Healthy Eating for Successful Living in Older AdultsTM

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Healthy Eating for Successful Living in Older
AdultsTM

• NCOA Model Programs Project Boston Team
• National Council on Aging/American Society on
  Aging Joint conference
• Mar 15, 2006
• Anaheim California

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NCOA Model Programs Project

• Developed, tested and disseminated four
  evidence-based model health programs
• Models designed to improve health of older adults
  and be readily implemented by community-based
  aging services organizations
• Utilized regional advisory panels
• Four model programs
• Physical Activity-Los Angeles, CA
• Depression-Houston, TX
• Diabetes Self Management-Portland, OR
• Nutrition-Boston, MA

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Key Concepts Incorporated into the Model Program
Design

• Linkages among community agencies and primary
  health care and/or mental health providers
• Evidence-based effective approaches to behavior
  change included
• Promoting older adults central role in managing
  his/her health
• Recognizing the importance of promotion and
  prevention

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Key Concepts Incorporated into the Model Program
Design

• Evidence-based effective approaches to behavior
  change included
• Providing older adult with the skills of goal
  setting, action planning and problem solving
• Providing ample opportunity to practice these new
  behaviors
• Encouraging peer support
• Talking about health promotion, not illness and
  disability

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Advantages of Evidence-based Approach

• Increases likelihood of successful outcomes when
  agencies move away from decision-making that
  relies too heavily on history, anecdotes and
  pressure from policy makers
• Enhances the ability to use common health
  indicators and match health programs to needs
• Makes it easier to defend or expand an existing
  program
• Provides hard data to advocate for new programs
• Generates new knowledge about what works and
  how to do it that can help others

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The Nutritional Model Program Healthy Eating
for Successful Living in Older Adults
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The Team

• Joseph Carlin MS,MA,RD, FADA
• Regional Nutrition Specialist, Administration on
  Aging
• Shirley Chao MS, RD, LD/N
• Director of Nutritional Services,
• MA Executive Office of Elder Affairs
• Rosanne DiStefano, MUA
• Executive Director
• Elder Services of Merrimack Valley
• Marta Frank MS
• Executive Director,
• Boston Home Care

• Ruth Palombo PhD, RD
• Assistant Professor of Public Health and Family
  Medicine
• Tufts University
• Margie Doyle MBA
• Program Director, Lahey Clinic
• Chris Economos PhD
• Jean Mayer USDA Human Nutrition
• Tufts University
• Robert Schreiber, MD
• Team Leader

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Why Nutrition Chosen?

• It is critically important in aging population
• Epidemic of arteriosclerosis vascular disease,
  diabetes and osteoporosis
• There is clear evidence documenting the
  effectiveness of sound nutritional strategies in
  preventing progression or prevention of disease
  in diabetes, hypertension, CAD, cancer

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Essential Elements for Successful Behavior Change

• Goal Setting
• Problem Solving
• Action-planning
• On-going support
• Monitoring

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Goals of Healthy Eating for Successful Living

• Designed to increase knowledge about enhancing
  heart and bone health through healthy diet
  choices and physical activity
• Adapt to culturally diverse populations
• Foster improvement in nutrition life-style to all
  seniors through peer-led behavioral change
• Participants learn how to set reasonable goals
  and solve problems related to common nutrition
  self-management issues, what community resources
  are available and how to use them

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The Nutrition Program

• Six sessions meet weekly for 21/2 hours
• A restaurant outing to test knowledge and skills
  is included as a seventh session
• Focus on heart and bone health
• Peer leaders are trained to facilitate using
  scripted curriculum
• Registered Dietitian/ Nutritionist serves as a
  resource
• Classes are small 8-12 facilitating active group
  participation

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Main Components of the Program

• Self-assessment and management of dietary
  patterns by each participant
• Goal setting, problem solving, and group support
• Education, relying on both group interaction and
  the expertise of a Registered Dietitian/Nutritioni
  st, when needed
• Behavior change strategies

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Target Populations

• Over age 60 cognitively intact
• Mobile, ability to attend programs
• Held in community based site
• Senior or community centers, congregate housing,
  religious centers and community dining center.
• Need to have access to food or have someone who
  will be able to provide food

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Framework of the Intervention

• Uses My Pyramid as the central framework to help
  participants create a nutritional lifestyle that
  meets individual needs
• Sessions are highly participatory with distinct
  components
• Education
• Hands-on activities
• Support
• Resource connections

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Outline of the Sessions

• Week 1 My Pyramid, Dietary Guidelines,
  Water and Exercise
• Week 2 Grains, Fruits, Vegetables and Water
• Week 3 Meat , Eggs, Legumes, Milk and Exercise
• Week 4 Milk, Sweets, Fats, and Exercise
• Week 5 Label Reading and Grocery Shopping
• Week 6 Putting It all Together
• Meal preparation or cooking
  demonstration
• Week 7 Restaurant Dining

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Peer Leader Role

• Not experts in nutrition or health
• Participate in two days of training to learn how
  to use a detailed script, behavioral change and
  group dynamic strategies to guide the process
• Play a key role in some of the hands-on activities

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Nutritionist Role

• Serves as a consultant to the peer leaders and to
  the participants
• Participates in the program sessions as needed to
  help with patient information needs

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Community Nutrition Sites

• Kit Clark Senior Services Boston 46
  participants
• Vietnamese (17), Cape Verdean (14)
•  Montachusett Opportunity Council Fitchburg
• 37 participants
• Hispanic (6)
• Andover Senior Center Andover
• 57 participants
• Mostly Caucasian

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Diverse Populations Adaptations

• Peer Leaders of same culture for the groups
• Challenges
• Translating Information
• Adapting food choices for ethnic preferences
• Journaling
• Literacy

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Measurement Tool

• Participant satisfaction survey after each
  session
• Brief final survey of participant self-reported
  changes in achieving personal goals and changes
  in eating habits
• Change in knowledge, cooking and shopping
  behaviors, dietary intake

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Findings

• Distinctly different dietary habits in accordance
  with ethnic backgrounds and demographics
• Issues in Vietnamese and Cape Verdean ability to
  use participant manuals
• Participants empowered and able to apply new new
  knowledge and skills
• Program was well-received by participants from
  diverse cultural backgrounds

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Reunion Data 1 Year Follow-upAndover

• 56 out of 57 participants attended the reunion
• Reading labels (almost everyone)
• Watching portion size
• Increased fluid intake
• Decreased fats and sugars
• More whole grains, fiber, fruit and vegetables
• Increased self awareness of intake

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Proposed Changes

• Conduct monthly follow up support groups
• Develop new modules for follow-up sessions
• Streamline survey tools and record keeping
• Provide information on calories
• Enhance physical activity component
• Translate model program into Spanish for expanded
  dissemination

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Next Steps

• Expand evaluation for include outcome measures
• Work with Executive Office of Elder Affairs to
  identify additional sites, e.g. HUD housing
  sites, SCOs, and train personnel to implement
  program
• Conduct additional trainings for interested new
  Massachusetts sites
• Orchard Cove
• Burlington and Wilmington Senior Centers
• Pepperhill and Shirley Senior Centers
• Elder Services of Merrimack Valley

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Next Steps

• Secure funding for testing model using a proposal
  with outcome measures
• HSL Center effort involving Adrienne Rosenberg,
  Sue Nonemaker, Richard Jones, Rob Schreiber,
  Philanthropy
• Translating Model into Spanish with opportunity
  to disseminate in Latin America (El Salvador)
  through PAO
• Collage Consortium

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For more information, please contact Anne-Reet
Ilves Annunziata, PhD RD LDN Project
Director Healthy Eating Program annereet_at_yahoo.com
Shirley Chao, MS RD LDN Director of
Nutrition Massachusetts Executive Office of Elder
Affairs 617-222-7469 Shirley.chao_at_state.ma.us