 successful aging in Canada findings from the Canadian longitudinal study will be presented by Dr. Mabel Ho. Dr. Ho is a registered social worker who has worked in the field of gerontological social work for over 20 years. She's recently, she recently completed her PhD in social work at the University of Toronto's Factor Inwantash Faculty of Social Work. Her research and practice interest focuses on the health and wellbeing of older adults. So I would like to welcome Mabel here now and all of you participants, all there's almost 130 today for this exciting webinar. I turn it over to you. Hi everyone, I'm so happy to be here and thank you so much for joining. My name is Mabel. Today I'm going to talk about successful aging in Canada findings from the Canadian longitudinal study on aging CLSA. Perhaps I will start the presentation by telling you a bit more about myself. I'm a social worker by training and for the past over 20 years, I had a privilege to work with older adults who have had a stroke, dementia and other chronic diseases and their family members. Over the years I thought, well, perhaps we can provide the best care, long-term care, all kinds of support for them. But are there any things we can do to better support them? So that's why I want to look into how we can better support older adults to live well and age well. So for the study, I will start by telling you more about the background. So successful aging is generally understood as aging well is a worldwide aim for many people, for older adults, for family members, for practitioners, for the community, so many people. And it's one of the ultimate goals of gerontology as well. So when we look into the study of successful aging, we notice that there are two sort of perspective on it. So one is the researcher divides definition of successful aging that usually classified about one third of older adults as successful ages. But when you ask middle age and older adults themselves, over 90% of them will tell you that they're actually doing quite well. And we know that most older adults are living with some form of chronic conditions or physical disabilities. So the researcher divides definitions of successful aging in the past that often grew out having chronic diseases and physical disability seems to need an update. And there are also fewer study on the topic in Canada. And when we prepare for the study, we look into different concept of aging well. We actually look into nine of them like active aging, optimal aging, and healthy aging. And the reason why successful aging was chosen for the study was for a few reasons. First of all, it has a relatively long history. We have been studying successful aging since the 60s and is still the most dominant as well as most frequently refer concept of aging well. And it also provide a broader understanding of aging by covering the physiological, psychological, and social aspect of aging. So the study was guided by a synthesized conceptual framework composed of three theoretical perspective. On Febony's ecological system theory, Yang said at all, a multi-dimensional model of successful aging and Kier's concept of complete mental health. So we're going to look into some of the intrapersonal, interpersonal, as well as factors that are affecting a person aging well. So for this expanded definition of successful aging is built on both the objective as well as subjective measures. So it is included no limitations in activities of daily living, activity of daily living, and instrumental activity of daily living, regardless of the numbers of chronic illnesses present. And freedom from any serious mental illness, memory problems, disabling chronic pain, as well as having adequate social support. And also the older adults self-reported happiness and their subjective perceptions of their physical health, mental health, as well as aging process. So we use the CLSA data, particularly some of the question to construct the measure of successful aging. So for the limitations in activities of daily living, we look into the ability to dress and then dress without help, the ability to eat without help, the ability to walk without help or with some help, like from another person or the use of a walking aid and getting in and out of bed without help or aid. And for the limitations in instrumental activity of daily living, we look into the ability to use the telephone without help, getting to places out of walking distance without help, a shopping, as well as preparing meals, doing housework without help, or with some help, to get back to vacation as well as handling money. And for the disabling pain and discomfort, we look into whether the person has any pain or discomfort that prevent them from doing their usual or daily activities. For the mental disorder, we look into anxiety, depression, PTSD, and memory problems. We also look into the mood. We look into whether the person feel depressed at all the time or do they not feel happy or satisfied with life all the time. And for the lack of social support, we look into whether the person who have someone to talk to when they're in crisis or when they have problems. Do they feel that they feel that they're loved? And the last one was about the lack of self-rated wellness, how the older adults rate themselves in terms of their physical health, their mental health, and the Asian process. So if the answer no to all these questions, they will be classified as successful ages, otherwise they'll be considered as typical ages. So we are not trying to see a successful or not, but we are looking into typical as well as successful people who are doing exceptionally well. We want to learn from them and seek how and why they're doing so well. Is there anything we can do to better support other older adults so that we can all live well and age well together? So for the baseline factor, we look into some main factor. It's actually my daughter of thesis is a three paper dissertation. So for the main factors, we look into the immigrant status, the marital trajectory and social participation. So for the demographic factors, we look into the age, the sex and the marital status. We also look into education level and lifestyle factors and BMI. So for the lifestyle factors, we look into smoking status, whether they smoke or not, and different types of physical activities as well as whether they have sleeping problems and then how their BMI is. And for the physical disability, we look into a couple of conditions like diabetes, heart disease, hypertension, arthritis and osteoporosis. We also look into the finance well-being. So the prevalence of successful aging, it's actually quite interesting. So using the expanded definition of successful aging, we notice that the prevalence of successful aging at time two, we used a baseline as well as to follow one data to do the analysis was about 70.5%. Which is about more than 7 in 10 of those responding to rate the aging process as good to excellent were identified as successful ages. So, in a way, we are able to to the gap between the researcher derived definition of successful aging and lay perspective of successful aging closer. And it's a more balanced definitions of successful aging. So for the study population, we use the CLSA data, the CLSA Comprehensive Court, and especially the data from the baseline data as well as follow one data. So the CLSA Comprehensive Court baseline, there are about 30,000 respondent. So we look into those who were aging successfully at baseline and were 60 years or older at time two. So the final samples were about 7600 plus respondent. So we use SPSS version 28 for all the analysis by various and multivariable binary logistic regression analysis were conducted. So it's a three paper dissertation. So the first paper will look into the immigrant status. The second paper we look into the marital trajectory and and the third one will look into the social participation. And for the first paper, which is the one about the relationships of immigrant status and social participations and successful agents were published in a special issue in the International Journal of Elemental Research and Public Health. So for the first paper, it was about immigrant status and successful aging. So the study examined the relationship between immigrant status and successful agents among older Canadians using the first two waves of stator from the CLSA. So the immigrant status was measured as a dichotomized variable according to whether the respondent self identify as being born in Canada or another country. So here are the research questions we have for this paper. Immigrants have a greater prevalence and higher age sex at just sort of successful aging than the Canadian born peers in the fallout wave of the CLSA comprehensive court. What baseline factors, if any, attenuate the association between immigrant status and successful aging. And we also do a separate analysis for the immigrants and what baseline characteristics predict successful aging during the fallout wave. So this is the result of the first paper. So we notice that the Canadian born older adults at a slightly higher prevalence of aging successfully at time to then their immigrant counterpart. And Canadian born older adults at approximately 24% higher odds compared to immigrants of aging successfully after we have adjusted about 20 additional factors. So, we noticed that some immigrant older adults had a lower prevalence of successful aging than their Canadian born peers. We definitely need to have more research to investigate better policies and interventions supporting all the immigrants and promoting a healthier lifestyle and hands over adults achieve successful aging in later lives. So we suggest that perhaps culturally and linguistically appropriate programs and services like acculturation programs, financial aids, language programs, language programs, information and services may support immigrant older adults to age well. So the second paper was about marital trajectories and successful aging. And this one we would look into the association between marital status, including trajectory of marital status on successful aging amount of older men and women. So we look into this sex defenses. And for the marital trajectories we look into the never married continuously married continuously riddle continuously divorce or separated. So they change from not married at baseline to marry at the photo one or the time to, or they change from married to not married at time to, and other changes as well. So for the research question. We had our trajectories of marital status associate with successful aging at time to. They're adjusting for 21 baseline characteristics with that attending with the association between trajectories of marital status and successful aging. And are there sex differences in the relationship between marital trajectories and successful aging at time to. And which trajectory of marital status associate with successful aging at time to for males and females. So we notice that the prevalence of successful agents at time to amount males and females was similar. The adjusted board of successful aging was significantly higher among those who were continuously married, or became married between the two waves. Then the adjusted order of successful aging were significantly higher in females than in males. And we notice that there were sex differences. So for the male respondent, we notice that the significant a positive association between marital status and successful aging were observed. In respondent who were continuously married continuously widdled or became married since baseline when compared to their never married peers. So on a chart, you can see the three red circle here. So for the female respondents, we notice that there were no significant differences with respect to successful aging between never married individuals and any of the other. Marital categories with the one exception being that those females who transition from married to not married between the two waves. That's a significantly lower art of successful aging, which is the green circle on the chart. So, we notice that in comparison to never married older adults. The odd of successful aging were higher for respondent who were continuously married or became married after baseline. And the association between the marital trajectories and successful aging differ significantly by sex. So we suggest that we need to support older adults, especially those who have experienced widowed divorce or separation in later life in connecting with others and developing a social support network. And we also need more research study to understand the rationale behind the observed association. So the third paper was about social participation and successful aging. So this one we particularly looking into six social activities, church or religious activities, educational activities, participation in service club neighborhood community activities, volunteer or charity work as well as recreational activities. So the research questions are, do the, do those who participate in social activities at baseline, have a higher prevalence of successful aging at time to do those who participate in social activities at baseline have higher age sex adjusts to the result of successful aging at time to. And the last question was, does adjusting for 22 baseline characteristics, attenuate the association between social participation isn't successful aging. We notice that the prevalence of successful aging at time to was significantly higher in respondent with baseline participate in these activities. The educational or cultural activities, neighborhood community or professional association activities, volunteer or charity work and recreational activities involving other people. In comparison to those who did not participate in these activities. The art of successful aging was significantly higher among older adults who at baseline participate in particularly volunteer or charity work, as well as recreational activities. So we notice that older adults who participate in volunteer or charity work and recreational activities were more likely to achieve successful aging than their counterparts who did not engage in these activities. So we suggest that perhaps social prescribing in volunteer opportunities and recreational programs may help support older adults health and well being. And we definitely need to have more research to a certain where their interventions in these areas result in an increase at board of successful aging. So summarize the study found that response who had higher art of successful aging were Canadian born versus and immigrants. And they were continuously married or newly very married that they get married between the two waves versus to never married. And those who engage in volunteer or charity work and recreational activities versus those who do not engage in these activities. And you also look into some of the other factors associated with successful aging. And you notice that some of the demographic and socio economical factors, like being younger and being female and having higher income and being married. But we also notice that there are some modifiable lifestyle and health related factors associated with successful aging, like not being obese, and maintain a healthy body weight, engage in exercise physical activities, and not having sleeping problems and free of heart disease or arthritis and not smoking. So whether is never smoking in the first paper or not currently smoking. So it's never too late to quit. And, and also not being so so isolated. So those are some of the lifestyle and health related factors that can be modified and it's something that we can work on together. But the limitation of the study. The study is constrained by variables available in the data set. And it's the data set is also disproportionately more educated. So the respondent, like 79.5% of them had poor secondary education, compared to about 45% in the population, and interviewed in a CS at CLSA were conducted in English and French. So the respondent would have better official language skill. So those who do not have the skill might not be able to participate and also fewer visible majority members in the sample with about 3.6 in the data set compares to about 8.1% in the population. But we cannot examine the cohort effect as when I was when we start the study. There was only two waves of data available, but now with more data is becoming available. We can learn so much about the respondent as well as on different topics. The short span from the baseline to time to which is about three or four years. Also restrict the changes in the marital trajectory used to explain successful aging. In a way, we do not know which one comes first and and observational nature of the study will hit the determination of causality. We also have to deal with some of the cases with missing entries and about 900 plus of the cases were excluded from the analysis because of the missing data. So for the indication, as we think, perhaps, culturally and linguistically appropriate programs and services can support some older adults, particularly older immigrants. And we know that they're modifiable, health related as well as lifestyle factors. So perhaps we can encourage people to engage into an active and healthy lifestyle. But it's not just about healthy eating or doing exercise. We also need to have to support out there to support people to do so. And also the prevention of chronic diseases and physical disabilities, promotion of positive mentality and social connections. How we can support older adults to build a social network so that they can get to know more people and we can support each other and definitely more research and policies and intervention to support older adults to live well and age well. And for future research directions, we do hope that we'll be able to learn more about the experiences of older visible minority immigrants. We'd love to learn more about the experiences of older adults who are never married or those who are widowed a divorce or separate, particularly later lives, what program and services and how we can better support them. We have been talking about social prescribing. So what about the long term benefits of social prescribing, particularly to volunteer or charity work as well as recreational activities. And the fourth one is actually quite interesting is the fourth paper that we are working on is called the resilient older adults. Because when we look into the data, we notice that there are people who are always typical ages, and there are people who are always doing well. And there are people who were doing well at baseline but not doing as well at time to. But then there are people who might not be doing so well at baseline but they improve over time. So we were wondering what happened to them is that something we can learn from them. So we would love to learn more about that that's about the resilience of the adults and how we can learn from them so that we can all live well and age well. And the last one was more about the modifiable lifestyle and health related factors. And how we can support people to engage into these activities and what program services, policies or research are needed. So to conclude the study, provide an expanded definition of successful aging. So is bringing the researcher to provide a definition of successful aging, as well as the lay perspective for successful aging closer together. And also provide more understanding of successful aging. Like about immigrants status about narratives trajectory about social participation. And perhaps policies and interventions can better support older adults to to live well and age well. And definitely we need more research to learn more about this secret to successful aging. So I really want to thank everyone at CLSA for all the wonderful work. So we have all this data to do all the analysis and findings. And I was provided with the CLSA data for free through the CLSA training fee waivers. And I'm also very grateful to my thesis supervisor, Dr. Esme Fuller Thompson of University of Toronto, Dr. Inventash Faculty of Social Work for teaching, guidance, support and inspiration during the entire study. And I'm also very thankful to Dr. David Burns, Dr. Anna Priyagams and so many wonderful people that I have met with during my studies. And I do look forward to our conversation so that we can talk more about how we can better support older adults to to age well and live well. And I also list some of the references at the end of the slide deck. And there it is. Okay, great. Well, thank you very much. Lots of information and hopefully useful information for our participants, both researchers, the gamut I think are part with us today. We have a bunch of questions. So I will just sort of start at the top and I will read them and get you to comment on each one and we'll we'll tick them off as we go. The first one is was BMI based on self reported height and weight. Also, weight and elderly people does not reflect sarcopenia and fat migration to the central region. Aka increased visceral adiposity where was circumference measures considered. Right. Yes, we actually use the data from the data set to calculate the BMI. But definitely there are considerations that we need to take into account. But thank you so much for the question. Great. And our next question is, she was wondering if those who are not aging successfully might be more likely to drop out of the CLA CLSA and how whether this might affect the findings. So have you given any thought of that? Right. And we know that the expanded definition of successful aging is the version as is now, but we are also looking into other things as well. And, but it's quite interesting that we know is that there are people who are typical ages, and there are also people who are always doing well or we call them the successful ages. So there are people who not doing so well with time, but there are also people doing better with time. It's something that we really need to look into and seeing how we can better support people to live well and age well. So I do see that there will be lots of study and papers to work on. Definitely. Okay, so the next question is, does marital status or does married include unmarried, cohabitating couples or civil union and common law relationship? Yes, yes. It is included in the data set in the way that they structure the question. But because when we start the study, only two waves of the data were available, so that the short span of time, which is about three to four years, we can really explain a lot. So with more CLSA data become available, we do look forward to learning more about the marital trajectories and how that is related to successful aging. And I think you also answered the next question already, which was how was married defined and if it was just legally married? No, it's a remember that they have married or common law and it depends on how the respond and respond to the question. Right. Okay, so the next one from James, very cool overview. So this is pretty much what we would expect on all fronts, given a huge literature on immigration and health, marriage, gender and health and social networks participation in health. Could you highlight what you see as any novel contributions, especially our understanding and theories around these constructs and successful aging? We are very excited about the expanded definition of successful aging, because when we look into the literature, oftentimes when we use the researchers to drive definitions of successful aging that usually classified about one third of the older population to be successful ages. But when you asked older adults or middle age people themselves, over 90% of them actually think that they're doing quite well. So by including the self rated wellness into the definition, and we are able to expand the definition and included more people and it's also a more balanced as well as more realistic definition of successful aging. All right. Great. Thank you. So now we have many models of successful aging include engaging in activities in their definitions such as row and con. And this is also commonly included in lay perspectives of healthy aging. I was hoping you could speak to why you chose not to include this in your model. And so we look into different concept of successful aging, like active aging, optimal aging, healthy aging, and the reason why we chose a successful aging, particularly the youngs at all, multi dimensional model of successful aging is because of its the structures of it. We talked about the physiological psychological as well as social aspect of successful aging. So that's why we include that in the, in the conceptual framework to guide the study. Okay. Great. And there was a question, I think it's disappeared, but because I think there was some other information posted, but it had to do with this being the research being very heteronormative. And if you could speak to whether or not any of this research how the queer population would sort of fit into this or what we know about that. Yes, yes. It's a three paper dissertation. So that's why we chose the three topics to work on. But the more we look into the data, the more we look into the study. The more we know that there are different areas we need to look into. Definitely we were looking to the successful aging in different aspects in the near future. Great. Yeah, I think there's, there's lots of lots that can be done. I think it's what a lot of what a lot of what you're saying so great paper four and five lineup. So to learn more about the secret to successful aging. And I do think that it's going to change with time. And the more we learn about it, the more we can provide, whether it's policy program services or research to support older adults to leave well in H well, definitely there's so many we can learn from the data set, especially when more CLSA data is becoming available. Yeah. This one's very Canadian. Is there anything that we can understand specifically about the Canadian context from these data that we couldn't just understand if we were taking our insights from American data. Right, right. Definitely. I would say that the CLSA is a very unique set of data and that provide lots of opportunities for study in aging. So we do look forward to looking into more of the Canadian perspective on on how we can support older Canadians to leave well in H well in the community. And there are this question is there eight social activities in the CLSA data set. Why did you select only six and how did you determine participation was the threshold based on once per month or once per week. Yes, that's a very good question. And we look into the activities. So when we do the analysis sample size was also a thing that we need to consider. And because we are not trying to look into the dose effect. So we categorize the answer to participate in those social activities. Yes or no. And if they participate in the activities, and then we'll consider that as yes, if not, then no, and we will just compare those people who participate in those activities or not. And definitely we can look into how those activities is related to a successful aging in so many other ways. We're just zipping through these questions very succinct answers. Sarah says thanks for the presentation. Is there any capacity through this data set to assess successful aging for people with cognitive decline or diagnosed dementia. Yes, yes. That's why I've been thinking about too. Because in the past over 20 years, I had a privilege to work with people living with dementia. And I do wonder is that as someone we can look into this particular population and how we can better support them. Definitely, I do look forward to doing more research on this. Yeah, and, and Sarah, there's the CLSA data platform does include a lot of cognitive testing and data. So I think it's definitely worthy of exploring and there'll be some information at the end of the webinar about our data access. Processes and you can always contact us for more information. There's my plug. Okay, so the next question is from Jonathan, and it's also the last one. So if anybody has any additional questions feel, please, we do have some more time. So please feel free to post them. So the question is, how did the study compensate for the differences between the sample population and the general population. In terms of education, income, immigrants, et cetera, before drawing the study conclusions. Right, right. And I would say that there are lots of variable daters in the data set, and we can learn so much from it. And I think it would be great if we can do more comparison of what we have found in a data set, as well as what's out there in the population. So I do see lots of opportunity with the CLSA data, and so much we can learn from it and from working on it. So I am very excited about all of this and I do think that and we'll learn so much, and we'll be able to work with everybody and older adults practitioner so that we can truly support older adults to live well and age well. And also just to note that the CLSA does look at sample weights and sort of comparability to the general population. So there is some literature about that if you wanted to look into that. Okay, so we have some more questions coming through. You framed your contribution specifically in terms of expanding our understanding of successful aging. Do you feel you can make any contributions to our understanding of social engagement networks, or are you using it mostly as a setting for your outcome measure? For the three papers, we noticed that being able to connect with others is actually very important. So, and whether it's social participation, particularly the one about recreational activities is with other people. And that's by being able to connect with other people and expand the social network would be an important factors. So I do look forward to learning more about how we can learn more about how we can better support older adults to to expand their social network. And if there is any programs or services that we can do to better support that. Okay. And will future studies include specific immigrant subgroups. So is this on your list of things to study? It's my coming 20 years. So I'm very excited about all this, but it's also depends on what is available in the data set though. But oftentimes when we are doing the analysis, we notice that there are some, sometimes we encounter like small sample size that we might not be able to to go on. But I think with more data becoming available, we will be able to do so much. And I don't know if you'll know the answer to this question. So maybe I could help, but what is the percentage of indigenous people, people's data in the CLSA database. I'll let you help me then. I actually don't know the exact answer, but I do know Amy is typing some information right now that she can share with you. The CLSA does have a does have indigenous identifiers as part of our data set. And if you'd like more information about that, please feel free to reach out to us and we can give you that information. All right. Okay, so could a study see the questions keep coming in if there's time. Could a could a future study include the role of pets and successful aging of pet owners. Love that question. So I was talking to some of my colleagues about this, and my colleagues is a cat person. So she was wondering, hmm, so what about the role of pets is like a family members to many people. And if there are questions in that data set, I would definitely look into it and wonder if we have some good findings related to that. Thank you so much. Great question. And was your study done with participants from across the CLSA or only certain groups or certain regions. We use the CLSA comprehensive court. But we look into those who were classified as successful ages at baseline, and they reached the age of 60 at time two. So that's how we could constrict the sample. And the final sample for all the three papers were about 7600 plus. Yeah, so, so I presume that would have you didn't look at provincial differences or regional differences. So everyone was looked at together. Yes. Okay, great. All right, where are we Andrea, did you consider everyone born outside of Canada as immigrant, irrespective of the length of time here. Or did you differentiate based on how long ago they immigrated. Right. We also did different analysis on that. And the immigrant status was a self reported question. So the answer whether they're Canadian born, or whether they're born in another country. But we also look into the, the length of immigration is quite a high number of us over 70% of the immigrants actually came into Canada for over 40 years. But still, we see the differences of the agents successfully. So definitely we need to look more into the experiences of older immigrants and how we can better support them. Okay. Great. Wow, that was I felt like that was like a rapid fire Q&A session. We got something is happening with my monitor as a note. The pet ownership issue is complicated and James has posted something for everyone to learn from. So, so I think what I will do is again, like I said, that was a rapid fire pretty intense question and answer. So we may finish a little bit early. If another question comes in while I'm wrapping up, we can always stay on to address it at the end. So, I guess I wanted to thank you again to Dr. Ho for being our presenter today. We greatly appreciate your participation. And thank you to all the attendees of the webinar. I'd like to remind everyone that the deadline for data access applications for use of the CLSA data platform is January 17 of 2024. So visit the CLSA website under data access to review the data that's available, as well as additional details about what the application application process entails. I'd also like to remind everyone about your survey upon exiting the session today so that we can learn about the topics that interest you and how well we're doing hopefully. Next, our next webinar. So this will be an exciting one as well. So our first webinar of 2024 will be assessing accessing linked CLSA data at HDRN Canada data centers. It will be presented on Wednesday, January 17 that 20 Wednesday, January 17 that noon. So same day the data access applications are due. Registration details are posted on our website, as well as in the chat box that Amy is monitoring. And I guess the last thing to say is, if you're a, if you're a Twitter or Twitter, remember that the CLSA promotes this webinar using the hashtag CLSA webinar so please feel free to share it. And we invite you to follow us on Twitter at at CLSA underscore ELCV. So thank you again for everyone who attended today. And if there's any follow up questions, I'm sure Dr. Howell could follow up with you. Her email was posted in the chat and this webinar will also become available on the CLSA website website for anyone to access after. Great. So thank you all. Enjoy the day and have a restful few weeks. Thank you so much.