Older Americans are relatively healthy and independent, with a large proportion free of disabilities. Many older persons lead fulfilling lives and continue to make important contributions both within their families and to society in general. Achieving and maintaining health and function in advanced years can be aided by a commitment to a lifestyle that promotes fitness, proper nutrition, and avoidance of smoking and other behaviors that adversely affect health. Even if healthy habits have been neglected, research has shown that it is almost never too late to begin these habits. Better health habits not only help people survive longer, but postpone the onset of disability and compress functional loss into fewer years at the end of life.
Recent research has shown: (1) disability levels for people age 65 and older have been falling at an accelerating pace since 1982, and (2) the benefits of this trend extend both to men and women and to minority groups. This decline contributes to improved functional ability for individuals and could have important economic and social implications. The need to maintain or accelerate this decline is urgent. By the year 2030, the number of Americans over age 65 will more than double, and by 2050, the number of Americans over age 85 will increase fourfold or more, placing a significantly greater number of people at risk for disability. Extending the current level of disability decline during the next 50 years could prevent increasing the number of disabled Americans in the face of the demographic challenge posed by the baby boom and overall population aging.
Developing Initiatives
Understand Declines in Disability Rates for Older Persons
To sustain continued decreases in disability, it will be critical to identify the social, educational, public health, and biomedical variables that affect length of life and rates of disability. Recent studies have identified trends that are likely to extend the disability decline, such as:
- Increasing education levels of older people
- Improvements in health-related behaviors
- Improvements in the availability and effectiveness of assistive devices
- Improvements in the treatments of conditions that lead to disability.
Based on the explanatory factors identified, additional research will consider interventions that could enhance the disability decline. Efforts also will be made to: (1) improve projections of disease and disability rates, and (2) clarify the implications of improving health for medical care costs. Unless we can better understand the disability decline and find ways to reduce disability, we may be faced with a significant increase in the numbers of disabled elders.
Improve Strategies for Promoting Healthy Behaviors
Diet
It is generally accepted that nutrition has a direct bearing on health in elders. Healthy diets have shown the potential to lower blood pressure and blood cholesterol, and studies are underway to determine the efficacy of various diets to prevent cancer, diabetes, and other conditions in older people. General recommendations for healthy eating in young or middle age may not be optimal for older people. More research is needed to uncover the basic mechanisms that underlie changes with advancing age in nutritional requirements such as for vitamins, minerals, fats, and proteins. Special dietary concerns related to difficulties that occur during aging in digesting food and absorbing nutrients at the cellular level and adverse interactions between drugs and nutrients need to be further explored. It also is unclear what weight is ideal in old age; this question is under study. Additional research attention must be given to the role of diet in preventing the progression of existing diseases and conditions to improve health outcomes and personal function.
Smoking and Alcohol Abuse
The harmful health effects of smoking and alcohol abuse are well documented. Studies have shown that people at any age can benefit from quitting both of these habits. Research is needed to improve strategies for encouraging behavioral changes to quit smoking and use alcohol only in moderation in later years.
Safety
New studies have shown that evaluating risk factors and making alterations in home and work environments can reduce falls and their consequences. Human factors research is discovering new ways to improve safety in the home and community and remove physical barriers and obstacles. Progress also is being made to identify factors that put older drivers at risk of automobile crashes. Research will continue to: (1) identify safety risks for older persons, (2) improve screening strategies, and (3) develop information to reduce risk.
Exercise
Exercise can help to:
- Delay the onset of disabilities and life-threatening diseases
- Reduce the risk of falls and fractures
- Improve mood and relieve depression
- Increase life expectancy
- Improve mental acuity.
These benefits are accessible even to the very old. Many physically frail people 90 years and older can more than double their strength through simple exercises in a fairly short time. Nevertheless, many Americans—especially older Americans—are not engaging in regular, sufficient physical activity. NIA-supported research is expanding our understanding of the benefits of physical fitness and the factors that motivate and deter people from making exercise a part of their daily routine. Studies also will focus on relating exercise to positive health outcomes and understanding exercise physiology and other basic science aspects to maximize exercise's positive effect on older people.
Evaluate Hormone Replacement Therapy and Dietary Supplements
Counteracting the effects of aging by supplementing hormones—such as estrogen, testosterone, human growth hormone, melatonin, and dehydroepiandrosterone—is an area of active study, but there are concerns that individuals may be taking such agents before knowledge of their safety is known. Although levels of these hormones may decline, on average, as people age, maintaining the former levels may not be needed as a person grows older. Even if effective, supplementation may entail risks. For example, estrogen supplementation can be successful in combating osteoporosis and may have beneficial effects on brain function and memory. However, estrogen replacement therapy may increase the risk of stroke and breast cancer. More research is needed to: (1) determine how the biologic action of these hormones changes in older people, and (2) assess whether replacement of these hormones will improve health.
Alternative approaches also are needed to realize the benefits of estrogen, testosterone, and other hormonal therapies while minimizing risks and undesirable side effects. Two principal strategies are being pursued: (1) synthesizing related compounds that produce the beneficial responses of hormones in the body without detrimental side effects, and (2) regulating hormone production in specific body tissues where increased or decreased amounts of these hormones is favorable to health. When successful, for example, these innovative approaches will enable men and women to benefit from the properties of estrogen without its unwanted side effects.
Research also is underway on the ability of antioxidants—such as vitamins C and E—to prevent cancer, delay aging, or keep cognition intact. Antioxidants are found in common foods and act as scavengers for oxygen radicals (molecules generated when cells produce energy) that can cause long-term harm and degradation to the body. NIA research will address the special dietary and nutrient needs of elderly persons, especially nutrients capable of delaying or mitigating the degenerative diseases that often accompany aging.
Improve Elder Interaction With the Health System
Research is benefiting health outcomes by helping to improve the quality of interactions among doctors, other health care providers, patients, and families. Research to enhance care and communication will lead to:
- Improved patient self-management
- Higher levels of patient satisfaction
- Better health outcomes.
It also is important for older individuals to recognize the implications of disease-related signs and symptoms and to consult a physician or other health care provider when they first occur. This consultation is neglected in many cases. Older people also frequently fail to report symptoms to their physicians. According to one study, fewer than 40 percent of persons who experienced symptoms associated with heart and circulation or musculoskeletal systems sought a physician's care. Similarly, women often avoid seeking care for urinary incontinence. Future research will help ensure that elders will appropriately seek medical advice and assistance.
Reduce Caregiver and Family Stress and Improve Individual Coping With Chronic Disease
Families and individuals who care for people with chronic disease may routinely face emotional stress and physical and financial burdens. Investigators also are evaluating strategies to improve social support, skills training, and assistive services for caregivers and others who cope with chronic disease. Research will:(1) provide information on needs and patterns of family caregiving and on how people make decisions on providing care, (2) improve guidance on support and skills, and (3) include a focus on families with diverse backgrounds.
