United Way Seniors Vulnerability Report 2011 - The … · United Way Seniors Vulnerability Report...

United WaySeniors Vulnerability Report

Aging with Dignity - Making it Happen for Everyone

2011

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Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Investment for seniors is a United Way priority . . . . . . . . . . . . . . . . . . . . . . . . . 6

Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Multiple dimensions of vulnerability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Seniors population projections and socio-demographic overview . . . . . . . . . 14

Economic security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Mental and physical health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Emotional wellbeing and living arrangements . . . . . . . . . . . . . . . . . . . . . . . . . 28

Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Transportation, transit and walkability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Physical mobility and the built environment . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Recommended strategic directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Table of contents

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This report could not have been possible without the support and guidance of the following advisors:

• Aileen Murphy (City of Surrey) • BeverleyPitman(UnitedWayoftheLowerMainland) • JohnStark(CityofNewWestminster) • MariamLarson(VoicesofBurnabySeniorsandNewWestminsterSeniorsNetwork) • MargaretManifold(CityofBurnaby) • NeilSpicer(MetroVancouver) • TuckerDoud(UnitedWayoftheLowerMainland) • VivChristison(NorthShoreSeniorsPlanningTable)

Wealsothankthefollowingexpertsfortheirinsightfuldiscussionsoftopicsrelevant tovulnerabilityamongseniorsinMetroVancouverandtheSeatoSkycorridor.

• AkberMithani(ClinicalAssociateProfessor,DepartmentofPsychiatry,UBCandVicePresident,CentreofInnovation,ProvidenceHealth)

• AndreaProcyk(ProjectCoordinator,SchoolofCommunityandRegionalPlanning,UBC)

• Jean-FrancoisKozak(Co-Director,PrimaryCareoftheElderlyResearchGroup, DepartmentofFamilyandCommunityMedicine,ProvidenceHealthCare)

• LawrenceFrank (Professor,SchoolofCommunityandRegionalPlanningand BombardierChairinSustainableTransportation,UBC)

• KarenKobayashi(AssociateProfessor,SociologyandResearchAffiliate,CentreinAging,UVic)

• MaureenAshe(AssistantProfessor,DepartmentofFamilyPracticeandInvestigator,CentreforHipHealthandMobility,UBC)

Inaddition,wethankEricHertzmanforhis technicalexpertise inproducingthehighlyinformativeandvisuallystrikingmapsforthisimportantproject.

We gratefully acknowledge the ongoing activities of Statistics Canada and, in particular,itsvaluableworkwiththelongformcensus.

Finally,weareespeciallygrateful to theSocialPlanningandResearchCouncilof BritishColumbia(SPARCBC)forleadingandcoordinatingtheresearchandanalysisworkforthisproject.

Acknowledgements

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This report focuses on vulnerable seniors inMetroVancouverandtheSeatoSky corridor.1Itrecognizesmultipledimen-sions of vulnerability in order to grasp thesituationofat-riskseniorsandiden-tifywaystoimprovetheirqualityoflife.

The contents of this report are based on a review of relevant statistics and secondary literature pertaining to the qualityof lifeofvulnerableseniors inour region,asdiscussed ina seriesofdiscussion papers authored by scholars and researchers from post-secondary institutions and public interest research organizationsinBC.

The report is divided into several sections,eachofwhichfeatureskeyfactsanddiscussionpoints.Throughoutthereport, maps are presented regarding

conditions affecting seniors which in turn identify ‘hot spots’ or clusters of at-riskseniors inMetroVancouverandwherepossibletheSeatoSkycorridor.

Socio-demographic indicators are pre-sentedafterthis introduction,whichisfollowedby a discussion of economicsecurityissuesaffectingseniors.Mentaland physical healthmatters negative-ly affecting seniors are explorednext.The livingarrangementsandemotion-alwell-being of seniors are discussedin the subsequent section, which is followed by a review of key housingfacts and trends contributing to seniors’ vulnerability. Transportation, tran-sitandissuesofwalkabilityforseniorsconstitutes the next section.The sec-ond last section focuses on physical mobility and related considerations

for the built environment. Strategicdirections for research, services/pro-gramsandpolicypertainingtovulner-able seniors are described in the final section in an effort to advance the dialogue andactionleadingtowardimprovedwellbeingforallseniorsinourregion.

The report is accompanied by six discussionpapers,eachofwhichelaborates ononedimensionofvulnerability.Ninecommunity information bulletins serveasadditionalcompanionsto thisreport,providing analysis of key socio-demo-graphic and economic indicators for municipalitiesintheregion.Thebulletinsareintendedforuseatthemunicipallevelandbyseniors’communityplanningtables.

Introduction

1 Seniorsaredefinedaspeopleaged65orolderunlessotherwisestated.Formoreonthisdefinition,see:Turcotte,M.,&Schellenberg,G.(2007).Catalogue no. 89-519-XIE. A Portrait of Seniors in Canada. ProducedforStatisticsCanada:SocialandAboriginalStatisticsDivision.RetrievedonJuly22,2011.www.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=89-519-XIE&lang=eng.

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UnitedWayhasbeensupportingservicesforseniorsintheMetroVancouver/SeatoSkyareafordecades.

Researchdemonstratesthatbyfocusingonthefollowingissuesfacedbyseniors,wecanstrengthenourcommunityinawaythatbenefitsusall.

Withoneinfiveseniorslivinginpoverty–andwithseniorssoontooutnumberchildreninmanyLowerMainlandcom-munities–wefaceagrowingriskofse-niorvulnerabilityandisolation.Ignoringtheirneedstodaymeanstoughchallengestomorrow,astheimpactofdemographicchangequickensandtheimplicationsofanagingsocietyisfeltbyallofus.Whenolderpeoplearelonelyandisolated,poororhomeless,wealllose.

UnitedWay is helping seniors to agewell–intheirownhomesandcommuni-ties,surroundedbyfriends,familiesandcaregivers.Ourgoalisindependentandengaged seniors who contribute fully to society.Byproviding seniorswith thesupporttheyneed,UnitedWaypreventsisolation, loneliness,andrelatedhealthproblems.Wecanchangethefuturebyhelping seniors live independently for as longaspossible.

Today,UnitedWayoftheLowerMainlandisacatalyst foractionbyorganizationsand individuals devoted to strengthening ourcommunity.Forexample,UnitedWay helped to establish and is now funding 10 seniors community planning tablesthroughout the region and in 2011, a regionalseniorcommunityplanningtablewaslaunched.

UnitedWaybringstogethertheresourcesneededtoimprovelivesandstrengthencommunities.Weinvest inpreventative socialservicesthroughout23communi-ties,fromPembertontoLangley.Together, withanetworkofcommunitypartners,we’re building a healthy, caring and inclusivecommunity.

UnitedWayoftheLowerMainlanddoesmorethanraiseanddistributefundstothecommunity.

Wepreventproblemsby:

• Focusingonunderlyingcauses;

• Engagingincommunity-based planningsolutions;and,

• Strengtheningcommunitycapacitytohelpthosewhoarevulnerable.

Webuildpartnershipsby:

• Identifyingsharedgoalsfor communitychange;

• Providingthefoundationfor communitiestoworktogether; and,

• SupportingthemostcomprehensivesocialservicecollaborationinBC.

Investment for seniors is a United Way priority

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It is a priority for United Way of the Lower Mainland to work together with partners to support an active aging agenda and ensure that seniors have the opportunity to live well and contribute to the community.

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Thisreportfocusesonkeysocio-demo-graphicandeconomicfactspertainingtovulnerableseniors inMetroVancouver and the Sea to Sky corridor. Special attention is paid to analyzing and discussing primary data and related issues that affect older adults who are at-riskinvariousways.

The purpose of this report is to review factors facing vulnerable seniors in order tobuildavisionforhowtheUnitedWay oftheLowerMainland(UWLM)cantarget investments and work with commu-nity partners to create supportive,age-friendly communities. The reportbuilds on the goodwork already go-ing on in communities and adds im-portant insights about how to tacklethe social, economic, cultural andbuilt environment-related conditions thathavethegreatestdetrimentalimpacton the livesofolderadults.Themapsfeatured throughout the report highlight areas of the region where concentrations ofat-riskseniorsresideandwhere themostworkneedstobedone.

This summaryprovidesa snapshotof the key facts and discussion points presentedinthebodyofthereport.

Key socio-demographic highlights

• In 2010, therewere an estimated677,770seniorsinBritishColumbia. InMetroVancouver,2 there were 316,972 seniors (13percentof thetotal population). The Squamish LillooetRegionalDistrict3had3,152seniors(8percentofthetotalpopu-lation).

• Thefirstbabyboomers (bornbe-tween1947and1956)areturning65thisyear.Thetotalnumberof55to64yearoldsinMetroVancouverin2006wasalmostaslargeasthetotalnumberofseniors65+inthesameyear.Weareonthevergeofamajordemographicshiftasbabyboomers hit their senior years: by 2036, MetroVancouver’s65+populationisexpectedtomorethandouble–closeto1in4peoplewillqualifyasa‘senior.’

• Women comprise 56.1 percent ofall seniors in theLowerMainland(2006).Amongseniors85+,women outnumbermenbymorethan2to1.

• Over half of allMetroVancouver seniors in 2006 immigrated to Canada with 77 percent arriving in1990orbefore.Recentimmigrant

seniors arriving in 2001 or after totaled 5,900 inMetroVancouver in2006,makingupjust2percentofallseniors.

• AlmostonethirdofseniorsinMetro Vancouver consider themselvesmembersofavisibleminoritygroup.This is the highest incidence of visible minority seniors in any metropolitanareainCanada.

• MetroVancouverhasalargenumber of seniors and older adults with different mother tongues. Fifteenpercent speak neither English orFrench.

Key findings on seniors’ economic security

• Some groups of seniors aremore likely to fall below the before tax low income cut-offs (LICOs)4, and thus are more

Executive summary

2 Note:Statisticalinformationfor‘MetroVancouver’isutilizedtodescribecircumstancesfortheLowerMainland.The‘MetroVancouver’areaispopulatedbyresidentsofthefollowing21municipalities:Anmore,Belcarra,BowenIsland,Burnaby,Coquitlam,Delta,Langley(CityandDistrict Municipality),LionsBay,MapleRidge,NewWestminster,NorthVancouver (CityandDistrictMunicipality),PittMeadows,PortCoquitlam, PortMoody,Richmond,Surrey,Vancouver,WestVancouver,WhiteRock,ElectoralAreaAandtheGreaterVancouverRegionalDistrict(GVRD).DataforAbbotsford,ChilliwackandMissionarenotincludedinthisreport.

3 TheSquamish-LillooetRegionalDistrict(SLRD)iscomprisedoffourmembermunicipalities-Squamish,Whistler,PembertonandLillooet–andfourElectoralAreas–A,B,C,andD.Whereverpossible,thisreportfocusesonlyonPemberton,WhistlerandSquamishsincethesecommunitiesareservedbytheUnitedWayoftheLowerMainland.

In Metro Vancouver, projections suggest the 85+ population will increase by 200 percent by 2036 from 2006 levels, growing from 35,700 to 108,300.

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economically vulnerable. Thesegroupsincludeseniorwomen75+,bothmale and female unattached seniors, visible minority seniors,Aboriginal seniors, recent immi-grantseniors,andseniorswithoutacertificate,degree,ordiploma.

• Olderseniors(75+)aremorelikelytobelivingineconomicinsecurity:23percent–almost1in4–ofindi-vidualsaged75+inVancouverfellbelowthebefore-taxLICOin2006.

• Areas ofUWLM’s region that are“hotspots” for low-incomeseniorsinclude:Maillardville/Burquitlam,SouthBurnaby/NewWestminster,RichmondCityCentrearea,andtheDowntown Eastside/Downtown/MountPleasantareasofVancouver.

• SimilartoCanadaasawhole,MetroVancouverandSeatoSkycorridorhavewitnessedalargeimprovementintheeconomicinsecurityofseniorsover thepast threedecades.Since2007,however,thistrendseemstobe reversing forMetroVancouverseniors.

Key findings on seniors’ mental and physical health

• Thereisacorrelationbetweenlifeex-pectancyandsocio-economicstatus. Seniors in the region’s wealthier neighbourhoodsaremore likely tolive longer lives than those in poorer areas.

• SeniorsandolderadultsinBCdealwiththeimpactsofchronicdiseasedaily.InBC,27percentofseniorsliv-ingathomeand38percentofseniorsin carehomes experience chronic pain every day. In Richmond, 41 percent of seniors report suffering fromarthritis.

• InMetroVancouver,5to13percentofseniorsperceivethemselvestobelivingwith‘alotofstress.’

• AlmosthalfofallseniorsinBChaveadisability,withratesbeinghigherforwomenthanmen.

• Residents inMetroVancouverandSeatoSkycorridorarelivinglonger lives than ever before. In MetroVancouver,overall lifeexpectancyrangesfrom79to85years.

Key findings on emotional wellbeing and living arrangements for seniors

• Older adults who live alone andhavesmallsocialnetworksareoften believed to be vulnerable to de-creasedemotionalwell-beingduetotheirlimitedsocialconnections.

• InBC,27percentofseniors65+livealone.In2006,theproportionofse-niorsaged75+livingalonginMetroVancouverandSeatoSkycorridorrangedfrom16percentofseniorsinWhistlerto53percentofseniorsintheCityofLangley.Othercommuni-

tieswithlargeproportions(40per-centormore)of live-alone seniorsareBowenIsland,theCityofNorthVancouver,NewWestminster,WestVancouverandWhiteRock.

• Womenaremuchmorelikelythan

mentoliveontheirown.InBC’s65+population, 36percent ofwomen and17percentofmen livealone.Livingalone isalso influencedbyage, ethnicity, immigration status,andplaceofresidence.

• Social isolation ismorecommoninwomenthanmen,especiallyamongthose who are widowed, amongworking class older adults, andamongthosewhoareinpoorhealthandhavemobility limitations.Noteveryone livingalonecharacterizes themselves as vulnerable due to socialisolation.Somevaluetimealone as solitudewhileother experiencepainfulloneliness.

• Studies link largesupportivesocial networks to improved health outcomesinlaterlife;whereashaving a small unsupportive network in-creasesone’sriskforpoorphysicalandmentalhealth.

• The highest proportion of older adults in Metro Vancouver who perceivethemselvesashavinga lot of stress live in themore affluent areasofWestandNorthVancouver.

4 Low-incomecutoffs(LICOs)“representanincomethresholdwhereafamilyislikelytospend20percentmoreofitsincomeonfood,shelterandclothing thantheaveragefamily, leavingless incomeavailableforotherexpensessuchashealth,education,transportationandrecreation.LICOsare calculatedforfamiliesandcommunitiesofdifferentsizes”(StatisticsCanada2008).

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Key findings on seniors’ housing

• InMetroVancouver,thenumberofsenior led households in core hous-ing need5hasincreasedsince1996.IntheSeatoSkycorridor,therehasbeenasmallyearoveryearincreaseinthenumberofseniorledhouse-holdsincorehousingneed.

• Approximately 36 percent of all senior-led economic families in MetroVancouverwhorentedin2006werespending30percentormoreof their incomeonhousingcosts,while 12 percent were spending 50percentormore.

• A significant share of seniors living aloneareprecariouslyhoused.Ap-proximately 60 percent of unat-tached senior renters were spending 30percentormoreoftheir income

on housing while 26 percent were spending50percentormore.

• InMetroVancouver 6,990 seniorrenter households are in ‘worst case need.’Thesearehouseholdsthatarespendingmore than50percentoftheirincomeontheirhousingcostsandareconsideredtobeatextremeriskofbecominghomeless.

• The number of seniors living onthestreetsorstayinginemergency sheltersisontherise.Localplanning tablesandseniorserviceorganiza-tions across the region have recently reportedthepresenceoffrail,older

seniors (80+) inthesheltersystemforthefirsttime.

• Seniors social housing units are con-centratedinVancouverandBurnaby.Asof2011,therewere2,312seniorsonBCHousing’sApplicantRegistrywaitlist,upfrom1,946in2010.

Key findings on seniors’ transportation, transit and walkability

• Asweage,theworldwegetaroundinshrinks.Thetravelbehaviourofseniors65+isconsiderablydifferent

5 Ahouseholdisconsideredtobeincorehousingneediftheyareunabletofindhousingintheircommunitythatissuitableinsizeoringoodrepairwithoutspending30percentormoreoftheirincomeonhousingcosts.

Seniors living alone and older adults are more precariously housed. Based on the available 2006 data, approximately 60 percent of unattached senior renters were spending 30 percent or more of their income on housing while 26 percent were spending 50 percent or more.

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thanthatofotheragecohorts.Olderadults take fewer trips out of thehome and for different reasons. Vulnerable seniors, such as olderadultswithhealthconcerns,mobility impairmentsor low-incomes, leavetheirhomestheleast.

• Older drivers depend on private vehicles to make the majority oftheir trips.Olderadults’ability tooperateacar,however,canchangequickly and those living in car dependent environments can experiencea sudden lossof inde-pendence.Olderadultswhodonotdrivearereportedtomakeonlyhalfthenumberof tripsas theirolderdrivingcounterparts.

• Wide streets, limited railings andwalkways, fastcarsandadizzying pace of life can contribute to insecurity about navigating the community.Amixoflanduses(i.e. having a variety of destinations withinacloseproximity)andhigher density neighbourhoods with well connected streets encourage increased levels of physical activity as seniors canwalktoclosebyamenities.

• Walkability in Metro Vancouvervariesbyregion.Delta,Langley,PittMeadows,SouthSurreyandWestVancouverareareaswithlowwalk-ability and high concentrations of older adults. Delta,Maple Ridge,PittMeadows, South Surrey andWestVancouverarealsoareaswithlimitedaccesstotransit.

Key findings on seniors’ personal physical mobility and the built environment

• Approximately 134,645 seniors inMetro Vancouver experience ac-tivity limitations.The number ofactivity limitedmaleseniors (65+)falling below LICO (before tax)rosebetween2001and2006,from9,355individualsin2001to10,610 individuals in 2006.The numberof activity limited female seniors fallingbelowtheLICO(beforetax)also rosebetween2001and2006,from19,940individualsin2001to20,590individualsin2006.

• Sidewalks–theirpresence,location,materialandcondition–canplayanimportantroleinthelifeofanolder adult. This is especially true forthose older adults who have physical impairments.Thepresenceand lo-cationoflevel,unobstructedpath-waysencouragephysicalactivity.Alackofadequatecurbcuts,aswellascracksanddisruptionscausedbytreerootsareafallssafetyhazard.

• Getting outside has benefits forqualityoflifeandlongevity.Vulner-able older adults and seniors with reducedmobilitymaybeathigherrisk of poor physical andmentalhealth.

Key overall findings

Vulnerabilitiesinourseniors’population are concentrated in certain groups of 65+individualsintheMetroVancouverandtheSeatoSkycorridor.

Groupsmostaffectedinclude:

• The“oldestold”women(85+);

• Unattached,single-incomeseniors;

• Visibleminorityseniors;

• Aboriginalseniors;

• Recentimmigrantseniors;

• Seniorswithoutacertificate,degree,ordiploma;and,

• Seniors with mobility limitationsand/orchronicillnesses.

Weknowthatvulnerableolderadultsare often concentrated in certain neigh-bourhoodsinourregion.

Aswecontinueourworktogetherwithpartners to support an active aging agenda, theUnitedWayof theLowerMainland will pay increasing attention to these epicenters of need to help ensure that all older people – and especiallythemostvulnerable–havetheopportunity to both live independently as long as possible and participate in theircommunities to reap thepositivebenefitsofbeingincluded.

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Thisreportandaccompanyinginforma-tion(e.g.,discussionpapersandcommu-nity informationbulletins) are focusedon vulnerable seniors living in Metro VancouverandtheSeatoSkycorridor.Populationgroupsdefinedasvulnerable,ingeneral, identifywithsome typeofbarriertoaccessingagoodqualityoflife.

Dimensionsofvulnerabilityreferredtointhisreportandaccompanying informa-tionincludebutarenotlimitedto:

• Economic insecurity • Social isolation

• Inadequate and unaffordable housing

• Poor mental and physical health

• Inaccessible transportation and built environments

• Food insecurity

• Physical mobility limitations

• Marginalized identities and cultures

• Barriers to multi-lingual communication and lack of multi-lingual services

Below we define each dimension of vulnerability based on points raised in thecompaniondiscussionpapers.

• Economic insecurity: Seniors are consideredtobeeconomicallyinsecure when their household does not have availablemoneytobuyhealthyfood,affordappropriatehousing,payforutilitiesandservices,enrollinrecre-ationalactivitiesorcovermedicalanddentalcosts.InthisreportweutilizeStatistics Canada’s before tax low incomecut-offs (LICOs) tomeasureeconomicinsecurity.StatisticsCanada explains thatLICOs“representan incomethresholdwhereafamilyislikelytospend20percentmoreofitsincomeonfood,shelterandclothingthantheaveragefamily,leavinglessin-comeavailableforotherexpensessuch ashealth,education,transportation andrecreation.LICOsarecalculated for families and communities of differentsizes.”Individualscanhavealowincomebutnotlivein‘poverty’because they have financial assets and savingsthatmayhelpthemthroughhardtimes.

• Social Isolation: Seniors are generally thought to be socially isolated when theirsocialnetworksaresmall,weak,orlackingaltogether.Havingasmallunsupportive network increasedone’s risk for poor physical and mentalhealth.Notallolderadultswholivealoneconsiderthemselvesto be vulnerable because of their solitarylifestyle.

• Inadequate and unaffordable housing: Generally,anyhouseholdthatisexperiencinginadequateandunaffordable housing is said to be

incorehousingneed.Tobeincore housing need is to be unable to find housing in one’s community thatissuitable insizeor ingoodrepairwithoutspending30percentormoreof one’s income on housing costswithavailableresources.

• Poor mental and physical health: Physical and mental health is a complex interplay of biology andgenes,thesocial,culturalandphysi-calenvironmentsthatwelivein,thehealth services accessible to us and that we actually receive, and ourown individual behavior.To havereal or perceived poor health is a commonconditionformanyseniorsinourregionand limitedavailablelocaldatamakesitdifficulttoknowmuchaboutthehealthtrendsofourseniors.

• Inaccessible transportation and built environments:Olderadults whoexperiencetransportationandother services as inaccessible live in households where these things aredifficult to reach for somerea-son.Theymayhavephysicalmobil-ity limitations, live ina (suburban)householdwithoutacar,livetoofarawayfromabusstop,orlackthere-sourcestousepublictransit.Ortheymaylive inaneighbourhoodwith-outservices,likegrocerystores,andlackacartoovercomethedistancesinvolved.

• Food insecurity: A lack of food security is the absence of reliable

Multiple dimensions of vulnerability

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6 Althoughfoodinsecurityisnotaddressedinthisreport,thecommunityinformationbulletinsdoincludesomereferencetothelocationofgrocerystoresandtheirspatialrelationtowhereconcentrationsofvulnerableseniorsarelivinginourcities.FormoreinformationonfoodsecurityintheBCcontext,see:BCProvincialHealthOfficer.(2006).Food,healthandwell-beinginBritishColumbia:ProvincialHealthOfficer’sAnnualReport2005.Victoria,B.C.

accesstonutritiousfood.Foodsecurity is generally understood as the development of community food systems inwhich foodproduction,processing, distribution and con-sumptionareintegratedtoenhancetheenvironmental,economic,socialand nutritional health of a specific place.Foodsecurity is increasinglyframed as a social determinant ofhealth,whereweaknessesinthefoodsystemcanpresentbarrierstoaccess-ing healthy local food which can in turnleadtopublichealthproblems.6

• Physical mobility limitations: Personalmobilityisakeydeterminantofindependenceandqualityoflife.Definedasthecapacityofindividuals to physically move through their environment,goodmobilitycontrib-utestoadynamic,independentlife,andisfundamentaltohealthyaging.Whenapersonlosestheirabilitytomoveandnavigatetheirenvironment,theirworldshrinksdramaticallyandisoftenaccompaniedwithnegativehealthimpacts.

• Marginalized identities, cultures

and histories: Older adultswhoseidentities,culturesorhistoriesaremar-ginalized find themselves relegated to the fringes of society. Excludedfrommeaningfulparticipationinthelargersociety,theyareisolatedboth individually and as members of theirsocio-culturalgroup–inethnic enclaves,forexample.Materialdepri-vationisacommonresult.

• Barriers to multi-lingual commu-nication and lack of multi-lingual services: Older adults who face linguistic barriers generally do not possess either English or French languageskillsandarenotable to access services in their mother tongue.Thismaybebecausetheyaresimplynotavailableornotavailableatcoststheycanafford.

Seniors that identify with any one or combination of these dimensions of vulnerabilitymaybelessablethanothers tomeetandsafeguardtheirownneedsandinterests.Wheregroupsofolder adults experiencemultipledimensionsofvulner-ability,andliveinsuchcircumstancesoverextendedperiodsoftime,theoutcomeisoften troubling and persistent disparities withinandacrossourcommunities.

The data in this report suggest that disparitieswithinthe65+populationarequitecommoninourregion.Theyarenotinevitable,however.Manydisparitiesaretheresultofsocialpractices,publicpolicy priorities and a combination of action takenwithouttheneedsofoldermembersofthepopulationinmind.

To facilitate the identification of needed research,programsandpolicyinMetroVancouverandSeatoSkycorridorregard-ingseniors’healthandwellbeing, thisreportconcentratesonaselectionofkeydimensionsofvulnerabilityexperiencedbymanyseniorsinourregion.Throughthesefoci,weprovideanevidence-basedpictureofwhatcontemporaryissuesaffectthe lives of older adults as well as a lens throughwhichwecanlookintoafuturethatwehavetheabilitytoshapetoday.

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7 BCStatistics(2010).RegionalPopulationEstimates.RetrievedAugust24,2011. www.bcstats.gov.bc.ca/data/pop/pop/dynamic/PopulationStatistics/Query.asp?category=Census&type=RD&topic=Estimates&agegrouptype= Standard&subtype=&region=15000&year=2010&agegroup=5-year&gender=t&output=browser&rowsperpage=all

8 BCStatistics(2010).RegionalPopulationEstimatesandProjections.RetrievedAugust10,2011. www.bcstats.gov.bc.ca/data/pop/pop/dynamic/PopulationStatistics/SelectRegionType.asp?category=Census

In2010,therewereanestimated677,770seniors65+inBCmakingup15percentof the total provincial population. In Metro Vancouver there were 316,972 seniors (or 13 percent of the region’s pop-ulation).IntheSquamishLillooetRegion-alDistrict(SLRD)therewere3,152seniors(8percentoftheregion’spopulation).7

Weareonthevergeofamajordemo-graphicshiftasbabyboomershit their

senior years (the first baby boomersturned65thisyear).Projectionsindicate that by 2036 Canada’s population of seniorswill bedouble its 2006figure,growing from 14 to 25 percent of thecountry’stotalpopulation.Closeto1in4peoplewillqualifyasa‘senior.’

Seniorsaged85+,referredtoasthe“oldest old”, are the fastest growing segment ofseniors.InMetroVancouver,thetotal

numberof55 to64yearolds in2006 wasalmostaslargeasthetotalnumberofseniorsinthesameyear.8

By2036MetroVancouver’s85+popu-lation is to increase300percent (from35,700 in 2006 to 108,300). Figure 1 shows the projected growth of olderadults by age category from 1976 to2036.Note thegradual levelingof the55-64group.

Seniors population projections and socio-demographic overview

Figure 1: Projected number of adults 55+, by gender and age groups, Metro Vancouver, 1976-2036

Source: BC Stats. (2010). Regional Population Estimates and Projections. Retrieved August 24, 2011. www.bcstats.gov.bc.ca/data/pop/pop/dynamic/PopulationStatistics/SelectRegionType.asp?category=Census

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The number of seniors has grown substantiallybetween1996and2006inMetroVancouverandSeatoSkycensus subdivisions.Bynumbers,Surrey’s65+population grew most significantly, followedbyVancouverandRichmond. WhiteRockwastheonlyareatoseea decrease inthisagegroup.Bypercent, thesmallercommunitiesofPemberton

andWhistler experienced the fastestrate of 65+ population growth (333 percentand324percentrespectively). In2006,womencomprised56percentofallseniorsinMetroVancouver.Amongseniors85+, thereare twowomen to everyoneman.Seniorsarenotevenlydistributedacrossourregion.Population bycensustractshowthatseniorsmake

up25percentormoreofthepopulation inSouthSurrey/WhiteRock,partsof WestVancouverandahandfuloftracts inVancouver,Burnaby,NewWestminster andLangley.Figure 2 demonstrates the uneven growth of seniors populations inMetroVancouverfrom1996to2006.

Figure 2: Change in Metro Vancouver and Sea to Sky corridor seniors population, 1996 to 2006

Sea to Sky Corridor

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Aboriginalpeoples compriseda rela-tively smallpercentage (2percent) oftheregion’s2006totalpopulation.9Dueto a young age structure, this group comprised an even lower percentage ofMetroVancouver’s seniorspopula-tion–0.6percent (1,640 individuals)in2006.

Over half of all Metro Vancouver se-niors in 2006 immigrated to Canada,10 ofwhich themajority arrived prior to1990.11Seniorswhorecentlyimmigrated (between 2001 and 2006) total just5,900 in Metro Vancouver and aremost likely to live in Vancouver, SurreyorRichmond.Twoofthelargest

concentrationsofrecentimmigrantseniors wereinSurrey(Newtonarea),andRich-mondCityCentre.Seniors’populationsintheseareasweremorethan40percentrecent immigrants.The encircled areas are hot spots identified in mapping software.12 (see Figure 3)

Figure 3: Number of seniors in Metro Vancouver who immigrated to Canada between 2001 and 2006

Source:StatisticsCanada2006Census.Catalogue No. 97-557-XCB2006012. Immigrant Status and Place of Birth (38), Sex (3) and Age Groups (10) for the Population of Census Metropolitan Areas, Tracted Census Agglomerations and Census Tracts and (2006h). Catalogue No. 97-557-XCB2006018. Place of Birth (33), Period of Immigration (9), Sex (3) and Age Groups (10) for the Immigrant Population of Census Metropolitan Areas, Tracted Census Agglomerations and Census Tracts.

9 MetroVancouver.(2008).2006 Census Bulletin: Data on Aboriginal Peoples. RetrievedJuly30,2011. www.metrovancouver.org/region/aboriginal/Aboriginal%20Affairs%20documents/2006CensusBulletinOnAboriginalPeoples.pdf

StatisticsCanada(2006c).2006 Census. Age(123)andSex(3)forthepopulationofCensusMetropolitanAreas,TractedCensusAgglomerationsandCensusTracts,2006Census–100%Data.

StatisticsCanada(2006d)2006 Census. Catalogue No.97-557-XCB2006013.ImmigrantStatusandPlaceofBirth(38),Sex(3)andAgeGroups(10)for thePopulationofCanada,Provinces,Territories,CensusMetropolitanAreasandCensusAgglomerations,2006Census-20%SampleData.

Hotspotanalysisusesacombinationofgeography,statistics,andspatialanalyticparameters(distance,spatialrelationshipmodels)todeterminestatisticallysignificantconcentrationsofhighandlowvaluesbasedontheinputgeography.Thistypeofanalysisisperformedonseveralothermapsinthereport.

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At 32 percent,MetroVancouver hadthe highest percentage of visible mi-norities13 among its seniorpopulationofanymetropolitanarea inCanada, in2006.Visibleminoritiescomprisedhighpercentages of the seniors population in Richmond (52percentof seniorswere

visibleminoritiesin2006),Vancouver(47percent),andBurnaby(39percent).

Linguistically, most seniors in Metro VancouverspeakEnglish,but15percent speakneitherEnglishnorFrench.Metro Vancouver seniors who speak neither

officiallanguagewereheavilyconcentrated in Vancouver, Surrey, Richmond andBurnaby.Figure 4 shows the incidence ofseniorswhospeakneitherFrenchnor English,includinghotspots.

Figure 4: Percentage of seniors who speak neither English nor French in Metro Vancouver, 2006

Source: Statistics Canada. (2006i).2006 Census. TB_Ethnic_Minorities_97-562-XCB2006016. VisibleMinorityGroups (15), ImmigrantStatusandPeriodofImmigration(9),AgeGroups(10)andSex(3)forthePopulationofCanada,Provinces,Territories,CensusDivisionsandCensusSubdivisions,2006Census

TheEmploymentEquityActdefinesvisibleminoritiesas“persons,otherthanAboriginalpeoples,whoarenon-Caucasianinraceornon-whitein‘colour’” (StatisticsCanada,2006).

13

18

MetroVancouver has a large numberof older adults with diverse mothertongues.Bynumberofspeakers,themostcommonmother tongues in2006wereEnglish, Chinese, Cantonese, Punjabi andGerman (indescendingorder).53out ofMetroVancouver’s 409 censustractshadanon-Englishlanguageasthetopseniors’mother tongue.CantoneseandChinesespeakersarevisiblyconcen-tratedinVancouver’sEastside,primarilyalongKingswayandGrandviewHighway corridors as well as in Chinatown,

Strathcona,andRichmondCityCentre. Punjabi was the top seniors’ mothertongueinmanypartsofSurrey(Newton, Whalley and Fleetwood) and South Vancouver. Italianwas the topmothertongue among seniors inVancouver’s HastingsSunrisearea.14 Figure 5 shows themost commonmother tonguesby censustractintheregion.

The lack of English (or French) on the part of 15 percent of the region’s seniorsmeans thatabout38,470older

people are at a distinct disadvantage whenitcomestomeetingandsafeguard-ingtheirneedsandinterests.Itmakes themdependentuponEnglish-speakers in the family, neighbourhood and community who may or may not havetheolderperson’sneedsinmind.Perhapsmost obviously, the lack ofEnglish-speaking skills places theseseniorsatagreaterriskinrelationtohealth,legalandhousingservices.

Figure 5: Top mother tongues among seniors in Metro Vancouver, 2006

Source:StatisticsCanada.(2006l).2006Census.CatalogueNo.97-555-XCB2006014.DetailedMotherTongue(103),KnowledgeofOfficialLanguages(5),AgeGroups(17A0,andSex(3)forthePopulationofCensusMetropolitanAreas,CensusAgglomerations,andCensusTracts

Vancouver.(2011).NeighbourhoodProfiles.RetrievedJuly1,2011.http://vancouver.ca/community_profiles/communitylist.htm14

19

Content in this section is drawn from the discussion paper on seniors and economic security authored by SPARC BC.

Overall, the low income situation ofseniors in Canada has significantly improved over thepast four decades.

The percentage of seniors in Canada fallingbelowthebeforetaxLICOwentfrom43percentin1977to12percentin2009.BChaswitnessedasimilardrop.In theVancouverCensusMetropolitanArea, thepercentageof seniors fallingbelow the before tax LICO dropped

from51percentin1977to18percentin2009.Despitetheselongtermgains,itis important to note the recent increasein the percentage of seniors in Metro VancouverfallingbelowthebeforetaxLICObetween2007and2009.15

Economic security

Source:StatisticsCanada.(2011).Survey of Labour and Income Dynamics (SLID).Modifiedtable202-0802–PersonsinLowIncomeAnnual(After-TaxandBefore-Tax).

Figure 6: Percentage of seniors falling below the before-tax LICO, Canada, BC and Vancouver (1977 - 2009)

SurveyofLabourandIncomeDynamicsofCanadausesmetropolitanareasfordata,VancouverCMArepresentstheVancouverMetropolitanareaandhas thesameboundariesandjurisdictionscontainedwithinitasMetroVancouver(alsoknownastheGreaterVancouverRegionalDistrictincensusdata).

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StatisticsCanada(2008a)defineseconomicfamiliesas“agroupoftwoormorepersonswholiveinthesamedwellingandarerelatedtoeachotherbyblood,marriage,common-laworadoption.Unattachedindividualsreferstoindividualswhoarenotinaneconomicfamily.”TheSurveyofLabourandIncomeDynamicsdefineselderlypersonsas65+yearsofage,thesameasthedefinitionofseniorsusedinthisdiscussionpaper.

Almosthalf(46percent)ofallunattached seniors living alone were living below the before tax LICO rate in 2009. Bycontrast, seniors in economic familiesin theVancouverCMAhadbefore taxLICOratesof7percent.16Lowincomeamongmaleunattached seniors is lessprevalent than for female unattached seniors: the 2009before taxLICO for maleunattachedseniorswas43percent,

whiletherateforfemaleunattachedseniors was48percentinMetroVancouver.

Asmeasuredbythenumberofseniors falling below the before tax LICO levels in 2006, economic insecurity amongst seniors is most pressing in the following hotspots around the region: Maillardville/Burquitlam(womenespe-cially);SouthBurnaby/NewWestminster

(bothmenandwomen);RichmondCityCentrearea(bothmenandwomen,withfewermenbelowLICO);andDowntownEastside/Downtown/Mount Pleasant areas of Vancouver (both men and women).Themapsbelow show thatwomen reportedhigher rates of low income and in a greater number of concentratedareasthanmen.

Figure 7: Percentage of female seniors falling below the before-tax LICO by census tracts in Metro Vancouver, 2006

Source:StatisticsCanada,2006Census.UPP06_Table1-CT: UPP06_Table1:AgeGroups(34),Sex(3),IncomeStatusBeforeTax(3)andSelectedCultural,ActivityLimitationandDemographicCharacteristics(36)forthePopulationinPrivateHouseholdsofCensusMetropolitanAreas,TractedCensusAgglomerationsandCensusTracts,2006Census-20percentSampleData

16

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PembertonandtheCityofLangleyhadthe highest percentages of seniors falling belowthebeforetaxLICOamongseniors(menandwomen)in2006intheregion,at46percentand31percentrespectively, followedbyVancouver(27percent)andRichmond(25percent). Inotherwords,almost1in2olderadultsinPemberton, almost1in3inLangleyCityandabout 1in4inVancouverandRichmondwere poor. In contrast,manyof the smaller outer census subdivisions had no seniors living below the before tax LICO in

2006, with i.e. Anmore, Lions Bay, WhistlerandBowenIsland.Suchspatial variationshighlightthesocialpolarization ofincomeamongsttheregion’sseniors.

These below before tax LICO groupsinclude senior women over 75 yearsof age, unattached seniors (bothmale and female), visible minority seniors, Aboriginal seniors, recent immigrantseniorsandseniorswithout acertificate,degree,ordiploma.

Olderseniors(75+)aremorelikelytobelivingineconomicinsecurity:23percent –almost1in4–ofindividualsaged75+ in Metro Vancouver fell below the before-taxLICOin2006.Womeninthatage group had the highest incidence of low-income. Twenty-eight percent(19,015)ofwomenaged75+fellinthiscategory–ormorethan1in4women.

Figure 8: Percentage of male seniors falling below the before-tax LICO by census tracts in Metro Vancouver, 2006

Source:StatisticsCanada,2006Census.UPP06_Table1-CT: UPP06_Table1:AgeGroups(34),Sex(3),IncomeStatusBeforeTax(3)andSelectedCultural,ActivityLimitationandDemographicCharacteristics(36)forthePopulationinPrivateHouseholdsofCensusMetropolitanAreas,TractedCensusAgglomerationsandCensusTracts,2006Census-20percentSampleData

22

Aboriginal seniors had much higher incidencesofbeforetaxLICO(34percent) compared to non-Aboriginal seniors (21percent).Therewere1,450Aboriginal seniors in Metro Vancouver in 2006,490ofwhom fellbelow thebefore taxLICO.17Overonethird(34percent)ofallrecentimmigrantswereinlow-incomeas measured by before tax LICOmeasure in2006.Twenty-sevenpercentofvisible minority seniors fell below LICO compared to18percentofnon-visibleminority seniors living inMetroVan-couver.

Educationalsoappears toberelatedtowhetherseniorsarebelowthebeforetax

LICO; 27 percent ofMetroVancouver seniorswithnocertificate,nodiploma,ordegreewerebelowthebeforetaxLICOin2006.Incomparison,only16percentofMetroVancouverseniorswithpostsec-ondarycertificates,diplomas,ordegreeswerebelowLICObeforetax.18

ItisimportanttonotethatwhileseniorslivingbelowtheLICOcanbefoundin abundance in the region’s hotspots (16,875 in total), the totalnumberof seniorslivingbelowLICOinnon-hotspot areasishigh(36,255).

It is also worth noting that in 2004,therewereanestimated300,000seniors

eligible for GIS or the Survivors Allowance who had not applied.19,20 About50,000seniorswhowereeligible for OAS and had not applied and 55,000seniorseligible forCPPhadnotapplied. Elderly single women, one ofthemostvulnerablegroupsofseniors, wereamongthemostlikelytonotapply fortheireligiblebenefits. 21 More effort needs to be invested into informing seniorsaboutthesebenefits.

ThisisbasedonUrbanPovertyProjectdataonthebasisofansweringtheincomequestionsontheshort-formcensus.Somepeopledidnotanswertheincomequestion,therefore,thetotalnumberofAboriginalseniorsmaybeslightlylargerthanthetotalprovidedhere.

StatisticsCanada.(2006b).UPP06_Table-03: Age Groups (8), Sex (3), Income Status Before Tax (3) and Selected Educational and Labour Force Characteristics (84) for the Population 15 Years and Over Living in Private Households of Canada, Provinces, Territories, Census Divisions and Census Subdivisions, 2006 Census - 20% Sample Data

NoarticlewithmorerecentdataonthenumberofseniorsnotinformedaboutGISandOASwasfound.Therefore,the2004numberswereused. NationalCouncilonAging.(2005).AginginPovertyinCanada.FederalGovernmentofCanada.P.15 Ibid.P.15

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18

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20

21

23

Content in this section is drawn from the discussion paper co-authored by Dr. Jean Kozak and Dr. Akber Mithani.

Note:A lackofhealthdata forseniors inMetroVancouver/SeatoSkyCorridorisperhapsthemostsignificantlimitation of this report. While the Canadian Community Health Survey providessomeusefulhealthinformation,itreports at large geographies (Health Service DeliveryAreas) and is based on smallsamplesofolderadults.Seniors’healthdata is currently collected at the level of smaller geographies (the municipality and census tract) by the two health authorities intheregion,namelyFraserHealthAuthorityandVancouverCoastal Health Authority. However, it is not madeavailabletothepubliconauniform basis. As such, the following section relies on data from the Canadian Community Health Survey, BC-wide statisticsandsecondarysources.

Asweage,ourhealthgenerallydeclinesandhealthy livingbecomesapriority. But individuals 65 years and older, aswithanyagegroup,rangeinhealth from the fully independent healthyperson to the frail dependent person living in the community or institutionalsector.Theyincludepeople whoare at endof life requiringpainand symptom management controlall the way to those requiring onlyepisodic care through the health care system.

InBC,75percentofseniorswerefoundto have one or more chronic health

problems.22 Moreover, many 65+ live withchronicdailypain(about27percent ofthose livingathomeand38percent of those in care homes, compared to 15.5percentof adultsunder65 living at home).23 One of themore common chronichealthproblems inour region among seniors is arthritis. Figure 9 mapsratesof seniorswitharthritis in

theregion.Arthritisisexperiencedvari-ouslyacrosstheregionandexperiences rangefrom32percentofseniors inthe Richmond area to 40.8 percent in the NorthShoreandCoastGaribaldiregions. Variationscanalsobeseeninreported arthritisamongolderwomenandmen,withtheformertypicallyhigher.

Mental and physical health

ChapmanKR,TashkinDP,PyeDJ.GenderbiasinthediagnosisofCOPD.Chest.2001Jun;119(6):1691-5. Ramage-MorinPL.ChronicpaininCanadianseniors.StatisticsCanada.2008.

22

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24

Between one to five percent of seniorshave a major diagnosed depressive disorder.24 Rates vary across living arrangements, with seniors residing innursing homes having higher rates of depression25 and olderwomenhavinghigherratesofdepressionthanoldermen. Thehighestratesofhospitalizationfor anxietydisorders ingeneralhospitals are among those aged 65+. 26 Suicide

ratesamongseniorsarealsohigherthanfor the general public, especially formen.27 The suicide rate for Canadian men 65+ ranges from 14.2 to 23.8per 100,000 persons, which is very highcomparedtotheoverallCanadiansuiciderateof12.2/100,000.28

Figure 9: Percentage of seniors (male and female) with arthritis by health service delivery area, 2010

Source:StatisticsCanada,2011.Health Profile. June 2011. From Canadian Community Health Survey.

PepersackT,DeBreuckerS,MekongoYP,RogiersA,BeyerI.Correlatesofunrecogniseddepressionamonghospitalisedgeriatricpatients.JournalofPsychiatricPractice2006;12:160–167.

AreportonmentalillnessesinCanada.PublicHealthAgencyofCanada,HealthCanada,2002. DepressionamongseniorsinResidentialCare.AnalysisinBrief.CanadianInstituteforHealthInformation,2010. Suicidesandsuiciderate,bysexandbyagegroup:MaleRateandFemaleRate,StatisticsCanada.2007.www.40.statcan.gc.ca/l01/cst01/hlth66e-eng.htm Ibid.P.15

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InMetroVancouver,5.4percentto12.5 percentofseniorsperceivethemselvesto be livingwith ‘a lotof stress.’Ascanbe seen in Figure 10, seniors residing intheVancouverareahadthegreatest decrease in reported stress on this dimension (from 9.2 percent in 2003 to 5.4 percent in 2010). Geographic variations are also evident, with the percentage of seniors reporting high stress being slightly higher in NorthVancouver/Coast/Garibaldi and FraserNorththanotherregions.

Figure 10: Percentage of seniors reporting stress by health service delivery area, 2003-2010


26

InMetroVancouver, thepercentageofseniors reporting poor perceived health variedbyregionandsex,rangingfrom16 percent for older males in FraserNorthto28.4percentforoldermalesinVancouver(seeFigure 11).

Almost half (45.7 percent) of seniors65years of age and older in BChavea disability, with rates being higher

for older women than men.29 Over50,000 seniors inBChaveadiagnosis of dementia. Of those, the majority(90 percent) will experience problem behaviours over their lifetime withthedisease (e.g.,wandering,agitation, physicallystrikingout).30

Seventy-five percent of BC seniors regularly takeoneormoreprescribed

medications, almosthalf take three to sixmedicationsandtwelvepercenttake11ormore.31 Takingtherightmedication attherighttimeisaskillmostseniors must master, and one that can be complicatedby thehealth issues thatmerittheprescription.

Figure 11: Percentage of seniors (male and female) reporting perceived poor health by health service delivery area, 2010


WisterAV,SixsmithA,AdamsRG,SindenD.FactBookonAginginBritishColumbia.5thEdition.GerontologyResearchCentre,SimonFraserUniversity,2009. SteinbergM,ShaoH,ZandiP,LyketsosCG,Welsh-BohmerKA,NortonMC,BreitnerJC,SteffensDC,TschanzJT;CacheCountyInvestigators.Pointand

5-yearperiodprevalenceofneuropsychiatricsymptomsindementia:theCacheCountyStudy.InternationalJournalofGeriatricPsychiatry2008;23:170-177.

ProfileofseniorsinBritishColumbia.BCMinistryofHealthServices,2004.www.health.gov.bc.ca/hcc/dialogue.html

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27

Despitesomeofthesehealthchallenges,residentsofMetroVancouverand theSeatoSkyregionarelivinglongerlivesthaneverbefore. InMetroVancouver, overall life expectancy ranges from79 to 85years.Womengenerally live longer than men (81 years comparedto76years), thoughthegaphasbeenshrinkingsincethe1980s.32Thenumber ofyearsapersoncanexpecttolivefree

fromdisabilityordiseasealsovariesbygender(70yearsforwomenand67yearsformen).

Figure 12, a map of life expectancy groupings, points to a correlation betweensocio-economicstatusandlifeexpectancy(e.g.,higherlifeexpectancyinWestVancouverversusMapleRidge).InallGreaterVancouverandSquamish

local health areas, the female life expectancies were at least 2 years longer thanthemale lifeexpectancies.TheDowntownEastsideLocalHealthArea had an especially large spread between female and male life expectancies, with females expectedto live10years longer thantheirmalecounterparts (84.6 years compared to74.6years).

Figure 12: Life expectancy in Metro Vancouver municipalities, 2010

Source:B.C.Stats,2011.LifeExpectancyatBirth–LocalHealthAreaQuery.RetrievedJuly12,2011.http://www.bcstats.gov.bc.ca/data/pop/pop/dynamic/LifeExpectancy/Query.asp?type=HA

DesMeulesM,ManuelD,ChoR.Women’sHealthSurveillanceReport:AmultidimensionallookatthehealthofCanadianwomen.HealthIssues,2003.www.phac-aspc.gc.ca/publicat/whsr-rssf/index-eng.php

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28

Content in this section is drawn from the discussion paper authored by Dr. Karen Kobayashi.

InBC,27percentof seniors livealone (36percentofwomenand17percentofmen).33Thisproportion isdown from 29percentin2001,asaresultperhapsof increased life expectancy, increasedratesofremarriageamongstwidowedor divorcedseniormenandthereturnofadultchildrentothe‘emptynest.’

TheexperienceoflivingaloneinBCisgendered;thatis,olderwomenaremuchmorelikelythantheirmalecounterpartstoliveontheirown.Itisalsoinfluencedbyothersocio-demographicfactorslikeage,ethnicity, immigrationstatus,andplace of residence. For example, it ismorecommonfortheoldestold,thosewhoare85+years,tolivealoneandforvisibleminorityolderadults(e.g.,SouthAsiansandChinese)toliveinmultigen-erational households with their children and grandchildren than non-visibleminorityolderadults.34RichmondandSurrey have large pockets of visible minorityolder immigrants, the formerbeingpredominatelyChinese and thelatterSouthAsian.

Seniors and older adults who live alone andhavesmallsocialnetworksareoften believed to be vulnerable to decreased emotional wellbeing due to their limitedsocialconnections.35 Those who are socially isolated have fewer social tiestorelyonforpracticalandemotionalsupport.

Social isolation is more common in womenthanmen;36 amongthosewho are widowed;37 among working classolder adults;38 and in those who are in poor health and have mobility issues. 39 Characteristics of socially isolated persons are related to broader socio-culturalcontexts.

• Increased length of residence inBCissignificantlyassociatedwith lowerlevelsofisolation.

• Olderadultswhorenttheirhomescompared to owning them havehigheroddsofbeingisolated.

• Those who move later in life orwho have spent less time in acommunity are more vulnerable tosocialisolation.

• The odds of being socially isolated aremuchhigherforthosewhodonotattendanyreligiouseventinamonthcompared with those who attendmoreregularly(e.g.,monthly).

Emotional wellbeing and living arrangements

BCStatistics.(2008).2006CensusFastFacts:LivingArrangementsofSeniorsinBritishColumbia.www.bcstats.gov.bc.ca/data/cen06/facts/cff0606.pdf Koehn,S.(2011).IntersectingSourcesofInequalityinPunjabi-SpeakingFamiliesinBC.Retrievedfrom file:///Users/karen/Library/Caches/TemporaryItems/Intersectionality%20and%20th(TFCE)/Intersectionality%20and%20th(TFCE Cloutier-Fisher,D.,Kobayashi,K.M.&A.P.Smith.2011.Thesubjectivedimensionofsocialisolation:Aqualitativeinvestigationofolderadults’experiences insmallsocialsupportnetworks.Journal of Aging Studies. 21:andGrenade,L.,&Boldy,D.(2008).Socialisolationandlonelinessamongolderpeople: Issuesandfuturechallengesincommunityandresidentialsettings.Australian Health Review, 32,468-478. Qureshi,H.,&Walker,A.(1989).Thecaringrelationship,elderlypeopleandtheirfamilies.Basingstoke:Macmillan. Carey,R.G.(1977).Thewidowed:ayearlater.JournalofCounsellingPsychology,24,125-131. Lowenthal,M.,&Robinson,B.(1976).Socialnetworksandisolation.InR.Binstock,&E.Shanas(Eds.),Handbookofagingandthesocialsciences (pp.432–456).NewYork:VanNostrandRheinhold. Lynch,J.J.(1977).Thebrokenheart:ThemedicalconsequencesoflonelinessinAmerica.NewYork:BasicBooks.

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Studies link large supportive social networksto improvedhealthoutcomes in later life, whereas having a small unsupportivenetworkincreasesone’sriskforpoorphysical andmentalhealth.40 Socially isolated individuals are also at greater risk of long-term exclusionfromsocialrelationsandaremorelikelytoexperiencereducedaccess tohealth services.41

Noteveryonelivingalonecharacterizes themselves as vulnerable to social isolationorloneliness.Somevaluetimealoneassolitudewhileothersexperiencepainful loneliness.All socially isolatedolder adults, however, require more assistanceorsupportfrombothinformalandformalsourcesastheyage.

Althoughsocialisolationisusuallyframednegatively vis-à-vis health outcomesamongolderadults,thereareexceptions.Recentresearchonolderethno-cultural minority immigrant women in the LowerMainland,a largeproportionofwhomarefamily-sponsoredimmigrants, indicates that living with family members inmulti-generational house-holds does not necessarily result in better emotionalwell-being than livingalonefor thisgroup.42Unsafe circumstances canmanifestaselderabuseorneglect for older adults and seniors living withfamily.Contributingtothisproblem is the fact that sponsored parents are financially dependent for 10 years, ineligible formanyservices, andmayexperience significant status and role reversalsinthefamily.

Bosworth,H.B.,&WarnerSchaie,K.(1997).Therelationshipofsocialenvironment,socialnetworks,andhealthoutcomesintheSeattleLongitudinalStudy:Twoanalyticalapproaches.Journal of Gerontology: Psychological Sciences, 52B,197-205.;Wenger,G.C.,Davies,R.,Shahtahmasebi,S.,&Scott,A.(1996).Socialisolationandlonelinessinoldage:Reviewandmodelrefinement.Ageing and Society,16:333-358.

Scharf,T.,&SmithA.E.(2004).Olderpeopleinurbanneighbourhoods:Addressingtheriskofsocialexclusioninlaterlife.InC.Phillipson,G.Allan, &D.Morgan(Eds),Social Networks and Social Exclusion: Sociological and Policy Perspectives(pp162-179).Burlington,VT:Ashgate. Koehn,S.(2011).IntersectingSourcesofInequalityinPunjabi-SpeakingFamiliesinBC.

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Threekey indicatorsofsocial isolation are: (1) livingalone, (2)emotionalwell-being and stress, and (3) perceivedhealth.Figure 13 shows that a significant number of the census tracts inwhich

a large proportion of older adults live alone are found in the downtown core andDowntownEastsideofVancouver,two areas where poverty rates, poorhealthstatusand low lifeexpectancies

arehigher thanaverage forbothmen andwomen.Themapsalsoshowthatolderseniors(aged75-84years)aremorelikelytolivealoneandbemorewidelydispersedacrosstheregion.

Figure 13: Percentage of seniors living alone in Metro Vancouver, by age range, 2006

Source: Statistics Canada, 2006. CatalogueNo.97-553-XCB2006017. HouseholdLivingArrangements(11),AgeGroups(20)andSex(3) for the Population in Private HouseholdsofCensusMetropolitan Areas, Census Agglomerations andCensusTracts,2006Census-20percentSampleData

31

The living arrangements of seniors appeartobelinkedtotheirlow-incomestatusevenmorethanageandgender.Forexample,elderlypersonsineconomic families in the Vancouver Census MetropolitanAreahadbeforetaxLICOratesof7percent in2009. 43 This was much lower than thebefore taxLICO rate of 46 percent for unattached elderlyindividuals.

Regarding emotional well-being, thehighest proportion of older adults who perceive themselvesashavinga lotofstress live in the more affluent areas of West and North Vancouver andnot inCityofVancouver,wheremany sociallyisolatedlowincomeolderadultsreside.44

Therealityofreducedsocialnetworksmay be perceived to translate into theuseofhealthservicesinlaterlife.But the socially isolated and other older adults report similar levels of service usage.An examination of health care utilizationpatternsrevealsnostatistically significant differences in annual doctor visits, nights spent in hospital, homecare or tele-health use between the socially isolatedand theirnon-sociallyisolatedcounterparts.45

SociallyisolatedolderadultsinBCare not heavier users of the predominanthealthservices(i.e.,doctorsandhospitals) most often identifiedwithvulnerable populations.Sociallyisolatedolderadults in BChave similar profiles to sociallyisolatedolderCanadians;notably, theyareolder,proportionallymorelikelyto

befemale,tohavelowerincome,tobewidowedorsingle,tohavepoorerhealth

anda tendency towardsmorechronicconditions.46

StatisticsCanada(2008a)defineseconomicfamiliesas“agroupoftwoormorepersonswholiveinthesamedwellingandarerelatedtoeachotherbyblood,marriage,common-laworadoption.Unattachedindividualsreferstoindividualswhoarenotinaneconomicfamily.”TheSurveyofLabourandIncomeDynamicsdefineselderlypersonsas65+yearsofage,thesameasthedefinitionofseniorsusedinthisdiscussionpaper.

Thisobservationrunscountertothefindingsintheliteratureonsociallyisolatedolderadults.Itisimportanttofurtherexaminethewayinwhich“emotional well-being,”ismeasuredbyBCStats,i.e.,whatvariablesareusedasproxiesforemotionalhealth,andhow“accurate”thesemeasuresreallyare.

Kobayashi,K.M.,Cloutier-Fisher,D.&Roth,M.(2009).Makingmeaningfulconnections:Aprofileofsocialisolationandhealthamongolderadultsinsmalltownandsmallcity,BritishColumbia,JournalofAgingandHealth,21(2),374-397.

Cloutier-Fisher,D.,&Kobayashi,K.M.(2009).Examiningsocialisolationbygenderandgeography:conceptualandoperationalchallengesusingpopulationhealthdatainCanada.Gender,PlaceandCulture,16(2),181-199.

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Content in this section is drawn from the discussion paper on seniors and housing authored by SPARC BC.

Access to safe, secure and affordable housing is recognizedasbothabasic needandhumanrightinCanada.Without access to housing with these characteris-tics,thelivesoffamiliesandindividuals areupsetbysignificant insecurity.The changing needs of an aging population represent an important area of con-sideration in termsofhousing choices andaffordability,particularlyasitrelates

to vulnerable and low income seniors andolderadults.

Across Metro Vancouver, there were158,395senior-ledhouseholdsin2006.47 Thisincludes119,750whichwereliving in the ownership market and 36,605 that were renters.48 Of the senior-led households, approximately 43 percent are livingalone.49Whileeachof these different households have different circumstances and challenges, it is importanttonotethatacrossbothowners and renters there aremany senior-led

householdsthatfacesignificanteconomicdifficultiesasaresultofdependenceon asingleorfixedincome.

Whilebothseniorswhorentandseniorswhoownfaceincomeconstraints,thosewhoowntypicallyhavemoreresources todrawonintimesofneed.In2006,asimilarpercentageofMetroVancouversenior-ledhouseholdsrentedcompared toCanadiansenior-ledhouseholdsand BCsenior-ledhouseholds(seeFigure 14).

Housing

CMHC(CanadaMortgageandHousingCorporation),2010.CanadianHousingObserver:HouseholdCharacteristicsDataTable. CMHC(CanadaMortgageandHousingCorporation),2007.

StatisticsCanada,2006.CatalogueNo.97-554-XCB2006007. SLRD(SquamishLillooetRegionalDistrict)containsareasinadditiontotheSquamish,Whistler,andPembertonareasservicedbyUnitedWayofthe

LowerMainland. TheuniverseofseniorledhouseholdsforSLRDfromCMHC,2007,isslightlysmallerthantheuniverseprovidedbyStatisticsCanada,2006.Catalogue

No.97-554-XCB2006035,whichis1,645households.

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48

49

50

51

Figure 14: Number of senior-led renter households in Canada, BC, Metro Vancouver and Sea to Sky, 2006

50,51

Source:CMHC,2010.CanadianHousingObserver:HouseholdCharacteristicsDataTable.

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Housingneedsamongseniorstypically cut across a number of different dimensions.Theseincludeaffordabilityconsiderations as well as specific housing andsupportneeds.Housingaffordability can typicallybeviewedasan incomeproblemaswellasahousingproblem.For seniors (especially somesenior-ledrenter households) the challenges that they face are related to the fact that they do not have the income or resourcesneeded to access suitable and appropriate housing in the private rental marketwithoutspendingmorethan30percentoftheirincomeontheirhousing.

Approximately36percentofallsenior-ledeconomicfamilieswhorentedwerespending30-99percentoftheirincomeonhousingcosts,while12percentwerespending50-99percent.52

Unattached seniors and older adults(thoselivingalone)aremoreprecariously housed. Based on the available 2006data,approximately60percentofsingleseniorswhorentedwere spending30percentormoreoftheirincomeontheirhousing costs while 26 percent were spending50percentormore.53

In2006acrossMetroVancouver, therewere129,145householdsincorehousing need,ofwhich29,695or23percentweresenior-led.Ofthosesenior-ledhouseholds in core housing need, approximately16,205or55percentwere renters.Ofthe seniors in core housing need (both renters and owners) average housing cost was $740 per month and their average annual income was $19,797.Amongseniorswhorent,theiraveragehousingcostswere$713permonth.InMetroVancouverthenumberofseniorled households in core housing need has continuedtoincreasesince1996.

In theSea toSkyregion in2006therewere1,390householdsincorehousing need,ofwhich195weresenior-led.Ofthoseapproximatelyhalfwererenters.Of the seniors in core housing need,average housing cost was $578 permonthandaverageannual incomewas$17,474. Senior renters housing costswere$722permonthinthisregion.In theSea toSky region, thenumberof senior led households in core housing need has continued to increase. In addition, thedatasuggests thatalmosthalf of all senior-led householdswho

rent in theSquamish-LillooetRegionalDistrictwereincorehousingneed.

IntheLowerMainland,ofthoseseniorrenter households who were in core housingneed6,990or43percentwerein ‘worstcaseneed.’Thesearehouseholdsthatarespendingmorethan50percentof their incomeontheirhousingcostsandareconsideredtobeatextremeriskofbecominghomeless.

Recenthomelesscounts showthat thenumberofseniorslivingonthestreetsor staying in emergency shelters has increasedover time.Whileage-specificdatafromMetroVancouver’smostrecent2011homelesscountisnotyetavailable,previousregionalhomelesscountshavereported a significant increase in the number of seniorswhowerewithout a place to live. Local planning tables andseniorserviceorganizationsacrossthe region have recently reported the presenceoffrail,olderseniors(80+)inthesheltersystemforthefirsttime.Thechange in incidence of homelessnessamongolderadultsinMetroVancouveris laid out in Figure 15.

StatisticsCanada.2006b.UPP06_Table9EFPartA. StatisticsCanada.2006a.UPP06_Table9UIPartA.

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Figure 15: Incidence of homelessness among older adults aged 55+ in Metro Vancouver

Source:GVRD,2002.MetroVancouver,2005.MetroVancouver,2008.

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These findings show that not only have there been significant year over year increasesinthenumberofseniorswhoare homeless, but also that homeless seniorsarecomprisingalargershareofthetotalhomelesspopulation.

The LowerMainland is recognized ashaving some of the highest housingcosts inCanada.Theaverageincomeofseniorswho rent inMetroVancouver($35,357in2006)ridesclosetotheedgeof affordability in a market where the averagerentfora1bedroomunitis$940(requiring$37,600in2010).Foraseniorlivingonfixed income, it isdifficult tofind the resources needed to close the gap betweenincome,thecostofhousing,andotherbasiccosts(e.g.,food,medication). Furthermore,many low income seniorshave very little to fall back on in an emergency.

Notonlyisfindinghousingdifficultfor someseniors,butstayingintheirhousing is difficult for renters where security oftenureisanissue.Severalhighprofile cases inVancouver,particularly in the West End and Kitsilano areas, have involved tenants being evicted fromtheir suites to allow for their suites to be upgradedandre-rentedatmarketvalue.54 Noofficialstatisticshavebeenkepton theserenovation-relatedevictions,buta rentaladvocacygroup,RentersatRisk, estimated that over 50 buildings have beentrackedfor“renovictions”(renovation- relatedevictions)inthepastfewyears.55

AcrosstheMetroVancouverregionthereareapproximately19,950socialhousingunits(notincludingco-operativehousingunits) that have been developed under a rangeofhousingprograms to respond to the specific needs of seniors. This

representsalmosthalfof the inventoryofsocialhousingacrosstheregion.Animportant asset for responding to the on-going affordability challenges thatmany seniors face, many low income seniors have been assisted through this housing.

As of 2011, therewere approximately2,312seniorsonBCHousing’sApplicant Registrywhowere inneedofhousing,upfrom1,946in2010.Thesehouseholdshavetowaitforaunittobecomevacantbeforetheycanbehoused.Between2010and2011,thenumberofseniorsonBCHousing’swaitinglisthasincreasedbyalmost 400 households which means thatdemandisgrowingatafasterratethansupply.

Sinoski,K.(2011).“Rentersrallytoprotectrightsagainstunfairevictions”.VancouverSun.May7,2011. Ibid.

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BCHousing.(2011).Independent Living BC.Retrievedon-linefromwww.bchousing.org/Initiatives/Creating/ILBC BCStats.(2011).Population Projections – BC and Regional. RetrievedJuly29,2011.www.bcstats.gov.bc.ca/data/pop/pop/popproj.asp

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WithinMetroVancouver,therehavebeenapproximately4,300newIndependent LivingBCunitscreated inresponse tothe increaseddemand.56Basedon theexpected increase of 474,600 seniors acrossMetroVancouverover thenext 25years(from2011to2036),itisantici-patedthatthedemandforthistypeofhousing and related supportive services willremainhigh.57

Seniors in theLowerMainlandare at the intersection of two strong trends: rising housing costs and unchanging social support incomes. If the cost of livinggrowsandfixedincomesdonot, weare likely to see a continuationof the current trend towards increases in seniors in core housing need and continued increases in the sizeof the seniorshomelesspopulation.

36

Content in this section is drawn from the discussion paper authored by Dr. Lawrence Frank and Andrea Procyk.

Accesstotransportation,whethertakingpublic transitordrivingacar,enablesus to complete day to day tasks such as shopping, going to appointmentsand participating in social, cultural, and recreational activities. For manypeople theabilityto travel is linkedto independence,personalfreedom,personal image, andwell-being.58,59,60Access to transportationcanbecomeproblematicinolderage,andasaresult,seniorsmaysufferfromreducedmobility,increasedisolation and the associated health consequences.

Evidence suggests that the travel behaviourofseniors65+isconsiderably differentthanthatofotheragegroups.Olderadultstakefewertripsoutofthehomeandfordifferentreasons.2008inMetroVancouver, thenumberofdailytripsmadeby seniors age 65-79was2.49duringa24hourperiod.Forolder seniorsaged80+,theaveragenumber of trips made per day was 1.68. Comparatively, theaveragenumberoftripsmadeperdaybyallresidentsoftheLowerMainlandwas2.65.61

Older drivers depend on private vehicles tomake themajority of theirtrips.62 Through the aging process there isageneralshiftfrombeingacardrivertobecominga carpassengerand thentorelyingonpublictransit,particularlyforwomen.63Withthisshiftcancomeadiminishedsenseof independenceandfeelingsofguiltandshamefromrelying onfriendsandfamiliesforrides.64Older adults’abilitytooperateacar,however, canchangequicklyandthose livingin cardependentenvironmentscanexperi-

enceasuddenlossofindependence.Also,older adults who do not drive are reported tomakeonlyhalfthenumberoftripsastheirolderdrivingcounterparts.

Therearesubstantialnumbersofolderadults in the Lower Mainland/Sea toSkyregionchoosingtoage inplace in suburbanandruralcommunitiesthatarecardependent.These individualsmayexperiencereducedaccesstoamenities, community services and medical carewhen driving is no longer an option.

Transportation, transit and walkability

Cobb,R.&Coughlin,J.(2004).Transportpolicyforanageingsociety:KeepingolderAmericansonthemoveinTransportation in an Aging Society: A Decade of Experience. TransportResearchConferenceProceedings,27,272-292.

Coughlin,J.(2000).Transportation and older persons: Needs, preferences and activities. PublicPolicyInstitute,AmericanAssociationofRetiredPersons,Washington,D.C. Harrison,A.&Ragland,D.R.(2003).Consequencesofdrivingreductionorcessationforolderadults.Transportation Research Record, 1843,96–104. MustelGroupMarketResearchandHalcrowConsultingInc.(2010).TransLink’s2008RegionalTripDiarySurvey:FinalReport.PresentedtoTransLink,

SouthCoastBritishColumbiaTransportationAuthority.Accessedonlineat www.translink.ca/~/media/Documents/bpotp/plans/trip_diary/2008%20TransLink%20Trip%20Diary%20Survey%20Report.ashx

Ibid. Golob,T.,&Hensher,A.(2007).ThetripchainingactivityofSydneyresidents:Across-sectionassessmentbyagegroupwithafocusonseniors.Journal of Transport

Geography, 15:298-312. Coughlin,J.(2001).Transportation and older persons: Perceptions and preferences. Washington,DC:AARP.

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A lack of affordable and appropriate transportation options increases risks of social isolation65 and those over age 60areoftenconsideredtobeathigherriskofbecoming“transportcaptives.”66 Although services such as volunteer driversandcommunityshuttlesexisttofill thetransportationgap, theycanbeexpensiveandinefficient.67

Ascapacitydeclineswithage,thephysical environmentplaysan increasingly im-portantroleinhelpingadultsmaintainhealthandindependence.Thenegativeeffects of dependence on the personal vehicle is less exaggerated in urban locations characterized bymixed-use

zoningwherecommercialandresidential lotsarewithinwalkabledistancesandsafe pedestrian networks (includingaccessible sidewalks, crosswalks, etc.).Amixoflandusesandhigherdensityneighbourhoods with well connected streets encourage increased levels of physical activity, mostly in the form of walking.68 This is true for all age groups.Residentsofmediumwalkableneighbourhoods are 32 percent less likelytobeoverweightrelativetothoseinlowwalkableneighbourhoods.69

BasedondatafromtheMetroVancouverWalkabilityIndex(VWI),70walkabilityinMetroVancouvervariesbycommunity.

Areasofhighwalkabilityarecharacter-izedbyhigherpopulationdensities,amixoflandusesandconnectedstreetnetworks. In the context of an aging population, it is expected that areas ofhigherwalkabilitywill offer olderadultsmoretransportationoptions.

Figure 16 depictsareas inMetroVan-couverwithbothhighand lowwalk-ability that have a high concentration of older adults. The map shows that Delta,Langley,PortCoquitlam,South SurreyandWestVancouverhavebothlowwalkabilityandhighconcentrationofolderadults.

Cvitkovich,Y.&Wister,A.(2001).Theimportanceoftransportationandprioritizationofenvironmentalneedstosustainwell-beingamongolderadults,Environment and Behavior, 33(6),809–829.

Hine,J.&Mitchell,F.(2003).Betterforeveryone?Travelexperiencesandtransportexclusion.Urban Studies, 38(2),319-322. BritishColumbiaPsychogeriatricAssociation.Seniors Policy Lens Toolkit. Accessed online at: www.seniorspolicylens.ca/Root/AccessibilityTransport.htmlAccessedAugust,2011. Frank,L.D.,Engelke,P.O.,&Schmid,T.(2003).Health and community design: The impact of the built environment on physical activity. IslandPress,Washington,DC. Frank,L.,Kerr,J.,Rosenberg,D.,&King,A.(2010).Healthyagingandwhereyoulive:Communitydesignrelationshipswithphysicalactivityandbodyweight

inolderAmericans.Journal of Physical Activity and Health, 7(Suppl1),S82-S90. DevelopedbyUBC’sActiveTransportationLab.

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Figure 16: Metro Vancouver areas with high concentrations of older adults 65+ and high or low walkability

Source:Procyk,A.andFrank,L.(2011).Transportation,communitydesignandhealthyaging.ActiveTransportationCollaboratory,UniversityofBritishColumbia

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Similarly,Figure 17 below depicts areas where transit accessibility71 is lower and where non-driving older adults maythereforeexperiencedifficultyaccessinggoods,servicesandactivities.

Areaswithlimitedaccesstotransitanda high concentration of older adults in-cludeSouthSurrey,Delta,MapleRidge,PittMeadowsandWestVancouver.The

areasshadedinpurplerepresentapprox-imately25,000olderadults.

Figure 17: Metro Vancouver areas with high concentrations of older adults 65+ and high and low transit accessibility


UsingtheTransitAccessibilityIndex(TAI),whichisbasedonthreemeasures:servicecoverage,frequencyandcapacity.71

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WhentheVWI isoverlaidwithsocio-economic and demographic informa-tion itprovidesamechanismtoassessdisparitiesacrossspecificmobilityandhealthoutcomesforvulnerablepopula-tions.Figure 18 illustrates areas of low averageincome,lowtransitaccessandahighconcentrationofolderadults.

GiventheveryhighcostofhousingintheLowerMainlandregion,olderadults

with low incomes may not have the optiontomovetomorewalkable,transit- orientedneighbourhoodastheyage.

While higher density, more walkableneighbourhoods have many potentialbenefits for aging populations, some attentionmust be given to potentially adverse health impacts of acute andchronic exposure to air pollution. Evidencesuggests that theelderlyare

particularly susceptible to elevated exposures to pollution with day today changes.There are several policy approaches toaddressandmitigateairpollutionexposure incentralwalkableareas.Theseincludestrategiestoreducevehicleuseoncertaincorridors,requirecleanervehicles,anddesignforsetbackfromroadwayedges.

Figure 18: Metro Vancouver areas with low average income and low transit access with high concentrations of older adults 65+


40

Content in this section is drawn from the discussion paper by Dr. Maureen Ashe.

Approximately134,645seniorsinMetroVancouver experience activity limita-tions.The number of activity-limitedmale seniors (65+) fallingbelowLICObeforetaxrosefrom9,355individualsin2001to10,610individualsin2006.The number of activity-limited female seniors fallingbelowLICObefore taxalso rose between 2001 and 2006,from 19,940 individuals to 20,590 individuals.

Personalmobility isakeydeterminantof independence and quality of life. Definedas thecapacityof individuals to physically move through their environment,goodmobilitycontributestoadynamic, independent life,and isfundamental tohealthyaging.Whenaperson loses theirability tomoveandnavigatetheirenvironment,theirworldshrinksdramatically.

Asweage,ourspatialfootprint(thesizeof theenvironmentour life is lived in) decreases.Evenactive,community-dwell-ingolderadults takefewerandshortertrips from home than their younger

counterparts.72Vulnerableseniors,suchas older adults with health concerns, mobility impairments or low-incomes,may get out even less frequently.73 Researchhasshownthatgettingoutsidehasbenefitsforqualityoflifeandlongevity. Vulnerableolderadultsandseniorswithreducedmobilitymaybeathigherrisk ofpoorphysicalandmentalhealth.75

Olderadults’participationintheircom-munity isdependenton theirphysicalcapacity, cognition,motivation to getoutside,self-confidenceand,ofcourse,theopportunitiesthatarepresent.Thebuilt environment, or urban form, is increasinglybecomingrecognizedasanimportantdeterminantinfluencingolderadults’physicalactivityandcommunity participation.76 Wide streets, limited railingsandwalkways, fastcarsandadizzying pace of life can contribute to insecurity about navigating the community.Other issues relate to theproximityofavailableamenitieswithina community, such as grocery stores,drugstoresandmedicalservices.Thesecommunity features cananddoeffectan older adult’s decision to venture outside.Microscalefeaturesofthebuilt environment, including the presence

and condition of sidewalks, benches,andbathrooms,affectolderadults’fallsriskandmobility.

Physical mobility and the built environment

McInnesL,BriggsP,LittleL,RochesterL.Newmetricsforexploringtherelationshipbetweenmobilityandsuccessfulageing.Sheffield,UK:UniversityofSheffield;2010.

Cohen-MansfieldJ,ShmotkinD,HazanH.Homeboundolderpersons:Prevalence,characteristics,andlongitudinalpredictors.ArchGerontolGeriatr2011. SimonsickEM,GuralnikJM,VolpatoS,BalfourJ,FriedLP.Justgetoutthedoor!Importanceofwalkingoutsidethehomeformaintainingmobility:findings

fromthewomen’shealthandagingstudy.JAmGeriatrSoc2005;53:198-203. QiuWQ,DeanM,LiuT,etal.Physicalandmentalhealthofhomeboundolderadults:anoverlookedpopulation.JAmGeriatrSoc2010;58:2423-8. VanCauwenbergJ,DeBourdeaudhuijI,DeMeesterF,etal.Relationshipbetweenthephysicalenvironmentandphysicalactivityinolderadults:Asystematic

review.Health&place2011;17:458-69.

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Sidewalks – their presence, location, material and condition – canplay an important role in the life of an olderadult.This isespecially true for thoseolderadultswhohavephysicalimpair-ments. The presence and location oflevel,unobstructedpathwaysencouragephysicalactivity.Lackofadequatecurbcuts,aswellascracksanddisruptionscaused by tree roots are a falls safety hazard.77Thiscan leadto injuriesandare barriers for older adults to leave theirhomesinthefirstplace.Although Vancouver is generally described aswalkable,thereareareasacrosstheLower Mainlandwheremorecouldbedonetoenhancewalkability,especiallyforthoseregions with a higher concentration of olderadults.

Thepresenceofbenchesandsafe,cleanbathroomscanalsoencouragemobility.Olderadultswithhealthconcernshavespecialchallengeswhenventuringoutside. Appropriately placed benches or shel-ters can provide a short refuge while journeying to a destination such as the grocery store or doctor’s office. Bathrooms along the path are also important–foreveryone,notjustolderadults.Numerousstudies indicate thatcontinence can be significant factor in a numberofadversehealthoutcomessuchas depression, social isolation and an increasedriskforfalls.Asacommunity,we need to support older adults who wishtoageinplace.Puttinginplaceabuiltenvironment thathelpseveryone

get out and get around is a critical part of supportingthatgoal.

Social environments “encompass theimmediatephysicalsurroundings,social relationships, and cultural milieuswithin which defined groups of people function and interact.”78 Creating a positive,welcomingsocialenvironmentcan help encourage people to get out and reap the positive health benefits of increasedmobilityandinteraction.

Walkingprogramsareoneapproachtoencouragesocializationandcommunity participation.Walkingisthemostpopular form of exercise for older Canadians. The least active group of older adults arewomen aged 80+79As previously discussed,olderwomenarealsoat the greatest risk for social isolation andpoverty.Encouraging intergenerational walking programs may be one way ofmeetingthischallenge.

Gardening initiatives are another recreational activity that encour-ages socializing andmobility. It’s the ultimate ‘green exercise.’ Gardeningwas the secondmostpopular typeofphysical activity reported by older Canadians.80 Therapeutic gardening or horticulture therapy is reported to be positively associatedwithwell-being, increasedphysicalactivity,andincreasedconsumption of vegetables. Whileoutdoor gardening is optimal, indoor gardeningalsoprovidesbenefits.

GallagherEM,ScottVJ.TheSTEPSProject:participatoryactionresearchtoreducefallsinpublicplacesamongseniorsandpersonswithdisabilities.CanadianjournalofpublichealthRevuecanadiennedesantepublique1997;88:129-33.

AARPPublicPolicyInstitute.PlanningCompleteStreetsforanAgingAmerica.WashingtonDC:AARPPublicPolicyInstitute;2009. AsheMC,MillerWC,EngJJ,NoreauL.Olderadults,chronicdiseaseandleisure-timephysicalactivity.Gerontology2009;55:64-72. Ibid.

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This report and its companion docu-ments(i.e.,expertdiscussionpapersandcommunity profiles) put United WayoftheLowerMainlandanditspartnersinagoodpositiontoaddressthemajor issues that affect vulnerable seniors in theregion.

It is important to note that UWLM’swork is always with seniors, com-munity, researchers and government partners.Byprovidingthefunding,time,knowledgeandcontinuitynecessarytoengageandmobilize communities suc-cessfully,UWLMcanleadthewaytoabetterfutureforall.

TheUWLMhasaroleandresponsibilitytotackleourcommunity’skeysocialissues inprofoundways.Our role: tobuildahealthy,caring, inclusivecommunity;acommunitythatweareallproudtocallhome.Ourresponsibility: todo itwithintegrity and courage and to ensure sustainabilityandembracediversity,every stepoftheway.

The recommendations below provideUnitedWay of the Lower Mainland, governments,partneragencies,researchers and the public with clear directions to better serve and support the region’s agingpopulation, includingvulnerableseniors.

There are three proposed direc-tions extending from the analysis inthis report: research directions, pro-gram/service directions and policy directions.

Recommended research directions

1. Reinstitute mandatory comple-tion of the long-form census. In the meantime, encourage government, services agencies and working groups in the region to think creatively in the formation of a public research agenda to help compensate for the loss of the long- form data from Statistics Canada

• Multi-yeardatadrawnfromthelong-form census (especiallycensustract leveldata) formedthe backbone ofmuch of the researchandmapworkinthis report.Eliminatingthelongform censusanditsmandatorycom-pletionmeansthatpublicinterest researchers,plannersandserviceproviders can not develop pop-ulationlevelanalysisatsmaller geographies in the future, renderingcomparisonsovertimeimpossible and as a corollary affecting our collective ability toassesstheefficacyofcurrentpublicpolicydecisionmakingregardingseniors.

2. Conduct further longitudinal research to follow socially isolated older adults over time in order to determine how their vulnerable status changes and affects their health and/or health service use over time

• Particular attention could bepaid to the role that gender plays in this relationship.Research isalsorequiredthatwouldincludelargersamplesofsociallyisolatedolder adults living within several specific smaller communities toenable a better understanding of the relationship between individ-ualhealthwithinlocalcommunitycontexts.

3. Undertake research to examine the role that culture, immigration and length of settlement play in terms of older adults’ inclusion in communities

• Studies of this nature would providemuchneededinsightintosocialisolationamongsubgroupsof vulnerable older adults in the region, such as ethno-cultural minorityolderimmigrantwomen.

Recommended strategic directions

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4. Examine the effects of specific interventions like outreach programs in socially isolated older adults to explore gains in health and/or more effective (i.e., appropriate) use of health services over time.

• A close look atparticularpro-gramsthroughtheuseofcom-parative case studies or a review of performance measurementoutcomeswillbeausefulstartingpoint todeterminewhathelpsgetolderadultsmoreengagedintheircommunities.

5. Use partnership approaches to engage Aboriginal organizations in the co-development of a research agenda that is relevant and re-sponsive to the needs and interests of Aboriginal Elders in the region

• BecauseAboriginalpersonsmakeupasmallrelativeshareofseniorsintheregion,itisachallengetocapture an accurate picture of aging and vulnerability for Ab-original seniors. Participatoryand partnership approaches to researchwillensurethatknowl-edge about Aboriginal Eldersare respected and included in a processofknowledgeexchangeabout how their diverse abilities can be honored and best sup-portedastheyage.

6. Adopt research processes and reporting formats that help set achievable goals in the increased health and quality of life of seniors and older adults – monitor whether goals are met

• OnesuchapproachisthatwhichHealthyPeople2020usedtosetandmonitor population healthgoalsintheUnitedStates(www.healthypeople.gov/2020/default.aspx).Standardizedhealthpro-

cesses and report formats canprovidedatatoinformaLowerMainlandandSeatoSkyregionalhealthreport.Ongoingreportingwilladdtotheknowledgebaseintheregionandassistplanning.

7. Develop and coordinate an inte-grated health intelligence system in the Lower Mainland and Sea to Sky region

• Ourability tounderstandandmeetthehealthneedsofseniors,and thatofanypopulation, isdependenton informationthatiscomprehensive,reliable,andrecent.Unfortunately,ourun-derstanding of the health of seniors in the lowermainland,and across Canada in general,isgreatlyhinderedbythelackof such information.Poolmu-nicipalandHealthAuthorityre-sourcestocollectadministrativehealthandsocialannonymizeddata,andcoordinatetheanalysisof data on the region’s popula-tiononaregularbasis.

8. Conduct additional research into the travel patterns of older adults and the built environment’s con-nection to various health outcomes in Metro Vancouver and the Sea to Sky region

• Create a descriptive visual as-sessment of older adults’ envi-ronments. Building on currentanalyses it would be possible to evaluate the spatial distribu-tionofolderadultsintheLowerMainland relative to a variety of servicesincludingtransit,medicalfacilities,socialservices,parksandopenspace,andfoodoutlets.Itwould also be possible to evaluate proximitytoadversefeaturessuchashighspeedtraffic,airpollution,noise,congestion,andmore.Such

anassessmentcouldbestratifiedbyageandincometoobserveifandwheredisparitiesexist.

• Evaluateseniorstravelpatternsand urban form using Trans-Link’s 2008 travel survey spa-tiallymatchedtothewalkabilitysurfacetoprovideacomprehen-sive overview of the variations in travel behavior of older adults across levelsofwalkabilityand socio-demographic contexts.Astratified approach to data analysis wouldalsohelptoinformusofchanges in travel patterns that occur across different age groups ofseniors.Theoutcomesofthisresearch would support policy development and planning inland use and transportation at the municipalandregionallevel.

• Evaluatetherelationshipbetweenhealthstatus,healthcareutilizationandurbanform.Aprojectcom-biningthewalkabilitysurfaceanddatafromtheCanadianCommu-nityHealthSurveywouldenable researcherstodocumentvariations in older adult health status based onwalkability.Thisstudycouldprovide valuable evidence to municipalcouncilsinsupportofpoliciesandinvestmentsencour-agingcompact,walkable,transitorientedcommunities.

• Conductapre-postinfrastructure studytoanalyzetheimpactsofnew public transit or pedes-trian infrastructure on the travel behaviour,physicalactivityandhealth of older adults before and aftertheintervention.

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Recommended program/service directions

The number of older adults and seniorsisprojectedtodoubleinthenexttwentyyears.Severalservicedirectionsarerecommended inorder tomeet theneedsof thisgrowingpopulation,par-ticularlythevulnerableamongstthem.

1. Increase public and professional awareness on healthy aging as a lifelong matter that concerns everyone

• Focusonchronicdiseaseasthecauseofdisabilityandprematuredeath,notaging.Sharethismes-sagethroughmultiplemediaven-uestoreachallgroupsandages.

Analyzehowimagesofvulner-ablegroups,suchasathleteswithdisabilities, are able to changepublicperceptions.

2. Expand ethnocultural organiza-tions’ ability to offer a wide variety of culturally inclusive programs and services

• Ethnoculturalorganizationshavenot just provided culturally-specificprograms,theyhavealsohelped to provide seniors housing (e.g., Italian Cultural Centre Society, 2011) and quality of life outreach programs (e.g.,S.U.C.C.E.S.S,2011).Expandanddiversify funding options for these largelynon-profitorgani-zationstoensuretheycontinueto provide culturally inclusive support to the regions’ culturally diverseolderadultsandseniors.

3. Make the pursuit of English fluency an attainable goal for all seniors by reducing costs and strategically increasing programming in needed areas

• A largeshare (14.9percent)ofMetroVancouverseniorsdonotspeakeitherEnglishorFrench.Beingunabletocommunicateincertain situations can be danger-ousandisolating.Itiscrucialthat affordable English classes andconversation groups be madeavailable forseniors,aswellastranslation services.81 Followlocal leaders in thisarea, suchasBurnaby’sESLconversationgroupsforseniors.

4. Enrich housing and housing sup-ports for low-income seniors who are renters

• Aseniorwhohasalowincomebutownsahomehassubstantial‘rainyday assets.’ Seniorswhorent and have few financial assets aremoreprecariouslypositioned.Focusattentiononprogramsthathelplowincomerenterssuchasthe rent supplement programShelterAidforElderlyRenters(SAFER)aswellasthecontinued construction of affordable housing forseniors.

5. Switch focus from Episodic Care82 to Integrated Community Primary Care Networks

• Though chronic illness is the majorhealthproblem facedbyseniors, health services have been designed to focus on episodicacutehealthproblems. Form integrated primary caremodelsacrosshealthsectors.Tailor care plans to suit seniors’ desired qualityof lifeandcomorbid 83 diseasestatus.Standardizeclinical assessmenttoolssoasnottobeoneroustocliniciansorseniors.

6. Invite regional universities and colleges as well as professional associations to create a geriatric certification training program for the health care workforce to en-hance knowledge about seniors and the issues that affect them

• A program of this kind will increase skill and knowledge,while offering existing health

UniversityofToronto.(2002).Improving Quality of Life for Urban Canadian Seniors: A Community-Based Participatory Project, Vancouver, British Columbia. RetrievedJuly13,2011.www.utoronto.ca/seniors/Vancouver/finalReport.pdf

Episodiccareisapatternofmedicalandnursingcareinwhichservicesareprovidedtoapersonforaparticularproblem,withoutanongoingrelationshipbeingestablishedbetweenthepersonandhealthcareprofessionals.

Comorbiddescribesadiseaseorotherpathologicalprocessthatoccurssimultaneouslywithanother.

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care providers opportunities to enhanceprofessionalcredentials.

7. Explore the development of com-munity-based services for the de-livery of Instrumental Activities of Daily Living (like finding resources, arranging or providing travel, preparing meals, etc.) services to seniors in the community

• CurrentworkbytheUnitedWay oftheLowerMainlandonthisissue will provide significant insight into the effectiveness of such services, including costs,and how services could best be structured.

8. Optimize caregiver support across the region including the sharing of limited respite beds and develop-ing community caregiver networks

• PartnerwithstakeholderssuchastheAlzheimerSocietyofBC,theBCPsychogeriatricSocietyandsimilargroupstoenhancetheidentification and provision of professionalsocialworkservices, for example, via primary care offices.

9. Explore the development of low-cost dental services across the region by partnering with the UBC Geriatric Dentistry Program and other dental schools/colleges in the region

• Oneexamplemightbetheen-

hancementoforalhealthclinics through the dental training programs.

10. Explore the development of sup-portive housing for seniors with mild to moderate dementia who are medically stable and do not exhibit acute problem behaviours

• Seniorswith dementia are in a positionofparticularvulnerability. Housing supports need to be flexible to the different needs of individuals experiencing dementiaindifferentways.

11. Program outreach initiatives like telehealth84 and meals on wheels programs to support socially isolated seniors

• Giventhelimitedsocialnetworksand personal characteristics of sociallyisolatedseniors,thismayhelp provide opportunities to improvehealth and contributetoemotionalwell-being.Remainsensitive to the gendered nature of vulnerability and resilience in

later life and design opportunities totargetbothmenandwomen.

12. Design a communications approach to ensure seniors know what benefits they are eligible for. In-form seniors of the income security options available to them

• Use outreach approaches to informthemostvulnerablethat are integrated with other services suchasmealsonwheels.

Telehealthistheremotecaredeliveryormonitoringbetweenahealthcareproviderandapatient.Therearetwotypesoftelehealth:phonemonitoring(scheduledencountersviathetelephone)andtelemonitoring(collectionandtransmissionofclinicaldatathroughelectronicinformationprocessingtechnologies).

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Recommended policy directions

The growing population and diversity of vulnerable seniors and older adults in MetroVancouverandtheSeatoSkyregion have important policy development considerations.

1. Make planning with and for seniors an ongoing policy priority

• Includeseniorsandseniorsserv-

ingorganizations(e.g.,theCouncil ofSeniorCitizen’sOrganizationsof BC) in community planning activities (e.g.,Official Commu-nityPlans).Theneedforseniorsplanninghasbeenrecognizedatthe highest level globally in the WorldHealthOrganization(WHO) initiative,“AgeFriendlyCities.”85 BowenIsland,Burnaby,andWestVancouverhavetakenupthecall86 andotherareasarealsoembarking on the age-friendly communityplanning process as well (e.g.,NewWestminster).

2. Reduce miscommunication by translating all relevant government documents and public interest information for seniors into plain language in the top languages spoken by seniors in the region

• Fornon-officiallanguagespeaking seniors it can be a challenge to comprehendmore complicatedinformationanddocumentssuchas listsofgovernmentservices.Followthedirectionofwww.se-niorsbc.caandprovidemultilin-gualresourcespagesforseniors.

3. Consider advocating for the weight-ing of GIS and OAS contribution programs so benefits reflect the disparate costs of living in different regions

• In metropolitan areas charac-terizedbyahighcostofliving,GISandOASratesmaynotbe sufficienttoassistseniorsintheirliving expenses. Increasing theamountoftheGISbyevensmallamountstoreflectthecostofliving wouldhelptobringmoreseniorsabovethelow-incomeline.87

4. Keep Canadian Pension Plan (CPP) contribution rates stable

• FinancialanalysisoftheCanadianPensionPlan(CPP)indicatesthatthe plan is in sound shape finan-cially and should continue to be strongoverthenext75years.Nopolicyshouldbemadethatwill result in a decrease in contribution rates or the pension plan financing schememaybecomelessstable.

5. Develop a poverty reduction plan (with targets and timelines) that includes a focus on seniors

• The recent increase in the percentage of seniors falling below thebefore taxLICO is apoint of concern. Civil society organizations and governmentneedtoworktogethertodevelop a poverty reduction strategy that includesacommitmenttonotletmore seniors fall intopoverty -and create supports and benefits that regularly liftmore seniorsoutofpoverty.

6. Provide adequate funding and support for agencies that offer programs to assist in bringing isolated seniors out of their homes so they can get involved in the community and access public health nurses, mental health specialists, dentists, hospitals, eye specialists and alternative health care practitioners within local communities

• It is critical thatprogramsandservices address the interests,physical and emotional healthneeds and improvement of so-cially isolated seniors’ health and well-being.Accesstoimmediate, preventative health support in early years will defray more intrusiveandcostlymajorhealthinterventionslaterinlife.

7. Act as an advocate on behalf of seniors rights to a liveable environment

• Review current standards andset progressive targets for future building and neighbourhood designtoincreasemobilityandaccessibilityforall.Indevelopingpolicy,seekthecounselofolderadultsto“walkintheirshoes”and adopt guidelines that create walkable,engagedcommunities.

8. Raise the maximum income levels for eligibility for rental supple-ment programs for seniors

• Rental supplements such as SAFER can help more seniors afford appropriate hous-ing in the places where they

WHO(WorldHealthOrganization)(2007).Global Age Friendly Cities: A Guide. Retrievedon-linefrom http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf SeniorsBC.(2011).Profiling Age-friendly Communities. Retrievedwww.seniorsbc.ca/agefriendly/communities/profiles.html. Battle,K.andTorjmann,S.(2009).The Federal Role in Poverty Reduction.ProducedfortheCaledonInstituteofSocialPolicy.P.10

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live. Aging in place is an ex-emplary and viable goal withthe right supports. Reducing barriers to eligibility for rental supplements will help more seniorsstayintheircommunitiesdespitefinancialchallenges.

9. For municipalities, encourage the development of affordable hous-ing by waiving development cost charges, applying inclusionary zoning and density bonuses and other methods

• Weneedtomakeiteasiertobuild affordable housing as without proper supply frameworks in place,themarketplacewillnot be able to provide enough affordable housing for seniors andothersonfixedincomes.

10. For provincial and federal govern-ments, create affordable housing strategies that include ongoing funding for housing programs and affordable housing development for seniors

• Inthisregionwherelandcostsareveryhigh,financialincentivesontheirownmaynotbesufficientto create affordable housing units –visionarypolicyandlong-termstrategiesareneeded.

11. Continue to support municipalities to “prepare and implement hous-ing action plans” as outlined in the Metro Vancouver growth strategy

• Having plans in place in each municipalitywhichcaneffectively accomplish thisgoalwillbe animportantstepinensuringthereisanadequatehousingsupplyforseniors.

12. Subsidize the use of care aids and nursing professionals for families to make these services more affordable

• Supportive housing costs areprohibitively expensive formanyseniors.Asaresultofthesehighcosts,manyfamiliesendupproviding unpaid care for senior relatives. Care aids and homenursing professionals may beable to assist in care challenges withoutrequiringtheneedforseniorstomoveintoexpensivesupportivehousingfacilities.

13. Implement specific planning policies to increase the mobility of older adults

• Increaseland-usemixtofacilitatebetter access to goods and services close to home.Older adults insprawlingresidentialareasmayencountermoredifficultytravel-ling,whichmayreducefunctional independence (e.g., ability topurchase food formeals, pick-ingupprescriptions,managingfinancesatthebank).

• Improve the connectivity ofstreetnetworksinordertoreduce triplengthtotransit,shopsandservicesforolderadults.

• Increase residentialdensities.Higherdensityneighbourhoods are essential to provide the criticalmassofpeoplenecessarytosupportadiversityofshops, servicesandtransitoptions.

• Invest in accessible forms ofpublic transit. Access to safeand reliable public transit is important for seniors tomain-tain independence and access recreationalfacilities.

• Municipalinvestmentsinmicro-scale features to enhance safety andcomfortforseniors.Dense,connected,mixed-usecommuni-tiesaren’tenoughinthemselves.Olderadultsrequirebenchesforrest,qualitysidewalks,andclearly markedcurbs.

• Modifypedestriandesignguide-linestoreflectthesafetyneedsofolderadults.Trafficlightsandappropriatelytimedcross-walkswould improve the safety of older pedestrians crossing arterialroadsandbusystreets.

• Identify appropriate locationstosite facilities forseniors.For example,mappingareasofhighlevelsofparticulatematterandexcessive noise could supportbetter decisions about facility location.

• Sitenewnursinghomes,subsi-dizedsenior’shousingandothersenior’sfacilitiesinmorewalkableneighbourhoods.

• Encourageretailandservicestolocate in community-orientedcentres as opposed to develop-mentalongarterialroadways.

3665-1011

4543CanadaWayBurnaby,B.C.V5G4T4

Phone:604.294.8929•Fax:604.293.0220E-mail:[email protected]•www.uwlm.ca

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