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Archived Comments for: A survey of local health promotion initiatives for older people in Wales

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  1. Public health interventions on age-grounds

    Gareth Morgan, Welsh Assembly Government

    5 February 2009

    The survey of local health promotion initiatives for older people in Wales provides helpful data on service provision across the country. Experience from other countries suggests that there is a need to ensure that initiatives which improve health or reduce disease risk are fully maximised for population benefit. For example, data from the US highlights scope for further uptake of cancer screening and vaccination interventions in older adults (1). In this study, only about one-quarter of adults aged 50-64 accessed all of these disease control initiatives in 2004 and of concern is that this figure fell from about one-third in 1997 (1).

    A recent European study highlights the increasing life expectancy in the population as well as the inequalities observed between countries and the need for further improvements in population health (2). Of importance to the latter issue is to recognise new disease trends for older people, such as increasing incidence of sexually transmitted illness (3). Furthermore, there are also new ageing definitions being proposed, for example, ‘old’ (65-85 years), the ‘very old’ (85-100 years) and the ‘extremely old’ (over 100 years) (4). The optimal delivery of public health initiatives to reduce disease risk and promote healthy ageing may vary across these different age groups and also across different settings or contexts.

    There are also pharmacological interventions on age grounds that may also have increasing future significance to the public health agenda. For example, the potential use of low-dose aspirin at the age of 50 years has been suggested, given that risk of vascular events increases with age (5). Ongoing trials with low-dose aspirin will give further evidence on the balance of benefits and undesirable effects although there may also be scope for supporting research to be conducted on the possible effects of aspirin on the ageing process, perhaps using biomarkers such as telomeres (6).

    In conclusion, this survey is relevant to Welsh strategies such as the National Service Framework for Older People and it offers an important foundation on which further research may be conducted within the wider context of emerging evidence on health promotion issues in the ageing population (7). Further research might also contribute to a critical examination of related wider issues, such as health promotion theory and definition (8).

    Gareth Morgan, FRSPH. January 12th 2008.
    NSF for Older People Project Manager.
    Welsh Assembly Government.

    The author has no conflict of interest to declare and the above is a personal statement provided in the capacity as NSF for Older People Project Manager.

    1. Shenson D, Adams M, Bolen J. Delivery of preventive services to adults aged 50-64 : monitoring performance using a composite measure, 1997 – 2004. J. Gen. Intern. Med. 2008; 23(6): 733-40.

    2. Jagger C, Gillies C, Moscone F, Cambois E, Van Oyen H, Nusselder W, Robine JM; the EHLEIS team. Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet 2008; Nov. 14 (epud ahead of print).

    3. Bodley-Tickell AT, Olowokure B, Bhaduri S, White DJ, Ward D, Ross JD, Smith G, Duggal HV, Goold P. Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system. Sex. Transm. Infect. 2008;84(4):312-7.

    4. Brown G. Living end. Palgrave 2007; ISBN: 9780230517578

    5. Bulugahapitiya U, Siyambalapitiya S, Sithole J, Fernando DJ, Idris I. Age threshold for vascular prophylaxis by aspirin in patients without diabetes. Heart. 2008 Nov;94(11):1429-32.

    6. Morgan G. Salicylates, reduced disease risk, survival advantage and telomere length.

    7. Harari D, Iliffe S, Kharicha K, Egger M, Gillmann G, von Renteln-Kruse W, Beck J, Swift C, Stuck A. Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice. Age Ageing. 2008 Sep;37(5):565-71

    8. Tannahill A. Health promotion : The Tannahill model revisited. Public Health 2008;122:1387-91.

    Competing interests

    No competing interests.