The process of aging well is yours to control. Learn the pest practices from Dr. John Puxty, Gerontologist, about finance, health care, meds, in-home care and downsizing.

1. Age Well – Your Choice
Dr. John Puxty
puxtyj@providencecare.ca

2. Presentation Outline
Popular images of Aging
Why prepare for life beyond 65
Strategies for successful aging

3. Longevity in 19th
Century
Jane Austin
Out-lived sisters,
friend and cousins
Died at 42 years of
age!

4. 4
Jeanne Calment lived to 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 at Age 65 in Canada

7. Composition of Population by Age groups
1971-2051
Sources
Statistics Canada 2010, population estimates, 1971 to 2010, and
population projections, 2009 to 2036.

8. New Norm
• Very old 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
• Very old 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 for 65 +?
• 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 you don't prepare?
• Increased probability of frailty and adverse outcomes
• Physical and Mental Frailty
• Social vulnerability
• Multiple chronic disease and polypharmacy

12. Canadian Study of Aging & 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 Institutionalization Avoidance
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 Survival based 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 you don'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 Users of 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 use is 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 Is a 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 you don'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 Residential Care 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 Aging Well
• Improving Physical and Mental Health
• Modify diet: reduce meat increase vegetables, tofu
and beans

26. Planning for Aging Well
• 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 Aging Well
• Improving Physical and Mental Health
• Modify diet: reduce meat increase vegetables, tofu
and beans
• Regular low-intensity activity
• Reduce risky behaviours

28. Planning for Aging Well
• 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 Disease Management
Customize “best practices” based on patient goals and
life expectancy

30. Improving Chronic Disease Management
Customize “best practices” based on patient goals and
life expectancy
Seek to avoid polypharmacy (deprescribing)

31. Is it feasible and 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 Disease Management
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 Aging Well
Improving Physical and Mental Health
Maintaining and building strong family and
social networks

34. Planning for Aging Well
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
Outdoor spaces 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 “Age Friendly”
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 companies 3% 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 Aging Well
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 residents and 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 activated cell phone, sensors and GPS
Broad for falls, cardiac monitoring etc

41. Technology
GPS sneakers
GPS embedded in 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 Aging Well
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 by Age 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 Aging Well
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 Desired Retirement 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 Aging Well
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. www.sagelink.ca

49. 49
Enjoy life to the fullest!