Perceived Health Status
Contrary to other studies on immigration and health (Koya & Egede, 2007; McLeroy et al., 1988), more elderly Korean immigrants had better perceived health than elderly Koreans in this study. The hypothesis that elderly Korean immigrants would have poorer perceived health than elderly Koreans was not supported. Perceived health status is subjective and can be a reflection of people’s evaluations of many medical, psychological, and social conditions in their lives (McLeroy et al., 1988; Molarius & Janson, 2002). As the socio-ecological model of health promotion illustrates (McLeroy et al., 1988), better social welfare systems (e.g., monthly stipend from the federal government, independent living status) (Sin, LoGerfo, Belza, & Cunningham, 2004) could have influenced better perceived health in elderly Korean immigrants, as well as geographical selection of participants and convenience sampling. Similar to study findings in other countries (Asfar et al., 2007; Parslow et al., 2004), men in both groups had better perceived health than women. In both groups, more men were married and lived with a spouse. Other studies have reported a positive relationship between social support, including marriage, and perceived health (Fry, 2001; Joutsenniemi et al., 2006; Rutledge, Matthews, Lui, Stone, & Cauley, 2003).
Cardiovascular Risk Factors
Obesity, high blood pressure, and diabetes were commonly found health problems in both elderly Korean immigrants and elderly Koreans. Despite the better perceived health of elderly Korean immigrants, more elderly Korean immigrants than elderly Koreans had been diagnosed with hyperlipidemia, diabetes, and high blood pressure, supporting the hypothesis of this study. This supports the high prevalence of CVD risk factors and mortality found among immigrants (Cho & Juon, 2006; Sin et al., 2009). The socio-ecological model of health promotion might explain the high prevalence of CVD risk factors among immigrants.
Although the prevalence of overweight/obesity between elderly Korean immigrants and elderly Koreans was not significantly different, it was the dominant health problem (79.6% in elderly Korean immigrants, 70.2% in elderly Koreans), followed by high blood pressure in both groups. More than half of the participants in both groups were above normal weight range, according to Asian BMI criteria (WHO Expert Consultation, 2004). Obesity is a primary risk factor for the development of high blood pressure, high blood cholesterol, and diabetes mellitus (Janssen, Katzmarzyk, & Ross, 2004; Snijder et al., 2004).
In addition to the influence of aging on decreased muscle and increased body fat (Westerterp & Meijer, 2001; Wickramasinghe, DeFilippis, Lloyd-Jones, & Blumenthal, 2003), environment and lifestyle have a significant influence on weight gain and obesity (Whitaker, 2002). Participants’ length of residency in the United States ranged from 1 to 35 years. Several studies have reported a significant relationship between long-term immigration and a high risk of obesity among immigrants in the United States (Kaplan, Huguet, Newsom, & McFarland, 2004; Neuhouser, Thompson, Coronado, & Solomon, 2004). One study reported a positive association between overweight and length of residence in Korean American adults in California (Cho & Juon, 2006).
Most Koreans who participated in this study had small body frames with lack of apparent fat. Although Asians tend to have a lower BMI, they do have a higher percentage of body fat and different fat distribution than Caucasians with the same BMI (Martorell, Malina, Castillo, Mendoza, & Pawson, 1988). Health care providers not familiar with these physiological differences may overlook signs of obesity and its negative consequences in elderly Korean immigrants. These findings might be useful for health care providers for better health risk assessment of Asian Americans.
Women in this study had a higher prevalence of overweight/obesity than men, which is similar to findings from previous studies (Sharkey & Branch, 2004). This observation may reasonably be concluded as one of the reasons for a higher mortality rate from CVD (Rosamond et al., 2007). It further supports the lower perceived health status in women versus men in this study. This study supports the necessity for more studies on health management behaviors and emotional well-being of women to promote their health.
High blood pressure was the second most common health problem in both groups, as reported in another study on elderly Korean immigrants (M.T. Kim, Juon, Hill, Post, & Kim, 2001). More than 50% of elderly Korean immigrants and elderly Koreans had high blood pressure. Many factors, such as environment (e.g., increased sodium intake, physical inactivity) and race, might have influenced high blood pressure incidence (Reusser & McCarron, 2006). Increased blood pressure has been strongly associated with increased salt intake in other racial and ethnic groups (Franco & Oparil, 2006; Yamori et al., 2002). Koreans tend to have high dietary sodium intake. According to the Korean Food and Drug Administration, Koreans eat 4.9 grams of sodium on average every day, nearly twice the recommended level of less than 2.4 grams set by the WHO (Park, Paik, Skinner, Spindler, & Park, 2004). Main sources of sodium include traditional Korean foods such as kimchi, soybean paste, and soy sauce. High sodium intake might have a significant relationship with the high prevalence of high blood pressure in Koreans. Dietary assessment and counseling are needed to better manage high blood pressure in both elderly Korean immigrants and elderly Koreans.
According to the American Heart Association (AHA; n.d.b), nearly one in three U.S. adults has high blood pressure, but one third of these people are not aware of having it. In addition, poorly controlled blood pressure was reported among people taking high blood pressure medications (Lloyd-Jones et al., 2000). Only 51.1% of elderly Korean immigrants in this study had a regular health check-up. It is possible that many elderly Korean immigrants were not aware of their potential for having high blood pressure because they did not experience or recognize any associated symptoms. Considering the high prevalence of high blood pressure in elderly Korean immigrants, more attention on blood pressure management is needed by health care providers.
Diabetes mellitus was the third most prevalent health problem diagnosed in both elderly Korean immigrants and elderly Koreans. More elderly Korean immigrants had diagnosed diabetes mellitus than elderly Koreans (34.1% versus 18.3%). Changes in health management behaviors (e.g., sedentary behavior) and health status (e.g., overweight) may be two of the factors influencing higher prevalence of diabetes in elderly Korean immigrants. Elderly Korean immigrants’ poor recognition and control of diabetes may be due to poor health care utilization (Sohn, 2004). Diabetes mellitus was the cause of death of 73,965 Americans in 2003 (AHA, n.d.a), and thus early detection, awareness, and proper control are needed to prevent adverse effects of undermanaged diabetes in elderly Korean immigrants.
Approximately 19% of elderly Korean immigrants and nearly 4% of elderly Koreans reported having high blood cholesterol (hyperlipidemia). Although this is a significant finding, the prevalence of high blood cholesterol in elderly Korean immigrants may actually be higher than the results reported in this study, mostly due to lack of awareness (Lee, Yeo, & Gallagher-Thompson, 1993) and poor health care utilization (Sohn, 2004). Data from the 2000 Korean American Health Survey, a survey of 1,660 Korean Americans living in Los Angeles County, showed that 31% had never visited a medical doctor within the past 12 months for a check-up or consultation (Sohn, 2004).
Dietary pattern has a significant relationship with high cholesterol levels (Lee et al., 1993). The traditional Korean diet is based on rice and vegetables with rare consumption of saturated fats. A significant relationship between immigration and less consumption of Korean foods at home has been reported (J. Kim & Chan, 2004; K.K. Kim et al., 2000). Diet is critical in preventing many chronic diseases, especially CVD. Given the reported increase in the number of CVD risk factors, studies of dietary patterns in this growing segment of older adult minorities is compelling because of its potential for CVD risk factor prevention.