Chronic diseases disproportionately affect older adults and are associated with disability, diminished quality of life, and increased costs for health care and long-term care. Today, about 80% of older adults have at least one chronic condition, and 50% have at least two. These conditions can cause years of pain and loss of function. Public health efforts can help Americans avoid preventable illness and disability as they age. Research has shown that poor health is not an inevitable consequence of aging. Effective public health strategies already exist to help older adults remain independent longer, improve their quality of life, and potentially delay the need for long-term care.

Our growing knowledge of critical factors that help to protect and promote health has led to opportunities to address emerging public health issues that affect older adults. These include opportunities to:

• Promote an up-to-date measure for clinical preventive services. Population-based data on preventive services recommended for older adults, such as immunizations and regular health screenings, are currently monitored individually. An up-to-date measure would help us to promote these services and collect better data to improve public health services and guide policy.
• Address depression. Depression affects nearly 7 million older adults, but many do not receive treatment. Undiagnosed and untreated depression among older adults can increase complications from other conditions, such as heart disease and disability, as well as risk for death.
• Promote caregiving interventions. In 2004, about 35 million people were providing unpaid care for family members, friends, and neighbors for adults aged 50 years or older. This number is expected to rise sharply as the U.S. population ages. Family caregiving has been associated with increased levels of depression and anxiety, as well as with high use of psychoactive medications, poor self-reported physical health, compromised immune function, and increased mortality among caregivers.
• Address end-of-life issues. The public health community has only recently come to recognize end-of-life issues as a public health concern. These issues are important because of the substantial burden and impact on people who are dying and their family members, as well as the financial costs for individuals and society and the potential to prevent suffering.

In 2007, CDC and the Alzheimer’s Association released The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health (http://www.cdc.gov/aging/roadmap). This publication outlines specific actions for making cognitive health a major public health issue and preparing society for dealing with this issue. CDC has several projects associated with the priority actions outlined in this publication, including Supporting the HAN to increase CDC’s understanding of the public’s needs and beliefs about cognitive health, including those of caregivers and health care providers: supporting the Alzheimer’s Association to develop and implement community demonstration projects to increase knowledge and foster positive attitudes about cognitive health among African American baby boomers, and developing, testing, and implementing a survey to assess and monitor the public’s beliefs about the impact of cognitive decline at national and state level to guide policies and programs.