Ageism

 The following is from the Lancet, published in March 2021.

On March 18, 2021, the Global Report on Ageism was launched by WHO, the Office of the UN High Commissioner for Human Rights, the UN Department of Economic and Social Affairs, and the UN Population Fund. Combating ageism is one of the four action areas of the Decade of Healthy Ageing (2021–2030). Changing how we think, feel, and act towards age and ageing is a prerequisite for successful action on healthy ageing and for progress on the three other action areas of the Decade of Healthy Ageing: developing communities that foster older people's abilities, delivering person-centred integrated care and primary health services responsive to older people's needs, and providing long-term care for older people who need it.

The COVID-19 pandemic has taken the lives of many older people, it has also exposed ageism in different settings—eg, discrimination in access to health care, inadequate protection of older people in care homes and of young people's mental health, and stereotypical media portrayals that pit generations against each other.

Consensus on the meaning of ageism has remained elusive and there is insufficient evidence on the topic. The Global Report on Ageism highlights that ageism can be institutional, interpersonal, or self-directed and summarises the best evidence on the scale, impacts, and determinants of ageism against both older and younger people and the most effective strategies to address ageism. Ageism is an important social determinant of health that has been largely neglected until now.

Like all forms of discrimination, ageism generates divisions and hierarchies in society and influences social position on the basis of age. Ageism results in various harms, disadvantages, and injustices, including age-based health inequities and poorer health outcomes.

Globally, ageism affects billions of people: at least one in two people hold ageist attitudes against older adults, with rates much higher in lower-income countries. In Europe, the only region for which data about ageism are available for all age groups, one in three people have experienced ageism.

Ageism impacts all aspects of older people's health. For instance, it shortens their lifespan, worsens their physical and mental health, hinders recovery from disability, and accelerates cognitive decline.1 Ageism also exacerbates social isolation and loneliness and reduces access to employment, education, and health care, all of which impact health.

As the Global Report on Ageism shows, ageism places a heavy economic burden on individuals and society, including in health-care costs. Annually, ageism accounts for US$1 in every $7—or $63 billion—spent in the USA on health care for the eight conditions with the highest health-care costs among people aged 60 years and older.12

The evidence reviewed in the report shows that three strategies are effective to reduce ageism: policy and law, education, and inter generational contact interventions. Policy and law can address discrimination and inequality on the basis of age and protect human rights. Educational interventions across all levels of education can correct misconceptions, provide accurate information, and counter stereotypes. Inter generational contact interventions are among the interventions that work best to reduce ageism against older people and could also have a role in combating ageism against younger people.

The Global Report on Ageism makes three recommendations for concrete actions that all stakeholders can take to combat ageism. First, invest in effective strategies to prevent and respond to ageism. Second, fund and improve data and research to better understand ageism and how to address it. Third, build a movement to change the narrative around age and ageing. The promise of the Decade of Healthy Ageing can only be fully realised if ageism is recognised as a social determinant of health and tackled.

Are those real?

I was sitting in the Dentists Chair and the Hygienist was talking about how important it is to still keep your own teeth as you get older. She asked me what I thought the most talked about thing was when seniors (older than me) got together. I said, "I did not know." She replied, "Their teeth." She went on to say that I was lucky that I had all my own teeth, including my wisdom teeth. She said I must take good care of my teeth. 

I did not say that for many years, when I was younger, I did not take care of my teeth. I was very lucky about 20 years ago to find a Dentist that helped me understand the importance of taking care of your Dental Health.

As she continued on with her cleaning, she told me the following story, which I will share with you.

An older widower went to a party at the seniors home he was living in and he noticed a very striking women with a very nice figure and he noticed she had a beautiful smile with dazzling white teeth. She was about his age and he realised that he had not met her yet. He went over to her and they struck up a conversation and talked for a long time. They talked about the home, they talked about their situation, they talked about family and friends. After about two hours of intense conversation that was starting to get intimate, the man leaned over to the woman and asked, "Are those real?" She sat up straight, puffed her chest out, put her hands under her breasts and said proudly "These babies are real, they are all me." He looked at her with embarrassment and said, "No, I was asking about your teeth."

The 2020 national public opinion research survey on Dementia

The 2020 report to Parliament on A Dementia Strategy for Canada: Together We Aspire marks the first anniversary of the release of the strategy. This report, through the variety of initiatives selected this year as examples of our collective effort, underlines that progress on the strategy and its impact over time relies on the initiatives and investments of all levels of government and from many different organizations across Canada.

As Canada continues to implement the strategy and pursues its aspirations, the Public Health Agency of Canada (PHAC) will continue to gather information to increase our understanding of the initiatives and investments across Canada that are aligned with the strategy’s three national objectives: prevent dementia; advance therapies and find a cure; and improve the quality of life of people living with dementia and caregivers.

It is also clear that the impact of COVID-19 on Canadians, including people living with dementia and caregivers, will shape and inform federal and other efforts related to dementia as we move forward.

The 2020 national public opinion research survey is part of the Government of Canada’s initial work on implementation and is helping us better understand the knowledge and perceptions of Canadians on key aspects of dementia, including risk reduction and stigma. The 2020 survey revealed some key areas where awareness-raising efforts in the years ahead can be particularly important. For example, knowledge gaps are higher in some regions of the country and within some populations that are at higher risk. As well, about one-quarter of respondents were unaware that there are actions that can be taken to reduce the risk of dementia. There are also knowledge gaps regarding some risk factors linked to dementia, including existing health conditions such as high blood pressure (hypertension), heart disease and diabetes, and how certain behaviours or environmental factors such as smoking, and air pollution can increase risk. Only one quarter of survey respondents reported taking steps specifically intended to reduce their risk for developing dementia.

The survey also confirms more work needs to be done to reduce and ultimately eliminate stigma and improve quality of life for people living with dementia. There is good news in that only 12% of respondents reported that they would not be comfortable interacting with someone living with dementia, largely due to uncertainty or lack of knowledge about dementia which suggests there is potential to increase this comfort level among this small group. However, only 46% of respondents feel efforts to make the community safer for people living with dementia are moderate to excellent and only 51% rated opportunities for social engagement/social connection for this population at moderate to excellent. One-quarter of respondents felt that the level of support in their community for people living with dementia is poor while 25% did not know, suggesting that while there is room for awareness raising and improvement of support, there is also much happening that is making a difference and is recognized.

All organizations across Canada involved in dementia-related initiatives are encouraged to share information with PHAC about their work. This effort to create a more comprehensive understanding of our national effort will provide a more accurate portrait of the magnitude and scope of work underway in Canada, while identifying gaps in programs and services. If you would like to receive communications about the national dementia strategy and funding opportunities or provide information about your activities, please contact the PHAC Dementia Policy Secretariat. 

Support for caregivers of people living with Dementia

Caregivers for people living with dementia face unique challenges and may jeopardize their own health while trying to provide the best support they can to their loved ones. Improving support for caregivers is an area of focus of the national dementia strategy. The 2020 public opinion research survey found that almost two out of five Canadians (36%) had aided someone living with dementia within the last five years. Of those caregivers, only 57% agreed that they were able to provide the care needed, suggesting that more can be done to support caregivers.14 This year’s report shares some examples of initiatives underway across Canada that support dementia caregivers.

Building knowledge

•    Introducing Gentle Persuasive Approaches in Dementia Care is an initiative that aims to strengthen the knowledge of formal (paid) and informal (unpaid and often family/friend) caregivers (Alzheimer Society of New Brunswick and Horizon Health).

•    The Community Dementia Ambassador Training pilot program provides resources and in-person supports to partners and caregivers of people living with dementia in remote communities in the Northwest Territories (Alzheimer Society of Alberta and the Northwest Territories).

•    In Yukon, the Shine a Light on Dementia: Caregiver Training Program aims to equip caregivers with knowledge and skills while sharing experiences and resources (Yukon Department of  Health and Social Services).

•    My Tools 4 Care-In Care is a web-based platform that provides interactive activities, resources and guidelines to support caregivers to improve  mental wellbeing by  fostering social inclusion and building skills and knowledge in working with long-term care providers (University of Alberta).

Financial support

•    The Government of Nova Scotia Caregiver Benefit Program provides funding to eligible caregivers who are providing assistance to qualified care recipients, including those with moderate cognitive and high physical impairment residing in the community (Nova Scotia Health Authority).

•    Federal personal income tax assistance is provided in recognition of the fact that people living with dementia and those who care for them may have a reduced ability to pay tax.

Community-based services

•    The Community-based Innovations for Dementia Care initiative provides funding to 14 local community and health service providers to implement projects that build innovative approaches in person-centred dementia services (Alberta).

•    The Home and Community Care Program provides home and community care services in all communities, such as home support and respite care for caregivers as well as for Nunavummiut diagnosed with dementia-related illness who are able to be supported at home. A new 24-bed long-term care facility will provide around-the-clock nursing care to support the medical and cultural needs of a growing population of Nunavut seniors (Nunavut).