IMMIGRANTS AND
REFUGEES:
AGING ISSUES &
CHALLENGES
Muthoni Imungi, Assistant Professor
School of Social Work
Grand Valley State University
DEFINITIONS
• Who is a “REFUGEE”
• 1951 Convention Relating to the Status of
Refugees (28 July, 1951) defines a refugee as
• Any person who is outside their country of origin
and unable or unwilling to return there or to avail
themselves of its protection, on account of a wellfounded fear of persecution for reasons of race,
religion, nationality, membership of a particular
group, or political opinion.
DEFINITION
• Who is an “IMMIGRANT”
• An immigrant is anyone who moves from one
country to another with the intention of
settling there permanently
DIFFERENCE BETWEEN
THE TWO
• IMMIGRANT
• REFUGEE
• Makes the decision to
migrate
• Is forced to migrate
• Often safe journey
• Arduous and
dangerous journey
taking days, months.
• Is able to return to
their home country
• 37.9 million in 2007
• Most often do not have
the ability to return
home
• 48,281 in 2007
U.S. IMMIGRATION
POLICY
• Three sets rules:
1
Govern legal migration, mainly family reunification
or employment. U.S. citizens 21 or older could
sponsor the immigration of their PARENT’S, as well
as spouses and minor children. [IMMIGRANTS]
2
Govern humanitarian reasons for entering the U.S.
i.e. those fleeing oppressive political regimes,
parolees and those admitted during emergency
situations [REFUGEES AND ASSYLUM SEEKERS].
3
Govern illegal immigration [UNDOCUMENTED
IMMIGRANTS]
WELFARE POLICY
INFLUENCE
• Type of entry governs social welfare entitlements
• REFUGEES
• Are entitled to special assistance similar to those
of U.S. citizens i.e. SSI, AFDC, TANF, Medicaid,
food stamps (Refugee Act of 1980)
• IMMIGRANTS
• Are excluded from federally funded program for
the first 5 years (PROWRA Act of 1996)
WHY FOCUS ON OLDER
ADULTS
• In 1900s older adults comprised 5% of the
population
• According to a recent census older adults
comprised 12.7% of the population or 33 million
people
• Trend towards a growing older adult population is
expected to continue to rise as more adults live
into late life
OTHER CHANGES IN THE OLDER
ADULT POPULATION
• The older adult population will increase in diversity
• Between 1990 and 2050 the non-white older adult
population in the U.S. is projected to double from 10.2% to
21.3% (0thers 16% to 32.6%)
• Between 1990 and 2050 the Asian population over the
age of 65 increase by 625% followed by Hipsanic, Native
American and African Americans at the rate of 150%
• At the turn of the century, the non-Hispanic-white
population will account for approximately 72% of the U.S.
Population, by 2050 they will account for less than 53% of
that same populatin
REASON FOR DIVERSITY
• Older adults resettled as refugees and
immigrants
• Aging of younger cohorts of immigrants
• Immigration
• Over the past 40 years immigration streams
have shifted towards Africa, Asia and Latin
America
• Family reunification, enable older parents
immigrate
KNOWLEDGE GAPS
• Little research on older adults in general
because the comprise a small percentage of
the population
• Event less is known of the health or health
trajectories in older immigrants and refugees
• Increase in number of older immigrants and
refugees in the U.S. presents a new challenge
to practitioners and policy makers concerned
with promoting healthy aging.
AGING
CHALLENGES
IMMIGRANTS AND REFUGEES
LANGUAGE
• Many older adults who immigrate later in life from
non-English speaking countries do not speak English
• For example, in 20001
• 4.5% of older adult Asian Immigrants spoke English well
• 42.8 spoke English less than very well
• 18.6 had graduate/professional degrees
• No research evidence suggests that older adults
cannot successfully learn another language, however,
evidence finds that it is easier for pre-pubescent
children to acquire language faster and speak it
without an accent
ACCULTURATION
• LANGUAGE
• Lack of language hampers acculturation.
• MOBILITY
• Older adults may also be more home-bound resulting in less
interaction with mainstream culture, thereby hampering
acculturation
• Older age at immigration is associated with lower levels of
acculturation, acculturative stress and depression.
• DIFFERING RATES OF ACCUTURATION
• Differential rates of acculturation within families are source
of distress
• It is near impossible for older immigrants to achieve
complete assimilation to a new culture
LOSS
• LOSS OF FAMILIARITY AND NETWORKS
• Older adults had previously established roots, relationships
and a familiar way of life in their home country
• Moving to a new culture where they have few if any network
and no established way of life can lead to feelings of loss
• Feelings of loss and isolation are common
• VIEW OF OLDER ADULTS
• Many come from cultures where old age is equated with
wisdom and privilege to a culture where it is associated with
loss of productivity
• Loss of status is experienced
LIVING ARRANGEMENTS
• MULTIGENERATIONAL LIVING ARRANGEMENTS
• Most immigrants who arrive as older adults are sponsored by their adult
children through family unification
• Older adults are unlikely find employment or may not able to work.
Without a source of income they often live with their children’s families
• Having to share space with their young children is often a radically
different living arrangement that can be a source of distress and
depression
• Multiple generation households can also lead to strained relationships
• According to the 2000 U.S. census approx. 50% of immigrants 65 years
and older lived in the homes of their children compared to 4% of older
U.S. born immigrants
LIVING ARRANGEMENTS
• POOR HOUSING
• Older adults immigrating in the past 20 years are likely
to live in the inner city in substandard and
overcrowded housing which sometimes lacks basic
necessities
• The living conditions have implications for
• Physical health
• Mental health
• Safety
HEALTH
• PROWRA (1996)
• Barred legal immigrants admitted after September 1996 from many
federal and state benefits. States can also bar legal permanent resident
aliens from TANF, AFDC and Medicaid.
• This waiver is especially aimed at baring sponsored immigrants from
becoming a public charge
• Public welfare and immigration policy place responsibility for taking care
of older adults solely on family members
• Taking care of older adults can be especially burdensome to immigrants
and refugees with limited social support and knowledge of resources
• A study in Canada found that recent older adult immigrants, had poorer
health than longer-domiciled immigrants or Canadian citizens
HEALTH
• Older adults may suffer poor health because
• They are not be able to see health practitioners
due to high cost and lack of insurance
• Older adults may not mention their poor health
for fear of further burdening the family
• Lack of understanding of the health system and
cultural norms may prevent their seeking health
care
MENTAL HEALTH
• Isolation, limited language ability, loss, poor
health can be a source of depression and
anxiety among older adults
• Refugees may especially be prone to poorer
health and PTSD
• Older adult immigrants however may not seek
mental health services for these problems
because they may not be familiar with the
disorders or symptomatology
ELDER ABUSE
• The limited acculturation, language ability and
income of older adults immigrants means that many
of them will depend on family member for financial
support, transport, language an cultural brokering.
• This sense of responsibility can be overwhelming for
family members that can lead to elder abuse
• Physical Abuse
• Financial abuse
• Emotional abuse
INTERVENTIONS
INTERVENTIONS
1
Language classes tailored for older adult
2
Acculturation and adaptation services
3
Sensitization about mental health disorders
4
Access to culturally competent mental health and health
practitioners
5
Funding for mental health and health care services
6
Adult day care services/friendship classes
7
Family preservation programs
8
Advocate for policy changes
Research Interventions
• To provide appropriate services to older
immigrants from diverse backgrounds service
providers need to understand their
race/ethnicity, culture, immigration history,
acculturation level and family relationships.
• Need to understand health status and health
behaviors
Research
• Little research looking at within group
diversity
• Asian immigrants constitute people from over
20 different nations
• Most research aggregates cultural groups as
one thereby masking important health
disparities