Kathi Wilson Mark Rosenberg Department of Geography Department of Geography

1. 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 Queen’s University Sylvia Abonyi Community Health and Epidemiology University of Saskatchewan SEDAP II - Canada in the 21st Century: Moving Towards an Older Society

2. 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

3. 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)

4. Aboriginal Peoples in Canada Aboriginal identity pop’n • 1 million • represent 3.8% of Canada’s total population (2.8% in 1996) Source: Statistics Canada, 2001 http://www12.statcan.ca/english/census01/Products/Analytic/companion/abor/canada.cfm

5. Source: Statistics Canada. 2006. http://www12.statcan.ca/english/census06/data/highlights/Aboriginal/pages/Page.cfm?Lang=E&Geo=PR&Code=01&Table=1&Data=Count&Sex=1&Age=9&StartRec=1&Sort=2&Display=Page Age Distribution Median age 2006 • Aboriginal - 27 years • Non-Aboriginal - 40 years

7. 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

8. 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)

9. 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)

10. Incomplete Picture of Aboriginal Peoples • ‘Age’ focus of health research: • General population profiles • Youth

11. 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

12. Research Team Investigators: Mark Rosenberg Sylvia Abonyi Geography Community Health and Epidemiology Queen’s University University of Saskatchewan Aboriginal Advisor Bob Lovelace Sir Sanford Fleming College

13. 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

14. Phase 2 Data Sources

15. 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

16. Data Access • CCHS and APS microdata file accessed through Statistics Canada’s 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.

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

18. Population Reporting Fair/Poor Self-Assessed Health Status *Chi-Square Significance p<0.001

19. Population Reporting Difficulty with Activities *Chi-Square Significance p<0.001

20. Total Number of Chronic Conditions *Chi-Square Significance p<0.001

21. Visited Physician within Past 12 Months *Chi-Square Significance p<0.001

22. Visited Nurse within Past 12 Months *Chi-Square Significance p<0.001

23. 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

24. 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+)

25. Percentage of Aboriginal Population 55 years and older, 2001 Source: Statistics Canada. 2001. *Chi-Square Significance p<0.001

26. Population Reporting Fair/Poor Self-Assessed Health Status Source: Statistics Canada. 2001. *Chi-Square Significance p<0.001

27. Population Reporting Difficulty with Activities Source: Statistics Canada. 2001. *Chi-Square Significance p<0.001

28. Total Number of Chronic Conditions Source: Statistics Canada. 2001. *Chi-Square Significance p<0.001

29. Visited Physician within Past 12 Months Source: Statistics Canada. 2001. *Chi-Square Significance p<0.001

30. Visited Nurse within Past 12 Months Source: Statistics Canada. 2001. *Chi-Square Significance p<0.001

31. 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

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

33. 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’?

34. 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