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The Promotion of Health and Wellness for Optimal Aging
Thursday, February 21, 2008
(Charlene Quinn, RN, PhD) --
Welcome to the Horizon Foundation web column,
Health and Aging: Research to Community and
Practice. This series presents research
findings which will assist those in the
community—nurses, physicians, social workers,
families, older adults themselves—to redefine
our perceptions of aging and
health.
This column focuses on
promotion of health and wellness for optimal
aging. Numerous studies identify five key
traits that characterize optimal aging: free of
disease, satisfaction with life and resilience,
disability-free, active life engagement and
independent functioning (including physical
and/or cognitive functioning).1
Clearly, genetics, environment and lifestyle
behavior all influence how successful we
are in achieving optimal aging. Our challenge
is to encourage our communities and
stakeholders to establish goals and resources
to support it.
Disease Free
At least 12 major aging related diseases and conditions are preventable through screening, early detection, diet, exercise, weight loss, and medications. These include cardiovascular heart disease, stroke, hypertension, diabetes, osteoporotic fractures, pneumonia, depression and falls. The health media constantly reminds us to 1. maintain healthy weight, 2. eat a diet of five or more fruits and vegetables each day, 3. be physically active at least 30 minutes daily five days a week and 4. not smoke. Only three percent of the population, however, engage in all four of these healthy behaviors. While genetics plays a role in the development of age related disease, science-based guidelines have been developed to manage the symptoms and progression of such disease. For example, health care provider guidelines for diabetes are available and have recently been developed for an older population (see the American Geriatrics Society and the Joslin Diabetes Center 2, 3).
Satisfaction with
Life and Resilience
Recent studies are examining
how older adults can avoid loss of well-being
and/or depression especially following changes
in health status or loss of function. A large
five year study found that middle and older age
persons participating continuously
in voluntary groups moderated the effects of
physical decline. Other studies of resilience
among older adults suggest five contributing
factors: equanimity, meaningfulness,
perseverance, self-reliance and
acceptance.
Disability
Free
Disabling conditions
affecting older adults can be reversed.
Conditions such as incontinence, anemia, muscle
strength, and osteoporosis, are treatable
through education programs, physical activity
and medications.
Independent
Functioning and Active Life
Engagement
Physical and
cognitive functioning are essential elements of
successful aging. Older persons often express
concern about declining physical and cognitive
abilities. Declines or severe changes in
function lead to loss of independence and
living status. Recent research
demonstrates that exercise and ongoing
mental stimulation may prevent mental
decline. A large national study of
nurses, 70 and older, showed that those who
exercised regularly by walking at a leisurely
pace for 90 minutes per week had a lower risk
of cognitive impairment than those who were
inactive. Several large studies have shown that
older persons who regularly engage in
intellectually stimulating activities -
including social activities requiring mental
effort - are less likely to develop Alzheimer's
than those who do so less frequently.
Translation to the
Community
The Center for
Healthy Aging (Center), University of
Pittsburgh, translates the scientific evidence
for the five areas of optimal aging to 10 Keys
to Healthy Aging. Based on evidence-based
practice guidelines, the 10 Keys are: Control
blood pressure (SBP<140), regulate blood
glucose (<100), lower lipids (LDL <
100),stop smoking, be active, participate in
cancer screenings (breast cervical, prostate,
colon), get regular immunizations, prevent bone
loss and muscle weakness, combat depression,
and maintain social contact. Using the 10
Keys, the Center has worked with older adults
in senior high rise apartments and employers to
identify what is needed to achieve healthy
aging. Individuals use a set of questions for
health and service providers designed
around each of the 10 Keys. The questions
include requests for feedback if the individual
is not achieving a health goal, i.e. systolic
blood pressure less than 140. The senior high
rise participants recommended onsite
clinical labs for blood work, exercise
equipment, cooking classes for diabetes or food
for one, and local food banks with fresh fruits
and vegetables to help them achieve conformance
with the Keys.Evaluators have identified other programs effective in encouraging physical activity by older adults. Axia Health offers an exercise program called SilverSneakers, to more than 2.4 million older adults nationally. "Experience Corps," is a Johns Hopkins initiative matching older volunteer tutors and mentors with schoolchildren in troubled urban schools. The program reports that its volunteers showed improvement in cognitive and physical well being, social involvement, a decline in the frequency of falls, and a 50% decrease in use of walking canes.
In light of the great promise research in healthy aging and function holds for older adults, we need to find ways to bring vital aging and cognitive longevity to our communities.
1 Steven M. Albert, PhD. "Public Health Goals for the Second Fifty Years". Presentation to the University of Maryland Baltimore, December 14, 2007.
2 Brown, AF. Guidelines for improving the care of older person with diabetes mellitus, J Am Geriatr Soc 51 (5 Suppl Guidelines): S265-80, 2003.
80, 2003.
3 http://www.joslin.org/Files/Guideline_For_Care_Of_Older_Adults_with_Diabetes.pdf