 Well, I'm Dr. Joanne Miller. I'm the site coordinator for the UVIC site. To begin, I'd like to acknowledge with respect the one good speaking peoples on whose traditional territory the university stands and the Songhees, Esquimote, and Waseinuk people whose historical relationships with the land continue to this day. I'd like to thank all of you for taking the time to attend tonight's event, including our panelists, to all of our participants, including those who are watching this via live streaming and to those that are here in person. A very big thank you to each and every one of you. Some of you are participating in the tracking cohort. Those are the folks on the live stream. Everybody here, I believe, is in the comprehensive cohort. Regardless of how you're participating in the CLSA, your commitment to the study is greatly appreciated and is absolutely crucial for understanding of aging. All of you have participated in two rounds of data collection. Some of you have recently completed or are in the process of completing the third round. Thank you very, very much for participating and volunteering your time. Tonight's event has been developed as a direct result of comments you have made and questions you have raised over the past couple of years. And if my staff are in here, if I don't know whether they are, are any of the CLSA site staff here? Okay, is that better? Okay, I'll try. Okay, are any of the CLSA staff in here? Okay, they're the folks that were at the reception tables helping you out with the refreshments, et cetera. These individuals, individually and collectively, are what make the UVic CLS site work effectively. How about the Institute of Aging and Lifelong Health folks? Are they in the auditorium I know Lois is? There's some of our support staff. This study falls under the Institute of Aging and Lifelong Health. The staff over there, pass on your messages to us. We're located down at the Gorge Road Hospital. They're the ones that pass on the messages to us letting us know about the missed appointments or that we've forgotten something or pass on your updated contact information. Make sure that there's a room available at our HUD if that's where you choose to have your interview. And their support is absolutely essential for this study as well. And finally, but most importantly, from in terms of information providing, I'd like to thank all of our panel members for taking the time out of their busy schedule and being here tonight. I'd like to now ask Dr. Scott Hoffer, the director of the Institute on Aging and Lifelong Health at UVic, and the primary investigator for the CLS site to say a few words. They're gonna, I think they're gonna move off. Yeah. Very good. Can you all hear me okay? No. No? Let me see what I can do here. Can you hear me better now? Yeah. All right. All right. I'm delighted you're all here tonight. I'm the director of the Institute on Aging and Lifelong Health and the Victoria Site principal investigator of the CLSA. The Canadian Longitudinal Study on Aging is Canada's largest and most comprehensive study on the health and wellbeing of the country's aging population. The CLSA study itself is one of the largest studies of its kind in the world. It permits a rigorous examination of genetic, biological, medical, psychological, lifestyle, social and economic factors and how these impact changes in both physical functioning and mental functioning in the midlife to later life. I'd like to acknowledge the contributions that each of you make as CLSA participants to this cutting edge Canadian research study on lifelong health and aging. You are the most important part of this study. This is a very large community effort all across Canada, 10 different research sites, participants all over Canada. And I'm delighted to have a role in this truly remarkable study. And so I welcome and I look forward to tonight. Thank you. Okay. I'm now gonna introduce our panelists for tonight. Dr. Denise Cloutier is a professor in the UVic Department of Geography and a research affiliate with the Institute on Aging and Lifelong Health. As a health and social geographer, Denise's primary interest is in geographies of aging, where she studies the continuum of care and integrated models of health service delivery for older adults. Her research and teaching focus on a wide array of methodologies, quantitative, qualitative, indigenous and mixed methods approaches. And Denise is on, thank you, Denise. Trying to figure out mile after my right. Dr. Scott Hoffer, you have already met. He's the director of the UVic Institute on Aging and Lifelong Health and a professor and Harold Moore MD and Willima Moore MD research chair in adult development and aging in the Department of Psychology. Scott is an expert in longitudinal research focusing on aging-related changes in cognitive and physical capabilities, the identification of life span factors and health-related causes underlying change in functioning as well as the evaluation of differences across birth cohorts in countries. And as we've mentioned, Scott is the Victoria site lead for the CLSA. Besides Scott is Dr. Marilyn Bader. Originally from Alberta, Dr. Bader moved to Victoria in July 1992 after completion of her medical training and specialization in geriatric medicine. She has worked as a consultant geriatrician in Victoria for 26 years, working in acute care and outpatient settings. For six years, Marilyn was the medical director for seniors health and has now returned to full-time clinical practice. And finally, Dr. Deborah Sheetz at the very end is an associate professor in the UVic School of Nursing. Her research interests focus on gerontology and in particular dementia, caregiving and technology in healthcare. Deborah is a co-leader researcher on the Voices in Motion project, an intergenerational choir for community dwelling people living with memory loss and their family caregivers. The study is reducing the stigma of dementia and increasing social connections. She is also PI of an Amazon Echo Technology project to improve the quality of life of people with memory loss and to support caregivers. She was one of the previous site co-leads for the CLSA here at UVic. Okay, thank you. So Denise. Okay, just right here. Thank you. Thank you very much, Joanne. Can you hear me? Okay, good. Thank you. It's my tremendous pleasure to be here tonight with you. And in my time, I was going to talk about the, thank you very much, the Canadian Longitudinal Study on Aging and the Determinance of Health. And I wanna start initially, I guess, by making a disclosure or a confession that I have been involved with the CLSA from the very beginning in developing many of the questions that you answer in terms of the social working group, but I have not used the data myself yet. And I'm so anxious and so appreciative to get a chance to use the data that you are all providing. Excuse me. So, oh no, not a good start. So in my, well, what I wanted to begin with is to think about why the CLSA survey instruments ask individuals all these questions about their age, gender, marital status, income sources, health, housing, behaviors related to smoking, alcohol use, exercise and nutrition, driving and mobility, to name a few. And how these questions relate to and help us think about the research and the factors and conditions that are important in considering what determines our health. The CLSA and the opportunities it provides help us to understand the range of factors and conditions, opportunities and constraints that determine our health. And we are able to use this information to help to make improvements in our health and our quality of life, our health care services and our communities. With this CLSA opportunity, we have the opportunity, we have the possibility of following older adults for 20 years to try to make improvements and to understand what it is that keeps some individuals healthy and what it is that makes other persons more vulnerable in terms of their health and well-being. We know quite a lot about many of the things that influence our health and wellness, like the value of quitting smoking and exercising and eating well, reducing our alcohol consumption, rats and keeping physically and mentally active. But there are many other areas to explore, especially with respect to rare outcomes and to all of the interrelationships that exist between these factors. And finally, on this first slide, I have a picture of the coat of many colors and it is on there quite deliberately to illustrate that as aging individuals, aging persons, we have common characteristics and common health outcomes, but we are also tremendously diverse as individuals. And even though we are doing this very large population-based survey, no single other person will have all of the experiences that we have in our lives. So I wanted to begin as a geographer with a little bit of information about population aging trends in Canada and in BC. So we know that demographic aging is an important factor shaping society nowadays. And many of you will know that as of the 2016 census, for the first time in history, there are more individuals that are 65 years of age and older in our population than there are individuals under the age of 14. And this is a very important factor. Like many other developed nations around the globe, with this demographic aging, Canada must plan and prepare for this growth in older adult populations with all that that implies. In Canada today, about 17% of the population are 65 years of age and over. In British Columbia, we have one of the fastest growing older adult populations in the Canadian context, but we are a little bit behind the Atlantic provinces who are growing more rapidly in terms of older adults than we are. The highest proportion of older adults live on the island, 23%, and the interior of British Columbia where there's also about 23% of the population are 65 years of age and over. In Victoria, it's about 21%. And an interesting factoid for comparison is that in BC, and many of you will know this as well, we have many of the oldest communities in Canada in terms of population aging, such as Sydney, White Rock, Penticton, Qualicum and Parksville. And Qualicum Beach has 50% of its population who are age 65 and over. So we see that demographic aging is an important trend that has significant influences in shaping our society. And this is something that the CLSA and the work that you do in giving your information to us helps us to understand, to plan for the growth in older adult populations. So when we talk about health, maybe let's just begin and think about a holistic concept that considers our physical, mental, social, emotional and spiritual wellness and well-being. This is kind of the context in which the CLSA has developed to think about health. And this particular model of the determinants of health by Dolgren and Whitehead has been around since the 1990s. But it helps us to understand that individuals have characteristics such as age and our gender identity and our genetics. And we live within contexts that consider our networks of families and neighborhoods and communities. And all of the things that that entails. And all of these things have different influences on our health and wellness. And so that is one of the reasons that you see the CLSA survey asking you questions about the nature of your family dynamics. Again, those age and gender, housing, the nature of your community, food security questions, questions about unemployment, water and sanitation, access to health care services, and your housing. These are all kind of this constellation of influences at our individual level where we live on a day-to-day basis and within our communities. And thinking about how all of that influences our health and well-being is important within the context of the CLSA. If we think about what are the core determinants of our health, researchers for some time have been playing around with these percentages. But what we know is that about 10% of our health is influenced by our genetics, human biology, our age and gender. 50 to 60% is influenced by our socioeconomic status. This refers to our education, our income, and our occupational categories. And our lifestyle behaviors are considered within that as well. Smoking, drinking, exercise, nutrition, the nature of our relationships with family and friends, the nature of our housing in terms of whether we own or rent, whether we live in apartments or duplexes or co-housing units, and our sense of belonging to those communities and our life satisfaction. All of these things are implicated in our health as well. And you can see that that 50 to 60% of an influence on our health comes from what we call the social determinants of health. About 10 to 20% of our health is believed to be influenced by the environment, our air quality, water quality, the peacefulness of our society, whether we're engaged in constant wars or battles or different political debates. And 10 to 25% of our health is influenced by our health care. That is access to available comprehensive services that are of high quality. So this is how we think about the core determinants of our health. And again, you will see how some of the questions that you've been filling in, all of the questions and information you've been providing taps in or ties in at some level to this understanding of what influences or determines our health. In the early 2000s, researchers and policy makers in a Canadian context came up with about 12 to 14 social determinants of health. And study after study have pointed to the importance of these social factors as being critical and meaningful in determining and shaping our health and wellness in a Canadian context. We know that these factors listed up there at the top have a tremendous influence on mortality trends, morbidity, that is our illness and disease patterns and our health and wellbeing. There has been a lot of research done that tells us our health and wellness is strongly correlated with these determinants. And again, this is why the CLSA asks you a range of questions on these types of subjects. Probably one of the most important determinants of our health is the social gradient and largely related to our income status, as well though related and influenced by education and occupation. But we've known since the mid 1980s that where we are in society on that income or social gradient has a tremendous bearing on our health and wellness over time. So this is why within the CLSA there are a lot of questions about income and income is tried to, while within the questionnaires and the surveys we try to get at income in a number of different ways. What are the range of sources that you rely upon? What is your average or annual household income? All of these things are important ways of looking at income because we know how important it is and how influential it is in shaping our health and wellness. And we know that people who are in lower income categories who face poverty, who face food insecurity at different times are more likely to have challenges with their health and well-being. We will see them being more vulnerable in some ways. And this is something that we are interested of course in understanding in a Canadian context and reducing the negative consequences of some of these determinants so that we can promote the health and well-being of populations. In terms of lifestyle determinants of health, these are some things that we may be able to modify to promote better health for ourselves. Maybe because not all of us can, but their lifestyle or their behavioral determinants, physical activity levels, mental activity, nutrition, smoking and drinking behaviors, et cetera. There are a lot of questions in the CLSA on these areas again, because they help us to understand the kind of positive or negative health behaviors that people are engaging in and tell us a lot about how those are associated or related to particular kinds of health outcomes. And by looking at these trends and patterns that will emerge, doctors, dentists, public health officials and planners, policy makers as well have more evidence and information to help individuals in regards to health and wellness and preventing illness and disease throughout the lifespan. So finally, in my last slide, I wanted to emphasize something that I said at the beginning again. For the first time, and Scott mentioned this as well, with the CLSA, with these 20 years of data, we will be able to understand how some of these patterns in terms of mental health, physical health education, the influence of moves and migration on health outcomes, changes in occupational status and marital status, how when we can look at how things change for individuals over time, we have even more information at our disposal to understand what needs to be done in terms of health service development, public health interventions, personal lifestyle interventions. And for the first time, we have this exciting possibility in a Canadian context to do this type of research. So I hope that I have given you a little bit of a flavor for why the CLSA asks some of the many questions that it does and why scientists are interested in this information now and over time. And finally, I hope that my comments have served to illustrate how important your participation in this research is for yourselves, hopefully first and foremost, but also for all older Canadians today and into the future. Thank you very much. Okay, I'm gonna say a few words about what I understand is everyone's favorite module, the cognition one. I want you to know first though that your cognitive performance, your scores on these tests, they will vary even within day. Whether you have work stress or relationship stress, how well you slept last night, whether you're fatigued, all of these impact your performance within day. And we know this from different kinds of studies that we do. But there are also a number of factors across the lifespan that impact the growth of your cognitive ability, as well as maybe begins to slow some of these types of activities. We know that some types of cognitive ability remain stable and increase with age, and some types of cognitive ability, like speed of processing, your reaction time, that probably peaks in your mid to early 20s, where we begin to see some gradual changes across mid life and until later life. So this happens to us all. This is typical, but we also show a lot of individual differences. Not everybody's going to show the typical kind of age related changes. So we see a lot of individual differences. We're interested in a number of questions around cognition, and we have some answers from many of these studies around the world, but we expect to get some better answers here from this Canadian study. When does aging related decline begin? We don't really know the answer. Depending on whether you look at cross-sectional studies for age differences, we see that it peaks in the early to mid 20s. From longitudinal studies, we see that it's rather stable and then maybe begins to show some changes in later life. We're very interested in why these changes occur, and particularly in understanding why these changes occur, how can we prevent, delay, or treat these changes? We're interested in understanding whether an individual is changing more rapidly than they have in the past. So beginning to detect those changes that might be related to some brain pathology. And what is the impact of early life characteristics, and how does this play out over adolescence and young adulthood in the mid-life and later life? So we really take a long-term view of changes in both physical and mental functioning across the lifespan and see how these changes occur across that long period of time. So within this Canadian longitudinal study, and in the context of other longitudinal studies, we're very interested in the role that lifespan factors have on health and cognitive functioning. We're interested in, from early childhood through later life, we're often focusing on long periods of the lifespan. We know that we need to follow up individuals, that every one of you is different in terms of your experiences across the lifespan, the types of contexts, the types of work environments, all kinds of differences. And we're trying to understand this complexity within these studies. We're also very much aware that there are birth cohort differences that people born in different birth years, born early in the 19th century, differ from those born in the middle of the 19th century. And we're interested in what those exposures, what those different contexts, what those different systems were and how they impact people. We know from a variety of studies that there are risk factors and protective factors for your cognitive health. Not surprisingly, many of the risk factors relate to particular types of diseases, chronic diseases, particularly vascular disease. So basically what is good for your heart is good for your brain. So we see cardiovascular disease, diabetes, and so on. But also mental health, depression, visual and hearing deficits, smoking, these all seem to have some detrimental effects on cognitive health. In terms of decreasing risk, individuals with higher physical activity, greater cognitive engagement, more social interaction, less social isolation, Mediterranean diet, educational attainment, socioeconomic status, and so on. So there's a variety of things that are modifiable across a lifespan and even presently that one can do to improve one's cognitive health. Now, I understand that these tests are not often fun to do. I want you to know that nobody really enjoys them, that I've met. They're often very challenging. They're meant to be very challenging. They're meant not to have perfect scores. So that, you know, we don't want people to get a perfect score on these tests. So we make them deliberately very, very hard. So don't expect you're gonna do well on these, you know, or you're gonna perceive you're gonna do well because that's how they're designed. So I just wanted to talk about a few of these tests. I think you've all experienced these. And just to let you know a little bit about what they're meant to measure and why that's important. So the Ray Auditory Verbal Learning Test, this is where you're given a list of words and you're asked to recall these words and then after a few minutes recall them again, this delayed recall. So this is measuring your memory retention, your ability to learn a list of words that really have no meaning for you, but this is what you're asked to do. We found in preliminary results that women recall slightly more words in their age group than men. Animal naming is a measure of verbal fluency and it's a test often used in neuropsychology to dissociate normal cognitive changes from early stage dementia. So this is where you're asked to produce as many animal names as you can within a minute. Men and women show similar results and there were some language differences in terms of this particular test. The mental alteration test is a measure both of your cognitive processing speed, how quickly you can perform a task and your mental flexibility. So this is a particular test where you're asked to alternate between the alphabet and numbers, so A1, B2, C3 and so on, as quickly as you can. And as I mentioned, this is one of those kinds of tests where younger people tend to do better. It's that speed of processing that is just really at its peak early in life. The Stroop test is a very similar type of test. It has this kind of switching aspect to it. So it measures attention, mental speed, mental control, by asking you to identify the name of a color and the color of a word on a page. So there's some interference sometime about that and that's always quite challenging. And again, here younger participants are able often to complete the test with more quickly than older individuals and this is found across many types of studies. The FAS is similar to animals. Here you're asked to produce as many words as possible in 60 seconds that begin with F or A or S. And I just wanted to, and we can talk more about this. I look forward to your questions. I just wanted to reinforce that this study, as are many of these studies, it's really all about better understanding of what determines healthy aging. What are the individual differences that lead to some individuals be able to perform better, function better physically, mentally across their lifespan. And it's really meant to bend this curve to increase this idea of health span, to increase the number of healthy years of life. And that's really a major aim of this kind of study that has both individual and policy implications. So I'll stop with that. Thank you. Thank you. I'm the sole non-researcher here. My participation in the longitudinal study of aging was really, I have probably seen many of you as I've driven up and down the island to do physical exams and see people personally. The purpose from a geriatrician perspective, from a clinician perspective, is really for us to try and find out what happens to people as they age, as they are diverse, as people have said before. What is it that makes people frail? Because that's really what we're most interested in. Geriatricians look at people from a holistic pattern, but we are not organ specific, right? So we can look at your heart as well as your nervous system, as well as your stomach at the same time. And we will actually answer more than one question at a time. So we look at the physical and the cognitive as well as the emotional state. And in particular, look at some of those social factors that really are important for people to age well. And there's been in the news a lot of studies now coming out about how loneliness affects age and frailty. And frailty has really been something that we've been concerned about for the last 30 years. It's really what happens to somebody with a constellation of comorbidities. So different diseases, and they build up and make people more vulnerable to adverse outcome. So disability and death, really. And so it's a clinical syndrome where people complain of feeling weak and feeling tired and they're not able to do things and they may not eat well. These are our tea and toasters who don't really want to eat, don't want to bother making a meal. These are my people. These are the people that I see. I mostly wouldn't see any of you because my patients can't come out to a function like this. These are people who have sarcopenia, which is a loss of muscle that they have difficulty getting in and out of chairs. They have problems with their balance and with their walking and they're prone to falls. They become quite deconditioned so they can't do as much as they used to do. So where they used to be able to go out and shop, now they maybe can't leave the house. And they have osteopenia, which just means their bone mass is not normal. So it's a little weaker but not necessarily osteoporotic. And what happens is that if somebody has a lot of those features, then tiny little insults physiologically can tip them over. So somebody who's really robust can have a bladder infection or a pneumonia or something and recover quite well. But if you already have no functional reserve, that can drop you down to a state where you really don't recover. And what this shows here is that the younger person, the fit person will have a dip in their function and recover quite quickly and give back to normal. So those are the people that geriatricians never see. What we see are the people who are frail, who are more marginal needing, they're just kind of hanging in on by their fingernails at home and then something happens to them. And they become very much more debilitated, less able to manage needing help, requiring assistance with things. And they have a much longer recovery. They don't recover the same way as a robust person and they may not ever actually get back to their pre-morbid, their pre-disease state. So for us, the reason why frailty is important is because these people are complicated. That's why I went into geriatrics, because they're complicated and they're interesting, but it also makes treatment much more complicated because the treatment for one disease has impact on treatment for another. They have much more complex care planning so that if they are in hospital and have had surgery, they can't just send them out on day three. They need to usually have a bit more time and supports put in place. And there's much greater costs for care then. And in this day and age, then costs for that individual to have care because the public system only provides so much. It's a very dynamic process and some of it is reversible. We need to try and sort out what we can fix, what we can make better in people. Certainly frail people are more likely to die from disease than people who are robust. And with chronic diseases, all of these, if you have more diseases and frailty, then you're more likely to succumb to your disease, right? So we really want to try and people who are at risk for frailty. So before you become frail, try and sort out what we can do differently, what we can do preventively to try and help people. And that way we can target our resources both in the hospital and in the community so that these people can go into fall prevention programs. They can be in programs where they do weight training, where they have social groups and interaction with people, meal programs, because frailty is really something that we have to use as a way to try and make healthcare decisions as well. So people who are extremely frail and more likely to have a drop in their health and well-being with surgery or with treatment for different diseases, you have to take that frailty into account. So whether or not the benefits of surgery or chemotherapy are really worth it. And whether it's going to make them their life less than what they'd want, right? And then the palliative and therapeutic harmonization is just what we do is we try and look at frailty and all the complex diseases and put it into context for them so they can help with making their decisions about what treatments they want. So whether or not those kinds of things are truly beneficial to them. Because just because a physician says that they should have open heart surgery doesn't mean that you want to have open heart surgery, right? So in the study, we do look at cardiovascular wellness, look at exercise tolerance. How far can you walk? What can you do? How active are you? Because that is important for your overall sense of well-being. If you've had any heart disease, other vascular risk factors, high blood pressure, diabetes, high cholesterol, you do an EKG which is pretty easy. Cardiovascular health, we're really trying to prevent looking at your stroke risk. Again, it's high blood pressure, heart disease, diabetes, heart rhythm problems, all of those things that predispose one to having stroke. Because although we have made huge advances with stroke management, still it can be a devastating, a catastrophic change in your health. Falls and fractures. This is what is something that we know to be a problem for individuals that really impacts on their life going forward. There are lots of different diseases that cause falls, whether you have Meniere's disease, the inner ear problem, you have Parkinson's disease, you've had previous strokes, if you have osteoarthritis and get a lot of pain, all of those things can predispose you to falls. And we have fall prevention programs to try and help with those. What is devastating is when you also have low bone density. So your maximum bone density happens when you're 25 or 30. And then it goes down. Every year, every year, it just goes down slowly. It accelerates down with women, with menopause. And so women tend to have more problems with osteoporosis than men until later in life. And men then catch up. What we used to do was give you your T score on the bone densitometry, and it would give you a risk of what your likelihood was to have a fracture with fall. And now we do a frack score, which is something that gives you a 10-year probability. So the bone densitometry, which some of you have had, really looks at what the bone mineral density is at the hip. It doesn't really talk about, unless you have a whole body scan, it won't tell you about your vertebral column. It won't give you that score. It won't tell you what your risk of fracture is of your wrist as you're falling and you put out your hand. But the radiation exposure from that, which is what people are most concerned about, is about what your background radiation is every day. Get more radiation flying to Hawaii and back than you'd get from a bone densitometry. And the frack score, you can do with or without the densitometry now. The frack score looks at all the risk factors that we know that predispose you to having a fracture of your bone with minimal trauma. So just falling from a standing height. So the older you are, more likely, because you're going to have lower bone density. If you've had previous fractures, obviously you already have osteoporosis, and so you're predisposed to it. If you have a disease where you fall a lot, you're more likely because you're going to have more opportunity to break. If you've been on steroids, you've been on prednisone for anything, for asthma, if you've had it for gout or arthritis to settle down the flares, if you've had some kind of immune disease, then you're more likely to have problems because it leaches the calcium out of your bones. If you have a family history of hip fractures, so if your parents had hip fractures, you're more likely to have hip fractures. If you smoke or if you had too much alcohol, excess alcohol in your past, you're more likely to have a fracture again because it leaches the calcium out of your bones. And then for certain diseases, rheumatoid arthritis, liver disease, malabsorption, all of those kinds of things will interfere with how you absorb calcium, absorb vitamin D, or it interferes with your mobility so your bones just don't stay as strong. And fractures, for me as a geriatrician, for us as a health community, are important because it causes chronic pain, causes deformity. So you've seen the people with multiple vertebral compression fractures who are just hunched over because they collapse the front of their vertebrae and then they don't have good lung expansion either, so it's a cascade of problems that happen. They get depressed because they can't do things because they're always in pain. The less they do, the less they're able to do and they die. So 50% of people who have a hip fracture require a walking aid or they don't walk again. And 25% of them will require residential care and won't go home after hospitalization. And at five years, there's a significant increase in mortality in patients who have had hip fracture than those who haven't. So for us, we need to figure out whatever we can to try and prevent that from happening. So from a geriatrician perspective, this longitudinal study is helping, I hope, change what happens going forward so that the patients in another 10 years time or 20 years time, will have a better understanding of what we can do to prevent the problems before they begin. Thank you, Dr. Bader. I'm savoring this evening because in 2011 with the help of Center on Aging staff, now the Institute on Aging, my colleague Lynn Young and I helped open the data collection site in August 2012 and I've now stepped down and I'm so grateful to Scott that he's taking this on. It's such an important study and it's the kind of work that we're doing off the side of our desk. We get reassigned time from teaching. It's a labor of love and it's a labor of love for you to participate and I'm so grateful to see so many of you. It's so rare that we get to gather and you get to hear a little bit about why the study matters and why we hope you'll continue participating for the next 14 years. So some of you are now 91 years old if you were 85 when it started. So we're getting to a really interesting part and this next year we'll have two data points and so some of what I'm presenting tonight is really just descriptive data, simple analyses, but we're going to be able to start doing some much more interesting work moving forward. So, okay, I'm going to talk tonight a little bit about caregiving and care-receiving. How many of you have been caregivers? Just raise your hand. Yes, look around the room. Almost half of you, I think. So about 8 million Canadians have been caregivers for family members or friends. Caregiving, unfortunately, can have quite negative effects on health and also on finances. In particular, on health caregivers and care recipients can become isolated as chronic conditions progress and I don't know how many of you know them. In the UK they've appointed a Minister of Loneliness now because the impact of loneliness and social isolation is as great as smoking 15 cigarettes or being overweight. So I think as we move forward it's going to be interesting to look at some of the social data and the impact that caregiving has on social connections amongst people. Unfortunately, home care is not covered under the Canada Health Act even if it's considered medically necessary. So home care varies across provinces and unfortunately about almost a half million Canadians have unmet needs for home care. The CLSA is the first longitudinal study to collect data on caregiving and care receiving and so we now have an opportunity to examine patterns and that's the power of a longitudinal study. We can see variation within individuals and you can't do that when you just have data at one point and it becomes more powerful as we move forward. So over the next three years we'll have three data points and that will allow us to really see change over time. So particularly with caregiving the patterns we're interested in is who provides care, what types of care are they providing. We know for example that if you're caring for someone with memory loss it's much more stressful. It has much more of an impact on caregivers than someone who needs more personal care, physical care. We're interested in the impact of caregiving on relationships, on work, on health, also the use of assistive technologies and environmental accommodations and how that can mitigate disabling conditions and allow people to function more independently. So some of the measures for caregiving that we're looking at are the type of care people get, the number of people who are providing care because there's often one primary caregiver but there can also be other family members who provide a bit of support. We like to know whether or not the caregiver is living with the care recipient and what's the sex of the care recipient? What's the relationship they have? Are you an adult daughter caring for a parent? Are you a spouse caring for your husband or wife? It's also important to look at in regards to caregiving the intensity of care required. How long have you been caregiving? How many weeks? How many hours each week are you providing care? So all of these things give us a sense of the intensity, the duration, the impact of caregiving. Now when we look at care receiving, many of the questions are similar and you've probably noticed that. But we also ask about the type of care being received and the intensity of care, so those overlap. But then we also ask about whether or not people are receiving professional or paid assistance. Are you paying for home care? Are you receiving home care? Who paid for the care? Is it coming out of your pocket or is it something that happens to be covered by the provincial, by the health authority? We ask about the activity that required the most assistance. You know, is it bathing or is it shopping or it gives us a sense of just the difficulty someone may be having. We ask about the person who provided the most time and resources and their relationship and living arrangements. So it's very comprehensive and it really is going to give us a unique look at caregiving as well as care receiving. So what are some of the findings that we're learning about? Well, in terms of age, caregiving is highest among participants who are 55 to 64 years of age. Almost 50% of caregivers fall into that category. Care receivers were highest among those age 75 years and older. So about one in five care receivers are age 75 and older. Not too surprising, but this gives us information that can allow us to do some planning. In terms of sex, women were more likely to be both caregivers about 54% and they were also more likely to be care receivers about 58%. Caregivers were usually married and compared to care receivers. And education caregivers were more likely to have graduated from high school. Living arrangements. Typically caregivers are living with their spouse so we have a lot of spousal caregivers. Care receivers were more likely to live alone. That's often because the care receiver is widowed and may just be struggling. Employment. Many caregivers were retired about 42%. But about 61% of care receivers were retired. So more care receivers were retired. But still 60%. It tells us that 40% of people who need care are still doing some sort of work, which is interesting. Findings in terms of health. Caregivers 65% were more likely to report excellent or very good health compared to care receivers. The care receivers only 1 in 3 reported excellent or very good health. This is a statistic that kind of points out the difference between how you self-report your health versus having a disability. You can be in good health and still have difficulty doing certain tasks. Let me go back to that for a minute. Let me just tell you I accidentally pushed it. Chronic conditions. About 16% of caregivers report depression. Among care recipients, that's about 1 in 4 people who report depression. Diabetes. 15% of caregivers had diabetes. 27% of care receivers. Almost double the number of care receivers had diabetes, which is a significant cause of renal failure, of limb loss, and of a lot of other health conditions. Among caregivers, 14% reported having cancer and heart disease. Care receivers had twice the rates of heart disease, about almost 20%. So 1 in 5 care receivers had heart disease. But caregivers also, 9% had heart disease. I think I learned this when I was working in critical care a number of years back. I was just charging patients who were almost in their 90s to their 70-year-old adult children, and we were expecting them to be in good enough health to be the caregiver. That just wasn't the case always, and it didn't make sense. It points to the real need for home care and support. We're living longer, and our adult children are sometimes in their 70s, 60s, 50s, and we need to have social systems that support people aging in place with some supports. Quality of life. So social activities. About half of all caregivers report that they're able to get out once a week as do care receivers. But some caregivers, 7% of caregivers and 14% of care receivers report only getting out about once a year. So this harkens back to the loneliness issue, right? And other studies have shown that about one in four older adults don't have anyone that they can confide in, anyone that they feel close to. So that's reflected in some of these social activities and the lack thereof. Life satisfaction. We ask about life satisfaction in about one in 10 caregivers and 20% of care receivers report poor life satisfaction. So just to wrap up, what are the next steps? We're looking forward to doing some analyses of the care being given and received and the intensity and duration of that. We don't have that yet. And the relationship between the caregiver and care receiver. We need to have some multivariate model to understand the factors, the many factors that affect care giving and care receiving. And there's a whole group that I'm particularly interested in, those who are aging with lifelong disabilities like polio, multiple sclerosis, rheumatoid arthritis, or traumatic brain injury. Often we haven't had studies that allow us to look at some of these subgroups that are particularly affected because over the course of a lifetime it seems like they age a bit faster in terms of if you've had for example, like a traumatic brain injury, you're at greater risk for having cognitive impairment in later life. So this study, the CLSA is going to allow us to look at some of those relationships as well. And someone who's had polio, which is now an artifact, you probably all remember polio from the 1950s. But we thought that when people recovered from polio that they were pretty stable and there were people who were passers you would call, you'd never know that they had polio. Well they started having secondary health conditions associated with that polio that were related to kind of the hidden effects of the neurological trauma that had occurred. And so in a sense they were aging more quickly. They were having more disabilities, more problems aging in place. And so being aware of those kinds of things has implications for other neurological conditions as well potentially. So these longitudinal, we're looking forward to doing longitudinal analyses because what I've just reported is really just from one point in time. By early this next year we should have some data on the two points in time and we'll have some very interesting things to report to you. Thank you. So I have type 1 diabetes and I noticed that diabetes was pointed up there as an aging factor. So does it matter to your aging study whether it's type 1 or type 2? Dr. Bader? It doesn't matter to us. Type 1, type 2, it doesn't matter. It's the same difference that what happens at a microscopic level and at a microvascular level. So we see that vascular changes and neurologic changes probably 10 years before a diagnosis of type 2 diabetes. So we see complications from type 2 happening earlier than what we do for type 1 for after diagnosis. So it makes no difference to us. Thank you. This question is for Dr. Cloutier. I was wondering if you could explain why the environment is just 10 to 20% of health determinants. It seems to me that air quality, water quality, I would add soil quality and peace are fundamental to health and life. So can you explain that please? Thank you. That is a wonderful question. And it's not really very easy to explain, but one of the simplest explanations I believe is that we have not tended to study air quality, water quality, soils in relation to health in sufficient measure. So that partly it's an underestimate in terms of the actual environmental attributes and how they influence our health. In part it's being studied more under epigenetics and again as we talked about thinking about the complex nature of some of these relationships and their interactions. Within the CLSA we can start to look at the data in that kind of a fashion. But I don't think historically we have done an adequate job and part of the reason has been that ministries of health don't necessarily work with the Ministry of the Environment and the Ministry of Natural Resources to share those data that would provide a clearer more definitive picture about what some of the trends and relationships are. Thank you for your question. I was just thinking about that question myself and I was wondering if it is because all of the data is gathered within Canada because we don't have that great diversity. If we're looking at international data in places like Palestine I think it would have a much bigger impact. Yeah, really a good point and I think with the advent of geographic information systems we're now starting to gather more information in terms of air quality and water quality through monitoring stations and being able to look at some of the spatial patterns which we didn't see before in those types of studies. So I think we'll see more of this research on a continuous basis than we have in the past. Hold it nice and close to your mouth. Hi. Could you ask the questioner to hold the microphone very close to their mouth? We cannot hear the question at all. Can you hear me? I'm just behind you anyway. Anyway. In the risk for fall there was nothing mentioned about balance or loss of equilibrium or anything like that and is that important or is it not a factor or... Oh absolutely, it's important. So part of, in the questioner that you do there are some some diseases that are that we know are related to falling that people are asked about but balance is complex and so lots of times it's a combination of a few things together that causes a loss of balance so it's hard to without extending your survey questions it's hard to kind of tease that out so we... I think the study was looking at a broad pattern of falls. Absolutely there's some reasonable evidence that things like Tai Chi and stuff like that really help with balance even if people who have impaired balance and so that's the kind of stuff that we're trying to do from a therapeutic perspective but is loss of balance a symptom of aging? I don't think it's a symptom of aging, I think it's loss of balance is a result of a whole bunch of comorbidities so loss of muscle strength and slowing of reflexes so in that respect if your balance is off you are more likely to fall because you can't correct yourself the center of gravity in your body is a little different with age again because of a change in the ratio of fat to lean muscle mass and so those things are all just incrementally push you more likely to having falls but we all fall actually when I was at Botanical Beach on Saturday I had a close encounter with the Salal to try and prevent me from having my head go against a rock so there are lots of different things that cause balance it's just that it's more likely to be problematic the older you are the family you are right again is that better just before we do another question from the audience I'll do one of the written ones this one's for Scott I think what other nations are doing similar work on aging and are there any multinational studies that you know of there are there are aging studies all over the world I direct a network funded by the National Institute on aging in the US that has over 120 studies that are part of our network and what we do is we bring these various studies and research teams together to analyze so we can better compare results across these studies there are a few studies like the health and retirement study the English longitudinal study and a whole variety of studies that are based on those models that permit you to more directly compare aging health, economic status and other questions across these countries the HRS model of studies is an excellent model it's all telephone survey it doesn't go it's beginning to go into some of the detail but not near the detail that this Canadian longitudinal study provides so we're going to get a lot more in-depth information about about aging and the determinants of aging from this study I think that are maybe a little broader in that way okay and this question is for Deborah while caregiving seem to I think your presentation seem to refer to caring for elderly care receivers is there a correlation when caring for younger people for example grandchildren so when we're talking about caregivers care receivers yeah very good question there are a lot of grandparents for grandchildren because of adult children who have drug problems or alcohol problems that really can impose a bit of a financial burden on caregivers yeah so it's complex and then there are the parents who have children adult children with developmental disabilities those children are now out living those adult children with down syndrome and other conditions are out living their parents and that can really take a toll on caregivers too because because they're growing older and they're providing a lot of support to their adult children with perhaps mental disabilities thank you okay thank you and I'm going to answer this one the hearing test at the Gord Road hospital is not valid the room is not sound proof and I can always hear noises in the hall next room to where the interviews are will a new venue be found soon we're not looking for a new venue but we did sound proof the room or we tried to sound proof the room in fact we've done such a good job at putting sound proof we've put some weather stripping, weather proofing stuff around the door and it works so well now the staff can't hear when the hearing test ends okay so is there a question another question in the audience okay Ashleigh Johnfield it strikes me that you should be studying personality because I think bearing personality it strikes me that you should be studying personality because different personalities react differently and it's a huge factor I think I don't think that this study is doing it but we have looked certainly at consistency in caregivers and in the study that we did when it was called the center of aging with Holly Tuko caregivers for seniors were providing around 69 hours of caregiving hours every week which is huge and it really was what we found the ones who struggled and it was the ones who didn't it really was about resiliency and their ability to seek help and kind of roll with the punches to a certain extent and I also we also found that if you're caregiving for someone who seems depressed or apathetic or inactive and not doing stuff much harder for the caregiver to deal with than someone who isn't I wasn't thinking so much of the caretakers I was thinking of people who are getting older and sort of fighting their body and I just thinking of longitudinal studies of aging depending on one's personality you could last longer if you're stubborn enough you know Scott did you want to address it did you want to say something and the impact of optimism versus someone else so while personality isn't currently part of the CLSA it may be in the future it is part of many other longitudinal studies and as part of this multi-study framework we have a terrific team at Northwestern University that is looking at personality they just we just had a workshop on what's called healthy neuroticism to test this idea that if you're really concerned about your physical and mental health and your high on neuroticism does that at some point become good for you unfortunately the answer was no so Ashley yes I have another question if I may we'll come back to you if we have time okay I was wondering why there were so few questions about physical doing exercising I don't think I've been asked like you're told you that I walk I go on a half hour walk every day I do aqua fit I go hiking and so forth and there haven't been any questions in this area Joanne can you speak to the questions in the CLSA I actually will ask one of the in-home interviewers Ashley you could some of the questions that you ask at the in-home interview there's a number of questions actually around exercise participation in sports and recreation did you want to try the shot at it you're more familiar with the tools oh I was asking Ashley Clark who's sitting beside you is one of our in-home interviewers and I know in the in-home interview there are a number of questions that we ask about mild, moderate and intense exercising we ask about walking and things like pickleball and swimming and golf and whole work but there's also other questions do you want to speak to it so the physical activity questioner looks at over the past seven days and they ask how often you engage in sitting activities walking, light sports moderate sports continuous activities and then things like weightlifting so you should have been asked about just the past seven days of your physical activity and then you have a chance to say if that's typical for you in the past year or if it's not typical this is also a perfect time if you have questions and McMaster may not appreciate by saying this but if you have questions about the kinds of questions you're asked or you want to review the kinds of questions that you're asked on the CLSA site which is clsa-elcv.ca the website there is a section for researchers which is publicly available to everybody which does have the interview tools so you can review in that section in that section of the website the types of questions that are asked and need to the various sections thank you and I just wanted to say that's a great question physical activity is really one of the most important modifiable lifestyle factors we have it affects both physical and mental health in so many ways it's just such an important factor what we recommend is five days a week 30 minutes of moderate exercise which is exercise enough to make you a bit breathless so you can still talk but you can't sing okay Ashley thank you countries like Finland and Denmark are some of the most happiest countries in the world we have over there they have basic level of income from birth to death and I see those countries where they ensure what your categories are for social, economic, education all those key factors to a good life from again birth to death this study are you guys able to leverage our own government to help them because you guys talked about having lack of funding for basic essential needs as we age and yet we have countries that have seem to have figured it out quite easily I would just say quickly that's a great question we just had a terrific phone call with the office of the seniors advocate here in BC this office contacted the CLSA and then put them in touch with us we will be working closely together as well as with other seniors advocates across Canada so we expect that the CLSA and the data that you're all providing is going to have an impact broadly across Canada and for policy and to inform government it was a very exciting phone call we're very enthusiastic about this collaboration and it's going to be an important step I was just going to add that the Scandinavian countries as many of you will know are heavily taxed for all of the social programs that are provided there and in a Canadian context we have not necessarily been interested in that kind of a level of taxation to support some of the programs that we need as Deborah mentioned more investment in home care more investment in family friendly policies so that our workplaces may let us engage in caregiving roles and so from the 1970s we kind of feel that Canada has been falling behind in terms of some of these more progressive social policies we've actually been dismantling our safety net quite effectively and yet by the same token we don't want that high level of taxation that might be required so we have to find some middle ground solutions and use this information to mobilize the knowledge that we find and change policy with your voices and with the research findings is one way that we can try to move these things forward I'm going to also take some written questions because there's several on the same general topic and Deborah I'm going to put you on the spot for this since you were involved in the earlier stage most of the questions have to do with how the participants were selected for the study there's questions like there seems to be very little diversity of participants no First Nations or other than older white people, how were the participants selected how were the 50,000 individuals selected, does the study represent the demographics of Canada was there a peer review process of the data were the participants in the study selected to reflect the ethnicity of the Canadian population etc so the sample was selected very carefully to try to ensure balance now of course many of the participants in the CLSA that come into the data collection sites there's 30,000 that come into the data collection sites so you have to live within 25 kilometers of a site so that restricts it a bit and the effort to counter that sort of bias was to have a cohort of 20,000 people that were randomly selected also through phone by phone calling randomly selected across a much broader geographic area but it's true the people that come into the DCS are people who can make it to our data collection site so they tend to be healthier they tend to appreciate the value of research so we've tried to make it as unbiased as possible and pretty rigorous sampling it also had to be balanced with age groups and by gender so all of that's been a bit of a challenge but I wanted to mention Joanne I don't know if all of you know that there is a report that was put out I think it was in April by the CLSA that has a number of chapters of research using the data and it was it's been released and I'm sure it's available on the CLSA website and I encourage you to download that it's a PDF and it's free and available to you and you'll see my chapter on caregiving and other chapters on cognition and lots of different topics it's a first big publication it's about 200 and some pages so a little light reading for you there was a copy on the table out in the in the foyer but Deborah's right it is on the website so if you have trouble finding it just let me know at the DCS site and I'll give you the proper link but you can access it through the website good evening I'm an engineer so I'm prefacing my comments right now but first of all congratulations on four very interesting presentations I think they were well worth the time my question from an engineering perspective is I've been in the side of science and research and gathering data but data in and of itself doesn't affect change and what I would like to get from the four of you is your vision on where you think this data gathering will take us in terms of new construction techniques to allow people to age in place for transportation or improvements in medical care where do you think it's going to take us because right now data by itself will not affect the change and you'd like a comment from each of the panelists okay Scott you're on so the sample size of the Canadian longitudinal study is sufficient to permit us to get better answers to how these various risk and protective factors complement or interact with one another we don't know that that really hasn't been done because most of these longitudinal studies are in the hundreds of individuals or perhaps a few thousands and so that the level of detail, the level of richness of the data that are available to us I think we're going to get better answers and new answers that we've been able to get to before and I also mentioned our partnership with the seniors advocate office I think this is a very important step to work with that kinds of ombudsman that is an arm's length away from the government but which produces the level and quality of reports that really do affect decision making so I think that is a really great step for us and for CLSA okay Marilyn well I think probably the best that we can hope for is that we're going to make a difference with respect to some of the social determinants, the caregiving housing and support what is for ongoing medicine itself I will say that older adults are kind of like a black hole in medical data so the studies are done on younger people and extrapolated to older people and so as geriatricians we kind of well we don't usually follow the guidelines because the guidelines are for people who are in their 40s and 50s with one specific disease as opposed to somebody in their 80s with seven different diseases so what I would hope that it would do is kind of help us to identify things that might be preventative that might alter that trajectory into frailty and as well support the people who are going to support folk who need it okay and did these yeah that's such a great question thank you for asking it I think one of the things that I would say is we need to turn that question around to this group and it kind of builds on what Debra said as well we've got two data points now we're going to get another data point that kind of level of information starts to help us understand how things are going and what their implications are and what's important and what needs to be addressed in terms of public health policy helping geriatricians and physicians provide the care that they need and all of the other care workers who are involved in supporting older adults so I think you know we need you to continue to build on these data and allow us to do the research that we're doing with it to inform policy we no longer have the luxury of just doing research for the sake of doing research anymore all of the research that we do is meant to be more applied is meant to be translated and mobilized so we have a very strong sense of responsibility for moving these data forward into policy into change into meaningful change for helping older adults to live well and healthy and families who care for them and providers who care for them as well so I thank you for that question and what I can add to that is there is a bit of a movement of foot that needs to grow into a real social movement have you heard about age friendly communities and dementia friendly communities we need to work with our partners partner organizations in the community to really try to mobilize the public voice to demand that communities are age friendly that people are able to go out and walk and have a place to sit that we can encourage them to be more active that people have access to the things that can help them lead healthy and high quality lives thank you Ashley I would like to know how you define caregiving I'm rather stumped when I get that question because I don't live with my father but he's alone I come on the phone with him every day I take care of all his finances do his medical appointments even though he lives in another city so does that count I mean is that what you're looking for it's not very clear exactly I've always answered no but now I'm questioning it you should be answering yes you probably think you're just being a good daughter and that's the issue caregivers don't think of themselves as caregivers they hesitate to use that term but when you're providing support to another person that's enabling them to remain in their home that's definitely caregiving whether it's personal or more instrumental kinds of help like helping them with their check book and stuff like that all of that counts as caregiving okay and I'm going to add one of the written questions to that which is is a wife considered a caregiver or a husband depends what the husband needs the wife needs yeah it depends I think kind of support you know what role you're in you are a wife and you can also be a caregiver you can be a husband and you can be a caregiver we wear multiple roles don't we we're parents, we're children, we're sisters so caregivings like that it cuts across a number it just adds to the roles that we take on okay any questions I want to say thank you first for doing the study I had a work injury and I was a part of it so I had the full MRI everything six months before my injury and then a year and a half after and to see the difference in the MRI and what I'm going through right now is I have 40% loss on my leg and that's just my leg and what I'm I'm screaming for help from everyone I've been to the hospital all they give me is opioids and send me home and I've been to emergency psychiatric I talked to a doctor and the doctor said well I'm not a psychiatrist and I talked to a psychiatrist and said well I'm not from Worksafe and I'm fighting Worksafe this has been going on for four years with they lie, actually okay I'm not allowed to say they lie even I changed some documents and I've been lawyers, they're like they need money up front I've been fighting this, I've been my own advocate and everywhere I go to for help is all I get is a phone number and they're like well phone this number and then I get an answering machine at the end of it and if by chance someone does call me back they're like well sorry I don't need that service I've had four social workers coming to my home telling me well you can bathe yourself so sorry you don't fit the criteria and well and then they say well it's clear that you need help but you're falling through the cracks and this has been going on for four years now and I'm at my end and my building just had a flood in it so I spent four days in a hotel room and now I'm in a new place with boxes blocking my I don't even have a bath for pain management I have a shower so the movers came in blocked off my shower blocked off my kitchen sink and I need help and I'm screaming for help and I'm falling through the cracks I need help and even you people like where do I go because all I'm getting are phone numbers with the answering machines at the end and good question by you because it was a work injury WorkSafe is pushing me to the disability and the disability is pushing me on to WorkSafe and I got $300 more a month for WorkSafe somebody to come into my home to help me and the disability took that away and WorkSafe is saying well you take care of her and the disability is saying well to WorkSafe well you take care of her who's taking care of me and I'm still getting phone numbers today I got a phone number from someone saying well phone this number maybe you can get help I phone this Salvation Army who provides service for people that need help really Dr. Rader is that something that you feel you could address not necessarily from a geriatrician but just from a senior services end so I appreciate your frustration because with the public home care system you have to require personal care in order for them to go in any longer due to budget stuff so I'm unfortunately going away tomorrow out of province however let me let me take your information afterwards and I will have somebody call you we'll call you okay because I I really don't know exactly what we can do through the public system okay another question for Dr. Rader maybe a little easier but again several questions on it the use of DNA why don't you take DNA data into account are you considering using DNA to augment study data at risk for dementia are you interested in DNA results etc so there are studies looking at biomarkers to try and predict if people are going to develop dementia however most dementia does not appear to be the genetic component does not appear to be that important there are some autosomal dominant ones where people de-ment very early in their 30s and 40s where we have good genetics the apolipoprotein E studies just gives you more likely or less likely there's no guarantee there are some other biomarkers that people are are attempting to use but it's really in the research category the other thing that I would say about genetic markers is that that has huge implications for life insurance and things like that particularly when at this point we don't really have any good treatment so I'm not sure that it has any clinical relevance I think in a specific study well crafted looking at lots of cognitive tests as well as imaging and biomarkers that might be useful going forward but I think right now in dementia literature we've had 15 years of negative studies with respect to treatment so we don't have anything new so that's why we don't do DNA testing at this point I would just add to that that the biological samples are a very important part of the study they are being held at McMaster University in a biorepository a number of freezers there are plans under discussion of how this machine will be used it's very valuable material and I think it needs to be very carefully developed and I think we're also waiting for the longitudinal data to accrue that'll make it much more valuable as well okay and Scott will you're still on a roll there what can we expect in the way of individual interviews phone calls questionnaires in the next 14 years so put him on the spot on the site PI right so can you give us some thoughts about what's coming down or what might be coming down I think more of the same to some extent but I hope more differences as well the CLSA is not only a longitudinal study and typically when you start a longitudinal study you do the same thing over and over and over again you want to maintain that continuity so you can really study change change within person change on the exact same variables but it's also a research platform it's a platform that allows new questions new measures new biological assays and things to be done so we hope that it does also change and adapt and be a cutting edge aspect of our gerontological science as well so I think you can expect there to be differences year to year as well as the core set of measurements okay and just as we finish off is there anything else that any of the panelists would like to address given the range of questions that we've had I'll just say that you know the baby boomers have done a lot for this world so they changed education and they changed how we shop and they changed how we work and now they're going to change how we age and they are a very powerful group you are a very powerful group and it will be I think you will get the ear of government and there will be change eternally optimistic hey Denise or Deborah did you want to add anything I just say ditto to what Dr. Bader said I think that's really important yeah we're already seeing new models of housing co-housing so all of those things are going to continue to change us this cohort moves through and it's one of the healthiest subgroups that's come through so I think we're looking at a pretty good old age thank you okay and I just like again to thank you for coming out tonight this has been a good session reminder to check the CLSA website and I'll give you the website address again www.clsa www.clsa-elcv.ca check that website the report that Deborah mentioned it's got webinars that come out new research findings etc so as the study progresses continue to check and monitor that website for all the new information even if it's a webinar that's happened across the country everything that CLSA does is available just as this event has been so thank you very much for coming out tonight look forward to seeing you again in the future and a big thanks to Joanne for tonight's event