On Aging, Summary

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. 

This is a complicated subject. Lots of people are involved from geriatricians to crafters of public policy to you and me. So sit back and position yourself. For those with other priorities (I understand) or short attention spans (I know who you are) skip on out or just read my summary, or even just read the bold headlines. Hopefully you find it provides insight, and even guidance. 

As I continued to write, this blog grew in size and began to poke out in many different directions. The complete version for those who have the time and interest in reading it can be found at On Aging, Original, starting at Section A. https://powellponderings.com/on-aging-introduction-a-science-of-aging-including-health-determinants-and-suggested-actions/

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), which lists the books used for a portion of the sources. https://powellponderings.com/on-aging-attachments-1-5/

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.

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.

As Dr. Sherwin Nuland in his book “The Art of Aging: A Doctor’s Prescription for Well-Being” 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). 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.

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.”

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.

4. The brain and the body are fully integrated so cognition is a product of the whole body: 

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: The basics are: 1. Slash the sugar, including artificial sugars; choose alternatives like honey; check sodium content – it is often high in baked goods (cakes, frozen pizza, cookies), canned soup, frozen foods. 2. Regularly consume fresh veggies, whole berries; fish and seafood; healthy fats; nuts and seeds; beans and other legumes; whole fruits (in addition to berries); low sugar, low fat dairy; poultry; whole grains; add more Omega-3 fatty acids from dietary sources, e.g. fatty fish; 3. Limit fried food; pastries; sugary foods; processed foods; red meat, red meat products (bacon); whole-fat dairy high in saturated fat; salt; 4. Reduce portions; 5. Plan ahead and don’t get caught starving and eating junk food.

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.

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.

6. Sleep habits are part of healthy aging: Sleep is not a state of neural idleness; it is a stage during which the body replenishes itself. The science is quite solid – get at least 7 to 8 hours per night; stick to a schedule and avoid long naps; get up at the same time every day, weekends included; 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 (calming activities, etc.)

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.

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.

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..

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. 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.

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: This is the single most important thing one can do to enhance the brain’s function and resiliency to disease. 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, “Many of the factors such as physical activity…that ward off frailty also help ward off dementia.”

We can gain a lot 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. Our genome expects and requires frequent movement. (We’ve had to, to survive).

Note: the major cause of injury among seniors in Canada is falls; exercise diminished the possibilities.

9. Engaged social habits and connections are part of healthy aging:. We need social connection to thrive (not just the number but the quality, type, and purpose). 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. 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; so – get a computer or a smart phone. It’s good to maintain social relationships with different ages.

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. 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.

The key is continued education in the form of reading, learning, and socializing (“use it or lose it” is the reality of the brain). 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.)

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 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. 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.

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. 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: 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, 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.

14. Regarding love – it may help sustain people when they grow old: 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. 

15. Spending time in “green” areas produces healthier people; this is particularly so as we get older: In 2019, British researchers 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: Climate change does not affect all Canadians equally. Hot weather conditions affect seniors more. As we grow older our body’s physiology changes. Smoke from forest fires and other sources of air pollution have a greater impact on the elderly. In Ontario 40% of long term care facilities are still not fully air conditioned.

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.

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.

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. One practical example is a program called Sweet Readers. The program provides support for engagement between the students and their adult partners, who live with Alzheimer’s or some form of dementia.

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, e.g. the concept of a “walkable city”.

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. With some examples these include travel (agencies that focus on seniors); systems (mobile all-in-one medical alert devices); merchandise (electric jar openers); services (pension funds for retirees, e.g. “Longevity”); sports (curling delivery stick option); and entertainment (an Ageless International Film Festival). 

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 which constantly reinforce our fears and needs. 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, cosmetic surgery, implants, drugs, supplements. 

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. And where certain populations (especially Okinawans) have incredibly low rates of dementia).

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). Germany, Finland, Bulgaria, Greece, Sweden, Latvia, Croatia, France and Denmark all have 20 to 21% of their population over 65.

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 Agingto illuminate the factors that are associated with this resilience, and to determine whether those factors can be harnessed. 

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.

Another example is Singapore, which aimed to create an age-friendly city through the overall concept of ageing-in-place. 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.. 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.. 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.

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. They include Global Burden of Disease (GBD): a World Bank study whichendeavours to measure disability and death from a multitude of causes worldwide. In Canada we have the Canadian Centre for Activity and Aging at Western University, Ryerson University’s National Institute on Ageing, Trent University and the Trent Centre for Aging & Society. Associations that have aging dynamics as their mission include AARP in the US and 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.

B. Philosophical and Historical Aspects of Aging

This section deals with the features of, and attitudes toward, the aging sector, aging and ageism. It touches on the approach of different cultures; female vs male roles; cultural issues; what aging brings both positively and the challenges; and issues around death.

1. Attitudes towards old people have evolved significantly over time: In the 17th and 18th centuries there weren’t enough old people for anyone to view them as a major social burden. In the 1790 first US census, 2% were over 65. So those that did survive enjoyed high status.By the late 1960s in the US the over sixty-fivers were influenced by the dissident spirit of the times (many grandparents, for example, marched against the Vietnam War). Also, older voters played a role in the passage of Medicare in 1965. There was also increased longevity due to a better standard of living.

Nearly 25% of 19th century children had lost at least one parent. In the early decades of the 20th century, children had less than a 40% chance of having two living grandparents. A majority of first world children now have four living grandparents.

2. Some cultures revere their elders: Elders are very important and respected members of many cultures, in particular, for example, First Nation, Métis, and Inuit communities.

3. Old age is a critical women’s issue; females are the survivors: There are aging differences between men and women, physically and culturally. Almost everywhere in the world, women live longer than men (in the US the average female life expectancy is 81.1 years, five more than men). In the US two-thirds of people over 85 (and 85% of centenarians) are women. Also, a much higher percentage of men are married, e.g. for the ages 75 to 84, 74% of men are married but only 38% of the women. Over age 85, 60% of men, are married, but only 15% of women. 

Women are much more likely than men to experience all of the most severe quality-of-life problems associated with longevity (for example women are more likely to suffer from cognitive impairment). In old age it becomes an issue of how women are to survive alone (whether economically, physically or emotionally). 

4. Reasons for aging: it helps survival, brings wisdom, positivity and purpose: Age brings greater accumulation of knowledge and experience, so elders become critical contributors to survival. It allows the ability to solve problems based on experience and the integration of information. People with positive self-perceptions about aging demonstrate median survival rates 7.5 years longer then do those with negative self-perceptions.

5. Seniors make a significant contribution to the richness of Canadian life and to the economy: Older people provide a wealth of experience, knowledge, continuity, support and love to younger generations. They contribute in such areas as: unpaid work for their families and communities; care for their grandchildren; as caregivers to spouses, family, friends and neighbours (a force in reducing health care and social service costs); voluntary contributions to  civil society programs; and as the largest per capita donors to charity. They also make an important contribution to the paid economy (they are 4.5% of workforce).

6. We should fear ageism, not aging; seniors need to be seen as active and valuable societal contributors; aging needs to be redefined and venerated: Ageism is ingrained in our society. One scholar calls the high number of deaths from the virus in long term care “eldercide”. “The problem” she said “is we don’t value old age. COVID made ageism far worse as we saw people in nursing homes dying because their lives did not matter enough. Many people think that was incompetence, true – but ageism explains it better.”

A re-envisioning of the aging process is needed. Rather than viewing older adults as individuals to be taken care of, Canada must see its older population as the active and valuable contributors that they are. 

7. Growing old is an art that can bring rewards: The onset of aging can be so gradual that we are often surprised to find that one day it is fully upon us. The changes to the senses, appearance, reflexes, physical endurance, and sexual appetites are undeniable and rarely welcome. Yet, as Dr. Nuland shows, “getting older has its surprising blessings. Age concentrates not only the mind, but the body’s energies, leading many to new sources of creativity, perception, and spiritual intensity.” “Growing old”, Nuland teaches us, “is not a disease but an art – and for those who practice it well, it can bring extraordinary rewards.” He states that “Faith and inner strength, the deepening of personal relationships, the realization that career does not define identity, the acceptance that some goals will remain unaccomplished – these are among the secrets of those who age well.” We are all old people in training.

A recent study published in the New England Journal of Medicine, found that at age 60 you reach the top your potential, and this continues into your 80s. It declares that if you are between 60 and 70 you are in the “best level of your life.” If you are between 70 and 80, it’s the second best level. (The third best is from 50 to 60.)

In her 70s Betty Friedman wrote in The Fountain of Age, “We have barely even considered the possibilities in age for new kinds of loving intimacy, purposeful work and activity, learning and knowing, community and care…For to see age as continued human development involves a revolutionary paradigm shift.”

8. Sharing the aging journey unites those on the same path: Aging and sharing of the aging journey brings a unique closeness and understanding with a spouse and close friends who are making the journey with you in real time. Previously these boundaries knew far fewer confines. Everything within those boundaries becomes more precious than it was before: love, learning, family, work, health, and even the lessened time itself.

9. There are poignant aging markers entering life’s wrap-up chapter; the actuarial stats become a reality: When you are in your 40s to 70s there are few indicators or reminders of the finiteness of one’s life span. But something begins to happen as one pushes beyond. Body related markers are all too obvious.

As we age the obits become harder to shrug off. Death becomes a more conscious presence in everyday life. Members of your high school or university class, or of your book club or social club aren’t just having troubles; they are dying. Funerals are disturbing for 40 or 50 year olds because they are unusual; not so past say 75; they happen with troubling frequency.

10. Older societies will be less likely to wage war: An American political scientist, Mark Haas, believes that older societies will be less so inclined because there are fewer young people available to fight, and governments must divert funding away from the military to provide social programs for older citizens. He calls this rather long-term phenomenon the “geriatric peace”. He says that “statistical evidence shows that when countries reach a median age of 30 and a fertility level of 2.0, the likelihood of war is significantly reduced.”

11. The talk of “vanquishing” old age has to be countered with realism: Anyone over 85 has a 50-50 chance of winding up in a nursing home. If you are 65 you have a 50% chance of spending time in a nursing home before you die. Around 10% of the stays will be short-term, for recuperation after hospitalization. The remainder will be for the long haul, with discharge to a funeral parlour. 

The optimistic psychobabble comes from different places: the downplaying of real disabilities (particularly the explosion of Alzheimer’s and drug companies with “cures”); marketers of anti-aging products, etc. Living longer is great; dying longer is not so good.

12. All of us are like a story, but for the elderly you only see the last two pages: There is a reality that as people get old those significantly younger who encounter them, have no concept of what they once were. 

“All of us are like a story,” a veteran’s hospital doctor tell his students. “You’re seeing the last two pages of the book. You know so little about him. He was once a little kid. He was your age once.”

13. Different age cohorts have unique strategies for communicating, with generational differences speeding up: My parents wrote letters, and often during the war used telegrams. Telephone was used sparingly. My age cohort uses the phone a lot and have comfortably moved to mobile phones. We have gone through letter writing and now are comfortable with email. Our children don’t write letters; they are computer and mobile phone oriented using email and more and more texts, also FaceTime and its alternatives. Our grandchildren are very oriented to the mobile phone, but for texting, not speaking.

14. Choosing activities to pursue in the final chapter of one’s life can bring focus and meaning to this stage: As one reaches a certain stage, the reality is that seniors give thought to activities and priorities they would like to accomplish before they become incapable of taking action. The obvious ones might include how to distribute one’s assets; downsizing those items that one will never use; remaining actively in touch with family and in groups and clubs that provide comfort and external social and intellectual stimulation; and completing projects that one wants done for posterity..

15. The cycle of acquisition and disposition changes as we age with the emphasis on the latter: All our lives we buy, build or collect material stuff. As we approach the era of adapting, consolidating and gradually moving down in living arrangements (into condos, eventually into seniors’ residents and to nursing homes), the stuff is sold, given away (to sometimes resistant children) or scrapped, and where ultimately to where no control occurs post death. It becomes a question of nostalgia conflicting with space, with the former usually losing.

16. Most Canadians are not financially prepared to retire: The average Canadian median savings at retirement is only $3,500. Keeping the house maintained and safe (retrofit for manoeuvring stairs, etc.) is more than most can handle. Then there are the home health care costs, which are climbing. (The most the government will pay for home care is $3,500 per month, which amounts to 3 hours/day.)  Alternative approaches can be pursued.

17. The search for a decent death is a complex equation; our death-denying culture makes things more challenging: Life has its ultimate bookends: birth and death; any discussion about aging must address the latter. Death is always the same: we all live, then die. In the US today only 20% die at home, although 90% want to. More than half die in hospitals and 20% in ICUs probably hooked up. 25% die in nursing homes. A small number die in hospices. One third of the costs of death are spent in the final year of life, and one third of that in the final month!

There is a gap between the way people die and the way they say they want to die. We have a death-denying culture that makes it difficult to discuss issues openly. This tends to discourage people from doing advanced care planning. 

18. One central focus of religion is dealing in and with death: Fear of aging is more than fear of decrepitude. Ultimately it is the fear of death. (As well, Homo sapiens are the only animals with awareness that they will one day die.) So I cautiously say that the fear of death, and the thought of life being without some possibility of post-death “presence”, are fundamental to most religions. 

Traditionally churches have also been where, upon death, we say good bye to our family and friends, and they say good-bye to us. Solace is provided. The rituals are comforting and allow some sort of closure. Some suggest that religion developed in order to provide reassurance that death is not final, that something of us goes on.

Ernest Becker, in his book The Denial of Death, suggests that man’s paradox is that he feels agonizingly unique and yet he knows that this doesn’t make any difference as far as ultimates are concerned. He has to go the way of the grasshopper, even though it takes longer. Becker came to believe that individual character is essentially formed around the process of denying one’s own mortality, that this denial is a necessary component of functioning in the world, and that this character-armour masks and obscures genuine self-knowledge. Much of the evil in the world, he believed, was a consequence of this need to deny death.

19. The presence or absence of either spirituality or religious adherence has little association with successful aging: In the famous landmark Harvard Study of Adult Development (the longest prospective study of physical and mental health in the world), participants were asked at age 75 if their spiritual life had deepened. The majority answered, “No.” As Dr. George Vaillant, current director of the study, said in his book Aging Well, “Yes there are more old people than young people in church but that does not prove that people go to church more as they grow older. It may simply reflect that as the younger generation gets more science, anthropology, and history in school than their grandparents – and less religious instruction – they may also attend church and temple less than their grandparents ever did. In old age they may continue to do so.”

20. The scriptures are full of promises of advice and blessings in old age: It’s important to remember that the definition of old age back in Biblical times was radically different, when the average life span was in the 30s (and interestingly, lower for females because of childbirth difficulties). In the time of Jesus a person of 33 years old (his estimated age at death) was a senior.

The Bible says that sooner than we think all will become old. It provides some advice on aging and (through Paul) it is “Aged men (are to) be sober, grave, temperate, sound in faith, in charity, in patience.” Gulp.

21. In Canada, through MAID, Canadians have a legally acknowledged right to die: In March 2021, Bill C-7 passed making a number of changes to Canada’s MAID law, originally passed in 2016 – the most notable being the repeal of the stipulation that an individual’s death has to be “reasonably foreseeable” (terminal) to qualify for medical assistance.

22. How we view death varies across cultures: There are nearly 200 countries around the world. Within each, and crossing borders with all, are hundreds of religions, races, original peoples. How different cultures view (and handle) death is quite diverse.

C.  Political and Public Policy Considerations Regarding Aging

This section deals with the consequences of balancing public policy for all segments of society, and in particular describing and understanding the demographics of a growing aging citizenry. The consequences affect many areas: health care, pension plan policies, labour markets, long-term care systems, immigration. A plea is made for a coordinated national plan for supporting our aging population. 

1. Life expectancy has increased dramatically: For much of humankind’s existence we did not even live long enough to exhaust our reproductive potential. In the wild, death after the end of the reproductive years was the rule. Man is one of the few animals to survive much beyond that point. 

As late as the time of the Roman Empire, when modern Homo sapiens had already been in existence for some 70,000 years, average life expectancy was less than 30 years (the big killers: infectious diseases and trauma). At the turn of the 20th century, life expectancy still had not gone much beyond 45 years. As Montaigne wrote, “To die of age is a rare, singular, and extraordinary death, and so much less natural than others: it is the last and extremest kind of dying.”

The 20th century saw a 33 year gain in life expectancy, an astonishing figure compared to any comparable period in history.

2. Life expectancy increases have resulted from multiple factors, many of which have public policy implications: Among them are: 

1. Improvements in public health (immunizations, antibiotics, water purification, more adequate housing, better clothing, enhanced sanitation); 
2. Medical progress. Including treatments for cancer, lung disease, stroke, chronic diseases such as diabetes, hypertension, osteoporosis, kidney failure, dementias, arthritis; 
3. Higher socio-economic status and net worth, e.g. 35% of the US elderly population lived below the poverty line in 1959 vs 10% in 2003; 
4. Improved diet through better education and increased knowledge of nutrition plus improved food supply;
5. More understanding of the importance of physical and intellectual activity; 
6. Public health campaigns resulting in such critical initiatives as laws mandating seat belt use and smoking cessation efforts (cigarette smoking is implicated in eight of the top 14 causes of death for adults 65 years of age or older)
7. Continuing research on the biology and medical consequences of aging

3. Canada’s population is aging and below replacement: We are not making babies like we used to. In 1959, when the baby boom peaked, the total fertility rate (the average number of children a women would have in her lifetime) was 3.9. Today it is a record low of 1.4. (Safe legal abortion and the pill helped. Note: a 2.1 fertility rate is holding ground.) While immigration will reduce the impact of societal aging, it can’t reverse it. In 1950 the mean age of Canada’s population was 27.7 years; in 2020, it was 41.1 years.

Those over the age of 65 outnumber children under the age of 14. There are more seniors (5.9 million) than children (5.8 million) in Canada. In 2021, 1 in 5 people will be over the age of 65, and 1 in 3 over the age of 55. Ten years ago, 14% of the population were seniors; by 2030, it will be 23%. By 2061, it is projected that there will be 12 million seniors to 8 million children. This coincides with the increase in the Baby Boomer cohort (born in the period 1946-1965).

As the Canadian workforce ages, a quarter-million employed will reach the traditional retirement age of 65 in the next year (the number will creep higher until late in the decade). Since 2008-09, an aging workforce has subtracted one million workers from the economy. 

4. The largest age cohort, called the Baby Boomers, will strain the health care and pension systems: Boomers remain the most populous generation in Canada and they are still making waves as they age: Boomers will strain the health care and pension system. By 2030, every member of the Baby Boomer generation will be 65 or older; the oldest will be in their 80s.

5. Canada’s immigration strategies are one lever for rejuvenating our aging workforce and helping stimulate economic activity: Immigration is a source of growth and economic dynamism. Canada has a points-based immigration program; it favours skills but those at prime working age. Age points are important, i.e. while a 29-year-old scores a maximum 110 Comprehensive Ranking System (CRS) points for age, those points begin a sharp decline from the candidate’s 30th birthday onwards. By the time they reach 39, just 55 points are available, and none from age 45 on.

6. Our health care system is under pressure from an increasing and rapidly aging population: While Canada is among the highest spenders on health care per capita among comparable countries, we have some of the poorest results. In particular we wait longer for specialists than do residents of peer countries; have among the fewest beds per 1,000 people – 2.5, vs 5.8 in France and 7.9 in Germany; rank nearly last for acute-care spaces; wait longer for “elective” procedures – 39 weeks for orthopedic surgery; hospitals routinely operate at or exceeding max capacity (this leaves little flexibility with situations such as the COVID pandemic where there are few acute care beds). Throw into the mix the consequences of dementia, as mentioned, and it becomes quite serious.

7. There aren’t enough geriatricians in Canada to cope with the number of older adults: A paper published in the Canadian Geriatrics Journal in 2012 stated that “There are currently 242 certified specialists in geriatric medicine in Canada, 35% of which are more than 55 years old. According to conservative estimates, the health-care system needs at least 700 geriatricians to meet basic needs.”

8. Seniors require support to alleviate physical and mental limitations, housing, lifestyle and social needs: The four are interrelated and must be advanced together if seniors are to age well. The current model gives predominance to the first. Regarding housing, many options should be available that seniors can choose in a flexible way as their state of health changes. It can range from the family home at one end and a LTC facility or continuing care hospital at the other.

9. Not everybody gets to die where they wish: In Canada 61% of deaths occur in hospital (In the Netherlands, it is 30%; in the US it is 20%). While 85% of Canadians say they want to die in a homelike setting, only 15% actually do. According to the authors of a recent C. D. Howe report, “Canadians spend more on end of life care than other high-income countries, including the US, yet we receive poor results compared to most.”

Each year, about one in every 100 Canadians dies. 80% are people over the age of 65, and most die of chronic illnesses such as cancer, cardiovascular disease, diabetes and COPD. But 2 in 5 end up dying in hospital. Most of the health care costs in our lifetime are incurred in the final months. Canadian costs are high because they often get all manner of unnecessary treatment in intensive care units (as opposed to just focussing on quality of life), and that’s because of the way our system is structured. First of all we have too few palliative care beds; we also have very few hospice beds in specialized facilities that deliver end-of-life care (and they depend largely on private funding and charitable donations to operate.)

Then there is home care which doesn’t have the resources to deliver palliative care. But the biggest problem with end-of-life care is in the long-term care (LTC) homes.

10. Aging at home as long as possible is sought by seniors but Canada significantly under invests in home care: As many as 97% of seniors want to age at home as long as possible (according to a September 2021 poll by Campaign Research). There is a fondness for things like a garden, familiar possessions and memories, plus the neighbours and local facilities you know well. This is also generally a cheaper, more efficient way to treat seniors, plus the cost of selling and finding a smaller alternative is climbing (the cost of new dwellings, many with condo fees, etc., are not much less than the homes they’re in). 

As the November 2020 Aging Well report (led by Don Drummond of Queen’s University) said, “The great majority of seniors want to age well and in place, in homes and communities they can call their own. They want to be able to choose where they live and the structure of their living arrangements. Far too many Canadian seniors get placed where they do not want

to be and do not age well. Many remain in alternative level of care beds in hospitals for long periods and are then placed in long-term care homes (LTC-homes).”

Funding will need to shift away from creating beds in hospitals and nursing homes and instead supporting people in their homes (it’s cheaper). This can include day programs in the community or services provided in the home.

The 0.2% of GDP Canada spends on home care is one of the lowest allocations to home care in the OECD. And even worse than that, the ratio of more than 6 dollars spent on institutional care for every dollar spent on home care is one of the most imbalanced resource allocations in the developed world. Many countries spend equally on institutions and home care and some that are renowned for the life satisfaction of seniors, Denmark being a good example, spend more on home than institutional care.

11. Eldercare in Canada needs serious reform particularly in long-term care homes: As just stated the biggest problem with end-of-life care is in the LTC homes. The Aging Well report states “If the current propensity to place seniors in LTC-homes continues, the number of beds needed will double between now and 2041, adding another 250,000 beds. Current plans would only supply a fraction of that. There is a valid need to upgrade LTC, but nobody is talking about it in the context of the pending surge in the number of older seniors.”

There are approximately 200,000 LTC beds in Canada, but the Canadian Association for Long Term Care said in 2018 that as many as 42,000 more were needed by 2023. According to the Royal Bank there will be about 650,000 people living in Canadian seniors’ residences or nursing homes in 2030, up from 450,000 now. Public and private resources needed to build the extra capacity will cost at least $140 billion. Numerous recent reviews have resulted in a number of recommendations for LTC-homes (more and better qualified workers, better infrastructure, more sanitary protocols, greater safety, etc.) 

From 2005 to 2015, the number of LTC beds for every 1,000 Canadians over the age of 65 actually fell by 12.2%, according to the OECD.

It is estimated that the current 1.3% of GDP spent on LTC will surge to 4.2% by 2041. As the Drummond Report says “Nobody can afford it …and few want to be in LTC-homes in the first place…In addition to being the least desired, continuing care hospitals and alternative levels of care in hospitals are the most expensive care options available for seniors, ringing in at almost $1,000 per day. LTC-homes are less expensive at about $142 a day. Communal housing is much less expensive still and formal home care can provide a lot of the services needed to support ‘Ageing Well’ for around $45 per day.”

There is concern with what is happening to those in LTC facilities which bore the brunt of the COVID pandemic (deaths, isolation, etc). About 81% of Canada’s reported COVID-19 deaths occurred in long-term care – by far the highest proportion of OECD countries, where the average was 38%!

The sub-title of André Picard’s recent book Neglected No More says it all: The Urgent Need to Improve the Lives of Canada’s Elders in the Wake of a Pandemic. He doesn’t pull punches: “Eldercare in Canada is so disorganized and so poorly regulated, the staffing so inadequate, the infrastructure so outdated, the accountability so non-existent and ageism so rampant, there seems to be no limit to what care homes can get away with.” His book is about fixing the system. It’s a plea to stop dehumanizing elders, and to reimagine long-term care. 

12. Political consequences of societal aging include financing the resources needed: “Supporting and caring for a larger number of older Canadians will be a primary theme of the 2020s”, predicted a Royal Bank report published in 2020. The report said that “working-age Canadians will feel the financial squeeze. There will be fewer of them to shoulder the additional costs of our aging society. In 2010, there were 2.3 working-aged Canadians for every youth and senior. By 2030 we expect that number to fall to 1.7.” The slowing growth of the labour force will be a problem for governments, who will have to shoulder an increased burden.

Medicare was based on equal medical access for all. So why is it different when an aging population needs chronic rather than acute care? Our current system was invented back in the mid-1950s. As Dr. Samir Sinha, director of geriatrics at Sinai Health System, said in a recent interview, “At that time very few lived beyond our 60s and 70s, so we built the system we needed then.” It was one based on doctors and acute care in hospitals, not one that catered to the needs of an aging and infirm population with complex chronic diseases. 

The feds transferred health care dollars to the provinces but there were gaps, such as home care and pharmacare. We have a long-term care system that “exists on the edges and that’s underfunded to the tune of one-third of what the average OECD country spends.”

The boomer cohort will require more and more resources (until in 30 years or so they will be gone); as they become senior citizens they will be needing care. Dealing with this will compete with resources for other priorities, currently such as climate change, housing supports, and a national child care program (although these can change), all requiring large increases in spending,.

13. Labour shortages due to aging are creating difficulties in rural areas: The food sector, for instance, is limited by this fast-aging population on our farms and in fish processing plants. The average farmer in Canada is 55 years old, and it’s about the same for fish plant workers. The average for fish harvesters is 50, and recent research shows that inland captains are finding it extremely difficult to find crew members. One potential solution is for the government to tailor its immigration policy to encourage new Canadians to go to rural communities (as they have done to small urban centres).

14. The idea that nearly everyone should expect to retire is very recent: Just a couple of generations ago, it was assumed that you would work until you were physically incapable of doing so. Now retirement age is the age at which a person is expected or required to cease work and is usually the age at which they may be entitled to receive superannuation or other government benefits, like a state created pension. Policy makers now usually consider the demography, fiscal cost of aging, health, life expectancy, nature of profession, supply of labour force, etc. while deciding the retirement age. The increase in life expectancy is used in some jurisdictions as an argument to increase the age of retirement in the 21st Century.

As Michael Adams, president of Environics, in his book Stayin’ Alive: “The notion that every Canadian should have a few decades of robust good health at the end of life, to be filled not with economic productivity but with travel, tinkering, gardening, golf, reading, and lying around watching reruns, is quite new.”

15. Canada’s old-age pension system is an accepted, mainstream aspect of post-work life: The old-age pension is a government initiative to help Canadians avoid poverty in retirement. It has changed from a strictly anti-poverty measure, that often humiliated the elderly, into an accepted, mainstream aspect of post-work life. Some fear the system is unsustainable and heading toward bankruptcy, while others argue it is financially sound. The debate is too complicated for this blog, except to acknowledge the current plans in place and identify the pressures.

The current Canadian support systems include: the Old Age Security (OAS) Act, the Canada Pension Plan (CPP/QPP), the Guaranteed Income Supplement (GIS), the Spouse’s Allowance, the Registered Retirement Savings Plan (RRSPs). See Attachment #5: Old Age Security In Canadain my attachment document for a brief summary of the above.

16. Government pension plans are beginning to crack: Having described Canada’s current plans, the reality is that throughout the rich world the pressure of increased demands on benefits and diminished contributions (because generations entering their prime working years are smaller than those beginning to draw their pensions) is creating extreme pressure. The reality is that personal retirement savings are pretty lean. About a third of all Canadians have no retirement savings at all; of the remaining two-thirds, only a minority believe they’ve saved enough to ensure that their retirement is comfortably independent. (Household saving rates have declined from the early 80s at 20% of annual disposable income, to under 5% now.)

However Canada has one of the lowest rates of elder poverty in the world: 4.4% as compared to an OECD average of 12.3%. Most Canadian seniors are currently eligible for OAS and CPP funds, funds that will cover many of the basics. The “problem” is that we are living longer. So the financial dilemma is whether it is practical to fund a large cohort for thirty idle years between the day they retire and the day they die (especially given that the government will also be paying health care costs, etc.)

17. There are strategies to increase the financial security of older Canadians: John Ibbitson, in a recent Globe & Mail article suggested: A. Publicly supported long-term care insurance, financed by employee and employer contributions, which pays for home or institutional care for people for later in life; B. For governments to facilitate dynamic pension pools, in which retirees have the option to pool their retirement savings, with the funds of those who die earlier remaining in the pool to subsidize those who live longer; and then C. There is always the strategy of encouraging seniors to not access their Canada Pension Fund Plan payments until they turn 70, which then provides a substantially higher monthly benefit (it more than doubles). There is also D. The strategy of utilizing a reverse mortgage (as one can get up to 55% of a home’s current value).

18. The above issues suggest that Canada needs a national plan to support our aging population: We are headed to be a super-aged society; the pandemic has highlighted LTC weaknesses; access to primary care is restricted and not adequate to meet future demand (witness the shortage of family docs); geriatricians are needed; older women have unique medical needs; access by seniors (and especially women) is often restricted to noninsured health services, such as dental, vision and hearing. 

An integrated national federal/provincial plan is urgently required. It needs to examine elements of what other successful countries are doing, including an increased, but scrutinized, role for the private sector. (Over 30% is already being spent on private care, and around 70% is delivered privately.) It needs also to be dove-tailed into an improved national health-care system (currently more accurately a sickness-care system), one that at some point needs to face the overpowering financial realities, where many options to close the revenue/expense gap have  to be explored. (On that list, I suggest, would be some sort of income adjusted user pay system .)  Huge benefits would result from a renewed vigour in dealing directly with the underlining social determinants of health as well as a rejigging of our health care emphasis from one oriented to a repair mentality to one promoting healthy living.  

D. Ken’s influencing factors/personal approach

I have some personal activities, first of all following the advice described in Section A. 

Occasionally a reminder is necessary regarding my good fortune to have made it this far: When I look back some examples emerge, some silly, some lucky, and some just living: Example are contained in my longer version.

As humorist Garrison Keeler said in one of his articles, these “close calls…narrowly averted that would’ve obliged my friends to speak at the memorial service about my promising career tragically cut short and instead of that we meet for lunch and talk about hearing loss and ocular degeneration.”

My background and lifestyle was fortunate: I chose my parents and sisters well; my food, exercise, and habits were healthy, and I did not smoke.

Like many of my age, I was not connected with all of my grandparents: Essentially I was connected with two of the four, and not long with the other two.

As I look around, there are more and more of those I know dropping off the radar: I’ve been the keeper of the records for my Ridley class and the numbers dying are eerily following actuarial precision. The litany of serious illnesses, afflictions and general etiolation of those remaining is intimidating: strokes, cancers, Alzheimer’s, Parkinson’s, Non-Hodgkins’s Lymphoma, alcoholism, heart parts replaced, etc; never mind the new knees, hips, ankles, back surgeries. 

As I age, diminished mobility restricts some things Penny and I used to do together: The main example is skiing. However hiking, cycling, canoeing and kayaking remain, I’ll get Penny golfing and curling.

How one’s values shift over time (I’m trying to be flexible; is this wisdom?): For example, I once was an Ayn Rand advocate of rejecting collectivist values in favour of individual self interest, but the older I get the more inclined I am to recognize the value of sound public policy and civil order. The concept of “freedom” that is gratuitously been thrown about quite a bit lately, needs to be disentangled from it being a cudgel to erode democracy and civil rights. I’ll discuss my other values over a nice glass of wine.

After 50 “we become invisible”; I’m resisting that: There is an inclination for the elderly to be ignored or discounted for either lack of relevance or current knowledge. I’m attempting to stay current in things technical, political or cultural. I seek involvement and common communication. Also it’s difficult for youth to perceive an old body doing young things. It is a common observation of seniors that the young do not realize (or cannot imagine) the achievements of the old.

I accept the age markers of years travelled: My body has deteriorating signs that I’ve earned, so I’m proud of my grey hair and lines. As the ballad goes: “And if they found a fountain of youth, I wouldn’t drink a drop and that’s the truth, The older I get, The better I am, At knowing when to give, And when to just not give a damn.” My sentiments.

As we age we realize we won’t be part of the future that’s been part of our present: One perhaps poignant reality of aging is the gradual realization that I won’t be around to watch or be part of some very interesting, perhaps even profound, events. The first one is watching, and being part of, the lives of my offspring (and those of Penny) – our children and grandchildren, and the quite tantalizing future beyond them. The second reality includes the accumulated outcomes of the probably quite astonishing scientific, political, environmental, cultural events and challenges facing the world, and the universe. My quick list of the challenges I think might be significant can be found in Attachment #2: Potential Future Events of Significance. https://powellponderings.com/on-aging-attachments-1-5/

Seniors have done a lot and seen a lot; well, I think I have over the years! Certainly my life has been a full one by whatever measure one might use: people met, interests pursued, jobs performed, travel taken, and knowledge gained. As Márquez wrote “No matter what, nobody can take away the dance you’ve already had.” 

There is a joke on the Internet that goes “I’m tired of being part of a major historical event.” While I wasn’t around when electricity was invented (or the wheel) I have been around when some significant events occurred. For fun I’ve picked a few random political, cultural, environmental, scientific, medical events to illustrate by year (and we all have our own lists and how these events affected and influenced us). They are listed in Attachment #3: Major Historical Events in My Lifetime. https://powellponderings.com/on-aging-attachments-1-5/ I think it makes for a fascinating scan.

Choosing activities and projects to pursue in the final chapter of ones life: In my case I have fifteen:

1. Family: prime for me is continuing a hearty involvement with my family.
2. Old Friends: I’ve been in a “friendship-enjoying” stage for some period of time as connecting with my good friends is a very high priority. They come from many different areas and remaining involved provides social and intellectual stimulation. Penny and I both have our personal connections, but we also share and cultivate common friendships.
3. Accepting new friends:  while #2 dominates, I’m receptive to meeting new faces, from a wide age bracket and set of interests. 
4. Attitude; values: life is joyful and quite irresistible, so I just live it. It’s possibly more joyful when you’re aware that it’s finite, because you’ve got to make the most of it while you’ve got it. And change: the essence of life might very well be change. The really good things in life will happen if you just show up and share your enthusiasms with people. It can be mutually contagious. Life’s purpose may be as simple as “to live”. And probably to live very much in the moment – and with some vigour. 
5. Giving back: is one of the themes of a long life, and in many ways this has defined my journey from my mid fifties after I left the shadowboxing of striving careerism.. My life has been busy with many causes and organizations. 
6. Learning: every time I write a blog, I’m learning a great deal; I think that’s one of the main reasons I write. Reading is a big part of my life, what with my men’s book club and all the other possibilities available. It provides the context for challenging old ideas with new ones – plus it’s pleasurable. New software for organization and manipulation of my photographs is a constant. Taking courses on line keeps me nimble.
7. Writing: my blog; perhaps with some other things on the horizon. Then there was writing my autobiography, which I have done. 
8. Exercise and movement: I’m trying to stay physically active, whether it’s gardening, at the cottage, canoeing, biking, hiking, golfing, Y’ing, curling.
9. Photography: I will continue with my prime hobby. This means shooting lots, organizing, manipulating and utilizing the photos I have, continuing the digitizing efforts, preparing a complete index, and working out how my family can navigate the hard drives full of photos. 
10. Eating: continuing my current reasonable healthy eating habits (little meat; lots of fish), while further moving off sugars (pop, cookies – well not really), hydrating more and eating less volume.
11. Sleep: I have changed my sleep habits significantly. I am now targeting for at least seven hours per night (vs the 3 to 5 I’ve been accustomed to).
12. Downsize the collections of a pack rat. Be they files, clothes, or doodads! Although I do crave comfort from my things, I still want to lighten my load – and the load of those who will have to deal with the stuff after I’ve turned to dust. So sell it, give it away, throw it out. I’m in a subtraction mode!
13. Keep: I want to add little to my possessions, and more to my experiences. I will retain certain memorabilia that provides me joy in reflecting on the stories in my life. My collection of 200+ masks from around the world classifies as such. My books do too; they are old friends.
14. Travel: I will continue to wander the world as long as I can.
15. Bucket list idea: re the typical “bucket” list of things to do during ones life, my approach is not to get into checking off lists but just to do what I’ve always done naturally – travel, read, write, photograph, engage, live and love. My life has been my bucket list.

E. Wrap-up

Broad themes from this analysis: This blog is an attempt at assembling some facts and trends and trying to make some sense of them, and then through this synthesis sorting out some broad themes:

Re science of aging and suggested actions:

• There’s a lot of serendipity in the aging process (genes inherited; personality; country of birth/brought up in; all the social determinants of health; luck, and on and on)
• Having said that, most humans have a lot of control over the important aging determinants: diet, sleep, exercise, socializing and learning habits and having purpose (purpose is protective)
• Our brains and our bodies are one integrated system, communicating back and forth
• Love and humour play a role in the aging equation; so does the environment and well designed urban spaces
• Mixing generations has benefits
• Aging is resulting in design adaptation to accommodate the process; a huge industry has developed to both monetize and celebrate the senior sector. There is a large commercial side in disguising or inhibiting aging in today’s society
• Examples exist, with individuals and with countries, of healthy aging and age-friendly systems
• Dealing with dementia is, and will be, one of our most important medical, and social issues facing society.  No one can know at any point whether he or she will still have a functioning brain in old age 

Re philosophical and historical aspects of aging:

• Attitudes towards old people have evolved significantly over time
• Old age is a critical women’s issues; females are the survivors 
• Aging can bring knowledge and experience, wisdom, positivity and purpose 
• Seniors make a significant contribution now to the richness of Canadian life and to the economy
• We should fear ageism, not aging; seniors need to be seen as active and valuable societal contributors; aging needs to be redefined and venerated
• Growing old is an art that can bring rewards 
• Sharing the aging journey unites those on the same path
• There are poignant aging markers, especially the obits
• The talk of “vanquishing” old age has to be countered with realism; living longer is great; dying longer is not so good
• Focussing on selected priorities in the final chapter gives focus and meaning
• The fear of aging is more than fear of decrepitude; ultimately it is the fear of death; the search for a decent death is a complex equation; our death-denying culture makes things more challenging 
• One central focus of religion is dealing in and with death, The presence or absence of either spirituality or religious adherence has little association with successful aging
• How we view death varies across cultures

Re political and public policy considerations:

• Canada, and the world, is aging rapidly, and there are consequences. First world population growth is below replacement; this is coupled with longer lifespans
• The largest age cohort, the Baby Boomers, will strain the health care and pension systems
• Canada’s immigration strategies are one lever for rejuvenating our aging workforce
• Our medical system is under pressure from a rapidly aging and increasing population; also, there aren’t enough geriatricians
• Not everyone gets to die where they wish
• Aging at home as long as possible is sought by seniors but Canada underinvests in home care
• Eldercare in Canada is needs serious reform particularly in long-term care homes
• Political consequences of societal aging include financing the resources needed 
• While Canada’s old-age pension system is an accepted aspect of post-work life, the systems are under significant pressure
• Canada needs a national plan to support our aging population

Regarding the objectives I set up at the start, I do intend that this blog might be useful in accomplishing the first one regarding healthy living strategies. Secondly, on the reality of aging, everyone will. A combination of serendipity, genes and lifestyle will determine whether it is joyful; we know also there will be challenges. As to my third objective, the reality of the feds and provinces getting together on a national strategy is possible, but it needs leadership and that I currently can’t spot. When examining the demographics, there is a ton of self interest.