Aging, Health and Health Care: Examining Differences between Aboriginal and non-Aboriginal Seniors in Canada

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Aging, Health and Health Care Examining
Differences between Aboriginal and
non-Aboriginal Seniors in Canada

• Kathi Wilson Mark Rosenberg
• Department of Geography Department of Geography
• University of Toronto Mississauga Queens
  University
• Sylvia Abonyi
• Community Health and Epidemiology
• University of Saskatchewan

SEDAP II - Canada in the 21st Century Moving
Towards an Older Society
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Outline

• Background
• Population and demographic comparisons
• Overview of existing literature
• Objectives and goals of current research
• Data and Methods
• Aboriginal Peoples Survey (APS) 2001
• Canadian Community Health Survey (CCHS) 2000/2001
• Exploratory examination of differences
• Results
• Conclusions/Implications

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Who are Older Aboriginal Peoples?

• Older - demographic concept (65 years and older)
• Elder - cultural concept
• reflects status of honour, wisdom and respect
  regardless of age (McLeod-Shabogesic, 1998
  Medicine, 1983)

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Aboriginal Peoples in Canada

• Aboriginal identity popn
• 1 million
• represent 3.8 of Canadas total population (2.8
  in 1996)

Source Statistics Canada, 2001
http//www12.statcan.ca/english/census01/Products/
Analytic/companion/abor/canada.cfm
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Age Distribution

• Median age 2006
• Aboriginal - 27 years
• Non-Aboriginal - 40 years

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(No Transcript)
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Projected Population Growth

• Aboriginal seniors - 6.5 (2017)
• Non-Aboriginal seniors - 17 (2017)

Source Statistics Canada, Projections of the
Aboriginal Populations, Canada, Provinces and
Territories 2001 to 2017
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Research on Older Aboriginal Peoples

• Growing literature on Aboriginal peoples
• Canadian Journal of Native Studies (1981)
• Native Studies Review (1984)
• Lack of attention toward older Aboriginal
  peoples
• major reports on older Native people continue to
  be based almost entirely on anecdotal evidence
  (Buchignani and Armstrong-Esther, 1999, p.7)

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Review of Aboriginal Health Research in the
Social Sciences

• 1995-2005
• 96 articles
• Only 3 focus on older Aboriginal peoples
• Mental health (Cattarinich et al., 2001)
• Inuit - successful aging (Collings, 2001)
• Informal care (Buchignani and Armstrong-Esther,
  1999)

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Incomplete Picture of Aboriginal Peoples

• Age focus of health research
• General population profiles
• Youth

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Purpose of Research

• Objectives
• Provide a comparison between Aboriginal and
  non-Aboriginal seniors
• Provide comprehensive portrait of the health
  status of older Aboriginal peoples and their use
  of health services
• Goals
• Enhance understanding of Aboriginal health status
  and use of services in Canada
• Knowledge transfer to the Aboriginal and general
  policy and planning communities
• Provide contextual platform to develop future
  qualitative research

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Research Team

• Investigators
• Mark Rosenberg Sylvia Abonyi
• Geography Community Health and Epidemiology
• Queens University University of Saskatchewan
• Aboriginal Advisor
• Bob Lovelace
• Sir Sanford Fleming College

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Five-year Research Plan

• Phase 1- Population Aging Among Aboriginal
  Peoples in Canada
• 2001 Census of Canada
• Departmental Data, DIAND
• Phase 2 - Health Status of Older Aboriginal
  Peoples and their Utilisation of Health Services
• 2001 CCHS 2001 APS
• differences between non-Aboriginal and Aboriginal
  peoples
• differences within Aboriginal population
• Phase 3 - Experiences of Aging among Older
  Aboriginal Peoples

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Phase 2 Data Sources
2001 APS 2000/2001 CCHS
Targeted Population Aboriginal identity Aboriginal ancestry reserve/off-reserve Private dwellings 0-14 years 15 years and older Individuals in private dwellings (not Aboriginal peoples with reserve-residency) 12 years and older
Survey Questions education, income, language, labour activity, income, health, communication, mobility, housing Metis, Children, Arctic physical/mental well-being, lifestyle, use of health care services, access to are common optional content
Respondents 98,649 130,827
Response Rate 84 84.7
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Common Health and Health Care VariablesAPS
(2001) and CCHS (2001)

• Age cohorts 18-54, 55-64, 65-74, 75
• Health Status
• Self-assessed (excellent/very good/good vs.
  fair/poor)
• Difficulty with activities Do you have any
  difficulty hearing, seeing, communicating,
  walking, climbing stairs, bending, learning etc?
• 9 Chronic conditions (diagnosed)
• Health Care use in past 12 months
• Physician use
• Nurse

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Data Access

• CCHS and APS microdata file accessed through
  Statistics Canadas Regional Data Centre at
  McMaster University
• The research and analysis are based on data from
  Statistics Canada and the opinions expressed do
  not represent the views of Statistics Canada.

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Results

• Exploratory analysis
• Stage 1
• Older Aboriginal and non-Aboriginal
• Stage 2
• Older Aboriginal peoples (North American Indian,
  Métis, Inuit)

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Population Reporting Fair/Poor Self-Assessed
Health Status
Chi-Square Significance plt0.001
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Population Reporting Difficulty with Activities
Chi-Square Significance plt0.001
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Total Number of Chronic Conditions
Chi-Square Significance plt0.001
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Visited Physician within Past 12 Months
Chi-Square Significance plt0.001
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Visited Nurse within Past 12 Months
Chi-Square Significance plt0.001
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Summary

• Health Status
• In general, Aboriginal population unhealthier
  than Aboriginal population
• Older cohorts unhealthier than younger cohorts
• Health appears to converge among oldest
  Aboriginal and non-Aboriginal seniors
• Health Care Use
• Similar access to physicians
• Higher reliance on nurses within Aboriginal
  population

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Differences within Aboriginal population

• APS (2001)
• North American Indian
• Métis
• Inuit
• Demographic composition
• Health status (18-44, 45-64, 65)
• Use of health care services (18-44, 45-64, 65)

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Percentage of Aboriginal Population 55 years and
older, 2001
Source Statistics Canada. 2001.
Chi-Square Significance plt0.001
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Population Reporting Fair/Poor Self-Assessed
Health Status
Source Statistics Canada. 2001.
Chi-Square Significance plt0.001
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Population Reporting Difficulty with Activities
Source Statistics Canada. 2001.
Chi-Square Significance plt0.001
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Total Number of Chronic Conditions
Source Statistics Canada. 2001.
Chi-Square Significance plt0.001
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Visited Physician within Past 12 Months
Source Statistics Canada. 2001.
Chi-Square Significance plt0.001
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Visited Nurse within Past 12 Months
Source Statistics Canada. 2001.
Chi-Square Significance plt0.001
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Summary

• Stage 1 Differences between older Aboriginal
  non-Aboriginal Canadians
• Non-Aboriginal population healthier across age
  cohorts
• But health status converges among oldest age
  cohorts
• Older Aboriginal peoples higher reliance on
  nurses
• Stage 2 Differences within Aboriginal population
• Health status
• Older Inuit appear healthier
• Health care use
• Older Inuit lower levels physician use
• But much higher reliance on nurses

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Limitations

• Self-reports
• Measuring health status - biomedical
• Health care use - incidence vs. frequency
• Diversity of the Aboriginal population
• e.g., on vs. off-reserve

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Implications

• Almost no research on older Aboriginal cohorts
• Represent 5 of Aboriginal population
• Represent 1.5 of older Canadian population
• This research health picture of seniors living
  in community
• Questions remain
• no knowledge of population living in institutions
• formal/informal caregiving
• Know little about health, services creating
  services
• Who collects data? What type of data?

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Next Steps

• Phase 2 Determinants of health and health care
  use
• Traditional healing
• Phase 3 Qualitative research study
• Experiences perceptions of aging
• Broader perspectives on health/health care
• Ontario
• Saskatchewan