Prevention: Why Does It Matter

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Prevention Why Does It Matter?

• Nancy Whitelaw, PhD
• Director, Center for Healthy Aging
• Senior Vice President
• National Council on Aging
• March, 2007

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Honest doc--if I had known I was gonna to live
this long, Id have taken better care of myself.
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We Face an Epidemic of Unparalleled Proportions

• More than 1.7 million Americans die of a chronic
  disease each year.
• One-third of the years of potential life lost
  before age 65 is due to chronic disease.
• Four chronic diseasesheart disease, cancer,
  stroke, and diabetescause almost two-thirds of
  all deaths each year.

• Mensah www.nga.org/Files/ppt/0412academyMensah.p
  pt18

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Leading Causes of Death Age 65Medical
Diagnoses

• Heart Disease 32
• Cancer 22
• Stroke 8
• Chronic respiratory 6
• Flu/Pneumonia 3
• Diabetes 3
• Alzheimers 3

State of Aging and Health 2007 www.cdc.gov/aging
CDC/NCHS Health US, 2002
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Selected Chronic Conditions Age 65 and over by
Sex, 2003-2004
Percent
Data source National Health Interview Survey
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Difficulty with IADLs or ADLs Percent of
Medicare Beneficiaries by Age, 2002
Percent
Data source Medicare Current Beneficiary Survey
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Actual Causes of Death Behavioral Risk
Factors

• Behavior of deaths, 2000
• Smoking 19
• Poor diet nutrition/ 14
  Physical inactivity
• Alcohol 5
• Infections, pneumonia 4
• Racial, ethnic, economic ?
  Disparities
• McGinnis Foege, JAMA, 1993 Mokdad et al, JAMA,
  2004

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Threats to Health and Well-being Among Seniors

• 73 age 65 - 74 report no regular physical
  activity
• 81 age 75 report no regular physical activity
• 61 - unhealthy weight
• 33 - fall each year
• 20 - clinically significant depression
• 35 - no flu shot in past 12 months
• 45 - no pneumococcal vaccine
• 20 - prescribed unsuitable medications
• www.cdc.gov/nchs

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Total Cardiovascular Disease Deaths, 1999(per
100,000 population)
190.5230.8 231.1250.0 255.5284.8 285.1354.9
United States - 172
www.cdc.gov/nccdphp/publications/burden/
National Vital Statistics System, National
Center for Health Statistics, CDC
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Variation in Heart Disease Rates, Why?

• 200 difference between high and low states
• Nearly 2/3 of the difference in death rates is
  explained by differences in modifiable risks
• tobacco
• overweight
• high blood pressure
• high cholesterol
• physical inactivity
• diabetes

Byers et al. Prev Med, 1998
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Disability by Age and Health Risk
Progression of disability delayed approximately 7
years in low risk vs. high risk.
Study of University of Pennsylvania Alumni Risk
based upon BMI, smoking, exercise Note A
disability index of 0.1 minimal
disability. Vita et al. NEJM, 1998.
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Chronic diseases account for 75 of the 1.4
trillion we spend on health care
Mensah www.nga.org/Files/ppt/0412academyMensah.pp
t21 Heffler et al. Health Affairs, March/April
2002.
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Health Care Spending by Age Group, 2000
Rosen www.americanhealthcarecongress.org/proceedi
ngs/MasterPresentation2005.pdf Meara, White, and
Cutler, Health Affairs, 2004
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US Federal Spending in Billions, 2006
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Life Expectancy by Health Care Spending
Our nation spends more on health care than any
other country in the world Mensah
www.nga.org/Files/ppt/0412academyMensah.ppt22
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Growth of the Medicare Population
Rosen www.americanhealthcarecongress.org/proceedi
ngs/MasterPresentation2005.pdf
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Growth of the 85 Population
Rosen www.americanhealthcarecongress.org/proceedi
ngs/MasterPresentation2005.pdf
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Prevention Works for Older Adults

• Longer life
• Reduced disability
• Later onset
• Fewer years of disability
• prior to death
• Fewer falls
• Improved mental health
• Positive effect on depressive symptoms
• Possible delays in loss of cognitive function
• Lower health care costs
• www.healthyagingprograms.org/content.asp?sectionid
  85ElementID304

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Challenges Confronting Prevention

• Ageism in health promotion and disease prevention
• Great disparities based upon race, ethnicity,
  income, location
• Science not shared growing body of evidence of
  interventions that can positively impact health,
  disability and quality of life
• Untapped assets of 29,000 organizations currently
  reaching 7-10 million older adults
• Fragmented systems and services across aging,
  medical care, mental health and public health

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Social Ecologic Model of Healthy Aging
McLeroy et al. Health Educ Q, 1988 Sallis et al.
Am J Prev Med, 1998
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What the Social-Ecological Perspectives Says

• The health and well-being of older adults will be
  improved only if we work from a broad
  perspective.
• Comprehensive planning and partnerships at all
  levels are required.
• Harassing individuals about their bad habits has
  very little impact.
• Changes at the individual level will come with
  improvements at the organizational, community and
  policy levels.

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NCOAs Center for Healthy Aging

• Increase the quality and accessibility of health
  programming for older adults
• Collaborate with diverse organizations to
  contribute to a broad-based national movement.
• Identify, translate and disseminate evidence on
  what works scientific studies and best
  practices.
• Promote community organizations as essential
  agents for improving the health of older adults.
• Advocate for greater support for strong and
  effective community programs.

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Center for Healthy Aging

• National Resource Center on Evidence-based
  Prevention
• Evidence-based Model Health Programs
• Falls Free National Falls Prevention Action Plan
• Moving Out Best Practices in Physical Activity
• MD Link Connecting Physicians to Model Health
  Programs
• New Connections Partnerships between PH and
  Aging
• Get Connected Partnerships between MH and Aging

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Our Partners Local and State Collaborations
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Our Partners Academics and Researchers

• Stanford University
• Healthy Aging Research Network including
• University of Washington
• University of Illinois, Chicago
• University of North Carolina
• Texas AM Active for Life Initiative
• West Virginia University
• UCLA the Resource Centers on Minority Aging
  Research
• University of Illinois Urbana Champaign
• Academic partners to state and local teams
• Center for the Advancement of Health

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Our Partners Strategy and Funding

• Atlantic Philanthropies
• Robert Wood Johnson Foundation
• The John A. Hartford Foundation of NY
• Administration on Aging
• Centers for Disease Control Prevention
• Substance Abuse and Mental Health Services
  Administration
• Centers for Medicare and Medicaid Services
• Archstone Foundation
• Home Safety Council
• Merck Institute on Aging and Health

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Learn More

• Booth at the conference- just outside the
  Ballrooms
• Sessions throughout the conference get a list
  at the booth.
• Visit our website
• www.healthyagingprograms.org

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Prevention Workswww.healthyagingprograms.org