The Last Scene

Fortunately, the prospects for playing out life’s last scene have never been better. For one thing, most Canadians in their 80s are no longer “sans teeth” and “sans eyes,” thanks to better dental care and advances in cataract surgery.

Life expectancy in Canada rose steadily during the 20th century and reached record highs in 1998: 76 years for men and 81 years for women. On average, today’s seniors can expect to live about 20 years longer than their grandparents – the estimated life span for that generation was just 59 years.

The Queen Mum might be the world’s best-known centenarian, but she is by no means alone. Some 3,700 Canadians have already reached age 100, and that number is likely to double over the next 20 years. While life expectancy won’t continue to rise indefinitely, health-policy analysts predict further increases because fewer older people are smoking.

Closer to home, we can take inspiration from the likes of artist Doris McCarthy (BA Woodsworth 1989). McCarthy retired in 1972 after 40 years of teaching art, but continues to paint every summer at a Georgian Bay cottage and is writing her third book. “My passion for my work energizes me,” she says. A living example of lifelong learning, she went back to school and earned a BA in her 70s, and tries to take a course every year at the University of Toronto at Scarborough.

McCarthy, 91, is the perfect rebuttal of Shakespeare’s rather grim characterization of old age. Although her hearing and distance vision are “no great shakes,” she drives, does her own housework and until recently, was able to read without glasses. She still lives in her own longtime home, which she calls “Fool’s Paradise,” overlooking the Scarborough Bluffs. Her landscapes have been exhibited at the McMichael Canadian Art Collection in Kleinburg, Ont., but she calls her home her most precious work of art. “I plan to live there until I’m carried out,” she says.

“The elderly are getting healthier all the time,” observes Dr. Michael Rachlis, health policy analyst and associate professor in the department of health policy, management and evaluation. “Old people today have less disability than their historical peers.”

But will the curtain close on a happy ending for the increasing ranks of the elderly? In just 15 years, seniors will outnumber children in Canada for the first time, and the health-care system and other social programs may become strained to the snapping point. In 25 years, the first baby boomers will turn 80. That’s when some fear the health-care system may finally fall apart, as elderly boomers in their 80s flood the system and overwhelm society’s ability to care for them.

However, we shouldn’t blame old people for rising hospital costs, says Rachlis. “It is illness and dying, not aging itself” that are associated with high medical costs. We need to make better use of our resources, and if we are smart about it, he says, better care for the elderly won’t break the bank. For example, instead of paying physicians to teach diet and preventive care in 10-minute office visits, more nurses, dietitians and social workers should be available to provide patient education for elderly people with diabetes. According to Rachlis, the system also needs more palliative and hospice care for sick, elderly people – particularly cancer patients, who would prefer to die away from expensive hospital settings.

One underserved area that affects many people in the last stage of life is home care. Only a small percentage of Canadian seniors receive some type of health care at home (estimates vary from three to 12 per cent), and that’s a pity, says Dr. Peter Coyte, professor of health economics and co-director of the Home and Community Care Evaluation & Research Centre. He calls our current approach to health care short-sighted. “We have a Cadillac health-care system we can be proud of when it comes to doctors and hospitals,” he says, “but when it comes to services like rehabilitation, physiotherapy, chemotherapy, dialysis, wound care, personal attendants and nursing homes, the system is bankrupt.” If the system doesn’t do a good job of providing health care when people need it at home, it’s going to cost Canadians more: more for emergency and acute care; more for premature institutionalization of the elderly; and more to treat family caregivers dropping from stress-related illnesses, says Dr. Coyte.

Will we have enough health-care providers – family members and professionals – by the year 2025, when the baby boomers become octogenarians? The simple answer is no, according to Dr. Alex Jadad, a professor of health policy, management and evaluation. “We don’t have enough doctors, nurses, medical technologists, physiotherapists and personal attendants now,” he says. But Jadad thinks the natural laws of supply and demand will kick in eventually. Indeed, young people making career choices now who want to ensure they won’t ever be out of work would do well to consider the health-care field.

When it comes to health and well-being, how are older Canadians doing right now? About seven per cent of Canadians over 65 live in a retirement residence, chronic-care hospital or nursing home (we have one of the world’s highest rates of institutionalizing the elderly). But that means that more than 90 per cent of our seniors are still living at home and enjoying relative good health and independence. That’s a good thing, says Pia Kontos, a doctoral candidate in the department of public health sciences, who believes that home “plays a critical role” in maintaining seniors’ sense of personal identity.

McCarthy, for one, doesn’t hesitate when asked how her retirement decades compare with her career era. “Much richer,” she says. “I don’t actually have to do anything,” and “I haven’t lost contact with the young.” What’s her advice? Eat sensibly (at one time she was overweight but gave up desserts), don’t smoke (“I smoked for 20 years and stopped the day I read the first medical report of the relationship between health and smoking, in 1950”) and get exercise (she skates briskly for an hour three mornings a week, except in summer, at her local recreation centre, and every morning, she does 36 leg lifts with eight-pound weights on each leg).

There is no trace of oblivion in her voice.

Alzheimer’s vaccine ready for tests

While most of us who survive to 80 and beyond will do so with our minds intact, there is no doubt that aging is the main risk factor for Alzheimer’s disease. About one-third of those over the age of 85 will show some symptoms – including memory loss, wandering, inappropriate behaviour and hallucinations.

Dr. Paul Fraser, associate professor of medical biophysics at the Centre for Research in Neurodegenerative Diseases, and his colleagues, are ready to test a potential vaccine against Alzheimer’s on humans. The vaccine (developed mainly as a treatment, although it might be used preventively) is based on the theory that an accumulation of beta-amyloid protein in the brain is largely responsible for nerve-cell death, which in turn causes memory loss and the other devastating symptoms of the disease.

Using genetic engineering, Fraser’s team created a strain of mice with brain deposits of beta-amyloid that interfered with their ability to function normally. The researchers developed a vaccine that reduced the protein deposits and also improved the mice’s ability to find a hidden platform in a pool of water. The vaccine-treated mice did almost as well as a healthy group of control mice. “We’re still looking for funding for clinical trials in humans,” says Fraser, who knows how expensive and lengthy such trials are. The therapy appears to be safe and non-toxic, with no adverse side-effects, he says.

Making home a safer place

More than half of those over age 80 already use some kind of mobility aid – a cane, a motorized scooter, a walker – to help them get around their homes and communities more comfortably and safely. Researchers at the Centre for Studies in Aging (CSiA) at Sunnybrook and Women’s College Health Sciences Centre in Toronto are designing new and better devices to keep seniors mobile.

One of the CSiA’s most recent inventions is the “Toilevator” – an easy-to-install, relatively inexpensive device that raises the height of a toilet a few inches at its base, to help people who have trouble using a standard toilet because of arthritis, balance problems and limitations due to wheelchair use. Although the CSiA has designed items that are more high-tech and expensive than this one, CSiA director Geoff Fernie is especially proud of the Toilevator, which won the Canadian Retail Hardware Association’s Best New Canadian Product Award last year. Two other CSiA inventions:

• A safe, easily accessible bathtub with two grab bars and a wide ledge that allows older or disabled persons to sit down, then swing their legs into the tub.
• SturdyLift, the world’s first battery-powered portable overhead lift, which allows caregivers to safely lift someone in or out of a bed, chair or bathtub. Other lifts used in hospitals and homes depend on a ready source of electricity.

The final hours

Most people don’t get to choose what they eventually die from. But if we’re fortunate, we can have a say in how and where our last days will be spent. After her husband, Ian Anderson (Cert. Bus. 1974 Woodsworth), died of cancer in 1990, Margaret Anderson (BA 1981 Woodsworth) decided that quality of life is just as important at the end as in our prime. She donated $1 million to found the Ian Anderson Continuing Education Program in End-of-Life Care in her late husband’s memory. The program will train about 10,000 physicians and specialists across Canada to deal with all aspects of death: everything from breaking bad news to patients and families, to controlling pain and easing the last hours of life.