Determinants of Health Related to Chronic Disease Management of Elderly in Canada
It is agreeable that the health of Canada’s population is well, particularly in contrast to various developed economies. However, the prevention and management of chronic diseases among the elderly present the greatest challenge to Canada’s health care system. Today, the seniors have a tendency to living longer as they are healthier and economically better off compared to the previous generations. However, as they age, studies reveal that the elderly suffer increasingly from chronic diseases that exert extra burdens on the country’s healthcare system. Canada’s elderly populations are highly prone to poverty and have the greatest demands for community, home and acute care services (Belanger, Gosselin Valois & Abdous, 2014). Lack of government support and the shortage of home care nurses imply that most of the seniors are confronting health challenges of aging. As a result, the only health care alternatives are the ambulances from emergency units to hospital admission (Belanger, Gosselin Valois & Abdous, 2014).
Little is known about the distinct impact of social determinants of health to chronic disease management for the elderly in Canada. However, it is evident that the spiritual, emotional and physical dimensions of chronic disease management among this population are distinctly influenced by a variety of social determinants. This literature review will focus on three major social determinants. They include access to health services, physical environment and income and social status, which influence the management of chronic diseases of the elderly along a continuum from excellent to poor health. In fact, “Illness related variables were associated with poor health, with smaller but significant contributions from demographic and lifestyle factor” (Cott, Gignac, & Badley, 1999, p.731). For the sake of this literature review, the three determinants of health will be explored.
Access to health services, physical environment and income and social status influence the health vulnerability and chronic disease management of the elderly. This population is not only a burden on the national health care system but is normally restricted to from access to resources, which could ameliorate their problems. Not only do the three determinants influence the diverse health outcomes of the seniors but they also trigger health complications that often result in circumstances that in turn, reflect subsequent health determinants (Mery, Wodchis, & Laporte, 2015). For example, living in low-income households is associated with high levels of illness and disability. In turn, this reflects diminished opportunities to participate in gainful employment hence aggravating poverty and chronic diseases among the elderly.
Researchers in this area have attained tentative agreement regarding the three determinants of health related to chronic disease management of elderly in Canada (Belanger, Gosselin Valois & Abdous, 2014). Moreover, the contexts and mechanisms via which these determinants influence the health of this group have been articulated clearly. For decades, researchers have been mapping the complex interconnections that prevail. These researchers have demonstrated these linkages in an empirical format (Belanger, Gosselin Valois & Abdous, 2014).
Access to health Services
Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, and Beckles (2016) measured Health Inequities and Social Determinants of Health to Support the Advancement of Health Equity. They report Canadians must have the social, physical and political access to these services to experience the benefits of the advanced healthcare system. However, often, this is not the case for Canadian seniors suffering from chronic diseases. The nation’s system of healthcare delivery for seniors with chronic diseases mirrors a program with fragmented delivery, limited accountability and jurisdictional ambiguity. Salzman, Collins, & Hajjar (2012) added that the present health care services for chronic diseases for the elderly are focused on communicable illnesses. However, morbidity and mortality among the elderly are increasingly due to chronic illness. Similarly, social access to health care is limited for the elderly because the healthcare system accounts for neither age nor the social position of the seniors’ health (Salzman, Collins, & Hajjar, 2012).
Compared to other populations, the elderly living in rural areas have challenges accessing healthcare services for their chronic illnesses because of long wait list (Salzman, Collins & Hajjar, 2012). Moreover, they are restricted to required services unapproved or covered by the government –Non-Insured Health Benefit (NHIB) Plan, and nurses or doctors not being available in their area. Researchers have also cited frequent cases of inadequate or culturally inappropriate health provision. Because many Canadian seniors live in isolated and rural communities, it presents an obstacle in accessing the much-needed health care services (Cott, Gignac, M & Badley, 1999).
For the roughly 50% of Canada’s seniors living in the remote and rural areas, lack of transport, low population density, long waits and inadequate human resources pose as significant obstacles to healthcare access. Low population density and large distance imply greater delivery costs per capita. In turn, this translates into reduced health professionals and access to health services for seniors living with chronic illness (Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, & Beckles, 2016).
In particular, this geographic remoteness acts as an obstacle in Northern Canada, a region characterized by remote and rural communities. Belanger, Gosselin Valois and Abdous (2014) focused on individual and contextual determinants of social home care usage. For instance, his findings indicate that of the Inuit Nunaat communities that hold the majority of Canada’s Inuit population; only a few have hospitals, and none have year-round road access. In such communities, healthcare provision tends to be via health facilities, staffed by a nurse rather than a physician. Seniors with chronic diseases are less likely to access specialized health care experts like a family physician, dentists and other medical experts, greatly because these experts are often non-residents and are only flown into communities for short periods to attend to patients. The isolation and remoteness of such communities similarly lead to low retention of health professionals (Cott, Gignac, & Badley, 1999).
Most Canadian seniors battling with chronic illness live in rural communities, characterized by a crucial shortage of medical personnel. Canada’s nursing industry is in crisis and from a proportional perspective, the number of doctors serving this population is said to be “under half of that serving the cities” (Mery, Wodchis, & Laporte, 2015). Low retention rates combined with the lack of permanent health professionals leads to less continuity of care. Consequently, this lowers the effectiveness of health services for chronic disease management among Canada’s elderly. For instance, patients undergo lengthy paper work procedures that could take even days or months before they can obtain a drug exemption for a drug that is not presently listed on the NHIB program’s drug benefit list. For the elderly, this procedure is so complex because patients ought to depend on visiting health experts who tend to be available for appointments one per month (Mery, Wodchis, & Laporte, 2015).
According to Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, and Beckles. (2016), lack of access to healthcare services for the management of chronic diseases among the elderly has had numerous implications. First, these patients have been forced to leave their communities to access specialized care. Typically, they are transferred to cities for medical appointments with medical specialists, emergencies, hospitalizations, diagnosis and treatment. This implies that they tend to leave behind their support networks and communities. For instance, 10% of seniors with chronic disease in Inuit Nunaat report that they had to be temporarily away from their communities for months due to sickness. A lack of an interpreter could add additional stress to patients who cannot speak because they cannot understand the nature of the disease or the treatment prescriptions. The concluded that “Although much is understood about the role of social determinants of health in shaping the health of populations, researchers should continue to advance understanding of the pathways through which they operate on particular health outcomes” (p.S33).
Not only must the Canadian elderly have physical access to healthcare services for their chronic diseases to experience positive health outcomes, but also the quality, nature and appropriateness of such services need to be considered. Salzman Collins & Hajjar (2012) point out that, modes of in urban locales are not effective in remote and rural locales. The quality and nature of services are affected by the timeliness of the service. The most notable impact of systemic obstacles to healthcare access such as lack of health specialists and long waits is that early diagnosis of chronic illness is inhibited (Bradley-Springer, 2012). Naturally, given that the elderly cannot feel that they can access care regularly to manage their chronic illness or trust their medical specialists, they will be less expected to pursue help when they experience signs. Belanger, Gosselin Valois and Abdous (2014) agreed that chronic diseases in the elderly cannot be detected early, and treatable diseases are discovered when complete recovery is impossible. Researchers have also discovered that Canada’s elderly with chronic disease are to be diagnosed at later stages of the diseases hence leading to higher mortality rates. These studies attribute such rates to restricted access to treatment and screening services, coupled with a dearth of knowledge for early detection and prevention (Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, & Beckles, 2016).
Income and Social Status
Studies focusing on health demonstrate a sharp tie between income and social status and health outcomes in chronic disease management of the elderly. For example, Mery, Wodchis, and Laporte, (2015) claim that the state of health and longevity increase with position on the income scales. This means that income is the most crucial social determinant of health in the management of chronic disease among Canadian seniors. Income level shapes a person’s overall living conditions and drives health related behaviors like tobacco use, quality of diet and physical activity. In Canada, influences the quality of other social health determinants such as housing, food security and other basic requirements of health (Mery, Wodchis, & Laporte, 2015).
Chronic disease management of elderly in Canada is associated with a person’s capacity to access latent benefits of employment like meaningful productivity, social support and having a role identity. Bradley-Springer (2012) identified both employed and self-employed individuals have a considerably reduced chance of experiencing a high rate of chronic disease. On the contrary, people who are unemployed or unable to work are statistically more likely to experience a high degree of chronic disease. In other studies, the unemployed are twice as expected to experience a very high rate of chronic illness, unlike employed persons (Bradley-Springer, 2012).
Belanger, Gosselin Valois and Abdous (2014) established that individuals with an annual household income of below $20,000 were statistically greatly prone to chronic disease. On the contrary, individuals with an income above $60,000 were less likely to experience chronic disease (Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, & Beckles, 016). Evidently, there is a reduction of chronic illness with the increase in per capita household income. The literature presents a sharp link between higher rates of chronic illness with an increase in socioeconomic disadvantage.
Mery, Wodchis, & Laporte, (2015) argued that that chronic disease in the elderly is more a function of a person’s perception of his/her financial status rather than employment status. It is emerging that health outcomes in chronic disease management among the elderly is associated with unemployment. Perceptions of financial health are said to be the best predictor of recovery from chronic disease. Precisely, income is important as the federal government offers fewer important benefits and services as a right for citizens. In fact, necessary medical procedures and public education until Grade 5 are government funded but housing and retirement resources must be bought and paid for by the elderly. In addition, it has been established that seniors in wealthier areas of Canada live longer unlike other neighborhoods. Following such trends, seniors living in the most deprived locales had death rates 30% higher than the least deprived areas, as far as chronic illness is concerned (Mery, Wodchis, & Laporte, 2015).
Chronic disease may be especially problematic among less advantaged seniors for numerous reasons. First, Salzman, Collins and Hajjar (2012) believed that disadvantaged senior with chronic disease might lack adequate access to the crucial resources necessary to manage the illness, like nutritious food and healthcare services. Second, the increased burden of health care expenses further intensifies the impacts of poverty, especially because it consumes a higher percentage of a person’s income. Finally, chronic disease can reduce a person’s productivity and opportunities leading to further employment associated issues. If left unmanaged, such conditions could exacerbate the cycle leading to resource deprivation, poverty and social isolation of seniors with chronic illness (Salzman, Collins, & Hajjar, 2012).
Or (2001) explored the effects of health care on mortality across OECD countries. The findings reveal that social exclusion significantly aggravates the risk of death because of myocardial infarction. Higher overall mortality in chronic disease is reported in cases where there are no social support networks. Raphael (2009) conducted a meta-analysis confirming the relationship between chronic disease mortality rate and the effects of social relationships. Raphael argues that social support be crucial as they offer instrumental support, motivation to seek preventive and medical care and emotional support for seniors with chronic disease. Depending on the number of friends, family members and social contacts a person has, social support might have both psychological and material influence. This is because their support involves not only emotional support and communication but also financial and material assistance (Cott, Gignac, M & Badley, 1999).
The physical environment assumes a crucial role in determining the health of seniors living with chronic illness. Among Canadian population, detrimental physical environments are imposed through current settlement structures and historical disposition of traditional territories. In Canada, lack of affordable housing has triggered a situation of overcrowded communities such as the Inuit community and homelessness for the elderly in urban locales (Raphael, 2009). Most on-reserve homes lack proper ventilations and are overcrowded, a situation that has led to excessive mold, which has been implicated in various health complications among the elderly including chronic illness (Raphael, 2009). It worsens when seniors living in reserve and rural areas confront significant medication insecurity associated with challenges of obtaining both traditional and market drugs. The transportation costs of market drugs to rural regions imply that most seniors with chronic disease cannot afford the drugs they need. Poverty does not only limit the extent to which families and individuals can access drugs but also renders the costs of pursuing these drugs out of reach for many (Cott, Gignac, M & Badley, 1999).
According to Kralik, Paterson, & Coates (2010), the quality of housing also affects health outcomes chronic disease management in the elderly. Most seniors live in poor dwelling conditions that need major repairs. In fact, recent surveys from the Nations Regional Longitudinal Health indicate that roughly 50% of Canadian seniors are living in crowded housing conditions (Kralik, Paterson, & Coates 2010). Such overcrowding is closely tied to various poor health outcomes including increased risk of chronic diseases and mental health issues.
Previous studies on health in Canada prove that access to healthcare, income and physical environment are imperative to positive outcomes in chronic disease management of the elderly. This review of literature is an account of the already published information about social determinants of health in related to chronic disease management of elderly in Canada. While seeking to enhance the health of seniors living with chronic disease, the intervention approaches must tailor to their socio-demographic factors and knowledge. Besides, the strategies adopted must factor the socio-economic matters of the elderly to encourage positive health behaviors for this population based on theoretical interventions. Based on the socio-economic models and interventions, the strategies might change the communities and individuals’ attitudes towards health (Mery, Wodchis, & Laporte, 2015).
Health research institutes, Ministry of Health and healthcare organizations should allocate funds to conduct research on chronic disease in the elderly to help reduce the prevalence of the diseases among the elderly. In future, researchers need to concentrate on fronting qualitative studies on obstacles to screening such as ways to overcome individual, psychological and structural barriers to screening. In the review, the highlighted factors have been used to explain and predict individual health outcomes as far as chronic disease is concerned. It is by understanding the three determinants that a more affirmative action through proper interventions could me devised to change the health status of Canadian seniors living with chronic disease.
Belanger, D. Gosselin P, Valois P, & Abdous B. et al. (2014). Perceived Adverse Health Effects of Heat and Their Determinants in Deprived Neighborhoods: A Cross-Sectional Survey of Nine Cities in Canada. International Journal of Environmental Research and Public Health, Volume 11, Issue 11, pp. 11028-11053
Bradley-Springer, L. (2012). The social determinants of health. The Journal of the Association of Nurses in Aids Care: Janac, 23, 3.)
Cott, C. A., Gignac, M. A. M & Badley, E. M. (1999). Determinants of Self Rated Health for Canadians with Chronic Disease and Disability. Journal of Epidemiology and Community Health (1979-). Vol. 53, No. 11: 731-736
Kralik, D., Paterson, B. L., & Coates, V. E. (2010). Translating chronic illness research into practice. Chichester, Toronto: Wiley-Blackwell.
Mery, G., Wodchis, W.P. & Laporte, A. (2015). The Determinants of the Propensity to Receive Publicly Funded Home Care Services for the Elderly In Canada: A Panel 2-Stage Residual Inclusion Approach. Health Economics Review, 12/Volume 6, Issue 1, pp. 1-18
Or, Z. (2001). Exploring the Effects of Health Care on Mortality Across OECD Countries. Honolulu, HI: Chronic Disease Management and Control Branch.
Penman-Aguilar, A., Talih, M., Huang, D., Moonesinghe, R., Bouye, K., & Beckles, G. (2016). Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity. Journal of Public Health Management and Practice: Jphmp, 22: S33-43
Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives. Toronto: Canadian Scholar’s Press.
Salzman, B., Collins, L., & Hajjar, E. R. (2012). Chronic Disease Management. Toronto: Saunders.
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