Aging, Health and Health Care: Examining Differences between Aboriginal and non-Aboriginal Seniors in Canada Kathi WilsonMark RosenbergDepartment of Geography University of Toronto MississaugaQueen’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 Results Conclusions/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,

Age Distribution Median age 2006  Aboriginal - 27 years  Non-Aboriginal - 40 years Source: Statistics Canada Code=01&Table=1&Data=Count&Sex=1&Age=9&StartRec=1&Sort=2&Display=Page

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 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 RosenbergSylvia Abonyi GeographyCommunity Health and Epidemiology Queen’s UniversityUniversity 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 APS2000/2001 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 Respondents98,649130,827 Response Rate84%84.7%

Common Health and Health Care Variables APS (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 *Chi-Square Significance p<0.001

Population Reporting Difficulty with Activities *Chi-Square Significance p<0.001

Total Number of Chronic Conditions *Chi-Square Significance p<0.001

Visited Physician within Past 12 Months *Chi-Square Significance p<0.001

Visited Nurse within Past 12 Months *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 *Chi-Square Significance p<0.001 Source: Statistics Canada

Population Reporting Fair/Poor Self-Assessed Health Status *Chi-Square Significance p<0.001 Source: Statistics Canada

Population Reporting Difficulty with Activities *Chi-Square Significance p<0.001 Source: Statistics Canada

Total Number of Chronic Conditions *Chi-Square Significance p<0.001 Source: Statistics Canada

Visited Physician within Past 12 Months *Chi-Square Significance p<0.001 Source: Statistics Canada

Visited Nurse within Past 12 Months *Chi-Square Significance p<0.001 Source: Statistics Canada

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