by Michael Todd
photography by Mckenzie James
I thought I was immortal. That is, until my tooth cracked. Then my reading glasses weren’t strong enough. Next came foot problems. The signs were irrefutable. I was aging, my chimeric immortality disappearing faster than a snow cone at the CNE.
But I’m not alone. There are lots of people just like me – in fact, all of humankind. In 2006, almost 500 million people worldwide were 65 and older. By 2030, that total is projected to skyrocket to one billion – that’s one in every eight people. In 2050, the number of those 65 and older is expected to top out at about 1.5 billion. That will represent 16 per cent of the world’s population. The planet will soon have more old people than children.
Population aging will have dramatic effects on social entitlement programs, labour supply, trade and savings around the globe, and may demand new fiscal approaches to accommodate a changing world. So what does it mean to grow old? Ask various experts who study aging – as we did for this article – and you’ll get just as many different answers. We all have our own take on what it means to age with dignity. But one thing is clear: As the baby boom generation retires, -Canada is quickly heading towards becoming a blue-rinse nation. By 2050, 31 per cent of all Canadians will be 60 or older. That’s nearly a third of the country’s present population.
There are many myths and misconceptions about what aging is and what it means to grow old. One is that the baby boomers, and the elderly in general, are going to place an incredible burden on the economy when they retire. But the journal PLOS ONE suggests otherwise in a case study on aging populations in Germany.
While people will live longer, they’ll also stay healthier longer. According to the study, the average German man in 2050 will spend 80 per cent of his life in good health, compared to 63 per cent today. There will also be more old people with higher levels of education than in our parents’ time. This could help offset any decline in the labour force. As well, boomers will be inheriting their parents’ wealth, which will help them fund their retirement without relying as heavily on government support. Quality of life levels are also expected to rise in the next decades, with leisure time increasing on average. This will not only benefit the elderly, but also the generations behind them.
While the most developed countries have the oldest population profiles, less-developed countries have the most rapidly aging populations. What’s driving this demographic trend? Declines in fertility and improvements in longevity are two major factors. Between 2010 and 2050, the number of older people in less developed countries is projected to increase by more than 250 per cent, compared to 71 per cent in developed countries. In China, the world’s most populous country, those aged 65 and over is predicted to swell from 110 million today to 330 million by 2050. By the middle of the century there could be 100 million Chinese people over the age of 80.
Experts predict that on a global level, the number of people aged 85 and over will increase by 351 per cent in the next 35 years. The global number of centenarians is projected to increase tenfold by 2050. This dramatic increase in life expectancy is one of the 20th century’s greatest achievements but also one of its major challenges in terms of social and economic policy.
As we get old, are we completely at the mercy of the calendar or can we go gently – and with dignity and comfort – into that good night? The short answer is maybe we can, but perhaps not in Canada. If you want to be assured you’ll have quality care provided by the state, you’d be better off in Nordic countries like Sweden, according to Professor Tamara Daly, who is among the roughly two dozen researchers doing aging-related work as part of the York University Centre for Aging Research & Education (YU-CARE), housed in the Faculty of Health.
In terms of caring for the oldest old, Canada lags far behind many of the more progressive European nations, says Daly, a Canadian Institutes for Health Research (CIHR) Chair in Gender, Work and Health, whose research focuses on health-care work, aging and long-term care policy, as well as gender, ethnicity and health policy.
According to Daly, Canada trails behind countries such as Sweden, Norway, Germany and the Netherlands in overall elder care. The Global AgeWatch Index (2013) corroborates this observation, noting that Canada placed fifth on the list behind those countries. However, the index also shows that, in terms of income security, Canada places 26th on the list of countries studied, due to an old-age poverty rate of 4.4 per cent.
“One of the biggest myths about the increasing number of older adults is that they are going to bankrupt the system,” says Daly. “That hasn’t happened in Sweden, where 20 per cent of the population is considered among the oldest old (that is, people over 85). It’s one of the oldest countries in the world and they do a very good job of housing older adults. They don’t warehouse them, they wrap care around them.”
Daly says that if she were a woman of 85 in Ontario today, she’d be nervous about going into long-term care. “We haven’t put enough resources in place to ensure facilities are safe and secure. They are also not stimulating environments. I personally don’t believe I would eat healthily enough, be stimulated enough or be safe enough. In Ontario alone, there have been 29 homicides in long-term care facilities between 2002 and 2012. And the most recent Canadian Institutes for Health Research data we have suggests that nearly 50 per cent of residents who live in Ontario’s long-term care facilities are classed either as aggressive or very aggressive.”
It isn’t just the old who are at risk in such facilities. It’s the staff, too. Daly also studies work issues around institutional care, including the lot of front-line caregivers. “These are workers that tend to be the lowest paid and work in conditions that are more challenging than those of most other health-care workers,” she says. “The end of life is a time people should be protected, and I don’t think we’re doing a very good job in Canada of either protecting the workers or the residents.”
Daly says current health-care policies for the old in Ontario expect a great deal from families and people’s own networks of friends and acquaintances. “Right now, I think our long-term care system is premised on this notion of individual responsibility instead of sharing risk.”
Gary Turner is a Faculty of Health professor, psychologist and member of YU-CARE whose research focuses on cognitive aging, stroke and stroke recovery. Turner’s angle on graceful aging is trying to understand how the brain changes as we get older and how these changes impact our cognitive abilities. There are two main ways of thinking about that, he says. One is to look at the brain at work and the other is to look at the actual structure of the brain itself.
Turner says researchers know the brain naturally loses volume as we get older. “It sounds negative, but it is a biological fact. It’s a natural progression but it isn’t even – that is, not all parts of the brain change at the same rate.”
Although the brain does gradually lose volume, that doesn’t always mean a change in cognitive function. Researchers like Turner have found the brain has a natural capacity to adapt. Areas not normally associated with a specific function can take on new jobs if other parts of the brain become damaged by disease or weakened through the natural aging processes. Turner is intrigued by what’s called “executive function” (EF), our brain’s more complex cognitive functioning processes which involve things like planning. In young brains, says Turner, EF is necessary to deal with the continuous parade of novel experiences that are part of young adulthood. At that age, there is a relatively limited repertoire of stored knowledge, so younger brains naturally have to problem solve more often and more rapidly. Not so for older brains. As you age, you naturally build up a store of experiences and knowledge that you can draw from, so relying on EF is not as much of a priority. You become more likely to act and think in comfortable, or predictable, ways. The brain’s networks that are involved in EF are not as taxed, meaning those networks are also not exercised as much as they were when we were young. Turner says, in terms of brain function, it’s a case of “if you don’t use it, you lose it.” If your behaviour is guided by a treasure trove of stored knowledge, it’s very efficient. Think, for example, about the effort involved in shopping in a grocery store you know well versus one you don’t.
But there are tradeoffs. As we age, EF naturally falls off, even in healthy aging brains. We come to rely more on our stored knowledge and experiences. “That scenario is fine as long as your environment remains predictable,” says Turner, “but when things change and you have to go back to problem solving, it’s a little more challenging.”
Turner’s work is all about understanding how this idea of stored knowledge and experience interacts with executive functioning as we get older – and how the brain regions -supporting these interactions are impacted by aging.
So how can we keep our brains fit as we get older? Turner, who is studying the brain function of both young and old people, suggests a need for balance, relying on your banked experience and also pushing yourself out of your comfort zone occasionally to get those EF networks fired up.
“This is something we’re looking at, both in terms of how the brain changes as we age and the behavioural impacts of those changes. My sense is that the more you’re able to continue to exercise problem-solving abilities and to flexibly work with the reservoir of stored knowledge as you age, the more you will be able to make optimal choices.”
William Gage, a Faculty of Health professor who is also the associate dean of research and innovation at York, a research scientist with the Toronto Rehabilitation Institute and the director of YU-CARE, says what we really mean by “aging” is deceptively complex. “What we talk about within YU-CARE is a whole bunch of different ways of thinking about aging itself, as opposed to just being ‘old.’ We’re interested in thinking about aging from a lifespan perspective. We’re looking at the whole aging picture, from molecular levels through to behavioural and on into societal systems.”
Gage’s area of expertise is neuromuscular control and the biomechanics of postural control and joint stability. “I am interested in neuroscience – the role of joint mechanoreceptors such as those which are found in our knees,” he says. “Those receptors tell us how we are standing and walking, and they work in parallel with our vestibular system and vision. I was looking in an experimental way at people who did not have joint receptors that were working. What happens when people’s receptors aren’t working? Does it look like they behave differently due to their absence? Answering such questions led me to look at not only older people, but those with knee replacements and knee arthritis, and how they recover balance. Because of joint disease, this is a group that’s at an even greater risk of falling than the elderly in general.”
Gage is particularly interested in mobility issues, and why the elderly fall more than young people. “In my lab, we’re looking at how people maintain their balance and how they recover if they are knocked off balance. We examine how the limbs move to recover balance – how you take a step or reach out to grab something solid – by activating different muscles. We look at how quickly the response occurs. It slows down as you age. Walking and talking simultaneously gradually becomes more difficult as you age. For example, if you start talking on your cell phone, you’re more likely to stop walking if you’re over 65. That is really a function of aging.”
Falling and balance issues for the elderly are of particular concern because one in three people over the age of 65 falls each year – often with devastating results. Gage says that, contrary to popular belief, walking is not an automatic function. “It is something we do naturally, but it requires constant involvement of and monitoring by the brain. The brain is involved all along in making conscious decisions about what tasks to support and how much.” In old age, that ability to multitask becomes less flexible. If the brain is asked to do one task, it may have to sacrifice something else because it is less efficient at processing. According to Gage, this could be one cause of the elderly being more prone to falling.
Gage believes that aging is really a state of mind. He says there is no doubt that there are people who age better and enjoy a higher quality of life. “I think it’s worth pointing out that an individual’s quality of life may not be so dependent on the amount of money they have, but on the enjoyment they can derive from life. Having said that, there is a statistical relationship between access to resources, such as money, and health-related quality of life, regardless of your age. Physically, these people are old, but mentally and spiritually they sure don’t seem old. On the other hand, we’ve all met persons who aren’t old but definitely present themselves that way.” ■