Immigrant Older Women - Care Accessibility Research Empowerment
Reprinted from the "Immigrants and Refugees" issue of Visions Journal, 2010, 6 (3), p. 17
Sixty-six-year-old Mei Lin Wong* looks after her husband, who has Alzheimer’s disease, and her grandson, now a teenager. Mei Lin supports the three of them on her meagre earnings from a part-time job in a corner grocery store. She is still legally ‘dependent’ on her adult children who sponsored her eight years ago and lives in a house in Abbotsford that her children bought.
They have since returned to China because they couldn’t find the engineering jobs for which they were qualified. As her husband’s needs increase and her grandson spends less time at home, Mei Lin finds she is increasingly anxious, especially now that she has angina. Although she is highly educated, Mei Lin’s arrival in Canada at age 58 made it difficult for her to learn English. While there are many Chinese services in Vancouver, most are in Cantonese, not Mandarin, her native language. Also, with little time and income and no subsidized bus pass, she finds it difficult to travel into Vancouver. Mei Lin doesn’t know how she will cope and doesn’t know where to turn.
The ICARE (Immigrant Older Women—Care Accessibility Research Empowerment) team is a diverse group of health providers, researchers, multicultural settlement agency workers and older immigrant women. Initial funding focused ICARE research on understanding the situation of visible minority older immigrant women such as Mei Lin.1 (Note: In our research we focus on immigrant groups only, because refugees often face very different issues, including experiences of trauma.) Since the majority of immigrants to BC come from Chinese-speaking (e.g., China, Hong Kong, Taiwan) and South Asian (e.g., India, Pakistan, Sri Lanka) countries, we focus specifically on older women from these communities.
Almost 90% of older immigrants to BC are sponsored, usually by their adult children. Compared to immigrants to Canada overall, these “Family Class” arrivals have lower levels of education and English language ability.2 Immigrant women over age 65, many of whom have never worked, are among the poorest in Canada.3 Older sponsored immigrants have poorer health than long-term immigrants and the Canadian-born population.4 And the risk of mental illness is higher among those who migrate after age 65.3
Several Canadian studies have found that older immigrant women from Chinese-speaking and South Asian countries are especially prone to depression.5-10 Yet we have little research that shows how social factors and discrimination combine to impact these women’s mental health and their access to services.11-14 We also know little about how to promote mental health in ways that are acceptable and accessible to older immigrant women and men alike.15-16 These are the gaps the ICARE team aims to fill.
Our approach to research
We begin with the understanding that health, including mental health, and access to health care are strongly influenced by social factors. These include gender, age, legal immigration status, visible minority and socio-economic status, and where people live.17 Experiences of discrimination (i.e., racism, sexism, ageism) are also relevant.
To fully understand the effects of gender on health, we will need to compare the experiences of immigrant men and women. We will be exploring social factors that affect mental health, including freedom from discrimination and violence, the support of family and friends, and income.18
The ICARE team held consultations to identify research priorities for addressing mental health needs among older South Asian and Chinese immigrant women. These consultations took the form of: 1) a day-long forum with partners from the multicultural settlement, community, health service provider and academic sectors; 2) a three-part, Punjabi-language community radio call-in program; and 3) a three-hour Mandarin-language discussion session with older women.
The ICARE Community Mental Health team was formed in October 2009 to address the identified priority: mental health promotion among older adults, particularly women in these communities.
The immigration experience and mental health
For many immigrant women, mental health issues result from the stress of the immigration process. Resettlement stress, poverty, racism, intergenerational conflict and family separation are common experiences that greatly affect their mental health.3,19
Canada’s immigration policy mandates that sponsored seniors are not eligible for financial or social supports (i.e., Old Age Security, Guaranteed Income Supplement, subsidized housing, bus passes, etc.) for 10 years. This makes them dependent on the adult children who sponsored them, which is also a source of stress for many older immigrants.20-22
This policy leaves older immigrant women, who often have less experience outside of the home, especially vulnerable and dependent on their family sponsors. This sometimes leads to abuse and neglect.23-25 A common form of financial abuse occurs when older women are pressured to sign over their old age pension cheques—which they can receive after the 10 years—to their family sponsors.11,24 Abuse and neglect clearly impact women’s mental health.
Immigration can result in a considerable drop in social status and a shift in roles. As a research participant explained: “In India, the daughter-in-law is under the [mother-in-law], but here, the roles are reversed. . .Here, the son and daughter-in-law have the money and, therefore, they are in control.”20
Role reversals often occur because the younger women here typically enjoy more independence outside the home, have a better understanding of Canadian society and its institutions, and speak more English than the older women. Decisions about matters of tradition, on which older Indian women were consulted back home, are not relevant here. And, well-educated older Chinese women find themselves unable to find work due to their age and lack of Canadian experience and English language skills.26
Older immigrant women in several Canadian studies and in the ICARE consultations identified their role in Canada as limited to housekeeper and child care provider, with little respect associated with either.11,20,26-29 And there is often an expectation on the part of family sponsors that older female relatives look after their grandchildren without pay.
Child care obligations
ICARE consultations with older women confirmed that talking about caring for grandchildren is a way for older immigrant women to talk about mental health challenges.
Many of these women have cooked, cleaned and provided care for family members throughout their lives, which has limited their access to education and work outside the home. In Canada, they often lack the skills to access services and mental health supports.20 Others, lucky enough to have had servants or access to education, find the adjustment to caregiving roles difficult. Like Mei Lin, they do caregiving out of indebtedness to their sponsoring children or the need to occupy a role when opportunities to work are limited.
Consultation participants expressed that while grandparenting may be satisfying and is a role women want to fulfill, it is also tiring. As a result, the caregiving affects their physical and mental health.
One woman from the Chinese focus group explained that before she immigrated to Canada, she was physically active. But since immigrating here to look after her grandchild and perform household chores, she can’t find time for these activities and has developed high blood sugar. Another woman said her family is too busy to help her when she gets sick. Older Punjabi women have similarly related how, with most of the younger women working outside the house, they aren’t attended to by family members when they get sick.29
Loss of status is also experienced through systemic occurrences of discrimination. For example, older immigrants from South Asia are economically disadvantaged compared to older immigrants from the United Kingdom and Australia. This is due to immigration policies that base the amount of Old Age Security on the country of origin.30
Additionally, many older South Asian and Chinese immigrant women experience individual discrimination on a day-to-day basis because of their skin colour, age and gender. As visible minority seniors with few, if any, English language skills, older Punjabi women often resort to employment as berry pickers. This is sometimes voluntary and sometimes enforced by their families. The working conditions can be extremely poor and the work itself hard, with negative consequences for their health. But the women are motivated to offset their indebtedness to their sponsors and to boost their self-esteem.20
Loneliness and isolation
Immigrants lose the family and friend support networks they had in their country of origin, particularly if they come from rural communities. This loss contributes to depression among older immigrants, particularly women. Women are more often confined to the home here due to language barriers, lack of experience outside the household, caregiving duties and cultural taboos.11,20,28 As with Mei Lin, many are unsure how to find their way around new cities.
Older women might also feel a communication and culture gap between themselves and their children, grandchildren and the community at large. Participants in our forum related how the Punjabi or Cantonese that their grandchildren speak is imperfect and rarely used in a way that shows appropriate levels of respect. They also complain that few community programs provide relevant English language classes for older adults.
A participant in our Chinese community consultation said she needs mental health support because her daughter and son don’t want her to live with them. If women who live with their relatives are unhappy, they may not complain for fear of being “kicked out” of the family house and left alone.
In the fall of 2010, our ICARE Community Mental Health team will work with University of the Fraser Valley students to develop an inventory of services in the Fraser Health Authority. These will be services that address factors affecting the mental health of late-in-life immigrants from the South Asian or Chinese communities. We will then apply for funding to evaluate these services and identify how to develop mental health promotion that is relevant to older adults in these two communities.
About the authors
Melanie is the Research Assistant to the ICARE (Immigrant Older Women—Care Accessibility Research Empowerment) team. She brings her commitment to health and social justice to this community-based health research program.
Sharon is a Research Associate at the Centre for Healthy Aging at Providence (CHAP), a Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia, and leads the ICARE team with Dr. Karen Kobayashi (University of Victoria)