XinQi Dong

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

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 could focus on fostering young immigrants’ attitude and behavior to provide more respect and greeting for aging parents to strengthen the family protection role.

Background and ObjectivesThe migrating age of an individual has far-reaching implications for their acculturation experience, social integration, and well-being. This study addressed two questions: Is migrating at older age associated with poorer psychological well-being? If so, what factors account for such differences?Research Design and MethodsUsing data of 3,138 Chinese elderly people in Chicago, we compared the levels of depression and quality of life among individuals who migrated in young adulthood (before 35), adulthood (35–49), midlife (50–64), and later life (65+). Negative binominal and logistic regressions were performed to examine the associations between age at migration and the two outcomes, controlling for demographics and four sets of explanatory variables (socioeconomic status, health status, acculturation level, and family/social relations).ResultsThe findings revealed mixed results. Migrating in later life was associated with more depressive symptoms, but also a higher chance of reporting good quality of life. Late-life immigrants’ greater depression was partially contributed to their low income, lack of access to health care, poor physical health, and weak social relations. In contrast, regardless of the explanatory variables, migrating at middle age was associated with lower quality of life.Discussion and ImplicationsAcknowledging that the older immigrant population is segmented with unique susceptibilities improves understanding of heterogeneity among the older immigrant populations and allows for targeted intervention. Gerontological practitioners should include migration history during their intakes and more actively screen for depression with socially isolated Chinese older immigrants who migrated at a later age.

Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization. Cross-sectional data were derived from the Population Study of Chinese Elderly in Chicago (PINE) collected between July 2011 and June 2013 (N = 3,159). Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between depressive symptoms and physician visits, ED visits, and hospitalization. U.S. Chinese older adults with depressive symptoms were more likely to have at least one ED visit (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.44–2.28) and hospitalization (OR = 1.9, 95% CI = 1.47–2.33) in the past 2 years than those without depressive symptoms, while adjusting for sociodemographic and health-related covariates. Other significant factors associated with health services utilization in this population included number of people in household, health insurance coverage, and acculturation. Depressive symptoms are positively associated with hospitalization and ED visits among U.S. Chinese older adults. Routine screenings of depressive symptoms should be part of the clinical encounter in these care settings so that appropriate treatment or timely mental health service referrals could be provided to this population to ultimately optimize their utilization of health services.

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

Elder self-neglect is a global public health and human rights issue that threatens older people’s health and safety. It commonly refers to refusal or failure to provide oneself with care and protection in areas of food, water, clothing, hygiene, medication, living environments, and safety precautions. While prevalent, the status of self-neglecting individuals remains largely unclear, in particular within community-dwelling populations. By reviewing the epidemiology of elder self-neglect (definition, prevalence, risk factors, and consequences) to date, the present paper identifies key research gaps such as methodological inconsistency in case identification and measurement, and study designs that are inadequate to determine risk factors of self-neglect. More importantly, in light of the rapidly growing older population, relevant stakeholders (researchers, healthcare providers, social service providers, legal professionals, community organizations, and policymakers) must be prepared for an expected increasing number of self-neglect cases and enlarging scope of the problem. Hence, in this article, I present an overview regarding the management issues of elderly self-neglect related to the detection, assessment, reporting and referral, and decision-making capacity. Based on the current literature, the paper is aimed to explore the present knowledge and challenges, and how they can pave the way for solutions to self-neglect research, practice, and policy.

The previous researchers have postulated that an abused child may abuse his or her abuser parent when the parent is getting old, also known as the intergenerational transmission of violence. However, few studies use data to support this model, and it has yet to be examined in the U.S. Chinese community. This study aims to examine the association between childhood abuse and elder abuse reported by Chinese adult children in the United States. Guided by a community-based participatory research approach, 548 Chinese adult children aged 21 years and older participated in this study. Childhood abuse was assessed by four-item Hurt–Insult–Threaten–Scream (HITS) scale. Elder abuse was assessed by a 10-item instrument derived from the Caregiver Abuse Screen (CASE). Logistic regression analysis was performed. Childhood abuse was associated with caregiver abuse screen results (odds ratio = 1.92, 95% confidence interval = 1.24–2.95). Being physically hurt (r = .13, p < .01), insulted (r = .15, p < .001), threatened (r = .12, p < .01), and screamed at (r = .18, p < .001) as a child were significantly correlated with caregiver abuse screen results. This study suggests that childhood abuse is associated with increased risk of elder abuse among Chinese adult children in the United States. Longitudinal research should be conducted to explore the mechanisms through which childhood abuse and its subtypes links with elder abuse.

Self-neglect and suicidal ideations are important public health issues among the aging population. This study aims to examine the association between self-neglect, its phenotypes, and suicidal ideation among U.S. Chinese older adults. Guided by a community-based participatory research approach, the Population Study of Chinese Elderly in Chicago (PINE) study is a population-based epidemiological study conducted from 2011 to 2013 among 3,159 Chinese older adults aged 60 years and older in the Greater Chicago area. Self-neglect was assessed by a 27-item instrument, describing five phenotypes with hoarding, poor personal hygiene, unsanitary condition, lack of utilities, and need of home repair. Suicidal ideation was assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9) and the Geriatric Mental State Examination-Version A (GMS-A). Logistic regression is utilized to analyze the association. Higher level of self-neglect was found significantly associated with increased risk of self-reported suicidal ideation within 2 weeks (odds ratio 2.97 [1.54–5.72]); 12 months (odds ratio 2.82 [1.77–4.51]); and lifetime (odds ratio 2.74 [1.89–3.95]). For phenotypes, the study found that poorer personal hygiene and severer level of unsanitary conditions were associated with increased risk of suicidal ideation at all three time periods. This study suggests that self-neglect and its phenotypes are significantly associated with suicidal ideation among Chinese older adults. Longitudinal studies are needed to explore the mechanisms through which self-neglect links with suicidal ideation.

This study aims to assess cognitive change in a 2-year period among U.S. Chinese older adults and examine sociodemographic characteristics associated with the change. Data were from the Population Study of Chinese Elderly (PINE) in which 2,713 participants (aged 60 and older) received in-home interviews at both the baseline and 2-year follow-up. A battery of cognitive tests that assessed episodic memory, working memory, perceptual speed, and overall cognitive status were administered in both times. A composite global cognition was constructed using all tests. Mixed-effect regression was conducted. Older age was associated with worse baseline cognition (ie, in all cognitive abilities) and faster decline in global cognition, episodic memory, and perceptual speed—rates of decline increased by .006, .004, and .009 standard score units, respectively, for each year older. More education was associated with better baseline cognition, but each year of additional schooling increased rates of decline in global cognition and episodic memory by .004 and .012 standard score units, respectively. Men performed better than women in most cognitive abilities at baseline but had faster rates of decline in working memory. Higher income was associated with better cognition at baseline and reduced rates of decline in working memory. Findings suggest differences in the rates of cognitive change by age, sex, education, and income. Those in advancing age are vulnerable to cognitive decline. The effects of education and sex on baseline performance versus change suggest a role for life experiences in cognition.

Elder abuse (EA) is a global public health issue. However, no prior longitudinal research has quantified the incidence of EA, which is critical to understand risk factors and future prevention strategies. The study is based on a longitudinal cohort design. We followed 2,713 U.S. Chinese older adults who agreed to participate in the study within 2011 to 2015. A structured questionnaire was used to collect data regarding the 2-year incidence of EA and its subtypes. We employed multiple logistic regression analyses to examine the associations between the sociodemographic characteristics and incident EA. The incidence of overall EA was 8.8% with 4.8% for psychological, 2.9% for financial, 0.5% for physical, 0.1% for sexual abuse, and 1.1% for caregiver neglect. Age, gender, duration of residence, language preference and health status change were associated with incident EA. Self-perceived worsened health was positively associated with overall EA (odds ratio [OR] 1.28 (1.01, 1.62). Women (OR 2.98 [1.10, 8.11]) and older individuals (OR 1.06 [1.00, 1.13]) had an increased risk of caregiver neglect. Older adults who have lived in the U.S. longer had a higher risk of financial exploitation (OR 1.02 [1.00, 1.05]). Individuals who prefer to speak Mandarin or English were more likely to experience EA (OR 2.08 [1.21, 3.58]) and sexual or physical abuse (OR 3.91 [1.01, 15.17]). No significant association was observed between education, income, marital status, number of children, country of origin, overall health, life quality, and incident EA. This study presents the first illustration of EA incidence in a longitudinal cohort study, the findings of which verify and challenge prior fundamental assumptions of risk factors associated with EA, and are relevant to future prevention strategies.