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Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States

BACKGROUND AND OBJECTIVES: Advance care planning (ACP) is a critical component of health care affecting the quality of later life. Responding to the increase in the older immigrant population in the United States, this empirical study explored the racial/ethnic gaps in ACP behaviors among older immi...

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Autor principal: Grace Yi, Eun-Hye
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561643/
https://www.ncbi.nlm.nih.gov/pubmed/31206041
http://dx.doi.org/10.1093/geroni/igz012
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author Grace Yi, Eun-Hye
author_facet Grace Yi, Eun-Hye
author_sort Grace Yi, Eun-Hye
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description BACKGROUND AND OBJECTIVES: Advance care planning (ACP) is a critical component of health care affecting the quality of later life. Responding to the increase in the older immigrant population in the United States, this empirical study explored the racial/ethnic gaps in ACP behaviors among older immigrants and examined the end-of-life (EOL) care planning and preferences of foreign-born immigrant older adults focusing on race/ethnicity, acculturation, health need factors, and enabling social factors (financial capability, public assistance, and informal supports) after controlling predisposing factors (sociodemographic characteristics). RESEARCH DESIGN AND METHODS: Using a subsample from the National Health and Aging Trends Study 2011 and 2012, hierarchical logistic regression models of the EOL plan and preferences were examined with 50 multiple imputation data sets (n = 232). RESULTS: Descriptive statistics reveal lower ACP engagement of immigrants from racial/ethnic minority groups. In logistic models, however, only Black immigrants were less likely than Whites to have EOL conversations. Among acculturation factors, age at immigration was only negatively associated with having a durable power of attorney for health, but not significantly associated with other ACP behaviors. Instead, health and social factors, primarily need in health and informal support (i.e., number of coresidents and receiving financial help from family members), were associated with different types of ACP components. Receiving public assistance (i.e., receiving Medicaid and SSI) were positively associated with EOL treatment preferences. DISCUSSION AND IMPLICATIONS: Older foreign-born immigrants, in general, showed lower ACP engagement than the overall older population. Moreover, minority immigrants were lower on ACP engagement than both White immigrants. This study highlights the need for formal and informal assistance for enhancing EOL planning for older immigrants. Adding to the culturally competent approach, policy efforts should address social and health factors that accrued throughout individuals’ life spans and affect older immigrants’ EOL preparation and care.
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spelling pubmed-65616432019-06-14 Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States Grace Yi, Eun-Hye Innov Aging Original Research Article BACKGROUND AND OBJECTIVES: Advance care planning (ACP) is a critical component of health care affecting the quality of later life. Responding to the increase in the older immigrant population in the United States, this empirical study explored the racial/ethnic gaps in ACP behaviors among older immigrants and examined the end-of-life (EOL) care planning and preferences of foreign-born immigrant older adults focusing on race/ethnicity, acculturation, health need factors, and enabling social factors (financial capability, public assistance, and informal supports) after controlling predisposing factors (sociodemographic characteristics). RESEARCH DESIGN AND METHODS: Using a subsample from the National Health and Aging Trends Study 2011 and 2012, hierarchical logistic regression models of the EOL plan and preferences were examined with 50 multiple imputation data sets (n = 232). RESULTS: Descriptive statistics reveal lower ACP engagement of immigrants from racial/ethnic minority groups. In logistic models, however, only Black immigrants were less likely than Whites to have EOL conversations. Among acculturation factors, age at immigration was only negatively associated with having a durable power of attorney for health, but not significantly associated with other ACP behaviors. Instead, health and social factors, primarily need in health and informal support (i.e., number of coresidents and receiving financial help from family members), were associated with different types of ACP components. Receiving public assistance (i.e., receiving Medicaid and SSI) were positively associated with EOL treatment preferences. DISCUSSION AND IMPLICATIONS: Older foreign-born immigrants, in general, showed lower ACP engagement than the overall older population. Moreover, minority immigrants were lower on ACP engagement than both White immigrants. This study highlights the need for formal and informal assistance for enhancing EOL planning for older immigrants. Adding to the culturally competent approach, policy efforts should address social and health factors that accrued throughout individuals’ life spans and affect older immigrants’ EOL preparation and care. Oxford University Press 2019-06-12 /pmc/articles/PMC6561643/ /pubmed/31206041 http://dx.doi.org/10.1093/geroni/igz012 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Research Article
Grace Yi, Eun-Hye
Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States
title Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States
title_full Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States
title_fullStr Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States
title_full_unstemmed Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States
title_short Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States
title_sort does acculturation matter? end-of-life care planning and preference of foreign-born older immigrants in the united states
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561643/
https://www.ncbi.nlm.nih.gov/pubmed/31206041
http://dx.doi.org/10.1093/geroni/igz012
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