Foreward

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In November 2001, Health Canada's Division of Aging and Seniors convened experts, nongovernmental stakeholders and governmental representatives to a Workshop on Healthy Aging. The first part of the workshop, whose findings are available in a companion report, examined how key personal health practices contributed to healthy aging. The second segment of the workshop focussed on Diabetes and Seniors, and is the object of this report. A discussion of diabetes in a workshop on healthy aging is not surprising, considering the significance of the issue among older adults and the potential of controlling diabetes through healthy behaviours.

Over two and a half million Canadians are estimated to have diabetes, and seniors are one of the two populations most at risk of having the disease along with Aboriginal people. Type 2 diabetes (or adult-onset diabetes) is one of the most common chronic diseases affecting older Canadians. Approximately 10 percent of Canadian seniors have been diagnosed with diabetes, and it is estimated than an equivalent number have undiagnosed diabetes. The proportion of Canadians with diabetes increases significantly with age; for example, it is estimated that up to a quarter of Canadians aged 85 or older have diabetes, compared to 3 percent of adults aged 35 to 64. As well as the disease itself, the long-term complications of diabetes are serious among the senior population; for example, the rate of hospitalization of seniors with diabetes is 70 percent higher than for other seniors, and seniors with diabetes are twice as likely to have a cerebrovascular accident or myocardial infarction and fifteen times more likely to suffer amputation.

As could be expected, diabetes is a growing concern in the context of an aging population, and notably the rapid rise in the population of older seniors. In fact, it is estimated that the prevalence of seniors with diagnosed diabetes will increase by 44 percent over the next two decades. But this is not simply a consequence of the growth of the seniors population. This is also due in part to an increase in society of certain key risk factors associated with diabetes. Physical inactivity and unhealthy eating, leading to obesity, play a major role in the onset and progression of type 2 diabetes. As more and more Canadian adults are obese or inactive, more and more older adults are at risk of being diagnosed with diabetes in later life.

On the flip side, the onset of type 2 diabetes can be prevented or delayed through a healthy lifestyle, and persons diagnosed with diabetes can enjoy active and independent lives if they carefully manage their disease. Canadians of all ages can prevent or control diabetes, and prevent or delay the complications associated with diabetes such as heart disease, by adopting healthy lifestyles - for example, by learning more about diabetes, planning their meals, being physically active, maintaining a healthy weight and learning to reduce stress. Hence, healthy aging and the prevention and control of diabetes go hand in hand.

Health Canada describes "healthy aging" as:

Healthy aging considers the full range of determinants of health instead of concentrating on individual risk factors. Some of the most important contributors to healthy aging are personal health practices. Evidence shows that lifestyle becomes more important to health as people age, that healthy lifestyles can prevent or delay chronic diseases, and that older adults of all ages have the potential to improve their health and well-being through behaviour change. As well, lifestyle changes that reduce the risk of one disease will also reduce the risk or delay the onset of other diseases.

Health Canada has been active in the area of healthy aging since 1972, with the introduction of the New Horizons program. In the late 1990s, there was a need for renewed action and more focussed efforts. Health Canada's Division of Aging and Seniors undertook a series of internal studies and investigations to set priorities in the area of healthy aging. Working with issue specialists across Health Canada, the Division came to identify four key determinants that had the greatest potential for furthering healthy aging: healthy eating, injury prevention, physical activity, and smoking cessation. The Division of Aging and Seniors then sought to solicit the advice of experts and stakeholders on the development of an action plan on healthy aging, with a specific focus on the four areas noted above. In light of the link between healthy aging and the prevention and control of diabetes, notably in the areas of nutrition and physical activity, the Division decided to capitalize on the presence of key stakeholders and organize a follow-up event dealing solely with diabetes. An expanded, three-day Workshop on Healthy Aging was thus organized in November 2001.

During the first 1½ days, key stakeholders were convened to the Workshop on Healthy Aging: Aging and Health Practices featuring expert presentations and group discussions on physical activity, nutrition, smoking cessation and injury prevention. Prior to the workshop, participants were provided with background papers on the four issues as viewed through a healthy aging lens. Through their discussions, workshop participants developed a series of recommendations for action on healthy aging, identifying strategic directions, objectives and potential partners. The report from the Workshop on Healthy Aging: Aging and Health Practices, and the four background papers (revised with participant comments) are available as companion pieces to this report.

At the conclusion of this first part, key stakeholders were invited to attend the Workshop on Healthy Aging: Seniors and Diabetes. Of note, almost all participants in the workshop on diabetes also attended the workshop on health practices and benefited from the discussions of previous days. During the next 1½ days, participants built on the existing knowledge base on healthy aging - specifically physical activity and nutrition - to identify type 2 diabetes prevention strategies for seniors. After presentations on key facts about diabetes and notable diabetes initiatives, participants worked in small groups to identify potential strategies for action in diabetes prevention, and discussed together ways to increase the involvement of the seniors sector in initiatives and community projects addressing diabetes among seniors.

Health Canada is committed to continuing its work in the area of healthy aging, building on its experience and successes over the past thirty years. As it moves forward, Health Canada will be able to base its policy and program development on a stronger conceptual foundation, and place the greater emphasis on the four cornerstone issues of: physical activity, healthy eating, smoking cessation, and the prevention of falls and injuries. The guidance provided by the Workshop on Healthy Aging: Aging and Health Practices will be significant in framing the development of new Health Canada initiatives and interventions to improve the health and quality of life of older Canadians by promoting key personal health practices and creating environments that support healthy behaviours. Summaries of presentations and the results from discussions constitute the main elements of this report.

Through the Workshop on Healthy Aging: Diabetes and Seniors, Health Canada and the Division of Aging and Seniors received significant guidance on strategic directions for the development of a workplan that addresses diabetes prevention strategies among at-risk seniors and seniors with type 2 diabetes. The workshop also provided opportunities for participants to develop new linkages and partnerships with other stakeholders, and to integrate the knowledge and lessons learned from workshop discussions in their current activities or future projects. The Workshop on Healthy Aging: Diabetes and Seniors should contribute to the development, both by the federal government and non-governmental sector, of new community-based diabetes initiatives for seniors, featuring greater involvement of the seniors sector. Through the promotion of healthy aging and healthy personal practices such as healthy eating and physical activity, government and stakeholders can work together to foster the prevention and control of type 2 diabetes among seniors, thus enhancing the health and quality of life of older Canadians.

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