The United States and other Western countries have seen a steady increase in the number of immigrants since the 1970s. A recent report from the U.S. Census Bureau indicates that close to 13 percent of the U.S. population is foreign-born, and about 12 percent of the immigrant population are ages 65 and older (Grieco et al., 2012). A majority of recent immigrants are from Latin America and Asia, and Latino adults, particularly of Mexican origin, represent a growing segment of the aging population.
Immigrants, especially from developing countries, may benefit from the improved living conditions and better healthcare of their destination country. But migration has often been considered a major stressful life event because it entails a dramatic change in living arrangements, employment, and cultural opportunities, and, the topic of this article, social relationships (Friis, Yngve, and Persson, 1998; Markides and Gerst, 2011).
Social relationships encompass the nature and type of social networks, as well as the support perceived or received from friends, family, or the community at large. The existence of supportive social connections and relationships may help immigrants acclimate to their new living situations, benefitting health. However, immigrants’ ability to make friends and maintain social relationships varies by such contextual factors as age at migration and acculturation level.
Research on immigration, social relationships, and health is limited, but a majority of the extant literature suggests that older adult immigrants are more dependent than are native-born elders on smaller, close-knit social networks for support and care in later life. Below, we provide an overview of immigration, social relationships, and health, with particular attention paid to older immigrants from Latin America, especially Mexico. We focus on the roles of neighborhood context, religious involvement, family, and friendship networks.
Immigration’s Impact on Health
In the United States, foreign-born persons live longer and tend to be healthier than their native-born counterparts (Cho et al., 2004; Markides and Eschbach, 2005; Mehta, Sudharsanan, and Elo, 2014; Rogers, Hummer, and Nam, 2000; Ronellenfitsch et al., 2006; Singh and Hiatt, 2006). Markides and Coreil (1986) suggested such a “healthy migrant” or “migration selection” effect might explain the relatively low mortality rates and good health of Mexican Americans living in the Southwestern United States. They used the term “epidemiologic paradox” because Mexican Americans shared similar socioeconomic characteristics and conditions with African Americans, yet their mortality and health conditions were similar to the more advantaged non-Hispanic whites (see also Markides and Eschbach, 2005 and 2011).
Immigration typically involves younger and healthier individuals. Most people immigrate for employment, which requires a relatively good level of health. And Western countries typically require medical screenings by prospective immigrants. Plus, people who immigrate tend to have a positive outlook on their lives and futures, which is consistent with good health (Markides and Gerst, 2011). However, as immigrants live in their destination country longer and become more acculturated, their physical and mental health status often begins to mirror that of their native-born counterparts (Antecol and Bedard, 2006).
This mirroring has been attributed to lifestyle factors such as poor diet, increased alcohol and cigarette use, and reduced physical activity, which can contribute to adverse health outcomes (Friis, Yngve, and Persson, 1998; Singh et al., 2011). For some, linguistic and economic barriers, encounters with discrimination, and less access to healthcare can have an adverse effect on health. Immigrants are less likely to have insurance and a regular source of care than are native-born adults in the United States, are less satisfied with their care, and report more discrimination in healthcare settings (Derose et al., 2009). The more rapid health decline observed for foreign-born adults in the United States in later life has also been attributed to the erosion of social and familial ties that arises from acculturative processes (Mehta, Sudharsanan, and Elo, 2014). Yet, a majority of older adult immigrants rely heavily on their social networks for financial, social, and emotional support.
The neighborhood environment can affect health depending upon how well it provides resources and safety to its inhabitants. Immigrants, on average, have lower levels of educational attainment and are more likely to live in poverty than the native born (Greico et al., 2012). Older immigrant health, more so than younger immigrant health, may be influenced by neighborhood context because of restricted mobility in later life (Yen, Michael, and Perdue, 2009). Specifically, older immigrants tend to be concentrated in poor neighborhoods with few resources (Iceland, 2009). Poor neighborhoods compromise health because of poor housing quality, close proximity to environmental toxins (including poor air and water quality), higher crime rates, and overall lack of resources (Hill and Maimon, 2013).
Older foreign-born adults, however, tend to live in homogenous neighborhoods, which may provide sociocultural benefits that protect against health decline (Markides, Angel, and Peek, 2013). For example, Eschbach and colleagues (2004) found that older Mexican Americans living in the Southwestern United States in high-density immigrant areas tend to have more favorable health profiles and a slower health decline over time than those in low-density areas.
Sociocultural resources, such as the perception or ability to rely on neighbors for help and feelings of neighborhood solidarity may provide benefits to psychological well-being and, consequently, physical health. Almeida and colleagues (2009) found some support for the notion that those who live in high immigrant–density areas report more supportive and expansive social networks. Neighbors in high immigrant–density areas tend to speak the same language, which can facilitate close personal friendships. Neighbors may also help one another in a number of capacities that allow older adults to remain in the community, including assistance with instrumental activities of daily living such as providing transportation to the grocery store, and help with housework or yard work. Overall, neighborhoods provide the structural basis that allows for supportive relationships and exchanges, and neighbors may be key purveyors of help and assistance for older immigrants. Similar to neighborhoods, religious communities can also facilitate social connectedness.
Religious attendance is an indicator of social engagement, and can help with the trauma of relocating to a new country (see Cadge and Ecklund, 2007). In terms of age, older immigrants tend to report more frequent religious participation than younger immigrants (Van Tubergen, 2006). In general, older adults who attend religious services on a regular basis tend to have lower risks of premature mortality, psychological distress, and cognitive impairment (Ellison et al., 2000; Hill et al., 2005; Hill et al., 2006; Krause, 2006; Reyes-Ortiz et al., 2008) and less fear of falling (Reyes-Ortiz et al., 2006).
Religious organizations may also serve to preserve customs and help immigrants adapt to new living situations. Many religious organizations provide social services to their congregants with direct assistance for food, clothing, and housing, and provide the opportunities for integration into social networks that lead to work opportunities and civic engagement (Cadge and Ecklund, 2007).
Past research also demonstrates that older immigrants derive more emotional benefits from religious participation than native-born older adults (Hao and Johnson, 2000). The benefits of attending religious services may be especially protective for immigrants who arrive earlier in life, because this allows them to develop and maintain strong social ties. Several mechanisms linking religious attendance to health have been described in previous research, namely, social support, social control of health-compromising behaviors such as heavy drinking or smoking, and a sense of control (Hill, Burdette, and Idler, 2011; Koenig, King, and Carson, 2012; Rote, Hill, and Ellison, 2013). Often, attending religious services is a family activity and families are a key source of social support for older immigrants.
Living with Family
A majority of immigrants live with other family members for financial and sociocultural reasons (Angel, Angel, and Markides, 2000). Specifically, Mexican-born adults living in the United States are more likely to live with family members than native-born adults (Angel et al., 1996). This is largely due to economic constraints, preferences for aging in place with loved ones, as well as health decline in later life. There is also evidence that Mexican-origin immigrants who immigrated in late rather than early life are more likely to live with children (Angel, Angel, and Markides, 2000; Angel et al., 1996). Those who immigrate later also report more expectations for social support from their family (Taylor et al., 2004), tend to have lower socioeconomic standing, and face more language barriers than those who immigrated earlier in life. Common late-life transitions, such as widowhood, often spur intergenerational co-residence.
About half of all current immigrants living in the United States are married (Grieco et al., 2012). Marriage results in better health through shared resources and income, shared support, and also social control of health behaviors. Spouses often help one another in times of need and provide assistance to one another in terms of financial, social, emotional, and tangible support (i.e., helping with activities of daily living such as dressing, bathing, preparing meals, etc.). Using data on older Mexican American couples, researchers have found high levels of spousal health concordance on blood pressure, hypertension, diabetes, arthritics, and cancer (Peek and Markides, 2003; Stimpson and Peek, 2005). Following widowhood, which results in losing such social and economic resources, and is more commonly experienced among women, many widows move in with adult children.
Older immigrants are especially likely to live with their adult children. However, there tends to be a high degree of reciprocity between the oldest generation and their middle-aged children because older adults may provide childcare for grandchildren or even some financial assistance to their children (Markides, Boldt, and Ray, 1986).
More attention needs to be paid to the types of support and help that older family members provide to their adult children. If the older family member is contributing time, money, and support to their children or grandchildren, this may be burdensome, however, it also may instill a sense of duty and feelings of reciprocity, which may be advantageous to elder immigrants’ mental well-being. Also, immigrant elders often maintain transnational ties in later life, especially immigrants who left their country of origin in late life. They may send money and exchange emotional support, as well as maintain a sense of belonging through telephone conversations with family members living abroad (Viruell-Fuentes and Schulz, 2009). Technology that helps older immigrants maintain connections with their family and friends abroad is likely to aid in maintaining these transnational ties.
Moving Near Friends
Immigrants also tend to relocate to areas of the United States in which they have existing social ties. Immigrants may rely on their social network more so than their native-born counterparts, which helps instill a sense of belonging and community (Almeida et al., 2009; Viruell-Fuentes and Schulz, 2009). Viruell-Fuentes and Schulz (2009), however, reviewed extant literature and found that few studies reported more social support among immigrants relative to their native-born counterparts, with some studies reporting significantly lower levels of social support and integration. Their in-depth interviews revealed that first-generation Latino immigrants tend to have small social networks with two to five close friends. Therefore, if one of the links or friendships is broken, foreign-born adults may be especially vulnerable to loneliness and isolation. Also, these networks can become overburdened if the older adult is highly dependent upon their social network for basic functions.
Timing of immigration is also an important consideration for social network ties. Those who immigrate earlier in life have more time and more settings (e.g., work, school, etc.) in which to develop and maintain social ties earlier on. Additionally, later-life immigrants who may have recently experienced functional decline or spousal loss often relocate to live with adult children. Those who immigrate in later life have smaller social networks than those who immigrated earlier in the life course (Weeks and Cuellar, 1983).
Social Isolation and Loneliness
Older immigrants may experience social isolation or loneliness when physical health limits their ability to leave the house or drive, especially in areas with inadequate public transportation. Even in conditions of good health, language barriers prevent some older adults from navigating the transportation system (Gentry, 2010), leaving them confined to their houses. When living with adult children, the children may be preoccupied with work and other family demands, and unable to devote much time to providing companionship to their aging family members (Treas and Mazumdar, 2002). Older immigrants may be out of the workforce and unable to make ties through work settings. This may be especially evident among those who immigrated in late life. Loneliness is linked to depression, anxiety, and biological risk (Friedman, 2012).
Conclusion: Social Relationships Ease the Stress of Immigration
The United States has seen a dramatic increase in the number of immigrants over the past forty years. Prior research finds an immigrant health advantage, but longer stays in the United States often lead to a more rapid health decline over time. This has largely been attributed to the (on average) lower socioeconomic standing of immigrants. Adjustment to life following immigration and language barriers in healthcare and school settings pose hurdles to many immigrants. Translating health and educational material to help immigrants understand health conditions, providing access to human services providers who speak native languages, and the use of community-based approaches are all important for older immigrant health (Gentry, 2010). Immigrants also tend to live in neighborhoods with fewer economic resources. However, close family networks are the foundation for supportive exchange processes for many immigrants who also lack access to aspects of the U.S. social safety net, especially in later life.
It is important for practitioners to incorporate close family members, especially middleaged children of aging parents who typically serve as caregivers, and be mindful that how old someone is when they immigrate affects social relationships and health. Assessing the daily lives and functioning of social relationships of elderly immigrants also is important to understand vulnerability to disease and disability in late life. Overall, adjustment to immigration often is a stressful experience, but social relationships can help ease the burden and improve health.
Sunshine Rote, Ph.D., is a postdoctoral fellow at the Sealy Center on Aging at the University of Texas Medical Branch in Galveston, Texas. She can be contacted at email@example.com. Kyriakos Markides, Ph.D., is a professor of aging studies in Preventive Medicine and Community Health at the University of Texas Medical Branch. He can be contacted at firstname.lastname@example.org.
Editor’s Note: This article is taken from the Spring 2014 issue of ASA’s quarterly journal, Generations, an issue devoted to the topic “Relationships, Health, and Well-Being in Later Life.” ASA members receive Generations as a membership benefit; non-members may purchase subscriptions or single copies of issues at our online store. Full digital access to current and back issues of Generations is also available to ASA members and Generations subscribers at Ingenta Connect. For details, click here.
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