Introduction To Public Health

Lecture 10

Magda Khutsishvili, Pharm B, MPH

Lecturer in the University of Georgia
School of Health Sciences
[email protected]
• Theme: public health and aging population
• Reading Materials: Introduction to Public Health 5th Edition by Mary-
Jane Schneider (Author) chapter 29, pages: 469-487.
 Public Health and The aging population
• The population is getting older, those who are above 65, is in the
process of retiring, in US.
• Concerns for public Health
1. The quality of life of the elderly is poorer than that for younger
people
2. The medical costs of elderly are higher
• Quality of life in later years depends on lifestyle in youth and middle
age, that’s why public health promotes healthy behaviors.
• Medicare program was created in the hope of enabling all older
people to receive adequate care.
• The challenges for public health is twofold:
1. To improve the health of older people by prevention of disease
and disabilities
2. To confront the issue of how costs can be controlled in an
equitable and humane way
Elderly Categorization
 Baby-Boom Generation
• Baby-Boomers: Those born between 1946 and 1964
• Future population size depends on both:
1. Birth rate-which is currently fairly stable
2. Immigration rates-which are unpredictable and depend on federal policies.
 The differences in gender by age groups
• Females outnumber males in older age groups.
• Among the oldest old, there are more than twice as many women as men.
• This is a consequence of the fact that women have a longer life expectancy than men.
 The role of Medicare against Poverty
• Social Security and Medicare have
helped most of the older population to
stay out of poverty.
• The percentage of people 65 and older
living in poverty declined from 15
percent to 9%in 2010.
• Elderly women were more likely to be
poor than elderly men.
• Poverty rates were higher for older
blacks and Hispanics than for whites.
 Health Status of Elderly

• Public Health concern for Americans

over 65 is:
1. Long-term chronic illness
2. Disability
3. Dependency
 Causes of Death in Elderly

• The causes of death of older people are

pretty much the same as the causes of
death in the overall population, with
cardiovascular disease and cancer
leading the list.
• Motor vehicle crashes and suicide are
also significant causes of death, among
older men far more than older women.
• Men are likely to die at a younger age,
whereas older women are more likely to
suffer from chronic, disabling diseases.
 longer life expectancy=healthy living?
Question:
• Does longer life expectancy mean more healthy
years for most people or, alternatively, it leads to
longer periods of chronic illness and disability?
• It is still unanswered question with very important
implications for public health and Medicare system
will be highly dependent on the answer.
• Ideally most people would prefer to live a long,
healthy life and then suddenly drop dead, a
scenario that would also save massive amounts of
Medicare money.
 Preventing disabilities in elderly

• Much of the disease and disability common in later life

is linked to unhealthy behavior in earlier years.

• There are preventive measures, which improve their

quality of life, like:
1. Vaccination against pneumonia and influenza
2. Smoking cessation
3. Blood pressure control.
 The Impact of Medications on Elderly
• Some treatments have unwanted side effects that may
seriously impair health and quality of life.
• The body of elderly people don’t have an ability to
metabolize drugs properly.
• Kidney and liver function are often impaired in older
people, leading to increased sensitivity to drugs.

• Older people often take a number of medications for

various chronic conditions and this could lead to
unexpected interactions between drugs.
• According to the Institute of Medicine (IOM), there is
an urgent need for more research on risk versus
benefit of various types of drugs in the elderly.
 Osteoporosis in Older People
• Bone loss is common with age, especially in women and is
greatest in the years following menopause.
• Increasing risk factors:
1. Smoking
2. Alcohol consumption
• Reducing factors:
1. Obesity

• The degree of osteoporosis depends on bone density earlier

in life, which is determined by:
• Genetics
• Diet
• Physical activity.
Results of Osteoporosis
 Prevention of Osteoporosis
• The Framingham Study, found that taking estrogen after menopause can protect women
from bone loss and reduce the risk of hip fracture.
• The Surgeon General’s report makes recommendations for preventing osteoporosis, like:
1. Calcium: 1000 milligrams [mg] per day for adults under 50 years and 1200 mg for those
over 50
2. vitamin D: 200 mg per day for everyone up to 50 years, 400 mg for those 51 to 70, and 600
mg for those over 70.
3. Physical activity: at least 30 minutes per day for adults and 60 minutes per day for children,
Falls in Elderly
 Impairment of Vision in Elderly
• Loss of vision increases the risk of:
falls and other injuries.
• It may restrict the individual’s
ability to drive
• The leading causes of visual
impairment among the elderly are:
1. Cataracts
2. Glaucoma
3. Macular degeneration
4. Diabetic retinopathy.
 Impairment of Hearing in Elderly
• The most common form of hearing loss among the elderly
is characterized by: reduced sensitivity to higher
frequency tones and, therefore, difficulty in
comprehending speech.
• populations living in relatively noise-free environments
are less likely to suffer age-related hearing loss.
• Many products can help people to hear better, including:
1. Hearing aids
2. Telephone amplifying devices
3. Assistive listening devices in public places
• One barrier that limits the access of many older
individuals to services and devices that correct the effects
of sensory loss, such as glasses and hearing aids, is that
Medicare does not cover them!
 Oral Health of Elderly
• Disorders of the mouth, like : tooth loss, dental caries,
periodontal disease, salivary dysfunction, cancer and
precancerous conditions, and chronic pain, may diminish:
1. social functioning by affecting speech
2. facial esthetics
3. self-esteem
Oral health in old age, like overall health, depends on healthy
behaviors throughout life, but older people can improve their
health status by instituting healthier habits at any time, like:
4. Quit smoking
5. Use better oral hygiene self-care practices
6. use professional dental services.
Unfortunately, many of the elderly do not have access to
dental services for financial reasons, and Medicare does not
cover them!
 Alzheimer’s and dementia in Elderly
• Alzheimer’s is the most common cause of dementia
in the elderly.
• The Alzheimer’s Association estimates that 11 percent
of people age 65 and older have the disease. Above
age 85 the prevalence is estimated at 32 percent.
• While a few types of dementia are treatable, there is
no cure for Alzheimer’s.
Preventive measures are:
• Weight control
• Physical activity
• Avoidance of smoking
• Treatment of high blood pressure and cholesterol
• Aspirin
Thank You For Your Attention!