CIHR Institute of Aging Strategic Plan 2023-2028
Reframing Aging – Empowering Older Adults

Strategic Direction C: Improve Lived and Living Experiences and Quality of Care in the Later Years

We recognize rights to self-determination as a vital part of health and wellbeing throughout the later years.

Research Priorities

Respect for older adult's lived and living experience and rights to self-determination

  • Ensure evidence, research and lived and living experiences inform and drive policy

Aging in the right places

  • Promote and implement research and best practices for age- and dementia-friendly communities
  • Optimize mobility and transportation for older adults
  • Examine transitions for community-dwelling to supportive living environments, including to long-term care

Addressing challenges in the later years

  • Promote prevention and best practices with frailty and falls

Priority 1: Respect for older adult’s lived and living experience and rights to self-determination

We all benefit from an inclusive culture that welcomes older adults into communities and ensures opportunities to hear and learn from their lived and living experiences. This empowers older adults to stay active and socially connected while continuing to contribute to society. It also protects against negative views of aging and ageism by embracing healthy aging as a valued part of the life course.

The COVID-19 pandemic perpetuated ageism and many older adults were limited in their ability to be self-determining in decision making. Older adults living in long-term care and other residential settings were forced into isolation and separated from family caregivers, with the view that this would provide protection from infection. In addition to the profoundly negative mental health consequences of this prolonged isolation, older adults and their families were not able to participate in making this decision about their own wellbeing.


All research and policy development related to older adults should be informed by older adults and include evidence from their lived experiences and expression of needs. We have an opportunity to learn from experiences during the COVID-19 pandemic and ensure that older adults are empowered and involved in determining what is right for them during aging, and feel confident that their needs and wishes will be respected and prioritized if assistance is required from family and caregivers.

Priority 2: Aging in the right places

Most older Canadians live in their homes in the community and wish to stay there for as long as possible as they grow older, with about 10% living in residential care facilities including long-term careFootnote 13. Living at home can be desirable as it offers familiarity and relative independence, however, over time increasing support from family, friends and community-based services may be required. Living at home also requires access to transportation to ensure that needs can be met, including accessing health care. For some older adults, remaining at home may lead to social isolation and loneliness and result in an unsafe living environment, particularly for those living alone. Caregivers may not be able to continue to support an older adult as health conditions change, leading to a need to transition to another living environment. More research is needed to find solutions for older adults to continue to age-in-place in their homes longer with enhanced support from home care services and integration of hospital and continuing care sectorsFootnote 9. While many older Canadians have financial security, poverty affects many older adults and, in particular, older women. To enhance the potential for older adults remaining independent and engaged in their communities, research on access to reasonable income supports, affordable housing and inclusive transportation services will be neededFootnote 14.


Housing, living arrangements and transportation approaches that are adapted for older adults as they age emerged as areas in urgent need of research during our consultations. The pandemic shed light on longstanding problems in the long-term care system, putting attention on the need for change. This has led to some rapid interventions, but most have not undergone sufficient evaluation to determine whether they are or will meet the needs of older adults and the system. However, Canada’s emerging National Long-Term Care Standards, led by the Standards Council of Canada (SCC), Canadian Standards Association (CSA Group) and Health Standards Organization (HSO), could be a game-changer for older adults and their families considering long-term care. Similarly, many older adults have not been able to safely access community-based and home care services during the pandemic and this problem persists, at least in part, due to a shortage of workforce for program delivery. These issues present key opportunities for research. For example, we need to better understand the factors that support older adults to live at home in their communities for as long as possible, and we need to mobilize evidence to ensure that models for long-term care meet the needs of the most vulnerable older adults.

Priority 3: Addressing challenges in the later years

Later life can be associated with multiple medical conditions, declining health and the onset of frailty, a common syndrome where individuals become increasingly vulnerable to poor health outcomesFootnote 15. Frailty often accompanies inactivity, poor nutrition, prescription of multiple medications and social isolation and loneliness, and can result in the body’s inability to cope with minor illness, leading to rapid deterioration of healthFootnote 16. Older adults experiencing frailty are also at increased risk of falls leading to injury or death, but frailty is not an inevitable part of aging and steps can be taken to aid older adults in avoiding frailtyFootnote 16.

In late life, palliative care can relieve suffering of the person and their families by treating and attending to physical, psychosocial and spiritual needs. Palliative care can extend to bereavement and support of the family after experiencing loss. There are critical gaps in palliative care and end-of-life services for older adults, particularly in the area of persons living with dementia and those living in long-term care homes. While it is considered that persons living with advanced dementia and their families could benefit from a palliative approach or hospice care, this is generally not providedFootnote 17,Footnote 18.


Significant advances in the clinical evaluation of frailty have been made with the development of the Frailty Index and Clinical Evaluation Scale by Canadian clinician-researchersFootnote 19,Footnote 20. A critical element for effective care and treatment of persons living with frailty, or at-risk of frailty, would be implementation of a primary care model that engages patients and caregivers with an integrated health system that links community services and specialistsFootnote 21. This is an area requiring research to develop and evaluate programs for effective implementation of frailty prevention programs in primary care and community services. Additionally, palliative care and hospice services would benefit substantially from accurate and complete data and research on best practices related to older adults and particularly those with dementia, strategies for implementation and policy development.

Success and Impact

Within the timeframe of this Strategic Plan, research will contribute to:

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