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Aging, Health and Health Care: Examining Differences between Aboriginal and non-Aboriginal Seniors in Canada. Kathi WilsonMark Rosenberg Department of GeographyDepartment of Geography University of Toronto MississaugaQueen’s University Sylvia Abonyi Community Health and Epidemiology - PowerPoint PPT Presentation
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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
