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OVERVIEW AND GENERAL PRINCIPLES

Immigration and immigrant population have gained increasing attention in the public health research and policy domains in recent years in the United States, and immigration is a global phenomenon. Although immigration is often the consequence of the push and pull of economic, environmental, sociopolitical, and safety factors, it is also a social determinant of health that plays an important role in the care of an older immigrant due to related health inequities and disparities. However, there is little written on immigration as a social determinant of health for older adults. The lack of high-quality studies examining immigration as a social determinant of health has a serious impact on health policies for older immigrants. To provide comprehensive care to older adults, it is important to look at immigration from the context of structural, cultural, and behavioral frameworks. To be inclusive of diverse older persons, the American Geriatrics Society (AGS) Ethnogeriatrics Committee developed a positional statement in 2016 that outlined health care disparities in the United States and provided guidance on quality indicators to promote high-quality multicultural geriatric care. This chapter provides an overview of the definitions commonly used to describe immigrants, the demographics of older immigrants in the United States, health insurance and access to care for older immigrants in the United States, common barriers and their impact on the care of older immigrants, interventions and resources, and the future steps to improve the care of older immigrants.

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American Geriatrics Society Ethnogeriatrics Committee. Achieving high-quality multicultural geriatric care. J Am Geriatri Soc. 2016;64(2):255–260.
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Castaneda  H, Holmes  SM, Madrigal  DS, Young  ME, Beyeler  N, Quesada  J. Immigration as a social determinant of health. Annu Rev Public Health. 2015;36:375–392.  [PubMed: 25494053]

DEFINITIONS

Clarity in definitions could aid in the understanding of immigrant communities and characteristics that may contribute to health-related behaviors and risks. However, there is a lack of formal consensus on the definitions, concepts, and categories of migrants. The United Nations International Organization for Migration defines a migrant broadly as a person who has moved across an international border or within a state away from the original place of residence, regardless of the legal status, whether the move is voluntary or involuntary, what the causes for the movements are, and what the length of stay is. Migrant is a neutral term regardless of the direction of movement. Based on the US Immigration and Nationality Act and for the purpose of this chapter, an immigrant refers to a foreign-born person who migrated across an international border into a destination country.

From the legal perspective, there are different categories of immigrants in the United States (Figure 78–1). These immigrants are categorized as authorized and unauthorized based on the legal status of whether they have been granted the rights to stay in the United States. Among the authorized lawful immigrants, some reside in the ...

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