This study is part of a pan Canadian movement to find viable solutions for supporting aging in place. The Aboriginal population over the age of 65 has nearly doubled since 2006. Chronic diseases are more prevalent and recovery more difficult for Aboriginals compared to non-Aboriginals. Living in rural areas, limited access to family doctors and specialists, as well as social isolation are thought to be among the primary causes. Moreover, there are many barriers to aging in place, including a decreasing number of natural caregivers, and challenges related to finding community resources in their language of choice. The purpose of this project is to support Aboriginal elders who wish to live healthy and safely at home. The project offers initiatives aimed at providing care, transportation services and accompaniment during medical appointments. A mobile application, installed on a tablet distributed to study participants, serves as a communication tool between the Elder and the services that are offered as part of this project. This webinar presents how the project initiatives were put into practice in the Madawaska Maliseet First Nation community, and preliminary results (if available).

1. Health Needs of the
Elders of the Madawaska
Maliseet First Nation
(MMFN)
Micheline Plante, Community Health Representative,
Madawaska Maliseet First Nation (MMFN)
michemplante@hotmail.com
France Chassé, Nursing, PhD., professor researcher
Nursing science sector , University of Moncton, Edmundston campus
France.chasse@umoncton.ca
Presentation to the New Brunswick Department of Health
October 27, 2021

2. Study context
2
New-Brunswick a
bilingual province
Population is 2/3
English-speaking and
1/3 French-speaking
15 First Nations
communities
MMFN community
located in the
northwest
375 citizens, 15%
aged 55 and over
Two official
languages present in
the MMFN

3. Where did the idea for the project come from
• Growing increase in demands for specialized care outside the region,
elsewhere in the province, and even outside the province.
• Language barrier.
• Aging population.
• Various transportation needs for health appointments (doctor, diagnostic
tests, optometrist, pharmacy, dentist, etc.).
• The decreasing number of informal caregivers.
• Funding opportunity has been offered.
• Partner group created.

4. Introduction
• Growth in the number of Aboriginal people aged 65 in Canada. 11
• Increase in chronic diseases among indigenous populations. 1, 3, 5, 8
• Prolonged recovery period among First Nations.3, 8, 9
• Distance limits access to health care and services. 2, 5, 13
• Extended waiting time. 5
• Decline of informal caregivers and social isolation.5, 11
• Language barrier.2, 5, 13
• Using technology to learn about health and specialized programs. 5, 9
• Programs established to assist First Nations must respect the context,
traditions and cultural competencies .2, 3, 8, 13
4

5. Aim of the
project
Reduce barriers to access to health care and
services by using a mobile application placed on an
electronic tablet connected to the MMFN's
Community Health Center, in order to allow elders
to remain safely in the home.
Targeted objectives are:
1. Identify the health needs of MMFN elders living at
home.
2. Develop initiatives (care, services and resources) aimed
at responding to identified needs.
3. Train elders to use technology to demand initiatives.
5

6. Methodology
• Participatory approach involving a mixed estimate.
• 5 steps : data collection, analysis and interpretation, development of initiatives,
creation of the mobile application and training of elders.
• Ethical approval obtained.
• Recruitment made by personalized invitation to elders of the MMFN community
+ invitation targeted by the Health Center.
• To participate, the person had to: be 55 years of age and over, speak and
understand French or English and be able to answer questions.
• Research assistant (external) hired and trained to conduct a semi-structured
home interview of the 35 study participants.
6

7. Sociodemographic results (35 respondents)
7
Characteristic Results Percentage
Gender:
Female
Male
23
12
66 %
34 %
Age group:
55 – 64 years
65 – 74 years
75 years +
17
10
8
48 %
29 %
23 %
How many people live under your roof:
Single person
Two or more people
15
20
43 %
57 %
Caregiver for someone around you:
No
Yes
26
9
74 %
26 %

8. Sociodemographic results (35 respondents)
8
Characteristic Results Percentage
How do you travel for your appointments?
I drive
I ask a family member / friends / taxi
27
8
77 %
23 %
Is something preventing you from leaving the house?
No
Yes, reasons given: physical health conditions, weakness, pain, spousal care,
weather and COVID-19
24
11
69 %
31 %
What technology do you use to communicate with those around
you?
Telephone
Tablet and/or computer
35
12
100 %
34 %
Do you feel safe at home:
No
Yes
2
33
6 %
94 %

9. Outcomes related to health status
9
Subscales Average Standard
deviation
Limitation of roles due to personal or emotional problems 79,05 37,99
Social functioning 78,21 25,79
Emotional balance 73,60 18,79
Functional physical capacity 61,86 30,73
Body pain 61,57 28,86
Perception of the state of health in general 57,00 26,13
Energy and fatigue level 55,29 24,10
Changes in health status 45,71 23,86
Limitation of roles due to physical problems 44,29 39,80

10. Results: Identified needs and proposed solutions
10
• Need transportation « …it would take us someone with transportation for the people in
need, to transport them to the hospital, to take them to the doctor or to the pharmacy. I'm
troubleshooting at the moment, but it's not really my domain.»
« To get there (Quebec hospital) […] it was quick, but I had to go back there every week […], it takes
transport and a good driver. »
« If I need to go to the doctor and there's a storm, it would be nice to have someone to drive me. »
Accompaniment « […] if he (his partner) goes outside [...] he must have someone to bring
him with his wheelchair […]
«I would like to be driven and I'm not going there alone .»
• Language barrier« If I speak English to someone and they don't understand me, we need to
find someone who speaks English » (free translation)
• Home reprieve services «Could someone come here (at home) for him (spouse) to do
exercises, have him read and practice speaking? »

11. Results: Identified needs and proposed solutions
11
• Access to health services «We would like to have a doctor more present, that you
can call or text and he answers you.»
« […] an emergency service too, you have a button on you that you press and it calls 911 or the
ambulance.»
« […] when we are sick or have problems, we need to have a contact list, that if you have that, do
that […]»
« [...] the nurse must have more authority and power with patients.»
• Help at home «…having the help of someone to maintain my house would help me a lot ... »
(free translation)
« […] I need someone to shovel the snow in the winter.»
« I can't cut my grass, my arms get numb when pushing»
• Shopping« […] I need someone to pick up my prescriptions.» (free translation)
• Technology training « We use it (the technology) a little, but we don't use it a lot. It’s
because we don’t really know how to make it work. »
• Social activities «Get together to do crafts, play drums, etc.»

12. Elders Initiatives Project
(MEI) for MMFN
On the technical level:
• Three priority initiatives (services) offered:
• Transport / accompaniment / translation.
• Home services, and
• Other requests.
• Develop the mobile application
• Create an account at « Apple Store »
• Buy electronic tablets
12

13. Communication and distance
issues
• Information available in both official languages.
• Simple language.
• Combination of images, symbols and text.
• Drop-down menu to offer answer choices.
• Instructions to follow on each page.
• The button lights up when you press send.
• Confirmation that the request is transmitted.
• Follow-up call from the employee to validate the
information and confirm the service offer.
• Tutorial always available in the "Help" tab and a hard
copy.

14. Elders Initiatives Project (MEI) for MMFN
On the operational plan:
• Create a new position within the community worker team.
• Hire a Global Health Assistant (GHA).
• Train the Auxiliary in global health (GHA).
• Train senior participants to use technology.
• Two weeks of practical tests, adjustments, and ...
• Official launch of the MEI project took place on October 15, 2020.
14

15. Information generated by
the mobile application
IMPLEMENTATION
PHASE

16. Requests per month
0
5
10
15
20
25
30
35
40
November December January February March April May June July August September
Completed Cancelled

17. Nature of requests
0
5
10
15
20
25
30
35
Footcare Doctor Health Center Hospital
Optometrist Dentist Grocery Pharmacy
Home Care Interior Maintenance Hospital Leave

18. Travel within and outside the province
0
0.5
1
1.5
2
2.5
Within the province Outside the province

19. New services added
0
1
2
3
4
5
6
7
November December January February March April May June July August September
Telephone follow-up Equipment loans Friendly visit

20. Level of appreciation
0
5
10
15
20
25
30
35
40
Numbers of requests Appreciation level

21. Conclusion
• The purchase of an adapted vehicle by Chief et Council demonstrates the
importance given to the well-being of seniors in the MMFN community, as well as a
lasting commitment to the future of the project.
• In the past year, there have been three deaths and four new registrations.
• 36 registered participants and 28 tablets distributed.
• 67% of participants use technology to request services.
• Transportation service is always the most in demand.
• We must continue to promote initiatives and new services added.
• Provide advanced training for seniors to maintain virtual communications, pay bills
online, etc.

22. THANK YOU!!!

23. 1. Agence de santé publique du Canada (ASPC, 2018). Les principales inégalités en santé au Canada : un portrait national.
http://publications.gc.ca/collections/collection_2018/aspc-phac/HP35-109-2018-fra.pdf
2. Auger, M., Howell, T., & Gomes, T. (2016). Moving toward holistic wellness, empowerment and self-determination for Indigenous peoples in Canada : Can traditional
Indigenous health care practices increase ownership over health and health care decisions? Canadian Journal Public Health, 107(4-5), e393-e398. Doi :
10.17269/CJPH.107.5366
3. Brooks, L., Darroch, F.E., & Giles, A. (2013). Policy (Mis) Alignment : Addressing Type 2 Diabetes in Aboriginal Communities in Canada. The International Indigenous
Policy Journal, 4(2) doi : 10.18584/iipj.2013.4.2.3 https://ir.lib.uwo.ca/iipj/vol4/iss2/3/
4. Chou, W.H., Lai, Y.-T. & Liu, K.-H. (2013). User requirements of social media for the elderly : a case study in Taiwan. Behaviour & Information Technology, 32(9), 920-
937. http://dx.doi.org/10.1080/0144929X.2012.681068
5. Habjan, S., Prince, H., & Kelley, M.L. (2012). Caregiving for Elders in First Nations Communities : Social System Perspective on Barriers and Challenges. Canadian
Journal on Aging / La Revue canadienne du vieillissement, 31(2), 209-222. Doi : 10.1017/S071498081200013X
6. Harvey, J., Beck, A. & Carr, C.T. (2019). A Cognitive Social Media Training Program and Intergenerational Learning : A Pilot Study With Older Adults and Speech-
Language Pathology Graduate Students. Perspective of the ASHA Special Interest Groups, 4, 683-695. http://dx.doi.org/10.1080/0144929X.2012.681068
7. Horril, T. C., Linton, J., Lavoie, J. G., Martin, D., Wiens, A., & Schultz, A. S. H. (2019). Access to cancer care among Indigenous peoples in Canada:
A scoping review. Social science & medicine, 238. doi: https://doi.org/10.1016/j.socscimed.2019.112495
8. Howell, T., Auger, M., Gomes, T., Brown, F.L., & Leon, A.Y. (2016). Sharing Our Wisdom : A Holistic Aboriginal Health Initiative. International Journal of Indigenous
Health. 11(1), 111-132.
9. Jacklyn, K., Walker, J.D., & Shawande, M. (2013). The Emergence of Dementia as a Health Concern Among First Nations Populations in Alberta, Canada. Canadian
Journal of Public Health, 109, 717-725
10. Moult, A. Burroughs, H., Kingston, T. & Chew-Graham, C. (2018). How older adults self-manage distress - does the internet have a rôle? A qualitative study. BMF
Family Practice, 19(185), 1-8. https://doi.org/10.1186/s12875-018-0874-7
11. Pineault, R. et Daveluy, C. (1995). La planification de la santé. Canada: Les éditions Nouvelles.
12. Ramage-Morin, P. L. & Bougie, E. (2017). Family networks and health among Métis aged 45 or older. Health Reports, (12), 12-20. Statistics Canada, Catalogue no. 82-
003-X
13. Statistique Canada (2017). Les peuples autochtones au Canada – Faits saillants. Le Quotidien – https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025a-
fra.htm?indid=14430-1&indgeo=0
14. Tonkin, R., Freeman, S., Martin, J., Ward, V., & Skinner, K. (2018). First Nations Elders’ perspectives of engagement in community programs in Nak’azdli Whut’en,
British Columbia, Canada. Canadian Journal of Public Health, 104(1), e39-e44. https://doi.org/10.17269/s41997-018-0125-7
23
References