Much of the variation in rates of mental disorders among minority elderly groups can also be attributed to the differential distribution of standard risk factors across ethnic groups: older minorities are more likely to be less educated, impoverished, living alone with fewer social contacts, and to be physically ill and disabled than mainstream elderly (Blazer, Burchett, et al., 1991). This can be misleading, however, in that variations across ethnic groups can be considerable. Hispanics, for example, are more likely to have greater social support available, and Asian Americans are less likely to be of low socioeconomic status (Paniagua, 1998).
More importantly, the profiles of disease and disability vary substantially across ethnic and cultural groups. Whereas the most prevalent chronic conditions among older non-Hispanic whites are cardiovascular disease, stroke, and cancer, African American elderly evidence elevated rates of hypertension and renal disease, and Hispanic elderly evidence increased rates of diabetes, cirrhosis, and gallbladder disease (Fried & Wallce, 1992; Markides, Rudkin, Angel, & Espino, 1997). Differences in disability rates are also apparent. In comparison to older non-Hispanic whites, for example, older African Americans and Hispanics appear to experience greater rates of disability, whereas the rates among older Asian Americans appear to be lower (Guralnik & Simonsick, 1993). Differences in other factors such as health behaviors associated with mental disorders are also evident. Older African American males, for example, have higher rates of smoking, and older Hispanics have elevated rates of obesity, behaviors that have both been linked to elevated rates of mental disorders (Berkman & Mullen, 1997).
Research has also identified certain factors unique to older minorities that influence the development of mental disorders among the elderly. Many groups of minority elderly are largely composed of immigrants: almost 50% of older Hispanic Americans and 66% of older Asian Americans, for example, are immigrants (Hobbs & Damon, 1996). Studies on immigration have demonstrated both positive and negative effects regarding health and mental health. Overall, immigrants tend to be healthier than nonimmigrants, referred to as the healthy immigrant effect or migration selection (Moscicki, Locke, Rae, & Boyd, 1989). Immigration is also, however, a stressful event with lasting consequences such as reduced resources and social support. A recent study of older Mexican Americans (Black, Markides, & Miller, 1998) demonstrated that older male immigrants reflect the healthy immigrant effect in that they experience lower rates of depressive symptoms than males born in the United States. Among older females, however, immigrants experienced considerably higher rates of depressive symptoms than the U.S. born. Furthermore, both males and females who were recent immigrants (previous 5 years) evidenced the highest rates of depressive symptoms. It has been postulated that females and recent immigrants do not reflect the healthy immigrant effect, because they came to the United States at later ages and for different reasons than male immigrants, whereas the majority of older males migrated to the United States in childhood or early adulthood, the majority of females migrated in later life to be with spouses or adult children (Black, Markides, & Miller, 1998).
Acculturation, the process of adaptation and adjustment to the dominant society, as well as linguistic and cultural barriers, have also been found to play substantial roles in the mental health of older minorities. Low acculturation has been found to be associated with increased rates of cognitive impairment, depression, and anxiety (Griffin, 1983; Henderson, 1996; Masten, Penland, & Nayani, 1994). The process of acculturation is recognized as stressful, a primary factor in the adjustment of immigrants to their new society (Moyerman & Forman, 1992). Furthermore, the acculturating individual can become caught between the two cultures, attempting to maintain the behaviors of the traditional culture while adapting to the new culture (Paniagua, 1998).
Other cultural factors such as social support and family structure, religion, integration of belief systems, cultural norms, and the expression of distress have been recognized as having dramatic influence on the mental well-being of older adults. The level of adaptation or ease of functioning in the dominant society has been found to influence the mental health of predominantly nonimmigrant minorities such as African Americans and Native Americans, as well as Hispanic Americans and Asian Americans (Gutman, 1992). Beliefs systems also influence the mental health, as well as the assessment, of older minorities. Among the Chinese, for example, cognitive impairment and dementia are much less likely to be viewed as illness than as a normal part of aging (Elliott, DiMinno, Lam, & Tu, 1996), whereas the Japanese are more likely to view such a condition as a stigma (Tempo & Saito, 1996). In either case, older individuals, as well as their families, are less likely to seek assessment or treatment.
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