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In developed societies, the success of disease prevention strategies over the last century, coupled with more effective treatments for many diseases, has resulted in a decline in mortality due to acute disease. However, this has been associated with a rise in chronic illness and attendant morbidity in the form of chronic disability in old age. The sheer magnitude of the elderly population of the near future will place critical demands on existing health care delivery systems. Continued independent functioning of the elderly population has therefore emerged as a major challenge to public health. The ability to perform activities of daily living is essential for ensuring independent living. Thus, preventive gerontology—the study of individual and population health strategies across the life span aimed at maximizing both the quality and quantity of human longevity—must now aim not just to retard chronic disease but also to prevent functional decline.

Aging is a lifelong process in which early- and mid-life events and behaviors can have an important influence on the health and functioning of individuals as they age. Development of chronic disease, functional decline, and loss of independence are not inevitable consequences of aging. Health and function in late life can be seen to a great degree as under one's own personal control. Disability is associated with chronic conditions that are potentially preventable, and changes in behavior and lifestyle will reduce risk factors that lead to many chronic conditions. This is true throughout life, and has been shown to apply even for persons of advanced age.

What should the primary care provider advise his/her young adult and middle-aged patients about how to maintain optimal health and function into their later years? Health promotion efforts at the level of the individual should ideally be established early in life and maintained throughout life. Chronic disease, an avoidable outcome intermediate in the pathway to functional decline or death (Figure 9-1), is unlikely to have a single cause but rather, to be the result of the interactions of multiple factors. Efforts to prevent such disease require a comprehensive approach that focuses primarily on behavioral modification.

Figure 9-1.

Conceptual model of how health behaviors impact the combined outcome of functional decline or death.

Individuals who pursue a healthy lifestyle have a lower risk of developing a chronic disease. A healthy lifestyle can be conceptualized as one that involves avoidance of health-damaging behaviors along with the adoption of a proactive approach to one's health. This chapter will first examine those behaviors that should be avoided and then focus on those that should be adopted if one is to maximize the time spent in a state of independent functioning.

Achieving and maintaining health and function in advanced years can be aided by a commitment to a lifestyle that involves avoidance of smoking and other behaviors that adversely affect health. ...

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