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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
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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
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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.
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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
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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.
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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
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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
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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
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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
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The Second Fifty Years: Promoting Health and Preventing Disability The Second Fifty Years
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