Primary prevention of disease of old age

Disability Among Older Adults in South-Eastern Nigeria

Disability is a common reason for the loss of independence. There is a dearth of data on older adults with disability in south-eastern Nigeria. Using a multistage sampling technique and disability indexes, we assessed 816 persons aged 65 years and above living with a disability. While respondents' experiences of abuse and property inheritance differ by gender, they have poor health status. Elevated risks of disability were associated with gender, increased age, education, smoking, alcohol use, and engagement in physical exercise. Findings suggest urgency in formulating and implementing ageing welfare policy in this African community undergoing demographic and social changes. While this is underway, we recommend a massive health promotion among older adults in this community. We also suggest the integration of courses on ageing in schools' curriculum since ageing is a life course phenomenon. This in the long run would provide ageing-friendly education that averts old age's deleterious effects.

Public health options for improving cardiovascular health among older Americans

Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices.

The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients

OBJECTIVES

To test the predictive properties of the Vulnerable Elders-13 Survey (VES-13) a short tool that predicts functional decline and mortality over a 1- to 2-year follow-up interval over a 5-year interval.

DESIGN

Longitudinal evaluation with mean follow-up of 4.5 years.

SETTING

Two managed-care organizations.

PARTICIPANTS

Six hundred forty-nine community-dwelling older adults (> or = 75) enrolled in the Assessing Care of Vulnerable Elders observational study who screened positive for symptoms of falls or fear of falling, bothersome urinary incontinence, or memory problems.

MEASUREMENTS

VES-13 score (range 1-10, higher score indicates worse prognosis), functional decline (decline in count of 5 activities of daily living or nursing home entry), and deaths.

RESULTS

Higher VES-13 scores were associated with greater predicted probability of death and decline in older patients over a mean observation period of 4.5 years. For each additional VES-13 point, the odds of the combined outcome of functional decline or death was 1.37 (95% confidence interval (CI)=1.25-1.50), and the area under the receiver operating curve was 0.75 (95% CI=0.71-0.80). In the Cox proportional hazards model predicting time to death, the hazard ratio was 1.23 (95% CI=1.19-1.27) per additional VES-13 point.

CONCLUSION

This study extends the utility of the VES-13 to clinical decisions that require longer-term prognostic estimates of functional status and survival.

[Preventing dependency in the elderly.]

INTRODUCTION

dependency, i.e. the need to depend on another person to perform activities of daily living, is the main concern and cause of suffering and poor quality of life in the elderly. The prevalence of dependency increases with age and is related to the presence of prior disease and fragility. Dependency is associated with increased morbidity, mortality and institutionalization, as well as with greater health and social resource utilization, all of which increases health costs.

OBJECTIVE

to create a consensus document on the main health recommendations for the prevention of dependency in the elderly, based on the scientific evidence available to date, with the collaboration of scientific societies and public health administrations (the Spanish Ministry of Health, Autonomous Communities and Cities).

METHODS

a) a preliminary consensus document was drafted by an expert group composed of representatives of various scientific societies and health administrations. This document was based on a review of the recommendations and guidelines published by the main organizations involved in health promotion and the prevention of disease, functional deterioration and dependency in the elderly; b) the consensus document was reviewed by the remaining experts assigned by the scientific societies and central and autonomous administrations; c) the final document was approved after a session in which the text was discussed and reviewed by all the experts participating in the working group (including the academic committee); d) the document was presented and discussed in the First National Conference on Prevention and Health Promotion in Clinical Practice in Spain. All participating experts signed a conflicts of interest statement.

RESULTS

the document provides recommendations, with their grades of evidence, grouped in the following three categories: a) health promotion and disease prevention, with specific preventive activities for the elderly, including prevention of geriatric syndromes; b) prevention of functional deterioration, with clinical recommendations that can be applied in primary and specialized care; c) prevention of iatrogeny (drug prescription, inappropriate use of diagnostic and therapeutic modalities and healthcare). These recommendations were tailored to the characteristics of the older person (OP), categorized in five groups: healthy OP, OP with chronic disease, fragile or at risk OP, dependent OP, and OP at the end of life.

CONCLUSION

these recommendations should be implemented by public health administrations to improve strategies for the prevention of dependency in the elderly in the XXI century.

New approach to gerontology: building up "successful aging" conditions

BACKGROUND AND AIMS

Great efforts have been made in developed societies to extend human life expectancy as much as possible. Continuing investments into extending the life-span into the "fourth age" actually reduce the opportunities of people to age successfully and die in dignity. Consequently, in recent years, the concept of "Successful Aging" (SA) has gained increased attention: investigators recognize the importance of separating pathologic changes from those which may be attributed to aging in itself, in order to interpret correctly the differences between Pathologic Aging, Normal Aging, and Successful Aging. Hence, according to recent literature on aging, our aim was to question here the validity of recommendations made in the literature for policy making in the treatment of aging and suggest new alternatives.

METHODS

We have tried to understand and develop a method of analysis to the following question: what do we actually mean by SA? Successful Aging may be seen as an arbitrary, subjective term, so we studied which indicators characterize elderly persons as successful aged.

RESULTS

The results of this study show that older people's views of SA appear to be multidimensional and more complex than the apparent viewpoint of many of early studies, which tended to focus on a single dimension of health - psychological or mental.

CONCLUSIONS

We argue the proper use of various health indicators and health enhancers, as proposed in the current international literature, in the definition of SA.

Dietary approaches that delay age-related diseases

Reducing food intake in lower animals such as the rat decreases body weight, retards many aging processes, delays the onset of most diseases of old age, and prolongs life. A number of clinical trials of food restriction in healthy adult human subjects running over 2-15 years show significant reductions in body weight, blood cholesterol, blood glucose, and blood pressure, which are risk factors for the development of cardiovascular disease and diabetes. Lifestyle interventions that lower energy balance by reducing body weight such as physical exercise can also delay the development of diabetes and cardiovascular disease. In general, clinical trials are suggesting that diets high in calories or fat along with overweight are associated with increased risk for cardiovascular disease, type 2 diabetes, some cancers, and dementia. There is a growing literature indicating that specific dietary constituents are able to influence the development of age-related diseases, including certain fats (trans fatty acids, saturated, and polyunsaturated fats) and cholesterol for cardiovascular disease, glycemic index and fiber for diabetes, fruits and vegetables for cardiovascular disease, and calcium and vitamin D for osteoporosis and bone fracture. In addition, there are dietary compounds from different functional foods, herbs, and neutraceuticals such as ginseng, nuts, grains, and polyphenols that may affect the development of age-related diseases. Long-term prospective clinical trials will be needed to confirm these diet-disease relationships. On the basis of current research, the best diet to delay age-related disease onset is one low in calories and saturated fat and high in wholegrain cereals, legumes, fruits and vegetables, and which maintains a lean body weight. Such a diet should become a key component of healthy aging, delaying age-related diseases and perhaps intervening in the aging process itself. Furthermore, there are studies suggesting that nutrition in childhood and even in the fetus may influence the later development of aging diseases and lifespan.

Health promotion for mid- and later-life women

Health outcomes in later life are dependent in part on activities started in midlife. Primary and secondary prevention strategies include seeking healthier life choices, early detection of disease, and specific disease avoidance through immunization and other activities. The recommendations for various screenings and health care for postmenopausal women have changed rapidly over the past 2 years but still include the basics of nutrition, exercise, testing for common illnesses, and control of existing health problems.

Economic implications of increased longevity in the United States

The elderly population in America is growing in size owing to declining death rates, increasing life expectancy, and the aging of the baby boomers. Although the prevalence of chronic illness and disability increases with age, successful aging in the elderly population is widespread, and the elderly are generally healthy. Indeed, the prevalence of disability among the elderly is declining, and expenditures for their care are increasingly concentrated at the end of life rather than during extra years of relatively healthy life. Nevertheless, health care costs will undoubtedly increase during the next 30 years as a result of the baby boomers entering late life. The economic and social impact of future growing health care expenditures for the elderly will be significant. Important policy issues will include the continued viability of the Medicare and Social Security programs, future needs for long-term care, improvement of the health status of the elderly, technological advances, the need for a geriatric work force, and development of viable strategies to pay for escalating medical care costs.