How to add quality of life for Canada’s older adults? — AVOID frailty

By John Muscedere

The global pandemic has struck a death blow across our senior population. Canada has had almost 9,000 deaths from COVID-19 so far, with the vast majority (97 per cent) occurring in those over age 60. 

Canada also holds the unenviable record among developed nations for the highest percentage of COVID-19 deaths occurring in long-term care facilities: 81 per cent compared to just 28 per cent in Australia or 31 per cent in the United States, for example. 

Many who died from COVID-19 were living with frailty.

Frailty is a state of vulnerability when an individual is more susceptible to major and minor health events including infections, illness and chronic disease and may experience a decline across many body systems.

Frailty directly affects quality and quantity of life and can be used as a measure to predict functional impairment, falls, loneliness, depression, institutionalization and death.

Over one and a half million Canadians are estimated to live with frailty — affecting another 3.75 million Canadians who act as family caregivers. The prevalence of frailty in Indigenous populations is double the national average where 50 per cent of those over age 65 are living with frailty.

The COVID-19 pandemic has highlighted the pitfalls of how we approach ageing in our society. Currently we use a reactive, problem-based approach to ageing instead of a preventive, holistic approach.

Preventing or delaying frailty won’t prevent COVID-19, but it will help make Canadian seniors more resilient generally, it will add quality of life to remaining years, and reduce the stress on our health and social services and on family caregivers. And it will help us prepare for the next pandemic and/or looming social care crisis.

So, what can be done?

At the individual level, we can AVOID frailty by:

  • Activity – Regular exercise, particularly strength training, balancing exercises and activities that get your heart rate up daily.
  • Vaccination – Keep your vaccinations and boosters up to date, including for flu, shingles and pneumonia.
  • Optimizing Medication – Have your health provider review your medications annually, including prescriptions and over-the-counter drugs, vitamins and supplements so you are only taking essential medications.
  • Interacting – Social isolation can lead to frailty and advanced aging, is linked to high blood pressure, depression and dementia.
  • Diet and Nutrition – As we age, we need more vitamin D, calcium and protein found in meat, fish, eggs and beans to keep our muscles and bones strong. 

We also need governments to create programs and policies that promote an active and healthy lifestyle. 

Governments at all levels need to fund programs that promote independence and physical function, focused on daily living activities that would allow seniors to stay in their own homes for as long as possible. Nursing homes should be the last option, not the only option, for seniors that need assistance with daily living.

Governments also need to combat social isolation and fund programs to reduce social vulnerability in seniors, including innovative online programming during the pandemic. 

We also need governments to support policies to encourage healthy food options and better nutrition for seniors, with specific attention to the needs of older adults living with frailty, including establishing nutrition standards for care facilities, acute care and programs like Meals on Wheels.

Importantly, governments need to address poverty amongst seniors by funding and implementing a national pharmacare program, a housing strategy specific to seniors and providing adequate income supports for seniors to enable financial security and healthy retirement.

Finally, together, we need to combat ageism. It is not acceptable that so many of our older adults have died during COVID-19. They are not expendable. Older adults can have quality lives if we give them the safeguards and the supports they need – to live through the pandemic and well beyond it

John Muscedere is the Scientific Director and CEO of the Canadian Frailty Network (CFN) and a Professor in the School of Medicine at Queen’s University and an intensivist at Kingston Health Sciences Centre.