PROMOTING BETTER HEALTH AMONG THE ELDERLYAuthor(s): John M. LastSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 73, No.1 (JANUARY/FEBRUARY 1982), pp. 20-21Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41988032 .

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Editorial

PROMOTING BETTER HEALTH AMONG THE ELDERLY

The National Advisory Council on Aging has produced a brief, well- reasoned statement, "Priorities for Action"1 containing recommendations that cover a broad range - education, health and social services, income and retirement issues. Many aspects deserve comments.

The social demography of Canada's elderly population is well known. The proportion of persons aged 65 and over is now slightly less than 10%. It will rise steadily between now and the year 2031 when it will reach about 20% as the children of the baby boom generation enter retirement age.2 The rising pro- portion of the elderly will be accompan- ied by an increase in the proportion who live alone, quite often with no close kin- folk even in the same city.

In 1976, the most recent year for which figures are available, 12 percent of men aged 65 and over, and 32 percent of women aged 65 and over lived alone. The higher male than female mortality in early and middle adult life leads to a higher proportion of older women than men in the population. After age 75 there are more than twice as many old women as old men. Substantial numbers still occupy what was once the family home, now too large and often falling into disrepair.

The economic statistics are equally sobering. Over one third of the elderly in Canada require income assistance in order even to reach the level of income defined officially as "poverty".3 Another statistic is that a higher pro- portion of the elderly population are in some form of institutional living than in

any other western country. Despite considerable provision of subsidized rental housing for the elderly, very little specially designed accommodation has been provided for elderly Canadians who could thereby continue to maintain an independent existence. Fittings and fixtures adapted to arthritic joints and declining muscular strength, hand rails in bath tubs and alongside toilet seats, and similar aids to the elderly and infirm but still independent citizens are seldom provided. Instead, we have invested our tax dollars in high density apartment buildings, sometimes in downtown city centres, at other times in suburban areas. Our emphasis on the unadorned architectural features of housing for the elderly is in sharp con- trast to the care and attention lavished upon these and other special needs in some other countries, such as the United Kingdom and Denmark. The purpose-built accommodation for the elderly in Canada, moreover, makes few concessions to the realities of our harsh winter climate. There is usually no pro- vision for easy access between domestic accommodation and shopping facilities such as might be provided by building homes for the elderly immediately adja- cent to a shopping mall. There has instead been a tendency to create ghet- tos for the elderly by building accom- modation intended exclusively for older people rather than integrated housing in which older people and young families live side by side in the same urban development as the Danes and the Brit- ish often do.

I have commented at some length on

the shortcomings of housing for the elderly in Canada because it has consid- erable public health importance. Many of the physical, mental and emotional infirmities of old age can be prevented, or at least minimized by thoughtful planning to meet the domestic and social needs of persons who, while other- wise fit, are experiencing some decline in vitality and the onset of sensory and motor impairments of various kinds. Surveys of older persons consistently find that distressing impairments which limit mobility such as painful feet and stiff and painful joints elsewhere in the body are the most common com- plaints.4 Social isolation and a feeling of being rejected by society are also com- mon. Housing which integrates elderly people with the rest of society and which provides opportunities for easy access to gentle physical exercise, such as strol- ling through a climate-controlled shop- ping mall, could help to prevent deterio- ration which would otherwise result from thse impairments.

A number of studies in Canada and elsewhere have demonstrated convinc- ingly that the provision by local public health services of several kinds of assist- ance for the elderly, such as a home care program, meals-on-wheels, and a nurs- ing service (with emphasis on counsel- ling not bedside care) can all be benefi- cial.5 Moreover, these are not costly services, particularly when it is appre- ciated that they can help maintain people in independent existence where the alternative would be placement in an institution, with all that this implies not only for increased cost, but for pro-

20 Canadian Journal of Public Health Vol. 73, January/ February 1982

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gressive deterioration, loss of morale, the development of institutional neuro- sis, nosocomial infections, and all the other adverse consequences of institu- tional living.

There are many advantages in main- taining the integration of older, middle- aged and younger Canadians. The young have much to learn from the old and the old can retain self esteem and a useful social role by participating actively in the affairs of the community in all sorts of ways, many of which require interaction with people in other age groups. Everyone whose work brings them into contact with older per- sons is only too well aware that the maintenance of a meaningful role and function in society is probably the single most important factor contributing to high morale and this in turn, because it makes life worth living, may do more than all the visits to the doctor and the

bottles of tonic which may be offered as an alternative method of promoting good health among the elderly.

Local public health authorities have an important leadership role in helping to mobilize and coordinate the social agencies that exist to serve older Canadians.

Those Who plan and direct educa- tional programs in the health field, have an equally important responsibility and could do much more to encourage higher proportions of the best and brightest graduates to consider care of the elderly as a worthwhile activity to occupy their professional careers. Piti- fully few medical students and young medical graduates are attracted towards geriatrics as a career. To a considerable extent the same is true of nursing. The existence of the large generation gap between youthful students in training and the elderly citizens whom they

could care for when trained, may account for the lack of appeal of geria- trics to young health professionals. In the past it has also had an image of being a rather "hopeless" specialty. Changing this attitude is an important challenge for clinical and other teachers in the health science centres.

JML

REFERENCES 1. National Advisory Council on Aging, Priori-

ties for Action, Ottawa, 1981. 2. Statistics Canada, 1976, Census of Canada,

Vol. 2: Population; Demographic Characteris- tics, Household and Family Status by Age Groups.

3. Statistics Canada: Canada's Elderly, Ottawa, 1979.

4. Besdine R W. The content of geriatric medicine in A.W. Somers and D.R. Fabian (Eds) The Geriatric Imperative. New York: Appleton Century Crofts, 1981. pp. 39-54.

5. Flett DE, Last JM, Lynch GW. Evaluation of the Public Health Nurse as Primary Health Care Provider for Elderly People in V.W. Marshall, Ed. Aging in Canada. Toronto: Fitzhenry and Whiteside, 1980. pp. 177-188.

ENCOURAGER LA SANTE CHEZ LES PERSONNES AGEES

Le Conseil consultatif national sur le troisième âge a présenté un exposé bref et ténu, "Priorités d'action"1, qui com- prend des recommandations sur un grand nombre de sujets, comme l'éduca- tion, les services sociaux et de santé, les revenus et la retraite. Plusieurs des aspects du rapport méritent qu'on s'y arrête.

On connaît bien la démographie soci- ale de la population âgée au Canada. Le taux des personnes de plus de 65 ans atteint presque 10%. Il s'accroîtra de façon régulière jusqu'à 2031, où il atteindra alors 23 % de la population, pendant que les enfants de la génération qui a connu l'explosion des naissances atteindront l'âge de la retraite2. A l'ac- croissement des personnes âgées, se combinera celui de personnes seules, souvent sans parents dans leur ville de résidence.

Pour l'année la plus récente où nous pouvons obtenir des données, X % des

hommes de plus de 65 ans, et Y % des femmes de la même catégorie, vivaient seuls. Le taux plus élevé de mortalité chez les hommes à un âge plus jeune entraîne une population féminine plus élevée. Chez les plus de 75 ans, on re- trouve au moins deux fois plus de femmes que d'hommes. Nombre d'entre eux occupent toujours ce que l'on appe- lait auparavant une résidence familiale, dorénavant beaucoup trop grande et laissée à l'abandon.

Les données à incidence économique sont tout autant sérieuses. A peu près le tiers des personnes âgées au Canada doit avoir recours à l'assistance pub- lique pour s'assurer des revenus qui rejoignent ce qu'on appelle officielle- ment le "seuil de la pauvreté"3. D'autres statistiques révèlent qu'une plus grande partie des personnes âgées vit en institu- tion, par rapport à tout autre pays occidental. Malgré l'aide considérable apportée à la subvention de logements

aux personnes âgées, on n'a pratique- ment pas prévu de types d'habitations qui pourraient leur permettre de conti- nuer à vivre de façon indépendante. On a à peine pensé à leur fournir des instal- lations et des appareils propres à s'ajus- ter aux arthrites et aux déficiences mus- culaires, des appuis près des baignoires et toilettes, ainsi que d'autres formes de supports physiques qui pourraient les aider, ainsi que les infirmes, à agir en personnes indépendantes. Nous avons plutôt investi nos impôts à construire des résidences à fort taux d'occupation, quelquefois au centre des grandes villes, autrement en banlieue. Nous avons mis l'accent sur la construction d'édifices sans goût architectural pour les per- sonnes âgées, à rencontre de ce qui a été fait dans d'autres pays pour leur porter soin, attention et autres exgences, comme au Royaume-Uni et au Dane- mark. De plus, les habitations constru- ites au Canada pour les personnes âgées

January/ February 1982 21

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