Health promotion for older Americans in the 21st century

Objectives. To provide a broad overview of the role of the individual, the physical environment, and the social environment on health and functioning in older adults (65 and older), and to highlight interventions and recommendations for action on each of these levels. Data Sources. Published studies and government reports on health and functioning in older Americans and on the individual, social and physical environmental contributors to health were identified through journal and government documents review and computer library searches of medical and social science data bases for 1980-1993. Study Selection. Preference was given to published studies and government reports that focused specifically on behavioral and environmental contributors and barriers to health promotion in Americans 65 and older and/or that highlighted creative interventions with relevance to this population. Both review articles and presentations of original research were included with the fatter selected based on soundness of design and execution and/or creativity of intervention described. Data Extraction. Studies were examined and their findings organized under three major headings: (1) behavioral risk factors and risk reduction, including current government standards for prevention and screening (2) the rob of the physical environment; and (3) the role of the social environment in relation to health promotion of older adults. Data Synthesis. Although most attention has been paid to the role of behavioral factors in health promotion for older adults, a substantial body of evidence suggests that physical and social environmental factors also play a key role. Similarly, interventions that promote individual behavioral risk reduction and interventions targeting the broader social or physical environment all may contribute to health in the later years. Conclusions. With the rapid aging of America's population increased attention must be focused on health promotion for those who are or will soon be older adults. Promising intervention strategies addressing the individual, the physical environment, and the social environment should be identified and tested, and their potential for replication explored, as we work toward a more comprehensive approach to improving the health of older Americans in the 21st century.