 My name is Mark Ramis, and I'm an associate professor in the School of Public Health and Health Systems at the University of Waterloo. I'm also an associate scientific director for the Canadian Longitudinal Study on Aging. And today I will introduce Dr. Verena Menick. Verena is a full professor in the Department of Community Health Studies at the University of Manitoba. She holds a Canada Research Chair in Healthy Aging, and her main research interests lie in, not surprisingly, the area of healthy aging, the determinants of healthy aging, age-friendly communities, and healthcare utilization among older adults, particularly at the end of life. Verena has a direct connection to the Canadian Longitudinal Study on Aging. She is the local principal investigator of the Manitoba site of the CLSA, and she will be speaking to us today on age-supportive environments and healthy aging. Just a word about process before I give the microphone over to Verena. We mute everybody, and that is simply because if everyone was unmuted, there would be a lot of feedback, and you wouldn't be able to hear Verena present. So because you're muted, if you have a question that you would like to ask of our speaker, at the lower left-hand side of the window for the Blackbird Collaborate Application, you'll see the chat feature. Just type your question into the chat feature, and at the end of the talk, I will read out the questions to everyone and give Verena an opportunity to answer your query. So I'll stop talking now, and I will pass the baton over to Verena. Verena? Thanks for having me and letting me speak on age-supportive environments, or actually as I probably more commonly will refer to them as age-friendly environments, age-friendly communities, because that's the term I have used. They are used interchangeably, so if I switch back and forth, that's not an issue. Now, Mark said to type in questions, I really do encourage you to use that chat function. I have to tell you this is rather odd sitting in front of my computer and talking to my computer. I thought maybe I'll talk to my plants over there, but so if you can even just say hi once in a while, just so I know that I am, in fact, talking to somebody, that would be great. So maybe somebody can just say hi. That'd be really wonderful. Great. Thanks. I'll keep an eye on those. Very cute. Thank you. See, that makes me so much better. It feels so much better. Okay. I feel obliged to start off with the world is aging slide here as you know, and I know you know that the world is, in fact, aging. It will grow to projection say that we will have 2 billion individuals age 60 plus, this is 60 plus year old age cut off in 2050. So really the issue about promoting healthy aging has come to the attention of certainly not just researchers, but very much policy makers. So making communities age supportive or age friendly is proposed as one of the solutions to promoting healthy aging. Let me give you just a little bit of a run down in terms of what are some of the historical perspectives on that relationship between aging and healthy aging and the environment. And this is highly selected as I pointed out in the title because clearly I just picked and chose a few items. In gerontology, those who are in gerontology would be very familiar with environmental gerontology. Lawton would be the name associated with that who, you know, starting in the 70s, early 70s talked about person environment fit. So the relationship between the person and as that person is embedded within an environment. We have many, many determinants of health and I would say healthy aging models because it applies as much to healthy aging as it does just to health. Which also outlined that physical, physical and social environment is one of the determinants of health and or healthy aging. Those of you who are familiar, for example, with the Evan started model 1990, those elements are in that model and certainly in many others. Just as a more of a policy document, the Madrid plan of action in 2002 had one of the action items among many, many action items. Talking about ensuring, enabling and supportive environments has been one important aspect of promoting or dealing with an aging population or supporting an aging population. Some of you may be familiar with all the literature out of the public health field, which has been growing enormously, enormously, I guess, in the last, what, 10, 15 years in terms of the relationship between the social and also very much with the physical environment and various health outcomes, for example, how does neighborhood walkability relate to physical activity like walking and we in turn know that walking is good for health or how do these organic environments relate to weight and consequently also to health. So there's a very large area, a lot of research in that area, which has really more recently also been applied to older adults. The last issue that is the last document I guess that I want to refer to is the, thank you Brenda. I'd like to have to know that again. I'm talking to somebody. The WHO in 2007 started to talk about age-friendly communities and I'll go a little bit in more detail into that because it really has been the foundation of my research in this area. So in 2006, the World Health Organization launched the Global Age-Friendly Cities Project. This project was designed to really identify what makes a community, a city, a neighborhood in an area age-friendly. The brochure that you see and you can't read, you were not intended to be able to read that. It's just a pamphlet that came out at the time really describing what this project was about. The focus groups conducted around the world as part of the project and it led to a guide about how to make communities more age-friendly. In that document, so both in the brochure there but also in the document, an age-friendly community is described as one where policy services and structures related to the physical and social environment are designed to support and enable all the people to age actively. Aging actively here is not just physical activity at all but it's more broadly conceptualized in terms of security health as well as participation. So in terms of the WHO framework, there were eight domains proposed that are critical to an age-friendly community or age-friendly city or age-friendly neighborhood. It doesn't matter really what scale you're looking at it and it involves transportation, housing, social participation, respect social inclusion, civic participation, employment, communication, information, community supports and health services, and then outdoor spaces and buildings which is very much related to the physical environment. So a number of areas that were described by the WHO as being critical and really the link towards to health. So if you had an age-friendly community that presumably one could promote healthy aging. In 2007, the Global Age-Friendly Cities Guide was released so you can find that easily online if you're not familiar with the document. If you are familiar, or if not, I would also point you to a Canadian document, Age-Friendly Rural and Remote Communities Guide which was also released in 2007 as a parallel project, parallel document to the city's guide because of the awareness that rural and remote communities are different, they're different challenges. And so there was a Canadian project that very much also looked at the same issues of transportation, housing, outdoor spaces, but in a rural and remote context. Again, you can easily find that online under the title Age-Friendly Rural and Remote Communities Guide. So that's the way the context in terms of the background how I came into the Age-Friendly Area because I was part of the Age-Friendly Cities project as well as that rural and remote communities project. So let me give you a little bit more detail around the context of my research. One of them is in terms of conceptual framework using an ecological framework. So that's building on various ecological frameworks as well as lot in the idea of the person embedded within the environment. If you look at the diagram in front of you, we're starting with the older person in the middle. That person is embedded within a family and friendship environment. So there's a social network, but then the person lives in the community and is also then living within a larger policy environment. All of the factors, all of these factors impact the older person and how that individuals will age. Just in terms of community environment, I've put in some of those domains that would make a community age-friendly like the physical environment. So outdoor spaces, buildings, housing, and again social environment, which is more the social cohesion perhaps, so other social factors and so on. In terms of the social connectivity piece that's in the middle there in yellow, if it shows up in yellow on your monitor, it doesn't mind. The idea being that really an age-friendly community connects. It connects people and there are various social aspects to an age-friendly community. Fundamentally, it promotes social inclusion. At any level that you would look at, there's a certain connectivity factor. Intentionally, we used here the term social connectivity to stay away from specific concepts, but you could plug in in certain contexts. You could think of it as social capital at the community level. You could think of it as social engagement at an individual level. And you could have a connection and more of a partnership type of connection more on the policy environment level that interacts with the individual. So broadly then, we're using an ecological framework to situate the research. The other context I need to mention is that my research is in the context of the age-friendly Manitoba initiative. This was a government initiative that was launched in 2008 on the heels of the World Health Organization's age-friendly cities project. The initiative designed to make communities throughout Manitoba more age-friendly. There are currently 100 communities part of the initiative and the little red dots on the map of Manitoba there show you those communities. It spreads out around the whole province and those of you who know Manitoba know that it's a very sparsely populated province but very large geographically. So you go way up into the north, the populations are very, very sparse. Overall, 80% of the population are part of communities that are part of the age-friendly initiative. So in terms of research, our extent scope has been into most of these communities, not all of them, not all 100, but many of those. Method-wise, we use surveys from very much mixed methods, surveys, interviews, neighborhood audits, for example. Thought-of-voice, some of the results, some of the images that will show come from a thought-of-voice methodology project where people are given cameras and they were simply asked to take pictures of what they thought was age-friendly or not in their community. They filled out journals and they were focus groups and it's a very nice methodology to give a really rich description of what is age-friendly and so on in each supportive environment. We also had expert opinion groups and all the research is very community-based. It's very applied in nature. It's designed to help communities become more age-friendly while at the same time finding out more about what we mean by age-friendliness. So in terms of just giving you a bit of an overview then of our findings and what we've learned over the years, so this is research that's gone on for several years, for a number of years. First of all, I just wanted to briefly talk about what is an age-friendly community and then also more applied in nature. What factors help a community become more age-friendly? What are some of the community-level factors also more broadly in the broader issues that I'll talk about in a moment? So what is age-friendliness? I presented earlier the WHO domains, the very broad domains, but within those. So what makes a community age-friendly? And there are many, many factors that make it age-friendly. You have the physical environment. You have the social environment. The pictures that I'm showing here and the comments. The comments are in italics from participants who had cameras. So these are pictures taken by them. We get a lot of different issues. The sidewalk issue, the ice issue is an example. On the right side you have buildings which may look really kind of nothing special there, but really the person said, this is a community within a community for seniors. Very positive. There are a lot of individuals there. It's a social environment. So clearly there are many, many aspects of an age-friendly community. Way too many than I can go into at this point. I just want to highlight the opportunities and choices piece because I think that's an important one. I simply love this quote from a participant. You want to go skydiving. Find it's your individual choice. I think this is just great and really in a way it underlies age-friendliness. You want to have choices. You want to be included. You want to be independent. You want to have services, but you do want to ultimately have choices. An age-friendly community is intergenerational. This is one of the things that has come up at many levels in a lot of the discussions, the focus groups we've had, the various individual interviews, and this is from a participant in the photo voice study. If you build the community for seniors, the young will come, but when you just build the community for the young, the seniors will disappear. It is age-friendly. It is not just senior-friendly. It's not just age-friendly. It's a community for everybody. And if one builds the right community for everybody, older adults will be included and will have better quality of life, one would imagine. So the intergenerational component of an age-friendly community. Another factor is that the factors in the physical and social environment are very much interrelated, and I just pulled one quote out to illustrators. This is a picture of the building, and you could just look at it as a building, but it's a lot more than that, of course. It's not just housing, but it's also activities, like exercises, meals. Getting together, it's a social environment, and on top of that, the person brings in, and certainly not the only one who brought in the transportation. So yes, you have a building with social and physical programs, exercise programs are provided, but you need to be able to get there. So when you look at age-friendly, age-supportive environments, disentangling the physical from the social is perhaps not even possible, nor desirable, because there's so much interrelated in people's minds, and at one point I started to talk about the globe. It's just a globe of stuff. People put it all together. They mush it all together, and it's how people live. You live in a physical environment, but it's not just that alone, but of course it helps you be socially engaged, and it's a broader issue than just one or the other. Let me just actually get back. There's another comment to this issue from a research perspective that makes it a little more difficult, the whole topic, because as researchers we like to isolate effects. We like to look at simple effects and look at, preferably, causality and specific relationships, but people don't really talk about it like that. They really talk about various aspects being very much interrelated. Taking into account the diversity of seniors is absolutely critical. There are various characteristics of older adults, aging individuals. Income is one of them. That impact that is almost one of those cross-cutting issues that makes a big difference if one is older and with a good income, if you're stable financially, various barriers are not as big. I've given you a quote from the North. This is Northern Manitoba Seniors on a Limited Income who used this mode of transportation, and this is to get to Winnipeg, sometimes for healthcare services located in Winnipeg, and the trip is nine hours. That's a long, long trip for somebody. Maybe if one had more income, one could fly down. Mobility is another intersecting issue. Challenges become greater when one has mobility problems to get around versus not, so in terms of physical issues, physical disabilities, it gets harder to get around. Mobility more broadly, if one does not have access to transportation, it gets harder to access services, to get to programs, to get to facilities, to get to healthcare services. So clearly, people are not homogenous, are not a homogenous group. Some of the major issues that we heard throughout our research in Manitoba, I would suspect, this is similar in other jurisdictions. This is especially issued in rural areas. Housing and transportation are big housing interests of having different range of housing options for older adults, assisted living, independent living, right-side supports. And then again, that transportation issue, you get around to maintain independence, to get to services. Big, big issue. So that's kind of a bit of a flavor of what is age-friendly, what are some of the issues. Let me turn to some of the aspects of what makes a community become more age-friendly. What are some of the facilitators, some of the barriers? First of all, just perhaps to quite relate to this, but I put it under this umbrella slide, in terms of what have people done, what have communities done in terms of becoming more age-friendly in Manitoba? We did a process evaluation some years into the age-friendly Manitoba initiative to find out what has been happening in communities, what have they done in terms of projects, and also what processes they have to use to become more age-friendly. And clearly, short-term small projects were easier to implement. That comes as no surprise because it's much more easy to install a power door or repair sidewalks, even, or put a bench in rather than tackling the really big issues which are housing and transportation. So creating housing, new housing is going to take years so we would not see that show up. The pictures here are Manitoba pictures. I like the top one on the right because that's a machine that shapes down sidewalks and makes them more even, which I thought was a really nifty approach. Sidewalks being a big issue for seniors that came up again, both in terms of uneven for walking, presumably also for scooters. I don't know how that affects how scooters are affected by uneven sidewalks, but then also in the winter in terms of maintenance and ice. So short-term small projects for fairly easily implemented and the bigger ones were still on hold. In terms of other factors, leadership is critical at the community level and age-friendly committee. That is in Manitoba, we have a context that where communities have age-friendly committee. So if it's a good age, if it's a functional age-friendly committee or if they're engaged one with a champion, things move along much more easily to become more age-friendly or at least move towards becoming more age-friendly. Community plans are critical of the community consultations, so needs assessment, what is needed, what are the priorities and integrating age-friendliness with other initiatives or strategies also is an important factor. So some communities that were very successful in starting to move towards becoming more age-friendly and putting this rather in a complicated way because really you don't become age-friendly overnight. These are complex issues when you think of all the domains that you could address and all the issues and factors you might want to address. So it's really a process of trying to become more age-friendly over time. So integrating that with other strategies is really quite critical, for example, in terms of health promotion programs, safe neighborhoods, walkable neighborhoods, any time a community started to link those concepts together which naturally fit together, they made better programs. Communities that promote age-friendliness tend to be more successful than those who don't and partnerships are absolutely critical. This is not one issue for one organization or even one jurisdiction. It's mystical. It's provincial. It's also federal in terms of promotion. And from a research perspective, just as an aside, research perspective-wise, this is very much an area where interdisciplinary research is needed because you're cutting across disciplines and issues. So no one discipline really has cornered the market on age-friendliness or age-supportive environments. There are lots of big challenges that communities have experienced that are volunteer burnout, competing demands. You know, it's just yet another issue that they need to attend to besides infrastructure and who knows what else and lacking budgets on top of that perhaps. So lack of leadership was a real issue as well at the municipal level and it's also certainly very much required I think at a larger regional or provincial level to promote this concept of age-supportive environments and the potential benefits that it could reap. Funding-big, big issues communities are challenged to get funding for issues. Again, the big ones have a real challenge like housing, transportation is another one. Retrofitting old neighborhoods that are not designed the right ways remedying old mistakes becomes very challenging time-consuming and costly. Another issue really is the communities themselves so of course they vary tremendously. The graph on the right is just to say that communities vary in terms of age-friendliness. We developed an age-friendly index an age-friendly survey that tries to capture a lot of these domains that the WHO talked about including the housing issues, transportation issues recreational programs community supports and availability of them and so on. So we created an index and just simply here is just the mean on this index across a number of communities in Manitoba and just the lines the height of the bar just tells you how age-friendly the communities would be and there's a tremendous variation and some of that variation is due to the location of the community so some communities are less age-friendly than others just because geographically they're different but also historically they're different in Manitoba for example the northern communities are quite different from southern communities in mining towns they tend to be young communities where aging hasn't been possible aging in place has not been possible so they haven't had to really deal with an aging population they're also geographically so isolated that issues of transportation and creating housing and there's other issues become a real challenge so location matters size matters in terms of becoming more age-friendly both in the positive and negative and I'll mention that briefly again in a moment I've just added a few points a lot of points but you can think of others I've added the history I think my example of a mining town comes to mind just the difference in a mining town versus a southern place in Manitoba more southern community there might be more agricultural in nature communities different communities different in terms of social capital so just kind of how how engaged people are and what the historical perspectives are in terms of the community cohesion and that helps in terms of age-friendly age-friendly is nuts and makes a difference in becoming more age-friendly so again to reiterate here that these communities are diverse they have strengths and weaknesses some may have really strong social ties and this is now from expert opinions where we ask people so experts in the field so what helps a community become age-friendly be age-friendly and rural and remote community more specifically so small rural communities actually have an advantage they may have strong social ties they have local leaders that are quite accessible it's easier to engage residents and it may abuse to be self-reliant on the other hand they do have those big weaknesses to overcome like geographic distances which have transportation implications you have lack of availability of services and so on and difficulty attracting resources so every community will have various strengths and weaknesses whether the community is large or small and then dealing with those becomes an issue the broader socio-political context makes a difference there's an extra S there that should not be there so the broader and what I mean by that there's perceptions of ingrained perceptions of aging losing independence and asking the difficulties for people to ask for health so I think those are my conclusion we really do need to tackle those broader issues which sometimes relate to ageism and it does come from seniors themselves and I'll give you two quotes here in terms of the first one came in the context of people not wanting to attend senior centers and I like to comment somebody 75 years old who will not come to the senior center because they're not old enough clearly I mean this person thinks this is an issue and the second one it would be terrible if you had to admit that you were so lonely that you had to call and ask for a visitor to come to your house so some of the challenges are not less flying in communities having the right social and physical environment to come from within from social norms from people needing to change their attitudes about aging and also asking for help trying to access services that might actually be there which requires that they know about them but also then to access them secondly the importance of the grassroots the community based approach and the provincial government I say provincial government but it could be a regional government approach so communities cannot become age friendly without that larger community larger support and often the funding that needs to come from provincial government again very much that ecologic framework where you have different influences at different levels all of which interact with each other this slide is simply to reiterate some of what I've said it's against circles I happen to like circles so I tend to think in circles here we don't start from the person but from the community in the middle what makes a sustainable age friendly community it requires leadership buying in at the leadership levels at the community level it requires engagement it requires partnerships but then all of those factors are also moderated by various broader community characteristics and I've just highlighted a few you could add many more history, population size demographic mix so is it the young community is it an older community younger communities may not see age friendliness as important is it an urban role of remote so what's the location and not just the location itself but where is the community situated relative to other communities and then overall there's a policy environment there's a sociopolitical environment that all impacts whether communities will be able to become age friendly so just some overarching considerations and then many more I've just picked a few one of the really difficult questions to address is so what is a desirable level of age friendliness so how age friendly can a community or a neighborhood or a city reasonably be expected to become that's not every community will be completely 100% age friendly however we would define that it depends again on what the location is what the socio demographics are and so on so really disentangling what comes to minimal requirements that we would strive towards so yes there's the ideal we want to be really age the 45 environment both in the physical environment and the social environment but then what is the reality we really haven't disentangled this one yet do people want age friendly communities it's an assumption that certainly us working in aging we think having environments that help older adults age well are very important but not not everybody would think that we're competing against other areas other issues just think of environmental pollution we have economic factors come in so what are the facts how can we bring the agenda forward more strongly as an issue and how can we also work at various levels in terms of policy makers but also the general public to make more clear that age supportive environments are quite very important to people's life and will be important for everybody even those younger people at some point they will be older age friendly for whom refers to that interaction between the person and the environment and who we are actually talking about I mentioned before that various barriers for example in the physical environment they really become an issue when they're depending on the person when there are disabilities it may not be an issue for people who have no problems and I noticed Kathy, hi Kathy you're on the webinar people without hearing problems will not even realize that restaurants may not realize as much that restaurants are really bad places for people about when you have a bit of a hearing issue that becomes much more salient so how do we make environments age friendly but who do we target the big question is when we have big policy initiatives like an age friendly manitoba initiative does it actually contribute to healthy aging now I started off with the assumption that it does but we really need to test that and that will take time initiatives are young yet so we can't really demonstrate the effect from a research perspective of course we can look at other data and see what are some of those expected relationships between the social and physical environment very broadly define those domains that I had at the very beginning and how do this relate to various health related outcomes as well as then health let me just conclude with a word about CLSA and how it might support this issue around this area of age supportive environments there are variables in the variables the measurements around everything in CLSA or there will be measurements around everything in CLSA but currently in the maintaining contact questionnaire there are environment variables and there are two levels one is at the housing level which is an environment that I haven't talked about but that also you could think about in terms of age supportive environments so that's at the housing level how do we create housing for the person living within that environment and how can it be better made and so there are questions around that and then there's broader community context questions which focus a little bit more on social cohesion so more the social environment as an example most people in this area can be trusted and we have research that says that that social environment is important to various health outcomes so that can be looked at and they also the possibility of data linkage for example very simply we could look at rural urban differences we might link census data to CLSA data and as those are just two examples maybe there's other data that could be linked in geocoded to the CLSA data so in the short term these are some of the ways to look at the environment in CLSA by the way there's also transportation questions which will give some indication of how people get around and I would think in the future there will be other variables that will come into CLSA that again we'll maybe talk to the broader environment so I'll end there and I saw there were a few comments there that I couldn't quite see as they were passing by but that I can express in the questions section. Thank you very much Marina this was an excellent talk and I enjoyed it thoroughly and I'm sure that the listeners enjoyed it equally as thoroughly even more thoroughly than I did. There was one point that was made in the first ten minutes of your talk someone said good point about the person environment transactions and then there was Kathy's comment and I think that you have addressed it if not Kathy you can just type a question if you require further elaboration and we have a question from Pam and she says there is a question of who will pay for all the age friendly initiatives the major tax base will be younger people who will be a minority they won't be able to afford all of the changes and I guess this is very similar to for example people are sounding alarm bells about the Canada pension plan whereby more and more people are drawing upon the pension plan and there is an ever smaller base of people paying into the plan and of course people who pay into the plan today that money is being used to pay pensioners today so there is questions of sustainability of the Canada pension plan in the future and I guess Pam's comment is related to that is the tax base of younger people might be in the future there is an implicit assumption here that only younger people are tax payers but all the people certainly contribute financially to communities in very big ways they do they shop and they pay taxes still they contribute to the economics of a community as well so if you take all the people out of the community you would also have a challenge there clearly the financing is a big issue but if you think of it in a broader sense we're not talking so much and this is where really the point about intergenerational is absolutely critical we're not just saying you have to make special accommodations for all the people that will only be good for all the people but these are things that make communities places better places to live in for everybody so if you make if you if you create better transportation systems they can help everybody so it's more that integration of the concept of a better place and with a lens on all the people but if you catch some of the issues that are real challenges for all the people it will also really benefit the younger people so it's not one or the other I think it would be really wrong to think of it we're just really targeting all the people I think from a rural perspective particularly accommodations for those specifically all the people is really very good it's a really good strategy because they're aging so rural communities tend to be older and this is a big generalization that I didn't realize but we have communities to give you a local example while in the provincial proportion of older adults 65 plus in Manitoba 14 percent in some rural communities it would be 40-50 percent so there's there are older people living in those communities if they cannot live there if they cannot age there if they move out likely a community is not sustainable because you're taking a lot of things out of it and you take even the tax based tax dollars out you're still taking out all the economic contributions to local businesses to services that those older people provide so the other point and that's just rather long answers the other point that I was trying to make is that this age supportive environment will not come about just from one perspective this is a larger policy change at any level it has to be at the provincial level it has to be at the municipal level but the public has to be behind as well so there's many levels of influences that have to come together to actually make it feasible so I'll stop there so maybe if PEM wants to if you want to elaborate you can elaborate and I'm not sure if I addressed Cassie's question really just before I get to some of the other questions you had mentioned in your presentation about remote communities and the mining communities for example would be primarily younger and contrasted that to some of the rural communities where upwards of 50% the people can be older I've been to Churchill Manitoba for those of you who don't know where it is it's in northern Manitoba on Hudson's Bay it's a 36 hour train ride from Winnipeg and it's isolated, it's small but it does have connection and there are some seniors there so have there been any any initiatives that have been specifically directed to these remote communities that do exist through Manitoba? Yes there has and Churchill is part of the HPM in Manitoba in fact Churchill might actually be it's very remote, absolutely it's a long ways up there it might actually be more it might be easier for Churchill to be age friendly in a way than some other northern communities and I'm saying that because because of the link to the healthcare resources in Winnipeg Manitoba is an odd province and not a lot of the healthcare services, the tertiary healthcare services are localized in Winnipeg so people from up north have to come into the city into Winnipeg and Churchill has a good connection there the other communities there are other northern communities that are part of age friendly and they have been struggling so if you saw that graph where I lined up the mean age friendliness and it goes from pretty low to a little bit higher there some of those northern communities would be on the low end and that is partly because there's no, they don't have people have not historically aged in those places so some of the other communities have had all the populations for quite some time so they've adapted to that by for example having activities for all the people or some housing for all the people maybe a nursing home for all the people but of those mining towns up north really haven't had that chance yet now this is changing now as people want to age up there up in the north so now it becomes an issue so how do you add some of those services in at this point and some of them have been some of those communities have been struggling there's no doubt so it's harder and partly it's way up north it is really, really far and they can't line from other communities that have caused that we have a question from Megan thanking you for your presentation are there specific criteria or processes for city towns etc to become age friendly in Manitoba or Canada or do they follow the WHO criteria formulated in 2007 in Canada and Manitoba is going with that they're the milestones so they're the HMB milestones you could find those on the fax of public health agency of Canada website go under age friendly milestones you'll see them listed so they're very much aligned with the WHO what do they call them now steps to becoming age friendly so it involves engagement community engagement and then developing the action plan of evaluating the success of becoming more age friendly so those milestones are used in Manitoba in other provinces in Canada and when there are communities in Manitoba attain the milestones and this would be similar in other provinces who use the milestones those are the fax milestones that is public health agencies of Canada so when a community attain those milestones then they get a recognition award so that's just publicly acknowledged as having done good work it does not mean the milestones do not mean the process they specify the process they don't say that you have to become so into age friendly which gets us back to my comment at the very end you're not saying you have to have I don't know, X number of buses you have to have X number of buildings that are accessible you have to have so many support services for seniors in a community it just lays out what are the processes that you should follow to basically put that aging lens on to your programs great so go to Mary asks if we can receive the references that have been cited and perhaps you could just send them to Sue Sue can post them on the CLSA website oh there they are and on the website where the presentation we can see about pasting that list of references or they can just contact you for the list separately so Brenda is asking are age friendly is age friendly actually age friendly and she's wondering if by actualizing the term is age friendly that we have actually maybe hurt the cause of achieving age friendly communities and further down she's also asking if why is it that Europe seems to age so much better you know the issue around contextualizing it within aging that's such a good point and that keeps coming up as an issue and what are we really talking about really what we're talking about is good places for people I think the danger of taking it that broad is is that we lose older adults yet again because currently places are not very people friendly in a lot of ways they become better because of the disability movement also people are complaining but you know getting around can be really hard so by focusing on older people we're saying yes there are different challenges that come with aging and we're highlighting those yet at the same time we always have to as I have done talks about this and as we listen to communities who actually try to roll this idea out in their community there's a quick addition to that and saying well but we're not saying this is only good for older people we're saying that it is also good for younger people so the comment about if we build places that are good places for older people we have also built better places for younger people so it's an interesting point that I keep coming back to I would disagree with saying that it actually hurts the cause but we don't want to argue just for older adults either I think it becomes too much one or the other we're pitting young against old and I don't think that's the idea just from a very local perspective in terms of when we've had various I mean this is coming out in the research and evaluation work the communities that have the best success in starting to move towards becoming age friendly implementing projects and promoting the idea and raising awareness have actually been intergenerational by design so they intentionally have younger people involved including thinking of one particular community at an age friendly committee and there is a high school student on it so you're building that in you don't want to polarize the discussion around it's us against them trying to find it why does Europe seem to be aging better well that's a good one and I think partly it's that social political and cultural background and I'm just working on a paper I didn't talk about it at all but in terms of whether people in Winnipeg we ask people in Winnipeg how important it was to them to walk to have a walkable neighborhood and you know what not surprisingly a lot of them say it's not really really important to them so here we are on the one hand saying walkable neighborhoods would be not only good for your health but get better and everything would be good but people are not don't really care about it so being from Europe I have been concentrating this interesting issue and I think it's because North America was built with sprawl Winnipeg is urban sprawl it's a car culture and it becomes so ingrained that it's really hard to change. European cities are much more walkable right from the design because historically they were denser and they have to make do there so then cycling becomes an issue I mean you try to cycle in Winnipeg it's really hard plus you have winters but apart from that I think there's this whole historical long historical perspective that in many ways our cities our communities and I will include rural communities that also have sprawl surprisingly and you think they're small but they also sprawl they've built the wrong way so now we have to retrofit them and we have to change a culture and that's really great great thanks so we've got many excellent comments in the chat and I think one of our listeners questions was answered by another listener so that's great we are just past three o'clock so unfortunately we are going to have to put an end to the webinar as I'm sure everyone has other things to attend to today so Verina this was an excellent presentation it generated a whole lot of interest as you can see by the chat comments and also a very high number of people signed in today so clearly your topic is something that has generated a great deal of interest among Canadian researchers and policy makers etc in this field so on behalf of everyone at CLSA and most importantly our listeners I'd just like to thank you very much for presenting this interesting topic today yes thank you I was just reading the comments you just looked at the comments I think that we might want to bring you back for part two perhaps sometime in the fall or the winter just because I think that there's so much interest in this area good point yeah and it's the heat wave and pairs all very very excellent yet all but for those of you who are keeping the chat going great thank you very much thanks again to Verina and I just like to give a brief announcement about our next webinar so this will be the final webinar before the summer we are not going to have webinars in July and August we'll continue with our webinar series in September but there's one more at the end of the spring so it's on June 15th from one to two in the afternoon eastern time estimating dementia prevalence in Canada using data from national surveys potential use of CLSA data and Dr. Julian Mulvail who is an assistant professor in health policy and management at McMaster is going to present a stock she'll be presenting a rose out of a paper on dementia prevalence cost that was the subject of a workshop retreated the Alzheimer's Society of Canada last weekend it's a very interesting paper talking about the challenges of measuring dementia prevalence and although CLSA cannot be used to measure prevalence because we are excluding people with cognitive impairment baseline CLSA still has a role to play in estimating the various epidemiologic factors related to dementia so Julian will be talking about that on June 15th and we look forward to having all of you back to listen to that and again thanks Farina and we'll look forward to having you back sometime in the fall perhaps to continue discussions about age-friendly communities so we'll sign off now thank you everyone for joining and participating in the chat and we look forward to having you back in June and enjoy the long weekend coming up find out