The Concept of Healthy Aging

Being free of disease or infirmity is not a requirement for Healthy Ageing as many older adults have one or more health conditions that, when well-controlled, have little influence on their wellbeing

Canada is ageing and by 2035, there will be more than 30% of the population will be 60 years and over. Are we ready?

The ageing of the Canadian population is characterized by:

• A decrease in the number of younger people, as a result of a lower birth rate.

• An increase in the number of people who are reaching old age due to the fact that more people engage in healthy lifestyles.

• A drastic increase in the number and proportion of the oldest old (i.e. individuals who are aged 85 and over), including an explosion of centenarians.

• An increase in the difference between the relative numbers of men and women, the latter representing the vast majority of the oldest.

The ageing landscape in Canada is increasingly characterized by diversity in individual trajectories, including a higher number of people working later in life, either by choice or by financial obligation.

Genetic makeup, epigenetic exposures, and, mostly, lifestyle choices, such as nutrition, physical exercise and cognitive stimulation, are known to be drivers of vitality in late life. Despite the diversity in the trajectories of ageing and in particular between women and men, the late years do allow for multiple opportunities, whether in relation to work, family time, further education, travel, entrepreneurship and community engagement.

As a result of lifelong adaptation and resilience, older individuals represent a source of invaluable wisdom that should be better integrated into all aspects of society. Older adults contribute massively to families and their communities through caregiving as well as volunteer activities. Health and wellness throughout our life trajectory and in the late years represent a central tenant of our Canadian values of happiness and fulfilment.

At the same time, multiple chronic conditions still characterize the health of older individuals and more than half (57%) of individuals aged 80 and over live with three or more chronic conditions, many of which are controlled by medication and/ or lifestyle. Moreover, frailty is a prevalent condition that affects up to 35% of older Canadians placing them at higher risk of disability, institutionalization and even mortality.

Frailty is particularly onerous in those aged 85 and older, reaching a prevalence of close to 50%. Frailty is associated with an increased risk of injuries due to falls, mobility disability, depression, and cognitive impairment. Cognitive impairment resulting in dementia is one of the most prominent and debilitating conditions for all older people and their caregivers, particularly among those in the oldest-old age group (more than 40% of individuals aged 85 and over are living with some form of dementia).

Despite these challenges, the vast majority of people aged 65 and over still live in private dwellings (92% for those aged 65 and over, and 68% for those aged 85 and over), while only a fraction (8% for those aged 65 and over, and 32% for those aged 85 and over) live in protected and /or long- term care facilities.

Nevertheless, the environment in which older Canadians live is not always supportive of health and wellness. There is a clear need for more age-friendly housing and communities in both urban and rural environments, as well as for more knowledge to address the issues of stigma and elder abuse, regardless of the form they may take (i.e. physical, emotional, psychological, or financial). Loneliness also represents a major challenge for many older individuals, especially within the oldest old age group.

Older people with health challenges represent an important proportion of health system users and associated costs. Unfortunately, the system is not equipped to deal with older individuals who have multiple chronic conditions, in particular as it relates to ensuring a coherent transition between the different components of the health system, especially in the last years of life.

Canada’s demographic landscape and ageing trajectory is characterized by an ongoing increase in the numbers of older people and even more of the oldest old. In order to optimize health and wellness in ageing, as well as adapted health and social interventions and health services that will support older individuals in their needs and diversity we will need the will, determination and luck.