Evidence-Based Healthy Aging

1
Evidence-Based Healthy Aging

• Building Community Partnerships for Health
• June Simmons
• Partners in Care Foundation

2
The Move to Evidence-Based Health Promotion

• The shift to health from health care
• The new demographics of health
• The Chronic Care Model

3
Nationwide StatisticsOpportunity for Impact

• 50 of Americans have a chronic condition
• 25 have multiple chronic conditions.
• 7 of 10 deaths in US each year due to chronic
  disease
• 7 of Medicaid population but 54 of costs
• 80 of health care costs go to 20 of patients --
  those with chronic diseases

4
Chronic Illness in California

• Largest and most diverse state
• 38 million residents
• 3.9 million residents ages 65 (10)1
• 62 of all older people report having 2 chronic
  conditions2,3
• 58 of older Californians have some type of
  arthritis4
• 14.8 of CA seniors suffer from diabetes5
• 30 of the states elderly minorities are
  diabetic5
• Heart disease accounts for 29 of the states
  deaths6

1 CDC. Population Estimate 2006. 2Yen I, Trupin
L, Yelin E. The relationship between health and
employment. San Francisco, CA Institute for
Health Policy Studies 2001. 3 Partnership for
Solutions. Chronic conditions Making the case
for ongoing care. Baltimore, MD Johns Hopkins
University 2002. 4 Lund LE. Prevalence of
Arthritis in California Counties, 2001 Center
for Health Statistics December 2003. 5 Lund LE.
Prevalence of Diabetes in California Counties
2003 Update Center for Health Statistics
February 2005. 6 CDC. Chronic diseases The
leading causes of death California. CDC.
Available at http//www.cdc.gov/nccd
php/publications/factsheet/chronicDisease/Californ
ia.ntml. Accessed 8/1, 2006.
5
Californians Age 65 and Over
Age
65 years old and over 10.7
Ethnic Background
White persons, not Hispanic 44.5
Persons Hispanic or Latino 34.7
Asian persons 12.1
Black persons 6.8
Other 1.9
Socio-economic Characteristics
Of Medi-Cal beneficiaries 20.5
Below Poverty 8.1
Near Poor (0-199 of Poverty) 28.6
Limited English Proficient 16.9
Health/Functional Status
Fair or Poor Health 29.6
Have any disability 42.2
Sedentary Lifestyle 37.2
Arthritis/Moderately or highly limited in daily activities 57.7
DiabetesEver Diagnosed 14.8
HypertensionEver Diagnosed 53.5
Heart DiseaseEver Diagnosed 23.7
Impaired Activities Due to Emotional Problems Last Month 11.5
6
The Chronic Care Model
7
New leadership from AoA and NCOA

• Development of New Evidence-Based Health
  Promotion Models
• Transformation of the Aging Network
• What is Evidence-Based

8
Available Programs
9
Framework for Partnerships

• A New Vision is Being Crafted
• Health Care Providers do not have to solve the
  problem of chronic disease alone
• There are powerful, proven programs available
• New strategies are being developed and tested to
  take these new programs to scale

10
Core Program Stanford Chronic Disease Self
Management

• Peer-led, 2-hour sessions for 6 weeks
• Any chronic disease
• Focus on goals and action plans
• Techniques to deal with problems such as
  frustration, fatigue, pain and isolation
• Appropriate exercise for maintaining and
  improving strength, flexibility, and endurance
• Appropriate use of medications
• Communicating effectively with family, friends,
  and health professionals
• Nutrition
• How to evaluate new treatments.

11
Effectiveness of CDSMP

• After 12 months, significant improvement in
• Amount of exercise (ROM aerobic),
• Cognitive symptom management
• Communication with physicians
• Self-efficacy Confidence in coping
• Health status (fatigue, shortness of breath,
  pain, role function, depression, health distress)
  
• Utilization
• Emergency department (ED) visits
• Physician visits
• Hospital days
• Spanish version available Effective among
  minorities

12
State Programs Funded by US Admin. on Aging
Natl. Council on Aging

• Arkansas
• Arizona
• California
• Colorado
• Connecticut
• Florida
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Maine
• Maryland

• Massachusetts
• Michigan
• Minnesota
• New Jersey
• New York
• North Carolina
• Ohio
• Oklahoma
• Oregon
• Rhode Island
• South Carolina
• Texas
• Washington
• Wisconsin

13
Interests Align Around Evidence-Based Prevention
Programs

• Health care cost savings in programs that improve
  quality of life
• CMS working with AoA at national level Move
  senior centers from recreation to wellness
• Aging Departments working with Public Health at
  state level Fall prevention, flu, etc.
• Locally, health care and aging/disability service
  providers pursuing goal of individual
  responsibility and empowerment in self-care

14
Many Strategies Being Developed and Tested

• How can we reach real scale
• Tobacco is a good example of the model of change
• How do we engage people in this change?
• Physicians are proven most powerful referral
  source

15
California as an example

• 3.9 million older adults
• Chronic disease summary
• Strategies to reach evolving
• Want to build a distribution system that is
  scalable and sustainable

16
Target Sectors For ADOPTION/ENGAGEMENT
17
Physicians Older Adult Education Programs

• New Partnerships to identify and engage older
  adults
• Physician practices a location where many elders
  are seen
• Physicians can identify those with chronic
  conditions
• Physician referral is the most powerful tool

18
Role of Physicians Beyond Referral

• Emphasize patient responsibility
• Empower the patient You CAN do it!
• Know the resources
• Write the prescription for all chronic
  conditions
• Follow-up encouragement
• What changes did you make?

Physician is the most powerful influence in
patients signing up for and completing the 6-week
program
19
Sustainable Sources of Support

• Community Colleges and K-12 offer free non-credit
  education to older adults
• Paid for attendance
• Can add new curricula
• Have marketing in place
• Teach in community settings

20
Promoting Health and Preventing Decline the New
Imperative

• Quality of life is at stake
• The health dollar is at stake
• With new knowledge and methods, we must transform
  community understanding
• Mobilize the population to rise to the challenge
• Take on the leadership