Ethnic Differences In the Measurement of Physical Functioning for Older Asian Americans

Background and Purpose: According to the 2000 Census, there are more than 900,000 Asian Americans aged 65 and older in the US. By the year 2050, it is estimated that this population will account for 6.3% of the total elderly US population. Evidence from recent decades suggests that there have been dramatic increases in both population and diversity of Asian elderly in the US. This paper examines a measure of physical functioning for a nationally representative sample of older Asian Americans. Physical functioning is an important indicator of well-being and has broad implications for health status among the elderly. Because of the inherent differences in language, cultural practices, migration history and support systems, it is hypothesized that the measurement properties of physical functioning would vary among these groups.

Methods: This paper used data from the 2009 American Community Survey (ACS), collected annually by the US Census Bureau. Analysis from the ACS critically impacts policy decisions regarding issues such as funding for services based on functional disabilities. The six functional disability items are 1) Difficulty hearing, 2) Difficulty seeing, 3) Difficulty concentrating, remembering, or making decisions, 4) Difficulty walking or climbing stairs, 5) Difficulty dressing or bathing, and 6) Difficulty going out alone.

Reliability and confirmatory factor analysis were conducted on the items, first for Asian elders aggregated as a group, and then separately for Chinese, Filipino, Vietnamese, Korean and Japanese. The overall sample consisted of 30,257 individuals aged 50 and older, with 10,084 Chinese, 7,945 Filipino, 3,323 Vietnamese, 3,511 Korean and 4,533 Japanese elders.

Results: Initial analysis on the dimensionality of the six-item scale measuring functional disability indicated a poor fit with the data. “Difficulty remembering” was dropped from the scale due to empirical evidence as well as inherent problems in capturing cognitive decline for an elderly population. The final congeneric model included five items, in which the error measurements of “Difficulty hearing” and “Difficulty seeing” were correlated. This model was supported reasonably well with the aggregated sample (χ2 =65.82, df = 4, p < 0.001, RMSEA = 0.0226, GFI = 0.956, AGFI = 0.833). Separate CFA models with the exact factor pattern for each of the ethnic group yielded similar results. Factor loadings for the items were fairly similar, with the exception of “Difficulty seeing”, which differed substantially across each of the ethnic groups.

Conclusions and Implications: Results suggest that the five item scale for disability reasonably captures physical functioning for the overall older Asian population. Although the goodness of fit statistics for the congeneric measurement model was similar across all groups, evidence of differences in factor loadings suggest that this measure may not be appropriate for cross-ethnic comparison. Public policy regarding funding for services should take into account how physical functioning, particularly visual impairment, may be perceived differently among Asian subgroups. Future research should also establish a meaningful clinical cutoff score of physical functioning for both clinical services and interventions.