Factors that Influence Quality of Life among Low-Income Elderly Korean Immigrants in Adult Day Health Care (ADHC).

摘要

The elderly population will rapidly increase and will be more diversified in the U.S. Among the diverse elderly population, the number of elderly Asians has increased 400% between 1990 and 2007. One such group is elderly Koreans. The population was only 35,000 in 1990 and now is 170,000 in 2010, 500% increase during the past 20 years.;Elderly Korean immigrants have unique needs for long-term care because of their socio-cultural status. Many elderly Korean immigrants especially are economically vulnerable. In particular, more than 20% of elderly Korean immigrants have incomes below the poverty line. This figure is two times higher than that of the general older adult population. In addition, economically vulnerable Korean elderly immigrants are more likely to suffer from poor health or lack resources and support for acculturation. Thus, this population has dire need for community-based care in order to help to address these challenges.;In the LA area, the number of adult day health care centers for low-income elderly Koreans, that provide both medical and social services, has dramatically increased from 4 in 1997 to 12 in 2009. That is because adult day health centers play a significant role for older Korean immigrants to maintain and increase physical and mental status. About 67% of low-income elderly Korean immigrants attend adult day health care in Los Angeles area. Although most low-income elderly Korean immigrants receive basic medical services under Medi-Cal or Medicare, it is a challenge to find agencies that can provide culturally-competent social services. Moreover, most low-income elderly Korean immigrants live alone or only with their spouses, so the need for comprehensive social and medical services is substantial.;The ultimate goal of adult day health care (ADHC) is to increase clients' physical and mental abilities to improve the quality of life (QOL) for low-income elderly Korean immigrants. Notably, in spite of this goal to improve participants' quality of life, there are no studies that examine the impact of adult day health care on quality of life for low-income elderly Korean immigrants. There is a need to better understand the extent and ways in which adult day health care addresses quality of life for low-income elderly immigrants.;This study asked two research questions: (1) What are the factors that influence QOL among low-income elderly Korean immigrants in ADHC?; (2) Does participating in adult day health care mediate the influence of family support on QOL among low-income elderly Korean immigrants in ADHC?;Using a cross-sectional survey design, face-to-face interviews were conducted with 210 elderly Korean immigrants 65 or older who resided in Los Angeles County. Participants were interviewed once at adult day health care centers where they received services.;Bilingual professional interviewers asked questions consisting of the four distinct sections to measure the study's key constructs: (1) individual characteristics such as socioeconomic status, cognitive functioning, and physical health; (2) social environment, in particular, family support; (3) physical environments (number of days and years attending ADHC; (4) quality of life (total QOL and three components such as physical QOL, mental QOL, and reported health transition) using SF-36 scale.;Using the advanced multi modeling, the study identified significant relationships among individual characteristics, social environment, physical environments, and QOL. The study found that participants with strong family support are more likely to have high QOL. Also, the study found that participants who have attended ADHC longer are more likely to high QOL. Finally, participants with strong family support are more likely to attend ADHC longer, so their QOL is higher. As a result, the study found both direct and indirect effect of family on QOL significantly.;This study contributes to the existing body of knowledge on factors relating to QOL among low-income elderly Korean immigrants in ADHC. Most independent variables (socio-demographic, cognitive, physical, family support) are significantly correlated with QOL as previous studies indicated. In particular, this study found the association of ADHC attendance with QOL with showing the positive relationship between the years in ADHC and QOL; therefore, policy makers and practitioners can emphasize the importance of attendance in ADHC to improve QOL among low-income elderly Korean immigrants.;Also, the present findings suggest that QOL (individuals' adaptation) is influenced not only by individuals' characteristics but also by the environments such as social and physical environments as the social ecological theory posits. Based on the social ecological theory, this study provided policy implications for informing the development of practice and policy strategies not only in the individual level but also in the environmental and policy influences.;Moreover, given the current economic climate and the resultant threats to eliminate or minimize funding for adult day health care, the study provides justification for using public funds to support adult day health care by demonstrating the effect of adult day health care on older adults from minority backgrounds such as low-income elderly Korean immigrants. Finally, this study raised further research agenda to broaden the scope of the present research.