The health and well-being of seniors continues to be a major focus of public health activities in Canada. The goal of the Seniors Quality of Life Project was to develop and implement a means by which Canadian seniors could identify and work to influence the determinants of their health and well-being. Seniors groups in Quebec City, Montreal, Ottawa, Toronto, Regina, Vancouver and Whitehorse organized and carried out a series of public consultations on Issues and Factors Affecting The Quality of Life And Well-being of Seniors. In each participating city, seniors determined how project activities would occur. While the primary focus was on urban areas, some locations involved rural-living seniors in their local projects. The project was funded by the Population Health Fund of Health Canada.
This article provides a summary of findings. The local reports are available at http://www.utoronto.ca/seniors. The full synthesis report is available at http://www.yorku.ca/ychs.
The project drew upon recent advances in understanding how the health of Canada's seniors is affected by individual, community and societal factors, or what are termed the determinants of health. The project provided a mechanism by which seniors could both learn about these determinants and identify their effects upon their health. The project also provided a foundation for action to address the issues identified. In each participating city, a lead seniors group--usually a municipal seniors council--supported by a project coordinator and municipal partners, organized the project. Some projects had strong local university involvement while others had less or none. Each city formed a Seniors Coordinating Committee that controlled the project and an Advisory Committee consisting of representatives from seniors groups, service sectors and municipal staff. These working groups adapted the general project design to their specific locality.
A participatory and qualitative methodology enabled seniors themselves to identify how the determinants of health influence their own quality of life. Methods consisted of focus groups and interviews with seniors, service providers and others involved in seniors' issues within each community such as municipal staff. Each project developed somewhat similar open-ended questions that helped identify the key issues affecting seniors.
Seniors themselves determined the formats of the reports and the interpretations of findings. Each project reported its findings, drew its own conclusions, offered its own recommendations and concluded with an eight-month action component. Seniors were responsible for implementing project findings by disseminating results through their networks, lobbying and advocating.
There was agreement across all locations as to the importance to seniors' quality of life of the following: access to information, health care, housing, income security, safety and security, social contacts and networks and transportation. Participants in most localities also identified issues of ageism of society, having voices heard, promoting healthy lifestyles and lack of political will as barriers to address key issues. The following section highlights some of the issues on which there was consensus across local projects.
A Access to Information
Participants expressed concern about seniors' access to information about available programs and services. Seniors need to be able to access information about the availability of services and resources in formats that are easy to read and comprehend. Community organizations and governments need to work with seniors to develop and make these kinds of information available.
B Health Care
Participants expressed concern about recent federal and provincial decisions that are leading to a demise of the principles of Medicare. They are also concerned about reductions in federal transfers to provincial health plans. Participants related health issues to concerns about the state of long-term care and home care services. Coupled with these concerns was the continued ability of seniors to access the health services they need and to make decisions about their own care and where they receive it. Access to required drugs is also a common concern.
In some localities, participants identified ageism among health care professionals and their perception of seniors as unable to understand their health care issues. In most localities, participants thought that there should be special training on seniors issues for health care professionals. With the increasing demographic of older Canadians, the need for such training and education is apparent.
Seniors were especially concerned about the lack of housing options for seniors. They tied housing to financial independence and autonomy and the ability to access social and health services. Seniors need to be able to choose where and how they live and not to have a decision forced upon them by others. Participants made numerous suggestions for increasing the housing stock. Underlying all of these actions was the political will to create more affordable housing for seniors and other Canadians.
D Income Security
Participants identified income security, particularly for senior women, as a serious issue. It represented the difference between independence and dependence on others and, most importantly, the ability to remain in one's own home in the community. Women and immigrants may not have worked or worked at jobs that did not provide pensions. Economic issues are seen largely in terms of pension plans and having enough money to remain active. They frequently considered existing pensions such as Canada Pension Plan, Old Age Security and the Guaranteed Annual Income as insufficient. Participants across localities recommended indexing these plans to inflation.
Transportation and the attendant issue of mobility are important issues for seniors. Participants linked these issues to avoiding loneliness and isolation, particularly among those suffering chronic health problems, recently widowed or living alone. They identified good public transit as key to link seniors to recreation activities and support networks. Participants considered public transit and volunteer drivers as means to help seniors with mobility difficulties to get around their cities to access services they need and participate in the life of their cities.
F Barriers to Change
All locations identified ageism as a significant barrier. Many attributed this difficulty to prevailing attitudes towards seniors, particularly through the perpetuation of myths about seniors. Participants linked ageism to older adults' lack of political voice. Many argued that society does not value seniors for their wisdom from life experience. Participants called for recognition of seniors and appropriate representation of seniors in public consultations. Governments need to consult seniors and include them in decision-making processes, particularly on decisions that affect the well-being of seniors.
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The Seniors Quality of Life Project provided an opportunity for seniors to organize and implement projects to identify and explore the key determinants of Canadian seniors' quality of life. The complexity of the findings across localities and seniors' ability to report these findings in a clear understandable manner demonstrates the usefulness of the determinants of health perspective and the participatory research methodological approach. Seniors' willingness to examine broad policy issues and the roles governments, service agencies and communities can play to promote seniors' quality of life demonstrates the value in carrying out such projects. As such they provide rich areas for public health inquiry and action to improve the health and well-being of our increasingly growing older population.