Skip to main content
Log in

Cultural Considerations for Comprehensively Assessing Foreign Born Older Adults in the United States

  • REVIEW
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

As demographic patterns in the United States (US) shift rapidly toward an increased prevalence of older adult residents from diverse ethnoracial backgrounds, it is especially important for healthcare practitioners to familiarize themselves with the unique attitudes, beliefs, and practices of their patients. The life stories of foreign-born older adult patients are individually unique, and they can intimately impact their bio-phyco-social profiles and needs that may not be captured in full by the traditional domains of the comprehensive geriatric assessment (CGA). This review paper attempts to describe some of the most frequently encountered themes in current literature that may potentially impact how the CGA is approached in this patient population.

Recent Findings

Ethnoracial identity and belonging is a personal and dynamic experience, which continues throughout life and into older adulthood. CGA should explore any personal, familial, gender-specific, or community centered factors, beliefs, and cultural practices, as well as how patients individually relate to them. Effective communication involves closely collaborating with foreign language interpreters. Loneliness and isolation can be perceived even in the presence of family and are crucially impactful on healthcare practice and wellbeing. Immigrants are more likely to report serious psychological distress the longer they live in the US. Cultural considerations are now incorporated into specific diagnostic criteria for psychiatric illnesses. Screening tools for assessing cognitive impairment, delirium, social isolation, and loneliness have been validated across differing cultures.

Summary

Addressing the traditional domains of CGA are useful, though additional considerations need to be taken for the foreign-born older adult. The practice of cultural humility is superior to cultural competence, and it is rooted in curiosity, equity, receptiveness, and commitment to lifelong learning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Data Availability

Not applicable.

Code Availability

Not applicable.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kristin Kerns-D'Amore BM, L. Slagan Locklear. Migration in the United States: 2006 to 2019. Bureau USDoCUSC. 2023.

  2. Nobuko Mizoguchi LW, Edward Trevelyan, Bashiruddin Ahmed. The older foreign-born population in the United States: 2012–2016. U.S. Government Printing Office: U.S. Census Bureau. 2019.

  3. Skinner JS, Duke L, Wilkins CH. Why is Ethnogeriatrics Important. In: Cummings-Vaughn LDMCO, editor. Ethnogeriatrics. Springer International Publishing; 2017.

    Google Scholar 

  4. Mazya AL, Garvin P, Ekdahl AW. Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization. Aging Clin Exp Res. 2019;31(4):519–25.

    Article  PubMed  Google Scholar 

  5. Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, et al. What is comprehensive geriatric assessment (CGA)? An umbrella review. Age Ageing. 2018;47(1):149–55.

    Article  CAS  PubMed  Google Scholar 

  6. McCusker J, Verdon J. Do geriatric interventions reduce emergency department visits? A systematic review. J Gerontol A Biol Sci Med Sci. 2006;61(1):53–62.

    Article  PubMed  Google Scholar 

  7. •• Ward KT, Hess M, Wu S. Geriatric assessment in multicultural immigrant populations. Geriatrics (Basel). 2019;4(3):40. The traditional CGA does not address the unique characteristics associated with being foreign born. In addition the commonly used screening tests for cognition, gunction, mental health assessment, abuse, and advance care planning are not validated in other countries/languages and may not be applicable. The authords discuss additional topics to be taken into consideration in a multicultural geriatric assessment which include healthcare disparities, language barriers, health literacy, acculturation level, and culturally defined beliefs

    Article  PubMed  Google Scholar 

  8. Amy Morin L. Differences Between Race vs. Ethnicity2023 August 10, 2023. Available from: https://www.verywellmind.com/difference-between-race-and-ethnicity-5074205.

  9. Martinez RAM, Andrabi N, Goodwin AN, Wilbur RE, Smith NR, Zivich PN. Conceptualization, operationalization, and utilization of race and ethnicity in major epidemiology journals, 1995–2018: a systematic review. Am J Epidemiol. 2023;192(3):483–96.

    Article  PubMed  Google Scholar 

  10. Breen CF. Late-life changes in ethnoracial self-identification: evidence from social security admnistrative data. Popul Res Policy Rev. 2023.

  11. Committee IR. Migrants, asylum seekers, refugees and immigrants: What's the difference? 2018 [updated July 13, 2022. Available from: https://www.rescue.org.

  12. Moon H, Badana ANS, Hwang SY, Sears JS, Haley WE. Dementia prevalence in older adults: variation by race/ethnicity and immigrant status. Am J Geriatr Psychiatry. 2019;27(3):241–50.

    Article  PubMed  Google Scholar 

  13. Fornazzari L, Fischer C, Hansen T, Ringer L. Knowledge of Alzheimer’s disease and subjective memory impairment in Latin American seniors in the Greater Toronto Area. Int Psychogeriatr. 2009;21(5):966–9.

    Article  CAS  PubMed  Google Scholar 

  14. Limpawattana P, Tiamkao S, Sawanyawisuth K, Thinkhamrop B. Can rowland universal dementia assessment scale (RUDAS) replace Mini-mental State Examination (MMSE) for dementia screening in a Thai geriatric outpatient setting? Am J Alzheimers Dis Other Demen. 2012;27(4):254–9.

    Article  PubMed  Google Scholar 

  15. Daniel B, Agenagnew L, Workicho A, Abera M. Validation of the rowlands universal dementia assessment scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020. PLoS One. 2022;17(1):e0262483.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chary AN, Torres B, Brickhouse E, Santangelo I, Godwin KM, Naik AD, et al. Language discordance in emergency department delirium screening: Results from a qualitative interview-based study. J Am Geriatr Soc. 2023;71(4):1328–31.

    Article  PubMed  Google Scholar 

  17. Reppas-Rindlisbacher C, Panov ED, Cuperfain AB, Rawal S. A Survey of nurses’ perspectives on delirium screening in older adult medical inpatients with limited English proficiency. J Gerontol Nurs. 2021;47(4):29–34.

    Article  PubMed  Google Scholar 

  18. Reppas-Rindlisbacher C, Shin S, Purohit U, Verma A, Razak F, Rochon P, et al. Association between non-English language and use of physical and chemical restraints among medical inpatients with delirium. J Am Geriatr Soc. 2022;70(12):3640–3.

    Article  PubMed  Google Scholar 

  19. Mariz J, Costa Castanho T, Teixeira J, Sousa N, Correia Santos N. Delirium diagnostic and screening instruments in the emergency department: an up-to-date systematic review. Geriatrics (Basel). 2016;1(3):22.

    Article  PubMed  Google Scholar 

  20. Danzeng QZ, Cui N, Wang H, Pan WJ, Long Y, Deji YZ, et al. Translation and validation of the Tibetan confusion assessment method for the intensive care unit. Chin Med J (Engl). 2019;132(10):1154–8.

    Article  PubMed  Google Scholar 

  21. Chanques G, Garnier O, Carr J, Conseil M, de Jong A, Rowan CM, et al. The CAM-ICU has now a French “official” version. The translation process of the 2014 updated complete training manual of the confusion assessment method for the intensive care unit in French (CAM-ICU.fr). Anaesth Crit Care Pain Med. 2017;36(5):297–300.

    Article  PubMed  Google Scholar 

  22. Developed by the American Geriatrics Society Ethnogeriatrics C. Achieving high-quality multicultural geriatric care. J Am Geriatr Soc. 2016;64(2):255–60.

  23. Critical Illness BD, and Survivorship (CIBS) Center. Resource Language Translations [Available from: https://www.icudelirium.org/medical-professionals/downloads/resource-language-translations.

  24. Lee JS, Tong T, Tierney MC, Kiss A, Chignell M. Predictive ability of a serious game to identify emergency patients with unrecognized delirium. J Am Geriatr Soc. 2019;67(11):2370–5.

    Article  PubMed  Google Scholar 

  25. Jang H, Pilkauskas NV, Tang F. Age at immigration and depression: the mediating role of contemporary relationships with adult children among older immigrants. J Gerontol B Psychol Sci Soc Sci. 2022;77(2):413–23.

    Article  PubMed  Google Scholar 

  26. Ikonte CO, Prigmore HL, Dawson AZ, Egede LE. Trends in prevalence of depression and serious psychological distress in United States immigrant and non-immigrant populations, 2010–2016. J Affect Disord. 2020;274:719–25.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gubernskaya Z. Age at migration and self-rated health trajectories after age 50: understanding the older immigrant health paradox. J Gerontol B Psychol Sci Soc Sci. 2015;70(2):279–90.

    Article  PubMed  Google Scholar 

  28. Oh KM, Baird B, Alqahtani N, Peppard L, Kitsantas P. Exploring levels and correlates of depression literacy among older Korean immigrants. J Cross Cult Gerontol. 2022;37(3):295–313.

    Article  PubMed  Google Scholar 

  29. Tieu Y, Konnert C, Wang J. Depression literacy among older Chinese immigrants in Canada: a comparison with a population-based survey. Int Psychogeriatr. 2010;22(8):1318–26.

    Article  PubMed  Google Scholar 

  30. Reuland DS, Cherrington A, Watkins GS, Bradford DW, Blanco RA, Gaynes BN. Diagnostic accuracy of Spanish language depression-screening instruments. Ann Fam Med. 2009;7(5):455–62.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Limon FJ, Lamson AL, Hodgson J, Bowler M, Saeed S. Screening for depression in Latino immigrants: a systematic review of depression screening instruments translated into Spanish. J Immigr Minor Health. 2016;18(4):787–98.

    Article  PubMed  Google Scholar 

  32. Dow B, Lin X, Pachana NA, Bryant C, LoGiudice D, A MYG, et al. Reliability, concurrent validity, and cultural adaptation of the Geriatric Depression Scale and the Geriatric Anxiety Inventory for detecting depression and anxiety symptoms among older Chinese immigrants: an Australian study. Int Psychogeriatr. 2018;30(5):735–48.

  33. Herizchi S, Barzegar H, Amiri S, Fakhari A, Sadeghi-Bazargani H, Noorazar SG, et al. Reliability and validity of Azeri Turkish version of geriatric depression scale. Health Promot Perspect. 2020;10(1):74–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Justo-Henriques SI, Perez-Saez E, Carvalho JO, Bobrowicz-Campos E, Apostolo JLA, Otero P, et al. Reliability and validity of the geriatric depression scale in a sample of portuguese older adults with mild-to-moderate cognitive impairment. Brain Sci. 2023;13(8):1160.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Massai P, Colalelli F, Sansoni J, Valente D, Tofani M, Fabbrini G, et al. Reliability and validity of the geriatric depression scale in Italian subjects with Parkinson’s disease. Parkinsons Dis. 2018;2018:7347859.

    PubMed  PubMed Central  Google Scholar 

  36. Association AP. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 5th ed. American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  37. Association AP. Diagnostic and Statistical Manual of Mental Disorders, Text Revision DSM-5-TR. 5th ed. Amer Psychiatric Pub Inc; 2022.

    Book  Google Scholar 

  38. Weber O, Klemp J, Chmetz F, Daliani A, Diserens EA, Faucherre F. Interpreter-mediated psychiatric assessments: Metacommunication as key. Transcult Psychiatry. 2022:13634615221119383.

  39. •• Hawkins MM, Holliday DD, Weinhardt LS, Florsheim P, Ngui E, AbuZahra T. Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature. BMC Public Health. 2022;22(1):755. Foreign born older adults face unique and heterogeneous healthcare related barriers, of which lack of social support and isolation play significant roles. This review encompasses 20 years of literature and proposes a model for health promotion for foreign born older adults based on several relavant exisiting theories.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Cornwell EY, Waite LJ. Measuring social isolation among older adults using multiple indicators from the NSHAP study. J Gerontol B Psychol Sci Soc Sci. 2009;64 Suppl 1(Suppl 1):i38-46.

    Article  PubMed  Google Scholar 

  41. Valero-Martinez C, Martinez-Rivera C, Zhen-Duan J, Fukuda M, Alegria M. Attitudes toward COVID-19 Vaccine Uptake: a qualitative study of mostly immigrant racial/ethnic minority older adults. Geriatrics (Basel). 2023;8(1):17.

    Article  PubMed  Google Scholar 

  42. Li M, Guo M, Stensland M, Silverstein M, Dong X. Typology of family relationship and elder mistreatment in a US Chinese population. J Am Geriatr Soc. 2019;67(S3):S493–8.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lu M, Bronskill SE, Strauss R, Boblitz A, Guan J, Im JHB, et al. Factors associated with loneliness in immigrant and Canadian-born older adults in Ontario, Canada: a population-based study. BMC Geriatr. 2023;23(1):380.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Santini ZI, Jose PE, York Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5(1):e62–70.

    Article  PubMed  Google Scholar 

  45. Gehui Zhang HJZ. Beyond the bible and the cross: a social and cultural analysis of chinese elders’ participation in christian congregations in the united states. Sociol Spectr. 2009;29(2):295–317.

    Article  Google Scholar 

  46. Johnson S, Bacsu J, McIntosh T, Jeffery B, Novik N. Competing challenges for immigrant seniors: Social isolation and the pandemic. Healthc Manage Forum. 2021;34(5):266–71.

    Article  PubMed  PubMed Central  Google Scholar 

  47. • Gardam O, Ferguson RJ, Ouimet AJ, Cobigo V. Measuring social isolation in older adults: A rapid review informing evidence-based research and practice. Clin Gerontol. 2023;46(4):478–97. Social isolation and loneliness are associated with negative health outcomes and increased mortality. Evidence based screening tools for measuring social isolation and loneliness can alow for effective interventions. Twelve screening measures were identified in literature review and then further assessed for suitability for use in older adults.

    Article  PubMed  Google Scholar 

  48. Cheung SL, Hobbelen H, van der Schans CP, Krijnen WP. Cross-cultural equivalence of de Jong Gierveld loneliness scale among older native and diasporic Chinese adults. Gerontologist. 2022;62(2):e62–72.

    Article  PubMed  Google Scholar 

  49. Caycho-Rodriguez T, Tomas JM, Hontangas PM, Ventura-Leon J, Burga-Leon A, Barboza-Palomino M, et al. Validation of the De Jong Gierveld loneliness scale in Peruvian old adults: a study based on SEM and IRT multidimensional models. J Gen Psychol. 2023;150(1):46–70.

    Article  PubMed  Google Scholar 

  50. Rodriguez-Blazquez C, Ayala-Garcia A, Forjaz MJ, Gallardo-Peralta LP. Validation of the De Jong Gierveld Loneliness Scale, 6-item version, in a multiethnic population of Chilean older adults. Australas J Ageing. 2021;40(2):e100–8.

    Article  PubMed  Google Scholar 

  51. Jaafar MH, Villiers-Tuthill A, Lim MA, Ragunathan D, Morgan K. Validation of the Malay Version of the De Jong Gierveld Loneliness Scale. Australas J Ageing. 2020;39(1):e9–15.

    Article  PubMed  Google Scholar 

  52. Vilar-Compte M, Vargas-Bustamante A, Lubben J. Validation study of the abbreviated version of the Lubben social network scale Spanish translation among Mexican and Mexican-American older adults. J Cross Cult Gerontol. 2018;33(1):83–99.

    Article  PubMed  Google Scholar 

  53. Chang Q, Sha F, Chan CH, Yip PSF. Validation of an abbreviated version of the Lubben Social Network Scale (“LSNS-6”) and its associations with suicidality among older adults in China. PLoS One. 2018;13(8):e0201612.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Kurimoto A, Awata S, Ohkubo T, Tsubota-Utsugi M, Asayama K, Takahashi K, et al. Reliability and validity of the Japanese version of the abbreviated Lubben social network scale. Nihon Ronen Igakkai Zasshi. 2011;48(2):149–57.

    Article  PubMed  Google Scholar 

  55. Wilson L, Rubens-Augustson T, Murphy M, Jardine C, Crowcroft N, Hui C, et al. Barriers to immunization among newcomers: A systematic review. Vaccine. 2018;36(8):1055–62.

    Article  PubMed  Google Scholar 

  56. Amirehsani KA, Hu J, Wallace DC, McCoy TP. Herbal/plant remedies and supplements used by hispanics/latinxs for diabetes: source of functional foods? Sci Diabetes Self Manag Care. 2021;47(1):94–104.

    Article  PubMed  Google Scholar 

  57. Guruge S, Birpreet B, Samuels-Dennis JA. Health status and health determinants of older immigrant women in Canada: a scoping review. J Aging Res. 2015;2015:393761.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Lai DW, Surood S. Chinese health beliefs of older Chinese in Canada. J Aging Health. 2009;21(1):38–62.

    Article  PubMed  Google Scholar 

  59. Riggs E, Brown S, Szwarc J, Nesvadba N, Yelland J. Teach-back in interpreter-mediated consultations: reflections from a case study. Health Lit Res Pract. 2021;5(3):e256–61.

    PubMed  PubMed Central  Google Scholar 

  60. Zhu T, Martina D, Heide AV, Korfage IJ, Rietjens JA. The role of acculturation in the process of advance care planning among Chinese immigrants: A narrative systematic review. Palliat Med. 2023:2692163231179255.

  61. •• Lekas HM, Pahl K, Fuller LC. Rethinking cultural competence: shifting to cultural humility. Health Serv Insights. 2020;13:1178632920970580. Culturally competent medical practitioners are thought to deliver most appropriate health care across varied subsets of population; however, assuming that one is competent in the beliefs and practices of a culture foreign to them, has the potential to breed sterotyping and stigmatizing behaviors, as well as create implicit biases. Cultural humilty assumes that our patients are their own experts in the culture(s) with which they identify and demands for curiosity and openness to lifelife long learning.

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Contributions

KK performed the literature search and drafted the article.

Corresponding author

Correspondence to Kinga B Kiszko.

Ethics declarations

Conflicts of Interest

The author has no relevant financial or nonfinancial interests to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kiszko, K.B. Cultural Considerations for Comprehensively Assessing Foreign Born Older Adults in the United States. Curr Geri Rep 13, 18–25 (2024). https://doi.org/10.1007/s13670-024-00405-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-024-00405-y

Keywords

Navigation