Facilitating healthy aging among men: making some impact
Article Outline
This Editorial forms the lead-in to a series on the Aging Male. The first series-article is planned for publication in jmh Vol. 6, Issue III, September 2009
Populations living in the developed world are beginning a longevity revolution. By 2030 it is estimated that one in every five Americans will be over the age of 65 years [1] and similar demographic changes are expected throughout the developed world. This population change will put increasing demands on aging social services and health care systems. The goal will be to help the aging population live healthy, productive and satisfying lives in socioculturally optimal ways. This will include enhancing directed services and education to enhance individual well-being, as well as to reduce disability and mortality. After all, poor health is not an inevitable consequence of aging.
Unfortunately, trends among older adults include being overweight and physically inactive. Falls and disabling injuries become more common. Chronic disorders causing long-term disability, early mortality, and diminished quality of life cause distress during aging. In many cases, these injuries and chronic disorders can be avoided by known prevention measures including a healthy lifestyle and use of early detection practices. Our goal should be to provide not just longevity, but healthier and higher quality lives. Prevention and early detection can only succeed with bilateral efforts involving both health systems-based activities as well as public education programs. Part of that effort requires societal energy and prioritization, but the other part requires clinicians of all types to be always thinking about how to prevent the morbidity of chronic disorders in aging persons by education, prevention, and early detection.
Healthy aging includes (1) physical activity and good nutrition, (2) disease prevention and health promotion, and (3) maintaining independence through injury prevention and decreasing disability risk. Lifestyle changes can promote better health and help older adults remain independent. Specific lifestyle modifications, including not smoking, being physically active, and eating a healthy diet, are more important than genetic factors in helping people avoid the deterioration usually associated with aging. Some experts estimate that just maintaining these three healthy habits can delay disability among older adults by as much as 10 years [2]. This makes sense looking at the major causes of mortality and morbidity in the Western world, which include: (1) cardiovascular disease, (2) cancer, (3) chronic lung disease (primarily emphysema) and (4) diabetes. In order for clinicians to do a better job in meeting the needs of the aging population, we need to understand the distribution, risk factors, and early diagnosis for developing disorders and to be prepared to encourage and/or initiate effective measures to prevent or delay their onset.
The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” [3]. Mental health is certainly a foundation for a good life integrated with family, workplace, and the wider society among both younger and older persons. The prevalence of some type of mental health concern in the USA is as high as 20% among people over the age of 55 years [4]. Mental health problems are a leading cause for persons over the age of 50 years leaving the labor market, and these issues must be addressed with the same urgency as physical health. In the USA, the mental health of older persons has been designated a priority by both the Healthy People 2010 objectives, and the 2005 White House Council on Aging [5], [6].
Gender-based medicine has established that men and women have different disease prevalence and natural histories as well as different responses to biologic and, perhaps, psychologic treatments. Although men have higher rates of earlier death from most of the common causes of morbidity around the world, views of older men's health issues often remain centered on the limited areas of sexual function and the genitourinary system. The US Food and Drug Agency's health report series titled “Maturity Health Matters” notes in a series written for older adults, families and caregivers, that the issues important to older men include (1) prostate health, (2) erection problems, (3) urinary incontinence, (4) penile cancer, (5) osteoporosis, and (6) breast cancer [7]. The United Kingdom is only slightly more expansive in its list of health threats to the welfare of aging men listing (1) prostate disease, (2) bladder cancer, (3) incontinence, (4) testicular problems, (5) erectile dysfunction, (6) heart disease, and (7) male menopause (mid-life crisis or andropause) [8]. These lists of concerns omit the major disorders affecting older persons of both genders as well as any mental health concerns, resulting in a narrow view of which screening, education, and prevention measures may help optimize real, as well as perceived, well-being among older men.
There are many other issues involved in enabling healthy aging among males. Although the complete reasons for the “male disadvantage” in longevity are not known, increased risk behaviors, decreased health attendance and screening, and a perceived lack of interest in improving health and following recommended medical regimens appear important factors [9]. Health care professionals may also sometimes be guilty of short-changing men because of perceived lack of interest or involvement on the part of the male patient [9]. Select cancer screening and cardiac risk factors may be assessed, but minimal attention is paid to occupational, self-esteem, relationship or other psychosocial issues, or to counseling about healthy lifestyles.
An opportunity for intervention is revealed by recent data from Australia, which show that mid-life men visit the doctor in higher numbers, possibly because of recognition of physical illnesses [10]. Taking advantage of these mid-life visits to offer men more services and education may encourage healthier habits [9]. Broader guidelines need to be developed clarifying which interventions, clinical and educational, might be useful to help men age more successfully with productive and satisfying lives [9].
In order to encourage a broader scope of care for aging men that will enhance multiple areas of well-being, this editorial introduces a series of articles focusing on issues related to (1) improving longitudinal well-being, (2) encouraging healthier lifestyles among older men and helping them to initiate healthy changes, (3) screening for medical disease and early recognition of impending problems, and (4) enhancing mental well-being. We also intend to discuss some of the major sociocultural issues involved in trying to improve men's health. It is hoped that these articles will provide the foundation for health care practitioners of all types to spend a little more time with older men in both clinical activities and health care education and to stimulate men to work to achieve a higher state of well-being. These articles, which will be evidence-based when evidence exists, are not meant to be comprehensive guides to everything we need to do for men throughout their older years, but to provide some recommendations and stimulate discussion about how health care practitioners can better promote healthy behavior and meet the needs of men over 50 years of age.
References
- Centers for Disease Control and Prevention. Healthy Aging for Older Adults. CDC Report. Atlanta, GA: CDC; 2005. Accessed on February 18, 2009. Available from: www.cdc.gov/aging.
- Walsh M, Haynes P, Sady C, L’Italien M. Healthy Aging. A Report Prepared for the Blaine House Conference on Aging, September 2006. Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service; 2006. Accessed on February 18, 2009. Available from: http://muskie.usm.maine.edu/Publications/HealthyAging.pdf.
- World Health Organization. Constitution of the World Health Organization. New York: WHO; 1946. Accessed on February 18, 2009. Available from: http://www.who.int/governance/eb/who_constitution_en.pdf.
- American Association of Geriatric Psychiatry. Geriatrics and Mental Health - The Facts. Bethesda, MD: AAGP; 2008. Accessed on February 18, 2009. Available from: http://www.aagpgpa.org/prof/facts_mh.asp.
- US Department of Health and Human Services. Healthy People 2010. Rockville, MD: US Dept. of Health and Human Services; 2000. Accessed on February 18, 2009. Available from: http://www.health.gov/healthypeople.
- US Department of Health and Human Services. 2005 White House Conference on Aging. Washington, DC: U.S. Administration on Aging; 2006. Accessed on February 18, 2009. Available from: http://www.whcoa.gov/index.asp.
- US Food and Drug Administration. Maturity Health Matters. FDA Health news for Older Adults, Their Families and Caregivers. Fall/Winter 2007-2008; Issue No. 7. Available from: http://www.fda.gov/cdrh/maturityhealthmatters/issue7.pdf.
- Directgov. Older Men's Health. London: Crown Copyright. Accessed on February 18, 2009. Available from: http://www.direct.gov.uk/en/Over50s/Over50HealthAndWellBeing/LookingAfterYourself/DG_10026837.
- . Men's healthcare needs improvement: a recommendation for a midlife men's health assessment visit. JMHG. 2005;2(3):375–381
- Bayram C, Britt H, Kelly Z, Valente L. Male consultations in general practice in Australia, 1999-00. GP Statistics and Classification Unit. AIHW Cat. No. GEP 11. Canberra: Australia Institute of Health and Welfare; 2003. Available from: http://www.aihw.gov.au/publications/index.cfm/title/8389.
PII: S1875-6867(09)00034-7
doi:10.1016/j.jomh.2009.02.002
© 2009 WPMH GmbH. Published by Elsevier Inc. All rights reserved.
