“Aging societies reflect a triumph of science and technology over premature death.” So begins a recent article on optimizing health in today’s societies. While many personal, societal, and policy challenges confront aging populations, this article urges us to recall that in a single century, 30 years were added to the average life expectancy. Such increases continue today, with an average of three months being added to life expectancy at age 65 each year. In 2012, for the first time in history, the US population included more individuals over 65 than under 15 years old. Those individuals over 65 are also healthier than ever before. Even being born 10 years apart was associated with “strikingly better outcomes” for younger participants on tests of cognition and functional health in old age.
However, the many successes in treating acute illnesses that have led to these positive developments mean that “we confront an entirely new set of challenges stemming from lives that last longer than our ancestors ever could have imagined.” In particular, chronic diseases brought about by lifestyle now require much greater attention. The past century’s boom in prosperity has also brought about some lifestyle changes that impose increasing risks and burdens for our aging society. Many of the technological advances have meant that individuals are engaging in less physical activity, while cheap, easy access to high-calorie, processed food has brought about increases in obesity. A century ago, 40 percent of prospective military recruits failed to meet minimum weight requirements. Today, about the same percentage is obese. In fact, experts warn that in a single generation, obesity could erase all the health gains made in the past 50 years, due to its association with a number of chronic medical conditions including hypertension, diabetes, and arthritis. In light of this, the authors of this article emphasize that “In addition to medical treatments that target disease, the focus must expand to encompass behavior change aimed at disease prevention.”
The key to this disease prevention is behavior change, which has been notoriously difficult to accomplish. Two main avenues have traditionally been employed in attempts to achieve this: increasing public knowledge and environmental modifications. Knowledge alone seems insufficient to bring this about; most Americans are aware of the importance of diet and exercise for health, but many fail to act on this knowledge. Some successes have been achieved through environmental modification and incentives, such as increasing access to sidewalks, banning smoking in restaurants, and providing healthier food options in schools, worksites, and convenience stores.
The authors return to the main cause of the drastic improvements in longevity and health when they propose a potential third avenue to behavior change: technology. They write that “Our best chance of realizing the potential gift that longevity represents lies in science and technology.” In particular, they point out the promise of mobile technologies, noting that smartphone technology “has completely changed our ability to both measure behavior and respond to it at the very moment that users are making health decisions.” Mobile technology promises an ability not only to track behavior, but also to communicate with health professionals and even run diagnostic tests outside of a hospital. They suggest that the ability to accurately measure behaviors with such technology presents an opportunity to tailor recommendations for individuals across their lifespan. They also note that tracking behaviors may prove motivating enough to bring about lifestyle change. If shared with others, tracking behavior with mobile technology also provides the opportunity for feedback that can occur in personalized and meaningful ways. While adoption of technology has traditionally been considered difficult for older populations in particular, the authors view this as primarily a challenge to designers. They cite the example of Skype as proof that older adults have shown a willingness to adopt a technology when they are convinced of its value and when the interface is well-designed.
The authors conclude that “Given the scope of the challenges in changing a wide range of health related behaviors, we will need to motivate a number of small lifestyle changes through a variety of techniques across a wide range of ages.” Mobile technologies are a promising new route to the encouragement of lifestyle changes that can be used in conjunction with the traditional approaches of public health education and environmental modification. The health risks posed to aging adults in the twenty-first century will need to be tackled by greater overall attention and resources dedicated to the risks posed by lifestyle and by creative attempts to tackle this problem from multiple directions.
Carstensen LL, Rosenberger ME, Smith K, et al. Optimizing health in aging societies Public Policy Aging Report (2015); 25 (2): 38–42.