The Future of Aging According to 11 Canadian Experts
Here, we take stock of what we know about healthy aging and what we might learn in the decade to come. Illustration: Joanna Wood
Canadian experts review their research into everything from sexuality to robotics to genetics, all designed to help older adults age well, while we offer a glimpse of the future.
What kinds of exercise can help us age well? Does ethnicity play a role in how we age? How are Canadians dealing with aging and sex? These are important questions. The older cohort – the baby boomers and gen-Xers – represent nearly 45 per cent of Canada’s population, or 16,753,198 people. By 2030, Statistics Canada estimates it will be 46.5 per cent, or 19,461,400 people.
The World Health Organization’s 10 Priorities for a Decade of Action on Healthy Ageing makes it clear that an effective plan requires better global data. As the WHO states, “What gets measured gets done.”
Canadian researchers are stepping up. That includes scientists working on the most comprehensive study of aging in the world, led by investigators at McMaster, McGill and Dalhousie universities. It’s called the Canadian Longitudinal Study on Aging (CLSA) and it has been amassing reams of data on more than 50,000 older adults since 2010, when researchers began collecting information on the lives of participants between the ages of 45 and 85.
“Aging is as much a social phenomenon as it is a biological phenomenon,” says McMaster University’s Parminder Raina, the study’s lead investigator. “If you want to understand the biology of aging, you really have to understand the social aspects, psychological aspects, economic aspects and so on.”
Add to that the work of the Canadian Institutes of Health Research, the Canadian Institute for Advanced Research and universities across the country, and we have a wealth of expertise to tap. In that spirit, we asked 11 Canadians working on aging-related projects to tell us about the biggest advances in their fields in the last decade and what’s on the horizon. Then we do some crystal-ball gazing of our own to highlight some of the groundbreaking work underway at home and abroad.
[ Spotlight / Toronto ]
Alex McKay, executive director of the Sex Information and Education Council of Canada, is a sexual health education researcher and co-designer of the 2017 Trojan/SIECCAN Sexual Health at Midlife Study.
“Over the last decade, researchers increased their focus on the sexuality of mid-life people and seniors. What they found is that boomers have firmly jettisoned obsolete stereotypes about the sexuality and sexual behaviour of people over 50. It’s become clear that people over 50 are not just sexually active, but also see sexual satisfaction and pleasure as important components of their quality of life.
“In the Trojan/SIECCAN Sexual Health at Midlife Study, 87 per cent of Canadians aged 55 to 59 participating in the survey agreed with the statement, ‘My sexual health contributes to my overall health and well-being.’ Furthermore, over half agreed that, ‘Compared to a decade ago, I am more interested in trying new things to enhance sexual pleasure.’
“As the current generation of mid- and later-in-life Canadians chart their course forward, I think we will see more people leading their sexual and relationship lives in innovative and creative ways. Those in monogamous relationships will place greater priority on exploring new ways to enhance sexual pleasure. The growing segment of seniors that are single and in search of sexual connection will increasingly try out new relationship configurations that are traditionally associated with younger people. Friends with benefits, anyone?”
Film director Tim Burton and actress Helena Bonham-Carter did it; so did artists Frida Kahlo and Diego Rivera. Now there’s a name for committed, long-term relationships without cohabitation – Living Apart Together – and it’s a small but growing trend in family life. Statistics Canada data from 2017 shows 1.5 million Canadians aged 24 to 65 were in an LAT relationship, or nine per cent, compared with six per cent a decade earlier. You might call it boyfriend-girlfriend, but Montreal filmmaker Sharon Hyman, who is making a documentary called Apartners: Living Happily Ever After Apart, has been doing it for 20 years. In a 2019 Globe and Mail opinion piece, she noted there is no “fighting over picking up socks or taking out the garbage,” and living alone “allows me to be more present for my spouse.”
[ Spotlight / Montreal ]
McGill University’s Brent Richards is an endocrinologist who studies the genetic determinants of common age-related diseases.
“Rapid advances in artificial intelligence and genomics have allowed for increasingly accurate prediction of aging-related diseases like heart attacks, osteoporosis and cancer. What scientists can now do is capture information from a patient’s entire genome through a technique called a polygenic risk score. These scores summarize genetic risk of disease and, in some instances, provide better predictions than currently available risk factors.
“For example, a polygenic risk score for heart attacks can identify eight per cent of the population that has a three-fold increased risk of heart attacks. To put this in perspective, Type 2 diabetes affects roughly eight per cent of the population as well but only increases the risk of heart attacks by two-fold. More importantly, most people at high genetic risk have few other risk factors, and a polygenic risk score can identify people at risk who would have otherwise been missed. By more accurately identifying people at risk for common diseases, screening, diagnosis and treatment could be transformed in the next decade. Specifically, we are rapidly reaching the point when we can identify people who should be screened early for serious diseases like breast cancer and heart attacks.”
Harvard University researchers announced in November 2019 that a combination of three genes associated with longevity, delivered by injection, showed promise in mice models by reversing diabetes, obesity and heart and kidney failure in some and improving heart and kidney function in others.
[ Spotlight / Vancouver ]
University of British Columbia’s B. Brett Finlay is a microbiologist interested in the microbiome’s effect on the “bookends of life” – birth and aging.
“The past decade has seen an explosion of information about the microbes that live in and on us and their effects on health, including healthy aging. We now realize they play a funda-mental role in our early development, including impacting the immune system, the gut and even brain development.
“As we create ever more hygienic environments, these missing microbes seem to play a major role in aging and disease. They impact cardiovascular disease, Type 2 diabetes, obesity and inflammatory bowel disease. Although diet and exercise are touted as healthy aging factors, we now know that many of their effects are actually a result of their impact on our microbiota (its genetic material makes up the microbiome).
“The next decade will see an explosion in microbiota-based preventatives and therapies, moving from fecal material transfers to biotherapeutic products – live bacteria from healthy people’s digestive systems. Perhaps the most exciting promise is in the gut-brain axis. It seems that gut bugs have some effects on the brain, although we know little about how. Still, they can affect dementia, Alzheimer’s disease, Parkinson’s disease, anxiety, stress, depression and autism. It’s no exaggeration to say the microbiota is causing a revolution in medicine, including new ways to think about health, disease and longevity.”
A 2014 study of aging mice by Dalhousie University researchers suggests frailty associated with old age may be related to gut bacteria. They say an aging microbiome could affect the availability of vitamins B12 and B7, as well as DNA repair, and may interfere with the effectiveness of drugs. They hope the findings lead to new treatments.
[ Spotlight / Toronto ]
The University of Toronto’s Goldie Nejat is a mechanical engineer, professor and the Canada Research Chair in Robots for Society. She designs assistive devices and robots to help seniors.
“Over the past 10 years, my research team has been designing interactive robots to help older adults – especially those with cognitive impairments – with daily life and recreational activities to promote independence and overall well-being. The robots are intelligent and use sensors to recognize what a person is doing and their intent. They can interpret your vocal intonations, body language and even your facial expressions in order to appropriately respond.
“Our robots can facilitate bingo games, trivia and other types of memory games and help with daily tasks such as meal preparation or provide clothing recommendations based on the weather. They can also lead you through exercises and sense when you’re doing a good job. Our robots show emotions, they can become ‘happy’ – some smile and wave their arms around to celebrate.
“We’ve done studies with our robots in long-term care/retirement homes and with older adults living on their own. They’ll naturally talk to the robots and ask them questions. Their body language shows they are engaged and they are compliant when a robot asks them to do a task. In the future, these assistive robots will be able to help with multiple tasks while detecting a person’s emotions and responding by using their own emotional behaviours. They will seamlessly interact with multiple users at a time to improve quality of life as we age.”
The Japanese labour ministry invested US$65 million to develop and test “elder-care” robots, according to a 2018 Reuters report, with more than 20 models – including a therapy “seal” named Paro – in 5,000 nursing homes across the country. It hopes the robots, which can lead exercise routines and make rudimentary conversation, will help with a predicted shortfall of 380,000 elder-care workers by 2025.
[ Spotlight / Toronto ]
Dr. Howard Chertkow is a cognitive neurologist at Baycrest’s Rotman Research Institute and scientific director of the Canadian Consortium on Neurodegeneration in Aging.
“Many dementias can be prevented. It appears that if nine lifestyle factors were corrected, there would be about 30 per cent fewer people with dementia. These are: low levels of education, mid-life hearing loss, physical inactivity, high blood pressure, Type 2 diabetes, obesity, smoking, depression and social isolation. The question is can people actually control these factors?
“There is no single brain abnormality and, therefore, no single cause behind most cases of dementia. This means effective therapies will need to be combinations of drugs. Targeting the brain’s ‘resistance’ to these dementias is important and should include managing medical conditions such as kidney disease and sleep apnea, which can affect brain health, regularly getting a good night’s sleep and keeping fit.
“While amyloid protein – the most common brain abnormality seen in Alzheimer’s disease – is no longer considered the sole cause, it plays a big role and anti-amyloid drugs should help, particularly early on in the disease. Up till now, however, anti-amyloid drugs have failed in large human trials. In December 2019, Biogen announced a drug, Aducanumab, had finally been found that slows progression of cognitive decline in people with very early Alzheimer’s disease by about 25 per cent. This is good news and suggests that we have turned the corner in the search for effective treatments.”
Researchers at Sweden’s Karolinksa Institutet have come up with a simple tool to show life expectancy after a dementia diagnosis, helping patients, caregivers and family to prepare. The prognosis is based on various factors, including sex, age, cognitive ability and the category of dementia (Alzheimer’s disease, for example, doesn’t progress as fast
as other dementias).
6. Climate Change
[ Spotlight / Kingston ]
Dr. John Muscedere is a critical care physician at Kingston Health Science Centre in Ontario and scientific director of the Canadian Frailty Network.
“The past decade has seen the emergence of two existential threats in Canadians’ collective consciousness — climate change and the aging population. While aging itself is not the issue, the rapidly increasing number of frail Canadians is. These are older people with multiple medical problems, loss of function and reduced quality of life. Right now, there are 1.5 million frail Canadians; this will rise to more than two million by 2030. These are the Canadians who will be most impacted by climate change.
“Temperatures have warmed significantly and will likely continue to rise, causing more frequent and intense heat waves. Extreme summer and winter storms will increase, along with forest fires, infectious disease outbreaks and agricultural disruptions leading to higher food prices. Climate change does not affect everyone equally – those who are frail are at greater risk. Frailty risk factors such as living alone, social isolation and low socio-economic status also increase the risk from extreme weather.
“Over the next 10 years, every senior will need an emergency preparedness plan, developed with their caregivers and support agencies. It should detail who will check on them during a climate crisis and where they might go if conditions are unsafe. Government and disaster relief agencies will need to harness technology such as personal sensors, social media and big data to help identify and deliver services to people at risk in the face of climate events.”
In July 2018, 66 people died in Montreal during a heat wave – the hottest month on record in 97 years. Sixty-six per cent were 65 or older. Many lived alone, and two-thirds lived in neighbourhoods with lots of concrete and few trees to provide shade. Montreal’s public health agency plans to set up a detailed registry that will map high-risk neighbourhoods and homes in order to mitigate climate-related deaths. As Muscedere says, “Forward planning such as this is important for all neighbourhoods to safeguard our older adults.”
[ Spotlight / Toronto ]
Nazeefah Laher is a public health expert and the author of a Wellesley Institute report on the expanding ethnocultural diversity of seniors in Ontario’s home and community care system.
“Diversity is our strength and with it comes a responsibility to acknowledge the diverse needs of Canadians. Between 2006 and 2016, there was an 87 per cent increase in visible minority older adults in Canada and a 227 per cent increase in Toronto. Almost a quarter of older adults in Canada speak a non-official language, and language barriers make it difficult to access health and social services and can also affect their quality of care. Unmet language needs in our health-care system can result in poor communication between patients and health-care providers, which can lead to adverse outcomes such as medication errors, lack of compliance with medical recommendations and inappropriate medical testing.
“As we move into the next decade, there are ways in which we can invest in the needs of our aging population. We need targeted funding for programs and services for ethnically and linguistically diverse older adults. We need to invest in quality interpretation services and translated materials. We need the stories of older adults captured in the media and in research to reflect the diversity of Canada. This will allow for a more inclusive aging landscape.”
Research out of Laurentian University, published in 2017, was the first to look at aging in a nationally representative sample of First Nations seniors. Its findings are alarming: “First Nations frailty levels in the 45- to 54-year-old age group were similar to those for aged 65 to 74 in the general population.” As the authors note, this means there is a need for specialized services such as home care for First Nations people at an earlier age than the general population. The findings are no surprise. According to the United Nations’ Department of Economic and Social Affairs for Indigenous Peoples, from an early age, they “suffer from poorer health, are more likely to experience disability and reduced quality of life and ultimately die younger than their non-Indigenous counterparts.” It notes the gap in life expectancy between Indigenous and non-Indigenous people is 17 years in Canada, compared with 20 years in Nepal and Australia, 13 in Guatemala; 11 in New Zealand, 10 in Panama and six in Mexico.
[ Spotlight / Guelph St. Catherines ]
Brock University’s Arne Stinchcombe and the University of Guelph’s Kimberley Wilson are Ontario researchers in gerontology who study LGBTQ+ aging.
“Readers can remember a time when the social and policy climates in Canada made it unsafe to ‘come out of the closet.’ It was only 15 years ago when same-sex marriage was legalized across Canada and only three years ago when gender identity and gender expression were added as protected grounds in the Canadian Human Rights Act.
“Aging experiences are shaped by these historical contexts, and their importance has traditionally been overlooked in research, policy and practice. Over the past decade or so, large Canadian research projects have started to collect data on sexual orientation and gender identity. This data shows older LGBTQ+ adults have higher rates of chronic diseases like respiratory problems, osteoporosis and cancer, which may, in part, be due to lifetime experiences of stigma and discrimination.
“In our research, we showcase stories of strength and resilience through digital storytelling, in which older LGBTQ+ adults develop a brief narrative about their aging experience, paired with images, videos and audio. These stories have highlighted optimism around aging, legacies of advocacy and rich care networks among LGBTQ+ communities.
“By partnering with older adults and community-based organizations, we believe it’s possible to create a future where no one has to go back ‘into the closet’ to receive equitable care.”
According to a 2017 survey by the Canadian advocacy organization Egale, more than half of senior LGBTQI2S respondents agreed their top
issue is the fear of being re-closeted in residential care. Toronto has a number of city-run retirement homes that are LGBTQ-positive. Fudger House, a long-term care home, houses 250 seniors within blocks of the vibrant downtown neighbourhood known as the Gay Village.
9. Social Isolation and Loneliness
[ Spotlight / Vancouver ]
Eddy Elmer, British Columbia Psychogeriatric Association board member, is doing his PhD in social gerontology at Vrije Universiteit Amsterdam, focusing on loneliness in marginalized groups.
“Isolation and loneliness increase the risk of poor health and early death, especially among older adults. In response, governments have declared a public health crisis, with the U.K. even appointing a Minister of Loneliness. In Vancouver, the Healthy City Strategy calls for everyone to have at least four people to rely on in times of need.
“Yet, in trying to foster social connection, much of our focus has been on the ‘low-hanging fruit,’ like people at seniors centres. We overlook those who want to be socially connected but are homebound, introverted or don’t consider themselves seniors. Cities must increasingly focus on reaching older adults where they are and make neighbourhoods more conducive to social interaction.
“Supporting ‘naturally occurring retirement communities’ is one way. These are large communities of seniors who decide to age in place instead of moving into retirement homes. Expanding Vancouver’s Hey Neighbour program, where apartment dwellers are paid to be social concierges, will also help. We can give incentives to developers to incorporate sociable design in new buildings, such as common rooms, outdoor seating and intersecting pathways. And postal carriers, police and firefighters might start getting to know people in their neighbourhoods through community events. In an era of fiscal deficits, these initiatives may seem like luxuries, but for those with no social contact, they can be life-saving.”
Researchers at the University of Toronto have created a non-language-specific Android app called InTouch that allows seniors to communicate without typing. They can say hello simply by waving their hand. The project, according to Elmer, shows that even older adults with cognitive impairment and physical disabilities such as poor dexterity can enjoy the benefits of online social networking.
[ Spotlight / Hamilton]
McMaster University’s Stuart Phillips is a professor in kinesiology who studies how exercise affects strength and muscle mass in older people.
“In the last 10 years, we’ve learned a lot about aerobic exercise (walking, jogging, running, cycling, swimming) and what it can do for health. It’s a great way to promote healthy aging. But what about strength? Strength-training research has advanced by leaps and bounds, and we can say with confidence that being stronger as we age is as important as being aerobically fit. People need to stay fit but build strength by working against an external resistance. The resistance could be your own body weight; it could be actual weights or elastic exercise bands, but it’s all about developing strength
“Exercise does as much for your mind as it does for your body: it leads to reduced risk of dementia, Alzheimer’s disease and depression. In fact, it’s now an almost weekly occurrence that we’re able to list yet another benefit of what exercise can do to positively affect your health – for example, a reduced risk of 13 of the 26 most common types of cancer.
“It would be great to see more of the built environment become exercise-friendly: bike lanes, walking paths, parks with playgrounds that are accessible and aimed at seniors. Aging in place requires solutions that are age-friendly; recreation and physical activity have to be front and centre. Seniors’ exercise parks like the one the City of Toronto recently built in North York are a great example: we played in parks as kids and, let’s face it, it never really goes away.”
Barcelona, Spain, has built playgrounds for older adults designed
to improve fitness and decrease isolation. According to a report from the U.S. Public Radio International, the parks are designed to improve the health of body and mind. “A few of the stations are, in fact, games where you match colours or shapes or numbers.”
A version of this article appeared in the March/April 2019/20 issue with the headline, “Your Health Vision 20/20,” p. 50.