Do immigrants really have better health than Canadian-born older adults?

By: Venessa Wong

At the time of arrival, immigrants have better health than their Canadian-born peers. However, the health of immigrants diminishes over time until it matches Canadian-born (Ng, 2011; Gee, Kobayashi & Prus, 2004). Is there a way to support immigrants so they can maintain or slow the decline in health as they age?

Physical Activity, Health and Immigrant Older Adults

In recent years, physical activity is increasingly recognized as a way to prevent and treat chronic conditions. While medicine treats specific conditions, physical activity has been shown to prevent and treat many common conditions such as diabetes, cancer, osteoporosis, obesity, depression and anxiety (Warburton, Nicol & Bredin, 2006; Penedo & Dahn, 2005). For example, regular physical activity reduces the risk of cardiovascular disease and can slow or “reverse the disease progression” (Warburton, Nicol & Bredin, 2006, p. 802). With further investigation, physical activity is associated with biological mechanisms that improve health. Examples of these mechanisms include improving body composition, blood flow and insulin sensitivity (Warburton, Nicol & Bredin, 2006). Despite the known benefits of physical activity, minorities and immigrants are least likely to be moderately active (Bryan, Tremblay, Pérez, Ardern & Katzmarzyk, 2006; Gilmour, 2007).

The decision to be active and engage in physical activity is complex and influenced by many factors. Many older adults face challenges including intrinsic factors such as health problems, fear of falling, lack of self-discipline and lack of motivation (Matthews et al., 2010; Dergance, Calmbach, Dhanda, Miles, Hazuda & Mouton, 2003). They also face barriers related to weather, transportation and finances (Belza, Walsick, Shiu-Thorton, Schwartz, Taylor & LoGerfo, 2004). Although many older adults face these barriers, immigrants face added challenges related to their immigrant status.

Researchers have drawn links between immigrant status and service access. Examples of barriers immigrants face include lack of culturally appropriate services, language barriers, and lack of knowledge of existing services (Stewart, Shizha, Makwarimba, Spitzer, Khalema & Ksaliwa, 2011).

Is there a solution?

Physical activity has many health benefits but immigrant older adults face challenges with being physically active. This raises an important question: how can we support immigrant older adults to increase their activity level? Given the diversity of individuals, and factors that influence their decision to be active, there needs to be a tailored approach to supporting immigrant older adults to become more physically active.

The Choose to Move Model

Our lab, the Active Aging Research Team (AART), reviewed the literature and created a model called Choose to Move. In this model, a trained activity coach provides guidance and support that older adults need to engage in more situation and ability-appropriate physical activity.

In the first two phases of Choose to Move, in January 2016 to May 2017, we engaged over 450 older adults in BC. We observed that Choose to Move enhances physical activity and social connectedness among participants (McKay et al., 2018).

We are now in the third phase of Choose to Move, January 2018 to June 2021. Our aim is to engage over 2000 older adults in 73 communities. To reach more diverse populations, one arm of Choose to Move aims to “scale-out” the model. Scaling-out is a relatively new concept and is defined as “the deliberate use of strategies to implement, test, improve, and sustain [evidence-based interventions] as they are delivered in novel circumstances distinct from, but closely related to, previous implementations” (Aarons, Sklar, Mustanski, Benbow & Brown, 2017, p. 2). To scale out Choose to Move, we selected three delivery organizations in the Vancouver area that serve Chinese-speaking older adults. These organizations are Frog Hollow Neighbourhood House, Options Community Services and Yarrow Intergenerational Society for Justice.

We engaged the organizations through surveys, interviews, teleconferences and observations to understand how Choose to Move is adapted to better fit their participants. Through these interactions, activity coaches highlighted challenges participants face when increasing their physical activity. Many of the challenges are in line with the literature. Let’s take a look at some strategies these activity coaches have used to tackle the challenges.

1. Make a pairing. We know from activity coaches and previous studies that lack of self-discipline and motivation are barriers to engaging in physical activity (Dergance, Calmbach, Dhanda, Miles, Hazuda & Mouton, 2003). Through one-on-one consultations, activity coaches understand the older adult’s needs and pairs those with similar interests together. Having someone to engage in physical activity together acts as a source of accountability.
2. Culturally appropriate opportunities. Culturally inappropriate opportunities and language barriers deter older adults from engaging in physical activity. Unsurprisingly, it is difficult to engage in an activity where you do not feel connected or have a challenge understanding others. Activity coaches help older adults to navigate and find activities and facilities that are both culturally appropriate and offer a language they speak.
3. Familiarize spaces. Formal establishments geared towards physical activity and recreation, such as community centres, may be known to immigrant older adults but the services offered may not. To overcome this barrier, an activity coach provided a tour of the local community centre. This approach can help immigrant older adults familiarize themselves with the space and show them what’s available within the facility.

The decision to engage in physical activity and be active is complex. Immigrant older adults face challenges to engaging in physical activity such as lack of motivation, transportation, language barriers, lack of culturally appropriate services and lack of knowledge on services available (Matthews et al., 2010; Dergance, Calmbach, Dhanda, Miles, Hazuda & Mouton, 2003; Belza, Walsick, Shiu-Thorton, Schwartz, Taylor & LoGerfo, 2004; Stewart, Shizha, Makwarimba, Spitzer, Khalema & Ksaliwa, 2011). Through Choose to Move, participants receive guidance and support from their activity coach to overcome these challenges. With guidance and support, they can break down barriers and reap the benefits of physical activity.

Since 2015, the Active Aging Research Team, the BC Recreation and Parks Association, YMCA and the United Way of the Lower Mainland have been working in partnership to enhance the health, physical activity and social connectedness of BC seniors through Choose to Move.

References

Aarons, G. A., Sklar, M., Mustanski, B., Benbow, N., & Brown, C. H. (2017). “Scaling-out” evidence-based interventions to new populations or new health care delivery systems. Implementation Science, 12(1), 1–13. doi:10.1186/s13012–017–0640–6

Belza, B., Walwick, J., Shiu-Thornton, S., Schwartz, S., Taylor, M., & LoGerfo, J. (2004). Older adult perspectives on physical activity and exercise: Voices from multiple cultures. Preventing Chronic Disease, 1(4), A09-A09.

Bryan, S. N., Tremblay, M. S., Pérez, C. E., Ardern, C. I., & Katzmarzyk, P. T. (2006). Physical activity and ethnicity: Evidence from the Canadian community health survey. Canadian Journal of Public Health, 97(4), 271–276.

Dergance, J. M., Calmbach, W. L., Dhanda, R., Miles, T. P., Hazuda, H. P., & Mouton, C. P. (2003). Barriers to and benefits of leisure time physical activity in the elderly: Differences across cultures. Journal of the American Geriatrics Society, 51(6), 863–868. doi:10.1046/j.13652389.2003.51271.x

Gee, E. M. T., Kobayashi, K. M., & Prus, S. G. (2004). Examining the healthy immigrant effect in mid- to later life: Findings from the Canadian community health survey. Canadian Journal on Aging, 23(5), S55-S63. doi:10.1353/cja.2005.0032

Gilmour, H. (2007). Physically active Canadians. Ottawa, ON: Statistics Canada. Retrieved August 2019, from https://www150.statcan.gc.ca/n1/en/pub/82-003-x/82-003-x2006009eng.pdf?st=N19MetpY

Mathews, A., Laditka, S., Laditka, J., Wilcox, S., Corwin, S., Liu, R., … Logsdon, R. (2010). Older adults’ perceived physical activity enablers and barriers: A multicultural perspective. Journal of Aging and Physical Activity, 18(2), 119–140. doi:10.1123/japa.18.2.119

McKay, H., Nettlefold, L., Bauman, A., Hoy, C., Gray, S., Lau, E., & Sims-Gould, J. (2018). Implementation of a co-designed physical activity program for older adults: Positive impact when delivered at scale. BMC Public Health, 18(1), 1289–1289. doi:10.1186/s12889–0186210–2

Ng, E. (2011). The healthy immigrant effect and mortality rates. Health Reports, 22(4), C1.

Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical
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Stewart, M., Shizha, E., Makwarimba, E., Spitzer, D., Khalema, E. N., & Nsaliwa, C. D. (2011). Challenges and barriers to services for immigrant seniors in Canada: “you are among others but you feel alone”. International Journal of Migration, Health and Social Care, 7(1), 16–32. doi:10.1108/17479891111176278

Warburton, D., Nicol, C., & Bredin, S. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal, 174(6), 801–809. doi:10.1503/cmaj.051351