Healthy Aging for Older Adults in the US-Satariano - Center for ...

Healthy Aging for Older Adults in the United StatesWilliam A. Satariano, Ph.D., MPHSchool of Public HealthUniversity of California, Berkeley

Global AgingThe human population is aging.Percent of the Population Aged 65+ by Region, 2000Europe North America Asia14.0 12.6 5.9

Global AgingThe human population is aging.Percent of the Population Aged 65+ by Region, 2030Europe North America Asia23.1 20.3 11.9

Global AgingThe human population is aging.Percent of the Population Aged 65+ by Region, 2050Europe North America Asia28.6 20.7 18.0

Implications of Aging SocietiesDoes aging represent a global problem?Is it possible to identify and enhancepositive aspects of aging?What is healthy aging? Is it possible?

AimsDefinition of Healthy AgingImplications for Research and PracticeNew DirectionsConsider these issues within the U.S.context

Important QuestionsWhat is healthy aging?Whom do we ask?

Successful AgingLow risk of disease and disease-relateddisability.High mental and physical function.Active engagement with life.Rowe J, Kahn R. Human aging: Usual and successful. Science1987;237:143-149.

Related ConceptsChronological Age vs. Functional AgeWHO Definition of Health. Not just the absenceof disease. Complete state of physical, mental,and social well-being.

EpidemiologyBased on the premise that health outcomes arenot distributed randomly in the population.Describe and explain patterns of healthoutcomes in populations.

Conceptualization and Measurement ofSuccessful AgingConcept assumes some distribution of healthand functioning in older populations.Concept assumes that “successful aging” isreflected at the upper end of the distribution.– Top 20%– Top 33%Concept assumes that the components ofsuccessful aging are clustered.

Measurement of Successful AgingTop 20% of a summated score based on thefollowing:– ADL– Physical functioning (Rosow-Breslau & Nagi items)– IADL– Physical exerciseGuralnik J, Kaplan G. Predictors of healthy aging: Prospective evidencefrom the Alameda County Study. American Journal of Public Health1989;79:703-708.

QuestionsWhat about older people with multiple conditionsand limitations who remain engaged in everydaylife?Among older people diagnosed and treated forspecific conditions, why do some survive longerand better than others?Is it possible for older adults with multiple healthconditions and limitations to age healthfully?

SalutogenesisThe causes of health.Not only those people at the upper end of thehealth-disease spectrum, but also those who areable to maintain their health in spite of a highriskprofile.______________Antonovsky A. Health, Stress, and Coping. San Francisco: Jossey-Bass, 1979

Healthy Aging: An Expanded Definition?Is healthy aging more than individual capacity,number and severity of health conditions, andlevels of activity?Does this suggest that healthy aging may bemore prevalent than originally thought?Does this expand our notion of the causes ofhealthy aging as well as the types of programsand policies to enhance healthy aging?

CDC Healthy Aging NetworkHealthy aging is the development and maintenance of optimalphysical, mental and social well-being and function in older adults.It is most likely to be achieved when physical environments andcommunities are safe, and support the adoption and maintenanceby individuals of attitudes and behaviors known to promote healthand well-being;And by the effective use of health services and community programsto prevent or minimize the impact of acute and chronic disease onfunction.

Implications for Research and PracticeEpidemiology of Aging– Patterns of health and well-being vary by– Socioeconomic status– Living arrangements– Past and current health behaviors– Place

Supportive EnvironmentIs it possible to preserve and promote healthyaging among older adults with reduced capacitythrough environmental design?

Promotion of walkingis an efficient andeffective public healthstrategy to promoteand preserve healthand functioning inaging populations.Background

How best to promotewalking in olderpopulations?Background

ObjectiveExamine to what extent functional capacity anda diverse range of neighborhood elements areassociated with level of walking among olderadults.

ObjectiveExamine to what extent elements of theneighborhood environment moderate theassociation between reduced functional capacityand sedentary behavior among older adults.

ImplicationsBetter understanding of the reasons why somewalk and others do not.Environmental design may contribute to thecontinuation of walking, especially among olderpeople with reduced lower-body function.

Areas that encourage walking

Areas that discourage walking

Neighborhood EnvironmentPotential for affecting large numbers ofpeople now and in the future (“UpstreamPerspective”)Central to a consideration of aging.

Lawton Environmental Theory of AgingThe effects of theenvironment becomemore pronouncedwith age-relateddeclines in health andfunctioning.Person-EnvironmentFit Model

ExamplesClarke P, George LK. The role of the builtenvironment in the disablement process. Am JPublic Health 2005;95(11):1933-1939.– Among older people with lower extremity function,those residing in areas with more land-use diversitywere more likely to be independent in ADL and IADLthan older people with the same lower extremityfunction but residing in areas with less land-usediversity.

FIGURE 1-- Effect of housing density and land-use diversity on (a) ADL and (b) IADL disabilityby lower extremity functional limitationsClarke, P. et al. Am J Public Health 2005;95:1933-1939Copyright ©2005 American Public Health Association

ResultsElements of the neighborhoodenvironment improve activity among olderadults with reduced capacity.Suggests that environmental design mayenhance activity among adults with agerelatedlimitations.

U.S. Policy implicationsThe aging population in the U.S. isbecoming more racially and ethnicallydiverse.– Percent of non-Hispanic white seniors will declinefrom 83.5% to 64.2% between 2000 and 2050.

U.S. Policy implicationsRegional and geographic diversity.Place-based programs that take these factorsinto account may succeed.

Environmental InterventionsEnvironmental Modifications (e.g., land-usediversity and density, sidewalks)Environmental Linkage (e.g., “walking maps”,technological innovations)

New DirectionsMultidisciplinary research designs.Multidisciplinary research infrastructureFunding ResourcesTraining Programs

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Is Healthy Aging Really Possible?Yes, and probably in all of those cases.Healthy aging is not one thing.Look beyond capacity and consider factors thatserve to either impede or enhance health,functioning, and engagement in everyday life.