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Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
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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

Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
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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.

Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
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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

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
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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

Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
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Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
×
Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
×

The Second Fifty Years

Suggested Citation:"Front Matter." Institute of Medicine. 1992. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: The National Academies Press. doi: 10.17226/1578.
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Taking its title from the second 50 years of the human life span of about 100 years, this book presents wide-ranging and practical recommendations for health care providers, policymakers, and other sectors of society. These recommendations range from setting new national policies to changing the way elderly patients are interviewed in the doctor's office and from what exercises older persons should do to how city planners should design our urban environment.

The bulk of this volume presents the latest research on 13 major health threats to the elderly, covering prevalence, impact on the older person's life, cost, and intervention.

In addition, the authors provide a detailed analysis of why older people often do not receive the benefit of prevention programs.

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