Aging, Health and Health Care: Examining Differences between

Aboriginal and non-Aboriginal Seniors in Canada

Kathi Wilson Mark Rosenberg

Department of Geography Department of Geography

University of Toronto Mississauga Queen’s University

Sylvia Abonyi

Community Health and Epidemiology

University of Saskatchewan

SEDAP II - Canada in the 21st Century: Moving Towards an Older Society

Outline

Background: Population and demographic comparisons Overview of existing literature Objectives and goals of current research

Data and Methods: Aboriginal Peoples Survey (APS) 2001 Canadian Community Health Survey (CCHS) 2000/2001 Exploratory examination of differences

ResultsConclusions/Implications

Who are Older Aboriginal Peoples?

• Older - demographic concept (65 years and older)

• Elder - cultural concept• reflects status of honour, wisdom and respect regardless

of age (McLeod-Shabogesic, 1998; Medicine, 1983)

Aboriginal Peoples in Canada

Aboriginal identity pop’n• 1 million

• represent 3.8% of Canada’s total population (2.8% in 1996)

Source: Statistics Canada, 2001 http://www12.statcan.ca/english/census01/Products/Analytic/companion/abor/canada.cfm

Age Distribution

Median age 2006Aboriginal - 27 yearsNon-Aboriginal - 40 years

Source: Statistics Canada. 2006. http://www12.statcan.ca/english/census06/data/highlights/Aboriginal/pages/Page.cfm?Lang=E&Geo=PR&Code=01&Table=1&Data=Count&Sex=1&Age=9&StartRec=1&Sort=2&Display=Page

Age Groups Aboriginal (%) non-Aboriginal (%)0-14 30 1715-24 18 1325-54 40 4455-64 7 1365+ 5 13

Age Groups 2001 2006 % change0-14 323960 348,900 815-24 169065 212,010 2525-64 443600 555415 2565+ 39680 56,460 42

Projected Population Growth

• Aboriginal seniors - 6.5% (2017)• Non-Aboriginal seniors - 17% (2017)

Source: Statistics Canada, Projections of the Aboriginal Populations, Canada, Provinces and Territories: 2001 to 2017

Research on Older Aboriginal Peoples

• Growing literature on Aboriginal peoples Canadian Journal of Native Studies (1981) Native Studies Review (1984)

• Lack of attention toward “older” Aboriginal peoples

• “major reports on older Native people continue to be based almost entirely on anecdotal evidence” (Buchignani and Armstrong-Esther, 1999, p.7)

Review of Aboriginal Health Research in the Social Sciences

• 1995-2005• 96 articles• Only 3 focus on older Aboriginal peoples

Mental health (Cattarinich et al., 2001) Inuit - successful aging (Collings, 2001) Informal care (Buchignani and Armstrong-Esther, 1999)

Incomplete Picture of Aboriginal Peoples

• ‘Age’ focus of health research: General population profiles Youth

Purpose of Research

Objectives: Provide a comparison between Aboriginal and non-Aboriginal

seniors Provide comprehensive portrait of the health status of older

Aboriginal peoples and their use of health services

• Goals: Enhance understanding of Aboriginal health status and use of

services in Canada Knowledge transfer to the Aboriginal and general policy and

planning communities Provide contextual platform to develop future qualitative research

Research Team

Investigators:

Mark Rosenberg Sylvia Abonyi

Geography Community Health and Epidemiology

Queen’s University University of Saskatchewan

Aboriginal Advisor

Bob Lovelace

Sir Sanford Fleming College

Five-year Research Plan

• Phase 1- Population Aging Among Aboriginal Peoples in Canada 2001 Census of Canada Departmental Data, DIAND

• Phase 2 - Health Status of Older Aboriginal Peoples and their Utilisation of Health Services 2001 CCHS; 2001 APS differences between non-Aboriginal and Aboriginal peoples differences within Aboriginal population

• Phase 3 - Experiences of Aging among Older Aboriginal Peoples

Phase 2 Data Sources

2001 APS 2000/2001 CCHS

Targeted Population • Aboriginal identity

• Aboriginal ancestry• reserve/off-reserve• Private dwellings• 0-14 years• 15 years and older

• Individuals in private dwellings (not Aboriginal peoples with reserve-residency)

•12 years and older

Survey Questions • education, income, language, labour activity, income, health, communication, mobility, housing

• Metis, Children, Arctic

• physical/mental well-being, lifestyle, use of health care services, access to are

• common & optional content

Respondents 98,649 130,827

Response Rate 84% 84.7%

Common Health and Health Care VariablesAPS (2001) and CCHS (2001)

• Age cohorts: 18-54, 55-64, 65-74, 75+

• Health Status Self-assessed (excellent/very good/good vs. fair/poor)

Difficulty with activities: “Do you have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning etc”?

9 Chronic conditions (diagnosed)

• Health Care use in past 12 months Physician use Nurse

Data Access

• CCHS and APS microdata file accessed through Statistics Canada’s Regional Data Centre at McMaster University

The research and analysis are based on data from Statistics Canada and the opinions expressed do not represent the views of Statistics Canada.

Results

• Exploratory analysis

• Stage 1 Older Aboriginal and non-Aboriginal

• Stage 2 Older Aboriginal peoples (North American Indian, Métis, Inuit)

Population Reporting Fair/Poor Self-Assessed Health Status

15

39

44

48

25

36

19

8

0

10

20

30

40

50

60

18-54 55-64 65-74 75+Age

Perc

en

t

Aboriginalnon-Aboriginal

*Chi-Square Significance p<0.001

Population Reporting Difficulty with Activities

26

50

65

78

33

44

65

18

0

10

20

30

40

50

60

70

80

90

18-54 55-64 65-74 75+Age

Perc

en

t

Aboriginalnon-Aboriginal

*Chi-Square Significance p<0.001

Total Number of Chronic Conditions

*Chi-Square Significance p<0.001

Visited Physician within Past 12 Months

0

10

20

30

40

50

60

70

80

90

100

18-54 55-64 65-74 75+Age

Perc

en

t

Aboriginalnon-Aboriginal

*Chi-Square Significance p<0.001

Visited Nurse within Past 12 Months

2725

30

39

9 9 10

15

0

5

10

15

20

25

30

35

40

45

18-54 55-64 65-74 75+Age

Pe

rce

nt

Aboriginalnon-Aboriginal

*Chi-Square Significance p<0.001

Summary

Health Status• In general, Aboriginal population ‘unhealthier’ than Aboriginal population• Older cohorts unhealthier than younger cohorts• Health appears to converge among oldest Aboriginal and non-Aboriginal

seniors

Health Care Use• Similar access to physicians• Higher reliance on nurses within Aboriginal population

Differences within Aboriginal population

• APS (2001) North American Indian Métis Inuit

• Demographic composition• Health status (18-44, 45-64, 65+)• Use of health care services (18-44, 45-64, 65+)

Percentage of Aboriginal Population 55 years and older, 2001

0

1

2

3

4

5

6

7

total Aboriginal North AmericanIndian

Metis Inuit

Perc

en

t

55-64 65-74

75+

*Chi-Square Significance p<0.001

Source: Statistics Canada. 2001.

Population Reporting Fair/Poor Self-Assessed Health Status

13

33

45

11

29

46

9

21

34

0

5

10

15

20

25

30

35

40

45

50

18-44 45-64 65+

Perc

en

t

North American Indian

Metis

Inuit

*Chi-Square Significance p<0.001

Source: Statistics Canada. 2001.

Population Reporting Difficulty with Activities

23

45

71

21

43

66

22

39

72

0

10

20

30

40

50

60

70

80

18-44 45-64 65+Age

Perc

en

t

North American IndianMetisInuit

*Chi-Square Significance p<0.001

Source: Statistics Canada. 2001.

Total Number of Chronic Conditions

*Chi-Square Significance p<0.001

Source: Statistics Canada. 2001.

Visited Physician within Past 12 Months

0

10

20

30

40

50

60

70

80

90

18-44 45-64 65+Age

Perc

ent

North American Indian

Metis

Inuit

*Chi-Square Significance p<0.001

Source: Statistics Canada. 2001.

Visited Nurse within Past 12 Months

30

2420

27

74

36

26

55 55

0

10

20

30

40

50

60

70

80

18-44 45-64 65+Age

Perc

en

t

North American Indian

Metis

Inuit

*Chi-Square Significance p<0.001

Source: Statistics Canada. 2001.

Summary

Stage 1: Differences between older Aboriginal & non-Aboriginal Canadians Non-Aboriginal population ‘healthier’ across age cohorts But health status converges among oldest age cohorts Older Aboriginal peoples higher reliance on nurses

Stage 2: Differences within Aboriginal population• Health status

Older Inuit appear ‘healthier’

• Health care use Older Inuit lower levels physician use But much higher reliance on nurses

Limitations

• Self-reports

• Measuring health status - biomedical

• Health care use - incidence vs. frequency

• Diversity of the Aboriginal population e.g., on vs. off-reserve

Implications

• Almost no research on older Aboriginal cohorts Represent 5% of Aboriginal population Represent 1.5% of older Canadian population

• This research: health picture of seniors living in ‘community’

• Questions remain… no knowledge of population living in institutions formal/informal caregiving

• Know little about health, services & creating services Who collects ‘data’? What type of ‘data’?

Next Steps

• Phase 2: Determinants of health and health care use Traditional healing

• Phase 3: Qualitative research study Experiences & perceptions of aging Broader perspectives on health/health care

Ontario Saskatchewan