Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 101

In the United States, approximately 13.5% of the population over 65 is foreign‐born.⁹ Of those, three of four are naturalized citizens. Foreign‐born older adults are significantly less likely to speak English at home; approximately half of foreign‐born older adults reported to the US Census that they speak English ‘less than very well.’ This is an important consideration for providers working with older adults, as it could have major impacts on their ability to navigate the complex American healthcare system.

One in ten foreign‐born older adults in the US migrated as an older adult, most commonly following sponsorship by their adult children. Adults who migrate at older ages are considered a vulnerable migrant population and face a unique set of challenges as compared to native‐born adults. Older adult migrants are much more likely to have low incomes and be financially dependent on others.¹⁰ They are also more likely to suffer from social isolation and loneliness. Engagement with family and neighbours (particularly in the absence of language barriers) and engagement with religious organizations have been shown to ameliorate loneliness and improve quality of life.¹¹

Globally, adults over 65 make up approximately 11.7% of the total migrant population. As in the US, the majority of immigrants tend to migrate at a younger age and remain in their destination country at an older age (www.migrationdataportal.org). This trend is more prominent in developed countries and the Northern hemisphere. In the Southern hemisphere, older adults are more likely to return to their country of origin. However, complete immigration data for a number of developing countries is lacking. As in the US, international immigrants are particularly vulnerable to social isolation and financial insecurity. Many older adult immigrant households are composed of immigrant grandparents and their naturalized grandchildren, suggesting that immigrants play an important role in childcare and help to maintain the household of their adult children.

Figure 4.2 United States population separated by age and gender in 2020 and 2050 (projected).

Source: Data from United States population separate by age and gender in 2020 and 2050, United Nations Data Retrieval System (www.un.org).

Adult immigrants may have different rates of certain diseases in older age than the population to which they immigrated. For example, immigrants from Yugoslavia and Hungary had a higher stroke incidence than Swedes living in Malmo, Sweden,¹² and Japanese immigrants to Brazil have different cancer mortality rates than do Japanese in Japan.¹³ The ‘healthy immigrant effect’ is a phenomenon in which immigrants are, on average, healthier than native‐born residents.¹⁴ It has been described in the US, Canada, Australia, and several European countries. There are many explanations for this effect, including self‐selection (i.e. a tendency for healthier and/or wealthier individuals to migrate), health screening requirements in receiving countries, and retention of healthier, native habits. The health of immigrants and native‐born individuals does tend to converge after multiple decades, likely due to immigrants adopting the health and lifestyle habits of their receiving country. However, immigrants may or may not adapt to the diet and health practices of their host country.

Quality of life may also change. Older American‐born adults of Polish descent had a significantly better subjective quality of life than first‐generation Polish immigrants living in the US, who in turn had a better subjective quality of life than those who lived their entire lives in Poland.¹⁵ Studies of Chinese immigrants to Canada and New Zealand have suggested a high rate of depression compared with the general population, and a similarly high rate of depression is seen in Hispanic immigrants to those countries.¹⁶