8. Healthy Aging

Healthy Aging

(definition)

The development and maintenance of optimal physical, mental, and social well-being in older adults

Aging as a Life Course Phenomenon

People do not suddenly become old at a specific age

Combined lifetime experiences interacting with social, behavioural, and biomedical processes (no single chronological marker of old age)

5 Practices Associated with Longer and Healthier Lives

1) avoiding smoking

2) exercising regularly

3) maintaining a healthy body weight

4) sleeping between 7-8 hours nightly

5) limiting consumption of alcoholic drinks

Physical Activity Interventions

• resistance to physical activity — “exercise is harmful for older adults”

• interventions include a supportive environment for enhancing motivation for being physically active

Order These Studies…

Effectiveness Studies

Efficacy Studies

Dissemination and Implementation Studies

Determinant Studies

1) determinant studies

2) efficacy studies

3) effectiveness studies

4) dissemination and implementation studies

At the macro level, all evidence-based programs have 2 components

What are they?

1) therapeutic element studies

2) delivery mechanism

Personalized (precision) medicine has drawn attention to the concept of _____

Personalized risk factors

Translation of interventions is necessary to ____?

Disseminate the known benefits of evidence-based interventions to new populations and settings

Translation/ Intervention Adaptation

Needed to develop programs that are response to the changing needs and demands of populations and settings

Treatment Fidelity

The degree that an intervention is delivered in the way it was originally intended

• assess the accuracy of an intervention’s delivery in terms of the manuals, protocols, and models from which it was derived

Program Drift

Often occurs when an intervention is delivered over a period of time and/ or in multiple setting

Consists of slight modifications (intentional or unintentional) that result in less than perfect replications and program delivery

What can overcomplicate the observers’ view?

In relation to fidelity monitoring

If too many items are being observed (before, during, and after the program is delivered)

Scalability

Increasing the number of individuals served is essential to ensure aging-related programs meet their goals — maximizing the program’s reach before setting it out in the community

Sustainability

Planning is essential in determining target populations, community partners, and annual budgets

Set up programs where older adults congregate — more likely to participate and attend here

When does sustainability begin?

Prior to the programs’s implementation

Intervention Type: Silos

Independently based on funding source, discipline, or community setting

When are community-clinical interactions necessary when implementing programs?

When thinking about interventions for disease management, medication management, physical activity, and other initiatives for older adults

Rowe and Kahn:

Usual Aging

• age-intrinsic

• nonpathological but high-risk

• focuses on physiological functions and the normal decline with functioning age

Rowe and Kahn:

Successful Aging

• low-risk but high-functioning

• implies that extrinsic and intrinsic factors play important roles in maintaining individuals’ health within each age group (characteristics are age-related rather than age-dependent)

Rowe and Kahn:

Successful Aging — According to 3 Standards

What are they?

1) low probability of disease and disease-related disability and related risk factors

2) high cognitive and physical functional capacity

3) active engagement with life

WHO:

4 Elements of Healthy Aging

1) functional abilities

2) intrinsic capabilities (physical and mental)

3) environments (extrinsic world)

4) well-being

Domains of Health Aging (5)

1) physiological and metabolic health

2) physical capability

3) cognitive function

4) social well-being

5) psychological well-being

Domains of Health Aging:

Physiological and Metabolic Health

• blood pressure

• absence of chronic disease

• BMI

• fasting glucose levels

• sleep quality

Domains of Health Aging:

Physical Capability

• balance

• ADLs and IADLs grip strength

• walking speed

• chair rise test

• mobility limitations

• frequency of activity

Domains of Health Aging:

Cognitive Function

• word recall tests

• verbal fluency tests

• Montreal Cognitive Assessment

Domains of Health Aging:

Social Well-being

• isolation vs. interaction frequencies

• frequency of contact with family and friends

• social network size

• marital status

• volunteer work

Domains of Health Aging:

Psychological Well-being

• scanning for depression

• anxiety

• loneliness

• life-satisfaction

Why have researchers criticized Rowe and Kahn’s 3 standards?

• exclude older people with any evidence of incapacity

• retained only a small ‘elite’ group group of older adults

Older Age is…

Homogenous or Heterogenous?

Heterogenous

The National Framework of Aging:

Overall Vision

Overall Vision: “Canada. a society for all age, promotes the well-being and contributions of older people in all saspects of life”

The National Framework of Aging:

Five Principles

1) dignity

2) independence

3) participation

4) fairness

5) security

The National Framework of Aging:

3 Pillars of Action

1) health, wellness, and security

2) continuous learning, work, an participation in society

3) supporting and caring in the community

Percentage of population is seniors (now vs. in 2031)

Now: 13%

2031: 25%

Why Invest in Healthy Aging?

• seniors can make a significant contribution to the richness of Canadian life and the economy (providing assistance to family)

• can delay and minimize the severity of chronic diseases and disabilities in later life (saving health care costs later on)

• build on existing opprtunities

Five Key Focus Areas: The Evidence Base

• social connectedness (older individual more likely to exercise, etc. if a friend/ family member accompanies them)

• physical activity

• healthy eating

• falls prevention (major cause of injury in seniors)

• tobacco control (implicated as a top killer in Canada; expected loss of 15 years of life)

Three Key Mechanisms

To pursue the new vision for healthy aging

1) supportive environments (policies, services, programs, etc.)

2) mutual aid (individuals supporting each other)

3) self-care (choices and actions of individuals for themselves)

WHO Definition of Healthy Aging

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

• process!

• key is to learn to ENJOY life

• “remain physically, mentally, and socially healthy” — the 3 aspects of health are all interconneced

What is the focus of healthy aging?

To improve the quality of remaining life, rather than just lengthening life

Concepts:

Successful Aging - what is it about?

Individual health

Concepts:

Healthy Aging - what is it about?

Society

Concepts:

Aging Well - who does it invovle?

Policymakers

Healthy aging does NOT mean…

Not experiencing the natural aging process that occurs during aging

WHO Model of Healthy Aging

What does this focus on? (thinking and approach)

• wholistic thinking

• multidisciplinary approach

Indicators of Health Aging

• functioning and disability

• physical activity

• cognitive capability

• prevalence of chronic disease and multi morbidity

• social engagement and contribution (harder to measure)

• measurable, quantifiable

Important Questions about Healthy Aging:

How can the big picture be addressed?

Seeking input from all groups, especially those who are not always well heard

Important Questions about Healthy Aging:

How can we make sure the ‘intervention’ worked?

Central idea of what you want to achieve, tailor it to the community (aligned with the moral beliefs, social norms, etc. of the community)

Measure the indicators!

Important Questions about Healthy Aging:

Does society think that healthy aging is achievable?

Not always, people don’t always look in favour of ‘healthy aging’

Change society’s view, or they will never listen!

Aging in Place

(Policy)

• to keep established social connections, continuous use of resources

• older adults tend to live in their family home unless forced to move

• provides a sense of identity and security (emotional and financial)

Are older adults really the least active age group?

• NO

• physical activities sometimes have just not been adjusted for the abilities of older adults properly — this info needs to be changed!

Why don’t some interventions work?

• the evidence is wrong

• implementation is wrong

• wrong modifications

A good intervention…

• has clear and specific goals

• focuses on a particular sub-population of older adults

• intervention is clearly defined — duration and method of delivery

• outcome is measureable