Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Grace Yi EH

PROVIDER: S-EPMC6561643 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

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

Grace Yi Eun-Hye EH

Innovation in aging 20190501 2

<h4>Background and objectives</h4>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 socia ...[more]

PMID: 31206041

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Project description:BACKGROUND:Media reporting on communicable diseases has been demonstrated to affect the perception of the public. Communicable disease reporting related to foreign-born persons has not yet been evaluated. OBJECTIVE:Examine how political leaning in the media affects reporting on tuberculosis (TB) in foreign-born persons. METHODS:HealthMap, a digital surveillance platform that aggregates news sources on global infectious diseases, was used. Data was queried for media reports from the U.S. between 2011-2019, containing the term "TB" or "tuberculosis" and "foreign born", "refugee (s)," or "im (migrants)." Reports were reviewed to exclude duplicates and non-human cases. Each media source was rated using two independent media bias indicators to assess political leaning. Forty-six non-tuberculosis reports were randomly sampled and evaluated as a control. Two independent reviewers performed sentiment analysis on each report. RESULTS:Of 891 TB-associated reports in the US, 46 referenced foreign-born individuals, and were included in this analysis. 60.9% (28) of reports were published in right-leaning news media and 6.5% (3) of reports in left-leaning media, while 39.1% (18) of the control group reports were published in left- leaning media and 10.9% (5) in right-leaning media (p < .001). 43% (20) of all study reports were posted in 2016. Sentiment analysis revealed that right-leaning reports often portrayed foreign-born persons negatively. CONCLUSION:Preliminary data from this pilot suggest that political leaning may affect reporting on TB in US foreign-born populations. Right-leaning news organizations produced the most reports on TB, and the majority of these reports portrayed foreign-born persons negatively. In addition, the control group comprised of non-TB, non-foreign born reports on communicable diseases featured a higher percentage of left-leaning news outlets, suggesting that reporting on TB in foreign-born individuals may be of greater interest to right-leaning outlets. Further investigation both in the U.S. and globally is needed.

Project description:ObjectiveTo synthesize outputs and outcomes of community-based tuberculosis targeted testing and treatment (TTT) programs in foreign-born populations (FBP) in the United States (US).MethodsWe systematically searched five bibliographic databases and other key resources. Two reviewers independently applied eligibility criteria to screen citations and extracted data from included studies. We excluded studies that contained <50% FBP participants or that examined steps only after diagnosis of latent TB infection (LTBI). We stratified studies as majority FBP (50-90%) and predominantly FBP (>90%). We used random-effects meta-analytic models to calculate pooled proportions and 95% confidence intervals (CI) for community-based TTT cascade steps (e.g., recruited, tested and treated), and used them to create two hypothetical cascades for 100 individuals.ResultsFifteen studies conducted in 10 US states met inclusion criteria. Studies were heterogeneous in recruitment strategies and mostly recruited participants born in Latin America. Of 100 hypothetical participants (predominantly FBP) reached by community-based TTT, 40.4 (95% CI 28.6 to 50.1) would have valid test results, 15.7 (95% CI 9.9 to 21.8) would test positive, and 3.6 (95% CI 1.4 to 6.0) would complete LTBI treatment. Likewise, of 100 hypothetical participants (majority FBP) reached, 77.9 (95% CI 54.0 to 92.1) would have valid test results, 26.5 (95% CI 18.0 to 33.5) would test positive, and 5.4 (95% CI 2.1 to 9.0) would complete LTBI treatment. Of those with valid test results, pooled proportions of LTBI test positive for predominantly FBP and majority FBP were 38.9% (95% CI 28.6 to 49.8) and 34.3% (95% CI 29.3 to 39.5), respectively.ConclusionsWe observed high attrition throughout the care cascade in FBP participating in LTBI community-based TTT studies. Few studies included cascade steps prior to LTBI diagnosis, limiting our review findings. Moreover, Asia-born populations in the US are substantially underrepresented in the FBP community-based TTT literature.

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Dataset Information

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

Background and objectives

Research design and methods

Results

Discussion and implications

Publications

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

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