flowchart LR
A["🌍 Ecological Factors<br/>• Culture<br/>• Social norms<br/>• Policies & regulations<br/>• Discrimination<br/>• Health systems"]
B["🧠 Individual Factors<br/>• Mental health<br/>• Cellular changes<br/>• Socioeconomic resources<br/>• Coping & resilience<br/>• Language skills"]
A <--> B
D["🏥 Access & Quality of Care<br/>• Healthcare access<br/>• Cultural competence<br/>• Outreach & communication<br/>• Insurance coverage"]
A --> D
B --> D
E["❤️ Individual Health Outcomes<br/>• Healthy ageing<br/>• Functional independence<br/>• Well-being<br/>• Disease risk"]
F["📊 Population Health Outcomes<br/>• Health disparities<br/>• Unequal prevalence<br/>• System blind spots"]
D --> E
D --> F
G["🚶 Migrant-Specific Challenges<br/>• Cultural mismatch<br/>• Isolation<br/>• Help-seeking barriers<br/>• Unmet expectations"]
G --> D
Towards an inclusive healthy ageing agenda
that accommodates the healthcare needs and limitations
in older migrants
‘More assimilated’ = citizens, speak English well, in the US for 29 years.
‘Less assimilated’ = noncitizens, poor English skills, in the US for 12 years
Challenges
Over-representation of WEIRD populations in the literature.
Low generalizability and limited clinical relevance of accessible samples.
Shifted standard to online modes of data collection favors individuals with technology access and digital skills.
Goals
Increase research participation among older migrants through cost-effective data collection methods.
Complementary recruitment and sampling strategies.
Special attention given to socially isolated, (pre-)frail, homeless and substance-abusing older migrants.
Solutions
Combine active recruitment and one of sampling strategies: social media, time-location, respondent driven.
Join efforts with community leaders and family members.
Adress travel logistics and costs.
Challenges
Older migrants treated as a homogeneous group.
Fragmented theory.
The unique effects of time, age, and cohort remain blurred.
Efficiency in disease diagnosis, prevention, and treatment is hindered by the pending integration of diverse perspectives.
Goals
Obtain longitudinal data that capture the complexity and diversity of risk factors and health needs of older migrants.
Solutions
Address the ‘when, how, why’ notions of ethnicity and culture in a social-constructivist paradigm.
Develop theory that integrates lifespan developmental and cultural adaptation explanations.
Leverage biographical insights to inform and complement quantitative assessment.
Apply the ‘convoy model’ and ‘social network theory’ to describe lifespan implications of changing social environment.
Address biases in self reports of individuals with cognitive impairment by involving family members and friends.
Integrate the perspective of health professionals.
Integrate biological and physiological explanations.
Challenges
Self-reports often yield low data quality which leads to fragmented theory.
Self-reports do not capture short-term fluctuations in risk factors and health outcomes.
Un-known solutions to complementing cognitive-demanding self-reports with more objective and non-invasive methods.
Complex pathology remains understudied.
Goals
Collect longitudinal data that integrate self-reports and digital data to continuously document the multimodal, intersectional, and evolving nature of ageing in a foreign country.
Solutions
Digital phenotyping (use personal digital devices to enhance accuracy of self-reports).
Reduce recall and selection biases, mitigate linguistic and cultural barriers through integration of passive sensing devices into study designs.
Improve digital literacy as a integral research strategy.
Challenges
Proposed solutions realistically integrate into existing systems and infrastructure that, overall, are non-inclusive.
An inclusive strategy tailored to older migrants will generate complex observations.
Migrant older populations may face hidden ethical risks.
Specific individuals may risk violations of their rights.
Goals
Develop an ecosystem that facilitates and promotes longitudinal assessment, evaluation, and intervention tailored to the health needs and constraints of older migrants.
Protect individuals from exacerbated vulnerabilities.
Coordination with policymakers and health and healthcare institutions.
Solutions
Leverage expertise and build on existent infrastructure.
Improve synergies by creating panels targeting migrant populations.
Address unknown ethical threats in processes of research co-production.
Include target populations and significant others in decision-making and research processes.
Involve law and policy makers to ensure the protection of indiviudals in situations of vulneratbility.
Create outreach campaigns to facilitate the research committed in the wider population.
An online series of expert talks and interviews to bridge knowledge gaps between recent scientific findings and the general public.
Older migrants represent one of the most overlooked yet rapidly growing segments of ageing societies, and their exclusion from mainstream healthy ageing research carries real consequences for their well-being, for health system equity, and for science itself.
This agenda is not merely a call for more research.
It is also a call for better research
Participatory, culturally responsive, and built on sustained partnerships with stakeholders and the communities it seeks to serve.
The inclusion of digital health technology in an inclusive fashion
is promising for extending the reach of health promotion and personalizing care.
Co-authors
Ana C. Teixeira-Santos, Bernd Weiß, Christin-Melanie Vauclair, Gabriela Christofoletti, Isabelle Albert, Ivana Paccoud, Jean-Paul Steinmetz, Juliana Ferreira, Klaus Boehnke, Niovi Vavoula
Contributors
Annika Heinz, Charles Agyemang, Celine Gaillard, Helena Korjonen, Jochen Klucken, Maria Noel Pi Alperin
Managing team
Dalia Dirmaite, Dominic Harion, Sofie van Herzeele
Funding
Institute of Advanced Studies (IAS) at the University of Luxembourg (U-AGR-6185-00-Z)
Fonds National de la Recherche Luxembourg (C23/SC/17995805)
