On Aging: Introduction; A. Science of Aging, Including Health Determinants, and Suggested Actions

On Aging

(“It’s not for cowards.” Tennessee Williams)

Introduction

The process of human aging is one of mankind’s most profound social, economic – and personal issues. While the demographics are inexorable, hard societal and behavioural facts are elusive and require longitudinal studies that take, well, a long tine. As well, our brains are the last frontier in our quest to uncover how the full human body works and how it can be influenced, and perhaps repaired. 

Why am I qualified to write this blog? Well, I’ve reached the age category it’s all about –  the “later years”, or “evening of life”, or “the ultimate decade”, or being an elder, a senior. 

My objectives with this blog are;

1. Provide a summary of some healthy living strategies useful in navigating the senior aging phenomenon (Section A)
2. Proselytize on the joys, and challenges, of being a senior, while reminding everyone who reads this that, even if they haven’t, they too will arrive there (Section B)
3. Make the case for a coordinated national federal/provincial strategy for supporting our aging population (Section C)

I admit that “aging” is not a good euphemism for old, because while we are all aging, we are not all old. Everyone is aging; my 10 year old granddaughter is aging. And no one escapes aging; everyone will eventually die. So to be clear, this blog is about aging at the far end of the scale – to the “last scene of all” as Shakespeare put it in As You Like It through his “seven ages of man” monologue. 

His words are depressing. In his day, old people were treated as “little children,” and Shakespeare describes this stage as a second childhood. He starts with:

All the world’s a stage,

And all the men and women merely players; 

They have their exits and their entrances,

And one man in his time plays many parts.

His acts being seven ages. At first the infant,

Mewling and puking in the nurse’s arms…

And finishes with the:

Last scene of all,

That ends this strange eventful history,

Is second childishness and mere oblivion,

Sans teeth, sans eyes, sans taste, sans everything.

I don’t agree with “mere oblivion”and “sans everything”. However the sans teeth and eyes cut to the quick, never mind the knees, hips, fingers, and “what did you say?” 

This is a complicated subject. Lots of people are involved from geriatricians to crafters of public policy to you and me. As I continued to write, this blog grew in size and began to poke out in many different directions. For those with other priorities (I understand) or short attention spans (I know who you are) skip on out or just read my summary – On Aging, Summary, https://powellponderings.com/on-aging-summary/ or even just read the bold headlines.

A caveat on sources: some of what I have written is original thought, and much is not. Occasionally I have provided the source, but not always. (Dates, authors, publications, direct URLs, etc. can get quite lengthy.) I chose to err on the side of making this read less like a scientific thesis, to keep it simpler and shorter. (See Attachment #1: Bibliography, https://powellponderings.com/on-aging-attachments-1-5/ which lists the books used for a portion of the sources.)

One amusing outcome of writing this blog is the number of unsolicited possibilities that have been presented to me for my future amusement and health, all well-meaning, I’m sure. In researching the subject I cruised through many areas on the internet, so became a target. Says one note: “Senior dating – your true love is just a few clicks away”. “Prostate updates” were offered, along with “Top advice for wrinkled skin”; “Try-on glasses at home”; dental implants; massage possibilities, a “do-it-yourself testosterone solution for men”, and so on.

I’ll break up this blog into five parts:, A. Science of aging, including health determinants, and suggested actions;  B. Philosophical and historical aspects of aging, C. Political and public policy considerations regarding aging; D. Ken’s influencing factors/personal approach; and E. Wrap-up. 

A. Science of Aging, including Health Determinants, and Suggested Actions

This section covers the important science and predictors of aging, including both physical and environmental, along with actions humans can and do take to ameliorate the process (diet, sleep, exercise, social, etc.). It addresses where seniors choose to reside; the industry of aging (both design adaptation and monetizing); selected approaches around the world; and the profound impact of dementia.

Caveat: There is a lot of literature on healthy habits, be they eating, exercise, sleep, and social connections. Not all of it is accurate; some of it has conflicting claims and conflicts with selling products.

1. What is happening to the body as it ages – four interdependent factors: First of all, aging is not a disease. It is a risk factor for many diseases. Many men and women reach great age without sickness. Four factors in aging are interdependent: normative genetic aging changes; disease; environmental influences; decreased expectations resulting in inactivity of body and mind. Plus there is extreme variability between individuals. 

As Dr. Sherwin Nuland in his book “The Art of Aging: A Doctor’s Prescription for Well-Being” says: “The better shape we are in, the less prone we are to the condition that gerontologists call ‘immunosenescence’ – senility of the immune system.” Nuland states that the key body part is the brain, and its influence on its own aging. Aging increases reaction time because the process of cognition – the awareness and instantaneous processing of information – is somewhat slowed, as is the peripheral motor response to stimuli. 

Dr. Atul Gawande, in his book Being Mortal, states that “The story of aging is the story of our parts.” Around age 60 the heart begins to enlarge a bit; older hearts can’t vary their rates up or down as easily. “More than half of us develop hypertension by the age of 65” says Gawande. Osteoporosis (the lowered concentration of calcium in the bones – thus they become less dense) is present in one-third of men over 75 (worse in women). 

We decrease in muscle (by age 65/70 it’s about one-third lost) and increase in fat as we age (largely because of a decreased ability to manufacture the necessary protein); so weight training is good. Skin gets less resilient, lax and wrinkled with time. Hearing loss is the most common of all chronic health issues among men over 65; less so for women. All glands and organs lose elements of function as they become older. Regarding sexuality, Dr. Nuland says “There is no way to know what’s sexually ‘normal’ at any time of life, and the older years are more resistant to the word’s definition than any others.” The variability in sexual activity, ability, and satisfaction is enormous. For more, go and read about it yourself.

2. Chronic stress accelerates the rate of aging: This is true according to researchers who study the biological impact of stress. So does traumatic stress, the type that arises in life-threatening situations, like falling ill with COVID-19 or someone close to you getting sick. They found that “stress wears on your body, it hampers its ability to repair itself, and the effects go beyond what you feel or see in the mirror. It can take years off your life.”

Researchers at the University of California, San Francisco also believe that psychological stress alters the immune system in ways that increase both the risk of psychological disorders and autoimmune disorders. The lead researcher, Dr. O’Donnovan, thought at first they were studying what stress does to physical health and what it does to mental health. “Over time, we’ve come to realize it’s just one question”, she said. The good news is you can slow and perhaps, to some extent, turn back the clock.

3. Low-grade inflammation is a negative factor to many illnesses, particularly dementia: It has been found that low-grade inflammation is a key contributor to many chronic illnesses (heart disease, type 2 diabetes, arthritis, depression). Cognitive decline and dementia are also tied to chronic inflammation. New research published November, 2021 in the journal Neurology found that participants in the study whose diets had the highest dietary inflammatory scores were three times more likely to develop dementia over a three year period than those whose diets had the lowest inflammatory scores. A diet high in calories, refined starchy foods, added sugars, and unhealthy fats may cause or worsen inflammation; a low-fibre diet may also contribute to inflammation.

What’s an anti-inflammatory diet? There are a number: Mediterranean, Nordic and Okinawan or the Dietary Approaches to Stop Hypertension (DASH) diet. So eat a variety of anti-inflammatory foods (colourful fruits and veggies, whole grains, pulses, nuts and seeds); and cook with unsaturated oils; limit intake of red and processed meat, refined grains, sugary deserts and beverages, butter and fried foods. More on diet shortly.

4. The brain and the body are fully integrated so cognition is a product of the whole body: A recent book by Dr. Thomas Verny, The Embodied Mind, suggests that the mind is not separate from the body, and that the emphasis on the brain as if it was a separate object is misguided. He suggests that cognition is a product of the full body, of an interconnected, unified, multilevel self-regulating and cellular memory system. He points out that research now shows that people who have heart disease have a much higher rate of Alzheimer’s. 

In Dr. Sanjay Gupta’s recent book Keep Sharp part of his thesis is the connection between brain health and body health. Gupta provides five pillars of brain health: 1. Diet/nutrition; 2. Sleep/relaxation; 3. Exercise/movement; 4. Connection; and 5. Purpose/learning/discovery. (For an extensive summary of Gupta’s book see Attachment #6: Keep Sharp: Build a Better Brain at Any Age. https://powellponderings.com/on-aging-attachment-6/ I will use him as a guide in some of these areas. For those who stay current on health matters, much of this you will have been exposed to – however refreshers are useful and some surprising bits might be found.)

5. Diet and good nutrition are part of healthy aging: An English Proverb might have it right: “Don’t dig your grave with your knife and fork”.Gupta’s book provides an excellent guide on diet; he uses the acronym SHARP: 

S: Slash the sugar and stick to your ABCs. A lot of sugar comes in liquid form – soda, juice, etc. To get sweet try honey, maple syrup, natural stevia. Say “no” to artificial sugars like aspartame, saccharin or even sucralose (the human body can’t digest them plus they affect gut bacteria which leads to insulin resistance and diabetes). So severely limit chips, cookies, pastries, muffins, baked deserts, candy, bagels. 

His A list (foods to consume regularly): fresh veggies; whole berries; fish and seafood; healthy fats, e.g. extra virgin olive oil, avocados, whole eggs; nuts and seeds. His B list (include these also): beans and other legumes; whole fruits (in addition to berries); low sugar, low fat dairy, e.g. plain yogurt, cottage cheese; poultry; whole grains. His C list (we should keep a tight limit on): fried food; pastries; sugary foods; processed foods; red meat, e.g. beef, lamb, pork, buffalo, duck; red meat products (bacon); whole-fat dairy high in saturated fat (cheese, butter); salt.

H: Hydrate smartly: as we age our ability to perceive thirst diminishes; a good rule is if you feel any thirst, you have already waited too long. Drink instead of eat. There is a link between hydration status and cognitive ability and mood. Water is best; also morning tea or coffee. Jury is out on alcohol being healthy; for some it is; some not. Also as we age, our ability to metabolize alcohol deceases. If you do drink, moderation is the key, i.e. for men up to two drinks/day; for women one/day (a drink is 12 oz beer, 5 oz wine, red being better, 1.5 oz liquor).

A: Add more Omega-3 fatty acids from dietary sources, e.g. fatty fish (salmon, mackerel, trout, sardines); flaxseed, plant derived oils (olive, canola, soybean, avocado, grape seed), nuts, seeds (chia seeds, pumpkin, sunflower). Choose food sources, not supplements (when you eat right you don’t need them).

R: Reduce portions. Watch caloric intake. Everything in moderation. Note: don’t fry; instead boil, poach, steam, bake, and broil. Re fasting: it challenges the brain, forcing it to react by activating adaptive stress responses that help cope with disease. Try intermittent fasting.

P: Plan ahead. Don’t get caught starving and resorting to junk food; animal instincts will push us in the wrong direction when hunger strikes. Plan your meals, i.e. build in more fibre (this is key), including whole fruits (bananas, apples, mangoes, berries) and veggies (the darker the colour, the higher the fibre content); beans and legumes; whole grains and seeds, including wild and brown rice.

Check sodium content; it is often high in baked goods (cakes, frozen pizza, cookies), canned soup, frozen foods. Steer clear of partially hydrogenated oils (trans fats; they raise your harmful cholesterol, LDL – and lower your good, HDL, cholesterol); they appear in doughnuts, baked goods, margarines and other spreads. Final note: floss; protecting gums is good for the brain (gum disease equals increased stroke risk).

Some conventionally grown foods are more likely to contain pesticide residues. If there is any reluctance to eating non-organic then choose from the “Clean 15” list: avocado, sweet corn, pineapple, cabbage, onion, sweet peas, papaya, asparagus, mango, eggplant, honeydew, kiwi, cantaloupe, cauliflower, broccoli. His “Dirty Dozen” list (where it is suggested they first be washed, peeled or skin removed; or just wash in water with vinegar): strawberries, spinach, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, potatoes, sweet bell peppers. 

Note: increasing fruit intake by just one serving per day has the potential of reducing dying from a cardiovascular event by 8%. Only 10% of Americans get the recommended number of fruits and veggies per day. More than one-third eat fast food daily.

Many special diet programs and supplements have been developed and marketed, so caution has to be exercised.

So you can start today by passing on the salt shaker and piling your plate high with fruits, whole grains, nuts, seeds, and vegetables. Just like Mom probably told you to do. This old epigram resonates in my memory:

Beans, beans the musical fruit.

The more you eat, the more you toot. 

The more you toot, the better you feel. 

So eat beans at every meal.

6. Sleep habits are part of healthy aging: The science is quite solid now – get at least 7 to 8 hours per night (six or fewer hours reduces daytime alertness by about a third); stick to a schedule and avoid long naps; get up at the same time every day, weekends included; try and have a similar time for packing it in; don’t be a night owl; best before midnight; non-REM (rapid eye movement) sleep tends to dominate sleep cycles in early part of night; dream-rich REM occurs closer to dawn; non-REM is deeper and more restorative; avoid blue light (eliminate electronics, screens, etc.) at least an hour before; no caffeine; windows dark; cool and quiet; stick to a schedule; establish bedtime rituals: engage in calming activities (stretch, read, music, bath); no arguing; know the sleep warning signs: frequent snoring; trouble falling/staying asleep three times per week for at least three months; persistent daytime sleepiness.

Sleep is not a state of neural idleness; it is a stage during which the body replenishes itself. Sleep habits rule everything about us; sleep controls our hormonal cycles (that all correlate with the solar day). Sleep is essential for consolidating our memories and filing them away for later recall. During sleep, cleansing or washing takes place (it is speculated that sleep scrubs the brain of metabolic refuse). 

Chronic inadequate sleep puts people at higher risk for dementia, depression, learning and memory problems, heart disease, high blood pressure, weight gain, diabetes, cancer. Sleep aids (meds, etc.) do not allow one to experience sleep as restful as natural sleep; some impair thinking and balance and some are linked to increased chance of developing Alzheimer’s.

In his book Sleep Thieves, Dr. Stanley Coren, suggests that to ignore our biological clocks is to court disaster, for he notes that sleep deprivation weakens the immune system, leaving the body more vulnerable to infection and illness, even death. He presents persuasive evidence that the major disasters of Chernobyl, Three Mile Island, and the Exxon Valdez were all caused by human beings with too little sleep.

A “sleep tourism” industry is forming around going on vacation for the express purpose of getting some decent sleep. Some resorts have special “sleep rooms” with all electronics removed, guests receiving “sleep packs” that contain bath salts, CBD chamomile tea, lavender pillow mist, etc. Some install circadian lighting based on the 24-hour human internal clock, provide an AI enabled “Bryte Bed” designed to “promote total relaxation”, and professionals that give massages, nutrition advice and lead special relaxing yoga.

7. Daytime relaxation is needed (as well as good sleep): Our mental well-being depends on including activities of rest and relaxation into our waking lives – and it is suggested that greater mental well-being is associated with reduced dementia risks. The reverse is true – conditions like certain types of anxiety and depression can be warning signs for cognitive decline.

There are some excellent possibilities for say just 20 to 30 minutes a day, e.g. meditation, i.e. being present in the moment and observing what is happening in your life. A 2005 Harvard’s Massachusetts General Hospital imaging study showed that particular areas of the cerebral cortex were thicker in people who frequently meditated; follow-up studies have found that “thick-brained” people tend to be smarter and have stronger memories. These cortical areas are used for planning complicated cognitive activities. 

Consider also: the power of touching (Chinese medicine uses a lot of touch – it’s empathetic); massage; yoga; progressive muscle relaxation; breathing exercises; setting aside 15 minutes/day for yourself; taking breaks from email/social media; focusing on one task at a time; even decluttering your life and cleaning out the stuff around you.

8. Exercise habits are part of healthy aging: According to Gupta, this is the single most important thing one can do to enhance the brain’s function and resiliency to disease. It is the only behavioural activity scientifically proven to trigger biological effects that can help the brain think more quickly, clearly and focussed. Exercise improves digestion, metabolism, body tone and strength, and bone density; it reduces stress. According to the 2020 Aging Well report led by Don Drummond from Queen’s University, “Regular physical activity and socialization are two lifestyle changes that greatly improve health conditions and support independent living…Many of the factors such as physical activity and education that ward off frailty also help ward off dementia.”

We can gain a lot more than previously realized from relatively low-intensity activities (walking, gardening, swimming). We need at least 150 minutes/week; up to an hour/day is better. Then add interval training (alternate between varying levels of speed, intensity and effort) and strength training (weights, resistance bands or own body weight as resistance) into the mix. 

Sitting for long stretches is bad. Our circulation slows down and the body uses less of one’s blood sugar. It negatively influences blood fats, high density lipoprotein (the good cholesterol), resting blood pressure, and the satiety hormone (which tells you when to stop eating); it puts muscles into a sort of dormant state. Our genome expects and requires frequent movement. (We’ve had to, to survive).

Regarding falls prevention: unintentional injuries among older adults account for a significant burden in both human and economic terms. The major cause of injury among seniors in Canada is falls. In a country with winter, ice and snow can be hazardous plus inhibit people from exercising outside. Among older adults, injuries due to falls threaten independent living, autonomy, mobility, functional ability and health status. It is estimated that fall-related injuries in Canada among those 65 and older cost the economy $2.8 billion a year. The Public Health Agency of Canada estimates that a reduction in falls by 20% could result in 7,500 fewer hospitalizations and 1,800 fewer permanently disabled seniors. 

9. Engaged social habits and connections are part of healthy aging: Data from the Canadian Community Health Survey show that seniors who report a strong sense of community belonging are 62% more likely to be in good health, compared to 49% who feel less connected. We need social connection to thrive (not just the number but the quality, type, and purpose). Some important facts:

• the health of one spouse is important to that of the other spouse (in the first six months after loss of a spouse, there is a 41% increased risk of mortality of the other). Divorcees are twice as likely as married people to develop dementia
• people with fewer social connections have disrupted sleep patterns, altered immune systems, more inflammation, and higher levels of stress hormones
• loneliness accelerates cognitive decline in older adults; at least 1 in 5 Americans suffers from loneliness (and feelings of exclusion lead to feelings of loneliness). (BTW: one-third of Americans older than 65 and half over 85 are now living alone)
• the Rush University Memory and Aging Project has shown that those with larger social networks (particularly when centred around some sort of challenging activity) were better protected against the cognitive declines related to Alzheimer’s than the people with a smaller group of friends
• being online and connected through social media, etc. equals a greater sense of independence and happiness (vs being offline); so – get a computer or a smart phone
• it’s good to maintain social relationships with different ages. It’s also good to join a club; adopt a pet

Dr. Leo Cooney, founder and director of the Section of Geriatrics at the Yale School of Medicine, provides a compelling quote: “If there is a Holy Grail, it’s relationships with other people. In fact, if you have decided between going to the gym or being with your grandchildren, I’d choose the grandchildren.” 

10. Learning, discovery, and having purpose are part of healthy aging: This is about active living and staying engaged through socialization and participating in stimulating activities. Cognitive reserve or brain resiliency is your brain’s ability to improvise and navigate around impediments it may encounter that could prevent it from getting the job done. Recent research shows people with greater cognitive reserve are more likely to stave off the degenerative brain changes associated with dementia. 

It can also help you function better for longer if exposed to life’s challenging events (chronic stress, surgery, toxins in the environment, etc.) It’s a reflection of how much you have challenged your brain over the years through education, work, other activities. There is some evidence that suggests people with higher education, even IQ, occupational achievements or engagement in leisure activities have a reduced risk of developing Alzheimer’s.

Other important elements:

• the key is continued education in the form of reading, learning, and socializing (“use it or lose it” is the reality of the brain). This is about active living/aging; staying engaged through socialization and participating in such things as learning a new language, taking up a musical instrument, speed training games (any thing that demands more long-term memory)
• cognitive stimulation builds a brain more resistant to stress
• sense of purpose: studies demonstrate that old people with a sense of purpose in life are less likely to develop a slew of ailments (including cognitive impairment, heart attacks, strokes, etc.)
• with a sense of purpose comes a love for life and all the experiences it offers
• with a sense of purpose comes optimism (that, plus self-acceptance, vitality and positive relationships are all elements of mental well-being)
• one final concept: getting in the flow. This is described as being in a mental state that has one totally immersed in an activity without distraction or agitation; being deeply focused, enjoying intense energy absorbed in the activity. One needs to have a sense of purpose to be in the flow

11. The social determinants of health become magnified with age: It has been confirmed by the World Health Organization that health suffers when people are subjected to prolonged hardship, distress and disparity, and this becomes magnified with age. The Centers for Disease Control (CDC) in the US defines social determinants of health as the “circumstances in which people are born, grow up, live, work, and age. This also includes the systems in place to offer health care and services to a community. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”  Practically, they can be important in: intellectual ability and health literacy; ability to afford medications, healthy food, and home medical devices; accessible supplies and medications; and transportation to get the things they need. The Canadian Senate, in a 2009 report, concluded that 50% of the health of a population is determined by socio-economic factors such as education and income. 

Social isolation and cognitive health also play a role. Older adults living alone may have very real barriers to decision making and social integration and it’s compounded when memory loss is also present. A holistic approach to address poverty and penurious living conditions can allow the senior population to move into old age with less trauma (plus help rein in health costs).

12. Research has helped uncover key predictors of healthy longevity, with a sense of purpose being key: The decades-long Grant Study of Adult Development uncovered six predictors of healthy aging: good relationships with others; a good marriage; a sense of humour about life; a strong focus on friendship; altruistic behaviours; and a keen sense of forgiveness, gratitude, and loving kindness. Then there is the concept of resilience which refers to the ability to cope with adversity and regain one’s balance; it’s like a return to homeostasis.

The key predictor of longevity discovered in the Eight-Decade Study of 1,500 men and women in their 80 and 90s was conscientiousness. People with conscientiousness “find their way to happier marriages, better friendships, and healthier work situations.”  In a further study, the Midlife in the United States (MIDUS) study has shown that having a sense of purpose has a direct positive impact on health and longevity. In the MIDUS study those with higher levels of purpose have higher levels of continued personal growth. Moreover, those with high purpose have less cognitive impairment, better physiologic responses to stress, and fewer heart attacks and strokes, and they live longer. Purpose is protective. 

13. Regarding humour – it helps a lot as we age: As just mentioned, one important way to survive the challenges of aging is through humour. Gupta says we should look for laughter; it secretes “feel good” hormones such as endorphins, dopamine, and serotonin which can relieve stress, reduce anxiety, and even lessen pain. Dr. Agronin, one of America’s leading geriatric psychiatrists, in his book The End of Old Age: Living a Longer, More Purposeful Life talks about the concept of “positive aging”. It being a state of mind that is “positive, optimistic, courageous, and able to adapt and cope in flexible ways with life’s changes”, with humour being one important coping tool. It represents one of the ways in which we actively manage the good and the bad that aging brings us.

The comedian Art Buchwald’s book, Too Soon to Say Goodbye, is about his experiences when he entered hospice after declining dialysis and having a leg amputated. He was unfazed by the inevitable, holding court with his family and friends – and joking about things you usually don’t talk about before you die. The subtitle for the book is a good example of Art’s mischievousness: “I don’t know where I’m going. I don’t even know why I’m here.”

There are many quips that help us. “My memory’s not as sharp as it used to be. Also, my memory’s not as sharp as it used to be.“ Ogden Nash wrote “Senescence begins, and middle-age ends, the day your descendants outnumber your friends.” Danny Kaye had a good one: “A clear conscience is usually the sign of a bad memory.” The internet regularly delivers such gems as: “I see people about my age mountain climbing; I feel good getting my leg through my underwear without losing my balance.” And perhaps the most relevant from George Bernard Shaw: “Remember, you don’t stop laughing when you grow old, you grow old when you stop laughing.”

14. Regarding love – it may help sustain people when they grow old: While our bodies age, there is no age limit on love. In fact research is beginning to discover that love may help sustain people in their later years. At Simon Fraser University they have been doing work that show people who idealize their partners later in life, who unconsciously choose to remember only the good things, have fewer incidents of chronic disease. Discussing, not fighting, keeps cortisol levels low – and high cortisol levels are significantly associated with illnesses such as heart disease. 

The author, Gabriel Márquez, wrote a letter to his friends in 2009 (after he discovered he had an incurable disease), “To all, I would say how mistaken they are when they think that they can stop falling in love when they grow old, without knowing that they can grow old when they stop falling in love.”

15. Spending time in “green” areas produces healthier people; this is particularly so as we get older: In 2019, British researchers crunched leisure and health data from 20,000 people and concluded that those who spent at least two hours per week in “green” areas such as parks, beaches and woodlands were measurably healthier than those who accumulated less time in such places. Time in nature has been linked to stress levels, mood, immune function and even the risk of conditions including heart disease and cancer.

16. Climate change and environmental factors can put seniors at risk: The World Health Organization has declared climate change the number one health threat of this century, and it will not affect all Canadians equally. Hot weather conditions affect seniors more. As we grow older our body’s physiology changes. For example, by the time one feel thirsty, he or she may already be dehydrated. Smoke from forest fires and other sources of air pollution have a greater impact on the elderly. Close to 500 people in BC’s 2021 summer heat wave died, the majority of them being 60 and older. In Ontario 40% of long term care facilities are still not fully air conditioned. A couple of doctors in a recent Globe and Mail op ed suggest that “air conditioning should be classified as a medical device when it is used to enable vulnerable people to stay cool.”

Examples have been identified where seniors are vulnerable to environmental hazards. In a recent study, researchers have found that elderly people living nearby fracking operations, and especially downwind from the sites, are at a greater risk of premature death. Published in the journal Nature Energy, the study found that living near unconventional oil and gas developments (UOGD) increased seniors’ mortality rates about 2.5%, while mortality rates for seniors living both nearby and downwind were found to be about 3.5% higher than among those living farther from UOGD, pointing to the dangers of airborne toxins emanating from such developments.

17. Loneliness is a major risk factor for depression in seniors; more so during the pandemic: A survey of more than 24,000 Canadians over the age of 50 found they were twice as likely to experience symptoms after the first pandemic lockdown. 43% experienced an increasing severity of symptoms as the months went on. It was greater in women than men. Those aged 50 to 65 faired more poorly than older seniors, with the former perhaps juggling jobs, children and aging parents.

18. Mixing generations is healthy – the old and the young need each other: When older adults contribute to the well-being of youth, it cultivates a sense of purpose and extends benefits both ways, according to a new study from the Stanford Centre for Longevity. The director of the Centre said, “Contrary to widespread beliefs that older populations consume resources that would otherwise go to youth, there is growing reason to think that older people may be just the resource children need.” Research has found that as people age, their brains actually improve in many ways, including in complex problem-solving and emotional skills. “It is a huge loss for society not to offer such counsel and experience to others, especially young people,” said the director. The report pointed out that the older adults benefited, experiencing emotional satisfaction in relationships with young people and experiencing the excitement of seeing the world through a younger perspective.

There are a number of programs in the school systems in the US and Canada designed to connect seniors (many with dementia issues) with students. Some of these programs are created by the schools. Other programs are more formal. One practical example is a program called Sweet Readers. The program provides three types of programs – Intergenerational Programs, Community Events and a Leadership Council, each developed to support engagement between the students and their adult partners, who live with Alzheimer’s or some form of dementia. Students ages 11-14 (called Sweet Readers) and adults join in a group setting in school classrooms, eldercare centres and museums. They have a clear goal: to discover the person behind the masks of aging and Alzheimer’s. 

St. Clements School, a private girls school in Toronto, have their middle school students participate in this program and their wonderful tagline is “connecting generations”. This is meant to be (and apparently it is) a mutually beneficial experience for both students and the adults involved.

The Gray Panthers were organized in 1970 to oppose the war in Vietnam, but became an intergenerational bond for social change. They were opposed to the segregation of older people out of society. Maggie Kuhn, the founder of the Panthers, was quoted as saying:” It’s wrong to sell (seniors) places just to play to keep them out of the way. There ought to be a moratorium on building more retirement facilities, Leisure Worlds, nursing homes. Shared housing avoids the need of such institutionalization.”

19. Urban spaces are starting to reflect the range of needs and abilities of seniors: As cities grow denser, more crowded, and increasingly inter-connected, the urban environment becomes a critical element in thinking about how to house, heal, and engage the ageing populace. All manner of design adaptations are being considered and challenging whether spaces are geared more for young able-bodied people or friendly to those with mobility challenges. The concepts of a “walkable city” plus one with accessible public transportation and parks are important elements. The challenge of an ageing demographic is more than a social and population policy issue.

20. Product and system design adaptations are recognizing aging challenges and a huge industry has developed to monetize this: The challenges people develop as they age (declining vision, hearing, mobility, flexibility, strength, etc.) are being taken up by a responsive market place covering a wide range of possibilities, including travel, systems, merchandise, services, sports, and entertainment. 

The travel industry has agencies that focus on seniors, and offer selected advice and tips. They’re careful in assuring that their offers are adaptable to the mobility and other restrictions of their older clientele. Some airlines are careful advising about proper hydration, alcohol consumption and especially about the effects associated with prolonged immobility, such as blood clots in the legs (deep vein thrombosis – DVT).

Business operations and services are evolving through simplifying systems that have become too complex; This includes: simple and easy to use family computers that combine video chat, photo sharing and email; TV sub titles and bluetooth into hearing aid buds; hands-free, voice-controlled devices (“Alexa”); dementia-friendly mobile phones; mobile all-in-one medical alert devices; and on-demand ride services (Uber, Lyft, etc.) Wikipedia has replaced encyclopedias. There are even pension funds for retirees, e.g. “Longevity” by Purpose Investments which is recommended by CARP.

Products and services are evolving. Tesla cars have been designed explicitly to be easier to drive, with cameras that look different ways so drivers don’t have to turn their heads. Retailers sell clothing designed for easy dressing, comfort and style while addressing the challenges of potential decreased mobility, need for maintenance of independence, and the need for assisted dressing. There are large print playing cards and books; incontinence underwear; compression socks; foot massagers; heated blankets; electric jar openers; motion activated lights for dark corners; gel and memory foam cushions; grab bars for car entrance or exit; canes and rolling walkers; tension poles and grab bars that can be installed anywhere to give extra help when getting up from the couch, recliner, or toilet.

There is the discount-off game: Shoppers Drug Mart offers 20% off on Thursday Seniors’ Day, Walmart offers a regular 15% senior’s discount, and so on. In the US you can enrol in an AARP or Association of Mature American Citizens (AMAC) membership as early as your 50th birthday to get seniors discounts. CAA in Canada do the same. 

There is even an Ageless International Film Festival being developed. The actor, Don McKellar, was quoted as saying we’re showing “meaningful films on the older people behind the camera and on the screen.” There is a desire now “to portray the reality and the range of experiences of older adults”.

In sports, certain activities are adapting to the slower pace or diminished physical capability of seniors, such as golf (which thankfully has forward tee boxes), curling (which offers the delivery stick option instead of crouching down in the hack), lawn bowling, pétanque, etc. There are free ski lift tickets for those over 80. The World Masters Games is an international multi-sport event held every four years. Athletes can participate in the games so long as they are over the age of 35. (The Games are popular with retired professional athletes and former Olympic competitors.) In the US they have the Senior Olympics for adults aged 50+ (events are divided into age groups with five year intervals).

An attempt is being made to put a value on the return on investment in various health care interventions such as renal transplant, coronary artery bypass etc. Arthroplasties, especially hip and knee, score very well on that scale, along with pacemakers and cataract surgery. There is even an acronym QALY per dollar, which stands for quality adjusted life years. A strong argument is being made for how these procedures can improve health by extending such things as exercise capability, mobility, etc.

21. There is a huge commercial side in disguising or inhibiting aging in today’s society: We live in a youth-obsessed culture and this culture is amplified by social media (Instagram, Facebook, etc.) which constantly reinforce our fears and needs. 

My father ran Yardley Canada which sold makeup and skin products basically, as he would say, to disguise age. The whole cosmetic industry has flourished catering to both sexes searching to stretch out youth and resist aging. The same objectives can be found in industries promoting clothing, hair styling, food, photo enhancement tools on our phones, cosmetic surgery (sagging eyes, chin flaps, wrinkles all can be tightened and reshaped), implants, drugs (botox anyone?), supplements (for example, huge ingestions of Vitamin C a la Dr. Linus Pauling, who claimed in 1990 that the vitamin in “optimum amounts” plus certain other supplements would increase life by 25 to 35 years). 

Most advertising and TV advice for products for those over 65 use ageless actors. Medications to treat erectile dysfunction (impotence is a forbidden word) were intended primarily for men over 60 (or for men with diseases, like diabetes that impair potency) but feature couples who appear no older than their forties. To put someone old in an ad would draw attention to what advertisers are trying to avoid – the fact that people are going to grow old, and visibly so, regardless of whatever drug they take, whatever they eat, and whatever “anti-aging” skin potion they buy.

22. Some examples of long life (in countries and people) help us understand aging; others defy explanation: There are some places in the world where the population is long living. Japan is home to the oldest citizenry in the world, with 27% of its population being 65 years of age or older. The number is steadily rising each year. It is predicted that nearly a third of the Japanese people will be senior citizens by 2030. In Japan, especially Okinawa (where certain populations have incredibly low rates of dementia), they use the word ikigai which roughly translated means your reason for being. There isn’t even a word for retirement in Okinawa; people do different things as they get older, not necessarily fewer things. People are honoured and included even more as they age, as a sign of respect but also an acknowledgement of their experience. Also Okinawans take in a smaller number of calories (10 to 20% less) and get less of their energy from fat than we do. Why? We know that the body slows its rate of metabolism when fed fewer calories (a survival mechanism).

Italy has 23% of its population 65 years of age or older (and is known to have the highest relative public spending on pensions of any country in the EU. Pensions take over 16% of Italy’s GDP, as compared to 11% for the rest of the European Union). Portugal is next with 22% 65 and older (it also seems many pensioners from colder countries within the EU choose to retire in this sunny country, upping the number). Germany, Finland, Bulgaria, Greece, Sweden, Latvia, Croatia, France and Denmark all have 20 to 21% of their population over 65.

Regarding people: the longest known lives present mixed messages. Examples include: a French woman, Jeanne Louise Calment, the oldest person in recorded history; she died in 1997 age 122 and 164 days; she loved chocolate and a regular glass of port. She was not an exercise fanatic but was active; she smoked two cigarettes a day. Misao Okawa was a 117-year-old Japanese woman who attributed her age to sushi and sleep. Hendrikje van Andel-Schipper was a Dutch woman who got to 116. She led an average life style with daily doses of raw herring and orange juice. A Japanese male, Jiroemon Kimura, lived to 116; he credited eating small portions of food as the key to a long and healthy life. 

Some people seem resistant to age-related disease and dysfunction. These “super-agers” may even perform cognitively or physically at levels more often seen in people who are decades younger. Work is going on in the US through the National Institute on Aging to illuminate the factors that are associated with this resilience, and to determine whether those factors can be harnessed to increase resilience more broadly across the population. 

23. There are some excellent examples of countries and cities being age-friendly: One example is Arnsberg, Germany where the whole community is senior friendly. From wide pavements, shaded benches, and a host of activities, this city is one of the most aging-friendly places in the world. Today, the town’s population of seniors has one in five over the age of 65. In 2030 it will be one in three. The town did a survey and found that the respondents didn’t want to sit home after they retired, they wanted to participate in social activities, to continue learning, and to continue contributing to society. And most of all, they didn’t want to be alone in their senior years. As a result the town moved from what seniors could no longer do and building nursing homes, to what they could do and creating new programs to encompass that.

In 2004 the town set up a Department of Future of Ageing. It now supports over 200 projects for the elderly. They introduced affordable residential complexes tailored to the residents’ need so that seniors live independently at home longer. They created a Dementia Learning Lab to change people’s attitudes about dementia by providing information about the disease and to reduce the fear that people had about seniors who have it. Now people are much more empathetic. They built the Café Zeitlos (Timeless Cafe), an inclusive space where people with dementia and their caregivers get to relax and mingle with people of all ages and create art. 

Another example is Singapore, which aimed to create an age-friendly city through the overall concept of ageing-in-place. This framework was highly relevant to its urban environment due to the prevalence of high-rise public housing flats, and the fact that over 80% of Singapore’s resident population live in these flats. Singapore launched the “City For All Ages” project in 2011, aimed at building senior-friendly communities. Then in 2015 they introduced the national “Action Plan for Successful Ageing”. This plan covered about 60 initiatives over 12 areas (health and wellness, learning, volunteerism, employment, housing, transport, public spaces, respect and social inclusion, retirement adequacy, healthcare and aged care, protection for vulnerable seniors and research).

24. Dealing with dementia is, and will be, one of the most important medical, and social issues facing society: The most important risk factor remains a simple one: age. Dementia is a condition that accompanies dozens of different diseases – of which the most important is Alzheimer’s, accounting for 60-80% of cases – to almost all of which people become more susceptible as they get older. According to Dr. Gawande, “By age 85, working memory and judgement are sufficiently impaired that 40% of us have textbook dementia.”

The world will have to learn to live with huge numbers of people with dementia. Most of the projected increase in dementia is the result of two global factors: increases in population and longevity. Alzheimers’s has devastating consequences both for patients and their caregivers. It is the sixth leading cause of death in the US. The number of Americans with Alzheimer’s is expected to rise to about 13 million by 2050 from more than 6 million currently. No country has yet worked out how it is going to pay for the care these people will need. And in many places it is far from clear where the carers will be found. 

There is, as yet, no vaccine and no cure. Our inchoate understanding of the brain remains hugely influential. In June 2021 US regulators approved a drug as the first treatment to attack a likely cause of the disease. The drug made by Biogen Inc, called aducanumab (and to be sold as Aduhelm), works by removing sticky deposits of a protein called amyloid beta from the brains of patients in earlier stages of Alzheimer’s in order to stave off its ravages. It’s not presented as a cure, but a drug that will slow the progression of the disease. 

25. The study of aging, and in particular related diseases, is extensive; aging related associations are active: Research bodies around the world are discovering/promulgating information and advice about aging. Some examples include:

• Global Burden of Disease (GBD): a World Bank study which endeavours to measure disability and death from a multitude of causes worldwide. They promote the fact that in 2017 more than half of diet-related deaths and two-thirds of diet-related DALYs (disability-adjusted life-years) were attributable to high intake of sodium, low intake of whole grains and low intake of fruits. Low intake of whole grains was the leading dietary risk factor for DALYs among men and women and the leading dietary risk factor for mortality among women.
• Canadian Centre for Activity and Aging: the CCAA is a unique, national research and education centre within the Faculty of Health Sciences at Western University. It promotes physical activity and well-being for older adults through a combination of basic and applied research, education, and community-based exercise programs.
• Ryerson University’s National Institute on Ageing: this think tank is focused on the realities of Canada’s aging population. Their mission is to enhance successful aging across the life course and to make Canada the best place to grow up and grow old.
• Trent University and the Trent Centre for Aging & Society: a seniors’s village was created that involves a multi-decade research and teaching agreement with peopleCare (a private company) that will advance promising practices in long-term care as well as enhancing quality of life for local seniors and providing experiential learning for Trent students (including new graduate programs).

There are also some associations that have aging dynamics as their mission, such as:

• AARP (was originally named the American Association of Retired Persons, but changed its name to reflect that it no longer requires members be retired) 
• Active Aging Canada: a national not-for-profit organization committed to promoting healthy aging among older Canadian adults.

See Attachment #4: Research bodies and organizations focusing on ageing for more of them, and about them. https://powellponderings.com/on-aging-attachments-1-5/

Click here for Section B. Philosophical and Historical Aspects of Aging https://powellponderings.com/on-aging-b-philosophical-historical-aspects-of-aging/