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Why is it important to know how long you will live?

Identifying how long one can expect to live is important for several reasons. For example, it has implications for health and service programs, retirement programs, and the development of age-appropriate housing. Living longer will certainly present challenges in all these areas.

Average Longevity

This is often referred to as life expectancy. It is a statistical measure that refers to the age at which half of the individuals born in a given year will have died. It remains profoundly influenced by income. Life expectancies are increasing rapidly. For example, between 1921 and 2011, the gain in overall life expectancy for Canadians was nearly 25 years, with almost half of the gains in life expectancy occurring between 1921 and 1951 due to decreases in infant mortality.

Maximum Longevity

This refers to the oldest age an individual can live.

In 2021, the average Canadian life expectancy at birth was estimated to be

82.66 years of age If you live in British Columbia, Alberta, Ontario, or Quebec, you are expected to live

In 2019, Nunavut had the

lowest life expectancy at birth

The United States (average age of 78.99 years) has had a long-standing health disadvantage relative to

other high-income countries that extends beyond life expectancy to include higher rates of disease and cause-specific mortality rates.

Americans suffer higher death rates from

smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant deaths. In addition to this, deeper poverty and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other wealthy countries and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other wealthy countries

Women in all countries around the world

outlive men.

In 2019, global life expectancy at birth was

74.2 years for women and 69.8 years for men. Women with the longest life expectancy in the world live in

The longest male life expectancies in the world live in

Japan, Spain, and South Korea

Why do women live longer than men?

a combination of biological, social, and genetic factors account for the difference

Newborn girls are more likely to survive to their first birthday than newborn boys are because boys are

more susceptible to infectious diseases.

Women may live longer than men as a result of

lower lifetime risk behaviours such as smoking and alcohol use. Men also experience higher rates of violence than women and are more likely to die prematurely (e.g., work-related accidents, motor vehicle crashes, victims of war). Alternatively, it may be the effect of harder-to-identify biological advantages that result in relatively lower rates of cardiovascular disease and cancer in women.

The gap in life expectancy between women and men is narrowing to some extent in some developed countrie which may be due to

increased smoking among women and falling rates of cardiovascular disease among men. However, in some settings, notably in parts of Asia, these advantages are overridden by gender-based discrimination so that female life expectancy at birth is lower than or equal to that of males. Life expectancy for women also varies across regions and income levels of countries.

For instance, life expectancy for women is more than 80 years in at least 35 countries. However, in the WHO African Region, and particularly in East and Southern Africa, life expectancy for women can range from

54-65 years of age. This lack of improvement in life expectancy in Africa is mainly due to HIV/AIDS and maternal mortality.

It is projected that the older population will almost double by

2050, when it is expected to reach over 1.5 billion persons

On July 1, 2020, there were almost seven million Canadians 65 years of age and older. And, for the first time in history, Canada as well as most countries in the world, now has more individuals 65 and older than

children aged 14 and younger

Individuals who live to be 100 to 110 years of age are called

centenarians. Recent statistics indicate that there were 11 517 centenarians in Canada as of July 1, 2020—up 1 137 people from July 1, 2019, or nearly ten times the population growth rate of the overall population

Among G7 countries, Canada currently has one of the lowest proportions of

individuals 65 years of age and older (16.5 percent)

Japan has one of the oldest populations in the world and the highest proportion of

people 65 years and older of any G7 country (27 percent), or just over one in four people.

The United States is the only G7 country where the proportion aged 65 and older is

lower (15 percent) than in Canada (Statistics Canada, 2016).

Maximum longevity

is the oldest age one can possibly live.

Supercentenarians

are a special group of people who live beyond 110 years.

Jeanne Louise Calment

was a supercentenarian who has lived the longest of any human to date. She lived to the authenticated age of 122 years, 164 days.

The healthy immigrant effect

Canada and the United States, foreign-born individuals tend to live longer and are in better health than those who are native-born.

The three main reasons given for this effect are the healthy habits and behaviours practiced by immigrants prior to leaving their home countries

immigrant self-selection, in that a country’s healthiest and wealthiest have the financial and physical means to migrate; and strict health screening by authorities in the host country prior to immigration. This healthy immigrant effect is even higher when you compare foreign-born individuals to native-born individuals from the same ethnic group

The increased similarity between immigrants and native-born residents’ health is attributed to

the adoption of the behaviours and eating habits of the host country by the immigrant population

Immigrants have a smaller gap between female–male life expectancy compared to Canadian born individuals. This smaller gap has been attributed to

smaller sex differences in suicides and mortality from cancer, particularly lung cancer.

There often is a lack of information about Indigenous identity on

medical, birth, and death records which contributes to inaccurate health information. There are other significant challenges to collecting Indigenous health information. There is a lack of relevant, consistent, and inclusive Indigenous identity indicators in core population health data sets, and meaningful Indigenous leadership and Indigenous people themselves participating in the governance and management of Indigenous health data is lacking

The Indigenous populations of Canada are much

younger and have faster population growth than the overall Canadian non-Indigenous population.

Twin studies have shown that genetic factors account for only

25 to 30 percent of the individual differences in lifespan

Eviromemtal factors such as

air and water pollution may contribute to a shorter life as may the carcinogens present in some of the food we eat. Smoking, as well as the abuse of drugs and alcohol, are lifestyle factors that can contribute to a shorter life. Having a lower socio-economic status has been linked to a decrease in lifespan because of reduced opportunities to eat healthily and exercise. Reduced access to healthcare services also is a factor. While there is equal access to healthcare in Canada, some Canadians may not be able to afford drug prescriptions or health and/or visual aids (e.g., glasses) that they may need.

Health

a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

Critisms of health - the requirement of complete physical, mental, and social well-being would undoubtedly

leave the majority of us unhealthy most of the time.

Critisms of health 

the epidemiological pattern of diseases has shifted over time, from high rates of death from acute diseases (e.g., infectious and/or parasitic diseases) and short life expectancy to high rates of chronic disease and longer life expectancy. As such, the number of people living with chronic diseases is continuing to increase worldwide, making the WHO definition of health counterproductive in that it characterizes individuals with chronic diseases (and with a disability or disabilities) as definitely ill

Revised definition of health

a resource for everyday life, not the objective of living (WHO, 2012). Health is a positive concept emphasizing social and personal resources, as well as physical capacities

73 percent of Canadians aged 65 and older have at least

one of 10 chronic diseases

Hypertension and periodontal disease are the two

most prevalent diseases/conditions in adults aged 65 and older, followed by osteoarthritis, ischemic heart disease, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease (COPD). Asthma and mood and anxiety disorders are the least prevalent chronic diseases and conditions in Canadians 65 and older.

Determinants of health

include the physical environment, the social and economic environments, and individual characteristics and behaviours

Chronic, or non-communicable, diseases

now make up seven of the 10 leading causes of death (WHO, 2020a). In 2019, the top 10 causes of death accounted for 55 percent of the 55.4 million deaths worldwide, with seven of the ten leading causes of death in 2019 due to non-communicable disease

The top conditions that are prevalent in the 65+ age group include

ischemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer’s disease and other dementias, diabetes mellitus, and kidney diseases, with these six non-communicable diseases accounted for 44 percent of all deaths or 80 percent of the top ten deaths

Falls are the leading cause of

unintentional injury and injury-related hospitalizations among Canadian adults aged 65 and older, with eight percent of injury hospitalizations among older adults in 2017-2018 due to falls. Risk factors for falls in older adults are multifactorial and include increasing age, medication use, cognitive impairment, chronic and acute health conditions, impaired balance or gait deficits, sensory factors, inadequate nutrition, social isolation, as well as factors related to the built and social environments

Women 75 years of age experiencing more disability than same-aged males.Proposed reasons

greater longevity of women, more chronic conditions, lower bone density, and higher rates of life-style factors such as sedentary behaviour and obesity

Two components to disability

Activities of Daily Living (ADLs) (basic) and Instrumental Activities of Daily Living or IADLs (complex)

Two major models of disability

the medical model and the social model

the medical model

which views disability as being caused by a disease, injury, or health condition (Barnes & Mercer, 2003). In this model, an intervention is needed to correct the problem within the individual. The social model understands disability as a socially created problem and not an attribute of the individual and, therefore, something in the political environment must change

Frailty

is most often defined as an aging-related syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes

Functional health status

is how well a person is functioning in daily life. Assessing functional health status helps to identify older adults who need assistance with everyday activities. Generally speaking, older Canadian adults report themselves to be in good functional health

The four most common risk factors of diseases are

tobacco use, physical inactivity, harmful use of alcohol, and an unhealthy diet.

Obesity contributes to an increased risk of poor health outcomes in older adults due to

increased morbidity and mortality from illnesses such as Type 2 diabetes, hypertension, and heart disease.

The compression of morbidity hypothesis proposes that

people will stay healthier for a longer time and will be in poor health for a shorter time.

Expansion of morbidity hypothesis

that people will be living longer in poor health.

Dynamic equilibrium hypothesis

in which the postponement of death is accompanied by delays in disability such that the relative time in poor health remains the same (Manton, 1982). Supporting evidence for the three theories is mixed due in part to differences in the way that disability is measured, as well as to differences in findings across countries.

polypharmacy

the use of five or more medications daily. It is associated with adverse outcomes in older adults including mortality, falls, adverse drug reactions, increased length of stay in hospital, and readmission to hospital soon after discharge

Older patients are at even greater risk of adverse effects due to decreased

renal and hepatic function, lower lean body mass, as well as reduced hearing, vision, cognition, and mobility

Altered pharmacokinetics

can make an older adult patient more susceptible to the side effects of drugs.

Pharmacodynamics

the older adult is deemed to be more sensitive to the effects of certain drugs, particularly those that affect the central nervous system.

Pharmacokinetics includes

absorption, distribution, and clearance of a drug. In older adults, absorption is generally slower, particularly for drugs that are administered orally.

Metabolism of drugs also can be affected in some older adults due to

changes in the cytochrome P450 system, a major enzyme system by which the liver metabolizes drugs. Reductions in renal blood flow with age, resulting in decreased kidney function, can affect clearance of drugs in the older population.

Changes to drug receptors can make older adults

more sensitive to certain medications. Changes in the blood-brain barrier can affect drugs that act on the central nervous system.

Factors that affect Quality of life

health status, economic status, life satisfaction, well-being, and physical activity

A Model of Quality of Life in Late-life Disability (king)

dignity and having a sense of control in some aspect of daily life was central to quality of life in the participants. Maintaining current level of functioning, a positive attitude, and having positive social relationships also contributed to a higher quality of life.

Canada’s healthcare system known as

Medicare, the publicly funded system provides universal health insurance coverage to all Canadian citizens and permanent residents.

In 1984, the Canada Health Act was enacted, with this Act specifying the criteria and conditions required by

provinces and territories to receive funding for healthcare

The Canadian healthcare system is based on five principles

(UPPAC) Universality, Portability, Public administration, Accessibility, Comprehensiveness

Universality

All eligible residents are entitled to public health insurance coverage on uniform terms and conditions;

Portability

Coverage for insured services must be maintained when an insured person moves or travels within Canada or travels outside the country;

Public administration

The health insurance plan of a province or territory must be administered on a nonprofit basis by a public authority;

Accessibility

Reasonable access by insured persons to medically necessary hospital and physician services must not be impeded by financial or other barriers; and

Comprehensiveness

All medically necessary services provided by hospitals and doctors must be insured.

In terms of funding, the Canadian federal government provides cash and tax transfers to the provinces and territories to support

health systems.

The two major types of private health insurance in the United States, initiated in 1966, are

Medicaid and Medicare.

Medicaid

is a publicly-funded health program supported by both federal and state funds, and is administered at the state level.

Medicare

on the other hand, is a health program for individuals 65 and older, patients with end-stage renal disease, and younger individuals with disabilities.

Four components to Medicare

hospital insurance (Part A), medical insurance that covers everyday needs such as physicians' appointments, urgent care visits, counselling, medical equipment, and preventive care (Part B), private health plans, coverage for some other services not covered by original Medicare plans (Part C), and a prescription drug plan offered by private insurance plans that have been approved by Medicare

Some of the key features of Obamacare are

the elimination of pre-existing conditions, expansion of free preventive services and health benefits, expansion of Medicaid, improvements to Medicare, and elimination of insurance companies from “dropping policy holders when they are sick”

It is anticipated that, overall, health spending represents

11.5 percent of Canada's gross domestic product (GDP)

What are some solutions to this escalating demand for older adults' care?

One of the solutions identified by the Canadian Medical Association working group is to shift more long-term care to home care, where individuals receive care in their own home. It is anticipated that with this shift, nearly 37 000 fewer Canadians would be using long-term care (and instead rely on home care), resulting in an overall cost savings of $794 million in 2031

Cumming and Henry (1961) regarded successful aging as the desire of

older people to disengage from active life in order to prepare themselves for death.

Ryff’s (1989) model in which successful aging is seen as

a developmental process in which continued personal growth is very much possible in old age.

Rowe and Kahn three key components to successful aging

the avoidance of disease and disability, the maintenance of cognitive and physical function, and engagement with life. Selective Optimization with Compensation (SOC) model developed by Baltes and Baltes

A criticism of the SOC model

is that compensation and optimization strategies may become increasingly difficult to use because of age-related losses in resources (Ouwehand et al., 2007).

A difficulty with Rowe and Kahn’s model is

that very few older adults meet their successful aging criteria. That is, the complete absence of disease as we age is unrealistic for many people

Another criticism of the successful aging models in general is that they

neglect the structural forces that influence functioning later in life and assume that older adults have the resources, such as having access to healthcare and living above the poverty line, to age successfully. Also absent from successful aging models are the opinions from different cultures.

Low-income older adults from North Korea named “success of adult children” as

a factor in successful aging.

Bangladesh, successful aging encompasses dimensions such as adaptation to an

aging body, financial security, family and intergenerational care, and social participation. In particular, having your family able to care for you in old age

Categorizing total health as "good aging" and the presence of disease or disability as "bad aging" creates

a very simplistic either/or category that does not capture the diversity in which we age

Most commonly referred to themes across cultures were to stay healthy and engage in

appropriate physical activity, to be able to age at home, to be socially engaged, and to have a positive attitude about life and about aging. However, social engagement was mentioned more consistently than any of the other concepts. And it was not just to engage with friends and family but also to give back and be connected to the larger community in meaningful ways. Also of note was that older adults favoured psychological and social criteria over biomedical criteria. While most older adults valued physical health, the ability to achieve high psychological well-being when confronted with unpredictable physical ailments and life changes appeared more important to older adults than their objective physical health.

Manitoba study found successful aging is

having goals and interests and being engaged with family are important to successful aging.

The European Union has developed the European Innovation Partnership on Active and Healthy Ageing (EWAHA)

and each year, the program sponsors a weeklong event to bring attention to active aging and solidarity between generations, with the aim to establish a culture across Europe of people remaining active into older adulthood. This initiative has helped convey a more positive image of population aging in Europe by highlighting the potentials of older people and promoting their active participation in society and in the economy. Reversing the belief that older adults are a burden on society is their biggest aim.

The World Health Organization (WHO) World Report on Ageing and Health (2015b)

the National Seniors Council in Canada identified key issues that Canada faces as the population ages and developed four supporting pillars, These are Independent, Productive and Engaged Citizens, Healthy and Active Lives, Care Closer to Home, and Support for Caregivers.

ParticipACTION

resources for older adults include Canadian physical activity guidelines for adults 65 and older, physical activity tips, guides to healthy eating, and advice for safety in the home