and ethnic differences in health is less certain, and it may depend not just on the particular interventions, but also on their specific design, targeting, and implementation. We consider the role of health promotion at older ages and then touch briefly on its possible effect on differences, about which little research has been done.

Health Promotion at Older Ages

Health promotion can make a difference in the care of older persons. Some health care providers are trained to counsel older persons to stop smoking, moderate their alcohol use, exercise, and lose weight. Older persons on their own sometimes attempt to improve their health by modifying behavior, making choices about medical care, or using complementary or alternative therapies.

Health promotion interventions take place in a complex environment that includes family and social relationships, economic and geographic factors, and physical barriers and opportunities, all of which influence older persons’ ability to process health information and translate it into new behavior. Furthermore, outcomes are also influenced by how individuals choose to incorporate health promotion ideas that may reach them, with various levels of accuracy, from various sources. Cultural factors may also modify individual responses.

Health promotion may be more effective with older than younger people, who may be more willing to adopt healthy life-styles (Stewart et al., 2001). To reduce the incidence of diabetes, Knowler et al. (2002) found that a life-style intervention was superior to Metformin (a drug which keeps the liver from making too much sugar), with the life-style intervention being particularly effective in an older age group. Likewise, Appel et al. (2001) showed that hypertension could be reduced in a cohort of older persons through a 9-month sodium intervention. There may be important differences between younger and older persons in how they respond to health promotion activities.

The focus of health promotion in later life is different than at younger ages. For those over age 65, the focus is primarily to reduce age-associated morbidity and disability and the effects of cumulative disease comorbidities. For instance, the Fitness Arthritis in Seniors Trial achieved a significant reduction in disability and an improvement in physical performance in an older cohort despite having no effect on the actual disease process (Ettinger et al., 1997). In the over-85 age group, health promotion focuses almost exclusively on maintaining function and enhancing the quality of life.



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