Dietary and health supplement use among older Australians: results from a national survey

Objectives: To measure the extent of dietary and health supplement use among older Australians and to contrast older supplement users from older non‐supplement users. Method: Survey participants (n= 1,263) provided information related to demographic, health and lifestyle features. The target population were Australians aged 65 years and over, randomly chosen from the Australian Electoral Commission. Data was obtained using a 12‐page self‐administered, mail questionnaire. Results: Forty‐three percent (n=548) of the sample reported using at least one dietary and health supplement, 52% of females and 35% of males. Supplement use was significantly related to several demographic and lifestyle features including: gender, educational level, smoking status and number of visits to complementary health therapists. Conclusions: Clearly, supplements were chosen more for their perceived ability to attenuate or modify ailments, rather than their role in correcting nutritional deficiencies. Older Australians appear intent on taking health matters in their own hands. Approximately one third of them rarely inform their doctor about the supplements they use, which raises concerns about the safety and appropriateness of this action.     

Medicines and disease information needs of older Arabic‐speaking Australians

Aim: To explore access, satisfaction, awareness and needs for medicines and disease information (MADI) sources for older Arabic‐speaking Australians. Method: Five focus groups were conducted (in Arabic) with 29 participants with a chronic disease, aged over 65 years, and unable to speak or read English fluently. Discussions were audiotape recorded, simultaneously interpreted into English, transcribed verbatim and content analysed. Results: Arabic‐speaking general practitioners were identified as the main source of MADI, despite dissatisfaction with their counselling. Written Arabic MADI was not accessed by participants, who revealed low English and Arabic literacy levels and a reliance on family members to act as interpreters. Male participants were more concerned and active about their health and medicine information than female participants. Conclusions: This study highlighted limited availability and access to Arabic MADI for older Arabic‐speaking Australians, with reliance on Arabic‐speaking health‐care professionals for information and family members as interpreters. An accessible and sustainable system for MADI is required.     

Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: site-specific results from the REACH national collaborative study

PURPOSE: Few empirical studies have compared the efficacy between psychoeducational (skill-building) approaches for reducing caregivers' psychological distress and interventions modeled after typical community-based support groups. We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia. DESIGN AND METHODS: The change from preassessment to postassessment (baseline to 3 months) for 213 female caregivers (122 Anglo and 91 Latino) is presented. They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program (instruction and practice in small groups to learn specific cognitive and behavioral skills) or in the Enhanced Support Group condition (guided discussion and empathic listening to develop reciprocal support within the group). Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers, and they were delivered in either English or Spanish by trained interventionists. RESULTS: Overall, participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms, increased use of adaptive coping strategies, and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition. Results were similar for both ethnic groups: there were no main effects for ethnicity, and no significant ethnicity by treatment interaction effects. IMPLICATIONS: This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone. We find it very encouraging that the Latino caregivers responded well on key outcome variables, suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs.     

Oral health beliefs and practices among Greek and Italian older Australians: A focus group approach

Introduction: The oral health of older Australians is a major public health challenge in the twenty‐first century. However, little is known about the oral health status and needs of older migrants. Aims: This paper uses a qualitative methodology to obtain a better understanding of the oral health meanings and experiences of Greek and Italian older migrants. Methods: Seventeen focus group discussions were conducted, made up of 172 participants, recruited from eight Italian and nine Greek elderly clubs in Melbourne. Results: Participants were aware of the major oral diseases and treatments available. The data suggests that, although they knew of the need for periodic dental check‐ups, there were barrier, which interfered with seeking check‐ups. Participants also held a number of false beliefs, and strong negative attitudes towards dentistry. Conclusion: If programs are to increase the use of oral health services, specific barriers, myths, false beliefs and negative attitudes must be addressed.     

Ethnicity and stress among older Australians

The impact of ethnicity on the stress process in old age was examined using two surveys of Australians aged 60 years and older. Four different "ethnic strata" were defined: namely, mainstream Australians, British migrants, and non-British migrants--who were split on the basis of whether their English proficiency was good or poor. The ethnic stratum most different from mainstream Australian, non-British migrants with poor English proficiency, was a significant predictor of psychological distress in the context of other relevant variables. Within the four "ethnic" strata, network variables were significantly related to psychological distress only for non-British migrants, with relatives being important for those with poor English and nonrelatives for those with good English. For mainstream Australians, female gender, poor health, and specific living arrangements were significant predictors of psychological distress.     

The Role of Acculturation in Health Status and Utilization of Health Services among the Iranian Elderly in Metropolitan Sydney

The present study explores the impact of acculturation on health status and use of health and community aged care services among elderly Iranian-born immigrants to Australia. Three hundred two Iranian immigrants aged 65 years and over who had lived in the Sydney Metropolitan area for at least six months participated. Data were collected using a written survey instrument, face-to-face interviews, and telephone interviews. Iranian immigrants had higher levels of psychological distress, more limited physical function, greater need for help or assistance with activities of daily living, lower feelings of wellbeing, and were much less likely to use aged care services than the general population of older Australians. Participants who did not speak English at home were more likely to experience psychological distress and had greater limitations in their physical functioning. Elderly Iranians with better English proficiency had lower levels of anxiety and depressive symptoms and reported less need for help and supervision in activities of daily living; they were also more likely to access health care services. Elderly Iranian immigrants experience higher levels of psychological distress and lower levels of physical function than the general population of older Australians; those with limited proficiency in English are at greatest risk. These findings contribute to the enrichment of multicultural policy, social fairness, access, and equity for ethnic aged people.     

Ethnic Identity of Older Chinese in Canada

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.     

Awareness and Completion of Advance Directives in Older Korean‐American Adults

There has been growing concern about racial and ethnic disparities in completion rates of advance directives (ADs) in community‐dwelling older populations. Although differences in AD completion rates between non‐Hispanic whites and African Americans have been reported, not much is known about the awareness and completion of ADs in other groups of ethnic minorities. Using a sample of community‐dwelling Korean‐American older adults (n = 675) as a target, factors associated with their awareness and completion of ADs were explored. Guided by Andersen's behavioral health model, predisposing (age, sex, marital status, education), need (chronic conditions, functional disability), and enabling (health insurance, acculturation) variables were included in the separate logistic regression models of AD awareness and AD completion. In both models, acculturation was found to be a significant predictor; those who were more acculturated were more likely to be aware of ADs and to have completed ADs. This study contributes to the knowledge about the role of acculturation in explaining AD awareness and completion in Korean‐American older adults and provides recommendations for possible AD educational interventions for this older adult minority population.     

Knowledge and Beliefs of Older Australians about Sexuality and Health

Objective : To report on the relationships between a range of demographic and social variables of a sample of older Australians and their answers to six questions concerning sexuality and health in later life Method : A self‐completed questionnaire was returned by 844 randomly selected older persons. Two questions were included as indicators of older Australians' knowledge of the impact of health on sexuality in later life; two questions examined beliefs about the possible physical and psychological benefits of sexuality; and two questions examined older people's expectations of sexuality as people age Results : Regression analysis was performed to test for associations between sexual ‘awareness’ and gender, age, relationship status, marital status, number of sexual partners and spirituality. Responses were combined into what we have called a ‘Sexual Health Knowledge and Beliefs Index’ (SHKB Index). The results show that males and those currently in sexual relationships have significantly higher scores on this index. There were, however, significant differences for individual item scores by gender, age, being in a sexual relationship, and number of sexual partners Conclusions : The study discusses how the SHKB Index can be used to identify people who have poorer knowledge and less positive attitudes towards sexuality in later life so that education and services can be planned accordingly.     

Self‐provision in retirement: Quantitative evidence on older Australians’ expectations and experiences

Objectives: To explore factors that correlate with expectations and experiences of self‐provision in retirement. Methods: A regression modelling approach is adopted using a national survey that contains data on the retirement expectations and experiences of older Australians. Results: Older Australians approaching retirement are more likely to expect to be self‐funded in retirement if they possess high qualification levels, stable employment and have healthy levels of wealth holdings. Divorced or separated older women are more likely to expect to be welfare‐reliant than other groups. The presence of children, disabilities and residence outside major cities do not affect prospective retirees’ expectations of being primarily self‐funded in retirement, but they do impact negatively on actual self‐provision in retirement. Forced retirement will significantly decrease the probability of self‐provision in retirement. Conclusions: Policy reforms that focus on increasing employment opportunities for women after child‐bearing and promoting retirement choice will reduce welfare reliance among older Australians.     

Difference in subjective well-being between ethnic Korean and Japanese elderly residents in an urban community in Japan

Background:   The ethnic Korean community in Japan has witnessed the increasing aging of their population structure. The purpose of our study was to clarify the differences in standards of living between elderly ethnic Korean and elderly Japanese populations living in Japan, and to examine whether there is any difference in subjective well-being between the two populations.
Methods:   We conducted a cross-sectional questionnaire-based survey that consisted of items addressing ethnicity, age, gender, literacy, living conditions, mental health, "sense of purpose in life", activities of daily living (ADL), medical history, quality of life (QOL), and receipt of pension benefits and public assistance; the participants were 425 elderly people (ethnic Korean residents in Japan, n  = 204; Japanese, n  = 221) aged 65 and older living in a community in Osaka City. Findings from the two groups were compared using the Student's t -test and the χ² test. We also employed multiple linear regression analysis.
Results:   We found that the ethnic Korean group had less formal education ( P  < 0.001), lower ADL ( P  < 0.05) and QOL ( P  < 0.001), higher illiteracy ( P  < 0.05) and depression rates ( P  < 0.001), and a higher prevalence of hypertension, myocardial infarction and diabetes mellitus than the Japanese group. Ethnicity was a significant variable for subjective well-being in simple linear regression analysis. After adjusting for literacy, absence of sense of purpose in life and mental health in multiple regression analysis, ethnicity remained a significant variable.
Conclusions:   The present findings indicate that ethnic Korean elderly have poor health and social situations compared with the Japanese group, and that there was a difference in subjective well-being between the two ethnic groups.     

The accuracy of older and younger Australians' understanding of mental health and aging.

Inadequacies in contemporary mental health care for elderly individuals may come about partly through ignorance of both positive aspects of mental health in old age (e.g., the responsiveness of older clients to psychotherapy) and the negative aspects (e.g., elderly men's unusually high suicide risk). A quiz measuring knowledge of both kinds was administered to a total of 250 Australian men and women aged seventeen to eighty-one years who were either retired, employed, housewives, or university students. As hypothesized, the retired group scored lowest on the quiz, with no significant differences among younger students versus non-students. Age was found to be a more important mediator of the retired group's low scores than gender, living with an older person, or self-definition as retired versus employed or a housewife. A previous finding of higher scores by Australians than by U.S. undergraduates in an aging course was also replicated and extended to older nonstudent groups. Implications of these findings for mental health services for elderly individuals and for educational interventions to improve understanding of mental health in older age groups were considered.     

Gender and ethnic/racial disparities in health care utilization among older adults

OBJECTIVE: We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults. METHODS: Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access. RESULTS: African American men had fewer physician contacts; minority and non-Hispanic White women used fewer hospital or outpatient surgery services; minority men used less outpatient surgery; and Hispanic women were less likely to use nursing home care, compared with non-Hispanic White men, controlling for predisposing factors and measures of need. Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. However, economic access accounted for minority disparities in dental care, which is not covered by Medicare. DISCUSSION: Medicare plays a significant role in providing older women and minorities access to medical services. Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities.     

Age at migration, social connections, and well-being among elderly Hispanics

This study employs data from the 1988 National Survey of Hispanic Elderly People to examine the impact of age at migration and social contacts on the self-assessed health, functional disability, and life satisfaction of elderly Cuban Americans, Mexican Americans, and Puerto Ricans in the United States. The results indicate that the difficulties associated with immigration late in life undermine an older person's morale and interfere with the ability to perform basic activities of daily living. Although children are important sources of social support for all Hispanic groups, our findings also reveal important group differences in the use of other community social resources and their impact on health. Older Cuban Americans, in particular, appear to benefit from residence in ethnic enclaves in which they have largely duplicated their culture of origin.     

Ethnic differences in self-rated health among older adults: a cross-sectional and longitudinal analysis

The objectives of this study were to examine whether self-rated health differs among older adults of different ethnic backgrounds and to explore what factors may account for potential differences. The study was based on the 1983 and 1996 waves of the Aging in Manitoba study. A self-report measure of ethnic background was used to categorize participants into four groups: British/Canadian, Northern/Central European, Eastern European, and Other. In both 1983 and 1996, older Eastern European adults had significantly reduced odds of rating their health as good or excellent relative to British/Canadian adults. Controlling for demographic variables, socioeconomic status, language spoken, and health status attenuated but did not eliminate the difference. Global, subjective ratings of health are frequently used to measure health. The ethnic differences found here suggest, however, that ratings may be influenced by cultural factors, which may warrant some caution in making comparisons across ethnic groups.     

Individualism, Collectivism and Ethnic Identity: Cultural Assumptions in Accounting for Caregiving Behaviour in Britain

Britain is experiencing the ageing of a large number of minority ethnic groups for the first time in its history, due to the post-war migration of people from the Caribbean and the Indian subcontinent. Stereotypes about a high level of provision of informal caregiving among minority ethnic groups are common in Britain, as in the US, despite quantitative studies refuting this assumption. This paper reports on a qualitative analysis of in-depth interviews with older people from five different ethnic groups about their conceptualisation of their ethnic identity, and their attributions of motivations of caregiving within their own ethnic group and in other groups. It is argued that ethnic identity becomes salient after migration and becoming a part of an ethnic minority group in the new country. Therefore, White British people who have never migrated do not have a great sense of ethnic identity. Further, a strong sense of ethnic identity is linked with identifying with the collective rather than the individual, which explains why the White British participants gave an individualist account of their motivations for informal care, whereas the minority ethnic participants gave a collectivist account of their motivations of care. Crucially, members of all ethnic groups were providing or receiving informal care, so it was the attribution and not the behaviour which differed.     

Health and social needs of older Australians from culturally and linguistically diverse backgrounds: issues and implications

Australia has one of the most diverse migrant populations in the world. This pattern of cultural diversity is also reflected in the older population, with increasing numbers of older people from culturally and linguistically diverse (CALD) backgrounds. The aim of the present review is to examine the evidence base related to the health and social needs and existing support systems for older Australians from CALD backgrounds. It is difficult to generalise the issues and challenges associated with these groups because of their heterogeneity, both between and within groups. However, their health and social needs may be particularly acute as a result of cultural and language barriers; their geographical location and the circumstances of migration, which impact on their financial circumstances as well as psycho‐social health. Whilst there is a range of community and government stakeholders involved in addressing these issues, the evidence base for policy and practice is not well understood.     

Health insurance reform and older Australians

Objectives: This study aims to (i) document the changing proportions of older persons with health insurance in a period of policy change, (ii) examine why older persons do and do not purchase health insurance, and (iii) discuss these findings in relation to implications for current and future cohorts of the aged. Method: Data from the Private Health Insurance Administrative Council and the ABS are used to estimate cross‐sectional and cohort shifts in health insurance coverage among persons aged 55 years and over. Results: Prior to recent reforms, approximately 37% of persons aged 55 years and older have hospital health insurance compared with 45% in 2001, with considerable variation in coverage by age and sex. Conclusion: Health insurance coverage has increased among older Australians, albeit disproportionately. Affordability remains a key issue for older Australians and may become more problematic in future age cohorts.     

Use of annual physical examinations by aging Chinese Canadians

OBJECTIVES: This study identified predictors of use of annual physical examination by aging Chinese Canadians. METHODS: Data were collected from a random sample of 2,272 Chinese Canadians aged 55 and older. Based on the Andersen-Newman service utilization framework, hierarchical logistic regression analysis was used to examine the predictors of annual physical examination use. RESULTS: Predicting factors of annual physical health examination use were marital status, gender, length of residency in Canada, Chinese ethnic identity, social support, number of illnesses, dependency in instrumental activities of daily living (IADL), and depressive symptoms. DISCUSSION: Findings showed importance in targeting identified groups for preventive health education. Strengthened ethnic identity may serve to enhance one's social support network, which in turn facilitates the use of annual physical examinations. There may be awareness within the Chinese cultural network that builds education and attentiveness to preventive health care. The misconceptions about annual physical examinations were also discussed.