 So why are studies of aging so important now? Well, it's because we are an aging society. In the census of 2016, for the first time in Canada, there were more older Canadians, Canadians 65 years of age are greater than children. Children would be 14 years of age or under. So there are slightly more, 16.9% of the population were 65 and over, compared to 16.6% who were 14 and under. Now this is a big change for our country. In a lot of part of the 19th century, the age that sort of split the Canadian population 50-50, 50% older, 50% younger would be around 17 or 18 years. So you can see the dramatic change in the composition of our society. Now there are many good things that happen as we grow older, but there are also some health challenges and there are some possible consequences to the public purse. So there are many potential goals for studies of aging, but I think you would agree probably the most important ones are how best to promote healthy aging. How can we stay young for as old as possible? And also what are strategies that can prevent or minimize any handicaps that might arise as we grow older? And then finally, we'd like to find more about therapeutic approaches, which could be medications but also might be diet, physical activity, health practices, for conditions which disproportionately affect older individuals. And these conditions tend to be what we call chronic conditions, chronic medical conditions. Now to achieve all these goals, we do require a better understanding of aging. We need to know more than an older person on average is different than a younger person. We have to understand what the differences are and how can we capitalize on the resources the aging individual has to minimize any adverse consequences that might arise because they are growing older. Now the Canadian Longitudinal Study of aging is what we call a Longitudinal Study. Now like many studies done in health research are what we call a cross-sectional studies. You see a person once, you do some type of assessment, and then you'd leave that poor soul alone. And a Longitudinal Study, you follow people over time. You have repeated observations or evaluations of that same person over time. So you get serial measurements obtained on one group of subjects. Now because of the repeated observations at the level of the person at the individual, you have a lot more power than these other studies, these cross-sectional studies, to observe what we call a terrible order of events. What precedes, for example, a particular outcome, whether it's good or bad? What are the factors that predict people doing well or predict maybe not doing as well as we or they would hope? So what leads to what? A Longitudinal Study allows you to address this or look at it much better than other forms of studies. Now major concerns with Longitudinal Studies are the cost, because you have to have an infrastructure in place for many years to see people repeatedly. And the length of time it takes to complete the study. When this study finishes, I'll be about 80, 85 years of age. And the loss of participants over time. People withdraw for a variety of reasons. And that withdrawal could kind of work or skew your results. For example, if people who tend to do not as well withdraw more commonly, then you might get an excessively hopeful perspective of aging, because all the people who are running the problems disappear from your study and vice versa. So you want to keep people in the study as best you can. Now we also need to remember in Longitudinal Studies that each generation is exposed to a very unique environment, a unique set of circumstances that coincides with their lifespan. And that could explain some differences we see with age or between generations. And we always have to keep that in mind. Someone born in 1900 will experience a very different life or has experienced a very different life than someone born in 1954 like myself. And we always have to keep that in mind. Now the United Kingdom probably has led the world in establishing Longitudinal Studies, which have followed people over a long period of time. And I'll just give you an example of one. It's called the 1946 National Birth Cohort. That's sort of the short name for it. But it really, the longer name is the MRC, National Survey of Health and Development. So this was launched in 1946. And it was developed to address two questions which were really important at the time in the United Kingdom. One question was why was the birth rate dropping in the United Kingdom? And they were very worried about this because this was the time the era before immigration into England. And they were concerned that their population would stop, start dropping. And that might put them at a disadvantage. For example, in competing with other countries like Germany or Russia, the United States, which had a growing population. They would have fewer workers for example. And there also was a great deal of interest in the distribution, use and effectiveness of obstetrical and midwifery services. So the study was launched in 1946 to answer those questions. So what they did is that they enrolled everyone born on a week in March in 1946 in England. And of that larger group, they picked a smaller group that they enrolled in a study, that they agreed to go in the study, their mother and the child, and they were going to follow them. Initially they were going to follow them only for a number of years, but God forbid they followed them all the way out to 2017 and they're still going. So people are now 71 years of age who were enrolled in that study. Now over time the objectives of the study have changed. And they've changed with the age of the participants in the interest in society at that time. So initially it was about birth weight, why was that dropping, and what about obstetrical and midwifery services in that country. Then later on they became very interested in the influence of inequities in society, like people from rich families, did they do better in school compared to children from poorer families, and why would that be? So they studied that. And then they also became very interested in education, the influence of education on children and their success in life when they went into the workforce. But since 1977 they focused on aging, the person's ability to remain independent and look after themselves, what we call self-care, and also how receptive they are to health promotion and embracing healthy lifestyles. So the whole study has morphed and changed over time to address different questions that arose within that society over that long period of time. Now we definitely hope that the Canadian long-term study in aging will be useful for Canadians now and Canadians in the future and will address major policy issues as well as individual questions people have about how to promote their own health. So that's really the thinking behind the CLSA. Now some of you have probably already visited the website, that's the web address if you do use the internet. And you can get a lot of information about the study there. The study to CLSA is what's called a strategic initiative of the CHR. That means that the Canadian Institute of Health Research, that's what CHR stands for, realized that this was an important investment in research and it was different than other investments they have made in research as it relates to health and health care. And the intent is to be a national long-term study that would follow approximately 50,000 men and women, 45 to 85 at the time of enrollment for 20 or more years. So that's kind of the intent. A friend of mine who was 85 said he wanted to get into the study because he liked to live to be 105. But it sort of doesn't work that way. But the information would be collected on the evolution over time of these individuals, biological, physical, psychological, social, and livestock characteristics. And that was going to be done in order to better understand how individually and in combination these factors impact on the person's health, their maintenance of health, and the development of diseases and disability as they grow older. That's really the overall intent of the study. Now there are two components of the study of the 50,000. They're what we call the tracking and then the comprehensive group or cohort is another term we use. Core just means group. So the tracking group is approximately 20,000 individuals and their data is collected through computer-assisted telephone interviews. There's a person who calls and asks questions but they have a computer screen that helps them in asking the questions at the appropriate time in the appropriate order. So that's what computer-assisted telephone interviews means. The other 30,000 are part of the comprehensive group and most of you, I think all of you would be in a comprehensive group, approximately 30,000 and they undergo an in-home interview and then they visit the CLSA data collection site and you visited the CLSA site here in Calgary in the TRW building and at that visit additional data including physical assessments like how quickly you might walk or how well you can grip and your hand grip strength and how well you might see or hear are collected. Then samples like blood samples and urine samples are collected. Now those who are in the tracking component or group can be from anywhere within the 10 Canadian provinces. While those recruited in the comprehensive have to live when in 25 to 50 kilometers radius of their local DCS. So they have to be, for example, in Calgary, you have to be around Calgary. Of course Western city is very different than Eastern city so when we say when in 25, 50 kilometers of Calgary that basically means Calgary. In Eastern city they have these communities all around the city so it can get quite a bit more complicated. So these are the three lead investigators or called principal investigators in the CLSA. The person in the middle is Dr. Praminder Rani who's a master. Dr. Christina, she goes by Tina Wilson, is on your left and Dr. Susan Kirkland is on your right. She's from Dalhousie and Tina's from McGill. Now in addition to these three principal investigators there are 11 local site principal investigators and I happen to be one. I happen to be the one for Calgary. There are eight working groups. These are researchers across the country who collect and deal with a particular topic or issue in the CLSA. I also lead one of the working groups. It's called the clinical working group. So we would review the questions that would be asked that relates to what conditions you might have or what your general health is like. There's other groups for example one on psychology and other one on lifestyle and they also are researchers from around the country who meet on a regular basis to discuss to study what information is being collected and how well that information is being collected. Now there are over 160 researchers across the country and 26 post-secondary institutions who are researchers within the CLSA and there are over 120 operational staff across the country so you can see it's getting to be quite a large enterprise. Now as I mentioned the target was 50,000 and a total of 51,352 people were enrolled into the study for the initial evaluation, the baseline evaluation so we more than achieved our goal. Now there's also a lot of structures around the country. There are 11 data collection sites and I've listed them here and you can see Calgary and Winnipeg are the ones in the prairies. There are three in British Columbia. You can see that there's two in Vancouver it's because people thought it's too difficult to drive across Vancouver to go to one site so they got two sites. One at the University of British Columbia and one at Simon Fraser University and then you can see the other sites. There is a national coordinating center in McMaster and there's also a center where all the specimens, the blood specimens and urine specimens are frozen and stored and also some of them are analyzed. Though I should mention a lot of the blood analysis will be done here in Calgary through Calgary lab services. There is a center at McGill where all that data is being stored and people would make requests to that center for access to that data and we'll talk a bit about that in a few minutes. Then there's a genetics and epigenetic center at the University of British Columbia which is planned but not an operation yet and then there are four computer assisted telephone interview centers across the country so that's the infrastructure for the study. These are the staff in the Calgary site. I don't know if any of them are in the room or they're all working really hard but I've listed them all here alphabetically. No favoritism shown here at all and most are here tonight helping with the event. Now the data that's been collected on the CLC is now becoming available and you could visit our website I put it up here at the top line and it's called the data preview site and you can see overall what type of information is being collected, what questions are being asked and how people might apply for access to that information and possibly the biological samples down the road. Not everything is available at the present time but it is made available to Canadian international public sector researchers and no preference has been given to anyone. Anyone has a good idea or thought about how this data should be used or it would be encouraged to apply. There is a review process people have to meet certain conditions and then they're provided that information that they requested if they passed mustard. Now if you're interested to better understand about how people might apply for the data you can navigate around that site you can find information and a good place to start is what they call frequently asked questions section, the facts section and that's a useful place to get a start. So as I mentioned the data is now available and more and more is becoming available as time goes on. So the questionnaire data from the more than 51,000 participants is available and the comprehensive FISCO assessment and some of the blood work hemological biomarkers are now available from the more than 30,000 participants who visited a data collection site or DCS across the country. So data will be released to researchers who submit and the submission would be reviewed and if it meets all the conditions after review of their application they would be provided the data. They are charged typically $3,000 in that fee just to cover the cost of preparing the data and making it available to them and they have certain conditions for example in confidentiality and how they're going to use the data and they have to only limit their use to that particular question they wanted to answer. Now to give you an idea of some of the data and you have a data portal you can go and you can take a look at the answers to a lot of these questions. I just picked the one dealing with sleep because I'm sure everyone here has great sleep no sleeping problems at all and I thought it just sort of interesting to look at it. So there are eight questions dealing with sleep at the initial evaluation, the baseline evaluation and adult with overall sleep satisfaction, sleep duration whether people had trouble getting to sleep that's called sleep onset insomnia or if they had trouble staying to sleep that's called sleep maintenance insomnia where they sleep be the next day because they weren't sleeping well and then they have some sleep problems one called restless leg syndrome that's sort of an irritating feeling that your legs can't stay still you have to move them and if you walk that sometimes will relieve that discomfort and another sleep condition called REM sleep behavior disorder so REM sleep, REM is our dream sleep and normally when we dream we have REM sleep we don't move, we're paralyzed people with a REM sleep behavior disorder can move while they're having their dream and will act out a dream and often will thrash around and be quite active and may in fact be so active they drive away their sleep partner and there was an interest about how common that might be in the Canadian population overall the aging Canadian population and Braque as I put you where the various questions come from they come from various questionnaires or tools which have been developed to look at sleep and throughout the CLSA you'll find that where certain questions and certain groups of questions have been taken or selected from other questionnaires which have been validated or proven to be useful in other studies so that's the source where all the problems came from so before we look at the data maybe just think about what proportion of people in the CLSA, the 30,000 who did the comprehensive said they were unhappy or very unhappy with their sleep just think about what figure that might be think about how long they slept on average I'm sure your mother told you sleep 8 hours or 9 hours and then how often people had these other problems and I'll show you some of the data and this is just the overall response to a lesser age you can see that nearly a quarter said they were dissatisfied or very dissatisfied with their sleep so 25% which is pretty high when you think of it the average amount of sleep was 6.8 hours which is a lot less than your mom told you to sleep and SD stands for standard deviation that serves a spread so most people slept between 5.5 hours and 8.1 hours over the past month how often did it take you more than 30 minutes to fall asleep and you can see that over 15% said that happened 3 or more times every week which is quite a bit over the last month how often did you wake in the middle of the night or too early in the morning and found it difficult to fall asleep again you can see again if you count how many people said yes 3 or more times a week it was close to 14% over the last month how often do you find it difficult to stay awake during your normal waking hours when you want to and near 9% said that and now on these other questions there are a number of follow-up questions if you answered yes or you had a certain frequency of problem then there will be follow-up questions about how long you've had this problem does it interfere with your daily functioning and and that would be for the questions about he had trouble falling asleep or waking up in the middle of the night and not being able to get back to sleep or staying awake the next day then the question how have you ever been told or suspect yourself that you seem to act out your dreams while sleeping see nearly 1 in 10 said that do you have or have you sometimes experienced recurrent uncomfortable feelings or sensations in your legs while sitting or lying down do you have or have you sometimes experienced recurrent need to urge to move your legs while sitting or lying down you can see nearly a third answered yes to either question and then there were follow-up questions to ask about that now one question you didn't see there was snoring my wife would say you should ask that question but I wasn't asked in the initial evaluation but it was added to the first follow-up and you might recall being asked that question and the question is well do you snore loudly and that was defined as more than talking level or could be heard through a closed door or someone noticed that you stopped breathing while you were asleep and we'll see how many people respond yes to those questions because we do spend a third of our life asleep and it's sort of an interesting issue about how well we're sleeping affective sleep and sleep problems on what happens to us in the other 16 hours a day now if you visit a website and that page right there you can see all the studies which are now being done using the CLSA data you might kind of feel well we've done this but is anyone using the data and the answer is yes and it's increasing year after year after year so approved projects in 2013 there was only one in 2014 there was three in 2015 it went up to 17 in 2016 there are now 40 new studies which were started using CLSA data and so far this year up to the end of April there were six and we'd anticipate that they'll be about the same number if not more than seen in 2016 now the analysis is going to be done by current but also future researchers and we have at least one future researcher and two way back there and just wave so Anne was one of the early ones I believe you got approval in 2014 and Anne's interesting looking at the benefits and challenges of pet ownership as we age and if the question period later on if you have any questions directed to Anne about that particular issue she'd be happy to answer them there was another young researcher who was going to try to make it but I don't know if she was able to make it that's Nayara I don't think she's here oh there you are please stand up and she's visiting us from Oxford and she's come here to use CLSA data to look at the relationship between mobility and walking in particular and thinking as we age because it's found there's this interesting link between our ability to walk and how well we walk with our thinking abilities and this shows the international interest in this study coming all the way from Oxford where in England they have all these longitudinal studies but here we have a very good longitudinal study with very interesting data that researchers from around the world would be interested in so I'd like to thank Anne and Nayara I read for their work and their interest in the study and for your contributions because I'm getting older every day so let's move on and just talk a bit about promoting healthy aging and the first thing I was asked to talk a bit about was brain and thinking and I'm going to give you sort of some general points I'm happy to get into more specifics later on but even when we talk about more specifics it's still going to have to be fairly general because I want to know all the details which might be important to really answer your particular question because as Margaret Atwood said context is all there are so many details you have to know about a person's situation to really be able to give informed opinion or advice let's talk a bit about brain and thinking as we get older first off I can reassure you that we all forget things there was a study done in Iceland where they looked at people at university in Iceland and they asked them to go around with a diary and keep track of every time they forgot something and on average they forgot at least once a day and the more busy you are the more stressed you are the more tired you are the more likely you are to forget so we all have slippages now and then and every time you forget something doesn't mean you're developing an Alzheimer's disease or dementia so please be reassured about that now with normal aging some things do get better what we're thinking in general for example our vocabulary tends to get better and our vocabulary tends to get better and we could probably tell more interesting stories than when we were younger but typically there is a mild decline in memory as we get older and the type of memory problem we have when we get older is a problem with retrieval the memory is there but we just can't pull it out really quick we often will get it when we get a hint or a cue and we often have that tip of the tongue phenomenon we know it's there but it just doesn't come out until it's too late and that's normal with aging now some people have no changes with memory as they get older but in general all of us will encounter some of these aggravations another problem that tends to happen with most people but not everyone is we have a little bit more trouble with attention we have more trouble focusing our attention a little bit more distractible I was younger in university and where I lived if there was a party going on I could still study because I never went to parties I just studied but I could focus my attention but now if I go to the library someone is whispering two miles away bothers me and I have less ability to ignore it and just focus my attention on the task at hand we also tend not to be as fast we tend to have more challenges with tasks that require taking and a lot of information and analyzing in a new way but again there's a lot of variability and with normal aging the changes which may occur we can compensate for those changes and we can work around them now what's of more concern is when these problems get more severe and starting having an impact on our lives we've all heard the term dementia but there's now another condition you hear more and more about called mild cognitive impairment now mild cognitive impairment is that sort of boundary between normality and a dementia so someone with mild cognitive impairment still is independent still has good general thinking but if you test them they definitely do worse on certain aspects of thinking worse than you'd expect of their age or their sex or their education they definitely have a problem and they feel often they have a problem and those who know and love that person feel, yeah there's been a change you know not quite as good as they were still independent now mild cognitive impairment many people stay the same some people get better but some people do get worse it's a state of increased risk of progression to more serious problems so dementia that means you have an acquired problem with thinking that means you are doing better at one time but there's been a change and there's been a decline if unfortunately you had a developmental handicap and there's been no change you've always had that degree of difficulty that would not be a dementia dementia means there's been a change and that thinking problem usually includes memory but usually some other aspect of thinking is decision making or language with your speech and these problems are severe enough to interfere with your ability to live independently and it can't be better explained by something like a depression or an acute confusion or what we call a delirium we've all had deliriums when we think back when you were a child and you had a high fever and you had that sort of green like state you weren't quite sure what was real what wasn't real whether you were awake or not that's sort of like a delirium problem and once that acute problem is dealt with or passes you would recover and return by and large to your prior abilities so there are many potential causes of dementia the most common cause in our society would be Alzheimer's disease now the aging of Canadian society is expected to lead to a large increase in number of people dementia so last year the Alzheimer's Society of Canada estimated that there were about 564,000 persons in Canada living with dementia and 2031 purely because of the aging of our society that number is expected to increase to a little bit less than 1 million 937,000 a Calgary essentially and that will have a major impact on them themselves but also on their families and also on the health and social services of our country but there is good news there is studies which have shown that in high income countries like Canada the risk of dementia at specific ages may have declined over the last quarter of a century over the last 25 years and I'll give you one example this was a study published earlier this year from the United States it's a national American study that compared the risk of having dementia 65 and over in the year 2000 and in the year 2012 so in 2000 11.6% of everyone 65 and over had a dementia and in 2012 that had declined to 8.8% so that's a 24% drop now of course the $100 million question is why and people have looked at it partially accounted by education and I'll just digress here it's been known for a long time that more highly educated people are less likely to develop dementia and that's felt to be possibly because education stimulates your mind and kind of exercises the brain much as we exercise a muscle when we run or lift weights and that we have more reserve and we're able to tolerate more problems as we get older and in the states in 2000, 2012 the average number of years of education went up in 12 years by one year so let's say in 2000 the average number of years would be 10 years it was 11 years in 2012 and that was felt to account for some of it another part of it might be explained by better treatment of cardiovascular diseases I'm thinking here like hypertension and diabetes and high cholesterol levels looking up on those things better and these conditions are risk factors for developing thinking problems as we get older so it might be partly accounted for that but to be honest we don't fully understand what's going on but it's good news and we like to kind of leverage on that and the thinking now is that if we could address use of tobacco poor diet physical inactivity raised high blood pressure elevated cholesterol obesity and diabetes we could reduce the likelihood to mention the gas is that we might be reduced might be able to reduce the numbers by 20% over the next 20 years which is nothing to sneeze at of course we like it to be 100% but it's a good start and particularly if we have a better understanding of what's going on we hopefully can make that 20% higher a higher rate of reduction so also felt that we could add to that figure by maximizing protective factors remember I talked about years of education if we have more cognitive enrichment that might be good for us if we have more stimulation of our minds over our lives that would be good if we're more socially engaged we're more involved in groups we come out to talks like this tonight if we sleep better and if we could minimize risky behaviors like traumatic brain injuries like hockey players and football players and excessive alcohol intake and substance abuse and also deal with mental health issues like decreased likelihood of depression or depressive symptoms or excessive stress or what we call neuroticism which is a tendency to respond with negative emotions when we get frustrated or lost some people when something bad happens to them they keep on going it doesn't bother them it's water off the back of the duck it does not tolerate any type of frustration and it just drives them wild but if you could sort of just let it go and keep moving on that would probably be a better way for you and less likely to lead to problems down the road so if we could do all those things we might even be able to improve it even a bit more even now what our imperfect understanding now I was also asked to talk a bit about lifestyles and practices and attitudes and impact on aging and healthy aging there's a lot of information that keeping active and engaged mentally physically and socially is good for us as we get older the worst thing to do when you retire is to go home and watch TV and that's all you do you have to stay part of your community part of your social network part of your family and keep active and engaged keeping mentally active by reading going to galleries going to concerts going to talks is all good and being physically active you know, exercising and for example when we go to the mall maybe not park close to the mall but far away in the parking lot and walk in would be better for us we should make our lives a little bit harder in some ways and then if we have a better diet our heart healthy diet because a diet which is good for our heart is also good for our brain and other aspects of our health and there's a lot of interest right now in the Mediterranean diet and I'll talk a little bit about that in a few minutes and then attitude all of us have to have meaning and have to have joy in our lives and if we have a positive attitude towards aging there's increasing evidence that is good for us as we get older and we're less likely to have more evidence as we get older there's a quote from Betty Frieden like is aging is not lost use but new stage of opportunity and strength we can't look backwards we must look forward so physical activity what's recommended the Canadian Society of Exercise Physiology gave the same recommendations for adults 1864 as for adults 65 and over they recommend at least 150 minutes of moderate to vigorous intensity aerobic physical activity per week so they define moderate it would be akin to a brisk walk and vigorous would be jogging and the bouts of that activity should be at least 10 minutes that's what they recommend they also would suggest that it would be beneficial to add muscle or bone strengthening activities for larger muscles and they also feel that more physical activity would provide greater health benefits that if you do 150 minutes and you enjoy it and it's not a burden for you and you can fit in into your lives maybe 180 minutes would be even better so that's what they suggest now for diet miniaturine diet is this it's primarily plant based fruits and vegetables and nuts that you use olive oil rather than butter and you use herbs and spices rather than salt to flavor your food you limit red meat to no more than a few times a month and fish and poultry at least twice a week and sort of the one that's a bit argued about is red wine and moderation so if you are a responsible consumer of alcohol this would be one more reason to carry on with that pleasure in your life but you'd never recommend people start drinking for their health because it's too slippery a slope now the other question is what's moderate I mean most doctors define moderate as what I drink and heavy drinking would be anything more than that but really moderate alcohol intake would be no more than three to four standard drinks per session and no more than nine drinks per week for women and 12 to 14 for men so you could sort of I'm not asking to vote or anything but just keep in mind you'd want to be moderate or less and also what's moderate varies from country to country like with moderate in Canada might be very different than you'd see in France there is limited data, not conclusive but encouraging data that there are benefits in preventing chronic conditions if you follow a Mediterranean diet much like that now also there are lessons we can learn from other longitudinal studies there is a longitudinal study being done in Ireland called Tilda now I hate these acronyms where they take letters from the middle of words to make something and that's what they did here so Tilda is taken from the Irish longitudinal study on aging you can see I bolded the letters that you talk and why they picked those particular letters in the middle of words I have no idea and as far as I can tell Tilda doesn't mean anything in Gaelic I did look it up so what they found was that independent of changes in people's health like having a stroke or God forbid a bone fracture or the onset of depression negative perceptions how you look at aging if you look at aging in a negative way and your expectations of what the future will be like as you get older your sense of control of yourself as you get older and you're just sort of core response emotional response to aging if you are more negative in the way you looked at growing older that predicted declines over the next couple of years in your self-esteem your satisfaction with life and your self-rated health it also was likely to be associated with worse health behaviors you're less likely to exercise you're less likely to follow a healthy diet you're less likely to have consistent business to a health care practitioner you spent less time in leisure activities and you're less engaged in your community and that led to hard changes in people's thinking they did worse on thinking tests much like the ones you did in the CLSA and did worse on tests of physical functioning for example grip strength or walking speed so how you think about aging how you think about yourself does have an influence on what actually does happen to you as you get older and the last I was asked to talk a bit about living well with chronic conditions and of course each chronic condition is a bit different but I'm just going to talk about things in general and if there's time we could talk about specific questions about specific problems if you wish so over time in our country if we compare 2017 with 1917 or 1817 there's been a change in the types of health problems we encounter and there's also been a change in people as they age the type of health problems they encounter at earlier times in our country and at earlier ages for us we tend to be bedeviled mainly by acute conditions and injuries so main health problems would be things like broken bones or getting an infection like a pneumonia but as we get older but also as Canada has gotten older we're moving to a time where the major health issues are chronic conditions and chronic diseases now we do have to change the way we respond to that because to deal with acute conditions and injuries you have a healthcare system and you have a healthcare habits which tend to be reactive and you have episodic care so you only see healthcare practitioner when you develop an acute problem and you just deal with that acute problem for that short period of time then it's gone and then you forget about it and you move on you have to change from that way of dealing with healthcare to a more proactive way of looking at health and also relying more on ongoing care because these are problems which will not disappear and we have to think more about health promotion and disease prevention and the new healthcare system that we're painfully moving towards there's going to have to be greater collaboration between the person with the condition they have to be informed they have to be engaged and they have to have the knowledge and skills they need to deal with their health conditions and the tools they require to help manage that condition and you have to have that allied with healthcare services which are proactive and look for problems at an earlier stage rather than responding to when they become more severe that's also provided in a coordinated and integrated fashion and provided mainly in the community not in the hospital because hospitals have to be there, we need hospitals I'm not saying close hospitals but we like to nip problems into bud before they've progressed to the point where hospitalization becomes the best option for them and that's what we're moving towards as time goes on now we have time for the questions and I think we have our staff with microphones and if you have questions please feel free to answer there's one way over here have you had any significant surprises so far in the data you've collected you know it's so early in the stage of analysis of the data I mean one thing I found and I think every time you look at the data sometimes you'll find surprising things I show you some of the data from sleep, I was just interested in sleep and I was a bit surprised I was surprised how many people are not happy with their sleep and seem to be sleeping relatively short periods of time you often hear that we're all sleep deprived and this seems to kind of feed into it a bit now really the big question is like when you look at that group you want to split it out those who are satisfied in sleeping well but those who are not and how they differ and is there any way to shift the satisfied group into the satisfied group that's really the follow up question which can be really very important to answer the people who developed that module that section of the CLSA they're analyzing the data right now and also with a longitudinal study it's really going to be interesting to know if you're satisfied with your sleep in 2015 what's it like in 2018 has it gotten better or worse, stayed about the same so that's going to be really interesting question to look at as well so anything that's earth shattering totally beyond the realms I can't say that but it's still early in the analysis bit but I think every time you look at the data you sort of see interesting things you say well why is that and you wonder about that back here I think first in your tilde you have mental state impacting physical abilities or behavior how do you know this is not a chicken and egg type question where in some cases mental effects physical but physical may be driving the mental so the question is I'll try to maybe you repeat it to me then I'll repeat it is it chicken and egg because mental could impact physical mental could impact physical or physical can impact mental which you then correlate so you've got a correlation but not necessarily causation the only thing about the tilde data that I showed you was that they looked at time 1 they looked at time 2 and they looked at change so the people who had the negative attitudes about aging they're the ones who showed a more definite decline in their functional abilities even when they try to factor in all other potential explanations so it was not a cross-sectional study where you looked at everyone at the same time this was predictive if you had negative attitudes about aging it predicted worse health even if you try to account for everything else but that's a very good important question and whenever you see correlation that doesn't prove causation and you have to look harder yeah are you looking at what role genetics plays in aging? yes definitely and that's for example the blood samples that's going to be a genetic analysis to look at what correlates with more personally meaningful successful aging as we grow older I think for us as we grow older what kind of predicts that is our genes I think are important I also think what we do and what we've been exposed to is important I also think time is going to be important and also I think luck and chance things happen to people even if you do everything right or everything wrong that would be somewhat unexpected I don't think there's going to be a gene one gene that explains everything but I think it's all going to be part of this kind of complex equation that will lead to better or not so successful aging and clearly you'd like to be able to find out if there's a genetic predisposition is there anything you could do about that is there some way to confound that deficit or fill in the gap so that you're less likely to show the consequences of that maybe not as desirable genetic makeup our genes are funny things and some genes will lead to problems but some genes lead to great successes for us our genes are us and also what genes are turned on or turned off are also going to influence by things in the environment in the in the 1946 study that I mentioned they found for example that your birth weight predicted your grip strength when you're 50 years old so what happens to us in very early in life sometimes there's this thing that can sometimes be very difficult to intervene and change but of course in Canada we're impatient and we're not going to do a 70 year study to answer that question and we obviously want the answers now and we want answers now particularly for ourselves but also even more so for our children just wanted to ask did you say that we would be able to get access to our own personal data no it's all anonymized is it possible to get that no because there's a lot of tests that we're done and I've been in conversation with my doctor about doing different things so we won't be able to get that so no you do get at the end of your visit to DCS you do get that sheet that gives you some information about your evaluation now one thing you got in the baseline you haven't got in the follow up was your dexa, your bone density but you'll be getting something that's better than a dexa score is called a frax that's a fracture risk assessment and it looks at the dexa but it also looks at other factors which help predict whether you're going to have a fracture or whether you're at high mid or low risk for fractures that could be shared with your doctor just one more question I've been on sleeping medication for going on 30 years is that information being captured with the people that are having sleep problems yes it is and by the way there are some specifics I can't get into but if you have any kind of specific question if you send it to the email address on the first slide I'll do my best to respond to you or maybe get in touch with you to ask about a specific question you might have I was wondering I'm not sure I was wondering if you were capturing any data on menopause for women relative to sleeping and maybe other health issues there's a whole section on women's health unfortunately I don't believe there's an equivalent section on men's health so we have to work on that but yes has the effect of stress been factored in? I'm looking right now at the amount of stress that's taking place on the east coast with the floods etc and once upon a time they used to say that stress could turn your hair white well I'm looking around this room but has that been factored in in any way shape or form as to the effect on aging? yes and you know on the data being collected there are questions about stress there are going to be more questions being asked in the future about anxiety and some of the blood tests could also look for markers of stress within people's blood so that definitely will be looked at the other thing that would be kind of interesting in the future we hope to be able to link the data being collected in these urban sites across the country with the environmental information we'll be able to compare it for example average temperatures climate change storms you talk about stress think of 2013 but this time and flooding here or what happened in Fort McMurray last year and I think we kind of have to look at other data sources that might give us a bit more information and add to the data being collected from all of you when you come in and because this crossed the country we could compare various countries in various parts of the country and whether there are changes I mean a couple years ago there was another large Canadian study called the Canadian study of health and aging and they looked at how people define successful or healthy aging in different parts of the country and there are differences people can back define it differently than people in the west for example so that's an interesting why is that you know and what's important in eastern Canada compared to western Canada all those things will have to be looked at and in myself we're part of a group that will be looking at CLA say data from urban communities across the country that have different policies for being age friendly and we're trying to evaluate the impact of age friendliness of the community on how people perceive their aging and it might be interesting to follow that group over time there seems to that there could be a bias to in the comprehensive study towards urban Canadians versus rural and managing that potential bias well it's it's recognized and it's going to be always kept in mind when the data is being analyzed but the CLA say no matter how big it is can't answer all research questions and there might well have to be something done separately for Canadians living rural and remote areas it also will answer very little about indigenous populations indigenous people who live in urban areas can be part of the study but if they live on reserves in remote areas they will not be part of the study so that's a hole in the study and that's recognized I'm part of a group of indigenous researchers who will be looking at the CLA say data to see how much information we're collecting could be used by them and what holes they are and how we could best fill those gaps Dr. Hogan I was wondering if you could tell all of this data collection is so impressive are any of our governments our government representatives seeing this data are they able to plan our health care better in the future like what's going to be used with this? It's still very early in the evolution of the CLA say and impact on public policy yet in Canada but I know the 1946 birth cohort study did impact how things were done in the United Kingdom it did have influence on education it did have an influence on trying to deal with social inequities at birth and I think as time goes on and to be honest with you I think it might take maybe two or three cycles before the data the information really becomes powerful and so unique that it should influence public policy national policy definitely we do our best to inform politicians at all three levels about the study and how it could possibly be used to inform public policy and for example we are working with colleagues in the city of Calgary to look at CLA data and whether that is a useful source of data for them when they look at public policy as it relates to an 18 Calgary population and that's something we're working with quite closely with them yes my son my partner and I have been square dancing for over 25 years as I look around the majority of the people here should be dancing with us and there have been many medical much medical documentation to support this activity I'm just a little bit surprised that it hasn't sunk in a little better because when they do these articles they do emphasize the importance of being able to dance and listen to a cure at the same time and they do compare it with all kinds of card games and they said there's no card game bridge crib or any other card game that has the same ability to minimize the progress towards Alzheimer's then squirreling around dancing because of the fact you have to be able to listen and carry out the activity at the same time so we'd like a little more promotion yes from the medical society or from anybody because it's really a wonderful activity social and otherwise I think dancing is a very interesting form of activity because it's good from a physical standpoint but from a mental standpoint as well and also a social standpoint and sort of hits all the boxes but you can imagine the difficulty of proving that in studies you know because it's hard to randomly allocate dancing because people choose to dance or not to dance and that might be an important influence on good outcomes yeah yeah yeah personally I just do break dancing that's what I do no no I'm not arguing with all I just wondered if the information being gathered is sufficient to drill down in certain ways I'm thinking certainly the physical, mental, social we're talking about and my real question is the interaction with small children and the grandchildren and great-grandchildren with aging people and if there would be enough information gathered to be able to say you know what we need to get more formalized connection between elementary schools and elderly homes nearby and stuff which you know to create that kind of interaction which is positive positive mentally and physically and everything else yeah I agree with you, one of the problems when I study like CLSA and you've gone through it and you know a lot of data is being collected but someone can always say well why don't you ask this you know why don't you add this question and we're going through preparations for the next follow-up phase right now so at the start we say well let's go through and let's see what questions we could drop you know and you go through 10,000 pages a document and you might find two questions you say yeah we could drop those but there's about 10,000 more questions people want to add and it's really hard to keep it under control I think the point to make is a good one because we are collecting a lot of very useful information but sometimes it's not quite as deep as we would want you know and they told this study that I talked about you know they asked this questionnaire about people's perception of aging we haven't done that and that would be an interesting question and you kind of say well why didn't we do that shouldn't we do that well if we add something then we really should be taking something out and what do you take out and it becomes a very very difficult exercise but I agree with you entirely I think also I agree with this idea that we should be part of a generational community I don't think it's good for us to live in age restricted silos you know any of us at any age I mean that's my opinion yes you have the microphone okay oh sorry can you just well if you do I'll have to I'll have to how do you want to do it Birchman can we let this lady go first and then we'll run it over okay thank you okay I'm interested in the incentives okay I'm interested in the incentives that are inherent in funding models and the funding model we have now that was developed when Medicare was instituted largely focused on acute care and excluded psychiatric care if my recollection is correct do you anticipate as the study goes along that the funding model might change to reward might change to reward care for ongoing chronic health problems so the question is the influence of the funding model for healthcare and when Medicare came in we were dealing as I mentioned before mainly in a society where acute health problems were the big issue and in fact you know when I looked at the Hall Commission they said that they were going to provide healthcare for everyone at a certain level but they were going to restrict any enhanced care for older people or for people with mental health issues until the general population was dwell dealt with which is the opposite of what happened in the United States right they targeted the money they spent on healthcare to older Americans so we sort of did the flip I do think that we are trying to shift but it's really hard to move money from acute care hospitals into the community based services where I think it should be spent because that means you might have to close a hospital and when you look at the newspaper you read the Herald healthcare crisis is usually about backups in the emergency room or not enough hospital beds and I know politicians have their failings but you can see the problems they face if they say we want to shift money from let's say a hospital system into a community based system they get a lot of push back when they try to do that and sometimes it all comes from general public sometimes it comes from the healthcare practitioners including physicians and sometimes to really end up saving money in the community you have to make an initial investment up front and the money is so tight it's hard to find that extra money to set up the services the way you want I think all we can do is fight the good fight and make the case over and over and over again because clearly that's the way we should be going the CLSA probably will not talk directly to that particular issue because it's not going to cover all research questions we have in this country but it's a great question and it's a really important point oh sorry I think this gentleman here we have to bring the okay now this is a very selfish question I'm going to ask I respect the fact that you have a lot of data and that you're doing and you're doing a lot of research but how does that affect me now there's another thing somebody should write a book on what to expect as you grow older because when I passed 81 I'll tell you I got some pretty big shocks and no one prepared me and it's hard to live with things and you have nobody to ask when you get to a certain age there's nobody around I'm going to be 89 congratulations so why don't you send a note to that email address and we'll sit up and have a cup of coffee sometime that's the best way to do it justice did you ever read a book about growing old honestly yes but one of the sections he talked about was the pill drill you know like trying to keep and order all the pills he had to take I'll tell you one of the biggest shocks is boobs I had a pretty good chest I used to lift weights and then when I hit about 82 or 83 they dropped well well I think our live streaming has got x-rated right now yes oh sorry can you just go is there any connection between longevity and personality the reason I ask is I skate in the winter and I golf in the summer and the 90 year olds and late 80 year olds that I golf and skate with are type A personalities is there any proven connection there are a number of studies done and people live to be 100 or greater and they looked at kind of what predicted that I mean one is having good genes that came up earlier another one was having good health habits no men lived to be 100 if they were a smoker some women did like the queen mother but no men did you had to have good health habits but they also found personality traits and being more able to deal with things which happen in life and not dwell on it unduly and moving on looking forward was really important there was a gentleman I saw a number of years ago when murmur queen Elizabeth had the diamond jubilee medals and this gentleman was winning an award and he was 97 and I was talking to his daughter afterwards and then she said well I have to run right now and I said well dad is going home he is working on his five year plan he was looking forward I was looking forward sorry maybe here he is here is my question do you think the whole darn thing might be skewed because people who would volunteer for this type of study would tend to be keeners a little more keen about their health you always have that with volunteers in a study volunteers are different than people who don't volunteer absolutely but one way around that you try to make the study big enough that there is a range of characteristics in the people in the study and you still hopefully will get useful information but you are right volunteers are different than people who don't volunteer we also know that there is other biases in the study about the issue of rural and remote communities we also have indigenous populations we also have to be proficient in English or French and immigrant populations would tend to be underrepresented one thing we want to do in the data here in Calgary is to look how skewed it is because we will compare the characteristics of the population who go into the study in Calgary to the overall population of the same Asian Calgary so we know how different it is you still I think will get useful information but it is not going to answer every possible question you might have about aging in our country there is no way it is going to do that but it is still a very important study but it is a great point that you make Dr. Hogan you are my comment you are just comments just now or anticipated my comment is that when I look around the room sadly there are very very few people of color and I suspect very few recent immigrants or first generation immigrants and yet the future of Canada is a different color from many many countries so I think that the study is not collecting that data that is right and obviously that is there are potential solutions or remedies for these problems for example it may be that in a few years there will be targeted recruitment to try to bring in people from different backgrounds into the study but that has not been addressed or answered yes but I can reassure you that people in the study are aware of this and obviously we would wish it was a more representative population but it is what it is but I also want to say that I really am appreciative for all of you for being in the study so don't go anywhere stay there is one here thank you this question has to do with the cost of the study because it is longitudinal do you know how much it is going to cost per person that is involved in the study yes to be honest with you let me look it up can you send me an email and I will send that to you because rather than trying to pull it out of the air let me look at it and get back to you about that ok I will do that question back here again I just wanted to follow up on one comment made earlier about sharing with government agencies, policy makers your thoughts may be on being able to share the information with physicians and educators and I am talking here about as early as elementary if we are talking about the impact of healthy mental state and healthy living might as well start early the benefits of sharing it with educators it is a little just another comment you mentioned phase two and taking consideration of suggestions and other comments questions that might be introduced I think the impression that you got to add one, you got to take one away in terms of the time I spend answering the questionnaire or the time I spend in the clinic and this is just a personal opinion I would suggest if you want to add a couple questions don't take two away we've got time to do this serious stuff I just want to make a couple comments about that is when we look at changing we also looked at all the comments made from the staff but also participants and things they thought should be added or things which weren't quite right from their perspective that's always been looked at very seriously one way around this is that rather than maybe asking all 30,000 all people the same set of questions the addition we might be doing what we call sub studies like you know recruiting people from the larger group are willing to do that extra work or go through that extra evaluation the other thing that's being looked at is allowing people to maybe do the in-home interviews through a web-based format logging on, doing it yourself rather than having to go through the interview itself that's something else that's being considered and looked at and also for people who become less able to come into the DCS we are now doing what we call the DCS at home for people who can't come though we have to keep that quite limited but we want to keep as many people as we can within the study because we don't want a high attrition rate because I will just undermine even more so the study but your comment about aging as sort of a societal issue is a really important one and I remember when I was in training a long time ago going to a high school and talking about aging to a bunch of 16-year-olds and my god they thought 30 was aging but it's a challenge but it should be done I just had a couple of quick questions one was just out of curiosity has there been much dropout rate or attrition rate? No, the attrition rate is very low it's less than predicted and Canadians are great joiners a number of longitudinal studies which were launched around the world about the same time as CLSA were canned, were stopped because they had so much trouble recruiting but in Canada people like yourself are volunteered for the study are participating in the study and it's a great reflection for us as a country and for all of you and thank you very much now I should tell you I have trouble telling interactions I can only hear out of one ear sometimes I'm looking at the wrong spot when people are talking I had another quick question that was about family history to my recollection I've not yet been asked about family history is that deliberate? That's a sore point for me I think that's a big lack in the study and has to be added but the difficulty is trying to find the right type of family history format for getting this information but it's been identified as a clear hole right now I agree with you entirely it's hard to have an agent study without a good family history My question is actually for the lady who's doing the research on pet ownership and I just wondered if you've had any what kind of impact has pet ownership on healthy aging? I guess I'll go check my emails now I think the answer is quite complicated and that there are there's evidence for some really interesting benefits there's some evidence for some challenges as has been a little bit of the theme of the night a lot of it is contextual contextually dependent for instance this isn't the work that I'm doing but studies have shown things like for older adults who have lower amounts of social support having a pet might support their mental health as they're going through a crisis or some sort of grief you really have to get quite specific some of my work prior to accessing the CLSA was actually looking at a fairly straightforward activity which would be dog walking and just the physical activity support the social interactions the mental health and companionship so it's one of those social phenomenon that is it doesn't have a black and white yes and no answer but I'm very interested to try and try and understand it more because even as a phenomenon our views of pets are shifting and changing over time I should mention Anne's working and very close to the end of her PhD and your thesis defense is coming up and good luck thank you earlier you mentioned that there's a finite life to the study and obviously you can't go on forever I think by my calculation it's about 2025 or so the study will end by that time a great number of people in this room will still be alive so I know that the study is focusing on a lot of things like the quality of life and chronic problems and those sorts of things but I think people would also be interested to know about mortality and so is there any plan that following the end of the term to track the people in the study to determine how long they actually do live and use that data in some fashion definitely mortality is being tracked but the other thing that's being looked at in the study is we're looking at end of life and the care and people's perception of it not clearly we're getting this more from a loved one who knew the person and they're giving their perception end of life is something that unfortunately is going to happen to all of us we don't dwell on it but it's something that's going to occur but I think all of us want it to be as meaningful as possible and with us in control as much as possible so right now in Canada is a very interesting area because of medically assisted death and how that's going to roll out and the impact that's going to have on our society it's unknown but there's a particular module now that has been developed to look at end of life stages and anyone who unfortunately passes away who have been in the study will be collecting that information on them and as the study goes on we'll have more and more and more information and we'll be able to track changes over time and we can also look at differences across the country yes yes could you comment on the age distribution of the 50,000 participants and your feelings on any shortcomings in that distribution for example if there's just not that you mentioned 45 to 85 is there a real a posity of participants in the 45 to 55 year old range yeah it more or less mirrors the population distribution in Canada but a group that was harder to recruit were the younger men you know men 45, 55 they were just harder to pull in by and large in volunteer studies we talked a bit about volunteer studies women volunteer more than men and men of working age often feel they're too busy have other demands on their time they just kind of march up to the counter as other population groups did so that's a relative deficiency still a lot of younger men but not as many and it was harder to recruit as compared to other demographics so if not look we've come to the witching hour, 8.30 I really like to thank all of you for coming it was great questions a lot of jest for thought and any of you have any follow up questions or anything you didn't want to raise please send an email thanks again