Appendix A: Small Group Work - Suggested Strategies

[Previous] [Table of Contents]

In small groups, workshop participants were asked to identify five priority areas for action and for each priority:

• indicate what you are trying to achieve (overall objective)
• identify key partners/stakeholders who need to be involved.

 

A.1 Injury Prevention

Priority: Disseminating the knowledge we have accumulated to seniors, the general public, families and caregivers through a variety of channels (e.g. seniors community centres, mass media).

Strategic direction: public awareness and education.

Overall objective: to increase the general public's knowledge and awareness of unintentional injury among seniors.

Key partners: a high-profile spokesperson, general public (e.g. seniors, caregivers, families), media, professional groups, specific interest groups (e.g. farm injuries, Aboriginal, seniors with disabilities), all levels of government, advocacy groups, injury prevention groups, seniors organizations, VON (Victorian Order of Nurses), VAC (Veterans Affairs Canada), insurance industry, emergency services (e.g. fire department, ambulance), funding bodies, Canadian Standards Association, the SmartRisk Foundation, Canadian Health Network, geriatric nurses, building trade (building codes), building inspectors, product manufacturers, surveillance, CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program).

Other comments: The group discussed the need for positive images of aging, to replace a lot of the negative images seen by the general public, seniors, caregivers, health professionals and families. The group felt this was an important part of raising awareness. The group also spoke about the need for a high-profile spokesperson to draw attention and research dollars to the issue. This spokesperson would also help to address some of the negative images of aging that are entrenched in our society.

The group discussed the possibility of combining efforts when delivering injury prevention messages to seniors. Some examples included linking the dissemination of information to seniors through the flu shot campaign, existing health fairs, pancake breakfasts in communities, etc.

The issue of priority being given to youth and workplaces (with the exception of farms) was also raised as a concern and a barrier for moving forward.

The group addressed the need to ensure that the diversity among seniors' needs and abilities is always taken into consideration.

Priority: Develop broader networks of injury prevention programmers and researchers by connecting groups and organizations working on injury prevention.

Strategic direction: public policy and legislation/community action.

Overall objectives:

• to increase leadership and coordination in the area of unintentional injury among seniors
• to translate and disseminate accessible information.

Key partners: a high-profile spokesperson, general public (e.g. seniors, caregivers, families), media, professional groups, specific interest groups (e.g. farm injuries, Aboriginal, seniors with disabilities), all levels of government, advocacy groups, injury prevention groups, seniors organizations, VON (Victorian Order of Nurses), VAC (Veterans Affairs Canada), insurance industry, emergency services (e.g. fire department, ambulance), funding bodies, Canadian Standards Association, the SmartRisk Foundation, Canadian Health Network, geriatric nurses, building trade (building codes), building inspectors, product manufacturers, surveillance, CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program).

Other comments: The group discussed the apparent gap in policy regarding seniors in general. There was a great deal of discussion around the lack of awareness of seniors' issues and the group identified that a link to seniors themselves is missing.

The idea of linking into the Romanow Commission was raised as one way to identify the need to make the prevention of seniors' unintentional injuries a priority issue.

Priority: Involve industry partners (e.g. product manufacturers, building trades, building inspectors) in developing senior-safe products (e.g. oxygen pack, telephones, stoves, pill bottles, ATM machines, assistive devices). Address stereotyping and ageism among health professionals, institutions and caregivers.

Strategic direction: professional information and education/public policy and legislation.

Overall objectives:

• to increase awareness of seniors' unintentional injuries among professionals
• to develop senior-friendly environments.

Key partners: a high-profile spokesperson, general public (e.g. seniors, caregivers, families), media, professional groups, specific interest groups (e.g. farm injuries, Aboriginal, seniors with disabilities), all levels of government, advocacy groups, injury prevention groups, seniors organizations, VON (Victorian Order of Nurses), VAC (Veterans Affairs Canada), insurance industry, emergency services (e.g. fire department, ambulance), funding bodies, Canadian Standards Association, the SmartRisk Foundation, Canadian Health Network, geriatric nurses, building trade (building codes), building inspectors, product manufacturers, surveillance, CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program).

Other comments: One of the group members raised the idea of introducing a seniors' council of reviewers. This idea has been developed in the United States and is called "1000 elders." The council is a market-testing group that reviews products which target seniors as an audience. The council can approve the product with "1000 elders seal of approval." This essentially labels the product as senior friendly.

The group also discussed the conflicting safety needs of children and seniors. Examples, such as pill bottles and stoves, were discussed. The group discussed the complexity of introducing assistive devices or technologies into the home. One member spoke of the difficulty in putting up grab bar rails. She mentioned that the placement of the grab bar rail depends on many factors, including the nature of the disability, the size of the person, the location of the wall studs, etc.

Priority: Conduct research (e.g. attitudes of seniors regarding unintentional injury prevention, precursors to fall injuries, what works and what does not). Data collection and surveillance resources are also required.

Strategic direction: knowledge development.

Overall objective: to increase our knowledge regarding unintentional injuries and seniors.

Key partners: a high-profile spokesperson, general public (e.g. seniors, caregivers, families), media, professional groups, specific interest groups (e.g. farm injuries, Aboriginal, seniors with disabilities), all levels of government, advocacy groups, injury prevention groups, seniors organizations, VON (Victorian Order of Nurses), VAC (Veterans Affairs Canada), insurance industry, emergency services (e.g. fire department, ambulance), funding bodies, Canadian Standards Association, the SmartRisk Foundation, Canadian Health Network, geriatric nurses, building trade (building codes), building inspectors, product manufacturers, surveillance, CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program).

Other comments: What we have learned about preventing falls in seniors can be applied to the prevention of other unintentional injuries among seniors. There is currently a great deal of "pooling" of researchers across the country. It is crucial that there be appropriate representation of those knowledgeable about injury prevention among seniors included in collaborative initiatives.

Group members discussed the need to capture important unintentional injury information in emergency rooms, doctors' offices, walk-in clinics, institutions, etc. This information needs to be shared with researchers and then translated and disseminated to programs. CHIRPP collects and analyses data on the circumstances of injuries treated at the emergency department and the group discussed the need to broaden CHIRPP from the current 10 hospitals, of which seven represent children. The group agreed with the background paper that since most of the hospitals are pediatric hospitals, the current capacity for surveillance of seniors is insufficient.

Overall

In summary, the group would like to implement a multi-strategy approach that includes:

• raising awareness
• community development
• research
• networking
• evaluation and dissemination.

Overall objectives for this strategy are to:

• prevent injuries, not just falls
• influence partners to raise money
• support community programming
• create links between researchers and programmers, policy makers and research funders
• influence policy.

Health Canada's role in this approach would be to:

• provide leadership in policies, programming and knowledge development
• coordinate efforts
• provide resources (money and people).

A.2 Nutrition

Priority: Surveillance

There is a lack of data about nutrition intake for all Canadians, including specific information relating to seniors. The prevalence of malnutrition in institutional settings may be as high as 65%. People in community care situations are also not receiving adequate nutrition services, particularly those who are in their own homes. This can be especially true for those in remote areas and, in particular, in jurisdictions where home care services have been reduced.

Strategic direction: knowledge development.

What we should be trying to achieve: A survey that addresses all segments of the seniors' population, including those in community living situations and both formal and informal home care. It should also take into account cultural differences, as the current Canadian standards are not applicable to all groups (e.g. some groups may have a smaller bone mass and require smaller dietary intakes).

Key partners and stakeholders: Health Canada needs to make the decision to fund and carry out a national survey. Other stakeholders include the National Academy of Science and groups representing different cultures.

Priority: Access to good quality food in institutions and in the community.

Seniors are often alone and on the fringes of the community. If they become aware of something and are enticed to try something new, they can become interested. However, this will not be achieved by young people simply delivering messages, such as take your multivitamins, don't forget your cane when you go out, etc. This is patronizing and does not make the intended actions appealing.

The social aspect of food is often missing in the lives of seniors. Social isolation leads to a lack of interest in nutrition, and poor eating habits. Eating is enhanced in a social environment.

Strategic directions:

• public awareness and education
• public policy and legislation
• community action
• professional information and education.

What we should be trying to achieve:

• Interest seniors in good quality food and make it available in institutions and in the community, including balanced, appropriate portions in restaurants; balanced, appropriate portions in prepackaged frozen foods in supermarkets (that are easy to prepare and easy to open); fresh, tasty meals delivered to homes.
• Provide transportation to restaurants, supermarkets, etc.
• Make eating a social occasion for seniors.
• The quality, portions and appropriateness (including cultural appropriateness) of food delivered by groups such as Meals on Wheels should meet some standards. Key partners: restaurants, supermarkets (e.g. Loblaws), long-term care institutions and hospitality organizations.

Priority: Changing attitudes.

The attitudes of society at large, professionals and seniors themselves need to change around seniors and physical activity, nutrition and prevention. To do this, we need a better understanding of motivations for change. For example, one of the seniors in the small group discussion uses meditation (which he does in a group setting) to help keep himself motivated.

Societal attitudes

Because we live in a capitalistic society that values economic productivity, seniors (who are retired) find themselves at the fringe and feel undervalued. Asian nursing homes in Toronto were cited as an example of successful long-term care facilities where the residents enjoy a high quality of life. This was attributed to the fact that in Asian cultures seniors are seen as valuable members of society, and are valued for their wisdom.

Seniors

Older people need to believe it is never too late to change their habits and start eating well, exercising, etc.

Professionals

This group also needs to re-evaluate its attitudes toward seniors and respect the expertise of seniors themselves.

Strategic directions:

• public awareness and education
• community action
• professional information and education.

What we are trying to achieve: A change in attitude. Seniors need to alter a pervasive belief that health practices cannot be reversed. Many of them feel it is too late to change. Messages should be developed specifically for seniors and be realistic (not focus on recapturing youth). An approach should be developed that does not rely only on messages being passed from the top down. Discussions should be community-based and include seniors as well as professionals.

Key partners and stakeholders:

• seniors
• all of society
• health professionals.

Other: This priority is linked with dissemination.

Priority: Screening.

This priority is linked to and is a follow-up from surveillance. Screening measures are needed for institutions, individuals and the community.

Strategic directions:

• public policy and legislation
• professional information and education
• knowledge development.

What we should be trying to achieve:

• Develop appropriate screening tools (including those that are culturally appropriate) to identify those who are at risk.
• Develop proper dietary intake recommendations for seniors.

Key partners and stakeholders: the community, institutions, cultural groups.

Priority: Dissemination.

This is the element which links research with practice. It is essential that knowledge learned from surveillance and screening lead to action.

Canada's Physical Activity Guide has been adapted for seniors, but food guides have not been.

Strategic directions:

• professional information and education
• knowledge development.

What we should be trying to achieve:

• Act on the information gleaned from surveillance and screening.
• Define appropriate intakes and develop culturally appropriate tools in various languages.
• Adapt existing food guides (such as Canada's Food Guide to Healthy Eating) for seniors, and make them culturally appropriate.
• Build partnerships to successfully disseminate information.

Overall

All of the priorities touch on all of the strategic directions. The proposed priorities should build on what has already been done. A link should be made with the policy report Nutrition for Health: An Agenda for Action, 1996 which has already been adopted by the federal government.

A group should be formed with knowledgeable individuals at the community level to link with existing initiatives and identify concrete actions. Best practices should be gathered and shared.

A list of government-funded programs and services already exists that can be consulted and used as a starting point. A consultation is currently under way regarding healthy aging and ethnic seniors. About 350 interviews have been held with seniors from different cultural backgrounds across the country. The result will be a compilation of programs and services for seniors from different cultural groups across the country.

If a strategy is being developed to deal with aging and health, it is important that all the determinants of health be incorporated. It must be a holistic piece. The spiritual side of nutrition (and other issues) should not be forgotten.

A.3 Smoking Cessation

Priority: Provide positive reinforcement for smoking cessation, using seniors as role models and in targeted media campaigns.

Strategic directions:

• public awareness and education
• community action.

What we should be trying to achieve: There was an overall feeling that the "it's never too late to quit" campaign evokes a negative reaction as it does not address the benefits of quitting smoking. This campaign seems to suggest that smoking must be avoided, but does not provide alternatives for equally pleasurable activities.

The benefit message needs to outweigh the "pleasure" factor associated with smoking. The health implications alone are often not a factor, especially in long-term smokers (a feeling of having already beat the odds), until the individual is presented with an actual compromise in health related to smoking (e.g. emphysema).

A suggested improvement in promoting the benefits message is to include peer groups, for example in group home environments, where other seniors give personal testimonials of how they quit smoking and how it has enhanced their lives. Seniors who do quit smoking also have a higher success rate than the general population; therefore, information dissemination needs to focus on the targeted senior-related data.

Media campaigns are currently focused on "don't start" campaigns for youth. Focus also needs to be placed on successful quitting campaigns for seniors, as these two groups have very different experiences and attitudes toward smoking. There is a need to make seniors more "visible" in media campaigning.

Campaigns may also use the "love" factor; looking at the effects of seniors' smoking habits on their loved ones (e.g. spouses, grandchildren). This approach may not be as effective, however, for seniors living alone or who use smoking as a social activity among friends and family.

Stakeholders: CARP (Canadian Association of Retired Persons), Health Canada, long-term care facilities, tobacco control groups, family members, senior peer groups.

Priority: Incorporate smoking cessation benefits messages into other related health campaigns that focus on seniors.

Strategic direction: public awareness and education.

What we should be trying to achieve: Include discussions of the positive effects that quitting smoking have on other related health problems, such as diabetes and heart disease.

Smoking can also be related to safety campaigns with respect to personal injury and property damage from fire as a result of careless smoking.

Key partners and stakeholders: Canadian Security Council, Health Canada, community-based health promotion groups.

Priority: Increase the role of health care practitioners in promoting successful smoking cessation in seniors.

Strategic direction: professional information and education.

What we should be trying to achieve: Encourage health care professionals to regularly address smoking cessation programs and strategies with seniors (teachable moments). Provide health care practitioners with resources pertaining specifically to seniors and tobacco use to support this initiative.

A suggestion was also made to include warnings on medication, similar to alcohol warnings, if use of tobacco with the medication can alter the medication's efficacy.

Stakeholders: physicians, nurses, public health nurses, pharmacists, health care workers dealing directly with seniors.

Priority: Conduct a systematic review of best practices and of intervention evidence specifically related to older smokers.

Strategic direction: knowledge development.

What we should be trying to achieve: A continual review of best practices is needed to provide new evidence and to reinforce existing evidence of the benefits of smoking cessation for seniors. A systematic review is also needed to provide evidence for the difference in success rates among various intervention programs for seniors.

There is a large amount of clinical data on smoking, but it has not yet been analyzed for age- related trends. This was a suggested next step.

Key partners and stakeholders: Health Canada, tobacco control groups, health researchers and professionals.

Other discussions: Many of the other priorities this group discussed focused around education and increasing public awareness. The group came up with several ideas dealing with education. They were:

• Target messages toward seniors in promotional materials.
• Education and promotional material should focus on motivating seniors to quit smoking. Older Canadians are more successful in quitting when they decide for themselves.
• Include seniors in anti-smoking campaigns and increase the visibility of smoking concerns relating to seniors.
• Professional information should be provided by physicians, nurses, public health workers and pharmacists.
• The group also felt there was a gap in the area of knowledge development, particularly the differences between older and younger smokers. If they do not exist, evidence-based guidelines of best practices for helping seniors quit should be developed.

A.4 Physical Activity

Priority: Form a seniors' advocacy group to ensure senior representation and input on matters pertaining to physical activity, or strengthen existing seniors' coalitions. Get seniors on agendas at conferences, meetings and other discussions, and give them the opportunity to provide input on physical activity opportunities and programs that meet their needs.

Strategic direction: community action.

Overall objective: to provide a stronger voice for seniors on physical activity in Canada.

Key partners: national seniors' organizations, Canadian Association on Gerontology, ALCOA (Active Living Coalition for Older Adults).

Priority: Get physicians to routinely ask patients about their level of physical activity when they come in for an appointment, and refer them to community resources.

• Need to provide increased education to physicians and other health care professionals, perhaps through involvement in university curriculum, so they will have the knowledge and tools they need to provide basic guidance and advice to patients on physical activity.
• Build bridges between physicians and the network of experts in physical activity. Interface may have to start with professionals in the community who offer wellness- consulting skills. For example, in Yukon there is a pilot project in which physicians provide patients with prescriptions for physical activity.
• Advocate use of Canada's Physical Activity Guide for Older Adults as a tool for all professionals.

Strategic direction: professional information and education.

Overall objective: to ensure that physicians express interest in patients' physical activity level to raise awareness of the importance of physical activity and to inform seniors of physical activity opportunities.

Key partners: College of Family Physicians of Canada, Canadian Nurses Association, Canadian Medical Association.

Priority: Make Canada's Physical Activity Guide for Older Adults more readily available to seniors in their communities and have knowledgeable people available to explain and interpret it.

Strategic direction: public awareness and education.

Overall objective: to use available tools more effectively to empower seniors to be more physically active.

Key partners: Health Canada, Victorian Order of Nurses, more than 60 Canadian physical activity guide endorsers.

Priority: Offer tax rebates and seniors' discounts for exercise equipment and fitness club memberships, and give insurance discounts to those who are physically active. Make exercise equipment available for use in public spaces (e.g. shopping malls, waiting areas, airports, libraries, community centres, federal and provincial offices).

Strategic direction: public policy and legislation.

Overall objective: to reduce financial barriers to physical activity and establish a reward system for those who are physically active.

Key partners: Revenue Canada, Sporting Goods Manufacturers Association, recreation facilities, insurance companies.

Priority: Use television programs and commercials to provide older adults with messages about physical activity and how it is fun and beneficial, as well as to involve them in physical activity while they are watching television.

Strategic direction: public awareness and education.

Overall objective: to mobilize people in their homes and communities.

Key partners: television stations, Heart and Stroke Foundation and other health organizations, ALCOA, corporate partners.

Other priority areas:

• Increase funding to, revamp and increase social marketing of major physical activity.
• Ensure consistent use of terminology and messaging (i.e. physical activity instead of physical fitness). Refer to Canada's Physical Activity Guide.
• Improve collaboration between the federal government and community groups by sharing information and reducing overlap among initiatives.
• Reduce safety concerns related to physical activity among seniors through all messaging, and by creating safe conditions in which seniors can participate in physical activity (e.g. ensuring streets are cleared of snow and ice).

A.5 Overall Strategies

The fifth group looked at the four main issue areas being discussed at the workshop to identify priority areas and suggest strategies that could have an impact on healthy aging as a whole. These priorities were then grouped by strategic direction.

Public Awareness and Education

Suggestions regarding public awareness and education included:

• Seniors are not feeling supported due to a lack of information and/or a lack of effective dissemination and accessibility.
• Many seniors are fearful of doing exercise after the age of 70.
• Ageism must be exposed. We live in a youth-oriented society and research must examine the impact of ageism on people's perspective on aging.
• Seniors need to be involved in all awareness and education initiatives dealing with healthy aging, especially at the strategic planning level.
• We need to avoid homogenizing seniors; they require tailored strategies for particular needs of various subgroups. For example, the level of seniors' disability/functional capacity determines needs – some seniors are well, others are frail, others are institutionalized.
• Complacency in seniors regarding health matters must be confronted. We need hard-hitting information to break through ignorance, complacency and denial.
• Accessibility is a key issue. Seniors often cannot afford to stay active or are unable to get to seniors centres.
• Many programs are run by volunteers and the volunteer base is shrinking.
• Government needs to put money into healthy aging programs. Sustainability of money for seniors programs has been a problem.

Public Policy and Legislation

The group felt that the issues surrounding public policy and legislation should be examined with the following slogan in mind: "Go big or go home." This slogan referred to the need to make meaningful policy changes or do nothing. There was consensus among the group that hard resources should be allocated to areas of need, from basic survival to self-actualization. The group established that there is a need for a national "Blueprint on Aging." This could include:

• Cabinet-level representation
• reinstating a federal Minister of State for seniors
• an "Older Canadians Act"
• paid staff/incentives for volunteers
• affordable housing for seniors
• 1% of pharmaceutical profits to go to healthy aging
• rebirth of "ParticipACTION" program
• financial incentives (e.g. tax breaks) for healthy living.

Community Action

• There is a need for more involvement and empowerment of seniors.
• There is a lack of care centres or affordable places to go to that are not just drop-in centres, preferably where someone is available to talk with seniors.
• Seniors who are highly visible should advocate for seniors' issues.
• Address the lack of funding for coordination of grassroots effort.
• Make better use of university/college programs, including collaboration between schools and community.

Professional Information and Education

• Health and social aspects of aging needs to be part of the core curriculum in postsecondary education. Currently, healthy aging is conceived as an "add-on." It should be built-in training for doctors, nurses and other health professionals.
• Healthy aging needs to be put on the agenda of professional organizations to lobby and prepare practitioners.
• Mobilize links between professionals and caregivers (e.g. children and spouses).
• Ensure that health care professionals are aware of seniors' issues.
• Facilitate in self-help; offer incentives to professionals to assist.
• Mental health is a priority: seniors cannot eat well or exercise if depressed; bereavement help is hard to find in rural communities and should be made available.

Knowledge Development

• Funding for research projects could be contingent on seniors' involvement, knowledge transfer and "marketing" of knowledge gained.
• Include seniors as part of research team and in planning and dissemination.

Other Discussion

• Healthy aging should not be seen as separate, but should be part of the whole health care system.
• Useful trichotomy is: well seniors; frail seniors; institutionalized seniors.
• Healthy aging is everyone's business.
• Some seniors need to learn how to communicate better; must ask questions and demand answers.

 

[Previous] [Table of Contents]