Senior Citizens Benefit from Health Maintenance Programs

Stephen Allen Christensen @ suite101.com

Aging baby boomers want to remain healthy as they look toward retirement and beyond. Guidelines for maintaining optimal health in geriatric populations can help.

Studies show that older individuals benefit from adhering to preventive health care guidelines. Recommendations for health maintenance depend not only on personal expectations, but on population dynamics as well.

Causes of Mortality

Many of the leading causes of death in older adults are mirrored by modifiable risk factors—called “actual causes of death”—that have become part of the American lifestyle:

• Leading causes of death: Heart disease, cancer, stroke, emphysema, diabetes, Alzheimer’s disease, infection
• Actual causes of death: Tobacco use, poor diet, physical inactivity, alcohol consumption, microbial agents, toxic agents, motor vehicle crashes, firearms, sexual behaviors, illicit drug use

Changes in lifestyle can potentially mitigate some aspects of mortality. This holds true even for elderly adults: For example, smoking cessation at the age of 65 increases life expectancy by approximately 1.7 years in men and 3.2 years in women.

Preventive Strategies

• Tobacco cessation: Smoking cessation at any age benefits the smoker. Additionally, people exposed to secondhand smoke experience significant reduction in risk. Current recommendations include frequent counseling sessions between physicians and patients; medications are discretionary.
• Improved nutrition: Elimination of dietary trans-fats would prevent 6 to 19 percent of all coronary events in the US each year. A healthy diet (e.g., Mediterranean) in association with other desirable health practices has been shown to reduce all-cause mortality by up to 50%. Anyone with diet-related illness (diabetes, hypertension, hypercholesterolemia, obesity) should receive nutrition counseling.
• Exercise: Regular exercise helps to prevent osteoporosis and obesity, and benefits those with hypertension, diabetes, and cardiovascular disease. The US Surgeon General recommends that all adults participate in aerobic activity three times weekly for at least thirty minutes, in addition to twice-weekly strength training.
• Aspirin: For those at highest risk for heart disease, daily aspirin therapy should be considered. Those aged 70 to 84 benefit the most, but others who might benefit include men older than 40, postmenopausal women, and premenopausal women who smoke or who have hypertension or hypercholesterolemia. Aspirin, however, can contribute to gastrointestinal or intracranial bleeding.
• Cholesterol reduction: Statin therapy is currently recommended for elderly patients with elevated cholesterol and other risk factors for cardiovascular disease.
• Immunizations: Annual influenza vaccination is recommended for those 55 years and older, as is a one-time pneumococcal vaccine at age 65. Tetanus and diphtheria immunity should be updated and renewed every 10 years thereafter.

Screening

• Breast cancer: Mammography is recommended every one to two years for women aged 40 years and older who have a life expectancy of five or more years.
• Cervical cancer: This disease is rare in women over 65 who have had previous normal (negative) screens. Pap smears for previously-screened women over 65—and for those who have had a hysterectomy for benign reasons—are not recommended.
• Colorectal cancer: This cancer doubles in incidence every seven years beginning at age 50. Men and women 50 years and older with a life expectancy of five years or more should be screened with either colonoscopy (repeated every 10 years), flexible sigmoidoscopy every five years, or yearly fecal occult blood testing.
• Prostate cancer: Because of the unclear benefit of treatment, screening with PSA or digital rectal examination is not recommended for men with a life expectancy of less than 10 years.
• Osteoporosis: Screening for women should begin at age 65; those with risk factors (daily steroid use, family history, menopause before age 45, or infrequent menses) should be screened earlier.
• Abdominal aortic aneurysm: In men between the ages of 65 and 75, repair of large aneurysms in the abdominal aorta significantly reduces mortality. A one-time ultrasound is recommended for men in this age group who have never smoked. Smokers carry a higher risk, and should be screened earlier and/or more frequently.

Clearly, each individual’s health risks vary, and one’s life expectancy is influenced by many factors. Patients and their physicians should discuss preventive health issues at every opportunity.