Presentation Transcript

1. Seniors in Rural Canada Katherine Clark GERO 820 November 29th, 2010
2. Outline What is Rural Canada? Myths about Aging in Rural Canada Report: How Healthy are Rural Canadians Understanding the trends Aging in Community Understanding age friendly communities: related to rural communities What’s happening in Whistler Conclusions and Questions
3. What is “Rural Canada”? Census Canada defines “rural” as: Population less than 10,000 people Population density less than 400 people/sq.km. Constitutes approximately 30% of Canadian population No universal application of definition, making it difficult to compare results nationally and internationally ie. Some research defined rural as less than 20,000 people
4. Seniors in Rural Canada Seniors are over-represented in rural vs. urban Canada Factors affecting aging: Population density and distance: proportion of seniors in the community, distance from nearest health care center History: length of settlement of the community, number of years the elder has lived there Rural ideology: life orienting themes of rural elders, how much do they identify as “rural”
5. Myths about aging in rural settings… Class input: what are some ideas that you have or have heard about living or aging in rural Canada?
6. Myth #1 “Rural” is a defining and homogeneous characteristic
7. Myth Busted! True because: False because: There is huge diversity in the experience of living in a rural place: rural living spans a broad category North vs. south Farm vs. nonfarm Oldtimer vs. newcomer Distance from metropolitan influence There are some “typical” characteristics: Lower income Lower education Strong sense of community belonging Over-representation of youth and seniors
8. Myth #2 Rural settings are peaceful and idyllic
9. Myth Busted… True because: False because: Lower income, lower standards of housing Housing quality has been noted to correlate with self-reported well-being Industrial dereliction in some towns, especially if primary economy has been closed Cleaner air Less crowded Lower car and household insurance Physical access to outdoors is higher due to lower population density
10. Myth #3 Informal social support is high
11. Myth Busted… True because: False because: Differences between “newcomers” and “oldtimers” Neighbours may also be older and unable to provide necessary support (Joseph et al, 1993) Cannot assume family members will be cooperative (Keating, 1991) Many younger family members move away More never married individuals (Nagarajan, 2004) Strong sense of community belonging (Nagarajan, 2004) More involvement in volunteer and church organizations compared to urban seniors (Keating, 1991) High visibility with neighbours, low anonymity
12. Myth #4 Needs of rural seniors exceed what is available
13. True because: Objective measures of service report that rural services fail to meet standards (Keating, 1991) Long distances, additional expenses for specialized help (Nagarajan, 2004) Less likely to receive hospital treatment, visit a dentist (Keating, 1991) Narrow range, few health care providers (Bull, 1998)
14. False because: Needs and health care access are narrowly defined and bound by biomedical model “Determinants of health cannot be defined only as the availability and access to health care” (CPHI, 2006) Subjective health status of rural seniors is higher Alignment between perceived needs and perceived availability of services (Keating, 1993)
15. Perceptions of urban vs. rural hospital patients about return to their communities Costello et al, 1977 Asked hospital patients 65yr+ feelings about the availability of 13 services versus personal need for those services in their local community Rural = less than 5000 people Found that perceived availability was higher for those in urban areas However, ALSO found that perceived availability was greater than perceived need in both areas
16. How Healthy are Rural Canadians? Question asked by researchers of the Canadian Population Health Initiative, 2006
17. Initiative: Canada’s Rural Communities Purpose: understanding rural health and its determinants Methods: analyzed data from the following sources: Canadian Cancer Registry Canadian annual mortality data Canadian community health survey Definitions: Senior = 65 yr. + Rural = less than 10, 000 people Metropolitan Areas and Census Agglomeration Influenced Zones (CMA and MIZ)
18. CMA and MIZ Census Metropolitan Area (CMA): large urban area or urban core Metropolitan Influenced Zone (MIZ): populations living outside CMA classified according to degree of influence of the CMA. Used to define rurality Strong MIZ: 30%+ of the labour force works in the CMA Moderate MIZ: 5-30% work in CMA Weak MIZ: 0.1-5% work in CMA No MIZ: 0% commute to CMA, and less than 40 people are working in the area -- attempts to better show the effects of metropolitan accessibility on non-metropolitan areas
19. So, how healthy are rural Canadians? All cause mortality rates higher in Moderate, Weak and No-MIZ areas Mortality risks increase as MIZ level decreases Life expectancy is 2-3 years less than in CMA Greater obesity, diabetes, circulatory disease, and respiratory disease rates Greater risk of death from injuries and poisoning Overall, statistics show that rural Canadians are less healthy than their urban counterparts. Many of the risks come from modifiable risk factors, which could benefit from health promotion efforts, such as reducing smoking and increasing physical activity.
20. However, rural seniors have a different story… Satisfaction with health is greater than urban counterparts Mortality rates are lower or equal Women age 65+ had lower injury and poisoning rates Cancer rates were equal to urban statistics
21. Why is this? Class input: What reasons might there be for healthier seniors among a population of less healthy rural residents?
22. Some possibilities Unhealthy seniors may be relocating to urban centers to be closer to medical or family support Migration study confirmed that unhealthy people were more likely to move, and that out migration from rural towns > in migration for 70+ yr olds Healthy seniors may be moving to rural areas in retirement Survivor hypothesis: those who didn’t die prematurely are healthier, wealthier, or smarter Cohort effect: maybe seniors we are studying today were healthier all their lives
23. How does this impact health promotion programs for rural regions? We need to learn more about what is causing this disparity between seniors and the general rural population Creating appropriate needs assessments to understand what seniors feel they need within their community to enhance their ability to age in place, and: If seniors are indeed leaving rural areas when they become more frail, there should be a system in place to allow them to age in place/age in community
24. Population Health Framework for Rural Health
25. Creating age friendly communities Age friendly communities “promote physical and psychosocial wellbeing of community members throughout the lifecycle” (Scharlach, 2009) Most current research focuses on creating age friendly components within urban settings From aging in place to aging in community: obsession with aging within ones own home may be equally as suffocating as institutional environments Moving away from focusing on dwellings and towards relationships (Thomas and Blanchard, 2009)
26. Analyzing Rural Communities… Person-environment fit: how well does an individual function in his/her community? This also relates to the perception of needs and availability noted earlier Transportation issues commonly cited as rural problem Who is defining this “fit” Behaviour settings: when individuals are in supportive environments they are more likely to have greater functioning Cognitive adaptation to familiar setting = positive self image and higher perceived competence
27. Analyzing Rural Communities… 3. Individuals as constructive agents: people ascribe meaning to places, and these places in turn shape the meanings available to the person as he/she ages Understanding the subjective component to aging in place Life span developmental processes: context between person and their environment When studying rural places, it may be useful to examine the relationship between a person’s health and time in their life span they moved to a rural setting
28. Analyzing Rural Communities… 5. Physical, social, cultural environments: where we live shapes our chances and opportunities for how we live While people are “aging in place”, their homes are too! Macro level forces: politics and economics effect the experience for seniors regardless of size of town May serve to disadvantage rural areas which don’t have the economies of scale to accrue the number and diversity of services Assessing service needs: can’t be done without input from rural elders
29. Analyzing Rural Communities. Needs Assessments: Desired state of affairs “goal” – who has stated the goals? Taking control of one’s own QoL means determining one’s own health goals Way in which actual state of affairs relates to goal “need” – gap between current situation and goal Depends on how the research questions are asked Needs often determined from urban norms and objective measures
30. Aging in Community An example: Whistler, BC Population: 9000 Density: 57.2/sq.km Distance: 125 km from Vancouver (closest major medical center) Industry: Tourism
31. History First settled in 1910 by fishers and trappers Became a municipality in 1975 Site of the 2010 Olympic Games: this had a significant effect on infrastructure, accessibility and economic capital Many of the seniors who live in Whistler have helped make it the community it is today
32. Ideology Inhabitants identify with a rural ideology: less traffic, less pollution than in the city Many residents dislike heading down to the “big city” Influx of tourists and seasonal employees have led permanent residents to create a close knit community, its hard to go anywhere without bumping into someone you know. Active and youth-centered
33. Creating Community WHA: creating affordable, senior-friendly housing options WCSS: community gardens, food bank, used clothing store, newcomers dinner Whistler2020: “Comprehensive sustainability plan and vision” Yearly community surveys
34. Health Promotion…Barriers Lack of full-time specialists Focus on acute care Very expensive place to live Snow! And other hazardous terrain Not many activities to do in the evening, besides going to the bar…
35. Health Promotion: Unique Solutions Health care specialists visit Whistler on a regular basis MAC: promoting healthy aging and community life Inviting senior participation and feedback Seniors-only classes at the local recreation facility The community values physical activity and enjoyment of the outdoors The village has become increasingly accessible due to vocal seniors and wheelchair bound athletes ie. paralympians
36. What would make it even better? Accessible, seniors-specific housing (this has been an ongoing struggle, as real-estate is so expensive) More healthy, seniors friendly activities to do at night (ie. LUNA for younger adults) “Foster grandparents”: living in a rural area, seniors and children may be removed from their extended families Home care services and resources for those becoming more frail Car-sharing and appointment blocks for seeing specialists in Vancouver
37. Conclusion…
38. Conclusion We cannot make assumptions about the health status of seniors in an environment, nor about what their needs may be Integral to any health promotion initiative is to… TALK TO THE PEOPLE! Even the best planned initiatives are not used if the do not incorporate the views of the potential users Need to increase our understanding of perceived needs vs. perceived availability and how that impacts the health of rural seniors Urban perspectives are being used to study rural issues…the way we frame our research limits the “solutions” we end up with
39. Conclusion There may be more differences between newcomers and old-timers than between rural and urban seniors Newcomers may have better health literacy and SES Old-timers have greater social capital Can we combine these resources? Future research: how does health effect migration and vice versa Biggest influence on health may be migration… how do we help seniors age in community?
40. Class Input: Questions or comments about the presentation? In what ways does studying Whistler reduce our understanding of other aspects of rural Canada? Michael Ignatieff said: “If there’s 2 tiered health care in Canada, it’s not between rich and poor, it’s between urban and rural.” (Ottawa Citizen 2006) Do you agree??