EvidenceBased Programming for Older Adults

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Evidence-Based Programming for Older Adults

• Nancy Whitelaw, PhD
• Director, Center for Healthy Aging
• Senior Vice President
• National Council on Aging
• April, 2007

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Chronic Disease is an Epidemic of Unparalleled
Proportions

• More than 1.7 million Americans die of a chronic
  disease each year.
• 80 of older adults have at least one chronic
  condition 50 at least two
• Greater prevalence among minority populations
• 95 of health care spending for older adults
  attributed to chronic conditions
• Four chronic diseasesheart disease, cancer,
  stroke, and diabetescause almost two-thirds of
  all deaths each year.

• Mensah www.nga.org/Files/ppt/0412academyMensah.p
  pt18
• State of Aging and Health in America 2007
  www.cdc.gov/aging

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Chronic diseases account for 75 of the 1.4
trillion we spend on health care
Mensah www.nga.org/Files/ppt/0412academyMensah.pp
t21 Heffler et al. Health Affairs, March/April
2002.
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Life Expectancy by Health Care Spending
Our nation spends more on health care than any
other country in the world Mensah
www.nga.org/Files/ppt/0412academyMensah.ppt22
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US Federal Spending in Billions, 2006
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Guiding Principles for Improvement

• Make Prevention a Priority
• Start with the Science Evidence
• Work for Equity and Social Justice
• Foster Interdependence
• Aging network
• Health care
• Public health
• Long term care
• Mental health
• Research
• James Marks, MD

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The Expanded Chronic Care Model, (Barr, Robinson,
Marin-Link, Underhill, Dotts, Ravensdale,
Salivaras, 2003).
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Confronting our Challenges

• Ageism in health promotion and disease prevention
• Great disparities based upon race, ethnicity,
  income, location
• Science not shared growing body of evidence of
  interventions that can positively impact health,
  disability and quality of life
• Untapped assets of 29,000 organizations currently
  reaching 7-10 million older adults
• Fragmented systems and services across aging,
  medical care, mental health and public health

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Evidence-Based Prevention

• 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.
• Bronson and others

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Modifiable Risk Factors Something Should be
Done.
http//www.cdc.gov/nchs/data/ad/ad370.pdf
http//www.cdc.gov/aging
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Leading Causes of Death Age 65Medical
Diagnoses

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

State of Aging and Health 2007 www.cdc.gov/aging
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

No longer is each risk factor and chronic
illness being considered in isolation. Awareness
is increasing that similar strategies can be
equally effective in treating many different
conditions. Epping-Jordon, WHO, 26 March 2004
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Threats to Health and Well-being Among Seniors

• 73 age 65 - 74 report no regular physical
  activity
• 81 age 75 report no regular physical activity
• 61 - unhealthy weight
• 33 - fall each year
• 35 - no flu shot in past 12 months
• 45 - no pneumococcal vaccine
• 20 - prescribed unsuitable medications
• www.cdc.gov/nchs

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Total Cardiovascular Disease Deaths, 1999(per
100,000 population)
190.5230.8 231.1250.0 255.5284.8 285.1354.9
United States - 172
www.cdc.gov/nccdphp/publications/burden/
National Vital Statistics System, National
Center for Health Statistics, CDC
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Variation in Heart Disease Rates, Why?

• 200 difference between high and low states
• Nearly 2/3 of the difference in death rates is
  explained by differences in modifiable risks
• tobacco
• overweight
• high blood pressure
• high cholesterol
• physical inactivity
• diabetes

Byers et al. Prev Med, 1998
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Interventions that Work This Should be Done.
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Prevention Works for Older Adults

• Longer life
• Reduced disability
• Later onset
• Fewer years of disability prior to death
• Fewer falls
• Improved mental health
• Positive effect on depressive symptoms
• Possible delays in loss of cognitive function
• Lower health care costs
• www.healthyagingprograms.org/content.asp?sectionid
  85ElementID304

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Science Not Shared

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

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Frameworks for Evidence-Based Programming How
This Should be Done.
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AoAs Choices for Independence Initiative

• Empowers individuals to make informed decisions
  about their long-term support options
• Aging and Disability Resource Centers
• Provides more choices and flexible funding for
  individuals at high-risk of nursing home
  placement
• Community living incentive
• Enables older people to make lifestyle
  modifications that can reduce their risk of
  disease, disability, and injury
• Evidence-based health promotion and disease
  prevention programs through local aging services
  provider organizations

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More How - Evidence-Based Prevention Programs

• Usual question Does what we are doing work?
• Evidence-based 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?
• How can we tell if we are doing it right?

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(P)RE-AIM Framework www.re-aim.org
Planning and Partnering
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Translation Developing Your Program

• Detail the PRE-AIM Components
• Planning and Partnering
• Reach and Adoption
• Implementation
• Fidelity A The program you develop retains the
  core components from the original intervention
  studies.
• Fidelity B The program you implement retains the
  core components from the developed program.
• Effectiveness
• Maintenance

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Does It Work? Demonstration Findings

• Reach in 3 years, over 4100 participants/clients
  .
• 1/3 African American
• 1/4 Latino
• Other minorities
• 1/10 non-English speaking
• Adoption - Over 100 local settings in 14 sites.
• Implementation - Staff can understand the
  importance the fidelity and use tools to support
  it.
• Effectiveness Findings available and very
  positive for CDSMP, MOB, EF, Healthy IDEAS and
  Medication Management.

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Prevention Workswww.healthyagingprograms.org