The silver tsnuami shift

Some call it the silver tsunami—a massive wave of aging baby boomers now entering their retirement years; a demographic so large it will—according to the popular meme—overwhelm our health-care system and wreak havoc on everything from pensions to public services.

Not so fast, say researchers at the University of Saskatchewan, including Dr. Jenny Basran (MD’98), head and associate professor at the College of Medicine’s Division of Geriatric Medicine.

“I’ve heard the ‘tsunami’ term used to describe aging boomers, but I don’t use it. It not only implies a wholly destructive force, it also implies that we don’t know it’s coming. Neither is accurate.”

Basran is one of many at the U of S exploring ways and means to prepare our health and social systems to meet the future needs of aging baby boomers.

For the first time, Canadians aged 65-plus outnumber children under the age of 14, at 16.9 per cent versus 16.6 per cent of the population, respectively. Although Saskatchewan’s population is younger than the national average (65-plus make up 15.5 per cent of our population), things get interesting when you break out the baby boom cohort born between 1946 and 1964. Using recent data from the Saskatchewan Bureau of Statistics, ages 53 to 71 make up 21.7 per cent of our provincial population (add another 8.7 per cent for ages 72-plus). As a cohort, boomers are healthier, wealthier and living longer than any generation before.

“The fact that baby boomers are living longer is a big success story for medicine,” Basran said. “People are surviving heart attacks, strokes, cancer—that’s good news. But it also means that more people are accumulating chronic health conditions as they age.”

Multiple chronic conditions make diagnosis and treatment more complex. An 85-year-old, for example, might arrive at the hospital ER with a broken hip due to a fall—a clear-cut issue with a clear-cut response. But what if the patient also has osteoporosis, diabetes, cardiac issues, dementia, high blood pressure or all of the above?

“Our health system was designed for a population that didn’t live as long,” Basran said. “Hospitals were there for short-term trauma care, family doctors provided day-to-day care. But that’s not what we’re seeing. Family physicians are seeing older patients come in with a variety of vague symptoms. We see people in hospital because of multiple chronic disease; they’re not acutely ill, but they’re also not well enough to go home or live on their own. That’s why we’re exploring continuity of care and team-based care.”

As Saskatchewan’s only geriatrician, Basran’s expertise is in demand on many levels. She is physician co-lead for the province’s Emergency Department (ED) Waits and Patient Flow Initiative and co-chair of the Senior Home Visit Initiative. She has worked with health regions to restructure clinical services to meet the growing demands of an aging population, and she continues to work with engineering and computer science colleagues at the University of Saskatchewan on the development of a falls detection system for older adults. 

One area that has her particularly excited is computer simulation modelling to improve patient flow, a collaboration with the Saskatchewan Health Quality Council and Nate Osgood, professor in the Department of Computer Science. Modelling allows policy makers to use what-if scenarios to explore how changes in one area can affect other areas.

“This is an area where I think Saskatchewan is leading,” Basran said. “The computer model is based on health data in a specific health region or area of care. By taking a deep dive into the data, you can identify the unmet needs in an area of care or a region, go to the literature to find best practices, review what’s already in place and then fill in the gaps.”

By allowing for what-if scenarios, the computer model also helps stakeholders see how changes in one area might affect the larger system.

“Basically, it allows best practice for specific jurisdictions,” Basran said. “What works well in a small town like Cabri, for example, might be very different than what works well in an urban centre like Saskatoon.”

A recent initiative by the Health Quality Council is based on this work. Computer simulation models are being used to explore various what-if scenarios as part of the ED Waits and Patient Flow Initiative.

Basran is also involved in creating team-based care in hospital and community settings. “We’re exploring ways to bring the various resources of community care together to offer team-based care in specific geographic areas. This allows us to be more responsive to patient needs, and also to link with community partners and associations.”

The common thread through much of Basran’s work is keeping people healthier longer and to delay the need for more complex or acute-care services. This will help create capacity so the health-care system is ready when baby boomers start entering their 80s.

“Boomers have a strong voice; they will demand a different way of handling their health issues as they age,” Basran said. “As a generation, they’ve changed every single thing they’ve touched since the 1960s, and I think they will change the concept of retirement and aging well.”

Though the full extent of the effects a growing aging population will have on society is unknown, one thing is certain, incidence rates of diseases and illnesses like Parkinson’s, Alzheimer’s, arthritis and dementia are bound follow an upward trajectory; and U of S experts in varied disciplines are grappling with these issues.

For Alexander Crizzle, a gerontologist and assistant professor in the School of Public Health, improving safety and quality of life for older adults is a key research focus. Crizzle is exploring mobility issues through a variety of lenses, notably driving, alternative modes of transportation, rehabilitation interventions and fall prevention. His research aims to help people age in their own homes and remain engaged in their communities for as long as possible.

“If we can improve aging in place for seniors right now, it will impact quality of life not just for baby boomers but also future generations,” Crizzle said. “We don’t have the necessary infrastructure to handle the volume of baby boomers coming, so we’re trying to put that in place.”

Crizzle’s first foray into research was a six-week pilot program to test hydrotherapy on people with Parkinson’s at the local YMCA. The success of the pilot encouraged him to follow up an undergraduate degree in kinesiology with a graduate certificate in gerontology, a master’s degree in public health and a PhD in health and gerontology. His dissertation examined the driving behaviour of those with Parkinson’s compared to age-matched controls.

Driving remained the focus of his research during two post-doctoral positions, one at the University of Florida, the other at McMaster University. There, he used 3D modelling software and force plates to quantify falls as older adults exit and enter vehicles. The study, which is still underway, will inform future changes to vehicle design.

Crizzle has brought several research projects to the University of Saskatchewan, including two international collaborations. He is the lead researcher on a national study tracking causes and rates of common injuries in middle-aged Canadians, a study launched in collaboration with the University of Bordeaux in France.

“The University of Bordeaux has been using a longitudinal study to track injury types and rates as people age for over 25 years. Every five years, they conduct the same survey with the same cohort, who are now in their late 60s and 70s,” Crizzle said. “The international partnership lets us adapt the study to Canada. It also means we can compare injury prevention policies on an international level, which could potentially lead to improved systems in Canada, particularly for the elderly.”

Crizzle is also supervising a graduate student who is using the cohort data to look at the impact of common medications, such as anti-depressants and anti-psychotics, on the risk of senior falls.

The risk of falls is the focus of Crizzle’s second international collaboration, this one with the University of West Indies in Barbados.

“In Canada, we have well-developed, well-maintained urban infrastructure, like roads and sidewalks. In Barbados, infrastructure is not so well-developed or well-maintained. We’re looking at falls and walkability in these very different environments. Do well-maintained sidewalks improve mobility and prevent falls? We’re also linking diet and physical activity to walkability and general sense of life-space mobility. Does improved infrastructure, such as easier access to services and amenities, result in more life-space mobility, and hence better health?”

Crizzle points out that his findings, particularly research on driving-related injuries among older adults, are not meant to take driver’s licences away from older people.

“The goal is always to improve safety and quality of life, not take things away. So when someone can no longer drive, how do they maintain their mobility and social connections?”

This question led to a new initiative funded by the Saskatchewan Health Research Foundation on alternate transportation. Crizzle is involved in other research initiatives as well. In each, he tries to involve stakeholders—policy makers, planners, agencies and associations—as well as researchers and students.

“I can do the research and present the findings,” he said, “but without the involvement of stakeholders, those findings just sit there. My focus is to collect data that informs change.”

Between 1921 and 2005, average life expectancy in Canada rose from 59 to 78 years for men and from 61 to 83 years for women. By 2031, average life expectancy will rise to 82 years for men and 86 years for women.

Adding 20 years to the average lifespan puts the notion of retiring at age 65 in a new light. The financial implications are sobering as more baby boomers are heading into retirement with debt.

“I’ve heard of people outliving their savings, and these would be scary situations,” said Brian Lane (BComm’00, MBA’02), assistant professor in the Edwards School of Business and a certified financial planner (CFP). “A lot of people working today don’t have a defined benefit pension, and fewer companies are offering one, so more financial responsibility for saving for retirement is placed on the individual.”

Advisors caution against depending on Canada Pension Plan and Old Age Security—not because it will disappear, but because it won’t provide for the kind of lifestyle most of us, boomers to millennials, have come to expect.

Lane thinks the first step in saving for the future is simply acknowledging that you might, in fact, live beyond 80.

“Some advisors are even suggesting people use age 95 as their ‘terminal’ age when planning for retirement,” he said.

Lane suggests using three simple rules to save for the long-term: spend less than you make, make savings automatic and significant, and make giving automatic and significant.

Rule one is the cardinal rule, but it’s become something of a tough sell in our credit-addicted society.

“Credit is debt—that’s a message I give my students,” Lane said. “Seniors aren’t immune to easy credit either, so I think it’s more important than ever to be diligent. When you borrow money, you have to pay it back, and you’re going to pay back more than you borrow.”

The second rule is also a common sense stand-by. Lane likes to use an analogy with his students: “The Canada Revenue Agency automatically deducts tax from your paycheque. If tax payments are treated with this much importance, perhaps we should treat our personal savings deposits in the same way.”

In Lane’s opinion, the concept of retirement does not have to include the traditional "full-stop" at age 65 and can follow a more flexible model.

“I don’t look forward to a traditional retirement, personally. I think the trend among boomers will be to take on more flexible work, the kind of work they want to do. That way, you earn an income and you stay busy, happy and healthy.”

And the dream of Freedom 55? “Think about it,” Lane said. “To full-on retire at 55, you would essentially have to earn enough in 30 to 35 years of work to fund 40 years of retirement. That’s a tall order.”