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Learning from The Lived Experiences of Aging
Immigrants: Extending the Reach of Photovoice
Using World Café Methods
Laura Kadowaki, Sharon D. Koehn, Shari Brotman,
Julien Simard, Ilyan Ferrer, Émilie Raymond, and Pam Orzeck
Abstract
is article reports on a series of Stakeholder Outreach Forums hosted in Canadian communities
from 2018 to 2019. ese forums built on a previous research project, e Lived Experiences of Aging
Immigrants, which sought to amplify the voices of older immigrants through Photovoice and life course
narratives analyzed through an intersectional life course perspective. e forums used World Café methods
to encourage cumulative discussions among a broad range of stakeholders who work with or inuence
the lives of immigrant older adults. Participants viewed the previously created Lived Experiences of Aging
Immigrants Photovoice exhibit, which provided a springboard for these discussions. e forums’ aim was
to increase the stakeholders’ awareness of the experiences of immigrants in Canada as they age and to
create space for the stakeholders to reect upon and discuss the experiences of aging immigrants. Here
we illustrate how the forums complement the narrative Photovoice research methodology and highlight
the potential of Photovoice and targeted outreach strategies to extend academic research ndings to
relevant stakeholders. Across all forums, participants identied structural and systemic barriers that
shape experiences of and responses to social exclusion in the daily lives of immigrant older adults. ey
further identied challenges and strengths in their own work specic to the issues of social inclusion,
caregiving, housing, and transportation. Intersectoral solutions are needed to address the structural and
systemic roots of exclusion at the public policy and organizational levels.
is article reports on a series of Stakeholder
Outreach Forums hosted in Canadian communities
from 2018 to 2019. e forums engaged a broad
range of stakeholders who work with or inuence
the lives of immigrant older adults. eir aim was
to increase the stakeholders’ awareness of older
immigrants’ lived experiences and to create space
for stakeholders to reect upon and discuss the
experiences of aging immigrants. e forums built
on a previous narrative Photovoice research project,
entitled e Lived Experiences of Aging Immigrants,
which we describe in greater detail below
(Brotman et al., 2017). In each forum, participants
rst viewed the previously created narrative
Photovoice exhibit, then engaged in discussions
about its content with diverse stakeholders in
accordance with World Café methods (World Café
Foundation, 2015). Our worked example illustrates
the potential of Photovoice and targeted outreach
strategies employing the World Café approach to
extend the reach of academic research ndings to
relevant stakeholders.
Background: Aging Immigrants in Canada
In Canada’s most recent census, immigrants
were almost one-quarter of the population
(Statistics Canada, 2022). Most immigrants
come to Canada through economic programs
during their core working age years (25–54).
By the time they reach age 65, most of these
immigrants have been living in Canada for at
least 20 years. Immigrant older adults who have
been living in Canada for less than 20 years have
typically arrived through family sponsorship
programs (Kei et al., 2019) that allow individuals
to sponsor the immigration of specied family
members to Canada (e.g., a child or grandchild
can sponsor their parent or grandparent). e
federal government requires that the family of
sponsored parents and gr andparents support them
nancially for a period of 20 years (in the past the
requirement was 10 years), during which time
the sponsored immigrant is ineligible for most
government benets and subsidies (Government
of Canada, 2019). e policy has been shown to
engender dependency of older adults on their
sponsors, which exposes them to vulnerabilities
such as diminished access to health and social
care, housing insecurity, and even abuse (Koehn,
2022; Koehn et al., 2010; Matsuoka et al., 2013).
Canada also has a parent and grandparent
super visa program to facilitate long-term family
visits, allowing an individual to visit their child or
grandchild for up to 5 years at a time (Government
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of Canada, 2022). Older adults who arrive under
the super visa program must be supported by
their families and have private medical insurance
since they are ineligible for Canadian health and
social care services. Both sponsorship and super
visa programs have been critiqued for transferring
the responsibilities of the state, such as aordable
child care, onto the shoulders of overburdened
immigrants. is in turn “transform[s] dynamics
of care for families from the Global South” and
exposes many older adults to dependency and
increased vulnerabilities (Ferrer, 2015, p. 253).
Although there is diversity among
them, older immigrants are more likely than
the broader population of older adults in
Canada to be disadvantaged by the eects of
lifelong intersections of economic and social
discrimination rooted in racialization (Brotman,
2003a; Ferrer, 2017; Forbat, 2004). Recent and
sponsored immigrants and refugees have been
identied as especially vulnerable to inequities
that negatively inuence their access to health
care and render them susceptible to nancial
precarity and marginalization in later life (Curtis
& Lightman, 2017; Kei et al., 2019; Koehn et al.,
2010; Salma & Salami, 2020a; Stewart et al., 2008).
For example, eligibility for Old Age Security
(OAS) and Guaranteed Income Supplement
(GIS) requires a minimum 10 years’ residence in
Canada as a Landed Immigrant (an individual
who has immigrated to Canada and been granted
permanent resident status). Even then, full
pension entitlements are only available aer a
period of 40 years.
Recent studies have also highlighted the
inequities experienced by aging immigrants who
arrived under various domestic worker programs
and the parent and grandparent super visa
(Ferrer, 2015, 2017). Evidence further points to
gaps in the availability and suitability of support
for marginalized older immigrants in areas such
as health and elder care (Badger & Koehn, 2015;
Brotman, 2003a; Koehn et al., 2018; Salma &
Salami, 2020a; Wang et al., 2019), mental health
(Guruge et al., 2015; Koehn et al., 2014), pensions
and retirement security (Coloma & Pino, 2016;
Curtis et al., 2017; Curtis & Lightman, 2017; Ferrer
et al., 2022), and access to community services and
social participation (Koehn et al., 2016; Koehn,
Donahue, et al., 2022; Salami et al., 2019; Salma &
Salami, 2020b). Health and social care providers
must grapple
with the complexities of providing
“culturally competent” care (Choi, 2014; Levko et
al., 2014) to diverse older adults, and the
workforce
is insuciently prepared for this challenge. For
example, only 5% of social workers undergo
gerontological training, and sustained eort is
needed to build capacity in this area (Rozario &
Chadiha, 2014).
Furthermore, current programs and policies
intended to serve older adults fall short of
meeting the needs of the immigrants among
them. Commonly identied barriers to health
and social care services for immigrant older adults
include culturally and linguistically incongruent
organizations and services (Koehn, Donahue, et
al., 2022; Stewart et al., 2011; Wang et al., 2019);
language barriers that are exacerbated by a lack of
resources for translation/interpretation services
and language classes for immigrants (Koehn, Ferrer,
& Brotman, 2022; Stewart et al., 2011; Wang et al.,
2019); racism and discrimination by institutions
and service providers (Stewart et al., 2011); mobility
and transportation barriers that prevent access
to needed services (Stewart et al., 2011; Wang et
al., 2019); lack of accessible information about
services (Koehn, Donahue, et al., 2022; Stewart et
al., 2011); strict eligibility rules based on income,
immigration status, and/or sponsorship status that
limit access to public services and government
benets (Ferrer et al., 2017; Koehn et al., 2010;
Stewart et al., 2011); and nancial barriers that are
exacerbated by government sponsorship, pension,
and employment policies (Ferrer et al., 2017; Koehn
et al., 2010; Stewart et al., 2011; Wang et al., 2019).
Guidance for policy-makers and practitioners
in the academic literature is limited, however,
because few studies account for the heterogeneity
among older immigrants and refugees that arises
from unique
congurations of determinants of
aging (Koehn et al., 2013). Attention to the type
of immigration and eects of immigrant status
is increasing in the gerontological literature, but
other dimensions of identity such as ethnocultural
background, country of origin, religion, language,
income, timing of migration, gender, racialized
status, and family and living arrangements are also
important (Durst, 2010; Northcott & Northcott,
2010). Too oen, the behaviors and health and
social outcomes of immigrants are explained solely
with reference to their culture. Inadvertently, such
explanations shi the burden of responsibility
for inequitable treatment to older adults and
their families. Oen they conate the eects of
culture with the eects of other factors, such as
socioeconomic disadvantage and discrimination
based on skin color or disability (Brotman, 2003b;
Koehn, 2009; Torres, 2019).
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Background: e Lived Experiences of Aging
Immigrants
e Stakeholder Outreach Forums discussed
in this article built upon e Lived Experiences
of Aging Immigrants. is academic study was
conducted between 2014 and 2017 by Brotman,
Koehn, and Ferrer and gave rise to the Photovoice
exhibit used as a springboard for our World Café
forums. e study explored everyday stories of aging
among diverse older adults in two culturally and
geographically distinct Canadian provinces: British
Columbia and Quebec. Brotman, Koehn, and
Ferrer sought to understand the aging experiences
of older immigrants and refugees situated at the
intersections of multiple neglected identities. ey
aimed to address the urgent need for studies of the
aging experience that explore the contributions
of mutually compounding intersections between
multiple identities and oppressions that accumulate
over a lifetime (Koehn et al., 2013; Torres, 2019).
e 19 participants in their study lived in the
metropolitan regions of Vancouver and Montreal
and represented underresearched groups, including
immigrants and refugees from Afghanistan, Chile,
Columbia, Guyana, North and South Korea,
Nicaragua, Pakistan, the Philippines, and Trinidad
and Tobago.
is work was guided by their development of
the intersectional life course perspective (ILCP),
reported elsewhere (Ferrer et al., 2017). Briey,
the ILCP examines the multiple and interlocking
systems of domination that shape and structure
people’s lives through the interplay of categories
of dierence (such as age, race, gender, class,
and citizenship) (Collins, 2015; Crenshaw,
1991). e life course perspective is integrated
with intersectionality theory to explore how
intersectionality operates across time and space
and provides a holistic view of life (Grenier,
2012). e interrogation of structural inequality
and intersectional oppression are central to
the ILCP. Intersectional analyses across the life
course can enable a richer and more nuanced
examination of aging within racialized and
(im)migrant communities by linking lived
experiences to state and institutional policies
and practices (e.g., within the health and social
care, labor, retirement and immigration sectors)
that shape these experiences (Ferrer et al.,
2017). e approach further enables exploration
of both resilience (strength in coping with
exclusion and oppression) and resistance
(pushing back against forces of exclusion and
oppression; Hulko et al., 2019).
So far, the research team has applied the ILCP
to study data in publications on social isolation
(Koehn, Ferrer, & Brotman, 2022) and economic
precarity (Ferrer et al., 2022). However, few health
and social practitioners or policy-makers have
access to such publications or the time to read
them. Nor do they typically have opportunities
to discuss their eorts to engage with or adapt
services to older immigrants and their families or
to share knowledge and strategies for action with
other relevant stakeholders (Koehn, Donahue, et
al., 2022; Manthorpe et al., 2010). Accordingly,
the research design included a Photovoice
component intended to compliment participants’
rich narratives by providing a visual record of their
day-to-day experiences of aging in Canada and a
more accessible means of communicating these
experiences to relevant stakeholders.
Data for the Lived Experiences of Aging
Immigrants study were collected via life story
narrative interviews and Photovoice. Brotman et
al. (2020) argued that in combination, these two
strategies operationalize theoretical tenets of the
ILCP. Photovoice is a form of participatory action
research that provides participants the opportunity
to express themselves via photography. Arguably,
it creates space for multiple ways of knowing and
oers an alternative means of knowledge exchange
capable of reaching audiences dierent than those
traditionally reached by academic literature. e
Photovoice exhibit was created from the interviews
with and photographs by the diverse older
immigrants and featured six dominant themes:
(a) community engagement, (b) family and care,
(c) housing and transportation, (d) precarious
employment, (e) trauma of the past, and (f)
resilience. It debuted simultaneously in Vancouver
and Montreal in May 2017 in both English and
French. e Vancouver exhibit was retained for an
additional month in the community center venue
and was subsequently exhibited at three seniors’
centers in the Greater Vancouver region, on request
of their administrators. e exhibits were hugely
successful in reaching participants, their families,
and the broader communities in which they lived.
However, Photovoice has been recognized as an
eective method for sharing experiences, learning,
and advocating for change (Mysyuk & Huisman,
2020), and the research team felt strongly that the
exhibits had more potential to engage targeted
stakeholders who work with or inuence the lives
of immigrant older adults. Committed to expanded
outreach, the Lived Experiences of Aging Immigrants
research team secured additional funding (see
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Acknowledgments) to host Stakeholder Outreach
Forums. e research scope was expanded from
Greater Vancouver and Greater Montreal to include
Calgary and Quebec City. Additional academic
and community members were also brought into
the fold. In the next section, the methods used for
the Stakeholder Outreach Forums are described.
Methods
Community-Engaged Research Approach
As a community-engaged research approach,
Photovoice is “used to explore and address
community needs, strengths and challenges,
stimulate individual empowerment and create
critical dialogue to advocate community change”
(Mysyuk & Huisman, 2020, p. 2). Ahmed and
Palermo (2010, p. 1383) dene “[c]ommunity
engagement in research [as] a process of inclusive
participation that supports mutual respect of values,
strategies, and actions for authentic partnership.”
History, relationship building, trust, respect, and
transparency are key contextual factors that can
inuence the engagement process with community
(Key et al., 2019). e Stakeholder Outreach
Forums extended the community-engaged
approach underlying the Lived Experiences of
Aging Immigrants Photovoice exhibit by convening
World Café discussions at community forums.
Participants in the forums were stakeholders
from each local community. Stakeholders
were dened as individuals who worked with
older immigrants or who were in a position to
otherwise inuence the lives of immigrant older
adults through their involvement in program
development and delivery, advocacy, or policy-
making. ey included representatives (sta,
volunteers, or seniors) from public sector
services, immigrant-serving agencies, and seniors’
and ethnocultural-specic community-based
organizations. Community forums have been
identied as an eective community engagement
mechanism to identify and understand community
needs, create common ground, and develop trust
and relationships (Han et al., 2021). Based on
their ability to bring together a range of voices and
perspectives to address a given topic, community
forums have been widely adopted by researchers
to elicit stakeholder input on a range of health and
social care issues pertaining to older adults (e.g.,
Heckman et al., 2022; Holroyd-Leduc et al., 2017;
Hulko et al., 2021).
We adopted the World Café method (World
Café Foundation, 2015) to elicit participants’
perspectives at each of the forums. is community-
engaged method is particularly appropriate “when
the goal is the focused use of dialogue to foster
productive relationships, collaborative learning,
and collective insight” (Brown & Isaacs, 2005,
p. 21). World Café encourages diverse groups to
participate in iterative rounds of dialogue and
knowledge cocreation through the enactment of
seven key principles (Brown & Isaacs, 2005; World
Café Foundation, 2015):
1. Set the context.
2. Create a hospitable space.
3. Explore questions that matter.
4. Encourage everyone’s contribution.
5. Connect diverse perspectives.
6. Listen together for patterns and insights.
7. Share collective discoveries.
Key strengths of the World Café method include
its ability to engage diverse groups of participants,
create a welcoming environment for discussions,
facilitate collective knowledge sharing, allow
for reections on the ideas of others, build
relationships, and collect large amounts of data
in a short period of time (Fouché & Light, 2011;
Löhr et al., 2020). As with focus groups, the
World Café method may not be appropriate for
discussing sensitive topics and it does not usually
allow for dierentiation between subgroups in
the data analysis (Löhr et al., 2020). To date, it
has primarily been used within North American
research contexts (Löhr et al., 2020). Within the
aging eld, the World Café method has been used
to engage older adults and related stakeholders
in discussions on topics such as falls prevention
(Khong et al., 2017), technology development
(Lund et al., 2021), and care delivery to LGBT+
older adults (Haord-Letcheld et al., 2021).
Organizing the Forums
Ten Stakeholder Outreach Forums were held
in Greater Montreal, Quebec City, Calgary, and
Greater Vancouver between 2018 and 2019. At each
forum, the Lived Experiences of Aging Immigrants
Photovoice exhibit was used as a springboard
for discussions about the experiences of aging
immigrants in relation to key themes identied in
the exhibit: (a) caregiving, family, and home care;
(b) housing, disability, and transportation; and
(c) social inclusion and community engagement.
e Calgary and Greater Vancouver forums were
conducted in English. e Greater Montreal and
Quebec City forums were conducted in French.
Research leads at each site partnered with one
or more local community organizations to host
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the forums (details of partners and number of
attendees can be found in the site-specic and nal
project reports on the project website). Community
partners played pivotal roles in assisting with
stakeholder participant recruitment, ensuring
the agenda and approach reected the needs of
the local community, and organizing the forums.
Partnerships with local organizations helped to
establish the credibility and trustworthiness of
the research teams. To align forum themes and
organization with community priorities and the
local context, each site was aorded some exibility
in its interpretation. Researchers balanced the
need for community partners to share control of
forum design with the need to maintain some level
of consistency across sites.
For example, when community partners in
Calgary wanted to focus discussions on elder
abuse, an issue not originally identied as a major
theme of the Lived Experiences study, the Calgary-
based researchers identied connections between
this topic and several study themes such as social
exclusion and family care, thereby substantiating
their focus as distinct from other sites. In Quebec
City, where the proportion of older immigrants
is lower than the national average (Statistics
Canada, 2018), partners identied the relatively
recent inux of immigrants of all ages as a reason
for the limited attention on older immigrants in
public sector service provision. Educating dierent
sectors on the issues facing older immigrants
was thus deemed necessary before intersectoral
collaboration could be eective, and health and
social care providers and immigrant-service
providers were therefore invited to separate
Quebec City events. In Greater Vancouver, two of
the forums were held in the aernoon in order to
draw participants from morning events hosted by
a community partner, the United Way of the Lower
Mainland. is strategy leveraged the partner’s
networks and access to space. In Montreal, the main
project partner engaged additional organizations
as event partners to reect the distinct themes of
each event as well as neighborhood and/or local
service contexts, such as those related to housing
or caregiving.
Site teams’ ability to leverage their preexisting
connections and relationships was critical to
the forums’ success. For example, at the Greater
Vancouver site, a local immigrant-serving
organization (MOSAIC) hosted one of the forums
in its space free of charge based on its long-standing
relationship with the lead investigator. In Montreal,
the main partner (ACCÉSSS), an advocacy-based
organization working to redress inequities in
health and social care services among Montreal’s
ethnocultural, immigrant, and racialized
communities, leveraged its enduring trust-based
relationships with the communities it serves to
maximize outreach. Such alliances, combined with
the research team’s preexisting relationships with
key service providers within public sector and
municipal services, ensured that the intersectoral
dialogue approach was successfully achieved.
Ethics approval for the Lived Experiences
of Aging Immigrants project was obtained from
McGill University and Simon Fraser University
research ethics boards. e Stakeholder Outreach
Forums were knowledge exchange events intended
to (a) validate and explore the relevance of the
Lived Experiences of Aging Immigrants project
ndings and (b) encourage the development
of possible actions/responses on the part of
stakeholder groups. As such, ethics approval was
not required. Nonetheless, forum participants
formally consented to being photographed and
having their input in World Café tables included in
reports, policy briefs, and publications and on the
project website.
Engaging Participants
e Stakeholder Outreach Forums brought
together a broad range of stakeholders, including
municipal service providers, representatives of
government and community service organizations,
advocates, volunteers, older adults, and academics.
Invitations were sent approximately 1 month in
advance of each forum to stakeholders involved
in domains relevant to the forum theme. Invited
stakeholders were either engaged in working with
immigrant older adults and their communities
or were interested in doing so. Older adults were
included as participants at all forums to ensure
their voices were heard. Forum attendance
ranged from 21 to 62 participants in each forum,
comprising a total of 352 participants in the 10
forums. Forum locations were mindfully selected
for their accessibility to all participants, including
those with disabilities, and food was provided. e
forums also provided a valuable opportunity for
networking and colearning among participants.
Each forum followed a similar agenda: (a) an
opening plenary by a guest speaker, (b) viewing of the
Lived Experiences of Aging Immigrants Photovoice
exhibit, (c) World Café style discussions, and (d)
a nal full-group report-back and discussion. e
forums lasted about 3 hours. Guest speakers were
representatives of local organizations, content
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area experts, older adults, or other advocates. At
one forum in Greater Vancouver, the BC Seniors
Advocate agreed to speak. e guest presentations
were approximately 15 minutes in length and
were intended to encourage reection among
participants and provide information that would
help frame the discussions.
Viewing the Photovoice exhibit was an
important tool for stimulating discussion and
provided all the participants (particularly those
with limited experience working with immigrant
older adults) with common ground for their
conversations (See Figures 1 and 2).
At each World Café table, small groups
of participants discussed insights from the
Photovoice exhibit in relation to forum themes,
action items, and the actors responsible for such
actions. Participants were asked to provide their
impressions about the forum theme or subthemes
based on viewing the exhibit and potential
solutions or actions that could be taken to remove
barriers and/or build on strengths. e small
groups were strategically developed to ensure that
stakeholders from dierent sectors sat together
(i.e., public services, governmental agencies, and
community organizations). is intersectoral
dialogue was key to the success of most events,
with many participants noting that they had not
previously had an opportunity to meet face-to-face
with those from other sectors. Table notetakers
(members of the research team or local community
partner organizations) were present at each table
to record the discussion and report back to the
wider group in the wrap-up discussion. Site teams
modied the World Café approach to align with
the number of themes/subthemes and number
of participants at their forums. At the Greater
Vancouver sites, participants rotated between
dierent World Café tables, each featuring a single
component of a theme (e.g., disability, housing,
or transportation), until each participant had
contributed to three subthemes. At the Quebec
City, Greater Montreal, and Calgary forums,
however, participants remained in the same group
to discuss the questions, relying instead on the
strategic cross-sectoral placement of participants
at each table to fuel dynamic discussions. is
adaptation of the World Café methodology was
deemed necessary to ensure sustained dialogue
among table participants. Most importantly, the
organizers adhered to the seven key principles of
the methodology.
A nal full-group report-back and discussion
was held at the end of each forum. e report-backs
provided an opportunity for member-checking,
as they highlighted the most salient points of the
World Café discussions and invited feedback and
discussion from the participants. Following the
report-back, three questions guided the group
discussion: (a) How do each of the table themes
connect to the solutions? (b) Are there any gaps in
understanding that preclude action right now? and
(b) Who needs to be responsible for the action?
Data Analysis and Knowledge Dissemination
Aer the forums, the research team at each
site reviewed the notes from the World Café and
group discussions. e notes were compiled
into site reports that were shared with the forum
participants. All sites also developed at least one
policy brief (Bradette et al., 2021; Brotman et al.,
2021; Ferrer et al., 2021; Haig et al., 2020; Lonsdale
& Koehn, 2020; Simard et al., 2021) that drew
on the knowledge gained from the forums to
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Figure 1. Viewing Exhibit Figure 2. World Café Table Discussion
identify local issues and recommend actions to
improve services and policies to better meet the
needs of aging immigrants. A national report was
developed through thematic analysis of the 10 site
reports to identify overarching themes. All reports
are housed on web pages dedicated to the project.
ematic analysis is an approach to data
analysis that seeks to systematically analyze data
within a data set and link the data to broader
concepts and collective issues through the
identication of themes or “patterns of shared
meaning underpinned or united by a core concept”
(Braun & Clarke, 2019, p. 589). Kadowaki, a graduate
trainee at the Vancouver site, used the qualitative
data management program NVivo to code the
site reports. Four main forum topics—social
inclusion, caregiving, housing, transportation—
were initially identied from the site reports, and
the data related to each of these topics was coded.
Coding focused on two types of themes: (a) topical
themes related to the experiences and challenges
of older immigrants and (b) recommendations
and solutions proposed by participants. Kadowaki
and other team members further identied three
inductive themes that emerged from the data:
structural and systemic barriers, nancial precarity,
and family and community as sources of resilience.
ese cross-cutting themes represented broad,
higher-order concepts identied at all sites that
inuenced the lives of aging immigrants across all
four topical domains.
Results
Cross-Cutting emes (Across Topics and Sites)
Structural and Systemic Barriers. Structural
and systemic barriers were key topics of
discussion at the forums. Participants identied
several challenges rooted in health care, long-
term care, transportation, and social service
systems that were poorly designed to meet the
needs of aging immigrants. ese systems were
described as complex and dicult to navigate,
lacking translation and interpretation services
to address language barriers, decient in cultural
safety to curb racism and discrimination, short
on education and outreach targeting immigrant
older adults, and replete with inexible and non-
responsive policies and services.
Participants highlighted policies such as the
parent and grandparent sponsorship and super
visa programs, previously discussed, as formidable
structural barriers for many immigrants. ey
identied the hardships endured by sponsored
immigrants due to their long period of required
dependency on family members (20 years, except
in Quebec, where it remains 10 years). During this
period, they are ineligible for certain health and
social care services, with some local variation, and
must pay for these out of pocket.
Participants further highlighted the lack
of support available to newcomers and recent
immigrants to help them overcome structural
barriers. ey emphasized the need for programs
to improve the accessibility and delivery of
language courses and to enhance “systems literacy”
(knowledge of how to navigate government
systems). Participants also described how
structural barriers encountered by immigrants
earlier in the life course (e.g., employment barriers,
lack of recognition of educational and professional
credentials) negatively impacted immigrants as
they aged because their lower wages limited their
ability to save for retirement and reduced access to
pension entitlements.
Financial Precarity. Financial precarity
emerged as a cross-cutting theme that could create
challenges in many domains of life for aging
immigrants.
Participants identied it as a barrier
to accessing essential services and supports such
as suitable housing, long-term care services,
community and social activities, and transportation.
Older immigrants’ nancial situations vary;
consistent with the research literature, forum
participants identied recent and sponsored
immigrants as the most economically vulnerable.
When they are ineligible for government benets
and subsidies, sponsored immigrants are oen
fully dependent on family for nancial support.
While some families can comfortably support
aging parents/grandparents, many may themselves
be experiencing nancial insecurity. Participants
related stories of older immigrants who are thus
forced to continue working in later life, most oen
in the secondary labor market, to ensure their
family’s economic survival.
Family and Community as Sources of
Resilience. Forum participants discussed the
centrality of family in the lives of many older
immigrants and identied how family can be
an important source of resilience and social
support. ey indicated that sponsored and
recent immigrants oen live in multigenerational
households with children and grandchildren who
help support them in old age. Importantly, however,
they noted that the provision of social support is
usually bidirectional: Older immigrants’ many
contributions to their family’s well-being (e.g.,
child care, nancial support) are oen overlooked
JCES Vol. 16, No. 1 —JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 7
as a source of family solidarity and strength.
Participants also cautioned against assuming that
all immigrant older adults are being supported by
family; for some, family members are nonexistent,
incapable, or not physically or emotionally close
enough to provide support. Participants identied
nancial and emotional mistreatment of older
immigrants as a mostly invisible but pressing issue.
Faith and community were also identied
as important sources of resilience, support, and
information for older immigrants. Upon arrival in
Canada, many immigrants seek companionship and
support from local faith-based and ethnocultural
minority community organizations, neighbors,
and groups. Participants noted that peers are
inuential resources who share information,
mentor new immigrants, and advocate for change.
Opportunities for older immigrants to participate
in community and access local services were
viewed as key to reducing their isolation.
Topical emes (Across Sites)
Social Inclusion. Having relinquished well-
established community and social networks,
older immigrants commonly experience culture
shock upon arrival in Canada, although forum
participants recognized that immigration
pathways are diverse and experiences were
varied. ey identied late-in-life sponsored
immigrants and refugees as typically facing the
greatest challenges integrating into Canadian
society. Most importantly, they emphasized
that the supports provided to new immigrants
are insucient. Especially needed are exible
programs for language learning (e.g., not limited
to immigrants’ initial 5 years in Canada); programs
targeted at hard-to-reach groups, especially those
barriered by gendered cultural expectations
of care work (e.g., older women, grandparents
caring for grandchildren); support for educational
and professional credentialing; and programs to
assist with systems navigation and integration.
Participants emphasized that opportunities to
develop English and/or French language skills are
particularly important, as linguistic isolation can
contribute to social isolation, particularly among
sponsored older immigrants and women.
Public institutions and local community
organizations oer services that can assist
older immigrants in many areas (e.g., housing,
social activities, translation services). However,
participants noted that some organizations and
services may be ill-equipped to meet the needs of
some immigrants because they are inaccessible,
nonrepresentative, and/or not culturally safe or
relevant. Experiences of racism and discrimination
and mistrust of public institutions due to past
negative experiences, particularly if the person
immigrated from a country with an oppressive
government, may also impede access. Participants
identied faith-based, ethnocultural-specic, and
immigrant-serving organizations as inclusive
spaces that provided culturally and linguistically
relevant programming for older immigrants.
However, they cautioned that these organizations
are oen underfunded and may not be present in
all communities.
Cultural barriers that intersect with gender
norms and expected family roles to limit women’s
activities outside of the domestic sphere were
identied as preventing some older immigrants
from participating in the community. Older
immigrant women are commonly the main
providers of child care for grandchildren, and they
oen have limited time for social participation and
social mobility.
Caregiving. At all sites, forum participants
expressed concern about declining access to formal
long-term care and home care services and the lack
of supports for caregivers. ese were recognized as
systemic issues impacting all older adults; however,
unique structural barriers further limit access for
older immigrants. ese include challenges with
navigating unfamiliar and language-incongruent
systems, the paucity of interpretation/translation
services, and service providers’ assumptions
that immigrant families already provide care.
Sponsored immigrants are further limited by their
ineligibility to access formal services. Participants
were concerned that the dependency on family
engendered by sponsorship rules could amplify the
vulnerability of older immigrants to elder abuse.
Participants remarked that there is an all-
too-common assumption among health and
social service providers and policy-makers that
the families of immigrant older adults are both
willing and nancially, spatially, and relationally
capable of caring for their aging relatives at
home. Despite cultural norms that support this
notion, migration has created intergenerational
dierences in care expectations. Immigrant
family members can also be mobile and hence
unavailable or subject to employment, economic,
and/or housing precarity, which can also preclude
their assumption of care responsibilities.
Forum participants agreed that formal
services are oen inappropriate for the needs of
older immigrants and that health care providers
JCES Vol. 16, No. 1 —JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 8
sometimes lack experience in providing culturally
safe, immigrant-tailored care. e lack of culturally
appropriate meals in most long-term care facilities
is one such example. Positive examples of ethno-
specic long-term care facilities and residences
were acknowledged as solutions, but participants
noted that the development of such facilities was
a lengthy and arduous process. Stigma associated
with accessing formal services can also be a barrier
to access in some cases.
Participants observed that older immigrants
who provide care for a spouse, a child/grandchild,
or a friend can be especially isolated and vulnerable.
Not only are they potentially disconnected from
their extended family by migration but they are
also oen unaware of available support in Canada.
Housing. Forum participants underscored
how older immigrants are especially vulnerable
to the impacts of Canada’s pervasive housing
crisis. Although challenging for all older adults,
navigation of the housing market for many older
immigrants can be further complicated by their
lack of knowledge about the Canadian housing
market, lower literacy levels, linguistic barriers,
and racial discrimination. Additionally, they
may be unaware of their rights should a landlord
discriminate against them, neglect the property,
or attempt to unfairly evict them. Participants
commented that organizations oering support
for navigating the housing market are overworked
and rarely oer services that meet the needs of
immigrant older adults.
While older immigrants are diverse,
collectively they are more likely to experience
poverty and discrimination and to live in poor
quality and/or overcrowded housing. Moreover,
in Greater Vancouver and Greater Montreal,
participants explained that gentrication
was pushing immigrant communities out
of traditional neighborhoods, such as Parc-
Extension and East Vancouver, and thus
disconnecting older immigrants from their
ethnocultural communities.
Participants observed that older immigrants
frequently live in multigenerational households,
especially if they are sponsored and/or recent
immigrants. Although multigenerational
households can provide benets to older adults
such as social support, participants conceded
that as sponsored and recent immigrants without
eligibility for government benets and subsidized
housing, they usually have limited options if they
desire more independence or if a conict occurs
in their family relationship.
Transportation. Late-in-life older immigrants
oen do not drive, and older women are less
likely than men to have a driver’s license. Forum
participants were thus concerned by the lack of
education and outreach directed toward older
immigrants on how to use public transportation
services. ey noted that recent immigrants may
also face administrative or nancial barriers
when attempting to access subsidized bus or
subway passes.
Participants related that older immigrants
typically live in suburban communities and oen
need to travel long distances to access cultural,
religious, and linguistic resources (e.g., places of
worship, cultural centers, volunteer services, ethnic
foods). Stakeholders, including representatives
from local transit services, acknowledged that
public transportation routes may not service
important destinations for older immigrants or the
suburban communities in which they reside. eir
ability to participate socially in ethnoculturally
appropriate activities was observed to be strongly
associated with the availability of transportation.
Recommended Actions to Address Barriers and
Build on Strengths
Forum participants were asked to identify
actions that should be taken to improve the lives of
older immigrants and address barriers or build on
strengths. eir recommendations are synthesized
into eight themes, listed in Table 1.
Discussion
Forum participants conrmed the importance
of the ILCP for understanding the lived experiences
of immigrant older adults. ey frequently
emphasized the extent to which challenges
were exacerbated by multiple and intersecting
institutional structures and policies, and they
identied challenges faced by older immigrants on
a regular basis across each of the personal, familial,
relational, communal, and structural levels. Time
since immigration was identied as especially
salient, with recent and sponsored immigrants
facing the most signicant challenges in old age.
Intersections between age, ethnocultural identity,
and gender were also highlighted in discussions of
barriers to social participation.
Experiences of nancial precarity were linked
to structural barriers experienced earlier in the
life course, discrimination, and sponsorship rules
and policies restricting access to government
benets. ese ndings illustrate key concepts of
the ILCP, including the enduring consequences
JCES Vol. 16, No. 1 —JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 9
JCES Vol. 16, No. 1 —JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 10
Theme Recommended actions
Increasing access to
needed services
• Engage in targeted education and outreach aimed at immigrant
older adults
• Communicate information that is tailored to meet cultural needs in
multiple languages
• Deliver information via appropriate means (e.g., written materials,
radio, TV, peers)
• Use peer mentors and system navigators to help immigrant older
adults access needed services
• Build bonds of trust with immigrant communities (e.g., outreach at
places of worship, friendly visits)
Addressing linguistic
barriers
• Ensure that language classes are available, exible (e.g., no
penalties for missed classes), and tailored to meet the learning
needs of older adults
• Provide more nancial support for translation and interpretation
services
• Communicate information and oer programming in multiple
languages
Addressing situations
of nancial precarity
• Reconsider eligibility requirements for OAS and other government
benets
• Oer programs free of charge
• Provide free or highly subsidized transit passes to all older adults,
regardless of immigrant status
Ensuring culturally
safe and relevant
programs and
policies
• Increase representation and diversity within organizations
• Ensure health professionals and service providers receive training
on providing culturally safe care
• Recognize the value of lived experiences and the expertise of
immigrant communities
• Listen to immigrant communities and older adults to understand
their unmet needs
• Form partnerships between immigrant and senior-serving organizations
Recognizing the
central role of family
• Use family-centered approaches for outreach, education, and
programming
• Promote intergenerational activities to support the inclusion of older
adults who care for grandchildren
Building the capacity
of community
• Provide funding to build the capacity of community organizations
serving immigrant older adults
• Build coalitions of community organizations and engage in collective
advocacy
• Provide opportunities for immigrant older adults to make
contributions to community (e.g., volunteering)
Providing access
to aordable and
appropriate housing
options
• Increase the available stock of social housing (including building
larger units suitable for multigenerational families and accessible
units suitable for people with disabilities)
• Introduce policies that promote the development of aordable,
accessible, and appropriate housing units for low-income older
adults
• Support the development of innovative housing models (e.g.,
ethnocultural-specic seniors’ residences, multigenerational housing
models)
Increasing the
accessibility of
public transportation
services
• Consult with local communities about public transportation routes
and ensure service to suburban areas and important community sites
• Develop bus routes specically for seniors
• Provide education for immigrant older adults who are new transit
users
Table 1. Recommended Actions to Address Barriers and Build on Strengths
of disadvantageous institutional structures and
policies experienced earlier in life on the aging
experiences of older immigrants. Stakeholders’
input on the barriers posed by employment,
nancial, and sponsorship policies aligns with
prior studies (Ferrer et al., 2017; Koehn et al., 2010;
Stewart et al., 2011; Wang et al., 2019). Statistics
Canada data (Kei et al., 2019) reveal that the
nancial well-being of older immigrants is closely
related to their length of residency in Canada.
About one-quarter of immigrants who have lived in
Canada for 1 to 30 years are low-income compared
to 11% of those who have resided in Canada for 40
or more years.
Sponsored immigrants and recent
immigrants were clearly identied across forums
as the most vulnerable to nancial precarity. At
one level, forum participants’ observations are
consistent with an analysis of Canadian census
data by Curtis et al. (2017) that conrmed that
length of residence in Canada (less than 20
years) and lack of prociency in English or
French are associated with lower uptake of OAS
benets. rough the lens of the ILCP, this
outcome illustrates the compounding eects of
sources of marginalization that include type of
immigration, racialization, and increasing age
(Ferrer et al., 2022). Moving forward, forum
participants recommended that current eligibility
requirements for OAS and other government
benets be revised. Statistics Canada data reveal
that public pensions constitute only 8% of total
income among sponsored older immigrants who
have lived in Canada less than 10 years. is
compares to 71% among older immigrants who
have been living in Canada for 11 to 20 years (Kei
et al., 2019), suggesting a heavy reliance on public
pensions for nancial security among them.
Decreasing the number of years of residence
required for government benet eligibility—
which can be interpreted, according to the ILCP,
as institutional racism (Ferrer et al., 2017)—could
make a positive dierence in the lives of many
older immigrants.
Among the structural and systemic barriers
discussed by forum participants, the lack of
culturally safe and culturally relevant long-term
care services and policies predominated. e
literature on older immigrants similarly illustrates
that cultural incongruence can impede the
utilization of formal services (Koehn et al., 2018;
Koehn, Donahue, et al., 2022; Salma & Salami,
2020a). is area was highlighted as warranting
further attention for future research and action.
e ILCP further emphasizes recognizing
sources of resilience in the lives of aging
immigrants: Family was highlighted at the
forums as a central source of resilience for older
immigrants. However, in accordance with the
Lived Experience study ndings (Koehn, Ferrer,
& Brotman, 2022), forum participants also
cautioned against idealizing multigenerational
living and assuming all older immigrants have
family support available. According to Statistics
Canada (2017), multigenerational households
are the fastest growing type of household and
are most common in Indigenous and immigrant
populations. Some research suggests that living
with family positively impacts the well-being of
older immigrants (Mahmood et al., 2011; Ng &
Northcott, 2015). However, feelings of loneliness
and social isolation occur even when older
immigrants reside with family, sometimes more
intensely so (Alvi & Zaidi, 2017; Cruz et al., 2001;
Ip et al., 2007; King et al., 2014; Koehn, Ferrer,
& Brotman, 2022; Seo & Mazumdar, 2011).
Integration of older immigrants into the broader
community is essential, as family alone cannot
fully replace the social networks le behind in
their home country (Cela & Fokkema, 2017; Kim,
2013; Oglak & Hussein, 2016).
Forum participants attributed older
immigrants’ social isolation in part to their
linguistic isolation. is premise is supported by
data from the Canadian General Social Survey
indicating that older immigrants whose mother
tongue is not English or French (de Jong Gierveld
et al., 2015) and who have resided in Canada for
fewer years (Wu & Penning, 2015) are more likely
to report being lonely. ese ndings reinforce
recommendations by forum participants that
language training and civic participation support
for newcomers and recent immigrants should
be increased to include older adults within their
scope. Overcoming such barriers is pivotal due to
the valuable contributions that older immigrants
can make to civil society (Wright-St Clair & Nayar,
2017). Forum participants further identied,
in alignment with research ndings (Koehn,
Donahue, et al., 2022; Stewart et al., 2011; Wang
et al., 2019), that language barriers can impede
access to health and social care services. What is
less apparent in the forum participants’ accounts is
the understanding, revealed by an ILCP analysis,
of the ways in which “language barriers” mask the
structural racism embedded in regulations that
exclude older immigrants from language classes
or job opportunities because their immigration
JCES Vol. 16, No. 1 —JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 11
experiences did not t the template according to
which eligibility was determined (Ferrer et al.,
2022; Koehn, Ferrer, & Brotman, 2022).
While forum participants acknowledged
the important role played by local community
organizations and nonprots in supporting
immigrant older adults, they also noted the lack
of diversity and inclusivity in some organizations.
eir observation of the need for greater inclusion
of immigrants in community organizations
and recreation spaces has also been reported in
previous research, which underscores the eects of
racism in this exclusion (Koehn et al., 2014; Salami
et al., 2019; Stewart et al., 2011).
Transportation is recognized by forum
participants and Lamanna et al. (2020) as essential
for facilitating the social participation of older
adults. Transportation is certainly mentioned
in the literature as a barrier to accessing health
and social services (Stewart et al., 2011; Wang
et al., 2019) and social participation (Cela
& Fokkema, 2017; King et al., 2014; Koehn,
Ferrer, & Brotman, 2022; Wright-St Clair &
Nayar, 2020; Yoon, 2009), but it has not been
a key focus of these studies. One exception is
Dabelko-Schoeny et al.’s (2021) study with older
immigrants and refugees in the United States
that identied similar transportation barriers to
those highlighted in our forums. ese included
linguistic incongruity, lack of information,
inconvenient service schedules, accessibility
issues, lack of availability of public transportation
options, and the built environment. To this, our
participants added the importance of accessing
culturally safe spaces and services provided in
their own language when their children are not
available to take them places, as is oen the case.
In the broader literature on transportation and
older adults, ndings emphasize the need to
consult with older adults on transportation needs
(Lamanna et al., 2020). e unique challenges and
added importance of independent transportation,
as highlighted by forum participants, Dabelko-
Schoeny et al. (2021), and others, underscore the
importance of including older immigrants and
their advocates in those consultations.
Housing is a signicant concern for many
older Canadians. e Federal/Provincial/
Territorial Committee of Ministers Responsible
for Seniors (Canada; 2019) found that, in 2016,
up to a quarter of older adults were living in a
dwelling with an issue of adequacy (e.g., needed
major repairs), suitability (e.g., not enough
bedrooms), or aordability. Consistent with
the ILCP (Ferrer et al., 2017; Koehn, Ferrer, &
Brotman, 2022), forum participants identied the
compounding eects of age and immigration on
housing acquisition that included lower literacy
levels, lack of knowledge on how to navigate the
Canadian housing market, nancial barriers, and
dependence on children. Similar challenges were
identied in a Photovoice research project with
low-income immigrant and refugee older adults
in Edmonton (Keenan, 2017). Both the published
literature (Chaudhury et al., 2005; Keenan, 2017;
Koehn, Ferrer, & Brotman, 2022; Ng et al., 2007)
and our forum participants have established that
the housing needs of older immigrants are closely
intertwined with transportation needs, with older
immigrants desiring locations with easy access
to services and access to public transportation.
Advocacy to address the underfunding of social
housing, including the need for repairs to existing
units, adaptations to improve accessibility for
those with disabilities, and responses to increasing
gentrication of low-income and ethnocultural
minority immigrant neighborhoods, was high on
the list of policy recommendations emerging from
the forums.
Study Limitations
is study involved stakeholders from four
diverse communities representing Canada’s two
ocial languages (English and French) and mid-
size and large cities. However, we acknowledge
that the ndings may not reect the heterogeneity
of immigrant experiences in all communities (e.g.,
rural communities, northern communities). A
second limitation of the study is that discussions
among forum participants oen focused
on the experiences and challenges of recent
immigrants—those that they viewed as most
marginalized; these insights are not necessarily
reective of the experiences and realities of long-
established immigrants.
Conclusion
e main goal of the Stakeholder Outreach
Forums was to extend the reach of the Lived
Experiences of Aging Immigrants Photovoice
exhibit to stakeholders with the power to inuence
policy and practice in the domains that emerged
as central in our life story narrative/Photovoice
research. Moreover, we sought to create space for
those stakeholders to discuss how they understood
the issues raised by our research participants and
Photovoice cocreators, both with the research team
and with each other. Participants were intersectoral
JCES Vol. 16, No. 1 —JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 12
by design. is strategy has the potential to increase
uptake of research ndings, deepen understanding
of the most salient ndings, and raise awareness
and a willingness to act on current decits in
programming and policies.
e forums were one component of an
integrated community-engaged research and
knowledge exchange strategy that began with
the research design—a combined life story
narrative/Photovoice approach that employed the
ILCP to give space for the emergence of diverse
voices and pathways oen not represented in the
academic literature (see Brotman et al., 2020;
Ferrer et al., 2017). Together, the ILCP and
Photovoice situate the diverse lived experiences
of older immigrants in Canada relative to the
structural and systemic barriers underlying their
struggles, while centering participants’ emphasis
on their resistance and resilience. is account
underscores the importance of recognizing the
ongoing and targeted eorts needed to reach
dierent audiences. While the exhibits were
initially successful in speaking to local geographic
and cultural community members, extending
our research ndings to practitioners, decision-
makers, and advocates engaged with specic issues
(e.g., housing versus home care) across sectors
required more purposeful planning to ensure that
the right people could be in the right place at the
right time. Community partnerships were key to
this undertaking in all communities, as were the
extensive networks of research team members.
e 352 stakeholders who engaged in
World Café discussions across four sites,
both Anglophone and Francophone across
western Canada and Quebec, brought a
wealth of knowledge and diverse intersectoral
experience to the table. eir insights built
on and expanded the material included in
the Photovoice exhibit and, to a great extent,
validated our interpretations of the life story
narratives. Moreover, their observations and
recommendations are congruent with more
recent and critical international literature on
the topic. As such, their reections should be
recognized as valuable data unto itself. is
work has identied key priorities for change, one
of which is the need for additional support for
programs and policy initiatives that recognize
and address the compounding challenges
experienced at the intersection of old age and
immigration. In sum, as one participant wrote in
their event evaluation: “People and their stories
need to be at the forefront of policy and practice.
ese stories need to be shared with the broader
public, policy-makers, and funders.”
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Funding Information
We would like to thank our funders Social
Sciences and Humanities Research Council of
Canada – SSSHRC (Grants 430-2014-00506 and
611-2018-0254), Michael Smith Foundation
for Health Research, Centre de recherche et
d'expertise en gérontologie sociale [CREGÉS]) for
their nancial support of this project.
Acknowledgements
We would also like to thank our community
partners: Pascual Delgado (Alliance des
communautés culturelles pour l’égalité dans la
santé et services sociaux - ACCÉSSS); Raphaël
Massé (Table de concertation des aînés de
l'île de Montréal - TCAIM); Valérie Lemieux
(Direction régionale de santé publique de
Montréal - DRSP, CIUSSS du Centre-Sud-de-l'Île-
de-Montréal); Mazen Houdeib (Regroupement
des organismes du Montréal ethnique pour le
logement – ROMEL); Carole Charvet (Carrefour
d'intercultures de Laval); Laura Tellalian (Hay
Doun); Zelda Freitas (Centre de recherche et
d'expertise en gérontologie sociale - CREGÉS,
CIUSSS du Centre-Ouest-del'île-de-Montréal);
Krista James (Canadian Centre for Elder Law -
CCEL); Kahir Lalji (United Way of the Lower
Mainland); Marichu Antonio (ActionDignity);
Josh Dalledonne (Arts Commons); Lalita Singh
(North of McKnight Communities Society).
We would also like to thank all the stakeholders
who attended our forums and provided their
valuable insights on the issues faced by aging
immigrants in Canada and their recommendations
for change.
About the Authors
Laura Kadowaki is an adjunct professor in
the Department of Gerontology at Simon Fraser
University. Sharon D. Koehn is principal of Sharon
Koehn Research Consulting. Shari Brotman is an
associate professor in the School of Social Work
at McGill University. Julien Simard is a researcher
of urban studies at the Université du Québec à
Montréal. Ilyan Ferrer is an assistant professor in
the School of Social Work at Carleton University.
Émilie Raymond is a professor in the School of
Social Work and Criminology at Université Laval.
Pam Orzeck is an assistant professor in the School
of Social Work at McGill University.
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