Diversity

From Chapter 1: Introduction in Improving our Response to Older Adults with Substance Use, Mental Health and Gambling Problems: A Guide for Supervisors, Managers and Clinical Staff

As an age group, older adults are the most heterogeneous (American Psychological Association, 2004). They range in age from 55 to 100. Within the older adult age group, certain groups of older persons may face discrimination and disadvantage in addition to ageism and stigma, increasing their vulnerability to mental health and substance use problems or intensifying existing problems. These groups may also face significant additional barriers to health care and social services. Awareness of some of the unique issues affecting these groups can help service providers to respond to their special needs.

Gender

Older women and men differ in that:

• women tend to live longer than men and are therefore more likely to:
  - care for infirm husbands and ultimately outlive them
  - act as caregivers and to carry more of the burden of home care concerns than older men (Ontario Human Rights Commission, 2001)
  - experience age-related problems such as dementia and other medical conditions (American Psychological Association, 2004; Ontario Human Rights Commission, 2001)
• older women tend to have fewer financial resources than older men (American Psychological Association, 2004; Ontario Human Rights Commission, 2001)
• women are more prone to intoxication and to substance use problems at lower levels of substance use than men because women’s bodies metabolize alcohol and other substances differently than men’s bodies
• older men are at especially high risk for suicide; in 1997 the suicide rate for older Canadian men was nearly twice that of the nation as a whole (Canadian Coalition for Seniors’ Mental Health, 2006c)
• men are more likely than women to drink heavily and more than twice as likely to be dependent on alcohol (Tjepkema, 2004).

Disability

In Canada, 35 per cent of all people with disabilities are seniors; many of these disabilities develop in later life. The most common disabilities among seniors are those affecting mobility (74 per cent), physical flexibility and agility (65 per cent), hearing (42 per cent) and vision (26 per cent) (National Advisory Council on Aging, 2005a). Other disabilities include psychiatric, developmental and cognitive challenges.

Older adults with long-term disabilities may have had lifelong problems with employment, transportation, housing and discrimination. Aging can aggravate chronic patterns of poverty and social discrimination among people with disabilities (Ontario Human Rights Commis-sion, 2001).

When disabilities arise in old age, they are likely to cause a sudden change in the older person’s life circumstances and may precipitate a rapid decline. Either way, older people with disabilities may have high levels of stress, pain, social isolation and they may be more vulnerable to abuse from others. All these factors can affect their ability to cope and increase their vulnerability to substance use and mental health problems. Issues of transportation and accessibility may limit their access to treatment services and other community supports.

Sexual orientation and gender identity

A person’s sexual identity is a central and important part of who that person is throughout life, including old age. When people feel they must keep this aspect of their personal identity hidden, it prevents them from living and expressing themselves fully. This can have a negative affect on their mental health.

People who are lesbian, gay, bisexual, transsexual, transgendered, two-spirit, intersex or queer (LGBTTTIQ) face discrimination from people they know, from strangers and from health care, social service and senior service providers. While rates of substance use and mental health problems are high in these communities (National Advisory Council on Aging, 2002), many people do not access care because of fear of discrimination and stigma.

LGBTTTIQ people may have developed an alternative family structure of support, which may not be recognized or welcomed by mainstream services. Many of the present generation of older people who are LGBTTTIQ may have hidden lives or go “back into the closet” to avoid facing the discrimination of service providers.

Ethnocultural groups

Attitudes toward older adults and their expected role in society vary broadly among ethnocultural groups. Some regard older adults highly for their experience and wisdom; others downplay older adults’ ideas and knowledge, viewing them as outdated. Ethnocultural groups also vary in their understanding of mental health, substance use and gambling problems. These factors influence older adults’ risk of and resilience to developing problems, the level of support available to them, and the attitude older people have toward seeking help for these problems.

Some immigrant seniors experience high levels of isolation and low levels of awareness of available supports such as transportation and health and social services. The immigrant experience may intensify fears of economic dependency and lessen the elder’s status within the family.

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