Health Promotion and Healthy Aging

Presentation by Irving Rootman to SFU Class on Principles and

Practices of Health Promotion September 20, 2010

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?

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).

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”.

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

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.

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).

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

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.

3. How healthy are older adults in Canada?

66

80

88

95

79

45

64

70

93

68

22

37

41

95

63

Overall good health Good functional health Independent in activitiesof daily living

Good self-perceivedmental health

Good self-perceivedgeneral health

Perc

en

t

65-74 75-84 85+

Percentage of People in Good Health, by Age Group, Household Population, Aged 65 and Over(Shields and Martel, 2006)

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).

Figure 1.2: Causes of Chronic Diseases, WHO (2005).

UNDERLYING SOCIOECONOMIC, CULTURAL, POLICTICAL AND ENVIRONMENTAL DETERMINANTS

COMMON MODIFIABLE RISK FACTORS

NON-MODIFIABLE RISK FACTORS

MAIN CHRONIC DISEASES

INTERMEDIATE RISK FACTORS

Globalizationion

Urbanization

Population ageing

Unhealthy diet

Physical inactivity

Tobacco use

Age

Heredity

Raised blood pressure

Raised blood glucose

Abnormal blood lipids

Overweight/Obesity

Heart disease

Stroke

Cancer

Chronic respiratory diseases

Diabetes

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

Physical Activity by Age Group and Sex, Household Population, 2005

0% 10% 20% 30% 40% 50% 60% 70% 80%

Males

Females

Males

Females

Males

Females

Males

Females

Males

Females

Males

Females

Ag

e 3

5-4

4A

ge 4

5-5

4A

ge 5

5-6

4A

ge 6

5-7

4A

ge 7

5an

d O

ver

Percentage

Active Inactive

Source: Statistics Canada, 2005

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

Obesity rates, by age group, household population aged 18 or older, Canada excluding territories, 1978/79 and 2004

(Tjepkema, 2005)

Barriers to healthy eating Income

Transportation

Socio-cultural norms

Oral health

Food production and marketing

Support networks

Estimated Rates of Injuries Resulting From a Fall,By Age Group and Gender, Age 65+, Canada, 2002/03 Public

Health Agency of Canada (2005)

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)

Source: Statistics Canada, 2004

Barriers to refraining from smoking

Lifelong practice

Loneliness

Boredom

Misinformation

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%

Barriers to Health Literacy

Low literacy

Deterioration of capacities

Non use of skills

Stigma

Complexity of health information

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)

SES Barriers

Less access to resources

High demands from the environment

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

Barriers to Connectedness

Social isolation

Poor access to health and social services and transportation

Marginalization

Social exclusion

Ageism

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)

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

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)

Barriers to Neighborhood safety for older adults

Cost

Attitudes

Balance

Lack of policies

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)

Barriers to home safety

Tendency to focus on individual approaches

Cost of structural approaches

Absence of policies

6. What contributions can health promotion make to Aging research and practice?

Values Concepts Theories Strategies Approaches Tools Knowledge Resources

Relevant Values

Empowerment Participation Social Justice/Equity Respect Choice Positive health

Relevant Concepts Health

Determinants of Health

Empowerment

Healthy Communities

Healthy Public Policy

Health Literacy

Quality of Life

Relevant Theory

Intrapersonal Health Behavior Models/Theories

Interpersonal Health Behavior Models/Theories

Community and Group Intervention Models/Theories

Planning and Ecological Models/Theories

Relevant Strategies

Building healthy public policies

Creating supportive environments

Strengthening community action

Developing personal skills

Reorienting health services

Relevant Approaches

Communication Education Legislation Fiscal measures Organizational change Community development Participatory research

Relevant Tools

Epp Model

Hamilton-Bhatti Framework

Supportive Environments

Mutual Aid

Self Care

* Selected Areas of Focus• Social Connectedness• Physical Activity• Healthy Eating• Falls Prevention• Tobacco Control

Guiding Principles

• Dignity• Independence• Participation• Fairness• Security

VisionA 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.

Healthy aging planning model (BCMOH, 2005)

Relevant Knowledge

About the determinants of health

About the effectiveness of interventions

About best practices

About the evaluation and results of interventions

Relevant Interventions

Age Friendly Cities Initiative

Chronic Disease Self-Management Project

Tenderloin Project

Promoting Action Toward Health Project (PATH)

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

Questions? Comments?