Tobacco Documents Online

persons over 65 report doing any regular exercise including walking. Older people need to maintain flexibility, strength, coordination, balance and aerobic conditioning or else they do develop what George Burns calls "the old person's act". 6) Adult day care centers and senior centers should be mobilized to build health promotion and disease prevention activities. These can provide opportunities for socialization; hot meals with assured nutrition; information about health habits and relief of family burdens which means principally respite for women who care for older family members. 7) Medicare reforms. There should be important legislative steps to build upon Medicare's preventive package to create a stronger preventive geriatrics. This should certainly include increased payment or reimbursement for primary care under the resource-based relative value schedule, to cover time for specific counseling about prevention. So far Medicare covers pneumonia and flu vaccines, the PAP test for cervical cancer, and mammograms. There should be Medicare support for screening for cancer as well as hearing and vision. The latter two account for many injuries and both are excluded from Medicare coverage. But it is particularly important to find a Medicare code for geriatrics assessment which aims to gauge function and its maintenance and restoration. The essential goal of geriatrics is to maintain functional status. Revised 5/4/93 -11 -

8) There should be a national campaign to avoid unintentional injuries (or accidents) among the top ten causes of death of older persons. It is possible to evaluate living arrangements to protect against falls which account for some 200,000 hip fractures, in excess of $2 billion in costs, per year. 9) Professional education is as essential as public education in prevention. Specifically physicians must be reached through continuing medical education. 10) Older persons and persons of all ages should maintain health diaries (a method that has been used with some success in Japan) to help raise health consciousness. 11) Legislative Efforts: It has been established that taxation of tobacco does change behavior. For every increase in taxation there is reduction in purchase, especially among the young. It has been estimated that a 10% increase in tobacco tax would account for 4% reduction in purchase. When cigarette taxes began to rise in Canada, tobacco consumption fell by 20%. It should be noted that cigarette consumption in the U.S. and Canada were about equal in the early 1980s but not today. Taken together taxation on alcohol and tobacco is also a source of funds to finance health promotion and health care reforms. Obviously as tobacco and alcohol use declines it leads to a fall in revenues, a happy result. If tobacco and liquor companies were to cut prices there could be a comparable tax increase to keep prices stable. Revised 5/4/93 -12 -

12) Regulation of smoking is also restricted in restaurants, airplanes and other public places. * . * * * Conclusion I have oriented my remarks specifically to the later years drawing some attention to the Baby Boom generation which is in transition to old age. In truth, health promotion and disease prevention is a life-long activity and its promotion would do much to insure a higher quality late life. Similarly, environmental and occupational safety and health would enhance late life and save billions of dollars in worker's compensation. There has been a gathering and extraordinary movement toward national goals of health promotion and disease prevention over the last 15 years. In 1979, the U.S. Public Health Service under the Carter Administration began to specify such goals. These goals and the supporting data-bases are most recently summarized under Health Objectives for the Year 2000, a U.S. Public Health Service initiative. The private sector through the Institute of Medicine of the National Academy of Sciences has produced the important volume The Second Fifty Years. There is no question that self-responsibility is of great importance. We should enhance self-consciousness regarding one's responsibility for one's health. But certain caveats are in order. Those less advantaged, the poor in general and members of minority groups, may have enough to do to get through the day. They do not have the time or education to pursue health habits. The older age Revised 5/4/93 -13-

group of today grew up in a different era when there was less knowledge of health promotion and disease prevention. Moreover, their physicians had less knowledge as well. This is why it will take some time for self-responsibility to evolve. As part of the eagerly awaited national health reforms, we must build a national campaign to promote healthy lifestyles. It will not be easy and it will take time. Moreover, we must support research to better understand health as well as disease. We have a National Institutes of Health, not a National Institutes of Disease. In the meantime, we must apply what we know. Our rewards will be a higher quality of life in old age and a marked reduction in health costs. Revised 5/4/93 -14 -

TABLE 1 HEALTH PROMOTION AND DISEASE PREVENTION GERIATRICS PERSPECTIVE First line of defense -- Immunization Program Prevention of injuries Informed Nutrition Oral Health No Smoking Moderate Alcohol Use Second line of defense - Detection and treatment - prompt detection of reversible confusional states. - early detection of depression and suicide prevention. - control of hypertension - screening for cancer - hearing check - vision check - elder abuse check - osteoporosis prevention - smoking cessation - Medicare codes for geriatrics assessment and care = coordination. Third line of defense - Geriatric Rehabilitation stroke rehabilitation amputation rehabilitation cardiac rehabilitation rehabilation to end ventilator dependence (chronic obstructive pulmonary disease). Revised 5/4/93

TABLE 2 QUALITY TIME If you're healthy at age 86, you can expect to remain independent for most of your remaining years. But even if you're dependent at this age, you have a good chance for another year of active living. (Remaining life expectancy for individuals aged 70 to 92 and percent of remaining life expected to be lived independently, by age and dependency status at beginning of age interval, 1984.) Independent Independent Total Years Percent remaining Independent at age 70 ............................ 13.4 75% 72 ............................ 12.2 73 74 ............................ 11.1 71 76 ............................ 10.0 68 78 ............................ 9.0 66 80 ............................ 8.1 63 82 ............................ 7.3 61 84 ............................ 6.6 59 86 ............................ 6.0 57 88 ............................ 5.5 56 90 ............................ 5.2 56 92 ............................ 4.9 53 Independent at age Dependent Total Years remaining Percent Independent 70 ..................... ....... 12.5 51% 72 ..................... ....... 11.3 48 74 ..................... ....... 10.1 41 76 ..................... ....... 8.9 32 78 ..................... ....... 8.0 29 80 ..................... ....... 7.2 28 82 ..................... ....... 6.5 25 84 ..................... ....... 5.9 24 86 ..................... ....... 5.3 21 88 ..................... ....... 4.8 18 90 ..................... ....... 4.5 19 92 ..................... ....... 4.3 19 Source: Richard Rogers, Andrei Rogers and Alain Belanger, "Active Life Among the Elderly in the United States: Multistate Life-Table Estimates and Population Projections," The Milbank Quarterly, Vol. 67, No. 3-4, 1989.