Anti-Asian Hate: Russell Jeung, Lingsheng Li, & Jessica Eng

Transcription

Eric 00:01

Welcome to the GeriPal podcast. This is Eric Widera.

Alex 00:03

This is Alex Smith.

Eric 00:04

And Alex, full house again today.

Alex 00:05

Full house. We are delighted to welcome Russell Jeung, who’s a sociologist and professor of Asian American Studies at San Francisco State University and co-founder of Stop AAPI-Hate. Russell, welcome to the GeriPal podcast.

Russell 00:19

I’m glad to be here.

Alex 00:20

And we’re delighted to welcome in studio Lingsheng Li, who is a geriatrician and palliative care doc and currently a t 32 research fellow in the UCSF division of Geriatrics. Lingsheng, welcome to the GeriPal podcast

Lingsheng

Hi, everyone.

Alex

And we’re delighted to welcome back to GeriPal, Jessica Eng, who is the medical director of On Lok, a program of all inclusive care for the elderly, or PACE, and first of its kind, that’s located in San Francisco, and associate professor at UCSF in the division of Geriatrics. Jessica, welcome back to GeriPal.

Jessica 00:49

Happy to be here.

Eric 00:50

So we’re going to be talking about anti-asian hate and the older adult. But before we do, we always ask for a song request. Do we have a song request for Alex?

Lingsheng 01:00

We absolutely do. I requested Dynamite by BTS.

Eric 01:05

And why did you pick this song, Lingsheng?

Lingsheng 01:07

I feel like someone had to pick BTS as a part of the GeriPal podcast, and it’s an honor and privilege to be that first person. Also, as some of you may know, BTS as a group actually came and visited the White House in 2022 to talk about the importance of asian inclusion and representation in response to the rise in anti-asian hate. This song was their first song recorded all in English. It was released during the earlier parts of the pandemic as a way to remind the world to focus on the little things that bring you meaning and joy while everyone’s going through a really hard time. And since today’s topic is quite a somber one, I wanted to help start and end the episode with something a little bit more upbeat and bright.

Russell 01:52

Actually, you know, BTS’s tweet Stop AAPI Hate, was the most retweeted post in the world in 2021 that shows how global the movement became.

Eric 02:04

Oh, wow.

Alex 02:05

Wow. And I have to say, when I first heard this, I thought, no way I’m gonna be able to do this because this is like a highly produced boy band with multiple singers. But I had a lot of fun with it. So here is a little bit.

Alex

(singing)

Lingsheng 03:19

That was awesome.

Eric 03:20

Lingsheng, who did it better?

Alex 03:22

Yeah, right.

Lingsheng 03:23

You know, I don’t want to offend millions and billions of BTS army, but this was incredible.

Eric 03:29

Yeah, don’t offend the tens of the GeriPal army (laughter).

Lingsheng 03:36

I think the number of viewers that you’re about to get is going to triple after this one.

Eric 03:43

Well, I want to thank all three of you for being on this podcast again. Like Lingsheng said, a little bit of a somber topic that we’re going to be talking about anti-asian hate and the older adulthood. I wonder if we can just start off. Maybe I’ll turn to you, Russell, first, how should I be thinking as far as defining what anti-asian hate is? Who is included in that? And what do we mean by hate?

Russell 04:10

Yeah, that’s a good question. I think anti-asian hate for me is a broad term. Both who’s asian and what consists of hate. I Asian Americans, I would say, are anybody who self defines themselves as asian so they can include South Asians, East Asians, Southeast Asians, Muslims. It’s a broad umbrella grouping. So the way we at stop API hate understood, it was, again, who self understands themselves. Asian hate is, again, another umbrella term for racism and discrimination. It’s both institutionalized racism where there are policies and practices by corporations, by government that create inequality. And then we particularly focus on interpersonal violence and harassment that Asians face during Covid-19.

Eric 05:07

What actually happened with Covid-19 well.

Russell 05:11

With COVID when I first heard that it was coming from China, I was really concerned because I knew from history that whenever diseases came from Asia, Asians would then face interpersonal violence. They get blamed for it, and then they’ll face racist policies that helped it with the bubonic plague that happened with SARS. And so I was really primed to pay attention on the news. What was happening to Asians globally. And once Covid started spreading, anti-asian hate began to proliferate all around the world, in Australia, England, Southeast Asia, and then the US. And so we began to track it through a website here in the United States.

And once we launched that website, we received hundreds of. I was shocked because I didn’t think anybody knew about this website, but we got reports nationwide. I was shocked by the extent of it and I was more shocked by how virulently angry people were towards Asians, how much they vilified us because of this disease.

Eric 06:19

What do we know what was happening before Covid-19?

Russell 06:23

We don’t. But new research has shown that when elected officials use the term chinese virus, that term went viral over social media and that was clearly associated with hate and anti-asian sentiment and anti-asian behavior. We know that people weren’t documenting the extent of racism before Covid-19 but since then, there’s been a steady trend in how much Asian Americans experience harassment and.

Eric 06:59

Microaggressions and violence and what’s included under the hate umbrella. When you think about anti-asian hate, how should I think about defining the hate component?

Russell 07:10

The hate component, again, is both institutionalized policies and interpersonal violence. And in our reporting center, we tracked physical assaults, verbal harassment. But then people kept on reporting being spat upon and coughed at. Right. And that’s a particular COVID epidemic response. So we actually included that in our survey. We included vandalism, denial of service. So there were a range of commonly named incidences. So we just included them and kept on adjusting our reporting tool to include the most common forms of hate, sadly.

Eric 07:51

But I guess where, where do you draw the line between, because violence happens all the time, harassment can happen outside of hate, how do you define, like, when something becomes anti-asian hate?

Russell 08:05

Yeah. So again, it is sort of self defined. So we’re going to take the subjective experience of Asian Americans who they themselves say, I feel like someone’s. If it’s a self perceived understanding that people are singling me out because I’m asian and I’m reporting it, then we just accept their perspective. We also ask them what was said during the incident. And so that’s the more easy way to understand bias, is if something was said. Like, at least a fifth of our reports had people saying, go back to China, you effing chink. So that was, those direct statements are how the legal system defined racial bias.

Eric 08:49

All right, Jess, from your perspective, so you work at onlock. There’s a large asian component of older adults in onlock. What was your experience as someone who, working within that system during COVID around anti-asian hate for older adults?

Jessica 09:08

Well, you know, it’s funny. I was actually working with you guys at the beginning of COVID at the VA when Covid started. And I think what, you know, for when I was there, the asian american veterans, it definitely came up during our visits. Even when I was doing my geriatrician life history, they started talking. I had never had people talk about before, but, like, the discrimination that they faced as Asian Americans 30, 40 years ago. But that was bringing back, you know, with what was going on in the news and how they didn’t want to leave their home, that they were, you know, that they were afraid.

And actually, just my experience of that actually, I think made me want to be more, to understand more about what was going on in the community and be more part of how we could support older adults in the community, particularly around asian hate, which then I ended up moving to unlock in 2022. And I think that in the height of the pandemic, programs like unlock, I think, was really trying to address the social isolation. I think that was happening during the pandemic and which I think worsened by the asian hate incidents in terms of making sure we were visiting, addressing people’s safety issues. We were handing out whistles to people to make sure that they could alert if something was happening with them, but also making sure that they knew they had a team to rely on, that they felt welcome and safe to talk to. And that continues to be what our mission is.

As we started in Chinatown over 50 years ago, and over two thirds of our participants are still Asian Americans, Pacific islanders, but really trying to be that safe community space and team for people when they have a number of different things that are happening in their life.

Eric 11:02

And did you have older adults who wouldn’t want to leave their house or become more socially isolated because of their fear around these incidents happening?

Jessica 11:11

Absolutely. And as a geriatrician, it was, you know, you’re trying to, especially during COVID you’re trying to make sure people don’t lose their mobility or, you know, as they’re isolated, you worry about their cognition. And I was trying. I remember trying to convince this older chinese american man to just. I was like, can you just leave your house and do one walk around the block? You know, just, you know, a little bit of exercise. He’s like. And he was just like, I’m afraid, you know, I was like, you know, we were. It was like, you know, talking. It was like talking about smoking cessation. You’re like, okay, you know, are you contemplative? You’re pre contemplative. Like, do you think maybe, you know, let’s educate. Let’s talk about, like, what are.

What you think are the barriers. Like, maybe your son can come and you could walk the first time you’d walk together. And it was very different than, I think, anything I had experienced as a geriatrician before. I think in talking about really that, you know, trying to figure out how to address those fears. Yeah. You know, in concern for people’s health.

Russell 12:09

Yeah. And related to fears, we asked our respondents, what’s your greatest stressor during the pandemic? And they said racism was their greatest fear. And when you think about that, that’s pretty stunning that Asian Americans were more afraid of their neighbors than they were of the pandemic that killed a million people. Right. We could wear masks against Covid, but we couldn’t vaccinate against racism. And so that isolation that Jessica talked about was really an example of the trauma we were experiencing. So I’m calling this a period of collective racial trauma. And there’s now over, like 30, 40 studies that have been published about the impact of Covid-19 racism on the psychological health of Asian Americans.

Eric 12:57

And Lingsheng, what was your experience as a clinician? Geriatrician?

Lingsheng 13:02

The study that we’re about to talk about is really personal to me on different levels. A few months into my geriatrics training, and this was around the height of the pandemic, before vaccinations were even a thing, we started hearing stories on the news about older adults, older Asians and Asian Americans being attacked just randomly on the streets, in public places. This was happening in San Francisco. This was happening in all major cities. Seattle, Boston, New York, York. And one particular story that happened in San Francisco was of a 84 year old thai man named Visha Ratanapakhti.

He was pushed to the ground and later died of a brain bleed. And this actually happened just a few minutes away from where I was practicing geriatrics medicine as a part of my fellowship. And a lot of my patients at that time identified as older asian immigrant. One particular patient, I remember, he and his daughter were basically direct victims. They were walking down Ocean beach, and this person came up to them, started chasing them down the beach, started calling them racial slurs. And because of this encounter, this patient went to the emergency room twice due to having panic episodes that felt like heart attacks. And my preceptor and I had to start him on an antidepressant. And this was someone that for months we were trying to do prescribed medications. So just one example of many of how it impacts patients and how we as clinicians see it from our perspective and their perspective.

Eric 14:41

You mentioned the study. I’m going to jump to the study. You published two studies, one in JAGs journal American Geriatric Society, one in Jamaim that just came out. Is that the nidus of how you thought about kind of doing these studies about anti-asian hate in older adults?

Lingsheng 14:58

Yeah. And maybe I can let Alex speak about it because he is my mentor and senior author on this paper. And so he and his team actually started laying the groundwork back in 2021. I would just say that as a 1.5 generation Chinese American and a geriatrician, it really impacted me in very personal ways. And, you know, thinking about improving the health and outcomes of older Asians and Asian Americans out there, I really wanted to better understand how these hate incidents not only impact their health, but thinking about the long term consequences, the indirect experiences beyond just the physical harm and the trauma.

Alex 15:37

Yeah. Before I respond to that question, Lingsheng, you said, I’m a 1.5 generation. Can you explain for our listeners what that means?

Lingsheng 15:47

And me, that means I immigrated to the US and from China before the age of 18. So I came. I was born in northeastern China, grew up with my grandparents, and moved to the US when I was ten years old.

Alex 16:01

And so what is. How does that mean? It’s 1.5?

Lingsheng 16:05

I guess, like, traditionally, we think about first generation, second generation, and in between. So those younger than 18, when they immigrate to a different country, you’re called a 1.5.

Alex 16:15

Okay.

Lingsheng 16:15

It might be a new term.

Eric 16:17

I haven’t heard of it.

Alex 16:17

I’m learning. This is great. Yeah. I think a lot of what Ling Xing said, that at the time, during COVID there are all these widely publicized incidents, and there’s a lot of concern about the direct victims. But we were seeing, as you’ve heard, that there was a lot of indirect harm from these hate incidents on the health and well being of older adults. And that’s what we want to capture. I’ll just say, personally, I was motivated to do this because of the. I think a lot of us are motivated because of our personal stories, for the work that we do by the patients we care for and also our personal histories. And I remember being eight years old in Michigan. My mom, who’s half chinese and half hawaiian, helped rally the asian american community in Michigan after the Vincent Chin incident. Some of you may remember he was assaulted and killed by some auto workers who mistook him for a japanese american person.

They’re angry about, presumably angry about japanese auto industry on the rise in american auto industry on the decline in Michigan. And one of the things that we’ll talk about today is how did the community respond? And what are the strengths of the community in responding to this? And that’s an element that we tried to capture in these studies as well.

Eric 17:35

Well, let me ask you about the studies. Let’s turn to the JAG study first. What did you actually do in that study?

Lingsheng 17:41

The Jaks paper was based on quantitative data. So which means we distributed surveys and over 293 older asians responded. When we looked at the data, we basically asked people about their experiences with hate and more specifically, direct experiences, meaning if they ever been mistreated because of their ethnicity or their identity, ever. Or during COVID in the past year, at the height of the pandemic, around the time that we distributed the surveys. So we had a timeframe around that. We also asked them about their indirect experiences, meaning, you know, how familiar are they with these incidents? How have they been hearing about these issues? And also, you know, do they know of anyone, friends, family, coworkers who’s been attacked, were assaulted as a part of these incidents?

Eric 18:34

And what did you find?

Lingsheng 18:36

We just kind of thinking about the data. It’s very sobering. Basically, one of three respondents to the survey reported that they’ve been a kind of a personal victim of these incidents. So directly attacked, were assaulted, and that ranged from verbal harassment to shunning or avoidance refusal in public places, like Russell was saying. And also physical assault from serious injuries to just kind of hearing about friends who have died from this incident. And then over 90% of people said that they were at least somewhat worried about being a victim themselves. We also find that people who are direct victims and people who had higher levels of worry about being a victim had higher likelihood of having anxiety, loneliness, and changes in daily activities attributed to the rise in anti aging hate as a part of the pandemic.

Eric 19:37

Russell just face validity of that. Does that all seem congruent with what you’re seeing?

Russell 19:44

Yeah, really. Similar trends of about a third of the population affected high rates of anxiety and depression. And maybe Lingsheng you could talk about the isolation and loneliness, especially elderly. So the elderly, we found, were a vulnerable population because, again, they’re more frail physically, but also in the Bay area, because of language and class issues, they may be more isolated. So maybe Lingsheng could talk about that, too.

Lingsheng 20:13

And maybe this is jumping ahead a bit. You know, we wanted to make sure that we have the data, and it’s shocking, it’s scary. But then we wanted a stories, one of the quotes from participants. And I think that really conceptualized the issue on a grander scheme. So we heard stories of people, like, not leaving their house for weeks due to fear of being a victim. People avoided going to the doctor’s office for two years because that would require them to go outside, get on a bus, which is where a lot of these attacks happened. People said, I had a mental breakdown which prevented me from going to work. People were literally afraid of the streets. They go to the bus stop. One person said, I’m afraid that I wouldn’t be able to come home alive. And I think stories and quotes like that, it just shows what profound implications anti aging hate has on the community.

Eric 21:09

And they were worried from incidents, not.

Lingsheng 21:10

From COVID That’s right. Yeah. Specifically about anti agent hate.

Eric 21:14

And was that from your JAMA study or was that from this study or kind of the same data set?

Lingsheng 21:18

Yeah, same kind of bigger study. It was two parts. One was the surveys that we distributed to the communities, and the second part was the interview with both the survey respondents who identify as older agents, as well as with clinicians who provide a care for them. And I think, you know, as a part of the surveys, even though it was close ended, we also had some questions asking people about, you know, how, how was your physical health impacted? And we’ll get some short answer responses that really aligned with the interview response as well.

Alex 21:52

I’ll also mention that we had a, after we published the paper in GMIM, we had an email exchange with a colleague and friend, Govind Prasad from Colorado, who’s been on this podcast talking about that. One of the things that we need better population level data about what’s going on, because all of these studies we’re talking about are limited. Our study, the survey was essentially a convenience sample of people who responded. We did in depth interviews to try and get better sense of what’s going on on the ground. And yet we were missing, I’ll openly acknowledge we’re missing, like, the frailest frail, the oldest old, the people who are primarily, who are isolated. So even when we report high rates of loneliness and social isolation, it’s an underestimate.

And in our survey of those people, it was like the rates of people who reported being victims themselves was like. Was a third about. Yeah, but only 10% said they reported the incident. So when Russell’s talking about this huge number of reports of incidents. We don’t know what the denominator is there. We don’t have, like, population level data of, you know, what’s changing over time, how common in this, and what’s happening as Covid. As what Eric will probably get to.

Jessica 23:11

Yeah, I think that. But, you know, donut, don’t beat up on yourself. Like, I absolutely want us to have the population level data, but I just really want to thank you both for doing these studies. I think when I read them, I was just like, yes, this is exactly, I think, what both, I think, clinicians are experiencing in terms of trying to respond and also my asian american patients, what they’re responding and that there are lots of. It’s helpful to have both the stories and I think clinicians I talked to have stories, but also this data that really, I think, speaks powerfully if we want to be doing more advocacy. So I wanna thank you guys for laying that groundwork and doing these studies. I think it’s a really important start to trying to address.

Eric 23:59

And we do have some hate crime data, at least from the state of California. We can actually see that. Actually, we had to pull it up yesterday that hate crimes actually did spike during 2021, 2022, definitely for Asians. Really, across the board, there was a spike, and it seemed to have, seems to have come down from 2022 to 2023. As far as the numbers, pretty significantly. It’s still obviously quite there. It’s higher than the baselines before. How should I think about those hate crime numbers? And do we think we’re seeing the same thing with these other hate incidents?

Russell 24:37

Yeah, for me, I think so. Now we’ve. Because of the COVID racism, more groups are doing national surveys. And so the Asian American Foundation’s national survey, they found that one third of Asian Americans continue to experience microaggressions and harassment. So that number seems to be pretty consistent. Over the last three or four years that they’ve done this study. Asian Americans, they found, are the racial group who have the least sense of belonging and acceptance in the United States. And so that’s also striking. I think, because of the racism and because of the discrimination, we have this sort of sensibility that we’re not accepted. So I think although Covid may have subsided, still, there’s US China antagonisms that spur anti-asian hate.

Islamophobia stirs anti-asian hate. Southeast Asians experience more higher rates of racism than East Asians, possibly because of class factors or racial factors. So I think it’s because of COVID we’ve recognized while Asian Americans face racism on the microaggression level as much as other communities of color. And so that was something we didn’t really recognize as much in terms of hate crimes. Yeah, it may have gone down, but maybe, again, hate crime reporting has always been sort of iffy.

Jessica 26:08

Russell, I’ll be interested in some of the others about, you know, to me, like, we were talking about Asian Americans maybe collectively being traumatized, you know, during the pandemic. And then, like, maybe, like, you know, my patient, like, eventually, like, leaves his house and you start feeling safe, but then you hear about another incident, and it’s almost, you know, like, re traumatizing in the sense of, like, you know, will I ever feel safe like I did before? You know, even if, like, the hate crime data is. It’s better. But I, you know, there’s still so much that is happening. That’s how I think about it.

Russell 26:38

Yeah, I think we’re still coming out of the pandemic. And, you know, people don’t want to return to the work. I know students don’t want to come back to school. So I can imagine elders being slow to resume previous levels of engagement and interaction.

Jessica 26:52

Or even if they do, I did, like, a quick, like, text to a bunch of the pcps this morning, being like, hey, like, have you guys heard of anything recently? And they’re like, oh, yes. I had a patient who was slapped at the grocery store, and I was like, oh, she was, like, a couple of months ago, and in some place where she previously had felt safe, her local grocery store. And I’m thinking about the experience of that person. So it’s like, when I think about the kind of rate, I don’t know. We can talk about hate crime rates, but the general how every time you hear or you know somebody who has been through something, it just kind of overall keeps kind of decreasing your level of safety and reiterates that other kind of narrative of, you know, not belonging.

Russell 27:36

Yeah. And then there’s regular crimes of opportunity, right? So you have the regular crime rate, and then you have hate crimes, and they often get conflated. If I’m asian, then they’re just targeting me because I’m asian. So I think elders feel that, too, that, you know, you don’t know why people are targeting you, but you hear a lot in the news, I think a lot in chinese media about the crime. And that’s why, whether it’s hate crime or not, there’s a general level of fear among the elderly that we really need to address.

Eric 28:09

Lingsheng, you ready to say something?

Lingsheng 28:10

I was thinking, maybe this is the researcher in my mind, but I’m skeptical about the numbers. Perhaps the numbers have truly gone down, but also, maybe people are just not reporting as much because it’s not getting enough attention in the media. But just like Russell and Jess were saying, these incidents, no matter whether they happen to you directly or indirectly, it becomes a part of your life experience, unfortunately. And that has an impact, as we’ve shown in the papers, on your social health, your mental health and physical health. And one area is impacted, the others follow as well. Just a few days ago, there was news of an older filipino woman who was pushed to her death at one of the BART stations.

So I think when that happens, whether it was racially motivated or not, just like Jessica was saying, it resurfaces trauma for people. And I can imagine some of the participants in our study are probably very afraid right now just thinking about it and what might happen in the future.

Eric 29:09

Okay, I got a question for you, lingqing. We’re not a general policy podcast. We do talk about healthcare policy. We do a lot of clinical focused discussions. I love that part of your JAMA IM study was actually asking clinicians about this. And I think that gets to my question is how much of this is important for the clinician to focus on during these patient encounters. What did you learn from the clinicians in your JAMA IM study?

Lingsheng 29:39

That was one of the most interesting findings, I would say we had pretty divergent perspectives from clinicians, and this was all based on one on one interviews with them. So some people said we had very strong opinions about, as clinicians, we should absolutely address these incidents and screen for them. There are also very strong opinions about, this is outside of our scope. We shouldn’t be screening every older age and adult who comes into our clinic about these incidents for different reasons. We also asked participants, what were the reasons. Also, both the older agent participants and the clinicians had some similar themes. So the reasons for not screening are time constraint. I mean, these visits with pcps are 15 minutes. There are other acute issues, blood pressure medication, diabetes. You’re going to want to talk about that first before diving into something that’s more challenging, sensitive, except if they’re not.

Eric 30:37

Picking up their blood pressure medicines because they’re afraid to leave their apartment.

Lingsheng 30:40

Exactly. Or, you know, if their blood pressure medications are being maxed because they feel like their blood pressure rises every time they go outside, because that’s what happened to one of our participants that’s the issue, and that should be addressed. Other kind of barriers thinking about it is just lack of resources. You know, one person said, and they’re also a researcher and clinician. They said, you know, if I can’t fix something, why should I be screening for it? And that’s something I actually wholeheartedly believed when I was in training. You know, we are taught in residency that you shouldn’t just screen everyone for a problem if you can’t address it or fix it.

Eric 31:19

Yeah. Don’t do a diagnostic test if you’re not going to do any treatment for it.

Lingsheng 31:24

Yeah, but now we know this is a health issue, and just because we can’t fix the underlying problem doesn’t mean we can’t talk about it. And that goes to the point of why we should screen. So people, both older Asians as well as clinicians, said, this is a whole person issue. If my doctor asked me about anti aging hate, it would show me that they cared. And we had social workers tell us if clinicians don’t talk about it, then this is never going to change. And so just kind of thinking about the big picture here. As a geriatrician, palliative care physician, we’ve been in situations where we talk about things that we can’t fix, death and dying, end of life care, but it doesn’t mean that we should avoid those topics. And I think it’s important for clinicians to create a safe space for listening, for starting these conversations, and to show people that we care.

Russell 32:16

Sorry, do you think the elders would be open to talking to their clinicians about it?

Lingsheng 32:21

Yeah. From the surveys, we actually found that 70% of older asian participants actually felt comfortable talking about this issue with their doctor, but only 11% recalled a clinician ever bringing it up with them in a medical encounter. And, you know, through interviews, too, some people will say, I don’t think that’s within my doctor’s scope of practice. I don’t know what they would say, me. But at the same time, it’s a really important issue, and maybe they don’t want to talk about it. Now, maybe that comes up another visit, or maybe as clinicians, we pay attention if their blood pressure is changing or if their medications are changing, if we’re not seeing them in person for months and years, what’s happening outside of the home? And we actually came up with a question during the interview process as a way to kind of broach this potentially sensitive topic. Do you feel safe outside of your home?

Alex 33:17

Yeah, we had to workshop this. This was quite an experience that Lingsheng led of trying to find the right question because clinicians were sort of uncomfortable asking directly about anti-asian hate incidents. Because, one, the question of attribution, like, who’s asian? Who’s not asian. Second, because it’s very specific. And then if you start asking your older asian patients, should you ask patients of varying ethnicities, should you ask patients of varying religious religions? There are many wars, conflicts, the numbers that I saw.

Eric 33:53

While hate crimes have decreased amongst Asians and other ethnicities, jewish and muslim hate crimes have actually increased.

Alex 34:01

Yeah. So do you ask about every single. So Lingqing led this process and found that clinicians often ask, or there are screening questions before patients are seen, where they’re asked, do you feel safe in your home? Like, that’s a standard question. I get that at Kaiser every time I go to Kaiser. So what Ling Xing realized is you could just layer onto that, do you feel safe outside your home? And that’s a way of opening up this conversation without mentioning race and ethnicity specifically.

Jessica 34:30

I love it. You know, I think you got it right on, like, because we do, as geriatricians, screen for elder abuse, you know, and so I love that. I think that whatever workshopping you guys did, I think, for me, I can see how clinicians would feel more comfortable, or it could be added to even the pre visit screening questions or something. And if someone brings it up, then great. You can talk about it during the visit.

Russell 34:58

Yeah. If clinicians ask about it, safety, mental health, well being, then I think that helps alerts elders. I should pay attention to it, too.

Eric 35:08

Right?

Russell 35:08

It prioritizes for them that their safety is important, that their well being and mental health is actually relevant and important for enough to discuss. So I think integrating mental health into their overall health is really important.

Jessica 35:24

And we talk about safety all the time. I think in, you know, geriatrics physically talk about falls, we talk about, you know, their home. We talk about, like, you know, what their safety awareness is, if they have cognitive issues. So it feels like in the realm of, you know, what we. What we do as part of our usual assessments.

Russell 35:42

Yeah. So maybe that’s a good way to talk about mental health for Asian Americans is through health and safety, not necessarily, you know, mental health, which is sort of a weird concept.

Eric 35:55

What was the question again? So I can.

Lingsheng 35:58

Yeah. Do you feel safe outside of your home?

Eric 36:02

And have you used that question?

Lingsheng 36:03

I’ve been on the inpatient service, so it’s a little bit harder to use. And as you know, the population we serve here often do not identify as asian. But if I were in the PCP setting or clinic, again, I would definitely use it.

Eric 36:16

But part of the reason I love this question is it doesn’t matter. We know for older adults in general that not just hate incidents, but incidents for older adults are high injuries from others. So I love this question because it can apply to really any population, especially when we’re talking about older adults, where we do see incidents against them. And that safety question is really important. Is that the reason that they’re not picking up their medications or not taking their medications? Is that the reason that they’re not following through with recommendations around fall reduction?

Jessica 36:52

Yeah, or going to get, you know, going to the grocery store to get the, you know, fresh fruits and all the things that we recommend or socializing to see their family or their friends, like, all the things that we know are important for health.

Alex 37:04

And at the same time, I think our, this work uncovered a lot of gaps in the systems, and it sort of varied by system. You know, we interviewed people at onlock. Thank you, Jessica, for helping to facilitate that, both clinicians and patients. And we interviewed people in asian health services and at self help for the elderly. Thank you. Shout out to Annie Chung for helping arrange that that serves a largely, maybe exclusively older asian population in San Francisco. And she had us on her cantonese speaking news channel, Channel 26, the other day. And where I was going with this is, where was I going with this? Oh, yes. And that there were big differences by system and on lock. They said, you know, we refer to mental health, we refer to social work because we have language concordant providers. We have these resources in other settings. Those resources are lacking, aren’t they?

Lingsheng 38:03

Yeah. I mean, yes, it’s the clinician’s responsibility, from my point of view, to screen for these incidents. But this is a bigger systems issue. One participant who’s a clinician said, yes, these resources are important, but for them to happen, we need funding, and we need to make sure that the people who need them the most have access to these resources. We just don’t have enough mental health providers who are bilingual and who can serve these monolingual populations and, you know, in terms of communications training, too, or just having space and room, literally time to talk about these issues is also a barrier.

Jessica 38:40

Yeah, I’m thinking about just, you know, in the mental health provider space, you know, telehealth, it’s become huge. A lot of mental health providers switching from in person to do, you know, you doing a number of services, and I’ve talked to them. I was just like, but, you know, can you do language concordance? How do you address, how do you adapt it for older adults? But, you know, I think, but there’s a lot of concern that’s where a lot of the mental health providers are and not as accessible, I think, to some older adults. And also the language concordance has been an issue, I think, for both in person and telehealth care.

Alex 39:16

I want to relate one story that comes back to my mother’s story of sort of rallying the community in Michigan, the asian american community in Midmichigan after Vincent Chin incident. And that is one of the first interviews we did. Ling Shing will remember this with an older agent. We asked him, how has your exercising changed? And he said, oh, I’m exercising more. And we said, well, that surprised us. Right. That’s not at all what we expected. We said, why is that? And he said, well, I feel like it’s my responsibility to be a chaperone, to go out there and help other people walk safely to the grocery store and back. And that’s part of this story of, like, the asian american community, AAPI community having strengths that they reply upon rallying and working together. And that’s part of Russell’s. Don, I wonder if, Russell, you want to comment more about what you’ve seen in terms of the response from the community?

Russell 40:11

Yeah, that’s a great example. In the face of trauma, people go into a fight or flight, right. I found that there’s another response that Asian Americans have done in the face of trauma, and that’s to flock and as a defense to threats and danger. They’ve really come together taking a sense of responsibility, not just for themselves, but for their families and for the overall community to really flock together to protect each other. And that’s why you’ve seen on lock and other groups have chaperoned services, self help has. That’s why you seeing this large social movement against anti-asian hate. That’s why Asian Americans have said, what’s the most common recommendation to deal with racism? It’s like, oh, we need social support.

And so for me, that collective communal sense of obligation, that sense of mutual responsibility to one another, that’s been a real source of resilience and strength for our community to come together and flock in the face of danger. So I have seen it across the nation, people coming together in vigils, at rallies, at employee groups, and especially for our elders, who we think are the most honored members of our community. Families have really checked up on their elders and really, again, sought to care for their elders in special ways during the pandemic.

Eric 41:38

Well, I wonder if my last question, all three of you, if you had a magic wand around this issue, you can change one thing that clinicians do, healthcare systems do. Anybody do. What would that magic wand be? Russell, I’ll start off with you.

Russell 41:52

The big picture is we have to change America’s narrative of who belongs. And I think the racism we’ve experienced is because we’re seen as perpetual foreigners. They’re attacking grandmas and spitting at them. Not because they’re model minorities who work so hard. It’s because people think, you don’t belong in our neighborhood. You have a foreign accent, you dress funny. And so that perception of Asians as being outsiders, as foreigners, as the yellow peril, needs to be changed. And so that’s what I hope to work on. And that’s the big picture source of the racism.

Eric 42:35

Thank you, Jess.

Jessica 42:37

Oh, if I had to wave a magic wand, I think funding for elder adult services like unlock, that. Create safe spaces for people to socialize and be active as older adults, that inter-professional care. And, of course, for clinicians who use the question that Lingsheng and Alex came up with in their papers and expand our thoughts around elder abuse to include safety outside the home.

Eric 43:06

And one more time, Alex, what’s the question?

Lingsheng 43:08

Do you feel safe outside of your home?

Eric 43:12

Okay, Lingsheng, what’s your magic wand?

Lingsheng 43:15

Gosh, you know, this strange place.

Eric 43:18

BTS.

Lingsheng 43:18

More BTS always. But honestly, I really wish we didn’t have to do this study in the first place. Right. Like that. This wouldn’t have been an issue. But the reality is that it’s a national and a public health issue. And so I think just encouraging colleagues like clinicians to address it, you know, to be able to talk to your patients openly about this.

Eric 43:42

Great. And I will use my magic wand to get some BTS played.

Alex 43:46

(singing)

Eric 44:44

Russell, Jess, Lingsheng, thank you for joining us on this GeriPal podcast.

Russell 44:52

Thank you.

Lingsheng 44:53

Thank you.

Jessica 44:53

Thank you so much.

Eric 44:54

And to all of our listeners, thank you for your continued support.

This episode is not CME eligible.