How research is creating an age-friendly society
By 2025, Canada will be a ‘super-aged’ society—this means more than 20 per cent of our population will be made up of adults 65 and over.
Last year, for the first time in Canada, the number of people over 65 outnumbered children under 15. Despite this expanding aging population, there are only 265 geriatricians in the country compared to 2,600 pediatricians, explains Dr. Nathan Stall, a research fellow at Women’s College Research Institute (WCRI). As this group continues to grow and diversify, so too will their healthcare needs. An increasingly older population will create a greater demand for social services, including healthcare, housing and caregiving.
“The goal of creating an age-friendly society where people can stay healthy, active and involved is one that should appeal to all of us,” says Dr. Stall.
“Caregiving has a tremendous impact across society.”
Geriatrician Dr. Paula Rochon, Vice President of Research at Women’s College Hospital (WCH) and Senior Scientist at WCRI, explains that all of us must be actively engaged when it comes to promoting health and wellness associated with aging. “From the time we are born, we are all aging. This issue doesn’t affect a specific group at a specific time, it impacts all of us—right now,” she says.
To improve the health and wellbeing of older adults and their (often) younger caregivers, WCRI has undertaken focused research targeted toward optimizing care for older people. The team is addressing international issues of societal importance related to aging—caregiving being one of these.
If we do not care for our caregivers, who will?
One of the primary issues facing an aging society is the prevalence of dementia. Already about 564,000 Canadians live with the disease and that number will rise to one million over the next 15 years. What’s more, contends Dr. Rochon, “dementia is an important issue for women because this is a condition that disproportionately impacts them.”
Women represent 61 per cent of older Canadians living with dementia and also provide two-thirds of dementia care to family members. Daughters and wives are more likely to take on the caregiver role than male family members.
The job of caregiving is associated with social isolation, loneliness and can lead to family strife, as one person frequently takes on the lion’s share of the load. And the economic cost can be severe, as caregivers cover out-of-pocket expenses or interrupt careers to manage daily routines, complicated medication regimens and navigate a complex healthcare system.
Although many take on caregiving willingly as a way of giving back to loved ones, the role is equal parts intense and demanding. “This is really a full-time, 24-seven, 365-days-a-year job,” says Dr. Stall. “And about 40 per cent of all caregivers experience caregiver distress. We see increased rates of anxiety, depression, adverse cardiovascular outcomes and even mortality in caregivers.”
WCRI focuses on research that enables older people to stay in their homes, and improves the health and wellness of caregivers. Potential solutions involve training caregivers in managing dementia; offering increased access to respite care; and implementing programs to ensure caregivers do not suffer economically, including more flexible workplaces and access to paid leave and benefits. “Caregiving has a tremendous impact across society,” says Dr. Rochon. “And we just don’t know enough about it.”
Medication reviews and avoiding prescribing ‘cascades’
Because older adults often exhibit multiple health conditions, many of them chronic, prescribing the right medication is another crucial factor in managing their care. As Dr. Rochon points out, the use of multiple medications puts older adults—particularly women—at risk of “adverse events” (what most of us refer to as ‘side effects’).
Dr. Rochon has been leading seminal research illustrating the harms associated with potentially inappropriate medications. She has also co-developed the concept of “prescribing cascades,” which harm older patients and result in the development of new medical conditions that may not need to occur.
A prescribing cascade begins when a healthcare provider misinterprets the side effect of a drug as a new medical condition. Doctors then prescribe a new potentially unnecessary drug to manage that new condition without considering it could be related to the initial prescription. The result? The patient gets a drug that they may not need.
“This puts pressure on the healthcare system because patients may require additional resources to address new health concerns that should never have existed in the first place,” says Dr. Rochon.
Preventing complications from potentially inappropriate prescribing may start with giving patients access to medication reviews, implementing electronic alerts to let doctors know they could be generating a prescribing cascade, and helping doctors, pharmacists, and patients to ask the right questions when a new health condition arises.
A deeper understanding of healthy aging and how to create communities and services to support older adults benefits all of us.
In Ontario and across the country, it is more important than ever to understand the aging process and implement strategies to ensure that older adults are set up for success. Healthy aging is not tomorrow’s issue—it needs our attention today so that we can improve health and wellness for all.