AGE AND ENLIGHTENMENT

The world's population is aging rapidly. In twenty years, one billion of the earth's inhabitants will be 65 years or older. In 40 years (by 2050), four-hundred million people will be over 80 years old. A new book, "Shock of Gray" by author Ted Fishman argues that we have been poorly prepared for the aging of the world's population, and how it will pit young against old; child against parent; worker against boss; companies against rivals, and nations against nations.

Fishman argues that as the ratio of the old to the young grows ever larger, global aging is reaching a critical stage. For the first time in known history the number of people of age 50 will be greater that those under age 18. He says no one has yet grasped the full massive effects this will have on economies, jobs and families.

I was reminded this week of the divergent effects in a couple of announcements from the Mayor of Ottawa Jim Watson, who incidentally turns 50 years old this week. The Mayor wore a helmet and a white tee-shirt on Sunday as he launched Ontario's first fully segregated bicycle lane along the length of Ottawa's Laurier Avenue. Cycling is an important form of recreation and Ottawa has close to 7000 kilometers of bike lanes, paved-shoulders and multi-use pathways. But only 2% of residents regularly rely on bicycles for commuting to work, which is the main mission of the Laurier Avenue initiative.

In business attire two days later, on Tuesday: Citing increasing mobility problems amongst the aged, Mayor Watson retired the last of Ottawa's "high-floor" buses. The city's one-thousand transit vehicles are now 100% so called "kneeling buses," capable of allowing people with mobility problems to roll-on and roll-off. Mayor Watson claims that is a first for any Canadian city. Therein the divergent problems of our modern urban environment. Cities were designed for the young, and we continue to develop and build infrastructure for that purpose. At the same time and all the while, it is the aging "boomers" who are putting the strain on our modern cities. - People are getting old fast, and we're doing it in communities designed for the sprightly.

The size of the aging boom is quite simply staggering. Every day for the next several decades, thousands of baby boomers will turn 65. That is in addition to the oldest-old, the 85-to-90 something, whose numbers have already grown by one-third in the last decade with no signs of slowing. The "New York Times" recently described the phenomenon as a..."silver tsunami (that) will challenge a youth oriented society." Since demographers have been warning about the phenomenon for years, it is shocking how far behind we are. And when any planning and forethought is given to the problem it's almost always viewed as a health issue - Preparing for the coming wave of Alzheimer's / Or as a political liability - When will the social safety nets collapse under the weight?

Cities and suburbs were designed for younger people, full of stairs, cars and now increasingly (it seems) bike lanes. The problem is that as these become more difficult to navigate older people retreat. As the population growth tilts to the majority of people over 50 years old or more, the challenge will be to keep them from retreating by adapting age friendly solutions to modern planning. It seems that we still have some distance to travel along the path...and not one of us is getting any younger.

THE FOUNTAIN OF YOUTH ISN'T IN A PRESCRIPTION FOR LIPITOR

I pick on the cholesterol reducer "Lipitor" only because it's widely advertised and hugely prescribed. There are thousands of other examples. But here in Ontario; Lipitor accounts for the single largest expense of the annual $3.5 billion Drug Benefit Program for residents over the age of 65.

On July first, the Ontario government is wiping-out a professional allowance (Read: Promotional) fee totalling $750 million per year paid by the drug manufacturers to pharmacists. The government claims the drug companies have been tacking-on the $ 3/4 billion fee to the cost of the drugs the pharmacists then sell back to the province.

One example cited is the oral Diabetes medication "Metformin" sold in Ontario for $0.10 to $0.15 a pill. In several American jurisdictions it's just given-away to diabetic patients as a loss leader on the sale of more testing supplies (monitors, strips etc) for the disease.

In the United-States, an in-depth investigation published by the respected Associated Press, caught my attention recently. It concludes that..."too much medical treatment is making many Americans sicker." Over treatment won't make people healthier, it may make them sicker. The Associated Press review of hundreds of pages of studies and interviews with dozens of specialists concludes that anywhere from one-fifth to one-third of medical tests and treatments are unnecessary.

It's a concept that our technology driven North American society, and our doctors find hard to believe: Avoidable care is costly in more ways than the bill - It may cause dangerous side effects. Physicians have the good intentions of doing what's best for their patients. But seems it's rare that a patient will say: Wait! I need more information. The A.P. analysis in the United-States concludes that our burgeoning epidemic of over treatment at every stage of life often means that someone could have fared as well or better with a lesser test or therapy, or maybe even none at all.

It frequently starts during birth where for platitudes expectant mothers choose Cesarean Section surgery; and it extends to futile intensive care efforts at the end of life. In between there are far too many CT (radiation) scans, MRI's, "stents" and bypasses for blocked arteries; and anti-biotics prescribed for viruses they can't help.

Though health care system delivery is different between Canada and in the United-States; the levelling fear for all North Americans is the ageing curve of the population explosion which followed the end of the Second World War. The early "baby boomers" have now entered their seventh decade of life. While there is no "fountain of youth", patient education is going to be extremely significant if we are to remain healthy before the money runs out.