Week 8: Healthy Aging

The National Framework on Agings mission

"Canada, a society for all ages, promotes the well-being and contributions of older people in all aspects of life" (Health Canada, 1998).

* The vision for healthy aging seeks to further specify how this will play out by providing age-friendly environments and opportunities for older Canadians to make healthy choices, which will enhance their independence and quality of life.

Planning for Canada’s Aging Population: A Framework

3 pillars

* health, wellness and security
* continuous learning, work and participation in society
* supporting and caring in the community.

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(specifically health, wellness and security)

In 1998, some __percent of Canadians aged 55-64 and __ percent of Canadians over 65 spent an average of 2.2 hours a day as volunteers.

The economic value to our communities is thought to be $___ billion each year

42

44

$60.2 billion

falls and costs associated

It is estimated that fall-related injuries in Canada among those 65 and older cost the economy $2.8 billion a year.

* The Public Health Agency of Canada estimates that a reduction in falls by 20 percent could result in 7,500 fewer hospitalizations and 1,800 fewer permanently disabled seniors; as well as national savings of $138 million annually

The vision:

A society that:

* values and supports the contributions of older people
* celebrates diversity, refutes ageism and reduces inequities; and
* provides age-friendly environments and opportunities for healthy choices that enhance independence and quality of life.

5 selected areas of focus

* Social Connectedness


* Physical Activity
* Healthy Eating
* Falls Prevention
* Tobacco Control

Guiding principles

* Dignity
* Independence
* Participation
* Fairness
* Security

the middle circles

* Supportive environments
* mutual aid
* self care

_________components are as important as biological components in healthy aging.

psychosocial

core principles of the social and behavioural aspects on aging

* heterogeneity of the older population
* aging as a life course phenomenon
* aging and social context
* the potential for intervention

research study continuum

1. determinant studies
2. efficacy studies
3. effectiveness studies
4. Dissemination & implementation studies

the ‘silo approach’

the formation of groups who examine only the amount of change in the health behaviour needed to have a meaningful effect or only focused practice implementation

multilevel approaches and multidisciplinary teams for behaviour change and health and well-being improvement

Community clinical integration

WHO definition of healthy aging

“the process of developing and maintaining the functional ability that enables wellbeing in older age” 

ability to:

* meet basic needs
* learn, grow, and make decisions
* be mobile
* build and maintain relationships
* contribute to society

Key considerations in healthy aging

 **1. There is no typical older person**

* Goal: improvement the functional ability of all older people, whether they are robust, care dependent or in between.

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2. **A large proportion of differences in capacity in older age is due to the cumulative (lifecourse) impacts of advantage and disadvantage across people’s lives**
* Healthy aging starts at birth!
* Relationships with environments
* Shaped by factors such as sex, age cohort, ethnicity, family, education and financial resources

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3. **Intervention is possible**
* Given we identify harming factors
* And target them
* A good intervention considers the big picture
4. Focus on improving quality of (remaining) life rather than only lengthening life

To achieve healthy aging…

differences between successful aging, healthy aging and aging well

Successful Aging is more about Individual Health

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 Healthy Aging involves the Society

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Aging Well involves policymakers

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however…

* In this course we call all healthy aging and won’t focus on these subtle differences. 

Aging successfully

How do you want to be when you are 65? 75? 85?

What are you willing to do to achieve those targets? 

*Does not mean not experiencing the natural aging process of aging* 

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* Low chance of chronic conditions and disability1
* High mental, physical, and social  functioning 
* Think of WHO definition of health

Indicators of healthy aging

* Functioning and disability
* Physical activity
* Cognitive capability

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* Prevalence of chronic diseases and multi-morbidity
* Social engagement and contribution

Measurable, quantifiable 

The vision of healthy aging

Important questions of the vision of healthy aging

Important questions:


1. How can the big picture (bio-psych-social aspects) be addressed?
2. How make sure the ‘intervention’ worked?  
3. Does the society think healthy aging is achievable? 

Aging in place

A policy to keep established social connection, continuous use of resources, no need to (many) additional direct individual-based interventions 

* Older adults strive to live in their family home unless forced to move
* Established ties 
* People
* Physical/built environment 
* Community 
* Provides a sense of identity and security
* Emotional, financial

How aging in place works

* **Adaptations needed as health, financial, and family situations change** 
* E.g. redesigning bathrooms and kitchens
* **Sometime occurs naturally**
* A whole community ages 
* **Mostly needs (some) interventions**
* Planned retirement communities 
* Various types of housing
* At the contextual (society) level

Society vs. healthy aging

Opinions:

Aging is inevitable, and health (linearly) decline until physical and mental frailty and we can’t do anything about it

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* For example, in all older people body and mind decline. It is nature’ law, so, why even waste resources to intervene?
* Look at Alzheimer, there is nothing we can do
* Why bother with interventions? They will not work in older adults anyway!

Physical activity

*Fact: Older adults are the least active age group*

* Why?
* Wrong information:
* It is harmful
* Older adults are unwilling to exercise

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**Canadian guidelines for older adults**

*“At least 150 minutes of moderate to vigorous aerobic physical activity/week, in bouts of 10 minutes or more”*

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What are the features of a good intervention for promoting physical activity?

design and evaluation of an intervention

Why don’t some interventions work?

1. The evidence is wrong
2. Implementation is wrong


3. Wrong modifications 
* Some “experts” think they are better than science

A good intervention

1. Has clear and specific goals
2. Focuses on a particular sub-population of older adults 
3. Intervention is clearly defined
* Duration, method of delivery
4. Outcome is measurable 

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Interventions aiming on healthy aging should also consider feasibility at the population level

feasible at the population level?

Takeaways

* Healthy aging is living a life at old age with **full capacity**, not merely living without diseases
* Achieving ‘healthy aging’ is possible by adopting evidence-based and well-implemented interventions
* After understanding the patterns of occurrence of health-related conditions in old age 
* What we learned in weeks 4 to 7