Improving health for elderly people: an international health promotion and disease prevention agenda
First Online: 25 July 2013 Received: 01 March 2010 Accepted: 06 May 2010 DOI:
Cite this article as: Besdine, R.W. & Wetle, T.F. Aging Clin Exp Res (2010) 22: 219. doi:10.1007/BF03324800 Abstract
Across the world, there are substantial but missed opportunities for promoting health of older persons and extending the health life span. Current approaches to health care rely on late detection and treatment of disease, and some of the most expensive systems of care have population health outcomes that are poor to mediocre. A majority of deaths and disability result from progression of preventable chronic diseases for which human behaviors are major contributing factors. An organized and aggressive agenda in health promotion and disease prevention emerges as an important part of the strategy to both promote health and control costs. After reviewing data on determinants of health and contribution of behavioral factors to morbidity and mortality, this paper presents the evidence for efficacy and effectiveness of specific behavioral and clinical interventions to reduce risk for many of the problems accounting for death and disability among elders. We address tobacco use, lack of exercise, inadequate nutrition, hypertension, delirium, obesity, falls, cancer screening, poor oral health, osteoporosis, immunizations and medication safety. Strategies for implementation of effective interventions present an international challenge.
Keywords Disease prevention health promotion healthy life expectancy References
World Health Report 2004: Changing History. Geneva, World Health Organization, 2004.
Schroeder S. We can do better — Improving the health of the American people. N Engl J Med 2007; 357: 1221–8 (Table 1).
McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affairs (Millwood) 2002; 21: 78–93.
The Health Benefits of Smoking Cessation. Washington, DC: Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 1990. DHHS publication CDC 90-8416.
Parsons A, Daley A, Begh R et al. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ 2010; 340:b5569.doi:10.1136/bm].b5569
Barnoya J, Glantz SA. Cardiovascular effects of secondhand smoke: nearly as large as smoking. Circulation 2005; 111: 2684–98.
Fiatarone MA, O’Neill EF, Ryan ND et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–75.
Singh MA. Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci 2002; 57: M262–82.
U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote physical activity: recommendation and rationale. Ann Intern Med 2002; 137: 205–7.
Nelson ME, Layne JE, Bernstein MJ et al. The effects of multidimensional home-based exercise on functional performance in elderly people. J Gerontol A Biol Sci Med Sc 2004; 59: 154–60.
Paffenbarger RS Jr, Hyde RT, Wing AL, Lee IM, Jung D, Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328: 538–45.
Fielding RA, LeBrasseur NK, Cuoco A, Bean J, Mizer K, Fiatarone Singh MA. High-velocity resistance training increases skeletal muscle peak power in older women. J Am Geriatr Soc 2002; 50: 655–62.
Foster C, Hillsdon M, Thorogood M. Interventions for promoting physical activity. Cochrane Database Syst Rev 2005, Issue 1. Art. No.: CD003180. DOI: 10.1002/14651858.CD003180.pub2.
Knoops KT, de Groot LC, Kromhout D et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004; 292: 1433–9.
Ammerman A, Pignone M, Fernandez L et al. Counseling to promote a healthy diet. Systematic Evidence Review No. 18. Rockville, MD: Agency for Healthcare Research and Quality. Available on the AHRQ website:
/clinic/serfiles.htm, January 1, 2003. (Prepared by Research Triangle Institute-University of North Carolina Evidence-Based Practice Center under Contract No. 290-97-011).
Maskarinec G, Chan CL, Meng L, Franke AA, Cooney RV. Exploring the feasibility and effects of a high-fruit and -vegetable diet in healthy women. Cancer Epidemiol Biomarkers Prev 1999; 8: 919–24.
Baldwin C, Weekes CE. Dietary advice for illness-related malnutrition in adults. Cochrane Database Syst Rev 2008, Issue 2. Art. No.: CD002008. DOI: 10.1002/14651858.CD002008.pub3.
Psaty BM, Lumley T, Furberg CD et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: A network meta-analysis. JAMA 2003; 289: 2534–44.
Amery A, Birkenhager W, Brixko P et al. Mortality and morbidity from the European Working Party on High Blood Pressure in the Elderly trial. Lancet 1985; 1: 1349–54.
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–64.
Kostis JB, Davis BR, Cutler J et al. Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1997; 278: 212–6.
Beckett NS, Peters R, Fletcher AE et al, for the HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–98.
Kostis JB. Treating hypertension in the very old. N Engl J Med 2008; 358: 1958–60.
Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry 2004; 12: 7–21
Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med 1998; 13: 234–42.
PubMedCentral PubMed CrossRef
Levkoff SE, Evans DA, Litpzin B et al. Delirium: the occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992; 152: 334–40.
Administration on Aging. A profile of older Americans. Washington, DC: Department of Health and Human Services, 2000.
Inouye S. Delirium in older persons. N Engl J Med 2006; 354: 1157–65.
Inouye SK, Bogardus ST Jr, Charpentier PA et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340: 669–76.
Francis J, Kapoor WN. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc 1992; 40: 601–6.
Murray AM, Levkoff SE, Wetle TT et al. Acute delirium and functional decline in the hospitalized elderly patient. J Gerontol 1993; 48: M181–6.
O’Keeffe S, Lavan J. The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 1997; 45: 174–8.
Department of Health and Human Services. 2004 CMS statistics. Washington, DC: Centers for Medicare and Medicaid Services, 2004. (CMS publication no. 03445.)
Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999; 106: 565–73.
Heiat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 2001; 161: 1194–203.
Arterburn DE, Crane PK, Sullivan SD. The coming epidemic of obesity in elderly Americans. J Am Geriatr Soc 2004; 52: 1907–12.
Rossner S. Obesity in the elderly — a future matter of concern? Obes Rev 2001; 2: 183–8.
Mokdad AH, Bowman BA, Ford ES et al. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001; 286: 1195–200.
Regal KM, Carroll MD, Ogden CL et al. Prevalence and trends in obesity among U.S. adults, 1999–2000. JAMA 2002; 288: 1723–7.
Muller DC, Elahi D, Tobin JD et al. The effect of age on insulin resistance and secretion: A review. Semin Nephrol 1996; 16: 289–98.
Fine JT, Colditz GA, Coakley EH et al. A prospective study of weight change and health-related quality of life in women. JAMA 1999; 282: 2136–42.
Must A, Spadano J, Coakley EH et al. The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523–9.
Jensen GL, Friedmann JM. Obesity is associated with functional decline in community-dwelling rural older persons. J Am Geriatr Soc 2002; 50: 918–23.
Zamboni M, Mazzali G, Zoico E et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 2005; 29: 1011–29.
Zamboni M, Mazzali G, Fantin F et al. Sarcopenic obesity: A new category of obesity in the elderly. Nutr Metab Cardiovasc Dis 2008; 18: 388–95.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–7.
Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA 1989; 261: 2663–8.
Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol 1991; 46: M164–70.
Sattin RW. Falls among older persons: a public health perspective. Annu Rev Public Health 1992; 13: 489–508.
Tinetti ME, Doucette J, Claus E, Marottoli RA. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995; 43: 1214–21.
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis. I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–9.
Tinetti ME, Baker DI, McAvay G et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 821–7.
Tinetti M. Preventing falls in elderly persons. N Engl J Med 2003; 348: 42–9.
Tinetti ME, Baker DI, King M et al. Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 2008; 359: 252–61.
PubMedCentral PubMed CrossRef
Oliver D, Connelly JB, Victor CR et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 2007; 334: 82.
Schenck AP, Peacock SC, Klabunde CN et al. Trends in Colorectal Cancer Test Use in the Medicare Population, 1998–2005. Am J Prev Med 2009; 37: 1–7
Quarini C, Gosney M. Review of the evidence for a colorectal cancer screening programme in elderly people. Age Ageing 2009; 38: 503–8.
Yabroff KR, Warren JL, Schrag D et al. Comparison of approaches for estimating incidence costs of care for colorectal cancer patients. Med Care 2009; 47 (7 suppl 1): S56–63.
Hao Y, Jemal A, Zhang X, Ward EM. Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States). Cancer Causes Control 2009 Jun 19. [Epub ahead of print]
Devon KM, Vergara-Fernandez O, Victor JC, McLeod RS. Colorectal cancer surgery in elderly patients: presentation, treatment, and outcomes. Dis Colon Rectum 2009; 52: 1272–7.
McCarthy D, Leatherman S. Percentage of community-dwelling adults ages 50 and older who ever received a sigmoidoscopy or colonoscopy. Performance Snapshots 2006;
National Cancer Institute. Surveillance, Epidemiology, and End Results. (SEER) Program Public-Use Data (1973–1998). Bethesda, MD: National Cancer Institute; 2002.
Silverberg E, Boring CC, Squires TS. Cancer statistics, 1990. CA Cancer J Clin 1990; 40: 9–26.
Kerlikowske K, Salzmann P, Phillips KA, Cauley JA, Cummings SR. Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness. JAMA 1999; 282: 2156–63.
Humphrey LL, Helfand M, Chan BK et al. Breast cancer screening: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002; 137: 347–60.
U.S. Cancer Statistics Working Group. United States cancer statistics: 1999–2002 incidence and mortality web-based report version. Atlanta: Centers for Disease Control and Prevention, 2005.
Use of mammograms among women age ≥40 years — United States, 2000–2005. MMWR Morb Mortal Wkly Rep 2007; 56: 49–51.
Smith RA, Saslow D, Sawyer KA et al. American Cancer Society guidelines for breast cancer screening: Update 2003. CA Cancer J Clin 2003; 53: 141–69.
Breast cancer screening in older women: American Geriatrics Society Clinical Practice Committee. J Am Geriatr Soc 2000; 48: 842–4.
Badgwell BD, Giordano SH, Duan ZZ et al. Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol 2008; 26: 2482–8.
Shay K. Infectious complications of dental and periodontal diseases in the elderly population. Clin Infect Dis 2002; 34: 1215–23.
Scannapieco FA, Mylotte JM. Relationships between periodontal disease and bacterial pneumonia. J Periodontol 1996; 67: 1114–22.
Navazesh M, Mulligan R. Systemic dissemination as a result of oral infection in individuals 50 years of age and older. Spec Care Dent 1995; 15: 11–9.
Collin H-L, Uusitupa M, Niskanen L et al. Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus. J Periodontol 1998; 69: 962–6.
Page RC. The pathobiology of periodontal disease may affect systemic diseases: inversion of a paradigm. Ann Periodontol 1998; 3: 108–20.
Loesche WJ, Lopatin DE. Interactions between periodontal disease, medical diseases and immunity in the older individual. Periodontology (2000) 1998; 16: 80–105.
Joshipura KJ, Rimm EB, Douglass CW et al. Poor oral health and coronary heart disease. J Dent Res 1996; 75: 1631–6.
Loesche WJ, Schork A, Terpenning MS et al. The relationship between dental disease and cerebral vascular accident in elderly United States veterans. Ann Periodontol 1998; 3: 161–74.
Haraszthy VI, Zambon JJ, Trevisan M. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000; 71: 1554–60.
Persson RE, Truelove EL, LeResche L et al. Therapeutic effects of daily or weekly chlorhexidine rinsing on oral health of a geriatric population. Oral Surg Oral Med Oral Pathol 1991; 72: 184–92.
Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the U.S. Medicare population. J Clin Epidemiol 1999; 52: 243–9.
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporos Int 2000; 11: 556–61.
Magaziner J, Hawkes W, Hebel JR et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000; 55: M498–507.
Maggi S, Siviero P, Wetle T, Besdine RW, Saugo M, Crepaldi G. A multicenter survey on profile of care for hip fracture: predictors of mortality and disability. Osteoporos Int 2010; 21: 223–31.[Epub 2009 May 5]
Marottoli RA, Berkman LF, Cooney LM Jr. Decline in physical function following hip fracture. J Am Geriatr Soc 1992; 40: 861–6.
U.S. Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med 2002; 137: 526–8.
Qaseem A, Snow V, Shekelle P, Hopkins R, Fordea MA, Owens D. Clinical efficacy assessment subcommittee of the American College of Physicians. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008; 149: 404–15.
Gurwitz JH, Field TS, Harrold LR et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 289: 1107–16.
Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA 1994; 272: 292–6.
Zhan C, Sangl J, Bierman AS et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the National 1996 Medical Expenditure Panel Survey. JAMA 2001; 286: 2823–9.
Pitkala KH, Strandberg TE, Tilvis RS. Inappropriate drug prescribing in home-dwelling elderly patients: a population-based survey. Arch Intern Med 2002; 162: 1707–12.
Hanlon JT, Schmader KE, Boult C et al. Use of inappropriate prescription drugs by older people. J Am Geriatr Soc 2002; 50: 26–34.
Trontell A. Expecting the unexpected — Drug safety, pharmacovigilance, and the prepared mind. N Engl J Med 2004; 51: 1385.
Fick DM, Cooper JW, Wade WE et al. Updating the Beers Criteria for inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003; 163: 2716.
Juurlink DN, Mamdani M, Kopp A. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 2003; 289: 1652.
Huss A, Scott P, Stuck AE et al. Efficacy of pneumococcal vaccination in adults: a meta-analysis. CMAJ 2009; 180: 48–58.
PubMedCentral PubMed CrossRef
Moberley SA, Holden J, Tatham DP et al. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 2008; (1): CD000422
Nichol KL, Nordin, JD, Nelson DB et al. Effectiveness of influenza vaccine in the community-dwelling elderly. N Engl J Med 2007; 357: 1373–81.
Treanor JD. Influenza — The goal of control. N Engl J Med 2007; 357: 1439.
PubMed CrossRef Copyright information
© Springer Internal Publishing Switzerland 2010