Chapter 8
Aging and Health of Older Populations

OBJECTIVES AND PHILOSOPHY

Older people represent a growing proportion of the population of most communities as a result of reduced death rates at younger ages and increased longevity. with growing numbers and proportions, planning and a more important segment of the life span for community and population health planning and a more important political force demanding facilities, services and other health resources. Increasing proportions of the elderly also live in communities without disabling illness, so the planning for their health needs can be addressed more to the health promotion than in the past when most of the attention to the elderly had to be on medical care and nursing care. This chapter attempts to shift the student's focus from viewing old age as a pitiable state and an unhappy phase of life to viewing it as a period when specific community interventions and supports can achieve the prolongation of good health, independent functioning, and enhance quality of life.

OVERVIEW

This chapter concludes Part II of the text, Health Through the Life Span. It reflects the cumulative harvest of successes and failures from previous decades' community health programs for younger ages. The heavy smoking increases of the 1940s, for example, are reflected in the increased lung cancer rates found today in the elderly. The improved smoking, dietary, and blood pressure control statistics of the  middle-age population in the 1970s are showing up as reduced cardiovascular disease and coronary death rates in the elderly. But a new epidemic of obesity is producing increased rates of diabetes and a leveling of the improvements in cardiovascular diseases.

These demographic and epidemiological trends combine with the social and economic forces of recent decades to set the stage for community health approaches for the elderly now. A particular emphasis of this chapter is on the involvement of the elderly in setting their own priorities and in designing their own programs for health promotion. Nowhere is the paternalistic tendency of government and voluntary agency programs more likely to undermine the very purpose of health promotion--to enable people to control the factors influencing their health--than with the elderly. They need to define their own quality-of-life concerns and the want to retain the dignity of caring for themselves as long as possible.

WHO Launches Project to Support Africa's Elderly  SENEGAL. (Panafrican News Agency - May 26, 1999) The team leader of WHO's program on "Aging and Health" (AHE), Dr. Alexandre Kalache, said the project  will, among other things, involve the collection and analysis of relevant data from Ghana, Tanzania, South Africa and Nigeria.

Panel Stumped On Medicare Overhaul. WASHINGTON (AP, Mar. 10, 1999)  Is restructuring Medicare  enough, or will more money be needed to provide adequate health care for growing numbers of elderly Americans? A commission that is supposed to recommend Medicare changes has so far been unable to resolve that question and other serious differences delaying its report to Congress and President Clinton. "We are not in agreement yet and it remains quite doubtful that we will be," said commission member Stuart Altman, a health policy professor at Brandeis University in Waltham, Mass. Both Republican congressional leaders and the president have said they'd prefer not to resort to tax increases to bolster Medicare. But Clinton has suggested using federal budget surpluses that are expected in coming years.

Aging Initiative of the Bureau of Primary Health Care, Health Resources and Services Administration

http://bphc.hrsa.gov/Aging/

American Association of Retired Persons (AARP)   http://www.aarp.org

Arthritis Foundation   http://www.arthritis.org

WHO/OMS Aging and Health web site   http://www.who.int/hpr/ageing/index.htm

Administration on Aging   http://www.aoa.gov

Living options for seniors                                         

Boyle JP, Honeycutt AA, Narayan KMV, et al. (2001). Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the US. Diabetes Care 2001;24:1936--40.

Connell, C. M. (1999). Older adults In health education research: some recommendations. Health Education Research 14(3): 427-31.

Liao, Y. L., McGee, D. L., Cao, G. C., Cooper, R. S. (1999). Black-White differences In disability And morbidity In the last years of life. American Journal of Epidemiology 149 (12): 1097-1103.

Moyer, A., Coristine, M., MacLean, L., & Meyer, M. (1999). A Model For Building Collective Capacity In Community-Based Programs: The Elderly In Need Project. Public Health Nursing 16 (3): 205-214.
    ABSTRACT: As the focus of health promotion moves from individuals to organizations, communities and broader social policy, the models that guide public health program planning and development need reexamination. Public health nurses are gaining experience in strengthening and supporting the ability of communities to grow and change. This study aimed to illuminate the process. Data, gathered as part of an action research project to develop individual and community-based strategies to decrease isolation in frail older adults, provided a rich source of qualitative data. Analysis was directed toward identifying the factors and processes of capacity-building. The emerging model was clarified and partially validated with academics and practitioners from health promotion programs across the age span. Four stages of building collective capacity were identified: identifying common ground, working cooperatively, working in partnership, and working across the community. At each stage, processes of relationship building, project management and capacity-building resulted in stage specific products. A model of building collective capacity, grounded in community health practice and supported by the Literature provides a base for developing practice indicators, and practice guidelines which will strengthen the ability to reach health goals.  See also: J Clin Nurs. 1999 Jan;8(1):103-11.

Ryan, A. A. (1999). Medication compliance and older people: a review of the literature.  International Journal of Nursing Studies  36 (2): 153-162.

Sloan, F. A., Taylor, D. H. Jr, & Picone, G. (1999). Costs And outcomes of hip fracture and stroke, 1984 to 1994. American Journal of Public Health  89 (6): 935-937.