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Findings

Like many nations, Canada is about to face an unprecedented era of population aging. From 8% fifty years ago, it is projected that Canadian seniors will comprise 23% to 25% of the population in about 25 years’ time.1 A major contributor to this demographic shift is the baby-boom cohort, defined as those born from 1946 to 1965.  The senior ranks will swell rapidly starting in 2011 when the first baby-boomers turn 65. Based on data from the 2009 Canadian Community Health Survey (CCHS)―Healthy Aging, this article addresses issues faced by the senior population, comparing them with people in the 45 to 64 age range.

The far-reaching social and economic consequences of the increase of the senior population have provoked debate about the availability and sustainability of health care resources.2-5 Central to this concern is the growing imbalance between the number of younger contributors to the social support system and the number of older beneficiaries of this support.3 Currently, Canada has, on average, five people of working age (15 to 64) to support each senior; by 2030, it is projected (based on a medium-growth scenario) that there will be three workers for every person aged 65 or older.1

Advancing age brings a greater likelihood of developing chronic conditions, many of which result in the need for informal support, medical care, medications, and institutionalization.6,7 In 2002, Building on Values: The Future of Health Care in Canada - Final Report focussed on the prevention of illness and disability, citing the importance of health practices related to smoking, diet and physical activity.4 Preventing, delaying, or at the very least, reducing the severity of chronic conditions would not only enhance individuals’ quality of life as they age, but might also ease demand on health care resources.5,8

This study provides up-to-date estimates of the prevalence of chronic conditions, good health, and factors related to good health for the household population aged 45 or older. Health is defined by a composite measure that includes self-perceived general and mental health, functional abilities and independence in activities of daily living. Each component of health is self-reported; respondents’ health status was not verified by any other source. Measures based on these criteria have been used in earlier studies8,12 and are consistent with the World Health Organization concept of health as being more than simply the absence of disease or infirmity.13 While chronic conditions are related to perceptions of health, functional abilities and independence, they are not part of the definition of health in this study. The presence of chronic conditions does not automatically exclude a person from reporting good health.

Eight factors that have the potential to affect health are examined in this analysis: smoking, body mass index (BMI), physical activity, diet, sleep, oral health, stress, and social participation.  While not an exhaustive list, these are some of the major factors for which data are available on the CCHS―Healthy Aging. Because of the cross-sectional nature of the data, temporal order cannot be inferred from associations between these factors and health. Longitudinal research has shown that many of these factors are predictors of maintaining good health and recovering from illness.12 However, it must be acknowledged that the relationships may also move in the reverse direction with health status affecting the selected factors.

The CCHS―Healthy Aging covers the household population; estimates from this survey do not represent the less than 1% of the population aged 45 to 64 and the 7% of seniors who reside in long-term health care institutions.11

Chronic conditions

The demographic shift over the last century took place in tandem with an epidemiological transition from mortality at younger ages as a result of infectious diseases, parasites and perinatal conditions to an era when degenerative diseases evolved as major health concerns.14 Degenerative diseases develop over a lifetime of behaviours, lifestyle factors and environmental influences, and so are more evident at older ages.

Results of the 2009 CCHS―Healthy Aging show that seniors were more likely than people aged 45 to 64 to experience a number of specific chronic conditions (Table 1). More than half of seniors, compared with about one-quarter of 45- to 64-year-olds, reported hypertension or the use of high blood pressure medication. Hypertension is a risk factor for other vascular disorders and a major cause of death.15 Arthritis does not cause death, but it can have a major impact on quality of life, because it is associated with disability, dependence, falls, fractures, and medication use.16-19 The prevalence of arthritis among seniors (43%) was more than double the prevalence among people aged 45 to 64 (20%). Like arthritis, back problems can affect quality of life;20 the prevalence of back problems was significantly higher among the older age group: 29% versus 25%. Although seniors were more likely than 45- to 64-year-olds to experience Alzheimer’s disease or other dementia and the effects of a stroke, these conditions were not common in either age group. People with dementia and stroke have higher odds of living in long-term health care facilities,6 so these conditions would not be expected to be highly prevalent in the household population.

Table 1
Prevalence of chronic conditions, by age group, household population aged 45 or older, Canada, 2009

Incontinence, too, is a predictor of moving to a health care institution,6 and like Alzheimer’s disease or other dementia and the effects of stroke, has a severe impact on health-related quality of life.21 Even so, more than one in ten seniors in the household population reported urinary incontinence.

Not surprisingly, as people age, they are more likely to have multiple chronic conditions.22 For example, 25% of seniors reported at least four chronic conditions, compared with 6% of 45- to 64-year olds (Figure 1). Coping with chronic conditions is challenging for the affected individuals,20,23 and for family members, friends and caregivers if the conditions result in greater dependency, hospitalizations and further complications.24-26

Figure 1
Percentage distribution of household population aged 45 to 64 and 65 or older, by number of diagnosed chronic conditions, Canada, 2009

Figure 1 Percentage  distribution of household population aged 45 to 64 and 65 or older, by number  of diagnosed chronic conditions, Canada, 2009

* significantly different from estimate for 45 to 64 age group (p < 0.05)
Source: 2009 Canadian Community Health Survey — Healthy Aging.

Good health

A sizeable percentage of people aged 45 or older were in good health, based on their self-perceived general and mental health, and measures of functional ability and independence (Figure 2). Understandably, the prevalence of good health declines with age, but even up to age 85, at least half the population were in good health in 2009. Among seniors, men were more likely than women to have good health, a difference that was not evident in the younger age group (Table 2). Higher levels of education were positively associated with good health, as was some form of shared living arrangement. As expected, the more chronic conditions people had, the less likely they were to have good health.

From 2000/2001 to 2009, the prevalence of good health rose significantly in almost every age group (Figure 2). The four factors comprising good health―self-perceived general health, self-perceived mental health, functional abilities and independence―each contributed to the overall increase (data not shown).

Figure 2
Prevalence of good health, by age group, household population aged 45 or older, Canada, 2000/2001 and 2009

Figure 2 Prevalence of good  health, by age group, household population aged 45 or older, Canada, 2000/2001 and 2009

* significantly different from estimate for 2000/2001 (p < 0.05)
Note: Depression used instead of self-percieved mental health for 2000/2001.
Source: 2009 Canadian Community Health Survey — Healthy Aging; 2000/2001 Canadian Community Health Survey.

Table 2
Prevalence of good health, by age group and other selected characteristics, household population aged 45 or older, Canada, 2009

Only the oldest seniors (85 or older) did not have a significant increase in good health over the nine years. The percentages reporting good self-perceived general health and functional health increased significantly, but the percentage who were independent in activities of daily living (ADL/IADL) decreased slightly (data not shown). This decrease may reflect changes in the ADL/IADL questions between the 2000/2001 and 2009 CCHS (see The data). The decrease in the prevalence of independence in ADL/IADL likely offset increases in the other factors, resulting in no net change over the period in the percentage of seniors aged 85 or older in good health.

Health-promoting factors

The development of chronic conditions is not inevitable. While genetic predisposition plays a role, factors within individuals’ control can prevent the development of chronic conditions or limit their severity. Eight potentially modifiable factors are examined in this study: smoking, BMI, physical activity, diet, sleep, oral health, stress, and social participation.

The vast majority of adults―84% of people aged 45 to 64 and and 91% of seniors―reported four or more positive tendencies with regard to these factors (Table 3). In fact, more than half (53%) of seniors reported at least six, compared with 37% of 45- to 64-year-olds.

Table 3
Prevalence of health-promoting factors, by age group, household population aged 45 or older, Canada, 2009

Fully 82% of seniors had either never smoked daily or had quit for at least 15 years, compared with 65% of the younger cohort.  As well, seniors were less likely to be obese and more likely to eat the recommended number of servings of fruit/vegetables. These differences may reflect a “healthy survivor effect,” whereby people who are non-smokers, eat well, and watch their weight have a greater likelihood of longevity. Alternatively, some seniors with health-promoting tendencies may have had health problems and responded with positive changes. Other differences may be associated with retirement or other age-related changes in how they use their time. For example, 57% of seniors reported low daily stress, compared with 34% of adults in mid-life. Seniors were slightly more likely to report frequent social participation: 75% versus 72% of the younger age group.

For the remaining factors, there were no significant differences by age. More than three-quarters of each age group reported sleeping well, and almost 90% had good oral health. Fewer than half were frequent walkers, the measure of physical activity.

Associations with good health

As expected, the number of diagnosed chronic conditions was negatively associated with good health (Table 2). At the same time, the modifiable factors examined in this study were each positively associated with good health. People who refrained from smoking, walked frequently and were not obese were more likely to be in good health than were those who did not have these characteristics. Positive associations were also evident between good health and frequent social participation, low daily stress, sleeping well, good oral health, and eating fruit/vegetables five or more times a day.

Health-promoting tendencies might be expected to cluster within individuals. However, when the eight factors were simultaneously controlled for in multivariate models along with socio-demographic factors, each was independently associated with good health for both age groups (Appendix Table A). For the most part, these associations persisted even when the number of chronic conditions was taken into account (Appendix Table B).

The results of the analysis suggest that the benefits of health-promoting tendencies are cumulative (Figure 3). Generally, with every additional health-promoting factor, the likelihood of good health increased. More than three-quarters (77%) of seniors who reported positive tendencies on all eight factors were in good health; among people aged 45 to 64, the figure was 92%. Although advancing age was associated with poorer health, a senior with positive tendencies on five or more factors was more likely to be in good health than was a 45- to 64-year-old with positive tendencies on two or fewer factors.

Figure 3
Prevalence of good health, by number of health-promoting factors and age group, household population aged 45 or older, Canada, 2009

Figure 3 Prevalence of good  health, by number of health-promoting factors and age group, household  population aged 45 or older, Canada, 2009

* significantly different from estimate for previous category in same age group (p < 0.05)
Source: 2009 Canadian Community Health Survey — Healthy Aging; 2000/2001 Canadian Community Health Survey.

Despite longitudinal evidence that many of the health-promoting factors have an impact on health,27,28 the cross-sectional nature of the CCHS―Healthy Aging does not allow the temporal order of events to be established. It is possible and probable that relationships between the health-promoting factors and health also work in the opposite direction. Ill health, for example, may interfere with the ability to exercise regularly, sleep well, and socialize. The experience of coping with chronic conditions may prove stressful. And illness may leave people without the resources to manage their weight, prepare healthful meals or optimize their oral health. Nonetheless, the importance of these factors in promoting good health remains.

Conclusion

Canada’s population is aging, and as the baby-boomers reach 65 during the next two decades, this demographic change will accelerate. The 2009 Canadian Community Health Survey―Healthy Aging indicates that even in the presence of some chronic conditions, 76% of people aged 45 to 64 and 56% of seniors living in private households (versus long-term health care institutions) had good health, based on their perceptions of general and mental health, functional abilities, and independence in activities of daily living. As well, Canadians in mid- to late life were slightly more likely to be in good health in 2009 than they had been almost a decade earlier.

A number of factors over which individuals have some control were associated with good health. Not smoking, weight control, regular exercise, fruit/vegetable consumption, sleeping well, oral health, stress reduction, and participation in activities with family and friends had a cumulative association with good health. A large majority of respondents reported four or more of these health-promoting tendencies.

Acknowledgement

Statistics Canada thanks all participants for their valuable input and advice during the development of the Canadian Community Health Survey―Healthy Aging. The survey content was developed by Health Statistics Division at Statistics Canada in consultation with Health Canada, the Public Health Agency of Canada, and experts conducting the Canadian Longitudinal Study on Aging (CLSA), a major strategic initiative of the Canadian Institutes of Health Research. Consultations also included stakeholders from Human Resources and Social Development Canada and provincial and territorial health ministries. The addition of 5,000 respondents aged 45 to 54 was funded by the CLSA.