Multiple Chronic Conditions and Disability Among Vietnamese Older Adults: Results from the Vietnamese Aging and Care Survey (VACS)

Background and Purpose. Approximately 86% of older Asian Americans (≥65 years) are immigrants, and they recorded the highest life expectancy. Selective migration can potentially explain the immigrants’ health advantage. However, less is known about the health of Asian-origin refugee populations. After the fall of Saigon in 1975, three waves of Vietnamese refugees/immigrants arrived in the U.S. Their population is currently 2.2 million and is still growing. The health of older Vietnamese, however, has been understudied. To explore this knowledge gap, we developed a health survey, the Vietnamese Aging and Care Survey (VACS), and collected community-dwelling older Vietnamese’ health data in Houston, Texas, the 2^nd largest Vietnamese-populated metropolitan area in the U.S. with 143,000 Vietnamese. Our data revealed their high prevalence of disability, arthritis, liver disease, depressive symptoms, and cognitive impairment. These conditions may have started in Vietnam, and have been exacerbated in the U.S. The purpose of the study was to examine their most common multiple chronic conditions and their associations with a disability. Understanding these associations in a refugee population is significant because despite having the highest life expectancy, older adults tend to have more chronic conditions and disabilities. Thus, this study will contribute to the limited knowledge of the refugee population.

Methods. Using the VACS data (N=210), we assessed their self-rated health, the number of chronic conditions that were prevalent in most older adults, ADL/IADL disability, depressive symptoms, and cognitive impairment, and examined the associations between their chronic conditions and disability by comorbidity clusters (≥3 comorbidities). We used chi-square tests and t-tests to compare the sociodemographic and health characteristics and multivariable logistic regression models to answer the research questions.

Results. The respondents (N=177) were on average 76 years old, married (62%), and female (58%). They lived in the U.S. for 24 years (mean) and spoke Vietnamese only (92%) in multi-generation (88%) low-income households (90% ≤$25K). They were in fair/poor health (84%) with 2 ADL and 4 IADL disabilities (mean) and ≥3 chronic conditions (60%). Hypertension (79%), arthritis (54%), diabetes (44%), depressive symptoms (40%), and cognitive impairment (32%) were the most common chronic conditions. Respondents with ≥3 chronic conditions had significantly higher ADL (OR=2.77) and IADL (OR=2.33) disabilities and cognitive impairment (50%). However, cognitive impairment had the most significant impact on their disability (ADL:2.94-3.75; IADL:5.41-5.79) when combined with most common chronic conditions.

Conclusions and Implications. Most older Vietnamese lived in multi-generation households in ethnic enclaves, which benefits them by having a strong family and community support system. However, the high prevalence of depressive symptoms and cognitive impairment, in particular, are two chronic conditions that all healthcare professionals should pay special attention to since the negative impact of cognitive impairment on their ADL/IADL disability was higher than those of any other chronic conditions. Culturally and linguistically tailored healthcare services created by a collaborative effort among policymakers, healthcare professionals, and local social service agencies are recommended for the well-being of refugee populations who could not come as selected immigrants but migrated to the U.S.where they all relied on a better life.