Preventing Disease and Improving Quality of Life Among Older Americans

At A Glance 2004

The Dramatic Aging of America, 1900–2030

“In 2011, the first wave of America’s 76 million baby boomers will turn 65 and trigger dramatic shifts in all aspects of American life. Our vision for the future is framed by productive, active engagement and high quality of life throughout the lifespan. Key to the achievement of that vision must be a substantially enhanced focus on preventing disease, promoting health, and preserving independence and quality of life among older Americans.”

William D. Novelli
Executive Director and CEO
AARP

The Health and Economic Effects of an Aging Society

One hundred years ago, only 3 million people in this country were over the age of 65. Today, more than 33 million Americans are in this age group, and that number is expected to double over the next 30 years, as baby boomers age. The seniors of the 2030s will be even more racially and ethnically diverse than today’s seniors.

The aging of America will trigger a huge demand for health care and social services. Health care expenditures for a 65-year-old are now four times those for a 40-year-old. Because the population will be older and greater in number, overall U.S. health care expenditures are projected to increase 25% by 2030.

Selected Chronic Conditions Affecting U.S. Adults 70 and Older

Currently, at least 80% of seniors have at least one chronic condition, and 50% have at least two. These conditions can cause years of pain, disability, and loss of function. About 12 million seniors living at home report that chronic conditions limit their activities. Three million older adults say they cannot perform basic activities of daily living, such as bathing, shopping, dressing, or eating. Their quality of life suffers as a result, and demands on family and caregivers can be challenging.

Preventing health problems is one of the few known ways to stem rising health care costs. By preventing disease and injury, we also can help seniors remain independent for as long as possible, which can improve their quality of life and delay the need for costly long-term care. A recent trend is encouraging: in the last 2 decades, rates of nursing home use have declined.

Opportunities To Improve Older Americans’ Health and Quality of Life

Poor health and loss of independence are not inevitable consequences of aging. The following strategies have proven effective in promoting the health of older adults:

• Healthy lifestyles. Research has shown that healthy lifestyles are more influential than genetic factors in helping older people avoid the deterioration traditionally associated with aging. People who are physically active, eat a healthy diet, do not use tobacco, and practice other healthy behaviors reduce their risk for chronic diseases and have half the rate of disability of those who do not.

• Early detection of diseases. Screening to detect chronic diseases early in their course, when they are most treatable, can save many lives; however, many older adults have not had recommended screenings. For example, 60% of Americans over age 65 have not had a sigmoidoscopy or colonoscopy in the previous 5 years to screen for colorectal cancer, even though Medicare covers the cost.

• Immunizations. More than 40,000 people aged 65 or older die each year of influenza and invasive pneumoccocal disease. Immunizations reduce a person’s risk for hospitalization and death from these diseases. Yet in 2002, 32% of Americans age 65 or older had not had a recent flu shot, and 37% had never received a pneumonia vaccine.

• Injury prevention. Falls are the most common cause of injuries to older adults. More than one-third of adults aged 65 or older fall each year, and of those who fall, 20%–30% suffer moderate to severe injuries that decrease mobility and independence. Removing tripping hazards in the home and installing grab bars are simple measures that can greatly reduce older Americans’ risk for falls and fractures.

• Self-management techniques. Programs to teach older Americans self-management techniques can reduce both the pain and costs of chronic disease. For example, the Arthritis Self-Help Course, disseminated by the Arthritis Foundation, has been shown to reduce arthritis pain by 20% and visits to physicians by 40%. Unfortunately, less than 1% of Americans with arthritis participate in such programs, and courses are not available in many areas.

CDC’s Roles in Promoting Healthy Aging

CDC promotes the health of older Americans in at least five ways:

1. Providing high-quality health information and resources to public health professionals, consumers, health care providers, and aging experts. CDC provides reliable, science-based, high-quality information on the health of seniors for policy makers, health and aging organizations, the media, and consumers. CDC disseminates this information through such avenues as publications, conferences, training sessions, and Web sites/listservs. CDC provides timely, practical information to health and aging professionals as well as the public. Working with the American Society on Aging, CDC engages journalists across the country on relevant issues such as disabilities, West Nile virus, and healthy lifestyles.



2. Supporting health care providers and organizations in their prevention efforts. Medicare pays for many preventive services, yet fewer than 1 in 10 adults age 65 or older has received all recommended screenings and immunizations. In a few areas of the country, programs are trying creative approaches to help health care providers reach more seniors.

   One such program is the Sickness Prevention Achieved through Regional Collaboration (SPARC) project. Partially funded by CDC, this program operates in selected counties of New York, Connecticut, and Massachusetts. In two counties, SPARC doubled the annual rate of pneumococcal shots during a single flu season and developed a model method for redistributing the flu vaccine in seasons when the supply is short, thus ensuring broader access for populations at risk.

   SPARC provides no direct services; rather, it coordinates and strengthens the efforts of local health care providers and organizations. CDC hopes to extend the reach of successful programs such as SPARC to benefit seniors nationwide.

Selected CDC-Supported Healthy Aging Programs

3. Integrating public health prevention expertise with the Administration on Aging’s (AOA) aging services network. As described in the Older Americans Act, CDC has an advisory role to the aging services network, which reaches seniors in virtually every U.S. community where they live and congregate. To take full advantage of opportunities to improve the health of older adults, CDC strives to integrate public health’s expertise in research, health tracking, and programs with the experience and reach of the aging services network. For instance, CDC and the AOA worked together on the Aging States Project, which identified aging issues important to state units on aging and state health departments. The project staff found that all states could benefit from additional resources and more opportunities to collaborate. In response, CDC and AOA funded mini grants to 10 states in fiscal year 2003 and 14 states in fiscal year 2004 that facilitate collaboration between the aging units and health departments on health promotion activities for older adults.
    
4. Identifying and putting into practice what works in prevention. Research shows that if seniors maintain just three healthy habits—moderate physical activity, good nutrition, and no smoking—they can delay disability by as much as 10 years. The benefits of such research, however, will never be realized unless this knowledge is applied to programs in communities. CDC funds many programs that are helping communities reap the benefits of prevention research. For example, seven of CDC’s Prevention Research Centers formed a Healthy Aging Research Network, which is evaluating physical activity programs for older adults to identify which programs are the most effective. 
    
5. Monitoring changes in the health of older Americans. CDC is the lead national agency responsible for collecting data and monitoring changes over time in the health of older Americans. This information helps strengthen efforts to prevent disease, disability, and injury. These data are also needed to identify health-related disparities among different groups of older adults and to create culturally appropriate, targeted interventions. With support from the National Institute on Aging, CDC’s National Center for Health Statistics has created the Data Warehouse on Trends in Health and Aging on the Internet. Other databases, such as the Behavioral Risk Factor Surveillance System (BRFSS) and the Web-based Injury Statistics Query and Reporting System (WISQARS), also provide useful information on health trends among older Americans.

Future Directions 

Future Directions The first wave of baby boomers, those born in 1946, will reach age 65 in 2011. As the United States faces the challenge of responding to the health and social service needs of so many older Americans, CDC will work to ensure that

• Added years are quality years. CDC’s goal is for older people to maintain their independence, good health, and engagement in life for as long as possible.

• Current myths about aging are dispelled. The public must understand that getting older does not have to mean inevitable decline and deterioration. People of any age can improve their health if they adopt a healthy lifestyle.

• Aging issues are seen as public health issues, and the value of prevention is realized. An enhanced focus on prevention is critical to helping seniors preserve their independence and reduce their long-term care needs. Prevention is also the most effective way to stem escalating health care costs.

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