We Still Have a Long Way to Go: Patterns of Health and Healthy Lifestyles Across the Generations

1. We Still Have a Long Way to Go: Patterns of Health and Healthy Lifestyles Across the Generations 19th John Friesen Conference April 23 & 24, 2009 Andrew Wister, Ph.D. Professor & Chair Department of Gerontology, SFU

2. Key Questions • 1. Are current and future cohorts/ generations becoming healthier? • 2. What can we do to improve?

3. Population Aging • 2001 – 13.6% of population • 2006 - 14.6% • 2011 – 15.3% Projected • 2021 – 20.4% • 2031 – 25.2%

4. Population Pyramid, 1981, 2001, 2006, Canada

5. Apocalyptic Prophesizing • Dychtwald (1997) Baby boomers are “train wrecks about to happen” (pandemic of chronic disease, mass dementia, inadequate pensions & pressures on deteriorating health care system)

6. Health System and Societal Costs • Over $120 billion in 2007 • Over $180 billion in total costs to the economy • Not surprising that someone has to be blamed – often older adults • Prevention may be the largest untapped area for cost savings*

7. What Constitutes Good Health?

8. Life Expectancy at Birth, Canada, 1979-2004 82.6 80.2 77.8 Statistics Canada, 2006

9. Compression of Morbidity • Onset of disease and disability compressed into a shorter time frame (Fries, 1983) • 1982-1999 – 2% per year decline in functional disability, 1% decline in mortality • Evidence from 1991 - 2007

10. Compression of Disability • Moderate support, but mostly for less severe disability, 75+; but also declining recovery (Wolf et al., 2007) • Less support when examining other measures of health (chronic illness, perceived health)

11. Have Rates of Chronic Illness Declined? • 1978/79 to 1998/99 decreases in arthritis, hypertension, heart disease, bronchitis/emphysema for person 45-64 (Statistics Canada, 1999) • Increases in diabetes, asthma & migraines • For 65+, no declines (positive trends); but diabetes, dementias, & asthma up • Cancers show unique and complex trends

12. A Health Paradox • Rising life expectancy and disability compression concurrent with rising rates of many chronic illnesses • Due to changes in utilization and health care? Improved services and technology to facilitate independence? Or healthy lifestyles?

13. Have Lifestyles Improved Over Time? Some state that older adults today and the future older adults of tomorrow (the boomers) are healthier than previous generations because they are wealthier, exercise, eat better, and knowledgeable about healthy lifestyles

20. Lifestyle Factors and Health Risk • Smoking increases mortality by 50% and doubles incidence of cancer and cardiovascular disease (CACR, 1999) • Quitting can lower risks within one year

21. Lifestyle Factors and Health Risk • Physically inactive have a 90% higher risk of developing CVD; 60% osteoporosis; and 40% higher risk of stroke, hypertension, colon cancer, and diabetes (Katzmarzyk et al., 2000) • Benefits of physical activity can be realized immediately no matter what age

22. Lifestyle Factors and Morbidity Risk • Obese individuals are more than twice as likely to have arthritis, heart disease, breast & colon cancer (Cairney and Wade, 1998)

23. Generational Movements Through Time • Unique health and illness trajectories connected to the size and composition of cohorts, and to earlier life experiences, normative milieu and historical events • Upward bound age escalator

28. The Exercise-Obesity Paradox • Paradox - exercise and obesity moving in opposite directions • Is the exercise measure flawed?

29. Leisure-time Physical Activity % Inactive, Canada, 1994/95 – 2002/03 Statistics Canada, 2007

30. Exercise and Obesity Correlation • Among 35-54 ages in 2000/01, there is a 25% relative risk reduction in obesity rate (>=30) among frequent exercisers compared to infrequent/sedentary • 19% relative risk reduction in infrequent/sedentary activity among those who are not obese, compared to those who are not

31. Dr. Phil Says Television Watching is the Culprit • Most studies linking TV and exercise or obesity are cross-sectional • Therefore problems of causality – which comes first?

32. Television Watching and Poor Lifestyles • Jeffery & French (1998) • TV watching associated with obesity at cross sectional level, but only among low-income women • At longitudinal level, no associations were supported

33. Population-Level Evidence • Canadian TV watching dropped from 23.3 hours/week in 1991 to 21.5 hours/week in 2000 (Statistics Canada, 2001) • For workers, average time spent watching TV dropped from 95 minutes in 1986 to 79 minutes in 2005 (Statistics Canada, 2007)

34. Technological Inactivity • Computer use at work has doubled between 1989 and 2000 (33% to 57%) (GSS 2000) • 80% of Canadians work at their computer every day • But, it is not enough to tip the scales, given exercise improvements

35. Nutrition and Food Consumption Patterns: The Good News • Consumption of fruits has increased 27% between the 1970s and 1997 (Alain, 1999) • Low fat milk up (e.g., 1% milk up from 12% in 1990 to 27% in 1997) • Consumption of red meat down

36. The Bad News • Over 25% of energy burned by adolescents and adults originates from the “Other Food Group” (Starkey at al., 2001)

37. Pop Consumption is Up • Pop consumption in Canada doubled between 1975 and 1997, from 60 liters to 106 liters per person per year (Alain, 1999)

38. Fast Food Supersized • 20% of all meals are consumed out of the home (Struempler, 2002) • Especially fast & inexpensive meals • McDonalds continues to lead the way

39. Bigger Is Not Always Better • Average serving size has increased between 20% - 70% over past two decades • 2-3 times the USDA recommended food size (Kendall, 2000)

40. Binkley et al., 2000 Study, International Journal of Obesity • Collected information on foods purchased in 24 hours before survey • Fast food sources predict obesity in men and women

41. Food Consumption Conclusion • Therefore it is both the quality and the quantity of food consumption that is the problem

42. Why Do We Have Poor Lifestyles?

43. Age-Related Barriers to Physical Activity • Boomers report time issues more often, seniors repot energy • Perception that when we age, we need to slow down • Health is a major issue for older adults • Energy drops from some • Fear of falling • But, it is never too late – Plethora of Intervention Studies

45. Time Constraints on Eating Healthy • 13% of Canadians reported that they did not have time to prepare a healthy meal • 74% eat in a hurry • 39% eat in a vehicle at least once a week because of a busy work schedule (FPT Advisory Committee on Population Health, 1999) • 40% of Canadian older adults report that they do not have the time or energy to exercise regularly

47. Too Many Diets, Contradictory Information • Over 50,000 diets in existence • Disagreement over what is good and what is bad • Concept of lifestyle change is not part of most diets

48. The Power of Media Messaging • Presentation of fast food is a multimillion dollar industry (Schlosser, 2002) • Low fat everything rather than making substantive changes to lifestyle habits • Positive lifestyle messages must compete on an uneven playing field • Messaging active lifestyles is easier than you think – axioms of inertia

49. http://www7.nationalgeographic.com/ngm/0511/sights_n_sounds/index.htmlhttp://www7.nationalgeographic.com/ngm/0511/sights_n_sounds/index.html

50. Exceptional Old Age • Okinawa, Japan Reason for living; social connectedness; physically active; low caloric intake – fish soup (highest obesity rate due to change in diet) • Sardinia More males; less stress; family and social connectedness; Mediterranean diet; mountain walking • Loma Linda – Seventh-day Adventists – Sabbath (day off); social capital; physical activity; nutrition • Genetics – Epi-genetics Gene-environment interaction