Last partial update: September 2019 - Please read disclaimer before proceeding
The 45s to 65s are responsible for the health of the nation
People the 45 to 65 year age group are responsible for most of the health of the nation because they are:
- usually responsible for looking after ageing generations (i.e. their parents)
- responsible for the health of many adolescents and some younger children
- the people who make most of the important decisions about health policy in Australia
- responsible, of course, for looking after themselves
It is thus very important for this group to be knowledgeable about health issues generally, not just those relating to their own age group, and to use this information to produce better health outcomes for all Australians. For this reason the table below lists important illnesses in all age groups.
This is the age group who need to tackle the important health problems of obesity, physically inactivity and poor ('take away' / processed food) diet that increasing afflict Australia today. After all, these problems have largely occurred in our generation; they are 'our' fault.
And, while on the subject of fault, it is time that we looked after our youth better. We have allowed them to be targeted and exploited by food, clothing /fashion and alcohol industries that are not concerned about exacerbating the already worrying obesity, alcohol and body image problems present in young people. We can do better. Above all, we need to show that we, as adults, politicians and corporate citizens, care for all children; not just our own.
‘The health and wellbeing of young people is a critical measure of a society for two reasons: in moral terms, how well a society cares for its weak and vulnerable is a measure of how civilised it is; in more pragmatic terms, a society that fails to cherish its young, fails. It’s as simple as that.’
Richard Eckersley, Australian scientist and author.
Preventable disease in Australia
The duration of people’s lives and the degree of disability, both mental and physical, that they endure are very important factors in determining their achievements and their level of happiness. Fortunately Australians have access to a high standard of public health and one of the world’s best health systems and it is thus not surprising that most of us enjoy a long and healthy life. Life expectancies are continuing to increase and people born in 2016 have one of the longest life expectancies in the Western world, being 80.4 years for men and 84.6 years for women. (This has risen from 51 for men and 57 for women at the beginning of Federation; 1901.) For those aged 65 years in 20, the life expectancy was 19.6 years for men and 22.3 years for women.
Unfortunately, some of this long life will be spent with some form of disability and, unlike longevity, the level of disability is not currently diminishing. (Over the 15 years from 1988 to 2003, the increase in life expectancy that occurred was accompanied by a similar increase in the number of years spent with disability and severe disability.) On average in 2011, women spend 9.9 years of their lives with some form of significant disability/ ill health. For men, the figure is 9.0 years. People aged 65 years can expect suffer some form of disability in about 55 per cent of their remaining years and spend about 20 per cent of their remaining years with a severe disability.
Our long lifespan with many years spent free of disability is probably adequate for most of us to achieve that which we need to / want to in our lives. However, many do not share in this ‘wealth of health’; they die prematurely or suffer unnecessary disability due to diseases that can often be prevented by living a healthy lifestyle. In 2000, 27 per cent of males and 16 per cent of females died before the age of 65.
The aim of this book is to provide the information needed to maximize people’s chance of avoiding preventable illness and thus provide the best chance of achieving a long stay on this mortal coil and staying well while enjoying it.
While this book provides much information that can be used by the individual, it was written with the partnership between general practitioner (GP) and patient in mind, as many aspects of illness prevention require the assistance of a supportive GP. Together, patient and doctor should be able to identify and coordinate the preventative measures required to minimise medical problems. Through regular GP visits, a management plan can be monitored and modified as necessary to address any changing circumstances. All this is very difficult to achieve alone.
Leading causes of burden of disease in Australians according to age (2015) |
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| Males | % of total disease burden | Females | % of total disease burden |
| Under 5 year age group | Under 5 year age group | ||
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| 5 to 14 year age group | 5 to 14 year age group | ||
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| 15 to 24 year age group | 15 to 24 year age group | ||
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| 25 to 44 year age group | 25 to 44 year age group | ||
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| 45 to 54 year age group | 45 to 54 year age group | ||
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| 55 to 64 year age group | 55 to 64 year age group | ||
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| 65 to 74 year age group | 65 to 74 year age group | ||
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| 75 to 84 year age group | 75 to 84 year age group | ||
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| Over 84 year age group | Over 84 year age group | ||
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Source: Adapted from Australian Institiute of Health and Welfare Burden of Disease Study 2015
Illness rates through life
As one might expect, disease rates increase throughout adult life; although interestingly you are still at less risk now than when you were in the womb / first year of life. (See graph below.) While the burden of disease per 1000 people continues to increase after the 65 to 69 year age group, the total burden of disease starts to decrease because there are fewer people living.
How much and what type of illness occurs in people aged 45 to 64?
As one might expect, people in the 45 year to 64 year age group have a reasonably high incidence of illness. The tables above show the most important illnesses in this age group. It also shows illnesses in all age groups because:
- this age group needs to know about older illnesses so that they can plan preventing future likely illness
- this age group is usually responsible for looking after ageing parents
- this age group is usually responsible for the health of older children and adolescents
- this age group makes most of the important community and government decisions about health
In other words, the 45 to 64 year age group is responsible for most of the health of the nation and especially its future health. It is thus very important for this group to be knowledgeable about health issues generally.
What important illnesses are commonly overlooked in Australia?
- Depression - About 50% remain undiagnosed.
- Diabetes - 50% of cases remain undiagnosed.
- High blood pressure - 50% remain undiagnosed and 25% of those who receive treatment are under-treated
- Heart failure - About 50% remain undiagnosed
- Chronic kidney failure - About 50% remain undiagnosed.
- Osteoporosis - Many people with osteoporosis are unaware they have the condition. (This includes a large number of people with spinal fractures that often occur with minimal symptoms.)
- Hearing loss - Most are undiagnosed.
- Obesity and physical activity - Many people are unaware that they are overweight / do not do sufficient physical activity.
All these illnesses are covered in this web site.
Illness prevention and the GP relationship
There are many preventive health issues that need to be covered in people aged 45 to 64 years. Not only do they need to worry about their present health problems, but they also need to worry about the future and prevent illness in old age. (Not uncommonly, they are also in the situation of looking after ageing parents and are responsible for the health of children and adolescents.) These are detailed below.
Once individuals have worked out which issues they need to cover, they will need to work out how they should best approach dealing with them.
A GP cannot do it by her or him self.
It has been calculated that it would take over seven hours of a GPs’ working day to address properly the preventive health issues of each of his or her patients. This is not possible and thus, if people are going to prevent illness occurring to them, they are going to have to do much of the work.
Luckily, much of this seven hours is taken up explaining the issues involved in maintaining health and this task can be done privately by sourcing appropriate, reliable information. The provision of this information is the purpose of the web site. Below is a guide to the issues that are relevant to preventing illness in people aged 45 to 65. They are all covered in this resource. Keep reading.
What do people need to do with their GP?
This web site acts as a starting point upon which people can build a preventive health program. Each person has different health needs and how individuals use the information in this web site is best decided in consultation with their GP. The required tasks include;
- discussing matters about which the patient requires more information so that decisions can be made
- obtaining help with organising tests etc
- sorting out action plans for lifestyle changes such as weight loss
- referral to other specialists as appropriate
- ongoing management and monitoring of chronic problems, such as high blood pressure, obesity or kidney disease.
Approaching illness prevention - Modifying risk factors
Achieving change
Most people know many of the issues that they need to address but choose not to do so or do so in a haphazard, unhelpful manner. Continually assessing life, deciding on priorities, setting goals to achieve these priorities and planning how to achieve goals is fundamental to living well. Failure to set aside enough time to do these things (or failure to do them at all) is the major reason for living poorly. This topic is fundamental to good health and is dealt with in detail in the section on entitled Achieving change.
Ageing well
Maintaining helpful attitudes to ageing is important to enjoyment and maintaining motivation for life in old age. This topic is discussed at length in the section on Ageing well.
Illness and modifiable risk factors
Burden of disease values have also been calculated for modifiable illness risk factors and it was estimated in 2015 that adopting poor lifestyle health options was responsible for 36% of all burden of disease. (The figure is slightly greater for men and slightly smaller for women.) This is a huge amount. The graph below provides a breakdown of which modifiable risk factors are most responsible for disease burden in both males and females. (Note that the total of all the risk factor burden mentioned in the graph is greater than 36% as some are mentioned twice and there is some overlap as some risk factors act on other risk factors (e.g. physicalactivity acting on obesity)).
Together, these modifiable risk factors are responsible for about;
- 33% of burden of disease due to cancers,
- 85% of the burden of disease due to ischaemic heart disease (heart attacks),
- 27% of the burden of disease due to anxiety and depression,
- 32% of the burden of disease due to injury and
- 60% of the burden of disease due to type 2 diabetes.
Not all of this illness is preventable as these risk factors cannot be completely eliminated. However, by modifying these risk factors people can significantly reduce both premature death and the length of time that they are likely to suffer from disability. Most significant disability occurs in the final twelve years of life and it is estimated that living a healthy life can reduce this period by almost half. Sounds good!
Source: Adapted from Australian Institute of Health and Welfare, 2015
22 preventative health questions adults need to address
- Do you have a family GP that you see regularly for check ups? When is your next check up due?
- Are your vaccinations up to date?
- Does your GP inspect your body for skin cancers at your regular check ups?
- Does your GP check your urine at your regular check ups?
- Do you know if you are a healthy weight? If you are overweight, have you sought advice regarding reducing them?
- Do you eat well?
- Do you partake in adequate physical activity?
- Have you had an assessment regarding your overall risk of having a heart attack?
- Have you had your cholesterol checked recently? If it was not normal, have you taken measures to reduce it?
- Do you have a healthy blood pressure level? (The target level varies according to overall risk factors for heart disease.) Has it been tested within the last two years?
- If you are over 55 or at increased risk of diabetes, have you been checked for diabetes within the last three years? (People at increased risk of diabetes need to be checked sooner.)
- Are you aware of the symptoms of depression? Is there someone you feel might be depressed for whom you should seek help; yourself, a relative or a friend?
- Are you or is a member of your family being adversely affected by alcohol consumption? Do you consume alcohol at safe levels and have at least two alcohol free days each week? Do you pass the AUDIT alcohol test?
- If you smoke or take illegal drugs, have you looked into stopping them? If you smoke, have you had your lung function checked? Smoking is probably already affecting your breathing ability, making you short of breath, and greatly increases your risk of heart attack and lung cancer.
- Do you spend time each day thinking about issues relating to improving relationships with family and friends? Do you suffer abuse in your relationship? If so, you need to tell your GP. (See Relationships section)
- Do you have a family medical history that may increase your risk of any disease, especially cancer, heart disease, diabetes, cystic fibrosis, thalassaemia or haemochromatosis? If so, have you discussed this with your GP.
- If you are over 50, do you have a screening check for blood in your bowel motions at least second yearly (a faecal occult blood test)?
- If you are female and have had sexual intercourse, do you have regular Pap smears?
- If you are female and over 50, do you have mammograms every two years?
- If you are female, have you discussed osteoporosis with your GP?
- Have you assessed your work and hobbies with regard to any specific health risks they may pose?
- Do you take precautions to protect your hearing when exposed to high noise levels? Hearing loss is the seventh most important cause of illness in men and the eleventh in women.
Important preventive health issues for people aged 45 to 64 years
While it may appear that this is a long list, please take the time to go over the complete list. While most people only have a few issues they need to deal with, they may not realise the importance of some issues and others may not have been previously considered at all.
Lifestyle change (the most important topic)
Lifestyle change. Most people are aware of many of the things they should do to improve their health but are either unsure how to approach achieving them or are unable to successfully implement appropriate changes. This section aims to provide the information you need to successfully implement change in your life. It is essential reading.
Cardiovascular disease
- Vascular disease prevention counseling. This should include assessment of risk factors for cardiovascular disease to work out overall risk of cardiovascular disease. This enables people to be sorted into low, medium and high risk groups with respect to their risk of having a heart attack. All the risk factors below should be addressed.
- Cholesterol All patients should have already had several screening blood test for cholesterol. Assess second yearly in low risk individuals and yearly in high risk individuals.)
- Blood pressure High blood pressure is common in older people and reducing it significantly reduces heart attack risk. Checks need to be done at least yearly.
- Diabetes All patients over 55 years of age should have already had several screening blood test for diabetes. People at increased risk of developing diabetes need to start having screening tests earlier; some as young as 35 years of age. Once screening commences, tests should be done at least every 3 years and yearly for those at high risk or who have had an abnormal test in the past.
- Smoking People aged 45 to 65 are in the age group that heart attacks and strokes start to commonly occur. Smokers who quit will significantly reduce their risk of death.
- Weight. Reducing obesity reduces blood pressure and insulin resistance (i.e. the risk of developing diabetes) and both these are significant causes of heart attacks. Obesity is also related to several cancers. Check with a GP to see whether weight loss would be beneficial.
- Exercise Exercise is important for prevention of numerous illnesses, including heart attacks. Moderate exercise for 30 minutes at least five times a week is the recommended minimum. (Increase exercise to this level should be done gradually.)
- Stroke prevention This basically involves reducing risk factors for cardiovascular disease. Sometimes minor or transient stroke symptoms can be missed and thus it is worth asking about these at each check up in those who are over 55 years of age and at high risk of having a stroke, which includes people:
- at high risk of cardiovascular disease
- with atrial fibrillation (A type of abnormal heart rhythm.)
- What should I do if I have already had a heart attack? People who have already had a heart attack are already at high risk of another and this section sets out how this can best be avoided.
- What should I do if I have a strong family history of heart attacks? People with a strong family history of heart attacks are at increased risk and need to take special precautions. They also need to find out if they have a inherited condition that has caused this increase in family heart attack incidence.
Cancer
- General concepts regarding cancer prevention Reducing cancer involves preventing it occurring, screening for early cancer, looking for early symptoms of cancer. There are important concepts that people need to be aware of regarding these prevention strategies.
- Colorectal cancer. This cancer is common in both men and women. Screening for this common cancer (by testing feces samples for the presence of blood every second year) should have been started at age 55 years and can be continued to age 75 years. Those at high risk may need earlier screening.
- Breast cancer. Screening for this common cancer (by mammography every second year) should have been commenced at age 50. It can be ceased at age 70 but benefit still exists past this age. Breast checks should be done by a GP at each check up.
- Cervical cancer Screening for cervical cancer with Pap smears should have been common practice for many years for all women who have been sexually active in the past.
- Skin cancer All skin cancers, including melanoma are common in this age group and an annual skin check is wise.
Mental health
- Anxiety and depression (and suicide) Anxiety and depression are common throughout life and are still important issues in this age group.
- Alcohol Excessive alcohol use is often still a significant problem in this age group, especially in males.
- Relationships Relationships with family and friends are the cornerstones of human existence. People who are having problems with important relationships in their life should deal with them sooner rather than later. The longer such problems exist, the harder they are to fix.
Other preventive health issues
- Hearing impairment - This is the last chance!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Hearing is a precious sense that needs to be protected. Unfortunately it is something that we take for granted and a huge number of people, especially men, suffer from hearing impairment due to excessive noise exposure throughout their lives. Hearing loss is the seventh most common cause of illness overall in men, ahead of well-recognised illnesses such as prostate cancer, colon cancer and road traffic accidents. I can not count the number of times I have driven past men mowing lawns without any hearing (or sight!!) protection. Not being able to hear music or loved ones properly is a huge burden to bear later in life. Please read the section on hearing loss!!!!!!!!!!
- Osteoporosis prevention and diagnosis / treatment: Osteoporosis is very common in older people, especially women, and is often undiagnosed and under treated. All people in this age group need to be aware of this condition and how to avoid / treat it. While keeping bones healthy needs to be a lifetime project, the onset of menopause is a time when osteoporosis can really establish itself. Thus, it is a good time to review risk factors for developing this disease and discus with a GP whether a measurement of bone density is appropriate.
- Loss of vision:
Loss of vision should be checked for at least every five years from the age of 50 years and there are some people who need more regular and special sight checks. These include people with:
Eighty percent of visual impairment is caused by five conditions: macular degeneration, cataracts, refractive error, diabetes and glaucoma. Visual loss from cataracts and refractive error can be completely avoided or successfully treated in most cases. Loss of vision from chronic glaucoma can also be prevented as long as it is found early on. Damage that has already occurred can not be repaired. Those with a family history of the disease need early screening for the disease from age 40 years. Only macular degeneration can not be significantly helped. Quitting smoking can help reduce visual oss in old age due to retinal damage.➢ Diabetes (Need at least yearly checks with an eye specialist.)
➢ People with a family history of chronic glaucoma - Immunisations Immunisations are important in all age groups.
- Kidney disease Routine testing of urine at each check up should be done to help detect kidney (and other) disease.
- Dietary issues Adults are responsible for household meals and it is important that they are aware of what constitutes a healthy diet; especially if the current obesity epidemic is to be beaten.
- Osteoarthritis Pain due to joints wearing out obviously can not be easily prevented. However, weight reduction is always beneficial in overweight individuals and reducing excessive weight bearing exercise can also help.
- Illness associated with medical treatment
Health workers are not perfect and occasionally mistakes happen and all treatments are associated with side effects and / or complications. The health system is doing its best to reduce these events but it is important that people are aware of what they can do to reduce unnecessary suffering due to medical treatment.
Burden of disease - DALYs
The table below shows the 20 leading causes of death and disability (or burden of disease) in Australia, most of which are significantly preventable. The figures used in this book to grade the death and disability caused by each illness are derived from information gathered and interpreted by the Australian Institute of Health and Welfare (AIHW). When assessing the importance of an illness, the AIHW does not just to look at its incidence. It also measures carefully the extent to which the illness causes premature death and the length and degree of disability the illness causes. Diseases that on average occur earlier in life, and thus cause earlier deaths or lengthier periods of disability, are given a higher rating. Both the disability and death caused by the particular illness are given a value in terms of years of healthy life lost, and, when added together, give an overall ‘burden of disease’ rating for the illness; expressed as ‘disability-adjusted life years or DALYs. The use of DALYs allows a comparison of the harm caused by all illnesses, whether they cause predominantly death or disability.
At present (2019) about 360 illnesses and 80 risk factors for illness are assessed in this manner. To ensure this colpex task is done accurately requires a staff of hundreds of people and a huge amount of time. Thus, assessments are only at infrequent intervals and usually are released several years after the information is gathered. (This can mean that it looks a bit out of date but medicine really changes slowly and being accurate is of paramount importance as National health policy (and funding) is determined by this data.
In 2015, the burden of disease was equally distributed between years of life lost due to death and years of life lost due to disability.
What are the most common causes of illness in Australia?
The leading causes of burden of disease in Australia (2015) |
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Cause - Males |
% of total burden of disease |
Cause - Females |
% of total burden of disease |
Coronary artery disease (heart attacks) |
8.6 |
Coronary artery disease |
5.0 |
*The figure for alcohol combines the harmful effects, which mainly occur in younger people, with the beneficial cardiovascular effects which occur mostly in older people. |
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