Health Promotion and Aging

Chapter 1 Introduction

Health

 World Health Organization (WHO) defines health as: A state

of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
 Health promotion is the process of enabling people to increase
control over, and to improve, their health.
 Health promotion moves beyond a focus on individual
behavior towards a wide range of social and environmental
interventions

Aging

 Aging is the process of growing old.

 Merriam Webster defines it as: Gradual change in an organism
that leads to increased weakness, disease and even death.
 Aging takes place in a cell, an organ, or the total organism over
the entire adult life span of any living thing. There is a decline
in biological functions and in ability to adapt to metabolic
stress.

Healthy People Initiatives

 In 1979 “The Surgeon General’s Report on Health Promotion

and Disease Prevention” was published.
 Many say this was the first initiative to focus on fostering
health promoting initiatives throughout the nation.
 By 1980 “Promoting Health Preventing Disease” outlined
Health objectives for the nation to achieve over the next 10
years.

Healthy People 2000

 In 1990 another national effort, Healthy People 2000, was

initiated by the US Health Service in an effort to reduce
preventable death and disability for Americans by the year
2000.
 This was followed by Healthy People 2010 and now we have
Healthy People 2020.
 Prior to these objectives outlined in 1979, health care priorities
were determined by tabulating the number of deaths from a few
diseases and then organizing a campaign against the most
prevalent ones – like heart disease and cancer.
 Unfortunately, because most of these initiatives are poorly
funded, not many of the lofty goals are ever met.
 In 2007 it was determined that at best 36% of the objectives for
the year 2010 would be met, and we were falling far short on
the other 64% of the goals.
 Older Americans were falling short of the goals not only for
lack of physical activity and obesity, but they were also eating
less fruits and vegetables, suffering tooth loss, suffering more
hip fractures and more fall related deaths were reported.
 Currently, we have been on a trend of becoming an aging
population.

 Unfortunately, our medical profession often struggles with the

idea of prevention because they get paid for treatments – not
prevention!
 However, our advancing medical technology has been able to
keep people alive longer.
 The question is – are they healthier, or just sicker for longer?
Population growth

 The average age of the American population has been

increasing dramatically.
 Between 1950 and 2050 the number of Americans age 65+
increases more than 6 fold.
 In 2010 the number of Americans between the ages of 45 and
64 was about twice that of those age 65 and over.
 “age pyramid” ==> “age rectangle”

The Baby Boomers

 the baby boomers are the 76 million persons who were born in
the United States between 1946 and 1964.

The “Older Old”

 The older population itself is getting older.

 The percentage of persons age 85 and over is growing faster
than any other age group.
 1980 – 1990: 36% (from 2.2 million to 3 million)
 1990 – 2000: 43% (from 3 million to 4.3 million)
 2000 – 2010: 40% (from 4.3 million to 6 million)
 Activities of daily living (ADL) is the standard for assessing
functionality and refers to difficulties with bathing, dressing,
eating, transferring, walking, and toileting.
 The older old (age 85+) have three to four times the
difficulties of the younger old (age 65-74).
Disability and Chronic Conditions

 Disability is defined by the U.S. Census Bureau as difficulty

with hearing, vision, cognition, ambulation, self-care, or
independent living.

 The leading chronic conditions are hypertension, arthritis,

heart disease, cancer, and diabetes.
 Women – higher levels of asthma, arthritis, and
hypertension
 Men – higher levels of heart disease, cancer, and
diabetes
 Longer lives do not mean significantly more disability.

Centenarians

 In 2010 the census showed that there were 53,634 people who
were 100 years old or older.
 An increase of 5.8% since the 2000 census.

Life Expectancy

 The life expectancy of Americans born in 2012 is 78.9 years.

 However, the US is behind 49 other countries in life
expectancy with the top 30 all into the 80’s.
 America’s life expectancy has been rising steadily since the
1900’s thanks in advance to improved sanitation, medicine, and
health behavior (most recently smoking cessation)
 Unfortunately, most recently we have experienced a huge
increase in percentage of obesity – so we will have to see how
this affects our over all life expectancy as a country.

Women live longer

 Currently, there is a decent gap in years of life expectancy

between men and women:
 Men – 76.2
 Women – 81.3
 This 5 year gap is actually the smallest since 1943
 Older men are now living longer.
 The population of men between the ages of 85 – 94 grew by
nearly 50% since the last reports and women of this same age
group grew by about 20%
 Best part about turning 100? No peer pressure!

Hospital Stays

 Average length of a hospital stay for an older patient continues

to decline
 1964 – 12 days
 1986 – 6.5 days
 1994 – 5 days
 2007 – 4.6 days
 Older patients account for 20% of all hospital stays in 1970
 By 2000 they accounted for 40% of hospital stays
 Older patients had more than 7 office visits with their doctors
in 2009
 45-65 average 4 office visits

Medicine Use
 Although hospital stays declined, medication costs among
Medicare enrollees went up.
 Older adults make up 13% of the population, but consume 32%
of all prescription drugs and 40% of the over-the-counter
drugs.
Leading causes of death

Health Habits

 The health habits of older adults may be slightly superior to

younger adults.
 People age 65 and over are less likely to smoke, drink alcohol,
or report high stress.
 However, older adults are more likely to be sedentary and
malnourished.
 Also, as far as less likely to smoke – most smokers die before
the age of 65, so this may be more of a “survival of the fittest”
concept.

Perception of “Health”

 Many people define health differently, so the when you ask

them about their “health” you will get different answers.
 76% of older adults age 65 and over rate their health as “good”,
“very good” or “excellent”
 Among those 85 and over, the percentage drops to 67%
 This number drops even more significantly (63%) for Blacks
and Hispanics, and to 56% among all races without a high
school education.
Work

 A growing percentage of older adults are remaining in the

workforce.
 Age 62-64 (male)
 1995 – 45%
 2011 – 53%
 Age 65-69 (male)
 1995 – 25%
 2011 – 37%
 Age 70+ (male)
 1995 – 10%
 2011 – 15%
 Labor force participation rates began to rise 10 years earlier for
women than for men, around 1985.
 With increasing life expectancy, workers can anticipate a
longer retirement phase to save for. Complicating matters is
that employees are increasingly less able to take advantage of
the security and predictability of defined benefit programs,
instead having to rely on defined contribution programs.
 Defined benefit programs – traditional, lifetime
pensions provided by employers
 Defined contribution programs – do-it-yourself
retirement savings plans that are subject to the whims
of the stock market.

Political Power

 Older adults are disproportionately likely to vote.

 1978 – 19%
 1986 – 21%
 1998 – 23%
 Older adults are more likely to demonstrate high levels of civic
engagement, paying more attention to politics affairs than
younger adults.

Internet Access

 Social-networking site use among Internet users ages 65 and

older more than tripled between 2009 (13%) and 2013 (43%).
 People younger than age 50 used social-networking websites to
stay in touch with friends, and people older than age 50
reported that they used them to connect with family,
particularly those who live far away.

Poverty

 The poverty rate among older persons had fallen from 35% of
those age 65 and over in 1969, to 9.5% in 2013 (may be
overstated).
 The poverty rate is almost three times higher for older
Hispanics and Blacks (19.8% and 17.6%) than for older Whites
(7.4%), and almost twice as high for older women (11.6%) as
for older men (6.8%).

Racial and Ethnic Composition

 The diversity of the older adult population in America is

increasing.
 The fastest growing minority will be Hispanic elders of nay
race, almost tripling in percentage between 2010 and 2050.
 2013, age 65+
 Asians – 10.7%
 African Americans – 9.8%
 American Indian and Native Alaskans – 9.4%
 Native Hawaiian and Other Pacific Islanders – 7.4 %
 Hispanics – 6.2%
 Acculturation is the degree to which individuals incorporate
the cultural values, beliefs, language, and skills of the
mainstream culture.

Components of Health

 Disease prevention, which comprises strategies to maintain

and to improve health through medical care, such as high blood
pressure control and immunization.
 Health protection, which includes strategies for modifying
environmental and social structural health risks, such as toxic
agent and radiation control, and accident prevention and injury
control.
 Health promotion, which includes strategies for reducing
lifestyle risk factors, such as avoiding smoking and the misuse
of alcohol and drugs, and adopting good nutritional habits and
a proper and adequate exercise regimen.

Prevention

 David Haber (our text) breaks prevention into three categories

1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention

1. Primary Prevention

 Primary focuses on asymptomatic individuals in whom

potential risk factors have been targeted.
 Regular exercise, good nutrition, smoking cessation,
immunizations – all recommended to delay or stop the onset of
disease.
 Primary prevention is different from health promotion in that it
is less broad in scope and tends to be the term used by
clinicians in a medical setting.

2. Secondary Prevention

 Also with asymptomatic individuals with whom actual risk

factors have been identified (rather than just a potential).
 Medical screening (mammogram, colonoscopy, fasting
glucose, bone density tests) are secondary prevention
measures.

3. Tertiary Prevention

 These individuals already have the disease and is symptomatic.

 Tertiary focuses on rehabilitation for maintenance of health so
the disease or disability might become slower in progression.
 Phase 1 – the care of a hospitalized cardiac patient.
 Phase 2 – rehabilitation of outpatients.
 Phase 3 – long-term maintenance
 Programs of tertiary prevention reduced the likelihood of
cardiovascular mortality by 25%.

 Health promotion – encompasses mental, emotional, and

spiritual health concerns. Also a more proactive approach than
primary prevention, which tends to imply a reaction to the
prospect of disease.

Wellness

 The only limitation to the term wellness is that it tends to be

identified with “alternative” activities – acupuncture,
homeopathy, spiritual healing, aromatherapy – to the exclusion
of more mainstream activities such as exercise and nutrition.

Anti-aging

 Anti-aging movements are now becoming more popular in the

United States.
 Most proponents of the antiaging movement are focused not on
the most aged, but on the middle aged and the young old, those
most concerned with combating the signs of aging.
 Anti-aging is really driven by hormone replacement.
 Men with low “T” commercials are prevalent every Saturday
and Sunday during football season, with the idea that
maintaining youthful testosterone levels will help slow the
atrophy of bones and muscles.

Pro-Aging

 There are also some Pro-Aging movements in the United States

that focuses on aging graceful.
 Pro-aging movement – emphasized the healthy aspects of
aging and the benefits that accrue with age.
 Exercise programs like “silver Sneakers” helps older adults
maintain an active lifestyle.
 Also, many retirement communities promote healthy active
adult communities for those over 65. In AZ they usually have
a gold course, go for community hikes, and have tennis courts,
swimming pools and health clubs all for those 65 +.

Compression of Morbidity

 The goal is to live in robust health to a point as close as one

can come to the end of the life span, so that one can die after
only a brief period of illness. In short, spend a longer time
living and a shorter time dying.
 Healthy aging – to be able to live life fully until death.
 Unfortunately, very few Americans who die at age 65 or later
are fully functional in the last year of life. Moreover, the
longer one has lived, the longer the period of disability before
death.
 At age 65, have about 17 years left to live, with 6.5
(38%) of those years spent in a dependent state.
 At age 85, have an average of 7 years left to live, with
4.4 (63%) of those years spent in a dependent state.
 Pessimists argue that the period of morbidity preceding death
will lengthen in the future as a result of
 Limited biomedical research funds available to improve
the physical and mental capacity of the very old
  The fact that some major disease, such as Alzheimer’s,
do not have recognized lifestyle risk factors that we can
modify
 Medical advances, such as dialysis and bypass surgery,
that will increase the life expectancy of individuals with
disease rather than prevent the occurrence of disease
 Optimists claim that there will be a compression of morbidity
in the future due to
 The likelihood of advances in biomedical research that
will prevent or delay the occurrence of disease
 The continued potential for reducing risk factors such
as smoking, high blood pressure, poor nutritional
habits, and sedentary lifestyles, which will result in
better health.
 The percentage of chronically disabled older person – those
having impairments for 3 months or longer that impede daily
activities – has been slowly falling (Manton).
 Will we be able to compress morbidity? Unfortunately, we do
not even know which factors most affect the compression of
morbidity.

Health Expectancy vs. Life Expectancy

 Life expectancy is based on the average age at which people

die, but we often want to know at what age can people live –
and be healthy?
 Health Expectancy is the number of healthy years you can
expect to have left, depends to a great extent on your level of
physical activity, nutritional intake, social support network,
access to good medical care, health education, and utilization
of health services.

Health Expectancy

 Health expectancy is more important to older adults than life

expectancy.
 The goal of Healthy People 2000 was to increase the number of
years of health after age 65 to 14. Meaning that you could
expect to live to be 79 and be healthy (few chronic or
debilitating health issues).
 However, we missed the goal of Healthy People 2000 and now
we if we make it to 65 we can expect 12.2 years of health after
that – 77.2 years old (on average).
 However, health is really based on the way we live!
 We shouldn’t look at death as being caused by heart disease,
cancer or diabetes – but by obesity, smoking or inactivity. This
is the difference between blaming the disease or the cause of
the disease.

Physical vs. Emotional Aspects of Aging

 As we age, it may be the case that good health becomes less

dependent on our physical status than on our emotional status.
