Presented by Daniel Lai, PhD, RSW Professor & Associate Dean (Research & Partnerships) Faculty of...
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Health Status and Social Determinants of Health of Immigrant Seniors In Canada Presented by Daniel Lai, PhD, RSW Professor & Associate Dean (Research & Partnerships) Faculty of Social Work, University of Calgary 1
Presented by Daniel Lai, PhD, RSW Professor & Associate Dean (Research & Partnerships) Faculty of Social Work, University of Calgary 1
Presented by Daniel Lai, PhD, RSW Professor & Associate
Dean (Research & Partnerships) Faculty of Social Work,
University of Calgary 1
Slide 2
Introduction Statistics of immigrants 18.4% born outside of
Canada (Ethnic Diversity Survey (EDS), Statistics Canada, 2003)
Aging immigrant population 65 -74: 29.8% immigrants; 10.3% visible
minorities 74 and older: 29.8% immigrants; 7.5% visible minorities
Gaps of research on aging immigrant population subgroup The
research community and the policy sector have indicated a growth in
interest to examine issues related to the health of culturally
diverse immigrant seniors and older adults. However, empirical
research findings on this aging population subgroup are limited.
2
Slide 3
Research Questions 1) How are immigrant seniors defined, and
what are unique distinctions amongst this population? 2) How does
immigrant seniors health status compared to Canadian seniors? 3)
Are there chronic diseases/conditions more prevalent among
immigrant seniors? 3
Slide 4
Research Questions 4) What are the community and individual
level determinants that influence the health status of immigrant
seniors in Canada the most? Are these determinants the same ones
that affect non-immigrant seniors in Canada the most? Are there
specific protective factors associated with these groups? 5) How
are immigrant seniors dealing with health care, and other health or
social services that they might need? What are the demographic,
economic, social and health implications of aging immigrants in
Canada? What are the main policy implications and recommendations?
4
Slide 5
Definitions Foreign-born It is defined in the 2006 Census as
persons who are, or who have been, landed immigrants in Canada.
Different ethnic origins Ethnic origin refers to the ethnic or
cultural origin of a persons ancestors, which should not be
confused with citizenship or nationality (Statistics Canada, 2006).
Age criteria In some studies, seniors 65 years and older were
included (Boyd, 1991; Chappell, 2003; Gee, 1999; Moore &
Rosenberg, 2001). In some other studies, people who were 55 years
and older were included (Chappell, 2005; Kaida, Moyser & Park,
2009; Lai, 2009; Lai & Surood, 2009; Streiner, Cairney &
Veldhuizen, 2006). 5
Slide 6
Demographic and Social Profile of immigrant seniors 2001 census
data In 2001, about 29% of seniors between the age of 65 and 74 and
28% of those between the age of 75 and 84 were immigrants.
Distinctions The immigrant population is older than the
non-immigrant population Fewer women than men among the immigrant
seniors Residence More of the immigrant seniors than Canadian-born
seniors reside in large urban areas 6
Slide 7
Demographic and Social Profile of immigrant seniors Ethnicity
Recent immigrant seniors are more likely to be visible minorities.
Religion Recent immigrant seniors and long-term immigrant seniors
are more likely (63% and 58%) to report religion as very important
than Canadian-born seniors (55%). Social characteristics Recent
immigrant seniors are more likely to be in low income than
long-term immigrant seniors. 7
Slide 8
Demographic and Social Profile of immigrant seniors Educational
attainment Immigrant seniors are less likely (22%) to have a
post-secondary credential when compared with the Canadian-born
seniors (24%). Living arrangements Recent immigrant seniors are
much less likely to live alone than long- term immigrants and
Canadian-born immigrants. Social networks and support Recent
immigrant seniors are more likely (65%) to receive care exclusively
from informal sources such as family or spouse, than Canadian-born
and long-term immigrant seniors (44%). 8
Slide 9
Health Status of Immigrant Seniors Two perspectives co-exist
Immigrants seniors, probably due to various forms of adjustment
challenges and socio-cultural barriers, tend to be less healthy
when compared with Canadian-born seniors (Lai, 2004c). Healthy
immigrant effects, -- recent immigrant seniors are usually
healthier than Canadian-born seniors as well as the immigrant
seniors that have been settled in Canada for longer (Gee,
Kobayashi, & Prus, 2004). 9
Slide 10
General Health Status General physical health In the 2003
Canadian Community Health Survey, 28% of recent immigrant seniors
rated their health as either excellent or very good, compared to
38% of Canadian-born seniors and 36% of long- term immigrant
seniors. Recent immigrant seniors who were 65 years and older
reported having poorer overall health when compared to
Canadian-born persons of the same age range (Gee, Kobayashi and
Prus, 2004). According to the data from 2,272 randomly selected
older Chinese in seven Canadian cities (Lai, Tsang, Chappell, Lai,
& Chau, 2003), the older Chinese reported a higher prevalence
of some health conditions than those in the general population
within the same age range. 10
Slide 11
General Health Status General mental health Older Chinese in
Canada reported the worst mental health, when compared with the
mental health of other older Chinese in Mainland China, Hong Kong,
and Taiwan (Lai, 2009). In one study examining the challenges that
elderly women from India encounter, the participants reported
experiencing isolation, loneliness, family conflict, economic
dependence, a loss of control with settling in, a struggle to cope,
and struggling for a sense of interdependence (Choudhry, 2001).
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Slide 12
General Health Status Life satisfaction & quality of life
Ujimoto (1987) indicated that aging Japanese Canadians who stressed
discipline, perseverance, and self-reliance were satisfied or very
satisfied with respect to their financial situation, family
relations and health. However, less satisfaction in health was
reported. Women reported significantly lower levels of satisfaction
than men. Those who were younger (under 65 years old) and those who
lived alone also reported a lower level of life satisfaction than
those who were older and lived with others (Lai, Tsang, Chappell,
Lai, & Chau, 2003). 12
Slide 13
General Health Status General oral health A major study on the
oral health of ethno-cultural minority seniors was conducted by
Swoboda, Kiyak, Persson, Yamaguchi, MacEntee, and Wyatt (2006). The
findings suggested that functional dentition and cavities influence
older adults oral health-related quality of life, but that
ethnicity and immigrant status play a larger role. 13
Slide 14
Health Conditions or Diseases Depression Depression is
prevalent among older immigrants (Kuo, Chong & Joseph, 2008).
Lai (2000a, 2000b, 2000c; 2004a): Prevalence rates of 20.9% to
24.2% percent were reported for Chinese immigrant seniors, using a
15-item Chinese version of the Geriatric Depression Scale. 21.4% of
220 randomly selected older South Asian immigrants of 55 years and
over reported being mildly depressive (Lai & Surood, 2008b).
14
Slide 15
Health Conditions or Diseases Elder abuse and neglect Walsh and
her colleagues (2007) explored the experiences of marginalized
elders and found that victims of elder abuse often suffered in
silence, and cultural factors, ageism and gender were ubiquitous to
elder abuse. Tam and Neysmith (2006) examined the relationship
between cultural factors and elder abuse in Chinese communities and
pointed out that disrespect was the key form of elder abuse in the
Chinese community, and social exclusion and marginalization put a
Chinese immigrant senior in vulnerable conditions of abuse. 15
Slide 16
Health Conditions or Diseases Alzheimers Disease Seniors
speaking two or more languages may delay the onset or diagnosis of
Alzheimers disease by almost 5 years (Chertkow, Whitehead,
Phillips, Wolfson, Atherton and Bergman, 2010). There was a lack of
knowledge about Alzheimers Disease among a sample of 125
Spanish-speaking adults 55 and older in the Greater Toronto Area
(Fornazzari, Fischer, Hansen and Ringer, 2009). 16
Slide 17
Health Conditions or Diseases Diabetes Health conditions such
as high blood pressure, stomach problems, and eye problems were
reported as having a higher prevalence among older Chinese than did
in the general population within the same age range (Lai, Tsang,
Chappell, Lai & Chau, 2003). 17
Slide 18
Health Conditions or Diseases Substance use Alcohol drinking
Recent immigrants are less likely to be heavy drinkers than non-
immigrants (Prez, 2002). Smoking Recent immigrant seniors are less
likely to be daily smokers than non-immigrants. In 2003, the
proportion of recent immigrant seniors who had never smoked in
their life was twice that of the Canadian-born (63% versus 31%)
(Turcotte & Schellenberg, 2007). Gambling Lai (2006a) pointed
out that being male, having lived in Canada for longer, having a
higher level of social support, having more service barriers, and
having a stronger level of Chinese ethnic identity would increase
the probability for an older Chinese person to participate in
gambling. 18
Slide 19
Health Conditions or Diseases Diet and nutrition Immigrants
were more likely to meet the Canadian recommendations for
carbohydrates and fat intake and less likely to have adequate
intakes of protein, iron, and calcium, compared to non-immigrants
(Pomerleau et al., 1998a; Pomerleau et al., 1998b). Johnson and
Garcia (2003) examined diet and physical activity among 54 older
immigrants from Cambodian, Latin- American, Vietnamese and Polish.
And found that 72.5% of them were at moderate to high risk of poor
nutrition. 19
Slide 20
Social Determinants of Health in General Canadian Seniors 1)
income and social status 2) social support networks 3) education
and literacy 4) employment/working conditions 5) social
environments 6) physical environments 7) personal health practices
and coping skills 8) healthy child development 9) biology and
genetic endowment 10) health services 11) gender 12) culture
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Slide 21
Social Determinants of Culturally Diverse immigrant Seniors Age
Immigrant seniors who are older in age tend to be less healthy or
more likely to be affected by a specific disease or chronic
condition. Age has been identified as an important predictor of
self-assessed health (Pennings, 1983). 21
Slide 22
Social Determinants of Culturally Diverse immigrant Seniors
Gender Most of the studies examining determinants of health of
immigrant seniors reported gender differences in the health and
health behaviors. Women often report a less favorable health and
well-being in most of research studies (Penning, 1983). Women
reported to be have poorer physical health, more chronic illnesses,
and more limitations in Instrumental Activities of Daily Living
than their male counterparts (Lai, Tsang, Chappell, Lai & Chau,
2007). 22
Slide 23
Social Determinants of Culturally Diverse immigrant Seniors
Marital status Marital status is identified as a significant factor
of psychological well-being of elderly Chinese in Canada (Chow,
2010; Lai, 2005a). Lais (2005a) study on older Taiwanese immigrants
also indicated that being single was a predictive factor of someone
reporting more depressive symptoms. 23
Slide 24
Social Determinants of Culturally Diverse immigrant Seniors
Education A higher level of education was significant in predicting
better mental health status of aging Chinese in Canada (Lai, Tsang,
Chappell, Lai, & Chau, 2007). Older Chinese who reported a
higher level of education reported a lower level of limitation in
Instrumental Activities of Daily Living (Chow, 2010). 24
Slide 25
Social Determinants of Culturally Diverse immigrant Seniors
Financial status Poorer financial status (i.e., lower adequacy of
finances, less satisfaction with economic status) was a significant
predictor of depression among immigrant older seniors and older
adults in Canada (Kuo & Guan, 2006; Lai, 2004a; 2004b; 2005a).
Financial status not only influences the health of immigrant
immigrants but also their health behaviors (Oliffe, Grewal,
Bottorff, Hislop, Phillips, Dhesi & Kang, 2009). 25
Slide 26
Social Determinants of Culturally Diverse immigrant Seniors
Living arrangement Living alone was a significant predictor of less
favorable mental health among older immigrants. Those who live
alone more were more likely to experience social isolation,
depression and poorer mental health (Lai, 2007a; 2009). 26
Slide 27
Social Determinants of Culturally Diverse immigrant Seniors
Language Immigrants who are more proficient in English and more
acculturated into the new host culture will suffer less from
cultural and other adjustment related stressors, and therefore
report lower levels of depression (Lai, 2004a). The lack of
proficiency in English language led to an increasing distance
between immigrant seniors and their grandchildren, causing
additional strain for the elderly immigrant (Choudhry, 2001).
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Slide 28
Social Determinants of Culturally Diverse immigrant Seniors
Ethnicity and religion Maintaining a stronger ethnic identity would
result in Chinese immigrant seniors being able to have better
access to ones ethnic networks that could assist them with
adjustments and challenges (Gee, 1999). Religion was a powerful
spiritual coping resource for elderly immigrant Indian women
(Acharya & Northcott, 2007; Choudhry, 2001). 28
Slide 29
Social Determinants of Culturally Diverse immigrant Seniors
Values and beliefs Cultural variables were significant in
explaining variance in physical health, mental health, number of
illnesses, and limitations in Instrumental Activities of Daily
Living (Lai, Tsang, Chappell, Lai, & Chau, 2007). Experience of
elder abuse is also affected by cultural values. Walsh and her
colleagues (2007) indicated that culture affects how elder abuse is
revealed due to the cultural reluctance to openly address the
issue. 29
Slide 30
Social Determinants of Culturally Diverse immigrant Seniors
Length of residence Those who lived in Canada for a longer period
of time reported a better psychological well-being (Chow, 2010).
Length of residence affects the use of Western health services. For
aging South Asian immigrants, those who had lived in Canada for a
longer period of time reported using more Western health services
(Surood & Lai, 2010). 30
Slide 31
Social Determinants of Culturally Diverse immigrant Seniors
Social support Social support was found to be a strong predictor of
life satisfaction of Chinese elderly immigrants (Lai &
McDonald, 1995; Gee, 2000). Lower social support increased the risk
for depressive symptoms of elderly Chinese (Lai,2004a). Family
conflicts among the elderly immigrants and their younger generation
will increase the stress for the seniors. Particularly, conflict
with daughter-in-law is the most frequent source of strain and
stress for the elderly people (Choudhry, 2001). 31
Slide 32
Social Determinants of Culturally Diverse immigrant Seniors
Life transitions and coping strategies Kuo and Guan (2006) measured
how older Chinese Canadians would cope with a hypothetical scenario
of depression. The study found that coping was significantly
correlated with lower depression scores. 32
Slide 33
Social Determinants of Culturally Diverse immigrant Seniors
Service barriers The perception of service barriers to health and
social services was a significant predictor of depression in
Chinese older adults in Canada (Kuo & Guan, 2006; Lai, 2004b,
2005a). Older immigrants reporting more service barriers reported
less healthy physical and mental health (Lai & Chau, 2007).
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Slide 34
Social Determinants of Culturally Diverse immigrant Seniors
Physical environments Age-induced musculoskeletal impairment and
cold, wet Canadian climate were the main restrictors of male
Punjabi Sikh seniors physical activity (Oliffe, Grewal, Bottorff,
Hislop, Phillips, Dhesi & Kang, 2009) 34
Slide 35
Protective Factors and Key Determinants Innate personally
characteristics Personally acquired characteristics or resources
Circumstantial and structural advantages 35
Slide 36
Protective Factors and Key Determinants For example: In the
study examining depressive symptoms of Chinese immigrant seniors
(Lai, 2004a), financial adequacy remained the strongest predictor
for being depressive. Cultural values also turned out to be the
most significant predictor of depression in the study on aging
South Asian immigrants (Lai & Surood, 2008b). 36
Slide 37
Policy Implications Strengthening mental health services It is
important for service providers and practitioners to pay attention
not only to the physical health and wellbeing, but also to the
mental health and specific psychological needs of immigrant seniors
and older adults. 37
Slide 38
Policy Implications Addressing financial needs It is important
for policy makers to reduce the financial gap between immigrant
seniors and Canadian-born seniors. 38
Slide 39
Policy Implications Living arrangement and independent living
Services such as long term and institutional care must be sensitive
to the different attitudes towards the elderly and sense of place
that exist among different culturally-defined segments of the
elderly (Moore & Rosenberg, 2001). 39
Slide 40
Policy Implications Housing and caring facilities Researchers
have reported that most immigrant seniors live with their families
are satisfied with their existing residences in Canada (Gee, 2000;
Mahmood, Chaudhury, Kobayashi & Valente, 2008). Immigrant
seniors living alone have been found to be less physically and
mentally healthy (Lai, 2004a, 2007a, 2009, Johnson & Garcia,
2003). Service providers should be more aware of the ethno-specific
needs of immigrant older adults when planning and designing seniors
housing and facilities (Ng, Northcott, & Laban, 2001). 40
Slide 41
Policy Implications Service delivery in health settings In view
of the challenges and associated with access barriers to health
services by many immigrant seniors who are culturally diverse,
there is a need for strengthening support and resources for this
population group (Lai & Chau, 2007b). Service providers have to
consider strategies for closing the cultural gaps that exist
between immigrant seniors and service providers. 41
Slide 42
Policy Implications Training of professionals Training content
and teaching materials of professional schools in various
disciplines have to be inclusive to ensure that culturally
competent and relevant training is delivered to the future
professionals who work in the field that is becoming increasingly
culturally diverse. 42
Slide 43
Policy Implications Staff composition and recruitment Health
care and community service organizations in Canada have to consider
developing staff recruitment and hiring strategies to reach out to
different ethno-cultural and immigrant communities. 43
Slide 44
Policy Implications Caregiving for immigrant seniors Caregiving
for a senior can be a burden for the family caregiver (Lai, 2007b;
Leung & McDonald, 2001), particularly when the care recipients
are frail and ill. This indicates the importance of developing and
providing culturally appropriate policies and services to support
culturally diverse immigrant caregivers (Lai, 2007b). 44
Slide 45
Recommendations Strengthening mental health services It is
important for the health care system to establish and develop more
culturally appropriate mental health services for diverse immigrant
seniors. 45
Slide 46
Recommendations Creating financial security Considerations
should be given at a policy level to address the financial needs of
immigrant seniors. Address policies related to postponed retirement
so that employees and employers would be free to work out
arrangements on normal, early, and postponed retirement (Grant
& Grant, 2002), facilitating immigrant seniors to continue with
earning employment while accumulating future retirement benefits.
It is important to consider the eligibility and sufficiency of
income maintenance for immigrant seniors. 46
Slide 47
Recommendations Supporting independent living Efforts should
not be focused only on providing caring facilities or housing
options. Array of coordinated services to strengthen social support
from within and outside of ones community, to provide financial
assistance, and to assist one to maintain functioning capacity
should be developed. Traditional community home support programs
and services should be prepared be more culturally sensitive and
appropriate. 47
Slide 48
Recommendations Development of appropriate housing facilities
Easy access to public transportation should be considered in
housing development, particularly due to the fact that immigrant
seniors are less likely to drive, particularly those who came in
recent years. Voices of culturally diverse immigrant seniors should
be incorporated into policy making process. 48
Slide 49
Recommendations Support for immigrant family caregiving In
order to adequately serve immigrant seniors who are in need for
more intensive care, the service delivery system has to be
sensitive to the fact that it is the family caregivers who have to
be supported as well. Programs and support designed for immigrant
family caregivers should take into consideration the fact that many
immigrant family caregivers are faced with the double challenge of
providing family caregiving and handling daily struggles related to
underemployment, financial challenges, and cultural barriers.
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Slide 50
Recommendations Development of culturally competent service
delivery system Services should be provided in ways that align with
the cultural and linguistic contexts of immigrant seniors.
Community education for immigrant seniors to build culturally
competent services. Strengthen staff capacity to work with
culturally diverse immigrant seniors. 50