How Can Canada Promote Immigrants’ and Seniors’ Well-Being?

Immigrants are gradually becoming the face of Canada. Today, the nation boasts one of the world’s highest immigration rates, with roughly 500,000 people entering Canada annually. But immigrants to Canada face unique difficulties that affect their ability to adapt to their new country, especially as they age.

For this and other reasons, researchers are studying how to improve social and mental well-being and life satisfaction in the immigrant population. Mental health has been associated with physical health, and one intriguing question is the degree to which living alone might influence life quality.

“We wanted to understand what drives the relationship between living arrangement (more specifically, living alone) and older people’s subjective well-being,” said Jing Shen, PhD, a research affiliate at the University of Toronto’s Institute for Life Course and Aging, Toronto, Ontario, Canada, and lead author of a study published online on August 13 in the International Journal of Aging and Human Development.

Shen and her team devised a subjective measure called “social disposition” (ie, personality-driven attitudes toward interpersonal relationships). Using latent class analysis, they compared social disposition’s role in determining life satisfaction among older immigrants and among Canadian-born older patients. The data were derived from approximately 12,000 respondents, aged 65 years or older, who participated in the Canadian Longitudinal Study on Aging (CLSA) between 2011 and 2015.

The researchers grouped participants into two social disposition archetypes that appeared to drive their social well-being. Socially dependent adults (ie, adults who were introverted and less agreeable, conscientious, emotionally stable, and open-minded) tended to be less content than older peers who were socially independent (ie, extroverted, agreeable, conscientious, emotionally stable, and open-minded). Moreover, the association appeared to vary between native- and immigrant-born older adults; socially independent, native-born participants were especially satisfied with their living status (coefficient = 0.170), while socially dependent older immigrants living alone had the lowest level of life satisfaction (0.87 points lower, coefficient = −0.534).

“Living alone, per se, is not likely to contribute to life satisfaction, but how older people living alone perceive their life status does,” coauthor Hongmei Tong, PhD, an associate professor of gerontology at MacEwan University in Edmonton, Alberta, Canada, told Medscape Medical News.

Beyond Social Disposition

Because a single measure of life satisfaction was used as a proxy for social well-being, it is unclear whether social independence or dependence truly determines outcomes for older immigrants. The authors noted that they only used one wave from the CLSA, which limited the ability to determine causality.

“I’m not 100% convinced that personality traits are the driving factor in terms of how these individuals are able to live,” said Jordana Salma, PhD, RN, associate professor of nursing at the University of Alberta in Edmonton, Alberta, Canada (who, at the time of our interview, had not reviewed the study findings). “A few dichotomies make a difference in later outcomes and quality of life,” she said. “One is if they arrived early on or later in life.”

Salma explained that people who come to Canada later in life as retired, older adults generally do so for family reunification. This situation raises challenges regarding healthcare access. “Older adults who come for family reunification are the most vulnerable in every way, including physical health, if not immediately, then over time,” she said. These adults are not eligible for Canadian Medicare and don’t have access to the same healthcare resources as Canadian residents do.

“The social isolation and loneliness experienced by many immigrants is further heightened by language barriers, limited health literacy, lack of access to healthcare services, lack of culturally appropriate mental health services, long-term care, and even end-of-life care,” said Tong. “Civic participation, how they contribute to society, is also different,” she said.

Community Building Key

Data from the Canadian Community Health Survey have shown that patients reporting a poor sense of community have a more than threefold higher risk of reporting poor health, and almost fivefold higher risk of reporting poor mental health.

The Centre for Immigrant and Community Services (CICS) has provided language, settlement, job search assistance, and training to immigrants in Canada for more than 50 years. Executive director Alfred Lam noted that the organization’s service offerings have shifted.

“More and more, we’re seeing ourselves as community builders, as opposed to just advocates,” said Lam. “Among the different vulnerable populations, among newcomers, seniors often face the most barriers in their integration journey. One thing that is unique is that they immigrated when they were already more advanced in age, and very few did so because it was their decision,” he said.

Lam explained that families immigrate to Canada for various reasons. Some seek a better future for their children, and others seek better career opportunities. But few families consider seniors’ needs, he added. “This puts them behind the eight ball from the get-go, psychologically and emotionally speaking,” he said.

To address these needs, CICS has implemented programs to help foster human connection. At the beginning of the pandemic, it partnered with restaurants and volunteers to deliver fully cooked meals to senior immigrants living alone. In the spirit of meeting people where they are, CICS started delivering services by phone. “Everything became virtual and online, which became a huge barrier due to the lack of digital literacy,” said Lam. “So, we had people here taking phone calls from seniors.”

Salma has likewise focused on creating a sense of community for immigrants to Alberta. “We started a walking group program with two components. It was led by a fitness instructor and targeted fall risk and physical mobility challenges. But the biggest draw was the opportunity to connect and socialize,” she said. “Another thing that really took off was virtual programming during the pandemic. For a lot of seniors, that was massive. They didn’t know how to use Zoom before, but now everybody knows.” The resulting sense of community was significant.

“The Conference Board of Canada, in a study conducted a few years ago, concluded that by 2035, 100% of Canada’s net population growth would be from immigration,” said Lam. “We need to stop thinking about immigrants as this ‘other’ population, think beyond just teaching them English and finding them jobs and so forth,” he said.

Like other G-7 nations, Canada has long lacked a sustainable vision for building housing and providing healthcare to support its growing population, said Lam. It’s time to ensure that the government supports immigrants and seniors, he added. This is going to take a larger vision and a willingness to accept that immigrants are not simply one segment of the population with unique needs, he said. “They’re not.”

Canada has always led the way in welcoming immigrants, Lam continued. “We have a lot of strength and experience to draw from, and there is an ingrained spirt of being welcoming in our population. I am hopeful, but I think that there needs to be political will to make decisions happen.”

Shen’s study was unfunded. Shen, Tong, Salma, and Lam reported no relevant financial relationships.

Liz Scherer is an independent health and science journalist based in the United States.