How anti-Asian hate is worsening the health of older San Franciscans

Fearing becoming victims of anti-Asian hate, older Asian San Franciscans are choosing to spend more time at home and forego activities they previously loved, such as exercising, seeing loved ones and dining out, it suggests research published like a letter in the diary, JAMA Internal Medicine.

This increased isolation could lead to poorer mental and physical health among the city’s older Asian community, based on the results of 80 in-depth interviews among Asian residents aged 50 and over and local doctors.

“We heard a lot of stories about people avoiding going outside for exercise and grocery shopping,” explains Lingsheng Li, MD, MHS, fellow in the UCSF Division of Geriatrics. Li conducted the study along with a team of UCSF faculty, staff and students. “These activities are essential for well-being and quality of life, especially for older adults who are already isolated in the community.”

“Some people even avoided going to the doctor’s office because it required getting on the bus, which is where many of these attacks have occurred.”

Among the 20 San Francisco health care workers interviewed, many reported that isolation worsened chronic conditions such as high blood pressure, diabetes and cognitive decline in some patients.

“I have seen a few cases where a patient had mild cognitive impairment that progressed to overt dementia,” one doctor told UCSF researchers. “After a thorough investigation, I have to conclude that this is because they no longer go outside and walk every day.”

Nationally, 1 in 3 Asians and Pacific Islanders experienced racial abuse in 2023. In San Francisco, between March 2020 and December 2021, about a quarter of anti-Asian attacks against Asians aged 60 and older involved physical violence.

The fear of becoming a victim of anti-Asian hate could be a risk factor for poorer mental, social and physical health among older members of the Asian community. While some doctors and patients in Li’s study said they felt screening for this would be difficult, many also felt that addressing the role of racism in health was part of comprehensive health care.

“We have also heard very strong recommendations from people who feel that doctors should screen for anti-Asian hate because it shows that doctors care about the whole person and that acts of racism and violence against them, their families and their communities not be okay,” Li says. explains.

“As clinicians, we may not be able to change the situation right away, but we can still provide that therapeutic listening space and show patients that we care.”

Li’s team, together with the doctors involved in the study, developed a simple screening question to spark a conversation between patients and healthcare providers: “Do you feel safe outside your home?”