 Dr. Yoko Ishigami Doyle is a research data analyst at Health Data Nova Scotia and the Faculty of Medicine's Department of Community Health and Epidemiology at Delhousie University. Yoko was born and raised in Shizuka, Japan, and moved to Canada, where she completed her undergraduate studies at the University of Victoria. As a multiple year Killon scholarship recipient, Yoko completed her PhD in Experimental Psychology at Delhousie. Her graduate research examined both basic and applied cognitive psychology throughout a person's lifespan, examining individual differences in visual attention. Yoko's postdoctoral training first included working at the Department of Psychiatry, where she investigated different ways attention functions change with age and age related diseases. Her second postdoctoral training was at the Department of Community Health and Epidemiology, where she is analyzing and evaluating population based data from the Canadian logistical study on aging. So welcome, Dr. Yoko Ishigami, and you can begin your talk. Hello, I'm Yoko. Thank you for inviting me to talk about study today. I'm going to talk about the first part of our study, meaning that the study to be continued. And I'm going to be mainly describing associations between assistive device use and some characteristics of Canadian people, as we are showing how the series data look like for these characteristics. I'm hoping that what I'm going to show you today will give some ideas about the series data for people who are interested in using the series data, give insights into profiles of assistive device users in Canada, inspire people for future assistive device related studies, or satisfy curiosity for those who are participating in the series data. As we all know, our population ages. This series is from 36 Canada and shows percentages of seniors in red and children in green for each year since 1951. You may already know that in 2015, for the first time, Canadian adults aged 65 years and older, numbered Canadian children aged between 10 and 14 years. And the proportion of seniors is expected to continue to increase. As you can see percentage of seniors steadily increases while percentage of children shows an opposite pattern. This is increased too. According to the 2012 Canadian survey on disability, the mean age of onset of disability is in the early 40s. This figures from statistics Canada shows the prevalence of disability by age group on the X axis for women in dark blue and men in light blue. You can see a dramatic increase of disability in the age here. Percentage of disability was about 60%. 60% for persons aged between 45 and 64 years. And rose to about 42% for persons aged 75 years and older. So the presence of disabilities of the latter group more than double for disabilities, the prevalence of more types increases with age. This figure is also from 2012 Canadian survey on disability showing prevalence of sensory and physical disabilities by age group on the X axis for different types of disabilities. These disabilities, disabilities involved with it and flexibility show greatest prevalence of prevalence followed by disabilities in hearing, disability and seeing. That Canadian population is aging and prevalence of disability is increasing. We may expect that prevalence of assistive device users is increasing too. But there are not a lot of studies looking at prevalence of device users, especially in Canadian context. It's from US study looking at mobility device use. By the way, I found that mobility device use is looked at most frequently among assistive devices in literature. And this figure shows percentage of mobility device users in the US increasing sharply with age. There is an increasing recognition that assistive devices support healthy aging or independent living. Independent living has both psychological and financial effects on individuals, caregivers and communities. For individuals being independent directly affects both work and social life as well as psychological living. Especially social participation was found to be a redefined determinant of health and successful aging. For caregivers who are also aging, caregivers independent affects affected in a similar way. We also found that depression and life dissatisfaction of caregivers increase with higher time intensity of care giving. For communities by emphasizing on independent living, support rather than care can be provided. This will involve radical change in policies and both individuals and their caregivers will be affected. Characteristics of assistive device users is a critical first step for informing future policy decisions as well as design developments so that provision of services and care can be efficient, appropriate and cost effective. But as I mentioned earlier, not many studies are looking at assistive device use of Canadian older adults. So the primary objective of the first part of our study is to describe profiles of assistive device users in Canada with regard to social demographic, health and social network characteristics. And the secondary objective is to show distribution of Canadian populations in the CSA for these characteristics. We tested, sorry, we used the data collected at baseline between 2010 and 2015 for a total sample of 51,338 older adults aged between 45 and 85 years. Our data both from CSA tracking and CSA comprehensive. CSA tracking were randomly selected from within the 10 Canadian provinces and provided information by a telephone interview and there were 21,000 participants there. And participants in the CSA comprehensive were randomly selected from within 25 to 50 km of data collection sites in 11 cities across Canada and provided in-depth information via face-to-face interviews at all, as well as physical assessments and by a fixed main collection at local data collection sites. And there were about 30,000 participants. We tested in the three territories in some remote regions, in federal post-nation reserves and other post-nation settlements in the provinces. I underline this criteria because this is important to note when we look at rates of assistive vice users across different ethnic groups. I'll show you distribution of Canadians for different ethnic groups in the CSA shortly. Full-time members of the Canadian Armed Forces, individuals living in institutions. And I underline this criteria too because it is more likely that people living in institutions are more likely to be using assistive devices and we may be missing those people. Individuals who are temporary visa holders all had traditional health coverage. Individuals unable to respond in English or French. I underline this criteria too to note that ethnic groups in the CSA may not be fully represented because of this criteria. And lastly, individuals with COVID-19 experiments at baseline. Vice users for hearing, vision and mobility. I'm going to explain how device users are defined in our study first. The measurement of assistive devices used for hearing was based on binary responses to a question. Do you use any specialized equipment or services or persons who are deaf or hard of hearing? For example, volume control, telephone, volume control, telephone or TV decoder. The response options were yes and no. Participants who answered yes were classified as hearing device users. I thought that some of you may want to know what kind of hearing devices we are talking about. Participants who answered yes were further asked to indicate types of hearing devices they used. I listed these devices in the order from used most frequently to least frequently according to participant responses. We can see that hearing aids were the most frequently used hearing devices as of all. The measurement of assistive devices used for vision was also based on binary responses to a question. Besides glasses or contact lenses, do you use any aids or specialized equipment or persons who are blind or visually impaired? For example, magnifiers or well-reading materials. The options were yes and no again. Participants who answered yes were classified as vision device users. And here too, I thought that you may want to know what kind of vision devices we are talking about. Participants who answered yes were further asked to indicate types of vision devices they used. The devices in the order from used most frequently to least frequently according to participant responses. Here, magnifiers were the most frequently used vision devices of all. Assistive devices for mobility was based on the question, during the past 12 months, have you used any of the following assistive devices? And there's a list of devices given to participants. And we used device options relevant to mobility from the list read to participants. The list of assistive devices include cane, walking stick, walker, leg raises or supportive device, wheelchair and motorized scooter. Just like hearing and vision devices, I ordered them in the order from used most frequently to least frequently. So cane or walking sticks was the most frequently used mobility device of all here. And participants were classified as mobility device users if they responded yes to any of the mobility devices listed here. We have measures for social demographic health and social network characteristics. We have ethnicity, mental status, education and total household income for social demographic characteristics. Number of chronic conditions, type of home care and perceived health for health characteristics. And in arrangement, social participation and social isolation for social network characteristics. The analysis is based on weighted cross tabulations to see and pick relationships between device users and selected characteristics and were appropriate by sex and or age groups. But I'm also showing the tradition of Canadian populations in the CSA for the characteristics to appreciate weights of device users. First, I want to show estimated Canadian population in the CSA. The figures show the estimated Canadian population for two age groups on the X axis. On the left, you see people between 45 and 64 years old, the younger group in the CSA. On the right, you see people between 65 and 85 years old, the older group in the CSA. Women are represented in blue and men are represented in green. Here, Canadians in the older group is about half of Canadians in the younger group. There are almost even number of women and men, even though there are slightly more women than men without less of an age group. And these patterns are consistent with statistic Canada 2017 database. Now, I'm going to show you percentages of assist device users in the CSA. Here on the left shows percentages of hearing device users with a function of age group on the X axis for women in blue and men in green. The figure in the middle is for vision device users and the figure on the right is for mobility device users. I'm going to show you how to read a figure by giving an example just in case. Let's look at women mobility device users in the younger group. About 10% of women in this age group use mobility devices, meaning that about 90% women in the same age group do not use mobility devices, which is not shown here. On the other hand, about 20% of women in the older group use mobility devices, meaning that about 80% of women in the same age group do not use mobility devices, which is not shown here. Okay, so let's talk about patterns of assist device users with CSA. The most obvious pattern you see here is that percentage of mobility device users are highest among all, followed by vision and hearing device users. You might recall the figure from the 2012 Canadian survey on disability I showed you earlier. According to that figure, the prevalence of disability for mobility was greater than disability for vision and hearing. So you can speculate reasons for higher percentages of mobility device users, differences in device use. There is a clear trend that percentage of device users increased with age regardless of types of devices, hearing, vision and mobility. But the differences seem to be most dramatic with hearing device users regardless of sex. This is in device use too, but 106 different acts of hearing, vision and mobility devices. In the younger group, there's not much difference between women and men regardless of the type of devices. But in the 65 to 85 years old group, percentage of vision and mobility device users were greater for women in blue than men in green. See in the hearing device users too, but the direction is opposite. Percentage of hearing device users was greater for men than women in both age groups. It is known that men have more hearing difficulties and again we could speculate why may use more hearing devices. Assisted device users were distributed for hearing, vision and mobility devices for women and men and for different age groups. That was not all. I'm going to show you more figures. So I want to tell you what I'm going to show so that you can distribute your attention accordingly because there will be a lot of information. As I briefly mentioned earlier, I'm going to show you distribution of Canadians for each characteristic as background information on the left side of my slide. On the right side of the slide, this is more important thing. I'm going to show you percentage of device users for the same characteristic for hearing, vision and mobility device users from left to right. What I try to do is to find common profile of device users across the three types of devices in terms of more frequent and more frequent users. But if I find something different, I will examine that particular device user in more detail. In my ethnicity, we use the question asking the participants their cultural background. Here the question asked in the CSAE, people living in Canada come from many different cultural and racial backgrounds. You and the list of cultural background was read to the participants. And then we categorized participants into four ethnic groups, white, Aboriginal, disabled minority and other. Since multiple responses were allowed, those who had multiple backgrounds across these four groups were categorized as others as well. And Canadians in the CSAE by ethnicity and sexes on the left side. As you see, we found that majority in the CSAE have white ethnic background, regardless of sex, and not shown here, but regardless of age groups as well. Perhaps all presented due in part to the exclusion criteria I talked earlier. Percentage of device users by ethnicity are on the right side for hearing in blue, vision in green, and mobility in yellow. To identify as Aboriginal has the highest percentage of hearing and mobility device users indicated by asterisks. Highest percentage of vision device users is seen in white Canadians. Highest percentage of vision, sorry, those who identified visible minority had the lowest percentage of all three types of device users indicated by dots. I'm supposed to examine vision device users more in detail here because the profile is different from hearing and mobility device users. But we have to look at these collapse data across sex and age groups because they are not a lot of vision device users in Aboriginal and visual minority groups. Now let's see how medical status is associated with device use. We used the CSAE question, what is your current medical partner status? So there are five response options to select. We combined responses for divorce and separated for our study. Distribution of Canadians in the CSAE by medical status sex in on the left. Married Canadians represented majority without less of sex and not shown here, but regardless of age groups as well. Percentage of device users by medical status are on the right side. Those who identified as videos had the highest percentage of all device users. While those who identified money had the lowest percentage of vision and mobility device users. Lowest percentage of hearing device users is seen in those who are single. Note that the Married Canadians use vision and mobility device recently, but percentage of hearing device users is not the lowest following the videos people. Let's see the profile of hearing device users in more detail. Percentage of hearing device users here by sex. The data across the age group because they are not a lot of hearing device users in the younger age group. We can see that same pattern we saw earlier. There are higher percentages of hearing device users in the widowed group regardless of sex. But again, the second highest is the married people. High percentage of hearing device users in marriage group, especially in men, may be something to do with importance of improving hearing for better communication when you have a partner. Let's look at the educational attainment. We use the CSA question, what is the highest degree certificate or diploma you have obtained? I listed six possible responses for the participants. There are participants into four categories of educational attainment by combining these as some post-secondary degree and these as post-secondary degree. An audience in the CSA by educational attainment and sex is on the left. In the CSA, connections with post-secondary degree or some post-secondary degree represent the majority regardless of sex. And again, not shown here by regardless of age groups. Sentences of device users by educational attainment are on the right side and lowest device users indicated by asterisks and dots. It's difficult to describe profiles in terms of four levels of educational attainment because profiles are different. I tried this. Those who had less than some post-secondary degree had higher percentage of all device users. Well, those who had more than some post-secondary degree had lower percentage of all device users. So all three devices seems to have similar user profiles by categorizing people into two groups. The last social development characteristic. Total household income was asked in the CSA and there are five response options for the participants. We include it unknown in our analysis because there are about 5% of people who either did not give an answer or refused to answer and we saw that it may not be appropriate to ignore them. In the CSA, income and age group is on the left. Family income is higher for the younger group in blue than older group in green, but the range between $50,000 and $100,000 seems to be the most common range. The percentage of device users by total household income are on the right side. The lowest income group had the highest percentage of vision and mobility device users. The highest percentage of hearing device users is seen in the income unknown group. On the other hand, the highest income group had the lowest percentage of all device users. With the profile is different for the hearing device users, so let's look at them more closely. Showing percentage of hearing device users by two age groups and sex. In the younger group on the left side, percentages of hearing device users are highest in the lowest income group. In the older group on the right side, skew this high percentage of users in unknown group, especially for women, that's in blue. But besides that, percentages of hearing device users are highest in the higher income group, regardless of sex. Interestingly, profile of hearing device users switch from lower income to higher income group with age. This has to explain that there are high percentages of hearing device users in the unknown income group in both age groups. Unlike vision and mobility device users, patterns of hearing device users seems to be a bit complicated. So we are moving from social demographic characteristics to health characteristics. The first health characteristic is number of chronic conditions. The participants were asked about long-term conditions, which are expected to last or have already lasted six months or more that have been diagnosed by health professionals. There are a lot of questions asked for the presence of chronic conditions, about the presence of subconditions for each condition listed here. For example, they are asked about osteoarthritis in the knees, in the hips, and in the hands. A participant was classified as having osteoarthritis if he or she responded yes to any of these subconditions, so knees, hips, and hands. Following this rule, number of chronic conditions was calculated for each participant, including other, their 11 conditions. So the maximum number the participants can get is seven, and the minimum number is zero. In the series C by the number of chronic conditions and age groups is on the left side. The common number of chronic conditions is higher for the older group. In green, then the younger group in blue. A pattern we could expect. Percentage of device users by the number of chronic conditions are on the right side. Those who reported to have more than five chronic conditions had the highest numbers, has the percentage of all device users. While those who reported to have no chronic conditions had the lowest percentage. You can see that percentages of assistive device users non-linearly increase with the number of chronic conditions, regardless of the device type. And not shown here, but also regardless of sex and age groups. Although the increase is sharpest with mobility devices. We also looked at types of home care as one of the health characteristics. We categorized home care into four types, informal, formal, both and not. We used questions for care receiving to identify formal and informal care receivers. The question you are looking at is for formal care. Asking about home care services, the participants have received. Excluding assistance from family, friends, or neighbors. I responded to any of activities listed at the end of this slide and considered to have received formal care for informal care. Asking about home care services, the participants have received. Excluding assistance from paid workers or volunteer organizations. And just like formal care. Participants who responded to any of activities listed at the end of the slide and considered to have received informal care. Tradition of Canadian in the series by types of home care and age groups is on the left side. In the series, the majority received no home care regardless of age groups as not shown here, but regardless of sex as well. Percentages of device users by types of home care are on the right side. Who reported to have formal care and informal care for both formal and informal care has the highest percentage of vision and mobility device users. Highest percentage of care device users is seen in the formal care group. Those who reported to receive no home care has the lowest percentage. The profile of device users are not identical. One common pattern is that high percentage of assistive devices is associated at least with formal home care. It's possible that formal home care is associated with accessibility to devices as health characteristics. The participants were asked to evaluate their health, excellent, very good, good, fair or poor. It is a subjective judgment for the participant's health. The distribution of Canadian that you say by passive health is on the left side. It's good to know that there are a lot of Canadians reporting good health. Both women and men are not shown here, but both younger and older groups. Percentages of device users by passive health are on the right side. Those who reported to health have the highest percentage of all device users. Well, those who reported excellent health has the lowest percentage. That is very similar to what we saw in the number of chronic conditions, including sharp increase of mobility device users as a function of passive health. A look that's subjective for health is associated with higher prevalence of assistive device users, especially mobility devices. We move from health characteristics to social network characteristics. The first one is reading arrangement. There's a question about reading arrangement in the CDC. How many people not including yourself currently live in your household? We define the participants as living alone if their response is zero. Otherwise, they are categorized as living with others. Distribution of Canadians in the CDC by reading arrangement and sex is on the left side. In the CDC, there are more people living with others, regardless of age, youth and also not shown here, but regardless of sex. Sentences of device users by reading arrangement are on the right side. Those who reported living with alone had higher percentages of all device users, while those who reported living with others had lower percentages. The difference between living with others and living alone is dramatic for vision and mobility users, but not a lot for sharing device users. In fact, the percentages of sharing device users are very close for people living with others and alone. Yet a really high percentage of sharing device users for those who live with others may be something to do with importance or improving hearing for better communication. You may recall that I said the same thing for married sharing device users. Look at social participation. In the CDC, there are a series of questions about social participation. The participants will ask if they participate in activities listed here in the past 12 months. Response option for the question is at least once a day, once a week, once a month, once a year, or never. We used Gilmore's method to categorize responses to frequent and infrequent social participation. Family or friends based, religious, sports or other recreational activities are done relatively frequently. So if participants answer that they participate in at least one of these activities at least weekly, it is considered as frequent social participation. Educational, service club, community or volunteer activities are done less frequently. So if participants answer that they participate in at least one of these activities at least monthly, it is considered as frequent social participation. Canadians by social participation and age groups is on the left side. In the CDC, both in younger and older groups, there are more people with frequent social participation. That is good. And not shown here both in May and May as well. Percentages of device users by social participation are on the right side. Reported infrequent social participation had higher percentage of vision and mobility device users. Interestingly, the frequent social participation group had a higher percentage of hearing device users. Again, hearing device users have different or robotic profiles. At least percentages of frequent and infrequent users are very similar. So let's do first and most closely. Here I'm showing percentages of hearing device users by two age groups and six. This one observation I want to note here. Percentages of hearing device users are not very higher for those with frequent social participation, especially in older groups. This is still a speculation, but hearing device may have a protective property with respect to social participation, especially in later life. The last characteristic of all in the study for social participation, the participants are asked how often they felt lonely in the past week. The response options were all of the time, occasionally, some of the time and really all level. We dichotomize levels of loneliness into two based on these responses. The vision of Canadians in the CSA by social isolation and age groups is on the left side. There are more people without social isolation regardless of age groups are not shown here, but also regardless of text. Percentages of device users by social isolation are on the right side. Those who reported lonely have higher percentages of all device users while those who reported not lonely have lower percentage of all these users. Again, hearing device users are bit different. Percentages of hearing device users are very close for people who are not lonely and people who are lonely. Very different from vision and mobility device users. It is again possible that hearing devices may have a protective property with respect to social isolation, files of assistive device users in Canada. Not surprisingly, we saw that the older we become, the more likely we use assistive devices. Consistent pattern that there is higher percentage of mobility device users than vision and hearing device users. It is possible that the greater preference of mobility device users may be simply reflecting the greater preference of mobility device users, mobility disabilities, as well as available funding. So far it's become common to all three assistive device users, like people with low education and poor health, as well as people who live alone and people who feel lonely. It looks like device users associated with negative characteristics, characteristics of device users who are unique to specific devices. When it comes to uniqueness, we saw that hearing device users have unique profiles and vision and mobility device users have more profiles in common. First of all, there was a greater percentage of men using hearing devices than women. Men typically have more hearing difficulties than women, so the preference of hearing devices may reflect the preference of hearing disability. There are more women who use vision and mobility devices than men. Women typically live longer and accordingly, more women suffer from disabilities, leading to aging. This may be reflecting the preference of vision and mobility devices. Importantly, we saw that people who get involved with frequent social participation use hearing devices slightly more than people who do not get involved with social participation. So when it comes to social connectedness, hearing devices may have positive properties comparing with other assistive devices. We can see that hearing devices are important to improve communication functions. Not the key profile that this could explain why being married is the second important maritime profile for hearing device users after being widowed, reflecting their own needs as well as others. Similarly, this may be why people living with others and also people who do not feel lonely had relatively high percentages of hearing devices. So I give an insight into the profiles of assistive device users among older adults in Canada, but there are some limitations too. Our study is a cross-section study, so we are investigating the dynamic nature of aging and assistive devices use across time. And also, we are limiting to studying how gender had an impact on this relationship. We are aware that there is an interest in distinguishing between sex that is biologically defined and gender that is socially defined. But the participants in the CSA at the baseline were simply asked, are you female or male? We make the assumption that it is a biological sex that is devoted here. And the issue of representativeness with a traditional participant was briefly mentioned earlier. Similarly, there is an issue of representativeness with a visible minority participant. So we need to be careful when interpreting the results. Talking today is the first part of our study, and the second part will involve determining the use of assistive devices among people whose health needs are unmet. We are also interested in looking at the association, this time, statistical rather than empirical between social devices and devices. Thank you very much for your attention. Thank you, Yoko. That was an excellent presentation. But now I'd like to open it up to questions. As a reminder, muting remains on, but you can enter your questions in the chat box in the bottom right corner of the WebEx window at any time. So Akeen says that the sample size is for too small to conclude much from the breakdowns by race. Do you want to comment on that? And also she mentions that a summary statistics cable sample included in the study may be helpful. Yes, and about the race, we are aware that this is very difficult, even though it's an interesting topic. But making conclusions is very difficult with such a small sample. So we try to include the variable, but try to be careful as much as possible about what to say, because we are aware of that limitation. And somebody said, yes, I think this is a good idea. Thank you. Yeah, so that was a question I was thinking as well. You were obviously trying to see if there were cultural differences in the adaptation or use of assistive devices. And that's a very interesting concept. Maybe cultural differences have to do with your living arrangements or who's giving you home care. Did you think about including any kind of personality differences on the uptake of assistive device use? I think this is an interesting concept, personality. But for now, for the first part, we haven't included that yet. But definitely this is something we can think about for the future step. Yeah, it may have to do with that big sex differentiation in some of these findings as well. Yes. So we have another question from Ben. Have you done any regression modeling to look at independent predictors? And he also has a second question. Were power wheelchair users included in the sample? In terms of pilot wheelchairs, I think the list of options related to the participants that include wheelchair and the scooter. So I think when they say yes, they talk about wheelchair, but the list doesn't say electric wheelchair. So probably we cannot differentiate between the minor wheelchair or electric wheelchair. And also, in terms of analysis, we haven't explored regression yet. So that will be our next study. So I guess the idea would be that power wheelchairs versus a cane would probably be a different group of people. So interesting idea. Yes, and also, that's the question, it's possible to say yes to multiple options. So some people might be using the cane as well as wheelchair at some different occasions. So it may be a little bit different to differentiate between the wheelchair user on one side and then cane user on the other side. Olive Brighton asked, was there a reason 85 plus were not included? Because in the TSA, the people, it's a maximum age of participants who are included. So I think the oldest person at the baseline for 85 years old. From Annie, presumably the most important determinants of use of assisted devices is the need for such devices. There may also be differences among the social demographic groups and hearing ability, vision and mobility. Do you have plans to adjust for hearing, visual acuity and mobility and the device use? So I think you kind of tried to get at that with some of your stratification work. But do you have any plans for being more sophisticated about the prevalence comparison to the future? Yes. This is something we try to improve in our next study. And this is a very simple analysis of the relationship between assisted devices users and characteristics. In our next study, we want to control for different variables, which we think is important, including those measurements here. Certainly. From Ed Gershpert, was there any attempt made to ascertain whether respondents required an assisted device but did not have access to or possessed the required device? The need for care versus use of assisted device. This is maybe something relating to our next step. We want to know what kind of people don't have devices, even though they need. But we maybe discuss to get the information if they have access or not. We may be able to get, for example, if a participant is receiving formal care and then it might be related to availability. And if they are receiving only informal care, knowledge about availability may be missing. Certainly. And Monica talks about the financial constraints addressed in the study. So I don't think you have a question about if financial constraints were a problem with using assisted devices, but you did look at that income. I wonder if this is related to the total household income with something relevant to the question. And in general, we saw that the low income people have used more devices. But you may notice that devices, especially mobility and vision are relatively inexpensive, like many five years or came. And when it comes to hearing devices, and specifically older people, people who have more financial resources can use hearing devices. Certainly. Well, thank you very much. We appreciate your participation in the CLSA webinar series. I'll go ahead and talk about our next webinar scheduled for next month, but we'll stay on the line afterwards. We want to continue the question and suggestion. I'd like to remind everyone that CLSA data access request applications are ongoing. The next deadline for the applications is on June 11. Please visit our website, the CLSA website under data access to review available data to find further information and to look at the details about the application process. Our next webinar is scheduled for next month. We'll be welcoming Dr. Yukiko Asada to discuss understanding inequalities and inequities and health and wellness among older Canadians. So please register soon and join us for next month webinar. And thank you to everybody for attending today's presentation. Thank you very much. Thank you.