Chapter 3. Perceptions of Healthy Aging among Mandarin-Speaking Immigrant Older Adults in Toronto

As the older adult population in Canada grows, it is also becoming more culturally diverse: In Canada, 30 percent of all older adults are foreign-born (Government of Canada, 2022). A large portion of older immigrants in Canada live in Ontario (Wang et al. 2019), and about 70 percent of all older adults in Toronto are immigrants (Um & Lightman, 2017). In 2021, Chinese older adults represented 28 percent of all racialized older adults in Canada (Ferreira, 2023). In 2021, 679,255 Mandarin speakers resided in Canada, with almost half living in Toronto (Government of Canada, 2022).

The lives of many Mandarin-speaking immigrants are based on a family structure that builds on respect for one’s elders and filial piety, whereby older adults are accorded higher status within the family (Yang & Zheng, 2019). Decisions made by older adults are respected and considered to better the family unit, creating an incentive for younger generations to care for older adults later in life (Li et al. 2018). However, values about family hierarchy and the importance of collective wellbeing may change after settling in a Western country such as Canada, where the prevailing ideology centres on the individual, personal fulfillment, and self-reliance over community needs (Kotlaja, 2018). In addition, younger family members may be consumed with their own family, educational, employment, and other responsibilities, leaving older adults to care for themselves. Language barriers often prevent older immigrants from accessing important services and programs (Ahmed et al. 2016; Kalich et al. 2016; Pandey et al. 2021; Pot et al. 2018), and as a result, older immigrants may find it difficult to navigate the aging process.

The World Health Organization (WHO) has stressed the need to support healthy aging by helping people develop and maintain a level of functional ability that enables wellbeing (WHO, 2017). The WHO’s 2015 World Report on Aging and Health emphasized the importance of mental health supports for older adults and their caregivers. In addition to mental health status, factors associated with healthy aging include resilience, use of technology, and cognitive functionality (Kwong et al. 2015; Reynolds et al. 2022). Some scholars have explored these factors in the Canadian context (Gu et al. 2020; Jeffery et al. 2018; Waldbrook, 2015), and some have focused on how they relate to older adults from diverse ethno-cultural backgrounds, acknowledging that healthy aging is defined differently across ethnocultural groups (Shooshtari et al. 2020). For example, Salma and Salami (2020) found that among older Muslim immigrants in Alberta, healthy aging is linked to a combination of individual, community, and societal factors. The following discussion focuses on the perceptions of aging among Mandarin-speaking older immigrants living in Toronto, Ontario. It contributes to much-needed scholarship exploring healthy aging among diverse older immigrant groups in Canada.

Methods

This chapter draws from a larger mixed-methods study that explored experiences of aging among Mandarin-, Arabic-, and Spanish-speaking immigrants, along with their access to services in four cities (London, Ottawa, Toronto, and Waterloo) in Ontario. The project included four different stakeholder groups: older women, older men, family members of older immigrants, and community leaders. Data collection sessions were held separately with each stakeholder group to maximize comfort and encourage dialogue. This article focuses on the qualitative data from Mandarin-speaking immigrant older adults in Toronto.

After obtaining approval from the research ethics boards at participating universities, we used a combination of convenience and snowball sampling strategies to recruit potential study participants. The inclusion criteria were: 60 years of age or older, spoke Mandarin as their primary language, and had lived in Canada less than 20 years (to ensure relatively recent immigrant status). The recruitment process began at community centres where older immigrants and their families gather for social activities; community partners also shared information about the project with their service users; and participants were also asked to share study information with others. All interested participants were asked to contact the study’s research assistants.

At the initial contact, research assistants asked participants a few questions to ensure they met the inclusion criteria. If eligible, the research assistants provided more information about the study, answered participants’ questions about the study, and then invited them to take part in a group interview. Those who agreed were asked to arrive at a scheduled group interview session 30 minutes before the start time to provide informed consent. Group interviews were held in various locations in Toronto that were familiar and convenient for participants such as community centres, community organizations, and churches.

Individuals who provided consent completed a socio-demographic questionnaire and then participated in a group interview, that lasted between 1.5 and 2 hours. Two research assistants moderated each group interview: the primary moderator was responsible for guiding the discussion, and the assistant moderator helped collect paperwork, took fieldnotes, and paid close attention to group dynamics and intervened if needed. Interview questions included: What does healthy aging mean to you? How do you see aging in Canada in relation to what you would have experienced or expected back home? Who do you rely on, day to day, for support and connection? What constraints or barriers do you face in coping with personal or health problems? What formal supports and services have you accessed or need?

All interviews were audio-recorded with consent and transcribed verbatim; all identifying names and places were removed. Data analysis was informed by the ecosystemic theoretical framework to understand the key factors at micro (personal/familial), meso (community), and macro (societal) levels that shape participants’ perceptions of healthy aging.

Socio-demographic profile of the study participants

Four group interviews were conducted (two with older women and two with older men), for a total of 36 participants (19 women and 17 men). Their average age was 72.14 (σ = 5.537); most (35) were born in China and one was born in Thailand. Most (29) were married, three were single, and four were divorced. With regard to immigration status, most (29) were permanent residents who had been sponsored as a parent/grandparent, four were Canadian citizens, two were dependents of a skilled worker, and one was a temporary resident. In terms of education, 14 participants had a bachelor’s degree, 10 had completed high school, and 6 held a college diploma. Most indicated that they lacked proficiency in English (28) or French (31). They reported major sources of income as: savings (11), wages or salaries (7), or a pension (4). Five participants indicated that they did not have their own source of income. Not all participants answered all demographic questions.

Findings

Seeing Aging in a Positive Light

Several participants suggested that healthy aging is achieved by maintaining an optimistic perspective on their circumstances as aging individuals. They mentioned that this helped them better manage their physical health and led to less anxiety over uncertainties about aging:

When you are 60 to 80, that’s a golden age. Right? Because you have less burden, there is no stress. That is good. If you are pessimistic, your body gets worse, your health gets worse…. We should be active and optimistic (8, older men FG1)

 

Once you have a healthy mind, you have a healthy body, then everything else is healthy too. Then, you no longer feel old. That’s how I feel (1, older women FG1)

Aging is unstoppable. You shouldn’t fear it. My physical status is really good, and I don’t drink or smoke. I can still take care of many things at home. I help with my children’s construction business. But I do realize that there are certain things I can’t do by myself anymore. I feel that I’m doing less than I want to. Sometimes, I get discouraged, but my wife always tells me not to compare myself to younger people. After all, you’re old! (5, older men FG2)

These statements demonstrate the importance of maintaining a positive attitude toward aging. This mindset may arise from the belief that aging is simply a phase of life.

A number of participants provided more context about how they had realized the need to stay optimistic during the aging process. For example, one participant described how he came to realize the importance of learning to mentally adapt to the challenges of aging while facing the inevitable deteriorations of his physical health:

Actually, many things are different. For example, my body is changing. Now I have high blood pressure, diabetes, and high cholesterol; a lot of challenges. However, to think from a different angle, since I’m close to retirement, I will have more time to worship God, as I belong to a religious community. I will have more time to serve my friends and my community. This is more meaningful to me. I used to be busy with my own things, now I can help others. So, how you see aging is up to you. It will happen and complaining is useless. (4, older men FG2)

As this participant explained, aging changes one’s intrinsic capacities over time. By changing his outlook about the inevitability of aging, he moved from focusing on physical deteriorations to the benefits brought about by aging, such as having more time to do what he values.

The Importance of Family in Aging Well

Many participants referred to the importance of family, both in terms of older adults’ own responsibility in making meaningful contributions to their family unit and also the family’s responsibility to support older adults’ healthy aging. They noted that strong family bonds make them happy by providing them with a sense of purpose, especially when their physical functioning declines and external environmental factors can prevent them from accessing public services outside the home. The following excerpts capture some of these ideas:

You’re not just taking care of yourself. You have the responsibility for your entire family. It makes you look forward to still supporting your family. (7, older men FG2)

 

Life isn’t easy for the young generation either… Our responsibility is to take care of their home. Conflicts are always there, so we need to learn to resolve them. (3, older women FG1)

Study participants reported feeling obligated to help around the house in any capacity they could, such as supervising their grandchildren, cooking, or cleaning. Many said their family members were grateful for help, which made our participants feel happy and experience a sense of purpose.

Some participants also referred to how much they are relying on their families for general support as well as specific support for their health and wellbeing, and in doing so placing a lot of burden on their children.

We can’t always rely on our children because they need to work. The Canadian government should provide friendly and reasonable supports and facilities. You can’t expect us to wait for 8, 10, or 20 years [to qualify for services] – we may not live that long. (5, older women FG2)

 

When you cannot take care of yourself, you feel bad. When you reach that age, you need your children. They will bring you to see a doctor. We look for doctors that speak Chinese. But when you need to go to hospital for an emergency, unlike in China, you can’t do anything. The doctors don’t understand us, and we don’t understand them. (4, older men FG1)

 

Participants said that they felt pressured to compromise their own wellbeing by staying home rather than asking family members or seeking services for help. Some commented on the problems that can arise when they ask for help and support from their adult children who are already struggling to balance taking care of their own children while also taking on eldercare responsibilities. In this context, the participants commented about wanting to access external supports to help manage pressure within the family which in turn help improve family dynamics.

Importance of Connections and Support in the Community

Participants identified access to a support network as an important factor that shapes the aging process. Support networks identified included health, social, and settlement service providers who are integral in assisting older adults manage the physical and psychological effects of aging in a new/relatively new country. In general, these networks can provide support when needed and connect older adults with others on a regular basis, all of which can foster a sense of belonging in older adults. However, many participants expressed frustration with the lack of or limited support available to them beyond their immediate family, and in particular, with the general lack of Mandarin-speaking services and activities. Participants’ comments included:

Especially in Toronto, older people are living a tough life. We don’t drive, don’t speak English, and can’t hear and listen well. I feel the kind of confusion I get is different between here and back in China. (6, older women FG1)

 

I only know some simple phrases, and I don’t understand many things [in English]. There’s no real communication with neighbours and community members. This bothers me, and I don’t think it’s healthy for aging. (2, older women FG2)

These statements demonstrate how the lack of community-level services in Mandarin prevents these older adults from engaging in meaningful connections and accessible activities, potentially leading to, or accelerating physical and mental health problems.

Structural Barriers to Health Aging

The lack of language specific services was a considerable structural barrier to healthy aging identified by study participants. Many of our participants said that because of the language barrier, they were only able to access services provided in Mandarin or those with an interpreter. Not all neighbourhoods in Toronto are equipped with culturally or linguistically accessible services. For example, one participant commented that libraries in north Toronto do not provide Chinese books and resources, forcing older immigrants to access libraries in other neighbourhoods using public transit. This involves its own challenges, as Mandarin-speaking older immigrants may find it difficult to access public transit due to language issues as well as physical challenges related to long trips during the winter months.

The lack of reliable public transportation combined with a lack of proximity to services were identified by many of our participants as a significant barrier to reach the health, social, and settlement services they needed.

 

There are almost no social services in the community here. We have to walk a long time to get to the nearest one. Social infrastructure does not catch up. There is not even a library nearby. (4, older men FG1)

For transport, the buses are not too safe for older adults. Also, if you are close to public transport, that’s good. But if you live far away from public transport, you have to walk far, which is very inconvenient. (7, older men FG1)

High transportation costs were also a recurring macro-level factor that concerned many participants: many did not drive and relied on public transportation to go around the neighbourhood and access resources. The following excerpts capture their sentiments:

 

I’m not asking them to make public transportation free; just lower the cost. More people will actually want to take public transportation if it’s cheaper. (7, older men FG2)

Buses are too expensive. In China, if you are above sixty years of age, you can take the bus for free. But here, if you want to take the bus, you have to pay at least three dollars one way. That’s six dollars round trip. So sometimes I don’t go out (1, older men FG 1)

Like this last participant, others also commented that the lack of access to safe, affordable public transportation deterred them from going out to access public resources and health and social services. They also noted that the resulting isolation from the community had negative effects on their aging process.

Another macro-level factor identified by study participants was the lack of affordable and accessible Mandarin-speaking treatment and medication options. Many participants commented that the process of aging is naturally accompanied by declining physical and mental health. They noted that the changes that accompany aging are worsened by the wait times to see medical specialists and to have diagnostic procedures, which are much longer in Canada than they were accustomed to in China:

It is not good for older adults who have chronic illness to live in Canada. For example, the wait time in hospital is just so long. When I had to have a medical scan for my eyes before surgery, they made me wait for three months. In China, if you request, they get things done for you on the same day. For older people, seeing doctors is a big issue. Canada needs to improve the efficiency of their medical system. (7, older men FG 2)

 

There are many organizations out there that are designated to serving Chinese immigrants. But they all charge high fees. This isn’t helping us because we don’t have much money. Many of us are too old to wait for the government’s financial aid to come. The aid used to come in 10 years after you immigrate, but now it’s 20 years (1, older men FG 2)

The changes to government aid regulations noted by this last participant are forcing new immigrants to wait longer to receive pension and other benefits making reliance on the public system challenging. Participants noted that many of the organizations and companies with programs for Mandarin-speaking older adults are beyond their financial means.

Discussion

Declining physical and mental health were commonly noted as a ‘natural’ part of the aging process by our study participants. They also discussed the importance of maintaining an optimistic perspective on their circumstances as aging individuals. The effects of health decline on people’s perceptions of aging are well documented (Li et al. 2018; Wang & Dong, 2018) and are considered in the WHO’s 2015 guidelines on maintaining intrinsic capacity (World Health Organization, 2017). Other research also highlights positive perceptions of aging as a key predictor of good quality of life among older adults (Ingrand et al. 2018). Historically, healthy aging has been equated with being physically healthy (Jang & Kim, 2020) or with the ability to perform daily activities (Velaithan et al. 2023). This means that conceptions about physical health remain strongly correlated with general musculoskeletal health (McPhee et al. 2016), with many studies focusing on reducing the rates of age-associated morbidities and frailty. For example, Liu and colleagues (2021) proposed that a daily walking regimen is correlated with lower morbidity rates. While this research shows the importance of focusing on improving physical health and managing chronic illness and/or the ability to engage in daily activities, doing so does not always lead to meaningful activities and engagement with others.

Our results demonstrate the need to shift focus from an individual’s physical health problems and limitations to a more family and community perspective. Many of our participants positively connected their aging to a continued sense of obligation to their family and the community, and a desire to contribute to society through activities in which they could take part. Many sympathized with their children who are tasked with unpaid eldercare and childcare responsibilities in Canada. They criticized the fact that older immigrants are expected to wait for 20 years before being eligible for government benefits, which is forcing many to be dependent on their children for financial support. This may create feelings of guilt for burdening their children, as well as force them to engage in unpaid household work, all of which can hinder their ability to prioritize their needs associated with healthy aging.

Our findings reveal that meaningful connections with individuals beyond one’s immediate family and accessible services in the community are important to ensuring healthy aging. Kim and colleagues (2015) noted that culturally meaningful activities had positive effects on older Korean immigrants to the United States. Similarly, Li and colleagues (2018) found that regular access to community networks is linked to resilience among Chinese older immigrants in the U.S. and advocated for more access to affordable social services. Wahl and colleagues (2012) also advocated for an environment-oriented model of aging where older adults are able to effectively interact with their community and build a sense of agency. Our findings indicate that many older immigrants rely on public transportation for such interactions, thus highlighting the importance of reliable, safe, and affordable public transportation to promote healthy aging. This calls for more investment in community infrastructure to assist older adults in healthy aging.

Societal views on aging influence government spending, with profound consequences for healthy aging. More financial support in the form of government funding would ensure older adults have more access to activities and services; the provision of more capital for family members who provide care would also give them more freedom to interact with their older family members in more fulfilling ways. Older adults who feel they are a burden to those around them because of a lack of caregiver support are likely to feel the passage of time and the effects of age more strongly.

Recent research into the accessibility of Canada’s current old age security program has revealed marked disadvantages for older immigrants. Curtis and colleagues (2017) investigated the barriers to old age security and found that older immigrants were less likely than their Canadian-born counterparts to receive any benefits, and that older Mandarin-speaking immigrants were the least likely to receive benefits of any amount. This last finding is particularly relevant because having access to financial supports and high-quality social services will promote healthy self-perception and reduce the likelihood that older adults will view themselves as an encumbrance on their families. Having access to supports and services (such as timely and accessible transportation and resources in their own language) would help improve quality of life for older adults and foster a healthy perception of self as older adults.

Accessibility of resources is particularly important for ethnic groups whose first language is not English, as with the Mandarin-speaking older adults in this study. Language plays a significant role in accessibility to services and other supports. Language barriers may prevent Mandarin-speaking and other older immigrants from accessing information about supports that are available, and from accessing services and supports not offered in their first language. Support workers can facilitate access by increasing the number of community referrals to services such as Meals on Wheels, day programs, deliveries from the pharmacy, library services, and supports and groups that are offered in the older adult’s first language. Our study participants would benefit from service promotion through pamphlets, posters, and telephone calls in Mandarin to clarify which supports are available. Connecting with these would increase older adults’ opportunities to interact with others and form social bonds, thereby contributing to a positive outlook. Our findings also suggest that accessibility of social services can increase the sense of agency among older Mandarin-speaking adults and decrease feelings of loneliness and isolation.

Limitations

The study participants were primarily recruited via convenience and snowball sampling strategies. Additional recruitment strategies could have helped recruit a more diverse study sample. The inclusion of Mandarin-speaking older adults from other Ontario cities would enable a richer understanding of the topic. Another limitation is that (as part of a larger mixed methods study) we utilized a group interview format which is much more structured than a more traditional focus group discussion; The latter would likely have provided more in-depth information on the topic.

Conclusions and Implications

Healthy aging requires a focus beyond physical health, and is shaped by factors at micro, meso, and macro levels. As immigrants from collectivist cultures, Mandarin speaking older adults believed in the importance of maintaining close family connections, contributing to their lives, and not being a burden on them. Our study participants identified the importance of more financial resources dedicated to caregivers assisting their elderly family members at home

Our findings clearly indicate the importance of allocation of funding for community infrastructure to help older adults develop connections outside their families, access community supports, and engage in a range of activities in the neighbourhood. Our study participants identified a lack of accessible Mandarin-speaking services. Our findings reveal a need for more community centres and health services in areas with dense Mandarin-speaking populations. The provision of more accessible supports and services may improve perceptions about aging well, rather than focusing on limitations and constraints.

While it would be helpful to mobilize members of the Mandarin-speaking community to promote the cultural values of caring for older adults, this may be an impossible task in the context of lack of accessible health, social, and settlement services and supports at the community level. Community level investments for aging immigrants can help Mandarin-speaking older adults age well and continue to participate as active community members. Investing in healthy aging among all older immigrant populations should be a key priority for stakeholders. Access to primary care, as well as community-level programs and services are essential to maintain wellbeing of aging immigrants. Policymakers must reexamine the ageist and racist policies to ensure equitable and timely access to and investment in all aging adults in Canada.

Acknowledgement: The authors would like to acknowledge all participants who provided valuable insights for this project.

Funding: The project is funded by the Partnership Development Grant, Social Sciences and Humanities Research Council of Canada

References

Ahmed, S., Shommu, N. S., Rumana, N., Barron, G. R. S., Wicklum, S., & Turin, T. C. 2016. Barriers to access of primary healthcare by immigrant populations in Canada: A literature review. Journal of Immigrant and Minority Health, 18(6), 1522-1540.

Curtis, J., Dong, W., Lightman, N., & Parbst, M. 2017. Race, language, or length of residency? Explaining unequal uptake of government pensions in Canada. Journal of Aging and Social Policy, 29(4), 332-351.

Ferreira, J. 2023. Is Canada ready for an increasingly diverse senior population? Here’s what health experts say. CTV News. https://www.ctvnews.ca/canada/is-canada-ready-for-an-increasingly-diverse-senior-population-here-s-what-health-experts-say-1.6652563

Government of Canada. 2022. Social isolation of seniors: A Focus on New Immigrant and Refugee Seniors in Canada. https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/social-isolation-immigrant-refugee.html

Gu, Q., Sable, C. M., Brooks-Wilson, A., & Murphy, R. A. 2020. Dietary patterns in the healthy oldest old in the healthy aging study and the Canadian Longitudinal Study of Aging: A Cohort Study. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01507-w

Ingrand, I., Paccalin, M., Liuu, E., Gil, R., & Ingrand, P. 2018. Positive perception of aging is a key predictor of quality-of-life in aging people. PLOS ONE, 13(10). https://doi.org/10.1371/journal.pone.0204044

Jang, E. S., & Kim, K. 2020. The mediating role of interpersonal needs on attitude towards ageing and its relationship with community sense and depression among community-dwelling older adults. Health and Social Care in the Community, 29(2), 547-553.

Jeffery, B., Muhajarine, N., Johnson, S., McIntosh, T., Hamilton, C., & Novik, N. 2018. An Overview of Healthy Aging Strategies in Rural and Urban Canada. Saskatchewan Population Health and Evaluation Research Unit, University of Regina and University of Saskatchewan.

Kalich, A., Heinemann, L., & Ghahari, S. 2016. A scoping review of immigrant experience of health care access barriers in Canada. Journal of Immigrant and Minority Health, 18(3), 697-709.

Kim, J., Kim, M., Han, A., & Chin, S. 2015. The importance of culturally meaningful activity for health benefits among older Korean immigrants living in the United States. International Journal of Qualitative Studies on Health and Well-Being, 10

Kwong, K., Du, Y., & Xu, Q. 2015. Healthy aging of minority and immigrant populations: Resilience in late life. Traumatology, 21(3), 136–144. https://doi.org/10.1037/trm0000034

Kotlaja, M. M. 2018. Cultural contexts of individualism vs. collectivism: Exploring the relationships between family bonding, supervision and deviance. Sage Journals. https://journals.sagepub.com/doi/full/10.1177/1477370818792482?casa_token=qB1PwwM-qwoAAAAA%3AVhZxc-29Xc9s3d2YDeFgKXhSF6ItNbpp3KIXmIHtn4dqYfrJCY_GBTofxCiqdd4ItkfqsGYlf6GX

Li, J., Xu, L., & Chi, I. 2018. Challenges and resilience related to aging in the United States among older Chinese immigrants. Aging & Mental Health, 22(12), 1548-1555.

Liu, P., Powers, M., & Padua, M. 2021. Walking in Your Culture: A Study of Culturally Sensitive Outdoor Walking Space for Chinese Elderly Immigrants. Sage Journals. https://journals.sagepub.com/doi/full/10.1177/1937586720985885#:~:text=Outdoor%20walking%20promotes%20the%20well,their%20motivation%20of%20outdoor%20walking.

McPhee, J. S., French, D. P., Jackson, D., Nazroo, J., Pendleton, N., & Degens, H. 2016. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology, 17(3), 567–580.

Pandey, M., Maina, R. G., Amoyaw, J., Li, Y., Kamrul, R., Michaels, C. R., & Maroof, R. 2021. Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Services Research. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06750-4

Pot, A., Keijzer, M., & De Bot, K. 2018. The language barrier in migrant aging. International Journal of Bilingual Education and Bilingualism, 23(9), 1139-1157.

Reynolds, C. F., Jeste, D. V., Sachdev, P. S., & Blazer, D. G. 2022. Mental health care for older adults: recent advances and new directions in clinical practice and research. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453913/

Salma, J., & Salami, B. 2020. “We are like any other people, but we don’t cry much because nobody listens”: The need to strengthen aging policies and service provision for minorities in Canada. The Gerontologist, 60(2), 279–290. https://doi.org/10.1093/geront/gnz184

Shooshtari, S., Menec, V., Swift, A., & Tate, R. 2020. Exploring ethno-cultural variations in how older Canadians define Healthy Aging: The Canadian Longitudinal Study on Aging (CLSA). Journal of Aging Studies, 52, 100834. https://doi.org/10.1016/j.jaging.2020.100834

Um, S., & Lightman, N. 2017. (rep.). Seniors health in the GTA: How immigration, language, and racialization impact seniors’ health (pp. 1–11). Toronto, ON: Wellesley Institute.

Velaithan, V., Tan, M., Yu, T., Liem, A., Teh, P., & Su, T. 2023. The Association of Self-Perception of Aging and Quality of Life in Older Adults: A Systematic Review. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10943510/

Wahl, H., Iwarsson, S., & Oswald, F. 2012. Aging well and the environment: Toward an integrative model and Research Agenda for the future. The Gerontologist, 52(3), 306–316. https://doi.org/10.1093/geront/gnr154

Waldbrook, N. 2015. Exploring opportunities for healthy aging among older persons with a history of homelessness in Toronto, Canada. Social Science & Medicine, 128, 126–133. https://doi.org/10.1016/j.socscimed.2015.01.015

Wang, B., & Dong, X. 2018. The association between personality and loneliness: Findings from a community-dwelling Chinese aging population. Gerontology & Geriatric Medicine, 4, 1-9.

Wang, L., Guruge, S., & Montana, G. 2019. Older immigrants’ access to primary health care in Canada: A scoping review. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 38(02), 193–209. https://doi.org/10.1017/s0714980818000648

World Health Organization. 2017. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

Yang, J., & Zheng, Y. 2019. Links between perceptions of successes, problems and health outcomes among adult Chinese children: The mediating role of perceptions of parents’ feelings and intergenerational relationships. Frontiers in Psychology, 10(2551).