A Research Project on
Aging 
Funded by
Health and
Social Needs
Assessment of Japanese Older Adults
in the
Principal
Investigator: Mitsuko Nakashima, MSW, PH.D.
Assistant
Professor
Research
Assistant: Ayumi Sawa, MSW
Graduate
of
Purpose of this
Study
This
research explored health and social service needs of older adults in
Japanese
communities in the
- Profile the health and
social service needs of Japanese older adults in
- Provide information to
guide program planning for the DC Japanese community;
- Identify salient health
and social services issues from the perspectives of older adults, their
caregivers and the DC Japanese community leaders and use this
information to
develop an understanding on targeted issues.
Background
Asian elders have rarely been included in
research for planning health and social service provision for older
adults. The
rationale has been that Asian subgroups were too small to provide valid
data
(LaViest, 1995). However, existing studies indicate that Asian
Americans elders
increasingly become vulnerable to physical and mental ailments. Asian
Americans
typically experience illnesses such as heart disease, cancer and
diabetes as
they age (Park, Yokoyama & Tokuyama, 1991). Depression is
experienced among
Asian American elders at a higher rate than the general elderly
population
(AAFNY, 2003). As such, omission of Asian American elders from research
has a
significant negative impact on current levels of service provision as
well as
on preparation for future service needs. The landmark study conducted
by The
Asian American Federation of New York (AAFNY) on Asian American elders’
health
and social needs and quality of life reported that even in an urban
area where
various Asian communities are more established in terms of existing
services
and social infrastructures, their Asian American elders experience
greater
socio-economic vulnerability and have fewer options for culturally and
linguistically
responsive health care and social services than the general elderly
population
in the city.
The populations of Asian American in the
Metropolitan Washington DC area grew by 53% from 204,466 in 1990 to
379,949 in
2000 (US Census, 2002). Japanese residents are widely dispersed
geographically
without densely populated communities (U.S. Census, 2002). In the
Japanese
communities of the Metropolitan Washington D.C. area, there has been a
rising
concern about the lack of culturally sensitive health and social
services for
elders. The projected demographic change for Asian older adults in this
area
will have a powerful impact on policy and the provision of health and
social
services as the volume of need among an important and often overlooked
aging minority
population increases dramatically.
Main Interview Questions
- What are some major
challenges and needs among senior citizens in the DC Japanese community?
- How much do senior
citizens and their family members know about existing health and social
services
in the DC community that are available for older adults and caregivers?
- How do they see them as
helpful or not helpful? How about these services’
availability, accessibility, affordability, and acceptability?
- What is lacking in the
DC Japanese community in terms of providing good social and health
services for
older adults and caregivers?
- What is an ideal
community where older adults in the DC Japanese community can live with
an
excellent quality of life? What do members of DC Japanese community
want to see
happen to improve their seniors’ quality of life in the near future?
Results
Some Prominent
Characteristics of the DC Japanese
Senior Citizens
- Women vs. Men
According to the U.S.
Census 2000, there are approximately 13,000 Japanese individuals who
live in
the Washington Metropolitan Area. The number of females is reported as
8,082
which exceedingly surpasses the size of Japanese male population that
is
reported as 4,881. Among those who are 55 year old or older, there are
more men
(2,717) than women (2,095). The census also reported that there were
862 households
that were resided by Japanese older adults. Among them 478 households
were
single person dwelling residences.
- High socio-economic status
Among Asian ethnic
groups, Japanese older adults enjoy a much higher socio-economic
status. About
eighty percent of men who were 65 year old or older had obtained their
education that was a college level or higher. Ninety three percent of
this
group has at least a high school diploma. Among female older adults in
the same
age group, approximately 25% people had obtained higher education. Over
80% of
the older Japanese women in the DC area has obtained at least a high
school
level education.
Among the households that
were headed by Japanese individuals whose age were between 65 and 74,
60% of
them had income that was higher than $30,000.
The thirty percent of this group reported in 2000 that
their income was
higher than $70,000.
- Adjustment to the
American Society and Life Style Preferences
Japanese senior citizens
have well adjusted to American society and are leading a well balanced
bi-cultural lifestyle. These study participants preferred Japanese
style
clothes and food but enjoyed amenities and space that the
Many of the adult
children of Japanese older adults in the DC areas live outside of this
area;
many of them live in foreign countries. Again, unlike other ethnic
groups,
Japanese older adults do not have frequent face-to-face contacts with
their adult
children and/or grandchildren. They keep contact with their family
members
mainly by phone calls and e-mail. These Japanese older adults have less
expectation compared to their peers in other Asian ethnic groups in
regards to
receiving care from their adult children and/or grandchildren when
their health
fails.
Two Major Issues
Addressed during the Focus Group
Interviews
- Advance Care Planning
A very few participants
in this study stated that
Japanese older adults in the DC area are well prepared for the coming
years of
frailty. In general, Japanese senior citizens are bewildered by
American legal
and health care system that is very complex and not friendly to its
consumers.
Negotiation with health insurance companies is especially painful as
mailed
insurance statements are frequently very difficult to understand and
expenses
for health care services are very high. Even though these older adults
feel
confident in speaking English in their daily lives, using specialized
terms and
negotiating with American workers seems to be a huge challenge.
The seniors often lack
knowledge regarding in-home
services and long-term care facilities. They prefer to depend on
friends and
Japanese organizations in the DC area rather than asking their adult
children
who are out of the DC area. These Japanese seniors, to our surprise,
have much
less expectations out of their adult children to become direct
caregivers when
their health status declines and they start requiring much hands-on
care.
- Mental Health Issues and
its Impact on Quality of Life
Many study participants
voiced their wishes to
develop an interdependent senior support network which can provide
various
kinds of supports for its members. They seem to be very enthusiastic to
be an
active part of such enterprise because associating with other Japanese
seniors
promotes their psychological well-being and gives them some assurance
of having
a safety net while their out-of-state children are not readily
available. They
also expressed their wish for Japanese associations to develop a
Japanese
senior citizen center where seniors can socialize through different
activities
and education seminars. Japanese older adults are very eager to learn
information that prepares them for later years and enjoy obtaining such
information from their Japanese peers because they tend to believe that
Japanese
sources are more credible in providing more trustworthy information.
Finally,
there was a consensus among study participants that they were willing
to use
services provided by Japanese mental health professionals who are
specialized in
geriatric psychiatric care as Japanese native speakers prefer to
discuss
sensitive issues in Japanese such as end-of-life issues, bereavement,
and other
mental health issues.
RECOMMENDATIONS
- Developing Expertise in
the DC Japanese Community to Assist their Seniors and Caregivers to
Develop Advance Care Planning.
* Create an information
clearing house to
provide accurate and abundant information on in-home services and
long-term
care facilities. Japanese older adults have a tendency to obtain
information
from their informal networks and the information is often incorrect.
Publicize
this service once the system is established.
* Develop a counseling
system where a
professional counselor who is knowledgeable about the cultural
differences
between Japanese and Americans as well as American legal, medical and
social
service system. This is called care management service in the U.S. and
the
demand for this type of counseling service for caregivers is on a
steady
increase.
* Collaborate with some
retirement communities
in the DC area to see if they could make efforts to provide culturally
sensitive and competent services for Japanese seniors.
* Also, collaborate with
assisted living
facilities. Compared to a nursing facility, their residents require
less care
as they are physically and mentally more independent compared to
nursing home
residents. An assisted living facility provides:
- Nursing care for 24
hours/7days.
- Cleaning, meal,
laundry, shopping services.
- Dispensing
medications.
- Assistance with
bathing, eating and transfers.
- Assistance with
changing clothes, brushing teeth and toileting.
- Night rounds.
- Improving Services in the
Field of Mental Health
# Establish
a Japanese senior center where any
Japanese older person can stop by to relax and socialize. Hire a
coordinator
who can create and organize different activities such as educational
seminars,
volunteering, recreational activities and so on.
# Many
Japanese older persons wish to not
burden their out-of-town children unless they develop a serious care
problem.
Create a interdependent volunteer group where volunteers can help one
another
with different tasks such as house chores, shopping, and exchanging
information.
# Recruit
Japanese mental health professionals
who can provide counseling in Japanese. Also, develop a volunteer
program so
that there will be some “friendly visitors” who can provide emotional
support
for home bound seniors.
School of Social Work,
University of Maryland has been
working closely with different entities in the local community to
assist grass
root level social service research and provisions. The major principles
in
American gerontological social service include respect for
self-determination
and human dignity, and operation of social and medical facilities that
collaborate with local residents. Japanese gerontological social
service has
historically emphasized on the importance of respect for the elderly
and
sincere communication with them. It is one of the most critical agendas
for the
DC Japanese community to address the enrichment of services for
Japanese
seniors who reside at home. Their quality of life will be improved
further with
much supports from the community associations.
In the future, I am very
interested in continuing the
collaboration that I have developed with the Japanese Americans’ Care
Fund and
Sakura Association. Participatory action research is very beneficial
for the
community as well as for the university to link both entities and
enable us to
work together to develop excellent services for Japanese older adults
in the DC
community. I have a very high level of expectations for the both
Japanese
associations as they have demonstrated the potential to service for
their
community members over the last several years through many different
and unique
events and programs. I would like to contribute to their efforts and
fruitful
results as an educator and researcher.