Among the older population many older adults experience a sense of 'double jeopardy' of risk factors causing them to become vulnerable and at a disadvantage within the health care system. Depending on the status of one’s social determinants of health and experience throughout the life course as the individual surpasses 65+ they can become vulnerable economically, financially, psychologically and socially. Social determinants of health are what influence our health outcomes and in turn have long term impacts on our health and can make us more or less vulnerable within the health care system. Schröder-Butterfill & Marianti (2006) defines vulnerability by reviewing a person's exposure, threats, coping strategies and outcomes that follow. This approach to vulnerability considers the life course approach while addressing how social determinants of health influences one’s susceptibility to being vulnerable. The older population has many risk factors that can label the individual as part of the vulnerable population. Many older adults experience more than one risk factor the puts them at a great disadvantage within the health are system. For example, older women are more likely to being vulnerable than men and if an older woman is indigenous she is at an even greater risk of poor health outcomes due to compounding disadvantages. Three main risk factors that contribute to vulnerability in older adults include; health status, cognitive ability and social network (Seniors First BC, n.d). The following are characteristics that determine certain groups within the older population as vulnerable groups (United Way Seniors Vulnerability Report, 2011):
The “oldest old” women (85+);
Unattached, single-income seniors;
Visible minority seniors;
Aboriginal seniors;
Recent immigrant seniors;
Seniors without a certificate, degree, or diploma; and,
Seniors with mobility limitations and/or chronic illnesses.
In addition to characteristics that help us determine who is vulnerable among the older population there are health determinants that the individual cannot always control that create health inequities and barriers to accessing heath care that ultimately make the individual vulnerable and lead to poor health outcomes. This is where policy change must recognize the various vulnerable groups within the older population and implement structures and policies to improve the health care system in order to; a) break down the barriers effecting vulnerable groups from getting the care and services they need b) help prevent older adults from becoming vulnerable or having compounding disadvantages.
A study completed by United Way Ottawa (2017) found that low income, living alone, geographic location, care giving, gender, older adults living wit disabilities and sexuality are the major contributing social determinants of health that influence vulnerabilities in the older population. As there are several vulnerable groups within the older population, for the sake of this blog post I will be focusing on older immigrant women as a vulnerable population. One of the most underserved and vulnerable groups within the aging population is older immigrant women (Guruge,Birpreet & Samuels-Dennis, 2015).
Older Women as a Vulnerable Group
Firstly I will review specific risk factors associated with vulnerability later in life for women. Women live longer than men and are at higher risk for social isolation which can worsen with the presence of chronic disease (United Way Ottawa, 2017). The phenomenon of women living longer than men is termed “feminization of aging” and influences the health outcomes and health status of women (Davidson, Digiacomo & Mcgrath, 2011). Older women typically have lower income then men and are more economically fragile (United Way Ottawa, 2017). Below is the ratio of women to men over the age of sixty-five.
According the WHO (2007) "A life-course perspective calls on policymakers and civil society to invest in the various phases of life, especially at key transition points when risks to well-being (p.5)." It is crucial that health care professionals recognize and are aware of specific risk factors for women related to vulnerability and disadvantages within health care in order to improve services and better serve older women as a vulnerable group. The following is a list of risk factors that women experience throughout the life-course that are likely to cause later life vulnerabilities.
Older Immigrant Women-The Double Jeopardy
As mentioned, many older adults face double jeopardy scenario's, or compounding disadvantages that hinder equitable access to health care causing poor health outcomes. Being a female and an immigrant puts the older adult at en even greater disadvantage then just being female or older. In this scenario there is actually three contributing risk factors causing reduced health outcomes; 1) gender 2) age and 3) immigrant status. Luo and Porch (2018) found that older immigrants were less likely to seek health care services due to predisposing factors (language, cultural and health beliefs), enabling or disabling factors at community and family levels (distance to hospitals and other health resources) and ‘needs factors’ for example the reasons for needing health care services. According to Um & Lightman (2017) 44% of the population of one of Ontario's most multicultural cities (Greater Toronto Area) are long-time immigrants (31+years). Below is the immigration status and time in Canada among the older population living in the GTA.
How can we Better Serve our Older Immigrant Women in Home Care?
Relevant to my role in home and community care it is important for service providers to identify vulnerable individuals in order to reduce health inequities and better serve the older population. However, there is a lack of policies and structures in place that help home care providers specifically assess vulnerabilities of individuals within the community. A common challenge among older immigrant women in home and community care is language barriers. Older immigrant women don't have the same ability to communicate with their workers and this certainly makes them more vulnerable compared to other older English speaking women. As a home care provider we do not have the capacity to equip older immigrant women with resources to help them in communicate their home care needs or concerns.
Another issue faced by older women in general in home and community care is the challenge of male to female workers. Meaning most older women prefer female only workers, however, sometimes providers are only able to offer male workers in the home in which case the client will often cancel there visit and not receive the care they need. This becomes a compounding disadvantage for older immigrant women as language, values and beliefs can defer them from accepting care.
A recommendation to better serve vulnerable groups in home and community care like older immigrant women is to integrate social services and resources as a part of the home care assessment to ensure we are providing individuals equal access to using home care services. However, funding is a major set back in the regard of social work being implemented into home care and only individuals with very specific criteria are provided social services while navigating throughout home care.
Nesbitt & Palomarez (2016) support the importance of educating and properly equipping health care providers to identify, recognize and reduce vulnerabilities among the older population in stating:
Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient’s cultural background to promote healthy behaviors.
A study on A Profile of Vulnerable Seniors in the Ottawa Region (2017) created a recommendation of a vulnerability index to be used at regional levels to better identify who of the older population is vulnerable and why and then implement interventions accordingly. The vulnerability index could be adapted by home and community care services to assist in improving home care to older vulnerable clients. This would allow regions to address specific population needs and utilize resources appropriately.
There is also a need for health care providers and professionals to implement strategies that detect susceptibility to later life health disadvantages and vulnerabilities. Preventative strategies can help reduce our vulnerable groups within the older population. It would be beneficial to have policies in place within the health care system in order to better identify and trigger health care professionals of individuals who are likely to become vulnerable due to the status of there social determinants. There is also a gap in addressing the complexities of the double jeopardy scenario of older adults and as the population ages older adults will begin to face several risk factors increasing the risk for poor health outcomes and further challenges within the health care system.
To conclude, as our older population continues to grow more older adults will become vulnerable and experience more than one risk factor influencing poor health outcomes and disadvantages. Thus, policies overlooking service providers must adapt to support the prevention of worsening controllable risk factors as well as create strategies to improve health care services for existing vulnerable populations.
References
Chappell, N., & Havens, B. (1980). Old and Female: Testing the Double Jeopardy Hypothesis. The Sociological Quarterly, 21(2), 157-171. Retrieved from http://www.jstor.org/stable/4106148
Davidson, P. M., Digiacomo, M., & Mcgrath, S. J. (2011). The Feminization of Aging: How Will This Impact on Health Outcomes and Services? Health Care for Women International, 32(12), 1031-1045. doi:10.1080/07399332.2011.610539
Guruge, S., Birpreet, B., & Samuels-Dennis, J. A. (2015). Health Status and Health Determinants of Older Immigrant Women in Canada: A Scoping Review. Journal of Aging Research, 2015, 1-12. doi:10.1155/2015/393761
Lightman, N., & Um, S. (2017). Seniors’ Health in the GTA: How Immigration, Language, and Racialization Impact Seniors' Health.Retrieved July 16, 2019, from http://www.wellesleyinstitute.com/wp-content/uploads/2017/05/Seniors-Health-in-the-GTA-Final.pdf
Luo, H., & Proch, K. (2018). Factors Affecting Healthcare Access for Older Immigrants: A Qualitative Study with Service Users and Healthcare Social Workers in a Central Canadian City. Gerontology & Geriatrics Studies, 3(3). doi:10.31031/ggs.2018.03.000561
Nesbitt, S., & Palomarez, R. E. (2016). Review: Increasing Awareness and Education on Health Disparities for Health Care Providers. Ethnicity & disease, 26(2), 181–190. doi:10.18865/ed.26.2.181
Schröder-Butterfill, E., & Marianti, R. (2006). A framework for understanding old-age vulnerabilities. Ageing and society, 26(1), 9–35. doi:10.1017/S0144686X05004423
Seniors First BC. (n.d.). Vulnerability. Retrieved July 8, 2019, from http://seniorsfirstbc.ca/for-professionals/vulnerability/
United Way Ottawa. (2017, June). A Profile of Vulnerable Seniors in the Ottawa Region. Retrieved July 8, 2019, from https://webcache.googleusercontent.com/search?q=cache:qw5zZzdXC_UJ:https://www.unitedwayottawa.ca/wp-content/uploads/2017/06/A-Profile-of-Vulnerable-Seniors-in-the-Ottawa-Region-EN.pdf &cd=4&hl=en&ct=clnk&gl=ca
United Way Seniors Vulnerability Report. (2011). Retrieved July 8, 2019, from https://cnpea.ca/en/resources/reports/942-united-way-seniors-vulnerability-report
World Health Organization. (2007). Women, Ageing and Health: A Framework for Action. Retrieved July 16, 2019, from https://apps.who.int/iris/bitstream/handle/10665/43810/9789241563529_eng.pdf;sequence=1
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