Lu Wang

Global forced displacement has reached unprecedented levels, with more than 123 million people uprooted by the end of 2024. Although older adults represent a growing proportion of refugee populations, their mental health needs remain overlooked. This scoping review synthesized current evidence on depression among older adult refugees aged 50 years and older. Guided by the Joanna Briggs Institute methodology and reported using PRISMA-ScR standards, searches were conducted in CINAHL, PsycINFO, AgeLine, and Medline for English-language publications from 2015 to 2025. A total of 1971 records were identified, with nine studies (N = 1370 participants) meeting eligibility criteria. Most studies employed cross-sectional designs and were conducted in high-income countries. Depression prevalence was consistently elevated, with rates ranging from 22% to over 70%, depending on population and measurement tools. Risk factors included female sex, widowhood, low socioeconomic status, chronic illness, functional impairment, trauma exposure, language barriers, social isolation, and limited access to care. Protective influences such as family support, higher socioeconomic status, and improved living conditions were identified but inconsistently reported. Findings indicate that older refugees are at high risk of depression, often shaped by intersecting aging- and displacement-related vulnerabilities. Findings highlight the need for culturally specific tools and longitudinal research to inform culturally safe care for older refugees.

Despite the increasing number of older Syrian refugees in Canada, little is known about how they manage their health care needs while contending with language barriers, cultural dissonance, and systemic inequities. This qualitative study explored how older Syrian refugees in the Greater Toronto Area (GTA) navigate healthcare across Canadian and transnational contexts. The study was guided by the transnational circulation of care framework and used an interpretive descriptive design. Following research ethics approval, 20 older Syrian refugees were interviewed by bilingual research assistants. In-depth individual interviews were conducted in Arabic and analyzed using reflexive thematic analysis. Four interrelated themes emerged: (1) Navigating a New System; (2) Living in Two Worlds; (3) Medication Portability, Herbal Practices, and Supplement Culture; and (4) Digital Health Across Borders. Findings demonstrate that older Syrian refugees actively construct hybrid care pathways that integrate biomedical, cultural, and transnational practices. These strategies reflect resilience and adaptability but also expose gaps in the healthcare system. The study underscores the need for culturally responsive and age-friendly healthcare practices that acknowledge transnational realities. By illuminating how care circulates across borders, this study provides actionable guidance for designing responsive health systems.

The global population of older adults is growing rapidly, and refugees are now a significant proportion of the older adult population in Canada. Transnational healthcare practices (THPs)—seeking health information or services from the country of origin—may be an essential strategy used by refugee older adults in Canada, but few studies have explored this phenomenon. This is a protocol for a study, which is aimed at developing a comprehensive understanding of the role THPs play in the lives of older adults from three refugee groups (Afghan, Syrian and Ukrainian) (re)settled in the Greater Toronto Area (GTA), Canada. It will be informed by Constructivist Grounded Theory and will consist of three phases. Phase 1 will involve semi-structured individual interviews with Afghan, Syrian, and Ukrainian refugee older adults living in the GTA (n = 75–90) to explore their perspectives and experiences with various types of THP. Phase 2 will also involve semi-structured interviews with 75–90 refugee older adults from the three communities to examine the role of THP in stress, coping, and resilience in the context of health promotion, illness diagnosis, and disease management as well as the individual and contextual factors driving the use of THPs. Phase 3 will involve six focus groups (n = 36–48) with refugee older adults from these communities to explore what information, care, supports, technology, and services are needed to manage their health and illnesses locally. This project will advance knowledge in the areas of (re)settlement and integration, aging, local healthcare access, and THPs among refugee older adults in Canada. The findings will inform more effective integration policies and the delivery of efficient and equitable health information, care, support, technology, and services that address the healthcare needs of refugee older adults, enabling them to age well and age in place.

Background/Objectives: While immigrants represent 21% of Canada’s total population, they represent 30% of the country’s older population. Sociocultural and economic barriers to the Canadian healthcare system have been frequently reported among older adult immigrants. These barriers are intricately linked to a vastly understudied phenomenon-transnational health practices (THP), which may involve travelling to home countries for healthcare, accessing medicine and health-related information and resources linked to home countries. This study aimed to explore the relationships among local healthcare experiences in Canada, individual characteristics and use of THP among older adult immigrants. Methods: A mixed-methods approach was used combining statistical, spatial and qualitative methods to analyze group patterns of THP and its influencing factors. Primary data was collected through surveys and focus groups of older Mainland Chinese and older South Korean immigrants residing in Toronto. They are the two largest East Asian groups in Canada, with documented transnational ties with their home country. Results: The study found that THP were sought by both groups but were more prevalent among older Chinese immigrants. By integrating quantitative and qualitative analyses, the study revealed complex relationships between THP and barriers in local healthcare access relating to wait times, cost, language, availability, spatial accessibility and quality of care, for different types of care including primary, specialist, eye and dental care. Conclusions: The study generates new knowledge on THP in Canada and adds to the growing body of literature on transnational healthcare practices and behaviours among migrants across different countries and regions. It provides implications to inform health policy and deliver care for older adult immigrants as their populations continue to increase.

Background: Vast spatial mobility changes happened globally during the COVID-19 pandemic, profoundly affecting older adults’ well-being and active aging experience. This study aims to examine how the virtual environment and cyberspace, in conjunction with the physical and social neighbourhood environments, influence outdoor activities and spatial mobility for older immigrants. Methods: Four online focus groups were conducted with 25 older Chinese immigrants aged 65 and over in the Greater Toronto Area, Canada. The focus groups explored coping strategies during the pandemic and spatial mobility patterns related to different activity types such as grocery shopping, leisure activities and physical exercises, social and familial activities, and healthcare. Qualitative thematic analysis was conducted guided by the neighbourhood and health theoretical framework. Results: The overall engagement of older Chinese immigrants in various types of outdoor activities declined drastically and the spatial mobility pattern was complex. This change was shaped largely by the intersecting physical/built (e.g., residential conditions, access to public spaces), social (e.g., social support, interpersonal cohesion) and virtual (e.g., online communities and internet-based resources) environmental factors, as well as individual risk perceptions towards COVID-19 and public health interventions during the pandemic. Conclusions: Virtual environment emerged as an important domain that compensates for the heavily reduced spatial mobility of the group during the pandemic. It functioned as a vital channel for older Chinese immigrants to sustain the necessary leisure, social, and healthcare-related activities and maintain well-being during the pandemic. The study provides implications for addressing neighbourhood-level factors in policymaking and implementing initiatives to enhance active ageing experience of older Chinese immigrants.

Objectives This study has two primary research objectives: (1) to investigate the spatial clustering pattern of mobility reductions and COVID-19 cases in Toronto and their relationships with marginalized populations, and (2) to identify the most relevant socioeconomic characteristics that relate to human mobility and COVID-19 case rates in Toronto’s neighbourhoods during five distinct time periods of the pandemic. Methods Using a spatial-quantitative approach, we combined hot spot analyses, Pearson correlation analyses, and Wilcoxon two-sample tests to analyze datasets including COVID-19 cases, a mobile device–derived indicator measuring neighbourhood-level time away from home (i.e., mobility), and socioeconomic data from 2016 census and Ontario Marginalization Index. Temporal variations among pandemic phases were examined as well. Results The paper identified important spatial clustering patterns of mobility reductions and COVID-19 cases in Toronto, as well as their relationships with marginalized populations. COVID-19 hot spots were in more materially deprived neighbourhood clusters that had more essential workers and people who spent more time away from home. While the spatial pattern of clusters of COVID-19 cases and mobility shifted slightly over time, the group socioeconomic characteristics that clusters shared remained similar in all but the first time period. A series of maps and visualizations were created to highlight the dynamic spatiotemporal patterns. Conclusion Toronto’s neighbourhoods have experienced the COVID-19 pandemic in significantly different ways, with hot spots of COVID-19 cases occurring in more materially and racially marginalized communities that are less likely to reduce their mobility. The study provides solid evidence in a Canadian context to enhance policy making and provide a deeper understanding of the social determinants of health in Toronto during the COVID-19 pandemic.

The effectiveness of public health measures in containing an infectious disease largely depends on how the general public is taking the prevention practices in daily lives. Previous studies have shown that different risk perceptions and sociodemographic characteristics may lead to vastly different prevention behaviors. This paper applies a temporal perspective in examining the changing patterns of prevention practices over time and their dynamic relationships with the perceived risk towards COVID-19 and its individual characteristics. Three key timelines (February, April, and June of 2020) were identified to represent the early, lockdown, and reopening stages of the first wave. Data were drawn from an online survey conducted in the Greater Toronto Area (GTA) of Canada (n = 470). Chi-square tests and logistic regression models revealed important temporal patterns in practicing different hygienic and mobility-related prevention measures and the respondents’ risk perceptions during the three timelines. The factors predicting the level of prevention practices vary across the three timelines, based on the specific type of prevention, and within the changing public health contexts. This study contributes to the literature on COVID-19 by incorporating a temporal perspective in conceptualizing prevention predictors. It provides crucial insights for developing timely public health strategies to improve infectious disease prevention at different stages and for individuals with varying backgrounds.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and has many negative consequences including limiting community and civic participation, increasing income insecurity, and increasing the risk of elder abuse. Additional factors such as the social, cultural, and economic changes that accompany migration, language differences, racism, and ageism, heighten older immigrants' vulnerability to social isolation. Objective: This multi-methods, sequential (qualitative – quantitative) study seeks to clarify older immigrants' social needs, networks and support, and how these shape their capacity, resilience, and independence in aging well in Ontario. Methods: Theoretically, our research is informed by an intersectionality perspective and an ecological model, allowing us to critically examine the complexity surrounding multiple dimensions of social identity (e.g., gender, immigration) and how these interrelate at the micro (individual, family), meso (community), and macro (societal) levels in diverse geographical settings. Methodologically, the project is guided by a collaborative, community-based, mixed-methods approach to engaging a range of stakeholders in Toronto, Ottawa, Waterloo, and London, in generating knowledge. The four settings were strategically chosen for their diversity in level of urbanization, size of community, and the number of immigrants and immigrant serving organizations. Interviews will be conducted in Arabic, Mandarin and Spanish with older women, older men, family members, community leaders, and service providers. The study protocol has received ethics approval from the four participating universities. Results: Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the wellbeing of older immigrants in different regions of Ontario. Conclusions: Given the comprehensive approach to incorporating local knowledge and expert contributions from multi-level stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the wellbeing of older men and women in immigrant communities.

Criminal activities are often unevenly distributed over space. The literature shows that the occurrence of crime is frequently concentrated in particular neighbourhoods and is related to a variety of socioeconomic and crime opportunity factors. This study explores the broad patterning of property and violent crime among different socio-economic stratums and across space by examining the neighbourhood socioeconomic conditions and individual characteristics of offenders associated with crime in the city of Toronto, which consists of 140 neighbourhoods. Despite being the largest urban centre in Canada, with a fast-growing population, Toronto is under-studied in crime analysis from a spatial perspective. In this study, both property and violent crime data sets from the years 2014 to 2016 and census-based Ontario-Marginalisation index are analysed using spatial and quantitative methods. Spatial techniques such as Local Moran’s I are applied to analyse the spatial distribution of criminal activity while accounting for spatial autocorrelation. Distance-to-crime is measured to explore the spatial behaviour of criminal activity. Ordinary Least Squares (OLS) linear regression is conducted to explore the ways in which individual and neighbourhood demographic characteristics relate to crime rates at the neighbourhood level. Geographically Weighted Regression (GWR) is used to further our understanding of the spatially varying relationships between crime and the independent variables included in the OLS model. Property and violent crime across the three years of the study show a similar distribution of significant crime hot spots in the core, northwest, and east end of the city. The OLS model indicates offender-related demographics (i.e., age, marital status) to be a significant predictor of both types of crime, but in different ways. Neighbourhood contextual variables are measured by the four dimensions of the Ontario-Marginalisation Index. They are significantly associated with violent and property crime in different ways. The GWR is a more suitable model to explain the variations in observed property crime rates across different neighbourhoods. It also identifies spatial non-stationarity in relationships. The study provides implications for crime prevention and security through an enhanced understanding of crime patterns and factors. It points to the need for safe neighbourhoods, to be built not only by the law enforcement sector but by a wide range of social and economic sectors and services.