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Chapter 5 LA
Chapter 5 LA
Chapter 5 LA
older adulthood.
● Identifying how long one can expect to live
○ Implications for health and service programs
○ Retirement programs
○ Development of age appropriate housing
● Living longer = challenges
○ Need for support housing that helps older adults remain independent in the
community
● Longevity = influences by genetic and environmental factors
○ Average longevity - life expectancyy
■ statistical measure that refers to the age at which half of the individuals
born in a given year will have died
■ Increasing rapidly
■ between 1921 and 2011, the gain in overall life expectancy for Canadians
was nearly 25 years, with almost half of the gains in life expectancy
occurring between 1921 and 1951 due to decreases in infant mortality
■ 2001 → life expectancy at birth = 81.76 years of age
■ Canadian national and provincial estimates for longevity at birth and at
age 65
■ live in British Columbia, Alberta, Ontario, or Quebec, you are expected to
live somewhat longer than Canadians in other provinces. Nunavut has the
lowest life expectancy at birth
■ born in the United States, you can expect to live to an average age of
78.7 years
● Aging across the provinces
○ structure of the three Prairie provinces is very different from the age structure of
the other seven provinces.
○ more young people in the Prairies than in other provinces.
■ Alberta has the youngest median age of the provinces at 36.3 years
■ Saskatchewan and Manitoba have populations much younger than the
national average.
● This is thought to be due in part to higher fertility rates,
international immigration, and interprovincial migration.
■ Nunavut has the youngest population with a median age of 26.1 and
almost 31 percent of its population under the age of 15.
■ In contrast, the four Atlantic provinces have the highest percentage of
people over the age of 65 years in Canada
Gender differences in longevity
● WHO - in all countries, women outlive men
● 2012 - global life expectancy at birth
○ 72.7 years for women
○ 68.1 years for men
● Japan - women have the longest life expectancy
○ Women in spain, switzerland
○ Singapore
● Men - 80 or more
○ Iceland, switzerland, australia
● Canada - 2016
○ 83.6 years for women
○ 79.4 years for men
○ Gap getting smaller
■ 6.1 years during 1994 to 1996
■ 4.6 years in 2006 to 2008
● life expectancy for both men and women is still less than 55 years in nine sub-Saharan
African countries: Angola, Central African Republic, Chad, Côte d’Ivoire, Democratic
Republic of the Congo, Lesotho, Mozambique, Nigeria, and Sierra Leone
● Africa = youngest continent in the world
● Dramatic differences in longevity around the world
● Why do women live longer then men
○ combination of biological, social, and genetic factors account for the difference
○ rate of men dying from the top three causes of death in Canada is significantly
higher than the rate for women
■ Some of the illnesses such as heart disease are associated with lifestyle
factors such as cigarette smoking and alcohol consumption
■ Men smoke and drink more then women
○ women have two X chromosomes (men only have one), and this is thought to be
a protective factor against heart disease in women
○ Men see physicians less often than women
○ Men = higher rates of violence
■ More likely to die prematurely
■ work-related acci- dents, motor vehicle crashes, victims of war
○ more male than female babies are born, men are more susceptible to infectious
diseases
○ None can account for all age differences between men and women
Aging baby boomers
● Aging at an unprecedented rate
● number of persons 65 years of age and older worldwide was 841 million in 2013
○ four times higher than the 202 million who were 65 and older in 1950
● older population will almost triple by 2050, when it is expected to surpass the two billion
mark
● number of Canadians 65 years of age and over should reach 20 percent in 2036 and 25
percent in 2061
● Canada now has more individuals 65 and older than children aged 14 and younger
○ First time in history
● those 65 years of age and older, it is the 85 years and older age group that is growing
the fastest
● July 1984, there were only 202 300 individuals 85 years or older.
○ In 2016, this number had more than tripled to 787 492
Centenarians in Canada and around the world
● 100 to 110 = centenarians
● 7345 centenarians in Canada as of July 2016
○ roughly 20 centenarians per 100 000 population
● 11 centenarians per 100 000 population in Canada in 2001
● individuals were just children at the start of World War I in 1914. They likely married, had
children of their own, and endured economic struggles during the Great Depression of
the 1930s. Most of them likely retired in the 1970s
● More woman then men reach this age
○ 13 male per 100 female centenarians
● Number of will rise
○ 2061, this number could reach more than 78 300 Statistics Canada
● Saskatchewan has the highest rate of individuals over the age of 100
○ while the three Territories as a group, as well as Newfoundland and Labrador,
have the lowest rates
● G7 countries
○ Canada currently has one of the lowest proportions of individuals 65 years of age
and older (16.5%) - G7
○ Japan has one of the oldest populations in the world and the highest proportion
of people 65 years and older of any G7 country
■ just over one in four people.
○ The United States is the only G7 country where the proportion aged 65 and older
is lower (15%) than in Canada
● G8 countries
○ Canada’s rate of centenarians in 2011 was 17.40 per 100 000 (Statistics Canada,
2016c)
■ slightly below the average of 19.7 per 100 000 among G8 countries.
○ France, Italy, and the United Kingdom all have higher rates of centenarians than
Canada
Maximum longevity
● Maximum longevity = oldest age one can possibly live.
● Supercentenarians = special group of people who live beyond 110 years
○ Jeanne Louise Calment = supercentenarian
■ lived the longest of any human to date.
■ She lived to the authenticated age of 122 years, 164 days.
■ died in Arles in southern France on August 4, 1997
■ When asked on her 120th birthday what she expected of the future, she
replied, “A very short one” (Whitney, February 22, 1995).
● Gerontologists originally thought that 110 to 120 years of age was the longest a person
could live
○ the idea that life cannot extend past 120 years is being reconsidered.
○ improvements in healthcare and better management of chronic conditions, we
just may see more people living past 100 years of age.
Ethnic differences in longevity
● Complex → because of a lack of data in many countries
● healthy immigrant effect = foreign-born individuals tend to live longer and are in better
health than those who are native born (canada and US)
○ healthy habits and behaviours practised by immigrants prior to leaving their home
country
○ immigrant self-selection in that a country’s healthiest and wealthiest have the
financial and physical means to migrate
○ strict health screening by authorities in the host country prior to immigration
● immigrant effect higher comparing foreign-born individuals to native-born individuals
from the same ethnic group
● the longer an immigrant lives in the host country, the more his or her health resembles
the health of people born in the host country
○ This increased similarity between immigrants and native-born residents’ health is
attributed to the adoption of the behaviors and eating habits of the host country
by the immigrant population
○ Trovato and Odynak (2011)
■ looked at sex differences in Canadian immigrant mortality
■ immigrant females enjoy a higher life expectancy than immigrant males
■ immigrants have a smaller gap between female–male life expectancy
compared to Canadian-born individuals → attributed to a smaller sex
difference in suicides and mortality from cancer, particularly lung cancer.
■ more research will be needed to understand how changes in health status
occur over time to better address the needs of an increasingly diverse
aging population
● Aboriginal peoples - hard to obtain accurate information
○ Remote areas birth and death certificates are not kept, recorded, or (rarely)
recorded multiple times
○ Required to travel outside of their home community to receive medical care - may
or may not be documented
○ Lack of info on identity on medical, birth, and death records
■ Contributing to inaccurate health info
○ Know
■ Younger and growing faster then non aboriginal population
■ 2011, the median age of the total Aboriginal population was 28 years,
which is 13 years younger than the median age of 41 years for
non-Aboriginal Canadians
■ 2011, it was estimated that there were 82 690 Aboriginal people who were
aged 65 and over, accounting for almost 6 percent of the total Aboriginal
population.
■ Compare this to the non-Aboriginal older adult population, which was
almost 14 percent of the total Canadian population in 2011 (Statistics
Canada, 2013a).
■ Because the Aboriginal population is much younger and smaller than the
non-Aboriginal populations in Canada, aging in general has not been a
focus of concern among Aboriginal health organizations until recently
Other factors affecting longevity
● Genetics
○ twin studies have shown that genetic factors account for only 25 to 30 percent of
the individual differences in lifespan
○ Human Genome Project (HGP) - learning more about genes, longevity, and aging
■ April 2003
■ have the ability to read the genetic blueprint needed to build a human
being
■ sequencing of DNA is now understood, we can now begin to identify
genes and mutations linked to different forms of cancer.
■ We now are beginning to understand the genotypes of specific viruses
that will help to identify appropriate treatment
● Environmental factors / lifestyle / socio economic factors
○ Air and water pollution can contribute to a shorter life
○ Carcinogens in food
○ Abuse of drugs, alcohol, smoking = lifestyle factors
○ Lower socio economic status = decrease in lifespan because of reduced
opportunities to eat and exercise
■ Reduced healthcare (prescriptions, health/visual aids)
Frailty
● Frailty → term that is used describe a state of increased vulnerability as a result of
age-associated declines in reserve and function, which results in a reduced ability of the
individual to cope with everyday stressors
○ There is a strong association between frailty and age
■ frailty affecting approximately 15.7 percent of adults 80 to 84 years of age
and 26.1 percent of those 85 years of age and older
○ challenging to identify and often goes unrecognized by healthcare professionals.
○ many instruments or measures that have been developed to assess fraility in
older adults.
■ The Frailty Index is a suitable measure for identifying frailty
Functional health
● impact of chronic conditions and disabilities on an older adult’s functional health status.
● Functional health status → how well a person is functioning in daily life.
● Assessing functional health status = helps to identify older adults who need assistance
with everyday activities.
● In hospitals, functional assessments conducted by occupational therapists assessing
cooking, banking, and knowledge of safety issues.
● Generally speaking, older Canadian adults report themselves to be in good functional
health
● many older adults do experience limitations as a result of long-term physical conditions
caused by injury and disease
● multiple disabilities can be caused by one condition
○ a person who has arthritis might develop pain and mobility impairment.
○ the older you get, the more likely it is that you will have a disability.
● Results from the Canadian Study of Health and Aging
○ showed that pain, foot problems, arthritis, mobility, cognitive impairment, and
vision problems contributed to ADL- and IADL-related functional disabilities
○ tremendous variability in the reported limitations in the functional health status of
older adults, emphasizing the diversity in health status within this large group
Trends in illness and disability
● Non-communicable diseases contribute significantly to death rates
● large percentage of non-communicable diseases are preventable → reduction of
behavioural risk factors.
● The four most common risk factors
○ tobacco use, physical inactivity, harmful use of alcohol, and an unhealthy diet.
● worldwide epidemic of obesity
○ Obesity, defined as a Body Mass Index (BMI) greater than or equal to 30, has
more than doubled since 1980
○ obesity contributes to an increased risk of poor health outcomes in older adults,
including Type 2 diabetes, hypertension, and heart disease.
● In 1980, James Fries hypothesized that because of increased prevention and improved
treatment of acute and chronic illnesses, the time (e.g., years) spent in disease and
disability would be delayed or compressed into a shorter period before the time of death.
○ compression of morbidity hypothesis proposes that the average age at which one
becomes disabled for the first time is postponed, causing the time between the
onset of disability and death to be compressed into a shorter period (i.e., people
will stay healthier for a longer time and will be in poor health for a shorter time)
○ There also is the possibility that there will be an expansion of morbidity such that
people will be living longer in poor health (expansion of morbidity hypothesis)
○ The third possibility, which takes a stance between the two extremes, proposes a
dynamic equilibrium hypothsis
■ postponement of death is accompanied by delays in disability such that
the relative time in poor health remains the same (Manton, 1982).
● Supporting evidence for the three theories is mixed due in part to differences in the way
that disability is measured, as well as to differences in findings across countries.
● many health trends and issues that are of concern in Canada today have their
foundation in younger age groups
○ emerging epidemic of obesity among the younger and middle-aged populations
may reverse any gains in reducing late-life functional decline, resulting in
increased rates of functional decline in future populations of older individuals.
Successful aging
Models of successful aging
● live in good health, remain independent, productive = become reality.
● last 60 years, many researchers have put forth definitions and criteria regarding what it
means to age successfully
○ the definition has changed significantly over time.
○ Cumming and Henry (1961) regarded successful aging → desire of older people
to disengage from active life in order to prepare themselves for death.
○ Ryff ’s (1989) model in which aging → developmental process in which continued
personal growth is very much possible in old age.
● International interest in successful aging has grown significantly since Rowe and Kahn
introduced their widely used model of successful aging in 1997
○ argue that there are three key components to successful aging:
■ the avoidance of disease and disability
■ maintenance of cognitive and physical function
■ engagement with life
● Another model of successful aging is the Selective Optimization with Compensation
(SOC) model developed by Baltes and Baltes (1990)
○ aging is a heterogeneous process with many different pathways and outcomes.
○ Successful agers select areas of their life that are important to them and then
make the most of the available resources that aid success in these areas.
○ At the same time, according to this model, people compensate for the losses they
experience in order to create an environment where aging successfully can be
attained.
● Over the years, other models have been developed to describe successful aging (see
Vaillant, 2002), but there remains much disagreement and criticism regarding the models
to date.
● A criticism of the SOC model is that compensation and optimization strategies may
become increasingly difficult to use because of age-related losses in resources
(Ouwehand, de Ridder, & Bensing, 2007).
● A difficulty with Rowe and Kahn’s model is that very few older adults meet their
successful aging criteria.
○ That is, the complete absence of disease as we age is unrealistic for many
people
● McLaughlin, Connell, Heeringa, Li, and Roberts (2010) used Rowe and Kahn’s criteria to
calculate the prevalence of successful aging in the United States using data from the
Health and Retirement Survey.
○ These researchers found that only 11.9 percent of participants met the criteria of
successful aging in any of the four time points measured.
○ Using 2009 data from the Canadian Community Health Survey, Meng and D’Arcy
(2014) found that only 35 percent of participants were deemed to be aging
successfully based on Rowe and Kahn’s criteria.
● Another criticism of the successful aging models → they neglect the structural forces that
influence functioning later in life and assume that older adults have the resources to age
successfully such as having access to healthcare and living above the poverty line
(Stowe & Cooney, 2015).
● Also absent from successful aging models are the opinions from different cultures.
○ How do people from other ethnic backgrounds define successful aging?
○ Chung and Park (2008) conducted one of the few studies investigating the
definition of successful aging in another culture.
■ low-income older adults from North Korea named “success of adult
children” as a factor in successful aging.
■ People in North Korea still tend to believe that the “children’s success is
the parent’s success.” (Chung & Park, 2008, p. 1071).
● In addition, some researchers are concerned that many of the models of successful
aging promote, rather than reduce, ageism.
○ For example, categorizing total health as good aging and the presence of
disease or disability as bad aging creates a very simplistic either/or category that
does not capture the diversity in which we age
● missing are criteria generated by older adults themselves.
○ How do older adults define successful aging?
○ Studies that have compared self-ratings of successful aging to the criteria set out
by Rowe and Khan (1997)
■ self-ratings from older adults are considerably higher than the successful
aging ratings they would have attained using Rowe and Kahn’s criteria
○ For example, Montross and colleagues (2006) found that the older adults in their
study viewed themselves as aging successfully even though the majority
experienced disability and chronic illness.
○ successful aging that older adults consider important is different than the criteria
set out in Rowe and Kahn’s model.
■ That is, a sample of 72 community-dwelling older adults stated that a
balance between self- acceptance, contentedness, self-growth, and
engagement in life were key components to aging successfully
○ Other findings sug- gest that having financial resources, a positive attitude, a
realistic perspective, and the ability to adapt to change are key components to
aging successfully
○ Data from the Manitoba Follow-Up Study (Tate, Lah, & Cuddy, 2003), which
followed a cohort of 3983 World War II veterans, showed that having goals and
interests and being engaged with family are important to successful aging.
○ As you can see from the results presented above, the responses given by older
adults are very diverse, indicating that aging successfully is very personal and
has multiple meanings.
● It is not hard to find celebrities who are thought to be aging well: Queen Elizabeth and
her husband Prince Phillip, Michael J. Fox, Donald Sutherland (President Snow in The
Hunger Games), William Shatner (a.k.a., Captain Kirk, for all you Trekkies out there),
Madonna, Betty White, and Jane Fonda are some who come to mind.
○ All remain active despite aches and pains and a chronic illness or two.
○ But it is not only celebrities who are aging well
○ many older adults who are not in the spotlight but who are engaged with life and
who are active and giving back to their communities.
○ Florence Storch was one very active older adult
● There is no special formula for aging successfully.
○ Aging is a lifelong process and it would make sense that it would be important to
make good lifestyle choices, not only at a young age but also as you age.
○ eating healthily, watching your cholesterol, keeping your brain active, exercising,
getting enough sleep, and drinking in moderation will help you to age
successfully
○ psychological factors such as feeling connected to others, staying involved in
some capacity, being able to learn new things, and continuing to grow as a
person also are very important.
Health promotion activities for older adults
● healthy aging initiatives → forefront around the world, including Canada.
● The European Union declared 2012 as the European Year for Active Aging and
Solidarity between Generations (Eurostat European Commission, 2011)
○ aim to establish a culture across Europe of people remaining active into older
adulthood.
○ initiative has helped convey → more positive image of population aging in Europe
by highlighting the potentials of older people and promoting their active
participation in society and in the economy.
○ Reversing the belief that older adults are a burden on society is the biggest aim
of the European Year for Active Aging and Solidarity Declaration.
○ European governments are looking for ways to involve older persons more in
society and to keep them active.
○ The hope is that these initiatives will result in economic benefits for society as a
whole, while at the same time promoting the mental, social, and physical
well-being of older adults.
● Vision for Healthy Aging in Canada
○ 2006, the Canadian provincial and federal governments
○ Efforts are being made to recognize, value, and support the contributions made
by older adults.
○ reduce ageism and inequities and provide age-friendly environments and
opportunities for older Canadians to make healthy choices
○ reintroduced its ParticipACTION program.
■ originally launched as a Canadian government program in the 1970s to
promote healthy living and physical fitness.
■ It ended in 2001 due to financial cutbacks but was revived in 2007.
■ Valuable ParticipACTION resources for older adults include Canadian
physical activity guidelines for adults 65 and older, physical activity tips,
guides to healthy eating, and advice for safety in the home