Throughout my involvement in MHST 601 – Critical Foundations in Health Disciplines, the introductory course to the Master of Health Studies graduate program, I have developed a heightened understanding of the complex factors influencing the health of Canadians. It has been intellectually stimulating to further explore, critically analyze, and curate content that aligns with my professional interests. I have been able to clarify and enrich my understanding of a professional interest of mine – healthy aging. As seen in Figure 1 below, “Observed and projected growing number of Canadian seniors living in community”, the senior population in Canada is expected to greatly increase.
The topic of healthy aging, while highlighting the importance of physical activity, are emerging themes in my ePortolio content and curated resources, as well as my profession. With an aging population, it is imperative to create supportive strategies to allow for the capability to live well. As we age, there is potential for a gradual decrease in physical and mental capacity and a growing risk for disease, however this is not definite or consistent to a certain age. There are often misconceptions of aging and health which affect our social norms and expectations of aging and contributes to increased barriers to health. As I reflect on my growth throughout MHST 601, I will provide an integrated analysis on the healthy aging of Canadians.
In the first week of the course, I performed a self audit of my current state of social media use, professionalism, and curation of health information and then developed a corresponding plan of action. I previously held onto the notion that a separation of my professional self and digital social media was best. As the weeks passed and I built my ePortfolio and expanded my network on Twitter, it became evident to me that holding a digital professional identity is beneficial and effective in facilitating inter-professional connectedness.
“Professionals should use digital media for positive purposes in ways that support principles of patient care, compassion, altruism, and trustworthiness. Professionals should be aware of the shaping nature of their relationships with digital media and they should maintain the capacity for deliberate, ethical, and accountable practice when using them.” (Ellaway, Coral, Topps and Topps, 2015).
I now follow the above statement and have created a more deliberate professional digital presence, which I have found to be vastly beneficial. This has allowed me to make connections and share, store, and interpret information that would previously be missed.
Our health is impacted and shaped by the federal Canada Health Act (CHA) and by the World Health Organization (WHO) definition of health, both of which are in need of updating for the current state of the aging population. The CHA has a lack of emphasis on prevention of ill health which has contributed to a burdened Canadian health system which focuses on funding medically necessary treatment. The current system was not designed to support the current aging population as people are living well into their 80’s and higher, while maintaining functional health despite having chronic disease. The current definition of health by WHO is "a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity" which has a lack of inclusion of the ability to adapt and does not include the influences of the social determinants of health. It is now the norm to age with multiple chronic diseases or health conditions and, when well controlled, can have little influence on one's quality of life and longevity.
The importance of being socially connected, physically active, mentally healthy, and well-supported across our lifespan is necessary for optimal health. WHO defines healthy aging as “the process of developing and maintaining the functional ability that enables well-being in older age” and have identified a Global Strategy and Action Plan on Ageing and Health. The Public Health Agency of Canada takes a slightly different approach and defines healthy aging as “the process of optimizing opportunities for physical, social and mental health to enable seniors to take an active part in society without discrimination and to enjoy independence and quality of life”. Initiatives should enhance the capacity for people to thrive in their communities, providing support in an integrated manner to promote healthy aging.
The social determinants of health need to be addressed and understood in regards to how the conditions in which we live and age in greatly shape our health. Some conditions which affect our health as we age include our access to appropriate housing, income, nutritious food, social supports, and health services. When social determinants are not addressed or strengthened by government policies, health inequities occur. Each provincial and territorial government is responsible to respond to the needs of the aging population and furthermore address the barriers to healthy living for vulnerable groups. Participating in forum discussions with my peers has helped me to understand the differing approaches by each provincial/territorial health systems to address the health of the aging population. In a joint blog post "A Look at Obesity in Alberta and Newfoundland & Labrador" with my classmate Rahul Girijappan from Newfoundland and Labrador, we found the adult obesity rates in each of our home provinces to be higher than the Canadian average of 26.3% (Canadian Institute of Health Information, 2016). See Figure 2 below for the obesity rates in each province as compared to the national average.
Each provincial government has strategies to address the prevalence of obesity, such as targeting physical activity, nutritious diet, and weight management. It is important to also highlight the significance of being underweight as an older adult which increases health risks such as malnutrition, osteoporosis, and mortality. It is interesting to note that being underweight may be a more important predictor of poor health than being overweight for those aged 65 years and older as falls are the leading cause of injury-related hospitalizations for this group (Public Health Agency of Canada, 2010). Falls prevention guidelines for seniors involves establishing conditions which prevent falls and providing interventions such as balance exercise programs, medication management, home modifications, and further education on reducing the risk of falls.
Corresponding provincial/territorial strategic approaches should recognize that healthy communities will ultimately support healthy aging and the prevention of growing rates of obesity, fragility, and chronic disease. The video below, "Get Fit for Active Living - Physical Activity to Prevent Chronic Disease" from the Canadian Centre for Activity and Aging (2015), describes in-depth the importance of physical activity in reducing chronic disease and maximizing function, independence, and improved healthy aging.
When challenged to analyze a health issue from a multi-level approach, I chose to explore the physical inactivity crisis of older Canadian adults in my blog post "You May NOT Want to Sit Down for This...Influences of Physical Activity for Older Adults".
I used the Social Ecological Model, see Figure 3, to analyze the influences at multiple interrelated levels including Individual, Interpersonal, Organizational, Community, and Public Policy. The complexity of how our built environment, social norms, appropriate resources, and strategic initiatives influence our ability to age well and engage in healthy behaviours such as physical activity is examined. Establishing increased movement in older adults as a social norm will require action at multiple levels. Further advocacy is required to promote and enable healthy aging for the general public, adapting to the needs for each generation and vulnerable populations.
In my blog post "Staying Socially Connected As We Age", I identify vulnerable groups of seniors at risk of social isolation and resulting poor health outcomes. These groups, as recognized by The Government of Canada, include seniors who are Aboriginal, caregivers, immigrants, LGBT, living alone, living in remote or rural areas, low-income or living in poverty, experiencing mental health issues, and/or living with health challenges or disabilities. Therefore, future health initiatives should focus on enhancing the conditions and social supports for these more vulnerable senior groups.
In my integrated analysis of healthy aging, some recommendations have emerged to further support the aging population:
- Share guidelines for physical activity promotion, social inclusion, falls prevention. Incorporate new research and technology.
- Increase funding initiatives at federal, provincial, and community level to foster supportive, capacity building environments. For example, through Age-friendly communities.
- Embracing diversity, addressing inequities, and building opportunities for healthy choices.
- Target initiatives to vulnerable senior groups at risk.
- Improve capacity to support those with chronic illness and disabilities to engage social and physical activities.
- Strengthen inter-generational understanding, programming, and social activities.
- Increase mental health research on seniors and provide appropriate support services, programs, and interventions.
- Align health systems to the needs of older adults, building capacity through integrated health services.
In conclusion, in order to promote healthy aging, we must build environments which support and maintain our functional ability and promote opportunities for positive physical, social, and mental health. In a study by Rao, Patel, Roberts, and Thompson (2018), it was determined that fewer chronic conditions, strong social supports, high independent functioning, and life satisfaction are indicators of successful aging. Future health should focus on optimizing these key findings with approaches that reinforce connection, adaptation, independence, and preventative healthy strategies for our life course. Throughout the MHST 601 course, it has become evident that health professionals have the capacity to further promote healthy aging and enhance the quality of life of individuals. I believe the future direction of health is making the necessary steps towards a more proactive approach to support successful aging, however there is much room for improvement. I will continue to use social media to enhance my inter-professional connections and further my ability to advocate for the promotion of healthy aging. My passion of promoting physical activity as an empowering tool to foster social connections, boost mental health, and minimize age-related declines has been strengthened throughout this course.
References:
Canadian Institute for Health Information. (2016). Obesity (Age 18 and Older). Retrieved from https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en&_ga=2.28547263.2053885766.1551494075-149880135.1548532639#!/indicators/076/obesity-age-18-and-older/;mapC1;mapLevel2;/
Ellaway, R. H., Coral, J., Topps, D., & Topps, M. (2015). Exploring digital professionalism. Medical
Teacher, 37(9), 844-849. Retrieved from https://doi.org/10.3109/0142159X.2015.1044956
The National Seniors Council. (2017, April 26). Who's at risk and what can be done about it? A review of the literature on the social isolation of different groups of seniors. Retrieved from https://www.canada.ca/en/national-seniors-council/programs/publications-reports/2017/review-social-isolation-seniors.html
Paterson, D., & Stathokostas, L. (2015, January 30). Physical Activity and Aging in Canada Video Series. Retrieved from https://www.uwo.ca/ccaa/research/stories/aging_demographics.html
Public Health Agency of Canada. (2014, October 09). The Chief Public Health Officer's Report on The State of Public Health in Canada 2010 – Growing older: Adding life to years. Retrieved from https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/annual-report-on-state-public-health-canada-2010.html#toc
Rao, D. P., Patel, P., Roberts, K. C., & Thompson, W. (2018). Obesity and healthy aging: Social, functional and mental well-being among older Canadians. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 38(12), 437-444. Retrieved from https://doi.org/10.24095/hpcdp.38.12.01
Statistics Canada. (2015, November 27). Overweight and obese adults (self-reported), 2014. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article/14185-eng.htm
Statistics Canada. (2016, July 28). Research Highlights on Health and Aging. Retrieved from https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2016001-eng.htm#a4
World Health Organization. (2018, February 08). What is Healthy Ageing? Retrieved from https://www.who.int/ageing/healthy-ageing/en/
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