Seniors Health

Alberta’s population is aging. In 2019, 13% of Albertans were aged 65 years and older, while this percentage is expected to increase to 20% by 2046. Both the proportion of people aged 65 and older and the annual growth of this age group have been increasing rapidly since the start of the decade, specifically since 2011 when the first baby boomers turned 65.

The aging trend is faster in rural compared to urban areas due to several reasons:

• Retired Canadians are moving to rural communities in growing numbers
• Youth aged 15-19 years are leaving
• There are fewer births in rural communities

This shift in demographics means that rural communities need to pay closer attention to their growing number of senior residents. Seniors are the backbone of many rural communities – they are often leaders of municipal governments and long-standing members of service organizations and churches. They also volunteer in great numbers for local causes.

Many seniors want to stay in their communities with their families and friends and an often strong social support system they can draw on. They enjoy the slower pace of rural life and the sense of community with ample volunteer opportunities.

There are big differences in the percentage of seniors that live in rural communities. For example, seniors accounted for more than 20% of the population in the districts of Hanna and Pincher Creek. In contrast, the districts of Wood Buffalo, Slave Lake and Grande Prairie had the lowest percentages of seniors in 2019.

Despite these geographic differences, seniors will make up a growing proportion in most rural communities in Alberta. This will impact future infrastructure and program needs in rural communities.

A study funded by Veterans Affairs Canada asked the question, “what makes a rural community a good place to grow old?”. The findings showed that seniors are a diverse group with diverse needs. They rated several social and structural factors as important to rural aging:

• Friendly and welcoming communities with opportunities to stay active and productive;
• Family and good neighbours close by;
• Affordable housing; and
• Good basic infrastructure (i.e., health and social services, transportation).

Rural communities have recognized the need to develop local programs and infrastructure to support the health and wellbeing of seniors.

The aging of the population around the globe means that we need to create cities and communities where seniors can live safely, enjoy good health, and stay involved.

In 2007, Canada launched its own study that focused specifically on rural communities in a Canadian context. The study considered things such as outdoor spaces and buildings, transportation, housing, opportunities for social participation, employment, and community support and health services.

Building on this work, the Alberta Government has created a guide for communities on how to become more age-friendly. Strategies might include snow removal on walkways and public places, personalized service and information instead of automated answering services, or easy access to neighbourhood stores and services. While this initiative does not target rural communities specifically, many of their suggestions are relevant for the rural context.

The Government website has many practical tools including a video that explains the pillars of age-friendly communities, the steps to get started, and the impact of becoming age-friendly.

Many rural residents lack access to transportation. This is a difficult issue for older adults that lost the ability to drive and rely on transportation to receive health care services. Creating cost-effective transportation systems in rural communities is challenging for many reasons:

• geographic barriers, such as sub-optimal road infrastructure; long travel distances and unsafe driving conditions;
• population-based barriers, such as low population density and low demand for service; and
• structural barriers, such as small tax base to fund services; limited coordination between existing transportation systems.

Access to transportation in rural communities is a social determinant of rural health. Mobility restrictions have consequences for the health and well-being of older adults. Without access to transport, rural seniors are more likely to delay medical appointments, preventive care, and health maintenance activities. They are also more vulnerable to social isolation, which can lead to an increased risk of illness and death.

 Older adults who stop driving take 15 percent fewer trips to the doctor, 59 percent fewer shopping trips, and 65 percent fewer social, family, religious and other life enhancing trips.

While the rural transportation issue for older adults is not new, the aging of rural communities make the challenges more acute. Also, as older adults will experience longer life spans, many of them will outlive their ability to drive and increasingly depend on alternative transportation for access to health care services.

New technologies may help solve some of the rural transportation challenges:

• More sophisticated transportation systems hardware and software can help integrate various rural transport services (public, private and volunteer transport services) into a single platform. This would lead to more efficient scheduling and dispatch of rides.
• Technology such as sensors, software, and drones can help improve real-time monitoring of rural road conditions and lead to better road safety.
• (Semi-)Autonomous vehicles can help seniors drive longer and increase their safety by avoiding accidents.

Some countries are moving towards a new transportation paradigm, Mobility as a Service. Rather than relying on ones own car, transportation can be accessed from a menu of options. Such a service would benefit everyone, regardless of income, geographic location, race/ethnicity, disability, or age. This could reduce inequities of our current transportation system, where non-drivers go underserved.

These solutions may all seem in the distant future; However, there are some interesting rural transportation initiatives in Alberta:

• The Rural Development Network pioneered the Battle River Bus (BRB), a regional transportation option for the Battle River Region.
• Maskwacis Medical Transportation provides transportation for clients living on reserve to access necessary medical health services.
• The Rural Transportation Pilot Program by the Government of Alberta has six pilot projects going that connect rural communities to local centres.
• The Alberta Government has a guide for rural communities how to plan for transportation services.
• The Northern Alberta Development Council prepared a review of best practices with case studies on rural transportation systems.

Frailty is a medical condition of reduced function and health in older individuals. Typical symptoms of frailty are unintentional weight loss, muscle loss or weakness, fatigue, slow walking speed and low levels of physical activity. Not all older people are frail, but aging increases the risk of becoming frail.

The health of frail adults can quickly deteriorate, and they need comprehensive and well-coordinated care.

The Canadian Frailty Network is a national network that tackles the issue of frailty. Their mandate is to improve the care of older adults living with frailty and support their families and caregivers. The network has a research arm and several projects specific to rural communities. They also have helpful videos on their website that explain how frailty impacts the lives of seniors and their families, like the one below.

Physical activity and exercise can prevent or delay the progression of frailty or even reverse frailty. The Rural Route to Active Aging is a guide for people who want to stay active as they age in rural communities. It is filled with information about the benefits of being active, how to prepare to get active, and activity ideas.

Like other jurisdictions, Alberta has been promoting ‘aging in place’, generally understood as being able to remain in familiar homes or communities for as long as possible. The idea is to promote independent living in later life, while shifting care for the older adults from institutions to home and community. Independent living is not only a cost-effective option compared to long-term care; it is also what most seniors want.

As chronic diseases and physical limitations increase with advancing age, living independently becomes more challenging. The recent focus has therefore changed to ‘aging in the right place’. This vision includes expanding alternative housing options such as group housing, active adult communities, or senior apartments where seniors can feel comfortable, competent, and in control. Smart homes are such an innovative housing option that might work well in the rural context.

Smart homes are equipped with technology that encourages a resident to stay healthy and independent. They may have features like stove use detectors, door locks, or automatic lighting. Smart homes may also be equipped with biomedical devices that help monitoring a resident’s health status (e.g. vital signs). Newer features might include smart sensors for falls detection or alerts for missed medications.

Smart homes are meant to build a bridge between independent living and assisted care facilities. Having a smart home could allow older adults to live independently for longer.

Bassano is in the process of integrating seven smart homes designed by an Alberta company. If successful, these smart homes may soon be a common sight in many rural communities.

Social isolation, or a lack of meaningful contacts with others, is on the rise. Social isolation is a special problem for seniors living at home – exactly where most want to remain when they age.

Some of the factors that increase the risk to become socially isolated include:

• being age 80 or older and living alone
• having health problems
• having no children or contact with family
• lacking access to transportation
• living with low income
• being a new immigrant

Critical life transitions such as retirement, death of a spouse, or losing a driver’s license increase the risk of becoming socially isolated. Even married couples can be socially isolated if they have no meaningful contacts aside from each other. Informal caregivers of older adults are at greater risk of becoming socially isolated, given that caregiving can be a very confining experience and occur over prolonged periods of time.

Social isolation comes at a great personal and societal cost: Socially isolated older adults tend to be sicker, have higher health care cost and die sooner than well-connected seniors. They further tend to have more difficulties with activities of daily living and suffer from depression.

Staying connected as a senior is not easy, but it has always been the way of rural living.

Communities are creating different programs to keep seniors socially connected. These include social recreation and support programs, friendly visiting programs, or telephone outreach.

Check out the Government of Alberta website for helpful resources on social isolation and how to stay connected as we age. The Government of Alberta proposes a social innovation approach to address social isolation.

 Social innovation is the process of diverse partners from public, private and non-profit sectors combining their funds, expertise and assets to address community-wide challenges.

Such an approach makes sense since social isolation has many causes rooted in poor health, low income, social status and lack of transportation that require collaborative solutions. The toolkit has a series of examples of social innovations solutions in Canada, many of the from rural communities.

In other parts of this Seniors Health section, we have highlighted the trends of an aging population in Alberta, in particular in rural areas. The emerging population of seniors, which includes the baby boomers, differs from the current generation. Future seniors are expected to be more educated and technology savvy, culturally diverse, and have higher incomes. With different lifestyles and demand for choices, they will influence the types of continuing care services provided in the coming decade.

Alberta has three levels of continuing care services:

1. Home care services that provide nursing, rehabilitation, and personal support services to clients in their own homes;
2. Supportive living services in congregate settings that offer accommodation, meals, housekeeping, and social activities as well as professional and personal support services; and
3. Long-term care (LTC) services that offer 24-hour residential nursing and personal care for clients with complex care needs.

Since the 1990s, provincial investments have focused on home care and supportive living as a way to support independent living and aging in place.

Despite the growing desire for independent living and aging in place, LTC services will likely increase in importance. The most rapid growth in seniors will be in people aged 80 years and older. It is estimated that one in three seniors over 85 will have age-related dementia, often paired with other chronic health conditions. Caring for these seniors is challenging and complex and often exceeds the capacity of family caregivers. As a result, many of these seniors will become residents of nursing homes, especially in advanced stages of dementia.

The initial stage of the COVID-19 pandemic has been extremely difficult for residents, their families, and staff of LTC homes, which have seen a tragic number of deaths amongst their seniors. These events have triggered federal and provincial reviews of LTC services with a commitment to change.

Any future LTC planning needs to consider the rural context. LTC homes are crucial for rural communities as they offer 24-hour nursing care close to home. This allows residents to remain connected with their people, community, and way of living. The Hythe Continuing Care Centre in northern Alberta managed to create a care environment where seniors thrive. Everything from food to staff and quality of care is outstanding, and a result of ongoing improvement efforts. The centre received the inaugural RhPAP Rhapsody Health-care Heroes Award in 2018.

Nursing homes are not just care facilities but social environments. Many care homes welcome visits from families, volunteers, children, and pets to create a sense of home. Creative, interactive recreation programs can also be effective ways to engage residents and foster social interaction. Nobody knows this better than Nicole Kulba, a recreational therapist at the Tofiled Health Centre.

The global aging trend has created shifts in LTC design. Newer nursing homes are designed to specifically support the physical and social needs of residents living with dementia. They feature evidence-based designs that support independence, orientation, and wayfinding. The nursing homes have smaller pods of residents, more spaces for family interactions, and outdoor areas that people with dementia can safely enjoy. Dementia villages, originating in Holland, emphasize quality of life for people with dementia by providing person-centred care in smaller scale and more home-like environments.

Farms for people with dementia have been established in Germany, Norway, Holland, and the UK for some years. Care farms combine agricultural activities with care and support services for a variety of client groups, including people with dementia. Farms and the agricultural environment are used to promote mental and physical health.

Research has found that farm-related activities such as feeding and observing animals or walking in nature can bring back memories and contribute to the well-being of older persons with dementia. Many care farms are established in rural areas with limited infrastructure. This has the added benefit of supporting the local economy and increasing awareness of mental illness among the rural population.

As Alberta gets ready for the new generation of seniors, innovative care models can enable seniors to remain connected and engaged in their communities as they age.