Evidence Based Health Promotion: What's the Buzz All About?

1. Evidence Based Health Promotion: What's the Buzz All About? Mary Hertel: Central MN Council on Aging Debra Laine: Arrowhead Area Agency on Aging Dave Fink: Metropolitan Area Agency on Aging Tuesday June 18, 2013 8:00 am to 9:15 Lake Superior Ballroom, City side

2. Information to be presented: • What are Evidence Based programs and why are they important • Research and demonstrated outcomes • How EBP can fit within the patient engagement model, compare/contrast with patient education • Overview of specific EBP’s including Stanford Self-Management, A Matter of Balance and Tai chi: Moving For Better Balance • Describe how you or your organization can get more involved

3. What is Evidence Based health promotion programming? Simply put it is: programs based on research.

4. What evidence do we need?

5. Why the interest in Evidence Based Programs?

6. EBP’s have Demonstrated Outcomes

7. Consider: • “people with chronic conditions rarely spend more than 1% of their life at a healthcare facility. It is the other 99% of one’s life - when an individual is at home - that determines whether they return to full health or not.” • Those with ongoing health issues will make many daily health decisions: • Diet, exercise, medication, when to seek medical care • may not fully understand implications of particular health decision • may lack support to make better choices

8. Can Clients Be Engaged? 23% adopted new health behaviors (but unsure could maintain if stressed) Remaining 77%: • Remain passive recipients (12%) • Lack basic facts to follow treatment recommendations (29%) • Have facts, but no skills, confidence (36%) Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation result in improved self-management behaviors? Health Services Research, 42, 1443-1463.

9. How can Evidence Based Programs help?

10. Self-management Patient Education Self-Management Differs From Patient Education (but we need both) - Manage life with disease • Problem solve and make decisions • Improve confidence in abilities to make changes • Increase skills & self-confidence - Change behaviour's • Information, technical skills • Disease–specific knowledge - Use specific tools (e.g., Care Plans, Action Plans)

11. Advantages of Evidence Based Programs: • First, they can significantly improve the health and well-being of older adults in the community. • Second, they can help attract new participants and funders through innovative programming. • Third, they can create powerful partnerships with other organizations, including health care providers Evidence-based programming provides value

12. Lets talk about some of the Evidence Based Programs Stanford University Self Management Programs: • Chronic Disease Self Management (Living Well with Chronic Conditions) • Chronic Pain Self Management • Diabetic Self Management Additional programs: • A Matter of Balance • Tai Chi Moving for Better Balance

13. What is the Stanford Chronic Disease Self-Management Program (CDSMP) “Living Well with Chronic Conditions” • Developed by Stanford University’s patient education program • Leader Training 4 Days lead by 2 Master Trainers • Structured 10-15 participants in a six-week workshop series done by 2 certified leaders • Participative instruction with peer support • Designed to enhance medical treatment • Outcome-driven: impacts show potential for reduced or avoided costs • Evidence-based: a tested model (intervention) that has demonstrated results

14. Living Well with Chronic ConditionsTechniques • Action planning • Feedback/ problem solving • Decision Making • Management Tools • Physical • Psychological • Emotional The process or the way CDSMP is taught is as important, if not more important than the subject matter that is taught.

15. Living Well With Chronic Conditions Workshops (CDSMP)

16. Keys to Success • The format addresses specific problems and goals for people with ongoing health problems. It is not a drop-in support group. • The workshops are not prescriptive. Participants choose their own goals and track their own progress toward success. • Pair of trained peer leaders offer guidance and support, but participants find practical solutions individually and together. Living Well With Chronic Conditions Workshop

17. Evidence CDSMP participants experienced the following outcomes 6 months after starting the CDSMP program • Increased exercise; • Better coping strategies and symptom management; • Better communication with their physicians; • Improvement in their self-rated health, disability, social and role activities, and health distress; • More energy and less fatigue; • Decreased disability; • Fewer physician visits and hospitalizations. Lorig et al., 1999

18. Stanford’s CDSMP is Evidence-based • Found to benefit targeted populations. Including a decrease in health care costs • Demonstrated it does not cause harm. • Demonstrated it does not waste resources. CDSMP can facilitate the Triple Aim Goals Lets do a quick demo!

19. Options for Involvement • Offer the program(s) at your clinic/organization with your staff, and/or volunteer peer leaders. Training is available through the Area Agencies on Aging • Offer the program at your clinic/organization in partnership with a community provider • Refer your patients to programs that your organization offers or to community partners; visit www.mnhealthyaging.org for a listing of workshops • or call Senior Linkage Line 1-800-333-2433

20. Resources • Minnesota Board on Aging: http://www.mnaging.org/ • National Council on Aging (NCOA): http://www.ncoa.org/ • NCOA: Center for Healthy Aging • http://www.ncoa.org/improve-health/center-for-healthy-aging/ • Online Training Modules: • http://www.ncoa.org/improve-health/center-for-healthy-aging/online-training-modules/ • Highest Tier Evidence-Based Health Promotion/Disease Prevention Programs • http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf • Stanford Patient Education Research Center: • http://patienteducation.stanford.edu/

21. A Matter of Balance: Managing Concerns about Falls(Falls Prevention)

22. What do we know about falls? • Up to 30% of community dwelling adults fall each year • About 20% of falls cause physical injury • Leading cause of hospitalized injury • Leading cause of ER-treated injury • MN ranks 3rd in the nation in fall related deaths – twice as many per capita as the national average

23. What we know about Falls • 1/2 to 2/3 of falls occur around the home • A majority of falls occur during routine activities • Falls usually aren’t caused by just one issue. It’s a combination of things coming together • A large portion of falls are preventable!

24. What we know about Falls • Falls are : • Common • Predictable • Preventable • Falls are not a natural part of aging!

25. What do we know about fear of falling? • It is reasonable to be concerned about falls - safety is important • 1/3 to 1/2 of older adults acknowledge fear of falling • Fear of falling is associated with: • decreased satisfaction with life • increased frailty • depression • decreased mobility and social activity • Fear of falling is a risk factor for falls

26. What is A Matter of Balance? A Matter of Balance is a program: • based upon research conducted by the Roybal Center for Enhancement of Late-Life Function at Boston University • designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls

27. A Matter of Balance: Managing Concerns About Falls During 8 two-hour classes, participants learn: • To view falls and fear of falling as controllable • To set realistic goals for increasing activity • To change their environment to reduce fall risk factors • To promote exercise to increase strength and balance

28. A Matter of Balance: Managing Concerns About Falls What Happens During Classes? • Group discussion • Problem-solving • Skill building • Assertiveness training • Exercise training • Videotapes • Sharing practical solutions

29. Who could benefit from A Matter of Balance? Anyone who: • is concerned about falls • has sustained a fall in the past • restricts activities because of concerns about falling • is interested in improving flexibility, balance and strength • is age 60 or older, ambulatory and able to problem-solve.

30. Administration on Aging Grant In 2003, AoA launched a three year public/private partnership to increase older people’s access to programs that have proven to be effective in reducing their risk of disease, disability and injury Grant Goals: •Develop a volunteer lay leader model and test whether it is successful when compared with original research •Share our approach with others in Maine and around the country

31. A Matter of Balance Outcomes Participant Outcomes • 97 % - more comfortable talking about fear of falling • 97 % - feel comfortable increasing activity • 99 % - plan to continue exercising • 98 %- would recommend A Matter of Balance * % who agree to strongly agree Comments: • I am more aware of my surroundings. I take time to do things and don’t hurry. • I have begun to exercise and am looking forward to a walking program. • I have more pep in not being afraid.

32. Participants Report: • Increased confidence in taking a walk, climbing stairs, carry bundles without falling • More confidence that they can increase their strength, find ways to reduce falls, and protect themselves if they do fall • An increase in the amount they exercise on a regular basis • Fewer falls after taking MOB

33. Impact in MN • Steady increase of participants • 2012; 845 participants with 721 completers • 2011; 777 participants • 2010; 444 participants • Less than 1% report no improvement in: • Finding a way to get up from a fall • More steady on feet • Finding a way to reduce a fall • Protecting yourself incase of a fall • Physical activity

35. Options for Involvement • Offer the program(s) at your clinic/organization with your staff, and/or volunteer peer leaders. Training is available through the Area Agencies on Aging • Offer the program at your clinic/organization in partnership with a community provider • Refer your patients to programs that your organization offers or to community partners; visit www.mnhealthyaging.org for a listing of workshops • or call Senior Linkage Line 1-800-333-2433

36. Resources • Minnesota Board on Aging: http://www.mnaging.org/ • National Council on Aging (NCOA): http://www.ncoa.org/ • NCOA: Center for Healthy Aging • http://www.ncoa.org/improve-health/center-for-healthy-aging/ • Online Training Modules: • http://www.ncoa.org/improve-health/center-for-healthy-aging/online-training-modules/ • Highest Tier Evidence-Based Health Promotion/Disease Prevention Programs • http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf • Stanford Patient Education Research Center: • http://patienteducation.stanford.edu/

38. The Question: Is there an evidence-based fall prevention program that would be culturally appropriate for and accessible to non-English speaking older adults?

39. Tai Chi: Moving For Better Balance (TCMFBB) • Developed by Dr. Fuzhong Li, Oregon Research Institute • 8 forms of Yang style Tai Chi adapted specifically for fall prevention • Reduces the risk of falls by improving balance, muscle strength, flexibility and mobility • Twice/week for 1 hour plus practice, 2 twelve week sessions • One certified leader

40. Tai Chi origins • Monks in the mountains of China 600 years ago • Created as a self-defense martial art • Evolved into a health & wellness exercise program

41. “Moving meditation” • 8 forms that emphasize • - weight shifting • - postural alignment • - coordinated movements • 4 S’s • slow - soft • smooth - safe • Integrated breathing

42. Seated & Standing

43. Leader qualifications • No previous Tai Chi experience required • Experience working with older adults & group exercise programs very helpful • Enjoy leading groups • Willing to learn, practice and continually improve

44. Leader training • 2 day intensive workshop • Led by Dr. Li • Follow-up sessions with local leader • Leader sharing sessions • DVD and tips

45. 2012 pilot test • Timeframe: April – December, 2012 • 10 bilingual leaders trained: • Initial 2-day training • 3 two hr. follow-up sessions • Quarterly leader sharing and updates • 7 languages: Laotian, Korean, Khmer, Hmong, Somali and Vietnamese and English • Classes: Two 12 week sessions, twice/week for 1 hour • Stipends: To organizations @ $30/class

46. Pilot test results • Participants: 124 first session, 129 second • Retention: 64% attended half or more, 49% attended 3/4 or more • Retention higher in organizations with active existing programming and leaders - 86% attended half or more, 68% attended 3/4 or more • Participation and retention higher with Asian older adults than East African older adults • “Timed up and go” test – avg. 2 second improvement

47. What participants said… • “The Tai Chi class helped me be able to use old muscles I have not used in a while. Now I can stretch my arms up very high.” • “I was walking with a cane for a couple of years. After I join the class I am able to walk without a cane.” • “The Tai Chi exercise program helped me a lot with emotional stress and physical improvement.” • “Because of a stroke, I couldn’t use my arm. But I am able to move and use my arm and lift up to my head.”

48. What we learned • Bilingual leaders are effective • Organizations with existing active older adult programs had stronger participation/retention • Cultural backgrounds may make a difference in participation/retention • Older adults will attend and do benefit

49. 2013 participating organizations • Brian Coyle Center Oromo, Somali • Centro Spanish • Common Bond English, Somali, Spanish • Korean Service Center Korean • Lao Advancement Org. of Am. Laotian • Presbyterian Homes & Services English • United Cambodian Assn. of MN Khmer • VOA/Park Elder Center Hmong • Vietnamese Social Services Vietnamese Also, Mahube-Otwa RSVP in Land of the Dancing Sky AAA and Central MN Council on Aging (both in English)

50. A word on funding • MAAA Title IIID funds target non-English speaking older adults • MAAA pays IIID organizations to host Tai Chi classes and funds the leader training • As space allows, other organizations attend leader training and reimburse MAAA for costs