A modest proposal

When women turn 50 in Ontario, we get a happy birthday message from the provincial government that lets you know it’s time for a mammogram, a pap smear and a colorectal cancer screening.  Yay, happy birthday, you are officially old.


Recently, in my consulting life, I’ve been working with several professions that fall into the rehabilitation/ mobility realm, and I’ve developed my own little pet project that I would undertake if I were the minister of health:  a comprehensive mobility assessment at the age of 50, and the development of a personal plan for strengthening and sustaining mobility.

I have been thinking about this a lot as I’ve entered my 50s, and started experiencing the weird stiffnesses and aches and changes in metabolism that come along with this decade.  I’ve noticed an increasing number of my peers who can’t comfortably walk up or down two or three flights of stairs.  I’m not talking about people with the kind of injury or deficit where they might already be seeing a physiotherapist or other mobility professional — I’m talking about the “move it or lose it” kind of agility and strength.

I’ve been thinking a lot about the need to sustain mobility as we age.  There is a lot of evidence that physical activity in older people is a critical part of preventing disease and sustaining wellness, maintaining independence and creating a good quality of life.  If we can’t move our bodies in some ways, we’re at greater risk for diabetes, high blood pressure, heart disease and depression.  If we don’t feel comfortable walking a few blocks, there are fewer and fewer activities available to us.  Mobility is critical to aging well — which is one of the main points of this blog’s existence.

And, there is almost nothing in our current primary healthcare framework that focuses on fostering agile aging.  We are screened for the biggest problems inside our bodies — cancer, heart disease, diabetes, and there is an increasing focus on health promotion (participaction and the carrot app, anyone?) that encourage individuals to take action. But my suspicion — supported by anecdotal evidence by my colleagues in cardiac rehab and mobility professions —  is that most of those programs are going to sweep in people who already see themselves as physically active in some way, or if their health providers have told them to become more active.

I think there would be huge benefit in providing a safe, supportive framework for an assessment by a healthcare provider focused on mobility (physiotherapist, athletic therapist, occupational therapist) at the age of 50 or so, and the development of a personalized plan for each person, focused on aging with the greatest mobility.  We don’t all need to climb mountains or do endurance runs or ride our bikes across Estonia.  But I do think that aging with the greatest agility, strength and ease available to each of us is more accessible than some people think.

o-OLDER-WOMEN-EXERCISING-OUTSIDE-facebookRight now, for the most part, access to the services of physiotherapy and these kinds of professions fall into the 30% of healthcare in Ontario that are privately funded, not publicly supported.  If you have a benefits plan that covers physiotherapy, a comprehensive assessment in your early 50s and goal-setting personal plan is accessible.  But most people are only referred to physios when they are already injured, and for those of us without this kind of funding, it’s never on our radar.  I think making planning for long-term mobility a normal part of aging should be something we all do — and it should be an integral part of our health system.

What do you think?





7 thoughts on “A modest proposal

  1. I think it would be brilliant. Do you have someone who could do a cost-benefit analysis? Prevention is generally far less expensive than dealing with the injuries and illnesses, but you would need an economist to calculate possible savings and bolster your case. I would appreciate follow ups too, just like I get for my mammogram and colonoscopy every few years. As I am now well into my 50s, I notice I am stiffer, and starting to wonder whether and how to dial back my physical activities to maintain optimal mobility.

  2. I think it’s smart, but I’m cynical that government would buy into it. I wholeheartedly support prevention, but it’s a hard sell, though perhaps the prior commenter’s idea about a health economist is sound. Case in point, our local hospital is shutting down a cardiac fitness institute which focused on secondary prevention (i.e., people who had cardiac issues trying to prevent future issues) because it does not fall into the silo of “acute care” and they cannot fit it into the budget. Short-sighted and more expensive in the long run I suspect, but with current funding models, tough to get around.

  3. I went through that “welcome to 50” battery a few years ago, and I remember technicians asking, “Do you manage to get any exercise?” — which seems to imply that a lot of able-bodied 50 year olds are not getting exercise at all, and maybe that they somehow feel unable to do it/ disconnected from any means of exercise. So, yes I think there is a real mobility problem, and that many people have stopped seeing themselves as capable of healthy activity.

  4. I also love this idea – it’s positively Scandinavian in its sense of what public wellness actually means! It also reminds me of something my yoga teacher, Sue Bremner at Yoga Centre London, says: we do Iyengar yoga so we can get off the toilet when we are 75.

    Two notes here: first, Iyengar is superb yoga-as-therapy; it’s a practice focused on props, long holds, and precision in the asanas so that you do not risk hurting yourself as you stretch and strengthen. It tends to invite very, very diverse groups – so for example I have practiced Iyengar with teenagers, elderly people, injured people, and mentally disabled people. It is not “traditional” in the sense that it does not attract a slender, show-off-y demographic – not at all.

    Second, I pay for my yoga out of pocket, though I have a small pot of money from my benefits plan I could apply to the cost, if I sacrificed other “extended health” things like massage or physiotherapy. This bothers me enormously. I recently filled out a survey for my union in which I noted that I would be ok with making lesser gains in salary in our next negotiation round if it meant we could achieve better, more supportive health benefits. Moving away from “doctor and medicine = primary; joint, aging, and self-care secondary” would be a paradigm shift, but somebody has to be exemplary, right?

    Thanks Cate!

  5. Yes ! Preventative health – an area sorely underrepresented in the U.S. That’s right, we turn 50 and get the mammogram, Pap, and colonoscopy speech ( the men, I believe the prostrate labs done at 55) , but no one is thinking about actively creating opportunities and promoting the over 50, or over 60 crowd being physically active.
    My parents, at 77 and 78, have a gym membership covered on their Medicare HMO plan – but it ‘s not the standard.

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