FHS researcher advances inclusivity for older adult immigrants through community research
By Kim McCready
When Sachindri Wijekoon was just a child, her family, along with her aunts and uncles, relocated to different countries through immigration, leaving her elderly grandparents in Sri Lanka–a difficult situation given the cultural expectation that aging parents be cared for by their children. Recognizing their need for support, her parents invited her grandparents to join them in Canada. This transition to a new life became a struggle for them.
“I could sense my grandparents were unhappy here because my parents and I would head to work and school each morning, leaving them seated at the kitchen table. When we would walk back through the door in the evening, there they were, rooted to the same spot at the kitchen table as if their day had paused in our absence,” said Wijekoon, an assistant professor in the School of Occupational Therapy at Western University.
Not long after their arrival, Wijekoon's grandparents made the difficult decision to return to their home country, unable to adapt to the unfamiliar environment. Observing her grandparents' struggles in Canada emphasized the complexities of aging and the unique challenges faced by certain groups within the elderly population.
Wijekoon's interest in occupational therapy (OT) was influenced from an early age by her parents, both deeply involved in the rehabilitation field—her mother as an occupational therapist and her father as a physiotherapist. This upbringing provided her with a holistic view of health, recognizing it as an integration of physical, mental, and social dimensions, beyond merely the absence of illness.
Her clinical experiences as an occupational therapist working with older adults, particularly those from ethnic, racial minority, and immigrant backgrounds, further shaped her understanding and research focus.
Despite being lumped together and assumed to have uniform needs; older adults are not a homogeneous group. Their diverse backgrounds can subject them to multiple types of discrimination beyond ageism, such as racism, sexism, religious bias, and ableism. Acknowledging the complex interplay of the simultaneous identities they may hold is essential for breaking down barriers to equity and inclusion, ensuring that their needs and voices are acknowledged and respected.
“If we understand the unique struggles and the unique strengths within their diverse communities, we can tailor care systems, including health care systems, social care systems, policies and programming so that we are better meeting the needs of these older adults,” she said.
Examining the challenges for late-life immigrants in new environments
Wijekoon's previous research has illuminated the challenges faced by late-life immigrants as they integrate into new environments. Her work specifically explored how everyday occupations are crucial in navigating these challenges and in constructing a sense of home, underscoring the importance of understanding the nuanced intersections between person, place, and occupation in the context of late-life immigration.
“If we understand the unique struggles and the unique strengths within their diverse communities, we can tailor care systems, including health care systems, social care systems, policies and programming so that we are better meeting the needs of these older adults.”
She has supervised graduate students who share similar research interests. One notable project involved looking at religious meaning making at the end of life for Dharmic religious adherents (i.e., Hindus, Buddhists, Jains and Sikhs). Wijekoon and two Master of Science in Occupational Therapy students, Bradley Wilson and Saghar Baqizada, reviewed meaningful Dharmic religious practices at the end of life, as well as the barriers and enablers to clients’ engagement in these practices. They not only identified language and access issues, but also significant systemic obstacles.
Among the primary barriers were resource constraints, conflicting care priorities, institutional policies and culturally insensitive behaviours from care teams.
“Healthcare providers often find themselves limited by time, staffing and available services, which hinder their ability to support clients’ cultural, religious and spiritual activities adequately,” said Wijekoon. “There is also a clash between Western emphasis on patient autonomy and the Dharmic religious communities’ reliance on family and religious guidance for end-of-life decisions.”
This divergence in priorities, she explained, can also lead to a neglect of religious preference, as ethnocentric policies often fail to recognize or accommodate the specific needs of Dharmic adherents.
For instance, within certain institutions, Wijekoon and her team found that food preferences were not consistently accommodated and restrictive hospital policies on the number of visitors or the playing of audio recordings of religious sermons further alienated these communities. They also found that religious practices unfamiliar to care providers were sometimes unfairly dismissed as odd or irrelevant, further hindering access to meaningful end-of-life activities.
These challenges, Wijekoon emphasizes, are rooted in systematic failures, highlighting the necessity for solutions needed at the societal and community levels instead of merely individual accommodations. Essential to this is involving community members – by sharing their experiences, they help shape the research.
“A critical aspect of this work is not to assume the role of an expert, but instead to inquire about what is happening in the community, what their needs are, and how we can address them,” she said.
Community participation to improve quality of life
Wijekoon is developing a project titled, 'Initiating a Participatory Action Research Process with South Asian Older Immigrants,' aimed at empowering study participants as co-researchers. This collaborative approach seeks to identify and address research priorities that are critical for enhancing South Asian older adults’ community participation and improving their quality of life.
Having voiced concerns about issues such as limited access to culturally sensitive healthcare, feelings of isolation, language barriers, and discrimination, participants will work collectively to not only identify key priorities, but also to develop actionable steps that can lead to tangible improvements in their lives. Stakeholders will be invited to participate in discussions to strategize on advancing these priorities.
The findings from this study are expected to lay the foundation for a larger grant, with the potential to significantly impact the lives of participants by addressing the challenges they face and promoting a more inclusive and supportive community environment.
Sachindri Wijekoon, PhD
The potential impact of this research resonates deeply with Wijekoon's own experiences and her commitment to equity and inclusion. “Being a racialized person, being an immigrant, being a woman, and holding multiple minoritized identities, I've had the privilege of witnessing how different people with diverse identities navigate hurdles in society.”
Articulating her commitment to anti-oppressive research methodologies, Wijekoon underlines the importance of critical reflexivity, which involves thoughtfully and continually examining our positionality, biases and assumptions throughout the research process to ensure that the research approach remains respectful, ethical, and genuinely beneficial to the marginalized community.
This commitment to reflexivity and inclusivity is the foundation of her advocacy for a revised OT framework, one that recognizes and addresses how power and oppression manifest within occupational science and occupational therapy, enabling individuals and communities to contribute to identifying solutions for mitigating oppression.
"I've engaged with occupational therapists and occupational scientists, discussing strategies for balancing power disparities in the research relationship and incorporating cultural humility,” she said. “I've learned throughout this process to meaningfully involve people with lived experience. It’s important not to take their data and then leave but engage them from the get-go and beyond the project."
Overcoming barriers to participation
Building connections with community organizations and stakeholders is a key focus for Wijekoon, as she believes interdisciplinary collaboration is essential to address complex issues. This approach not only brings diverse perspectives, but also expands networks, crucial for amplifying research impact. By engaging a wide range of stakeholders and embracing interdisciplinary methods, she aims to develop more effective solutions for community challenges. Currently, she is actively expanding her collaborations to include senior-run organizations, age-friendly city initiatives and immigration partnerships.
Wijekoon's research and life’s work is a response to the challenges her grandparents faced, to ensure that other older adults do not have access to equitable opportunities for participation and well-being.
In our communities and society at large, “there are many tangible impacts that can be made towards barriers to participation," said Wijekoon. “When informed by anti-oppressive frameworks, research has the potential to reshape societal structures, thereby providing older adults with equitable opportunities, and thus fostering environments where dignity, respect and inclusion are intrinsic components of their societies/communities.”
