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Dr. Puxty presents, Age Well - Your Choice
The presentation discusses strategies for successful aging, emphasizing the importance of preparation for life beyond 65 to maintain health, independence, and possibly extend life expectancy. It outlines the growing population of seniors, the financial and health implications of aging, and the significance of social networks and age-friendly communities. It also highlights the role of technology in supporting the elderly and the need for improved planning for retirement and chronic disease management.
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Dr. Puxty presents, Age Well - Your Choice
- 1. Age Well –Your Choice Dr. John Puxty puxtyj@providencecare.ca
- 2. Presentation Outline Popular imagesof Aging Why prepare for life beyond 65 Strategies for successful aging
- 3. Longevity in 19th Century JaneAustin Out-lived sisters, friend and cousins Died at 42 years of age!
- 4. 4 Jeanne Calment livedto 122 She smoke, drank and rarely formally exercised! Longevity in 21st Century
- 5. 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.
- 6. Life Expectancy atAge 65 in Canada
- 7. Composition of Populationby Age groups 1971-2051 Sources Statistics Canada 2010, population estimates, 1971 to 2010, and population projections, 2009 to 2036.
- 8. New Norm • Veryold 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
- 9. New Norm • Veryold 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!
- 10. Why Prepare for65 +? • 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
- 11. And if youdon't prepare? • Increased probability of frailty and adverse outcomes • Physical and Mental Frailty • Social vulnerability • Multiple chronic disease and polypharmacy
- 12. Canadian Study ofAging & 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
- 13. Probability of InstitutionalizationAvoidance Based on CSHA Frailty Scale Rockwood K, et al CMAJ 2005;173(5):489-95 Well Vulnerable Mild Frailty Moderate to severe Frailty 13
- 14. Probability of Survivalbased on CSHA Frailty Scale 14 Rockwood K, et al CMAJ 2005;173(5):489-95 Well Vulnerable Mild Frailty Moderate to severe Frailty
- 15. And if youdon'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
- 16. Seniors: Heavy Usersof 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. 16
- 17. Health Care useis not uniform by Seniors
- 18. 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 18 Room to Improve: Managing Chronic Conditions
- 19. Prescription Drugs: 19 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.
- 20. Drug Safety Isa 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.
- 21. And if youdon'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
- 22. Seniors in ResidentialCare Settings From 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. 22 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
- 23. Room to Improve:Flow Across Care Settings 23 47% of seniors designated ALC are waiting for LTC placement.
- 24. Age Well –Your choice!
- 25. Planning for AgingWell • Improving Physical and Mental Health • Modify diet: reduce meat increase vegetables, tofu and beans
- 26. Planning for AgingWell • 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
- 27. Planning for AgingWell • Improving Physical and Mental Health • Modify diet: reduce meat increase vegetables, tofu and beans • Regular low-intensity activity • Reduce risky behaviours
- 28. Planning for AgingWell • 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
- 29. Improving Chronic DiseaseManagement Customize “best practices” based on patient goals and life expectancy
- 30. Improving Chronic DiseaseManagement Customize “best practices” based on patient goals and life expectancy Seek to avoid polypharmacy (deprescribing)
- 31. Is it feasibleand 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%
- 32. Improving Chronic DiseaseManagement 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!
- 33. Planning for AgingWell Improving Physical and Mental Health Maintaining and building strong family and social networks
- 34. Planning for AgingWell Improving Physical and Mental Health Maintaining and building strong family and social networks Preparing housing and community to be “age- friendly”
- 35. Age-Friendly Community Dimensions Outdoorspaces 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
- 36. 36 Are Businesses “AgeFriendly” ALL RESPONDENTS Above Average Average 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:
- 37. 37 ALL RESPONDENTS Above Average Average Below Average Don't Know Gasoline companies3% 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”
- 38. Planning for AgingWell Improving Physical and Mental Health Maintaining and building strong family and social networks Preparing housing and community to be “age- friendly” Technology
- 39. Technology • Incoming residentsand 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
- 40. Technology Ollo Wearable Voice activatedcell phone, sensors and GPS Broad for falls, cardiac monitoring etc
- 41. Technology GPS sneakers GPS embeddedin sneakers outfitted with a microcomputer with satellite tracking can find anyone 24/7 Broad implications for cognitive impairment
- 42. 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.
- 43. Planning for AgingWell 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
- 44. Fatality Rate byAge 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.
- 45. Planning for AgingWell 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
- 46. Plans “post-retirement” At DesiredRetirement 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.
- 47. Planning for AgingWell 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
- 48.
- 49. 49 Enjoy life tothe fullest!
Editor's Notes
- #7 Life expectancy has continued to increase for Canadians of both sexes since 1961. While life expectancy among women at age 65 remains greater than that for men, there is some evidence that this gap is beginning to narrow. While life expectancy is increasing for both men and women across Canada, there remain distinct populations who are not experiencing equal gains. For example, life expectancy among Inuit seniors is, on average, significantly lower than that for the general Canadian population. Although most Aboriginal Canadians continue to live in urban centres and have a diverse socio-economic profile, many First Nations, Inuit and Métis communities are located in geographically isolated areas and have higher levels of poverty than other areas of Canada. In 2000–2001, men age 65 and older in the highest neighbourhood income could expect to live 1.1 years longer than senior men in the lowest tercile. In contrast, senior women from the wealthiest neighbourhoods did not live longer than their counterparts in the poorest neighbourhoods. In fact, they lived 0.2 years less on average
- #17 Keeping in mind that seniors account for just 14 percent of the Canadian population, consider: Seniors account for about 45% of all provincial and territorial government health spending. 40% of acute hospital stays were for patients 65 and older. Seniors are more likely to visit family doctors frequently—10 times a year or more. Seniors consume more publicly funded prescription drugs than younger adults. Seniors dominate among home care, residential care and hospital-based continuing care clients.
- #19 Seniors have significantly higher rates of emergency department (ED) use compared to their younger counterparts. They are also more likely than younger adults to seek care at EDs for conditions considered sensitive to ambulatory care, meaning conditions that can often be successfully managed in community settings. Seniors also have longer lengths of stay in ED, often waiting for inpatient beds to become available. Hospitalization rates for all ambulatory care sensitive conditions (ACSC’s) were higher in 2009-2010 for seniors compared to younger adults. Hospitalization rates for congestive heart failure and chronic obstructive pulmonary disease are considerably higher. This is largely driven by the high rates of hospitalization for these conditions among those 85 years of age and older. Notes on figure: Excludes cases where death occurred before discharge. Source: Hospital Morbidity Database, 2009–2010, Canadian Institute for Health Information.
- #20 More than half of seniors on public drug programs regularly use prescription drugs to treat two or more chronic conditions; in 2009 a quarter of seniors had claims for drugs to treat three or more conditions. In 2009: About two-thirds (63%) of seniors on public drug programs in six provinces were claiming five or more drugs from different drug classes Nearly one-quarter (23%) had claims for 10 or more. 5 of the top 10 drug classes used by seniors were for the treatment of high blood pressure or heart failure. These drugs are used by 65% of seniors. Note on Figure * The six provinces submitting data to the National Prescription Drug Utilization Information System Database as of March 2011: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and P.E.I. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.
- #21 Both the number of different medications (poly-pharmacy), and the specific medications seniors take can present challenges. For example: In 2009, roughly 1 in 10 was taking a drug that was potentially inappropriate for seniors (i.e. from the Beers list). Rates ranged from 11% in Alberta to 16% in New Brunswick. Note on Figure * The six provinces submitting data to the National Prescription Drug Utilization Information System Database as of March 2011: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and P.E.I. Source National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information.
- #23 A variety of factors including cognitive or physical decline, challenges with instruMental activities of daily living, and lack of informal support or increasing caregiver distress may precipitate a senior’s move to residential care. From 1981 to 2006, rates of institutionalization among seniors have declined: 1981: 3% of those between age 65 and 74, and 17% of those 75 and older lived in a special care facility -2006: 1.4% of those between age 65 and 74, and 12% of those 75 and older lived in a special care facility But, since 2004, the level of care provided to seniors in residential care has increased. Compared to seniors living in the community and receiving home care, seniors in residential care are more likely to be older (85+ years), unmarried and functionally dependent. Notes on table: * Includes Ontario, Nova Scotia and Yukon. † Includes a sample of residential care facilities in Newfoundland and Labrador, Nova Scotia, Ontario, Manitoba, Saskatchewan, British Columbia and Yukon. Sources Home Care Reporting System and Continuing Care Reporting System, 2009–2010, Canadian Institute for Health Information.
- #24 Alternate Level of Care (ALC) stays primarily affect seniors, with nearly 85% of ALC patients in 2009-2010 being aged 65 or older, and many (35%) aged 85 and over. Seniors designated ALC are most commonly waiting for placement in long term care (LTC) homes (47%). Palliative care numbered among the top conditions for which seniors were hospitalized in 2009-2010. Approximately half (48%) of the almost 110,000 adults who died in acute care hospitals in 2009-2010 were receiving palliative care; eight out of every 10 were seniors. Notes on figure: Excludes obstetrical cases, stillbirths, cadaveric donors and records with an invalid health care number. Source: Hospital Morbidity Database, 2009–2010, Canadian Institute for Health Information.
- #41 The GPS sneakers are designed by Isaac Daniel Footwear Known as the Compass Sneaker The model you have is the prototype for seniors with Velcro enclosures The GPS technology allows you to find a missing resident or a resident to send a help signal if lost. Features a Panic Button which is pushed by the wearer if they are lost or in crisis. Signal is sent to the company’s monitoring station and staff notifies the authorities of location of the sneaker. You can locate someone who is missing by calling the monitoring station with the unique id number given to each sneaker. They then activate its signal to find the sneaker location. You can not track anyone without going through the company’s monitoring system The sneaker will cost about $325 per pair plus a $20 per month monitoring fee. They will be on the market in the next few months The cancel button and alarm buttons are the little buttons on the left side of the shoe. The big button with the logo is the GPS unit The battery and program is on bottom of shoe One of the target markets for the sneaker is senior housing. They are exploring technology that would work for a community. There would be a perimeter around the building and all residents would wear the sneakers and the community would be notified if anyone left the perimeter of the GPS zone. Much like the Invisible Fence concept but they would not be shocking seniors.
- #42 The GPS sneakers are designed by Isaac Daniel Footwear Known as the Compass Sneaker The model you have is the prototype for seniors with Velcro enclosures The GPS technology allows you to find a missing resident or a resident to send a help signal if lost. Features a Panic Button which is pushed by the wearer if they are lost or in crisis. Signal is sent to the company’s monitoring station and staff notifies the authorities of location of the sneaker. You can locate someone who is missing by calling the monitoring station with the unique id number given to each sneaker. They then activate its signal to find the sneaker location. You can not track anyone without going through the company’s monitoring system The sneaker will cost about $325 per pair plus a $20 per month monitoring fee. They will be on the market in the next few months The cancel button and alarm buttons are the little buttons on the left side of the shoe. The big button with the logo is the GPS unit The battery and program is on bottom of shoe One of the target markets for the sneaker is senior housing. They are exploring technology that would work for a community. There would be a perimeter around the building and all residents would wear the sneakers and the community would be notified if anyone left the perimeter of the GPS zone. Much like the Invisible Fence concept but they would not be shocking seniors.
- #43 The car in the picture is known as Miss Daisy from the movie Driving Miss Daisy The goal is to enable older adults to drive safely for as long as possible It has systems that help to improve vision Has warning systems for merging and left turns It is called the Aware Car because it has systems in place that are designed to make seniors more aware and safer on the road