Health Promotion and Healthy Aging

1. Health Promotion and Healthy Aging Presentation by Irving Rootman to SFU Class on Principles and Practices of Health Promotion September 20, 2010

2. Outline 1. What is “healthy aging”? 2. Why focus on healthy aging? 3. How healthy are older adults in Canada? 4. What are the determinants of healthy aging? 5. What are the barriers to healthy aging? 6. What are the contributions of Health Promotion?

3. 1. What is healthy aging?: • “minimal interruption of usual function,” whether or not disease or disability is present” (Minkler, et al., 2000) • “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).

4. 2. Why focus on healthy aging? 1. Canada’s population is aging faster than ever before 2. Older adults make a significant contribution to the richness of Canadian life and to the economy 3. Healthy aging can delay and minimize the severity of chronic diseases and disabilities in later life, thus saving health care costs and reducing long-term care needs 4. The evidence compels us to build on existing opportunities, to put in place interventions that are known to be effective, and to show leadership by supporting innovative approaches 5. Canadians of all ages believe that efforts to enable seniors to remain healthy and independent are “the right thing to do”.

5. 1. Canada’s population is aging faster • Currently, people aged 65+ make up about 13% of the population; by 2031, they will account for 25% of the population, and will consists of about 9 million people (Statistics Canada, 2005) • Older Canadians are living longer and with fewer disabilities then previous generations but the majority have at least one chronic disease or condition

6. 2. Older adults make a contribution • In 1998, some 42 percent of Canadians aged 55-64 and 44 percent of Canadians over 65 spent an average of 2.2 hours a day as volunteers. The economic value to our communities is thought to be $60.2 billion each year (Statistics Canada, 1998). • It has been estimated that it would take almost 300,000 full-time employees at a cost of $6 billion per year to replace the work of the 2.1 million Canadians who care for seniors with long-term health problems (Keating et al., 2005). The majority of these caregivers are middle-aged and older women.

7. 3. Healthy Aging can delay &minimize severity of chronic disease and reduce costs • Even modest rates of physical activity have been shown to stave off functional declines in people with osteoarthritis (Feinglass et al., 2005). Appropriate physical activity also helps with pain management (Arthritis Society, 2005) • Costs of diagnosing, treating and managing chronic conditions can be controlled and reduced when older people remain healthy enough to live in the community in a variety of supportive living arrangements • PHAC estimates that a reduction in falls by 20 percent could result in 7,500 fewer hospitalizations and 1,800 fewer permanently disabled seniors; as well as national savings of $138 million annually (PHAC 2005).

8. 4. Opportunities to build on • There are some models and successful interventions that can be adapted to different settings • There are existing strategies in aging and healthy living underway in most jurisdictions • Canada has capacity in community-based research and good collaborative relationships nationally and internationally in the field of aging

9. 5. It is the “right thing to do” • Established values such as independence and interdependence, social justice, and respect for families with multiple generations help to define Canadian society • As a signatory of the 2002 International Plan of Action on Ageing, Canada has made a clear commitment to “enhancing life-long physical and mental health and well-being, maintaining independent living and expanding the participation of older persons in society” (United Nations, 2002) . • Investing in healthy aging is not an “either-or proposition” that sets up competition for resources between the young and old. • It is never too late to invest in people’s health.

10. 3. How healthy are older adults in Canada? Percentage of People in Good Health, by Age Group, Household Population, Aged 65 and Over(Shields and Martel, 2006)

11. Seniors and Chronic Diseases: Some Facts and Figures • Senior women are more likely than men to have arthritis/rheumatism, cataracts/glaucoma and back problems. Rates of heart disease, diabetes, cancer, the effects of stroke, and Alzheimer’s disease/dementia are higher among senior men (Gilmour and Park, 2006). • Between 10 and 15 percent of seniors in the community suffer from depressive symptoms and/or clinical depression (Conn, 2002). • Late-life dementias, which include Alzheimer’s disease, affect 8 percent of seniors over the age of 65 and more than 25 percent of those over the age of 80. Dementia is considered to be one of the greatest public health challenges of the coming generation (Canadian Study of Health and Aging Working Group, 1994).

12. INTERMEDIATE RISK FACTORS MAIN CHRONIC DISEASES UNDERLYING SOCIOECONOMIC, CULTURAL, POLICTICAL AND ENVIRONMENTAL DETERMINANTS COMMON MODIFIABLE RISK FACTORS NON-MODIFIABLE RISK FACTORS Heart disease Raised blood pressure Unhealthy diet Stroke Physical inactivity Raised blood glucose Cancer Tobacco use Globalizationion Abnormal blood lipids Chronic respiratory diseases Urbanization Population ageing Age Overweight/Obesity Diabetes Heredity Figure 1.2: Causes of Chronic Diseases, WHO (2005).

13. 4.What are important determinants of healthy aging? • Individual: • Physical activity • Healthy eating • Minimization of risks • Refraining from smoking • Health Literacy • Social Environment: • SES • Social Engagement • Social Support, Social Networks • Physical Environment: • Neighborhood safety • Home structure

14. Source: Statistics Canada, 2005

15. Barriers to Physical Activity • Fear of injury, illness, disability and pain • Lack of energy, motivation, skills and time • Inadequate facilities, cost and lack of safe places • Weather • Inadequate support • Care-giving responsibilities

16. Obesity rates, by age group, household population aged 18 or older, Canada excluding territories, 1978/79 and 2004 (Tjepkema, 2005)

17. Barriers to healthy eating • Income • Transportation • Socio-cultural norms • Oral health • Food production and marketing • Support networks

18. Estimated Rates of Injuries Resulting From a Fall,By Age Group and Gender, Age 65+, Canada, 2002/03 Public Health Agency of Canada (2005)

19. Contributors to falls • Biological and medical (e.g. age, chronic or acute disease, physical disability, muscle weakness, poor physical fitness) • Behavioral (e.g. climbing insecure ladder, use of multiple medications, inadequate diet and exercise) • Environmental (e.g. poorly placed furnishings, scatter rugs and other home hazards; potholes and poor lighting; poorly designed buildings and non-compliance with safety codes) • Socioeconomic (e.g. low income, food security)

20. Source: Statistics Canada, 2004

21. Barriers to refraining from smoking • Lifelong practice • Loneliness • Boredom • Misinformation

22. Low Health Literacy by Age in Canada, 2003 (CCL, 2007) 16-25 50% 26-35 49% 36-45 53% 46-55 59% 56-65 68% 65+ 88%

23. Barriers to Health Literacy • Low literacy • Deterioration of capacities • Non use of skills • Stigma • Complexity of health information

24. Socio-economic Status • Relationship between poor health and SES persists into old age • SES is among the most important risk factors for functional limitations in old age (Minkler et al.,2000)

25. SES Barriers • Less access to resources • High demands from the environment

26. Percentage with Positive Self-Perceived Health, by Frequency of Social Involvement, Institutional Population aged 65 or older, Canada Excluding Territories, 1996/9 (Ramage-Morin, 2006) * Significantly different from estimate for reference category

27. Barriers to Connectedness • Social isolation • Poor access to health and social services and transportation • Marginalization • Social exclusion • Ageism

28. Social Networks • Stronger social networks and higher levels of social support are associated with lower mortality, improved recovery from myocardial infarction, better physical functioning and less depression • Close personal contacts predict “successful aging” (Minkler et al.2000)

29. Barriers to Social Support/Networks • Absence of family and friends • Cultural values • Reluctance of older people to share some kinds of information • Health behaviours of families and friends

30. Neighborhood safety • Strong relationship between neighborhood safety and physical inactivity in the over 65 • Older adults have higher pedestrian death rates • Older adults are more likely to fall when street are icy (Minkler et al., 2000)

31. Barriers to Neighborhood safety for older adults • Cost • Attitudes • Balance • Lack of policies

32. Home structure • Structural factors impact on the ability of older people to engage in everyday tasks • Environmental factors such as poor housing design, rickety stairways and slippery floors contribute to the chance of falling (Minkler et al, 2000)

33. Barriers to home safety • Tendency to focus on individual approaches • Cost of structural approaches • Absence of policies

34. 6. What contributions can health promotion make to Aging research and practice? • Values • Concepts • Theories • Strategies • Approaches • Tools • Knowledge • Resources

35. Relevant Values • Empowerment • Participation • Social Justice/Equity • Respect • Choice • Positive health

36. Relevant Concepts • Health • Determinants of Health • Empowerment • Healthy Communities • Healthy Public Policy • Health Literacy • Quality of Life

37. Relevant Theory • Intrapersonal Health Behavior Models/Theories • Interpersonal Health Behavior Models/Theories • Community and Group Intervention Models/Theories • Planning and Ecological Models/Theories

38. Relevant Strategies • Building healthy public policies • Creating supportive environments • Strengthening community action • Developing personal skills • Reorienting health services

39. Relevant Approaches • Communication • Education • Legislation • Fiscal measures • Organizational change • Community development • Participatory research

40. Relevant Tools • Epp Model • Hamilton-Bhatti Framework

41. Vision A society that: values and supports the contributions of older people celebrates diversity, refutes ageism and reduces inequities provides age-friendly environments and opportunities for healthy choices that enhance independence and quality of life. * Selected Areas of Focus • Social Connectedness • Physical Activity • Healthy Eating • Falls Prevention • Tobacco Control Supportive Environments Mutual Aid Guiding Principles • Dignity • Independence • Participation • Fairness • Security Self Care

42. Healthy aging planning model (BCMOH, 2005)

43. Relevant Knowledge • About the determinants of health • About the effectiveness of interventions • About best practices • About the evaluation and results of interventions

44. Relevant Interventions • Age Friendly Cities Initiative • Chronic Disease Self-Management Project • Tenderloin Project • Promoting Action Toward Health Project (PATH)

45. Resource Contributions • Population Health Fund • Canadian Health Promotion Research Centres • Canadian Public Health Association and Provincial Associations • International Union for Health Promotion and Education • Journals and websites

46. Questions? Comments?