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.
Report of a study undertaken by the Committee on Health Promotion and Disability Prevention for the Second Fifty.
Includes bibliographical references.
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]
for Library of Congress 90-13385
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
Joseph Stokes III, M.D.
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.
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
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
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
ARTHUR L. CAPLAN,
University of Minnesota Center for Biomedical Ethics, Minneapolis (Appendix A)
Clinical Epidemiology Program, San Francisco General Hospital, University of California, San Francisco (Chapter 15)
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
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
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