Experts looking at how to age well in NOTL

Through the oversight of the co-chairs, Terry Mactaggart and Caroline Polgrabia, the Economic Development Task Force produced a thoughtful and clear report titled Strategic Direction: Ensuring Balance in a Thriving Community (An Economic Development Strategy for the Town of Niagara-on-the-Lake)  in November, after 10 months of consultations and research. 

Niagara-on-the-Lake’s population has reached the age of longevity earlier than other communities in Canada. While 67 per cent of the town’s resident population is over 40 years old, 31 per cent is over 65. The report states, “although [the aging population] is viewed a success, this poses unique challenges and increased demands on social, medical and other related services.”

To address these challenges, the report proposes that the town should be fashioned as a model community on how to create a ‘Longevity Economy’ by redrawing economic lines, changing the face of the workforce, advancing technology and innovation and “busting perceptions of what it means to age” (American Association of Retired Persons). 

In their book, The 100 Year Life: Living and Working in an Age of Longevity, Linda Gratton and Andrew Scott outline how individuals can better prepare for a longer life visit. Gratton and Scott point out that the classic three stages model – school, work, retirement – will not survive much longer. Babies born today have a good chance of surviving to be 105. If we are to exploit longevity opportunities, we must abandon outdated notions of a traditional life. 

The community can seize the opportunity to support individuals throughout their multi-stage lives in collaboration with businesses and governments. Specifically, the report states that the community should work on an agenda for the decades ahead and balance the needs of the “‘retirement/legacy community with emerging family populations.” It will be challenging to strike a balance between the different needs of different groups. Will more attention be given to retirement and healthcare at the expense of lifetime education, skill development, flexible working and transitions?

The Economic Development Task Force calls for the community to “balance our assets.” Differences in investment are what drives inequality, and over a longer life, inequality increases. During the 20th century, governments invested in free education and infant care – the key periods of investment for a three-stage life. With the multi-stage life from increasing longevity, other periods require similar investments. 

Resource investment decisions can have long-lasting impact. The changes required to adapt to a 100-year life have begun. Evidence within NOTL shows that re-inventing retirement is about other alternative retirement strategies including shifting away from full-time employment to other pursuits such as high-end consulting, starting an entrepreneurial business connected with a passion or hobby, sharing a home and other living expenses with a friend to help retirement funds go further, or choosing another creative career pathway that you love.

The increase in longevity has reached a level that requires redefinition of the social and financial institutions that support it. The report encourages the community to participate in this political and policy debate. While we can each look forward and do our best to prepare ourselves and our families for these longer lives, the whole community must work together to “nourish, nurture and navigate” diverse initiatives.

The town’s Community Wellness Committee also will release its report this month, and is expected to include how to support NOTL’s aging population.  As the town’s population ages, the number who are frail increases. When we reach this point in our life, we want and need safe, relationship-centered support, promoting physical and brain health, wherever we live.

Research has produced many amazing treatments such as hip replacement and chemotherapy to address specific health concerns. While these inventions have increased life expectancy, what most people want is to increase healthy life expectancy, to live longer better and not spend the last years of life in a home or dependent on children. We also have research that this is possible as the risks of dementia, frailty and dependency can be reduced.

The preventive services offered to people under 60, for example, treatment of high blood pressure, is still relevant. However, it is what we do for ourselves that matters most after age 60, principally keeping active or getting more active. By this we mean not only physically active, which is of great importance, but also socially active, either with family or work or volunteering, and intellectual activities such as learning a new skill.

Lifelong intellectual activity prevents intellectual decline. As with physical ability, most people decline more quickly than is due to aging alone, from lack of mental stimulation. There is what can be considered to be a fitness gap, analogous to the physical ability fitness gap, that gets wider as we age. However, as with loss of physical fitness, the gap can be narrowed by increased intellectual activity at any age. Increasing physical, social and intellectual activity helps us to not only become physically fitter but also feel emotionally better and, perhaps, of greatest importance, increase brain ability and reduce the risk of dementia. The community must help us close the fitness (physical and brain) gap.

Another consideration in the aging population, in addition to the fitness gap, is appropriate housing options. The attached figure outlines types of housing options for older adults, including those who are frail. The scale at the bottom of the figure extends from independent older adult to dependent older adult. The length of ‘housing’ bars indicate what level of dependency of older adults along this scale are supported for each housing option. For example, at home, living with family support, is a housing option that supports older adults regardless where they are on the scale. Note the wide variety of housing options, with availability being a question for NOTL.

The Economic Development Task Force report covers some of the ways of enhancing availability of diverse housing options for successful aging. A more comprehensive list of approaches for the town to consider is provided by Grantmaker in Aging (2019). According to this U.S. agency, the top five approaches are: 1) incentives through zoning, policy, and funding; 2) building new structures; 3) policies and practices so people can live at home; 4) retrofitting existing homes; and 5) technology-based approaches.

The ‘hallway medicine’ challenges for housing frail older adults go beyond living in a hospital, a nursing home or long-term care home. Society’s tendency to distinguish health-service provisions and social support for frail older adults as separate and independent is obsolete. When we are frail, we have a spectrum of needs (from acute episodes to more complex, chronic conditions), and we require a spectrum of responses (from single treatments to more continuous support), where distinctions between health needs and social support needs are largely meaningless. Intrinsic differences in our needs is more important than where support is provided, and the types of people who provide it.

The Economic Development report is an important catalyst in sparking the conversation within NOTL about how the community should adapt in response to the changing demographic. The political and policy debate arising from the report needs to cover how we can narrow the fitness (physical and brain) gap, diversify housing options for older adults, and increase economic activity within the community that also increases ability of our minds to interact with people and ideas.

Larry W. Chambers has authored 175 articles and books concerning disease prevention (e.g. dementia), quality improvement in long-term care homes and innovative approaches for continuing professional development. He is research director of the Niagara Regional Campus, School of Medicine, McMaster University. Eva Liu is a first-year medical student at the Niagara Regional Campus of the McMaster University School of Medicine.

Chambers, Liu and their colleagues are interested in improving community wellness of frail older adults in NOTL, by narrowing the fitness (physical and brain) gap, diversifying housing options for older adults, and increasing economic activity within the community that also increases ability of our minds to interact with people and ideas.