The Second Fifty Years

Promoting Health and Preventing Disability

Robert L. Berg and Joseph S. Cassells, Editors

INSTITUTE OF MEDICINE

Division of Health Promotion and Disease Prevention

NATIONAL ACADEMY PRESS
Washington, D.C. 1992



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability The Second Fifty Years Promoting Health and Preventing Disability Robert L. Berg and Joseph S. Cassells, Editors INSTITUTE OF MEDICINE Division of Health Promotion and Disease Prevention NATIONAL ACADEMY PRESS Washington, D.C. 1992

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability National Academy Press 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. This project was supported by funds from the National Institute on Aging, the National Institute for Dental Research, the Food and Drug Administration, the Alliance on Aging, the Charles A. Dana Foundation, and the Pew Charitable Trusts. Library of Congress Cataloging-in-Publication Data Institute of Medicine (U.S.). Division of Health Promotion and Disease Prevention. The second fifty years : promoting health and preventing disability / Division of Health Promotion and Disease Prevention, Institute of Medicine. p. cm. Report of a study undertaken by the Committee on Health Promotion and Disability Prevention for the Second Fifty. Includes bibliographical references. Includes index. ISBN 0-309-04681-5 1. Aged—Health and hygiene—United States. 2. Health promotion—United States. 3. Aged—Diseases—United States. 4. Aged—Services for—United States. 5. Primary Prevention—in old age. I. Institute of Medicine (U.S.). Committee on Health Promotion and Disability Prevention for the Second Fifty. II. Title. [DNLM: 1. Health Promotion—United States. 2. Health Services for the Aged—trends—United States. WT 30 I5915] RA564.8I57 1991 613'.0438' 0973—dc20 DNLM/DLC for Library of Congress 90-13385 CIP Copyright © 1990 by the National Academy of Sciences Printed in the United States of America Cover photograph: Superstock, Inc. First Printing, March 1992 Second Printing, January 1993

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability Acknowledgment Joseph Stokes III, M.D. 1924-1989 The Committee on Health Promotion and Disability Prevention for the Second Fifty would like to make special mention of the contribution of Joseph Stokes III, M.D. Dr. Stokes was instrumental in organizing and outlining the risk factors to be researched for this project, and his passing provided personal inspiration to the committee for further research in the area of cancer screening. This report was created to provide effective preventive and intervention procedures for physicians, the public, long-term care facilities, colleges, and universities. It is the committee's wish that this information will help raise the consciousness of the American public regarding healthy life practices and aging.

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability This page in the original is blank.

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability Committee on Health Promotion and Disability Prevention for the Second Fifty ROBERT BERG (Chairman), Professor and Chairman, Department of Preventive, Family/Rehabilitation Medicine, Strong Memorial Hospital, Rochester, New York ELIZABETH T. ANDERSON, Professor and Chair, Community Health and Gerontology Department, University of Texas Medical Branch, School of Nursing, Galveston WILLIAM APPLEGATE, Chief, Division of Geriatric Medicine, University of Tennessee, Memphis JEROME AVORN, Director, Program for Analysis of Clinical Strategies, Harvard Medical School, Boston, Massachusetts BEN D. BARKER, Professor and Dean, School of Dentistry, University of North Carolina, Chapel Hill JOHANNA T. DWYER, Director, Frances Stern Nutrition Center, New England Medical Center Hospital, and Professor of Medicine and Community Health, Tufts University Medical School, Boston, Massachusetts A. ALAN FISCHER, Professor and Chairman, Department of Family Medicine, Indiana University School of Medicine, Indianapolis PEARL S. GERMAN, Professor, Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland L. JOSEPH MELTON III, Professor and Head, Section of Clinical Epidemiology, Mayo Clinic, Rochester, Minnesota

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability RISA LAVIZZO-MOUREY, Acting Director, Program in Geriatric Medicine, University of Pennsylvania, Philadelphia GEORGE C. ROUSH, Director of Research, Cancer Prevention Research Institute, New York, New York FREDERICK L. RUBEN, Professor of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania ANNE R. SOMERS, Adjunct Professor, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Haverford, Pennsylvania JOSEPH STOKES III,* Boston University Medical Center, Boston, Massachusetts ALBERT J. STUNKARD, Professor of Psychiatry and Psychology, University of Pennsylvania School of Medicine, Philadelphia Liaison Members LEOPOLD G. SELKER, Associate Dean for Academic Affairs, College of Associated Health Professions, University of Illinois at Chicago, Chicago R. KNIGHT STEEL, West Newton, Massachusetts Commissioned Writers ARTHUR L. CAPLAN, University of Minnesota Center for Biomedical Ethics, Minneapolis (Appendix A) MICHAEL NEVITT, Clinical Epidemiology Program, San Francisco General Hospital, University of California, San Francisco (Chapter 15) Consultants HELEN C. GIFT, Chief, Health Promotion Section, National Institute of Dental Research, Bethesda, Maryland SHIRLEY P. BAGLEY, Assistant Director for Special Programs, National Institute on Aging, Bethesda, Maryland Institute of Medicine Staff GARY B. ELLIS, Division Director JOSEPH S. CASSELLS, Study Director TED MILLER, Research Assistant CRISTELLYN D. BANKS, Special Project Assistant/Sr. Secretary *   Deceased May 1989.

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability Preface Although the advances of recent years in the field of public health and acute care have been unprecedented, we are having trouble coping with success. People live longer, but their lives are not necessarily better. To accommodate the changing needs of an increasingly older society, we must broaden the traditional goals of health—curing disease and preventing its occurrence—to include preventing the ill from becoming disabled and helping the disabled cope with and prevent further disability. Dealing with disease must include dealing with the consequences of disease. This report of the study undertaken by the Committee on Health Promotion and Disability Prevention for the Second Fifty was written to assist the health care community in achieving this crucial transition. It is also the product of the Institute of Medicine's (IOM) long-standing interest in examining the aging population. A number of recent IOM publications (Health in an Older Society, Aging in Today's Environment, The Social and Built Environment in an Aging Society, and Improving the Quality of Care of Nursing Homes) have addressed the effects of ever-increasing numbers of elderly citizens on public attitudes, public behavior, and public policies. This report extends that interest to specific health issues and risk factor modification. The dynamism of American health care demands an equally dynamic report. In the past several years, the number and scope of health promotion and disease and disability prevention programs

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability have expanded significantly. This expansion can be attributed to a wide range of sources that include not only recent scientific findings but also new philosophies of health care. In the future, some of these new approaches may prove extremely beneficial to the health of older Americans. Nevertheless, the purpose of this report is not to provide an updated list of everything that is new. Rather, it was written primarily as an analysis of those approaches to health promotion and disability prevention for which there are adequate data from which to draw intelligent conclusions that may benefit the nation's older population. The committee believes that the innovative drive that animates U.S. health care today is a positive force, but it also believes that the course of American health care must be guided by a careful balance of optimism and prudence. The report therefore measures the effectiveness of new techniques designed to achieve old but worthy goals—such as improving nutrition and oral health and reducing hypertension and osteoporosis—and analyzes the current debate concerning new goals. Although no report is likely to satisfy every need, readers of this volume will find a wide variety of topics, ranging from the controversial techniques of intervention to the philosophical assumptions that inform broad health care goals. They will also find specific recommendations for the service, research, and education communities. In short, it is our hope that every reader will find something of interest—and something useful as well. Robert L. Berg, Chairman Joseph S. Cassells, Study Director

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability Contents     Summary   1 1   Introduction   11 2   Disability Classification   22 3   High Blood Pressure   33 4   Medications   53 5   Risk Factors for Infection in the Elderly   65 6   Osteoporosis   76 7   Preventing Disability Related to Sensory Loss in the Older Adult   101 8   Oral Heal Problems in the "Second Fifty"   119 9   Screening for Cancer   136 10   Nutrition   157 11   Cigarette Smoking   193 12   Depression   202 13   Physical Inactivity   224 14   Social Isolation Among Older Individuals: The Relationship to Mortality and Morbidity   243 15   Falls in Older Persons: Risk Factors and Prevention   263

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability     Appendixes     A   Can Philosophy Cure What Ails the Medical Model? Arthur Caplan   291 B   Looking for Order: Health Promotion, Disability Prevention, and the Disability Classification System of the World Health Organization Ted Miller   311     Index   321

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability The Second Fifty Years

OCR for page R1
The Second Fifty Years: Promoting Health and Preventing Disability This page in the original is blank.