As life expectancy continues to increase, issues arise about the quality of life of older people. One aspect of quality of life currently receiving a great deal of attention is the health status of older adults. Although the incidence of acute illness decreases with age, the probability of living with a chronic illness or disease increases. The majority of older Virginians have at least one chronic health problem; having to cope with multiple conditions is common with advancing old age. Another indicator of the health status of older individuals is their level of functioning or degree of disability resulting from their health conditions. According to the 1990 census, approximately 20 percent of noninstitutionalized Virginians 65 years of age and older report having one or more health conditions that limit their mobility and their personal care activities.

When considering health status in relationship to quality of life, health-care professionals and policy decision-makers must take into consideration the different experiences of subgroups of older adults--i.e., women, ethnic minorities, and rural elders--living in Virginia. Because of their longer life expectancy, women are more likely than their male counterparts to experience prolonged chronic health problems. Whereas men's lives are shortened by higher rates of fatal illnesses, older women's lives are filled with bothersome symptoms of nonfatal ones. When compared with white elders, older members of most ethnic minority groups report poorer overall health and more severe functional limitations. Socioeconomic factors, rather than group membership per se, contribute to health problems among minority elders. Finally, geographic residence contributes to differences in health status between older adults. Although rural elders perceive their health to be poorer than their urban counterparts, differences in health status also occur within the rural population. Rural non-farm elders, who represent the largest segment of rural elders, have the worst health profiles of older inhabitants of any other residential area.

HEALTH BEHAVIORS AND SUPPORTS

Health in the later years often is linked directly or indirectly to patterns of health behaviors throughout adulthood. Healthful habits can modify a number of aspects of biological aging, such as cardiac and pulmonary reserve, glucose tolerance, bone loss, cholesterol levels, and blood pressure. Good health habits cannot guarantee protection against disease, but they can greatly reduce the risk of disease and enhance the older adult's ability to manage most chronic health problems.

Personal Health Habits

During the past two decades, a greater emphasis has been placed on the value of individual behavior change and the importance of health promotion for preventing and managing disease. Recent outcome studies demonstrate that it is never too late to begin health-behavior modification, especially in the areas of exercise, nutrition, and stress reduction.

Whether exercising with others in a formal setting or alone, regular physical activity benefits the functioning of most body systems, including the heart, muscles, bones, lungs, and brain. Besides these physical health benefits, older adults who exercise also reap psychological benefits, such as lower levels of stress and anxiety and higher levels of self-esteem. Even small increases in physical activity apparently can improve older persons' functional abilities and continued independence.

Nutrition also plays a key role in maintaining good health as well as facilitating recovery from illness. As for specific behaviors, many older people have better eating habits than their younger counterparts. For those individuals who need to modify their diets because of specific health problems, older adults benefit just as much as younger adults from diet modification and weight reduction or control.

The stress associated with changes in health status also can influence the quality of life experienced by older adults. Older adults must learn to cope with changes associated with aging and develop skills to cope with feelings of frustration, anger, and depression that often accompany chronic illnesses. Older adults benefit most from stress reduction and management programs that help them to make informed choices, adopt new perspectives and generic skills that they can apply to new problems, practice new health behaviors, and maintain or regain emotional stability.

External Support

Elders are playing an expanded role in assuming greater self responsibility both for the prevention of illness and for the enhancement of their health. But personal behaviors cannot be viewed in isolation as social and economic factors also influence the lifestyle and behavior choices of older adults. For example, families play a pivotal role since good health practices can be encouraged or discouraged by family members. When health problems result in temporary or long-term limitations, aging parents often turn to their adult children for assistance for such things as household chores, transportation, and emotional support. Thus, in some situations, it may be beneficial for the family unit to learn about and understand the importance of engaging in health-promoting behaviors.

The availability of and access to community support programs also influence the health and well-being of older adults. For example, participation in senior centers and adult day centers provide opportunities for older adults to engage in healthy behaviors and activities that promote independence in later life. Other community resources, such as medical and mental health services, also enhance functioning in later life. Unfortunately, many older adults do not participate in supportive and/or preventive programs because of limited finances and health insurance restrictions.

ENSURING THE HEALTH OF OLDER VIRGINIANS

At the 1995 White House Conference on Aging (WHCoA), 18 of the 45 resolutions passed by the delegates specifically supported health related initiatives for older adults. For example, delegates resolved to support policies that preserve the nature of Medicaid, ensure the future of the Medicare program, ensure the avail-ability of a broad spectrum of health-related services, encourage personal responsibility for one's health, and promote prevention and wellness throughout one's lifespan.

Virginia's former Secretary of Health and Human Resources, Kay Coles James, offered the commonwealth's support for a variety of the WHCoA resolutions, including those addressing the empowerment of citizens and calling for the honest evaluation and reform of current health-care and social-service programs. As policymakers transform these resolutions into actions, Virginia's citizens and government leaders must advocate innovative health-care reform strategies that place greater emphasis on health promotion and prevention activities to reduce risk factors in the aging population and subsequent morbidity and mortality from chronic disease. Prevention not only improves quality of life, but also can reduce the overall cost of health care. Thus, programs and services that promote and support 'healthy aging' are as crucial to one's personal quality of life as they are to a viable health-care system.

Karen A. Roberto is director of the Center for Gerontology and a professor of family and child development at Virginia Tech. She has also been associate director for gerontology at the Geriatric Education Center at the University of Colorado Health Sciences Center and professor and coordinator of the gerontology program at the University of Northern Colorado. She is a member of the editorial board and a book review editor for the Journal of Women and Aging and sits on the editorial board of Family Relations. She holds fellow status in the Geron-tological Society of America and has served on the board of directors for the Association for Gerontology in Higher Education. Roberto has written articles related to aging and the elderly for numerous journals and other publications.

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