dr. puxty presents, age well - your choice
TRANSCRIPT
Presentation Outline
Popular images of Aging
Why prepare for life beyond 65
Strategies for successful aging
Longevity in 19th Century
Jane Austin
Out-lived sisters, friend and cousins
Died at 42 years of age!
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Jeanne Calment lived to 122She smoke, drank and rarely formally exercised!
Longevity in 21st Century
Jeanne Calment 1875 -1997
• At age 85 (1960), she took up fencing, and continued to ride her bicycle up until her 100th birthday. She was reportedly neither athletic nor fanatical about her health.
• Calment lived on her own until shortly before her 110th birthday, when it was decided that she needed to be moved to a nursing home after a cooking accident.
• She continued to walk until she fractured her femur during a fall at age 114 years 11 months.
Life Expectancy at Age 65 in Canada
Composition of Population by Age groups 1971-2051
SourcesStatistics Canada 2010, population estimates, 1971 to 2010, and
population projections, 2009 to 2036.
New Norm
• Very old becoming common• The 2011 Census enumerated 5,825 people aged 100 years
and older, compared to 4,635 in 2006 and 3,795 in 2001 • By 2050 there will be nearly 50,000
New Norm
• Very old becoming common• The 2011 Census enumerated 5,825 people aged 100 years
and older, compared to 4,635 in 2006 and 3,795 in 2001 • By 2050 there will be nearly 50,000
• The oldest Baby Boomer today can expect 17-20 years in retirement • Are they prepared?
• Changing expectations and realities• Baby Boomers have new roles as caregivers and future
seniors
• Predictions that life expectancy may increase 15-40 years by 2050!
Why Prepare for 65 +?
• To have greater control over the circumstances and well-being of the later years
• To leverage longevity (Likely 25% of life time)• To have a satisfying retirement• To heed the advice of retirees (Better to learn from
others than make the same mistakes!)• To reduce costs to our health and social systems,
ourselves and our families • To help maintain health and independence
And if you don't prepare?
• Increased probability of frailty and adverse outcomes• Physical and Mental Frailty• Social vulnerability • Multiple chronic disease and polypharmacy
Canadian Study of Aging & Health: Frailty in Canada
41.4% were felt to be well
15.2% were considered vulnerable with some evidence of slowing up in their normal activities
13.3 were mildly frail needing some help with IADL’s such as finances, driving, managing medication or cooking
39.1 were moderately or severely frail requiring help with ADL’s such as bathing, dressing, toileting and walking
Rockwood K, et al CMAJ 2005;173(5):489-9512
2,305 individuals 70 years or older were studied over 5 years
Probability of Institutionalization Avoidance Based on CSHA Frailty Scale
Rockwood K, et al CMAJ 2005;173(5):489-95
Well
Vulnerable
Mild Frailty
Moderate to severe Frailty
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Probability of Survival based on CSHA Frailty Scale
14Rockwood K, et al CMAJ 2005;173(5):489-95
Well
Vulnerable
Mild FrailtyModerate to
severe Frailty
And if you don't prepare?
• Increased probability of frailty and adverse outcomes• Physical and Mental Frailty• Social vulnerability • Multiple chronic disease and polypharmacy
• Disproportionate use of health and community services
Seniors: Heavy Users of Health Care
Seniors represent 14% of population, yet utilize 45% of all provincial/territorial public-sector health spending; 40% of acute hospital stays; 85% of hospital-based continuing care; 82% of home care; and 95% of residential care.
They are also more likely than younger adults to visit family doctors frequently and make claims for publicly funded prescription drugs.
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Health Care use is not uniform by Seniors
Compared with younger adults, seniors•Commonly have multiple chronic diseases•Seek care in EDs more often•Spend more time once in EDs•Are hospitalized at higher rates for conditions sensitive to ambulatory care
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Room to Improve: Managing Chronic Conditions
Prescription Drugs:
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In 2009, 63% of seniors on public drug programs claimed ≥5 drugs from different classes, while 23% claimed ≥10.
Five of the top 10 drug classes used by seniors treat high blood pressure and heart failure.
Drug Safety Is a Concern
In 2009, ~1 in 10 seniors were taking drugs that were potentially inappropriate.
Seniors are more likely than younger adults to take over-the-counter drugs and supplements.
Seniors are at increased risk of drug side-effects and interactions, compared with younger adults.
And if you don't prepare?
• Increased probability of frailty and adverse outcomes• Physical and Mental Frailty• Social vulnerability • Multiple chronic disease and polypharmacy
• Disproportionate use of health and community services
• Loss of “control” over future housing decisions
Seniors in Residential Care SettingsFrom 1981 to 2006, rates of institutionalization among seniors have ↓,
but since 2004, intensity of care provided in residential settings has ↑
Seniors in residential care are more likely to be older (85+ years),
unmarried and functionally dependent compared with those in
community settings.
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Characteristic Descriptive Home Care (%) Residential Care (%)
Age % accessed seniors pop age 85+
40 57
Marital Status Not married 64 76
Functional Status (Activities of Daily Living)
Extensive assistance/ dependence
18 74
Cognitive Performance Scale
Moderate to severe 14 60
Room to Improve: Flow Across Care Settings
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47% of seniors designated ALC are waiting for LTC placement.
Age Well – Your choice!
Planning for Aging Well
• Improving Physical and Mental Health• Modify diet: reduce meat increase vegetables, tofu
and beans
Planning for Aging Well
• Improving Physical and Mental Health• Modify diet: reduce meat increase vegetables, tofu
and beans• Regular low-intensity activity
• Sedentary people lose large amounts of muscle mass (20-40%)• 6% per decade loss of Lean Body Mass (LBM)• Aerobic activity not sufficient to stop this loss • Need combination of balance and flexibility training, capacity
building exercise 3-5 days for 30 minutes each week and weights/stairs
Planning for Aging Well
• Improving Physical and Mental Health• Modify diet: reduce meat increase vegetables, tofu
and beans• Regular low-intensity activity• Reduce risky behaviours
Planning for Aging Well
• Improving Physical and Mental Health• Modify diet: reduce meat increase vegetables, tofu
and beans• Regular low-intensity activity• Reduce risky behaviours• “Sense of Purpose” (Ikigai )• Eat to 80% full (hara hachi bu)• Drink moderate amount of wine• Improved chronic disease management
Improving Chronic Disease Management
Customize “best practices” based on patient goals and life expectancy
Improving Chronic Disease Management
Customize “best practices” based on patient goals and life expectancy
Seek to avoid polypharmacy (deprescribing)
Is it feasible and safe to use a medication discontinuation strategy
Generally approximately 2/3 of referrals have opportunities for discontinuation
Typically involves Anti-hypertensives Diuretics Anti-psychotics Sedatives Lipid lowering agents Analgesics
Failure rate of discontinuation 20-30%
Improving Chronic Disease Management
Customize “best practices” based on patient goals and life expectancy
Seek to avoid polypharmacy (deprescribing)
Desirability of case management to link effort and care
Need for “system navigation” and knowledge of system opportunities
Caregiver support is crucial!
Planning for Aging Well
Improving Physical and Mental Health
Maintaining and building strong family and social networks
Planning for Aging Well
Improving Physical and Mental Health
Maintaining and building strong family and social networks
Preparing housing and community to be “age-friendly”
Age-Friendly Community Dimensions
Outdoor spaces and Public Buildings
Transportation
Housing: accessibility and safety
Social Participation
Respect and social inclusion
Civic Participation and employment
Communication and information
Community support and health services
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Are Businesses “Age Friendly”
ALL RESPONDENTSAbove
AverageAverage
Below Average
Don't Know
Pharmacies 31% 57% 8% 4%Vacation destinations 27% 54% 9% 10%Seniors clubs / associations 25% 48% 7% 20%Book stores /sellers 20% 64% 7% 9%Specialty magazines / books 20% 60% 8% 12%Specialty food stores 19% 58% 10% 13%Restaurants 19% 67% 9% 4%Doctors 19% 58% 20% 4%Health / fitness clubs / gyms 18% 53% 16% 14%Pharmaceutical companies 18% 56% 19% 7%Travel agents 18% 58% 10% 14%Hotels 17% 65% 9% 9%
Ranked in order of “above average” in meeting the needs of aging baby boomers, the following “top 12” businesses, services or professions are shown:
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ALL RESPONDENTSAbove
AverageAverage
Below Average
Don't Know
Gasoline companies 3% 33% 56% 8%Provincial government 4% 40% 50% 7%Federal government 3% 41% 49% 6%Municipal government 4% 47% 43% 7%Retirement homes 15% 44% 25% 17%Automobile dealers 7% 58% 24% 11%Automobile manufacturers 8% 59% 23% 10%Airlines 8% 57% 23% 12%Home builders 7% 57% 23% 14%Banks 14% 59% 22% 5%
The businesses ranked most negatively – the percentage aging baby boomers who believe their needs are met on a “below average” basis :
Are Businesses “Age Friendly”
Planning for Aging Well
Improving Physical and Mental Health
Maintaining and building strong family and social networks
Preparing housing and community to be “age-friendly”
Technology
Technology
• Incoming residents and baby boomers represent the first generation to grow up around technology
• Expect a wave of innovation over the next 10 - 20 years to meet the growing needs of this market. This is the group that will be shopping for their parents now.
• Emerging trend for developments aimed at keeping seniors at home longer
Technology
Ollo WearableVoice activated cell phone, sensors and GPSBroad for falls, cardiac monitoring etc
Technology
GPS sneakers GPS embedded in sneakers outfitted with a microcomputer with satellite tracking can find anyone 24/7Broad implications for cognitive impairment
Technology
Driving systems – ‘aware’ car equipped with warning systems to control speed and monitor distance of oncoming traffic. Helps drivers make left hand turns and tailors airbag and steering wheel placement for seniors of smaller stature.
Planning for Aging Well
Improving Physical and Mental Health
Maintaining and building strong family and social networks
Preparing housing and community to be “age-friendly”
Technology
Transportation – anticipate 7-10 years survival beyond safe driving capacity
Fatality Rate by Age and Distance Traveled
On the basis of estimated annual travel, the fatality rate for drivers 85 and over is 9 times as high as the rate for drivers 25 through 69 years old.
Planning for Aging Well
Improving Physical and Mental Health
Maintaining and building strong family and social networks
Preparing housing and community to be “age-friendly”
Technology
Transportation – anticipate 7-10 years survival beyond safe driving capacity
Finance: 40% have inadequate planning
Plans “post-retirement”
At Desired Retirement Age I Will ...
8%
52%
18%
22%
Continue working on a full- time basis
No longer work
Not sure / don't know
Continue working on a part- time basis
By Age
55%
52%
52%
50%
47-49
50-54
55-59
60-64
By Net Worth
53%
50%
50%
59%
<$100,000
$100K - $249K
$250K - $499K
>$500,000
… Continue Working On Part-Time Basis.
Planning for Aging Well
Improving Physical and Mental Health
Maintaining and building strong family and social networks
Preparing housing and community to be “age-friendly”
Technology
Transportation – anticipate 7-10 years survival beyond safe driving capacity
Finance: 40% have inadequate planning
Ongoing access to information/education
www.sagelink.ca
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Enjoy life to the fullest!
