tag:theconversation.com,2011:/ca-fr/topics/seniors-20302/articlesSeniors – La Conversation2024-01-10T23:10:59Ztag:theconversation.com,2011:article/2174952024-01-10T23:10:59Z2024-01-10T23:10:59ZBreaking the curve: A call for comprehensive scoliosis awareness and care<figure><img src="https://images.theconversation.com/files/568748/original/file-20240110-29-9agwvv.jpg?ixlib=rb-1.1.0&rect=1417%2C0%2C7257%2C5787&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scoliosis is a prevalent and underappreciated condition across Canada.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/breaking-the-curve-a-call-for-comprehensive-scoliosis-awareness-and-care" width="100%" height="400"></iframe>
<p><a href="https://www.cbc.ca/news/canada/wait-times-marketplace-1.6620306">Cael</a> was a typical 15-year-old — until the discovery of an already advanced abnormal curvature of his spine. </p>
<p>“I felt like the Hunchback of Notre Dame,” Cael told CBC News, recalling the emotionally draining and gruesome two-year wait for spinal surgery during which his curve progressed to a whopping 108 degrees.</p>
<p><a href="https://doi.org/10.1016/s0140-6736(08)60658-3">Scoliosis is an abnormal twisting and curving of the spine that can develop at any age, but mostly occurs during rapid growth spurts in children</a>, and as part of spine aging in adults over the age of 60. </p>
<p>Of all types of scoliosis in children, adolescent idiopathic scoliosis is the most prevalent, <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">accounting for as many as nine in 10 cases and impacting up to one in 20 adolescents globally</a>. On the other end of the age spectrum, a staggering <a href="https://doi.org/10.1097/01.brs.0000160842.43482.cd">two-thirds of older adults are also affected</a>.</p>
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<a href="https://theconversation.com/explainer-everything-you-need-to-know-about-scoliosis-28409">Explainer: everything you need to know about scoliosis</a>
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<p>In clinical care, research and education related to scoliosis, disparities persist worldwide. Despite its widespread prevalence, scoliosis often goes undiagnosed, or has delayed diagnosis as in Cael’s case. It also receives limited attention in clinical and public health education, leading to significant gaps in health care.</p>
<p>This general lack of awareness has serious implications for thousands of people like Cael.</p>
<h2>Gaps in effective care</h2>
<p>In the United States, fewer than half of states legislate <a href="https://doi.org/10.1186/1748-7161-8-17">school-based scoliosis screening in children</a>. Even worse, Canada discontinued screening back in <a href="https://canadiantaskforce.ca/wp-content/uploads/2016/09/1994-red-brick-en.pdf">1979</a> because it was not considered cost-effective. </p>
<p>Pediatricians’ <a href="https://cps.ca/en/documents/position/greig-health-record-technical-report">screening</a> practices vary, and some cases of scoliosis in children are only discovered when an unrelated chest X-ray reveals a curved spine. With about <a href="https://doi.org/10.1007/s00586-011-2074-1">30 per cent of cases being hereditary</a>, parents may not recognize the signs early on.</p>
<p>The <a href="https://www.srs.org/Files/Patient-Brochures/Patient.Adolescent_Idiopathic_Scoliosis_Handbook_for_Patients.pdf">recommended care</a> in North America involves bracing for mild to moderate curves (25° to 45°) and surgery for curves exceeding 45°. Shockingly, <a href="https://doi.org/10.1097/brs.0b013e318059b5f7">32 per cent of Canadian children</a>, like Cael, face delayed referrals, discovering significant curves when they finally see specialists.</p>
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<img alt="X-ray images of two human torsos showing signs of scoliosis" src="https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=530&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=530&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=530&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=666&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=666&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=666&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Radiologic comparison of adult idiopathic scoliosis (A) and adult degenerative scoliosis (B).</span>
<span class="attribution"><span class="source">(Cho KJ, Kim YT, Shin SH, Suk SI)</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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<p>Despite documented success in managing scoliosis through early <a href="https://doi.org/10.1016/j.spinee.2015.01.019">screening</a>, <a href="https://doi.org/10.1016/j.physio.2023.07.005">exercise rehabilitation</a> and <a href="https://doi.org/10.1056/nejmoa1307337">brace</a> treatment, global health-care education often neglects this condition. </p>
<p>The general lack of global awareness leaves physicians, nurses and other practitioners unaware of effective treatments and referral processes, contributing to the misunderstanding and under-treatment of patients. Consequently, when children with scoliosis eventually reach specialists for care, they may encounter challenges navigating the health-care system as they transition into adulthood.</p>
<h2>Sex disparities</h2>
<p>It is unclear why adolescent idiopathic <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">scoliosis affects mainly girls</a>. The more severe the curve, the more likely the patient is female. Due to their specific biology, <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">females</a> also face a five-fold higher risk of progressive deformities and are 10 times more likely, compared to males, to require surgery.</p>
<p>Despite generally uncomplicated <a href="https://doi.org/10.1097/00007632-200107010-00015">pregnancies and deliveries</a>, women with scoliosis often face <a href="https://doi.org/10.1097/bpo.0000000000002499">difficulties receiving pain control</a> during labour, with higher epidural failure rates. Moreover, they often suffer pregnancy-related back pain, and their spine <a href="https://doi.org/10.7759/cureus.46782">curvature may worsen after pregnancy</a>.</p>
<h2>Health-care access barriers</h2>
<p>Health-care access in the U.S. is influenced by a range of factors including race, income and health insurance coverage. </p>
<p>Patients with <a href="https://doi.org/10.1097/bpo.0000000000002551">better insurance</a> plans tend to seek pediatric orthopedic care at a younger age. Those with public insurance tend to have worse spine curvatures by the time they reach a scoliosis specialist; this is particularly striking among Black patients with public insurance, who are <a href="https://doi.org/10.1097/bpo.0000000000002213">67 per cent less likely</a> to be diagnosed at a stage early enough for effective brace treatment compared to Black patients with private insurance.</p>
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<figcaption><span class="caption">A brief overview on recognizing idiopathic scoliosis produced by Veritas Health.</span></figcaption>
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<p>While Canada’s health-care system covers spinal fusion for severe scoliosis, the lack of a national insurance program in the U.S. leads to varying out-of-pocket expenses for patients. </p>
<p>Those without insurance often cannot afford surgery at all. </p>
<p>But even with Canada’s universal coverage, patients typically wait <a href="http://waittimes.alberta.ca/WaitTimeTrends.jsp?rcatID=56&rhaID=All_34_&doSearch=true&urgencyCode=9&facilityID=-9_&checkedRegionNo=0&oldCheckedRegionNo=0&oldCheckedFacilityNo=0&ifDisplayFacility=false&ifDisplayPhysician=false&command=goToAccessGoals&chartType=access_goal&subChartType=90_75_50_25_AVERAGE_&disabledChartType=trend&status=processAjax&ifHavingFPTMeasurement=true#WaitTimeInfo">an entire year</a> for surgery due to a shortage of providers. Because of regional variability in resources such as access to spinal surgeons, funding and specialized facilities, some kids, like Cael, wait even longer, experiencing physical, emotional and psychological burdens, while their curves get progressively worse. </p>
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Read more:
<a href="https://theconversation.com/how-healthy-is-the-canadian-health-care-system-82674">How healthy is the Canadian health-care system?</a>
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<p>Delayed surgery in Canada cost the health-care system <a href="https://www.childrenshealthcarecanada.ca/en/child-health-advocacy/no-child-elects-wait_october2023.pdf">$44.6 million</a> due to more complex surgeries, extended hospital stays, readmission and re-operation rates.</p>
<h2>Workforce and research disparities</h2>
<p>Ongoing gender disparities in the health-care workforce and lack of research funding for this female-predominant condition continue to hamper effective action.</p>
<p><a href="https://doi.org/10.1016/j.wneu.2018.09.152">Fewer than five per cent of spinal surgeons</a> identify as women. <a href="https://journals.lww.com/annalsofsurgery/toc/2011/04000">Glass-ceiling</a> effects surround women surgeons in this male-dominated culture, perpetuating gendered training environments, being held to higher standards and earning lower wages. The dearth of senior women role models and mentors is a further barrier for career advancement and retention.</p>
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Read more:
<a href="https://theconversation.com/canadas-health-care-crisis-is-gendered-how-the-burden-of-care-falls-to-women-215751">Canada’s health-care crisis is gendered: How the burden of care falls to women</a>
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<p>Furthermore, <a href="https://doi.org/10.1038/d41586-023-01472-5">research funding</a> for diseases, such as scoliosis, that mainly affect females has historically lagged far behind funding for male-predominant diseases. <a href="https://doi.org/10.1002/9781119374855.ch26">Improving workforce diversity</a> is an important facet of addressing health disparities and shaping research agendas.</p>
<p>Inequities abound in scoliosis care and research. The impact of lack of awareness and delayed care extends beyond physical challenges. The patient and their family suffer emotionally, incurring significant financial burden while fearing the future. </p>
<p>The message is clear, we must do better for this underserved population.</p><img src="https://counter.theconversation.com/content/217495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scoliosis is a treatable condition, but only if detected early. Greater awareness of the condition and its dynamics will greatly aid in patient care moving forward.Sanja Schreiber, Adjunct Professor, Faculty of Rehabilitation Medicine - Physical Therapy, University of AlbertaEmily Somers, Professor of Internal Medicine, Environmental Health Sciences, and Obstetrics & Gynecology, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164022023-11-09T21:40:27Z2023-11-09T21:40:27ZThe experiences of older drivers can help design cleaner and safer cars<figure><img src="https://images.theconversation.com/files/557839/original/file-20231106-267473-frkprb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Automobile technologies can be applied to allow older drivers continued mobility and independence.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/the-experiences-of-older-drivers-can-help-design-cleaner-and-safer-cars" width="100%" height="400"></iframe>
<p>The current pace of technological change in automobile technology rivals the period about a century ago when cars were moving from the exotic fringes of transportation into the lives of <a href="https://americanhistory.si.edu/america-on-the-move/americans-adopt-auto">ordinary people</a>. </p>
<p>The automobile has <a href="https://www.ushistory.org/us/46a.asp#:%7E:text=The%20social%20effects%20of%20the,shop%20in%20towns%20and%20cities">reshaped the world</a>, giving rise to new freedoms and greater access to distant places, creating jobs and wealth and changing the physical landscape with roads, service stations, dealerships and suburbs. </p>
<p>Cars have brought incredible convenience, but their proliferation has also resulted in traffic jams, oppressive freeways, pollution and high-speed <a href="https://www.thecanadianencyclopedia.ca/en/article/highway-disasters">crashes</a>. And, cars have played a <a href="https://www.fueleconomy.gov/feg/climate.shtml#:%7E:text=Highway%20vehicles%20release%20about%201.5,year%20for%20a%20typical%20vehicle">big part</a> in accelerating <a href="https://www.pwc.com/th/en/automotive/assets/co2.pdf">climate change</a>.</p>
<h2>Car transformations</h2>
<p>Automobile design is undergoing massive shifts. Cars are moving away from gasoline-powered internal combustion engines and toward electric vehicles that generate far less pollution and noise. Cars are getting safer, too, with sensors and cameras that can help drivers avoid collisions. </p>
<p>Self-driving cars don’t seem too far off either, but until then, automobile design should consider the changing needs of drivers.</p>
<p>For all drivers, but especially those who are older and more experienced, cars that can do more without involving the driver present both an opportunity and a threat. This presents an opportunity to support safe, independent driving for longer, in keeping with <a href="https://yourhealthsystem.cihi.ca/hsp/inbrief#!/indicators/011/life-expectancy-at-birth/;mapC1;mapLevel2;/">extended lifespans</a>, and address the social and practical needs of seniors to move around.</p>
<p>The threat is that a more autonomous car may lull drivers into feeling safer and make it harder to understand when drivers with health-related changes should no longer remain on the road. In fact, with added technology, <a href="https://doi.org/10.1177/0018720819900402">driving can require more advanced skills</a>.</p>
<h2>Safer for older drivers</h2>
<p>In my research, I work closely with older drivers, branches of government and automakers to ensure cars are as safe as can be.</p>
<p>I discussed these issues when I was invited to address <a href="https://sencanada.ca/en/Content/Sen/Committee/421/TRCM/53492-e">Canada’s Standing Senate Committee on Transport and Communications</a> in 2017. My colleagues and I continue to do research in partnership with older drivers and others, including <a href="https://doi.org/10.1016/j.aap.2020.105741">Transport Canada</a> and the <a href="https://www.flipsnack.com/caasco/caa-magazine-sco-winter-2020/full-view.html?p=20">Canadian Automobile Association</a>. </p>
<p>An important goal of my research and teaching is to help everyone — including seniors — understand that aging drivers are a growing yet varied group with a wide range of physical and cognitive abilities — and that, statistically speaking, <a href="https://www.iihs.org/topics/older-drivers">seniors are involved in fewer crashes than their middle-aged counterparts</a>. In other words, age alone does not determine who is safe or unsafe to be behind the wheel.</p>
<h2>Declining health</h2>
<p>We need to plan as humanely and responsibly as we can for the fact that, especially in the upper range of this demographic group, health-related declines and medical changes can happen <a href="https://publications.gc.ca/collections/Collection-R/LoPBdP/BP/bp351-e.htm">quickly</a> and are not always readily <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">apparent</a>. </p>
<p>For example, working with an advisory group of people with lived experience with dementia, my colleagues and I developed the <a href="https://drivinganddementia.ca/Acknowledgements">driving and dementia roadmap</a>. This is a free online resource to help health professionals, caregivers and individuals living with this disease be safer on the road.</p>
<p>As cars change, it is critical that manufacturers, engineers and regulators consider how drivers, particularly those in their later years, will respond to and engage with emerging technologies. It is also important to ensure new technology is created with older drivers in mind as much as anyone else, in keeping with the principles of <a href="https://universaldesign.ie/what-is-universal-design/">universal design</a>. </p>
<p>That includes making sure that getting in and out of a car, orienting oneself on the road and controlling all the systems of a vehicle are friendly to all drivers.</p>
<h2>Informed and transformed design</h2>
<p>My research team is embarking on a project in conjunction with our engineering colleagues and students at the <a href="https://electrification.mcmaster.ca">McMaster Automotive Resource Centre</a>, where we are inviting older drivers to volunteer and share their driving-related experiences. The aim is to inform the design of a 2023 Cadillac LYRIQ, an electric SUV, as part of the North American <a href="https://avtcseries.org/about-the-ecocar-ev-challenge/">EcoCar EV Challenge</a>. </p>
<p>The mandate of this contest is not just to make vehicles that are as efficient and as easy on the environment as possible, but also to optimize their safety and accessibility for drivers of different ages and abilities. </p>
<p>A modern car with fully loaded safety features and powered without gas will only be a great success if it’s designed for those who will use it. By involving older drivers — the most experienced on today’s roadways — in their research and development, the cars of tomorrow can be made clean, safe and accessible for all.</p><img src="https://counter.theconversation.com/content/216402/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brenda Vrkljan has received research funding from the Canadian Institutes of Health Research, the Government of Canada, and the Ontario Ministry of Transportation (MTO). </span></em></p>Automobile technology provides opportunities for older drivers to maintain their independence and autonomy, but cars need to be designed with their needs in mind.Brenda Vrkljan, Professor of Occupational Therapy, School of Rehabilitation Science, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139542023-10-01T15:12:14Z2023-10-01T15:12:14ZEarly indicators of dementia: 5 behaviour changes to look for after age 50<figure><img src="https://images.theconversation.com/files/551222/original/file-20230929-24-as88uw.jpg?ixlib=rb-1.1.0&rect=146%2C251%2C6514%2C4290&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Behaviour changes like apathy, lack of impulse control or socially inappropriate behaviour may indicate a risk of dementia in people over age 50.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/early-indicators-of-dementia-5-behaviour-changes-to-look-for-after-age-50" width="100%" height="400"></iframe>
<p>Dementia is often thought of as a memory problem, like when an elderly person asks the same questions or misplaces things. In reality, individuals with dementia will not only experience issues in other areas of cognition like learning, thinking, comprehension and judgement, but they may also experience <a href="https://www.alzint.org/u/World-Alzheimer-Report-2021.pdf">changes in behaviour</a>. </p>
<p>It’s important to understand what dementia is and how it manifests. I didn’t imagine my grandmother’s strange behaviours were an early warning sign of a far more serious condition. </p>
<p>She would become easily agitated if she wasn’t successful at completing tasks such as cooking or baking. She would claim to see a woman around the house even though no woman was really there. She also became distrustful of others and hid things in odd places. </p>
<p>These behaviours persisted for some time before she eventually received a dementia diagnosis.</p>
<h2>Cognitive and behavioural impairment</h2>
<p>When cognitive and behavioural changes interfere with an individual’s functional independence, that person is considered to have dementia. However, when cognitive and behavioural changes don’t interfere with an individual’s independence, yet still negatively affect relationships and workplace performance, they are referred to as <a href="https://alzheimer.ca/sites/default/files/documents/other-dementias_mild-cognitive-impairment.pdf">mild cognitive impairment (MCI)</a> and <a href="https://doi.org/10.1186/s13195-021-00949-7">mild behavioural impairment (MBI)</a>, respectively. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169943/">MCI and MBI can occur together</a>, but in one-third of people who develop Alzheimer’s dementia, the behavioural symptoms come <a href="http://dx.doi.org/10.1016/j.jagp.2019.01.215">before cognitive decline</a>. </p>
<p>Spotting these behavioural changes, which emerge in later life (ages 50 and over) and represent a persistent change from longstanding patterns, can be helpful for implementing preventive treatments before more severe symptoms arise. As a medical science PhD candidate, my research focuses on problem behaviours that arise later in life and indicate increased risk for dementia. </p>
<h2>Five behavioural signs to look for</h2>
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<a href="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of five behaviour changes that may indicate risk of dementia" src="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=659&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=659&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=659&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Spotting behavioural changes can be helpful for implementing preventive treatments before more severe symptoms arise.</span>
<span class="attribution"><span class="source">(Daniella Vellone)</span></span>
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<p>There are <a href="https://doi.org/10.3233%2FJAD-160979">five primary behaviours</a> we can look for in friends and family who are over the age of 50 that <a href="https://doi.org/10.1186/s13024-023-00631-6">might warrant further attention</a>. </p>
<h2>1. Apathy</h2>
<p><a href="https://doi.org/10.1002%2Ftrc2.12370">Apathy</a> is a decline in interest, motivation and drive.</p>
<p>An apathetic person might lose interest in friends, family or activities. They may lack curiosity in topics that normally would have interested them, lose the motivation to act on their obligations or become less spontaneous and active. They may also appear to lack emotions compared to their usual selves and seem like they no longer care about anything.</p>
<h2>2. Affective dysregulation</h2>
<p><a href="https://doi.org/10.1016/j.jad.2023.03.074">Affective dysregulation</a> includes mood or anxiety symptoms. Someone who shows affective dysregulation may develop sadness or mood instability or become more anxious or worried about routine things such as events or visits.</p>
<h2>3. Lack of impulse control</h2>
<p><a href="https://doi.org/10.1002%2Ftrc2.12016">Impulse dyscontrol</a> is the inability to delay gratification and control behaviour or impulses.</p>
<p>Someone who has impulse dyscontrol may become agitated, aggressive, irritable, temperamental, argumentative or easily frustrated. They may become more stubborn or rigid such that they are unwilling to see other views and are insistent on having their way. Sometimes they may develop sexually disinhibited or intrusive behaviours, exhibit repetitive behaviours or compulsions, start gambling or shoplifting, or experience difficulties regulating their consumption of substances like tobacco or alcohol.</p>
<h2>4. Social inappropriateness</h2>
<p><a href="http://dx.doi.org/10.1017/S1041610217001260">Social inappropriateness</a> includes difficulties adhering to societal norms in interactions with others.</p>
<p>Someone who is socially inappropriate may lose the social judgement they previously had about what to say or how to behave. They may become less concerned about how their words or actions affect others, discuss private matters openly, talk to strangers as if familiar, say rude things or lack empathy in interactions with others.</p>
<h2>5. Abnormal perceptions or thoughts</h2>
<p><a href="https://doi.org/10.1038/s44220-023-00043-x">Abnormal perception or thought content</a> refers to strongly held beliefs and sensory experiences.</p>
<p>Someone with abnormal perceptions or thoughts may become suspicious of other people’s intentions or think that others are planning to harm them or steal their belongings. They may also describe hearing voices or talk to imaginary people and/or act like they are seeing things that aren’t there.</p>
<p>Before considering any of these behaviours as a sign of a more serious problem, it’s important to rule out other potential causes of behavioural change such as drugs or medications, other medical conditions or infections, interpersonal conflict or stress, or a recurrence of psychiatric symptoms associated with a previous psychiatric diagnosis. If in doubt, it may be time for a doctor’s visit. </p>
<h2>The impact of dementia</h2>
<figure class="align-center ">
<img alt="A young man with his arms around an older man" src="https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some types of behaviour changes warrant further attention.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Many of us know someone who has either experienced dementia or cared for someone with dementia. This isn’t surprising, given that dementia is predicted to affect <a href="https://www.ctvnews.ca/health/nearly-one-million-canadians-will-live-with-dementia-by-2030-alzheimer-society-predicts-1.6056849#:">one million Canadians by 2030</a>.</p>
<p>While people between the ages of 20 and 40 may think that they have decades before dementia affects them, it’s important to realize that dementia isn’t an individual journey. In 2020, care partners — including family members, friends or neighbours — spent <a href="https://alzheimer.ca/sites/default/files/documents/Landmark-Study-1-Path-Forward-Alzheimer-Society-of-Canada-2022-wb.pdf">26 hours per week</a> assisting older Canadians living with dementia. This is equivalent to 235,000 full-time jobs or $7.3 billion annually. </p>
<p>These numbers are expected to triple by 2050, so it’s important to look for ways to offset these predicted trajectories by preventing or delaying the progression of dementia.</p>
<h2>Identifying those at risk</h2>
<p>While there is currently no cure for dementia, there has been progress towards <a href="https://alzheimer.ca/en/about-dementia/dementia-treatment-options-developments">developing effective treatments</a>, which <a href="https://alzheimer.ca/en/about-dementia/do-i-have-dementia/how-get-tested-dementia-tips-individuals-families-friends/10">may work better earlier in the disease course</a>. </p>
<p>More research is needed to understand dementia symptoms over time; for example, the online <a href="https://www.can-protect.ca/">CAN-PROTECT study</a> assesses many contributors to brain aging. </p>
<p>Identifying those at risk for dementia by recognizing later-life changes in cognition, function as well as behaviour is a step towards not only preventing consequences of those changes, but also potentially preventing the disease or its progression.</p><img src="https://counter.theconversation.com/content/213954/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniella Vellone does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dementia does not manifest solely as a memory problem. People with dementia can also experience issues with learning, comprehension and judgement, but they may also experience changes in behaviour.Daniella Vellone, Medical Science and Imaging PhD Candidate, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2128672023-09-26T21:10:43Z2023-09-26T21:10:43ZAre seniors being pressured into retirement homes by lack of community services?<figure><img src="https://images.theconversation.com/files/549798/original/file-20230922-29-uw9xz2.jpg?ixlib=rb-1.1.0&rect=715%2C169%2C7881%2C5254&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Retirement homes might seem like less of a lifestyle choice and more like relocation imposed upon older adults by fragmented and under-resourced primary and community care services.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/are-seniors-being-pressured-into-retirement-homes-by-lack-of-community-services" width="100%" height="400"></iframe>
<p>Ads for retirement homes often feature an older couple relaxing in comfortable surroundings, playing a board game or enjoying a meal with friends. They look well — and young for their age — with broad smiles and perfect silver hair. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Collage of three photo of healthy, smiling older adults." src="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=488&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=488&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=488&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=613&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=613&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=613&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Ads for retirement homes seem to offer a worry-free lifestyle choice. Above: stock images seen in marketing materials for retirement homes in Canada.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>These ads offer worry-free, active retirement living at its fullest, complete with delicious and nutritious food. It looks like a wonderful lifestyle choice. </p>
<p>But is it really a lifestyle choice? Or, is it imposed upon older adults by fragmented and under-resourced primary and community care services?</p>
<h2>Assisted living</h2>
<p>In Canada, retirement homes (also known by other names like assisted living) are increasingly for-profit living facilities for older adults. They offer a variable range of services paid for by residents. Across Canada, <a href="https://www.comfortlife.ca/retirement-community-resources/retirement-cost">monthly fees range from $1,600 to over $6,000 for spaces ranging from 300 to 600 square feet</a>. </p>
<p>In Ontario, <a href="https://www.cmhc-schl.gc.ca/blog/2021/2021-seniors-housing-survey-learn-more-insights">where monthly fees for retirement homes average almost $4,000</a>, at least two services must be provided, such as meals and medication administration, with additional services often available at extra cost. </p>
<figure class="align-center ">
<img alt="Two older women sitting at a table while a young man wearing an ID badge talks to them" src="https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Ontario, retirement homes must provide at least two services, such as meals and medication administration.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Some homes (for extra fees) offer services geared towards people with cognitive impairment, and others provide nursing and personal care to those who require physical support. Yet, these privately paid services are often not enough. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344365/">A 2017 study</a> in the Hamilton Niagara Haldimand Brant region of Ontario showed that up to 40 per cent of retirement home residents receive publicly funded home care services, in addition to those purchased from the home. In almost one-third of these cases, retirement home residents or their caregivers said they would be better off living elsewhere, such as in long-term care (LTC) homes, where they can receive 24-hour access to nursing and personal support services. </p>
<p>In Ontario, <a href="https://www.closingthegap.ca/long-term-care-homes-vs-retirement-homes-vs-home-care-in-ontario/">retirement homes are almost exclusively private facilities</a> offering accommodations and some paid care services for less frail seniors, and they operate under less stringent regulations by the <a href="https://www.ontario.ca/page/ministry-seniors-accessibility">Ministry for Seniors and Accessibility</a>. </p>
<p>In contrast, LTC homes provide 24/7 nursing care for more dependent individuals and are regulated and subsidized by the <a href="https://www.ontario.ca/page/ministry-long-term-care">Ministry of Long-Term Care</a>. Retirement homes typically feature private suites or apartments, whereas LTC homes have more institutional and less private accommodations.</p>
<p><a href="https://doi.org/10.1017/S0714980820000045">A recent review of research</a> showed that the opportunity for greater social interaction in retirement homes is an important consideration for some, and consistent anecdotal reports suggest that many residents have a boost in health and well-being after moving into a retirement home. </p>
<p>However, the primary drivers of relocation are concerns over age-associated decline in health, coupled with uncertainty over being able to access services — such as assistance with property upkeep, medications or personal care — in their current home.</p>
<h2>Unmet health-care needs</h2>
<p>We still have a limited picture about <a href="https://doi.org/10.1017/s0714980813000159">what happens when someone moves into a retirement home</a>. In contrast to the LTC sector, for which we have relatively rich information sources at the national level, there is almost no information on retirement home residents. </p>
<figure class="align-center ">
<img alt="A woman in a white coat with a stethoscope and clipboard stands and talks to an older woman in a chair" src="https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The role of primary care medical providers is not regulated in retirement homes in Ontario.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>What we do know paints a mixed picture. For example, retirement home residents living with dementia, and who can afford specialized memory care services, <a href="https://doi.org/10.1016/j.jamda.2021.07.002">are less likely to move to a LTC home</a>. In contrast, retirement home residents <a href="https://doi.org/10.1503/cmaj.211883">receive far fewer primary care visits</a> than those in LTC homes, and are more likely to visit the <a href="https://doi.org/10.1016/j.jamda.2023.06.024">emergency department</a>, <a href="https://doi.org/10.1016/j.jamda.2015.01.079">be hospitalized</a> and experience prolonged hospital stays.</p>
<p>Clearly, the service and health-care needs of retirement home residents are not being met, nor were these being met in the community, compelling the move to a retirement home in the first place. </p>
<p>In Canada, under-resourcing of home- and community-care sectors imposes limits on where an older person can reside as their health declines, though more choices are available to those living in larger cities and able to pay for expensive private home care. Canada spends <a href="https://www.oecd.org/health/long-term-care.htm">substantially less per capita on home and community-care than the OECD average</a>. </p>
<p>Despite evidence that the medical needs of retirement home residents have been growing more complex, the role of primary care medical providers is <a href="https://doi.org/10.1016/j.jamda.2021.12.012">not regulated</a>, nor is there much incentive to practice in these settings. Retirement homes look like <a href="https://doi.org/10.1503/cmaj.211883">primary care deserts</a>, with residents often having no meaningful access to their previous primary care provider due to mobility limitations in transportation to off-site clinic locations. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/preventing-delirium-protects-seniors-in-hospital-but-could-also-ease-overcrowding-and-emergency-room-backlogs-189220">Preventing delirium protects seniors in hospital, but could also ease overcrowding and emergency room backlogs</a>
</strong>
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<p>Retirement home residents are more likely to be hospitalized and experience accelerated functional and cognitive decline without access to co-ordinated, senior-friendly primary care. Reliance on the limited access to community-based primary care clinics is inadequate because outside primary care providers often can’t know the environment or staff in the retirement home. </p>
<p>Common issues, like falls, can go unaddressed given that there is no one on site to do a sufficiently thorough medical falls risk assessment. Dehydration related delirium (confusion) that could be addressed on site can instead lead to hospital admission and premature institutional care. </p>
<h2>Designed for institutionalization</h2>
<p>Our health-care system <a href="http://nationalseniorsstrategy.ca/wp-content/uploads/2020/09/NSS_2020_Third_Edition.pdf">seems designed to foster premature institutionalization</a>. The retirement home sector attempts to fill a care and service gap in the community, but is progressively less able to do so as resident care needs become more complex and exceed what they can afford out of pocket.</p>
<figure class="align-center ">
<img alt="A nurse taking a man's blood pressure on a sofa" src="https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The solution requires that publicly funded and integrated home and community services be made more accessible to older people regardless of where they choose to live.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The solution requires that publicly funded and integrated home and community services be <a href="http://nationalseniorsstrategy.ca/wp-content/uploads/2020/09/NSS_2020_Third_Edition.pdf">made accessible to older people regardless of where they chose to live</a>, whether in a retirement home or in the private residence where they have lived for years. </p>
<p>Specific attention is required for community dwelling older people with cognitive difficulties, many of whom could continue aging in place with minimal assistance for nutrition, medication management and surveillance of chronic medical conditions. </p>
<p>Interprofessional primary care (teams that include multiple health professionals such as doctors, nurse practitioners, dietitians and social workers) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198684/">would have greater capacity to support older people with complex health issues</a>. Such teams must be made available to prevent hospitalization and its often disabling consequences. </p>
<p>Since many residents have limited capacity to travel to office visits, providing on-site access to primary care in retirement homes is simply fulfilling the promise of the Canada Health Act that reasonable access to insured health services is provided to all Canadians. </p>
<p>More home care and better access to robust primary care services will better meet the needs of older adults in the community, optimize their health and independence, and reduce the huge <a href="https://doi.org/10.1503/cmaj.230719">strain on our hospitals</a> and caregivers. They will also allow older people greater choice over — and ability to afford — whatever lifestyle they prefer.</p><img src="https://counter.theconversation.com/content/212867/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>George A Heckman receives funding from the Schlegel Research Chair in Geriatric Medicine. The Schlegel Chair endowment was a charitable donation to the University of Waterloo, and there is no personal obligation to the donor. </span></em></p><p class="fine-print"><em><span>Andrew Costa receives funding from the Canadian Institutes of Health Research and the Public Health Agency of Canada for related research. He is the Schlegel Chair in Clinical Epidemiology & Aging and Canada Research Chair in Integrated Care for Seniors at McMaster University. The Schlegel Chair endowment was a charitable donation to McMaster, and there is no personal obligation to the donor. He is Research Director of St. Joseph’s Health System's Centre for Integrated Care (Hamilton).</span></em></p>Publicly funded primary and home care should be accessible to all older adults, regardless of where they live.George A Heckman, Schlegel Research Chair in Geriatric Medicine, Associate Professor, University of WaterlooAndrew Costa, Associate Professor | Schlegel Chair in Clinical Epidemiology & Aging | Canada Research Chair in Integrated Care for Seniors, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2109732023-09-24T12:10:16Z2023-09-24T12:10:16ZHow long will a loved one live? It’s difficult to hear, but harder not to know<figure><img src="https://images.theconversation.com/files/549786/original/file-20230922-27-gg4746.jpg?ixlib=rb-1.1.0&rect=201%2C70%2C6508%2C4054&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even for an experienced health-care professional, estimating the life expectancy of a patient with a serious illness is challenging.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-long-will-a-loved-one-live-its-difficult-to-hear-but-harder-not-to-know" width="100%" height="400"></iframe>
<p>Planning for the future is difficult for people living with a life-limiting illness. Clinicians, based on their experience, can offer broad estimates of survival — in days to weeks, weeks to months, or months to years. However, patients and their care partners often want greater precision when arranging or making decisions about their care. </p>
<p>An accurate prediction of survival can enable earlier conversations about preferences and wishes at the end of life, and earlier introduction of palliative care. </p>
<p>However, even for an experienced clinician, <a href="https://doi.org/10.1371/journal.pone.0161407">estimating the life expectancy</a> of a patient with a serious illness <a href="https://doi.org/10.1136/bmj.320.7233.469">is challenging</a>. It requires large amounts of data and an understanding of the relationship between the patient’s baseline health, the complexity of their medical condition and how they respond to or progress with treatment. This is where predictive algorithms could help. </p>
<h2>A tool for timely conversations and planning</h2>
<p><a href="https://www.projectbiglife.ca/respect-elder-life">RESPECT (Risk Evaluation for Support: Predictions for Elder life in their Communities Tool) is a risk communication tool</a> powered by prediction algorithms that estimate individuals’ survival — that is, how long someone will live. It was developed by the Project Big Life Research Team and validated <a href="https://doi.org/10.1503/cmaj.200022">using health-care data collected on nearly one million older adults who received home and community care</a> or nursing home care in Ontario. </p>
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<iframe src="https://player.vimeo.com/video/539710931" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">RESPECT is intended to help people plan for palliative and end-of-life care.</span></figcaption>
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<p>RESPECT was designed with patients’ information needs in mind, and with the intention of empowering patients and their care partners. By providing patients with data on the survival and experiences of other individuals who had similar disease journeys, the tool can help patients understand their own illness trajectory, have earlier conversations about their preferences and wishes, and advocate for the support they need. </p>
<h2>A tool for patients, care partners and clinicians</h2>
<p><a href="https://www.projectbiglife.ca/respect-elder-life">RESPECT</a> launched publicly on ProjectBigLife.ca in July 2021. <a href="https://www.projectbiglife.ca/">ProjectBigLife.ca</a> is home to several health calculators developed by the research team as a means of translating data and evidence into tools that can help Canadians think about their health and plan for their care. </p>
<p>Using the responses to 17 questions about their health and ability to care for themselves, RESPECT provides an estimate of a person’s survival based on information gathered on people who have similar characteristics. Older adults, their care partners and health care professionals who are uncertain about the life expectancy of someone living with a critical illness can use the calculator to gain a better understanding of their decline. </p>
<p>Beyond life expectancy, RESPECT reports measures of functional decline — for example, whether the patient is able to get around their house and engage in activities of daily living, like bathing and cooking, without any assistance. </p>
<p>A patient can use this information to discuss their care needs with their care partners and health-care providers. Similarly, health-care providers can use this tool to discuss with their patient what can be expected as the patient approaches the end of life, and plan for the supports that their patient may need.</p>
<p>RESPECT is also actively used in Ontario’s retirement homes and nursing homes. Many residents in these settings have a life expectancy of less than two years. Earlier conversations about the older person’s goals and wishes for their remaining life can enable the care team to provide the best quality of life and care for the individuals under their care.</p>
<h2>Sustainable infrastructure</h2>
<p>One of the goals of RESPECT is to provide sustainable infrastructure to study, learn and improve how we use predictive algorithms for end-of-life care.</p>
<p>Despite the benefits that are emerging from the early uses of RESPECT, many questions remain about when and how it can be most appropriately used. For example, poor numerical literacy — that is, a person’s understanding of numbers, mathematics and statistics — could lead to misinterpreting the estimate provided by RESPECT. While the resources supporting RESPECT were co-developed with patients and their care partners, more research is still needed to reduce such potential harms.</p>
<p>To ensure we optimize the benefits that can be gained from prediction algorithms like RESPECT, clinical epidemiologists Douglas Manuel and Justin Presseau, along with the co-authors of this article, have created the RESPECT Learning Health System — a network of care partners, researchers and health-care professionals collaborating to address these challenges. We combine research and practice to sustainably study, learn and improve end-of-life care and experience through predictive algorithms.</p>
<h2>Identification is just the first step</h2>
<p>Only <a href="https://www.cihi.ca/sites/default/files/document/access-to-palliative-care-in-canada-2023-report-en.pdf">58 per cent of people who die in Canada</a> receive some form of palliative care prior to death. Few (13 per cent) are able to die at home with the support of palliative home care. </p>
<p>In deepening our understanding of frailty and decline, RESPECT may help clinicians, patients and their care partners be prepared for a poor prognosis and help develop a personalized plan for their care. </p>
<p>However, to improve end-of-life care delivery in Canada and enable Canadians to die with dignity, more investment is still needed within our formal health-care system to meet the need of individuals at the end of life.</p><img src="https://counter.theconversation.com/content/210973/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span> Lysanne Lessard receives funding from Canadian Institutes of Health Research for research related to the RESPECT Learning Health System.
Lessard is a member of the University of Ottawa's LIFE Research Institute.</span></em></p><p class="fine-print"><em><span>Amy T. Hsu receives funding from the Canadian Institutes of Health Research for research related to the RESPECT Calculator. </span></em></p><p class="fine-print"><em><span>Peter Tanuseputro receives funding from the Canadian Institutes of Health Research for research related to the RESPECT calculator. </span></em></p><p class="fine-print"><em><span>Sampath Bemgal does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An accurate prediction of survival can enable earlier conversations about preferences and wishes at the end of life, and earlier introduction of palliative care.Lysanne Lessard, Associate Professor, Telfer School of Management, L’Université d’Ottawa/University of OttawaAmy T. Hsu, Brain and Mind-Bruyère Research Institute Chair in Primary Health Care in Dementia, L’Université d’Ottawa/University of OttawaPeter Tanuseputro, Associate Professor, Division of Palliative Care, Department of Medicine, L’Université d’Ottawa/University of OttawaSampath Bemgal, Assistant Professor, Management Information Systems, University of New BrunswickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2126072023-09-22T01:25:31Z2023-09-22T01:25:31ZKids dressing up as older people is harmless fun, right? No, it’s ageist, whatever Bluey says<figure><img src="https://images.theconversation.com/files/548462/original/file-20230915-23-t7k9vt.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C640&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-cute-little-baby-cosplaying-old-2161560119">Shutterstock</a></span></figcaption></figure><p>A child once approached me, hunched over, carrying a vacuum cleaner like a walking stick. In a wobbly voice, he asked:</p>
<blockquote>
<p>Do you want to play grannies?</p>
</blockquote>
<p>The idea came from the children’s TV show Bluey, which <a href="https://www.facebook.com/ABCKidsCommunity/videos/bluey-grannies/468144817266668/">has</a> <a href="https://www.facebook.com/ABCKidsCommunity/videos/new-bluey-episodes-the-grannies-are-back-abc-kids/371436135028190/">episodes</a>, <a href="https://www.bluey.tv/products/grannies-book/">a book</a>, <a href="https://www.discountmags.com/magazine/bluey-september-1-2023-digital">magazine</a> editions and an <a href="https://www.facebook.com/OfficialBlueyTV/videos/grannies-filter-bluey/5728362390510269/">image filter</a> about dressing up as “grannies”.</p>
<p>Children are also dressing up as 100-year-olds to mark their first “100 days of school”, an idea <a href="https://www.theage.com.au/national/victoria/old-people-s-home-for-five-year-olds-prep-students-don-senior-citizen-attire-20230801-p5dszb.html">gaining popularity</a> <a href="https://www.smh.com.au/education/cardigans-wigs-and-canes-why-kindy-students-are-dressing-up-as-100-year-olds-20230720-p5dpu8.html">in Australia</a>.</p>
<p>Is this all just harmless fun?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1632154977664921600"}"></div></p>
<h2>How stereotypes take hold</h2>
<p>When I look at the older people in my life, or the patients I see as a geriatrician, I cannot imagine how to suck out the individual to formulate a “look”.</p>
<p>But Google “older person dress-ups” and you will find <a href="https://www.pinterest.com.au/pin/dress-up-like-youre-100-years-old-100thdayofschool--15199717464361356/">Pinterests</a> and <a href="https://www.wikihow.com/Dress-Up-Like-an-Old-Person#:%7E:text=Dress%20in%20comfortable%2C%20loose%2Dfitting,older%20people%20may%20wear%20include%3A&text=Oversized%20sweatshirts">Wikihow pages</a> doing just that.</p>
<p>Waistcoats, walking sticks, glasses and hunched backs are the key. If you’re a “granny”, don’t forget a <a href="https://www.facebook.com/OfficialBlueyTV/videos/games-you-can-play-at-home-grannies-bluey/645964056227345/">shawl and tinned beans</a>. You can buy “old lady” <a href="https://www.spotlightstores.com/party/costumes-and-accessories/costume-accessories/wigs-hair-accessories/wigs/spartys-kids-old-lady-wig-with-curlers/80578132?gclsrc=aw.ds&gclsrc=aw.ds&gclid=Cj0KCQjw0vWnBhC6ARIsAJpJM6emZHoNxO72pUa80Wc8ihYYiq3AohZ_w72jmuWBBDlficdCMy_rsK8aAj47EALw_wcB">wigs</a> or an “old man” <a href="https://www.bigw.com.au/product/facial-hair-set-old-man-3-pieces/p/305026">moustache and bushy eyebrows</a>.</p>
<p>This depiction of how older people look and behave is a stereotype. And if dressing up as an older person is an example, such stereotypes are all around us.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older stylish couple sitting on sofa" src="https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What do older people really look like? I can’t see a walking stick or shawl. Can you?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-elderly-couple-sitting-on-sofa-2204006701">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-dont-grown-ups-play-like-kids-199176">Curious Kids: why don't grown-ups play like kids?</a>
</strong>
</em>
</p>
<hr>
<h2>What’s the harm?</h2>
<p>There is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/hypa.12170">some debate</a> about whether stereotyping is intrinsically wrong, and if it is, why. But there is plenty of research about the harms of <em>age</em> stereotypes or ageism. That’s harm to current older people and harm to future older people.</p>
<p>The World Health Organization <a href="https://www.who.int/health-topics/ageism#tab=tab_1">defines ageism</a> as:</p>
<blockquote>
<p>the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or ourselves based on age.</p>
</blockquote>
<p>Ageism <a href="https://www.who.int/health-topics/ageism#tab=tab_1">contributes to</a> social isolation, reduced health and life expectancy and costs economies <a href="https://academic.oup.com/gerontologist/article/60/1/174/5166947">billions of dollars</a> globally. </p>
<p>When it comes to health, the impact of negative stereotypes and beliefs about ageing may be even <a href="https://academic.oup.com/gerontologist/article/60/1/174/5166947">more harmful</a> than the discrimination itself. </p>
<p>In laboratory studies, older people perform <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360754/">worse</a> than expected on tasks such as memory or thinking after being shown negative stereotypes about ageing. This may be due to a “<a href="https://www.simplypsychology.org/stereotype-threat.html">stereotype threat</a>”. This is when a person’s performance is impaired because they are worried about confirming a negative stereotype about the group they belong to. In other words, they perform less well because they’re worried about acting “old”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older man doing a jigsaw puzzle" src="https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Older people perform less well on some tasks after seeing negative stereotypes of ageing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-male-hands-working-on-puzzle-1957542670">Shutterstock</a></span>
</figcaption>
</figure>
<p>Another theory is “stereotype embodiment”. This is where people absorb negative stereotypes throughout their life and come to believe decline is an inevitable consequence of ageing. This leads to biological, psychological and physiological changes that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927354/">create</a> a self-fulfilling prophecy. </p>
<p>I have seen this in my clinic with people who do well, until they realise they’re an older person – a birthday, a fall, a revelation when they look in the mirror. Then, they stop going out, stop exercising, stop seeing their friends. </p>
<p>Evidence for “stereotype embodiment” comes from studies that show people with more negative views about ageing are more likely to have higher levels of stress hormones (such as cortisol and C-reactive protein) and are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182003/">less likely</a> to engage in health behaviours, such as exercising and eating healthy foods.</p>
<p>Younger adults with negative views about ageing are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666386/">more likely</a> to have a heart attack up to about 40 years later. People with the most negative attitudes towards ageing have a lower life expectancy by as much as <a href="https://pubmed.ncbi.nlm.nih.gov/12150226/">7.5 years</a>. </p>
<p>Children are particularly susceptible to absorbing stereotypes, a process <a href="https://psycnet.apa.org/record/2007-09385-010">that starts</a> in early childhood. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older woman dressed in modern clothes enjoying herself making hand signals" src="https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You don’t see many children dressing up like this older person. There’s a reason for that.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/funny-grandmother-portraits-senior-old-woman-1522642565">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-people-get-old-190142">Curious Kids: why do people get old?</a>
</strong>
</em>
</p>
<hr>
<h2>Ageism is all around us</h2>
<p><a href="https://www.who.int/health-topics/ageism#tab=tab_1">One in two people</a> have ageist views, so tackling ageism is complicated given it is socially acceptable and normalised. </p>
<p>Think of all the birthday cards and jokes about ageing or phrases like “geezer” and “old duck”. Assuming a person (including yourself) is “too old” for something. Older people say it is harder to <a href="https://www.abc.net.au/news/2023-07-06/senior-job-seekers-struggle-to-get-a-foot-in-the-door/102563144">find work</a> and they face discrimination in <a href="https://www.hcnsw.org.au/wp-content/uploads/2021/03/Ageism-in-Health-Care_final.pdf">health care</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/giving-out-flowers-on-tiktok-is-this-a-random-act-of-kindness-or-just-benevolent-ageism-187064">Giving out flowers on TikTok: is this a 'random act of kindness' or just benevolent ageism?</a>
</strong>
</em>
</p>
<hr>
<h2>How can we reduce ageism?</h2>
<p>We can reduce ageism through laws, policies and education. But we can also reduce it via <a href="https://www.who.int/health-topics/ageism#tab=tab_1">intergenerational contact</a>, where older people and younger people come together. This helps break down the segregation that allows stereotypes to fester. Think of the TV series <a href="https://iview.abc.net.au/show/old-people-s-home-for-4-year-olds">Old People’s Home for 4 Year Olds</a> or the follow-up <a href="https://iview.abc.net.au/show/old-people-s-home-for-teenagers">Old People’s Home for Teenagers</a>. More simply, children can hang out with their older relatives, neighbours and friends. </p>
<p>We can also challenge a negative view of ageing. What if we allowed kids to imagine their lives as grandparents and 100-year-olds as freely as they view their current selves? What would be the harm in that?</p><img src="https://counter.theconversation.com/content/212607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Mitchell is affiliated with the Australian Labor Party.
Opinions are my own and do not represent the views of my affilitated universities or health care employer. </span></em></p>Children absorb these stereotypes from a young age. And ageism is all around us.Lisa Mitchell, Geriatrician working in clinical practice. PhD Candidate at The University of Melbourne studying ethics and ageism in health care. Affiliate lecturer, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2101052023-09-17T12:07:27Z2023-09-17T12:07:27ZOlder Canadians’ savings are shaped by their long-term care preferences<figure><img src="https://images.theconversation.com/files/547630/original/file-20230911-8406-rbs70z.jpg?ixlib=rb-1.1.0&rect=15%2C38%2C5160%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent study has found that Canadians are highly motivated to save money in preparation of long-term care.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/older-canadians-savings-are-shaped-by-their-long-term-care-preferences" width="100%" height="400"></iframe>
<p>Canada’s aging population is growing. According to the Organization for Economic Co-operation and Development, the proportion of Canadians aged 80 and older <a href="https://www.oecd.org/health/health-at-a-glance/">will surpass nine per cent by 2050</a>, up from 4.3 per cent in 2021. </p>
<p>This demographic shift is happening in most developed nations, and will result in a greater demand for long-term care. Québec, for instance, anticipates that <a href="https://creei.ca/wp-content/uploads/2021/02/cahier_21_01_financement_soutien_autonomie_personnes_agees_croisee_chemins.pdf">600,000 people will need long-term care by 2050</a> — nearly double the current number.</p>
<p>Meanwhile, escalated care expenses in recent years, <a href="https://www.statcan.gc.ca/o1/en/plus/4165-nurses-working-harder-more-hours-amid-increased-labour-shortage">attributed to labour shortages and exacerbated by COVID-19</a>, are a pressing concern.</p>
<h2>The costs of long-term care</h2>
<p>In Québec, <a href="https://bonjourresidences.com/blogue/couts-hebergement-chsld/">the rates (before any income-based subsidy) for public nursing home accommodations are around $2,000 a month</a>. But since public nursing homes have such long waiting lists, some choose private nursing homes instead. The costs of private nursing homes are estimated to be between $5,000 and $8,000 a month.</p>
<p>Home care — <a href="https://theconversation.com/canadians-want-home-care-not-long-term-care-facilities-after-covid-19-170620">a preferred option for many</a> — costs around $5,550 a month, excluding additional expenses like maintenance and food. Consequently, long-term care expenses present a substantial financial risk in old age, potentially motivating people to save for it ahead of time.</p>
<p>While both nursing homes and home care impose financial burdens, their distinct cost structures can influence precautionary savings in different ways. </p>
<p>Nursing homes bundle accommodation and food, offering limited additional services. In contrast, home care recipients can allocate savings for quality-of-life improvements like better food, home maintenance, etc. Additionally, people may inherently value spending more while at home.</p>
<h2>Long-term care and savings</h2>
<p>Our <a href="https://economie.esg.uqam.ca/wp-content/uploads/sites/54/2023/05/2023_02_docdt_eco.pdf">recent research project</a> aimed to understand how preferences for home-based care versus nursing homes affect people’s savings, using both survey responses and a simulation study.</p>
<p>Our research is crucial for two reasons. First, even before the pandemic, a reluctance to be institutionalized — known as <a href="https://doi.org/10.1016/j.jhe.2017.10.001">institutionalization aversion</a> — was documented. Second, COVID-19 has further <a href="https://doi.org/10.1016/j.jebo.2022.06.034">discouraged nursing home entry</a>, possibly due to excess mortality in nursing homes, as has been <a href="https://doi.org/10.1002/hec.4613">documented in many countries</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/inquiry-into-coronavirus-nursing-home-deaths-needs-to-include-discussion-of-workers-and-race-139017">Inquiry into coronavirus nursing home deaths needs to include discussion of workers and race</a>
</strong>
</em>
</p>
<hr>
<p>To model savings in different care settings effectively, we needed to understand how individuals allocated their resources in those settings. To accomplish this, we developed a set of survey questions aimed at uncovering these preferences.</p>
<p>These survey questions were designed to prompt respondents to consider how they would allocate their resources depending on the long-term care setting in a well-defined, hypothetical scenario.</p>
<p>Survey respondents were randomly assigned to different long-term care settings (home care, semi-private room in a nursing home or a private room in a nursing home). Their resource allocation choices allowed us to examine how their preferences for savings varied based on the type of long-term care setting.</p>
<p>Our analysis of 3,000 survey responses shows that Canadians are highly motivated to save money to be better prepared for long-term care. This willingness to save was much larger when respondents expected to use home care; respondents anticipating home care allocated 38 per cent more resources to savings. This reflects the greater financial needs associated with home care.</p>
<h2>Long-term care insurance</h2>
<p>We used the results from our survey to calibrate a simulation study — a computer-based experiment using a combination of economic theories and survey evidence — to simulate how households and individuals make financial decisions.</p>
<p>Our simulation study examined two scenarios: one based on the Canadian system, which includes a universal subsidy that lowers nursing home costs, and one based on the U.S. Medicaid system, which features a purely means-tested subsidy that provides free long-term care and ensures a minimum standard of living for those without sufficient income.</p>
<p>Differences in individual preferences for various care settings largely explain the savings disparities. In the Canada-like system, the prospect of receiving long-term care at home substantially boosts savings. On average, individuals planning to use home care saved $25,000 (8.3 per cent) more by the age of 66, compared to those planning to use private nursing home rooms, and $29,000 (9.8 per cent) more compared to those opting for semi-private rooms. </p>
<p>Under the U.S.-like system, the impacts on savings of different care settings were much smaller. This is because, in the absence of public subsidies, the minimum costs of a room in a nursing home are much higher than those of home care. When comparing the savings of individuals opting for home care versus a private room in a nursing home, the difference in savings was almost null. </p>
<p>However, when comparing savings between those opting for home care versus a semi-private room in a nursing home, we found that the former saved 3.7 per cent more.</p>
<h2>Policy implications</h2>
<p>Assessing how individuals value additional public subsidies for each type of long-term care setting can provide policymakers with valuable insights about how to expand public long-term care insurance effectively. </p>
<p>Our research found that all subsidies are valued well beyond costs, with home care subsidies being more valued than nursing home subsidies. Under the Canada-like system, the average valuation for a home care subsidy was $2.98 per $1 spent, surpassing private ($2.72) and semi-private ($2.35) nursing home subsidies.</p>
<p>Middle-income individuals who aren’t eligible for means-tested programs, but who have limited savings, placed the highest value on these subsidies. This shows that expanding subsidies for home care can be an effective way to protect Canadians from long-term care risks.</p><img src="https://counter.theconversation.com/content/210105/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Louise Leroux receives funding from FRQSC and SSHRC-CRSH. She is affiliated with CIRANO (Montreal) and CESifo (Munich). </span></em></p><p class="fine-print"><em><span>Franca Glenzer receives funding from SSHRC-CRSH. </span></em></p><p class="fine-print"><em><span>Bertrand Achou, Minjoon Lee, and Philippe De Donder do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While both nursing homes and home care impose financial burdens, their differing structures can influence how older Canadians save money.Marie-Louise Leroux, Professeure titulaire en Sciences Economiques, Université du Québec à Montréal (UQAM)Bertrand Achou, Assistant Professor, Economics, University of GroningenFranca Glenzer, Assistant Professor, Department of Finance, HEC MontréalMinjoon Lee, Assistant Professor, Economics, Carleton UniversityPhilippe De Donder, Research director (CNRS), Toulouse School of Economics – École d'Économie de ToulouseLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124262023-09-14T19:48:11Z2023-09-14T19:48:11ZNavigating the complexities of caregiving for dementia in South Asian communities<figure><img src="https://images.theconversation.com/files/547295/original/file-20230908-43950-v2nuih.jpg?ixlib=rb-1.1.0&rect=103%2C60%2C5647%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregiving in South Asian communities is characterized by close family bonds that emphasize respect for elders.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/navigating-the-complexities-of-caregiving-for-dementia-in-south-asian-communities" width="100%" height="400"></iframe>
<p>In 2020, an estimated <a href="https://alzheimer.ca/en/research/reports-dementia/landmark-study-report-1-path-forward">597,000</a> individuals were living with dementia in Canada. By 2030, that number is expected to increase to almost one million, and by 2050, almost 1.7 million. </p>
<p>Dementia is a global struggle affecting many around the world. In South Asian communities, an intricate tapestry of cultures, languages and traditions engenders a caregiving dynamic for those living with dementia.
Dementia care in South Asian households is nuanced and complex and is shaped by cultural, familial and societal forces. </p>
<p>Strong familial bonds and respect for elders provide a foundation for support. However, stigma, language barriers and gendered caregiving roles can create formidable challenges.</p>
<p>By understanding these diverse dynamics, experts and medical practitioners can provide better and more tailored support to South Asians with dementia and the people who care for them.</p>
<h2>Caregiving in South Asian communities</h2>
<p><strong>Strong family bonds:</strong> The South Asian community is characterized by its close-knit family structures, where family members often share caregiving responsibilities. This communal caregiving approach fosters unity and support, allowing individuals with dementia to remain within their familial environment. </p>
<p><strong>Respect for elders</strong>: South Asian cultures traditionally hold elders in high regard. This fosters a sense of duty and responsibility toward caring for aging family members and can translate into a heightened commitment to caregiving for individuals with <a href="https://brill.com/display/title/37884">dementia</a>. </p>
<p>These values are also informed by religious beliefs and cultural practices. In Hinduism, the concept of <a href="https://timesofindia.indiatimes.com/astrology/kundali-dasha-remedies/lal-kitab-remedies-for-pitru-rin/articleshow/68206686.cms">Pitru Rin (debt to ancestors)</a> emphasizes the obligation of children to <a href="https://doi.org/10.1177/1084822312439466">repay their parents for their nurturing and care</a>. Similarly, Islam strongly emphasizes <a href="https://doi.org/10.1007/s11562-020-00458-8">respecting and caring for one’s parents</a> and elderly relatives, as prescribed in the Qur’an and Hadith. In Sikhism, the concept of <a href="https://www.bbc.co.uk/bitesize/guides/zmcf3k7/revision/3">seva (selfless service)</a> extends to caring for elders in the community. Cultural norms and expectations shape the roles and responsibilities of care partners.</p>
<p><strong>Multi-generational households:</strong> Many South Asian households often have multiple generations living under one roof. This arrangement can benefit dementia caregiving, allowing continuous care, emotional support and companionship. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young Indian women places her arms around an older woman wearing a sari and holding a book." src="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Living in multi-generational households can provide people with dementia continuous care, emotional support and companionship.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Challenges to caregiving</h2>
<p><strong>Stigma and a lack of awareness</strong>: Stigma surrounding dementia is prevalent and can often mean people delay getting medical help and <a href="https://doi.org/10.1177/1471301212444806">lack awareness about available support</a>. This can lead to isolation and a lack of care for people with dementia.</p>
<p><strong>Collectivism:</strong> South Asian cultures emphasize collectivism, where the needs of the family or community take precedence over individual needs. This can influence the decision-making process regarding caregiving arrangements.</p>
<p>While collectivism can provide a robust support network, it can also lead to care partners neglecting their well-being in favour of the needs of the person living with dementia. </p>
<p><strong>Language and cultural barriers:</strong> Language and cultural differences can pose significant challenges in accessing appropriate care and information about dementia. People with dementia and their caregivers may not be fluent in the language of their host country. That can make it especially challenging to communicate effectively with doctors and navigate <a href="https://doi.org/10.1017/S1041610211000214">health-care systems</a>.</p>
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Read more:
<a href="https://theconversation.com/navigating-dementia-care-in-the-south-asian-community-overcoming-barriers-and-stigma-171788">Navigating dementia care in the South Asian community: Overcoming barriers and stigma</a>
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<p><strong>Emotional and financial stress:</strong> Caregiving for a loved one with dementia can be emotional and stressful for anyone. The constant demands of caregiving, coupled with the progressive nature of dementia, can lead to caregiver burnout and mental health issues. </p>
<p>In South Asian communities, caregiving responsibilities often fall on daughters or other female relatives due to <a href="https://doi.org/10.1159/000506363">gendered expectations</a> of their role in the family. Women often have to juggle caregiving with their other household and family duties. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close up of an elderly woman's hands being held by a younger woman." src="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Stigma surrounding dementia and language barriers can often lead to isolation or delayed treatment.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Living in multi-generational households can also bring additional stress for family members tasked with caregiving. Long-term care homes are often viewed negatively due to cultural values that prioritize family unity and the belief that it’s the responsibility of younger generations to care for their elders at home. That can be compounded by financial stress if caregivers have to quit jobs to provide care full-time. </p>
<h2>Supporting caregivers</h2>
<p>Acknowledging and supporting caregivers is crucial for a more equitable future. This support entails recognizing and valuing their unpaid care work.</p>
<p>Employers should promote flexibility and provide workplace resources to ease caregiving burdens. These could include offering flexible work arrangements, adjusted hours and remote working options. They can provide paid family leave to accommodate caregiving needs and consider providing childcare support. </p>
<p>Financial support and legal protections further empower caregivers. These concerted efforts from governments, employers and communities collectively contribute to a more equitable and inclusive society.</p>
<p>By acknowledging the positive aspects of caregiving and addressing the negatives, society can work toward enhancing the well-being of South Asian care partners and individuals with dementia. </p>
<p>It is imperative to address the unique challenges faced by South Asian care partners and individuals with dementia. This includes promoting awareness about dementia, overcoming language barriers in health care and fostering culturally sensitive support networks.</p><img src="https://counter.theconversation.com/content/212426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Navjot Gill does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dementia care in South Asian households is shaped by cultural, familial and societal forces that bring benefits and challenges.Navjot Gill, Doctoral Candidate, Aging, Health and Well-being, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2112662023-08-22T18:54:13Z2023-08-22T18:54:13ZAging with a healthy brain: How lifestyle changes could help prevent up to 40% of dementia cases<figure><img src="https://images.theconversation.com/files/543822/original/file-20230821-21-8h55nn.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4451&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Modifiable risk factors for dementia include high blood pressure, obesity, physical inactivity, diabetes, smoking, excessive alcohol consumption and infrequent social contact.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/aging-with-a-healthy-brain-how-lifestyle-changes-could-help-prevent-up-to-40-of-dementia-cases" width="100%" height="400"></iframe>
<p>A 65-year-old woman repeatedly seeks medical help for her failing memory. She is first told it’s nothing to worry about, then, a year later, that it’s “just normal aging.” Until finally, the penny drops: “It’s Alzheimer’s. There is no cure.” </p>
<p>Scenarios like this one are too common.</p>
<p>Dementia remains largely underdetected, even in high-income countries such as Canada where <a href="https://doi.org/10.1136%2Fbmjopen-2016-011146">rates of undetected cases exceed 60 per cent</a>. Beliefs that cognitive deficits are normal in elderly people, and the lack of knowledge of dementia symptoms and of diagnostic criteria amongst medical doctors have been identified as the <a href="https://doi.org/10.1590%2FS1980-57642011DN05040011">main culprits of missed cases and delayed diagnosis</a>.</p>
<p>Age-related memory losses should not be shaken off as just part of normal aging. Occasionally forgetting where we parked the car or where we left our keys can happen to everyone, but when these situations become frequent it’s important to seek medical advice. </p>
<p>While many individuals experiencing mild changes in their ability to think and remember information will not go on to develop dementia, in others, these declines constitute an early warning sign. Research has shown <a href="https://doi.org/10.1111/acps.12336">that people with mild changes in cognition</a> are at a greater risk of developing dementia later in life. </p>
<p>In fact, it has been demonstrated that <a href="https://doi.org/10.3390/ijms20225536">the disease process (changes in the brain’s structure and metabolism)</a> starts decades before the appearance of symptoms such as memory loss. Moreover, it is <a href="https://doi.org/10.1038/s43587-022-00269-x">increasingly recognized in the scientific community</a> that interventions that aim to slow down or <a href="https://doi.org/10.1016/S0140-6736(15)60461-5">prevent</a> disease development are more likely to be effective when initiated early in the disease course. </p>
<p>Despite this, protocols for early detection <a href="https://canadiantaskforce.ca/guidelines/published-guidelines/cognitive-impairment/">are not standard</a> in the medical community, in part because significant gaps remain in our understanding of dementia. </p>
<h2>Dementia and an aging population</h2>
<p>In my research, I use advanced brain MRI methods to characterize brain health in older adults who are at high risk of developing dementia. The goal is to identify new biomarkers of early pathology, which could lead to improved detection methods in the future. </p>
<figure class="align-center ">
<img alt="A woman with gray hair with health care worker in scrubs." src="https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">By 2050, the number of Canadians living with dementia is expected to exceed 1.7 million.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The proportion of senior Canadians is growing in our population. Dementia is strongly associated with aging, so the number of Canadians diagnosed with dementia — including Alzheimer’s — is expected to rise considerably in the next few decades, reaching an expected <a href="https://www.ctvnews.ca/health/nearly-one-million-canadians-will-live-with-dementia-by-2030-alzheimer-society-predicts-1.6056849">1.7 million</a> Canadians by 2050. That’s more than the <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000901">population of Manitoba</a>! </p>
<p>This projected increase will put an enormous pressure on our already strained health-care systems if no significant actions are taken to reverse this trend. This means that effective prevention strategies are now more urgent than ever.</p>
<p>Recent <a href="https://www.ctvnews.ca/health/promising-new-drug-to-treat-alzheimer-s-in-pipeline-of-approval-in-canada-1.6443850">news about promising new drugs</a> to treat Alzheimer’s disease also highlight the need for early detection. <a href="https://doi.org/10.1056/NEJMoa2212948">Clinical trials</a> showed that these drugs are most effective at slowing cognitive decline when administered early in the disease course. </p>
<p>Although these new treatment options represent breakthroughs for the Alzheimer’s field, more research is needed. These new therapies act on only one disease process (lowering the levels of amyloid, a substance thought to be toxic for neurons), so they may slow cognitive decline in <a href="https://doi.org/10.1093/braincomms/fcad175">only a narrow subset of patients</a>. A proper characterization of other processes, on a personalized basis, is required to combine these treatments with other strategies. </p>
<p>This is not to mention the significant increase in financial and human resources that will be necessary to deliver these new treatments, which could hinder access to them, especially in low- and middle-income countries, where <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">dementia cases are rising the most</a>.</p>
<h2>Lifestyle and brain health</h2>
<figure class="align-center ">
<img alt="Five older adults seated and doing arm exercises" src="https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Seniors participating in a seated exercise class. Physical inactivity is a modifiable risk factor for dementia.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Lifestyle changes, on the other hand, have been shown to decrease the risk of developing dementia with minimal costs and no side-effects. By making dementia risk assessment a part of routine medical visits for older adults, those who are most at risk could be identified and counselled on how to maintain brain health and cognition. </p>
<p>At-risk individuals likely need those interventions the most (potentially a combination of pharmaceutical and lifestyle interventions), but anyone can benefit from adopting healthy lifestyle habits, which are known to protect from diseases not only of the brain, but also of the heart and other organs.</p>
<p>According to an <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">influential report</a>, published in <em>The Lancet</em> in 2020, 40 per cent of dementia cases can be attributed to 12 modifiable risk factors. These include high blood pressure, obesity, physical inactivity, diabetes, smoking, excessive alcohol consumption and infrequent social contact. </p>
<p>This means that, by adopting positive lifestyle habits, we could theoretically prevent about 40 per cent of dementias, according to the report. While there is no guarantee of warding off cognitive decline, people can greatly reduce their risk of dementia by increasing their physical activity levels, ensuring they are mentally active and increasing social contact, while avoiding smoking and limiting alcohol consumption. </p>
<figure class="align-center ">
<img alt="A group of older adults attending an art class, and their teacher" src="https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">By encouraging people to be physically, mentally and socially active, we can potentially keep a significant number of dementia cases at bay.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Some evidence also suggests that a <a href="https://doi.org/10.3945/an.117.015495">Mediterranean diet</a>, which emphasizes high consumption of plants (especially leafy greens) while reducing saturated fats and meat intake, <a href="https://doi.org/10.1093/ajcn/nqx070">is also beneficial for brain health</a>. </p>
<p>In short, by encouraging people to be physically, mentally and socially active, a significant number of dementia cases could potentially be kept at bay. </p>
<h2>Barriers to healthy lifestyles</h2>
<p>At the same time, focusing on policy changes could address the societal inequalities that lead to the occurrence of several risk factors, <a href="https://aaic.alz.org/downloads2020/2020_Race_and_Ethnicity_Fact_Sheet.pdf">and higher prevalence of dementia</a>, in <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad201209">ethnic minorities</a> and vulnerable populations. Despite having a universal health-care system, Canada still has health inequalities. People <a href="https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html">at greater risk of health conditions</a> include those with lower socioeconomic status, people with disabilities, Indigenous people, racialized people, immigrants, ethnic minorities and LGBTQ2S people.</p>
<p>Policy changes could address these inequalities not only by promoting healthy lifestyles, but also by taking action to improve the <a href="https://doi.org/10.1016/j.joclim.2021.100035">circumstances in which people of these communities live</a>. Examples include <a href="https://doi.org/10.1093/heapro/dav022">improving access to sport centres</a> or prevention clinics for people with lower incomes and designing cities that are conducive to active lifestyles. Governments need to evaluate and address the barriers that prevent people from specific groups from adopting healthy lifestyle habits. </p>
<p>We must be ambitious about prevention. The future of our health-care system and that of our own health depends on it.</p><img src="https://counter.theconversation.com/content/211266/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stefanie Tremblay receives funding from the Canadian Institutes of Health Research (CIHR). She is affiliated with Dragonfly Mental Health, a not-for-profit organization advocating for better mental health in academia. </span></em></p>While there is no guarantee of warding off cognitive decline, encouraging people to be physically, mentally and socially active could potentially keep a significant number of dementia cases at bay.Stefanie Tremblay, PhD candidate in medical physics, studying MRI biomarkers of declining brain health in aging, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2100492023-07-25T19:48:45Z2023-07-25T19:48:45ZExtreme heat is particularly hard on older adults – an aging population and climate change put ever more people at risk<figure><img src="https://images.theconversation.com/files/539318/original/file-20230725-27-j9q9a4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8243%2C5450&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Without home cooling, Phoenix's weeks with temperatures over 110 F in July 2023 became dangerous. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/richard-verduzco-keeps-cool-on-his-porch-ahead-of-his-air-news-photo/1546524292">Brandon Bell/Getty Images</a></span></figcaption></figure><p>Scorching temperatures have put millions of Americans in danger this summer, with heat extremes stretching from coast to coast in the Southern U.S. </p>
<p>Phoenix hit 110 degrees Fahrenheit (43.3 Celsius) or higher every day for over three weeks in July. Other <a href="https://www.washingtonpost.com/weather/2023/07/17/heat-wave-southwest-south-records-climate/">major cities</a>, from Las Vegas to Miami, experienced relentless high temperatures, which residents described as “<a href="https://www.theguardian.com/us-news/2023/jul/14/phoenix-heatwave-summer-extreme-weather-arizona">hell on earth</a>.”</p>
<p>While the evening news runs footage of miserable sunbathers on Miami Beach and joggers in Austin, Texas, dousing themselves with water, these images conceal a growing hidden crisis: the millions of older adults who are suffering behind closed doors.</p>
<p>As researchers who study <a href="https://scholar.google.com/citations?user=ABRogW4AAAAJ&hl=en">older adults’ health</a> and <a href="https://scholar.google.com/citations?user=x756kywAAAAJ&hl=en">climate</a> <a href="https://scholar.google.com/citations?user=Hl912v8AAAAJ&hl=en">change</a>, we have found that two societal trends <a href="https://doi.org/10.1093/geront/gnad050">point to a potentially dire future</a>: The population is getting older, and temperatures are rising.</p>
<figure class="align-center ">
<img alt="A man rests while propping his head up with his arm on a table. A woman dozes in a chair in a room with several other people." src="https://images.theconversation.com/files/539313/original/file-20230725-25-cpxebf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539313/original/file-20230725-25-cpxebf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539313/original/file-20230725-25-cpxebf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539313/original/file-20230725-25-cpxebf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539313/original/file-20230725-25-cpxebf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539313/original/file-20230725-25-cpxebf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539313/original/file-20230725-25-cpxebf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">During the July 2023 heat wave, people gathered at the Justa Center, a day cooling center in downtown Phoenix for people age 55 and older who are homeless.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/PhoenixLeavingtheHeat/18a7e05d8150417cb82ce50c852d9eb1/photo">AP Photo/Matt York</a></span>
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<p>Some of the country’s hottest states, including Arizona, are forecast to see dramatic growth in their older adult populations. But heat isn’t just a problem in the South: Northern populations also face rising risks from extreme heat that many people aren’t accustomed to. </p>
<p>Communities, families and older residents need to understand these risks and be prepared.</p>
<h2>Why older adults face higher heat risks</h2>
<p>Triple-digit temperatures are miserable for everyone, but for <a href="https://www.cdc.gov/aging/emergency-preparedness/older-adults-extreme-heat/index.html">older adults they can be deadly</a>.</p>
<p>Older adults don’t sweat or cool down as efficiently as younger people. Heat stress can worsen underlying conditions like heart, lung and kidney disease, and extreme heat can <a href="https://doi.org/10.1002/cphy.c140017">trigger delirium</a>.</p>
<p>Poor <a href="https://www.epa.gov/climateimpacts/climate-change-and-health-older-adults#">air quality</a> makes it harder to breathe, especially among people who already have breathing difficulties. For older adults with physical health problems, temperatures as <a href="https://doi.org/10.1080/23328940.2018.1456257">low as 80 degrees F</a> (26.7 C) – to say nothing of 110 degrees – can pose a grave danger.</p>
<p><a href="https://www.kff.org/report-section/data-note-prescription-drugs-and-older-adults-methodology/">Prescription medications</a> make older people more sensitive to heat. Anticholinergics, used to treat <a href="https://www.cdc.gov/copd/index.html">chronic obstructive pulmonary disorder, or COPD</a>, reduce our capacity to sweat. Dehydration is a side effect of <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522">beta blockers</a> and <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/diuretics/art-20048129">diuretics</a>, which are used to help control blood pressure.</p>
<p>Medications also work best when <a href="https://www.medscape.com/viewarticle/562416?form=fpf">stored at room temperatures</a> of 68 to 77 degrees and may lose their effectiveness if not kept in a cool place on a very hot day.</p>
<figure class="align-center ">
<img alt="A man sits in a chair under a tree in a shopping center parking lot. He's wearing a baseball cap and his shirt is open to let the breeze in." src="https://images.theconversation.com/files/539311/original/file-20230725-22-vefahc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539311/original/file-20230725-22-vefahc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539311/original/file-20230725-22-vefahc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539311/original/file-20230725-22-vefahc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539311/original/file-20230725-22-vefahc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539311/original/file-20230725-22-vefahc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539311/original/file-20230725-22-vefahc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Randy Twede, 70, sits in the shade while waiting for the bus on July 10, 2023, in Austin, Texas. ‘These temperatures are no joke. I’m just trying to survive, that’s all,’ he told the photographer.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/randy-twede-sits-in-the-shade-while-waiting-for-the-bus-on-news-photo/1531835627">Brandon Bell/Getty Images</a></span>
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<p>And it’s not just physical health that suffers.</p>
<p>Having to stay indoors all day to keep cool and enduring the stress of heat emergencies can make older adults <a href="https://www.heat.gov/pages/who-is-at-risk-to-extreme-heat">depressed and isolated</a>. Those with <a href="https://health.gov/healthypeople/tools-action/browse-evidence-based-resources/cognitive-impairment-older-adults-screening">cognitive problems</a> or dementia may not understand their health risks or may not take proper precautions. Seniors with physical disabilities, limited mobility or lack of access to transportation can’t easily travel to a public cooling center – if there is one nearby.</p>
<h2>Drawn to high-risk regions</h2>
<p><a href="https://www.census.gov/library/publications/2022/demo/p23-218.html">Retirees are often drawn</a> to the South’s sunny skies, low taxes and costs of living and amenities, like golf courses, beaches, health care facilities and age 55+ residential communities tailored to their needs. In Phoenix, the share of residents over age 65 is projected to rise from 10% of its 1.6 million residents today <a href="https://doi.org/10.1093/geront/gnad050">to roughly 17% by 2050</a>.</p>
<p>At the same time that these populations are rising, the number of days people will need air conditioning is rising, too.</p>
<p>We used <a href="https://doi.org/10.1088/1748-9326/ab4a3a">scenarios of future county-level population</a> and <a href="https://www.nccs.nasa.gov/services/data-collections/land-based-products/nex-gddp-cmip6">climate model output from NASA</a> to assess the consequences of moderate and dramatic warming. <a href="https://doi.org/10.1093/geront/gnad050">Our projections show</a> that ever-rising numbers of older people are at risk of the harmful physical and mental health consequences of heat extremes.</p>
<p><iframe id="taoGc" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/taoGc/13/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>We found that populations in historically hot locations like Arizona and desert regions of California are aging at a rapid clip, placing demands on cities, counties and states to meet the pressing needs of older residents during heat waves.</p>
<p>These include providing cooling centers and ensuring that they are physically accessible to those with mobility challenges, and training first responders to be sensitive to the special needs of older adults who may be reluctant to leave their homes during a heat emergency.</p>
<p>Communities also need to find effective ways to warn “snowbirds,” vacationers or recent migrants who might hail from cooler climates and be less aware of, or adapted to, the risks of extreme heat.</p>
<h2>Northern regions are at risk, too</h2>
<p>Our research finds that historically cooler places like New England, the upper Midwest and the Pacific Northwest also have rising heat risks.</p>
<p>These regions – historically home to high shares of older adults – are projected to experience the steepest increases in heat exposure relative to temperatures historically experienced. Older adults who are accustomed to the New England chill may not fully understand the threats an extreme heat wave can pose, and they may <a href="https://doi.org/10.1073/pnas.1813145116">underestimate the harm</a> they might suffer from a day in the hot sun.</p>
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<img alt="Two women stand in a large fountain in Washington Square park. It has steps designed for people to sit or walk down to the water." src="https://images.theconversation.com/files/539315/original/file-20230725-20-1moa7d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539315/original/file-20230725-20-1moa7d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539315/original/file-20230725-20-1moa7d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539315/original/file-20230725-20-1moa7d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539315/original/file-20230725-20-1moa7d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539315/original/file-20230725-20-1moa7d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539315/original/file-20230725-20-1moa7d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Standing in a fountain can help cool a person off to a point, but being exposed to the sun when the heat index is 100 F, as this day in New York City was in 2021, can be dangerous, especially for older adults.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/two-women-stand-in-the-fountain-in-washington-square-park-news-photo/1333649056?adppopup=true">Alexi Rosenfeld/Getty Images</a></span>
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<p><iframe id="fMTok" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/fMTok/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Older homes in the Northeast also tend to have <a href="https://www.eia.gov/todayinenergy/detail.php?id=52558">less efficient cooling systems</a>. <a href="https://www.cnn.com/2023/06/30/weather/nighttime-heat-danger-climate-change-xpn-scn/index.html">Nighttime heat</a> can be particularly harmful for those without air conditioning, including people who live in densely populated Northeastern and Rust Belt cities where “heat islands” trap temperatures. For older adults with health conditions, <a href="https://www.sleepfoundation.org/insomnia/older-adults">a night of restless sleep</a> may make one more depressed and confused during waking hours.</p>
<h2>What you can do about it</h2>
<p>Older adults and their caregivers can take <a href="https://www.cdc.gov/aging/emergency-preparedness/older-adults-extreme-heat/index.html">some steps to adapt</a>.</p>
<p>Stay indoors. Use air conditioning. Drink plenty of water. Don’t use the oven, especially in small homes. Help an older adult with transportation to a cooling center. Place medications in the coolest spot in one’s home. Be sensitive to symptoms like dizziness and call for medical attention as needed.</p>
<p>However, <a href="https://doi.org/10.1080/08959420.2011.605642">community-scale adaptations also are needed</a>. <a href="https://doi.org/10.2105/AJPH.2022.307217">Public investments</a> in early <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15757-x">warning systems</a> for extreme weather, ride services to transport older adults to cooling centers and hospitals, geographic information systems to help first responders identify neighborhoods with high concentrations of older adults, and installation of energy-efficient air conditioning in homes and public settings can help to fight back against sweltering days in the future.</p><img src="https://counter.theconversation.com/content/210049/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Carr receives funding from National Institutes of Aging and RRF Foundation for Aging.</span></em></p><p class="fine-print"><em><span>Giacomo Falchetta receives funding from the Euro-Mediterranean Centre on Climate Change (CMCC).</span></em></p><p class="fine-print"><em><span>Ian Sue Wing received funding from the U.S. Department of Energy.</span></em></p>Health and climate change researchers explain the risks and why older adults, even those in northern states, need to pay attention.Deborah Carr, Professor of Sociology and Director of the Center for Innovation in Social Science, Boston UniversityGiacomo Falchetta, Postdoctoral Research Scholar in Energy, Climate and Environment, International Institute for Applied Systems Analysis (IIASA)Ian Sue Wing, Professor of Earth and Environment, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2068522023-06-25T13:35:00Z2023-06-25T13:35:00ZFinding joy at age 100: Talking to centenarians about living their best life at any age<figure><img src="https://images.theconversation.com/files/530460/original/file-20230606-27-okg1ov.png?ixlib=rb-1.1.0&rect=143%2C0%2C1657%2C1003&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Centenarian Clementina Ripplinger with researcher Heather Nelson. Researchers spoke to very elderly people about what brings them joy and how they plan for the future.</span> <span class="attribution"><span class="source">(Shane Luhning)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Aging is seen as a period of loss, and there are unhelpful <a href="https://www.nia.nih.gov/health/10-myths-about-aging">myths about older adults</a>. Myths lead to treatable conditions being considered normal parts of aging, including cognitive decline, dementia, depression and loneliness. Some even consider exercise dangerous in older adults.</p>
<p>At the same time, mainstream media promotes the message that <a href="https://doi.org/10.4236/jss.2017.58015">being young is central to a person’s value</a>. These ideas lead to ageism and older adults being seen as lesser.</p>
<p>After spending time with six female centenarians in assisted living facilities, our research team — which included four nursing researchers and a documentary filmmaker — learned there is plenty still worth living for. </p>
<p>Centenarians are a small but growing segment of the population with <a href="https://www150.statcan.gc.ca/n1/en/daily-quotidien/220928/dq220928c-eng.pdf?st=LrkfjZE_">13,844 centenarians in Canada</a>, and our findings debunk myths about the experience of aging.</p>
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<p>We asked the centenarians questions about what brings them joy and how they plan for the future because we wanted to learn how the very elderly plan for and find ways to live their best lives. The results of this study were <a href="https://vimeo.com/showcase/looking-forward-at-100">turned into a 32-minute documentary</a> that captures participants’ long and interesting lives and offers insight into continued meaning experienced by centenarians in their daily lives. Three of the centenarians died shortly after the interviews took place.</p>
<h2>Long and interesting lives</h2>
<p>The participants were born between the years 1919 and 1922. They were children during the Great Depression and young adults during the Second World War. </p>
<p>One of the women helped build bullet casings and worked on the <a href="https://www.britannica.com/technology/Lancaster-airplane">Lancaster bomber</a>. Another woman helped her husband protect the blueprints of the ill-fated <a href="https://www.thecanadianencyclopedia.ca/en/article/avro-arrow">Avro Arrow aircraft</a> when he brought them home from work. Two women lost their husbands when their children were small and had to go to work to support their families. They all experienced love and adventure. </p>
<p>Our team was fascinated by their stories and wanted to further explore what their lives look like today. </p>
<p>Betty, 101, saw happiness as a choice. “I don’t know what’s really to complain about. I went through life staying happy,” she said.</p>
<h2>Joy and challenges</h2>
<p>This study used a research method called <a href="https://www.scribd.com/doc/151684840/Braun-Clarke-2006-Using-Thematic-Analysis">thematic analysis</a> to find four themes: Finding Joy, Act your Age, Looking Forward and Putting Challenges into Perspective.</p>
<p>The centenarians found joy each day and enjoyed the little things such as activities, visits and treats. Betty enjoyed cheating at solitaire and Jean, 100, played the piano. Clementina, 101, had fun gambling and Joyce, 100, continued to write stories and watch her grandchildren in music concerts.</p>
<p>Family was central to their lives and they enjoyed spending time with their children, grandchildren and great-grandchildren. Two of the women stated that raising their children was the biggest accomplishment in their lives.</p>
<p>The centenarians also found great joy in reminiscing about their interesting lives. However, one of the challenges was that there was no one left alive who had the same shared experiences.</p>
<h2>Limitations</h2>
<p>The centenarians were constrained by the limitations of society, their bodies and their self-perceptions. “You have to act your age,” said Clementina. She physically described this phenomenon by clasping her hands together in her lap and sitting still. </p>
<p>Some participants found life to be boring at 100 compared to their lives as younger adults. They had limited opportunities to do what they would like. “We had homes,” said Joyce, 100, describing how they had known better lives, which made it hard to accept the constraints of their current existence. </p>
<p>In spite of these feelings, many of the participants continued to be busy and live life fully despite limitations. Jean, despite needing a wheelchair for mobility, continues to do people’s taxes for a volunteer organization, plays piano for church services and leads choirs within her facility. </p>
<p>“I am constantly rebelling against my situation physically,” she said.</p>
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<p>The other women in this study also continued to challenge norms of what their age and disabilities meant. Joyce writes and submits short stories for publication, and has a poem in the war archives in Ottawa.</p>
<p>Assisted living facilities often prioritize resident safety, but this can come at a cost to personal freedom. Some residents only leave their facility accompanied by a facility employee or a family member. Clementina rebelled against this restriction and at the age of 97, snuck out of her assisted living facility in a cab to go to the casino, pretending that she was going to meet her son.</p>
<p>All of the participants put their life challenges into perspective. They all had lost spouses, friends and some had lost their children. “I was broken,” Clementina said about losing her husband. </p>
<p>Christine, 102, was asked how she managed after losing her husband when her children were still small. “I am still here,” she said.</p>
<h2>The future</h2>
<p>Most of the centenarians had few plans for themselves for the future and were more interested in leading their day-to-day lives. Betty jokingly described the inevitability of her death and that she was “looking for the bucket.” Most described being prepared to die except for Jean, who laughed and said she didn’t have time to die. “I have too many plans.”</p>
<p>The centenarians looked to the future of their families and the larger community and entrusted the next generation to make good choices.</p>
<p>Participants in this study had long and interesting lives and continued to find meaning each day. This study supports the idea that older adults continue to lead engaging lives and that we need to support older adults to live their best lives at any age.</p>
<p><em>This article was also co-authored by journalist and filmmaker Kelly-Anne Riess and retired nursing instructor Susan Page.</em></p><img src="https://counter.theconversation.com/content/206852/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Joyce Nelson receives funding from the Saskatchewan Health Research Foundation and the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Beverlee Ziefflie receives funding from the Saskatchewan Health Research Foundation and the Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Paula Mayer receives funding from the Saskatchewan Health Research Foundation and the Social Sciences and Humanities Research Council. </span></em></p>What is life like at 100? Centenarians shared their joys and future hopes with a team of Saskatchewan researchers.Heather Joyce Nelson, Assistant Professor of Nursing, University of ReginaBeverlee Ziefflie, Instructor, Nursing, Saskatchewan PolytechnicPaula Mayer, Associate Research Scientist, Nursing, Saskatchewan PolytechnicLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067482023-06-01T20:46:39Z2023-06-01T20:46:39ZIntergenerational Day: How bringing different generations together can support our mental well-being<figure><img src="https://images.theconversation.com/files/529458/original/file-20230531-25420-dofez7.jpg?ixlib=rb-1.1.0&rect=22%2C128%2C5017%2C3234&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Programs that bring young and old together help foster meaningful relationships across generational divides.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>“You old bag!” </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in wheelchair receives birthday cards from young children." src="https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Herb receiving birthday cards from students in the iGen program.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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</figure>
<p>To many, this phrase might spark confusion or concern. But, for Herb, a long-term care resident of Saskatoon’s <a href="https://www.sherbrookecommunitycentre.ca/">Sherbrooke Community Centre</a>, it is his favourite phrase for teasing friends. </p>
<p>So, when he was gifted a t-shirt with those words on his 69th birthday, you couldn’t have seen a bigger smile on his face, nor heard more laughter from the friends who gave it to him — a class of 11- and 12-year-olds.</p>
<p>Herb’s connection with these young students is sincere and an important one to celebrate. Especially on June 1, which marks <a href="https://nationaltoday.com/intergenerational-day/#:%7E:text=Now%20more%20than%20ever%20we,on%20June%201%20was%20created">Intergenerational Day</a>.</p>
<p>Established in 2010, Intergenerational Day was created to shrink the <a href="https://www.pewresearch.org/social-trends/2009/08/12/ii-generations-apart-and-together/">widening gap</a> between the old and young, two generations that people believe differ wildly on a broad range of topics, from core moral values and political views to tastes in music. </p>
<p>Intergenerational Day serves as a reminder of what the old and young can learn from one another, as well as the benefits that come from connecting with others.</p>
<h2>Intergenerational classroom</h2>
<p>For the past three years, we have been researching the benefits of intergenerational connections. We have found that, just like Herb, most people not only feel a great deal of meaning in connecting with someone of a different age than themselves, but that these connections are associated with greater well-being.</p>
<p><a href="https://www.mdpi.com/1660-4601/20/5/4403">In our research</a>, we have focused our attention on a program called <a href="https://www.cbc.ca/news/canada/saskatchewan/community/long-term-care-eden-alternative-saskatoon-1.6692053">iGen</a>: an <a href="https://www.saskatoonpublicschools.ca/program/igen/Pages/default.aspx">intergenerational classroom</a> in Saskatoon housed at the Sherbrooke Community Centre and created in partnership with educator <a href="https://www.spsd.sk.ca/school/collegepark/Announcements/DispForm.aspx?ID=39&ContentTypeId=0x010400A523F8B49A40D74B94D75356FE80B353#/=">Keri Albert</a>.</p>
<p>Each year, 25 Grade 6 students complete the standard curriculum at Sherbrooke while interacting with the long-term care residents called Elders. The term “Elders” is used within the <a href="https://www.sherbrookecommunitycentre.ca/sherbrooke-difference/the-eden-alternative-philosophy/#:%7E:text=The%20Eden%20Alternative%20%C2%AE%20focuses,care%20of%20the%20human%20body.">Eden Alternative Philosophy</a> of long-term care to honour residents and the wisdom of their life experiences.</p>
<p>Every day, students connect with and support the Elders through various activities like reading, painting, playing games or simply chatting. These repeated interactions provide a comfortable opportunity for conversations and true friendships to grow.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/sp3r8PsQjDc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The iGen program brings young students together with older adults living in long-term care to foster intergenerational connections.</span></figcaption>
</figure>
<h2>Improving well-being</h2>
<p>In our recently published study, we worked with Albert and Sherbrooke’s Communications leader, Eric Anderson, to survey 24 students in the iGen class of 2020. Students told us about their experiences and rated how it had impacted several aspects of their well-being, such as their energy, self-esteem, optimism and life satisfaction.</p>
<p>What did we find? First, students’ ratings were off the charts: Students said that their conversations, activities and experiences with the Elders were incredibly meaningful and rated their well-being at the top of our scales. In other words, these students were enjoying their experience in iGen and feeling happy about themselves.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A girl and an elderly man in a wheelchair pose for a photo together." src="https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Frequent intergenerational interactions provide an opportunity for meaningful connections and friendships to grow.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Second, we found that forming meaningful connections with care home residents in the program was associated with greater happiness. Students who reported having more meaningful intergenerational experiences also reported greater well-being on every single measure included in our surveys, such as greater life satisfaction and self-esteem. </p>
<p>These findings align with <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.117.3.497">hundreds of studies</a> indicating that social relationships are a key source of happiness.</p>
<p>How were students and Elders able to form meaningful relationships? Responses to our survey offer one insight: spending time together. In fact, the more time that students spent with the Elders, the more meaningful they reported their intergenerational experiences to be. This suggests that when generations interact through programs like iGen, they can reap the potential benefits of these relationships.</p>
<p>Building intergenerational connections may be especially timely now given widespread worries of <a href="https://www.nytimes.com/2023/04/30/opinion/loneliness-epidemic-america.html">loneliness</a> for people of all ages, which may contribute to the young and elderly’s declining mental health. </p>
<p>One-in-five youth in Canada <a href="https://www.unicef.ca/en/blog/mental-health-top-concern-canadas-youth?ea.tracking.id=20DIAQ01OTE&19DIAQ02OTE=&gad=1&gclid=Cj0KCQjw4NujBhC5ARIsAF4Iv6epKZpNm_bqWnbwj9VKg7ElWEpj1Tq_-0zBa1OnMUttHPWBi7fqdAkaAkAkEALw_wcB">struggle with mental illness</a>. While in the U.S. the number of youth reporting feelings of <a href="https://www.apa.org/monitor/2023/01/trends-improving-youth-mental-health?utm_source=twitter&utm_medium=social&utm_campaign=apa-monitor-trends&utm_content=2023-trends-youth-mental-health">sadness and hopelessness</a> has grown by 40 per cent in the last 10 years. </p>
<p>At the other end of the lifespan, many older adults struggle with their well-being, with roughly seven per cent of the world’s older population <a href="https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults">suffering from depression</a>.</p>
<p>Yet, <a href="https://worldhappiness.report/ed/2023/world-happiness-trust-and-social-connections-in-times-of-crisis/">new data</a> shows that even in 2022, after years of separation due to the pandemic, people reported greater feelings of social connection than loneliness. This is promising, because feeling socially connected is one of the strongest predictors of greater well-being. And it provides us with yet more reasons to create and celebrate social connections across generations.</p>
<p>At a time when the young and old are <a href="https://hbr.org/2018/06/the-u-s-isnt-just-getting-older-its-getting-more-segregated-by-age">growing further apart</a>, we show that programs like iGen may help youth form valuable relationships that can bridge social divides like age and ability, and possibly, leave us all happier for it.</p><img src="https://counter.theconversation.com/content/206748/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Intergenerational Day serves as a reminder of what the old and young can learn from one another, as well as the benefits that come from connecting with others.Jason Proulx, PhD Student, Social Psychology, Simon Fraser UniversityJohn Helliwell, Professor Emeritus, Vancouver School of Economics, University of British ColumbiaLara Aknin, Distinguished Associate Professor of Psychology, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041082023-05-11T20:48:13Z2023-05-11T20:48:13ZOlder people who are homeless need better access to hospice and palliative care<figure><img src="https://images.theconversation.com/files/524435/original/file-20230504-15-gf7bsb.jpg?ixlib=rb-1.1.0&rect=149%2C86%2C3000%2C2048&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A core focus of palliative care is on easing symptoms and increasing quality of life for people who have a serious or chronic illness, and not solely for those who are dying.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Most people may not wish to devote much time to thinking about their death. However, it’s an unfortunate fact that the entry point into experiences or conversations around death and end-of-life care can happen abruptly. </p>
<p>An unexpected death or a terminal diagnosis can leave people ill-equipped to navigate what often feels like uncharted territory of navigating end-of-life care, bereavement and grief. </p>
<p>The challenging realities surrounding end-of-life care are especially difficult for older people experiencing homelessness. For these older adults, intersectional and compounding experiences of oppression, such as poverty, racial disparities and ageism, create barriers to accessing hospice care. </p>
<h2>Misconceptions about hospice care</h2>
<p>The need for end-of-life and palliative services for unhoused people will <a href="https://homelesshub.ca/sites/default/files/SOHC16_final_20Oct2016.pdf">likely continue to grow</a> as the population experiencing homelessness grows and ages. </p>
<p>Currently only 16 to 30 per cent of Canadians <a href="https://maisonstraphael.org/wp-content/uploads/2016/05/Fact_Sheet_HPC_in_Canada-Spring-2014-Final.pdf">have access to hospice and palliative care services</a>, and 34 per cent of Canadians are not clear on <a href="http://www.hpcintegration.ca/resources/what-canadians-say/survey-data-by-province.aspx">who is eligible or who should utilize hospice services</a>. In response, May 7-13 marks <a href="https://www.chpca.ca/campaigns/national-hospice-palliative-care-week/">National Hospice Palliative Care week</a>, which is aimed at increasing awareness about hospice care in Canada. </p>
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<img alt="senior man sitting in chair and talking with a health-care provider wearing scrubs and a stethoscope" src="https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Hospice care is provided in a number of settings, including in patients’ homes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The misconceptions about hospice care have had a direct impact on the engagement of services for the public, <a href="https://doi.org/10.1186%2Fs12904-019-0404-y">but also for Indigenous communities and for older adults experiencing homelessness</a>. </p>
<p>Efforts to increase awareness about hospice often neglect the most vulnerable populations. Future efforts must merge education and awareness with intersectionality, which takes into consideration the intersections of inequities that impact unhoused older adults.</p>
<p><a href="https://www.chpca.ca/about-hpc/">Hospice care</a> focuses on addressing the full spectrum of a patient’s physical, emotional, social and spiritual experiences and needs. A common misconception is that hospice is exclusively a location or place where people go to die. Contrary to this notion, hospice is a service that is provided in various settings including within one’s home, long-term care facilities, hospice centres or within a hospital. </p>
<h2>End-of-life care</h2>
<p>While many Canadians <a href="https://maisonstraphael.org/wp-content/uploads/2016/05/Fact_Sheet_HPC_in_Canada-Spring-2014-Final.pdf">prefer to die at home</a>, older people experiencing homelessness <a href="https://doi.org/10.1186/s12904-018-0320-6">do not have the same opportunities for end-of-life care options</a>, and as a result <a href="https://news.gov.bc.ca/releases/2022PSSG0063-001528">many unhoused older people die in the hospital or institutional settings</a>.</p>
<p>Family and friends often play an essential role in caring and advocating for a loved one during their end-of-life process. We can only hope to have loved ones by our side during these final stages; however, that is not the reality for many unhoused community members who do not have the option to die at home with loved ones. </p>
<p><a href="https://doi.org/10.1186/s12904-018-0320-6">Older people experiencing homelessness are especially vulnerable</a> due to limited family or social support networks. Lack of social support can result in unhoused older people feeling isolated and fearful about dying alone or anonymously.</p>
<p>A core focus of palliative care is on <a href="https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care">easing symptoms and increasing quality of life</a> for people who have a serious or chronic illness, and not solely for those who are dying. Palliative care can be a valuable form of health care for older people experiencing homelessness, as it can offer a tailored approach to managing multiple chronic or terminal illnesses, <a href="https://doi.org/10.1016/j.jpainsymman.2016.10.364">which are prevalent among unhoused older people</a>. </p>
<p>Palliative care that takes place in a hospital setting can decrease end-of-life care costs by nearly 50 per cent <a href="http://hpcintegration.ca/media/24434/TWF-Economics-report-Final.pdf">by reducing intensive care unit admissions and unnecessary intervention procedures</a>. </p>
<p>We believe it is valuable to consider that if end-of-life care costs were reduced by using palliative care practices, the cost savings could be used to fund services that directly support unhoused older adults, such as increased affordable housing options. </p>
<h2>Aging in the right place</h2>
<p>As members of the <a href="https://www.sfu.ca/airp.html">Aging in the Right Place</a> project research team at Simon Fraser University, we are working to better understand what aging and dying in the right place means to unhoused older adults in two sites providing end-of-life care in Vancouver. </p>
<p>May’s Place Hospice, which is in the Downtown Eastside of Vancouver, provides end-of-life care for community members in that part of the city. May’s Place has created a communal, home-like environment with private rooms, meals provided three times a day, 24-hour nursing care, a smoking lounge and family gathering space. </p>
<figure class="align-center ">
<img alt="A person in a hospital bed looking out a large window with a mug in their hands." src="https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Palliative care that takes place in a hospital setting can decrease end-of-life care costs by nearly 50 per cent.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Another inpatient hospice setting in Vancouver is Cottage Hospice, located in a 1924 heritage building. Patients have a view of the North Shore mountains and are close to the water. Cottage Hospice and May’s place provide the same types of hospice palliative care support, and both care for older patients experiencing homelessness, but serve different populations based on their location and setting, demonstrating that hospice and palliative care is not a one-size-fits all approach.</p>
<p>The Aging in the Right Place project captures the perspectives and lived experiences of older people experiencing homelessness through integrating photovoice interview research methods as well as data collection methods that focused on the hospice setting, the neighbourhood, and experiences of staff who work to support unhoused older people. <a href="https://doi.org/10.1177/109019819702400309">Photovoice is a method used in community-based research</a> in which participants use photo taking and storytelling to document their own perspectives and experiences.</p>
<p>In the Vancouver area where we work — also known as the land that belongs to the Skwxwú7mesh (Squamish), xʷməθkwəy̓əm (Musqueam) and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) people — and throughout the province, <a href="https://doi.org/10.1186/s12904-019-0404-y">colonization and colonial medical models have had lasting and detrimental impacts</a> on Indigenous knowledge and traditional practices around death and dying for First Nation communities.</p>
<p>One example of these impacts is that current hospice models may not reflect culturally relevant care models. Hospice organizations throughout B.C. should prioritize increasing policy and practice for Indigenous groups to ensure safety and culturally relevant care are implemented. Ensuring accessibility to hospice and palliative care is one step towards dismantling these barriers for Indigenous populations. </p>
<p>B.C. can turn to the <a href="https://www.icha-toronto.ca/programs/peach-palliative-education-and-care-for-the-homeless">Palliative Education and Care for the Homeless (PEACH) service fostered by Inner City Health Associates (ICHA)</a> in Toronto as an example. PEACH is taking a diverse and innovative approach to providing palliative care among the homeless and vulnerable populations, including Indigenous communities and older adults. Innovative and culturally sensitive services such as these, are a step in the right direction to providing better end-of-life care to older adults experiencing homelessness.</p>
<p>It is crucial that we make hospice and palliative care services available to all community members, especially with the <a href="https://www.cihi.ca/en/infographic-canadas-seniors-population-outlook-uncharted-territory">aging population</a> and an <a href="https://www.chpca.ca/wp-content/uploads/2020/03/CHPCA-FactSheet-D.pdf">increase in chronic illnesses</a> throughout Canada. </p>
<p>In addition to supporting community members, hospice and palliative care should focus efforts on tailoring approaches to provide culturally relevant care, increasing staff education about the lived experiences of older people experiencing homelessness, and creating safe and accessible services in B.C. for marginalized communities. </p>
<p>We must actively dismantle misconceptions about the role of hospice and palliative care through education and awareness to facilitate appropriate service delivery and use for diverse populations.</p><img src="https://counter.theconversation.com/content/204108/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachelle Patille receives funding Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) in affiliation with the AIRP Project which this piece is linked to.
</span></em></p><p class="fine-print"><em><span>Atiya Mahmood receives funding from Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) for the AIRP project which this piece is linked to.</span></em></p><p class="fine-print"><em><span>Gracen Bookmyer receives funding Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) in affiliation with the AIRP Project which this piece is linked to.</span></em></p><p class="fine-print"><em><span>Sarah Canham receives funding from the Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) in affiliation with the AIRP Project which this piece is linked to.</span></em></p>The challenging realities surrounding end-of-life care are especially difficult for older people experiencing homelessness, who have more barriers to accessing hospice care.Rachelle Patille, Researcher, Aging In the Right Place | M.A. student, Gerontology, Simon Fraser UniversityAtiya Mahmood, Associate professor, Gerontology Department, Simon Fraser UniversityGracen Bookmyer, Research Assistant, Aging In The Right Place | M.A. student, Gerontology, Simon Fraser UniversitySarah Canham, Associate Professor, City & Metropolitan Planning, College Of Social Work, University of UtahLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2016302023-04-02T11:46:49Z2023-04-02T11:46:49ZAgeism and the pandemic: How Canada continues to let older adults suffer and die from COVID-19<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/ageism-and-the-pandemic--how-canada-continues-to-let-older-adults-suffer-and-die-from-covid-19" width="100%" height="400"></iframe>
<p>Three years into this pandemic, most Canadians have taken off their masks and many have stopped getting booster shots. However, COVID-19 is rising among the <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401">leading causes of death</a> in Canada, <a href="https://www.finder.com/ca/what-are-the-top-10-causes-of-death-in-canada">reaching the No. 3 spot</a>.</p>
<p>This is the first time an infectious disease has pushed its way into the top five causes of death during the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/causesofdeathover100years/2017-09-18">last 80 years or so of the antibiotic era</a>.</p>
<p>Older adults account for most of those deaths, and we are letting it happen.</p>
<h2>COVID-19, aging and ageism</h2>
<p>COVID is a <a href="https://www.cdc.gov/globalhealth/immunization/diseases/index.html">vaccine-preventable disease</a>, but we are not using vaccines as well as we could. Most Canadians don’t understand the importance of booster shots in <a href="https://www.bmj.com/content/380/bmj-2022-072529">protecting them from long-term health issues that may follow infection</a>, such as long COVID. Even fewer recognize that getting vaccinated <a href="https://immunize.ca/">helps protect their entire community</a>, including older adults. </p>
<figure class="align-center ">
<img alt="A man and his grandson wearing face masks touching elbows greeting social" src="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Healthy seniors are assets to their communities. They are caregivers, volunteers and keepers of cultural knowledge.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Most COVID deaths are in older people. That’s not just a problem for them. It’s a problem for everyone. When older adults are healthy they are an incredible asset to our communities — they are <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2020001/article/00007-eng.htm">caregivers</a>, <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2021001/article/00002-eng.htm">volunteers</a> and <a href="https://www.bayshore.ca/resources/respect-your-elders-how-seniors-contribute-to-a-better-world/">repositories of knowledge and culture</a>. When they are unwell it is a <a href="https://www.canada.ca/en/public-health/services/publications/science-research-data/economic-burden-illness-canada-2010.html">tremendous strain</a> on them, their caregivers and <a href="https://www.cambridge.org/core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement/article/abs/chronic-health-conditions-changing-prevalence-in-an-aging-population-and-some-implications-for-the-delivery-of-health-care-services/0FFB314D39504F95027340EBD7534DCB">our health-care system</a>.</p>
<p><a href="https://www.cihi.ca/en/hospital-stays-in-canada">COVID has become the second-leading cause of hospitalization in Canada</a>, after childbirth. Among those over 50, it is the single leading cause of hospitalization. </p>
<p>We had <a href="https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data-surveillance/covid-19-data-tool?tab=outbreaks">more outbreaks in long-term care facilities in 2022</a> than we had in <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">2020 and 2021 combined, and more deaths and more hospitalizations than the first two years of the pandemic combined</a>. </p>
<p>COVID is not over, but we are acting like it is. Many COVID research programs are <a href="https://www.covid19immunitytaskforce.ca/citf-leadership/">winding down</a>. Can you imagine winding down research into any other condition on the top five mortality list? </p>
<p>The reason for not doing more to prevent COVID-19 appears to be ageism, plain and simple. There is no logical explanation for accepting an unnatural degree of hospitalization and premature deaths in elders except that we value the lives of younger people more. </p>
<h2>The toll of COVID-19 in older people</h2>
<p>Unfortunately, dying isn’t even necessarily the worst of it. </p>
<p>It’s just the part that’s easier to count and that makes the most headlines. There is still a sea of suffering out there, as older people — who are more likely to have other health issues — get sick with COVID and take a long time to recover, if they do recover. </p>
<figure class="align-center ">
<img alt="Rows of small white crosses on a lawn with a building in the background" src="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Canada had the highest proportion of COVID deaths in long-term care of any country in the Organisation for Economic Co-operation.
and Development. Crosses outside a Mississauga, Ont. long-term care centre during the first wave of the pandemic.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>For older adults, respiratory illness is often a <a href="https://doi.org/10.1007/978-3-030-22009-9_550">catalyst for other health problems</a>, triggering a spiral that ends in premature death. Illness also causes many people to <a href="https://www.nber.org/books-and-chapters/women-working-longer-increased-employment-older-ages/women-working-longer-labor-market-implications-providing-family-care">retire early because they or the people they care for are chronically ill</a>.</p>
<p>Canada had the <a href="https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf">highest proportion of COVID deaths in long-term care</a> of any country in the Organisation for Economic Co-operation and Development, because we did not prioritize preventing infectious disease. Now, because of the demographic bulge of the Baby Boom, the <a href="https://toronto.ctvnews.ca/wait-list-for-long-term-care-beds-in-ontario-nearly-doubled-in-10-years-oltca-says-1.6229216">demand for long-term care for older adults is rising</a>, even as COVID outbreaks continue in such facilities.</p>
<p>It’s hard to believe that after the <a href="https://www.cbc.ca/news/canada/montreal/quebec-herron-inquest-day-3-1.6170046">horror show</a> in so many Canadian long-term care homes during early months of COVID that we have slipped back into complacency, allowing Canadians’ parents, grandparents, neighbours and friends to become infected because the rest of us won’t take simple actions.</p>
<p>It doesn’t have to be this way, and it shouldn’t. </p>
<h2>Excess COVID-19 deaths in older adults are not inevitable</h2>
<p>Typically, people under 50 are likely to have much more social contact through school, social events and work, making them the most likely to be exposed to the virus. However, they are also the least likely to protect themselves — and others — by keeping up with their <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/#a5">booster shots</a> and <a href="https://angusreid.org/covid-unmasked-unwilling/">wearing masks</a>. </p>
<figure class="align-center ">
<img alt="An older woman walking outdoors with a younger woman who has her arm through the older woman's. Both are wearing face masks." src="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It may be easier for them to believe and behave as if the threat of COVID has passed, because they are far <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">more likely to make a quick and complete recovery</a> from COVID. But they are also the ones <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">most likely to spread it to those who have far less immune protection</a> and far less choice. </p>
<p>We shouldn’t treat COVID-19 in older adults as inevitable. With better testing, policy makers could have better information to make decisions about how to reduce the number of infections. If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</p>
<p>Older adults have inherent value and dignity, and are an asset to their communities. They are people who have already contributed to society in family, professional and social capacities, and who continue to do so. They deserve to live as long and as well as possible.</p><img src="https://counter.theconversation.com/content/201630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dawn ME Bowdish receives funding from the COVID-19 Immunity Task Force (Public Health Agency of Canada) for her research on COVID-19 infections and vaccinations in older adults. She is on the Board of Directors of the Lung Health Foundation. </span></em></p>COVID-19 is the third-leading cause of death in Canada, but it’s older people who are dying. That we accept this and carry on as if the pandemic is over reveals our ageism: We don’t value older people.Dawn ME Bowdish, Canada Research Chair in Aging & Immunity, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015412023-03-15T20:55:38Z2023-03-15T20:55:38ZOlder adults with dementia but without close family: Who are they? And who cares for them?<figure><img src="https://images.theconversation.com/files/515611/original/file-20230315-2738-i6ezz2.jpg?ixlib=rb-1.1.0&rect=372%2C128%2C3451%2C2456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than eight per cent of study subjects were 'kinless' at the time of their dementia diagnosis.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>What happens to <a href="https://www.nytimes.com/2022/12/03/health/elderly-living-alone.html">older adults who do not have close family</a> when they develop <a href="https://alzheimer.ca/sites/default/files/documents/ASC_What-is-dementia-info-sheet_en.pdf">dementia</a>? The truth is, we hardly know. </p>
<p><a href="https://census.gc.ca/census-recensement/2021/as-sa/98-200-X/2021003/98-200-X2021003-eng.cfm">Population aging</a> together with changing patterns of marriage and childrearing mean that growing numbers of people in North America <a href="https://doi.org/10.1093/geronb/gbab222">reach advanced ages without a living spouse or children</a>. This matters because the incidence of dementia increases with age, and considerable support and care are needed to live well as the condition progresses. The vast majority of this care is <a href="https://alzheimer.ca/sites/default/files/documents/Landmark-Study-Report-1-Path_Alzheimer-Society-Canada_0.pdf">provided by spouses and children</a>. </p>
<p>There is reason to worry that older adults who lack family in these two relationship categories may be <a href="https://www.nytimes.com/2015/09/29/health/near-the-end-its-best-to-be-friended.html">particularly vulnerable</a> if they develop dementia. Until now, however, very little research has examined the topic. </p>
<h2>Older adults with dementia without close kin</h2>
<p>I am a <a href="https://medanthro.net/about/about-medical-anthropology/">medical anthropologist</a> and I research social and cultural dimensions of illness and health care. (I am also the <a href="https://doi.org/10.1111/j.1548-1387.2008.00036.x">daughter of a mother who lived with dementia</a> for a very long time). </p>
<p>For the past several years, I have been working with a team of fifteen other researchers — in fields that range from social work to public health, public policy, demography, nursing and several different medical specialties — to find out what happens to older adults who are “kinless” (i.e., they do not have a living spouse or children) at the time they develop dementia. </p>
<figure class="align-center ">
<img alt="A woman with gray hair sitting beside a man with gray hair in a bed" src="https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A person’s role as caregiver (at the time they developed dementia, or previous to that) could have important consequences for their own ability to access care.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Our team has worked with information collected as part of a long-running medical research study of dementia called <a href="https://actagingresearch.org/">the Adult Changes in Thought (ACT) study</a>. Since the early 1990s, this study has been following participants recruited from the membership of an integrated health-delivery organization in Seattle to identify those who develop dementia. </p>
<p>Our team has been examining the research data and administrative documents generated by the ACT study, with an eye to what they can tell us about the circumstances and needs of older adults who were kinless when they developed dementia. </p>
<p>Qualitative analysis of ACT administrative documents, some of which contained clinical chart notes from participants’ medical records, proved to be an especially rich and informative source of data. </p>
<h2>Surprising findings</h2>
<figure class="align-center ">
<img alt="A older man looking into a kitchen cupboard and scratching his head" src="https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some kinless adults with dementia received support from neighbours and friends, however, in some cases community members appeared to have gotten involved only at moments of crisis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>We <a href="https://doi.org/10.1093/geronb/gbad030">recently published</a> what we believe is the first article on kinless older adults with dementia, and some of the findings might surprise you:</p>
<ul>
<li><p>This circumstance is not rare. In our sample of community-dwelling older adults, we found that 8.4 per cent were kinless at the time they developed dementia. (This is probably a conservative estimate, because more would likely become kinless after the onset of dementia, upon the death of a spouse and/or child).</p></li>
<li><p>This is a predicament to which anyone may be susceptible. The life trajectories that led people in our sample to be kinless at the time they developed dementia were quite varied. Some had never married or had children, but others had outlived both spouses and children. </p></li>
<li><p>The average age of the kinless older adults in our sample at the time they developed dementia was 87. Half were living alone at that point, and one-third were living with unrelated persons such as hired caregivers. Most were women who became kinless late in life and unexpectedly.</p></li>
<li><p>A person’s role as caregiver (at the time they developed dementia, or previous to that) could have important consequences for their own ability to access care. For example, some in our sample had previously moved to a residential setting to meet the needs of a spouse, which could mean that they were well situated to access care later. On the other hand, at least one of the 64 kinless older adults with dementia in our sample was serving as caregiver for a roommate (who also had dementia), which triggered an intervention when it led to a situation that was dangerous for both parties.</p></li>
<li><p>Some of the kinless older adults in our sample seemed to have little support, but others received considerable support from relatives such as nieces, nephews, sisters, grandchildren and others. </p></li>
<li><p>Some received support from neighbours and friends that could in some cases involve quite extensive hands-on care. In many instances, however, neighbours and other community members appeared to have gotten involved only at moments of crisis, as a form of rescue. </p></li>
</ul>
<p>This research affords a rare window into the circumstances and needs of a potentially very vulnerable group that up to now has remained largely invisible. Our findings have implications for clinicians and health systems, but also for society more broadly. </p>
<p>“Who cares?” is, on one level, an informational question about caregiving networks — one that our team, through this research, has begun to answer. On another level, however, “who cares?” is a provocation. The predicament of kinless older adults with dementia should provoke all of us to work to better support people facing <a href="https://doi.org/10.1016/j.jaging.2017.08.002">a form of precarity that anyone may be susceptible to in late life</a>.</p><img src="https://counter.theconversation.com/content/201541/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was supported by grant R21AG058056 from the National Institute on Aging at the National Institutes of Health. The Adult Changes in Thought study was supported by U01AG006781 (Larson and Crane, multiple PIs). Partial support for this research came from a Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure
grant, P2C HD042828, to the Center for Studies in Demography and Ecology (CSDE) at the University of Washington.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent
the official views of the National Institutes of Health</span></em></p>New research affords a rare window into the circumstances and needs of a potentially very vulnerable group that until now has remained largely invisible: people with dementia who have no close kin.Janelle S. Taylor, Professor, Medical Anthropology, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1984812023-02-08T18:43:39Z2023-02-08T18:43:39ZThe pandemic played into ageist stereotypes, but intergenerational contact and co-operation can overcome them<figure><img src="https://images.theconversation.com/files/508476/original/file-20230206-13-t4itv6.jpg?ixlib=rb-1.1.0&rect=63%2C40%2C3810%2C2532&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Stereotypes about the elderly having more than their fair share can be heightened during times of crisis when resources are seen to be scarce.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As the COVID-19 pandemic spread around the world, <a href="https://news.ontario.ca/en/statement/56348/enhanced-measures-to-protect-ontarians-from-covid-19">stringent public health regulations</a> were imposed to protect vulnerable individuals, with older people seen as a particularly vulnerable group.</p>
<p>In response, some argued the pandemic was just a problem for older people and that they should be <a href="https://doi.org/10.1093/geronb/gbaa102">locked away</a> so younger people could get on with their lives. Others showed <a href="https://doi.org/10.1037/amp0000699">increased concern</a> for older people, with dedicated shopping hours and food deliveries for seniors organized. </p>
<p>We are a team of researchers in psychology, sociology and political science with expertise in intergroup relations. Our research on ageism during the pandemic shows that the group-based beliefs and values people endorse have an impact on how older people are viewed. </p>
<p>This is important because it tells us what beliefs and values need to be targeted to create a more inclusive society, especially when facing a public health emergency like the COVID-19 pandemic.</p>
<p>In August 2020, we <a href="http://dx.doi.org/10.1111/josi.12554">conducted a survey</a> to gauge the attitudes and opinions of Canadians and Americans who were 18 to 65+ years old. The survey relied on nationally representative samples of 2,110 Canadians and 2,124 Americans. The goal was to assess how North Americans perceived older people during the pandemic and what factors explained these perceptions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A younger woman and an elderly man in a wheelchair place their hands on a glass barrier separating them." src="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People talk through a plexiglass barrier at Lynn Valley Care Centre in North Vancouver in July 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<h2>Intergenerational tension and its basis</h2>
<p>The survey results showed that younger respondents were especially likely to say that older people were using more than their fair share of societal resources, such as those related to health care. This was the case for both Canadians and Americans, and demonstrates <a href="https://doi.org/10.1037/a0032367">ageist consumption stereotypes</a>. These stereotypes can be heightened when resources seem to be scarce.</p>
<p>The degree of concern younger North Americans felt in terms of their own health and finances did not predict ageist consumption stereotypes. Instead, their beliefs and values about group relations were key.</p>
<p>Younger North Americans who endorsed the statement that some groups of people are simply inferior to other groups were more likely to endorse ageist consumption stereotypes. The same was true for those who held values emphasizing competition. In contrast, younger North Americans who valued collective goals and believed in personal sacrifice for the collective good were less likely to hold ageist consumption stereotypes.</p>
<p>At the time of the survey, social distancing measures were in effect, so we also asked survey respondents about their opinions about social distancing. We found that younger North Americans who believed social distancing carries too many problems were also more likely to endorse ageist consumption stereotypes.</p>
<h2>What can we learn?</h2>
<p>To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good, while downplaying competition and group-based dominance. This benefits all of us. First, it promotes social cohesion in society. In addition, most of us will be old people someday and would prefer not to experience ageism at that time. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly black woman with grey hair looking out of a window." src="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In the context of the pandemic and similar health emergencies, one way to do this is through public health messaging that emphasizes how people of all ages share both the risk of diseases such as COVID-19 and the responsibility for co-operating to overcome it. This way, the emphasis is on society as a whole and less on broad age categories.</p>
<p><a href="https://doi.org/10.1093/geronb/gbaa051">Another strategy</a> to reduce ageism is to encourage intergenerational contact to promote solidarity and relatedness across age groups. This could, for example, include more frequent quality contact between family members of different generations, personal contact with older neighbours and participation in volunteering programs that bring people of different ages together. </p>
<p>There is also <a href="https://doi.org/10.1080/02701960.2020.1737047">evidence</a> that if intergenerational contact is coupled with education on aging, ageism can be successfully reduced. </p>
<p>A <a href="https://doi.org/10.1111/josi.12545">recent study</a> conducted during the pandemic found that exposure to online information that shows positive intergenerational contact and provides education that challenges ageist stereotypes effectively reduced ageism and perceived intergenerational conflict among young adults.</p>
<p>Intergenerational tension exists but it is not inevitable. To overcome it, we must understand where it comes from and implement a variety of strategies that bring together people of all ages in order to promote co-operation in solving common problems, rather than competition and dominance.</p><img src="https://counter.theconversation.com/content/198481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Esses receives funding from Immigration, Refugees and Citizenship Canada. She has previously received funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Kate Choi receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Patrick Denice receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Alina Sutter, Joanie Bouchard, and Mamta Vaswani do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good.Victoria Esses, Director, Network for Economic and Social Trends (NEST); Co-Chair, Pathways to Prosperity Partnership, Western UniversityAlina Sutter, Postdoctoral Associate, Network for Economic and Social Trends (NEST), Western UniversityJoanie Bouchard, Assistant Professor in Political Science, Université de Sherbrooke Kate Choi, Associate Professor, Sociology, Western UniversityMamta Vaswani, Postdoctoral Associate, Network for Economic and Social Trends (NEST), Western UniversityPatrick Denice, Assistant Professor of Sociology; Affiliate, Network for Economic and Social Trends (NEST), Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1977662023-01-18T20:28:32Z2023-01-18T20:28:32ZStorytelling allows elders to transfer values and meaning to younger generations<figure><img src="https://images.theconversation.com/files/504829/original/file-20230117-22-olpvhe.jpg?ixlib=rb-1.1.0&rect=58%2C67%2C6416%2C4241&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People don’t necessarily tell the same stories over and over again because they’re losing cognitive function, but because the stories are important, and they feel we need to know them.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>If you spent time over the holidays with elderly relatives or friends, you may have heard many of the same stories repeated — perhaps stories you’d heard over the years, or even over the past few hours.</p>
<p>Repeated storytelling can sometimes be unnerving for friends and families, raising concerns about a loved one’s potential cognitive decline, memory loss or perhaps even the onset of dementia.</p>
<p><a href="https://tenstories.ca/">Our research</a> at Queen’s University suggests there is another way to think about repeated storytelling that makes it easier to listen and engage with the stories. We interviewed 20 middle-aged adults who felt they had heard the same stories over and over from their aging parent. We asked them to tell us those stories and we recorded and transcribed them. </p>
<p>We used a <a href="https://doi.org/10.1108/14439881211248356">narrative inquiry approach</a> to discover that repeated storytelling is a key method for elders to communicate what they believe to be important to their children and loved ones. Narrative inquiry uses the text of stories as research data to explore how people create meaning in their lives.</p>
<figure class="align-center ">
<img alt="An elderly couple and a young man sit around a table chatting." src="https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=357&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=357&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=357&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Storytelling is an essential human process and an effort to share what’s important.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Transmitting values</h2>
<p>Based on nearly 200 collected stories, we found that there are approximately <a href="https://doi.org/10.1111/scs.13121">10 stories</a> that older parents repeatedly tell to their adult children. </p>
<p>The hypothesis was that repeated storytelling was about inter-generational transmission of values. By exploring the themes of those repeated stories, we could uncover the meaning and messages elders were communicating to their loved ones. </p>
<p>The ultimate purpose was to offer a new and more constructive way of thinking about stories that we’ve heard many times before, and that can be otherwise perceived as alarming.</p>
<h2>Here’s what we have learned:</h2>
<ol>
<li><p>There are typically just 10 stories that people tell repeatedly. While 10 is not a magic number, it does seem to be about the right number to capture the stories that are told over and over. Interviewees felt that a set of approximately 10 allowed them to do justice to their parent’s stories.</p></li>
<li><p>Among our interviewees, a significant number of their parents’ stories – 87 per cent — took place when they were in their teens or twenties. A person’s second and third decades are a time when they make many of the decisions that shape the rest of their lives; a time when values are consolidated and the <a href="https://doi.org/10.1080/09658211.2013.863358">adult identity is formed</a></p></li>
<li><p>What’s important about the 10 stories is not the factual details, but the lesson that was learned, or the value that was reinforced — values like loyalty toward friends, putting family first, maintaining a sense of humour even in hard times, getting an education, speaking up against injustice, and doing what’s right.</p></li>
<li><p>Key themes in the stories reflected the significant events and prevailing values of the early to mid-20th century. Many of the stories revolved around the war, and both domestic and overseas experiences that were formative. Many of our interviewees heard stories about immigrating to Canada, starting out with very little, seeking a better life and working hard. Stories often reflected a more formal time when it was important to uphold standards, make a good impression, know one’s place and adhere to the rules.</p></li>
<li><p>The stories elders tell appear to be curated for the individual receiving them. They would be different if told to another child, a spouse or a friend.</p></li>
</ol>
<h2>Tips for listening</h2>
<p>Our research offers some tips for listening to stories from elders:</p>
<ul>
<li><p>Focus on just 10 stories. It can make the listening seem less overwhelming.</p></li>
<li><p>Write them down. Writing challenges us to get the story straight.</p></li>
<li><p>Notice your loved one’s role in the story, as the message is often contained in that role.</p></li>
<li><p>Be attentive to feelings, sensations, tension and discomfort. These can be signals or clues to the meaning of a story.</p></li>
<li><p>Finally, remember these stories are for you — selected and told in the context of your relationship with your loved one. As such, they are a gift from a loved one who is running out of time.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly Asian man speaking to a younger boy who is sitting in a woman's arms." src="https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many of the stories elderly people told their family and friends revolved around experiences that were formative.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>The importance of receiving stories</h2>
<p>Storytelling is an <a href="https://doi.org/10.1002/cad.20067">essential human process</a> and a universal experience associated with aging. Neuroscientists suggest that storytelling has practical survival value for individuals and communities, <a href="https://www.jonathangottschall.com/storytelling-animal">as well as social and psychological benefits</a>. </p>
<p>It may be as powerful as medication or therapy for <a href="https://doi.org/10.1002/gps.1018">overcoming depression among elders</a>. Storytelling becomes especially important <a href="https://doi.org/10.1080/13607863.2017.1396581">when people become aware of their mortality</a> — when they are ill, suffering or facing death.</p>
<p>People don’t necessarily tell the same stories over and over again because they’re losing cognitive function, but because the stories are important, and they feel we need to know them. Telling stories repeatedly isn’t about forgetfulness or dementia. It’s an effort to share what’s important.</p>
<p>Our hope is that by better understanding elderly storytelling, caregivers may be able to listen in a different way to those repeated stories and understand the messages they contain. Those 10 stories can help us to know our loved one at a deeper level and assist our parent or grandparent with an important developmental task of old age. </p>
<p>This research offers a constructive way for caregivers to hear the repeated stories told by their aging parents, and to offer their loved one the gift of knowing they have been seen and heard.</p><img src="https://counter.theconversation.com/content/197766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Ann McColl received funding for this work from the Government of Canada's New Horizons for Seniors program.</span></em></p>Repeated storytelling from elderly relatives doesn’t necessarily always signal age or cognitive decline. It’s about conveying memories and values to a new generation.Mary Ann McColl, Professor, School of Rehabilitation Therapy, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1956262023-01-11T21:34:04Z2023-01-11T21:34:04ZTo better address the needs of older populations, researchers and media should stop fussing over aging<figure><img src="https://images.theconversation.com/files/503690/original/file-20230109-7992-mvun5u.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6873%2C4506&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Positive and negative stereotypes about aging have cultural and political implications that determine how societies care for their older generations.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The world seems to be obsessed with aging. The media is plagued with articles about <a href="https://www.economist.com/films/2021/12/21/the-true-costs-of-ageing">the costs of growing older</a>, <a href="https://www.economist.com/books-and-arts/2021/02/06/ageing-can-be-cured-and-in-part-it-soon-will-be">the cure to aging</a> and <a href="https://www.nytimes.com/2021/12/31/well/live/aging-advice.html">secrets to aging successfully</a>. Alongside these concerns, we strive to <a href="https://www.nytimes.com/2021/09/13/well/live/stupid-things-i-do-when-get-old-book.html">age gracefully</a> or become “cognitive super-agers” — people <a href="https://www.nia.nih.gov/news/cognitive-super-agers-defy-typical-age-related-decline-brainpower">whose brains function like those of a much younger person</a>. </p>
<p>Not everyone fears aging. There are also those who embrace it, and suggest that, instead of viewing aging as something to overcome, we should view it as “<a href="https://www.penguinrandomhouse.com/books/9534/composing-a-further-life-by-mary-catherine-bateson/">second adulthood</a>” — an opportunity in life after retirement, to complete, consolidate and share experiences of lives that were meaningfully lived. But even in embracing aging, we seem to be defensive about it.</p>
<h2>Aging stereotypes in media</h2>
<p>The media is largely responsible for creating and driving ageist stereotypes of older adults. An analysis of more than one billion entries in British and American media databases found that negative aging descriptions <a href="https://doi.org/10.3390/ijerph18168822">were six times higher than the positive descriptions</a>. </p>
<p>The study found that negative descriptions of older adults tended to be physical, like portraying them as frail. On the other hand, positive descriptions tended to be behavioural, such as portraying older adults as caring.</p>
<p><a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003046790-6/visual-representations-older-persons-eug%C3%A8ne-loos-jo-thijssen">Visual representations of aging create good and bad stereotypes</a>. Images of active and happy older adults create positive ageist stereotypes, while images of vulnerable and frail older adults create compassionate ageist stereotypes that are patronizing. These positive and negative stereotypes have cultural and political implications that determine how societies care for their older generations.</p>
<figure class="align-right ">
<img alt="An older woman sitting outside reading a book" src="https://images.theconversation.com/files/503689/original/file-20230109-17065-qx6px8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/503689/original/file-20230109-17065-qx6px8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503689/original/file-20230109-17065-qx6px8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503689/original/file-20230109-17065-qx6px8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503689/original/file-20230109-17065-qx6px8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503689/original/file-20230109-17065-qx6px8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503689/original/file-20230109-17065-qx6px8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Images of active and happy older adults create positive ageist stereotypes, while images of vulnerable and frail older adults create compassionate ageist stereotypes.</span>
<span class="attribution"><span class="source">(Najmeh Khalili-Mahani)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For example, a study about <a href="https://doi.org/10.1177/00914150211024173">how older adults were portrayed in news media covering disasters in Canada</a> showed a mismatch in communication between journalists and the older individuals whose stories were reported. </p>
<p>The media portrayed older adults on a spectrum from vulnerable to heroic. By focusing on narratives of the brave older adult fighting for their home, journalists diverted the attention from the real need for disaster relief. </p>
<p>COVID-19 exposed the consequences of media ageism as well. One study found that news coverage of older adults in New Zealand treated them as a <a href="https://doi.org/10.1080/03036758.2021.1884098">nameless, homogeneous group who were at risk and passive</a>. The consequence of such messaging became evident in high rates of insensitive and <a href="https://doi.org/10.1111%2Fjgs.16508">stigmatizing comments about older adults on Twitter</a>. A cross-cultural study in the UK and Colombia showed that the <a href="https://doi.org/10.1111%2Fjosi.12538">older adults were also angered by the protective ageism exercised during COVID-19</a>. </p>
<p>Our own investigation of <a href="https://doi.org/10.1007/978-3-031-05581-2_26">the reactions on the social media to mainstream media articles about how older adults were coping with COVID-19 stress</a> showed that older adults strongly objected to the writers’ assumptions about their coping needs. We also found a generational difference between parents and children in understanding older adult coping resources.</p>
<h2>‘Successful aging’</h2>
<p>The concept of successful aging can be traced back to researchers John Rowe and Robert Kahn. In their 1987 study on different types of aging, <a href="https://doi.org/10.1126/science.3299702">they defined two distinct types</a>: successful aging (high functioning and low risk for developing age-related deficits) and usual aging (healthy but high risk for developing age-related deficits). They called on other researchers <a href="https://academic.oup.com/gerontologist/article/37/4/433/611033">to seek interventions that increased the likelihood of belonging to the successful aging group</a>. </p>
<p>Helping older adults age successfully is now a worldwide research initiative. In 2021, the World Health Organization (WHO) announced a collaboration with the United Nations’ agenda called <a href="https://www.who.int/initiatives/decade-of-healthy-ageing">the Decade of Healthy Ageing</a> to improve the lives of older people and their communities. </p>
<p>According to the WHO, healthy aging means the ability to maintain mental and physical capacity for staying mobile and active, making decisions, building and maintaining relationships, and contributing to society.</p>
<p>At first glance, concerns with aging seem to be motivated by a good cause, but upon closer inspection these concerns can be problematic. By overemphasising healthy aging, those who are unable to age successfully are implicitly stigmatized.</p>
<p>As gerontologist Tracey Gendron argues in her book <a href="https://www.penguinrandomhouse.com/books/700435/ageism-unmasked-by-tracey-gendron/"><em>Ageism Unmasked</em></a>, overstating the necessity of retaining independence and functionality in later years of life gives rise to ageism.</p>
<h2>The catch-22</h2>
<p><a href="https://aging.columbia.edu/about/robert-butler">Robert Neil Butler</a>, the founding director of the National Institute on Aging, coined the term <em>Ageism</em> in 1969. In his highly cited article <em><a href="https://academic.oup.com/gerontologist/article-abstract/9/4_Part_1/243/569551?redirectedFrom=fulltext">Age-Ism: Another Form of Bigotry</a></em> he wrote:</p>
<blockquote>
<p>“We have chosen mandatory retirement from the work force and thus removed the elderly from the mainstream of life. Ageism is manifested in the taunting remarks about "old fogeys” in the special vulnerability of the elderly to muggings and robberies, in age-discrimination in employment independent of individual competence, and in the probable inequalities in the allocation of research funds.“</p>
</blockquote>
<p>Ironically, to further emphasize the necessity of increasing funding for studying aging, Butler reverted back to highlighting the narrative of age-related deficit: "persons 65 years of age and over account for 25% of all public mental hospital admissions.” </p>
<figure class="align-center ">
<img alt="An older woman doing biceps curls with a resistance band" src="https://images.theconversation.com/files/503693/original/file-20230109-9407-l58nun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503693/original/file-20230109-9407-l58nun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503693/original/file-20230109-9407-l58nun.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503693/original/file-20230109-9407-l58nun.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503693/original/file-20230109-9407-l58nun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503693/original/file-20230109-9407-l58nun.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503693/original/file-20230109-9407-l58nun.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">By overemphasizing healthy aging, those who are unable to age successfully are implicitly stigmatized.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This is the catch-22, or <a href="http://www.nlpuniversitypress.com/html/D48.html">the double bind</a> created by paradoxical messaging from the same source. Like Butler, most researchers that focus on aging justify their proposals based on age-related deficits. </p>
<p>In a recent <a href="https://aging.jmir.org/2022/4/e43564/">literature review of assistive information technologies for healthy aging</a>, we found that the narrative of aging as a vulnerability or impending cost dominated the rationales for conducting research. </p>
<h2>Mind the language</h2>
<p>A <a href="https://www.cambridge.org/core/journals/ageing-and-society/article/expressions-of-selfageism-in-four-european-countries-a-comparative-analysis-of-predictors-across-cultural-contexts/8EA6817D98346A0AED4B3126D74E1CF1">multinational study of self-ageism</a> shows that self-ageism — internalized prejudices against one’s own age — is culturally grounded.</p>
<p>Yale health professor Becca Levy has <a href="https://www.harpercollins.com/products/breaking-the-age-code-becca-levy">extensively researched the adverse effects</a> of self-ageism on both mental and physical health. Beliefs about aging shape all aspects of our lives.</p>
<p>Negative stereotypes of aging <a href="https://doi.org/10.1093/geront/gnv094">mean older adults are less willing to seek help when they need it</a>. Ageism and a lack of age-friendly communications <a href="https://doi.org/10.1017/cts.2022.1">alienate older adults from participating in research about their health</a>. This makes them shy away from seeking care, or participating in research that can benefit them.</p>
<p>Those who study successful aging are well aware that age — as a generalizing variable — does not predict the capacities or needs of older study participants. But then why do we keep using age as a numerical or categorical index?</p>
<p>This catch-22 is a conflict in communication — the <a href="https://doi.org/10.1080/01924788.2021.1992712">words researchers use to communicate their goals matter</a>. If researchers wish to address the growing needs of older populations in a meaningful way and create effective assistive care strategies, they should stop sampling by age and start sampling by needs instead. To lock individuals into the narrative of age as a vulnerability means inevitably creating ageist stereotypes.</p><img src="https://counter.theconversation.com/content/195626/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Najmeh Khalili-Mahani received funding from FRQSC.</span></em></p>Locking individuals into the narrative of age as a vulnerability means inevitably creating ageist stereotypes.Najmeh Khalili-Mahani, Researcher, Director of Media-Health/Game-Clinic laboratory, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1937252022-12-19T21:23:31Z2022-12-19T21:23:31Z5 steps for tackling Canada’s long-term care crisis: It starts with valuing the well-being of workers<figure><img src="https://images.theconversation.com/files/501615/original/file-20221216-37196-hf7jl5.JPG?ixlib=rb-1.1.0&rect=238%2C175%2C2267%2C1706&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For workers in long-term care homes, distress due to difficult working conditions is often dismissed as a part of the job description. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Canada’s long-term care sector was <a href="https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/long-term-care">hard hit</a> by the COVID-19 pandemic. Rapidly climbing <a href="https://www.cbc.ca/news/canada/ottawa/canada-record-covid-19-deaths-wealthy-countries-cihi-1.5968749">patient deaths</a>, a <a href="https://doi.org/10.1139/facets-2020-0056">lack of safety provisions</a> coupled with <a href="https://doi.org/10.9778/cmajo.20210338">already-precarious employment</a> and difficult working conditions took its toll on the mental health of health-care workers.</p>
<p>Yet, wellness in the long-term care sector is rarely discussed. Distress due to difficult working conditions is often dismissed as a part of the job description. Workers are expected to “<a href="https://doi.org/10.1007/s12126-017-9288-4">suck it up</a>” and manage their own emotions on their own time.</p>
<p>The sector is currently being held together by a very vulnerable workforce and it is situated to fail without immediate intervention.</p>
<h2>Support for self-care and protection from moral distress</h2>
<p>In our research, we examined the impacts of two critical psychological safety factors on the long-term care workforce amidst the COVID-19 pandemic — <a href="https://mentalhealthcommission.ca/what-we-do/workplace/workplace-healthcare/">support for self-care and protection from moral distress</a>. Health-care workers expressed the increased need for resources to support their well-being and to address longstanding workforce issues. Five recommendations for a stronger long-term care sector are proposed.</p>
<h2>1. Address long-standing structural issues</h2>
<p>Structural issues have been brought to light during the COVID-19 pandemic. This includes issues that are economic, social and organizational in nature.</p>
<p>While the COVID-19 pandemic exacerbated the challenges facing the long-term care sector, workers stated that these issues are not new. Rather, <a href="https://files.ontario.ca/mltc-ltcc-final-report-en-2021-04-30.pdf">decades of neglect</a> and lack of funding has made low pay and unsafe working conditions acceptable.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign reading 'Now hiring PSWs RPNs RNs support services full/part time avail'" src="https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501618/original/file-20221216-16-3p84z6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A masked worker walks behind a hiring sign on his way into the Dover Cliffs long term care home in Port Dover, Ont. in November 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
</figcaption>
</figure>
<p>The pandemic intensified existing problems with staffing shortages. In 2020, long-term care staff members made up <a href="https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf">more than 10 per cent</a> of Canada’s total COVID-19 infection cases. Further, restricting <a href="https://www.mdpi.com/2079-9721/9/4/70/htm">informal caregivers</a> from entering homes contributed to increased workloads.</p>
<p>Institutional support for any sort of resource (mental health, personal protective equipment (PPE), staffing) was stretched thin to keep care homes running. Resource limitations kept the hands of management teams tied, suggesting that distress was endemic across the sector.</p>
<h2>2. Continuing education and training for self-care</h2>
<p>Supporting staff through continuing education and training can increase their capacity for psychological self-care and help protect them from moral distress.</p>
<figure class="align-center ">
<img alt="A woman with gray hair and a woman in scrubs and a face mask hold hands in a corridor" src="https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501620/original/file-20221216-22-htpzy7.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A resident holds hands with a health-care worker in a COVID-19 infected ward at Idola Saint-Jean long-term care home in Laval, Que. in February 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1002/gps.4488">Continuing education and training</a> can significantly improve psychological well-being among long-term care workers. Communication-focused training approaches have resulted in improvements in staff turnover, depression and anxiety. <a href="https://doi.org/10.1111/jgs.17155">Self-compassion</a> and <a href="https://doi.org/10.1089/acm.2019.0087">acceptance-based approaches</a> found a significant reduction in mental health symptoms. </p>
<p>Educational sessions connect staff with other staff, allowing them to share their expertise and frustrations — helping to alleviate conflicts and tensions amongst teams. Virtual forums can be used for peer-to-peer learning, community building and moral support.</p>
<p>Training must be made available to all staff. <a href="https://mentalhealthcommission.ca/resource/examining-two-psychosocial-factors-in-long-term-care-during-the-covid-19-pandemic-policy-brief/">Our study</a> found that unregulated staff such as personal support workers were often not invited to take part in training programs or company resources.</p>
<h2>3. Invest in leadership development</h2>
<p>Improved leadership can foster improved team functioning.</p>
<p><a href="https://doi.org/10.1093/geront/gnaa203">Bullying and gossip is particularly rampant</a> in the long-term care workplace. Workers expect one another to work through distress and asking for a day off can be seen as a weakness and increasing the workload for others. </p>
<p>Supportive managers are critical to the psychological well-being of staff. A study on <a href="https://doi.org/10.1080/02678370801979430">transformative leadership</a> found a reciprocal relationship between leadership, self-reported staff well-being, team efficacy and self-efficacy — leading to job satisfaction and well-being. Transformative leaders encourage employees to create change inwardly by connecting professional goals to a wider sense of belonging in their workplace.</p>
<p>Underfunding and resource constraints make it difficult to provide meaningful and accessible supports, reducing workers’ ability to protect themselves against moral distress in the workplace.</p>
<h2>4. Ensure safe working conditions</h2>
<figure class="align-center ">
<img alt="Three people in PPE seen through a window" src="https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501622/original/file-20221216-16-6jhldv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Long-term care workers in PPE look out the window of a long term care home in Québec during the first wave of COVID-19 in 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>Insufficient <a href="https://www.cihi.ca/en/health-workforce-in-canada-highlights-of-the-impact-of-covid-19/the-impact-of-covid-19-on-canadas">personal protection equipment (PPE)</a> at the workplace was a concern for workers in the sector. <a href="https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/long-term-care-and-covid-19">Staff shortages and lack of knowledge from management</a> contribute to poor infection control and safety. Low wages and limited benefits also place workers in vulnerable situations, with limited options to practice physical and psychological self-care.</p>
<p>Funnelling resources and funding into this sector will not only improve staffing. It is critical for reducing the rapid turnover caused by uncontrolled exposure to COVID-19.</p>
<h2>5. Supportive human resource policies</h2>
<p>Long-term care needs to develop and/or improve human resource policies that support workers and acknowledge their value.</p>
<p>Low wages and precarious employment characterize this sector. Workers were fearful to take time off to get the <a href="https://www.cbc.ca/news/canada/toronto/long-term-care-workers-covid-vaccine-hesitancy-1.5953946">COVID-19 vaccine</a> for fear of losing wages.</p>
<p>Part-time and contract workers in the sector, often personal support workers, are not eligible for medical benefits and must pay out-of-pocket for injuries incurred at work. Many of these workers are <a href="https://www.criaw-icref.ca/wp-content/uploads/2021/04/Racialized-Women-_-COVID-19-Challenges-in-Canada.pdf">racialized, immigrant women</a>. Workers also often do not have entitlement to paid sick days. These factors point to systemic discrimination and undervaluing compared to other professionals in the sector.</p>
<h2>A call to action</h2>
<p>The Royal Society of Canada argues that the <a href="https://rsc-src.ca/sites/default/files/LTC%20PB%20ES_EN_0.pdf">very first step</a> to tackling the long-term care crisis is through workforce reform and redesign. This not only addresses low wages and resource shortages but serves more importantly to rebuild trust and dignity. To bolster support for the sector, public awareness and advocacy play a <a href="https://nccdh.ca/images/uploads/comments/Advocacy_EN.pdf">key role</a> in advancing health-care reform.</p><img src="https://counter.theconversation.com/content/193725/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The long-term care sector is currently being held together by a very vulnerable workforce, and is at risk of failing without immediate solutions.Sophy Chan-Nguyen, Research Associate, Queen's University, OntarioColleen Grady, Associate Professor, Family Medicine, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892872022-12-06T21:35:54Z2022-12-06T21:35:54ZHeads or tails: What statistical models tell us about the probability of living beyond 110<figure><img src="https://images.theconversation.com/files/483348/original/file-20220907-4832-q9y5k0.jpeg?ixlib=rb-1.1.0&rect=8%2C2%2C988%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is there a limit to human life expectancy?</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The world’s presumed oldest person, Kane Tanaka of Japan, died in April in her native country <a href="https://www.nytimes.com/2022/04/27/world/asia/kane-tanaka-japan-worlds-oldest-person.html">at the age of 119</a>. Despite her spectacular longevity, she could not surpass the record set by France’s <a href="https://academic.oup.com/biomedgerontology/article/74/Supplement_1/S13/5569844">Jeanne Calment</a> 25 years ago.</p>
<p>Calment died on August 4, 1997 at the age of 122 years and five months (or precisely <a href="https://www.nytimes.com/1997/08/05/world/jeanne-calment-world-s-elder-dies-at-122.html">44,724 days</a>).</p>
<p>What are the chances of this record being beaten?</p>
<p>My area of expertise, a branch of statistics that deals with the modelling of rare events, can provide some answers to such questions.</p>
<h2>The question is, how many candidates for a new world record?</h2>
<p>It is worth noting that the phenomenon under study is exceedingly rare: according to the last census, only 0.3 per cent of the Canadian population is centenarian, or just over <a href="https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021004/98-200-x2021004-eng.cfm">9,500 people</a>. That’s less than in Japan, which boasted nearly <a href="https://www.stat.go.jp/english/data/jinsui/tsuki/index.html">87,000 people over 100 years old</a> in 2021.</p>
<p>Only a handful of these centenarians, less than one in a thousand, will reach 110. People who live beyond this age, the “<a href="https://www.genome.gov/27559848/researchers-examine-supercentenarians-genomes-for-longevity-key">supercentenarians</a>”, are rare exceptions.</p>
<h2>Statistical models to the rescue</h2>
<p>To determine whether or not the longevity record could be shattered, it is essential to build statistical models that describe mortality beyond 110 years.</p>
<p>For this, we need <a href="https://link.springer.com/book/10.1007/978-3-030-49970-9">quality data</a>. For example, the age at death of supercentenarians must be validated by analyzing registers and birth certificates, among other things, particularly to <a href="https://link.springer.com/book/10.1007/978-3-642-11520-2">identify inconsistencies</a>. This involves archival work: errors are frequent (bad transcription, identity theft, <a href="https://www.yourdictionary.com/necronym">necronyms</a>) and several applications are rejected because of insufficient evidence to establish identity or date of birth with certainty. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Handwriting on old paper" src="https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466651/original/file-20220601-20-exsvqb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Obtaining quality data on the actual age of supercentenarians is sometimes difficult.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The main source of information for my research is the <a href="https://www.supercentenarians.org/en/">International Longevity Database</a> (IDL), a joint effort of gerontologists and demographers who have recorded the age at death of more than 1,041 supercentenarians from several central European countries, Japan, Canada and the United States. </p>
<p>There are significantly <a href="https://www.supercentenarians.org/en/publications/">more female than male supercentenarians</a> on record, but this imbalance is shrinking over time in several countries, including the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/bulletins/estimatesoftheveryoldincludingcentenarians/2002to2020">United Kingdom</a>. </p>
<p>Data validation requires going back 150 years, a period when administration and census taking were of mixed quality. Countries that provide data have teams of demographers actively working on longevity, as well as archives that facilitate validation. Without a robust system, the data cannot be used.</p>
<p>Once we have acquired the necessary data on people living beyond 110 years, we can then tackle the modelling of their lifetimes. The simplest statistical model that is compatible with the data is roughly equivalent to a coin toss. If the coin comes up heads, the person will survive until their next birthday; if not, they will die within a year.</p>
<p>This model also implies that the risk of dying is stable and does not depend on the person’s past history. <a href="https://royalsocietypublishing.org/doi/10.1098/rsos.202097">According to our calculations</a>, the life expectancy of a supercentenarian person would be about a year and five months, a very short period.</p>
<p>Surviving from 110 to 122 years, like Calment, would therefore be like tossing 12 heads in a row, an event that occurs less than once in a million. In light of the number of living supercentenarians, it is not surprising that Calment’s record still stands after a quarter of a century.</p>
<h2>Jeanne Calment, unbeatable?</h2>
<p>This makes our initial question all the more intriguing: will <a href="https://academic.oup.com/biomedgerontology/article/74/Supplement_1/S13/5569844">Calment’s record</a> ever be broken? If so, what will be the new record? To answer these questions, we need demographic projections of supercentenarians that take into account the world population increase.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="vieil homme sur fond noir" src="https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466652/original/file-20220601-48776-4z2nb3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Will Jeanne Calment’s record age at death ever be surpassed?</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Based on these demographic projections and the coin toss model, researchers at the University of Washington have concluded that there is a good chance that Calment’s record will be broken by 2100, but that it is unlikely that the winner will live <a href="https://www.demographic-research.org/volumes/vol44/52/">past 130 years</a>.</p>
<h2>Is there a limit to human life expectancy?</h2>
<p>Several scientific studies have argued recently that human longevity is limited. <a href="https://www.annualreviews.org/doi/10.1146/annurev-statistics-040120-025426">These studies often have one feature in common</a>: they ignore how the data are collected, which skews their conclusions. </p>
<p>While life expectancy varies from country to country, longevity is an intrinsic characteristic of humankind. It is therefore illogical that a Dutch person cannot survive beyond 114 years while a Japanese person has survived to 119 years.</p>
<p>If we compare life to a long-distance race, a limit to longevity would be the equivalent of an insurmountable obstacle at the end of the run. A more logical explanation from a biological standpoint is that the person stops once his or her resources are exhausted.</p>
<p>Extrapolating the maximum age is fraught with uncertainty because of the small number of supercentenarians whose age at death has been validated. The increase in the number of countries offering reliable and validated historical data on centenarians is nevertheless promising for future research. </p>
<p><a href="https://www.annualreviews.org/doi/10.1146/annurev-statistics-040120-025426">Our analysis</a> of several reliable databases suggests that a limit to life expectancy would be well beyond Calment’s age, and that it would be surprising if it were less than 130 years.</p>
<p>Having no limit does not mean that a person could live forever: while it is possible to get tails on any coin toss, a long sequence where each throw falls on the same side is unlikely. </p>
<p>Even with the increase in the world’s population, the high mortality rate of supercentenarians limits the possibility of breaking Calment’s record. Only time will tell if the record will be beaten.</p><img src="https://counter.theconversation.com/content/189287/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Léo R. Belzile's research is funded by the Natural Sciences and Engineering Research Council of Canada (NSERC) and IVADO.</span></em></p>The oldest person in the world, Kane Tanaka of Japan, died in April 2022 at 119 years. The record of Jeanne Calment of France, who died at 122, has stood for almost 25 years. Will it be beaten?Léo R. Belzile, Professeur adjoint de sciences de la décision, HEC MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952922022-11-27T13:09:07Z2022-11-27T13:09:07ZRSV FAQ: What is RSV? Who is at risk? When should I seek emergency care for my child?<figure><img src="https://images.theconversation.com/files/497240/original/file-20221124-14-7r3k7l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5100%2C2868&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">RSV is the leading cause for hospital stays in infants in developed countries.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><h2>What is RSV?</h2>
<p>Respiratory syncytial virus (RSV) is <a href="https://doi.org/10.1093/cid/ciaa1719">one of many viruses that causes infection of the ear, nose, throat and lungs</a>. It <a href="https://doi.org/10.7150/ijbs.64762">infects people of all ages</a> and can be found worldwide.</p>
<h2>Who is at risk of RSV?</h2>
<p>RSV is an important cause of lung infections in children under two years of age, and is the leading reason for <a href="https://doi.org/10.1155/2017/4521302">hospital stays in children under one year of age (infants) in developed countries</a>. Premature infants, adults above 65 years of age and those with chronic heart and lung conditions are at <a href="https://doi.org/10.1056/nejmoa043951">higher risk for severe disease and hospitalization</a>.</p>
<h2>Why is RSV so prevalent this season?</h2>
<p>Infections due to RSV occur throughout the year, with higher numbers of infections in the late fall to early spring in North America. The start and end of RSV season changes slightly each year, <a href="http://dx.doi.org/10.15585/mmwr.mm6702a4">and infections peak in January and February</a>. Typically, RSV infections occur in two-year cycles — <a href="https://doi.org/10.1001/jamanetworkopen.2021.24650">a year of increased numbers and higher severity of illness alternating with a milder year</a>.</p>
<p>Most children will have had one RSV infection by two years of age, and some may have had more than one infection. Unfortunately, having been infected by RSV does not provide long lasting immunity, although re-infections are usually milder. Although antibodies (proteins made by the immune system in response to infection) are made against RSV, they only last six to 12 months and <a href="https://doi.org/10.1093/infdis/jiac192">require repeated exposure to keep high antibody levels</a>. </p>
<p>This likely explains why RSV infections have an alternating severe-mild cycle: in a bad year, patients develop high levels of antibodies that help protect against infection or a bad infection in the subsequent year.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-experts-explain-why-rates-of-this-virus-are-surging-this-year-194403">RSV: experts explain why rates of this virus are surging this year</a>
</strong>
</em>
</p>
<hr>
<h2>How does RSV spread?</h2>
<p>RSV is spread through two ways:</p>
<ul>
<li><p>Contact with an object that has been sneezed on, coughed on, drooled on, touched or been in the mouth of a person who is sick with RSV. That person, who now has germs on their hands, becomes sick when he/she touches their nose or mouth.</p></li>
<li><p>Breathing in the virus when the infected person coughs or sneezes, within one metre of others, without covering their nose or mouth.</p></li>
</ul>
<h2>What are the symptoms of RSV?</h2>
<p>In general, approximately three to seven days after being infected, people will develop symptoms of a common cold including fever, runny or stuffy nose, sore throat, cough and decreased energy. Patients may complain of muscle aches and their appetite may decrease. Some may have difficulty breathing. The symptoms of infection due to RSV are identical to the symptoms of other respiratory viruses.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KlHjKaGiWFY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">CBC covers the surge in children needing treatment for respiratory viruses.</span></figcaption>
</figure>
<p>Some patients develop pneumonia (infection of the lungs). Infants may develop bronchiolitis — inflammation (swelling) of the very small tubes that deliver air (oxygen) to the lungs. Infants with bronchiolitis commonly have wheezing — a whistling sound when they breathe out. This whistling sound sometimes is only heard using a stethoscope, but sometimes can be heard even without one. </p>
<p>Bronchiolitis and pneumonia can lead to lower oxygen levels in the blood in some patients. It is important to remember that other respiratory viruses can also lead to pneumonia and bronchiolitis.</p>
<h2>How is RSV treated?</h2>
<p>Since RSV is a virus, use of antibiotics will not lead to shortening of the illness nor will it lead to shortening the period that sick people are infectious to others. There are no antivirals for treatment of RSV infections. Most patients can be managed at home:</p>
<ul>
<li><p>Antipyretics (medications to lower fever) if fever is present. Lowering the fever does not lead to shortening of the illness, but will also treat any muscle aches and the general feeling of being unwell.</p></li>
<li><p>Saline sprays or drops help with nasal congestion, and can be used often without the risk of overdose.</p></li>
<li><p>Commercially available nasal aspirators can be used to help infants and children breathe easier </p></li>
<li><p>Encourage fluids to reduce the risk of dehydration — offer small amounts, but offer often. Fluids for infants should be breastmilk or formula. Older children can be offered a variety of fluids including oral rehydration fluids like <a href="https://www.webmd.com/drugs/2/drug-11147/pedialyte-oral/details">Pedialyte</a>, chicken broth, popsicles, ice cream and jello. Extended periods of only water should be avoided, as should relying on soda. A few days without solid food is not harmful.</p></li>
</ul>
<h2>When should I seek emergency care for my child for RSV?</h2>
<p>Although most patients can be managed at home, there are several reasons to seek medical care. They include:</p>
<ul>
<li>Breathing too hard to sleep or feed properly even when fever is not present;</li>
<li>For infants, feeding has been significantly reduced below normal; </li>
<li>Being excessively sleepy or difficult to wake;</li>
<li>Not urinating in 12 hours.</li>
</ul>
<p>Patients with RSV infections will need to be hospitalized if they need:</p>
<ul>
<li>extra oxygen;</li>
<li>intravenous fluids if they are dehydrated.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a hospital sign directing people to EMERGENCY CHILDREN / URGENCE ENFANTS" src="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ontario has asked thousands of family health-care workers to work evenings and weekends to help ease the burden on overwhelmed children’s hospitals.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<h2>How do I protect myself and my family from RSV?</h2>
<p>Although there are no vaccines against RSV, a scientifically prepared antibody, palivizumab, <a href="https://doi.org/10.14745/ccdr.v48i78a08">is recommended to reduce the risk of complications of RSV infection in premature infants and children with chronic lung or heart disease who meet certain criteria</a>. Palivizumab is given as monthly injections during RSV season.</p>
<p>The same general measures that protect against COVID-19 and other respiratory viruses lead to reduced risk of getting infected with RSV:</p>
<ul>
<li>Wash your hands well and often;</li>
<li>Stay two meters from others when in public places — patients with RSV may be infected and capable of infecting others before they have symptoms;</li>
<li>Wear a mask when in enclosed public places.</li>
</ul>
<p>Be a good neighbour and reduce the risk that others will get sick:</p>
<ul>
<li>Stay home from school or work if you are sick;</li>
<li>Cough etiquette — cough into your elbow or a tissue. This reduces the chance that viruses are on your hands, which can then be passed onto others or objects that others may handle.</li>
</ul><img src="https://counter.theconversation.com/content/195292/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Athena McConnell is affiliated with Sanofi as a member of an advisory board related to the development of nirsevimab, an alternate monoclonal antibody against RSV. </span></em></p>As visits to emergency departments surge — and in some cases overwhelm hospitals — here are answers to frequently asked questions about Respiratory syncytial virus (RSV).Athena McConnell, Associate Professor, Pediatric Infectious Diseases, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1886902022-11-22T19:45:30Z2022-11-22T19:45:30ZPuttin’ on the Ritz and improving well-being with older adults through virtual music theatre<figure><img src="https://images.theconversation.com/files/493940/original/file-20221107-17-grm9wr.jpg?ixlib=rb-1.1.0&rect=0%2C31%2C1000%2C514&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Whether you’re 16 going on 17 or 79 going on 80, singing classics and new numbers virtually with a group brings joy. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Digital programming and virtual interactions, initially considered to be stop-gap measures during the first few waves of the pandemic, may now be an important part of supporting many people’s health and well-being — including the well-being of older adults. </p>
<p>During the COVID-19 pandemic, group musical activities moved online, prompting a wave of <a href="https://ericwhitacre.com/the-virtual-choir">virtual choir</a> experiments and <a href="https://www.youtube.com/watch?v=5rzZ2F18MwI">virtual orchestra</a> offerings. </p>
<p>These and other online communities weren’t limited to students. A <a href="https://www150.statcan.gc.ca/n1/pub/45-28-0001/2021001/article/00027-eng.htm">Statistics Canada survey</a> found that more than half of Canadians between the ages of 64 and 74 increased their participation in online activities during the pandemic by connecting with family and friends through video conferencing, or accessing entertainment online. </p>
<p>Virtual opportunities in the <a href="https://doi.org/10.1371/journal.pone.0252956">performing arts are ripe with potential</a> for older adults to foster skills and creativity, and to improve well-being. </p>
<h2>Social connection</h2>
<figure class="align-left ">
<img alt="A woman in headphones laughing while looking at computer screen." src="https://images.theconversation.com/files/495162/original/file-20221114-15-7g5ay5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495162/original/file-20221114-15-7g5ay5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495162/original/file-20221114-15-7g5ay5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495162/original/file-20221114-15-7g5ay5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495162/original/file-20221114-15-7g5ay5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495162/original/file-20221114-15-7g5ay5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495162/original/file-20221114-15-7g5ay5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More than half of Canadians between 64 and 74 increased their participation in online activities during the pandemic.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Going digital serves many purposes, the most important of which may be social connection. </p>
<p>Since <a href="https://doi.org/10.1080/23748834.2020.1788770">connecting with others</a> remains important for older adults, this can be achieved through, or in addition to, virtual leisure or entertainment opportunities. </p>
<p>Our research has revealed that <a href="https://storage.googleapis.com/wzukusers/user-20563976/documents/598184972c66407e9334c5df1b37bb91/Renihan%2C%20Brook%2C%20Draisey-Collishaw.pdf">virtual music theatre — music theatre online — allows for a more accessible and a less exclusive way to engage with this art form</a> with many benefits for participants.</p>
<h2>Online performing arts</h2>
<p>The performing arts allow performers and audiences to feel, be creative in community, express themselves and communicate or play through song, movement or storytelling. </p>
<p>Benefits associated with participation in the arts include <a href="https://apps.who.int/iris/handle/10665/329834">improved mood and well-being</a> and sense of <a href="https://www.pbs.org/parents/thrive/turn-to-the-arts-to-boost-self-esteem">belonging</a>.</p>
<p>Research has also documented associations between seniors’ participation in the arts and improved <a href="https://doi.org/10.1159/000499402">mobility</a> and <a href="https://doi.org/10.1016/j.archger.2018.02.012">vocal health</a>.</p>
<p>Before the pandemic erupted, we had started leading a program, <a href="http://www.riseshinesing.ca/">Rise, Shine, Sing!</a>, that created opportunities for local citizens typically excluded from the creation of music theatre due to age, ability and access. The program was mostly attended by older adults, some with Parkinson’s Disease or other chronic conditions.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/59MTQnoi2hU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A trailer for the ‘Rise, Shine, Sing!’ program.</span></figcaption>
</figure>
<p>We held three weekly face-to-face sessions from the end of February 2020, until mid-March, and then moved the program online (via Zoom) for 12 sessions from April until June 2020. The program continues to be offered, with many participants indicating a preference to continue virtually.</p>
<p>Somewhat to our surprise, when the program moved online, the fact that participants could only hear the facilitator and themselves singing was not a deterrent to participating. Participants enjoyed singing, dancing and creating characters using costumes and props based on cues and feedback from facilitators.</p>
<h2>Paradigm shift for music theatre</h2>
<p>Virtual music theatre presents a serious paradigm shift for the genre. Most of the time when people think of music theatre, they think of live bodies moving in perfect synchrony <a href="https://www.americantheatre.org/2022/02/04/what-can-be-said-with-and-about-broadway-dance/">to choreographed movement</a>, and voices singing in perfect harmony while performers are physically present together.</p>
<p>Researchers have examined how group singing and movement fosters togetherness, <a href="https://doi.org/10.1057/s41599-020-00549-0">community</a> and <a href="https://doi.org/10.3389/fpsyg.2014.01096">social bonding</a>.</p>
<p>Music theatre has made strides to become more inclusive over the course of the 21st century. <a href="https://www.deafwest.org/">Los-Angeles based Deaf West Theatre</a>, for example, creates works of music theatre that can be experienced and performed by members of the Deaf and hearing communities. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/k08lV8GO43w?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">ASL version of ‘We Don’t Talk About Bruno,’ from Disney’s ‘Encanto’ with Deaf West.</span></figcaption>
</figure>
<p>A multitude of new works, stagings and casting practices are highlighting and supporting the experiences of marginalized groups, by <a href="https://www.blackoperaalliance.org/">diversifying</a> and <a href="https://doi.org/10.3390/arts9020069">queering</a> the field, for example. </p>
<p>Such works offer resistance and new stories to an industry that has traditionally been ableist, white and ageist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/canadas-theatre-community-must-nurture-bipoc-leadership-to-improve-racial-equity-162786">Canada's theatre community must nurture BIPOC leadership to improve racial equity</a>
</strong>
</em>
</p>
<hr>
<p>But despite a healthy <a href="https://global.oup.com/academic/product/beyond-broadway-9780190639525?cc=ca&lang=en&">community music theatre scene</a> in North America, most opportunities still leave out many people due to issues related to social anxiety, experience, mobility, family life and/or finances.</p>
<h2>Music theatre meets universal design</h2>
<p>We drew on the intersection of <a href="https://muse.jhu.edu/article/629960/pdf">music theatre performance</a> and <a href="https://www.cast.org/impact/universal-design-for-learning-udl">universal design for learning</a> to develop a model where success could look different from person to person. </p>
<p>In terms of the movement, participants could synchronize with the facilitator and/or other members of the group. They were equally welcome and encouraged to customize or adapt their movements to suit their own needs and interests. </p>
<p>We embraced dancing from both a seated and standing position, to explore different levels and to accommodate different mobility capabilities. Participants controlled how much they shared by deciding how visible they wanted to be on camera. </p>
<h2>Classics and newer numbers</h2>
<p>We drew on musical classics or standards from <a href="https://www.britannica.com/topic/Singin-in-the-Rain-film-1952"><em>Singin’ in the Rain</em></a>, the <em>Sound of Music</em>, <a href="https://www.thestar.com/entertainment/stage/2022/08/23/joseph-and-the-amazing-technicolor-dreamcoat-coming-to-toronto-as-a-test-run-for-possible-broadway-revival.html"><em>Joseph and The Amazing Technicolour Dreamcoat</em></a> — as well as newer numbers from <em>Wicked</em> and other popular songs. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Colourful lettering shows the 'Joseph and the Amazing Technicolour Dreamcoat' sign above a lit theatre marquee" src="https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495163/original/file-20221114-14-ufus7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘Rise, Shine, Sing!’ drew on songs from musicals like ‘Joseph and the Amazing Technicolour Dreamcoat’ as well as newer numbers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>We also <a href="http://www.riseshinesing.ca/glow.html">co-created our own songs</a> by combining our shared memories or inspirations through image, lyrics and movements to explore themes of joy and resilience in difficult times. </p>
<p>While the program was led virtually, before sessions, leaders dropped off or mailed prop boxes to all participants. These were filled with costumes including small scarves and ribbons that could be used for choreography. </p>
<h2>Promise of virtual musical theatre</h2>
<p>Virtual music theatre has shown incredible promise, even in the short time we have been exploring it. Digital connections reframe being together at the same time and in the same space. This adds new unexpected dimensions to <a href="https://doi.org/10.1111/j.1749-6632.2012.06530.x">making music in a group</a>.</p>
<p>First, goals and expectations of uniformity are replaced with goals of individual empowerment and creative exploration. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/music-helps-us-remember-who-we-are-and-how-we-belong-during-difficult-and-traumatic-times-136324">Music helps us remember who we are and how we belong during difficult and traumatic times</a>
</strong>
</em>
</p>
<hr>
<p>Second, participants remain committed to the community and group endeavour, but are also free to tailor and adapt the ways they engage with the material and with one another. If group members invite friends or family in other cities to participate virtually, as some in our group did, the virtual community also expands in meaningful ways. </p>
<p>Finally, participants can also adjust their personal comfort by sharing as much or little of themselves with the group without feeling like they are letting the group down.</p>
<h2>Our hybrid future</h2>
<p>The pandemic catalyzed the need for virtual interaction. While we know that <a href="https://doi.org/10.1093/occmed/kqab041">Zoom fatigue</a> is pervasive, virtual opportunities for music theatre participation and creation offer a new paradigm of artistic experience. </p>
<p>These opportunities also offer striking promise for bringing performers some of the <a href="https://doi.org/10.3389/fpsyg.2019.00778">same benefits</a> as in-person music theatre experiences. </p>
<p>In some cases, they also facilitate new access to music in community, and allow participants to engage with the art form and one another in ways that support personal agency and independence, while also maintaining social connection and interactivity. <a href="https://www.lyrics.com/lyric/6358131/George+Gershwin/I+Got+Rhythm">Who could ask for anything more</a>?</p><img src="https://counter.theconversation.com/content/188690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Brook receives funding from the Social Sciences and Humanities Research Council of Canada and the Canadian Foundation for Innovation. </span></em></p><p class="fine-print"><em><span>Colleen Renihan receives funding from The Sciences and Humanities Research Council of Canada and the Canadian Foundation for Innovation. </span></em></p>I’m happy again: A pandemic-induced move to virtual music theatre presents a paradigm shift for the genre, yet reveals surprising benefits in facilitating new access to music in community.Julia Brook, Director and Associate Professor, DAN School of Drama and Music, Queen's University, OntarioColleen Renihan, Associate Professor and Queen's National Scholar in Music Theatre and Opera, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1871192022-11-16T22:29:39Z2022-11-16T22:29:39ZAgeism in tech: Older adults should be included in the design of new technologies<figure><img src="https://images.theconversation.com/files/495402/original/file-20221115-23-8mdcj0.jpg?ixlib=rb-1.1.0&rect=0%2C44%2C3000%2C2335&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In 'Grace and Frankie,' the protagonists design a vibrator for use by older people.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Ageism refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) <a href="https://www.who.int/news-room/questions-and-answers/item/ageing-ageism">we might hold towards others or ourselves based on age</a>. </p>
<p>Ageism is a unique form of discrimination, given that it’s universal — it’s often referred to as <a href="https://www.springerpub.com/social-policy-for-an-aging-society-9780826196538.html">the last acceptable form of discrimination</a>. Ageism often intersects with other forms of discrimination, including sexism, racism and ableism.</p>
<p>When it comes to the development and distribution of technology, ageism has important implications. It not only shapes whether <a href="https://doi.org/10.1177/14614448221108959">new technologies are adopted</a> by older adults, but it also influences how new technologies are developed and marketed. </p>
<p>In recent years, there has been increasing awareness of how digital technologies and platforms can discriminate on the bases of <a href="https://data-feminism.mitpress.mit.edu/">gender</a>, <a href="https://nyupress.org/9781479837243/algorithms-of-oppression/">race</a> and <a href="https://us.macmillan.com/books/9781250074317/automatinginequality">class</a>. However, ageism has received less attention.</p>
<p>Artificial intelligence, health-care technologies, and monitoring and surveillance systems, among others, <a href="https://doi.org/10.1016/j.jaging.2018.01.009">are increasingly being integrated</a> into the lives of older people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two women, one older and one younger, sit on a sofa - the older woman is holding a tablet in her hand" src="https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495141/original/file-20221114-13-iw9mz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Older adults are increasingly using technology in their everyday lives.</span>
<span class="attribution"><span class="source">(Centre for Ageing Better)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Technologies play vital roles in everyday life, and it is important to investigate how older people’s uses of technology are influenced by ageism, self-perception and identity. </p>
<p>As a social gerontologist interested in ageism (Stephanie Hatzifilalithis), my questions are threefold: 1) Why don’t we do our best to create technologies that are based on <a href="https://universaldesign.ie/what-is-universal-design/the-7-principles/">principles of universal design</a>? 2) How does ageism affect technology, and vice versa? and 3) Why aren’t we listening to older people when designing tech for their use?</p>
<h2>People like us</h2>
<p>In a 2017 episode of the Netflix show <em>Grace and Frankie</em>, the protagonists (played by Jane Fonda, now 84 and Lily Tomlin, 83), decide to revolutionize the vibrator market to “create products for people like us.”</p>
<p>After Grace suffers an arthritis flare-up caused by using a sex toy, the friends design a vibrator that conforms to principles of <a href="https://universaldesign.ie/what-is-universal-design/">universal design</a>. Grace and Frankie then try to pitch their product, with little luck.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"841296247118036992"}"></div></p>
<p>While Grace and Frankie are forces to be reckoned with, they are fictional characters. In the real world, workers at the biggest tech companies are <a href="https://www.bloomberg.com/news/articles/2017-03-22/everyone-knows-tech-workers-are-mostly-white-men-except-tech-workers">overwhelmingly young, white and male</a>. </p>
<p>In my postdoctoral work with <a href="https://www.nicoledalmer.ca">social and critical gerontologist Nicole Dalmer</a>, we study how ageism is both produced and reproduced in the context of experience and design. We look at how older people think about, talk about and experience the technologies (and their related data) that play a role in their lives.</p>
<p>We are also interested in how those who are involved in the design and development of technologies understand the potential effects of ageism.</p>
<h2>Involving older people</h2>
<p>Our work is part of a growing movement towards the importance and appreciation of <a href="https://doi.org/10.1108/WWOP-09-2015-0022">person-centered, participatory and visual design and research methods</a>. Other researchers have suggested a framework to guide <a href="https://doi.org/10.1007/978-3-030-50252-2_4">co-designing technology with older people</a>.</p>
<p><a href="https://doi.org/10.3390/ijerph19137667">Co-design</a> is a well-established design approach that isn’t widely used yet among older people. It is an important aspect of our current research to ensure that our project is informed, directed and influenced by older people, and that the project’s outcomes are meaningfully aligned with their needs, experiences and expertise.</p>
<p>By focusing on both designers and older-adult end-users, we hope that our research will highlight best practices in the development of technologies that support independent living and enhance social participation in later life in a meaningful way.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/aTAEuLJFyqo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Co-design means involving end users in the design and development stages of a technology.</span></figcaption>
</figure>
<p>This will not only help to avoid costly barriers to technology adoption, but will help alleviate the increasing challenges of technologically related discrimination, exclusion, and inclusion that both explicitly and implicitly colour and shape experiences of aging. </p>
<p>Researchers, designers and technology developers need to take the initiative and spend time to think through personal biased related to age-based stereotypes to design tech with older people.</p><img src="https://counter.theconversation.com/content/187119/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Hatzifilalithis is a Postdoctoral Fellow in the Department of Health, Aging, and Society funded by the McMaster Institute for Research on Aging. </span></em></p><p class="fine-print"><em><span>Nicole Dalmer receives funding from the Social Sciences and Humanities Research Council and the McMaster Institute for Research on Aging. </span></em></p>Technologies are now ubiquitous in everyday modern life, but ageism means that older adults are excluded from the design of the technologies that they use.Stephanie Hatzifilalithis, Postdoctoral Fellow, McMaster Institute for Research on Aging, McMaster UniversityNicole Dalmer, Assistant Professor in the Department of Health, Aging and Society, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1940982022-11-09T16:46:34Z2022-11-09T16:46:34Z70-plus seems the new 50 for male politicians, but they’re threatening the world order<figure><img src="https://images.theconversation.com/files/494270/original/file-20221108-4292-14x072.jpg?ixlib=rb-1.1.0&rect=0%2C68%2C5760%2C3578&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Former president Donald Trump arrives for the Bedminster Invitational LIV Golf tournament in Bedminster, NJ., in July 2022. </span> <span class="attribution"><span class="source">(AP Photo/Seth Wenig)</span></span></figcaption></figure><p><a href="https://www.politico.com/news/2022/10/11/bidens-about-to-turn-80-dont-expect-a-blowout-birthday-bash-00061090">Joe Biden is turning 80</a> soon. Russia’s <a href="https://www.reuters.com/world/europe/amid-war-crisis-putin-turns-70-with-prayer-his-health-2022-10-07/">Vladimir Putin is 70</a>; India’s <a href="https://timesofindia.indiatimes.com/india/pm-modi-turns-72-how-he-celebrated-his-birthday-in-the-last-10-years/articleshow/94264591.cms">Narendra Modi is 72</a>, while China’s <a href="https://asia.nikkei.com/Politics/Xi-marks-69th-birthday-as-media-praise-grows">Xi Jinping at 69</a> is the youngest of the rulers of the major world powers.</p>
<p>None are planning to retire.</p>
<p>Brazil just elected a 77-year-old as its new president, while Israel’s incoming prime minister is 73. As younger men, both Luiz Inácio Lula da Silva and Benjamin Netanyahu <a href="https://www.cnn.com/2022/11/02/politics/trump-lula-da-silva-netanyahu-second-political-acts/index.html">held power previously</a>. <a href="https://people.com/politics/donald-trump-plans-to-celebrate-his-76th-birthday-in-new-jersey-bedminster/">Donald Trump, at age 76</a>, is reportedly about to announce that <a href="https://www.abc.net.au/news/2022-11-08/trump-to-make-big-announcement-next-week/101629732">he will seek the American presidency a second time</a> in 2024.</p>
<p>One reason for the gerontocracy is that those who assumed power at younger ages in non-democratic countries have amended constitutions and rules to allow unlimited terms of office. In Russia, Putin has ruled uninterrupted for 23 years, while in China, Xi has ensured unlimited years of rule for himself.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A black-and-white photo of a man with thinning dark hair wearing a suit and tie." src="https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Newly elected Sen. Joe Biden is seen in this 1972 photo.</span>
<span class="attribution"><span class="source">(AP Photo/Henry Griffin)</span></span>
</figcaption>
</figure>
<p>In democratic countries, older politicians draw on decades of political capital and alliances. Biden’s success in running for president was partly due to the fact that he convinced voters that his 36 years as senator and eight years as vice-president would benefit America. <a href="https://www.cbc.ca/news/world/midterm-morning-after-analysis-1.6645292">The surprisingly strong performance of Democrats</a> in the mid-term elections may suggest he has a point.</p>
<p>Like Biden, older leaders often promise continuity and stability. In a world beset with daunting problems — from climate change to pandemics and inflation — a capable leader, particularly of a major power, is often seen by citizens as someone who has a track record. Those with many years of political experience argue they are best placed to deal with what lies ahead.</p>
<h2>Challenges faced by novices</h2>
<p>The sorry tale of Liz Truss, Britain’s prime minister for 44 days earlier this year, shows how quickly and furiously the <a href="https://www.bbc.com/news/world-63333462">business and political establishment can turn on a novice leader</a>.</p>
<p>Curiously, western Europe, the region with the largest proportion of older citizens <a href="https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20210316-1">(more than a fifth of western Europeans are over age 65</a>), has the youngest leaders. France’s Emmanuel Macron, in his second term, <a href="https://gettotext.com/emmanuel-macron-celebrates-his-44-years-why-he-lived-very-badly-his-last-birthday-femme-actuelle-the-mag/">is 44</a>, while the United Kingdom’s <a href="https://economictimes.indiatimes.com/news/international/world-news/at-42-rishi-sunak-youngest-to-take-uk-pm-office-in-over-200-years/articleshow/95067616.cms">Rishi Sunak is 42</a>. German Chancellor <a href="https://www.britannica.com/biography/Olaf-Scholz">Olaf Scholz at 64</a> is the oldest leader of a major European country.</p>
<p>The phenomenon of younger leaders but a greying population in Europe is due to some extent to the unique politics of many countries in the region. Nearly all European nations have a multitude of political parties, meaning coalition governments are the norm. </p>
<p>Other countries, like the U.K., have party rules that make it relatively easy to replace leaders. Under such conditions, outcomes in political leadership races are less predictable, and there’s more turnover. Britain has had <a href="https://www.npr.org/2022/10/20/1130184234/liz-truss-prime-minister-resigns-uk-turmoil%5D">five prime ministers in the past six years</a>, while <a href="https://www.euronews.com/my-europe/2022/10/21/italy-is-set-for-its-68th-government-in-76-years-why-such-a-high-turnover">Italy has had four</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with long dark hair and wearing a white blouse adjusts her earphone." src="https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Finnish Prime Minister Sanna Marin adjusts her earphone during a media conference at the European Parliament in France in September 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Jean-Francois Badias)</span></span>
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<p>Women are largely absent among world leaders. The few women who have recently reached the pinnacle of political power have done so early in their careers. <a href="https://www.aljazeera.com/news/2022/10/22/italy-sworns-in-first-female-prime-minister-giorgia-meloni">Giorgia Meloni, the new prime minister of Italy, is 45</a> while <a href="https://www.britannica.com/biography/Jacinda-Ardern">Jacinda Ardern of New Zealand is 42</a>. <a href="https://www.britannica.com/biography/Sanna-Marin">Sanna Marin, the prime minister of Finland, turns 37 soon</a>.</p>
<h2>Working longer</h2>
<p>Around the world people are living longer and healthier lives than ever before in human history, <a href="https://www.theatlantic.com/newsletters/archive/2022/08/older-aging-politicians-athletes-culture/671027/">and in many cases working longer</a>. This is good news, but there are concerns about elderly and long-serving leaders.</p>
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Read more:
<a href="https://theconversation.com/antiquated-thinking-about-old-age-hinders-canadas-economic-and-social-development-182367">Antiquated thinking about old age hinders Canada’s economic and social development</a>
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<p>They may be out of touch with the younger generations they need to represent. Solutions to policy conundrums that worked for them decades ago might no longer apply now or in the future. </p>
<p>Their attitudes and perspectives may become conservative or inflexible. <a href="https://abtc.ng/meet-sanna-marins-adorable-daughter-emma-amalia-marin/">Unlike Finland’s Marin</a>, they probably don’t have children in kindergarten and so don’t see how policy plays out in real life.</p>
<figure class="align-right ">
<img alt="An ageing man poses for a photo with a young child." src="https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Supporters take photos of Luiz Inacio Lula da Silva on election day in São Paulo, Brazil, on Oct. 30, 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Marcelo Chello)</span></span>
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</figure>
<p>Transitions from one leader to another are among <a href="https://hbswk.hbs.edu/item/transitions-of-power-are-difficult-what-joe-biden-and-other-incoming-leaders-need-to-know">the most dangerous times</a> in the political life of a nation, whether they’re democracies or authoritarian regimes. The Capitol Hill riots in the United States during the <a href="https://thegroundtruthproject.org/capitol-breach-demonstrated-u-s-democracys-vulnerability-how-does-that-affect-americas-global-influence-president-trump-impeachment/">last days of Trump’s infamous presidency</a> are a reminder of how even in the “world’s greatest democracy,” long-established rules about the transfer of power can quickly be undermined.</p>
<p>But when the same person dominates public life in a nation for a long time, transitions are bound to be even more difficult. This is especially worrying in a large and powerful country since internal volatility can quickly have dramatic, and unpredictable, international repercussions.</p>
<p>Long-term rulers rarely prepare a succession plan, if only because doing so jeopardizes their grip on power. </p>
<p>But without a succession strategy and strong institutions that support a peaceful transition to the next leader, the aging leaders of the world’s superpowers can represent a serious threat to the global order.</p><img src="https://counter.theconversation.com/content/194098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas Klassen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many of the world’s most powerful and aspiring leaders are aging or elderly men. That’s a big problem.Thomas Klassen, Professor, School of Public Policy and Administration, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1936092022-11-07T21:58:53Z2022-11-07T21:58:53ZHow to prevent missing person incidents for seniors living with dementia<figure><img src="https://images.theconversation.com/files/493928/original/file-20221107-3609-4js0ul.jpg?ixlib=rb-1.1.0&rect=87%2C150%2C5207%2C3342&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Missing person calls involving an individual with dementia increased by between 10 and 50 per cent across all Ontario regions over the last five years.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>People living with dementia are at risk of getting lost, and <a href="https://doi.org/10.1155/2021/5572764">go missing every day in Canada</a>. For example, in July, a person living with dementia went missing and was found by the police <a href="https://www.thespec.com/news/hamilton-region/2022/07/23/man-71-with-early-onset-dementia-missing-in-east-hamilton-police.html">under a highway bridge more than 24 hours after he was last seen</a>. </p>
<p>But for some people, the outcome might be different. They might <a href="https://www.cbc.ca/news/canada/british-columbia/ioan-john-pop-missing-senior-found-dead-1.5337124">never return home</a>, or in some cases <a href="https://vancouversun.com/news/dementia-and-wandering-finding-a-way-forward">never be found</a>. </p>
<p>This is a growing problem. Today, <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">over 55 million people live with dementia worldwide</a>, and this number is projected to <a href="https://doi.org/10.1016/S2468-2667(21)00249-8">triple by 2050</a>. Recent research reported that the prevalence of missing person calls involving an individual with dementia has increased <a href="https://doi.org/10.1155/2021/5572764">by between 10 and 50 per cent across all Ontario regions over the last five years</a>. </p>
<p>The risk of getting lost differs among people living with dementia based on their <a href="https://doi.org/10.1093%2Fgeroni%2Figab046.2432">individual risk factors</a>. For example, some individuals may have <a href="https://doi.org/10.1093%2Fbrain%2Fawv276">reduced processing of pain and thermoregulation</a>, which means they don’t feel the cold or heat. That <a href="https://doi.org/10.1080/13607863.2014.924091">increases the likelihood of adverse outcomes when the person goes missing</a>.</p>
<h2>Prevention strategies</h2>
<p>Prevention is fundamental and <a href="https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/rspndng-mrgnc-vnts/nss/prev-prev-en.aspx">has the potential to save lives and decrease the risk of injuries</a> for persons living with dementia. For example, Alzheimer Scotland developed <a href="https://www.alzscot.org/purplealert">a missing person app called Purple Alert to support the safety and well-being of people living with dementia</a>. If someone with dementia goes missing in the area, the app sends an alert to community citizens who have opted in.</p>
<p>In Canada, data on missing older adults living with dementia are sparse, and information on reported incidents typically comes from news and media reports. Japan is the only country we know of that keeps annual statistics regarding the number of cases of missing adults with dementia. In 2021, <a href="https://www.nippon.com/en/news/yjj2022062300331/">17,636 persons living with dementia went missing in Japan</a>.</p>
<p>It is clear that as a country, Canada needs better approaches to manage and prevent missing incidents involving people living with dementia. For example, prevention strategies could include: </p>
<ol>
<li><p><a href="https://alzheimer.ca/sites/default/files/documents/First-Responder-Handbook-Alzheimer-Society.pdf">Specialized training of first responders</a> to identify and intervene when they see a missing person with dementia. </p></li>
<li><p><a href="https://www.alz.org/help-support/caregiving/stages-behaviors/wandering">Prevention measures at home</a> and in the community. This may include providing safe common areas at home such as a fenced patio, labelling doors to provide a reminder of what each room is for, having a recent photo of the individual, and becoming familiar with the neighbourhood, including likely places a person might wander to and any hazards such as ponds and busy roads.</p></li>
<li><p>Technology to support persons living with dementia and their caregivers. For example, <a href="http://canadiansafewandering.ca/">tools to assess individual risk for going missing and getting lost</a>.</p></li>
</ol>
<h2>Sharing data</h2>
<figure class="align-center ">
<img alt="A multi-ethnic group of senior adults are walking together on a trail through the park." src="https://images.theconversation.com/files/493197/original/file-20221103-13-32d08n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493197/original/file-20221103-13-32d08n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493197/original/file-20221103-13-32d08n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493197/original/file-20221103-13-32d08n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493197/original/file-20221103-13-32d08n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493197/original/file-20221103-13-32d08n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493197/original/file-20221103-13-32d08n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The risk of getting lost differs among people living with dementia based on their individual risk factors.</span>
<span class="attribution"><span class="source">(FatCamera/istockphoto)</span></span>
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</figure>
<p>Finally, Canada needs a national strategy for collecting data on incidents of missing people living with dementia. This could optimize time and resources spent on police and search and rescue efforts, and enhance the chances of saving the lives of those who go missing. </p>
<p>The integration of multiple data sources such as health care, social programs, police and other first responders, and volunteer search and rescue organizations is key to sustain preventive efforts and proactively identify risk in the community. Currently, <a href="https://doi.org/10.1177/08404704221106156">databases on missing incidents involving people living with dementia are managed in silos</a>.</p>
<p>Researchers at the University of Waterloo are leading an <a href="https://www.canada.ca/en/public-safety-canada/news/2022/06/government-of-canada-announces-21-million-to-enhance-search-and-rescue-capabilities-for-people-living-with-dementia.html">initiative to enhance search and rescue capabilities for people living with dementia</a>. This project includes <a href="https://uwaterloo.ca/managing-risks-of-disappearance-in-persons-living-with-dementia/">engagement with multiple partners across Canada</a>, such as <a href="https://youtu.be/XWK5_LMTPbo">police and community organizations, search and rescue, and people living with dementia</a>. The project includes collaboration with <a href="https://uwaterloo.ca/managing-risks-of-disappearance-in-persons-living-with-dementia/blog/dementia-friendly-first-responder-resource-meeting">First Nations communities</a> and first responders, such as firefighters, paramedics and peacekeepers, embedded in these communities.</p>
<p>The need for these resources is growing. By 2050, <a href="https://alzheimer.ca/en/research/reports-dementia/landmark-study-report-1-path-forward">more than 1.7 million Canadians are expected to be living with dementia, with an average of 685 individuals being diagnosed each day</a>. With an increasing number of people living with dementia worldwide and in Canada, it’s crucial to find ways to promote community awareness and prevent people with dementia from getting lost.</p><img src="https://counter.theconversation.com/content/193609/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hector Perez has received funding from AGE-WELL NCE and currently receives funding from the Games Institute at the University of Waterloo.</span></em></p><p class="fine-print"><em><span>Lili Liu receives funding from Public Safety Canada, AGE-WELL NCE, and University of Waterloo Games Institute.</span></em></p>With an increasing number of people living with dementia worldwide and in Canada, it’s crucial to find ways to promote community awareness and prevent people with dementia from getting lost.Hector Perez, Postdoctoral Fellow, School of Public Health Sciences, Faculty of Health, University of WaterlooLili Liu, Professor, School of Public Health Sciences and Dean, Faculty of Health, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.