Here They Come

When I was a teenager, a friend of my parents asked me what I was going to do when I grew up. I don’t remember my answer, but I vividly recall his reply. He said, “You should design decent retirement homes for seniors because they just might be ready by the time you need one.” That was four decades ago, and I never did take his advice. According to the community and regional planner Gerald Hodge, not enough of us have been thinking about the needs of seniors, and we had better get a move on. Hodge became a planner in the 1950s and spent his career designing communities for baby boomers and their young families. Now those baby boomers are aging a senior himself. To try to right the neglect, Hodge has written a highly practical book that explains the impact of the massive growth in the population of seniors and provides communities with a frame-work for response.

After reading Hodge’s book, I would propose elevating this issue to the status of a looming national disaster requiring an “Emergency Measures Operation” response, and I would put Hodge in charge. After all, if we knew that we were going to be hit by a tsunami within a short and predictable timeframe, surely it would be incumbent upon us to prepare. Not that this EMO-style response is to be found in Hodge’s book. Although he wants communities to address the challenges now, he disagrees with apocalyptic demography that draws dire conclusions based solely on the numbers of seniors. However, chapter after chapter of careful and comprehensive analysis lead Hodge to the following conclusion: “The impact of the seniors’ surge will be felt profoundly in all the communities in which seniors live, for this is where shortcomings in housing, transportation, home support, recreation, personal safety, physical infrastructure, and so forth will have to be confronted on a daily basis.” To deal with the impact, Hodge wants us to design “Senior-Smart” communities, and he tells us that very few municipalities have such plans in place. Since the surge of seniors will approach most communities in less than five years, maybe it is time to legislate community response studies from coast to coast to coast.

Hodge seems eminently qualified to head an EMO response team. The process he sets out in this book has the kind of in-depth understanding and applied knowledge that one would expect from someone whose textbook, Planning Canadian Communities: An Introduction to the Principles, Practice and Participants, is in its fifth edition. And he has the added advantage of experience. He concludes his book with a blow-by-blow description of what happened to him after he fell and broke his ankle and ended up becoming an example of his own statistics: a physically impaired community-living senior in a small island community on the coast of British Columbia. As he says, “I was not a frail senior when I started writing this book, but now I am much more aware of the realities that underlie the statistics and situations I’ve written about.”

Here is what lies ahead. The baby boom generation, born between 1946 and 1965, starts turning 65 in 2011, and we will be adding our numbers to the seniors already out there who are living longer than previous generations. There are about four million seniors today; from 2011 to 2021, that number will grow by nearly 40 percent, and by 2031 it will have almost doubled. At that point close to one quarter of Canadians will be seniors.

What might be lulling us into complacency about these figures is that we do not believe that people are automatically old when they hit age 65. We boomers are confident that we have redefined the “golden years” so that age 65 no longer has the significance it did for previous generations. And we are right. Canadian statistical sources use 65 as a threshold for old age since that is when retirement benefits tend to kick in and, historically, when health problems were expected to increase. But retirement patterns are changing, mandatory retirement has been abolished in several provinces and when it comes to health, our gender, income and ethnicity can be as much a predictor as our age.

So since we are all aging very differently, Hodge emphasizes the shakiness of using age alone as a proxy for neediness. Instead, he looks at an aggregate picture for seniors using 2001 data that consider living arrangement, income and health, and concludes that about 30 percent of today’s seniors require support in their daily activities, and they tend to be those over 80 years of age. (It is important to note that these figures do not take into account those needing institutional care.) As Hodge concludes, “the older the senior, the more likely he/she is to live alone, pay proportionately more for housing, not drive, be poor, and be frail.”

So to grasp the scope of the problem, it is more illuminating to use the gerontologist’s approach to labelling seniors by age cohort: old (65–74), old-old (75–84) and very old (over 85). Turns out that the numbers of both old-old and very old have been increasing, with the number of very old doubling from 1991 to 2006 to over half a million people. Hodge explains the impact: “the net result is that, compared to two decades ago, there are a greater number of seniors who are significantly more vulnerable to activity limitations due to health problems and who are also affected more substantially by changes in living arrangements and lower incomes.” In the decades ahead, the old-old and very old will continue to increase in both their numbers and in their share of the seniors’ population. By 2031 it is estimated that 47 percent of seniors will be 75 or older. But even beginning in 2011, Hodge warns that communities will experience a surge in the number of seniors who require home health services and institutional beds.

But we might remain unconcerned about even the projected numbers of old-olds and very olds if we believe that boomers are indeed zoomers, as Moses Znaimer calls them, and are confident that we will take aging in stride. (1) Hodge accepts that we boomers, as with every generation, will bring our own life experiences to our “golden years” and these will affect our needs, preferences and attitudes about aging. But what exactly might that mean? Certainly when it comes to attitude, it is clear that we want to redefine aging. We won’t tolerate agism, and we are determined to be in control of our own lives. But how different are we likely to be from our elderly parents and grandparents?

Let’s look at our health. On average, we are going to live longer, and our physical impediments may not occur until later in life. But since we are more likely to live until we are very old, we will be prone to dementia. In 2001, nearly one third of people over 85 required institutional care and as many as one half of the institutionalized very old suffered dementia (from Alzheimer’s and Parkinson’s diseases), requiring the most complex and costly care. So barring major medical advances, there will be many more of us at advanced years with physical and mental limitations. For fun, try out a couple of the life expectancy calculators that are available online. The calculator at <www.livingto100.com> predicts that I am going to live to 104. Even more terrifying are the results I received from <www. bluezones.com>. This calculator predicts that I’ll live to 98, but I’ll only be healthy until age 90.

On average, we are better educated and more affluent than today’s seniors, but the recent stock market meltdown has shown how quickly and dramatically our financial security can be affected by the state of the economy. Hodge points out that younger baby boomers (born between 1956 and 1965) are particularly vulnerable to financial instability and predicts that there will be substantial income disparity among seniors. Recent polls have found that many of us want to keep working past retirement age for reasons that include both financial need and desire for purposeful engagement. Extended participation in the workforce could shore up our financial resources, but that assumes we are able to find work.

One reason we might need money is to hire help to support us as we age. Because we boomers have redefined family and household composition, Hodge predicts that family support for the very old will be considerably reduced or even unavailable. This is worrisome when you realize just how much help seniors currently receive from their families. According to Statistics Canada, more than two thirds of those seniors who get help with work around the home, running errands or emotional support, receive it from a relative.

But even given the financial wherewithal to hire help, we will need to find the caregivers. Here we can look to Victoria, British Columbia, for a vision of the future. At nearly 18 percent seniors, Victoria is our “oldest” metropolitan area, and has been so for several decades. In the course of my own research, an 86-year-old longtime resident of the city informed me that she and her friends are finding it harder and harder to locate household help, and this is threatening people’s ability to stay in their homes.

Geriatric advocates may be somewhat new on the scene, but they are bound to multiply in the years to come. When adult children try to offer their parents advice about moving, retrofitting or hiring help, they tend to be consistently ignored, whereas when the advice comes from a professional, it is often listened to and followed. A good advocate can play a critical ongoing role in negotiating the terrain of seniors’ accommodation and caregivers.

One boomer advantage that Hodge does not mention is our comfort level with technology, which may facilitate our use of assistive devices. To get an idea of the kind of technology that might be available when we need it, look at the work being done by the Network for Effective Collaboration Technologies through Advanced Research (NECTAR at <www.nectar-research.net>). They are designing and evaluating electronic aids to help us carry on daily activities as we age and develop cognitive impairments. They envision tools (some of which many of us could use right now) to help us remember names, faces and appointments, and to find objects of importance such as glasses, wallets and keys. Other devices may be further in our future, including those that help us remember procedural instructions, such as taking medications, and help us communicate with distant loved ones.

Hodge recommends basing planning for Senior-Smart communities on two tenets: seniors’ independence and the concept of a continuum of care. He gives many examples of policies and programs for housing, transportation and community support that would support independence. Seniors can be maintained in their homes through programs such as Meals on Wheels, volunteer drivers and shoppers. Alternative housing can be made available in pedestrian-friendly, transit-accessible locations. Formal support can include home nursing, adult day care, seniors’ centres, recreation programs and transportation services.

More than half of the seniors who enter a hospital’s emergency ward do so because of a fall. If we do not redesign communities and our homes, our health system will collapse under the weight of our numbers. Perhaps the younger generation will decide to preserve our independence through strategies such as equipping all us elderly with personal airbags. According to an article in The Times of London last September, Japan has developed airbags for seniors with epilepsy to prevent injuries from falls. It is worn in a pouch around the waist and inflates to the size of three footballs if it senses a slip or misstep. As a cost-containment measure, one could follow the logic of seniors’ airbag legislation, reminiscent of the arguments for legislating seatbelts and airbags in cars.

Hodge’s second planning tenet, continuum of care, recognizes five stages of senior wellness, each covering a distinctive domain of care with its own standards and professional training. The continuum moves from the well elderly to the frail elderly living at home, to the functionally impaired elderly living at home, to the functionally impaired elderly living in facilities and requiring round-the-clock-medical care, to the ill elderly requiring intensive medical care. Most of us fantasize about a perfect old age that skips the continuum of care altogether. We dream of being a well elderly and then suddenly one day moving directly to the exit. Aging experts label our goal as compressing morbidity, which is perfectly captured by the carriage in Oliver Wendell Holmes’s poem “The Deacon’s Masterpiece.” The carriage is built so well that not a single part breaks down for 100 years. Then it collapses “all at once, and nothing first / Just as bubbles do when they burst.” According to Hodge, the odds of this outcome are not high. Instead, here is an all-too-typical example I encountered in my research: an 85-year-old husband who has moved three times in one year, partly living with his 84-year-old wife and, for the balance, visiting her several times daily in either a hospital or a long-term-care facility. He summed this experience up for me: “We’re not living longer—we’re dying longer.”

Looking back on that advice I received from my parents’ friend, I realize he was probably trying to improve prospects for his own old age by enlisting teenagers like me in the cause. Today I find myself in his shoes, wanting to engage younger people in creating supportive environments for my senior years. But the stakes are much higher now because there are so many more of us. If today’s young adults do not realize that they have no choice but to prepare for the seniors’ surge, it will swamp them.

Notes