Based on the National Household Survey (NHS), the Aboriginal population of Canada was estimated at 1,400,685 people in 2011, representing 4.3% of the total Canadian population (Statistics Canada, 2013a).Footnote 15 Although only 6% of the Aboriginal population is aged 65 and over, (compared to 16% in the Canadian population), the proportion of Aboriginal seniors is increasing over time due to declines in mortality (more survivors to older ages) and lower fertility (smaller younger cohorts).Footnote 16 Aboriginal seniors are a highly diverse group with about half living in cities, and the other half in rural and remote areas, mostly on reserve (Wister and McPherson, 2014).Footnote 17 Recommendations to tackle social isolation need to recognize the unique characteristics of these groups.
Aboriginal seniors have faced numerous challenges over the course of their lives that may follow them into older age. These include higher levels of unemployment and poverty, substandard housing, higher rates of crime and abuse, separation from families during the residential school period, higher mortality and morbidity rates, and fewer health care, residential and community services (Wilson et al., 2011; Wister and McPherson, 2014). In addition, as a result of the colonial experience, they have experienced marginalization, especially those living on reserve in more rural and remote areas (Richmond, 2007). This makes them a highly vulnerable group and one prone to risks associated with social isolation. Yet, research into social isolation among Aboriginal seniors is scarce, with most literature focusing on access to health and community care or social inclusion among Aboriginal people in general (Health Canada, 2009).
Approaches to addressing aging-related needs among Aboriginal communities from the vantage point of social inclusion have identified complex barriers and challenges (Habjan et al., 2012; Haskell and Randall, 2009; Wilson et al., 2011). Haskell and Randall (2009), for instance, note how social connectedness at the interpersonal level has often been fragmented due to traumatic experiences (e.g., family violence, suicide, substance abuse, poverty, dislocation, etc.). Treloar et al. (2014) identify three situational barriers that can undermine the experience of social inclusion of Aboriginal people in cancer treatments: low socio-economic security, lack of trust in health care provision, and lack of knowledge about the system of cancer treatment (health literacy). To overcome these challenges, health-care providers must acknowledge them and create practical and symbolic responses in partnership with Aboriginal people, communities and health organisations.
Similarly, Habjan et al. (2012) identified multiple barriers regarding health and social support, including lack of a family caregiver, limited access to professional and health care services and providers, educational and training needs, barriers linked to community and government relationships, and relevant and safe care. Beatty and Berdahl (2011) have also identified multiple factors that lead to health challenges among Aboriginal seniors, including poverty, lack of housing, lack of nursing homes, and education and literacy barriers, as well as limited policymaker and caregiver knowledge of the needs of Aboriginal seniors. To address these complex barriers, multi-level changes are required.
Numerous studies have shown that Aboriginal communities can harness community-based resources especially through participatory and action-oriented approaches that empower seniors, their families, and their communities (Wister and McPherson, 2014). At the same time, a paradox exists with respect to social support and health among Aboriginal people – while they experience higher rates of social support within Aboriginal communities, this important social determinant of health has not resulted in better health status for Aboriginal seniors (Richmond, 2009). Fewer personal (especially economic) and interpersonal resources likely contribute to this paradox. Additionally, Richmond (2009) has shown that there can be stress associated with the supportive roles community members are expected to fill. Due to the small size of many Aboriginal communities and their relative isolation, community members who are also nurses or social workers may have difficulties escaping their professional roles. This can have negative consequences for those providing support as well as those receiving it.
The level of social isolation experienced by older Aboriginal people is not known, and it is likely that there is a tremendous degree of diversity depending on the community, and type of senior (e.g., middle-class urban dweller, senior living in an isolated reserve community, etc.). However, cultural and structural factors, coupled with high rates of significant traumatic events over the life course, and trust and understanding of the health and community care systems, may increase the risk of loneliness and social isolation. Low education and health literacy, low income or poverty, geographic location and isolation, poor health status, cultural separation, a higher likelihood of experiencing traumatic events, and fragmented informal and formal support systems create a cascading of risk for social isolation among Aboriginal seniors. Approaches to reducing the risk of social isolation need to address a number of risk factors that appear to be integrally connected to historic, cultural and social marginalization and rooted in economic disadvantage.