Chapter 5. Health Statuses and Health Determinants of Older Immigrant Men in Canada

Table 5.1 Population, Concept, and Context (PCC) Framework
Framework Component	Criteria
Population	Older immigrant men, aged 55 years and older
Concepts	Health, health determinants
Context	Canada

Methods

The review was conducted using the Joanna Briggs Institute (JBI) methodology outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (Peters et al. 2015). The population, concepts, and context (PCC) framework was used in developing the research question and eligibility criteria that guided this scoping review, which is outlined in Table 5.1.

 

We included articles based on the following criteria: published in English; peer-reviewed; based on studies conducted in Canada; and focused on older immigrant men’s health. We defined “older adults” as individuals who are 55 years of age or older. We defined “immigrants” as individuals who were born outside of Canada and who at some point permanently relocated to Canada. To capture as many studies as possible, we included those that sampled both men and women as long as they provided separate results for older immigrant men’s health. We also included studies that focused on both immigrant older men and Canadian-born older men, as long as they provided separate results for immigrant older men.

 

The search was conducted using RULA (Toronto Metropolitan University Libraries’ academic search tool that is designed to capture most scholarly databases) as well as Google Scholar. The search focused on literature published between 1990 and 2024, and used a combination of the following keywords: senior, elder, older; immigrant, emigrant, migrant, transient, refugees, ethnic, cultural, visible minority, racial, racialized; health; and Canada, Canadian. Boolean operands OR/AND were incorporated through the search terms. Zotero, a reference management software, was used to organize and manage the articles. The eligibility screening process was conducted at two levels. At the first level, the titles and abstracts were read. If an article met (or was unclear regarding) the eligibility criteria, it was moved to the next (second) level, which entailed reading of the full text. Those that were found to be relevant were subjected to data extraction and charting. Table 5.2 presents the extracted data. A critical appraisal of the included studies was not performed because the aim of this scoping review was to gain an understanding of the scope and range of the studies on the topic. The narrative synthesis approach outlined by Popay and colleagues (2006) was used in synthesizing the data.

Results

The initial search yielded a total of 724 articles. All identified citations were uploaded onto Zotero, and 67 duplicates were removed. The remaining 657 articles were subjected to two-level eligibility screening process noted earlier, following which, 25 articles were identified as relevant. Of these, only four reported on studies that solely focused on older immigrant men (Bedi et al. 2008; Oliffe et al. 2010; 2009; 2007); the remaining 21 articles were based on mixed-gender articles. Most of the studies focused on Chinese older immigrants (n = 10) or Punjabi older immigrants (n = 6); all four studies that focused only on older immigrant men included Sikh participants only. Of the studies specifying location, most were conducted in Alberta (n = 8), followed by British Columbia (n = 7), and Ontario (n = 7); three were multi-site studies. One study was published before 2000, 14 were published between 2000 and 2010, and the remaining 10 were published from 2011 onwards.

 

We summarized the relevant information from the 25 articles under the following broad topic areas: physical health, mental health, elder abuse, access to health care, social connectedness, and altered lifestyle. Of note is that some topics received minimal research attention, and in some cases, only one study was found on the whole topic. Where available, we have presented comparative information pertaining to these topics.

Physical Health

Five articles focused on physical health (Chau & Lai, 2010; Kobayashi & Prus, 2012; Lai et al. 2007; Lemus 2013; Oliffe et al. 2009). Of these, four articles analyzed physical health status among older immigrant men and older immigrant women in Canada (Chau & Lai, 2010; Kobayashi & Prus, 2012; Lai et al. 2007; Lemus, 2013), whereas Oliffe and colleagues (2009) solely focused on older immigrant men.

 

In general, immigrant older men tended to report health problems similar to those experienced by older adults, in general. For example, older immigrant men in Lemus’ (2013) qualitative cross-sectional study reported diminished eyesight and bodily aches and pains in their hands, backs, and knees.

 

Of the four articles that included both older immigrant women and men, two articles from the same study compared the health status of older immigrant men and women (Chau & Lai, 2010; Lai et al. 2007). In Chau and Lai’s (2010) quantitative cross-sectional study conducted with 2,272 older Chinese immigrants, higher physical health scores were reported by men compared to their female counterparts. In an earlier publication from the same study, Lai and colleagues (2007, 178) found that “compared with the females, males reported better physical health, fewer chronic illnesses, and a lower level of limitation in IADL” (instrumental activities of daily living).

 

One study conducted by Kobayashi and Prus (2012) compared the health status of older immigrant men to that of their Canadian-born counterparts. These authors expanded upon previous research on the healthy immigrant effect in Canada using the 2005 Canadian Community Health Survey data. More specifically, the study compared midlife (45–64 years) and older (65+ years) immigrant men with their Canadian-born counterparts. The authors found that the healthy immigrant effect was applicable only to immigrant men in midlife who had come to Canada within 10 years of the data collection, and that it was especially apparent among racialized, recently immigrated men in their midlife. They further noted that this group was 85 percent less likely to report poor/fair health compared to Canadian-born men in midlife (Kobayashi & Prus, 2012). The authors noted that older immigrant men (65+ years) did not exhibit the healthy immigrant effect, and that recently immigrated, racialized older men “may actually have increased needs for services due to poor health status at migration” (Kobayashi & Prus, 2012, 4) and might have been developing illnesses as they migrate to Canada, and therefore be more likely to self-report a lower health status.

Mental Health

Seven articles focused on mental health (Bedi et al. 2008; Chow, 2010; Durbin et al. 2015; Kuo, Chong, & Joseph, 2008; Lai & Surood, 2008; Lai & Yeun, 2005; Oliffe et al. 2007). Of these, five compared mental health status between older immigrant women and older immigrant men in Canada (Chow, 2010; Durbin et al. 2015; Kuo, Chong, & Joseph, 2008; Lai & Surood, 2008; Lai & Yuen, 2005). In Lai and Surood’s (2008) study on the mental health status among 210 older South Asian immigrants in Calgary, men reported symptoms of depression less frequently than women. Others reported similar trends in Chinese immigrant communities (Durbin et al. 2015; Kuo, Chong, & Joseph, 2008; Lai & Yuen, 2005). For example, Lai and Yuen (2005) examined the mental health status of 96 older Chinese immigrants using the Geriatric Depression Scale, and found that older men scored significantly lower for depression than older women. Specifically, only 10 percent of the older male participants self-reported experiencing depression compared with 28.6 percent of the older immigrant women. In contrast, in Chow’s study (2010) with older Chinese immigrants in Calgary (100 women and 26 men), men reported worse mental health than their female counterparts.

 

Religion and spirituality emerged as an important facilitator for good mental health status. Oliffe and colleagues’ study (2007, 229) with older Sikh men in British Columbia found “strong linkages between spirituality and health.” The authors reported that many participants considered illnesses to be the result of kismet (destiny), and “accepted the inevitability of death and conceptualized it as a journey to another life or state of being” (229). Bedi and colleagues (2008, 221) observed related findings among older Sikh men in Calgary, who perceived their physical health problems as part of “God’s plan.”

Elder Abuse

Two studies reported on elder abuse among older immigrant men and women (Ploeg, Lohfeld, & Walsh, 2013; Tyyskä et al. 2013). Ploeg, Lohfeld, and Walsh (2013, 410–411) reported that older Punjabi men were found to remain silent on the topic of what constitutes elder abuse and instead focused only about financial, physical, and emotional abuse. Although participants were aware of cases where adult children stole their pension checks, they insisted this did not take place within their community. Rather, participants revealed detailed events where older immigrants were verbally or physically attacked. The participants attributed the latter to racist attitudes and prejudice, and reported that older members of their community were targeted because they were most vulnerable. A qualitative cross-section study conducted by Tyyskä and colleagues (2013, 69) found that older immigrant men’s mistrust of service providers and police was identified as a barrier that restricted their ability to report experiences of abuse.

Access to Healthcare Services

Two studies reported that language barriers are a key factor that hinder access to healthcare services among older immigrant men in Canada (Bedi et al. 2008; Oliffe et al. 2007). Bedi and colleagues’ (2008) grounded theory study examined the barriers to addressing coronary heart disease risks among older Sikh men in Calgary. The authors reported that many of their participants were unable to obtain appropriate health information because this information was commonly written in English and not often translated into the Punjabi language. The authors noted that without adequate health information, some older immigrant men did not even know that they required medical attention. For some older Sikh men in their sample, interpreters were their only point of contact for receiving health information and accessing healthcare services. Oliffe and colleagues’ (2007) study on the health of older South Asian Sikh immigrant men found that many of their participants were hesitant to access medical care even if they had family members to translate for them. The participants were much more open to medical care and treatment if they were recommended by a Punjabi doctor.

 

Other barriers to accessing healthcare services identified by Oliffe and colleagues (2007) included transportation, long wait times, and cost. These authors reported that older immigrant men often rely on their children for transportation, but that most younger people are busy working during the day. The lack of transportation and ability to travel independently limited older immigrant men’s access to healthcare, and especially to those services provided by healthcare professionals who speak their own language, which may be located far from home. The authors also found that many older immigrant men had to wait for a long time prior to being seen. Interestingly, some older immigrant men associated long wait times with doctor incompetence. Some reported going back to India and paying out of their own pocket for surgery in order to avoid the long wait period in Canada. Those with limited savings and/or low income had no alternatives but to endure the long wait time. Additionally, some older men reported taking prescribed medication less frequently than advised or not taking medication at all because not all prescribed medications were covered by the Canadian healthcare system.

 

Two studies (Gopaul-McNicol, Benjamin-Dartigue, & Francois, 1998; Oliffe et al. 2009) reported that religion was an important factor in determining whether older immigrant men seek healthcare services, suggesting that older immigrant men with religious beliefs are less likely to access medical treatment if they believe it will conflict with their beliefs. In Oliffe and colleagues’ (2009) study of 36 older Sikh men, one participant reported that “he did not need to go for a checkup” because “God will take care, whatever is meant to happen will happen” (229). Gopaul-McNicol, Benjamin-Dartigue, and Francois (1998) reported that an older male immigrant from Haiti, who was a devout Catholic, was hesitant to access help for mental illness because he felt that a psychologist would devalue his religious and spiritual beliefs.

 

One study (Oliffe et al. 2007) with older Sikh men in British Columbia reported that personal beliefs, values, and/or pre-migration experiences also affected some older male immigrants’ use of healthcare services. In this study, participants reported avoiding healthcare services because they did not deem their health problem as serious enough. Many had grown up in regions where it was difficult to access healthcare services, so they tended to access healthcare services only in life-threatening situations – and many continued this habit after moving to Canada.

Social Connectedness

Eight articles reported on living arrangements and social connectedness among older immigrants Canada (Gee, 2000; Lai & Leonenko, 2007; Luo, 2015; Luo & Menec, 2018; Ng, Northcott, & Abu-Laban, 2007; Oliffe et al. 2007; Oliffe et al. 2009; Wu & Hart, 2002). Six of these articles included both older immigrant women and men (Gee, 2000; Lai & Leonenko, 2007; Luo, 2015; Luo & Menec, 2018; Ng, Northcott, & Abu-Laban, 2007; Wu & Hart, 2002), and two articles from the same study reported specifically on social connectedness among a sample of older immigrant men (Oliffe et al. 2007; Oliffe et al. 2009). For example, Gee’s (2000) study compared (N = 2500) married older Chinese immigrant men in Canada who were living with their spouse only with those living with their children and grandchildren together with their spouse. They found that living arrangements were related to the health and wellbeing of older married Chinese men. Compared to married men living with their spouse only, married men living intergenerationally were less satisfied with their health and wellbeing. Gee (2000) also noted that while living intergenerationally was negatively correlated with Chinese older immigrant men’s health, their ability to see their children as often as they wanted was significantly related to wellbeing among this population.

 

Two studies reported that older immigrant men are more likely to live alone (Lai & Leonenko, 2007; Ng, Northcott, & Abu-Laban, 2007). For example, Lai and Leonenko’s (2007) study with 660 older Chinese immigrants in Canada found that the majority of the individuals living alone were men. Similarly, a study conducted by Ng and colleagues (2007) that analyzed housing and living arrangements among 161 South Asian immigrants in Edmonton found that among participants without a spouse, men were more likely to live alone compared to women who were more likely to live with extended family. They also compared the living arrangements of older women and men who were single, and found that 37 percent of single men lived alone, compared to only 3 percent of single women. The authors of both studies noted that acculturation is an important factor related to older men being more likely to live alone.

 

One study (Oliffe et al. 2007) reported that some older immigrant men obtained social support from places of worship. The authors noted that for older Sikh men in British Columbia, temples served as a place to socialize and engage in community service (sewa). The latter involved “freely giving their time to help others and making financial contributions to the temple” (229). Temples provided older men with a sense of belonging and connections with other people through activities, helping them feel part of a community.

 

Five studies reported on older immigrants’ participation in social activities and implications on their physical and mental wellbeing (Chow, 2010; Luo, 2015; Luo & Menec, 2018; Oliffe et al. 2009; Wu & Hart, 2002). Oliffe and colleagues (2009) found that older South Asian immigrant men in British Columbia organized physical activities and walking groups among themselves to stay healthy. Wu and Hart (2002) conducted a cross-sectional analysis of the National Population Health Survey undertaken by Statistics Canada in 1996–1997. They analyzed data related to 1737 older immigrant women and 1272 older immigrant men and found that male respondents were less likely to perceive the availability of social support and maintain a greater number of social contacts outside the home (Wu & Hart, 2002). Older immigrant men tend to have relatively lower levels of social involvement and report lower health status. Chow (2010) reported that older immigrant men might have lower levels of mental health wellbeing because they do not have the same level of social networks as their female counterparts.

 

It is important to note that two studies (Luo, 2015; Luo & Menec, 2018) reported findings with respect to social networks. Luo and Menec (2018) examined the relationship between social capital and health among 101 older Chinese immigrants in Winnipeg and reported that the level of social participation was significantly negatively correlated with older immigrant men’s physical health status. In a study of 30 older Chinese men in Winnipeg, Luo (2015) found that the level of social participation was significantly negatively correlated with overall physical health, but not mental health.

Altered Lifestyle and health behaviours

Altered lifestyle and health behaviors were discussed in six articles (Bedi et al. 2008; Da & Garcia, 2015; Jarvis et al. 2011; Oliffe et al. 2009; Oliffe et al. 2010; Zhou, 2012). Of these, three articles specifically examined older immigrant men (Bedi et al. 2008; Oliffe et al. 2009; Oliffe et al. 2010).

 

Oliffe and colleagues (2009) found that some older Punjabi men in their sample had been farmers before coming to Canada. Lack of access to farmland and/or inability to secure employment on Canadian farms prevented them from maintaining their prior lifestyle in Canada so they were forced to adopt a more sedentary lifestyle, with negative effects on their health. Many older Punjabi men in their study also reported preferring a hotter climate because they felt it was more conducive to maintaining their physical wellbeing, specifically because they believe that the heat keeps blood vessels open, and sweating is a way to cleanse. Some of their participants also commented that a hotter climate would allow them to perform physical work such as farming, which is a good form of exercise (Oliffe et al. 2009).

 

Immigration to Canada was also reported to influence diet and eating habits. In a later publication of the same ethnographic study, Oliffe and colleagues’ (2010) found that their participants, especially former farmers, had developed specific eating habits that they continued in Canada even when they knew it might not be healthy. For example, in Punjabi culture, dairy products are seen as symbols of wealth. The relatively low cost and easy access to these foods in Canada meant that many Punjabi older men consumed considerable fat and sugar even if they understood these may not be good for their health (Oliffe et al. 2010). This may be contributing to high rates of diabetes and cardiovascular disease among older Punjabi immigrant men in Canada (Oliffe et al. 2010; Bedi et al. 2008). Oliffe and colleagues (2010) also reported that masculine ideals that are deeply rooted in culture may be contributing to their consumption of alcohol. However, a few study participants reported altering their dietary practices after acquiring new health information in Canada. For example, instead of serving sweets to his guests, one participant described serving fresh fruit.

 

Four studies suggested that older men may feel a loss of power within their family after moving to Canada (Da & Garcia, 2015; Jarvis et al. 2011; Oliffe et al. 2009; Zhou 2012). Within patriarchal cultures, men are considered the head of household and enjoy decision-making powers (Da & Garcia, 2015). After moving to Canada, the role of older men tends to change from being the leader of the family to being dependent on their adult children (Oliffe et al. 2009). Their sense of power might further diminish because older women typically become the main caregiver to children and grandchildren, while older men take on a supportive role (Da & Garcia, 2015; Zhou, 2012). For example, a qualitative study by Zhou (2012) found that although elderly couples tend to work as a team to share care work and housework, women often are the primary caregiver, while men tend to provide peripheral assistance, such as playing with grandchildren, picking grandchildren up from kindergarten or school and snow shoveling. Overall, many older immigrant men report feeling less respected after moving to Canada, which can affect their mental wellbeing (Jarvis et al. 2011).

 

The article by Oliffe and colleagues (2009) on physical activity among 36 older male Punjabi immigrants in British Columbia reported that walking outdoors was the most popular physical activity among the study participants because this type of exercise is accessible, familiar, and feasible. Physical limitations and cold weather emerged as important barriers to exercise. Physical health problems, such as knee pain, limited the type of exercise that they could engage in. The authors also noted that many older Punjabi men were concerned that too much exercise might lead to more bodily pain such as “aching joints and bones” (Oliffe et al. 2009, 388). Many chose not to participate in winter sports including skiing, skating, and snowshoeing due to age, lack of interest, the cold, and the expenses associated with such sports. Individuals living in multigenerational households reported lacking adequate space at home to exercise indoors during the winter (Oliffe et al. 2009). Facilitators of physical activity included the opportunity to socialize while exercising. Members of walking groups informally shared health-related information and lived experiences with each other an in doing so acquired additional health information (Oliffe et al. 2009). Participants in this study reported that their sense of masculinity was disappearing because they felt less capable of carrying out daily tasks as they aged, and being able to discuss their past accomplishments with each other while walking helped them remain positive and regain a sense of self. These benefits encouraged many older immigrant men to participate in walking groups (Oliffe et al. 2009).

Discussion

This scoping review is the first we are aware of to focus on the health of older immigrant men in Canada. Some research suggests that older immigrant men generally experience better physical and mental health than older immigrant women (Chau & Lai, 2010; Lai et al. 2007; Durbin et al. 2015). Some studies noted that this may be related to older immigrant men’s higher degree of acculturation than their female counterparts (Lai & Leonenko, 2007; Ng, Northcott, & Abu-Laban, 2007). Older immigrant men usually have higher educational attainment, better language skills, and higher income or more savings than older immigrant women; as a result they tend to be more independent and are better able to access information, and consequently report better health status (Ng, Northcott, & Abu-Laban, 2007). Yet, this may be a double-edged sword because the higher degree of acculturation among immigrant men means that they are also more likely to live alone and to therefore receive less social support (Ng, Northcott, & Abu-Laban, 2007).

 

Chow (2010) suggested that older Chinese men report lower mental health status because they are less socially connected. Some immigrant men also struggled with their post-migration identity, such as loss of power; as a result of being dependent on their children (Jarvis et al. 2011).

 

Access to healthcare services is a key issue for older immigrant men. Scholars have called for more research on health and health status among older immigrant men. For example, Wang and colleagues (2019) reviewed studies on access to primary healthcare services among older immigrants in Canada and found that no studies between 2002 and 2017 focused specifically on men. Based on the limited studies available, our results suggest that older men face challenges when accessing healthcare services including language barriers, transportation, and financial constraints. These challenges are, however, not unique to older immigrant men; Guruge and colleagues (2010) have reported similar results for older women.

 

Overall, our findings point to a problematic gap in the existing literature: very few Canadian studies have focused specifically on the health of older immigrant men. Of the 25 articles we reviewed, only four focused specifically on older immigrant men. Moreover, in the few studies that included both older immigrant men and women, men were usually the minority, often representing about one-third of the total sample. As a result, unique health problems facing older immigrant men are not well known. Another issue is the limited geographical coverage of research on older immigrants: most studies exploring the health of older immigrant men have been conducted in British Columbia, Alberta, and Ontario. Finally, most relevant studies to date have focused predominantly on the Punjabi and Chinese immigrant communities. It is imperative to engage in research that focus on the health of older immigrant men from diverse ethnic backgrounds in order to inform the development of future health promotion strategies in Canada.

 

Future research is needed to focus on the intersection of social, cultural, political, geospatial, and economic factors that influence their health, health behaviours, and health outcomes. By examining factors, such as, accessibility to healthcare services, the impact of acculturation, and social connectedness among this under-studied and vulnerable population, we can tailor health promotion strategies to address their unique health needs. This can improve their overall health and wellbeing, thus reducing health disparities experienced by older immigrant men and promoting health equity in Canada.

Conclusions

Migration brings significant changes to the lives and wellbeing of older immigrant men in Canada. However, research dedicated to older immigrant men’s physical and mental health is scarce. Although we did not include grey literature and may therefore have missed articles that could have provided additional insights into the health and wellbeing of older immigrant men in Canada, we were able to identify several key areas of concern related to their health wellbeing. Some of the available literature provides contradictory results, which may be related to differences between studies in terms of the immigrant community of focus, participants’ length of stay in Canada, study sample size, measures of health and wellbeing, health behaviors, and social connectedness. More research is urgently needed to clarify the health statuses of older immigrant men to inform practice and policy efforts to ensure they remain healthy after coming to Canada.