Applying Social Determinants of Health to Understand Asian American Older Adults' Cognitive Difficulties

Background/Purpose

While Asians are the fastest growing racial group in the United States, limited research exists on their health needs, especially among older adults. Cognitive difficulties increase caregiving burdens, but little is known about patterns of cognitive health among Asian American older adults.

The Commission on Social Determinants of Health (CSDH) model explains health inequities as a function of structural determinants of health and intermediary determinants of health. Structural determinants are robust determinants of health and include factors related to the socioeconomic and political environment, indicators of social economic position, and social class. Intermediary determinants of health include material circumstances, biological, and psychosocial factors.

While much of prior research tended to simplify Asian American ethnic groups and aggregated into one racial group, Asian Americans originate in more than 40 countries across Asia with representation by dozens more ethnic backgrounds. In this study, data are disaggregated to focus on older adults from the six most populous Asian ethnicities: Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese.

This study applies the CSDH framework to test the main and joint effects of the structural determinants of Asian ethnicity and gender on cognitive health. structural and intermediary determinants on cognitive health among Asian American older adults.

The study tested the following research questions:

1. Are there differences in cognitive difficulties among the Asian ethnic groups?

1. Are there differences in cognitive difficulties by gender?

1. Are there joint effects between the structural determinants of Asian ethnic group and gender?

Methods

Data from the 2019 American Community Survey (ACS), 5-year sample were used for this study. Respondents aged 65 and over, who identified as Asian-alone, and not of Hispanic/Latino ethnicity were extracted. Further, the data were limited to individuals whose primary ethnicity was Chinese, Filipino, Indian, Japanese, Korean or Vietnamese (N=100,538). The ACS assessed cognitive health with one item: Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions? To account for the complex sampling methods in the American Community Survey, all analyses were conducted using Proc Survey commands in SAS.

Results

Multivariate analyses showed Filipino, Indian, and Vietnamese older adults were more likely than Chinese to report cognitive difficulties. Additionally, Asian American women were more likely to report cognitive difficulties compared to Asian American men. Joint effect analyses were statistically significant, thus we examined separate regression analyses by Asian ethnicity. Results showed that Vietnamese women were more likely than Vietnamese men to report cognitive difficulties. Across Asian ethnic groups, family relationships and economic factors play a major role in having a cognitive difficulty.

Conclusions/Implications

Overall, the results suggest that ethnic-specific analysis of the Asian American reveals a fuller picture of health in older adulthood. The interaction of structural determinants of health points to the need for community-engaged, ethnic-specific research to advance population health. Further research into the interplay between structural determinants is needed. Further, session participants will be able to formulate practice and policy interventions to address cognitive difficulties for older Asian Americans.