Health Promotion and Disease Prevention
By now you’re probably wondering how to promote successful aging. You may not be surprised to learn that there is no set of steps or magic potion you can take to guarantee that you will age optimally. But research is showing that there are some steps you can take to maximize your chances (Guralnik,
Preventive Strategies for Maximizing
Adopt a healthy lifestyle. Make it part of your daily routine.
Stay active cognitively. Keep an optimistic outlook and maintain your interest in things.
Maintain a social network and stay engaged with others.
Maintain good economic habits to avoid financial dependency.
2008). As you can see in Table 14.1, most of them are not complex. But they do capture the results of applying the model for maintaining and enhancing competence we examined at the beginning of the section. The key strategies are sound health habits; good habits of thought, including an optimistic outlook and interest in things; a social network; and sound economic habits.
These simple steps are difficult in practice, of course. Nevertheless, they will help maximize the chances of aging successfully. Setting up this favorable outcome is important. Because of the demographic shifts in the population, health care costs for older adults in most developed countries are expected to skyrocket during the first half of the 21st century. Minimizing this increase is key.
To support these changes, the U. S. Department of Health and Human Services created a national initiative to improve the health of all Americans through a coordinated and comprehensive emphasis on prevention. Updated every 10 years, the current version of this effort, the Healthy People initiative, sets targets for a healthier population based on three broad goals: increase the length of healthy life, reduce health disparities among Americans, and achieve access to preventive services for all. (You can find the latest version of the initiative at http://www. healthypeople. gov.)
Although significant gains have been made in earlier versions of the initiative, they were not universal. Many members of ethnic minority groups and the poor still have not seen significant improvements in their lives. With this in mind, there has been a shift from a focus that included only prevention to one that also includes optimum health practices.
The U. S. government allocates funds appropriated by the Older Americans Act through the Administration on Aging (AoA) to help support programs specifically aimed at improving the health of older adults. These funds support a wide variety of programs, including health risk assessments and screenings, nutrition screening and education, physical fitness, health promotion programs on chronic disabling conditions, home injury control services, counseling regarding social services, and follow-up health services.
One goal of these low-cost programs is to address the lack of awareness many people have about their own chronic health problems; for example, the AoA estimates that half of those with diabetes mellitus, more than half with hypertension, and 70% of those with high cholesterol levels are unaware that they have serious conditions. Health promotion and disease prevention programs such as those sponsored by the AoA could reduce the cost of treating the diseases through earlier diagnosis and better prevention education.
Issues in Prevention. In Chapter 4, we saw that Verb – rugge and Jette’s (1994) theoretical model offers a comprehensive account of disability resulting from chronic conditions and provides much guidance for research. Another benefit of the model is that it also provides insight into ways to intervene so that disability can be prevented or its progress slowed. Prevention efforts can be implemented in many ways, from providing flu vaccines to providing transportation to cultural events so that otherwise homebound people can enjoy these activities.
Traditionally, three types of prevention have been discussed: primary, secondary, and tertiary; more recently, the concept of quaternary prevention has
been added (Verbrugge, 1994). A brief summary is presented in Table 14.2. Primary prevention is any intervention that prevents a disease or condition from occurring. Examples of primary prevention include immunizing against illnesses such as polio and influenza or controlling risk factors such as serum cholesterol levels and cigarette smoking in healthy people.
Secondary prevention is instituted early after a condition has begun (but may not yet have been diagnosed) and before significant impairments have occurred. Examples of secondary intervention include cancer and cardiovascular disease screening and routine medical testing for other conditions. These steps help reduce the severity of the condition and may even reduce mortality from it. In terms of the main pathway in Verbrugge and Jette’s (1994) model, secondary prevention occurs between pathology and impairments.
Tertiary prevention involves efforts to avoid the development of complications or secondary chronic conditions, manage the pain associated with the primary chronic condition, and sustain life through medical intervention. Some chronic conditions have a high risk of creating additional medical problems; for example, being bedridden as a result of a chronic
disease often is associated with getting pneumonia. Tertiary prevention involves taking steps such as sitting the person up in bed to lower the risk of contracting additional diseases. In terms of the model, tertiary interventions are aimed at minimizing functional limitations and disability.
Historically, tertiary prevention efforts have not focused on functioning but rather on avoiding additional medical problems and sustaining life (Verbrugge, 1994). Consequently, the notion of quaternary prevention has been developed to address functional issues. Quaternary prevention is efforts specifically aimed at improving the functional capacities of people who have chronic conditions. Like tertiary prevention, quaternary prevention focuses on the functional limitations and disability components of the model. Some examples of quaternary prevention are cognitive interventions to help people with Alzheimer’s disease remember things and occupational therapy to help people maintain their independence.
Although most efforts with older adults to date have focused on primary prevention, increasing attention is being paid to secondary prevention through screening for early diagnosis of diseases such as cancer and cardiovascular disease (see Chapters 2 and 3). Few systematic studies of the benefits and outcomes of tertiary and quaternary prevention efforts have been done with older adult participants. However, the number of such programs being conducted in local senior centers and other settings attractive to older adults is increasing steadily, with the focus of many of them on nutrition and exercise (Coulston & Boushey, 2008). The stakes are high. Because tertiary and quaternary prevention programs are aimed at maintaining functional abilities and minimizing disability, they can be effective, lower-cost alternatives for addressing the needs of older adults with chronic conditions. They can also address concerns about quality of life (Michel et al., 2008).