This is because Canada’s rural areas have residents with lower incomes, less education, less adequate housing, less access to rail and public transit services and lower quality of health care than in the country’s urban areas.

“Our rural areas are elderly,” Novik said. “Young people moved to the cities. When we talk rural and remote, we talk about [distance]. [We gain an appreciation for] how rural and remote Saskatchewan is.”

Travel within the province is hard, she added. For seniors who live in Ottawa, Perth is 20 minutes away by car or rail. Rural communities that include the First Nations indigenous populations are one hour away from Watrous and Saskatoon, the province’s largest city with a population of 257,300. Woseley is one hour away from Regina, the capital of Sasketchewan, and a three- to four-hour drive from Preeceville in central Saskatoon. Residents can’t drive in or out of the region.

Yet rural areas are seen in a positive light, masking their socioeconomic problems, Novik said.

“One-dimensional views [of] problems leave little scope for addressing mental health,” she said. “Rural areas [are] often characterized as idyllic and pastoral with less stress, strong community networks and close connections to the land. [Yet, for example,] the provinces built [the] hospitals but [they’re] not sustainable.”

By contrast, research more than one century old did not romanticize the country’s rural areas, she said. In 1908, Canada had less than 10,000 people. “[The] rural [areas were] conceptualized as being underserved, sparsely populated and geographically disperse,” Novik said.

Meanwhile, SPHERU research in the present day found that about 15.4 percent of those 65 years old and older live in Canada. Between the years 2006 and 2026, the number of seniors in Canada is expected to increase from 4.3 million to 8 million. By 2036, seniors will reach approximately 25 percent of the total population.

Seniors made up 85 percent of all hospital patients in 2011. About 47 percent of them have completed hospital treatment but remain in acute care, skilled nursing facilities, nursing homes and rehabilitation because they await a transition to a long-term care facility.

At the same time, 80 percent of Canadians surveyed support the development of more home health care and community-based programs for the elderly.

As a result, more research must be generated to examine and improve the supports that enable rural seniors to stay at home to age in peace, although funding is hard to secure with government budgetary cuts, a troubled global economy and fierce competition for research dollars, Novik said.

“It is challenging to get research dollars,” she said, referring to the interdisciplinary SPHERU studies as focusing on Regina in Saskatchewan with provincial and national funding. “With our research, we can exchange insight and share mental health [facts and statistics].”

Novik said that Canada has adopted the World Health Organization’s (WHO) goals and objectives in 2009 for mental health.

“Addictions and other sources of stress exist [for seniors],” she said. “They [seniors must] cope with stress. [Reiterating WHO’s definition of mental health, it is a] state of well-being in which the individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his own community.”

Senior Community-based Interviews

Based on Canadian psychiatrist, professor and researcher James Cantor’s social care model of 1989 to identify government policy, community and kin-level interventions to improve rural aging, SPHERU’s “Rural Healthy Aging” research concentrated on the subject matter of formal and informal support for rural seniors. Researchers asked extensive questions about how senior respondents were being supported and where the support originated from.

Formal and informal supports meant home health care, senior housing, access to information about senior services, an accommodating public infrastructure and transportation. SPHERU researchers summarized the responses from seniors and interpreted them in five categories in terms of social interaction, independence, cognitive health, mental health, mobility and community involvement.

The project uses the tools of community-based participatory research (CBPR), collaboration and capacity building. Community partners are involved in all stages of the research from other questions that have been asked and investigated previously.

For the academic year of 2009 to 2010, the pilot study conducted 42 interviews over three years with rural seniors in Preeceville, Watrous and Woseley, all in Saskatchewan.

In 2011, SPHERU researchers conducted 40 interviews for 16 men and 24 women aged 64 to 98 years of age. In 2012, 36 interviews were performed with 14 men and 22 women of the same age range. The third wave of interviews occurred in Watrous in April 2012. Researchers completed two interviews with each participant in Woseley and final ones in November 2013.

Juanita Bacsu, project coordinator and a researcher with the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) of the University of Saskatchewan who recently completed her doctorate degree in community health and epidemiology at the school, said there were five key themes to interviewing rural seniors on mental health: gender, spousal health, finances, isolation and physical mobility.

“We looked at socioeconomics,” Bacsu said of the videos of senior testimonies. “They already had risk factors for mental health [problems]. [The research was] interwoven [with testimonies about] gender. Men described greater differences in mobility. [They viewed their] inability to complete outdoor work more negatively.

“Women identified [the] stress of learning new tasks [such as] driving [and] finances when spouses did this before. There is a sense of loss. You could [hear it] in [the] gentlemen’s voices.”

Mental health, she said, was linked to spousal health, especially caregivers. Caregivers often put spouses’ well-being first and they feared spousal separation through long-term care. Grief and loss of their spouses were identified as key issues.

Additionally, Bacsu said, there was a need for service awareness, particularly for respite for caregivers and long-term care for senior patients. A lack of service was a rich source of mental stress.

Women interviewees, she said, worried over the increasing costs of medicine, ambulances, home health care and the cost of living, especially paying their monthly bills. They said training in financing would be helpful and revealed that they handled their finances differently after their husbands died.

Aging respondents also spoke of the negative consequences of physical and mental isolation, Bacsu said.

“[There is] limited interaction [in the] small villages,” she said. “[There is] no running water.

[The] isolation [is] exacerbated by limited mobility and winter [because of] ice, cold [and] daylight. [The] caregivers [are] isolated [and are] unaware of supports. [They are] reluctant to ask for help [because they] don’t [want to] burden others. [There is] limited senior’s housing [so there is a] fear of being sent away [if they inquire about such services].”

Continued: Part Three

This article was originally published Feb. 19, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.