Healthy Aging: quality as well as quantity of life

healthy aging - Older gentleman on static bike with coachAfter he retired as a Managing Director for The McQuaig Institute that specializes in psychometric assessment and talent management, former triathlete Michael Gravelle pursued his passion for personal fitness by starting a second career as a fitness instructor, certified personal trainer, writer, and speaker. His focus is on healthy aging and today he speaks to groups and organizations on how they can age healthier and get more out of their working and retirement years.

In his presentations, Gravelle starts off with a game that he refers to as “Two Truths and a Lie” in which participants respond with two honest answers and one lie, and other participants have to guess which answer was the lie. The questions include: “The last time I exercised was…,” “The last time I ate at McDonald’s was…” and “In university I weighed _______ pounds more/less than I do today.” The questions serve as both an icebreaker and a wake-up call to a harsh reality: that most people’s “A-Ha!” moments of feeling the need to lose weight and get healthier often involved health scares such as an increased risk of heart attack, stroke, or diabetes. Ironically, Gravelle uses a Grecian myth to make people aware of modern realities. He tells the story of the immortal goddess Eos, who asked for immortality for her lover, Tithonus, but had forgotten to ask for his eternal youth. As a result, Tithonus lived forever but as a frail old man. This is the modern Canadian reality, says Gravelle: “Canadians live to an average age of 81, so we live longer, but too many of us live sicker.”

So what can we do to prevent our later years from being ones of sickness, ill health and diminished quality of life? How can we age with gusto? These are the questions that researchers with York’s Graceful Aging Alliance focus on from a multitude of perspectives: physical, psychological, societal, front line care, health systems and policy.

With a cross disciplinary team of researchers from York’s Faculty of Health (Kinesiology & Health Science; Psychology; Nursing and Health Policy & Management), the vision of the Graceful Aging Alliance is to promote graceful aging by approaching aging with active and positive responses to changes and challenges throughout the aging process on a societal and individual level. The Alliance’s mission is to contribute to improved health and well-being for older adults.  By promoting innovative research, education and advocacy on graceful aging, Alliance members wish to introduce a radical attitude shift about aging and contribute to improved health for older adults in Canada and around the world.

The Graceful Aging alliance steering committee is currently in the process developing a proposal for a new Organized Research Unit (ORU) to be called the York University Centre for Aging Research and Education (YU-CARE). YU-CARE will bring together researchers from within the Faculty of Health and from other Faculty departments such as the Department of Sociology in the Faculty of Liberal Arts and Professional Studies, to conduct research in the area of aging, develop curriculum in this area for the education of undergraduate and graduate students, as well as engage in outreach activities with the community. It is a critical infrastructure that will advance a new understanding of aging from all aspects - molecular/cellular, human systems and behaviour, clinical, and societal/cultural. The mandate of YU-CARE is to:

  1. Develop community responsive and culturally relevant interdisciplinary knowledge to improve healthy aging. The knowledge will inform policy, practice, and educational initiatives that prevent and facilitate management of health-related decline, chronic disease and disability in aging;
  2. Build capacity in optimal aging research, education and practice by mentoring students, post-doctoral fellows and junior faculty; and
  3. Promote optimal functioning throughout the aging process on an individual, system, and societal level.

“In short, we want to see a society where the quality, as well as quantity of life is extended, where we can all age with greater vitality,” says William Gage, Associate Dean, Research, in the Faculty of Health.

Debunking the Stereotype that Getting Older Means Slowing Down

Joe Baker, Associate Professor in the School of Kinesiology and Health Science, specializes in research on Masters athletes, those 35 and older who pursue athletic pursuits usually at a high level, and the clues they may provide to healthy aging in the general population.

JoeBakerMastersAthlete

Baker, co-editor (with Sean Horton and Patricia Weir) of The Masters Athlete: Understanding the Role of Sport and Exercise in Optimizing Aging (Routledge, 2010) and president of the Canadian Society for Psychomotor Learning and Sport Psychology, believes masters athletes can teach the general population a lot about aging well.

The book takes a multi-disciplinary look at masters athletes and their ability to maintain cognitive and physical functioning as they age. “It deconstructs the negative attitude many have about the aging population and offers some positive feedback on this group,” says Baker. “The performance of these masters athletes is continuing to shatter the assumptions about older people.”

Baker points to masters athlete Ed Whitlock of Milton, Ontario, who ran a marathon in under three hours at the age of 72 in 2003, roughly the same time as the fastest person to run a marathon in 1896, over 100 years earlier. Getting older doesn’t automatically mean people will be significantly less capable physically.

Joe Baker - faculty of health, York UniversityJoe Baker

"It’s important to get people to re-examine their outlook on aging,” says Baker, “that continual engagement in challenging activities like physical activity and sport is extremely important for aging well.”

Baker examines the evidence that cognitive skills, motor skills and physiological capabilities can be maintained at a high level with advancing age, and that age-related decline is slowed in athletes who continue to train and compete in their later years.

People don’t have to be masters athletes to benefit from continued physical fitness and participation in sports at an advanced age. “The benefits are clear for any aging person,” says Baker, including evidence of lower incidences of cardiovascular disease, hypertension and diabetes. “But somewhere along the line we buy into this view that we’re getting older and we should slow down.”healthy aging - Older woman running

It was Baker’s research into motor skill maintenance in sports that led him to look at the physical capabilities of aging adults. It goes back to the old saying, "Use it or lose it." Baker points to golfer Tom Watson, who nearly won the 2009 Open Championship at the age of 59. He would have been the oldest to do so.

How deep is your cognitive reserve and how changes to the brain’s default network may point to interventions to enhance cognitive capacity against age-related decline

Just as staying physically active is essential to healthy aging, it is equally important to keep our minds active and sharp. We have all been told of the importance of putting money away into retirement accounts but there is another fund that Psychologists tell us we should be keeping track of—a mental one. Each of us should be asking ourselves: How deep is my cognitive reserve?

Cognitive reserve is the term scientists use to describe the extent of the brain’s capacity to resist aging and degenerative conditions like Alzheimer’s disease.

Recent research at Rush University Medical Center in Chicago revealed that people who made a lifelong habit of reading and writing slowed their rate of mental decline by 32 percent over those who engaged in only average levels of these activities. Reading and writing aren’t the only ways to augment your cognitive reserve. Research on bilingualism by York U Psychology professor Ellen Bialystok, for example, has demonstrated that speaking more than one language delays the onset of Alzheimer’s symptoms by an average of five years.

Ellen Bialystok - Faculty of Health, York UniversityEllen Bialystok

Bialystok theorizes that the mental exercise required to speak multiple tongues—remembering which word belongs to which language—helps bilingual people build up their mental storehouse.

Bialystok’s colleague, York Psychology professor Gary Turner, and chair of the Graceful Aging Alliance, was part of a recent study with Cornell University researchers that found the brain’s default network, a collection of brain regions thought to be involved in cognitive functions such as memory, declines in volume with both normal aging and in Alzheimer’s disease.

These new findings suggest that structural changes in this collection of brain regions may be critical to Alzheimer’s disease onset and this could eventually lead to patients being diagnosed earlier.

“The default network was a vulnerable area and it was more vulnerable in those who would go on to develop the disease,” says Turner who is also a member of the Cognitive Aging Neuroscience and Neurointervention Lab in the Faculty of Health.Image of brain scan

The network of brain regions highlighted in red and yellow show atrophy in both healthy aging and neurodegenerative disease. These regions are susceptible to normal aging and dementia

Turner and Cornell University Professor Nathan Spreng, the Rebecca Q. and James C. Morgan Sesquicentennial Faculty Fellow and director of the Laboratory of Brain and Cognition at Cornell, found that the brain’s grey matter in the default network shrinks with normal aging across the lifespan, but it does so much more sharply in those who go on to develop dementia, as well as those with a genetic predisposition for the disease. These changes were also associated with declines in general cognitive ability.

“What we were really interested in doing with this work was looking at how the brain is altered across the lifespan,” says Turner. “The default network is already known to be implicated in Alzheimer’s disease but we believe this is one of the first reports demonstrating these structural network changes across the lifespan from young to older adulthood and into Alzheimer’s disease. And we were able to look at changes simultaneously across the whole default network.”

 Gary Turner - Faculty of Health, York UniversityGary Turner

“Our data suggest that these structural brain changes may be detectable many years before behavioral signs appear,” says Turner. This could allow for much earlier interventions for Alzheimer’s disease than is currently possible. The focus of Turner’s research, he says, is to translate these cognitive neuroscience research findings into rehabilitation interventions to enhance cognitive functioning in healthy aging and acquired brain injury and slow the trajectory of cognitive decline in brain disease.

Their paper, “Structural Covariance of the Default Network in Healthy and Pathological Aging”, was published in The Journal of Neuroscience.

Improving Front line Care and Systems for Healthier Aging

Canadians are living longer, with life expectancy now reaching a record 80.2 years. By 2026, one in five Canadians will be 65 or older; by 2041, it will be one in four. With so many of us expecting to fill the ranks of seniors within the next two decades, how can we ensure that our health care systems, such as our hospitals and long term care facilities, will be equipped to meet our needs?

Mary Fox, an Associate Professor in York’s School of Nursing, led a study that found hospitalized seniors fare better – have fewer falls, less functional decline at discharge and shorter stays – in acute geriatric care units where staff have a function-focused approach to care.

The purpose of the research was to determine the effectiveness of care for seniors in the acute phase of illness or injury admitted to acute geriatric units compared to seniors not admitted to these specialized centres.

“It is the first study to quantify the effectiveness of an innovative function-focused approach to older adults’ acute hospital care,” says York Professor Mary Fox of the graduate program in nursing in York’s School of Nursing, Faculty of Health. She is the first author of the article, “Effectiveness of Acute Geriatric Unit Care using ACE Components: A Systematic Review and Meta-Analysis”, published in the Journal of the American Geriatrics Society.

Mary Fox - Faculty of Health, York UniversityMary Fox

As the principal investigator of the Canadian Institutes of Health Research-funded study, Fox conducted a systematic review and meta-analysis of 13 trials involving 6,839 acutely ill or injured octogenarians. Acute geriatric units are those with at least one Acute Care for Elders (ACE) component, either patient-centred care, frequent medical review, early rehabilitation, early discharge planning or prepared environment. The goal of ACE components is to prevent hospital-acquired complications and functional deterioration associated with common hospital medications, treatments and procedures for older adults.

The researchers also found that seniors admitted to acute geriatric units had less delirium and were more likely to be discharged home as opposed to a nursing facility.

“It demonstrated that this approach has significant beneficial effects in improving both patient- and system-level outcomes over usual care,” says Fox. “Hospital administrators may anticipate cost savings of approximately $246 per person, per length of hospital stay (in US dollars, standardized to year 2000) and a reduced length of hospital stay by more than half a day, when compared to usual care.”

Seniors aged 65 and older are considered the “core business” of hospitals. They account for 40 per cent of all hospital care days even though they comprise only 14 per cent of the Canadian population.

“As older adults account for 50 per cent of Canadian hospital expenditures,” says Fox, “this cost difference may represent a significant future source of financial saving to Canada’s health-care system while improving patient outcomes.”

It is known that older adults face a higher risk of functional decline, falls, pressure ulcers and delirium when hospitalized, which is associated with increased hospital costs, institutionalization and death. “These poor outcomes are more often not related to their illness, but to other things, like not getting up and walking around while in the hospital or receiving treatments, such as drugs and catheters that make it difficult to move around. There are things that fall through the cracks,” says Fox. Early intervention is crucial in helping to circumvent these risks.

healthy aging - woman helping older man in hospital

The goal is to develop senior-friendly hospitals by informing and engaging decision makers – clinicians, hospital administrators, policymakers and funders – about the best interventions to prevent physical, cognitive and psychosocial functional decline. Acute geriatric care units would not only save hospitals money, but provide the most beneficial care for seniors.

York nursing Professors Malini Persaud, Deborah Tregunno and Ellen Schraa, along with York librarian IIo-Katryn Maimets, were co-authors of the study, which included a team of researchers from York University and the University of Toronto.

Looking at working conditions in long-term care settings and the impact on staff and resident health and safety

York Professor Tamara Daly, in the School of Health Policy & Management, will lead a research program studying the gendered health impacts of performing paid and unpaid care work for seniors in long-term care (LTC) settings.

Daly has been awarded one of nine Canadian Institutes of Health Research (CIHR) research chairs in Gender Work and Health. The program, Working Well: Understanding How Gender Influences Working Conditions and Health in Long-Term Care Settings Across Canada and Internationally, will receive $800,000 in CIHR funding over five years. It will train and mentor the next generation of researchers and to transfer knowledge to decision makers and front-line care workers.

Tamara Daly - Faculty of Health, York University

Tamara Daly

“Health care work is unhealthy and at times dangerous work, with the most challenging conditions prevailing in LTC settings. We don’t often talk about gender in LTC settings even though care work is primarily performed by women,” says Daly, a professor at the School of Health Policy & Management in York University’s Faculty of Health.

Approximately 200,000 older adults – also mostly women – live in one of the 2,136 long-term care facilities across the country, Daly cites Statistics Canada, explaining the need for research in the area.

According to the 2005 National Survey of the Work and Health of Nurses findings, LTC workers were more likely to report fair or poor health compared with those working in hospitals or the community.woman helping older woman in wheelchair

“LTC work is increasingly precarious, fast-paced and low paid and that leads to health implications. With more men entering the field and with families, volunteers, students and private companions contributing a great deal of informal care, we need to better understand not only how the work is shared – between men and women, and between staff and informal providers – but also how health and safety for residents and providers are affected,” says Daly.

Comparative studies exploring LTC working conditions among various provinces, as well as Canadian conditions in comparison with those in Germany, Sweden, Norway, the United Kingdom and the United States, are proposed as part of the five-year plan.

Graduate trainees will have opportunities to engage in domestic and international primary research, systematic reviews, data analysis and the preparation and presentation of papers to academic, policy and practice oriented conferences. They will be mentored in knowledge translation, and have opportunities to work directly with York U’s Knowledge Mobilization Unit.

“This program will help to better understand working in and receiving LTC, and to inform policymakers about resident’s and worker’s health and safety,” says Daly. It is built on her existing research program and will be supported by eight partner organizations collectively representing more than half a million care workers and 27,000 LTC facility beds in Ontario.

Don’t Fall: reaching out to promote safety and wellness

healthy aging - older adults practicing tai chiWilliam Gage, Associate Dean, Research, in the Faculty of Health, a professor of biomechanics and behavioural neuroscience in York’s School of Kinesiology & Health Science, and a member of York’s Graceful Aging Alliance, has spent the past 15 years conducting research into understanding why older adults are more likely to fall than younger people. Currently, 1 in 3 people over the age of 65 will fall this year. Those who have fallen previously are at higher risk of falling again. “There are many reasons why this is so,” says Gage, including weakened muscles and diminished balance from inactivity and tripping hazards such as clutter and throw rugs “but you’ll see that there are a lot of things that older people, and the people who care for them, can do to reduce the risk of falling.”

In addition to research and teaching, Gage thought an effective way to share knowledge to benefit the health and well-being of older people around the world was to reach out directly online – that’s why he started the website Don’t Fall (www.dontfall.ca)

“I chose the name ‘Don’t Fall’ for this project because I’d like for these words to become a motto, if you will, for older people, everywhere,” says Gage. Falling can be damaging, he adds, particularly for older people, not just physically, but also emotionally and mentally. “These words, Don’t Fall, can remind people of the power they have and the power they can gain through learning and knowledge, to maintain and improve their own health.”

Gage encourages visitors to the website to tell their friends about the site, as well as register with their email address to receive updates and notifications whenever a new article is posted.

Here are 10 tips from the website to reduce your risk of falling

  1. Reduce or eliminate clutter. Clutter on shelves in the bedroom can fall to the ­floor. Clutter on the ­floor, particularly around the bed, is a tripping hazard.
  2. Improve Lighting. Vision changes as we age, and good lighting becomes more and more important. Easy access to the light switch from the bed, or the bedside lamps is important. Light switches at the top and bottom of stairs prevents using the stairs in the dark. Eliminate shadows on the ­floor as much as possible.
  3. Get rid of throw rugs. Throw rugs slide and buckle up, creating a tripping hazard. Get rid of the throw rugs in your house.
  4. Stay Active. Exercising is crucial. Regular walking builds muscle and cardiovascular endurance. Balance exercises, such as Tai Chi, reduce the risk of falling.
  5. Watch where you step. Particularly on uneven terrain (e.g., grass, curbs), look where you’re stepping for each and every step. Keep looking there until your foot hits the ground.
  6. Get your medications checked. If you’ve fallen recently, have your physician check your medications immediately. Medication dosages may need to be adjusted.
  7. Reduce the number of medications you take. Do NOT stop taking any medications until you’ve spoken with your doctor. But ask your doctor if there are any medications you can stop taking or if you can reduce your dosage. 
  8. Get your eyes checked. Make sure that you have the right prescription for your glasses. Only 50% of people who are eligible to have their eyes checked actually do it. 
  9. Wear shoes. Even when you are inside. Of course, wear shoes outside. Avoid going barefoot. Don’t wear slippers – they don’t fit snuggly.
  10. Eat smaller meals regularly to control your blood sugar. 

Sources: YFile, Annie Murphy Paul Blog, Business Insider Magazine