Lessons on aging and care from Scandinavia
Elder individual with a walker.
Kayla Gauthier, BHSc candidate, Western University
Globally, our population is aging. By 2030, 1 in 6 people in the world will be 60 years or older (World Health Organization, 2022). With this demographic shift, countries need systemic changes in their healthcare system to accommodate the growing needs that an aging population requires. The Global AgeWatch Index is a tool that assesses the social and economic wellbeing of older adults in 96 countries around the world. According to their 2015 report, Canada is ranked fifth in the world. Above us, are two Scandinavian countries, Norway (ranked second) and Sweden (ranked third) (Global Rankings Table, 2015). This ranking suggests Canada has a lot to learn from Scandinavia. This is why the course Aging Globally: Lessons from Scandinavia was developed. From my interest in health and aging, I took part in the Aging Globally course in 2022, where I was immersed in opportunities for international learning and growth.
The course started in January, with a collaborative online international learning where we worked on two projects with students and professors from OsloMet University in Norway throughout the semester. In May, the class met in Oslo and continued for a 10-day trip across Scandinavia, visiting and learning from international partners in Norway, Sweden, and Denmark. Afterwards, with funding support from the Global Skills Opportunity program, I was fortunate to continue my learning in Sweden, completing a five-week research internship at Karolinska Institutet (KI) in Stockholm. After spending almost seven weeks learning in Scandinavia, it’s very difficult to articulate all of the things I’ve learned—about health, the world, and myself. After deep reflection, I’ve come to settle on three important lessons.
Lesson One — The Importance of Balance and Breaks
Before coming to Scandinavia, everyone told me to expect a different work ethic. Scandinavian countries have a reputation for their work-life balance. Even with this forewarning, I was shocked on my first day at KI. I worked until 5:30pm, a typical day of work in Canada. However, as I was finishing the last of my tasks for the day, my supervisor came in, concerned that I was still there. She told me not to work such late hours and asked if I was taking enough breaks throughout the day. She suggested I go for a walk, visit the gym, or have a nap in the nap room during the work days. I was completely surprised by this conversation as I have never had such an experience working in Canada. From then on, I finished my work days around 3:00pm, with having both a morning and afternoon coffee break in addition to lunch. Despite not working long hours, I was very productive. In fact, I finished more than what was expected during my time at KI.
Taking frequent breaks is a custom in Scandinavian cultures. Fika, meaning to have coffee, is when you practice taking a break from daily activities to enjoy coffee and a sweet treat with friends, family, or colleagues. Fika is incorporated into Scandinavian education as well, and the Swedish Occupational Therapy students were shocked when they learned how many hours in a day we Canadians spend studying. Incorporating Fika into daily life has the benefits of increasing mental clarity and productivity and alleviating stress. Practicing Fika was an important lesson for me, and I think is valuable for all Canadian students to lessen our mental distress during the school year.
Lesson Two — Culture plays a Huge Role in Healthcare Utilization
During a work conference, I had an interesting conversation with fellow researchers centered on how different ideologies shape how we give care to our older relatives. Specifically, my colleague told us about a discussion she had with associates from both individualistic and collectivist countries. The person with the individualistic perspective said, “out of respect for my mother, I wouldn’t want to wash her.” The one with a collectivist perspective then countered, “out of respect for my mother, I wouldn’t want anyone else to wash her.” I found it interesting how the two very different ways of caring had the same intention. Moreover, it is important to consider the effects of these vastly different cultural beliefs and how they translate into the utilization of healthcare services. For example, individualistic ideologies are more likely to rely on formal support, such as nursing homes, than collectivist ideologies (Killian, 2004). This may reflect the differences for long-term care (LTC) wait times between Sweden and Canada. While both individualistic countries, in Sweden, there is a heavy reliance on home care and informal caregivers, significantly more than the health infrastructure in Canada (Jegermalm, 2006). Consequently, the maximum wait time for LTC in Sweden is 90 days (three months), and the average wait time in Canada is 274 days (nine months) but can take up to seven years (Fukushima et al., 2010; Government of Ontario, 2022). Reflecting on and acknowledging how different ideologies influence healthcare utilization is critical when developing strategies to address systemic challenges in each respective country. There is not a one-size-fits-all approach to adequately address global aging.
However, in discussing differing ideologies and intersectionality with health, it is important not to lose sight of patient-centered care. In that conversation, I felt that a piece was still missing. No one mentioned asking the mother what she wanted. Patient-centered care allows health professionals to understand each patient’s unique circumstances, improving health outcomes and reducing unnecessary procedures. While addressing systemic problems associated with global aging, we must continue to emphasize intersectional models and patient-centered care within all provisions of healthcare. We must remember that: “health care, at its heart, is about people,” (Damji, Rejler & Henriks, n.d.).
Lesson Three — Scandinavia is Advanced in aspects, but No System is Perfect
From my experiences in Scandinavia, I have learned of many ways to improve the Canadian healthcare system. For example, the implementation of simple communication technologies we saw at Alma’s House (a demonstration apartment in Oslo showcasing good living environments with assistive technologies for people with dementia) to lessen social isolation, which is a significant burden for older adults in Canada. Special dementia training provided by Silviahemmet to all healthcare professionals that could improve the experience of those with dementia in Canada. Implementing electronic health records, that have been established for decades across Scandinavian countries, could improve profound communication barriers currently experienced by health professionals in Canada.
As mentioned above, Sweden has an established home care system. On my last day at KI, we made home visits to two older adults who receive home nursing on a regular basis. At the beginning of the visit, I was surprised to hear how time constricted these visits were, limited to about 10 minutes per patient. The time is based on a structured needs assessment completed by a government official. Then, we met a social
worker who described the best part of her job is helping these adults live independently, and the worst part is the time constraints. She explained that these are human beings and you can’t just leave someone on the toilet helpless because time has run out. While Canada can take important lessons from Sweden to implement better home care across our nation, it is important to acknowledge that Sweden’s system is not perfect. We have lessons to learn from each other, and growth to do with support of each other.
Overall, my experiences in the Aging Globally class and my internship at KI have been highlights of my university experience. Throughout my journey I discovered how diverse perspectives, paradigms, and intercultural approaches influence worldviews on aging and provision of healthcare and how to advocate for the betterment of care for older adults worldwide. Most importantly, this experience has helped me develop a growth mindset. Throughout this experiential learning experience, I was pushed outside of my comfort zone to try new things and expand my learning. It allowed me to discover my potential and prepare me for a successful career in healthcare.
Interested in learning more about the Aging Globally course offered at Western? Recent outline here: https://www.uwo.ca/fhs/shs/undergraduate/courses/22-23/HS3721B.pdf
References
Damji, A., Rejler, M., & Henriks, G. (n.d.). What is best for Esther? What Canada can learn from the Swedish health care service. Canadian Society of Physician Leaders. Retrieved October 11, 2022, from https://cjpl.ca/est.html#edittop
Fukushima, N., Adami, J., & Palme Mårten. (2010). The long-term care system for the elderly in Sweden. ENEPRI.
Global Rankings Table: Data. Global AgeWatch Index 2015. (2015). Retrieved from https://www.helpage.org/global-agewatch/population-ageing-data/global-rankings-table/
Government of Ontario (GO). (2022). Long-Term Care Home Waitlist January 2022. http://healthcareathome.ca/torontocentral/en/care/Documents/Jan%202022%20_%20S0044_LTCH_Public%20WaitList%20Report_V1.pdf
Jegermalm, M. (2006). Informal care in Sweden: A typology of care and caregivers. International Journal of Social Welfare, 15(4), 332–343. https://doi.org/10.1111/j.1468-2397.2006.00400.x
Killian, T., & Ganong, L. H. (2004). Ideology, context, and obligations to assist older persons. Journal of Marriage and Family, 64(4), 1080–1088. https://doi.org/10.1111/j.1741-3737.2002.01080.x
World Health Organization. (2022). Ageing and health. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
Photo credit Jessica Gow/TT
