SENIORS

1. SENIORS WHAT DO YOU NEED TO KNOW? Lynne Nash, MSW, RSW Geriatric Mental Health Consultant Geriatric Mental Health Consulting Services Calgary Health Region

2. WHY DO WE NEED TO KNOW ABOUT SENIORS?

3. Between 2006 and 2026, the number of seniors in Canada will increase from 4.3 million to 8 million. - www.alive.com, Oct/07 issue of Alive Magazine

4. In 1991, people aged 65 and older made up 12% of the Canadian population. By 2011, this number will rise to almost 22%.By 2031, there will be approximately 9 million seniors, and they will account for 25% of the total population.Healthy Aging in Canada,p. 7

5. The average life span is increasing in Canada – 100 years ago, the average life span was 78.3 years. It is now 84.2 years. www.alive.com, Oct/07 issue of Alive MagazineThe 85+ group is growing 4x faster than any other segment of the population

6. From 1991 to 2001, the percentage of Canadian seniors aged 80+ increased by 41% to 932,000. By 2011, it is expected to have increased another 43% to 1,300,000, the majority being women.Healthy Aging in Canada,p. 7

7. In the coming decades, seniors will comprise a larger share of the Canadian population, growing from 3.5 million people in 1996 to an estimated 6.9 million by 2021. • www.phac-aspc.gc.ca

8. By 2015, there will be more Canadians aged 65 or older than children under the age of 15Healthy Aging in Canada, p. 7

9. There are presently over 250,000 seniors with dementia in CanadaThis number is expected to rise to 778,000 by 2031There will be over 60,000 new cases of dementia in Canada each yearuntil then RNAO, 2003

10. “New diagnostic approaches which are detecting Alzheimer’s disease at earlier stages, the addition of the ‘baby boom’ numbers to the aging population, and the increasing incidence of the risk factors for Alzheimer’s disease are causing a striking increase in the number of younger people who are being diagnosed with the disease.”Alzheimer’s Society, 2006, p. 1

11. By 2011, almost 12,000 people in the Calgary Health Region will require access to services for dementia-related concernsThis number exceeds the total number of clients currently using home care servicesCHR

12. Although most seniors enjoy good mental health, at least 20% suffer mild to severe depressionNational Advisory Council on Aging

13. Seniors have the highest suicide rates of any age groupThe highest suicide rate is among single, white men aged 85 and older and they are more likely to succeed than females in the same age groupStatistics Canada, 2002; RNAO, 2003

14. “Our civilization’s greatest victory is that it has conquered disease. Its greatest failure is that it has not conquered fear of aging.”Jacques Seguela

15. HEALTHY AGINGANDAGEISM

16. Healthy aging includes three components: • Low risk of disease and disease-related disability • High level of mental and physical functioning • An active interaction with life • Maintaining close relationships with others • Continuing involvement in activities that have personal meaning and purpose Gall & Swabo, Psychosocial Aspects of Aging

17. “All persons confront age-specific issues and obstacles that must be surmounted if they are to successfully cope with various life stages.”Gall & Swabo, Psychosocial Aspects of Aging

18. “Older Canadians are living longer and with fewer disabilities than the generations before them. At the same time, the majority of seniors have at least one chronic disease or condition. . . If [healthy aging is] left unaddressed, the aging of the population will have far-reaching social, economic and political impacts … that will far outweigh the cost of investing in healthy aging now.” Healthy Aging in Canada, p. vi

19. “Older adults can live longer, healthier lives by staying socially connected, increasing their levels of physical activity, eating in a healthy way, taking steps to minimize their risks for falls and refraining from smoking. But there are real environmental, systemic and social barriers to adopting these healthy behaviours. Some relate to inequities as a result of gender culture, ability, income, geography, ageism and living situations.”Healthy Aging in Canada, p. vii

20. “Ageism - discrimination based on age, especially prejudice against older people - iscommon in all societies. Ageism occurs when people believe that enabling andpromoting healthy living among seniors is unimportant or too late to make adifference. For example, it is widely recognized that promoting activity is importantfor children and youth. There are many initiatives designed to do just that. But thereis a prevailing attitude that it is not as important to be physically active in later life - that it may be too late, that the cost is prohibitive, and that the benefits aren't as greatat this stage of life. This prejudice reflects our minimized expectations of olderadulthood and misconceptions about seniors' ongoing and futureparticipation androles in society.”Healthy Aging in Canada, p. 11

21. As an older adult ages, society’s assumptions and stereotypes greatly restrict the roles that are available for that person.Gall & Swabo, Psychosocial Aspects of Aging

22. Society’s beliefs regarding the inevitability of decline in health, functioning and mental abilities as we age are prevalent. Many older persons themselves believe aging = loss of “joie de vive”.Gall & Swabo, Psychosocial Aspects of Aging

23. Ageism and the discrimination it creates can increase the vulnerability of older adults. Assumptions about old age may result in symptoms of trauma being mistaken for age-related illness.HelpAge International, 2003

24. “It is time for a new vision on healthy aging – a vision that: • values and supports the contributions of older people; • celebrates diversity, refutes ageism and reduces inequities; and • provides age-friendly environments and opportunities for older Canadians to make healthy choices, which will enhance their independence and quality of life.” Healthy Aging in Canada, p. vii

25. Why is it important that seniors stay as healthy as possible? • Some 69% of older Canadians provide one or more types of assistance to spouses, children, grandchildren, friends and neighbours • Older Canadians make an important contribution to the voluntary sector • More than 300,000 Canadians 65 or older were in the labour force in 2001 Healthy Aging in Canada, p. vi

26. Healthy aging can delay and minimize the severity of chronic diseases and disabilities in later life, thus saving health care costs and reducing long-term care needs • Not surprisingly, older people in vulnerable communities (Aboriginal, economically disadvantaged groups) have the greatest chance of aging poorly • Chronic diseases are responsible for 67% of total direct costs in healthcare and 60% of total indirect costs ($52 billion) as a result of early death, loss of productivity and foregone income Healthy Aging in Canada, p. vii

27. What does Canada’s older population look like? • Canadian seniors are a highly diverse group • Men and women experience aging differently • There are huge differences between a 65-year-old and an 85-year-old, yet both are lumped into the same category • In 2001, almost 20% of the immigrant population of Canada was over 65, significantly higher than the national average • Although a relatively small proportion of Aboriginal Canadians are seniors, the number is expected to rise significantly by 2016 Healthy Aging in Canada, p. 2-3

28. What does Canada’s older population look like? • More than 90% of seniors live independently in the community and want to remain there • Only 7% of those over 65 live in long term care; this number increases to 14% in the 75+ age group • Most seniors aged 80 or older are women, the majority of whom live alone and are poor • Around 1/3 of Canadian seniors live alone Healthy Aging in Canada, p. 2-3 www.phac-aspc.gc.ca

29. What is Healthy Aging? “Healthy aging is ‘a lifelong process of optimizing opportunities for improving and preserving health and physical, social and mental wellness, independence, quality of life and enhancing successful life-course transitions’ (Health Canada, 2002). This definition takes a comprehensive view of health that includes physical, mental, social and spiritual well-being.” Healthy Aging in Canada, p. 4 “Health is seen as a positive resource … not the objective of living or the absence of disease” Healthy Aging in Canada, p. 3

30. What is Healthy Aging? “Promoting good mental health is increasingly recognized as a priority in policy and program development for seniors. By working to increase self-efficacy, self-esteem, coping skills and social support, mental health promotion empowers people and communities to interact with their environments in ways that enhance emotional and spiritual strength. It fosters individual resilience and mutual aid. Mental health promotion also challenges discrimination against those with mental health problems and fosters respect for culture, equity, social justice and personal dignity.” Healthy Aging in Canada, p. 3-4

31. Social Connectedness and Healthy Aging “Social connectedness has a positive effect on health. People who remain actively engaged in life and connected to those around them are generally happier, in better physical and mental health, and more empowered to cope effectively with change and life transitions. Distress, isolation and social exclusion increase substantially the risk of poor health and loneliness, and may even act as predictors of death.” Healthy Aging in Canada, p. 15

32. Social Connectedness and Healthy Aging • Social Support • usually provided by family, friends, neighbours and members of supportive organizations such as a church group • is a critical part of staying healthy physically (i.e., others provide encouragement and support to eat regularly) and mental health-wise • Positively influences self-perceptions of health Healthy Aging in Canada, p. 15

33. Social Connectedness and Healthy Aging • Social Networks • Much smaller than the social networks of younger adults, as many family and friends are deceased • As they age, some seniors start to avoid making new social contacts, as the experience of more loss is too painful • Declining health, decreased mobility, physical changes and sensory loss can make it very difficult for older adults to travel to or enjoy social outings • Social activity is also influenced by poor accessibility to public transport, substance abuse, living in poverty, language barriers and living geographically remote areas or far away from family Healthy Aging in Canada, p. 17

34. Social Connectedness and Healthy Aging “Studies have consistently found associations between loneliness and poor health … However, the relationship between loneliness and ill-health remains ambiguous. It is unclear whether loneliness occur as a result of poor health or if poor health is a result of loneliness” A recent study found that older women experiencing psychological stress (anxiety, feeling worthless or hopeless) were 60% more likely to die within eight years than those with lower stress levels. Healthy Aging in Canada, p. 19

35. Social Connectedness and Healthy Aging Although great strides have been made to reduce poverty amongst Canada’s seniors, those that remain poor are more likely to be women over the age of 80, divorced or separated, and have immigrated to Canada On average, women have more social connections than men, but older women are more likely to feel lonely, perhaps because they often outlive their spouse by several years Healthy Aging in Canada, p. 19-20

36. Social Connectedness and Healthy Aging Research indicates that seniors that are socially isolated and eat alone are more unlikely to have unhealthy eating habits and poor nutrition Poor nutrition, especially inadequate intake of B vitamins, contributes to cognitive decline and dementia Healthy Aging in Canada, p. 29

37. Social Connectedness and Healthy Aging “Living alone (for both sexes) increases the person’s vulnerability to financial difficulty, chronic health problems and loneliness. Such persons commonly are in need of financial assistance and social services, and they are at risk for premature institutionalization.” Gall & Swabo, Psychosocial Aspects of Aging

38. The majority of seniors live in urban areas About 10% of Calgarians and Edmontonians are seniors (18% of those living in Victoria) www.phac-aspc.gc.ca

39. www.phac-aspc.gc.ca

40. Healthy aging in the senior population is seriously affected by the 3 D’s – Delirium, Dementia and DepressionYet all three are often unrecognized due to their complexity and multi-faceted natureRNAO, 2003

41. Lack of recognition of Delirium, Dementia and Depression impacts the quality of life, morbidity and mortality of the older client RNAO, 2003

42. DELIRIUM

43. What is Delirium? Delirium involves a sudden change in behaviour, attention and/or memory Delirium usually develops over several hours or days Delirium is a medical emergency

44. What is Delirium? DSM-IV diagnosis: • disturbance of consciousness with a reduced ability to focus, sustain or shift attention • a change in cognition or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established or evolving dementia • The disturbance evolves over a short period of time (usually hours or days) and tends to fluctuate during the course of the day

45. Who Gets Delirium? • Babies and children with high temperatures • Adults who are very ill • Older adults – for a variety of reasons, they can be very susceptible to delirium CHR

46. Delirium - Prevalence • In hospital, as many as 50-65% of older adults become delirious, for a variety of reasons • Certain groups are at high risk: • Postcardiotomy – 35% • Post hip fracture – 40-65% • Geriatric/neuropsychiatric patients – 40-60% CHR

47. Delirium Issues • Commonly under-diagnosed in the elderly • Contributes significantly to morbidity and mortality in the geriatric age group • Associated with increased length of hospitalization and risk of placement • Often misdiagnosed as dementia GMHCS

48. Delirium Consequences • Prolonged cognitive impairment • Cognitively, most elderly people with delirium never return to baseline • The longer they are delirious, the greater the chance there will be irreversible cognitive changes GMHCS

49. Signs and Symptoms of Delirium • Don’t make sense when they speak • Hallucinations and delusional thinking (dead babies, pregnant, think they’re dead, kidnapped, transported by aliens, conspiracy theory, etc.) • Don’t pay attention to or recognize family or friends • Don’t recognize everyday objects • Forget things they’ve recently been told • Forget where they are and think they are somewhere else • Either restless and fidgety or sleepy and unresponsive

50. Signs and Symptoms of Delirium • Believe someone is trying to harm them • Imagine things, people and events that never really occurred • Try to get out of bed, crawling over bedrails • Try to pull tubing and IV lines out • Unable to control their bladder or bowel • Become either very withdrawn or may yell or scream or be physically aggressive CHR