Life expectancy has increased substantially during this century, and Texans who reach age 60 years have a high probability of living to age 80. Assuring that the added years are productive and satisfying often requires prevention and control of developmental changes and chronic health conditions. Chronic diseases (i.e., heart disease,diabetes, arthritis) are a particular concern because they can contribute to long term illness, diminish quality of life, and greatly increase health care costs.1 In 1994, nearly 40 percent (12 million) community-dwelling older adults were limited by chronic conditions. Of these, three million were unable to perform activities of daily living such as bathing, shopping, dressing or eating, placing caregiving demands on family and friends.2
The Texas Department on Aging’s Vision Statement for an Aging Texas states that older
persons should have the opportunity for optimal physical and mental health. Numerous
health problems often accompany the last decades of life, but research tells us that these
problems can be avoided, delayed or ameliorated through appropriate lifestyle and
health-prevention activities. This paper focuses on how to increase the
likelihood of healthy aging. Health is often negatively defined as absence of disease and
injury. Healthy aging is a positive concept of well-being based on evidence that attitudes and lifestyle behaviors can enhance the body’s resistance to and recovery from functional decline, illness, and disease. The healthy aging concept involves motivating individuals to engage in positive lifestyle behavior, preventing diseases and injury and equipping health care providers to focus on primary health care. Although this paper focuses on the health of the older adult, healthy aging is a process that occurs at all ages throughout the life course.
PREVENTION AND MANAGEMENT
OF CHRONIC DISEASE
Chronic diseases, illnesses that are prolonged and rarely cured pose a significant burden in terms of morbidity, mortality, and costs. Although the incidence of chronic disease and disability clearly increases with advancing age, poor health is not an inevitable consequence of aging. Research
has yielded effective preventive strategies for the nation’s leading causes of death, disease and disability.3

Unfortunately, strategies for preventing disease and injury, including healthy
behaviors and early detection and screening, are not widely applied. Once an individual is
diagnosed with a chronic disease, disease management strategies can have a significant
impact on individual health.
Healthy Behaviors
It is estimated that positive healthy lifestyle behaviors such as smoking cessation, physical
activity, nutrition, and oral health can contribute to 50 percent of an individuals’ healthy status.4
Furthermore, there is increasing evidence to indicate that behavior change, even late in life, is beneficial and can result in improved disease control and enhanced quality of life.
TDoA Office of Aging Policy and Information 3
Smoking remains the number one cause of preventable death in the United States. State data indicate that the median prevalence of current cigarette smoking in Texas is 26.1 percent among individuals aged 55-64 years, 19.9 percent among individuals aged 65-74 years, and 15.3 percent among individuals age 75 years and older.5 Despite the lower prevalence of smoking among older adults, older smokers are at greater risk from smoking because they have smoked longer, tend to be heavier smokers, and are more likely to suffer from smoking-related illnesses. However, smoking cessation, even at older ages, can improve the management of chronic disease symptoms and reduce the risk of adverse health outcomes.6 Research demonstrates that physical activity is
healthy for people of all ages, including the older population.7

The evidence shows that physical
activity can reduce the risk of chronic diseases such as cardiovascular disease, hypertension, certain types of cancer, diabetes, osteoporosis, and obesity. Exercise can also increase strength and balance to prevent injuries such as falls, relieve symptoms of depression, and help maintain independent living, thus enhancing overall quality of life.8 Older adults are, however, the least likely to participate in any type of physical activity. In Texas, 33 percent of those age 55 to 64 and 37 percent of those over age 65 reported no physical activity in the past month.9
A lack of physical activity in combination with poor nutrition are responsible for at least 14
percent of preventable deaths per year, second only to tobacco use.10 The majority of chronic conditions and deaths due to heart disease, stroke, cancer, diabetes and osteoporosis can be attributed to poor nutrition. Nutrition intervention (i.e., education, nutrition therapy with a nutrition professional) that could reduce adverse health outcomes is not covered by Medicare.11 Although varying amounts of nutrition information and counseling are included in some supplemental health care benefits packages, nutrition services are largely inconsistent or inadequate to meet
the needs of the older adult population.
Lifestyle behaviors such as poor nutrition and tobacco use can also affect oral health. Successful oral disease-prevention measures adopted by communities (i.e., water fluoridation), individuals, (i.e., self-care, healthy behaviors) and oral health professionals (i.e., patient education, advances in treatment), have led to marked improvements in the nation’s dental health.12 Despite these advances, gaps remain between the research findings on dental and oral diseases such as tooth decay, periodontal disease, or oral cancers, and the knowledge of the public and the health promotion practices of dental care providers.13

Injuries from motor vehicle crashes, firearms,
suffocation, and falls account for most deaths among older adults.14 Falls alone account for 87 percent of all fractures (i.e., hip) among people over 65 and often result in emergency room visits and extended hospital and long-term care stays.15 Over 60 percent of falls occur in the home, however common prevention strategies such modifying the home to remove common environmental fall hazards are not widely applied.16
4 OAPI Policy Paper – Healthy Aging
Infectious diseases such as pneumonia and influenza remain among the leading causes
of hospitalization and death among people over age 65.17 The risk of complications from
pneumococcal disease and influenza is especially high among those with chronic disease.18 Yet, the risk can be reduced by vaccinations and immunizations. Low coverage rates for these preventable diseases often are attributed to decreased access to health care services and limited knowledge among the public that vaccines are needed. In addition to other barriers such as financial constraints and language, many individuals often hold inaccurate beliefs that vaccines are ineffective or cause illness.19 Growing evidence suggests that effective programs oriented toward individual health behaviors require a multifaceted approach to helping people adopt and maintain healthful behavior. For example, informational approaches that focus on increasing physical activity have proven to motivate and enable individuals to change behavior, and maintain that behavior change over time.20 Educational campaigns may consist of information provided to the individual through the mass media, community groups,
health-care settings, and worksites. Communities also play critical roles in creating environments that encourage physical activity through access to resources such as safe and well-lighted walking trails, community facilities, and exercise equipment.21 Health care providers also play a role in motivating individuals to become more physically active since many older adults have a high degree of respect for medical professionals directives.22
Education and counseling have also successfully promoted primary prevention practices. For example, smoking-cessation counseling, even brief advice to quit smoking, can be effective among older persons. In 1992, the NHIS Cancer Control Supplement documented that 59 percent of current smokers aged 55 years and older who were examined by a physician during the preceding year reported that their doctor advised them to quit smoking.23 Overall, smokers who reported that a physician advised them to quit smoking during the preceding year were significantly more likely to report planning to quit during the next 6 months than smokers who were not advised to quit.24 Yet, education and counseling, while often effective, is rarely reimbursed by public and private health insurance.
Some individuals respond well to printed materials and/or telephone counseling. Others may not change behavior without a structured one-onone intervention, a method that is often effective, but is more time-consuming and expensive to administer. Each intervention type must recognize that individuals live within social, political, and economic systems that shape behaviors, as well as access to the resources they need to maintain good health.25
Disease Management
Cures for chronic conditions are rarely available.Thus, many individuals must learn to live with a disease long-term.

Chronic disease often requires
patients to learn methods to better manage their symptoms (e.g., pain, fatigue) in order to maintain their ability to function on a daily basis. Disease TDoA Office of Aging Policy and Information 5 management strategies often include practicing healthy lifestyle behaviors (i.e., physical activity, diet), adhering to strict medication regimens, and engaging in routine medical assessment and disease monitoring. Appropriate disease management strategies can have a significant impact on individual health, and have proven effective on reducing overall health care costs. For example, one dollar spent on diabetes outpatient education (i.e., daily medication regimens, insulin injection, blood glucose monitoring) can save two to three dollars in hospitalization costs.26 Similarly, those who
participated in an arthritis self-help course experienced 18 percent reduction in pain,
ultimately saving $267 in health care system costs per person over four years.27
Yet, disease management is complex and difficult from the perspectives of both patients and providers. Lifestyle behaviors (e.g., physical activity and proper nutrition) are difficult to
maintain for long periods. Moreover, substantial time and money are needed to successfully manage chronic disease through adequate patient education and social support.28 Daily medication regimens, routine tests, and treatment regimens may be complex. Older adults are especially vulnerable to adverse events related to prescription medication use. Older adults make up 13 percent of the population, but use almost 36 percent of all prescribed drugs.29 It has been estimated that approximately 87 percent of older adults take at least one prescription drug a day, along with multiple over-the-counter medications. 30 Physiologic changes resulting from the aging process increase sensitivity to the effects of medication. Polypharmacy is a concern when a patient is taking mulitple medications, or is inaccurately or over-prescribed medications by multiple health-care providers. Serious adverse events and hospitalization may also arise due to failure to adhere to the proper medication regimen.31

Coordination is needed among patients, providers, health-care delivery systems, and
communities. Providers need support from health-care systems to educate, monitor, and
manage patients with chronic disease. Providers experience high utilization rates and
resource consumption by older persons with chronic conditions, and collaborating with patients to achieve behavior change can be frustrating for providers.32
Early Detection and Screening While older Texans suffer from high prevalence rates for many chronic conditions, early detection (e.g., screening tests) and prophylactic treatment regimens (e.g., medications), can decrease the rate of deterioration in health and improve quality of life.33 These prevention practices have been associated with dramatic reductions in the morbidity and mortality for many of the leading causes of disease and death for individuals over age 65.
Many older adults, however, do not engage in early detection and screening practices. Though 99.3 percent of people age 65 and over have health insurance (Medicare), only 75 to 80 percent 6 OAPI Policy Paper – Healthy Aging report receiving a routine checkup during the preceding two years.34 The increasing evidence of the importance of prevention and screening means patients must assume greater responsibility for their health by actively seeking screening and prophylactic services. For example, many of the 11.9 percent of Texans with diabetes are not diagnosed until 12 years after the onset of the disease, when complications with lower extremities and/or visual function are beginning to set in.35 At this stage, treatment is much more costly.
Patient awareness and acceptance of prevention are high in some areas (e.g., screening for breast cancer), while others are less uniformly accepted.36 For example, the percentage of people age 55 years and older who receive screening for colorectal cancer is relatively low – approximately 25 percent for fecal occult blood testing (FOBT) and 45 percent for endoscopy.37 Patients’ failure to engage in routine screening and prevention practices may result from limited knowledge and skepticism about the effectiveness of prevention. Although there is a growing consensus regarding the value of preventive services among patients, health care providers are often limited by time and lack of reimbursement for preventive screening tests.38 At the system level, there has been an increase in reimbursement coverage for secondary prevention services (e.g., mammograms, colorectal screening) in Medicare and private insurance plans. For example, the Balanced Budget Act of 1997 (Public Law 105-33) added colorectal cancer screening among the preventive benefits under the Medicare program and expanded the coverage of mammography and cervical cancer screening.39 Although health insurance coverage alone is not sufficient to eliminate existing gaps in delivery, it is an important
factor in obtaining preventive services.
MENTAL HEALTH
Many older adults have mental disorders that exist simultaneously with other chronic diseases Thus, a specific diagnosis or treatment regimen is often difficult to determine. Approximately 20 percent of the 55+ population experiences illness such as depression, Alzheimer’s disease, substance misuse and abuse, anxiety, and late-life schizophrenia that are not a normal part of the aging process.40
In many cases, mental disorders can be treated to reduce symptoms and improve the quality of life for individuals and their caregivers.

Early detection and diagnosis are critical. Yet, social stigmas often cause health care
professionals, as well as patients and families, to inaccurately attribute abnormal behavior to the aging process instead of recognizing symptoms of disease.41 The consequences of underdiagnosis and lack of appropriate treatment can be severe, especially in cases of depression.42
There is a relationship between depression and suicide.43 Among those 65 and older, suicide rates are higher than any other age group.44 Individuals 65 and older are less likely than younger populations to use available community mental health services. While almost 25 percent of older adults have symptoms of mental illness, only four percent of the patients in community TDoA Office of Aging Policy and Information 7 mental health centers and two percent of patients seen in private clinics in Texas are elderly.45 Limited utilization may be attributed to financial barriers that exist when standard health insurance policies or federally-funded programs.46 For example, Medicare does not adequately cover mental health screening, diagnosis, community
services, and medication. Insurers often reimburse out-patient services by a psychiatric
specialist, but only at 50 percent—significantly less than the 80 percent reimbursement for nonpsychiatric services. Maximum dollar payments, limits on “incidents” of illness, and utilization review parameters all further limit benefits.47 As a result, many older patients who could benefit from treatment do not receive needed care services due to financial constraints.
ISSUES AND
RECOMMENDATIONS
TDoA and stakeholders evaluated numerous policy recommendations based on their ability to meet six general goals: 1) effectiveness 2) efficiency 3) fairness 4) affordability 5)
political acceptabil i ty, and 6) legality.
Following are the policy recommendations that were selected through this evaluation process.
PREVENTION AND MANAGEMENT
OF CHRONIC DISEASE
Issue Number 1: Strategies for health promotion and prevention of disease and
injury are not widely applied.
Recommendation: Educate older adults and baby boomers about prevention and wellness and promote adoption of healthy behaviors, that include, but are not limited to, smoking cessation, physical exercise, nutrition and weight control, dental care, and preventing injury such as falls.
Recommendation: Educate older adults and
baby boomers about the importance of healthy lifestyle practices such as obtaining influenza and pnuemoccocal vaccinations.
Recommendation: Educate community
decision-makers about the importance of health promotion and prevention policies. Educate communities about opportunities to support environmental choices that promote physical activity (e.g., walking trails; “safe public space designs”) and proper nutrition (e.g., educate restaurants and grocery stores about opportunities to offer healthy food options).
Recommendation: Encourage health care providers (e.g., physicians, pharmacies) and
insurance companies to provide health education and wellness information materials to older adults and to discuss the importance of adopting healthy behaviors such as smoking cessation, physical exercise, nutrition and weight control, dental care,
and preventing injury such as falls.
Issue Number 2: Strategies for disease management are not widely applied.
Recommendation: Educate older adults and their caregivers about strategies to better manage existing chronic disease through healthy behaviors such as smoking cessation, physical exercise, nutrition and weight control, dental care, and preventing injury such as falls.
8  OAPI Policy Paper – Healthy Aging

Recommendation: Encourage health care
providers (e.g., physicians, pharmacies) and insurance companies to provide disease
management information materials to older adults in order to control symptoms of chronic disease and improve quality of life.
Issue Number 3: Many older Texans do not engage in early detection and
screening practices.
Recommendation: Educate older adults and
baby boomers about the importance of obtaining medical screenings to detect diseases at an earlier stage.
Recommendation: Educate health care
providers about the importance of screening to detect disease, especially chronic conditions that may coexist with other health conditions among older adults.
MENTAL HEALTH
Issue Number 4: Many older adults have
mental disorders that exist simultaneously with other chronic diseases.
Recommendation: Educate individuals about the differences between normal aging and mental illness in an attempt to remove the negative social stigmas associated with mental illness among older adults.
Recommendation: Educate older adults and their caregivers about 1) detecting signs and symptoms of mental illness; and 2) when to seek help from a mental health professional.
Recommendation: Educate older adults and their caregivers about 1) how to be active participants in their care, including preventing medication misuse (e.g., “Top 10 things to ask your doctor”); 2) available mental health and substance abuse programs and services; and 3) support services available through HHS agencies.
Recommendation: Educate the community about mental illness among older adults in an
attempt to remove the negative social stigmas associated with mental illness among older adults.
Recommendation: Educate health care providers about strategies to assess mental illness, (i.e., depression, dementia, substance abuse, and medication misuse) in their older patients.
TDoA Office of Aging Policy and Information 9
ENDNOTES
1 Department of Health and Human Services, Centers for Disease Control and Prevention, Chronic Disease
Prevention Announcement: About Chronic Disease (Atlanta, GA: Department
of Health and Human Services, Centers for Disease Control and Prevention, 1999).
2 Ibid. 3 Ibid.
4 Department of Health and Human Services, Centers for Disease Control
and Prevention, “Surveillance for Five Health Risks Among Older Adults – United States,
1993-1997,” MMWR Report 48, No. SS08; 89
(December 1999) http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4808a5.htm
(Accessed August 14, 2002).
5 Ibid. 6 Department of Health and Human Services, Centers for Disease Control
and Prevention, Reducing Tobacco
Use: A Report of the Surgeon General (Atlanta, GA: Department of Health
and Human Services, Centers for
Disease Control and Prevention, 2000).
7 Department of Health and Human Services, Centers for Disease Controland Prevention, Physical Activity and  Health: A Report of the Surgeon General (Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, 1996), 10.

8 Department of Health and Human Services, Agency for Healthcare
Research and Quality and Centers for
Disease Control and Prevention, Physical Activity and Older Americans:
Benefits and Strategies (Washington, D.C: Department of Health and Human Services, 2002) http://www.ahrq.gov/ppip/activity.htm (Accessed August 14, 2002).
9 Texas Department of Health, Behavioral Risk Factor Surveillance System (BRFSS) http://www.tdh.state.tx.us/ chronicd/default.htm (Accessed August 13, 2002).
10 Department of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Health Statistics, Trends in Causes of Death Among the Elderly, by N.R. Sahyoun, H. Lentzner, D. Hoyert, K.N.
Robinson (Atlanta, GA: Department of Health and Human Services, Centers
for Disease Control and Prevention, National Center for Health Statistics, 2001).
11 Institute of Medicine, National Academy Press, The role of nutrition
in maintaining health in the nations elderly. (Washington, D.C.: Institute of Medicine, National Academy Press, 1999).
12 Department of Health and Human Services, National Institutes of
Health, National Institute of Dental and Craniofacial Research Oral Health in America: A Report of the Surgeon General. (Rockville, MD: Department
of Health and Human Services, National Institutes of Health, National
Institute of Dental and Craniofacial Research, 2000).
13 Ibid. 14 Department of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Health Statistics, Trends in Causes of Death Among the Elderly, by N.R. Sahyoun, H. Lentzner, D. Hoyert, K.N.
Robinson (Atlanta, GA: Department of Health and Human Services, Centers
for Disease Control and Prevention, National Center for Health Statistics, 2001).
15 Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among
elderly persons living in the community. (New England Journal of Medicine, 319(26), 1988) 1701-7.16 R.W. Sattin. Falls among older persons: A public health perspective.
Annual Review of Public Health, 13, 1992, 489-508.
17 Department of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Health Statistics, Trends in Causes of Death Among the Elderly, by N.R. Sahyoun, H. Lentzner, D. Hoyert, K.N.
Robinson (Atlanta, GA: Department of Health and Human Services, Centers
for Disease Control and Prevention, National Center for Health Statistics, 2001).
18 National Coalition for Adult Immunization, 1998 A Call to Action:
Improving Influenza and Pneumococcal Immunization Rates Among High Risk Adults
http://www.nfid.org/ncai/publications (Accessed August 14, 2002)
19 Task Force on Community Preventive Services. Recommendations
Regarding Interventions To Improve Vaccination Coverage In Children, Adolescents, and Adults.

American
Journal of Preventive Medicine, 18(1S),
2000, 92-96.
20 A.J. Dunn, S.N. Blair, Translating Evidence-Based Physical Activity
Interventions into Practice: The 2010 Challenge. Elsevier Science Inc., 22 (4S), 2002, 8-9.
10 OAPI Policy Paper – Healthy Aging 21 Ibid.
22 J.M. Heath, M.R. Stuart, Prescribing Exercise for Frail Elders.
Journal of American Board of Family Practice, 15(3), 2002, 218-228.
23 J.P. Hirdes, C.J. Maxwell, Smoking cessation and quality of life
outcomes among older adults in the Campbell’s survey on well-being. Canadian Journal of Public Health, 85, 1994, 99-102.
24 B.K. Rimer, C.T. Orleans, M.K. Keintz, S. Cristinzio, L. Fleisher.
The older smoker: status, challenges and opportunities for intervention. Chest 97, 1990, 547-53, In Health and Human Services, Centers for Disease
Control and Prevention “Surveillance for Use of Preventive
Health-Care Services by Older Adults, 1995-1997” MMWR Report 48(SS08), December 17, 1999, 51-88. 25 American Society on Aging/Edward R. Roybal Institute for Applied
Gerontology, Live Well, Live Long: Steps to Better Health. Health Promotion and Disease Prevention Survey Report
(Los Angeles, California State, 2001).
26 S.L. Norris, M.M. Engelgau, K.M. Venkat Narayan Effectiveness of
self-management training in type 2 diabetes:
a systematic review of randomized controlled trials. Diabetes Care, 24, 2001, 561—87.
27 Department of Health and Human Services, Centers for Disease Control and Prevention Chronic Disease Prevention Announcement: About Chronic Disease. (Atlanta, GA: Health and Human Services, Centers for Disease Control and Prevention, 1999).
28 American Society on Aging/Edward R. Roybal Institute for Applied
Gerontology, Live Well, Live Long: Steps to Better Health. Health Promotion and Disease Prevention Survey Report (Los Angeles, California State,2001).
29 Health Care Financing Administration, Office of National Cost
Estimates National Health Expenditures, 1988.
(Washington, D.C.: Health Care Financing Administration, Office of
National Cost Estimates, 11, 1990) 1-14.
30 J.F., Moeller, N.A. Mathiowetz: Prescribed Medications: A summary of
use and expenditures for Medicare
beneficiaries. Rockville, MD., Department of Health and Human Services,
publication PHC 89-3448, 1989.
31 K. Brummel-Smith. Polypharmacy and the Elderly Patient. Archives of
the American Academy of Orthopaedic
Surgeons, Vol. 2, No. 1, Winter, 1998.
32 Health and Human Services, Centers for Disease Control and
Prevention “Strategies for Reducing Morbidity
and Mortality from Diabetes Through Health-Care System Interventions
and Diabetes Self-Management
Education in Community Settings A Report on Recommendations of the Task Force on Community Preventive Services” MMWR Report 50(RR16) September 28, 2001, 1-15.
33 Center on an Aging Society, Georgetown University Data Profile
Screening for Chronic Conditions: Underused Services Number 1, (Washington D.C.: Georgetown University, January 2002)
34  General Accounting Office. Medicare: Beneficiary Use of Clinical Preventive Services. General Accounting Office-02-422 (Washington, D.C.: April, 2002)

35 Texas Department of Health Texas Diabetes Data

http://www.tdh.texas.gov/diabetes/factshee.htm

(Accessed August 13, 2002).

36 Health and Human Services, Centers for Disease Control and Prevention “Surveillance for Use of Preventive Health-Care Services by Older Adults, 1995-1997” MMWR Report 48(SS08), December 17, 1999, 51-88  37General Accounting Office. Medicare: Beneficiary Use of Clinical Preventive Services. General Accounting Office-02-422 (Washington, D.C.: April, 2002). 38 Ibid.

39
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Center on an Aging Society, Georgetown University Data Profile
Screening for Chronic Conditions: Underused
Services Number 1, (Washington D.C.: Georgetown University, January
2002).
40 Department of Health and Human Services, Public Health Service
Mental Health: A Surgeon General’s Report,
1999, Chapter 5: Older Adults and Mental Health
Department of Health and Human Services, Public Health Service
National Strategy for Suicide Prevention:
Goals and Objectives for Action (Rockville, MD: Department of Health
and Human Services, 2001) 55.
It’s best when you have a buffalo wild wings coupons and try the ruby tuesday menu.

42 Department of Health and Human Services, National Institute of
Health Consensus Development Panel on
Depression in Late Life, Diagnosis and treatment of depression in late
life. Journal of the American Medical
Association, 268, 1992, 1018-1024.
43 Institute on Aging, Institute on Aging Research Center, Suicide and
the Elderly http://www.gioa.org/programs/
cesp/sfacts.html. (Accessed August 15, 2002).
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44 Department of Health and Human Services, Public Health Service
National Strategy for Suicide Prevention:
TDoA Office of Aging Policy and Information 11
Goals and Objectives for Action (Rockville, MD: Department of Health
and Human Services, 2001) 32.

45 Texas Department of Mental Health and Mental Retardation, Impact of
Services for Aging Consumers and Caregivers. (Texas Department of Mental Health and Mental Retardation) May-August, 2001.
46 National Committee to Preserve Social Security and Medicare, SPRY
Foundation, American Association for Geriatric Psychiatry Mental Health and Aging:

The Challenge Confronting
America’s Families and Senior Citizens.
A Report on the Mental Health Needs of the Nation’s Seniors,
the Treatment of Mental Illness in Latter Years,
and Policy Initiatives the Federal Government Can Take September 2001.
47 Ibid.
48
Information obtained through this process, including forum
transcripts and issue briefs, is available on the
Texas Department on Aging’s website at www.tdoa.state.tx.us
49 The Texas Board on Aging established the APRG to provide guidance to
TDoA’s Office of Aging Policy and
Information in both long range planning and specific project
development
12 OAPI

Policy Paper – Healthy Aging
AGENDA DEVELOPMENT PROCESS
To develop an aging policy agenda in the area of healthy aging, TDoA set out to 1) define the issues; 2) develop a list of policy recommendations; 3) evaluate the policy
recommendations based on selected criteria; and 4) suggest actions for change. These steps are described below:

Define the Issues: TDoA staff identified the factors associated with
each issue and how older adults
are affected. This paper discusses the common issues identified and
does not capture all differences
within issues based on ethnicity, race, gender, socioeconomic status,
and geographic location.

Develop Policy Recommendations: TDoA generated a list of possible
policy recommendations to address the issues.
Evaluate Policy Recommendations: TDoA and stakeholders evaluated the
policy recommendations based on their ability to meet six general goals: 1) effectiveness 2) efficiency 3) fairness 4) affordability 5) political acceptability, and 6) legality.

A qualitative assessment was made as to whether a given
recommendation had the potential to meet these goals. Where possible,
TDoA staff evaluated each recommendation in terms of quantitative criteria. As a result of the evaluation process, certain policy recommendations were removed, clarified, or combined with other recommendations.

Make Policy Recommendations: This agenda presents the policy
recommendations selected through the evaluation process.
STEPS IN THE PROCESS:48
1. TDoA staff reviewed recent policy and research literature related to healthy aging.
2. TDoA held a series of regional aging policy roundtables across the state from February through August 2001.Roundtables were held in Austin, Arlington, Harlingen, Odessa, and Galveston. The purpose of these roundtables was to gather state and regional information on policy issues and potential recommendations in the areas of healthy aging, among other topics. Each roundtable sought the perspectives of experts from academia, private industry, and the public sector.

3. TDoA held a meeting with aging and issue-specific stakeholders in September 2001. This meeting was dedicated to reviewing the policy issues and recommendations raised at the regional public policy roundtables and planning the final state-level aging policy roundtable in Austin.

4. TDoA staff wrote issue briefs containing common issues and policy recommendations identified during the public input process and literature review in preparation for the state-level aging policy roundtable held in November 2001.

5. A final state-level aging policy roundtable was held in November 2001 at the State Capitol. Its purpose was to obtain comments from key policymakers on the feasibility economic, political, and social – of the policy recommendations developed through public input process and policy research. The panels consisted of key policymakers from the legislative, public, for-profit, and non-profit sectors.

6. TDoA held a second meeting with aging and issue-specific stakeholders in January 2002. In this meeting, stakeholders qualitatively evaluated the policy recommendations addressed at the final statelevel aging policy roundtable. Stakeholders who were unable to attend these meetings were sent the policy agenda materials and asked to provide input via email, regular mail, fax, or phone.

7. TDoA staff conducted interviews with key informants to determine how the suggested policy recommendations could be implemented.

8. Drafts of this policy paper were circulated to TDoA’s
Aging Policy Resources Group (APRG) for review and comment.49
TDoA Office of Aging Policy and Information 13 AGING MATTERS IN TEXAS

The mission of the Texas Department on Aging (TDoA) is to be the
state’s visible advocate and steward for a full range of services and
opportunities that allow older Texans to live healthy, dignified, and independent
lives.
Federal and state law charges TDoA with conducting long-range planning
activities on aging issues. The 76th Texas Legislature directed TDoA to
serve as the state’s primary resource on aging and to work with
federal and state organizations in conducting studies and surveys on the special problems
of older Texans (SB 374).

The 75th Texas Legislature (SCR 36) endorsed
TDoA’s Aging Texas Well
initiative to help Texans address individual and family preparedness
for retirement and aging well, and to form partnerships between state government agencies and elected officials to address public policy issues related to older Texans.

To fulfill its mission and statutory mandates, TDoA established the Office of Aging Policy and Information (OAPI). OAPI’s serves as a comprehensive resource for state
government and the general public on issues, trends, services and programs for an aging Texas. Staff conduct primary and secondary research, perform policy analysis, plan future agency activities, and disseminate information
about aging services through reports, public information, and partnerships with public and
private sector organizations. OAPI maintains a wide range of stakeholder relationships.

An Aging Policy Resource Group – consisting
of experts from state government, consumer groups, service providers,
and academic institutions - helps identify and prioritize aging issues and policy solutions. OAPI also relies on community forums, policy roundtables and similar events to ensure consumers and experts inform policy and planning
activities.

OAPI’s future work will continue to focus on the readiness of
state government and local communities for an aging population. TDoA is committed to ongoing analysis of aging issues and their policy
implications for Texas. OAPI will serve as a resource and partner to
other state agencies and state leadership to ensure that older Texans live healthy, dignified, and independent lives.
OAPI Policy Papers and other OAPI publications, including those
listed below, are available on the TDoA website (www.tdoa.state.tx.us).