IPA Bulletin Archive

Migration and Aging

Meinhardt S. Tropper, M.D., Ph.D. - Chairman, IPA Task Force on Migration and Aging

Recent data published by the United Nations and the International Organization for Migration (IOM) indicate that our turbulent world is confronted by huge waves of migration. Among the migration groups are increased numbers of Late Middle-Aged and Elderly Migrants (LMAEM) with a variety of psychopathological, psychosomatic and psychosocial problems. Migration, particular LMAEM, in the last decade has become an issue of deep concern of governments in countries receiving mass migration populations such as USA, Canada, Australia, New Zealand, Germany, Israel, and others.

Migration appears to be highly important to governmental immigration authorities who encounter various cases of relocated persons with medical and particularly mental health problems in LMAEP.

Current research has shown unprecedented numbers of those forced to migrate, several hundred thousand of whom are in late middle or old age with specific problems. These are people who never suffered from any mental disorders prior to their relocation, but who go through stages of psychosocial confrontation, accompanied by a wide range of psychopathological symptoms and syndromes such as depression, adjustment disorders, anxiety, paranoid states, reactivation of PTSD, early onset of cognitive disorders, etc. In addition to absorption, acculturation, integration aspects, societal attitudes towards immigrants and health aspects, particularly mental health, play a major role as vulnerability risk factors. Migration, particularly of those in late middle and old age, has become therefore an issue of high importance and concern.

Recent Activity Touching on Migration and Aging
The IPA Board of Directors decided in 1991 to establish an IPA Task Force on Migration and Aging in order to direct activity to this important issue.

Long before 1991, the IPA drew attention to LMAEM as an important issue in the field of mental health of the elderly. Lectures on the topic of Migration, Psychopathology and Aging were presented by Meinhardt Tropper and other IPA members at the World Congresses of Gerontology (Hamburg 1981, New York 1985), at the World Congresses of Psychiatry (Vienna 1983, Athens 1988, Madrid 1996), at the Fifth (Rome 1991), Sixth (Berlin 1993) and Seventh (Sydney 1995) IPA Congresses, the Joint Conference of IPA and AAGP (San Francisco 1982), and many other national and international forums. The Task Force organized a symposium (Berlin 1993) entitled "Psychopathology, Migration and Aging - Current Developments in the Last Decade of the Century", at which Ignaz Bubis, President of the Jewish Communities in Germany, delivered an important address on societal impacts and government responsibilities concerning migration.

During the last decade several papers on the topic of Migration and Aging were published by Task Force members.

Migration, Mental Health and Aging Symposium at IPA 8th Congress, 1997
At the forthcoming Eighth IPA Congress (Jerusalem, August 1997) the IPA Task Force on Migration and Aging will present a symposium entitled "Migration, Mental Health and Aging." This symposium will reflect current activities in this rapidly developing field of research and practice. The ultimate goal of these activities is the maintenance of the mental health of late middle age and elderly migrants in our turbulent world. Following is the structure of this symposium.

The first introductory lecture (M.S. Tropper, Israel) is dedicated to the issue of research, and interdisciplinary and international cooperation in the field. The second (M.O. Agbayewa, Canada) is focused on cross-cultural and ethnic aspects in the proper diagnosis and treatment of depression in old age. The third lecture (N. Katsnelson, USA) describes the organization of psychiatric services for immigrant older adults from Russia in the USA. The fourth lecture (D. Zivanovic et al, Yugoslavia) deals with health and psychosocial measures applied in cases of elderly refugees. The fifth lecture (E.Brettholz, I.Abramovici, Israel) points to the often encountered reactivation of traumatic experiences up to suicidal behavior in elderly migrants. The sixth lecture (A.Herst et al, Australia) represents a study of the effects of social isolation and other conditions on post WWII elderly immigrants in Tasmania.

The symposium content reflects the large gamut of topics relevant to this population strata, e.g. psychopathology, services organization, research, training, and last but not least, the urgent need for international cooperation.

Mission of IPA Task Force on Migration and Aging
The IPA Task Force on Migration and Aging decided recently that its principal aim will be to develop recommendations and standards for providing elderly immigrants in any country equitable access to mental health services. The Task Force noted that reliable detailed information about the mental health of aging immigrants (i.e., elderly and late-middle-aged people who are recent or longtime immigrants) is of vital importance to government and nongovernment institutions, particularly in high-emigration destination countries.

The Task Force defined equitable access to services as meaning that (1) an interpreter will be used if no suitable health care professional proficient in the elderly patient's language is available, and (2) "interactions, treatments, and interventions will be respectful, appropriate, and sensitive to the elderly patient's cultural background, migration circumstances, and related experiences".

The Task Force agreed to promote research and education activities aimed at fostering that goal. Among the activities are these:

1. facilitating research on factors determining the mental health and well-being of late-middle-aged and elderly immigrants;
2. evaluating mental health and dementia care services for aging immigrants in host countries, including immigrants' patterns of utilization of the services and the services' accessibility and appropriateness;
3. publishing and promoting models and examples of excellence in all areas of mental health practice and support services;
4. supporting researchers and practicing professionals in the area of migration, mental health, and aging by keeping them informed on specialist scientific and practice issues;
5. fostering development of assessment, treatment, and intervention methods that are linguistically and culturally relevant and appropriate;
6. fostering communication and coordinating the efforts of professionals by increasing awareness of the previously mentioned research and documentation and providing opportunities to exchange scientific information and practice experience through organization of regular regional conferences, seminars, and workshops;
7. fostering and strengthening links and cooperation with international and national bodies (International Organization for Migration - IOM, WHO, World Psychiatric Association, etc.), and keep them informed.
8. cooperating with the international journal Migration;
9. organizing symposia on mental health of aging migrants at IPA congresses and other professional meetings; and
10. establishing an international fund for the study of migration of late-middle-aged and elderly persons to secure financial support for the planned activities outlined here.

The IPA Task Force is composed mainly of professionals from countries with massive immigration. The Task Force members are M.S.Tropper (chair, Israel), I.Abramovici (Israel), M.O.Agbayewa (Canada), I.Brettholz (Israel), E.Chiu (Australia), R.Grypma (Australia), T.Iidaka (Japan), L.Israel (France), N.Katsnelson (United States), H.Klemm (Germany), D.J.Kozarevic (Serbia), D.Markovic-Zigic (Serbia; Russia), A.Milicevic (Serbia), H.Rabbani (France), A.Rudenko (Israel), and R. Vernikov (United States).

Based on accumulated data, activities of our IPA colleagues from different countries in this field, as well as on our own longitudinal ongoing study data (since 1974) carried out in Israel (a country of continuous immigration) on LMAEM, we are considering in the near future increasing the activity of the Task Force in order to foster the study of several issues, among them:

1. migrational stress (MS) as a risk factor for mental health (MH) in LMAED;
2. review and evaluation of MH services, including utilization, in hosting countries;
3. study of the "homeostatic physiological balance" under the impact of MS in LMAEM;
4. delineation of stages including psychopathological manifestations on the trajectory of migration starting from the decision-making process.
5. transcultural aspects of affective disorders in elderly migrants;
6. psychosocial factors affecting the health of elderly migrants;
7. education and training of multi-lingual migrant demented patients in early stages.
8. peculiarities of PTSD in elderly migrants;
9. ethnicity and cross-cultural aspects in LMAEM mental health.