Is Canada ready for an increasingly diverse senior population? Here's what health experts say

As a graduate student nine years ago, Dr. Saskia Sivananthan spent a couple of weeks living in an Ontario long-term care home as part of a research project. While there, she was able to interact with patients from different ethnic backgrounds, including one man who would hardly speak to staff members.

After noticing Sivananthan was South Asian, the man began speaking to her in Tamil, and she learned he had lost his ability to speak English following the onset of dementia. It’s common for older patients living with dementia to lose their ability to speak the most recent language they’ve learned, she said.

Sivananthan discovered the man was a member of the Brahmin caste, the social caste in Hinduism from which priests have historically been drawn. She learned he followed strict traditional protocols calling for married and unmarried men to generally abstain from touching women. This helped explain the trouble he had co-operating with female personal support workers (PSWs) when taking a shower or eating a meal, Sivananthan said.

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“He wasn't used to women touching him and providing personal care to him,” she told CTVNews.ca in a telephone interview. “So he would struggle when female personal support workers would come to help him, and he couldn't communicate in English anymore as his dementia had progressed.”

After additional conversations with staff members, a male PSW was assigned to the man, and daily tasks were translated into Tamil to help bridge gaps in communication, Sivananthan said. Although this interaction happened years ago, it remains a common experience for older immigrants today, she said.

“I continue to visit long-term care (and support family members dealing with this), and see the same lack of supports,” she wrote in an email to CTVNews.ca.

WHY IT'S 'CRUCIAL' TO TAKE CULTURE INTO CONSIDERATION

A person’s cultural background is “crucial” to consider when providing care for older adults in diverse communities, said Sivananthan, who is now an affiliate professor in the department of family medicine at McGill University. Not doing so can have a significant impact on their ability to access health-care services at all, she said.

“If (health workers) aren’t trained to think about that beforehand … sometimes, they’ll end up providing care that can be detrimental because it might scare the person and they don’t want to come back,” Sivananthan said.

Along with gaps in the provision of cultural competency training for health workers, there is also a lack of health data related to visible minority groups, she said, which raises questions about whether Canada’s health-care systems are ready for an increasingly diverse senior population.

New statistics from Environics Analytics, a marketing and analytical services company owned by Bell Canada, show the country’s senior population is projected to surpass 11 million by 2043. The data, based on a special analysis for CTV News, paints the senior population as the fastest-growing age group in the country.

As the number of seniors in Canada grows, so will the population of visible minorities, according to estimates released by Statistics Canada in 2022. Data from the agency shows the total number of seniors in racialized groups is expected to reach 2,950,000 in 2041, up from 1,020,000 in 2021. This represents an increase of 190 per cent over the span of 20 years.

DATA AT A GLANCE:

• Nearly two million immigrants were aged 65 or older in 2021, according to the latest census data from Statistics Canada, representing approximately 30 per cent of Canada’s senior population
• Based on this data, 45 per cent of immigrants aged 65 and older were originally born in Europe, while 36 per cent came from Asia. The remaining proportion of immigrants settled in Canada from the Americas (14 per cent), Africa (4.5 per cent) and Oceania (one per cent)
• The latest census data from 2021 also shows approximately one in seven seniors is a visible minority in Canada
• Visible minority groups expected to have the highest populations by 2041 are South Asian, Chinese and Black, according to Statistics Canada
• Among Canada’s Black population, more than 300 ethnic or cultural backgrounds were reported in the latest census data, including African, Jamaican and Yoruba

WHAT CHALLENGES ARE FACED BY DIVERSE COMMUNITIES?

Old age is a key risk factor for dementia, according to the Alzheimer Society of Canada. Dementia refers to a general set of symptoms caused by disorders that impact the brain. These symptoms usually include memory loss, mood changes and issues with problem-solving that are severe enough to affect a person’s ability to perform daily functions.

A recent report published by the organization shows approximately 570,000 Canadian seniors were living with dementia in 2020, making up 8.4 per cent of the senior population at the time. Fast forward to 2050, and projections show nearly 1.7 million seniors are expected to be living with dementia.

As Canada’s senior population grows, along with the number of people living with dementia, it is especially important that health-care systems have programs and supports adequately set up to help diverse communities, Sivananthan said.

In addition to language barriers, a lack of awareness around certain health conditions is another unique challenge facing visible minorities aged 65 and older, Sivananthan said. Languages such as Punjabi, for example, do not have words that directly translate to “dementia.”

There is also limited data on the needs and experiences of people living with dementia in Canada, experts say, particularly those in visible minority groups. But research has suggested that members of these groups face additional challenges due to the lack of culturally appropriate health-care options.

A 2012 study looking at South Asian Canadians living with dementia, for example, highlights concerns around the potential for discrimination by staff members in health-care settings, as well as gaps in knowledge around dementia itself and support programs and services.

In some communities, there’s also a stigma associated with dementia, said Dr. Roger Wong, a clinical professor of geriatric medicine at the University of British Columbia. Some may feel a sense of shame or embarrassment when diagnosed with dementia, viewing their symptoms as a sign of weakness, he said.

There may be assumptions that dementia is a normal part of aging, even though it is not, said Wong. Yvonne Appah, a nurse practitioner with Alberta Health Services, said this mentality can be common among members of different Black communities in Canada.

“I do think that there is a perception that the issues that happen during dementia, such as memory loss, depression, some of the behaviour issues, may be associated with normal aging in our community,” she told a virtual roundtable organized by the Alzheimer Society of Canada in February. “(Or) that it might be a flare of a personality as well, so there’s some misconceptions of what this disease looks like.”

Aging in Canada

• Part One: Senior Snapshot
• Part Two: Health Care in High Demand
• Part Three: Workforce Gaps Grow
• Part Four: Re-Evaluating Living Arrangements
• Part Five: Cultural Diversity

This stigma and lack of awareness can discourage people from seeking a diagnosis, Wong said. By the time these patients talk to a specialist, their dementia may have progressed much further than if they sought care earlier, he said.

“You can imagine if there's a later diagnosis (and) later access to health care, it can lead to more health-related problems down the road,” he said.

TAKING HEALTH RISKS INTO ACCOUNT

Additionally, people of different ethnic backgrounds can have an increased risk of developing dementia compared to other groups, Sivananthan said. She points to several studies conducted in the U.K. and the United States in recent years that show people from African, Caribbean and other Black communities are at higher risk of developing dementia than white men and women.

High blood pressure and diabetes, which are risk factors for dementia, are more common among Black community members than white members, for example.

Along with this, factors such as racial discrimination and living in neighbourhoods with limited resources have also been associated with a higher risk of developing dementia, according to the Alzheimer Society of Canada.

As part of a study released last year, researchers in the U.S. looked at instances of racism among nearly 1,000 middle-aged Black, Hispanic and white adults. Results from the study showed Black participants experienced the most exposure to racism, and that these experiences were linked to cognitive decline due to the trauma they inflicted.

These are all factors that medical professionals should take this into consideration when interacting with patients, Sivananthan said. As a result, culturally specific care should go beyond dementia, and apply to all forms of health care, Wong said.

This type of care should also include efforts to recruit candidates from diverse communities for clinical trials, Wong said. Historically, medical studies performed in Canada have not always been representative of the diverse populations seen across the country, so the results may not be applicable to those in various ethnic groups, he said.

Sivananthan agreed.

“You’re taking study results and applying them to a general population, but we actually don’t know if those drugs might react differently in people who have different genetic risks,” Sivananthan said. “When you don’t look at the diversity of populations in your research, it becomes problematic when you're trying to apply it.”

Studies have also shown that various racial groups face differences in the risk of developing chronic conditions such as cardiovascular disease and obesity.

Additionally, candidates from diverse communities are not always recruited for clinical trials, so the results may not be applicable to those across various racialized groups, Wong said. Historically, medical studies performed in Canada have not always included the same kind of diverse populations seen across the country, he said.

“Ideally, the individuals who participate in medical and health research should be reflective of the populations whom we serve,” he said. “All of us need to do a lot better in terms of making sure that we include the diversity of individuals who are participating in these research studies.”

“You’re taking study results and applying them to a general population, but we actually don’t know if those drugs might react differently in people who have different genetic risks,” Sivananthan said. “When you don’t look at the diversity of populations in your research, it becomes problematic when you're trying to apply it.”

CULTURALLY APPROPRIATE CARE IN ACTION

From a health perspective, it is “absolutely important” to provide older Canadians with culturally sensitive care that is personal to them, said Ito Peng, a professor of sociology at the University of Toronto and a Canada Research Chair in global social policy. This is done by taking into account their language and cultural background, as well as the kind of assumptions they may have around how care should be provided and who should provide it, she said.

One of her PhD students currently works at Yee Hong Centre, a facility that provides Chinese and Japanese residents with culturally appropriate long-term care. Built in 2004, the Yee Hong Centre’s Scarborough Finch site has 250 beds for Chinese and Japanese residents, and offers 24-hour care for patients with severe health conditions.

As a recreation worker at the centre’s Scarborough Finch location in Toronto, Izumi Niki organizes different activities in Chinese, Japanese and English, some of which are planned around major holidays such as Lunar New Year.

Izumi Niki is a recreation worker at Yee Hong Centre, a facility that provides Chinese and Japanese residents with culturally appropriate long-term care. Niki helps organize a variety of activities for residents in Chinese, Japanese and English. (HANDOUT / University of Toronto)

Activities can include concerts, during which residents sing songs in their native language, as well as exercising and crafts. Niki will also help residents cook foods they are already familiar with, such as onigiri, which are Japanese rice balls.

These types of experiences are what separate the home from other long-term care facilities, and help to create an increased sense of belonging, Niki said.

“I hear very positive things from the residents, that they are valued and they feel attached because they can see other people who are in a similar situation,” Niki told CTVNews.ca in a telephone interview. “Some of the seniors don’t have a family here, so feeling like a member of society is sometimes difficult.”

Residents at one of Yee Hong's centres celebrate Canada Day. (@yeehongcentre / Instagram)

Niki hopes to see the creation of more facilities such as Yee Hong Centre in the future, to better service members of minority communities.

“We have to cater to the needs of each individual,” said Niki, whose PhD focuses on elder care. “Not feeling isolated (and) feeling like you belong in society is the most important thing when you are aging.”

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Edited by Mary Nersessian, graphics produced by Jesse Tahirali