Читать книгу Aging People, Aging Places - Группа авторов - Страница 11
ОглавлениеLillian Wells
This vignette is based on my lived experience over time. My first job as a social worker in the early 1960s was with older adults (in one of the first home care programs in Canada). I learned much from them on how to live my life and how to optimize life as I grew older. My practice has focused on clinical work and community development, especially in the areas of health and gerontology. With students and colleagues, we developed an empowerment model of practice in long-term care with resident councils, initiatives with families, and staff training.
In the 1990s, a colleague enticed me to become a member of the Toronto Council on Aging, in order to raise awareness of the needs of older adults, improve their quality of life, foster their involvement in all aspects of community life, and support the experience of aging through education and leadership. I speak from my own experience, combined with what I have learned from older friends and from the wider community of older people through informal contacts and also research.
Aging in Toronto
I have lived in Saskatchewan, Manitoba, and now Ontario; in small towns, mid-sized cities, and for over 50 years in Toronto. While Toronto has great diversity and a rich array of social, recreation, education, volunteer, and employment possibilities, it is so very large and complex that it is difficult to know what these opportunities are and how to access them. Similarly, health and social services can be difficult to navigate, even for someone like myself who has experience and skills in this area.
Toronto has superior health resources, however, there can be long waiting times. Concepts of informed consent and person-centred care are increasingly accepted. However, that being said, many seniors report a paternalistic approach that diminishes their confidence, silences their voice, and lessens their autonomy.
In terms of municipal services, Toronto has recently implemented a Senior Strategy, appointed a councillor as the Seniors Advocate, and passed a motion to assess policies through a senior’s lens. The city council is restructuring its services to seniors, giving them higher priority and providing more coordinated service. Public transportation options are being slowly improved. Some years ago, seating was designated for seniors but indicated by tiny signs that were often poorly placed so not visible to passengers. Today there is clear signage for priority seating and the seats, in a different colour, stand out. Newer buses and streetcars are accessible, but many subway stations are not.
Understanding neighbourhood context is vital – a high proportion of older adults live in my community. The area of Toronto in which I live is on average middle class and considered to have few unmet needs. However, according to Statistics Canada, one of its neighbourhoods holds the highest density of seniors (23%) in Toronto which is about 50% higher than the city’s average. Of these, 82% live in rental apartments, 37% spend more than 30% of their income on housing, 40% live alone, and 48% have some activity limitations. We need to understand these implications and how to prevent adverse impacts.
The reality is that older people have often outlived family and friends, and it can be difficult to reach out on your own to new experiences, when familiar supports are unavailable.
New technologies such as smartphones are becoming increasingly important for contacting people and services and for obtaining information, but they are not necessarily designed for ease of use by seniors. Ageism is evident with older people seemingly invisible and ignored by service providers, community leaders, media, and the general public. It has been termed the last socially accepted prejudice. Internalized ageism is a barrier when seniors, themselves, accept negative stereotypes about being old.
Overall, older adulthood can be an enjoyable and enriching period of life. A high proportion of seniors live in the community. For most of us it is a happier and more contented time: most describe their health as good. It is a time to continue what one values and try new options. Every stage of life has its strengths.
Barriers to aging well in a large urban area
To begin, one has to recognize the age span (65 to over 100) and the heterogeneity of seniors. The life of someone aged 95 who golfs regularly and is a board member of a local children’s daycare is different from a person of 65 on limited income who uses a walker and lives alone, and from the grandmother who doesn’t speak English and looks after her grandchildren or from the man caring for his spouse with dementia. Lives differ and age is just a number.
In selecting one main barrier, I would choose accessibility. This means universal design in the built environment. Many older buildings in Toronto have steps, heavy doors, and no elevators, but even some newer buildings have such problems. It means improving walkability, having well-lit and maintained sidewalks with snow and ice removal, safe ways to cross streets, and convenient stores, banks, health and social services, ethnic-, cultural-, and faith-based facilities within walking distance. Online banking and ordering of food and other supplies are helpful, but can increase isolation and lead to lack of stimulation. Parks and streets need to have accessible seating. Lack of public washrooms can be a severe barrier. Access to public and private transportation, including that required by people with physical and cognitive limitations, is necessary. We need to think about accessibility beyond wheelchair access. What does it mean for those who find walking or other movements painful or for those with poor balance, or who are forgetful? Does the built environment provide facilities to enhance social connectedness?
The social environment is equally vital. Are values of respect, equity, and inclusion embedded in policy and services? Do leaders, service providers, and community members of all ages (including older people themselves) reflect these values in their attitudes and behaviours? Or, are seniors seen as unimportant, a burden, using up resources and not contributing to society? Do older adults have a voice and are their desires, talents, and abilities recognized and responded to?
Do seniors’ services really match their needs? Recently I attended an exercise class intended for seniors but scheduled for 9am – meaning that participants had to combat crowded buses and clogged roads; moreover, it was not designed for those in this group, the music was too fast-paced, and the instructor was not experienced.
Questions that I want us to think about are: Do older people have access to services geared to their needs? Do they have access to services that are affordable for them? The data and my experience in the field shows that seniors are increasingly lacking food security and needing to use food banks. Poverty and poor health are serious barriers that limit accessibility.
What needs to be done?
First, we need to recognize that what is designed for seniors will benefit all, rather than excluding some people of any age. Secondly, and central to any discussion about older adults, is that we need to ensure seniors themselves are involved in the planning, implementation, and evaluation of what affects them.
Most older adults want to remain in their own communities. We need to have a range of housing choices (shared housing, and models such as naturally occurring retirement communities) where the residents decide on priorities that will optimize their wellbeing. There is clear evidence that these lower-cost community services can enrich older people’s lives and decrease use of emergency departments, hospitals, and institutional care. Current home care uses a medical model and focuses on personal care and health-related issues such as bathing. Using a social, person-focused model, service is geared to what the individual values to enhance wellbeing. We also need to address the accessibility barrier as previously highlighted. Social isolation and loneliness are serious problems that have major impacts on health and wellbeing.
And last, but not least – we need to develop and implement an anti-ageism strategy to ensure that anti-ageism is at the centre of all policies affecting older adults – without it, interventions will not be nearly as successful as they should be.
My experience living in an urban environment
People’s experiences will always vary depending on the individual and family, and in Toronto, a city of neighbourhoods, location makes a big difference. For example, personally, for the most part, I do not need to commute long distances in my daily life and a short car ride, half an hour’s walk or bus journey, and the subway enable me to go where I want. I have a solid network of family, albeit at a distance, friends, and colleagues. The neighbourhood shopping centre with friendly, knowledgeable and courteous staff is convenient, as is the library, community centre, and church. I belong to a walking group and am an active volunteer, and in addition I do some part-time employment. The recent death of my husband and several long-term friends has required grieving and adjustments. The local funeral home holds a helpful bereavement group. I have access to a superior physician, physiotherapist, audiologist, and dentist. As I still have a car, I am able to drive friends with mobility issues. I can participate in cultural, recreational, and educational opportunities. I have the opportunity to belong to a church group that sponsors refugee families. Currently I live in the family home, but in the future plan to move to a life-lease apartment in the neighbourhood that is closer to resources and transportation. During most of my working life women earned a lower salary than men in comparable positions but I do have a comfortable income.
Mine is not an uncommon type of story for older adults.
