Perceived Burdensomeness of Older Korean Americans to Their Healthcare Partners: An Egocentric Network Assessment

Given the healthcare navigation challenges faced by older immigrant populations and their dependency on informal networks, it is important to attend to older immigrants’ psychological experiences with their healthcare partnerships. Using older Korean Americans as a target group and egocentric assessment as a methodological tool, we have examined how ego- and alter-related characteristics are associated with older adults’ perceived burdensomeness toward their healthcare partners. Survey information from older adults and their responses to a name-generating prompt yielded nested data for 2,150 egos and 3,402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. More than 83% of the healthcare partners named by the present sample of older Korean Americans were family members, a vast majority of whom were spouses or adult children. Perceived burdensomeness was negatively associated with English-speaking ability (B = −.05, SE = .02, p < .05), residence in a low-Korean-density area (B = −.17, SE = .04, p < .001), and emotional support received from alters (B = −.10, SE = .03, p < .01). In our exploration of cross-level interactions, we found that the link between emotional support and perceived burdensomeness was moderated by chronic medical conditions (B = −.05, SE = .02, p < .05). The burden-reducing benefit of emotional support was most notable among older adults with multi-comorbidities. Our findings call attention to the importance of social exchanges of comfort, companionship, consolation, and affection, particularly for those with greater health challenges. By identifying older immigrants prone to the sense of burdensomeness, the study informs programs and policies to promote their health and healthcare. Given that those with deprived personal resources (e.g., limited English proficiency) tend to be highly dependent on informal networks for their healthcare needs, resulting in increased feelings of burdensomeness, they should be prioritized in programs for healthcare navigation assistance. Provision of formal services with language assistance would help older immigrants with limited English proficiency become more self-sufficient in healthcare use and gain a sense of independence and dignity congruent with their culturally prescribed role for older adults. Given the context of collectivism and familism, family involvement in older Asians’ healthcare has often been regarded as a cultural norm. However, our findings shed light on older adults’ psychological responses to receiving help in the context of healthcare, highlighting the importance of fostering their independence and quality of support. The psychological burden associated with feelings of guilt due to overdependence on informal support systems suggests that healthcare programs and policies should offer accessible options for healthcare assistance for diverse populations.