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Positive lifestyle choices can help older adults increase "health span" and maintain independence

This is an excerpt from Exercise and Wellness for Older Adults-2nd Edition by Kay Van Norman.

Profile of Older Americans

According to the U.S. Census Bureau, in 2004 there were 36.3 million people in America aged 65 and older, an increase of 3.1 million since 1994. Between 2004 and 2005, this age group increased by 457,000 people, accounting for 12% of the total population. The 65 and older population in the United States is projected to reach 86.7 million by 2050, making up 21% of the total population (see figure 1.2). Projections show that the U.S. population as a whole will increase by 49% from 2000 to 2050, while the 65 and older population will increase by an amazing 147% (Administration on Aging, 2005).

One of the fastest-growing segments of the older population is adults older than 85, who numbered 4.2 million in 2000 and are expected to reach 6.1 million by 2010 (a 40% increase in one decade) and 7.3 million by 2020 (a 44% increase in one decade). The number of centenarians (100 and older) in 2006 was estimated at 79,682, with a projected increase to 580,605 by 2040 (Administration on Aging, 2005). The AARP Web site (www.aarp.org) is an excellent resource for statistics on the 65 and older population and their lifestyle. Look for the regularly updated Profiles of Older Americans at www.aarp.org/research/surveys/stats/demo/agingtrends/articles/aresearch-import-519.html.

Health in an Aging America

Population demographics will drive continued growth in the senior wellness industry. Properly designed wellness programs can help older Americans retain functional independence and quality of life. In 2004, only 27% of persons aged 65 to 74 and 16% of persons 75 and older reported that they engaged in regular leisure-time physical activity. Lack of physical activity contributes to many of the conditions frequently reported in adults age 65 and older, including hypertension (51%), arthritis (48%), heart disease (31%), cancer (21%), and diabetes (16%) (Administration on Aging, 2005). Figure 1.3 illustrates the increase in disability common with increased age. Without intervention, increased numbers of Americans older than 85 will mean increased disability and increased health care costs. Wellness programs for adults should focus on preventing disability by maximizing endurance, mobility, balance, and muscular strength and power.

Unhealthy lifestyles dramatically affect the health of children in America. Conditions such as diabetes and heart disease, long thought to be age related, are showing up in alarming numbers in sedentary children. The good news for all ages is that these conditions can be prevented or managed through positive lifestyle changes.

Maintaining Health Span and Productivity

For the past two decades, government and media outlets have predicted dire consequences resulting from aging world populations. However, the problems predicted to occur as a result of aging populations stem from advanced disability rather than just advanced age. They include the loss of health (i.e., a strain on health care systems); the loss of productivity (i.e., a diminished work force); and the loss of independence (i.e., a need for long-term care). If the number of people with unhealthy lifestyles (inactivity and poor nutrition) remains the same, a crisis will indeed accompany changing demographics. However, research proves that prevention works, and positive changes in the field of health and wellness promotion can help more adults than ever before embrace healthy lifestyles (CDC, 2007).

Regular exercise and other positive lifestyle choices help increase “health span,” the length of time that a person can enjoy a healthy, active life. Improving the health span of adults can mitigate the presumed impact of aging demographics on the health care industry. There is less concern now than a decade ago about a diminished work force because many healthy adults of retirement age are opting to continue working in their professions or have found entirely new work interests. The predictions of tremendous economic strain on social programs have given way to a cautious optimism that this generation of retirees will volunteer many hours to help sustain social programs.

Maintaining Independence

Maintaining independence requires the ability to perform basic self-care. The standard definition of functional independence is that a person must be able to perform the basic activities of daily living (BADLs), including bathing, dressing, transferring (getting in and out of beds and chairs), walking, eating, and using the toilet, without assistance (Spirduso et al., 2005). Figure 1.3 (p. 5) illustrates the loss of functional independence common in people 85 years and older. Exercise, especially power training, has been proven to increase people's ability to perform ADLs.

Almost every functional task listed in figure 1.3 requires power to perform effectively, so anyone interested in improving the functional status of older adults must understand the difference between strength and power. Simply put, strength is the ability to generate force, and power is the ability to generate force quickly. For example, stand up very slowly from a chair (4-6 counts), sit back down, and then stand up quickly. Slowly rising from a chair primarily uses strength alone and so is more difficult than rising quickly, which is the normal sit-to-stand functional pattern requiring power (i.e., strength 3 speed). For more than 20 years researchers and professionals have known that strength training can improve function, yet the idea that all older adults should strength train is just now starting to become a mainstream concept. Recent power-training research consistently demonstrates that power training affects functional status significantly more than does strength training alone; however, power has not yet been embraced by health and wellness promotion professionals and incorporated into exercise programs (Fielding et al., 2002; Hazell et al., 2007; Miszko et al., 2003).

Professionals must bring power training to the forefront of programming as soon as possible by making the transition from programming for strength alone to programming for power. In a rapidly aging world, we cannot afford to let power research languish for years as changes in protocols trickle down to practitioners and older adults. Discuss the role of power in function with colleagues and clients and follow new research on the topic. Request that professional organizations like the International Council on Active Aging, the National Council on Aging, and the American Society on Aging address the issue of power and functional independence at yearly conferences. Read Hazell and colleagues' (2007) review of studies investigating the effect of strength and power training on ADL performance. Figure 1.4 illustrates the differences in ADL performance reported in strength and power research. Refer to chapters 4 and 5 for more information and practical strategies for incorporating strength and power training into programs.

Improving functional status requires more than just creating the right programs—adults have to participate to benefit! Professionals must convince adults that although loss of functional independence is highly predictable, it is not inevitable. Changing perceptions of aging and physical activity is the first step to engaging people as partners in well-being. Furthermore, the disability movement demonstrates how people can live vital active lives with adaptive equipment and minimal assistance even with significant physical limitations. This could be viewed as a person's physical competence, regardless of abilities or disabilities. Programs must focus on improving people's functional ability and their ability to adapt to changing circumstances, regardless of age. See chapter 3 for a discussion of psychosocial elements that influence physical activity behavior, functional independence, and quality of life and chapter 4 for specific strategies to engage adults as partners in well-being.

This is an excerpt from Exercise and Wellness for Older Adults: Practical Programming Strategies, Second Edition.

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