Canada's elderly population: The challenges of diversity
Moore, Eric G; Rosenberg, Mark W. Canadian Geographer 04-012001
Byline: Moore, Eric G; Rosenberg, Mark W
Volume: 45
Number: 1
ISSN: 00083658
Publication Date: 04-01-2001
Page: 145
Type: Periodical
Language: English
Bourne and Rose (this issue) have pointed to the strong links between
the aging of the Canadian population and the broader social
transformations taking place within Canadian society. In the last half
century, we have become not only a more urban-- centered society
but also far more heterogeneous in cultural and social terms. These
changes do not affect the entire population in the same degree at the
same time. Social change in any period tends to be greatest among
younger adults and the broader effects are transmitted to their
children and to older individuals, both through diffusion of ideas and
attitudes and by the process of aging itself. Thus the consequences of
dramatic social and economic changes brought about by shifts in
fertility, in the role of women in the labour force, in the incidence of
divorce, in the magnitude and composition of immigration and
improvements in health are still working their way through the
demographic spectrum in Canada. While we must be aware of the fact
that the elderly 25 years from now will be substantially different from
the elderly of today, many of the precursors of these differences are
already observable.
Dimensions of aging and diversity stress fundamental differences
between individual aging and population aging (McPherson 1990).
Although there is no necessary relation between biological age and
attributes such as health, social relationships and economic activity,
individual aging is associated with changing likelihood of the
occurrence of critical events in people's lives. These events include
separation from the labour force, deterioration in health and mortality
of both individuals and their partners, as well as changes in
performance of activities of daily living, such as climbing stairs,
reading, hearing and eating. The social transformations in the larger
society have changed the attitudes, opportunities and outcomes for
elderly individuals. Changes in family structure, new employment-
pension relations and institutional changes in the ways in which
services are accessed and delivered all have affected outcomes for the
elderly in the last part of the twentieth century.
Population aging refers specifically to the relative size and attributes of
the elderly in the population as a whole. While trends in population
aging clearly reflect temporal shifts in the experiences of elderly
individuals, they are sensitive to changes in all segments of the
population, young and old. For example, the most significant
component of population aging in Canada derives from the long-lasting
effects of the baby boom, which followed World War II. Conventional
wisdom has focussed on the age of 65 as the significant dividing line
between 'young' and 'old', largely because of its traditional and
institutionalized links to retirement and to the initiation of a range of
social benefits. As we see below, however, there is considerable
diversity in the age composition of those over 65, which has
substantial import for a wide range of public and private actions. For
example, those between 65 and 80 tend to be active and in good
health, while the major stresses on the health care system are
generated by those over 80 (Statistics Canada 1999).
Although much of the discussion of the impacts of aging on Canadian
society has focused on national issues such as pensions, social security
or the demand for health care, there are real geographical issues in
the discussion of both individual and population aging. Individual
experiences of aging are very different in urban and rural
environments. The characteristics of population aging are also
sensitive to the significant variations in the landscape of economic
opportunity arising from the fact that thriving local economies both
attract and retain younger individuals at a higher rate than the elderly.
The ensuing discussion explores the nature of both social and
geographic diversity among the elderly, with particular emphasis on
emerging trends and issues for the future.
Aging in post-war Canada
Canada has experienced the increase in population aging that has
characterized all industrialized countries since the end of World War II.
Although Canada is still one of the younger industrialized countries,
with 12.2 percent of its population over 65, compared with an average
of 15.5 percent among the members of the European Union (EU)
(OECD1997), its elderly population is increasing at a rapid rate. Part of
the reason for this increase stems from the fact that the baby boom in
Canada was larger than in any European country; it has had a
profound and long-lasting impact on population aging and will continue
to do so for much of the first half of this century. By 2026, more than
21 percent of Canada's population will be over 65 and we shall have
had to adjust to the aging of the population more rapidly than virtually
all other developed countries.
While the overall population continues to grow at around 1 percent per
year, the older population grows much faster. The population over 65
has been growing at 2 to 3 percent per year while the population over
80 has been growing at over 4 percent. These absolute rates of
increase drive the dramatic increase in demand for a wide range of
age-related services in the health and social service sectors. As Foot
(1998) has noted, age-specific rates of occurrence for many relevant
behaviours do not change greatly over time; therefore, understanding
changes in the age composition of those over 65 is critical in
anticipating the changing demand for services.
Although immigration levels have been high during the last decade and
are now the main component of population growth in Canada, their
impact on population aging is minimal. Since immigrants are
concentrated in the young adult age groups (20-- 35 years old), there
is a short run effect of slowing the rate of population aging, but the
long run effect is small, as immigrants themselves age (Mitra 1992).
In fact, most recent evidence indicates better health and longer life
expectancies for immigrants of all ages, which will tend to mitigate the
small impacts of immigration in slowing population aging (Chen et al.
1996).
Immigration is much more significant in changing the future ethnic,
social and geographic characteristics of the elderly than in affecting its
relative size. Changes in immigration policy since the 1960s have been
associated with major shifts in the composition of immigrants from a
predominantly European focus prior to 1967 to an increasingly Asiandominated immigration since 1978. In the 1990s, immigrants of Asian
origin consistently made up more than 60 percent of the annual flows
to Canada and were overwhelmingly concentrated in the three largest
metropolitan areas of Toronto, Montreal and Vancouver. Because of
the relatively young age of immigrants, the composition of those over
65 in 2000 shows relatively little impact of Asian immigration. In 2001,
4.5 percent of those over 65 will be Asian but this proportion will rise
to at least seven percent by 2021. In Toronto, however, this
proportion will exceed 20 percent by 2021. While the social impact of
these changes is yet to be fully understood, there will have to be much
greater sensitivity to the needs of different culturally defined segments
of the elderly in the years to come.
In 1996, for example, the Asian-origin elderly population was much
more likely to live in larger households with children than was the nonAsian population. To what extent this trait reflects real differences in
the role of the family in looking after elderly members and to what
extent it reflects the fact that elderly Asians have significantly lower
incomes than non-Asians and are much less likely to speak English or
French, is difficult to tell. When associated with the observation that
individuals from the same cultural groups tend to live near each other,
however, these relationships suggest that services such as long term
and institutional care must be sensitive to the different attitudes
towards the elderly and sense of place that exist among different
culturally-defined segments of the elderly.
The geography of aging
In A Place to Grow Old, Stephen Golant (1984) identifies the types of
locational decisions faced by the elderly in making adjustments to
changes in family and work relationships as well as changing health.
Access to family and friends as well as to services is important, but so
too are the commitment to community and sense of place. The home
and the neighbourhood are important not only as physical shelter and
as the site of services, but for the memories they capture and the
connections to others that they evoke. As health deteriorates, often
the need for support from family increases; but with the growing
fragmentation of families both socially and geographically, tensions
increase between the desire for access to family and to familiar places.
These tensions are particularly evident in Canada as population
densities are low and distances between settlements large; parents
and their adult children are often separated by great distances. Social
networks are often stronger in rural places (Moore et al. 1997), but
economic opportunity has drawn children away to urban areas where
housing is expensive and friends may be few. We do not know enough
about how such situations are negotiated nor what the implications are
for future demands for services. These concerns should be reflected in
our research agendas.
In aggregate, the outcome of a myriad of individual location decisions
produces a changing landscape of aging. Population aging in any locale
is a function of locational decisions not only of the elderly, but of all
segments of the population. The outcomes of this process are
sometimes surprising, although there is a strong overall relationship
between the landscape of aging and economic disadvantage (Moore et
al. 1997). On the national stage, it is well known that the southern
Prairie regions of Saskatchewan and Manitoba as well as much of the
Atlantic Provinces have older populations because of the high outmigration of those in the labour force years (Figure 1). This situation is
exacerbated by the role of return migration among older individuals
who previously left these areas and wish to return to family and
familiar community in later life (Newbold 1996). At the same time,
population aging is slowed, particularly in Ontario and British
Columbia, by higher rates of in-migration of those in the labour force
years responding to economic growth in those provinces. Also within
these broad trends, there is significant regional and local variation
which deserves continued investigation (see, for example, Joseph and
Matthews 1994; Dahms 1996; Everitt and Gfellner 1996).
Within provinces, geographic differences also reflect paths of selective
migration. As rural residents migrate to urban areas in search of better
economic opportunities and as families form and seek housing
opportunities in the suburbs, corresponding changes occur in the
distribution of the elderly. Rural areas and small towns tend to have
higher proportions of elderly than do the larger cities, while newer
suburbs are considerably younger than inner city areas. In Toronto
and Montreal, the older inner suburbs established in the early 1950s
are aging relatively rapidly as children have left and their parents are
reaching retirement age (Moore et aL 1997). As the future unfolds, the
rate of growth in the elderly suburban populations will be high and we
must be prepared to create service environments that are responsive
to these pressures.
At a more general level, attempts to download services relating to the
elderly from the provincial to municipal levels are problematic, given
the links between economic disadvantage at the local level and aging.
Those areas with relatively weak local economies are more likely to
have higher concentrations of elderly but fewer resources to deal with
their needs. Equitable treatment of the elderly requires interventions
from higher levels of government.
The social dimensions of aging
Underlying the complex geography of Canada's aging population is an
intricate web of social relations. First and foremost is the gendered
nature of aging. Three measures capture this critical aspect of
Canada's population. In 1996, the sex ratio between men and women
over 65 years stood at 76 males per 100 females. Among the elderly
80 and over, the ratio changes to 57 males per 100 females. Although
the gap in life expectancy between men and women will continue to
narrow, by 2026, the sex ratios of the elderly population will still be 83
males per 100 females among the population aged 65 and over and 62
males per 100 females among the population aged 80 and over. A
second critical measure is the difference in the percentage of elderly
men and women who spend the later years of their lives living alone.
In 1996, almost 38 percent of elderly women compared to only 16
percent of elderly men lived alone. Among those 80 and over, more
than half of all women lived alone while only 23 percent of men lived
alone. These proportions can be expected to decline somewhat as the
gap in life expectancy narrows and may also decline if the proportion
of non-Europeans living with adult children increases. The third
measure is the percentage of seniors living below the Statistics Canada
low income cut-off lines (LICOs)1. Almost 24 percent of women aged
65 and over lived below the LICOs in 1996 compared to 13.2 percent
of men aged 65 and over. This measure climbs to 33.9 percent of
women aged 80 and over, but changes little for men aged 80 and over
where the percentage is 15.3. The increasing proportion of the
population receiving both private pensions and CPP/QPP will ameliorate
this situation for many but those whose access to pension monies is
limited, including many immigrants, will face serious financial
disadvantage. Unless addressed by public policy, there may be
growing issues of income inequality among the elderly as well as in the
population as a whole.
Economic and social status can be linked closely with health status
among the elderly population. There is a clear gradient relating age
and declining health status (Statistics Canada 1999). There is also a
strong link between age and health service utilization (Rosenberg and
James 2000). Although recent evidence supports improvement in
health status among cohorts approaching old age compared with the
current elderly (Chen and Millar 2000), numerically such
improvements are dominated by increases in the number of elderly,
with consequent increases in demand for health services. While there
is much evidence to show that the growth in health service utilization
is only partially explained by the growth in the elderly population in
need (e.g., Barer et al. 1987, 1995; McDaniel 1987), the increase in
health care expenditures has resulted in provincial governments
undertaking restructuring of their health services.
Table not reproduced: Figure 1
Health service restructuring has a strong geographic expression as
provincial governments employ four major strategies to accomplish
their goals: regionalization of health services; hospital closures and
conversions; downloading of services to the community (e.g., home
care); and a growing reliance on informal support. While the
implications of regionalization have yet to be analyzed from a
geographic perspective, hospital closures, which have mainly occurred
in the older areas of Canada's largest cities and in rural areas (see
Hanlon and Rosenberg 1998; James 1999), have affected seniors
disproportionately because of their greater need and geographic
concentration in these same places. Downloading of community
services has also had a disproportionate effect on seniors because they
are the major users and in most communities providers have not been
able to supply all of the services required at sufficient levels. Reliance
on informal support is also problematic for seniors, especially for those
living alone and in poverty and for whom social networks are limited.
Restructuring of health services together with improvements in health
has also led to a decline in the percentage of the elderly in institutions
(Statistics Canada 1999). Again, there is a strong age effect and the
impacts of government policy on the supply side will also affect the
proportion of seniors living in institutional settings. Among men and
women aged 65 and over, 3.7 percent and 7.3 percent respectively
live in institutional settings. This jumps to 13.8 percent and 27.4
percent of men and women aged 80 and over respectively who live in
institutional settings. The geography of these settings appears to be
changing as government-owned facilities are closed, especially in inner
city locations, and non-profit and for-profit facilities are opened in
suburban and exurban locations. The changing geography of
residential facilities for seniors is, however, one that has received little
attention in Canada and will need much more study in the coming
years as Canada's population aged 80 and over increases rapidly
(Trottier et al. 2000). Particularly given the separation of older
Canadians from their adult children, an important question arises as to
whether individuals are more influenced by the location of their family
or by proximity to current residence in the move to an institution.
Concluding comments
The changing socio-economic and ethnic characteristics of Canada's
elderly population, in combination with the changing geographies of
health and social services, ultimately raises questions about
geographies of access and disadvantage. Theoretically, communitybased services ought to be more accessible to the elderly population
than those services that are provided in hospitals. One future scenario
is that seniors will enjoy better access to services because more of the
health and social services they require will be delivered to them where
they live. A second future scenario is that more of the elderly
population is likely to live in lower density, suburban and rural areas,
making the delivery of community-based services less efficient and
encouraging a return to more centralized and institutionally based
services. While many seniors, both women and men, will have the
resources to take advantage of either future scenario, there will still be
those beyond the age of 80, living alone and in poverty with limited or
no informal networks of support who find themselves both lacking
access and economically disadvantaged.
Attempts to Improve access and reduce disadvantage will also be
negated if health and social service providers do not recognize that
Canada's future elderly population will be a more diverse population
both socially and culturally. In this regard, the current evidence is not
promising (Rosenberg and James 2000). Finally, we need to
investigate in more detail the links between the changing geographies
of the elderly population, the working age population and the
dynamics of local economies. The demonstrated linkages between
aging and economic disadvantage suggest that we should be
concerned that a landscape of service rich and service poor
communities is evolving in Canada and that we should be seeking
policies which reduce such inequalities.
Footnotes:
Notes
1 The Low Income Cut-Off (LICO) is a CPI-adjusted measure based on
patterns of family expenditures. It is not an absolute measure of
poverty (Ruggieri et al. 1994) but does provide a consistent measure
of relative disadvantage across sub-groups of the population measured
at a given time.
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Author Affiliation
ERIC G. MOORE
Department of Geography, Queens University, Kingston, Ontario,
Canada K7L 3N6 (e-mail: mooree@post.queensu.ca)
MARK W. ROSENBERG
Department of Geography, Queens University, Kingston, Ontario,
Canada K7L 3N6 (e-mail: rosenber@post.queensu.ca)
Copyright Canadian Association of Geographers Spring 2001