Keeping the elderly healthy - column

WASHINGTON, D.C. -- We already have enough data to keep many more older people healthy and free of disease were it not for "misplaced pessimism about aging."

"Many individuals lead satisfying lives and maintain their health well beyond society's expectations" says an Institute of Medicine report entitled The Second Fifty Years.

Many more of the aged would similarly enjoy a good quality of life if the nation had health policies which emphasized health promotion and disease prevention, according to recent findings.

The report notes that 30 percent of Medicare costs cover treatment in the last year of life. Thus, its authors ask, "Should we continue to devote thse resources to the providing of acute care or should we allocate more of them to promote independent functioning in a community setting?"

Such a shift in priorities would not necessarily cost more. It would reduce functional disability, shorten expensive medical services and postpone long-term care. While the report calls for more research to measure and compare treatments, it notes that we could do a far better job of acting on the information we already have. For example, it issued recommendations for 13 factors that affect large numbers of people for which remedial interventions are available.

High Blood Pressure: Everyone 50 and over, even those with no symptoms or family history, should have the blood pressure checked at least every two years. Medicare and private insurance should reimburse physicians for that examination. The elderly should also be included in research on hypertensive drugs, interventions such as low-salt diets, weight loss and exercise; and treatments for even mild high blood pressure.

Medications: Physicians should take age and body make-up into account when prescribing. Patients, in turn, should be alert to the dangers of multiple medications.

Osteoporosis: More than one million fractures occur annually because of this disease. Research is needed to design cost-effective screening programs to evaluate the efficacy of estrogen therapy, calcium supplements and exercise in preventing bone loss.

Sensory Loss: Loss of vision or hearing isolates people from their environment. Services and devices to help overcome such losses should be made readily available and be covered by public and private insurance.

Oral Health: Dental and oral disabilities are preventable in adults. Greater efforts should be made to extend care to older adults.

Cancer Screening: Screening and early treatment of cancer can be as effective in the elderly as in young people. The report cites studies in which screening and subsequent treatment for breast cancer in women 50 to 70 years old led to as much as a three-fold reduction in mortality.

Nutrition: Health-care providers periodically should assess the diets and nutritional status of elderly patients. As more of the very old live alone at home, better services for delivering meals or providing them in group settings are needed.

Cigarette smoking: Physicians should advise elderly patients to stop smoking, the Committee said. Also policy makers should ban advertising and eliminate Federal subsidies to tobacco growers.

Depression: Depression in the elderly "is seriously under diagnosed and often misdiagnosed," the report's authors note. They urge increased training for physicians in detection and treatment of mental disorders in the elderly. The problem of inadequate reimbursement for psychiatric care by public and private insurers also should be addressed.

Social Isolation: Isolated individuals should be identified. Health care providers, social institutions, families and friends should urge them to increase contact with others.

Falls: Although osteoporosis weakens the bones, a fall is usually the immediate cause of fractures in the aged. Recommended education programs on reducing hazards that may lead to falls are recommended.

Despite preventive measures, however, chronic illness and disability are constant companions of the elderly. Thus, the report urges an expansion of care for the elderly as well as establishing model procedures for the maintenance and restoration of maximal functioning in the face of chronic illness.

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