Aging, Health, and Culture: Two Recent Studies

Two recent articles in the Journal of Gerontology examine culture and its role in assessing well-being. Each article, one published in the Social Science section and one in the Psychological Science section, offers a useful conceptualization of culture toward the respective issues of residential crowding and depression in older adults.

The article on crowding compares residential patterns among Hispanics and non-Hispanic whites in metropolitan areas of the US, aged 65 and older (Burr et al 2010), based on 2000 US Census data. Rather than focusing on the consequences of crowding, or assuming that all forms of crowding (defined here as living in a household that contains more than 1 person per room) has a negative effect, the researchers focused solely on the association of individual and neighborhood factors with crowding. More specifically, they hypothesized that levels of assimilation, neighborhood segregation, and affordability of housing markets would correlate with crowding.

The researchers found that in every model they posited, including “an array of individual and contextual variables to the model of residential crowding, the impact of Hispanic ethnicity remains positive.” (Burr et al 2010:778) These variables were the individual variables of age, Hispanic subpopulation (i.e. Mexican, Puerto Rican, Central American), marital (though not partnership) status, self-care limitation, English language ability, year of immigration (or migration to the mainland US in the case of Puerto Rico), and income. Contextual variables included household composition (i.e. children, extended kin), and various structural facts about the neighborhood. English language skill, housing tenure (owner, renter, or co-resident), and duration of time in the mainland US was predictive of less crowding.

The authors suggest a few possibilities for the effect of Hispanic ethnicity, including cultural factors like different ideas of intergenerational co-residence, privacy, and general fertility and health patterns. The authors acknowledge that their data was limited in terms of a lack of social network data, like number of children and other dependents, and errors in the Census Bureau’s public-use data (as found in Alexander, Davern and Stevenson 2010, cf Burr et al 2010).  Provocatively, the authors suggest that their data may suggest that “policy makers need to adjust their definition of what constitutes overcrowded housing if some groups are more comfortable living in denser living arrangements” (Burr et al 2010: 781).

The study on depression looked at possible cultural influences on responses to the Center for Epidemiologic Studies-Depression scale (CES-D), which has been translated into 50 different languages and is used internationally (Jang et al 2010). Looking at a Korean sample, a Korean-American sample, and a non-Hispanic white sample of older adults taking the CES-D, the authors found that there was a different willingness to report positive affect: Non-Hispanic whites and Korean-Americans who scored high on a 12-item acculturation inventory were significantly more likely to report positive affect that Koreans and Korean-Americans with low acculturation scores.

The authors present this as an example of differential item functioning (DIF), which “occurs when respondents from different groups show differing tendencies toward endorsing an item despite being matched” in regard to the attribute that the item is supposed to measure (Jang et al 2010). So, in this example, in considering individuals who have low depression scores, Koreans are significantly less likely to endorse the positive affect items, items which, in non-Hispanic whites, correlate highly with other responses that counterindicate depression. The authors cite several studies that have found differential item functioning in the CES-D between men and women and African-Americans and non-Hispanic whites, indicating that it may not be valid for cross-group comparisons.

Each article uses the concept of assimilation to account for differences within migrant populations. While measuring assimilation by language ability and time spent in the US is useful in these large-scale studies, it is important not to overgeneralize to the level of the individual, where there may be vast differences in values and practices among individuals with similar language skills and times of residence.  Further, “assimilation” implies a monolithic and static view of the US culture. For instance, the non-Hispanic whites in the sample used in the Jang et al study certainly varied in the extent to which they shared broader American values of expressing optimism and positive thinking, which vary well may have led to different responses on positive affect items. Or, in the case of residential crowding, it would be interesting to compare differences across populations in 2000 with differences in 2010, following the ongoing economic troubles that have led to increased transgenerational and other shared co-residence. Certainly, ideas of when a residence becomes crowded have changed. (See our earlier post for a discussion of “culture” in gerontology.)

This, however, is not a failing in either of these two articles, which use databases large enough that an imprecise conceptualization of culture, like measures of assimilation, can illustrate important points. Rather, it points to how well such large-scale research and cultural psychiatry (and other ethnographic approaches) can contribute to one another.  Medical and psychological/psychiatric anthropology provide numerous examples of the ethnocentricity of psychiatric assessment scales (such as Kirmayer 2005 or Kleinman and Good 1985), like Jang et al show about the CES-D. Similarly, cultural anthropology also offers a perspective on migration and family patterns that may illuminate studies of residential crowding among immigrant communities of older adults (Foner 2003; Hirsch 2003). Incorporating this data could help identify the “unmeasured cultural factors” and the degree to which “some groups are more comfortable living in denser living arrangements” (Burr et al 2010: 780-1).

These two articles do an excellent job of pointing out how the role of culture and context inform the wellbeing of older adults, particularly given the diversity of ideas of aging, generation, and health that exist around the world. We invite our readers to offer comments on culture and aging. Is it relevant in your community, agency or family? Is an anthropological view of culture useful for gerontology?

Click for our earlier Aging in Action post on Cultural Psychiatry

Articles reviewed (click for links):

Burr, J.A., Mutchler, J.E., & Gerst, K. (2010). “Patterns of residential crowding among Hispanics in later life: immigration, assimilation, and housing market factors.” Journal of Gerontology: Social Sciences, 65B(6), 772–782.

Jang, Y., Kwag, K.H., & Chiriboga, D.A. (2010). “Not saying I am happy does not mean I am not: cultural influences on responses to positive affect items in the CES-D.” Journal of Gerontology: Psychological Sciences, 65B(6), 684–690.

Other works cited:

Foner, Nancy, ed. (2003). American Arrivals: Anthropology Engages the New Immigration.  Santa Fe: School of American Research Press.

Hirsch JS (2003). A Courtship After Marriage: Sexuality and Love in Mexican Transnational Families. Berkeley: University of California Press.

Kleinman, A. and B. Good, Eds, (1985). Culture and Depression. Berkeley: University of California Press.

Kirmayer, LJ (2005). “Culture, Context and Experience in Psychiatric Diagnosis.” Psychopathology 2005;38:192-196

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