#58 Our Aging Population: The Silver Tsunami or Red Herring?

Dr. Esme Fuller-Thomson, Director of the Institute of Life Course and Aging, University of Toronto

April 10, 2019

Aging is a biological process that acts on all of us, from the day we're born until the day we die. And for many people, it is a cause for concern. In fact, some scientists believe aging should be classified as a disease. Memory loss, aches and pains, wrinkles, loneliness - there are a lot of reasons for why one might fear getting old. On this episode of Raw Talk, we talk to memory expert Dr. Morris Moscovitch to unpack how and why our memory suffers as we age and discuss the ways in which memory loss can be delayed. Richie explains some of the molecular mechanisms surrounding aging. Finally, we spoke with Dr. Esme Fuller-Thomson, who shares why we may not need to be as worried about our aging population as we thought. She also voices her thoughts on creative considerations to improve healthcare for older adults as well as how to make our cities more age-friendly. Written by: Melissa Galati

Written by: Melissa Galati

Eryn Tong [0:00] How old is old?

Mashup Clip 1 [0:01] Maybe around like 70? When you reach 65? I mean, somebody who's 25 can think they're old compared to somebody who's 18 and somebody who's 80 cannot feel that they're old. I'd say 75 to 85 in that range is what I think to be old but it really depends on when your body starts giving up on you. I don't know. Am I allowed to say I don't know? It's a function of so many things.

Eryn Tong [0:27] It's clear that there are diverse perspectives on aging. And it's something that we all think a lot about. That makes sense because aging is the most universal process. We all age. And we spent billions of dollars trying to slow down our clocks to help us age gracefully. We all age, but it's clear that many of us don't want to.

Nathan Chan [0:44] And despite our best efforts, economists have warned about an impending silver tsunami, and the social and economic burden of an older and sicker population on our society. So how concerned should we be? On today's episode, we're going to unpack what it means to age, how we think about aging as a society, and what we can do about it. I'm Nathan.

Eryn Tong [1:02] I'm Eryn.

Melissa Galati [1:03] And I'm Melissa. Before we start, we wanted to let you know that Raw Talk is hosting its second ever live podcasting event on May 7, 2019 at J labs Toronto and the Mars discovery tower. The theme [is] Artificial Intelligence in Medicine. Tickets will be on sale soon, so keep your ears open. Okay, let's dive in. Welcome to Episode 58 of Raw Talk.

Dr. Esme Fuller-Thomson [1:38] The definition is pretty simple. It's basically getting older and the process of getting older. Now that has some genetic component to it. And it certainly has a very heavy environmental component. So the process in that you age is determined to a large extent by your environment, your habits, your lifestyle, where you live, and it goes back cumulatively to your prenatal environment and on up.

Dr. Morris Moscovitch [2:05] For me, I never thought of having to provide a definition. Natural process of growth and development over the years, so we usually refer to it as people who tend to be over 65. But it's a continuous process. Starting from birth, one could imagine aging being whatever happens to you. But technically, people refer to aging as a process that seems to get somewhat exacerbated, guess is the right word, as people get older than 50, or 60.

Melissa Galati [2:41] So aging is something that's happening to you all the time. We can't ignore that there are more significant physical and mental declines as we get much older, however you define it. We ask people what they were most worried about when it comes to aging?

Mashup Clip 2 [2:55] What I'm not looking forward to like my biggest personal worry is like having to rely on someone else [like] doing your daily chores. I'm afraid of like my buddy giving up on me. I mean, the first thing that comes to mind is one's brain being diseased, let's say, having dementia or Alzheimer's, for instance, I immediately think of that being an age related. That's old. I'm not looking forward to definitely, you know, mental capacities, things like Alzheimer's, scare me in a way. Not being able to recognize yourself for family members.

Nathan Chan [3:31] A number of people that we talked to mentioned memory loss as their main concern. How does memory work? And what types of things do we forget as we age? And how does this affect our day to day lives? We spoke with Dr. Morris Moscovitch, an expert in memory and perception across the lifespan. Dr. Moscovitch is the Max and Gianna Glassman Chair in Neuropsychology & Aging, a professor in the Psychology department at the University of Toronto, and senior scientist at the Rotman Research Institute at the Baycrest Centre for geriatric care. When we sat down with him, we were surprised to learn that memory loss starts a lot earlier than we thought.

Dr. Morris Moscovitch [4:04] It depends on the kind of memory that you're looking at but loss of memory for particular events or episodes that you experienced in daily life begins very early on. It begins in the late 20s, early 30s, and then progresses throughout one's life. And then there's sometimes a more precipitous decline when you get through really old age, maybe in the 70s. But usually, it's kind of a straight line function, as it is for a lot of cognitive abilities. So even things like short term memory bound by short term memory, it just means an event that you can hold in mind that happened very recently. Even that starts declining pretty early on. So there's nothing magical about old age. Let's say even a linear function, we tend not to notice. It's like walking up a hill, you don't really notice you're walking up a very slight, slight incline. But if you're walking on that hill for an hour, you'll start feeling it. And you can think of memory decline and old ages being the same thing. There's a little bit each year, and the time you get to be 60 or 70. You notice that the incline.

Melissa Galati [5:22] Okay, so our memory starts to decline a lot earlier than we might think. Dr. Moscovitch, which claims as early as our late 20s, which may not bode well for us grad students. But as you might have noticed, Dr. Moscovitch alluded to something very important, the existence of different types of memory. In particular, one of the types of memory that starts to decline as we get older is episodic memory, or the memory of autobiographical events and the contextual knowledge surrounding them. So what you ate for breakfast on your first day of university, the present you got for Christmas 10 years ago, or the song your cousin danced to at her wedding, are all examples of episodic memory. By definition, episodic memory allows you to travel mentally back in time and experience the event over again. And the part of your brain that's really important for episodic memory is the hippocampus. Remember that we'll come back to it later. So this type of memory gets worse as we get older, but older adults are still able to encode and recall memories, does the way that our brains form memories change as we age?

Dr. Morris Moscovitch [6:18] The answer is yes. This has nothing to do with the brain for the chose up and brain studies as well. The old studies when we tell a young person or ask the young person, here commit this to memory. They seem to do a very good job of it and they merely looking at the words and studying them briefly. They'll be able to know what those items are. Older adults seem not to be able to do that spontaneously, whatever it is, that's going wrong with them. Merely looking at words and committing them to memory doesn't work doesn't cut it. But if we tell them for each word, try to think of an associate for it, or answer these questions. Here are some words that I'm going to show you just answer these questions about each word. Is that an animal? Is it a vehicle, can it be found, in a house, all those kinds of words that indoor objects or outdoor objects. As soon as you orient them to the kind of processing that's necessary, you get memory for free. So we don't have memories. Because we make a conscious effort to commit information to memory, memory just happens in most cases. It doesn't just happen when you're studying for exams, or you're reading a manual to know how to do something, you sort of really have to pay attention. But even under those circumstances. This is Gus Craig's work and Lockhart as well. Memory seems to be a byproduct of perception and understanding, the better you understand something, the more you're going to remember it, you don't have to make an effort to do that. What happens between young and old people is that younger people can just look at something, understand that spontaneously or do whatever it is that has to be done, and commit the information to memory. Whereas older adults, have to be told what strategies are going to be most effective in committing that information to memory.

Eryn Tong [8:26] So we may struggle as we get older, but it's not all downhill. In fact, like a fine wine, some types of memory become better as we age. According to Dr. Moscovitch semantic memory, in other words the memory of general facts, actually seems to get better as we age. Looks like you do get wiser as you get older.

Dr. Morris Moscovitch [8:44] And it's not all memory, some memories actually get better with old age.

Melissa Galati [8:48] And so what would be the distinction?

Dr. Morris Moscovitch [8:51] The distinction has to do with accruing general knowledge. So memory of vocabulary, let's say, or facts about the world that accrues with life so that older people often have a much better vocabulary or noticeably better vocabulary than people in college.

Nathan Chan [9:09] Score one for aging. So scientists now understand a lot of different types of memory and the parts of the brain that are involved in encoding and recalling memory. Whether trying to understand now or the other brain processes that memory is involved in. Dr. Moscovitch explains that memory is important for things like problem solving, decision making, and even perception. So what type of memory is important for these processes? And what happens as we get older? Are we worse at things like problem solving?

Dr. Morris Moscovitch [9:34] Incidentally, I said semantics tends to rise with old age, which it does. There's no doubt about it. But on some tests of semantics, let's say where you ask people to generate all the items they could think of within minutes that are vegetables and fruits or all the animals they can think of in a minute. There is an episodic memory contribution to that semantic task. And the older adults show a little bit of a decline in the episodic contribution to a semantic task. So in terms of the problem solving tasks, I'll tell you one that we tried. There are others like these that are now starting to come out in the literature. This is called a social problem solving task. The work was conducted with Mary Pat McAndrews, who's here at Toronto Western and student, Sidney Sheldon, who's now a professor at McGill. And she looked at this test where you're told a little scenario. It's important to distinguish between two kinds of problem solving. Those that just require you to apply particular rules - math problems are the prototypical ones like that but there are other logical problems. Older Adults seem to be fine on those if they're simply enough, and they don't make a really heavy requirement on working memory. But they can do those fine. But there are other problem solving tasks that are open ended. There are no rules. You have to solve them by experience. And so here's one that we used: you move into a new neighborhood, and you want to make friends. The story ends with you've now made a few friends in this neighborhood. Describe how you go from A to B, from the beginning to the end. There are a whole bunch of steps you can take to make friends. You can imagine which ones they might be. Now there are no rules for this there are saying, you know, if you move into a new neighborhood, this is what you should do. What you have to do is to imagine what it was like moving into a neighborhood in the past, or what it's like to make new friends in general and apply some of those ideas. It's actually a standardized test, where you have certain steps that you can take and you get points, the better the step is. They're called relevant steps as compared to irrelevant steps. So an irrelevant step might be to go next door and ask to borrow some sugar or something. Even though you don't need sugar, we just do it to get to know the people. Or you find out that there is a neighborhood synagogue or church and you decide to attend and even though you're not a church or synagogue goer. So those you get points for. Another one might be , I don't know I'm going to just stand in front of the house and hope somebody notices me smiling and they'll come by and say hello. You don't get points for that. Anyway, the reason I'm telling you this story is that the better your hippocampus is, the more you can get these points for suggesting relevant solutions. And it it really is quite extraordinary people. So we have tests of hippocampal function. And the better your score on those tests, the better you'll do on this kind of problem solving. What it requires for you to do is to imagine an experience that you had, or some kind of past experience in detail. And those details help you derive a solution to a problem. So you derive your solution from the episodes, and the episodes are there to help you. And there's a variety of tests like that, where you see that older adults perform more poorly than the younger adults. You'd think they'd be better at solving that kind of problem. But they can't draw on these details because their hippocampus has deteriorated and they don't draw on them and they solve the problem.

Melissa Galati [13:31] They may know who their friends are, but not necessarily how they became like, want to become friends.

Dr. Morris Moscovitch [13:37] That's right. They may no longer remember, or they remember in general that they said I think we met at a party or something at work, but not remember the details of it so that they could draw on those that information to imagine a solution to a problem.

Melissa Galati [13:54] It seems our ability to problem solve may suffer as we get older. And like we said before, problem solving and higher order executive functions aren't the only things that suffer as our memory declines. Even something as simple as basic perception, like our ability to distinguish similar faces from one another declines. Dr. Moscovitch, he explains how memory and perception are linked.

Dr. Morris Moscovitch [14:17] So when you're young, you can make fine distinctions among perceptual elements that have a lot of overlapping features. Faces have a lot of overlapping features among everyone. But even more so among people who resemble each other. The way we did it is by morphing two faces with each other so that let's say you see a face that's 90% A and 10% B or 50/50, or the reverse 10% A and 90% B. and young adults don't have trouble distinguishing among these morphs. They're pretty good. You know, if they're very, very close together, they have trouble distinguishing but if they're separated by a little bit, they can do it. Older adults have more problems distinguishing between these very similar looking faces. So what happens in real life? In real life, you'll see someone and I can attest that this are starting to happen to me more than it used to. Everyone seems to remind you of someone else that you knew. So it's not that your memory is poor. It may be that your ability to distinguish similar faces one from the other, as also suffering. Is it just a perceptual problem? Turns out that it's an interaction between perception and memory. And what we're finding is that the hippocampus, that structure that's very, very important for memory that we know is crucial for memory, contributes to our ability to discriminate among faces that have a lot of overlapping features.

Eryn Tong [15:53] Okay, so memory is clearly important for a lot of higher order brain functions. And as certain areas of our brain deteriorate, like the hippocampus, those processes like problem solving and perception decline, along with our memory. But don't worry, we promise it's not all bad. We asked Dr. Moscovitch what we can do to maintain our memories.

Dr. Morris Moscovitch [16:12] Other people have taken some of the research that I've done and run with it, and shown how memories can be improved. But the basic ideas, the ones that really work best of all, are the kinds of things that your parents told you: eat well sleep, well exercise and pay attention. And those are really the best way to make sure one maintains a good memory. Doing exercises seems not to help beyond the particular task that you're exercising. There's no evidence that these memory exercises that they sell have any kind of general applicability.

Melissa Galati [16:57] Sorry, I don't mean to interrupt you. Apps that are claiming to train your brain or improve your memory, you would say...

Dr. Morris Moscovitch [17:05] Right now, there's no evidence that they help you beyond helping you do better on that app.

Nathan Chan [17:12] Yeah. So so you have brain exercises that are not necessarily going to help but if you have physical exercise, is that any different?

Dr. Morris Moscovitch [17:19] That's right, that that's going to help. The other thing that we found really helps memory. Well, not necessarily memory, but certainly performance on some memory tests, but delays the onset of Alzheimer's disease is bilingualism. So people who are fluently bilingual, that is they use two languages, often in their daily life, those people tend to develop the symptoms of Alzheimer's disease on an average three to five years later than people who are not bilingual people are monolingual. And it's not because their brains don't deteriorate. Their brains deteriorate at the same rate. It's just that they have enough brain reserve if you will so that they can tolerate that deterioration better. And so their symptoms don't show up until later.

Nathan Chan [18:06] And the more bilingual you are, the better. So the more you use the languages, you know, the more protective being bilingual is, Dr. Moscovitch isn't sure how early you need to learn another language in order to have that protective function. But he thinks it would make a great research question. His work also provides other ways we can give her memory a boost as well. For example, using locations.

Dr. Morris Moscovitch [18:27] One of the things that we found in recent research with former student Jessica Robin, is that locations (and that just as this people have known this, actually, for over 2000 years) are good cues from memory, if you're trying to commit something to memory. So if you call the method of low side, people used to give speeches, in order to memorize the speech, and know which parts follow which other ones you would place different parts of the speech in different locations have a place that's familiar to you, and you take a walk through that location picking up the parts of the speech as you go along. But what we found is that simply showing people pictures of familiar locations in Toronto, as compared to less familiar but known locations in Toronto, those that are highly familiar can serve as good cues for the events that happen there. So if I show you a picture, since you're at the university, let's say the Robarts library. If I show you a picture of the Robarts library, and ask you to tell me if an event that happened at the real price library, you're much more likely to remember an event there in great detail as compared to if I showed you a picture of the Bata Shoe museum.

Nathan Chan [19:48] So it's really interesting, it sounds that you can use different processes cognitively, to create memories even though that process might not have necessarily been designed so to speak for that metaphor.

Dr. Morris Moscovitch [19:59] That's right. Using spaces as a cue is terrific. And the reason I'm bringing to old age is that people often find that older adults tend not to do so well when they relocate from their home to a nursing home. So the environment can provide that support for all the old memories that you have. We haven't looked into this. This is a research idea. It may be the case that the reason older adults, especially as their memory is failing anyway and going into nursing homes, their nursing home may exacerbate their memory loss, not necessarily because of depression or things like that. But because the cues, the familiar environmental cues aren't there to trigger old memories. That's why in a lot of nursing homes these days, they ask people to bring artifacts from their house that may serve as cues for.

Melissa Galati [20:46] You may want to use the location idea for your next conference talk. We asked Dr. Moscovitch whether any other skills like musical ability help with memory as well.

Dr. Morris Moscovitch [20:55] Yes, music helps. The same people who did work on bilingualism show that if you do it often, and continued maintaining your music skills that also provides some protection. I don't think as much as bilingualism, but it does provide some. The other things that seemed to help a lot that I forgot to mention is to be socially active, that helps throughout life. And it helps particularly as you get older. So people who have large social circles and are socially active, tend to do well, even things like going dancing may help a lot. And part of the reason is that all these activities that we sort of see is trivial compared to let's say something like education, really require a lot of cognitive resources to be able to dance well, follow your partner know, what they're doing, keep track of the music, do your actions, do them at the right time. That's really difficult. It's not cognitively difficult.

Melissa Galati [21:58] It's a skill and it's physical activity.

Dr. Morris Moscovitch [22:00] That's right. It's a skill, and it's physical activity. And it's social, you have to pick up on lots of cues. So you have to be very sensitive to your environment. All of those things seem to have a protective effect throughout life and make you happy on the way even if you get, you know, God forbid Alzheimer's at an earlier age then you expected. First of all, you don't know when you would have gotten it if you hadn't done all these things. But these are things that really are the fabric of our life and not doing those things means that you're not exercising your potential.

Eryn Tong [22:31] And if you're wondering whether Dr. Moscovitch practices what he preaches.

Dr. Morris Moscovitch [22:34] The one thing I don't do well is sleep. Not because I don't sleep well, because I tend to try to pack in too much in my day, and I stay up longer than I should. But other than that I exercise, I try to have a large circle of friends, I would love to be able to continue being bilingual. I am. The languages I know, aside from English, I know a little bit of French, Romanian and Hebrew, but there's not much chance to exercise those on a daily basis. After my parents died then I can't do that. But no, I am an incredibly social person sociable person. So that ends as well. I like to dance.

Melissa Galati [23:15] There you go. See? You hit everything.

Dr. Morris Moscovitch [23:18] Yeah, who knows what's gonna happen anyway. It's good. To do these things, I think the wrong message is that you should do these things, because they'll put off some dreaded disease is probably not the right way to approach it. Because really, a young person or even a person in their 50s or 60s, isn't going to be worried about a person who they're going to be in their 80s. Right? If I tell you now, you got to dance now so that when you're 70, you won't get Alzheimer's disease. No one's gonna dance for those reasons.

Melissa Galati [23:51] So you'll have to do it because it's fun.

Dr. Morris Moscovitch [23:54] And there's so many things to do in this life that you could find any kinds of activities that are fun that exercise your mind and keep you active. Doing memory puzzles, doing apps is not fun and you probably shouldn't do that.

Richie Jeremian [24:11] Hi, listeners, Richie checking in here. And in case you were wondering, I still haven't showered since the Derm episode. So far, we've heard a lot about the biological implications of aging. But aging isn't only linked to memory or traits that we can see. In fact, there are a lot of changes on the molecular level that can explain how normal physiology breaks down over time. As adults age their gene expression profiles, that is which genes are expressed when and to what degree they're expressed change, resulting in altered function in cells and their corresponding tissues. Now why this happens is a complex and active topic of research and debate. One potential link to aging is the disruption of normal circadian rhythm that happens naturally over time, and can be accelerated by sustained sleep deprivation, behavioral modifications and mental illness. Go check out Episode 52 for more on that. But in fact, there are many factors that contribute to this process. The take home message is that accumulation of harmful compounds as well as the disruption of normal processes add up over time and can slow down and degrade normal function. It's also important to understand that aging is very much a program process, and clues for how you might age can actually be found in your DNA. A quick PubMed search will uncover that certain genetic mutations are associated with longevity, and others associated with early onset diseases. This might explain why it's not uncommon to see people living well into their 90s and beyond in certain parts of the world, the Mediterranean Island of Sardinia and regions of Japan come to mind. But the story doesn't end there. It turns out your genetic makeup can actually predict a certain aging outcome. And this outcome can be accounted for by the accumulation or loss of epigenetic factors, that is chemical modifications to the DNA sequence and its associated proteins. This ties into my labs own research into lactose intolerance. While the vast majority of humans and other mammals develop this trait after early childhood, about 30% of the human population carries genetic mutations that cause their lactase genes never to shut off, making them able to digest the milk sugar well into adulthood, and to enjoy those delicious dairy treats without issues. So how has research come along to provide some points of intervention? Well, dozens of genes and cell signaling pathways are associated with the aging process, and several compounds have been isolated that may be of some relevance. The first of these is nicotinamide, mononucleotide, or NMN, a chemical that can be used as a source of NADH a critical component in metabolic reactions. Another is resveratrol, a compound made by grapes during the fermentation process that may have the ability to jumpstart genes involved in longevity and youth. These and other compounds have been shown to slow down aging in mice and maybe promising in humans. Now, this is not to encourage everyone to go out and buy these supplements, and certainly not to load up on red wine. But these findings do suggest that in the future, there will be concrete compounds that could be recommended for healthy aging. In the meantime, we should still remember that lifestyle is important. And this is not a secret. A healthy diet of moderate eating regular exercise and little or no tobacco, as well as abstinence from alcohol and drug use go a long way, regardless of your genetic makeup.

Nathan Chan [27:23] Thanks, Richie. So far, we've talked about how to prevent or slow down aging. Despite the implications of aging, there are also a lot of things to look forward to.

Mashup Clip 3 [27:32] I'm looking forward to retiring. My parents and my in-laws are retired and they get to travel and do all kinds of amazing stuff and not have to wake up every morning and go to work. So I'm looking forward to that I'm looking forward to as my kids grow up having more time again for myself. So what I'd be looking forward to is retirement. Just because you have more freedom of what you can do with your time, you can still work if you're bored. So I know a lot of people who went back to work after retiring just because they didn't want to stay alone at home. And you can still volunteer and you spend time with her family is just there's more freedom. I guess you get you gain experience as you age. I guess your appreciation for life also improves. Some things you can appreciate. I feel like your sense of appreciation for many things grows over the years. I'm definitely looking forward to that.

Melissa Galati [28:30] It's pretty clear from the things we look forward to an aging that aging is just a part of our life course. To get a more holistic lens on aging, we spoke to Dr. Esme Fuller-Thomson. She's the director for the Institute of Life Course & Aging here at the University of Toronto. She holds the Sandra Rotman Endowed Chair in the Faculty of Social Work and is cross appointed with the Department of Family and Community Medicine and the Faculty of Nursing. As our conversation folded, we were pleasantly surprised to learn from her that our situation may not be as bad as we think.

Dr. Esme Fuller-Thomson [29:00] Gradually over the last 20-30 years, all kinds of things for older adults have gotten much better. We're getting older. But it's not just that we're getting older and we're decrepit. In fact, our disability free life expectancy has also increased so we're much more likely to live to 85. And even if we are 85 to still be living independently and healthfully without functional limitations. So that's fantastic news and there's all kinds of pieces to that. Macular degeneration has been declining 60% a generation. We also look at dementia, the incidence and the prevalence has been coming down dramatically and all of the Western world which is such great news because I think I think dementia is what people fear more than almost anything. Chronic pain and dementia that the idea is that they would lose their capacity. And the trajectory is so much better than it was even in the 1970s so that's really positive. Hearing is improving which we really hadn't anticipated. And in fact, when my friend's children say, oh, what career should we go into? I've always been saying audiology because I'm on the subway and I'm listening to kids listen to music very loudly. But even in the 20 to 69 year old age range, the problems of high frequency hearing loss have improved hugely, even in the last 15 years. So, in general, things are getting better. Hip fractures are down dramatically. So all the things that we worry about hip fractures are also something that's worth thinking about, falls in hip fractures, because people tend to die after hip fracture. It makes it much harder to live independently. That is, that's kind of a deal breaker often having a hip fracture. So all of these potential improvements, or all of these witnessed improvements, make the long term projections much happier for those of us aging.

Melissa Galati [30:52] It seems like there have been lots of positive changes. But a big question still remains how our aging population affect our society on a broader scale. Will the silver tsunami actually bankrupt us, like economists have been saying?

Dr. Esme Fuller-Thomson [31:05] So 2016, was a pivotal year in Canadian history, in that for the first time, there were more older adults 65 and up than there were children. That's brand new in our history, so we're in new territory right now. But because our older adults are healthier, and still very active members of society, I want to caution against the negative stereotype of older adults is bed blockers, you know, they're thick, and they're gonna cost us a fortune and all of those issues. So in fact, the amount of money you invest in children is very high. It's just a lot of it comes out of a personal pocket versus long term care and healthcare tends to be out of the general pocket. But the actual burden on society financially isn't really that dramatically different between younger people and older adults.

Nathan Chan [31:57] That's an interesting point that was just raised. And perhaps the anticipated financial societal burden may not be as great as what's been predicted. But what about our healthcare system? Is it equipped to take on our aging population?

Dr. Esme Fuller-Thomson [32:09] That's an excellent question, because I think we're way too siloed. We just talked about all these great improvements in older adults. What probably did that probably that was vaccinations when they were children. It was access to antibiotics when they had inflammatory diseases, flus, etc. It was better education. Better education is a huge predictor. So I think the fact we think healthcare happens in the hospital, and health happens across the life course. Excellent, prenatal care, makes a healthy, older adult. We really need to think holistically. So I would love to see a lot more of the investment from health going into public health and decreasing poverty. So poverty is a terrible risk factor for disease at any age. It takes years off your life. We were looking at in US data on living under the poverty line versus being rich. The difference is huge. It's a tenfold difference in functional limitations among older adults if you're living under the poverty line. But even if you just get up into an acceptable amount that you don't have to worry every day about putting food on your table, the levels of disability comes down hugely. So what are we doing with nutrition? How are we thinking through people eating better across the life course? There's a whole bunch of ways we can do it. So I would like to just move it outside of the hospital setting. But I do agree that the hospital probably will be somewhat taxed by the growing numbers of people at the end of life where the end of life is a very expensive time. So is the first year of life when you're a baby born, that's a very expensive time. And the year you die is a very expensive time. Luckily, we have a healthcare system where we pool the risk. The rest of us in the middle help subsidize those two ends of life where it's expensive. But part of the issue I think dementia care is also a very time and cost intensive. So I think we need to think more about options within long term care. And I think we need to think more creatively about helping people stay in their homes, because now there's not enough resources in the community. So even if you have a devoted caregiver, that person can't go 24/7 burns out, and the person ends up in long term care, which is a very expensive option, versus if we could have several hours of respite care a day that person might be able to stay in their home, which normally is a preference to stay in their home environment. But how do we go about it? How much resources do we put into modifying home environments so that they become safe, people can have baths, those types of things. So we really need to think out side of the box.

Melissa Galati [35:01] So in order to continue moving towards a society that is mindful of our aging population, there are lots of things we need to consider. Dr. Fuller-Thompson explained how we really do need to come up with creative solutions as we move forward, including things like retirement age. In Canada, we've removed the legal requirement that you need to retire at 65. So it gives increasingly healthier older adults the opportunity to continue working. But there needs to be a balance to keep people engaged without burning people out. What about part time options, there's still so much opportunity to leverage older adults wisdom, ability and skill sets, their knowledge about the world. What were her other thoughts on how our society can continue to be inclusive to our aging population?

Eryn Tong [38:14] And Dr. Fuller-Thompson is even working on finding these creative solutions herself. As we mentioned earlier, She's the Director of the Institute of Life Course & Aging at the University of Toronto. She elaborated to us some more about how the Institute first came to be and what the main goals and vision of the Institute are.

Melissa Galati [38:29] We're very proud that we are the oldest program in gerontology, the oldest of its kind in Canada. Blossom Wigdor, who is an emirita professor here, started it in 1979. By 1989, it became the Institute for Life Course & Aging. So it's really the first interdisciplinary venue for graduate students to study aging related issues. What happened is that there wasn't enough critical mass in any particular department, for people to have an aging specialization. If you were in nursing or OT or Institute of Medical Sciences or even medicine, you have geriatrics in general, but in there wasn't nearly as much of a concentration of people. So the idea is, how can we help people from all these different disciplines get their aging specialization? That's where the institute comes to play. So we have over 60 graduate students from across the university, from 18 different departments and faculties. We have people from Geography doing age-friendly communities, and then of course in Medicine and Nursing. Social work, we have about 20 from social work, who are really interested in gerontology-related issues. We have a core theory-based course and then we have elective courses that you can focus more on your specialization. Our other mandates are to promote interdisciplinary work. Research in aging and we're very fortunate to have 75 affiliated graduate professors from across the university again from 18 different faculties. So there's more and more push in from the different research bodies to have interdisciplinary research. We have it in spades because everybody can connect with each other and bring in new projects. So I just got a call from Baycrest about one project they're thinking about doing. They'd like some neighborhood components. The social science and medical and health fields can mix quite well together.

Nathan Chan [40:37] Another main mandate of the Institute is to promote knowledge transfer, which they do through many different avenues. They are very active on Twitter #LifecourseUofT (go follow them), and run a mailing list to quickly disseminate new information as it becomes available. They also run four-week workshops online for professionals that are already working in the field to enhance the population-based skills. Some topics include anxiety, hoarding in older adults, and drug and alcohol dependencies. Throughout the year, they also host a research seminar series for Emerging Scholars to present the interesting work that they're doing.

Dr. Esme Fuller-Thomson [41:08] Can I turn it back to you? Because Eryn, you did the program? Tell me a bit about it.

Eryn Tong [41:12] Yeah, I was actually in the palliative and supportive care stream. It was really wonderful to get to meet different people that were doing such interesting and collaborative work. I think we're all very siloed. We tend to be siloed in the university so it was neat to meet other people that were doing similar work and but from very different backgrounds. So I really enjoyed it.

Dr. Esme Fuller-Thomson [41:34] Right? Well as music to my ears.

Melissa Galati [41:37] Going into this episode, we all had our own perceptions and worries about aging. My grandfather is 91. And in the last year, he's lost almost all of his mobility and has started forgetting a lot about his own life and his family. He has full time help, but it makes me really sad to visit him because we can't talk or do any of the same activities that we used to and that scares me for my future. But at the same time, he's had 90 years of really amazing health and has had a lot of rich experiences. A lot of what both our guests said made me think about him and the kinds of things he's done as he's aged.

Eryn Tong [42:09] My biggest worry has always been to experience changes to my memory and cognitive function. So I think it was really encouraging for me to learn about the importance of maintaining healthy habits throughout our life. No matter how old we are to continuously exercise our minds and our bodies and to do this by engaging in hobbies and activities that we genuinely enjoy. And to this point, my grandparents have been such wonderful examples. They're now in their late 80s. And my grandpa continuously has a million projects for himself around the house, and it's truly a kid at heart. And my grandma has recently taken up painting and has created so many beautiful pieces. They both try to keep as busy and as engaged as possible with themselves, each other and with the rest of our family.

Nathan Chan [42:46] And I guess aging has always been something of a fascination for me. My grandfather had Alzheimer's disease. He passed away over a decade ago, but I still remember all the stresses my family faced on taking care of him. It was really hard. But there's been so much amazing research coming forth. Now. We understand the brain way better now. And how our lifestyles can impact the way we age. It's very clear that there are people working on solutions from many perspectives, including the ways that we can reduce the burden of caregivers. It's almost like everybody knows we can do better to take care of older adults. So I'm glad to hear conversations about not only the challenges with aging, but also the things we can do as individuals and as a society to help each other age gracefully. We'd love to hear from you listeners too. If this episode changed your perspective on aging and what it means for both yourself and our society. Please let us know.

Eryn Tong [43:31] And thank you to our esteemed guests, Dr. Morris Moskovitch and Dr. Esme Fuller-Thompson, and to the wonderful strangers who answered very personal questions about aging.

Melissa Galati [43:39] Content for this episode was developed by Nathan Aaron, Amber, Anton and myself, Melissa. Ritchie's corner was brought to you by the one and only Richie. Audio engineering was done by Kat. Thanks for listening and until next time, keep it raw.