Older Asian American Women: An Overview

1. Older Asian American Women:An Overview Gero-435 Andrea Chin

2. Who are Asian Americans? • People who identify with being Asian Indian, Cambodian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hmong and/or other cultural groups • Speak over 100 languages and dialects • Have immigrated to or have been born in or lived in the US

3. Immigration History • Between 1980 and 1990 alone, there was a two-fold increase in the number of AA older adults. • About 455,000 (6.3%) of the AA population are age 65 or over. Of those, about 154,000 (3%) are age 75 or over. • Two main waves of immigration for this group: • Migrants who arrived during the turn of the century and their children; this particularly applies to Japanese and Filipinos • Older migrants, primarily from Southeast Asia, who entered the U.S. in the 1970's with their families.

4. History of Immigration Discrimination • AAs are the only race to have been specifically barred in immigration legislation in the Chinese Exclusion Act of 18 • The Immigration Act of 1924 used national origins quotas all but halting the tide of immigration from Asia and elsewhere until it was repealed in 1965 • Many of the first wave of Asian female immigrants were forced into prostitution

5. Arrival of Asian Immigrant Women • Most of the 1st wave Asian immigrants were male laborers; high male:female ratio (except for the Japanese community) made it difficult for them to start families and make roots in the US • History of picture brides: received photos from “old country” of eligible brides to bring over to the US • WWII brides brought over many East Asian women ill-equipped to adjust to American life; many were abused by their veteran husbands

6. Japanese American Internment Camps • Executive Order 9066: 110,00 JAs were sent to internment camps “for their own good” • Real reason: High-ranking officials believed that they weren’t loyal to the US and might spy for the enemy, despite the fact that there was no evidence and that most of those sent were American-born • Families were given short notice to relocate and lost virtually all of their property

7. Japanese American Internment Camps • Intern camps such as Manzanar were located in rural areas; interns often ill-equipped to handle the below zero temperatures in these areas • Families were crammed into "tar paper-covered barracks of simple frame construction without plumbing or cooking facilities of any kind” (1943 War Authority Report) • Documented instances of guards shooting internees who reportedly attempted to walk outside the fences • Japanese people tended to comply with the U.S. government to prove themselves loyal citizens

8. Legacy of Internment • Many internees experienced depression and helplessness and were too ashamed to talk about what happened afterwards • 1992: public apology from the government and reparations finally made with $20,000 given to each surviving internee • Many still haven’t received their reparations • How can you repay for the loss of all their property and the shame they suffered?

9. California Demographics • AA women make up 12.4% of women 65 and older in the state of California • Nearly half are still married • They have a median personal income of $9,103, the second lowest of all racial groups • 8.6% of them live in poverty. • 62.2% of older AA women in California receive social security.

10. National Demographics • Nationally, older AA women make up 2.9% of the population. • Compared to older women of other races, they are the most likely to still be married; 48.1% of AA women who are 65 and older are. • The sex ratio is higher in the AA population compared to all other racial populations: there are 82 AA men per 100 women 65 and older. • More than 60% are concentrated in California and Hawaii. Most of the rest live either in New York, New Jersey, Illinois, Texas or Washington (state).

11. Religion and Spirituality • Many East and Southeast Asians practice Buddhism • Taoism is another common East Asian religion • Significant population of Hindu Asian Indians • Indonesia has the largest population of Muslims in the world; many other Muslims from India and South Asia • Meditation and tai chi are great forms of mental and physical exercise to reduce stress and develop balance

12. The Cultural Roles of Older AA Women • In Confucian/East Asian societies, filial piety (respect for elders) is a key value • If the eldest male has passed away, the eldest female is the leading authority figure in the family • Traditionally in Asia, households are multigenerational with younger female relatives looking after their elders • What happens if younger generations are unable/unwilling to fulfill the caregiving role?

13. Health Issues • Cancer and cardiovascular disease are the two leading causes of death for Asian Americans in the U.S • AA women have much lower rates of heart disease than women of other minority groups, but heart disease is still the second leading cause of death for this group. • AAs are 3 to 13 times more likely to die from liver cancer caused by Hepatitis B than Caucasians.

14. More Health Issues • Older AA women have a high risk of osteoporosis. The average calcium intake among them is half that of Westerners. As many as 90% of Asian Americans are lactose intolerant or cannot easily digest dairy products. • AA women have low breast and cervical cancer screening rates compared to other groups of women, and lower cholesterol and blood pressure screening rates than the national average. • They have a higher prevalence of tuberculosis than all other racial and ethnic groups

15. Mental Health Issues • AA women 65+ have the highest suicide rate of all women aged 65 and older. • Older AA women show a greater prevalence of dementia than the general population • 70% of Southeast Asian refugees receiving mental health care met diagnostic criteria for PTSD • Consistently low rates of help-seeking behavior • General stigma against mental illness; shame in being “found out” for treatment • More likely to describe somatic symptoms such as fatigue, headache, poor appetite, indigestion

16. Cultural Conceptions of Mental Illness • Linguistic differences: no real equivalent translation of Western notion of anxiety, depression or guilt in Chinese • Cultural attribution (such as Chinese and Cambodian) of mental illness to supernatural causes; “blame the victim” phenomenon • Fatalistic conception of mental illness as retributive punishment for ancestral sins • Dementia seen as normal aging; fatalistic attitudes about dementia as an untreatable condition

17. Mental Health Risk Factors • General stresses of immigration • Weaker support network • Southeast Asian refugees particularly at risk after experiencing premigration wartime trauma • Fear of loss of culture, values, status in acculturation • Culturally insensitive/ignorant clinicians viewing AAs under the model minority stereotype • Model minority: assumption that AAs are well-off and so integrated into American life that they are not in need of services; overlooks many issues within this population

18. Healthcare Barriers • Older AA women less likely to use formal health care services, such as those reimbursed under Medicare, and report poorer quality of care. • Traditional pathways to care may lead to reliance on folk medicine and alternative healers such as acupuncturists. • Many immigrants are low-income and lack insurance, and most are unaware of the options for affordable care such as sliding-scale fees. • Language barriers can be intimidating; many are unaware of their right to a medical interpreter. • Lack of familiarity with the system and fear of the system further limit access.

19. How to Address General Issues Facing Older AA Women • Health: screen for Hepatitis B, heart disease, diabetes, osteoporosis, breast cancer, dementia and depression • Multilingual service delivery: train more multilingual social workers and medical interpreters • Ask the clients how they conceptualize their issues and what resources they draw upon in their communities; integrate alternative therapies/support networks as appropriate

20. How to Address the Issues, continued • Outreach workshops on how to apply for Social Security and Medicare • If they’re not citizens, work to secure citizenship so that they are eligible for social services • Get younger AAs involved in care • Learn more about their immigration experience and experience living in the US • Be respectful!