Participants emphasized that ageism is a serious concern for today's seniors and is a barrier to positive and active aging. Ageist attitudes, biases and stereotypes exist in society and have an impact on how older people perceive themselves. By internalizing ageist attitudes, seniors may lack confidence, see themselves as a burden and not recognize their own skills and contributions. This in turn may limit seniors' opportunities for engagement with others, and may prevent them from trying new things, meeting new people, and being connected to their communities, all of which may negatively affect their health and well-being.
Ageism can take many forms and needs to be recognized and dispelled in general, and in community life specifically. The BIAS FREE Framework, developed by Canadian researchers and published by the Global Forum for Health Research, is a practical tool that could be applied to identify and address ageism. This tool has already been used successfully to eliminate service barriers resulting from gender, disability, age (with regard to children) and other such biases.25
In addition, the Federal/Provincial/Territorial (F/P/T) Committee of Officials for the F/P/T Ministers Responsible for Seniors completed The Seniors' Policy Handbook: A guide for developing and evaluating policies and programs for seniors, in 2009. Its purpose is to help policy analysts and program planners consider the perspective of seniors, the diversity of the seniors' population, and the needs and issues facing seniors today and in the future.26
Finally, participants encouraged the development of programs to promote positive images of aging, as well as, support intergenerational activities within the provincial and territorial educational systems.
Participants noted the following characteristics as being key to communities that promote positive and active aging.
Participants noted the importance of promoting physical and mental health and called for increased support for health promotion programs aimed at seniors, including those that promote active living, healthy eating, falls prevention, flu vaccination and blood pressure testing. Participants also noted the importance of ensuring that active living programs also promote positive mental health as it is an important component of positive and active aging. Opportunities to socialize, develop self-confidence and be valued by peers are especially important in this regard. Finally, some participants maintained that the cost of recreational and fitness activities was a barrier to participation in initiatives that promote physical and mental health.
Fundamental to promoting positive and active aging among seniors is ensuring seniors have social connections and are not socially isolated. Participants noted the importance of programs that encourage seniors to maintain social connections and promote community involvement. Examples of such programs included seniors' friendship clubs, community centres and recreational facilities that provide appropriate and stimulating programs targeting seniors.
Participants also supported the idea of creating programs that bring people of different generations together. These programs are mutually beneficial for both seniors and younger people. They prevent social isolation and provide an opportunity for seniors to share their experiences, wisdom and life skills with youth in their community, as well as learn new things from younger people. These programs also add to a reduction in ageist attitudes and a greater understanding of what it means to age. An example of these programs is the PHAC supported project entitled Across the Generations, which includes the development of an educational kit focused on youth in grades 4 and 5 to increase sensitivity and empathy about elder abuse and promote respectful intergenerational relationships.
The Government of Canada provides $28.1 million every year to the New Horizons for Seniors Program (NHSP) for projects that enable seniors participate in social activities, pursue an active life and contribute to their community. Since inception in 2004, the NHSP has funded more than 6,000 projects in hundreds of communities across Canada.
NHSP projects partner with organizations, community groups and Canadians to tackle complex social challenges. The reach of the NHSP is well demonstrated, but could be extended and/or leveraged further within communities to address priorities through multi-sectoral partnerships that enable seniors to contribute as a resource to their families, communities and economies. For example, a number of intergenerational community-based projects have already been funded. These projects bridge generations through seniors sharing skills, experience and wisdom with other age groups.
Finally, some participants noted that while funding is made available each year for new projects, there is little funding available for the continued support for existing projects. As a result, they called for the NHSP to consider providing more sustainable, longer-term funding to seniors' organizations to maintain their existing initiatives.
Participants noted that for people to age positively and actively, it is important that they have access to effective care services provided in their homes, communities or within care facilities. Participants also noted that as people age, they may move repeatedly across the spectrum of care, between receiving home care, care in the community and facility-based care, such as in hospitals or long-term care homes. This care may be provided by paid caregivers, such as nurses or therapists, or by unpaid caregivers, such as family and friends.
Given that the provision of many care services is the responsibility of the provinces and territories, a number of the issues, challenges and suggestions for action below are not within the federal government's jurisdiction. However, these have been included as a way to encourage dialogue across the jurisdictions as they work together to address the care needs of Canada's seniors.
In 1996, close to three million Canadians provided unpaid care for family members or friends with physical, mental, or cognitive impairments. A subset of caregivers are providing care specifically to seniors, a phenomenon that is anticipated to grow as the population ages. In 2007, 2.4 million or 72% of all care recipients were aged 65 and over. In addition, many of these caregivers are seniors themselves: in 2006, of Canada's 4.1 million seniors, 670,000 (16.5%) provided some form of unpaid care to another senior.
The circumstances under which families are expected to provide care have changed over the last 30 years. With the aging of the population, an increase in the incidence of disability, more women in the workforce, and the emergence of smaller, less traditional and more dispersed families, coupled with a trend towards deinstitutionalization, it is anticipated that the number of family caregivers needed in the future is likely to increase. Care is often more complex and required for longer periods of time. For example, some seniors report being on constant duty when providing care to spouses with such debilitating illnesses as Alzheimer's disease.
Caregivers are an essential component of the continuum of care, and are important to the sustainability of Canada's health care system. In 2008, the estimated cost of replacing those caregivers who provided care to seniors alone was estimated as high as $25 billion annually.
While caring for others can be rewarding, long-term or intense caregiving can cause caregivers to compromise their own health as well as their ability to lead balanced lives. Caregiving can negatively impact a person's health and well-being and can result in loss of sleep, lack of physical exercise, neglect of preventive health care and social isolation/exclusion. The consequences of family caregiving on physical health include back injuries, headaches and hypertension. Stress, burnout and depression are also examples of mental health impacts experienced by caregivers. In addition, caregivers can also face negative economic (out-of-pocket expenses, lost wages, reduced pensions) and social (exclusion/isolation) consequences as a result of their caring role.
Caregiving is emerging as a public health issue. In response, the PHAC is exploring ways to help community health providers become more aware of, and responsive to, the needs of senior caregivers. Roundtable participants called for further examination of the issue of family caregiving to better inform program and policy decision-making.
Participants noted the important role that home and community care plays to:
Participants noted that current community and home care investments are fragmented and called for increased investment in, and coordination of, community care by all levels of government.
Participants at several of the roundtables pointed to the success of the Government of Canada's Veterans Independence Program (VIP) and noted it could be expanded to provide a similar level of support to all senior Canadians. The VIP is a national home care program provided by Veterans Affairs Canada. It was established in 1981 to help eligible veterans and their primary caregivers remain healthy and independent in their own homes or communities. The program provides eligible veterans and their primary caregivers with health and support services, as well as home care services, such as grounds maintenance, personal care, nutrition and housekeeping.
The Government of Canada's First Nations & Inuit Home & Community Care Program assists people living on-reserve with chronic and acute illnesses to receive the care they need in their home or community. Care provided in these familiar settings allows First Nations and Inuit people to be close to their loved ones as long as possible and to keep their independence. Through Indian and Northern Affairs Canada's Assisted Living Program, the Government of Canada provides approximately $83 million annually to First Nations for the delivery of non-medical support services, such as in-home care, foster care, and institutional care.
While aging at home was identified as ideal by most participants, they also noted that some seniors must or will choose to live in long-term care facilities. These seniors will also need to be supported if they are to age positively and actively. Participants noted that long-term care facilities should provide opportunities for residents to access the range of community facilities which support active and positive aging.
To protect and support those living in long-term care facilities, the participants also called for the establishment of advocacy councils and committees that "look out for those in the home who cannot look out for themselves." Indeed, the prevention of elder abuse was identified as a key issue as abuse can be inflicted by a caregiver, a service provider, or other person in a situation of power or trust. Abuse can happen when a senior is living in an institution or a private residence.
Access to and availability of health care services was an issue of particular concern in some communities. Limited access to primary care family physicians in northern and rural communities was identified as a potential barrier to positive and active aging.
To address the issue of access to health care services, participants called for the federal government to encourage the recruitment of students and youth, through either an incentives program or a marketing campaign, into the fields of geriatrics and gerontology.
Participants noted the importance of ensuring that services provided to seniors in the community, in the home or in long-term care facilities, be provided in a culturally appropriate manner and in the seniors' language of choice. This was identified as particularly important to francophone seniors living in anglophone communities. Participants in the Iqaluit roundtable also noted the importance of providing services in Inuktitut, or other Aboriginal languages, and proposed that service providers offer translation services.
Participants noted the importance of transportation in accessing services that promote positive and active aging. Some participants called for safe driving programs while others noted the effectiveness of programs that provide free or reduced-fare public transit. Participants further noted that seniors living in rural and northern areas face particular barriers to transportation, such as limited or lack of public transportation.
One way the federal government supports seniors to meet their transportation needs is through the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE), which supports research on the health of drivers, the environment and infrastructure within which they drive, and options for retraining, graduated licensing and de-licensing. The federal government, through the PHAC, has also invested in the development of a National Blueprint for Injury Prevention in Older Drivers to enhance the capacity of older adults to maintain their fitness to drive for as long as possible and to maintain active engagement in life. The Blueprint outlines a number of priority goals such as promoting safe driving and mobility options for older adults and engaging policy makers to advance older driver safety issues.
Participants noted that the provision of services is only effective if the target audience is actually aware of these programs. There is a need to raise awareness of, and improve access to, information about existing community services and programs using tools that are accessible to seniors.
Participants noted that while more and more seniors access the internet, not all do. Communications should therefore be done using a variety of media—in print (newspaper, direct mail, magazine), online, television and radio. Similarly, information about programs and services may not reach seniors with low literacy levels or who do not speak or read English or French. Also, it is anticipated that as communities become more age-friendly there may be opportunities for Service Canada and other providers to enhance information access among older persons.
In addition to providing services to seniors, participants noted the importance of providing a community that is safe and offers effective protection for seniors. To ensure seniors are protected from abuse and exploitation, participants noted the importance of seniors' advocates.
The Government of Canada is taking action to combat elder abuse in all its forms—physical, sexual, psychological and financial, as well as neglect. In addition to the launch of the national awareness campaign, Elder Abuse – It's Time To Face The Reality, the Federal Elder Abuse Initiative (FEAI) provides funding to help professional associations, such as legal and health organizations, develop and disseminate information on elder abuse. Additionally, the NHSP includes an ongoing funding stream for elder abuse awareness projects. These initiatives reflect the advice the National Seniors Council gave the federal government to address elder abuse.
In November 2007, the National Seniors Council submitted the Report of the National Seniors Council on Elder Abuse to the Minister of State (Seniors), the Minister of Human Resources and Skills Development and the Minister of Health. After significant study and consultation with seniors, service providers, professionals, as well as social and community groups, the report included advice on ways to raise awareness and combat elder abuse and provided a number of examples for possible federal action. This report is available at www.seniorscouncil.gc.ca.
Participants noted that people cannot age positively or actively if they are living in poverty or are experiencing low income.
It is recognized that the Government of Canada plays a key role in contributing to the financial security of seniors. The retirement income system, including Old Age Security (OAS) and the Guaranteed Income Supplement (GIS), in conjunction with the Canada Pension Plan (CPP), has contributed significantly to the dramatic decline since 1980 in the proportion of Canadian seniors who are living below the low income line. In 2008-09, the OAS program provided $33.4 billion in benefits per year to 4.5 million recipients. This included $7.5 billion in GIS payments for low-income seniors. In the same year, the CPP paid over $28.9 billion in benefits to 4.4 million Canadians. The Government also provides significant support for low-income seniors in the form of tax measures. Some participants, however, called for increases to public pensions such as OAS and the GIS.
In February 2009, the National Seniors Council submitted the Report of the National Seniors Council on Low Income Among Seniors to the Minister of State (Seniors), the Minister of Human Resources and Skills Development and the Minister of Health. The report described challenges faced by low-income seniors and suggested five areas where action by the federal government could improve the well-being of these seniors. These five areas were: income; housing; transportation; health; and the delivery of services and benefits. This report is available at www.seniorscouncil.gc.ca.
The participants called for community planning and design that coordinates and supports positive and active aging. Participants at the roundtables pointed to the work of the WHO's Age-Friendly Cities program and the Canada's Age-Friendly Communities initiative as effective methods to design communities that facilitate positive and active aging. Projects for Age-Friendly Cities benefit people of all ages, not just older people, and provide guidelines for a wide range of audiences on how to create communities that are accessible to all. Participants noted that the Age-Friendly Cities initiative would be particularly effective at the local level and that it benefits every member of the community, provides guidance on the built environment and uses a holistic approach that focuses not only health, but social inclusion, housing, transportation and other factors that are vital to positive and active aging.
Participants also noted that seniors must be engaged and consulted in the design and planning of their communities.
Federal, provincial and territorial governments are working together towards the advancement and promotion of supportive environments for positive and active aging. The Forum of Federal/Provincial/Territorial Ministers Responsible for Seniors has endorsed the WHO's Global Age-friendly Cities Guide and was responsible for the development of Canada's Age-Friendly Rural and Remote Communities Guide. The Forum is now supporting the work of promoting healthy aging and age-friendly environments across Canada.
Finally, participants noted that current activity related to positive and active aging is fragmented. Canada has a number of innovative, successful pilot projects to promote positive and active aging, but information about these projects is not being broadly disseminated and therefore not reaching the wider population.
Participants noted the importance of developing a comprehensive understanding of the evolving needs of older Canadians and, given the aging population, Canadian society in general.
The Canadian Longitudinal Study on Aging (CLSA) will play a particularly important role in developing this body of knowledge. The CLSA is Canada's first, large-scale, long-term, comprehensive study that will regularly collect information over a 20-year period on the changing biological, medical, psychological, social and economic aspects of the participants' lives, starting at mid-life. The five year implementation phase of the CLSA is supported by the Government of Canada through the Canadian Institutes of Health Research and the Canada Foundation for Innovation. Considering the importance of the data and research resulting from this study, the Government of Canada should continue to support this research initiative.
In addition to the CLSA, a number of federal government departments and agencies are investing in research related to positive and active aging. For instance, Human Resources and Skills Development Canada conducts and commissions research on a number of related issues including: financial security of seniors; elder abuse; work-retirement transitions; income security in retirement for current and future seniors; the future performance of the retirement income system; and inclusion and well-being of immigrant seniors. HRSDC also conducts analysis, and develops policy frameworks, options and strategies to respond to emerging issues on retirement and aging, including the retirement income system, work-to-retirement transitions and the aging of society, among others.
The PHAC is involved in research and knowledge development and sharing in the areas of mental health, injury prevention and falls prevention. Canada Mortgage and Housing Corporation's (CMHC) research on seniors is designed to identify additional ways of enabling seniors to remain safe and independent in their homes (seniors aging in their place of choice), to further identify issues and solutions related to current forms of tenure, e.g., life lease housing, and to determine the implications of the aging of the Canadian population for housing and residential communities. A great deal of research and experimentation has been done on innovative housing designs and concepts, including universal design, barrier-free and adaptable housing, seniors' user-friendly homes, FlexHousingTM and examining strategies to help people with dementia to continue to live safely in their homes.
The participants also noted the importance of sharing and translating research into ways that can inform both policy and programs. The Interdepartmental Committee (IDC) on Seniors Research Subcommittee is one such venue for sharing research. The IDC on Seniors Research Subcommittee aims to advance knowledge and interdepartmental collaboration on issues affecting seniors and an aging population, and to provide the evidence base needed to support federal initiatives. The committee includes members from across the federal government and meets regularly to share information, coordinate research, identify knowledge gaps, data needs and emerging issues, and facilitate the translation of research into action.