Invisible Voices: An Intersectional Exploration of Quality of Life for Elderly South Asian Immigrant Women in a Canadian Sample

"You're Not Understood, and You're Isolated": A Narrative Account of Loneliness by Black Older Adults in Ontario, Canada

Loneliness among older adults is a leading health and social concern globally and in Canada, including racialized and minoritized groups. Although previous studies have explored loneliness among ethnic minoritized groups in Canada, little is known about the constellating factors contributing to loneliness among native-born and immigrant Black older adults (BOAs) in Canada and their unique ways of dealing with the experience. Our study explores the constellating factors shaping loneliness experiences among BOAs living in Ontario. Using a narrative approach, we purposively selected and interviewed 13 BOAs. Time as a driver of change, a sense of belonging reinforced through place identity, and challenges of making a new home were dominant themes. Our finding highlights the need for increased cultural sensitivity at the micro and macro levels, which will improve a sense of belonging and reduce loneliness among racialized immigrant older adults.

Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains

This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.

Religiosity, Aging in the Homeland, and Growing Old in the Diaspora: A Longitudinal Study of Two Cohorts of Indian Older Adults

This article reports a longitudinal study comparing religiosity among two cohorts of Indian older adults-those who age in the homeland of India (AIH cohort) and immigrants (to the USA) or diaspora older adults (DOA). Results indicated that AIH and DOA cohorts' religiosity outcomes were comparable at baseline but there was a statistically significant increase in all outcomes of the DOA cohort at subsequent time points. Women and single older adults in both the cohorts had higher religiosity scores at baseline. Religiosity scores were higher among those in the DOA cohort who migrated following marital disruption (widowhood, divorce) or grandchild birth and lived with adult immigrant children and their families. The immigration process can have an impact on religious orientation of older adults and place is a significant variable impacting religiosity possibly for augmenting the sense of self, acquire social capital and preserve cultural identity in the foreign land.

"Think positive and don't die alone" - Foreign-born, South Asian older adults' perceptions on healthy aging

South Asians are the largest and fastest-growing racialized group in Canada, yet there are limited data on various aspects of health and well-being within this population. This includes the South Asian older adults' ethnoculturally informed perceptions of ageing. The study aimed to understand how social and cultural forces impact the meaning assigned to healthy ageing amongst older South Asians in Canada. We recruited with purposeful and snowball sampling strategies in Southern Ontario. We conducted in-depth focus group and individual interviews (n = 19) in five South Asian languages, employing a multilingual and cross-cultural qualitative approach. In our analysis, we identified three central themes: (a) taking care of body (b) taking care of mind and heart and (c) healthy ageing through the integration of mind and body. Our study demonstrates that older immigrants are a diverse and heterogeneous population and that their conception of healthy ageing is strongly influenced by their country of origin. This study also demonstrates how racialized foreign-born older adults might provide distinctive perspectives on the ageing process and on social theories of ageing due to their simultaneous immersion in and belonging to global majority and global minority cultures. This research also adds to the limited body of literature on the theories of ageing, despite migration trends, still has a white-centric lens.

Neighbourhood Ethnic Density, Local Language Skills, and Loneliness among Older Migrants-A Population-Based Study on Russian Speakers in Finland

So far, little attention has been paid to contextual factors shaping loneliness and their interaction with individual characteristics. Moreover, the few existing studies have not included older migrants, identified as a group who are vulnerable to loneliness. This study examined the association between neighbourhood ethnic density (the proportion of own-group residents and the proportion of other ethnic residents in an area) and loneliness among older migrants. Furthermore, we investigated whether local language skills moderated this association. A population-based representative survey (The CHARM study, n = 1082, 57% men, mean age 63.2 years) and postal code area statistics were used to study Russian-speaking migrants aged 50 or older in Finland. The study design and data are hierarchical, with individuals nested in postcode areas. We accounted for this by estimating corresponding mixed models. We used a linear outcome specification and conducted logistic and ordinal robustness checks. After controlling for covariates, we found that ethnic density variables (measured as the proportion of Russian speakers and the proportion of other foreign speakers) were not associated with loneliness. Our interaction results showed that increased own-group ethnic density was associated with a higher level of loneliness among those with good local language skills but not among those with weaker skills. Good local language skills may indicate a stronger orientation towards the mainstream destination society and living in a neighbourhood with a higher concentration of own-language speakers may feel alienating for those who wish to be more included in mainstream society.

The Impact of Music Therapists’ Perspectives on Quality of Life in Building Relationships with Older Adults with Chronic Illness

Older adults with chronic illnesses have diminished qualities of life (QoL) due to physical and mental decline. To promote their QoL, music therapists create meaningful shared music experiences and positive therapeutic relationships to address their psychosocial needs. However, within this relationship-building process, healthcare professionals, staff, and even caregivers appear to project their own perceptions and expectations of what positive QoL of older adults should be. This misapprehension may challenge therapists to meet older adults’ actual QoL needs adequately. To date, no studies have explored music therapists’ perspectives on QoL in building relationships with older adults experiencing chronic illness. Eleven music therapists participated in online, semi-structured phenomenological interviews that were thematically analyzed. Three themes emerged: participants gained an increased awareness of unconscious biases, a deepened understanding of older adults’ QoL, and a purposeful alignment with older adults’ QoL. These highlighted the significance of therapists’ consistent self-reflection within the relationship-building process. Identifying their shared commonalities with older adults guided therapists to engage with clients more salutogenically and empathically. Additionally, recognizing their own biases being projected onto older adults empowered therapists to be more intentional to reconcile their perceptual discrepancies while prioritizing older adults’ authentic voices and capable selves.

Understanding racialised older adults' experiences of the Canadian healthcare system, and codesigning solutions: protocol for a qualitative study in nine languages

INTRODUCTION

Racialised immigrant older adults (RIOAs) in Canada have poorer self-rated health and are more likely to report chronic conditions, while they concurrently experience well-documented challenges in navigating and accessing the healthcare system. There is strong evidence that patient and caregiver engagement in their healthcare leads to improved management of chronic disease and better health outcomes. International research suggests that engagement has the potential to reduce health disparities and improve quality of care. We aim to (1) describe what role(s) RIOAs are/are not taking in their own healthcare, from the perspectives of participant groups (RIOAs, caregivers and healthcare providers (HCPs)); and (2) develop a codesign process with these participants, creating linguistically aligned and culturally aligned tools, resources or solutions to support patient engagement with RIOAs.

METHODS AND ANALYSIS

Using a cross-cultural participatory action research approach, our work will consist of three phases: phase 1, strengthen existing partnerships with RIOAs and appropriate agencies and cultural associations; phase 2, on receipt of informed consent, in-depth interviews with RIOAs and caregivers (n=~45) and HCPs (n=~10), professionally interpreted as needed. Phase 3, work with participants, in multiple interpreted sessions, to codesign culturally sensitive and linguistically sensitive/aligned patient engagement tools. We will conduct this research in the Waterloo-Wellington region of Ontario, in Arabic, Bangla, Cantonese, Hindi, Mandarin, Punjabi, Tamil and Urdu, plus English. Data will be transcribed, cleaned and entered into NVivo V.12, the software that will support team-based analysis. Analysis will include coding, theming and interpreting the data, and, preparing narrative descriptions that summarise each language group and each participant group (older adults, caregivers and HCPs), and illustrate themes.

ETHICS AND DISSEMINATION

Ethics clearance was obtained through the University of Waterloo Office of Research Ethics (ORE #43297). Findings will be disseminated through peer-reviewed publications, presentations and translated summary reports for our partners and participants.

"My Existence is not Haram": Intersectional Lives in LGBTQ Muslims Living in Canada

Little is known about the lived experiences of Lesbian, Gay, Bisexual, Transgendered and Queer (LGBTQ) Muslims living in Canada. Using an intersectional theoretical perspective and a qualitative methodology, this paper examines key themes emerging in the stories of six LGBTQ Muslim women and men living in Canada. The key themes emerging in this research were the tension between perceived family obligations and religious values, the ambiguous relationship with Islam, and coping with mental health issues. The research points to the importance of understanding such experiences as occurring in a matrix of identities and processes, as postulated by intersectionality theory.

Finding the Silver Lining: Aging Well Amongst Older Brazilian Women in the Post-Migration Context

STUDY BACKGROUND

The aging population in Canada has been increasing steadily over the past 40 years, however, there is limited information about the meaning of aging well amongst older Brazilian women in Canada.

METHODS

A Heideggerian interpretive phenomenology study was conducted to understand the meaning of aging well amongst older Brazilian women in the post-migration context living in the Greater Toronto Area (GTA) in Ontario, Canada.

RESULTS

Eight older Brazilian women residing in the GTA were recruited through purposive and snowball sampling and participated in individual face-to-face interviews. Through data analysis and the incorporation of Heidegger's four existentials of human existence, the themes that emerged were (a) Embracing being part of a mosaic, (b) Aging with grace, (c) Chasing your dreams and (d) Being a bridge and not a fence. The overarching theme was: Finding the silver lining: Aging well.

CONCLUSION

This study informs nursing practice, research and policy development to advance the health of older immigrant adults in Canada.

Facilitators and Barriers to Healthy Midlife Transition among South Asian Immigrant Women in Canada: A Qualitative Exploration

Background: South Asian immigrant women make up the largest visible minority in Canada, where visible minorities include persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour, and approximately half of these women are above the age of 35. Few studies have investigated the factors that impact the midlife transition for these women. This study aims to identify the facilitators and barriers experienced by South Asian immigrant women during the midlife transition. Methods: Two focus groups and ten one-on-one interviews about the midlife transition were held with South Asian first-generation immigrant women in the Greater Toronto Area, Ontario, Canada; discussions were analyzed thematically. Findings: Personal facilitators to the midlife transition included being employed and possessing adequate life skills. Personal barriers consisted of financial strain, overwhelming demands, and limited life skills. Familial facilitators were stable financial status and support. Familial barriers included limited understanding and support and high expectations. Community facilitators included a close social circle and adequate healthcare. Community barriers were limited social support and cultural expectations. Fair and respectful societies were a facilitator, whereas inadequate policy support and acculturative stress were societal barriers. An environmental barrier was the colder Canadian climate. Discussion: Employment and education programs for South Asian immigrant women need to be prioritized to help them integrate into society. Family-centred assessment and education can improve familial support. Communities need to foster peer support groups and culturally sensitive healthcare. Social and employment policies should accommodate the midlife transition. Conclusions: South Asian immigrant women experience unique facilitators and barriers to their midlife transition that should be considered by healthcare providers, policymakers and society to support them.

Social isolation and loneliness among immigrant and refugee seniors in Canada: a scoping review

Purpose

Social isolation and loneliness are global issues experienced by many seniors, especially immigrant and refugee seniors. Guided by the five-stage methodological framework proposed by Arksey and O’Malley and more recently Levac, Colquhoun and O’Brien, the purpose of this paper is to explore the existing literature on social isolation and loneliness among immigrant and refugee seniors in Canada.

Design/methodology/approach

The authors conducted a literature search of several databases including: PubMed; MEDLINE; CINAHL; Web of Science; HealthStar Ovid; PschyInfo Ovid; Social Services Abstracts; AgeLine; Public Health Database, Google Scholar and Cochrane Library. In total, 17 articles met the inclusion criteria.

Findings

Based on the current literature five themes related to social isolation and loneliness emerged: loss; living arrangements; dependency; barriers and challenges; and family conflict.

Research limitations/implications

Given the increasing demographic of aging immigrants in Canada, it is useful to highlight existing knowledge on social isolation and loneliness to facilitate research, policy and programs to support this growing population.

Practical implications

The population is aging around the world and it is also becoming increasingly diverse particularly in the high-income country context. Understanding and addressing social isolation is important for immigrant and refugee seniors, given the sociocultural and other differences.

Social implications

Social isolation is a waste of human resource and value created by seniors in the communities.

Originality/value

The paper makes a unique contribution by focusing on immigrant and refugee seniors.