Healthy Aging and Public Health - Position Statement
I. ASTHO Supports Comprehensive Policies and Programs that Support Healthy Aging
The Association of State and Territorial Health Officials (ASTHO) supports state and territorial health agencies in their work to promote healthy aging in their communities. Promoting healthy aging across the lifespan ensures that health policies and programs address the unique needs of both each age group and the community as a whole.
II. ASTHO’s recommendations include strategies for state and territorial health officials to prevent illness and injury by addressing the social and environmental determinants of health, improve medical and social services, and create a better future through planning and research.
- Aging in Place/Community-Based Living: Identify policies or waivers to support Medicaid or other state funding for community-based care options while supporting programs and initiatives that consistently engage older adults to prevent social isolation. This also includes creating pathways and vehicles for the aged to continue to contribute to and be active in society.
- Food Security: Implement policies and programs through organizational and programmatic nutrition standards to address older adults’ lack of access to healthy and affordable foods, improve food nutritional quality, and enhance food safety measures.
- Housing: Promote universal design to increase the possibility of aging in place and provide opportunities for older adults to live in safe, adequate, and affordable neighborhoods that are also close to family members, services, and transportation options. Identify presence of naturally occurring retirement communities.
- Injury and Falls Prevention: Promote effective, measureable, and sustainable injury and falls prevention initiatives that focus on education programs for older adults and caregivers; progressive physical activity programs to improve mobility, strength, and balance; medication review and management; vision exams and vision improvement; and home safety assessment and home modifications. Additionally, promote universal design in the community as a strategy to decrease injuries and falls.
- Mobility: Improve modes of accessible and safe public and private transportation, which are key to helping older adults maintain their independence. Consider developing or updating a comprehensive city planning guide to address accessibility issues for older adults, increasing safety and access to physical activity by improving sidewalks and walking trails, building or enhancing physical recreation facilities and parks, and promoting appropriate vision and hearing screening.
- Alcohol Abuse: Determine systematic strategies for detecting alcohol abuse in older adults, which may be hidden or misinterpreted as age-related illness; improve screening by educating caregivers on the signs and symptoms of alcohol abuse; develop specialized treatment approaches for older adults in a diversity of demographic populations; support local behavioral health resources that may provide abuse services and encourage the formation of rehabilitation services for older adults; and educate older adults on the dangers of mixing certain prescriptions with alcohol.
- Cultural Competence: Integrate racial or ethnic, LGBT, educational, socioeconomic, and geographic disparities into your interventions and outreach to help ensure that materials and initiatives are culturally appropriate.
- End-of-Life Care: Address the need to access and implement end of life directives and protocols. This includes supporting the development of and access to all forms of palliative care, including maximizing opportunities for hospice care.
- Family Caregiver Support: Identify and highlight methods for supporting caregivers in the community by providing them with access to appropriate resources and support. Promote barrier-free workplaces with long-term care benefits, flexible work hours, and part-time work for older adults and their caregivers
- Financial Security: Advance services surrounding financial care planning to care partners, families, and older adults, and explore and initiate financial benefit options (e.g., tax deductions, credits, Medicaid formularies, asset protection, long-term care insurance, federal health savings accounts, and reverse mortgages)
- Innovative Technological Techniques: Leverage advancements in telehealth and telemedicine, which serve as viable options for accessing physical and mental care and services for adults whose mobility has declined, including exploring licensing requirements to allow maximum use of telehealth. Additionally, leaders should explore strategies for providing and receiving reimbursement for home monitoring
- Mental and Behavioral Health: Employ policies and procedures that help protect older adults from social isolation, depression, and suicide. Consider implementing routine mental health universal screenings and employing navigators to help older adults navigate the healthcare system, co-locate health services and mental health services, and promote evidence-based home or clinic-based depression care management or cognitive behavior therapy interventions via statewide trainings and referrals. Encourage health plans and providers to expand access to “one stop shop” clinics located in communities proximate to older adult populations. Leverage resources to support CDC’s Healthy Brain Initiative.
- Oral Health: Increase state and community-based oral health surveillance; form working partnerships between public community stakeholders, private stakeholders, and oral health providers to improve access to and quality of dental care; and provide education to empower older adults and their caregivers to advocate for necessary services.
- Prescription Drug Misuse: Support policies to reduce the use of antipsychotic medications and other drugs for long-stay nursing home residents and other older adults, and enhance the use of non-pharmacologic approaches and person-centered dementia care practices where appropriate.
- Preventive Vaccinations and Screenings: Increase preventive screening among older adults, as recommended by the U.S. Preventive Services Task Force. This includes influenza and pneumococcal vaccinations, and screening for diabetes, hepatitis, osteoporosis, and colorectal cancer.1,2
- Workforce: Use competency-based educational strategies and materials to best serve older adults’ needs and bridge community health workers and community health teams. Ensure that individuals care for older adults in a manner that is culturally competent and maintains respect and dignity for older adults.
Planning and research
- Research: Evaluate and translate evidence- and practice-based research to strengthen state and territorial health agencies’ capacity to apply policy, organizational, and individual behavior change strategies to continually enhance older adults’ quality of life.
- Resilient Communities: Characterize the population by using community and state data about demographics, health status, medical conditions, service requirements, and other needs in order to develop and maintain medical and “special needs” registries (medical equipment, transportation, medicine, etc.) in the event of an emergency.
- State Plans for Older Adults: Engage in developing, maintaining, and executing the state aging plan and state Alzheimer’s plan. These plans provide a strategic framework unique to each state’s populations that help prioritize action items and inform funding opportunities. As part of this planning process, ASTHO recommends that states:
○ Assess the current clinical and social service databases and identify primary data collection needs to identify if older adult needs are being met within the community, including access to culturally and linguistically appropriate services.
○ Examine the potential for geographic information systems to help identify where older adult populations are located in the community and locate potential overlaps between health and housing facilities or neighborhoods in order to strategically target programs and initiatives.
○ Integrate cognitive health and impairment into state and local government plans to include all potential public health opportunities (e.g., coordinated chronic disease, preparedness, injury or falls prevention, and transportation).
○ Initiate, foster, and maintain strategic partnerships at the local, tribal, state, and national levels. These partnerships can both promote integrative development of programs and policies and identify ways to fund multifaceted, collaborative projects with public health departments and related agencies, academia, aging coalitions and networks, and aging agencies.
III. Background on Healthy Aging
As Americans live longer, they face an increasing risk of developing Alzheimer’s disease and other dementias as well as other chronic conditions, and more than a quarter of Americans and two out of three older Americans have multiple chronic conditions. In addition to the human cost of these conditions, employees’ need to care for loved ones costs American businesses almost $34 billion each year.3 To build an environment conducive to healthy aging and enhance the quality of life of older adults and their caregivers and loved ones, it is essential to engage stakeholders at all levels. State health officials and their leadership teams can be instrumental in engaging these stakeholders to continue to build an environment that is conducive to healthy aging for all.
Healthy older adults can be essential contributors to their communities through volunteering, participating in the activities they enjoy, and being mentors and caregivers for loved ones. As the National Prevention Strategy notes, states can promote healthy aging by improving older adults’ access to healthy foods, safe walking paths, safe and affordable housing options, opportunities for socialization with individuals in a range of age groups, and financial stability.4 This work requires partnering with leaders in transportation, housing, and parks and recreation at the federal, state, and local levels.
ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate policy committees and approved by the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.
Prevention Policy Committee Review and Approval: April 2015
Board of Directors review and approval: June 2015
Policy Expires: June 2018
For further information about this position statement, please contact ASTHO Prevention Policy staff at firstname.lastname@example.org. For ASTHO policies and additional publications related to this position statement, please visit www.astho.org/Policy-and-Position-Statements/.
- CDC, Administration on Aging, Agency for Healthcare Research and Quality, and Centers for Medicare and Medicaid Services. Enhancing Use of Clinical Preventive Services Among Older Adults. Washington, DC: AARP, 2011. Available at www.cdc.gov/aging and www.aarp.org/healthpros.
- Published Recommendations. U.S. Preventive Services Task Force. Available at: http://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations. Accessed 12-1-14.
- The MetLife Caregiving Cost Study: Productivity Losses to U.S. Business. (2006). MetLife Mature Market Institute and the National Alliance for Caregiving. Available at http://www.caregiving.org/data/Caregiver%20Cost%20Study.pdf.
- National Prevention Council, National Prevention Strategy, Washington, DC. HHS, Office of the Surgeon General, 2011.