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. Author manuscript; available in PMC: 2023 Feb 21.
Published in final edited form as: J Aging Health. 2014 Oct;26(7):1137–1154. doi: 10.1177/0898264314529332

The Perception of Social Support Among U.S. Chinese Older Adults: Findings From the PINE Study

Ruijia Chen 1, Melissa A Simon 2, E-Shien Chang 1, YingLiu Zhen 1, XinQi Dong 1
PMCID: PMC9942516  NIHMSID: NIHMS1865952  PMID: 25239970

Abstract

Objective:

This study examined perceptions and correlates of both positive and negative social support among U.S. Chinese older adults.

Method:

Data were drawn from the Population Study of Chinese Elderly in Chicago study, a population-based study of U.S. community-dwelling Chinese older adults aged 60 years and above in the Greater Chicago area.

Results:

The findings suggested that U.S. Chinese older adults were more likely to perceive positive and negative spouse and family support than friend support. Younger age, being female, higher levels of education, being married, living with a larger number of people, higher health status, better quality of life, and improved health over the past year were positively associated with positive social support. However, younger age, being male, higher levels of education, being married, having fewer children and grandchildren, living with more people, lower health status, and poorer quality of life were positively correlated with negative social support.

Discussion:

Chinese older adults perceive a high level of both positive and negative spouse and family support simultaneously. Further longitudinal studies should be conducted to better understand the factors and outcomes associated with perceived positive and negative social support.

Keywords: positive social support, negative social support, Chinese, older adults

Introduction

Social support is the supportive resource people perceive they get from their social network or the supportive resource they believe is available to them (Vangelisti, 2009). Social support influences well-being by two models: the main effect model and the stress buffering model (Cohen & Syme, 1985). On one hand, social support improves a person’s well-being through normative guidance on healthy behaviors, by improving self-esteem, and by increasing sense of belonging (Brown, Andrews, Harris, Adler, & Bridge, 1986). On the other hand, social support prevents damaging responses resulting from stressful events and thus improves well-being (Cohen & Wills, 1985).

Social support is important for maintaining health and successful aging (Rowe & Kahn, 1998). In a longitudinal study of 1,189 initially high-functioning older adults, greater emotional support at the baselines predicted better cognitive function at the 7.5-year follow-up (Seeman, Lusignolo, Albert, & Berkman, 2001). A study with 2,910 older adults aged from 57 to 85 years found that perceived lack of social support was associated with lower levels of physical health (Cornwell & Waite, 2009b). In addition, social support also protects older adults against negative events in later life such as elder abuse (Dong & Simon, 2008; Dong & Simon, 2010), bereavement (Krause, 1986), depression (Chi & Chou, 2001), and mortality (Lyyra & Heikkinen, 2006).

Despite its positive effects, social support can also be a source of strain and conflict (Rook, 1984). Prior studies demonstrated that negative social support may exacerbate life stress, depression, and loneliness (Fiore, Becker, & Coppel, 1983; Kiecolt-Glaser, Dyer, & Shuttleworth, 1988). More important, negative aspects of social support may have more powerful impacts on well-being, and in particular, on psychological symptoms than do positive aspects of social support (Finch, Okun, Barrera, Zautra, & Reich, 1989; Ingersoll-Dayton, Morgan, & Antonucci, 1997; Rook, 1990). For instance, a recent study using data from the National Social Life, Health and Aging Project (NSHAP) found that the negative aspect of social support had a stronger relationship with loneliness than the positive aspect of social support (Shiovitz-Ezra & Leitsch, 2010). However, most studies on negative aspects of social support were conducted in Western countries; studies that include both positive and negative aspects of social support among Chinese older adults are scarce.

Traditional cultural values may influence older adults’ perceptions of social support. Perceived social support in the Chinese population, for example, is typically shaped by traditional Chinese cultural norms (Chi & Chou, 2001). Chinese culture greatly emphasizes the value of collectivism and encourages conformity and cohesiveness (Ho & Chiu, 1994). Consequently, family support is often considered as the primary source of social support to the majority of Chinese older adults (Leung, Chen, Lue, & Hsu, 2007). In addition, as a predominant value of Confucian philosophy, filial piety demands children’s obligations of caring for and respecting older adults. Strongly influenced by Confucianism, Chinese older adults may place higher expectations on support from children than from other sources (Chappell & Kusch, 2007). A wide range of studies have confirmed the primary role of family support by showing that both family support received and given are related to better psychological well-being and a reduced likelihood of experiencing negative life events among Chinese older adults in different regions (Chen & Silverstein, 2000; Dong & Simon, 2008; Siu & Phillips, 2002).

However, recent studies on social support among Chinese older adults indicate that traditional intergenerational relationships may be disrupted due to dramatic social, cultural, and economic changes (Wong, Yoo, & Stewart, 2006). Immigration, in particular, may jeopardize traditional social support systems and change older adults’ perceptions of various types of social support. Thus, U.S. Chinese older adults may find it increasingly difficult to maintain desired social relationships (Pang, Jordan-Marsh, Silverstein, & Cody, 2003). Chinese Americans account for the oldest and largest Asian population in the United States (Barnes & Bennett, 2002). According to the U.S. Census Bureau, in 2010, there were 538,417 Chinese older adults in the United States (U.S. Census Bureau, 2010). Compared with other immigrant populations, the Chinese population is older in average age and less acculturated (Shinagawa, 2008). The demographic growth of U.S. Chinese aging populations and the changes of the social support system brought about by immigration calls for a deeper understanding of perceived social support among U.S. Chinese older adults.

The purposes of this study are to (a) describe perceptions of positive and negative social support among Chinese older adults, and (b) explore socio-demographic and health-related correlates of both positive and negative social support among Chinese older adults.

Method

Population and Settings

The Population Study of Chinese Elderly in Chicago (PINE) is a community-engaged, population-based epidemiological study of U.S. Chinese older adults aged 60 years and above in the Greater Chicago area. Briefly, the purpose of the PINE study is to collect community-level data of U.S. Chinese older adults to examine the key cultural determinants of health and well-being. The project was initiated by a synergistic community-academic collaboration among the Rush Institute for Healthy Aging, Northwestern University, and many community-based social services agencies and organizations throughout the Greater Chicago area (Dong, Wong, & Simon, 2014).

To ensure study relevance to the well-being of the Chinese community and enhance community participation, the PINE study implemented extensive culturally and linguistically appropriate community recruitment strategies strictly guided by a community-based participatory research (CBPR) approach. Over 20 social services agencies, community centers, health advocacy agencies, faith-based organizations, senior apartments, and social clubs served as study recruitment sites. Eligible participants were approached through routine social services and outreach efforts serving Chinese Americans families in the Chicago city and suburban areas. Out of 3,542 eligible participants who were approached, 3,159 agreed to participate in the study, yielding a response rate of 91.9%.

Trained multicultural and multilingual interviewers conducted face-to-face home interviews with participants in their preferred language and dialects, such as English, Cantonese, Taishanese, Mandarin, or Teochew dialect. Based on the available census data drawn from U.S. Census 2010 and a random block census project conducted in the Chinese community in Chicago, the PINE study is representative of the Chinese aging population in the Greater Chicago area with respect to key demographic attributes, including age, sex, income, education, number of children, and country of origin (Simon et al. 2014). The study was approved by the Institutional Review Board of the Rush University Medical Center.

Measurements

Socio-demographics.

Basic demographic information, including age (in years), sex (female and male), education (years of education completed), annual personal income (US$0-US$4,999 per year; US$5,000-US$9,999 per year; US$10,000-US$14,999 per year; US$15,000-US$19,999 per year; or more than US$20,000 per year), marital status (married, separated, divorced, or widowed), number of children, number of grandchildren, years in the community, and years in the United States were assessed in all participants. Living arrangement was categorized into four groups: (a) living alone, (b) living with one person, (c) living with two to three persons, or (d) living with four or more persons.

Overall health status, quality of life, and health changes over the last year.

Overall health status was measured through a self-report survey asking the question, “In general, how would you rate your health?” on a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = very good). Quality of life was assessed by asking, “In general, how would you rate your quality of life?” on a 4-point scale ranging from 1 = poor to 4 = very good. Health change over the last year was measured by asking, “Compared to one year ago, how would you rate your health now?” on a 3-point point scale (1 = worsened, 2 = same, 3 = improved).

Social support.

The social support measurement was drawn from the Health and Retirement study (HRS) and has also been used in the NSHAP (Cornwell & Waite, 2009a; Cornwell & Waite, 2009b; Juster & Suzman, 1995). We assessed participants’ levels of social support by asking the frequency of receipt of support from spouse, family members, and friends. The support acts were categorized under positive support and negative strain, as key indicators of the relationship quality.

Positive support was measured by asking the extent to which the participants liked to open up to spouse/family members/friends/, and how often they relied on spouse/family members/friends for help. Negative support was measured by asking how often the participants believed that too much was demanded of them by their spouse/family members/friends, and how often they had been criticized by spouse/family members/friends. Respondents indicated answers to each question on a 3-point scale ranging from 1 = hardly ever to 3 = often. Positive and negative support was calculated as the sum of the six items within each category. In this study, positive social support had a Cronbach’s alpha of .73 and negative social support had a Cronbach’s alpha of .63, indicating adequate reliability.

Data Analysis

We used descriptive statistics to summarize demographic information of the participants. Chi-square statistics were used to study perceived positive and negative social support of different sources. Pearson Correlation coefficients and Spearman’s rank correlation were calculated to examine socio-demographic and health-related factors with positive social support and negative social support. All statistical analyses were carried out with SAS, Version 9.2 (SAS Institute Inc., Cary, North Carolina).

Results

Sample Characteristics

Of the 3,159 participants, 58.9% were female (Table 1). The participants had a mean age of 72.8 years (SD = 8.3, range = 60–105). The majority of participants had equal or less than a high school education (78.9%) and 6.2% received no education at all. The majority of the participants (85.1%) had an annual personal income that was less than US$10,000 and only 2.8% of the participants had an annual income of more than 20,000. Nearly three out of four (71.3%) participants were married, while 24.5% were widowed. More than half (55.6%) of the participants had three or more children and 67.6% had three or more grandchildren. Among the participants, 21% lived alone. More than 1 in 4 (26.7%) of the participants had been in the United States for less than 10 years, and 57.5% had been in the community for less than 10 years. In all, 60.8% of the participants perceived fair or poor overall health status, 49.3% had a fair or poor quality of life, and 42.5% experienced worsened health status.

Table 1.

Characteristics of the PINE Study Participants.

N %
Age (years)
 60–64 681 21.6
 65–69 643 20.4
 70–74 606 19.2
 75–79 557 17.6
 80–84 396 12.5
 85 and over 276 8.7
Sex
 Male I,297 4I.I
 Female I,862 58.9
Education (years)
 0 I95 6.2
 1–6 1,179 37.6
 7–12 1,103 35.1
 13–16 576 18.3
 17 and over 87 2.8
Personal annual income
 US$0-US$4,999 1,041 33.3
 US$5,000-US$9,999 1,617 51.8
 US$I0,000-US$ 14,999 3I0 9.9
 US$I5,000-US$ 19,999 68 2.2
 US$20,000 and over 87 2.8
Marital status
 Married 2,237 71.3
 Separated 57 1.8
 Divorced 74 2.4
 Widowed 769 24.5
Number of children
 0 I28 4.1
 1–2 1,271 40.3
 3 and more I,752 55.6
Number of grandchildren
 0 357 11.4
 1–2 655 21.0
 3 and more 2,110 67.6
Living arrangement
 Living alone 679 21.5
 With 1 person 1,318 41.7
 2–3 743 23.5
 4 or more 4I8 13.2
Years in the United States
 0–10 840 26.7
 11–20 969 30.8
 21–30 767 24.4
 30 and more 568 18.1
Years in the community
 0–10 1,811 57.5
 1 1–20 740 23.5
 21–30 388 12.3
 30 and more 210 6.7
Overall health status
 Very good 139 4.4
 Good 1,092 34.8
 Fair 1,316 41.9
 Poor 594 18.9
Quality of life
 Very good 215 6.9
 Good 1,379 43.9
 Fair 1,447 46.1
 Poor 99 3.2
Health Changes over the last year
 Improved 274 8.7
 Same 1,530 48.7
 Worsened 1,335 42.5
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Positive Social Support by Different Sources

More than half of the participants (69.6%) often opened up to their spouse and over half of the participants (50.7%) often opened up to their family members (Table 2). By contrast, only 30.0% of the participants could often open up to friends, and 29.5% hardly ever opened up to friends. The majority of participants (68.5%) could rely on their spouse for help, and 60.4% of the participants could rely on their family members for help. However, 40.4% of the participants hardly ever relied on friends for help.

Table 2.

Different Sources of Positive Social Support.

Social support Hardly ever, N (%) Some of the time, N (%) Often, N (%)
Perceived support from spouse
 Open up to spouse 228 (10.1) 456 (20.2) 1,569 (69.6)
 Rely on spouse 279 (12.4) 431 (19.1) 1,541 (68.5)
Perceived support from family members
 Open up to family members 454 (14.4) 1,097 (34.9) 1,595 (50.7)
 Rely on family Members 310 (9.9) 935 (29.7) 1,901 (60.4)
Perceived support from friends
 Open up to friends 789 (29.5) 1,087 (40.6) 802 (30.0)
 Rely on friends 1,082 (40.4) 819 (30.6) 775 (29.0)
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Negative Social Support by Different Sources

In total, 14.2% of the participants thought that they were demanded too much by their spouse, 6.1% were demanded too much by family members, and a comparatively small number of the participants (2.5%) were demanded too much by friends (Table 3). In addition, 31.1% of the participants were criticized by their spouse, 11.4% of the participants were criticized by family members, and only 4.8% were criticized by friends.

Table 3.

Different Sources of Negative Social Support.

Social support Hardly ever, N (%) Some of the time, N (%) Often, N (%)
Perceived support from spouse
 Demanded too much by spouse 1,936 (85.8) 241 (10.7) 79 (3.5)
 Criticized by spouse 1,556 (69.0) 561 (24.9) 139 (6.2)
Perceived support from family members
 Demanded too much by family members 2,951(93.8) 152 (4.8) 42 (1.3)
 Criticized by family Members 2,784 (88.6) 320 (10.2) 39 (1.2)
Perceived support from friends
 Demanded too much by friends 2,610 (97.5) 57 (2.1) 10 (0.4)
 Criticized by friends 2,546 (95.2) 118 (4.4) 10 (0.4)
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Correlations of Perceived Positive and Negative Social Support With Demographic and Health Variables

Younger age (r = −.07, p < .001), being female (r = .04, p < .05), higher levels of education (r = .09, p < .001), being married (r = .08, p < .001), living with more household members (r = .09, p < .001), higher overall health status (r = .15, p < .001), better quality of life (r = .21, p < .001), and improved health over the last year (r = .05, p < .01) had significant positive correlations with positive social support (Table 4).

Table 4.

Correlations of Socio-Demographic and Health-Related Characteristics With Perceived Positive Social Support.

Age years Sex Edu Income MS Children Grandchildren Living OHS QOL HC PSS
Age years 1.0
Sex .01 1.0
Edu −.12*** −.21*** 1.0
Income .05** .00 .01 1.0
MS −.33*** −.32*** .22 −.03 1.0
Children .32*** .09 *** −.38*** .00 −.13*** 1.0
Grandchildren .43*** .13*** −.39*** −.02 −.18*** .72*** 1.0
Living −.35*** −.07*** .02 .16*** .24*** −.07*** −.10*** 1.0
OHS −.08*** −.06** .05** .08*** .05** .00 −.02 .00 1.0
QOL .06*** .05** .09*** .08*** −.03 .04* .05** −.04* .32*** 1.0
HC −.11*** −.03 .02 .05** .07*** −.02 −.05** .00 .35*** .15*** 1.0
PSS −.07*** .04* .09*** −.02 .09*** −.03 −.01 .09*** .15*** .21 *** .05** 1.0
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Note. Edu = education; MS = marital status; Children = number of children; Grandchildren = number of grandchildren; Living = living arrangement; OHS = overall health status; QOL = quality of life; HC = health changes in the past year; PSS = positive social support.

*

p < .05.

**

p < .01.

***

p <.001.

However, younger age (r = −.06, p < .001), being male (r = −.13, p < .001), higher levels of education (r = .19, p < .001), being married (r = .18, p < .001), living with more household members (r = .09, p < .001), having fewer children (r = .13, p < .001), having fewer grandchildren (r = .15, p < .001), lower overall health status (r = .04, p < .05), and inferior quality of life (r = .04, p < .05) were significantly and positively correlated with negative social support (Table 5).

Table 5.

Correlations of Socio-Demographic and Health-Related Characteristics With Perceived Negative Social Support.

Age years Sex Edu Income MS Children Grandchildren Living OHS QOL HC NSS
Age years 1.0
Sex .01 1.0
Edu −.12*** −.21 *** 1.0
Income .05** .00 .01 1.0
MS −.33*** −.32*** .22 −.03 1.0
Children .32*** .09*** −.38*** .00 −.13*** 1.0
Grandchildren .43*** .13*** −.39*** −.02 −.18*** .72*** 1.0
Living −.35*** −.07*** .02 .16*** .24*** −.07*** −.10*** 1.0
OHS −.08*** −.06** .05** .08*** .05** .00 −.02 .00 1.0
QOL .06*** .05** .09*** .08*** −.03 .04* .05** 0.04* .32*** 1.0
HC −.11*** −.03 .02 .05** 07*** −.02 −.05** .00 .35*** .15*** 1.0
NSS −.06*** −.13*** .19*** .00 .18*** −.13*** −.15*** .09*** −.04* −.04* −.03 1.0
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Note. Edu = education; MS = marital status; Children = number of children; Grandchildren = number of grandchildren; Living = living arrangement; OHS = overall health status; QOL = quality of life; HC = health changes in the past year; NSS = negative social support.

*

p < .05.

**

p < .01.

***

p <.001.

Discussion

This population-based study indicates that Chinese older adults perceive a higher level of positive and negative spouse and family support as compared with friend support. Moreover, this study suggests that younger age, being female, higher levels of education, being married, living with a larger number of people, higher health status, better quality of life, and improved health over the past year were positively associated with positive social support. However, younger age, being male, higher levels of education, being married, having fewer children and grandchildren, living with more people, lower health status, and poorer quality of life were positively correlated with negative social support.

The study contributes to existing knowledge in a number of different ways. First, this study represents the largest population-based study on perceived social support among U.S. Chinese older adults. Second, this study examines not only perceived positive social support but also perceived negative social support, which adds knowledge to the current understanding of perceived social support in U.S. Chinese older populations. In addition, strictly guided by CBPR principles, this study contributes in producing locally relevant and context-specific findings. With community’s full engagement, participants may be more comfortable in sharing their thoughts, especially negative feelings, with our research assistants by using their preferred language (Dong, Chang, Wong, & Simon, 2012a). Our study demonstrates the importance and effectiveness of the CBPR approach in investigating culturally sensitive issues among minority older adults.

This study suggests that Chinese older adults are more likely to perceive family or spouse support than friend support. Our study lends credence to studies in other Chinese populations that demonstrated the importance of family support to Chinese older adults. For example, a recent study using data from the China Health and Retirement Longitudinal Study found that older adults perceiving more family-based social support were more satisfied with their life (Shen & Yeatts, 2013). In another study of 150 Chinese older adults in mainland China and 145 American older adults in the United States, the association between family support and depression and loneliness were stronger for Chinese older adults than for U.S. older adults (Poulin, Deng, Ingersoll, Witt, & Swain, 2012). Taken together, the finding of our study and those from prior studies may reflect the role of cultural values such as filial piety and collectivism in shaping Chinese older adults’ perception of different sources of social support. In addition, we suspect that language barriers and a lack of transportation availability may lead U.S. Chinese older adults to be highly dependent on spouse and family members for basic activities of daily life. Moreover, immigration, especially late life immigration, may result in a disconnection of the friend network established in the country of origin and, thus, decrease the availability of friend support.

This study also indicates that Chinese older adults are more likely to report positive social support, as opposed to negative social support. In a study of 519 older African American adults aged from 55 to 96 years, the participants also reported a higher frequency of positive emotional support than negative interactions (Lincoln, Taylor, & Chatters, 2003). In accordance with prior studies in other racial groups, this study demonstrates that positive and negative social supports are not independent. That is, Chinese older adults may perceive high levels of positive and negative social support from their spouse and families simultaneously. The frequent interactions and a close relationship with spouse and families enhance older adults’ emotional support, while creating tensions that may trigger family conflicts and elder abuse, which is associated with increased risk for morbidity and mortality (Dong, Simon, Odwazny, & Gorbien, 2008; Dong et al., 2009; Dong, De Leon, & Evans, 2009; Dong et al., 2011).

Significant negative correlations are observed between age, and positive and negative social support. This finding is in contrast to an analysis of the Health and Retirement survey data, which suggested that the oldest-old perceived higher levels of positive support and lower levels of negative support than young older adults (Ailshire & Crimmins, 2011) We suspect that as age increases, older adults are more likely to experience social network crisis such as a loss of significant others and close friends. Thus, the availability of social support from different sources may decline with advanced age. In addition, the age-related decline in mobility may lead to further social isolation. Therefore, compared with young older adults, Chinese oldest-old adults may possess lower levels of social support.

In the study, being female is positively correlated with positive social support and inversely correlated with negative social support. This finding could be related to others indicating that women tend to be more vulnerable and more emotionally expressive (Simon & Nath, 2004). When confronting any difficulties, women are more likely to open up and seek help from outsiders. In addition, in Chinese culture, women are often described as the kin-keepers who play important roles in maintaining relationships within and across generations (Wu, Chi, Mjelde-Mossey, & Silverstein, 2008). These frequent interactions with other family members may yield better social support outcomes. In contrast to prior studies reporting no correlation between education and negative social support, this study shows a significant positive association between education and negative social support (Rook, 1984). However, it is possible that older adults with higher education levels are more likely to acknowledge negative interactions and family conflicts.

Interestingly, this study shows that the number of children and number of grandchildren are significantly and negatively correlated with negative social support. The roles of parent and grandparent are associated with wisdom and power in Chinese culture (Strom et al., 1999). The increased number of children and grandchildren may enhance older adults’ self-esteem and satisfaction of the intergenerational relationships. Yet, existing evidence suggested that the reciprocal support such as seeking advice from grandchildren may be burdensome to older adults (Lou, 2010). Further studies should be carried out to clarify this association.

Overall health status, quality of life, and health changes over the past year in the present study have significant positive correlations with positive social support. The notion that social support serves as a protective factor for functional disability has been grounded in theory (Cohen & Syme, 1985; Schwarzer & Leppin, 1991) and is supported by a wide range of empirical evidence (Avlund, Lund, Holstein, & Due, 2004; Everard, Lach, Fisher, & Baum, 2000). The findings of the present study further emphasize the need to adopt support groups as strategies for alleviating disease burden and functional disability among Chinese older adults. In addition, our study demonstrates that negative social support is correlated with poorer and worsened health status. This finding suggests that rather than the size of social networks, the quality of social support may be more important in determining health and well-being.

The findings of this study should be interpreted with limitations. First, all the study participants are based in the Greater Chicago area. As such, the generalizability of the findings to other Chinese populations remains unclear. Second, the cross-sectional nature of the data prevents the interference of the temporal relationship between social support and socio-demographic and health-related variables. Further longitudinal studies are needed to understand the factors associated with social support. In addition, this study considered all family members as a whole group. Given older adults’ expectations of social support may vary by family members, it will be important for further studies to collect data on support from children, grandchildren, and child-in-law separately. Furthermore, quantitative data is limited in understanding older adults’ perception in different cultural contexts. Future mixed method studies are needed to comprehensively understand the perception of social support and the cultural values associated with social support in U.S. Chinese older adults.

This study has important implications for researchers, community social workers, and policy makers. Given the significant role of family support, policies and programs targeting Chinese older immigrants should rest on the keen appreciation of the cultural value among Chinese older adults. Services designed for Chinese older adults could integrate the efforts from family members. In addition, recent evidence has shown that the majority of older Chinese immigrants perceived inadequate filial care due to the impact of generational gaps; it is, therefore, imperative to help nurture intergenerational relations and filial piety values and improve children’s understanding of the needs of their aging parents (Dong, Chang, Wong, & Simon, 2012b). In addition to enhancing family and spousal support, increasing efforts should be put into preventing and intervening potential negative interactions such as abuse and conflicts (Dong & Simon, 2011).

Conclusion

In sum, this study demonstrates high levels of positive and negative family and spousal support among U.S. Chinese older adults. In addition, both positive and negative social support is significantly correlated with a number of social demographic and health-related variables. The findings in this study point to the importance of integrating family and spousal supports into policy and program developments. Future studies should also be conducted to better understand risk factors and outcomes of perceived positive and negative social support among U.S. Chinese older adults.

Acknowledgments

We are grateful to Community Advisory Board members for their continued effort in this project. Particular thanks are extended to Bernie Wong, Vivian Xu, Yicklun Mo with Chinese American Service League (CASL), Dr. David Lee with Illinois College of Optometry, David Wu with Pui Tak Center, Dr. Hong Liu with Midwest Asian Health Association, Dr. Margaret Dolan with John H. Stroger Jr. Hospital, Mary Jane Welch with Rush University Medical Center, Florence Lei with CASL Pine Tree Council, Julia Wong with CASL Senior Housing, Dr. Jing Zhang with Asian Human Services, Marta Pereya with Coalition of Limited English Speaking Elderly, and Mona El-Shamaa with Asian Health Coalition.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. Dong was supported by National Institute on Aging grants (R01 AG042318, R01 MD006173, R01 AG11101, and RC4 AG039085), Paul B. Beeson Award in Aging (K23 AG030944), The Starr Foundation, American Federation for Aging Research, John A. Hartford Foundation, and The Atlantic Philanthropies.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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