The Associations between Physical Disability, Chronic Diseases, and Depressive Symptoms in Vietnamese Older Adults: Results from the Vietnamese Aging and Care Survey (VACS)

Background and Purpose. After the fall of Saigon in 1975, several waves of Vietnamese refugees/immigrants migrated to the U.S. accounting for over 2.2 million. Having been exposed to wartime physical and emotional violence, their traumatic escape from Vietnam, and relocation to U.S. cities, Vietnamese older adults are vulnerable to health disparities. Vietnamese are the fourth largest Asian-origin subgroup and a fast-growing refugee population in the U.S. Despite the risk and the large number, health research on this population is scarce. The health impact of their traumatic experiences on their lives has not yet been explored. To fill this gap, we developed the Vietnamese Aging and Care Survey and collected health data on older Vietnamese (community-dwelling ≥65 years) in Houston, Texas, the third-largest Vietnamese-populated city in the nation. The purposes of this study were to examine if ADL/IADL disability and chronic diseases are associated with Vietnamese older adults’ depressive symptoms and if so, to explore which disability and chronic diseases are associated with depressive symptoms.

Methods. We used Katz’s ADL and Lawton’s IADL scales to measure the number of physical disabilities. Chronic conditions included the eight most commonly-known chronic diseases among older adults such as arthritis, hypertension, diabetes, and cardiovascular diseases. Depressive symptoms were measured by the 20-item Center for Epidemiologic Studies Depression Scale. Descriptive statistics were used to summarize their sociodemographic characteristics. A nested linear regression approach was used to test the relationships between health conditions and the number of ADL/IADL disabilities, controlling for gender and marital status.

Results. The participants (N=208) were female (56%), on average 75 years old, and married (63%) with 8 years of education. All (100%) were born in Vietnam and lived in the U.S. for 25 years, and 91% belonged to low socioeconomic status (≤$25000). Most self-rated their health as fair/poor (80%) with ≥one chronic disease (76%). They lived in multi-generation households (80%) speaking Vietnamese only (88%). Of the eight reported chronic health conditions, we found a possible relationship between arthritis (p<0.001) and liver disease (p=0.017), and depressive symptoms. Difficulties in bathing (d=0.60, p=0.002), eating (d=0.59, p=0.021), and finances (d=0.53, p=0.002) were most associated with depressive symptoms. Linear regression results showed older Vietnamese who suffered from liver disease (ß=7.90, p<0.01), as well as those with more combined ADL/IADL disability (ß=0.40, p<0.01) reported higher depressive symptoms than older Vietnamese without those conditions.

Conclusions and Implications. Vietnamese older adults with more physical disabilities and suffering from arthritis and liver disease reported more depressive symptoms compared to participants with fewer physical disabilities and without chronic diseases. It is understandable that having more mobility issues and experiencing pain from chronic conditions may limit older adults’ activities and restrict them from enjoying their lives. However, by leveraging their living condition – living with other family members and relatives, they can obtain tangible support for their physical disabilities. Simultaneously, healthcare professionals can help older adults and their family members to connect with culturally and linguistically relevant senior and adult daycare centers to provide them with social and exercise opportunities.