1. Setting the Stage

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• About This Paper
• How Old is Older?
• What Does the Older Population Look Like?
• What is Healthy Aging?
• How Healthy are Older Canadians?

About This Paper

Purpose

Canada is undergoing an unprecedented demographic shift that brings healthy aging to the forefront of the social policy agenda. This paper describes a strong new vision for healthy aging in Canada and suggests five key focus areas for action (the what). It provides the rationale and evidence for investing in healthy aging (the why). Lastly, it describes a framework for action and suggests some key opportunities for moving ahead (the how).

Structure

The paper is divided into three parts:

Part I: Introduction provides some background information about seniors and their health, describes a new vision for healthy aging and makes the case for investing in

healthy aging now.

Part II: Key Areas of Focus summarizes what we know and don't know, and suggests the implications for policy and practice in five key areas of focus: social connectedness, physical activity, healthy eating, falls prevention and tobacco control.

Part III: Achieving the Vision suggests a framework for taking action to achieve the vision and suggests some possible steps for moving forward.

Appendix A provides additional information on some-but certainly not all- existing opportunities that can be built on.

Promising practices are described throughout the text, and "Spotlights" are used to provide information about selected programs and groups. Appendix B provides some additional examples.

Audience

This paper is written for people who develop, influence, and implement policies and practices that affect the well-being of Canadians aged 65 and over. These include ministers responsible for seniors and other government decision-makers at all levels and in a variety of sectors; the nongovernmental sector (including seniors' groups); service providers in health, recreation, housing and social development; and older Canadians themselves.

Foundations and Limitations

This paper builds on several strategic planning initiatives undertaken by the F/P/T Ministers Responsible for Seniors and draws on the substantial work already underway in many different jurisdictions. The evidence quoted in this paper comes from reliable sources. Wherever possible, it is drawn from meta-analyses and consensus summaries.

This paper does not provide a comprehensive inventory of existing programs and policies, but concentrates on an analysis of promising options that can be applied in different jurisdictions and through collaborative mechanisms.

While recognizing that healthy aging is dependent on many determinants (including income security, education, etc.), this paper concentrates on five key issues in healthy aging: social connectedness, physical activity, healthy eating, falls prevention and tobacco control. In May 2005, the F/P/T Ministers Responsible for Seniors endorsed these five issues as key determinants of healthy aging, based on their impact on seniors health, the availability and effectiveness of interventions, the costs associated with treatment for health problems associated with these factors and their potential to reduce health inequities.

How Old is "Older"?

Chronological age can be a poor predictor of the growth and declines that are associated with aging. Indeed, studies show that a privileged, active 70-year old man with a healthy weight can have the cardiovascular capacity of an inactive, overweight man who is 10 to 15 years younger (Shephard, 1998). On the other hand, consistent age-based criteria are required for data collection and policy development.

This paper uses the terms "senior", "older person" and "older adult" to describe someone who is age 65 and over. However, this age group is far from homogeneous.

What Does Canada's Older Population Look Like?

In Canada, "seniors" are typically described as all men and women age 65 and over. In fact, this large and growing population is a highly diverse group. Women and men experience aging in different ways. Clearly, there are significant differences between life at age 65, compared to age 75 and 85-plus. These age groups are also heterogeneous, reflecting diverse values, educational levels and socioeconomic status.

Aging may also reflect levels of independence and dependence. Most older Canadians (over 90 percent) live independently in the community and want to remain there. This will require a shift in priorities away from treatment and acute care toward health promotion, prevention, healthy aging and community support.

Seniors who need long-term care can still benefit from healthy aging initiatives adapted to their needs, strengths and interests (Health Canada and Pan American Health Organization, 2002). Currently, only 7 percent of seniors live in long-term care facilities, although this increases to 14 percent for those over age 75. This proportion is expected to grow as the number of very old (80-plus) seniors continues to increase (National Advisory Council on Aging (NACA), 2005b).

Canada is in a unique position, due to immigration and Aboriginal Peoples, in terms of ethnic, racial and linguistic diversity among the older population. Immigrant and Aboriginal seniors offer a valuable resource to Canadian society and should be encouraged to be active participants at all levels of organizations and initiatives that focus on healthy aging.

What is Healthy Aging?

"Health" refers to physical, mental and social well-being; therefore, policies and programs that promote mental health and social connections are as important as those that improve physical health status. Health is seen as a positive resource for everyday living, not the objective of living or the absence of disease (World Health Organization (WHO); Canadian Public Health Association; Department of Health and Welfare, 1986). This goal aims to optimize the well-being of all Canadians as they age, including those who are frail, disabled and in need of care.

Promoting good mental health is increasingly recognized as a priority in policy and program development for seniors. By working to increase self-efficacy, self-esteem, coping skills and social support, mental health promotion empowers people and communities to interact with their environments in ways that enhance emotional and spiritual strength. It fosters individual resilience and mutual aid. Mental health promotion also challenges discrimination against those with mental health problems and fosters respect for culture, equity, social justice and personal dignity.

Policies and interventions to promote healthy aging also need to pay particular attention to the links between mental health and other factors. For example, depression following the loss of a loved one or as a result of chronic pain may lead to poor nutrition and visa versa (i.e., unhealthy eating can lead to depressed feelings).

Maintaining independence as one grows older is a key objective for both individuals and policy makers. Dependency is highly related to the presence of chronic conditions and pain (Gilmour and Park, 2006). This suggests that supporting activities and choices that help seniors delay and manage chronic diseases and pain (such as appropriate physical activity) may reduce dependency associated with chronic conditions, and ultimately enhance seniors' ability to continue living in the community.

In light of this holistic understanding of health, healthy aging is defined as follows:

Healthy aging is "a lifelong process of optimizing opportunities for improving and preserving health and physical, social and mental wellness, independence, quality of life and enhancing successful life-course transitions" (Health Canada, 2002). This definition takes a comprehensive view of health that includes physical, mental, social and spiritual well-being. How Healthy are Older Canadians?

Today, men who survive to age 65 can expect to live an additional 17.4 years; women can expect an additional 20.8 years (Statistics Canada, 2005). The majority of seniors perceive that their health is generally good although the percentages with overall good health, good functional health and independence in activities of daily living declines sharply with age (Figure 1.1). Men are more likely (59 percent) than women (52 percent) to have overall good health.

How Healthy Are Older Canadians?

Today, men who survive to age 65 can expect to live an additional 17.4 years; women can expect an additional 20.8 years (Statistics Canada, 2005). The majority of seniors perceive that their health is generally good although the percentages with overall good health, good functional health and independence in activities of daily living declines sharply with age (Figure 1.1). Men are more likely (59 percent) than women (52 percent) to have overall good health.

Figure 1.1 Percentage of People in Good Health, by Age Group, Household Population, Aged 65 and Over

Source: 2003 Community Health Survey. Shields M, Martel L. (2006). Healthy living among seniors. Health at Older Ages. Health Reports, 16, Supplement. Statistics Canada, www.statcan.ca/english/freepub

Poor health and disability in older age is largely a consequence of chronic diseases and conditions (such as problems with vision and hearing) and injuries resulting from falls. The majority of seniors living in the community (81 percent) have at least one chronic condition and 33 percent have three or more chronic conditions (compared with 12 percent of younger adults) (Gilmour and Park, 2006).

Chronic diseases are the result of a complex web of causation. Research has identified a number of interrelated factors that are associated with the development of a disease (Harvey et al, 2002). Figure 1.2 shows how three modifiable risk factors-unhealthy diet, physical inactivity and tobacco use-in combination with the non-modifiable risk factors of age and heredity, explain the majority of most chronic diseases. These risk factors are expressed through the intermediate risk factors of high blood pressure, raised glucose levels, abnormal blood lipids, and overweight and obesity. However, the underlying determinants of chronic diseases (the causes of the causes) are a reflection of the social, economic and physical environments that impact on health and healthy aging (WHO, 2005).

Figure 1.2 Causes of Chronic Diseases

Source: WHO (2005). Preventing Chronic Diseases: A Vital Investment

Aging is an important marker of the accumulation of modifiable risks for chronic disease. The impact of risk factors begins early in life and increases over the life course (WHO, 2005). Policies and strategies for chronic disease and injury prevention that create supportive environments for social engagement, enjoyable physical activity, healthy eating, safe living and non-smoking are highly costeffective and can have a positive impact on the health of all ages, and seniors in particular (Public Health Agency of Canada (PHAC), 2005a).

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