Читать книгу Aging People, Aging Places - Группа авторов - Страница 9
ОглавлениеSamantha Biglieri, Maxwell Hartt, and Natalie S. Channer
In this overview chapter, we call upon data from Statistics Canada and the academic literature to present some stylized facts and figures regarding urban older adults and a synthesis of the challenges and opportunities of aging in urban environments. This chapter serves to provide (1) a snapshot of Canadian urban demographic trends, (2) an overview of the state-of-the-art thinking on urban aging, and (3) contextual framing for the in-depth research chapters and vignettes that make up the urban part of this book.
Canada is predominantly a nation of rural spaces. By land area, urban locations occupy only 0.25% of Canada’s 9.9 million square kilometres. However, urbanization is quickly changing the national landscape. While Canada’s urban areas are growing steadily, they are simultaneously driving considerable suburban growth in their periphery. As we note in Chapter 6, Canada is a suburban nation. And those huge suburbs are growing around Canada’s urban centres. The three largest metropolitan areas (which include both urban and suburban areas), Toronto, Montréal, and Vancouver, are home to more than a third of all Canadians, with a combined population of 12.5 million (Statistics Canada, 2019).
For many, urban Canada evokes images of these three iconic cities. Big, bustling conurbations with dense downtowns, skyscrapers, and expensive housing. But like suburban and rural areas, urban regions can take a variety of shapes and forms. Although there is no one perfect definition of ‘urban’, we adopt the following operational definition in order to provide a generalized overview of urban demographic trends in Canada: urban areas are dissemination areas (as defined by Statistics Canada) with a population density of 5,000 or more people per square kilometre, or areas with a population density of 1,000 to 5,000 people per square kilometre where fewer than 60% of population commutes by car (Channer et al, 2020).
Using data from the Statistics Canada (2019) population estimates, we found that 5.3 million of Canada’s roughly 35 million people live in urban areas. Of those 5.3 million, approximately 800,000 are aged 65 and over. Across Canada, the number of residents aged 65 and over is growing, and urban settings are no exception. Proportionally, 15% of Canada’s urban population are aged 65 and over, lower than suburban (17%) and rural (18%) locations.
Looking at the older urban population by province (Figure 1.1), we can see that the largest proportion reside in Ontario. In fact, Ontario is home to nearly half of Canada’s older urban population (46%) and total urban population (48%). In Québec, urban residents are proportionally overrepresented as 29% of urban Canadians aged 65 and over reside there, yet Québec houses 25% of Canada’s urban population. Both British Columbia and the Prairies provinces (Manitoba, Saskatchewan, and Alberta) also have slightly higher proportions of older urban residents.
Urban Canada is significantly more ethnically heterogeneous than its rural and suburban counterparts. Table 1.1 shows that 27% of urban Canadians aged 65 and over live in neighbourhoods where the principal language is neither English nor French – a complete contrast to rural regions that have only 1%. Urban Canada’s ethnic diversity is also denoted by the fact that 30% of older Canadians live in majority immigrant neighbourhoods. Older adults who live in majority immigrant neighbourhoods may be more vulnerable to consequences of social isolation from infrastructural barriers (Syed et al, 2017). Furthermore, of these older Canadians living in immigrant neighbourhoods, 34% of them are living on low incomes (defined by Statistics Canada’s after-tax low-income measure) and this proportion remains roughly the same for the cohort aged 85 and over. More broadly, across all types of neighbourhoods in urban Canada, one fifth of the older adult population are living on low incomes. Income inequality is a much more pronounced risk in urban areas where 21% of older Canadians live on low incomes, compared to 14% in rural areas.
Figure 1.1: Canada’s urban population by region and age
Source: Statistics Canada, 2019
Table 1.1: Number of Canadian urban residents by age, low income, immigrant neighbourhood, and foreign language neighbourhood
| Number of Canadian urban residents | ||||
| 65+ | 85+ | |||
| 65+ | Low income | 85+ | Low income | |
| Total | 1,282,615 | 268,892 | 197,445 | 42,140 |
| Immigrant neighbourhoods | 390,610 | 91,759 | 55,040 | 14,232 |
| Foreign-language neighbourhoods | 344,410 | 78,936 | 47,855 | 12,093 |
Source: Statistics Canada, 2019
Other key debates in urban aging centre around the extent to which policy for infrastructure, transportation, and housing can serve the older generation. Urban environments have many structural opportunities to support age-friendly communities, including existing public transport systems, larger bureaucracies, and a stronger non-governmental organization presence. However, there are also limitations to such large and developed urban locations, such as incorporating diversity and scale into decision making. In the rest of this chapter, we summarize existing research on aging in Canadian urban communities and further unpack the challenges and benefits of urban aging.
Challenges to aging well in urban Canada
Urban Canada’s older adult diversity requires a range of policies and facilities that reflect the heterogeneity of the population. Such policy considerations impact older adults’ mobility in urban areas, their housing provision, healthcare service allocation, and accessible transportation options.
Transportation policies in an aging society should emphasize how transport systems can best accommodate the requirements of a growing and increasingly diverse group of older Canadians. Recounting her own experience in Toronto in Chapter 3, Lillian Wells provides an important reminder that lived experiences differ and ‘age is just a number’. Diversity should be considered in transportation policy in a variety of ways including: infrastructure accessibility (eg installing elevators at subway stations, providing barrier-free access to buses and rail transit, installing wide, non-slip sidewalks, safe intersections, and implementing city-wide snow clearance from pavements), provision of alternative mobility options (eg public and paratransit services, active transportation) and licensing of older drivers in view of road safety (Ruben et al, 2010). In Chapter 2, Atiya Mahmood and Delphine Labbé examine barriers encountered by older mobility device users in Vancouver and argue that planners and policymakers need to take a broader look at inclusion and participation. Focusing on piecemeal remedies such as curb cuts and sidewalk extensions is not enough. Mobility options and road safety licence renewal (such as age-based licensing in Ontario for older urban residents) should recognize the importance of automobility among the population while acknowledging the need for alternatives to private car use to meet mobility demands. Active travel and public transportation are important options for older adults with a wide range of physical, cognitive, and social benefits. However, many older adults, even in urban areas, prefer and rely on automobile use. Mercado and Páez (2009) found that in Hamilton, Ontario, the expected decline in distance travelled as residents age is more pronounced for car driving compared to car passenger and bus transport methods. Older Canadians also tend, on average, to drive the same distance as long as they keep their driving ability intact. This is a challenge for age-friendly policy as dedicated drivers risk a radically heightened vulnerability once they lose their driving licence. Planning practitioners and decision makers need to enable older adults to be mobile through better land use and transportation policy in order to maintain and extend their quality of life. To accomplish this, a combination of walkable neighbourhoods and suitable transportation provision are needed to overcome individual barriers to mobility. In order to provide for Canada’s older urban citizens, there is a need to go beyond traditional policy focus and consider the increased heterogeneity of the older population in regard to lifestyle, mobility, resources, infrastructure, and health (Mercado and Páez, 2009).
Another element of aging policy that demands inclusivity is housing. Policymakers face the challenge of catering to a diverse mix of older Canadians and need to consider issues of low income, mobility, and cultural diversity. With more than a fifth of urban older adults living on a low income, it is unsurprising that affordability is the greatest challenge for housing older Canadians (Weeks and Leblanc, 2010). Clark (2005) found that 18% of Canadian older adults have problems with housing affordability. Affordability is a much greater issue for vulnerable older adults than for the general older adult population, especially those living on fixed incomes, and without pensions or assets (like owning property for instance) (Weeks and Leblanc, 2010). Furthermore, a majority of older adults live in single-detached housing, which can become unsuitable and inaccessible for older adults. For instance, stairs and designs that do not accommodate mobility devices, as well as grounds that they can no longer maintain. While urban centres are more likely to include apartment options, accessible features are not mandatory in residential buildings units – meaning that most of these housing options are still inaccessible or require significant investment to retrofit.
In addition to affordability, suitability poses a major challenge. Housing provision for older adults needs to be accessible, available, safe, and culturally appropriate. Older adults who have immigrated to urban locations in Canada may have different housing concerns than the Canadian-born population. In their study of housing experiences of South Asian immigrant older adults in Edmonton, Ng et al (2019) found that, unlike Canadian-born older adults, it was a rarity for South Asian immigrants to live alone and that living with extended families was the most common living arrangement. However, housing has typically been built for the so-called traditional nuclear family in a single-detached dwelling, as opposed to multi-unit dwelling options that would accommodate these needs – the ‘missing middle housing’ (eg duplexes, triplexes, and low-rise apartments).
Racialized and immigrant older adults also face more systemic barriers than their Caucasian and Canadian-born counterparts – for instance limited social supports, lower socio-economic status, and negative health outcomes, as well as being more at risk of social isolation and loneliness (Vang et al, 2017; Salma and Salami, 2019). With 30% of Canada’s older adult population being immigrants (Statistics Canada, 2017), and most of them living in urban areas, these systemic barriers indicate clearly that a one-size-fits-all approach to aging in place cannot be inclusive for Canada’s diverse population.
Urban locations also have unique healthcare challenges for older adults. These can range from lengthy waiting times for services (which can cause further health deterioration), to transportation and accessibility barriers to healthcare centres. Haggerty et al (2014) found that urban older adults tend, on average, to struggle more with distances to healthcare facilities to receive treatment than rural residents. They also concluded that added distance often results in people using closer emergency services for primary care, which is more costly for healthcare providers. Older adults tend to have strong preferences to obtain care from a familiar healthcare provider – one who is aware of their medical history and personal context – which can be less likely to occur in urban environments with a greater population density. While there is a higher concentration of care services for people living with dementia in urban centres, research comparing Ottawa, Calgary, and Edmonton suggested that ‘access to particular services at the time when they require it may depend on the specific centre that they reside in’ (Tam-Tham et al, 2016, p 8). Again, urban areas pose more significant challenges as a result of having a greater scale, as well as needing to plan for a wide diversity of individuals and coordinate organizations through policy and programming.
Finally, in terms of overall municipal age-friendly policy, research in Manitoba found that larger cities take longer to implement projects, encounter substantial bureaucracy and face coordination challenges between departments. Further, due to the scale, community engagement is more difficult when compared with smaller communities where everyone knows each other and already works together (Menec et al, 2014).
Opportunities to age well in urban Canada
Despite the aforementioned challenges for older Canadians, urban environments also offer unique opportunities to support aging in place. The physical scale of urban locations provides infrastructural advantages through increased services and larger transportation systems. As urban areas have such a diverse population, there is also scope for a wider range of services and community supports (Beatty and Berdahl, 2011; Novek and Menec, 2014). Spatially, urban environments are better equipped to provide services for older adults at a closer proximity than other, especially rural, neighbourhoods. Levasseur et al (2015) found that most urban older adults in Québec had access to services and amenities located within a five-minute walk of their dwelling. They found that increased social participation was associated with greater proximity to neighbourhood resources – emphasizing the important relationship between the socio-spatial. Richard et al (2008) found that accessible urban walking environments and suitable transportation services in Montréal correlated with frequency of use and significantly increased social participation. In Chapter 4, Marie-Soleil Cloutier and Florence Huguenin-Richard compare older adult urban walking experiences in Montréal and Lille, France. They found that older adults did indeed have different behaviours and decision-making habits when walking in cities compared to younger pedestrians. Furthermore, their research highlights the importance of exclusive pedestrian space to provide visibility and freedom of movement. The more walkable a neighbourhood is (ie the presence of accessible walking infrastructure and amenities within 400–800m distances), the more potential there is for increased social interaction and connection for older adults (Richard et al, 2008; Ferreira et al, 2016). Urban areas are more likely to be walkable, with a mix of uses and easy access to transportation and amenities, as well as providing easier access to one’s social network (ie family, friends, neighbours). These factors produce higher levels of physical activity in older adults – they are up to three times as likely to meet Canada’s physical activity guidelines than their suburban counterparts (Winters et al, 2015). Physical activity is integral to a better quality of life, and the main protective factor against Alzheimer’s, Parkinson’s, and cognitive decline (Kerr et al, 2012; Paillard et al, 2015; Hirsch et al, 2017; Stubbs et al, 2017). These factors also promote greater food security for older adults (Chung et al, 2011), and can lead to reduced social isolation, the building of social capital, and a sense of independence and dignity (Leyden, 2003; Levasseaur et al, 2015). Finally access to amenities like ‘third places’ (eg coffee shops, libraries, parks, etc) has been identified as important for the social health of older adults (Oldenburg, 1989; Alidoust et al, 2018).
As well as infrastructural advantages, urban locations generally have higher levels of healthcare provision and an increased variety of services to offer older adults. Urban neighbourhoods often offer walk-in clinics, a rarity in rural areas, which provide more care options without advance notice. A broader variety of services that provide better support influence healthcare satisfaction, which is higher in urban areas, as only 36% of urban residents reported unmet care needs compared to 52% or rural residents (Haggerty et al, 2014). More efficient access to healthcare is assisted by organizational mechanisms including car-sharing arrangements, more frequent interactions with physicians, walk-in services, and a greater availability of local care alternatives (Forbes et al, 2006; Gamble et al, 2011).
Another major benefit to urban aging communities is the increased presence of non-profit organizations and resources available to support them. In Chapter 5, Marianne Wilkat and Barry Pendergast share their experiences supporting the older adult community in Calgary through the Calgary Aging in Place Co-Operative and the Oakridge Seniors’ Association. Urban non-profit organizations like these have the potential to facilitate a variety of affiliations and collaborations with external bodies that can improve their services, reach, and help foster community partnerships. Increased connectivity and greater numbers of volunteers are more likely to be available in urban settings. Non-profit sustainable initiatives that improve older adults’ quality of life in a variety of ways can be supported by cross-sector collaborations, systematic municipal involvement, and community champions in urban neighbourhoods (Russell et al, 2019). Such supportive collaborations can provide urban aging non-governmental organizations with sponsorships, event spaces, promotion assistance, volunteers, and media guidance. The larger networks and available resources that are associated with urban locations may encourage the growth of supportive projects for older adults. That being said, the resultant complexity from so many organizations and programs can lead to confusion about what exists in a community for an individual older adult and could lead to difficulty navigating such a complex system.
Altogether, while urban areas may have infrastructure (eg walkable neighbourhoods, transportation, healthcare services) as well as the funding capacity to facilitate a wider breadth of age-friendly initiatives than their suburban or rural counterparts, their success still relies heavily on political leadership, investment, commitment, and advocacy to building a city that is truly age-inclusive.
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