Sagong Delves into the Intricacies of Frailty Among Korean Immigrants

As the world undergoes demographic changes, with many countries including the U.S. experiencing an aging population, age-related topics such as healthy aging and well-being in later life have gained significant attention. People are now more concerned about maintaining their health as they age.

A concern for the health of older Korean American immigrants prompted Dr. Hae Sagong, an assistant professor in the College of Nursing, to look at factors that influence their frailty. She describes frailty as a state in which a person is vulnerable to stress and has decreased physiological resilience, resulting in increased disability, adverse health outcomes, morbidity and mortality.

“It is essential to identify the factors of frailty based on the specific characteristics of the population to develop a structured frailty intervention that effectively reduces and prevents the condition,” Sagong said.

Frailty is not solely limited to older adults. According to Sagong, it can manifest in mid-life as well. “Unlike the natural process of aging, frailty is characterized by its potential reversibility and manageability if detected at an early stage. Therefore, it is crucial to assess, identify influencing factors, and manage frailty to promote healthy aging.”

She discovered a relationship between frailty and health literacy among Korean immigrants when she was working on her doctoral research. “Health literacy, which refers to the ability to access, understand, appraise and utilize health-related information, is a crucial factor that impacts an individual’s frailty,” she said. “Immigrant populations, due to their cultural backgrounds, perceptions, health beliefs and language barriers, are often considered vulnerable populations with low health literacy.”

The Auburn-Opelika area has unique characteristics that attract a significant Korean immigrant population. With more than 25 Korean vehicle-related industries around Auburn, Lee County has become one of Alabama’s most concentrated areas of the Korean population. Sagong said she was surprised by the fact that despite the large Korean population, there were limited health-related resources available to the immigrants, such as Korean healthcare providers, clinics or outdoor activities tailored to their needs.

“Many Korean immigrants in the area came to work in the automotive industry as adults and speak mainly Korean at work, resulting in low acculturation and limited English proficiency. As an immigrant myself, I have also experienced challenges in understanding and utilizing health care systems,” she added.

Given that Korean immigrants in this area face limited access to health care due to language barriers and low health literacy, Sagong became interested in investigating the specific factors that influence frailty among Korean immigrants.

“Even when considering common influencing factors such as physical activity and diet, Korean immigrants are likely to encounter distinct challenges and opportunities,” Sagong said.

Sagong’s fluency in Korean and English, and her understanding of the circumstances faced by Korean immigrants, helped her to combine her expertise in frailty research with the study of this specific population.

“Previous studies often categorized racial/ethnic groups broadly as white, black and Asian. However, within the Asian category, there are diverse nationalities such as Chinese, Korean, Japanese, Vietnamese and more. Each nationality possesses distinct health behaviors, beliefs, cultures, preferences and perceptions. It is necessary to understand these characteristics and identify how they can be incorporated into the current health care landscape,” Sagong said.

Her study, which specifically considers health literacy as an influencing factor, is relatively novel and exploratory in nature. Sagong began by conducting in-depth interviews to understand the thoughts, situations, barriers and facilitators experienced by older Korean immigrants. This initial qualitative approach aimed to gather evidence and foundational data for further research in this area.

Participants were recruited from local Korean churches in Lee County and an online Korean community for Lee County residents. To participate, they had to be 65 years and older; born in South Korea and moved to the U.S. more than a year ago; and able to speak and understand Korean. “The recommended focus group interview size is six to 12 participants; this study recruited 10 eligible participants who agreed to participate,” Sagong added.

She examined their health literacy, physical activity, diet and mental health, including factors such as depression or cognitive impairment. “These factors are commonly recognized as influential factors in frailty. Frailty encompasses various dimensions, including physical frailty characterized by sarcopenia and undernutrition. Newer concepts such as social frailty and cognitive frailty have emerged, emphasizing the need for a multifactorial approach to frailty management. All these aspects are potentially reversible and can be addressed through interventions.

“It is crucial to emphasize that such research not only benefits the local population but also has implications for all Korean immigrants in the United States.

“The approach can be extended to other populations as well. By identifying specific characteristics and barriers within different populations and developing interventions, we can adapt this approach to other racial/ethnic groups. For example, if a language barrier is identified as a major problem in accessing healthcare and managing frailty, we can explore solutions such as leveraging technology or implementing medical interpretation services or establishing a language-free healthcare system or recruiting/educating culturally competent healthcare providers. If these solutions prove successful, they can be applied to other ethnic groups facing similar language barriers,” Sagong added.

“Dr. Sagong’s research to tackle the health care access problem faced by Korean older immigrants is particularly timely given that high percentage of the population and lack of health care access of this vulnerable immigrant population in our community,” said Dr. Pao-Feng Tsai, associate dean for research at the College of Nursing. “If successful, the intervention developed by Dr. Sagong will not only benefit Korean immigrants locally, but the lessons learned from the research can be used to develop intervention programs that help other immigrant populations.”