Mental Health Issues in Racial and Ethnic Minority Elderly

Chronic pain as a mediator in the falls-frailty association: Evidence from middle-aged and older ethnic minorities in Yunnan, China

BACKGROUND

Falls are associated with an increased risk of frailty in middle-aged and older adults; however, the mediating role between falls and frailty remains underexplored, particularly among ethnic minority groups with distinct sociocultural and environmental exposures. Ethnic minority populations exhibit significant disparities in the prevalence of falls, frailty, and chronic pain compared to the majority. The primary objective of this study is to examine the relationship between falls and frailty in middle-aged and elderly individuals residing in Yunnan Province, China, with a specific emphasis on exploring the potential mediating effect of chronic pain across different ethnic groups.

METHODS

Employing a cross-sectional design, data were collected from July to December 2022 from adults aged ≥45 years in five ethnically diverse counties of Yunnan Province, China. Structured face-to-face interviews and stratified multistage cluster sampling were used for data collection. Baron and Kenny's causal steps method was used to explore the mediating effect of chronic pain on the relationship between falls and frailty. Spearman correlation analysis, multiple linear regression models, and bootstrap method were used for data analysis.

RESULTS

A total of 2710 respondents participated in this study. The age distribution was as follows: 1161 (42.84 %) aged 45-59 years, 863 (31.85 %) aged 60-69 years, and 686 (25.31 %) aged 70 years or older. The sample comprised 1218 males (44.94 %) and 1492 females (55.06 %). The prevalence of falls among middle-aged and older individuals was 12.77 %, while the prevalence of frailty in the same population was observed to be 21.62 %. Spearman correlation analysis revealed significant positive association between chronic pain and both falls (r = 0.135, P < 0.05) as well as frailty (r = 0.383, P < 0.05). Frailty also exhibited a significant positive correlation with falls (r = 0.162, P < 0.05). After adjusting for all covariates, the total effect of falls on frailty was estimated to be 1.065 (95 % bootstrap CI: 0.804∼1.326), with a direct effect estimate of 0.797 (95 % bootstrap CI: 0.511∼1.083). The indirect effect of chronic pain on this association was found to be approximately one-quarter at 0.268 (95 % bootstrap CI: 0.170∼0.366). The subgroup analysis discovered differences in the mediating effects across different ethnic groups; specifically, the proportions mediated by chronic pain were found to be 28.2 %, 18.4 %, and 21.5 % for Han majority group, Zhiguo ethnic minorities, and other ethnic minority groups, respectively.

CONCLUSION

This study provides valuable insights into the intricate association between frailty, falls, and chronic pain among middle-aged and older adults from diverse ethnic backgrounds in a western province of China. Effective management strategies targeting chronic pain and falls prevention could serve as crucial interventions to address frailty.

Factors affecting life satisfaction among retired older adults

Background

The population of older adult people is rapidly increasing in South Korea. Consequently, older adult people's life satisfaction, especially the retired older adult, is emerging as a social issue and not just an individual problem.

Objective

This study aimed to examine and identify the factors affecting the life satisfaction of the retired older adult.

Methods

A cross-sectional descriptive design was employed. The sample included 149 retired older adults living in Gyeonggi or Seoul, South Korea. The data included the general characteristics of study participants and the level of their life satisfaction, health conservation, self-efficacy, and social activity. The data was collected from January to February 2020 and analyzed using SPSS PC+ version 23.0.

Results

The factors affecting life satisfaction in retired older adults were health conservation (β = 0.28, p < 0.001), self-efficacy (β = 0.26, p = 0.001), marital status (β = 0.24, p = 0.001), social activity (β = 0.18, p = 0.018), and family relationships (β = -0.15, p = 0.048). The explanatory power of the final regression model was 59%.

Conclusion

The study suggests that to improve the life satisfaction of retired older adults, their health conservation, self-efficacy, social activity, and family relationships should be increased, and married status with spouse needs to be considered. Most importantly, health professionals need to pay attention to the factors that improve the life satisfaction of retired older adults in community fields.

Mental health status and associated contributing factors among the Hakka elderly in Fujian, China

Purpose

Little is known about the mental health of the Hakka elderly. This study explores the status of, and factors associated with mental health among Hakka elderly populations from Fujian, China.

Methods

This is a cross-sectional, community-based survey study containing a total of 1,262 valid samples. The Chinese version Symptom Checklist-90-R (SCL-90-R) was used to assess the mental health status of the Hakka elderly. We used t-tests to compare the differences for 10 dimensions of SCL-90-R scores between the Chinese national norm and the Hakka elderly. Univariate and multivariate analysis were performed by using linear regression analysis to identify the main socio-demographic factors that were most predictive of the total score of SCL-90-R in the Hakka elderly.

Results

The scores of somatization (1.78 ± 0.55 vs. 1.40 ± 0.46, P < 0.001) and phobic anxiety (1.21 ± 0.36 vs. 1.17 ± 0.31, P < 0.001) for the Hakka elderly in Fujian appeared to be significantly higher than the Chinese norm. The higher total scores of SCL-90-R were found among females (β = 0.030, P = 0.044), widowed persons (β = 0.053, P = 0.021), those with parent(s) alive (β = 0.047, P = 0.019), and those with poorer self-rated health status (β = 0.110, P < 0.001). The lower total scores of SCL-90-R were found among those who were currently living in town, those with lower education level, those with higher average annual household incomes, and those who were living with spouse or children.

Conclusion

The worse mental health conditions of the Hakka elderly in somatization and phobic anxiety were detected. The overall mental health status was shown to be worse among females, widowed persons, those who were living in village, those with lower education, and those with father or/and mother alive.

Diversify Your Emotional Assets: The Association Between the Variety of Sources of Emotional Support and Thoughts of Death or Self-harm Among US Older Adults

Using data from a nationally representative sample of community-dwelling older adults (age ≥ 65) (NHANES: n = 3,114), we examined the association between the variety in sources of emotional support and thoughts of death or self-harm in the past two weeks among US older adults and if such association is modified by gender and race/ethnicity. Overall, an additional category of source of emotional support was associated with the 0.36-fold lower odds of endorsing thoughts of death or self-harm in the past two weeks (WAOR: 0.64, 95% CI: 0.46-0.89), after controlling for demographic, socioeconomic, and health-related characteristics. The magnitudes of such association varied across different gender and racial/ethnic subgroups. While among older women and non-Hispanic Black older men, increase in the variety of sources of emotional support was associated with decrease in the odds of endorsing thoughts of death or self-harm in the past two weeks, for non-Hispanic White older men and Hispanic older men, increase in the variety of sources of emotional support was associated with increase in the odds of endorsing thoughts of death or self-harm in the past two weeks. Our findings highlight the importance of considering gender and race/ethnicity when designing and implementing successful interventions for reducing suicide ideation among diverse elderly persons.

Financial Preparedness for Emergencies: Age Patterns and Multilevel Vulnerabilities

Guided mainly by the social vulnerability perspective and life course perspective, this study examined age patterns of financial preparedness for emergencies and how they were contextualized by vulnerabilities at the individual and community levels. We matched data from the Federal Emergency Management Agency 2018 National Household Survey and 15 indicators of the Social Vulnerability Index at the county level. Two-level logistic regressions were conducted with the working sample, which included 4,623 respondents from 958 counties. The results showed that adults aged 18 to 44 were more likely than those aged 65 to 74 to set aside money for emergencies among Hispanics, those with minor children in the household, and in communities with higher levels of poverty, higher percentages of minorities, and higher percentages of no vehicles, but less likely to do so among the White and those with insurance. The findings were discussed within a multilevel layered vulnerability framework.

Issues of cultural competence in mental health care

As the United States' population continues to grow in its diversity, health care providers, including pharmacists, need to be able to provide culturally competent care to their patients. Cultural competence allows patients to feel comfortable with their provider and leads to their continuing to seek out care. Mental health is one of the most underused services in health care, particularly in underrepresented minority communities. This review looks at different published literature that assessed the reasons why individuals from minority communities may avoid seeking mental health care, cultural competence in psychiatric care for underrepresented minority communities, strategies for implementation for training providers in cultural competency, and barriers to implementation in mental health services. Current ideas include providing cultural competency training to students in their respective professional school or residency, incorporating the cultural formulation interview into psychiatric sessions, or increasing minority representation in the psychiatric services. On the basis of the literature examined, research is still needed to identify the best approach to improve culturally competent care in psychiatric services in the United States.

Mental health of older migrants migrating along with adult children in China: a systematic review

Due to urbanisation in China, about 7.74 million older people have migrated to urban centres, where their adult children reside and work, to care for their grandchildren. While older migrants may benefit from family reunion and mutual support, empirical studies have identified challenges to adaptation, integration and mental health. Employing a systematic literature review approach, this paper examines recent empirical studies on the mental health of older migrants migrating along with adult children in China, focusing on mental health and wellbeing outcomes and determinants and directions for social work interventions. It identifies directions for considering diversity in conceptualisations of mental health and in theoretical perspectives to enrich understanding of the experiences of Chinese older migrants migrating along with adult children and potential interventions.

Psychiatric Disorders Among Older Black Americans: Within- and Between-Group Differences

Psychiatric disorders impose significant personal, social, and financial costs for individuals, families, and the nation. Despite a large amount of research and several journals focused on psychiatric conditions, there is a paucity of research on psychiatric disorders among Black Americans (i.e., African Americans and Black Caribbeans), particularly older Black Americans. The present literature review examines research on psychiatric disorders among older Black Americans and provides a broad overview of research findings that are based on nationally representative studies. Collectively, this research finds: (1) older African Americans have lower rates of psychiatric disorders than younger African Americans; (2) family support is not protective of psychiatric disorders, whereas negative interaction with family members is a risk factor; (3) everyday discrimination is a risk factor for psychiatric disorders; (4) both older African Americans and African American across the adult age range have lower prevalence rates of psychiatric disorders than non-Latino whites; (5) Black Caribbean men have particularly high rates of depression, posttraumatic stress disorder, and suicide attempts; and (6) a significant proportion of African American older adults with mental health disorders do not receive professional help. This literature review also discusses the “Race Paradox” in mental health, the Environmental Affordances Model, and the importance of investigating ethnicity differences among Black Americans. Future research directions address issues that are directly relevant to the Black American population and include the following: (1) understanding the impact of mass incarceration on the psychiatric disorders of prisoners’ family members, (2) assessing the impact of immigration from African countries for ethnic diversity within the Black American population, (3) examining the impact of racial identity and racial socialization as potential protective factors for psychiatric morbidities, and (4) assessing racial diversity in life-course events and their impact on mental health.