Healthy Aging: Programs That Make a Difference

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Healthy Aging Programs That Make a Difference

• Nancy A. Whitelaw, Ph.D.
• Director, Center for Healthy Aging
• National Council on Aging
• March, 2006

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Guiding Principles for Action - Marks

• Primacy for Prevention
• Dependence on Science
• Quest for Equity and Social Justice
• Interdependence of Essential Partners
• Aging network
• Health care
• Public health
• Academe
• James Marks, MD, MPH when Director, National
  Center for Chronic Disease Prevention and Health
  Promotion, CDC

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Social Ecologic Model of Healthy Aging
McLeroy et al., 1988, Health Educ Q Sallis et
al., 1998, Am J Prev Med
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What the Social-Ecological Perspectives Says

• The health and well-being of older adults will be
  improved only if we work from a broad
  perspective.
• Comprehensive planning and partnerships at all
  levels are required.
• Harassing individuals about their bad habits has
  very little impact.
• Changes at the individual level will come with
  improvements at the organizational, community and
  policy levels.

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Leading Causes of Death, Age 65 (2001)

• Heart Disease 32
• Cancer 22
• Stroke 8
• Chronic respiratory 6
• Flu/Pneumonia 3
• Diabetes 3
• Alzheimers 3

CDC-MIAH 2004 CDC/NCHS Health US, 2002
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Underlying Risk Factors The Actual Causes of
Death

• Behavior of deaths, 2000
• Smoking 19
• Poor diet nutrition/ 14 Physical
  inactivity
• Alcohol 5
• Infections, pneumonia 4
• Racial, ethnic, economic ?
  disparities

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Threats to Health and Well-being Among Seniors

• 35 age 65 - 74 report no physical activity
• 46 age 75 report no physical activity
• 24 - obese
• 33 - fall each year
• 34 - no flu shot
• 45 - no pneumococcal vaccine
• 20 - prescribed unsuitable medications

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Science Not Shared Interventions that Work

• Chronic Disease Self-management Program Lorig et
  al. (1999) Medical Care.
• PEARLS Ciechanowski et al. (2004) Journal of the
  American Medical Association.
• Multifactorial Intervention Tinetti ME et al.
  (1994) New England Journal of Medicine.
• Matter Of Balance Tennsdedt, S et al. (1998)
  Journal of Gerontology.
• Enhance Fitness Wallace, JI et al. (1998)
  Journal of Gerontology.

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Our Definition of Evidence-Based

• A process of planning, implementing, and
  evaluating programs adapted from tested models or
  interventions in order to address health issues
  in an ecological context.
• Evidence about the health issue that supports the
  statement Something should be done
• Evidence about a tested intervention or model
  that supports the statement, This should be
  done
• Evidence about the design, context and
  attractiveness of the program that supports the
  statement, How this should be done.

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Evidence-Based Prevention

• Older adults are largely ignored by health
  promotion/prevention initiatives and funding.
• Recognize the importance of promotion and
  prevention for older adults make it a priority.
• Add evidence-based programming to current
  expertise of the aging network.
• Replicate evidence-based models by carefully
  adapting them to your community.
• Engage community organizations in this endeavor
  to maximize reach to at-risk populations.
• Not all programming can be evidence-based!!

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Local Collaborations

• Albany
• Aurora, CO
• Boston
• Chicago
• Columbia, MO
• Columbia, SC
• Grand Rapids, MI
• Hartford
• Houston
• Howard County, MD
• Johnson City, TN

• Los Angeles
• Madison
• Miami
• New Haven
• Philadelphia
• Portland, OR
• Portland, ME
• Raleigh
• Salt lake
• San Antonio
• Seattle
• Silver Spring, MD

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Members of National and Regional Teams

• Area agencies on aging and community aging
  service providers
• Local public health, mental health and social
  services departments
• Physicians, hospitals, health systems, health
  plans
• Consumer advocates
• Research centers, universities
• State units on aging and state health departments
• Health/disease associations
• Federal agencies

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Model Programs Project (2001)

• Diabetes Self Care Healthy Changes
• Nutrition Healthy Eating
• Physical Activity Healthy Moves
• Depression Healthy IDEAS

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Evidence-Based Prevention Initiative (2003)

• Disease self-management (5)
• Diabetes
• Heart disease
• Depression
• Chronic Disease Self-Management Program (2)
• Physical activity (4)
• Falls prevention (2)
• Nutrition (2)
• Medication management (1)

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The Questions for Evidence-Based Programs

• Old question Does what we are doing work?
• New question Can we do what is known to work?
• What do we know works?
• How well do we know it and understand it?
• About whom do we know it?

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Advantages of an Evidence-Based Approach

• Increases the likelihood of positive outcomes
• Makes it easier to justify funding
• Helps to establish partnerships esp. with health
  care
• Leads to efficient use of resources
• Facilitates the spread of programs
• Facilitates the use of common performance
  measures
• Supports continuous quality improvement

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Disadvantages of an Evidence-Based Approach

• Feels like standardization
• Difficult to build community support everyone
  wants home grown
• Tools and processes are unfamiliar
• Research studies are difficult to read and
  interpret
• Requires partnerships - some communities may not
  have partners that can help
• IT IS HARD sort of

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Doing What Works

• Evidence of problem The burden is great.
• Evidence of effective interventions The science
  is convincing.
• Core elements of an effective program Fidelity
  is possible with diverse populations and diverse
  organizations.

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Translation Developing Your Program

• Detail the following (RE-AIM)
• Reach Effectiveness
• Adoption Implementation Maintenance
• Fidelity A The program you develop retains the
  core components from the original intervention
  studies.
• Tracking Changes Tool
• Fidelity B The program you implement retains the
  core components from the developed program.

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The Evidence-Based Intervention
Credit Diane M. Dowdy, Ph.D., CHES Deputy
Director, Active For Life The Texas AM University
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Fidelity The program you develop and the program
you implement retains core elements with some
adaptations.
Credit Diane M. Dowdy, Ph.D., CHES Deputy
Director, Active For Life The Texas AM University
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Adaptations begin to change core elements.
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The program has lost core elements.
Credit Diane M. Dowdy, Ph.D., CHES Deputy
Director, Active For Life The Texas AM University
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Core Elements Crosscutting Themes

• Self efficacy, active learning and self care
• Effective self-management support strategies
• Assessment, goal-setting, action planning,
  problem solving, follow-up, positive
  reinforcement
• Peer support groups peer health mentors
• Social and familial context
• Cultural context
• Connections to health care
• Outcomes focus - social, mental, physical,
  functional

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Core Elements Group Programs

• Weekly group sessions 90 to 120 minutes
• 8 weeks or ongoing
• Manualized approach for group leader
• Behavior change model is at the core of each
  session
• Goal setting/problem-solving
• Feedback and support from peers
• Decision making gives ownership to the process
• Education embedded in program
• Resource identification

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Core Elements One to One Programs

• Training care managers
• Brief negotiation and motivational interviewing
• Behavioral activation therapy or simple movements
• Screening and assessment
• Linkage (referral) and education
• Self-management support
• Goal setting problem-solving building social
  support, follow-up
• Reinforcement from professionals, peers, family

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Reach into Diverse Populations

• Total participants approximately 3000
• 1/3 African American
• 1/4 Latino
• Other minorities
• 1/10 non-English speaking
• Varies by site
• Philadelphia 100 African American (N368)
• Miami 100 Latino (N215)

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Adoption

• Over 100 settings
• Senior centers
• Housing sites
• Culturally specific centers
• Faith-based organizations
• Social service agencies
• Case management offices
• Libraries
• Tribal communities

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Effectiveness

• Compare participant outcomes to original trails
• Use measures from the original trials
• Reduced set
• Typically self-report
• Measure pre and post (4-12 months later)
• Compare change scores with original trails
• Retention do participants stay in the programs
• Satisfaction what do participants like and not
  like

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Upcoming Sessions
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NCOAs Center for Healthy Aging

• Collaborate with diverse organizations to
  contribute to a broad-based national movement.
• Identify, translate and disseminate evidence on
  what works scientific studies and best
  practices.
• Promote community organizations as essential
  agents for improving the health of older adults.
• Advocate for greater support for strong and
  effective community programs.

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Funding and Strategy Partners

• Robert Wood Johnson Foundation
• The John A. Hartford Foundation of NY
• Administration on Aging
• Centers for Disease Control Prevention
• Substance Abuse and Mental Health Services Adm.
• Centers for Medicare and Medicaid Services
• Merck Institute on Aging and Health
• Archstone Foundation
• Home Safety Council

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Research Partners

• U of WA
• U of North Carolina
• Texas A M
• U of Ill, Chicago
• U of Ill, Urbana
• UCLA
• Stanford
• Texas Diabetes Inst
• PRC-Healthy Aging Research Network

• SUNY Albany
• U Conn
• U of Houston
• Baylor College of Medicine
• U of Southern California
• Thomas Jefferson Univ
• U of S Maine
• Oregon Research Inst

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www.healthyagingprograms.org

• Evidence-Based Practices and Aging Today
  430-600 Session 4312.0