According to the Canadian Institute of Health Research in a report on Healthy Ageing, healthy ageing is about
creating the environments and opportunities that enable people to be and do
what they value throughout their lives.
Being free of disease or
infirmity is not a requirement for Healthy Ageing as many older adults have one
or more health conditions that, when well-controlled, have little influence on
their wellbeing
Canada is ageing and by 2035,
there will be more than 30% of the population will be 60 years and over. Are we
ready?
The ageing of the Canadian population is characterized by:
•
A decrease in the number of younger people, as a result of a lower birth rate.
•
An increase in
the number of people who are reaching old age due to the fact that more people
engage in healthy lifestyles.
•
A drastic
increase in the number and proportion of the oldest old (i.e. individuals who
are aged 85 and over), including an explosion of centenarians.
•
An increase in
the difference between the relative numbers of men and women, the latter
representing the vast majority of the oldest.
The ageing landscape in
Canada is increasingly characterized by diversity in individual trajectories,
including a higher number of people working later in life, either by choice or
by financial obligation.
Genetic makeup, epigenetic
exposures, and, mostly, lifestyle choices, such as nutrition, physical exercise
and cognitive stimulation, are known to be drivers of vitality in late life.
Despite the diversity in the trajectories of ageing and in particular between
women and men, the late years do allow for multiple opportunities, whether in
relation to work, family time, further education, travel, entrepreneurship and
community engagement.
As a result of lifelong
adaptation and resilience, older individuals represent a source of invaluable
wisdom that should be better integrated in all aspects of society. Older adults
contribute massively to families and their communities through caregiving as
well as volunteer activities. Health and wellness throughout our life
trajectory and in the late years represent a central tenant of our Canadian
values of happiness and fulfilment.
At the same time, multiple
chronic conditions still characterize the health of older individuals and more
than half (57%) of individuals aged 80 and over live with three or more chronic
conditions, many of which are controlled by medication and/ or lifestyle.
Moreover, frailty is a prevalent condition that affects up to 35% of older
Canadians placing them at higher risk of disability, institutionalization and
even mortality.
Frailty is particularly
onerous in those aged 85 and older, reaching a prevalence of close to 50%.
Frailty is associated with an increased risk of injuries due to falls, mobility
disability, depression, and cognitive impairment. Cognitive impairment
resulting in dementia is one of the most prominent and debilitating conditions
for all older people and their caregivers, particularly among those in the
oldest-old age group (more than 40% of individuals aged 85 and over are living
with some form of dementia).
Despite these challenges, the vast majority of people aged 65 and over still live in private dwellings (92%
for those aged 65 and over, and 68% for those aged 85 and over), while only a
fraction (8% for those aged 65 and over, and 32% for those aged 85 and over)
live in protected and /or long- term care facilities.
Nevertheless, the environment
in which older Canadians live is not always supportive of health and wellness.
There is a clear need for more age-friendly housing and communities in both
urban and rural environments, as well as for more knowledge to address the
issues of stigma and elder abuse, regardless of the form they may take (i.e.
physical, emotional, psychological, or financial). Loneliness also represents a major challenge for many older individuals, especially within the oldest old
age group.
Older people with health
challenges represent an important proportion of health system users and
associated costs. Unfortunately, the system is not equipped to deal with older
individuals who have multiple chronic conditions, in particular as it relates
to ensure a coherent transition between the different components of the health system, especially in the last years of life.
Canada’s demographic
landscape and ageing trajectory is characterized by an ongoing increase in the
numbers of older people, and even more of the oldest old. In order to optimize
health and wellness in ageing, as well as adapted health and social
interventions and health services that will support older individuals in their
needs and diversity we will need will, determination and luck.
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