Chapter Summaries
The book is divided into six sections.
SECTION 1 provides a context within which intersections of aging and immigration is considered in this book in order to help readers (re)think about what it means to age well in Canada.
In Chapter 1, “Aging Well: Critical Issues of Concern for Older Immigrants in Canada,” Sepali Guruge introduces key issues of concern in relation to health and wellbeing, and (re)settlement and integration of older immigrants and refugees in Canada. She captures the role of social determinants, such as access to services, gender, and racism and discrimination in shaping the health and wellbeing of older adults in order to provide a context for issues related to aging and immigration in Canada. She stresses the need to understand the social determinants of health and how multiple institutional and structural elements create inequities in basic need areas for older immigrants, including housing, employment, transportation, and healthcare.
In Chapter 2, “Social Exclusion: A Lens for Understanding Aging in the Context of Migration,” Amanda Grenier and Jill Hanley explore the merits of thinking through social exclusion as a conceptual framework to better understand the experience of aging within the context of migration, in terms of the structural, organizational, and relational issues at the intersections of aging and migration and how they affect the lives of older migrants. Using composite examples at micro, meso, and micro levels of community-based practice, they illustrate dimensions of social exclusion in action, and how these affect the experiences of older migrants in the contexts of family sponsorship, dependency, and care. The authors underscore the need for a critical agenda that links the analysis of social exclusion with mechanisms for inclusion through advocacy and political change.
Mandarin-speaking older immigrants represent about 25 percent of the older adult population in Toronto, yet there is limited knowledge on their perspectives of aging in Canada. In Chapter 3: Perceptions of Healthy Aging among Mandarin-Speaking Immigrant Older Adults in Toronto, Sepali Guruge, Robert Ta, Ernest Leung, and Souraya Sidani report the results of their study that involved 36 Mandarin-speaking older immigrants in Toronto. They highlight that the older adults’ access to information and community-based programs, as well as formal and informal support for their care needs, were key factors contributing to healthy aging in this community. The authors call for a strength-based approach for mobilizing members of the Mandarin-speaking community to promote the cultural values of caring for older adults, and in involving service providers in enhancing accessibility to health care and social services that are essential to maintaining older adults’ wellbeing.
SECTION 2 focuses on health statuses and health determinants of older immigrants.
Based on a scoping review that included a sample of 47 articles, in Chapter 4, “Health Statuses and Health Determinants of Older Immigrant Women in Canada,” Sepali Guruge, Kaveenaa Chandrasekaran, Nishana Chandrasekaran, and Madelaine Woo report that older immigrant women in Canada experience decline in some aspects of their physical and mental health. They also underutilize preventive services such as cancer screening, and experience difficulties in accessing healthcare services. The authors report language, cultural differences, and digital literacy, among others, as key barriers to healthcare access and utilization. The authors highlight the need for culturally safe and linguistically tailored health services and health information, as well as consistent funding to ensure community-based social and settlement services to facilitate the health needs of older immigrant women in Canada.
The aging population and immigration-based population growth in Canada necessitate research, practice, and policy focusing on older immigrants’ health, which appears to deteriorate over time. In Chapter 5, “Health Status and Health Determinants of Older Immigrant Men in Canada,” Sepali Guruge, Kaveenaa Chandrasekaran, Ernest Leung, Tobert Ta, and Souraya Sidani examine what is known about the older immigrant men’s health, social determinants of health, and barriers to access to health services. Based on the analysis of the results of the 25 articles that were included in their scoping review, the authors report that the key social determinants of health include culture, religion, gender, and access to health services. They also highlight that older immigrant men use fewer health services than their Canadian-born counterparts as a result of cultural beliefs, lack of culturally and linguistically appropriate health services, financial difficulties, and ageism. The authors conclude that regardless of subcategories within this population, older immigrant men experience considerable health inequities.
SECTION 3 focuses on socioeconomic considerations for older immigrants’ wellbeing in Canada.
Multiple factors, including moving to a new country, can result in the loss of informal and formal social networks, leading to social isolation for older adults. The quantity and quality of lost (and sometimes gained) networks and support can shape where and how newcomers build their lives and participate in cultural and political life in Canada. In Chapter 6, “Loneliness Kills: Social Support and Social Interactions as Determinants of Aging Well and Inclusion Among Arabic- and Spanish-Speaking Senior Immigrants in Ottawa,” Paola Ortiz Loaiza, Denise L. Spitzer, and Radamis Zaky explore the informal and formal social networks and social support that shape the lives of immigrant older adults, and propose strategies and programs that can be tailored to meet diverse experiences (pre-, during, and post-migration) to ensure their effective uptake, implementation, and sustainability.
Exclusionary practices can affect the participation of older immigrants in the labour force; these include lack of recognition of overseas education, training, and skills, alongside of racism, discrimination, and ageism. In Chapter 7, “I helped them to help the country”: Lack of State Support for Precarious-Status Older Chinese Immigrants, Fanyuan Zhang, Jill Hanley, and Christina Klassen discuss the importance of recognizing the older immigrants’ everyday contributions in private homes and the broader community and society, and examine the exclusionary practices and policies that force older immigrants into poverty and housing insecurity and expose them to abuse.
Homelessness is increasing in Canada, and the proportion of older people who are homeless is also increasing. Studies on this population point to their unique health and service needs, which require special attention. In Chapter 8, “Housing Insecurity and Homelessness Among Older Immigrants in Canada,” Vibha Kaushik, Christine A. Walsh, and Jill Hoselton highlight that older immigrant adults may have unique psychosocial vulnerabilities. The authors examine the issue through an intersectional lens, with a focus on the various factors associated with aging, housing insecurity, and homelessness among immigrant older adults who experience a range of systemic challenges in accessing housing-related services.
SECTION 4 focuses on caregiving.
In Chapter 9, “Conceptualizing Person-Centred Care for Ethnocultural Minority Residents in Long-Term Care Homes,” Shreemouna Gurung, Atiya Mahmood, and Habib Chaudhury offer a conceptual framework for developing and implementing a person-centred care approach to meet the needs of ethnic and racialized individuals living in long-term care homes. They focus on integrating the concept of intersectionality into a person-centred practice framework alongside secondary evidence and key constructs from gerontology. Their framework is based on a multidisciplinary literature review on person-centred care and ethno-specific long-term case settings. The authors also identify future research directions based on the gaps in related frameworks and empirical evidence.
In Chapter 10, “Chinese Family Members Caring for Older Adults in Private, Senior, and Long-Term Care Homes,” Charlotte Lee, Doris Leung, Jason Wong, Paige (Pei-Chun) Wen, Sammy Chu, Frank Ng, Luna (Jiayue Fan), Lisa Seto Nielsen, Daphne Cheung, and Sepali Guruge examine the agency of family care partners who support older immigrants. This issue has been generally overlooked to date, and it is not yet clear whether, how, and when caregivers access resources. Based on their qualitative study involving 28 Chinese family care partners living with or near relatives in their private homes, assisted-living facilities, or long-term care facilities in the Greater Toronto Area, the authors explore dimensions of caregiving agency across intersections with the environment, including a mismatch between the needs of Chinese family caregivers and the available supports. They report that the mismatch is worst for Chinese family caregivers whose relatives live with them or nearby. Access to health and social services for their care recipient depends on the availability of community-based services that are culturally appropriate and match the shared financial capacity of the older adult and their caregiver.
Culture, religion, and society shape how individuals conceive of death, and strongly influence the process of dying. Views about death and dying vary between groups and also within them, and existential wellbeing may become much more important than physical and psychological health. The meaning of death (and life), and choices and decisions made in the processes of dying and bereavement are usually rooted in cultural values and beliefs. In Chapter 11, “The Diversity of Views About Death and Dying among Immigrants and Their Families” Hai Luo examines views of death and dying in contemporary Western societies and their theoretical foundations, followed by an overview of how various cultural and religious groups think about life and death, practices at the time of and after death, and bereavement and mourning processes.
SECTION 5 focuses on access to services.
In Chapter 12, “Elder Abuse Risk Factors and Intervention Strategies: Perspectives of Korean Older Immigrants,” Sepali Guruge, HeeJin Zhou, Ernest Leung, Souraya Sidani, and Tharsiny Thavarasa examine growing concerns about elder abuse in the newcomer Korean community. The first phase of their mixed-methods study with older Korean women and men in Toronto focuses on limited language proficiency, financial dependence, social isolation, and the lack of appropriate health, social, and settlement services as the most salient elder abuse risk factors. The second phase focuses on peer support, community outreach, and information about community outreach programs, psychoeducation, and English language classes as potentially effective interventions to prevent elder abuse.
Timely access to appropriate services is a key requirement for aging well, but older immigrants tend to underutilize social, settlement, health, and legal services, often due to intersecting barriers related to housing, employment, income, transportation, language, and problems with the services/service provisions themselves. In Chapter 13, “Awareness of Formal Social Supports Among Older Immigrants in Mid-Sized Urban Communities: The Case of Waterloo, Ontario,” Hector Goldar Perrote and Margaret Walton-Roberts discuss how eligibility for services is determined not by the individual seeking help nor the service provider, but rather by the interaction between the two, which can be affected by racist, ageist, and gendered policies. They use the candidacy model as a framework of engagement at the micro, meso, and macro levels to explore the intersecting oppressions experienced by older immigrants and how these might be addressed in terms of service access, use, and provision.
Based on a 4-phase project, in Chapter 14, “Spatial and Language Discordance in Accessing Physicians Among Older Immigrants in Toronto,” Lu Wang, Sepali Guruge, and Alexandra Wehr outline the barriers, facilitators, and interventions for Arabic- and Hindi-speaking older immigrants in the Greater Toronto area. The first phase is a scoping review of general and group-specific barriers to and facilitators of access to primary care. The second phase involves surveys, focus groups, and interviews with three groups of key stakeholders, that revealed gaps in systemic access to specialists and privatized health care, availability of culturally relevant educational resources, and utilization of mental health services. The third phase is a symposium bringing together stakeholders to share knowledge and explore new possibilities. The fourth and final phase focuses on synthesizing and sharing the co-created knowledge.
SECTION 6 focuses on research, practice, and policy considerations.
In Chapter 15, “Recruiting Older Immigrant for Research: Opportunities and Challenges,” Melissa Northwood, Ernest Leung, Souraya Sidani, and Sepali Guruge critically explore how to engage in community-based research that is respectful, ethical, and useful for older immigrant adults and their communities. The inclusion of older immigrants in research is critically important to generate a representative evidence base and prevent health inequalities that may arise from exclusion to participation. Part of the community can include physical, psychological, historical, linguistic, economic, cultural, political, social, and spiritual spaces, so the authors examine key issues related to fieldwork in research on the intersections of immigration and aging, such as recruiting older immigrants, ethical considerations for working with vulnerable populations, and the strengths and limitations of community-based research involving older immigrants, their families, and communities.
The processes of social, economic, and political inclusion among immigrants are fundamentally embedded in space and place, so it is imperative to understand the spatial needs and social lives of senior immigrants within the context of the public realm. In Chapter 16, “Aging in Third Places: Community Spaces and Social Infrastructure for Older Immigrants,” Zhixi Zhuang and Ryan Lok discuss the role of third places – social spaces outside of the home and workplace – and how they may mitigate social isolation and promote connectedness among older immigrants. The findings of their mixed-method project involving secondary data, ethnographic observations, and case studies reveal that third places provide a space for older immigrants to build community bonding through routine social, economic, and physical activities – and also empower them to participate more actively in public affairs and community advocacy.