Schulich School of Medicine and Dentistry

As the global population ages, the challenges related to aging have never been more significant. By 2050, the number of people aged 65 and older is expected to more than double, reaching 1.6 billion worldwide. Canada is no exception, with nearly 19 per cent of its population – around 7 million people – now in this age group. Leading the charge to reframe how we think about aging is Jane Rylett, a professor in the department of physiology and pharmacology at the Schulich School of Medicine & Dentistry and scientist in the Translational Neuroscience Group at Robarts Research Institute. Now beginning her second term as the scientific director of the Canadian Institutes of Health Research (CIHR) Institute of Aging, hosted at Western, she is committed to shifting the narrative from “chasing youth” to empowering older adults to live vibrant, healthy lives. In a recent conversation as part of the United Nations International Day of Older Persons, the global authority on aging and health care shared her insights on the health challenges of aging in Canada, along with the innovative research being led by Schulich Medicine & Dentistry in this critical field. Western News: What sparked your interest in this field? Jane Rylett: I come from a very long-lived family – my grandfather lived to be 103 and my mother and her siblings all lived to well advanced ages. So, I’ve always been around older people. As a PhD student, I worked with colleagues on Alzheimer’s disease and became very committed to understanding brain function and aging and strategies to promote brain health during aging. Research in my lab focuses on mechanisms regulating chemical communication in the nervous system in health, normal aging and disease. Given this global aging phenomenon, how close are we to becoming a ‘super aged’ country? JR: A super aged country, as described by the United Nations, is when 20 per cent of the population is 65 or older. Countries like Japan and Germany are described as super aged countries. The 2021 Statistics Canada data showed that 19 per cent of our population was 65 or older – that’s 7 million people. That’s a lot of older people considering Canada has a population of about 40 million. So, our demographics are definitely shifting and this is the fastest growing segment of the population in Canada. But with immigration of many older persons to Canada, we have a much longer tail on the baby boomer cohort going through. For example, in 2011 there were about 6,000 centenarians, and by 2022 there were closer to 14,000 – and that number is going to continue to double. So, we are certainly aging as a nation. Older adults represent the fastest growing demographic in Canada:

• Three times more Canadians aged 85+ by 2046 (2.5 million people)
• 16% increase in Canadian centenarians since 2016
• More Canadians aged 65+ than children under the age of 15

What health-care challenges do older Canadians face? JR: In developing the CIHR Institute of Aging strategic plan, we gathered insights from more than 2,100 researchers, health-care providers, community members and persons with lived and living experience of age-related conditions through online surveys, virtual town halls, workshops and interviews. We heard about the lack of appropriate housing and support systems for older persons, and the problems in long-term care, especially post-COVID. Sadly, we also heard a lot about ageism and the negative views that exist in society about aging. We also learned how the health-care system – really designed to meet the needs of relatively healthy young people with acute conditions – is not adequate to address the needs of older people with chronic conditions. Just engaging with the health-care system can be a challenge for older people. What did COVID-19 reveal about the state of health care for older adults? JR: The pandemic revealed real weaknesses in health care for older adults. Because older people may have more health challenges, when they got COVID, they were very much at risk of becoming much more ill, being hospitalized and maybe needing intensive care. Early in the pandemic, about 80 per cent of the people who died from COVID in Canada were older adults. This perpetuated an ageist attitude that was actually harmful to the self-esteem of older people, and created a negative perception about their value to society. We are looking at this problem and its solution in our strategic plan and how the health-care system must adapt to meet the needs of older persons. The pandemic has revealed real gaps in care for older adults in Canada:

• Restricted health care
• Profound mental health impacts from isolation
• Limited self-determination and decision making
• Increased incidences of cognitive impairment, dementia and frailty

What are some of the myths about aging and how are you reframing aging in the CIHR’s Institute of Aging strategy? JR: Aging is not a negative thing, but a change that happens to us as we go through life. As we age, we may have increased challenges related to our health. In fact, nearly 75 per cent of people aged 65-plus have at least one of 10 chronic diseases – from high blood pressure to periodontal disease or cancer. Three quarters of people age 85 have at least three of these chronic conditions. So, it’s assumed that older persons have some chronic condition, have medications and must interact with the health-care system. But that doesn’t mean they’re not living well. This is an important point. You can live well with these chronic conditions as long as they are managed, the health-care system is supporting you and you can interact with your environment. “Chasing youth” denies the fact that, as an older person, you can live well, meet your goals and have a positive life. So, we don’t want to chase youth; we want to help people live their best life during the aging process. We hear a lot about ageism. Can you define it and tell us about its dangers? JR: Individuals exposed to ageism not only have a decreased self-worth, but it also negatively impacts and their mental and physical health. Even a benevolent form of ageism – where we might restrain an older person’s activities for fear of injury – will limit the person’s ability. Often it will cause older people to retreat, to age more rapidly, and lose their abilities. So as part of our plan, we have a student doing an extensive literature review around ageism in the Canadian context. Information gathered will be used to develop strategies to engage on reducing ageist attitudes. How is increased life expectancy aligned with socioeconomic factors? JR: In 1961, life expectancy in Canada was 71. In 2015, it was 82. Now it’s over 84. So, you can see how life expectancy has increased, and we expect that trend to continue. But this is in middle class to wealthy neighbourhoods. Life expectancy for men in lower socioeconomic regions is now only 76. As we reframe aging, we must also consider the critical question of health equity for all as they grow older. What are the critical changes our health-care system needs to better support older adults? And are there examples of countries that are already doing this well? JR: One of the critical priorities in our strategic plan is adapting the health-care system to meet the needs of older persons. For example, our ERs are not designed for the increasingly large populations of older persons that come in with more serious health issues that may require more intensive care in addition to the acute problem that brought them to the hospital. Another challenge is to ensure continuity of care so that people don’t fall through the cracks. This can be maintained through access to subspecialties – like dieticians, physiotherapists, occupational therapy, cognitive health support – all coming together to reduce the transitions in care. Housing that is adapted to meet the needs of older persons is also important. Advances in smart home technology – from monitoring a person to alert to a fall, to in-home monitors for heart rate and respiratory – make this much more accessible to older persons. The challenge in rural and regional areas is adequate access to the Internet and a comfort with technology. There are countries getting it right. Scandinavian countries have great community-based support for older persons, housing that is suited for their needs and preventative lifestyle modifications that make better living possible. Japan has the longest living population and it has a tradition of intergenerational integration and support. While Canada can learn some very important lessons from these countries, we are seeing some interesting developments taking place. In B.C. for example, there’s a movement toward naturally occurring retirement communities, older people coming together to support each other, whether it’s acquiring housing or other needs together; basically, pooling their resources to acquire the support services they need. What are some of the ways research and researchers must adapt in order to bring a more evidence-based approach to aging? JR: We’re working very closely with the CIHR’s Institute of Human Development, Child and Youth Health to make a “whole life span approach” to health a normal part of research. This is a critical issue, and we are taking leadership around sex- and gender-based analysis and research issues. It used to be that mostly men were studied on health matters, so we know lots about men and cardiovascular disease and heart attack. We really didn’t know anything about women. When we looked at cardiovascular disease in women we realized the symptoms are totally different. If you look at residences and long-term care facilities, women definitely outnumber men. However, women have a higher incidence of Alzheimer’s disease, for example. We’re also arguing that all age groups need to be included in studies to ensure that we understand the differences of a particular drug across all ages. We’re also looking at gender diversity and different cultural groups to ensure they are included in studies. Some of the strategic funding opportunities that we develop and give to the research community will look at the underpinnings of social and structural determinants of health in certain groups and how we can address these disparities within the health-care system. When you talk about health equity, I’m glad to say that researchers are now making sure that older people, as well as people from different backgrounds, are part of clinical trials.

Rylett’s tips for changing aging research

• Older adults and concepts of age and aging must be included in research activities
• Older adults must be recognized as bringing significant value, contributions and opportunities to their communities
• Persons with lived and living experience should play a key role in research across the entire research ecosystem
• More Indigenous perspectives on aging are needed in research activities
• Ageism and stigma against older adults are critical social and structural determinants of health