19 th John Friesen Conference April 23 & 24, 2009 Andrew Wister, Ph.D. Professor & Chair...

19th John Friesen ConferenceApril 23 & 24, 2009

Andrew Wister, Ph.D.Professor & Chair

Department of Gerontology, SFU

1. Are current and future cohorts/ generations becoming healthier?

2. What can we do to improve?

2001 – 13.6% of population

2006 - 14.6%

2011 – 15.3% Projected

2021 – 20.4%

2031 – 25.2%

Dychtwald (1997) Baby boomers are “train wrecks about to happen” (pandemic of chronic disease, mass dementia, inadequate pensions & pressures on deteriorating health care system)

Over $120 billion in 2007 Over $180 billion in total costs

to the economy Not surprising that someone

has to be blamed – often older adults

Prevention may be the largest untapped area for cost savings*

What Constitutes Good What Constitutes Good Health?Health?

Statistics Canada, 2006

Life Expectancy at Birth, Canada, 1979-2004

82.6

80.2

77.8

Onset of disease and disability compressed into a shorter time frame (Fries, 1983)

1982-1999 – 2% per year decline in functional disability, 1% decline in mortality

Evidence from 1991 - 2007

Moderate support, but mostly for less severe disability, 75+; but also declining recovery (Wolf et al., 2007)

Less support when examining other measures of health (chronic illness, perceived health)

1978/79 to 1998/99 decreases in arthritis, hypertension, heart disease, bronchitis/emphysema for person 45-64 (Statistics Canada, 1999)

Increases in diabetes, asthma & migraines

For 65+, no declines (positive trends); but diabetes, dementias, & asthma up

Cancers show unique and complex trends

Rising life expectancy and disability compression concurrent with rising rates of many chronic illnesses

Due to changes in utilization and health care? Improved services and technology to facilitate independence? Or healthy lifestyles?

Some state that older adults today and the future older adults of tomorrow (the boomers) are healthier than previous generations because they are wealthier, exercise, eat better, and knowledgeable about healthy lifestyles

Commonality Of Risk Factors

Smoking

Unhealthy diet

Overweight

Sedentary lifestyle

Alcohol abuse

Psychosocialstress

RISKFACTORS

Cardiovasculardisease

Cancer

Diabetes

Chronicrespiratoryconditions

Mental ill-health

MAJ OR CHRONICDISEASES

Smoking increases mortality by 50% and doubles incidence of cancer and cardiovascular disease (CACR, 1999)

Quitting can lower risks within one year

Physically inactive have a 90% higher risk of developing CVD; 60% osteoporosis; and 40% higher risk of stroke, hypertension, colon cancer, and diabetes (Katzmarzyk et al., 2000)

Benefits of physical activity can be realized immediately no matter what age

Obese individuals are more than twice as likely to have arthritis, heart disease, breast & colon cancer (Cairney and Wade, 1998)

Unique health and illness trajectories connected to the size and composition of cohorts, and to earlier life experiences, normative milieu and historical events

Upward bound age escalator

Percentage of Canadian Population Obese (BMI 30+) by 5-year Age Groups, Males, 1985 - 2005

0

5

10

15

20

25

30

35

40

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

Age Group

Per

cen

tag

e

1985 HPS 1990 HPS 1994/95 NPHS2000/01 CCHS 2005 CCHS

Percentage of Canadian Population Obese (BMI 30+) by 5-year Age Groups, Females, 1985 - 2005

0

5

10

15

20

25

30

35

40

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

Age Group

Per

cen

tag

e

1985 HPS 1990 HPS 1994/95 NPHS2000/01 CCHS 2005 CCHS

Percentage of Canadian Population Sedentary or Infrequent Exercisers* by 5-year Age Groups, Males, 1978/79 - 2005

0

10

20

30

40

50

60

70

80

90

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

970

+

Age Group

Pe

rce

nta

ge

1978/79 CHS 1985 HPS 1990 HPS1994/95 NPHS 2000/01 CCHS 2005 CCHS

Percentage of Canadian Population Sedentary or Infrequent Exercisers* by 5-year Age Groups, Females, 1978/79 - 2005

0

10

20

30

40

50

60

70

80

90

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

970

+

Age Group

Pe

rce

nta

ge

1978/79 CHS 1985 HPS 1990 HPS1994/95 NPHS 2000/01 CCHS 2005 CCHS

Paradox - exercise and obesity moving in opposite directions

Is the exercise measure flawed?

Statistics Canada, 2007

Leisure-time Physical Activity % Inactive, Canada, 1994/95 – 2002/03

Age NPHS 1994/95 CCHS 2002-03

35-44 59.8 % 50.1 %

45-54 60.8 % 51.6 %

55-64 56.8 % 51.0 %

65-74 58.3 % 50.3 %

75+ 64.6 % 59.6 %

Among 35-54 ages in 2000/01, there is a 25% relative risk reduction in obesity rate (>=30) among frequent exercisers compared to infrequent/sedentary

19% relative risk reduction in infrequent/sedentary activity among those who are not obese, compared to those who are not

Most studies linking TV and exercise or obesity are cross-sectional

Therefore problems of causality – which comes first?

Jeffery & French (1998) TV watching associated with

obesity at cross sectional level, but only among low-income women

At longitudinal level, no associations were supported

Canadian TV watching dropped from 23.3 hours/week in 1991 to 21.5 hours/week in 2000 (Statistics Canada, 2001)

For workers, average time spent watching TV dropped from 95 minutes in 1986 to 79 minutes in 2005 (Statistics Canada, 2007)

Computer use at work has doubled between 1989 and 2000 (33% to 57%) (GSS 2000)

80% of Canadians work at their computer every day

But, it is not enough to tip the scales, given exercise improvements

Consumption of fruits has increased 27% between the 1970s and 1997 (Alain, 1999)

Low fat milk up (e.g., 1% milk up from 12% in 1990 to 27% in 1997)

Consumption of red meat down

Over 25% of energy burned by adolescents and adults originates from the “Other Food Group” (Starkey at al., 2001)

Pop consumption in Canada doubled between 1975 and 1997, from 60 liters to 106 liters per person per year (Alain, 1999)

20% of all meals are consumed out of the home (Struempler, 2002)

Especially fast & inexpensive meals

McDonalds continues to lead the way

Average serving size has increased between 20% - 70% over past two decades

2-3 times the USDA recommended food size (Kendall, 2000)

Collected information on foods purchased in 24 hours before survey

Fast food sources predict obesity in men and women

Therefore it is both the quality and the quantity of food consumption that is the problem

Why Do We Have Poor Why Do We Have Poor Lifestyles?Lifestyles?

Boomers report time issues more often, seniors repot energy

Perception that when we age, we need to slow down

Health is a major issue for older adults Energy drops from some Fear of falling But, it is never too late – Plethora of

Intervention Studies

13% of Canadians reported that they did not have time to prepare a healthy meal

74% eat in a hurry 39% eat in a vehicle at least once a

week because of a busy work schedule (FPT Advisory Committee on Population Health, 1999)

40% of Canadian older adults report that they do not have the time or energy to exercise regularly

Over 50,000 diets in existence Disagreement over what is good and

what is bad Concept of lifestyle change is not

part of most diets

Presentation of fast food is a multimillion dollar industry (Schlosser, 2002)

Low fat everything rather than making substantive changes to lifestyle habits

Positive lifestyle messages must compete on an uneven playing field

Messaging active lifestyles is easier than you think – axioms of inertia

http://www7.nationalgeographic.com/ngm/0511/sights_n_sounds/index.html

Okinawa, Japan Reason for living; social connectedness; physically active; low caloric intake – fish soup (highest obesity rate due to change in diet)

Sardinia More males; less stress; family and social connectedness; Mediterranean diet; mountain walking

Loma Linda – Seventh-day Adventists – Sabbath (day off); social capital; physical activity; nutrition

Genetics – Epi-genetics Gene-environment interaction

Income Sense of belonging, social

connectedness Physical activity Nutrition Moderate wine

How do we get people to sustain or improve health behaviours over the life course?

Increase confidence to make a change (efficacy) involves getting people to be introspective about health

Must keep messages simple but potent

Notion of “health credit” – investments into health multiply and carry forward

Innovations Diffusion – lifestyle change through natural networks (Rogers, 1983)

Mass Media – more effective in creating knowledge of innovations and agenda setting

Interpersonal Channels – better in changing attitudes & behaviour

Health Promotion

Interactive, tailored designs are more effective because more engaging, higher expectations, and motivational

Higher levels of fitness (Hurling et al., 2006)

Interactive cardiovascular interventions showed improved quality of life (Delgado et al., 2003)

ParticipAction program – between 1971 and 2000, it was run on less than 1 million per year

Being reinvented Canada’s Physical Activity Guide to

Healthy Active Living (1998) Older adult version (1999)

Integrated Pan-Canadian Healthy Living Strategy (2002)

$300M over 5 years Population health approach –

Phase One targets physical activity, eating habits and healthy weights

Many provinces have their own health promotion platforms to motivate Canadians to lead healthier lives: ActNow BC/2010 Olypics Active2010 (Ontario) Healthy U (Alberta) Saskatchewan in Motion

Four Cornerstones: Age Friendly Communities Mobilize and Support Volunteerism Promote Healthy Lifestyles Support Older Workers