategies; Health disparities; Joint arthroplasty; Osteoarthritis; Prayer
The current study analyzed the 1999 and 2001 waves of the Nihon University Japanese Longitudinal Study of Aging. Two measures of social integration were associated with lower risks of being physically disabled or depressed at Wave 1 and with a lower risk of progressing into deeper levels of physical disability and depression by Wave 2. Ceteris paribus, compared to elderly urbanites, elderly ruralites had a much higher risk of being physically disabled but much lower odds of being depressed. And compared to elderly men, elderly women had similar risks of being physically disabled but much higher odds of being depressed. Suggestions are made on how future research on longevity in Japan, the world’s most longevous nation, can explore the links among social integration, place, gender, and the postponement of mortality.
ADLs; IADLs; Depression; Longitudinal survey; Role enhancement; Role strain
Type 2 diabetes constitutes a leading and increasing cause of morbidity and mortality among older adults, particularly African Americans, Native Americans, Mexican Americans, and rural dwellers. To understand diabetes self-care, an essential determinant of diabetic and overall health outcomes, 80 middle aged and older adults from these four disproportionately affected racial/ethnic/residential groups engaged in in-depth interviews, focusing on approaches to and explanations for diabetes self-care. Certain self-care activities (medication-taking, diet, foot care) were performed regularly while others (blood glucose monitoring, exercise) were practiced less frequently. Despite research suggestions to the contrary, only one in four elders used unconventional diabetes therapies, and only one-third listed someone other than a health care provider as a primary information source. Few self-care differences emerged according to race/ethnicity/residence, perhaps because of the influential and common circumstance of low income. Thematic analyses suggest that inadequate resources, perceived efficacy of medication, great respect for biomedical authority, and lack of familiarity with and concerns about unconventional therapies are influential in establishing these patterns of self-care. We discuss the similarity of self-care practices and perspectives irrespective of race/ethnicity/residence and the predominance of biomedical acceptability.
Type 2 diabetes; African Americans; Mexican Americans; Native Americans; Rural residents; Self-care
Comorbidity is a growing challenge and the older adult population is most at risk of developing comorbid conditions. Comorbidity is associated with increased risk of mortality, increased hospitalizations, increased doctor visits, increased prescription medications, nursing home placement, poorer mental health, and physical disability. American Indians experience some of the highest rates of chronic conditions, but to date there have been only two published studies on the subject of comorbidity in this population. With a community-based sample of 505 American Indians aged 55 years or older, this study identified the most prevalent chronic conditions, described comorbidity, and identified socio-demographic, functional limitations, and psychosocial correlates of comorbidity. Results indicated that older American Indians experience higher rates of hypertension, diabetes, back pain, and vision loss compared to national statistics of older adults. Two-thirds of the sample experienced some degree of comorbidity according to the scale used. Older age, poorer physical functioning, more depressive symptomatology, and lower personal mastery were all correlates of higher comorbidity scores. Despite medical advances increasing life expectancy, morbidity and mortality statistics suggest that the health of older American Indians lags behind the majority population. These findings highlight the importance of supporting chronic care and management services for the older American Indian population.
American Indian; Chronic conditions; Comorbidity
The purpose of this paper is to integrate the literature on family and social ties among older ethnic minority men and women with the literature on chronic illness self-care among elders in these groups, in order to increase understanding of social influences on self-care behavior, raise questions for future research, and inform culturally appropriate interventions to maximize the health-promoting potential of social relationships. The paper presents demographic and chronic illness prevalence information, and then summarizes literature about patterns of chronic illness self-care behaviors for older African-Americans, Latinos, Asian-Americans, and American Indians in the U.S. For each group, the sociological literature about residential, cultural, and socioeconomic patterns, family lives, and other social ties is then reviewed, and the self-care literature that has accounted for these patterns is discussed. Finally, six themes are outlined and related questions are identified to further illuminate the social context of older adults’ chronic illness self-care.
Chronic illness; Ethnic minorities; Family; Older adults; Self-care; Social ties
Prior literature emphasizes that Asian Americans with dementia may be particularly vulnerable to the stigma of chronic mental illness. However, there is a dearth of empirical research to support this claim. This study examines the relationship of stigma and dementia in 32 qualitative interviews with Chinese and Vietnamese family caregivers. Stigma was a common theme in the interviews (91%). Further analysis of stigma revealed two sources: chronic mental illness stigma and stigma reflecting negative stereotypes of aging or the aged. Chinese and Vietnamese cultural views of normal aging are not a unitary category but accommodate different trajectories of aging, some more and some less desired. When applied to persons with dementia, a “normalized” but negative trajectory of aging carried with it significant stigma that was distinct from but in addition to the stigma of chronic and severe mental illness. Older Chinese and Vietnamese with dementia are thus at risk of experiencing multiple stigmas that include but go beyond the stigma associated with chronic and severe mental illness.
This study examined caregiver preferences in the event of hip fracture between Mexican-American and non-Latino White elders. The differential effects of ethnicity and a cultural factor were also examined to elucidate the role of culture on caregiver preference. Data came from a cross-sectional survey of 89 Mexican-American and 30 non-Latino White elders. Hierarchical binary logistic regression was used to examine the differential impact of ethnicity and a cultural factor on caregiver preference. Fewer Mexican-American elders than non-Latino White elders preferred to rely on a formal/professional helper, and a greater proportion of Mexican-Americans than non-Latino Whites would turn to informal caregivers when faced with care needs following a hip fracture. The cultural factor significantly mediated the ethnic effect on caregiver preference. The need for culturally-relevant services based on caregiver preference for long-term care is discussed in addressing health disparities for ethnically diverse elders.
Long-term care preference; Mexican-American elders; Cultural values; Culturally competent practice; Health disparities
This study examined how women in a Mexico City suburb conceptualized the construct of burden within the context of giving care to older relatives.
Data were collected on forty-one women through semi-structured interviews regarding their caregiving experiences to elderly relatives. Phenomenological principles were used to analyze meanings and understandings of caregiving experiences.
Burden was a multi-dimensional construct that referred to specific situations that made caregivers feel emotionally or physical “heavy.” Burden also referred to “being a burden” by being in the way, making things difficult, or being a ‘weight’ on caregivers' shoulders. However, women in this study also viewed burden as a positive sacrifice that involved love, initiative, and good will.
This study is an important first step in defining the ways in which caregiving is positively and negatively meaningful for Mexican caregivers and their families. Our findings offer an additional dimension of caregiver burden to broaden our understanding and measurement of the construct. The development of culturally appropriate instruments to measure caregiving burden in Mexico is necessary to provide an empirical foundation for policy recommendations that address the growing need for institutional support of caregivers. Moreover, our findings suggest that researchers studying caregiving in Mexico should think about how burden is measured on existing instruments before adapting them for widespread use.
aged; caregiver burden; informal caregiving; Mexico
This paper examines Bulgarian and American young adults’ perceptions of prior experiences of intergenerational communication. Irrespective of culture, as age of target increased from young adult to middle-aged and elderly adult, so did attributions of benevolence, norms of politeness and deference, and communicative respect and avoidance; conversely, attributions of personal vitality and communication satisfaction decreased linearly. However, American youth reported more of a tendency to avoid, but expressed more respect when communicating with, older adults than their Bulgarian counterparts. In both settings, young adults’ avoidant communication with older people negatively, and the norm of politeness positively, predicted intergenerational communication satisfaction. In Bulgaria only, age stereotypes also predicted communication satisfaction whereas only in the USA was communicative respect a predictor.
Age norms; Age stereotypes; Respect; Deference; Communication satisfaction; Middle-age; Elder; Bulgaria
To examine whether a multidimensional social support instrument can be used for comparative research in four diverse ethnic groups of women (African American, Latina, Chinese, non-Latina White). The social support instrument was administered as part of a larger survey to 1,137 women. We tested the reliability and validity of this instrument. A confirmatory factor analytic (CFA) framework was used to test for the invariance of the instrument’s psychometric properties across ethnic groups. We used multitrait scaling to eliminate items that did not meet the item-convergence criterion (r > 0.30) and where items were non-convergent items in at least three groups. A series of nested CFA models assessed the level of factorial invariance. One thousand seventy-four women completed the survey; Their mean age was 61 years with Chinese and Latinas reporting lower education compared to non-Latino Whites (p <. 001). A four-factor model (Tangible, Informational, Financial, Emotional/Companionship) fit within each ethnic group separately, suggested good fit. Multi-group CFA supported configural and metric invariance across all ethnic groups. Only partial scalar invariance was supported. This 8-item instrument is a reliable and valid tool that can be used as a multidimensional measure of social support. It can used to examine social support within one ethnic group and for comparative research across diverse ethnic groups of women.
African American; Latino; Asian; Chinese; Language; Spanish; Confirmatory factor analysis; Psychometric analysis
The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders.
AIDS; Care-giving; HIV; Older people; South Africa
Using a combined qualitative/quantitative approach, we interviewed 132 older African–Americans and whites with either osteoarthritis of the hip or knee (OAK/OAH) or ischemic heart disease (IHD) to address two questions: 1) What types of reactions to illness are expressed by this group of older adults who have OA or IHD? 2)? Are there differences in the characteristics of the respondents who respond more positively than those who respond more negatively? The responses were coded to illustrate those that reflected positive, negative, or combined (positive/negative) statements. The majority of the respondents, who were categorized as positive or combined, approached the illness experience with statements illustrating their ability to cope with their illness and adapt their lifestyles to the limitations imposed by the disease such as acceptance, feeling that others were worse off, or changing their lifestyles to adapt to their limitations. Those expressing negative reactions to their illness were fewer in number and responded with terms reflecting loss of identity, physical limitations, and other disease symptoms. The differences were more pronounced between the positive and negative groups where the latter were somewhat more likely to be African–American and female and significantly more likely to have less income, greater perceived disease severity, and more disability. We should look to the larger group in both the positive only and combined responses to explore how culture may play a role in perceptions of subjective well-being and the importance of “the local worlds of experience” experienced by both men and women, and African–Americans and whites. This study illustrates that using a simple, open-ended question that stimulates older people to narrate their reactions to having a chronic illness may allow clinicians to identify the persons most at-risk and intervene appropriately.
African-Americans; Chronic illness; Heart disease; Osteoarthritis; Qualitative/Quantitative research
The structure and organization of cognitive abilities has been examined across the life span. The current analysis had three specific aims: (1) test the factor structure of a broad cognitive ability battery across three age groups; (2) examine differences in the pattern of factor covariation across age groups; and (3) examine the pattern of factor mean differences across age groups. A sample of 512 older African Americans (mean age = 66.6 years, 25.4% male) from the Baltimore Study of Black Aging was administered a battery of cognitive tests assessing the domains of perceptual speed, verbal memory, inductive reasoning, vocabulary, and working memory. Factor models were estimated separately in middle-age adults (50-59 years, n = 107), young-old adults (60-69 years, n = 198), and old-old adults (70-79 years, n = 207). There was loading invariance across the three age groups that suggests that the selected tests measured cognition similarly across age. There was no evidence of dedifferentiation across increasingly older age groups. Factor mean differences were observed with the middle-age group having significantly higher factor means than the young-old and old-old groups; however, there was only one factor mean difference between the young-old and the old-old groups. The results suggest that a pattern of dedifferentiation of cognitive abilities does not exist within this sample of older African Americans and that the 60-69 year age range may be a critical period for cognitive decline in this population.
Cognition; Dedifferentiation; African Americans; Cognitive abilities; Cognitive aging
Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the United States. Because there is no known cure for OA, treatment is directed towards the alleviation of pain, improving function, and limiting disability. The major burden of care falls on the individual, who tailors personal systems of care to alleviate troublesome symptoms. To date, little has been known about the temporal variations in self-care that older patients with OA develop, nor has it been known to what extent self-care patterns vary with ethnicity and disease severity. This study was designed to demonstrate the self-care strategies used by older African Americans and whites to alleviate the symptoms of OA on a typical day and during specific segments of a typical day over the past 30 days. A sample of 551 older adults participated in in-depth interviews, and the authors clustered their responses into six categories. Findings showed that the frequency of particular behaviors varied by time of day, disease severity, and race. Overall, patterns of self-care behaviors were similar between African-Americans and whites, but African-Americans used them in different proportions than whites and in response to disease severity. Knowledge of what strategies persons with OA use to lessen their symptoms at various times of the day may enable practitioners and their patients to improve management of OA symptoms. Recognition that people may choose their strategies to ameliorate their symptoms by race and disease severity may further enable tailored symptom relief.
African-Americans; osteoarthritis; self-care; chronic disease
The aim of this study was to examine optimal self-management in osteoarthritis and its association with patient-reported outcomes. We recruited a population-based sample of Medicare beneficiaries (n=551) residing in Allegheny County, PA, USA and elicited an expanded set of self-management behaviors using open-ended inquiry. We defined optimal self-management according to clinical recommendations, including use of hot compresses on affected joints, alteration of activity, and exercise. Only 20% practiced optimal self-management as defined by two or more of these criteria. Optimal and suboptimal self-managers did not differ in sociodemographic features. Both white and African–Americans who practiced optimal self-management reported significantly less pain, but the benefit was greatest in severe disease for whites and for mild-moderate disease among African–Americans. This backdrop of naturally occurring self-management behaviors may be important to recognize in planning programs that seek to bolster self-management skills.
Osteoarthritis; Self-care; Race; Self-management; Population-based sample