In this population-based study, the findings indicate that feelings of hopelessness are common among U.S. Chinese older adults. Moreover, being older, being unmarried, having been in the U.S. and in the community for more years, having lower level of overall health status and quality of life, and having worsened health over the last year are significantly correlated with more feelings of hopelessness in the study population.
Our findings suggest that hopelessness is prevalent in this study sample of community- dwelling older adults. A total of 40.9% participants reported feelings of hopelessness. In a sample of Chinese hospitalized cancer patients, the prevalence for hopelessness was 64.4% [25
]. This higher prevalence may be due to the nature of a clinical sample of terminal cancer samples. However, to our knowledge, few studies have systematically study the prevalence of hopelessness among community-dwelling Chinese older adults in the U.S. Given that immigrant population are often at higher risks of health disparities, it is of critical importance to investigate distress among these vulnerable populations [26
In addition, hopelessness may be attributed to the high level of fatalism heavily influenced by Chinese cultural doctrines. Previous studies demonstrate that Chinese older adults often possess a sense of fatalism for illness prevention and intervention, and that the sentiment that the lack of control of life and death may predominantly prevent Chinese older adults from seeking timely treatment and medical compliance [27
]. In a population-based study of Chinese population in Hong Kong, about 20% of suicidal ideation and attempts was attributable to hopelessness [12
]. Among the PINE study cohort, the prevalence of suicidal ideation in the last two weeks, in the past twelve months and in life time was 3.5%, 4.8% and 9.4%, respectively. It is also reported that older age, female sex, lower education levels, lower income levels, living with fewer household members, lower overall health status, poorer quality of life, and worsened health changes over the last year were significantly correlated with suicidal ideation [28
]. Additional analysis indicated that the level of perceived filial piety receipt from older adults’ perceptive was associated with increased risk of suicidal ideation [29
]. More research is needed to examine the temporal relationship between filial piety and suicidal ideation. In addition, the association between suicide and hopelessness, which may likely be further intensified by cultural conceptualization of health and illness, warrants further attention in the Chinese population.
Our findings also suggest that lower level of overall health status, poorer quality of life, and worsening health over the last year are significantly correlated with higher levels of hopelessness among U.S. Chinese older adults. Relationship between levels of hopelessness, distress, and quality of life is often examined in the clinical setting including patients with palliative care, patients with cancer, and patients at the end-of-life care setting. These previous reports suggest that quality of life is often predicted by the level of hopelessness and clinical characteristics [30
]. Our report further suggests that the sentiment of hopelessness is also negatively correlated with self-reported health variables in a community-dwelling sample of Chinese older adults. Future studies are warranted to examine the relationship between hopelessness, health conditions, and specific comorbidities among older population.
Our finding further suggest that brevity and the Beck Hopelessness Scale -7 worked well in the less acculturated group of Chinese American older adults, and may be suitable for detecting feelings of hopelessness in population-based surveys. Whereas suicidal older adults may tend to have negative expectances regarding their future, they may likely to see life is not worth living. It is of critical important to consider how hopelessness influences the formation of suicidal thoughts, and consider integrating the measurement as part of the clinical screening procedure for older adults with depressive symptoms.
The result of this study should be interpreted with limitations. First, the PINE study sample is representative of Chinese older adults in the greater Chicago. Caution is advised when generalizing from these findings to other Chinese American older populations in the country or in Asian societies. Future research is needed to systematically compare the levels of hopelessness among global Chinese population. In addition, the present research predominately used quantitative methodology, which namely cannot explore the subjective experiences of older adults. Future research employing mixed-method approach is needed to enlighten the cultural conceptualization of hopelessness among U.S. Chinese older adults. Third, despite the merit of survey methodology in quantifying prevalence of hopelessness, the use of questionnaire may not be suitable to tease apart cultural perceptions and/or help-seeking behaviors toward feelings of hopelessness. Future research employing mixed methods is needed to expand our understanding on hopelessness. Last, this study is cross-sectional designed, and we could not postulate on the potential temporal relationships. Future longitudinal studies are called for to examine the risk factors and outcomes associated with hopelessness in Chinese older adults.
Our study has several practice implications. Suicide interventions designed specifically to promote hope in the Chinese aging population may be effective in reducing suicide risk. Aging service, health care providers and community providers can play an important role in promoting psychological well-being by increasing the sense of hope among community-dwelling older adults. Prior studies show that Chinese older adults exhibit highest suicide rate compared to other ethnic/racial groups [16
]. Increased attention for psychosocial aspects such as the relevancy of promoting hope in late life may represent an important target for suicide prevention [23
]. Screening for hopelessness among Chinese older adults may increase healthcare professionals’ ability to identify older adults at greatest risk of self-harm. In addition, prior studies in clinical settings also demonstrate that the association between depression and suicidal ideation was stronger within higher levels of hopelessness [3
]. Thus it is important to simultaneously consider depressive symptoms and hopelessness when treating suicidal ideation in late-life among older patients.
In addition, hopelessness is a critical aspect of depression that may be particularly important in older adults because it reflects appraisals about the future. Mortality
rates were reported as being higher for older adults who reported as hopelessness, as compared for those who were hopeful. Concerted efforts from community organizations and, health care management professionals, aging services providers to care and reach out to older adults are needed. Example may include regular home visits, phone calls, or bilingual/ bicultural community events. Systematic outreach to assess and support older adults with high-risk of hopelessness in improving life conditions and needs that can promote hope for the future are called for, especially older adults who are older, living along or with fewer people, widowed, or with worsening health.