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Great expectations: Boomers will reshape aging with high health demands

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TORONTO - Health care sees them coming.

With the largest generation ever starting to crest the hill of old age, medical specialties that deal with older adults are getting ready for the inevitable onslaught. Baby boomers are starting to reach the stage in life when things start aching or stop working, when age starts to steal away progressively larger bits of physical and cognitive function.

"This is on absolutely everyone's radar, without a doubt," said Jennifer Ryan, a senior scientist in the field of cognitive neuroscience of memory at Baycrest, a Toronto teaching hospital that specializes in studies in aging and the brain.

"As scientists, we are aware of the approach of the baby boomers towards 65 and older. And funding agencies as well are very aware of the challenges that are going to arise as a result. People are working, I think, as fast as they can to really improve the lives of the boomers who are approaching that later stage in life."

The number of Canadians aged 65 or older grew by 14.1 per cent between 2006 and 2011, the latest census numbers released Tuesday show — a reflection of the fact the leading edge of the baby boom began turning 65 last year. Seniors accounted for 14.8 per cent of the country's population in 2011, up from 13.7 per cent five years earlier.

The number of people aged 60 to 64 grew at a rate of 29 per cent since the previous survey in 2006 — the fastest-growing age group in Canada. And the number of centenarians in Canada — people aged 100 or older — reached 5,825 last year, a whopping 25.7 per cent increase.

The preparatory work ranges from trying to predict the demand for medical specialists like the orthopedic surgeons who replace worn-out hip and knee joints, to devising screening tools to spot adults who are developing memory problems, to figuring out how to adapt living spaces so that aging boomers can safely stay in their own homes for as long as possible.

"Who wants to end up in a 200-square foot room with a cupboard? I mean, really," said bioengineer Geoff Fernie. "People are saying, 'No, I want something better.'"

Not only are Canadians getting older, they're living longer, too. Statistics Canada's projections, based on medium growth, anticipate some 78,300 people in Canada living to the age of 100 by the year 2061.

Fernie is the research director at Toronto Rehab, a rehabilitation hospital and research institute affiliated with the University of Toronto. His team is working to solve the practical, day-to-day problems that can plague older adults. How do you use the toilet when you cannot lower yourself onto it or hoist yourself up? How can you shower safely? Is there footwear that can lower your risk of falling on the stairs or outside during the winter?

Fernie calls it "coming up with affordable things to help people manage." His team has already developed and marketed "Toilevator," a simple and inexpensive platform that raises a toilet to a level that's more accessible for those with stiff spines or stiff knees. Fernie's bioengineering team has a multitude of projects in the works that he said he believes boomers will need as they age.

"Once upon a time, people expected to end up in bed and be sick and die early and put up with things and be in misery," he said.

"And now they realize that just because you're old doesn't mean you have to put up with this stuff."

Ryan and others see the same challenge. The boomer generation isn't just a huge group of people. It's a huge group of people with attitude.

By dint of its size, the baby-boom generation is used to getting its own way. Boomers have had great expectations for their lives. And that isn't about to change just because they're becoming eligible for discounted bus fares.

"The baby boomers, I think, will not accept aging particularly well. They won't go grey any time soon. And I think that they have a value around preserving not just their looks, but I think their health as well," said Susan Kirkland, an epidemiologist in the department of community health at Dalhousie University in Halifax.

"What's unique about them is that they've kind of changed the face of health and health care all the way through their lives. And they're much different than previous generations in terms of how they deal with their health, what kind of services they expect and those kinds of things."

Kirkland is a principal investigator of a large national study that's recording the ups and downs of aging experienced by more than 50,000 Canadians over the next 20 years. The Canadian Longitudinal Study on Aging is enrolling adults aged 45 to 85 with a view to getting a sense of how they are living as they age. What problems they are facing? How healthy are they? Are government policies helping or hindering their passage through the last phase of life?

She doesn't expect to see boomers accept the physical limitations of age the way previous generations did. And she's not alone. Orthopedic surgeons — the medical specialty that deals with bones and musculoskeletal problems like cartilage damage and ligament tears — are already seeing the impact of the baby boom generation.

"People are wanting joint replacements done earlier now," said Dr. Cy Frank, an orthopedic surgeon who specializes in knee surgery. "People are wanting them now when they're in their ... 40s and 50s, not in their 60s and 70s. So that's increased the demand."

That's the boomer generation. If something hurts, they are not going to grimace and bear it. These are not going to be the grandparents of old, with tight perms or bad comb-overs, pressing a bag of frozen peas to arthritic knees in the hope of some fleeting pain relief.

"They expect more. And they want to be fixed," said Frank, the executive director of the Alberta Bone and Joint Institute.

"They want things repaired or replaced so that they can continue to live long, happy lives."

Frank, meanwhile, is concerned there may not be enough specialists to handle the work. He recently applied for a grant to do some modelling to try to figure out how to address the coming demand. One of his favoured approaches is team work — orthopedic surgeons working with podiatrists and chiropractors, physiotherapists and occupational therapists to use resources rationally.

He also favours early intervention. If boomers can be taught to spot looming problems before they hit the crisis stage, rehabilitation or minimally invasive procedures could forestall major surgeries and should help keep boomers active longer, he said.

Ryan, too, sees early intervention as key to what is seen as one of the biggest problems the aging baby boomers may face — dementia.

Her field is working to develop better tools to screen for signs of memory loss that could be the early symptoms of Alzheimer's or other degenerative cognitive conditions. She foresees a time when aging adults are urged to schedule memory screening tests in the same way they are encouraged to undergo colon cancer screening or mammograms for breast cancer.

"The idea is if you can catch some problems really early, then maybe you have a better chance of intervening or providing some kind of rehabilitation or compensatory strategy in order so that people can manage this declining cognitive function or maybe even keep it from declining further," Ryan said.

"We want to slow down the decline."

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