Seniors in Rural Canada

Katherine ClarkGERO 820

November 29th, 2010

Outline

A. What is Rural Canada?

B. Myths about Aging in Rural Canada

C. Report: How Healthy are Rural Canadians

D. Understanding the trends

E. Aging in Community Understanding age friendly communities: related to

rural communities What’s happening in Whistler

F. Conclusions and Questions

What is “Rural Canada”?

Census Canada defines “rural” as: Population less than 10,000 people Population density less than 400 people/sq.km.

Constitutes approximately 30% of Canadian population

No universal application of definition, making it difficult to compare results nationally and internationally

ie. Some research defined rural as less than 20,000 people

Seniors in Rural Canada

Seniors are over-represented in rural vs. urban Canada

Factors affecting aging:o Population density and distance: proportion of

seniors in the community, distance from nearest health care center

o History: length of settlement of the community, number of years the elder has lived there

o Rural ideology: life orienting themes of rural elders, how much do they identify as “rural”

Myths about aging in rural settings…

Class input: what are some ideas that you have or have heard about living or aging in rural

Canada?

Myth #1

“Rural” is a defining and homogeneous characteristic

Myth Busted!

True because:

There are some “typical” characteristics: Lower income Lower education Strong sense of

community belonging Over-representation of

youth and seniors

False because:

There is huge diversity in the experience of living in a rural place: rural living spans a broad category

North vs. south

Farm vs. nonfarm

Oldtimer vs. newcomer

Distance from metropolitan influence

Myth #2

Rural settings are peaceful and idyllic

Myth Busted…

True because:

Cleaner air

Less crowded

Lower car and household insurance

Physical access to outdoors is higher due to lower population density

False because:

Lower income, lower standards of housing Housing quality has

been noted to correlate with self-reported well-being

Industrial dereliction in some towns, especially if primary economy has been closed

Myth #3

Informal social support is high

Myth Busted…

True because:

Strong sense of community belonging (Nagarajan, 2004)

More involvement in volunteer and church organizations compared to urban seniors (Keating, 1991)

High visibility with neighbours, low anonymity

False because:

Differences between “newcomers” and “oldtimers”

Neighbours may also be older and unable to provide necessary support (Joseph et al, 1993)

Cannot assume family members will be cooperative (Keating, 1991)

Many younger family members move away

More never married individuals (Nagarajan, 2004)

Myth #4

Needs of rural seniors exceed

what is available

True because:

Objective measures of service report that rural services fail to meet standards (Keating, 1991)

Long distances, additional expenses for specialized help (Nagarajan, 2004)

Less likely to receive hospital treatment, visit a dentist (Keating, 1991)

Narrow range, few health care providers (Bull, 1998)

False because:

Needs and health care access are narrowly defined and bound by biomedical model “Determinants of health cannot be defined only

as the availability and access to health care” (CPHI, 2006)

Subjective health status of rural seniors is higher

Alignment between perceived needs and perceived availability of services (Keating, 1993)

Perceptions of urban vs. rural hospital patients about return to their

communities

Costello et al, 1977

Asked hospital patients 65yr+ feelings about the availability of 13 services versus personal need for those services in their local community

Rural = less than 5000 people

Found that perceived availability was higher for those in urban areas

However, ALSO found that perceived availability was greater than perceived need in both areas

How Healthy are Rural Canadians?

Question asked by researchers of the

Canadian Population Health Initiative, 2006

Initiative: Canada’s Rural Communities

Purpose: understanding rural health and its determinants

Methods: analyzed data from the following sources: Canadian Cancer Registry Canadian annual mortality data Canadian community health survey

Definitions: 1. Senior = 65 yr. +

2. Rural = less than 10, 000 people

3. Metropolitan Areas and Census Agglomeration Influenced Zones (CMA and MIZ)

CMA and MIZ

Census Metropolitan Area (CMA): large urban area or urban core

Metropolitan Influenced Zone (MIZ): populations living outside CMA classified according to degree of influence of the CMA. Used to define rurality

Strong MIZ: 30%+ of the labour force works in the CMA

Moderate MIZ: 5-30% work in CMA

Weak MIZ: 0.1-5% work in CMA

No MIZ: 0% commute to CMA, and less than 40 people are working in the area

-- attempts to better show the effects of metropolitan accessibility on non-metropolitan areas

So, how healthy are

rural Canadians?

All cause mortality rates higher in Moderate, Weak and No-MIZ areas

Mortality risks increase as MIZ level decreases

Life expectancy is 2-3 years less than in CMA

Greater obesity, diabetes, circulatory disease, and respiratory disease rates

Greater risk of death from injuries and poisoning

Overall, statistics show that rural Canadians are less healthy than

their urban counterparts.

Many of the risks come from modifiable risk factors, which could benefit from health

promotion efforts, such as reducing smoking

and increasing physical activity.

However, rural seniors have a different story…

1. Satisfaction with health is greater than urban counterparts

2. Mortality rates are lower or equal

3. Women age 65+ had lower injury and poisoning rates

4. Cancer rates were equal to urban statistics

Why is this?Class input: What reasons might there be for healthier seniors among a population of less

healthy rural residents?

Some possibilities

Unhealthy seniors may be relocating to urban centers to be closer to medical or family support Migration study confirmed that unhealthy people were

more likely to move, and that out migration from rural towns > in migration for 70+ yr olds

Healthy seniors may be moving to rural areas in retirement

Survivor hypothesis: those who didn’t die prematurely are healthier, wealthier, or smarter

Cohort effect: maybe seniors we are studying today were healthier all their lives

How does this impact health promotion programs for rural

regions?

We need to learn more about what is causing this disparity between seniors and the general rural population

Creating appropriate needs assessments to understand what seniors feel they need within their community to enhance their ability to age in place, and:

If seniors are indeed leaving rural areas when they become more frail, there should be a system in place to allow them to age in place/age in community

Population Health Framework for Rural

Health

Population Health Status

PlaceCommunity

ContextIndividual Context

Creating age friendly communities

Age friendly communities “promote physical and psychosocial wellbeing of community members throughout the lifecycle” (Scharlach, 2009)

Most current research focuses on creating age friendly components within urban settings

From aging in place to aging in community: obsession with aging within ones own home may be equally as suffocating as institutional environments

Moving away from focusing on dwellings and towards relationships (Thomas and Blanchard, 2009)

Analyzing Rural Communities…

1. Person-environment fit: how well does an individual function in his/her community?

This also relates to the perception of needs and availability noted earlier

Transportation issues commonly cited as rural problem

Who is defining this “fit”

2. Behaviour settings: when individuals are in supportive environments they are more likely to have greater functioning

Cognitive adaptation to familiar setting = positive self image and higher perceived competence

Analyzing Rural Communities…

3. Individuals as constructive agents: people ascribe meaning to places, and these places in turn shape the meanings available to the person as he/she ages Understanding the subjective component to aging in

place

4. Life span developmental processes: context between person and their environment

When studying rural places, it may be useful to examine the relationship between a person’s health and time in their life span they moved to a rural setting

Analyzing Rural Communities…

5. Physical, social, cultural environments: where we live shapes our chances and opportunities for how we live

While people are “aging in place”, their homes are too!

6. Macro level forces: politics and economics effect the experience for seniors regardless of size of town

May serve to disadvantage rural areas which don’t have the economies of scale to accrue the number and diversity of services

Assessing service needs: can’t be done without input from rural elders

Analyzing Rural Communities.

Needs Assessments:

1. Desired state of affairs “goal” – who has stated the goals? Taking control of one’s own QoL means determining

one’s own health goals

2. Way in which actual state of affairs relates to goal “need” – gap between current situation and goal Depends on how the research questions are asked Needs often determined from urban norms and

objective measures

Aging in Communit

yAn example:

Whistler, BC

Population: 9000Density: 57.2/sq.kmDistance: 125 km from Vancouver (closest major medical center)Industry: Tourism

History

First settled in 1910 by fishers and trappers

Became a municipality in 1975

Site of the 2010 Olympic Games: this had a significant effect on infrastructure, accessibility and economic capital

Many of the seniors who live in Whistler have helped make it the community it is today

Ideology

Inhabitants identify with a rural ideology: less traffic, less pollution than in the city

Many residents dislike heading down to the “big city”

Influx of tourists and seasonal employees have led permanent residents to create a close knit community, its hard to go anywhere without bumping into someone you know.

Active and youth-centered

Creating Community

WHA: creating affordable, senior-friendly housing options

WCSS: community gardens, food bank, used clothing store, newcomers dinner

Whistler2020: “Comprehensive sustainability plan and vision” Yearly community surveys

Health Promotion…Barriers

Lack of full-time specialists

Focus on acute care

Very expensive place to live

Snow! And other hazardous terrain

Not many activities to do in the evening, besides going to the bar…

Health Promotion: Unique Solutions

Health care specialists visit Whistler on a regular basis

MAC: promoting healthy aging and community life Inviting senior participation and feedback

Seniors-only classes at the local recreation facility

The community values physical activity and enjoyment of the outdoors

The village has become increasingly accessible due to vocal seniors and wheelchair bound athletes

ie. paralympians

What would make it even better?

Accessible, seniors-specific housing (this has been an ongoing struggle, as real-estate is so expensive)

More healthy, seniors friendly activities to do at night (ie. LUNA for younger adults)

“Foster grandparents”: living in a rural area, seniors and children may be removed from their extended families

Home care services and resources for those becoming more frail

Car-sharing and appointment blocks for seeing specialists in Vancouver

Conclusion…

Conclusion

We cannot make assumptions about the health status of seniors in an environment, nor about what their needs may be

Integral to any health promotion initiative is to…

TALK TO THE PEOPLE! Even the best planned initiatives are not used if the do not

incorporate the views of the potential users Need to increase our understanding of perceived needs vs.

perceived availability and how that impacts the health of rural seniors

Urban perspectives are being used to study rural issues…the way we frame our research limits the “solutions” we end up with

Conclusion

There may be more differences between newcomers and old-timers than between rural and urban seniors Newcomers may have better health literacy and

SES Old-timers have greater social capital Can we combine these resources? Future research: how does health effect migration

and vice versa

Biggest influence on health may be migration… how do we help seniors age in community?

Class Input:

Questions or comments about the presentation?

In what ways does studying Whistler reduce our understanding of other aspects of rural Canada?

Michael Ignatieff said: “If there’s 2 tiered health care in Canada, it’s not between rich and poor, it’s between urban and rural.” (Ottawa Citizen 2006)

Do you agree??