Nearly 40% of deaths in America can be attributed to smoking, physical inactivity, poor diet, or alcohol misuse-behaviors practiced by many people every day for much of their lives. Adopting healthy behaviors such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control the devastating effects of many of the nation's leading causes of death regardless of one's age.

Regular physical activity greatly reduces a person's risk from dying of heart disease, and decreases the risk for colon cancer, diabetes, and high blood pressure. Physical activity also helps to control weight; contributes to healthy bones, muscles, and joints; helps to relieve the pain of arthritis; reduces symptoms of anxiety and depression; and can decrease the need for hospitalizations, physician visits, and medications. Finally, physical activity does not need to be strenuous to be beneficial; people of all ages benefit from moderate physical activity. However, people tend to be less active as they age. By age 75, about one in three men and one in two women do not engage in any physical activity.¹ Organizations and agencies who are looking for assistance in planning strategies to help older adults increase their physical activity can use The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older.*

	Related Links about Health-Related Behaviors Physical Activity for Older Adults Nutrition Tobacco Cessation

Good nutrition, including a diet that is low in saturated fats and contains five or more servings of fruits and vegetables each day (see the 5 A Day for Better Health Program), is vital in maintaining good health. Improving the diet of older adults could extend the productive life span of Americans and reduce the occurrence of chronic diseases such as heart disease, stroke, some types of cancer, diabetes, and osteoporosis. Less than one-third of adults 65 years and older meet the 5 A Day recommendation.²

Tobacco Use is the single most preventable cause of death and disease in the United States. The American Cancer Society estimates that cigarette smoking is responsible for one of every five deaths in the United States, or more than 440,000 deaths each year. Tobacco use increases the risk for diseases of the heart and cancer. Smoking cessation has major and immediate health benefits for men and women of all ages, regardless of whether they have a smoking-related disease.

Back to top

Chronic Diseases

	Related Links about Chronic Diseases Arthritis Cardiovascular Health Cancer • Colorectal Cancer • Breast Cancer Diabetes Epilepsy Obesity Oral Health

Chronic Diseases are generally not prevented by vaccines or cured by medication, nor do they just disappear. To a large degree, the major chronic disease killers — heart disease, cancer, stroke, and diabetes — are an extension of what people do, or not do, as they go about their daily lives. Eighty-eight percent of those over 65 years of age have at least one chronic health condition.³ Health damaging behaviors — particularly tobacco use, lack of physical activity, and poor eating habits — are major contributors to the nation's leading chronic diseases. Clearly, promoting healthy behavior choices, through education and through community policies and practices, is essential to reducing the burden of chronic diseases.

Arthritis and related conditions are the leading cause of disability in the United States affecting nearly 43 million Americans. Although cost-effective interventions are available to reduce the burden of arthritis, they are currently underused. Regular, moderate exercise offers a whole host of benefits to people with arthritis by reducing joint pain and stiffness, building strong muscle around the joints, and increasing flexibility and endurance.

Cardiovascular Health is a growing concern for all Americans. Heart disease is the nation's leading cause of death. Three health-related behaviors—tobacco use, lack of physical activity, and poor nutrition—contribute markedly to heart disease. Modifying these behaviors is critical for both preventing and controlling heart disease. Modest changes in one or more of these risk factors among the population could have a profound public health impact.

Cancer is the second most common cause of death in the United States. Cancer is largely controllable through prevention, early detection, and treatment. Reducing the nation's cancer burden requires reducing the prevalence of the behavioral and environmental factors that increase cancer risk. It also requires ensuring that cancer screening services and high-quality treatment are available and accessible, particularly to medically underserved populations.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States, accounting for 10% of all cancer deaths. The risk of developing colorectal cancer increases with advancing age. Lack of physical activity, low fruit and vegetable intake, a low-fiber diet, obesity, alcohol consumption, and tobacco use may contribute to the risk for colorectal cancer.

Three screening tools flexible sigmoidoscopy, colonoscopy, and the fecal occult blood test (FOBT) are widely accepted and used to detect colorectal cancer in its earliest stages, when treatment is most effective. In 1999, 66% of Americans aged 50 years or older reported not having had a sigmoidoscopy or colonoscopy within the last five years, and 79% reported not having had a fecal occult blood test within the last year.⁴

Breast Cancer is best detected in its earliest, most treatable stage by mammography. Seventy-six percent of all diagnosed cases of breast cancer (are among women aged 50 years or older.⁴

Diabetes is a serious, costly, and increasingly common chronic disease. Early detection, improved delivery of care, and better self-management are the key strategies for preventing much of the burden of diabetes. Seven million persons aged 65 years or older (20.1% of all people in this age group) have diabetes.⁵

Epilepsy and seizures affect about 2.3 million Americans, and result in an estimated $12.5 billion in medical costs and lost or reduced earnings and production annually. People of all ages are affected, but particularly the very young and the elderly. About 10% of Americans will experience a seizure, and about 3% will have or will have had a diagnosis of epilepsy by age 80.

Obesity has reached epidemic proportions among Americans in all age groups. Obesity among adults has doubled since 1980. People who are obese or overweight are at increased risk for heart disease, high blood pressure, diabetes, arthritis-related disabilities, and some cancers.

Oral health is an important and often overlooked component of an older adult's general health and well-being. Oral health problems can cause pain and suffering as well as difficulty in speaking, chewing, swallowing, and maintaining a nutritious diet. During the past 50 years, the oral health and use of dental services among older adults have improved. Although this trend is expected to continue, additional improvement will depend on access to appropriate dental care.

Back to top

Mental Health

The majority of older Americans successfully cope with the physical and cognitive changes associated with aging as well as various losses, such as the loss of family and friends that frequently are associated with late life. However, a substantial proportion of the population aged 55 years and older—almost 20 percent of this age group—experience specific mental disorders that are not part of “normal” aging including depression, anxiety disorders, and dementia including Alzheimer’s disease which can be debilitating and severely affect an older adult’s quality of life.⁶

Depression – between 8 to 20 percent of older adults in the community and up to 37 percent in primary care settings suffer from depressive symptoms.1 These symptoms can range from depressive illness (major depressive disorder, dysthymic disorder, or bipolar disorder) to depressive symptoms that fall short of meeting full diagnostic criteria for a disorder and is associated with an increased risk of developing major depression (subsyndromal depression).^7-8 In any of these forms, however, depressive symptoms are not a normal part of aging. In contrast to the normal emotional experiences of sadness, grief, loss, or passing mood states, they tend to be persistent and to interfere significantly with an individual's ability to function. Depression often co-occurs with other serious illnesses such as heart disease, diabetes, or cancer.⁹ Because of these co-occurring conditions health care professionals may mistakenly conclude that depression is a normal consequence of these problems—an attitude often shared by patients themselves.¹⁰ These factors together contribute to the underdiagnosis and undertreatment of depressive disorders in older people. Depression can and should be treated when it occurs and many effective therapies are available. If left untreated, depression impairs one’s enjoyment of life and may increase disability. It can also delay recovery from or worsen the outcome of other co-occurring chronic illnesses.

Cognitive health – or brain health, is an important part of healthy aging. Cognitive health refers to maintaining and improving mental skills such as learning, memory, decision-making, and planning. Many older adults mistakenly believe becoming “senile” or forgetting is a normal part of aging. Although one in four older adults experiences these events (known collectively as cognitive decline), they are not a normal part of healthy aging.¹¹ There are certain changes in cognitive health that occur as you age. Normal changes usually mean a slower pace of learning and the need for new information to be repeated. While the majority of older adults will experience these normal changes in cognition, some older adults will experience cognitive decline. Older adults with cognitive decline have a higher risk of developing dementia later in life. Among Americans 65 years and older, approximately 6–10% have dementia, and two-thirds of people with dementia have Alzheimer’s disease.¹² Although research has not found a way to prevent dementia or Alzheimer’s disease, cognitive decline may be preventable. Recent research suggests that being physically active, controlling your hypertension, and engaging in social activities may help you maintain and improve your cognitive health.

Infectious Diseases

West Nile virus is a flavivirus commonly found in Africa, West Asia, and the Middle East. It was first detected on the east coast of the United States in 1999. Since then the virus has rapidly spread westward and West Nile virus has been detected in nearly every state in the country. The main route of human infection with West Nile virus is through the bite of an infected mosquito. The easiest and best way to avoid West Nile virus is to prevent mosquito bites. People over the age of 50 are more likely to develop serious symptoms from West Nile virus infection and should take special care to avoid mosquito bites. You can Fight the Bite! by 1) applying insect repellent containing DEET (Look for: N,N-diethyl-meta-toluamide); 2) when possible, wear long-sleeves, long pants and socks when outdoors to reduce the amount of bare skin exposed to mosquitoes and; 3) reduce the amount of time you are outdoors during dusk and dawn when mosquitoes are most active. There are other things you can do to reduce your risk of exposure to West Nile virus in your home and community. Visit the CDC Fight the Bite! Website for more information.

Back to top

Immunizations for Adults

	Related Links about Immunizations for Adults Influenza Vaccine Information Information on Pneumonia Vaccine- Preventable Adult Diseases

Although infectious diseases are no longer the most common causes of death, pneumonia and influenza remain among the top ten causes of death for older adults. In 2000, pneumonia and influenza were responsible for 3.3% or 58,557 deaths among people 65 years of age and older.¹³ Influenza vaccination can reduce both direct health-care costs (physician visits and antibiotic use) as well as indirect costs from work absenteeism associated with influenza illness. Among person aged 65 years and older, influenza vaccination levels have increased from 33% in 1989 to 66% in 1999, surpassing the Healthy People 2000 goal of 60%.¹⁴

Pneumonia is one of the most serious infections in older adults, especially among women and the oldest old. In a study of nursing home acquired pneumonia patients, pneumonia resulted in death among 40% of individuals who required hospitalization.¹⁵

Back to top

Injuries Among Older Adults

	Related links about Injuries Among Older Adults Preventing Falls Among Seniors Tool Kit to Prevent Senior Falls Rates of Motor-Vehicle Related Death Among Older Adults Nonfatal Motor-Vehicle Related Injuries Among Older Adults Risk Factors for Suicide Among the Elderly

In the United States, one of every three persons aged 65 years and older falls each year. Among older adults, falls are the leading cause of injuries, hospital admissions for trauma, and deaths due to injury. In 1999, about 10,097 seniors died of fall-related injuries.¹⁶ Fractures are the most serious health consequence of falls. Approximately 250,000 hip fractures, the most serious fracture, occur each year among people over age 65. Many of these falls and resulting injuries can be prevented. Strategies to prevent falls among older adults include exercises to improve strength, balance, and flexibility; reviews of medications that may affect balance; and home modifications that reduce fall hazards such as installing grab bars, improving lighting, and removing items that may cause tripping.

While rates of motor vehicle related death and nonfatal motor vehicle related injuries among older adults vary by state, there are some consistencies. In most states, the fatality rates for men are twice those for women. In all states, motor vehicle-related fatalities are higher among adults 75 years and older, as compared with adults between 65 and 74 years of age. Among older adult drivers, the number of motor vehicle-related fatalities increased 30% and the number of nonfatal injuries increased 21% between 1990 and 1997. However, the number of fatalities and nonfatal injuries among older adult pedestrians declined during these same years (23% and 24%, respectively).

Risk factors for suicide among the elderly differ from those among the young. Older persons have a higher prevalence of depression, a greater use of highly lethal methods and greater social isolation. From 1980–1998, the largest relative increases in suicide rates occurred among those 80–84 years of age. The rate of suicide is higher for elderly white men than for any other age group, including adolescents.¹³

People aged 65 and older are twice as likely to die in a home fire as the population at large. The National Fire Protection Association, with assistance from CDC, has developed a fire and fall injury prevention program directed at older adults called Remembering When*.

Back to top

Medicare

Medicare, the health insurance program for older adults, covers preventive health services and screenings for many of these chronic diseases.

Visit the Medicare site to learn more about coverage:

• Medicare Health Information Overview
  Prevention is the first step in staying healthy, learn about recent additions to Medicare covered preventive services
   
• Guide to Medicare's Preventive Services (PDF–200K)
  Learn more about PDFs.
   
• The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
  All Medicare beneficiaries – no matter how they get their health care today or whether they have existing drug coverage – will be eligible for drug coverage under a Medicare prescription drug plan beginning January 1, 2006. The following links provide resources and tools to help make informed decisions regarding prescription drug coverage.
  You may also call 1-800-MEDICARE.
   
  • Medicare Prescription Drug Finder
    will help you learn about the new Medicare prescription drug coverage and find and compare local drug plans that meet your personal needs
     
  • 2006 Medicare and You Handbook (PDF–410K)
    Summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare. Available in English and Spanish.
    Learn more about PDFs.
     
  • Benefits Checkup RX*
    This is a good first step if you have Medicare and are considering whether to sign up for the new Medicare Prescription Drug Coverage.
     
  • Tools for Professionals

Back to top

References:

1. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, 1996. 
2. Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. 
3. Physical Activity Interventions Targeting Older Adults, Am J. Prev. Med 1998;15(4):316–333. 
4. Centers for Disease Control and Prevention. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2002. 
5. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2000. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2002.
6. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
7. Alexopoulos GS. Mood disorders. In: Sadock BJ, Sadock VA, eds. Comprehensive Textbook of Psychiatry, 7th Edition, Vol. 2. Baltimore: Williams and Wilkins, 2000.
8. Horwath E, Johnson J, Klerman GL, Weissman MM. Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry 1992; 49(10):817–23.
9. Depression Guideline Panel. Depression in Primary Care: Volume 1. Detection and Diagnosis. Clinical Practice Guideline, Number 5. AHCPR Publication No. 93-0550. Rockville, MD: Agency for Health Care, Policy and Research, 1993.
10. Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF 3rd, Alexopoulos GS, Bruce ML, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P. Diagnosis and treatment of depression in late life. Consensus statement update. Journal of the American Medical Association 1997; 278(14):1186–90.
11. Unverzagt FW, Gao S, Baiyewu O, Ogunniyi AO, Gureje O, Perkins A, Emsley CL, Dickens J, Evans R, Musick B, Hall KS, Hui SL, Hendrie HC. Prevalence of cognitive impairment. Neurology 2001;57:1655–1662.
12. Hendrie HC. Epidemiology of dementia and Alzheimer's disease. Am J Geriatr Psychiatry 1998;6(2 Suppl 1):S3-18.
13. Andersen, RN. Deaths: Leading Causes for 2000. National Vital Statistics Reports; Volume 50  No. 6. Hyattsville, MD: National Center for Health Statistics, 2002.
14. Centers for Disease Control and Prevention. Prevention and Control of Influenza — Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2002;3:5–6. 
15. Marrie TJ. Pneumonia. Clin Geriatr Med 1992;8:721–34.
16. Centers for Disease Control and Prevention.Web-based Injury Statistics query and Reporting System (WISQARS) [Online]. (2001). National Center for Injury Prevention and Control, Center for Disease Control and Prevention (producer). Available from: URL: www.cdc.gov/ncipc/wisqars. [2002 Oct 16].