Chapter 1. Aging Well: The Critical Issues of Concern for Older Immigrants in Canada

The global population continues to age, and in conjunction with increases in international migration, the average ages and ethnic compositions of populations in many countries are rapidly changing. This is particularly true of countries in the Global North such as Canada, the United States, and England. In Canada, older immigrants now comprise a significant proportion of the population (Statistics Canada, 2022). Canada’s immigration policies have changed over time with regard to sponsorship criteria and countries of origin, and these changes have shaped the numbers and diversity of older residents in terms of ethno-cultural, religious, and racialized statuses. Historically, many immigrants to Canada originated in Europe, but more adults have been arriving from Asia and Africa in recent years. Canada’s responses to global emergencies, such as the Syrian and Ukrainian humanitarian crises, have also led to an influx of refugees, including older adults. At present, Canada has residents from more than 200 ethnic groups and more than 200 language groups, and 30 percent of all older adults in Canada were born outside the country, with many concentrated in large metropolitan cities such as Toronto, Vancouver, and Montreal (Statistics Canada, 2022).

Older immigrants in Canada can be loosely classified into two main groups: those who came to Canada at a younger age and those who arrived later in life. Their backgrounds are diverse, and their heterogeneous identities and lives are very much shaped by multiple and intersecting factors including immigration status, age, education, socioeconomic status, ability, gender identity, and sexual orientation. The meaning of aging itself can differ within and between groups. For example, age is not dichotomous, and older individuals may be classified as young-old adults, mid-old adults, and old-old adults. In Canada, older adult status is generally conferred to those 65 and older. In the context of older immigrant populations, some researchers draw from WHO guidelines to include those over the age of 60 or even 55. This is because lower- and middle-income countries usually have a lower life expectancy due to socioeconomic and other life factors that put residents at morbidity and mortality risks from a younger age. After arrival in Canada, the health and wellbeing outcomes of older immigrants are affected by the intersecting influences of diverse racialized status, English/French language fluency, socioeconomic status, immigration status at arrival, and current immigration status, among others.

Beyond these individual-level factors, all newcomers to Canada are affected by policy decisions. These macro-level factors can have considerable negative effects on the lives of older immigrants. For example, Canadian immigration policies related to the Super Visa program have reduced the numbers – and rights – of older adults who arrive in Canada as permanent residents. Another example is the Family Reunification program: many newcomer older adults arrive through this policy, but recent changes to Canadian immigration policy now require that the sponsoring relative guarantee financial and social support for the older adult for a period of 20 years (much longer than that of any other age group in the Family Class) (Government of Canada, 2023), during which time the sponsored older immigrant is prohibited from accessing many social programs, including Old Age Security. This policy often results in multi-generational co-residence (Martin, 2017). Many older newcomer adults become isolated at home, unable to find paid employment due to various structural barriers including ageism and racism, while also not qualifying for Old Age Security. They often engage in unpaid household activities such as cooking, cleaning, laundry, grocery shopping, and caring for grandchildren. Some also engage in volunteer work and other community activities that benefit other older adults and the broader community, but many of their contributions are ignored, even though the literature is clear that most immigrants arriving as sponsored relatives make significant socioeconomic contributions to their families and the communities, and by extension, to Canadian society. Essentially, Canadian society benefits from the unpaid labour carried out by older immigrants, which can even constitute a form of elder abuse.

These daily responsibilities can affect the general health and wellbeing of older immigrants over time. All immigrants undergo medical checks to qualify for admission to Canada: most arrive in better health than their Canadian-born counterparts, but this health status tends to worsen the longer they are in Canada. This “healthy immigrant effect” however is not applicable to all foreign-born individuals, for example, to refugees who may have left war-torn countries or other disasters. Many refugees have high levels of resilience, but they may also face considerable physical and mental health consequences (Bogic et al. 2015). Very few studies have explored the health of older immigrants and refugees, so it is not clear whether the healthy immigrant effect applies equally to this population or whether their health status is poorer than or equal to their Canadian-born counterparts. The lack of research attention to the health of older immigrants reflects the preference of Canada’s immigration policy for younger economic-stream applicants, as well as the general expectation within Canadian society for immigrants to acculturate and assimilate. The reality is that language differences, lack of familiarity with the Canadian healthcare system, and the loss of familiar health, physical activity, and dietary practices can make it nearly impossible for newcomer older immigrants to maintain and promote their health, prevent illnesses, and address illnesses in a timely, efficient, and effective manner.

Health and wellbeing are strongly influenced by cultural and religious values, beliefs, attitudes, norms, customs, and knowledge. Some of these influences may change over time in Canada, for example through assimilation and acculturation. Language fluency and cultural and religious differences create unique challenges and opportunities for healthcare, social, and settlement services providers. Older adults who are refugees face seemingly insurmountable barriers to health-related support, advice, and information, so they are a key priority for the Canadian healthcare system. However, very limited information about health and healthcare services is available in other languages, healthcare providers are not often equipped with paid translators and interpreters, and healthcare systems have not implemented measures to provide culturally safe care.

Beyond issues related to language-specific services and programs, older immigrants tend to underutilize social, settlement, health, and legal services due to intersecting factors related to housing, employment and income, transportation, unfamiliarity with services, and discriminatory and racist practices embedded within service delivery (Badger & Koehn, 2015; Hanley et al. 2019; Hepburn et al. 2015). Older adults also underutilize shelters, hotlines, and other such services (Guruge et al. 2019b) because of multiple intersecting factors such as lack of familiarity with services; lack of accessible, portable, and coordinated services; and confidentiality concerns (Hepburn et al. 2015). Together, all of these factors can work to the disadvantage of older immigrants who may or may not have access to their customary social networks and support.

Migration disrupts the social networks and support available to immigrants, affecting their ability to age well, independently, and with dignity (Guruge et al. 2015; Jang et al. 2016). Older immigrants report higher levels of social isolation than individuals born in Canada (Charpentier et al. 2019; Wu & Penning, 2015). Social networks – both informal (e.g., family, friends, neighbors, co-workers) and formal (e.g., healthcare providers, settlement workers) – can facilitate the settlement process, foster a sense of belonging, promote resilience and capacity, improve access to information and services, and reduce the effects of discrimination and racism (Ferrer, 2018; Gulbrandsen & Walsh, 2015; Walton-Roberts et al. 2019). Social inclusion is known to be associated with life satisfaction among older immigrants (Kim et al. 2015; Li et al. 2018; Tong et al. 2019), especially among those without ties to an established community (Jang et al. 2015). Individuals who arrive at a younger age, often become fluent in English or French, and/or are employed in paid work in Canada, and as such may be less isolated (Charpentier & Quéniart, 2017; Jang et al. 2015; Khan & Kobayashi, 2015).

Social connectedness is also affected by the size and density of ethnic communities, the availability of ethno-specific resources and services, and ready access to reliable and accessible public transportation (Agrawal & Kurtz, 2019; Wang et al. 2019). For example, over the last 20 years more immigrants in Canada have moved into suburban areas instead of downtown cores, but this change has not been reflected in funding, service, and resource allocation, resulting in extensive unmet social support needs (Gordon et al. 2018). While it is long known that place affects wellbeing, few studies have explored how living in small, mid-sized, and large cities affect older immigrants and their access to social networks. For example, life in ethnic neighborhoods in larger cities might be different from that in small cities where pressure to conform to cultural and religious values and beliefs may increase the risk of elder abuse (Guruge et al. 2012).

Rates of elder abuse are underreported globally (United Nations, 2023). Post-migration values, beliefs, expectations, and conditions are changing in many immigrant communities. These changes can alter social supports, gender roles, and socio-economic statuses in the context of other stressors, such as, language differences, discrimination, and racism (Williams et al. 2014). More daughters and daughters-in-law are now participating in the paid labour market, which is normalizing the expectation that older adults will care for grandchildren (Wilcox & Sahni, 2022), and can also prevent older immigrants from receiving ‘traditional’ elder care. Alongside such changes, older adults’ forced reliance on family, due to immigration and other policies, can lead to conflict (Hepburn et al. 2015). Another significant risk factor is isolation, which can make older immigrants more vulnerable to abuse. Victims, families, and communities may hide abuse to keep shameful family matters private (Baker et al. 2016). When adequate and appropriate resources are available, older immigrants may not be as reliant on family for support (Avery, 2016; Jang et al. 2015), and perhaps leave their abuser(s).

Access to financial resources and continued involvement in paid work are important aspects of feeling included in society and aging well in general. As noted above, most older immigrants in Canada experience economic difficulties related to factors including ageism, racism, and policy barriers, and many are financially dependent on their children. Research has revealed that the income gap between older immigrants and their Canadian-born counterparts can be as large as 50 percent (Curtis & McMullin, 2016; Preston et al. 2014). Although (as noted earlier) many older immigrants contribute to society through unpaid domestic labour and caregiving work, paid work, and volunteering, these contributions are rarely acknowledged by policymakers (Harbison et al. 2012). Some scholars have suggested that recognition of their contributions, and implementation of policies to enable such recognition, can help older immigrants age well (Avery, 2016). Economic support in the form of pensions and other benefits would also enable older immigrants to live independently of their children and avoid the tension and conflicts inherent in cohabitation. Policy is a particularly important issue: refugee policies and delays in processing claims can leave people without citizenship, making them feel socially disconnected from the recipient society and lonely because they cannot visit family members without a passport. Other policies, such as those that disperse newcomers into different parts of the country, can also isolated newcomers, and in doing so, reduce their chances of access to timely health, social, and settlement services. Most insidiously, many new immigrants and refugees are excluded from full participation in society due to racialization and its many intersections, e.g., with ageism, Islamophobia, sexism, and xenophobia.

One indicator of a healthy and inclusionary social system is political participation and civic engagement among immigrants. This kind of participation requires that immigrants can access political resources as well as social, infrastructural (e.g., transportation), and economic resources (Raymond et al. 2016; Shields et al. 2016). A mutual commitment is required between immigrants and Canadian society at large in order for them to feel a sense of belonging (Bilodeau, 2018). Immigrants must be given opportunities to cultivate a voice that reflects their needs. Community agencies, municipal offices, religious institutions, and multiethnic organizations are important sites of political and civic engagement (Zhuang, 2019). Immigrants can contact public officials, join community groups, volunteer, and vote (Zhuang, 2021; 2019), but a prerequisite to these types of engagements is that they feel included as valued citizens and community members.

Another important determinant of wellbeing is geospatial inclusion and place-making. All individuals, including older immigrants, need to feel a sense of belonging, feel accepted and valued within their communities, have spaces and places to actively take part in preferred social activities, and be able to form intimate social relationships (Koehn et al. 2014; 2016). Community growth and individual wellbeing require places and resources that promote community engagement (Michalski et al. 2023) and cooperation among individuals and institutions (Gomez et al. 2012). More research is now focusing on steps to fostering ‘age-friendly cities’ (Hordyk et al. 2015; Mitra et al. 2015). However, this emerging body of scholarship has largely neglected the specific needs of older immigrants. Some emerging evidence suggests that interventions are most effective (in terms of promoting uptake, implementation, and sustainability) if they are tailored to the specific needs, beliefs, and values of immigrant communities (Chu & Leino, 2017; Patel et al. 2017; Sekhon et al. 2017; Thomson et al. 2015).

The phenomenon of transnational aging has led to new challenges but also new opportunities. Recent advances in technologies have created new spaces to address challenges related to ‘aging in place.’ Older immigrants in Canada need more access to these technologies and training so that they can be more connected to their family and friends who live in Canada or in their countries of origin, and they also need more access to appropriate and necessary services. Overall, this population requires urgent attention in terms of policy, practice, and research that recognizes both their vulnerabilities and resiliencies.

This book presents an in-depth analysis of these critical issues faced by older immigrants in Canada, along with transferable knowledge, collaborative approaches, and innovative solutions to address those challenges. In doing so, the chapters examine aging at the intersection of immigration and (re)settlement. The hopes and dreams of older immigrants (including refugees) are discussed in juxtaposition to their challenges and struggles.

The volume’s 40 contributors draw from research on health, social, and settlement experiences of older immigrants in Canada through critical analyses and reconceptualization of theory, policy, and practice within the Canadian context to highlight the resiliency and agency of older immigrants in responding to the challenges of aging in this country. Contributors engage the readers in appreciating the shared and distinct migration and (re)settlement experiences of older immigrants. Chapters capture a diverse range of issues that are important to older immigrants and other stakeholders, with a focus on health, socioeconomic considerations, caregiving, access to services, and considerations for research, practice, and policy from a broad range of geographic, theoretical, and professional perspectives. Discussions related to policy, research, and practice implications are interwoven throughout the book, and we pay attention to how the resilience and strengths of older adults could be incorporated when developing programs and policies, and/or building community capacity.

Acknowledgement: This introduction draws from several grant proposals that were funded by the Social Sciences and Humanities Research Council.

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