Factors leading to morbidity and mortality among older adults include overweight, inadequate fruit and vegetable consumption, physical inactivity, and cigarette smoking. Healthy People 2010 (HP) is a comprehensive set of health objectives that identify public health priorities and quantifiable objectives for the nation by the year 2010. Relevant HP goals include a decrease in underweight and overweight to 40% of the adult U.S. population greater than 20 years of age, an increase in the percentage who consume a minimum of 2 fruits and 3 vegetables per day to 75% and 50%, respectively, a decrease in the number who participate in no leisure-time physical activity to 20%, and a decrease in the number of cigarette smokers to 12%.
Overweight: Overweight and obesity account for an estimated 300,000 deaths per year in the U.S. with an economic burden of $117 billion in 2000. Associated health problems include, but are not limited to, heart disease, diabetes, cancer, arthritis, reproductive complications, and psychological disorders. Here, the term 'over weight' includes two individual public health terms: overweight, a BMI of 25.0-29.9 kg/m2, and obesity, a BMI greater than or equal to 30.0 kg/m2. BMI is a measure of obesity, which is obtained by dividing the weight in kilograms by the height in meters squared. Individuals are considered overweight if they reported a BMI of greater than 25 kg/m2.
The median values by state (for 50 U.S. states, the District of Columbia, and Puerto Rico) of overweight persons aged 55 years or older were gathered from 81,137 BRFSS respondents. The corresponding values were gathered from 55 astronauts and 257 comparison participants, and the resulting values are summarized. The prevalence of overweight tends to decrease with increasing age for both the astronaut and BRFSS populations, but increases in the comparison participants. Nevertheless, as all three groups show more than 50% overweight prevalence in both age groups, they fall far short of the desired HP 2010 goal.
Inadequate Fruit and Vegetable Consumption: Diets rich in fruits and vegetables have been associated with a reduction in cardiovascular disease, some cancers, and diseases of the gastrointestinal tract. This led to the establishment of 5 A Day for Better Health, a comprehensive health promotion program designed to increase the consumption of fruits and vegetables to five or more servings per day by 2010. This program is sponsored by the National Cancer Institute in conjunction with the U.S. Department of Health and Human Services and the Produce for Better Health Foundation. Since the program's inception in 1991, the U.S. Department of Agriculture reports that the average daily consumption of fruits and vegetables by adults aged 18 years and older increased from 3.9 to 4.4, which is only about half a serving less than the recommended 5 servings per day.
Subjects in the LSAH and BRFSS populations were asked about their general dietary habits, including the frequency of fruit and vegetable consumption. Excluded is the consumption of fruits and vegetables served as mixed dishes. The eligible participants for this portion of the surveys are 29 Astronauts, 207 comparisons, and 71,517 BRFSS participants. The data were then analyzed to determine the percent of participants who consumed at least five servings of fruits and vegetables per day.
The prevalence of individuals who reported eating at least 5 servings of fruits and vegetables per day tends to increase with increasing age for each of the populations. Overall, both groups of LSAH participants have a higher prevalence of those eating at least five servings of fruits and vegetables as compared to the U.S. population, and are well on their way to meeting the HP 2010 goals.
Physical Inactivity Physical activity has been shown to contribute to overall health and wellness. Although benefits include disease risk reduction, increased musculoskeletal strength and function, and increased psychological well-being, over 60% of adults do not engage in the recommended amount of physical activity, and 25% are not active at all. Strenuous physical activity is not required to achieve health related benefits. Sessions can be as simple as 30 minutes of brisk walking or 15-20 minutes of jogging on most days of the week, depending on the fitness level of the individual. Thus, it is imperative for older adults to consult a medical professional before beginning a new program of physical activity.
LSAH and BRFSS survey participants were asked if they participated in any leisure-time physical activity regardless of frequency, duration, and intensity. Of 52 Astronauts, 266 comparisons, and 71,517 BRFSS participants, the percentage of those reporting physical inactivity is presented. The prevalence of LSAH participants who reported participating in no leisure-time physical activity tends to decrease with increasing age for each of the populations. All astronauts in the 65-74 stratum reported participation in physical activities. In contrast, BRFSS respondents show a significantly higher prevalence of physical inactivity in both age groups. In this category, all LSAH participants surpassed the HP 2010 goal.
Smoking Cigarette smoking has been called the single most preventable cause of premature death in the U.S., with over 400,000 attributable deaths per year and a 1998 excess of $75.5 billion in healthcare costs. Though the number of adult cigarette smokers has decreased significantly, a 2000 survey indicated that there are still 46.5 million current smokers. Older adults are particularly at risk of developing a smoking-related disease such as cardiovascular disease, because they generally have smoked longer and are heavier smokers.
The eligible participants for this portion of the surveys are 52 astronauts, 266 comparisons, and 116,690 BRFSS participants. Present smokers, along with those who have smoked at least 100 cigarettes in their lifetime, are classified as current smokers. Those who do not currently smoke but have smoked at least 100 cigarettes in their lifetime, are classified as current smokers but have smoked at least 100 cigarettes in their lifetime are classified as former smokers. Smoking history data were collected differently for each of the surveys. The LSQ combined data for both current and former smokers, i.e., as ever smokers, whereas the BRFSS distinguished between the two. Consequently, results for the 3 populations cannot be directly compared as with the other health factors. For LSAH populations the prevalence of ever smoker increases with increasing age. For BRFSS participants, the prevalence of current smokers decreases with increasing age, while the prevalence of former smokers increasing age.
Summary In general, LSAH participants are performing as well as or better than the general U.S. population with regards to the four health indicators examined here. Note that the results are based on self-reporting of respondents, which are subject to misreporting and recall bias. This review is also limited by the use of BMI because this weight-to height ratio does not distinguish between fat and muscle weight, so that a physically fit, muscular individual could inappropriately be classified as overweight. Also, this report only includes individuals aged 55 and older. Consequently it is also limited by survivor bias, i.e., survey participants may live healthier lifestyles, which have allowed them to outlive those with less healthy lifestyles.
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