In contemporary communities, the elderly population is more vulnerable to a range of chronic conditions and disorders than other age groups, necessitating the need for the promotion of its health. According to the 2012 estimates, the elderly population (65 years or older) was about “43 million and it is projected to double by 2050 to 83.7 million” elders (U.S. Census Bureau, 2015, para. 4). In Miami-Dade County, Florida, the elders constitute 15.2% of an ethnically diverse population that comprises predominantly of white, African-American, and American Indian groups (U.S. Census Bureau, 2015). Identifying population groups vulnerable to a particular health-related condition is essential in health promotion to raise survivorship rates.
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Many conditions and disorders threaten the clinical outcomes and quality of life of Miami’s elderly population. Specifically, Benign Prostate Hypertrophy (BPH), a condition that causes the prostate gland to enlarge inducing urethral obstruction, urinary flow restrictions, and urinary retention, has a high incidence among men aged above 50 years (Sarma & Wei, 2012). BPH affects more than half of the men 50 years and over with the histological prevalence of this condition increases with age (Sarma & Wei, 2012). Older adults with preexisting conditions such as cardiovascular disease and diabetes are at a greater risk of developing BPH.
In 2010, in the U.S., about 14 million adult males were diagnosed with symptoms indicative of BPH (Sarma & Wei, 2012). The complications associated with this condition include urinary retention due to urethra obstruction, acute pain, fear and anxiety, fluid volume deficiency, bladder and kidney damage, and urinary tract infections. In the U.S., the medical costs of BPH treatment, including emergency costs, are estimated at 1bn annually (Hollingsworth & Wei, 2006). Therefore, promoting the health of the elderly in Miami would lower the health care burden and reduce the prevalence of BPH in this population.
Problem Identification and Significance
BPH has significant adverse effects on the health of elderly men. Although various medical interventions for BPH exist, including minimally invasive surgical therapies, its prevalence at the population level remains high due to specific risk factors, such as age, diet, physical activity, and hormones, among others. The size of the prostate gland correlates with age. In a longitudinal study of male cohorts, the prostate gland was found to grow at a rate of 2.5 percent annually in men aged over 50 years (Bosch, Bangma, Groeneveld & Bohnen, 2008).
Thus, prominent prostates correlate with a heightened risk of BPH pathogenesis and lower urinary tract infections, which necessitates the need for surgical interventions (Bosch et al. 2008). As the population of baby boomers increases, BPH is likely to cause a significant burden to the Miami health care system.
The risk of BPH has also been associated with an elevated testosterone derivative at old age. A prospective study by Parsons, Palazzi-Churas, Bergstrom, and Barrett-Connor (2010) found that asymptomatic middle-aged men with high serum dihydrotestosterone (DHT) have a threefold risk of developing benign prostate hypertrophy compared to those with low concentrations of DHT. This result shows that the concentration of DHT positively correlates with the risk of BPH onset in older men. In this view, interventions to decrease the levels of DHT, a metabolite that induces prostate enlargement, could help delay the onset and clinical progression of the problem.
The BPH incidence rate is high in Western communities, including Miami, because of certain lifestyle factors. Elderly men diagnosed with BPH are likely to suffer from diabetes, obesity, and cardiovascular conditions due to inappropriate dietary practices and physical inactivity. In one study, a positive correlation was found between obesity and prostate volume (Parsons, Sarma, McVary & Wei, 2013).
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A rise in adiposity, including BMI and body waistline, is associated with larger prostates that predispose an individual to BPH. In the study by Parsons et al. (2013), a BMI increment of 1 kg/m3 caused the prostate to enlarge by 0.4 ccs while obese (BMI > 35) elderly subjects were 3.5 times more likely to have an enlarged prostate associated with bladder outlet obstruction than non-obese ones. This finding demonstrates that excessive weight contributes significantly to the onset of BPH. Therefore, poor dietary practices, such as high caloric intake, coupled with little physical activity may increase the risk of BPH in old adults.
The BPH risk may be higher in diabetic men than in non-diabetic ones. Therefore, poor management of diabetes may increase the BPH risk in patients. Higher levels of insulin growth factor 1, which is a marker for diabetes II, has been linked with a high likelihood of developing BPH complications requiring minimal invasive surgical therapies (Sarma, Parsons, McVary & Wei, 2009). In addition, serum levels of fasting plasma glucose and insulin positively correlate with prostate size (Sarma et al., 2009). Therefore, diabetes seems to trigger BPH, which implies that diabetic men are at a greater risk of this condition than non-diabetics are. In this view, health promotion should include diabetes management to reduce the BPH incidence in the Miami population.
The elderly, especially those living alone in Miami, are likely to engage in unhealthy dietary patterns, leading to a high BPH incidence rate. Proper dietary practices determine the risk of developing chronic conditions in old age. Kristal et al. (2008) found that a diet based on “vegetables (carotenoids), fruits, polyunsaturated fatty acids, and linoleic acid” significantly delays the onset of BPH symptoms and urinary tract infections (p. 928).
In addition, a high intake of vitamins A, D, and E as well as pigments such as lycopene and carotenoids decreases the risk while alcohol intake aggravates the condition (Kristal et al., 2008). It is evident that dietary interventions to regulate the intake of micronutrients and macronutrients could delay BPH in at-risk adult men. Therefore, one way of managing BPH is through proper diet and physical activity to avoid predisposing conditions such as obesity and diabetes.
The complications may be exacerbated if the elderly with systemic inflammation do not access appropriate medication. Histological inflammation of the prostate gland has been found to cause complications associated with non-malignant prostate enlargement (Nickel et al., 2008). Further, prostate inflammation is attributed to metabolic syndrome, a process that stimulates inflammatory mediators that cause carcinogenesis (Nickel et al., 2008).
Therefore, the development of BPH could involve a similar process, which, however, produces a benign form of growth. Evidence shows that inflammations of biopsies as are consistent with increased C-reactive protein and prostate-specific antigen (PSA) (Nickel et al., 2008). Elderly men with high serum levels of these inflammatory molecules are at risk of BPH. Thus, the suppression of inflammatory processes through medical therapy (NSAIDs) could prevent abnormal prostate enlargement and consequently lower the BPH risk.
Increased emergency visits and BPH surgeries may be attributed to physical inactivity, which is high among elderly men. In Miami, this population may consist of mainly retirees and veterans leading a sedentary lifestyle in their homes or senior centers. Regular physical activity is associated with a lower risk of developing BPH and urinary tract infections (Parsons et al., 2013). In fact, regular exercises have a protective effect, reducing BPH morbidity by up to 25 percent (Parsons et al., 2013). Community programs to promote physical activity in this population could reduce the prevalence of this condition in Miami.
The problem of BPH in Miami requires a lifestyle intervention and therapy to delay the onset and manage the problem. Since the current management of the disease principally entails watchful waiting and treatment, analyzing the efficacy of the two approaches would facilitate an understanding of the problem as a community health issue (Boyarsky et al., 2012). The proposed plan will seek to evaluate the relative success rates of watchful waiting versus medical treatments used in BPH management in Miami in a manner that would eventually lead to the promotion of the patients’ health status. The aim is to modulate the factors, such as obesity, that trigger this condition to reduce the BPH burden in this population.
The proposed plan will involve two interventions. The first initiative will evaluate the efficacy of the active surveillance involved in watchful waiting whereby the individual observes lifestyle changes besides engaging in a yearly examination. It will entail diet changes and routine exercises for the at-risk men (50-year-olds) to minimize the likelihood of developing the condition. The second initiative will involve medical treatment to improve urinary flow and curb the symptoms. The conventional treatments, including NSAIDs and reductase inhibitors, would require an evaluation to understand their role in mitigating the progression of the BPH condition.
One way the proposed plan would benefit the at-risk population in Miami is by facilitating informed decision-making concerning the use of either watchful waiting or treatment. The affected population, the elderly, would gain knowledge essential for deciding on the aspects of their lifestyle that require a change to reduce their chances of developing the problem. Additionally, the elderly would be in a better position to determine the relevance of the drug therapies, minimally invasive procedures, and surgeries associated with the treatment of BPH.
The plan would also benefit the healthcare system by facilitating the identification and treatment of BPH in community settings to reduce its prevalence. Further, lowering the incidence of this problem in Miami would reduce the burden on strained health care resources. As a result, hospitals would be able to reallocate their resources to deal effectively with other chronic conditions prevalent in this community.
BPH affects a large number of older men, lowering their quality of life. In the U.S., trends indicate a sharp increase in BPH prevalence as the number of the elderly population is expected to rise. Addressing the associated risk factors, such as poor diet and physical inactivity, is an effective strategy for combating this condition. The proposed plan entails active surveillance coupled with lifestyle changes to slow down the initiation and progression of the disease. An evaluation of treatments that prevent bladder obstruction and inhibit inflammatory responses would also help identify therapies with optimal benefits for patients diagnosed with BPH.
Bosch, J.L., Bangma, C.H., Groeneveld, F.P. & Bohnen, A.M. (2008). The Long-term Relationship between a Real Change in Prostate Volume and a Significant Change in Lower Urinary Tract Symptom Severity in Population-based Men: The Krimpen Study. European Urology, 53, 819–825. Web.
Boyarsky, S., Hinman, F. J., Caine, M., Chisholm, G. D., Gammelgaard, P. A., Madsen, P. O.,… Zinner, N. R. (2012). Benign prostatic hypertrophy. Berlin, Germany: Springer Science & Business Media. Web.
Hollingsworth, J.M. & Wei, J.T. (2006). Economic Impact of Surgical Intervention in the Treatment of Benign Prostatic Hyperplasia. Reviews in Urology, 8(3), 9-15. Web.
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Kristal, A.R., Arnold, K.B., Schenk, J.M., Neuhouser, M.L., Goodman, P., Penson, E. & Thompson, I.M. (2008). Dietary Patterns, Supplement Use, and the Risk of Symptomatic Benign Prostatic Hyperplasia: Results from the Prostate Cancer Prevention Trial. American Journal of Epidemiology, 167, 925–34. Web.
Nickel, J.C., Roehrborn, C.G., O’Leary, M.P., Bostwick, D.G., Somerville, M.C. & Rittmaster, R.S. (2008). The Relationship between Prostate Inflammation and Lower Urinary Tract Symptoms: Examination of Baseline Data from the REDUCE Trial. European Urology, 54(1), 1379–1384. Web.
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Sarma, A.V., Parsons, J.K., McVary, K. & Wei, J.T. (2009). Diabetes and Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms-What Do We Know?. Journal of Urology, 182(6), 32-37. Web.
Sarma, A.V. & Wei, J.T. (2012). Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. The New England Journal of Medicine, 367(3), 248-257. Web.
United States Census Bureau. (2015). QuickFacts: Miami-Dade County, Florida. Web.