Staying healthy is a top concern for many older adults, particularly in the areas of staying mentally sharp and physically fit. AARP encourages people to stay healthy as they age, in part, by assuming personal responsibility for their health by taking preventive measures to guard against illness and disease. While access to preventive services and quality health care are important components of health promotion, they are not enough. Social determinants of health—such as access to employment, education, housing, healthy foods, safe streets and neighborhoods, and social supports—are important predictors of health outcomes and health behaviors. Policymakers at all levels of government should consider interventions and public policies that can reduce barriers to healthy living and influence health outside of formal medical care systems. Policymakers and private entities, including insurers, and programs such as those offered in senior centers, should cover evidence-based exercise programs that have shown improvement individuals’ health and well-being.
To maximize their health outcomes, it is important for consumers and their family caregivers to understand how to engage effectively with medical systems as well as community-based resources that support and promote health. As formal health systems shift more decisions and costs to consumers and their family caregivers, it is important that they be equipped with the knowledge and skills they need to successfully work with these systems to maintain and/or improve health.
Although definitions of consumer and family engagement vary, for purposes of AARP public policy, consumer and family engagement means (a) providing consumers and their family caregivers with the knowledge, skills, and other tools they need to play an active role in maintaining and/or improving health and well-being and (b) helping consumers and family caregivers overcome structural and personal barriers to engaging with formal and informal systems of care.
It is important to note that, for a variety of reasons, not everyone has the capacity for or interest in engaging in activities that maintain, improve, or support their health. These individuals should not be penalized for this. Rather, public policymakers and private entities with interest in the field should work together to identify promising strategies to help people overcome barriers to engagement.
Maintaining cognitive health is a key component of healthy aging. Emerging evidence suggests that lifestyles that include physical exercise, good nutrition, social interaction, stress reduction, healthy sleep habits, and mental engagement can improve cognition and potentially reduce the risk of cognitive impairment and related forms of dementia. As the US population ages, the costs of providing care and services to individuals with cognitive decline and/or related dementia are likely to increase, impacting health and quality of life for individuals and their families and straining health resources. Policymakers must consider steps that individuals, the health care sector, government entities, and the private sector can take to maintain and improve cognitive health throughout the lifespan.
Finally, a growing number of consumers now have access to their own health information through electronic health records, as well as to increasing amounts of information on all aspects of health care through online sources. On the one hand, this information may help consumers and family caregivers make better health care decisions. On the other hand, decisions concerning insurance coverage, provider networks, and treatment options have become more complex and now demand higher-level understanding and engagement from consumers and family caregivers. Some consumers face challenges that prevent them from actively advocating for themselves. Consumers with low health literacy, people with cognitive impairment, and those who are ill, in pain, or experiencing stress from their health condition(s) may not be in a position to actively engage. In addition, for consumers, accessing transparent information on price and quality performance remains challenging. Many health care decisions—e.g., whether to seek health care and where to go for care—can have important financial consequences for individuals and the health care system.
To promote and encourage greater engagement from consumers, transparent information on price, quality, and outcomes must be available in ways that are accessible to consumers and families. The infrastructure should be in place to help consumers and family caregivers understand how that information can help them make better choices. Public and private entities should provide assistance and adequate support to empower individuals and help them self-advocate so that they can better engage with providers, health care systems, and health insurers. A high-quality health care system should adapt to the individual needs of consumers and their families and should build supports for family caregivers or others who take on the role of advocating and caring for people unable to advocate for themselves. Consumers’ health goals, preference, and outcomes should be elicited and become part of the person’s health care plan and treatment options.
Health Promotion and Consumer and Family Engagement in Health: Policy
When awarding grants for pilot programs designed to improve the health of people age 55–64 through community-based public interventions, the federal, state and local governments should develop and implement methods to evaluate the impact of the CDC Healthy Aging Program on Medicare costs.
Congress should review the adequacy of federal funding—in the US and its territories—to support a public health care infrastructure that fosters health promotion, disease prevention, and consumer and family engagement activities.
Disadvantaged and racial and ethnic groups that have experienced discrimination
When developing and implementing a national prevention and health-promotion outreach and education campaign, the federal government, along with its private-sector partners, should identify and take into consideration the special needs, concerns, and barriers faced by members of racial and ethnic groups that have experienced discrimination. Such campaigns should be designed and delivered in a culturally and linguistically appropriate manner.
When developing web-based tools to disseminate health-promotion and disease-prevention information and to generate personalized prevention plans, the federal government should ensure that such tools are developed in a culturally competent manner, make tools available in as many languages as is feasible, and/or provide some sort of website functionality for easy translation.
Promoting public health
Federal and state governments should undertake a variety of activities designed to promote public health, including:
- identifying health-promoting behaviors, the ways in which such behaviors are linked to health improvements, and the costs and benefits associated with health-promoting behaviors;
- adequately funding health-promotion programs (e.g., nutritional screening and counseling, exercise and weight-control programs, and drug-, alcohol-, and tobacco-addiction treatment programs), preventive health education programs for people most in need, and access to preventive health services;
- designing and funding health-promotion programs that focus on the needs of all communities, including racial and ethnic groups that have experienced discrimination and low-income consumers, where their needs are not met by existing programs;
- educating individuals about risk factors for prevalent health conditions, behaviors that reduce health risks (e.g., exercise and nutrition), and the importance of preventive care (e.g., mammography, cancer screening, early immunizations for children, and influenza and pneumococcal pneumonia immunizations for older Americans);
- educating the public about the effect of guns and violence on the public’s health, as well as the widespread human costs of preventable injuries and premature deaths;
- supporting the inclusion of prevention and health-promotion content in curricula for health care professionals;
- funding and supporting community-based strategies to address the social determinants of health;
- supporting outreach and education about the value of engaging in healthy behaviors, with information targeted to policymakers, consumers, family caregivers, and employers; and
- identifying ways to support the implementation of evidence-based, nondiscriminatory workplace wellness programs by small employers.
Through appropriate funding and programs, all levels of government should assist individuals in fulfilling their personal responsibility to safeguard their health by taking advantage of health-education opportunities and affordable and appropriate preventive health measures.
Health care priority
The public and private sectors should promote and support policies that make consumer and family caregiver engagement a health care priority. Policies should reflect the importance of consumers and family caregivers playing an active role in their health care and their need to access information and support when desired.
Individuals’ role in their health
All consumers should be encouraged and empowered to take control of their personal health. Individuals have an important role in maintaining their health, to the degree they are able, by pursuing a healthy lifestyle, using preventative services and health screenings, following clinician’s advice, and playing an active role in health care decisionmaking.
Consumers, particularly those with chronic conditions, should have access to and participate in relevant health self-management programs. The public and private sectors should fund and support education about health self-management programs to empower consumers and provide them with the skills they need to establish and meet their personal health goals. Self-management programs should be tailored so that vulnerable populations disproportionately impacted by certain health conditions have equitable access and opportunity to participate.
Consumers should have the right to choose when and how they want to participate in their health care, including the option to designate a family caregiver as an advocate. The public and private sectors should ensure that privacy policies are not a barrier to caregiver engagement. Consumers who do not actively engage in their health care should not be penalized.
The public and private sectors should support and fund education and training on consumer and family caregiver engagement. These trainings would educate providers on how to support consumer engagement and educate consumers and family caregivers on how to engage with the health care system and relevant community-based organizations. Training should be accessible, culturally and linguistically appropriate, provide information on culturally competent person- and family-centered care, and actively encourage consumer input and family caregiver engagement.
The public and private sectors should conduct research on the value and impact of effective consumer engagement in health care design transformation, shared decisionmaking, outcomes, patient-reported measures, and cost/spending. Research should focus on the various aspects of the health care system and on older adults of all races and ethnicities. The findings should be made available to the public and easy to understand.
The public and private sectors and individuals should work together to develop policies that promote shared decisionmaking between consumers, family caregivers, and their health care team.
Consumer and family caregiver engagement definition and quality measures
The public and private sectors should work with a variety of stakeholders, including consumers, to develop consistent definitions of consumer and family caregiver engagement. Public and private-sector efforts to support consumer and family engagement may include the development and use of measures to identify needs and target resources. Measures should be meaningful to consumers, take into consideration personal health goals, be person- and family-centered, and reflect consumers’ medical and social needs.
Federal and state governments should take the lead in disseminating findings from health behavior modification research to health care systems and clinicians. Emphasis should be placed on disseminating promising practices and focusing on personal goals and purpose as a way to modify consumer behavior.
The public and private sectors should design new health technologies that lead toward sustained changes in health behavior. Technologies should be easy to use, accessible, and tailored to individuals’ interests and goals. (See also Chapter 11, Regulation, Monitoring and Enforcement section—Privacy)