community conversations…rural health: past, present, & future march 15, 2011 bonnie jeffery,...
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Community Conversations…Rural Health: Past, Present, & Future
March 15, 2011
Bonnie Jeffery, University of Regina
Shanthi Johnson, University of Regina
Jim Daschuk, University of Regina
Diane Martz, University of Saskatchewan
Juanita Bacsu, University of Saskatchewan
Noreen Johns, Community Partner
Saskatchewan Population Health and Evaluation Research Unit
Bonnie Jeffery, PhD.
Director, SPHERU
Professor and Prince Albert Campus Coordinator
Faculty of Social Work, University of Regina
Who are we?
• The Saskatchewan Population Health & Evaluation Research Unit (SPHERU) is an interdisciplinary research unit committed to critical population health research
• Collaboration between U of S and U of R with 10 researchers working out of 3 locations in the province: Regina, Saskatoon, Prince Albert
• Funded by the Saskatchewan Health Research Foundation (SHRF) and other national and provincial project funding
What guides our health research?
VisionWorking with communities and policy makers to improve
the health of Saskatchewan people.
MissionThe promotion of health equity by understanding and
addressing population health disparities through policy-relevant research.
What do we do?
New Mapping slide from Paul H.
• Studies the role that culture plays as a health determinant.
• Our projects explore the role of culture in population health by looking at culture as a determinant of health, by considering culturally relevant definitions of health, and through refining cultural identity as an indicator of heath.
• Considers how context shape children’s health and development outcomes.
• Through our research in this area, and by working closely with decision-makers, community groups, policy-makers, etc., we hope to contribute to achieving better health and development for all children in Saskatchewan.
• SPHERU also engages in research evaluation projects and promotes health equity by addressing health disparities through policy relevant research.
• Rurality is a powerful determinant of women’s and men’s health. Rural people’s poorer health is a result of significant inequities in health-determining conditions.
• Rural health research projects conducted by SPHERU provide a better understanding of the impact of economic and cultural determinants on the health of rural women, men, and youth.
Knowledge Transfer and Exchange
Our Presentation
• We are pleased to have this opportunity to share our research findings with you this evening.
• Our presentation will focus on SPHERU’s Rural Health theme.
The Past
• Jim Daschuk, PhD
Changes in Rural Health from Past to Present
The Present• Shanthi Johnson
Falls and Injury Prevention in Older Adults
• Diane Martz
The Role of Social Systems in the Health of Senior Women Living in Rural Saskatchewan
• Juanita Bacsu
The Role of Social Systems in the Health of Senior Men Living in Rural Saskatchewan
Next Steps
• Noreen JohnsCommunity Partner
Changes in Rural Health from Past to Present
Jim Daschuk, PhD.
Assistant Professor
Faculty of Kinesiology and Health Studies
University of Regina
Hospital and Nurses 1910s
1919 The Spanish Flu
20th Century-Decline in Contagious Diseases USA (CDC 1997)
1920s-Long Term Care-Sanatoria, “Mental” Hospitals
Improved Technology
Polio
1946 The Swift Current Experiment
Public Health Inequalities 1950s
Smoking and
Cancer
Diabetes in Canada -Public Health Agency of Canada
Falls/Injury Prevention Among Older Adults
Shanthi Johnson, PhD
Professor & Associate Dean (Research & Graduate Studies), Faculty of Kinesiology and Health Studies
University of Regina
Healthy Aging…Falls• Common • Causes of falls• Preventable• Bellwether … health status• Costly … physical, psychological,
economic, and human costs – $6.2 billion
– 85% of all injury hospitalization for those over 65 years of age
– 75.7% of all in-house hospital deaths.
Public Health Agency of Canada, 2005; SmartRisk, 2009
Research Focus Epidemiology of falls
(Surveillance) fall, injury, hospitalization rates
Intervention research Exercise and nutrition Community-based Delivered through existing infrastructure (home care, LTC)
External causes of injury hospitalizations by age-group, Saskatchewan (1995 – 2005)
Seniors hospitalized with fall injury, Saskatchewan, 1995/96 - 2004/05
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05
Cru
de ra
te p
er 1
,000
pop
ulat
ion
Year
65-74 Female 65-74 Male 75-84 Female 75-84 Male
85+ Female 85+ Male Overall
Fall injury hospitalizations among older adults by area of residence at time of injury, 1995/96 – 2004/05
(N=30,757)
52.8246.48
0.70
10
20
30
40
50
60
Rural Urban North
Percentage
Survival analysis by sex for older adults (n=30,445) with fall-injury hospitalization, Saskatchewan, 1995/96 – 2004/05
0
0.2
0.4
0.6
0.8
1
65-7070-75
75-8080-85
85-9090-95
95-100
100-105
105-110
Age interval, years
Su
rviv
al f
un
ctio
n,
pro
po
rtio
n
Female
Male
Survival analysis by residence for older adults (n=30,445) with fall-injury hospitalization, Saskatchewan, 1995/96 – 2004/05
0
0.2
0.4
0.6
0.8
1
65-7070-75
75-8080-85
85-9090-95
95-100
100-105
105-110
Age interval, years
Su
rviv
al f
un
ctio
n,
pro
po
rtio
n
North
Rural
Urban
• Common, costly• Difficult to reach (frailty,
rural/remote areas, transportation issues, ..)
• Need to consider population and the place in trying to address falls.
Falls Prevention is KeyFalls Prevention is Key
Healthy Aging in Place
Presentation Overview
• Study Objectives
• Theoretical Framework
• Pilot Project Methods & Overview
• Preliminary Findings
Why study rural healthy aging?
• Compared to urban seniors, rural seniors are often more disadvantaged by having lower incomes, less education, less access to health services and overall poorer health outcomes (Sylvestre et al., 2006).
• Rural communities are facing escalating challenges in meeting the health care needs of a rapidly aging population (Skinner et al., 2008).
• In rural Saskatchewan, approximately 17% of the population are senior (Dandy & Bollman, 2008).
STUDY OBJECTIVES
1. To address gaps in our understanding of the health service needs of seniors living in rural communities
2. To identify the supports that enable rural seniors to stay independent and remain in their homes and communities longer
a) How well are these supports represented in Cantor’s Social Care Model (1991)
Theoretical Framework
Taken from J. Sims-Gould and A. Martin-Matthews, Family Caregiving or Caregiving Alone: Who Helps the Helper? 2007, Canadian Journal of Aging, 26(1), 27-46 originally adapted from M.J. Cantor, Family and Community: Changing Roles in an Aging Society, 1991, Gerontologist, 31(3), 337-346
Cantor’s Social Care Model
Healthy (not frail) (social)
Intermittent assistance and socialization
Moderately frail(moderate support)
Assistance with shopping and errands, escort to medical services, and some help with the management of finances
Greater incapacity(greater support)
Complete care of the home, including heavy housekeeping, laundry, and preparation of meals.
Personal carelevel of assistance(care)
Washing, bathing, toileting – and performing some medical procedures
Theoretical Framework: Cantor’s Model (1991)
Pilot Study Overview • Conducted a pilot study in the community of Watrous
and Preecevillle, SK from May –July 2010
• Worked with community partner, Noreen Johns who provided local insight and recruited study respondents
• 42 semi-structured interviews were conducted with 24 women and 18 men, ages 67 to 98 years old
• Interviews were digital audio-recorded where permissible, transcribed, and processed in Atlas-ti.
The Role of Social Systems in the Health of Senior Women Living in Rural Saskatchewan
Diane Martz, PhD
Director, Research Ethics OfficeUniversity of Saskatchewan
Preliminary Findings: Rural Networks
• People have networks of varying sizes and compositions from large networks with family and non-family to very small networks.
• The strength of people’s networks and social interactions are important predictors of health and wellbeing (Cohen, 2004).
• As people age, their networks tend to get smaller and family supports become more important.
• If networks can no longer provide supports, and formal services are not adequate, people may leave communities (Wenger and Keating, 2008)
Supports for Senior Rural Women
• Preliminary analysis shows that the vast majority of support comes from family (spouses and children).
• Support networks expand during medical emergencies.
• There is a strong element of reciprocity in the informal support system
Supports for Senior Rural Women…cont’d
• Senior women know formal support services are there, but are much more likely to rely on family.
• Implications for rural communities that are losing population:• Increased burden for those who remain in the
community; and• Increased worry for family living in distant places.
Accessibility: Driving• Mobility is an important social connector• Because rural communities do not have well
developed transportation systems, people’s mobility depends on being able to drive.
• Those who do not drive have significantly more unmet needs.
‘little things come up and you put them off or wait until you think someone has time to help or someone comes
around”
‘When you lose your license, you lose your independence’
Accessibility: Driving…cont’d
• Rural communities need to develop transport systems that reflect the context of limited resources, low population density and long distances (Dobbs and Strain, 2008).
• SHR Rural Health Strategy identified the need to work with communities to create transportation options for seniors.
The Role of Social Systems in the Health of Senior Men Living in Rural Saskatchewan
Juanita Bacsu
Project Coordinator, SPHERUUniversity of Saskatchewan
Why study healthy aging among rural men?
• Currently, little information is known about the support systems and the health care needs of rural senior men.
• Compared to urban seniors, rural seniors are often more disadvantaged by having lower incomes, less education, less access to health services and overall poorer health outcomes.
• Rural communities are facing escalating challenges in meeting the health care needs of a rapidly aging population.
Preliminary Findings: Support Perceptions
• Rural men are less likely to identify that they are receiving support if it was provided by a spouse or a family member.
• Supports often accessed by rural senior men include foot care, housekeeping and yard work.
• Our findings suggest that formal supports are only accessed if informal supports such as family and friends are unavailable to help.
Preliminary Findings: Support Perceptions
• Many senior men identified feeling a sense of shame in having to ask for help with tasks such as help with yard work or transportation.
“I’m the type of person that’s overly independent, that’s why I hate to have to get somebody to help... But now I can’t do it. It hurts for awhile. It’s hard to get past that you know?”
“I kind of feel bad that I can’t do it myself...”
Preliminary Findings: Support Perceptions
Senior men were forthcoming toward discussing their emotional supports.
“Well mostly the help I get is social activities, they keep me from becoming depressed.”
Emotional support? “I keep it to myself. Who wants to listen to my problems?”
Preliminary Findings: Caregivers
• Rural senior men who were caregivers for their wives expressed a strong need for more support.
“Ever since she’s got sick, everybody seems to stay away, you know. I find well, even family stays away...”
“Because I just got to get away... I like to golf, I like to fish, but I haven’t got anybody to leave her with, I can’t anymore...”
Preliminary Findings: Driving
• In describing health and well-being many rural senior men made reference to the importance of driving.
“What’s Healthy? There’s no pain and I take only a few pills, I feel good, I enjoy driving around out in the country and looking at the land and the air...”
Preliminary Findings: Driving…cont’d
• Rural men living in remote areas expressed greater importance with driving in direct relation to their quality of life.
“We’re lucky as long as we can drive, you know...
We’re a little too remote, we’re away from hospitals.
And for emergencies, a half hour is a long time
when somebody is dying.”
Preliminary Findings: Falls
• Many of the rural senior male respondents had experienced falls.
• Injury sustained from falls often resulted in the use of walking aids and hip replacements .
“I fell the other day and got hurt, I just grab a hold
on something and hold on for dear life,
I’ve had a couple of ribs cracked.”
Preliminary Findings: Mobility
• Rural senior men who experienced loss of mobility and their ability to walk expressed feelings of depression and hopelessness.
“I’ve got to move, I just can’t sit in the house...”
“I was thinking about it the other day, this is it for the rest of my life now. I don’t think I’ll ever get better.”
Next Stepsand
Future Plans
Noreen JohnsCommunity Partner
Future Plans
• Rural seniors’ health in Saskatchewan from the past to the present .
• Taking the next steps to move forward to improve rural seniors’ health in Saskatchewan.
Importance of Community-Based Research
• Rural communities face increasing challenges in meeting the health care needs of a rapidly growing population.
• Addressing the challenges:– Direct input from and collaboration with
community members is key to identifying their needs and discovering solutions.
Community InvolvementShort Term
• Community workshops– sharing findings and
gaining feedback;– community input guides the
future direction of the research process; and
– community dialogue informs the next steps and how to best move forward.
Long Term
• Expansion:– Allows for comparison
within different contexts and health regions;
• Collaborative efforts will identify solutions that will lead to solutions that better address healthy aging in place.
Contact Us:Bonnie Jeffery
(306) 953-5311
Jim Daschuk
(306) 337-3272
Juanita Bacsu
(306) 966-7942
Shanthi Johnson
(306) 337-3180
Diane Martz
(306)966-2975
Noreen Johns
(306) 257-3911
For more information …
Please visit our website for details on all
SPHERU projects
References
• Cohen, S. (2004) “Social relationships and health’, American Psychologist, vol 59, no 8, pp 676-84.
• Dobbs, B and L. Strain (2008) “Staying connected: issues of mobility of older rural adults” in Keating, Norah (ed) Rural Ageing: A good place to grow old? Bristol: The Polity Press.
• Wenger, G.C. and N. Keating(2008) “The evolution of networks of older adults” in Keating, Norah (ed) Rural Ageing: A good place to grow old? Bristol: The Polity Press.