Access to care

Recent immigrant older adults and some visible minorities who have aged here experience health inequities in Canada. These are primarily related to difficulties with the complex process of accessing suitable services and supports. Canadian research on the topic is extremely fragmented and hard to find, and knowledge users charged with designing policy and programs do not have the evidence they need to help them to address these access barriers. I have conducted a series of interrelated research projects to address that gap.


The ‘Barriers to Access to Care for Ethnic Minority Seniors’ (BACEMS) study in Vancouver, British Columbia, found that immigrant families torn between changing values and the economic realities that accompany immigration cannot always provide optimal care for their elders. Ethnic minority seniors further identified language barriers, immigration status, and limited awareness of the roles of the health authority and of specific service providers as barriers to health care. The configuration and delivery of health services, and health-care providers' limited knowledge of the seniors' needs confounded these problems. Read more in my published article.

Scoping review

The goal of our scoping review on the health and healthcare of ethnocultural minority older adults was to address an identified major knowledge gap in Canada utilizing both published and grey literature that employed quantitative and qualitative approaches. The review included 816 source documents in English and French, published between1980 and 2009, that were focused on the health of people 65 years of age and older from visible minority groups. In addition to Canadian documents, we included those on ethnocultural groups similar to Canada from countries with health systems similar to Canada. Especially salient articles from countries with health systems dissimilar to Canada were selectively included. In addition to a peer-reviewed publication, we generated a final report, with supplementary focused bibliographies, and presented at numerous conferences as well as community and professional stakeholder workshops.

Health care equity

The Health Care Equity for Minority Older Adults project built on the scoping review. I engaged six teams of researchers and knowledge user partners representing local, provincial or federal organizations. Three of the teams were in British Columbia and the remaining teams were located in Alberta, Ontario and Newfoundland. Knowledge users identified issues of concern to them and researchers and their graduate students conducted literature reviews that used the Candidacy Framework for understanding access to health and social services to provide a common ground for discussion. Our teams explored determinants of health, health promotion, dementia care, mental health services, abuse prevention and rural and remote communities in relation to access to care by ethnocultural minority older adults. Each team produced a chapter of our open access e-book. In a national meeting, all members discussed cross-cutting themes and identified the additional dimension of trust as key to access. Our Vancouver-based team subsequently developed our review of access to dementia care services (in partnerships with Fraser Health) into the Building Trust project.

All of these projects were conceived by multiple stakeholders in consultative forums. See also Integrated Knowledge Translation.