Transcript 幻灯片 1

Presented by
Daniel Lai, PhD, RSW
Professor & Associate Dean (Research & Partnerships)
Faculty of Social Work, University of Calgary
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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.
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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?
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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?
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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 person’s
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).
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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
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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.
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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 longterm 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%).
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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).
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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 longterm 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.
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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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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).
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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.
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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).
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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.
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Health Conditions or Diseases
 Alzheimer’s Disease
 Seniors speaking two or more languages may delay the onset or
diagnosis of Alzheimer’s disease by almost 5 years (Chertkow,
Whitehead, Phillips, Wolfson, Atherton and Bergman, 2010) .
 There was a lack of knowledge about Alzheimer’s Disease among a
sample of 125 Spanish-speaking adults 55 and older in the Greater
Toronto Area (Fornazzari, Fischer, Hansen and Ringer, 2009) .
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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).
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Health Conditions or Diseases
 Substance use
 Alcohol drinking
Recent immigrants are less likely to be heavy drinkers than nonimmigrants (Pérez, 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.
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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, LatinAmerican, Vietnamese and Polish. And found that 72.5% of
them were at moderate to high risk of poor nutrition.
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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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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).
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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) .
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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).
 Lai’s (2005a) study on older Taiwanese immigrants also
indicated that being single was a predictive factor of someone
reporting more depressive symptoms.
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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).
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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).
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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).
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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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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
one’s 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).
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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.
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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).
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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).
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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.
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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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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)
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Protective Factors and
Key Determinants
 Innate personally characteristics
 Personally acquired characteristics or resources
 Circumstantial and structural advantages
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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).
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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.
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Policy Implications
 Addressing financial needs
 It is important for policy makers to reduce the financial gap
between immigrant seniors and Canadian-born seniors.
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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).
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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).
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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.
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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.
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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.
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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).
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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 .
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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
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 one’s 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.
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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.
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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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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.
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Thank You!
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