Forging ahead: Linking health and behavior to improve quality of life in older people

This chapter will focus on conceptual and methodological issues related to health promotion/disability prevention for older people. The first section will begin with a discussion of why older people, as compared to younger persons, are not traditionally seen as targets of health promotion efforts. In recent years several national working groups have been established to examine how older people's health and functioning can be improved. Their objectives and recommendations for older Americans will be reviewed. The second section will address the conceptual framework underlying health and behavior research supported by the National Institute on Aging. The movement from correlational studies to studies of basic mechanisms linking health and behaviour will be discussed, with particular attention to interactions with aging processes. Examples of health and behavior research representing these processes will be presented as well as methodological issues in the measurement of health and functional outcomes for older people. Measurement of quality of life in the cognitively impaired is seen as especially difficult. The third section will review several common themes emanating from these research studies. These include attention to a life course perspective, variability in aging processes, alternative research approaches, and intervention strategies for both initiating and maintaining recommended behavioral changes. A fourth section will review current areas of investigation at the National Institute of Aging. Successful intervention strategies in both community and institutional settings will to presented. These include: (1) a comprehensive behavioral and environmental falls prevention program which has been shown to reduce falls in the community; (2) a health education program to increase older women's use of cancer-related health practices; and (3) behavioral strategies for reducing incontinence in nursing homes. A new NIA initiative on special care units for persons with dementia will also be discussed. The fifth and final section will deal with issues involved in the translation of research into policy and practice. Approaches for increasing the relevance of research to policymakers will be discussed.