A HIE was only partially supported among older adults.

Following the 1996 welfare reform, newly arrived older immigrants with less than 5 years of residence (NOIs) have been barred from Medicaid benefits. Neither are they eligible for Medicare due to lack of work history. This study examines the relationship between immigrant status (NOIs or not), health insurance, and health service use among older immigrants; whether insurance mediates the relationship between immigrant status and health service use. The 2000 National Health Interview Survey was analyzed. The sample includes respondents aged 65 or older who are foreign-born (N=1, 178). The adapted Andersen model was used. A series of logistic regressions show insurance is a complete mediator between immigrant status and health service use among older immigrants. Immigrant status was significantly related to the mediator, health insurance; older immigrants with longer than 5 years of residence were 31 times more likely than NOIs to have health insurance in terms of odds. Also, different from health service use among U.S.-born older adults, older immigrants' service use is significantly related to their insurance status. There was no direct relationship between immigrant status and health service use.

The objective of this paper is to increase understanding of geriatric depression in the public community long-term care system to guide intervention development. Protocols included screening 1,170 new clients of a public community long-term care agency and interviewing all clients with major, dysthymia, or subthreshold depression (n=299) and a randomly selected subset of non-depressed older adults (n=315) at baseline, 6-month, and 1 year. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript depression, one-half of a percent had dysthymia only, and another 19% had subthreshold depression. Over the year observation period, 40% were persistently depressed; 32% were assessed as depressed only at the first observation; and the remainder was intermittently depressed. There were high levels of comorbid medical, functional, and psychosocial conditions. Mental health service use was low, and clients reported attitudinal and other barriers to depression treatment. Findings suggest the need for universal screening for depression with some strategies for triaging the most severely and persistently depressed for treatment. Although there will be challenges to the development of depression interventions, the public community long-term care system has high potential to assist vulnerable older adults receive help with depression.

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Findings of the study suggest that there are ethnoracial variations in mental health service use between Latino and Asian non-U.S. citizens. Mental health professionals should consider developing tailored mental health interventions that account for cultural variations to enhance access to services for these vulnerable subgroups of Latinos and Asians. Further research should examine ethnic disparities in mental health service use among various non-U.S. citizen racial-ethnic subgroups.