Hmong Older Adults’ End-of-Life Care Preferences: Physical, Psychosocial, Cultural, Religious, and Spiritual

Abstract As the Hmong community continues to grow and age in the United States (US), mainstream healthcare providers may encounter Hmong older adults who prefer their cultural end-of-life (EOL) care. The challenge for these providers is to offer culturally sensitive EOL care to Hmong older adults within the realm of the Western healthcare system. One factor contributing to this challenge may be the lack of knowledge regarding Hmong older adults’ EOL care preferences. Another is Hmong EOL care is interwoven with care from domains such as culture, religion, and spirituality. The purpose of this study is to garner an understanding of the care preferences of Hmong older adults during the dying process. A qualitative study using inductive content analysis was conducted. Thirty Hmong older adults who reside in Wisconsin participated in semi-structured interviews that were audio recorded and transcribed. Data was analyzed using inductive content analysis by Elo & Kyngäs (2008). The findings revealed that participants preferred care at EOL in the domains: physical, psychosocial, cultural, religious, and spiritual. Physical care included ADL’s while psychosocial care related to communication and companionship. Cultural care included children as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults’ care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.

as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults' care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.

RELIGIOSITY AMONG YOUNG-ADULT BABY BOOMERS: ASSOCIATIONS WITH PSYCHOLOGICAL WELL-BEING OVER 45 YEARS
Kent Jason Cheng, 1 Maria Brown, 2 Woosang Hwang, 2 and Merril Silverstein, 2 1. Syracuse University,Syracuse,New York,United States,2. Syracuse University,Syracuse,New York,New York,United States Past studies on the influence of religiosity on psychological well-being tended to be cross-sectional in nature and neglected generational differences. In this study, we assess how religiosity in early adulthood (mean age = 19) affects baby-boomers' psychological well-being over the life course. We used waves 1 to 9 or 45 years of survey data from the Longitudinal Study of Generations (LSOG) (N=798), a sample of Southern Californians. First, we used latent class analyses on five domains to identify three typologies of baby boomers' religiosity in early adulthood. We call these typologies "strongly religious," "weakly religious," and "personally religious." Then, we used latent growth curve modelling to ascertain the influence of these religiosity typologies on psychological wellbeing from waves 1 to 9, controlling for timeinvariant (religious affiliation, age, sex, race, parental income) and varying (religious salience, education, marital status, and annual income) factors. We found that the strongly religious have a consistently upward psychological wellbeing trend throughout the study period whereas wellbeing started to decline for the weakly religious and personally religious at around wave 6, on when they were about mid-40s to almost 50. We provide evidence that religiosity in early adulthooda period in life characterized by the exploration of various options for the future brought about by greater personal freedom -positively influences baby boomer's psychological wellbeing over the life course.

STRUCTURE AND CHANGE: NEW DEVELOPMENTS IN RESEARCH ON CUMULATIVE DIS/ADVANTAGE Chair: William Dannefer Discussant: Carroll Estes
In a time of heightened social inequality and concern to reckon with its sources and consequences, the relevance of cumulative dis/advantage (CDA) to understanding patterns of aging has become even clearer, and CDA research has continued to expand in several fresh directions. Papers in this symposium will review the current state of knowledge regarding CDA and will present new analyses addressing key questions of its intersections with social change and its structural patterning. We will begin with a review of knowledge on comparative evidence regarding cumulative dis/ advantage and its cross-national patterning. With regard to change, will examine the compare the effect of the 2008 recession and subsequent recovery across generational cohorts through a comparative examination of trajectories of income inequality. We will also present evidence on the impact of gender, focusing on women's late-life health.

CUMULATIVE DIS/ADVANTEGE, STRUCTURE, AND CHANGE: THREE NEW DIRECTIONS FOR CDA RESEARCH William Dannefer, and Chengming HENGMING Han, Case Western Reserve University, Cleveland, Ohio, United States
Over the past several decades, evidence for cumulative dis/advantage as a regular feature of cohort aging has continued to cumulate, while new questions concerning the underlying dynamics continue to emerge. This paper reviews the accumulated knowledge base, and focused on three recently emerging lines of inquiry that hold great promise for expanding more fully our understanding of CDA processes: 1) the intersection of class stratification and race in the operation of CDA processes, 2) factors accounting for cross-national variations, and 3) the intersection of robust intracohort processed that generate cda with intercohort processes and the impact of historical and social change. These three new directions are briefly discussed.

IMPACT OF ECONOMIC SHOCKS ON CUMULATIVE ADVANTAGE PROCESSES: RECESSION, RECOVERY, AND TRAJECTORIES OF INEQUALITY
Stephen Crystal, Rutgers University, Princeton, New Jersey, United States This study compares the effect of the 2008 recession and subsequent recovery across generational cohorts by evaluating age-cohort trajectories of income inequality.