First Nations, Metis and Inuit of advancing years often have poorer health than their non-aboriginal counterparts but don't receive the same level of health-care services as other Canadian seniors, a report says.
The Health Council of Canada report, released Thursday, says the health of aboriginal seniors can be compromised by poverty, inadequate housing and poor diet, especially for those living in remote areas where nutritious foods may be prohibitively expensive.
Chronic conditions such as obesity, diabetes and heart disease are more prevalent among aboriginal Canadians, compared with the general population, and those disorders can worsen with age.
"The challenge with First Nations, Metis or Inuit is that many of those seniors have lived in poverty throughout their lifespan," said Dr. Catherine Cook, vice-president of population and aboriginal health for the Winnipeg Health Region and a councillor with the Health Council.
"So the challenges will have compounded in that," said Cook, who is Metis. "For example, if you've been eating a diet that is low-cost but high in carbohydrates, you may have acquired some of the illnesses that are chronic in nature, so you may be further down that spectrum of illness."
Many older aboriginal Canadians also carry the scars of rampant societal racism and the trauma of being torn from their families to live in residential schools, where abuse, neglect and substandard health care were pervasive within the system.
The report says those experiences have resulted in lingering mental health issues for some elders, such as depression or even post-traumatic stress disorder.
But accessing health care can be physically, emotionally and financially challenging for many aboriginal seniors, who may have to travel to urban centres for services that are unavailable in remote or isolated communities.
A lack of access to primary physicians and specialists can lead to worsening health problems, said Wenda Watteyne, director of Metis Nation of Ontario's health and wellness program.
"Oftentimes, complications related to chronic diseases aren't being diagnosed, treated or screened, so oftentimes those diseases reach a point of urgency and people are being treated in emergency wards once it reaches a crisis point," Watteyne said from Ottawa, referring to such complications as kidney failure from diabetes.
The Health Council says difficulties obtaining care are exacerbated by confusion over which level of government is responsible for which services and for which aboriginal groups.
For instance, First Nations and Inuit are covered by federal non-insured health benefits, but the Metis are ineligible for that program. The exclusion of First Nations from some provincial programs available to all other provincial residents is also contentious.
"You have a health-care (system) that has completely fragmented service for indigenous people," said Cook, associate dean of First Nations, Metis and Inuit health at the University of Manitoba.
Like many other aboriginal Canadians, Metis often have limited incomes, said Watteyne. "But what is distinct is the Metis' inability to access those non-insured health benefits. So that creates even greater pressures on limited incomes that are there.
"So just the ability to pay for expensive prescriptions, the ability to even cover the cost of transportation to see doctors and specialists (are difficult) because that's not covered either."
While the report details the barriers many aboriginal seniors face in accessing health care, it also lists examples of programs begun across the country to provide culturally appropriate services for these "respected and honoured" elder members of indigenous communities.
Metis Nation Ontario has developed 18 community support programs across the province that help seniors access care, said Watteyne. For example, volunteer drivers will transport seniors in northwestern Ontario to Winnipeg for cancer and other specialized care.
Marney Vermette, a registered nurse who oversees an educational program for personal support workers in several reserves in northwestern Ontario, said the key is teaching community health providers to take a holistic approach to seniors' needs.
"So not only looking at the physical aspects of your client, but the spiritual, the mental and emotional, and how important that is in caring for your client," said Vermette, who is the liaison for the Saint Elizabeth First Nations, Inuit and Metis Program, Wabauskang First Nation.
"The goal of this course was to provide health-care providers with the knowledge they would need to keep their elderly clients in the community safely for as long as possible."
But if an elderly person becomes so sick and frail they require specialized care, it could mean moving to a long-term facility in a city, which can be a blow for the individual, their family and the whole community, noted Vermette.
For the senior, "they're put into homes that are very foreign to them in the way care is provided. They're away from their families, they're lonely," she said. "Even for family members to go visit them, its very costly and I know that it's very difficult."
The senior can feel isolated and adrift because care providers in the long-term care home may not speak their language, the food would be "very different" and the likely regimented routine in the facility would be unfamiliar, she said.
"In my experience, it is also very sad for the community. It is a loss because not only is it a family member, but a lot of times these elders have a lot of (cultural) knowledge that's taken with them."