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Integrated Analysis of Aging and Health in Canada

  • Allison Loucks, RN
  • Jul 30, 2018
  • 7 min read

Introduction

http://www.uab.edu/institutionaleffectiveness/planning/131-staff/70-research-and-analysis

Over the last few months, the development of my professional ePortfolio facilitated a unique learning opportunity concerning health and aging in Canada, and the implications on oncology care. My learning was enhanced by sharing related curated resources, engaging with health professionals in dynamic virtual discussions. My initial online correspondence was guided by the College of Nurses of Ontario (CNO) in a webinar called Social Media: Reflect Before You Post, and CNO standards on common expectations for social media use, which helped me to maintain a respectful professional image.

My most significant learnings were of the multiple levels of the societal influence on the determinants of health for older adults in Canada, and how vulnerable populations are at risk for poor health-related outcomes due to these health determinants. I explored multilevel health models to demonstrate effective ways to address determinants of health factors that negatively impact the health of vulnerable older adults; this exploration generated ideas regarding future professional practice changes that I plan to make in my clinical setting with the population I work with.

Analysis of Aging and Health

Understanding of Health

https://www.k4health.org/toolkits/bangladesh-health-journalists/inequalities-health-key-issue

My journey started by curating resources related to health and associated concepts to broaden my understanding of health beyond the original limited WHO definition which states health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 2018). Brook’s (2017) article challenged my notion of health by querying how a community’s cultural of health can have implications on the health of community members, generating new ideas involving healthcare interventions implemented to promote and screen for the health of a culture, such as screening for prejudice and intolerance.

Determinants of health. Brook’s (2017) provocative query expanded my concept of health to include micro and macro level influences which impact the determinants of health, which are known to shape and mold the health of individuals over the life course. Broadening one’s perspective on health clarifies the role government must play to adequately promote health for communities by addressing these determinants before they result in barriers that inhibit equitable healthcare, and in turn result in poor health-outcomes (Public Health Agency of Canada, 2018).

Levels of influence. Kaplan’s (2004) article helped me to understand the various social structural influences on an individual’s health from a ground-up approach, examining the determinants of health that are found in various hierarchical levels of society from a historical, culture, political, and institutional.

Vulnerable Populations and Health Inequity

As a geriatric oncology nurse working with vulnerable older adults who often live alone with poor social supports, a decline in memory, function, and mobility; I frequently see how their health is further complicated by the initiation of cancer treatment which is often NOT tailored to one’s specific level of fitness based a personalized geriatric assessment (Bond et al., 2016; Extermann et al., 2005; Hurria et al., 2012). In addition to this, Canada’s aging population, is larger than ever and is projected to represent 23% of the total population (Statistics Canada, 2016), setting the stage for further health inequity, as the incidence of cancer in this growing population continues to climb (Xie et al., 2015).

www.rootsofhealthinequity.org

I wanted to better understand this vulnerable population that I work with to expose the social determinants in health inequity. To provide a comprehensive analysis, I applied a multilevel health approach to help me understand health inequity associated with older women, who are vulnerable, invisible, have more comorbidities and associated disability, poor self-rated health, and high risk to poor health outcomes (Public Health Agency of Canada, 2012; WHO, 2007). Through this exercise I learned that gender and age interplay with socioeconomic status, race and ethnicity, which greatly impacts health equity addressing the disparities between and among populations (WHO, 2007).

Older Women are uniquely vulnerable. Older women live longer and therefore are more likely to be socially isolated as they outlive their male counterparts, and are also more likely to suffer functional decline, poor self-rated health, and loss of independence due to the aging process and the presences of multiple chronic illness (WHO, 2007). Social determinants of health present health inequities for older women; an example of this are existing barriers in accessing care due to ageist structural barriers in health systems, making navigating doctors’ appointments challenging for those with visual, hearing, cognitive, and functional impairments, as well as the transportation and financial constraints of attending appointments for treatments and assessments (WHO, 2007).

Addressing health inequity. I examined the determinants of health further by approaching my

https://money.cnn.com/2014/05/13/retirement/retirement-women/index.html

analysis with a gender and age responsive framework (WHO, 2007). This framework exposes political, socioeconomic, institutional, genetic, biological and geographical factors contribute to the creation of the social determinants of health, shaping the health care experience and health-related outcomes of older women (WHO, 2007). The gender and age framework creates opportunities to promote women’s health, participation and security across the life span in order to enhance quality of life as women age by implementing gender-responsive policies, healthcare programs and practices that address older women’s rights, strengths and needs women throughout their life course (WHO, 2007).

The health status of the aging population with chronic health conditions can be better understood by implementing health-adjusted life expectancy, informing the quality and quantity of life in diverse populations, which also accounts for disparities in socioeconomic status and gender (Public Health Agency of Canada, 2012). I learned that as women live longer, they also have a higher risk than men in developing chronic conditions, and are more likely than men to have 2 or more chronic conditions with associated disabilities that affect their daily functioning and independence (Public Health Agency of Canada, 2012).

Future Professional Practice

To guide future professional practice, policy makers and health care professionals need to tailor healthcare delivery and interventions using a multilevel health model approach with a key focus on gender and aging to address the unique set of determinants for those living longer with chronic health conditions (Statistics Canada, 2016). Having good understanding of health-adjusted life expectancy of various vulnerable populations, such as older women, will ensure that health care delivery models can be designed and staffed appropriately to bring healthcare to older adults in their homes and prevent overwhelming hospital emergency departments.

Canada is committed to developing strategies that will improve the health of our aging population and to do this the Canadian Institute of Health Research Strategic Research on Aging (CIHR, 2018) developed the Institute of Aging (IA) which aims to guide and generate research focusing on identifying tangible solutions in managing and improving the health of Canada's aging population. In addition, the Canadian Network on Aging and Cancer (CNAC) was created in 2016 aimed to develop a Canadian collaborative multidisciplinary research network between investigators to improve health outcomes for older adults with cancer. I attended the first meeting in 2016 and I plan to attend the upcoming meeting in Fall 2018, to share, inform and guide our oncology practice with older adults in my cancer facility.

My Future Professional Practice

Upon the completion of my Master’s program, I plan to share more of my professional experience with the nursing, oncology, and geriatric oncology communities by publishing our program’s accomplishments in academic journals and presenting at professional conferences. I will contine to use specialized geriatric assessment tools in cancer care to reduce the toxicity and increase tolerance of cancer treatment in older adults to improve cancer-related health outcomes and decrease mortality and morbidity (Extermann et al., 2005).

I plan to use a gender and aging sensitive lens as I carefully critique the health inequities this population is faced with, and as I examine care delivery within my facility. In my articulation of our program findings, I will include critical factors related to the health of older adults with cancer, such as the social determinants of health, levels of influence on these determinants which create vulnerability in this population, and highlight specific roots of health inequity in this group to explain the poor health related outcomes they are high risk for experiencing.

Lastly, I will continue to use the guidance of the CNO, RNAO, and CANO to maintain my professionalism and update my professional nursing knowledge through continuing education.

Resources

Bond, S. M., Bryant, A. L., & Puts, M. (2016). The evolution of gero-oncology nursing. Seminars in Oncology Nursing, 32(Gero-Oncology Nursing). 3-15. Retrieved from: PMC4745375

Brook. R. H. (2017). Should the definition of health include a measure of tolerance? JAMA, 317 (6), 585-586. doi:10.1001/jama.2016.14372. Retrieved from: https://0-jamanetwork-com.aupac.lib.athabascau.ca/journals/jama/fullarticle/2601506

Canadian Network on Aging and Cancer (CNAC) (2016). Meeting the needs of the aging population: the Canadian Network on Aging and Cancer—report on the first Network meeting, 27 April 2016. Current Oncology: a Canadian Care Research Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407881/pdf/conc-24-e163.pdf

College of Nurses of Ontario (CNO) (2018). Social Media: Reflect Before You Post.

Extermann, M., Aapro, M., Bernabei, R., Cohen, HJ., Droz, JP., Lichtman, S., . . . Topinkova, E. (2005). Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Critical Review Oncology Hematology, 55(3), 241-52.

Hurria, A., Browner, I.S., Choen, H.J., Delinger, C.S., deShazo, M., Extermann, M., . . . Wildes, T. (2012). Senior adult oncology. National Comprehensive Cancer Network, 10(2).

International Nurse Regulators Collaborative (INRC), (2016). Social Media Use: Common Expectations for Nurses. http://www.cno.org/globalassets/docs/prac/incr-social-media-use-common-expectations-for-nurses.pdf

Institute of Aging (IA), (2018). Canadian Institute of Health Research Strategic Research on Aging. The Canadian Institute of Health Research (CIHR). Retrieved from: http://www.cihr-irsc.gc.ca/e/46837.html

Kaplan, G. A. (2004). What’s wrong with social epidemiology, and how can we make it better?. Epidemiologic Reviews, 26(1), 124-135.https://www.ncbi.nlm.nih.gov/pubmed/15234953

Public Health Agency of Canada (2012). Health-adjusted life expectancy Health-Adjusted Life Expectancy in Canada: 2012 Report by the Public Health Agency of Canada. Retrieved from: https://www.canada.ca/en/public-health/services/publications/science-research-data/health-adjusted-life-expectancy-canada-2012-report-public-health-agency-canada.html#c1

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.

Rosella, L. C., Fitzpatrick, T., Wodchis, W. P., Calzavara, A., Manson, H., & Goel, V. (2014). High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics. BMC health services research, 14(1), 532. Retrieved from: https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-014-0532-2

Statistics Canada (July 28, 2016). Research highlights on health and aging. Retrieved from: https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2016001-eng.htm

World Health Organization. (2018). Constitution of WHO: principles. Retrieved from: http://www.who.int/about/mission/en/

WHO (2018). Public health, environmental and social determinants of health (PHE). Retrieved from: http://www.who.int/phe/about_us/en/

World Health Organization. (2007). Women, ageing and health: A framework for action: Focus on gender. http://www.who.int/ageing/publications/Women-ageing-health-lowres.pdf

Xie, L., Semenciw, R., & Mery, L. (2015). Cancer incidence in Canada: trends and projections (1983–2032). Health promotion and chronic disease prevention in Canada: research, policy and practice, 35(Suppl 1), 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001519/

Images (in order of presentation).

Roots of health inequality (image) (n.d.). Retrieved from: www.rootsofhealthinequity.org

Retirement's gender gap leaves many women in poverty (Image) (2012). Retrieved from: CNN Money


 
 
 

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