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Evidence-Based Healthy Aging Programs for Older Adults

Evidence-Based Healthy Aging Programs for Older Adults. SHIP Director’s Conference June 10-13, 2007. Evidence-Based Prevention*.

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Evidence-Based Healthy Aging Programs for Older Adults

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  1. Evidence-Based Healthy Aging Programs for Older Adults SHIP Director’s Conference June 10-13, 2007

  2. 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

  3. Empowering Older Adults to Take More Control of Their Health Evidence-Based Prevention Programming for Older Adults Donald Grantt Center for Planning and Policy Development US Administration on Aging

  4. Older Americans Act Health Objectives • (2) The best possible physical and mental health which science can make available and without regard to economicstatus. • (9) Immediate benefit from proven research knowledge which can sustain and improve health and happiness.

  5. President’s HealthierUS goal • HHS Secretary Leavitt’s prevention priority • Assistant Secretary on Aging’s Strategic Plan

  6. AoA Strategic Plan Priorities • Creating a More Balanced System of Long Term Care • Promoting Health and Disease Prevention • Supporting our Nation’s Family Caregivers • Ensuring Rights of Older Persons and Preventing Abuse, Neglect & Exploitation

  7. AoA’s 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 • Consumer direction and cash and counseling models • 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

  8. HHS Partnerships • Translate Results of HHS Research into Community Service Programs for the Elderly • Research Primarily From: CDC, NIH, AHRQ, and CMS

  9. AoA Disease Prevention Demonstration Program • Modeled after John A. Hartford Foundation Program (4 grants - 3 years) – NCOA Resource Center • AoA funded 12 demonstration grants for 3 years at $6M • Grant to NCOA for National Resource Center

  10. Albany, NY Grand Rapids, MI Hartford, CT Houston, TX 2 Programs Los Angeles, CA 2 Programs Philadelphia, PA Portland, OR Portland, ME San Antonio, TX Miami, FL Local Grantees (2003-2007)

  11. US Administration on Aging Initiative • July, 2006 HHS Secretary Mike Leavitt Announces $15 Million Collaboration on Prevention for Older Americans • “Simply put, this collaboration will put the results of our research investments into the hands of older people so they can use it to improve the quality of their lives.”   • “HHS research has generated a growing body of scientific evidence on the effectiveness of interventions that can help older people to improve their health status by better managing their chronic diseases, improving their nutrition and diet, exercising more, and avoiding injuries such as falls.” • HHS, AP, and NCOA are supporting efforts to mobilize public/private collaborations that will support the delivery of evidence-based programs for seniors at the community level.

  12. 24 State Grantees • Arizona • Arkansas • California • Colorado • Connecticut • Florida • Hawaii • Idaho • Iowa • Illinois • Maryland • Maine • Massachusetts • Michigan • Minnesota • New Jersey • New York • North Carolina • Ohio • Oklahoma • Oregon • South Carolina • Texas • Wisconsin

  13. Terri Whirrett Deputy Director South Carolina Lt. Governor’s Office on Aging

  14. Need for Evidence-Based Healthy Aging Programs • SC ranks near the top of the nation for prevalence of chronic disease • Diabetes is the 6th leading cause of death in the nation and in SC • Nearly one out of 12 adults in SC has diabetes, the 2nd highest rate in the nation. • In SC, people 65 and older have nearly 5 times higher death rates from diabetes than those in the 45-64 year old age group.

  15. Cardiovascular Disease • Cardiovascular disease is the leading cause of death in SC and the nation. • People 65 and older have almost 8 times higher death rate from stroke and heart disease than those in the 45-64 year old age group.

  16. Arthritis • Arthritis is the leading cause of disability in the nation and SC. • SC has the 6th highest rate of arthritis in the nation. • Arthritis affects 57% of adults 60 and older in SC. • Arthritis causes activity limitations. • Lack of exercise and being overweight are problems among people over 60 in SC.

  17. Poor health and disability are not inevitable consequences of aging

  18. Chronic Diseases are Often Preventable Healthy Lifestyles Early Detection of Diseases Immunizations Prevention (of diseases and injuries) Self Management techniques

  19. Evidence-Based Prevention Programs • Less than 10% of all published prevention studies are translated into practice • LGOA and DHEC partnership provides an opportunity to reduce the gap between the production of evidence-based research and implementation in community settings

  20. Benefits of an Evidence-Based Approach • Science tells us it works • Increases the likelihood of positive outcomes • Leads to efficient use of resources • Facilitates the spread of programs • Uses common performance measures • Makes it easier to get funding

  21. The “Living Well South Carolina” program • Chronic disease self-management program is proven to work. • Chronic diseases and related injuries can be improved through not smoking, maintaining a healthy weight, and staying active. • Targeting persons with one or more chronic diseases, particularly the rural underserved and minorities in rural communities

  22. Second Program: A Matter of Balance (MOB) • An Evidence-based fall prevention program found to improve peoples’ confidence in ability to manage their fear of falling. • Will be implemented in 6 counties in year two of the grant. • Already being provided in two other counties. • Targeting persons with fear of falling or concern about falling.

  23. Key Partners • Partnership for Healthy Aging at State Level: • Health Department • USC Arnold School of Public Health • Care Improvement Plus- Medicare Special Needs Health Plan in SC • SC Hospital Association • 30+ Organizations and growing

  24. Partners at Local Level: • Aging Service providers (5 covering 19 counties) • Faith-based organizations • Health care organizations • Housing facilities/Assisted Living • AAAs – various staff

  25. Roles of Partners • Promote the program through own organization. • Refer older adults with chronic diseases to local programs. • Recommend people with chronic diseases who might be interested in becoming volunteer group leaders. (They would be trained to conduct the classes). • Provide funding for class materials, program group leader trainings, organization licensure, promotion materials.

  26. Potential Roles for SHIPs • Medicare Prevention: Screenings- CVD, Diabetes, Bone density Shots Tests Eye 1 time initial free exam Add referral to Chronic Disease Self Management Programs in your state when providing education about prevention

  27. Potential Roles for SHIPs • Assure that there is a partnership between the state and local SHIP offices, and any Medicare Special Needs Health plans. • CDSMP and Special Needs plans both have one similar goal: Improving the health of persons with chronic disease. • It is hoped that in the future Medicare will see the advantage reimbursement of the “proven to work” evidence-based programs that improve health outcomes and quality of life of seniors.

  28. MarylandLiving Well-Take Charge of Your Health Joseph V.Gennusa III PhD, RD, LDN Nutrition and Health Promotion Programs Manager Maryland Department of Aging

  29. Expressed Need for Evidence-Based Healthy Aging Programs • % of 60+ Marylanders to increase to 23% (currently 15%) by 2030 • Chronic disease: Maryland ranks 20th in heart disease (236 deaths/100,000); 31st in stroke (54 deaths/100,000), 16th in Diabetes (28 deaths/100,000) www.statehealthfacts.org • Cost: 2002- heart and stroke alone= $813 million in hospital charges while the direct cost of physical inactivity and obesity are approximately $24 billion (2002 Hospital Discharge Survey).

  30. Evidence-Based Programs Being Implemented • CDSMP- Assist in controlling chronic disease and cost; non-disease specific; and for grant. Current focus on aging population for grant purpose • Arthritis Program- Assist in controlling symptoms of arthritis. For individuals with varying degrees of arthritis. • Matter of Balance- Assist in balance efforts for individuals to prevent falls. For individuals who may be at risk of falls.

  31. Key Partners • DHMH- Assisting in Lead role, marketing, and LHD contacts as major players • Howard County Office on Aging- Mentor Agency, assisting with “bumps and bruises” • GOSV- State partner; assisting with volunteers • GOCI- State partner; assisting with Faith Based contacts • Rural Maryland Council- State partner; assisting with outreach in rural jurisdictions • CareFirst, Kaiser Permanente, and Care Improvement Plus- Assisting in marketing efforts of program, with possible long-term coverage for members

  32. Potential Roles for SHIPs • Future Roles for SHIPs: 1. Assist in marketing of program to all contacts 2. Assist contacts in enrolling into Living Well 3. Articulate Living Well as a prevention benefit for Medicare recipients

  33. Healthy Choices for MEEvidence-Based Health Promotion and Prevention Programs for Older AdultsSHIP Director’s ConferenceJune 6, 2007Mary Walsh, Director of Community ProgramsOffice of Elder ServicesMaine Dept. of Health and Human Services The funding for this program was provided in part by grant #90AM312001 from the Administration on Aging to the Maine Department of Health and Human Services, Office of Elder Services

  34. The Challenge & the Opportunity • Older adults suffer from chronic diseases, injuries and disabling conditions. • Preventable diseases account for nearly 70% of all medical care spending. • Growing evidence base indicates that changes in lifestyle at any age can improve health & function. • People want to change unhealthy habits, but need support. • The medical care sector alone can not improve the health of older adults with chronic conditions. • Community agencies have connections to the population and untapped capacity.

  35. Maine Program Goals • Develop statewide infrastructure • Create core capacity • Expand access to rural and underserved areas • Develop network of volunteers • Understand system of communication and referral patterns

  36. Healthy Choices for ME Program Dissemination • Living Well – Chronic Disease Self-Management • A Matter of Balance/Volunteer Lay Leader Model • EnhanceFitness • EnhanceWellness • Healthy IDEAS

  37. Aging in Maine • 14.4% of Maine’s population is 65 or older (representing 183,589 people)¹ • Oldest state in nation – median age 40.06 • Ranks third in country for highest % of older adults in population • 55.8% of Maine’s older adults live in rural settings compared to 21.7% nationally • Maine ranks 2nd nationwide for % of older adults living in rural settings² • Most elderly residents suffer from one or more chronic conditions • For persons aged 65 and older • 42% are overweight • 19% are obese • 36% do not do any leisure time physical activity³ ¹according to federal census estimates ²AARP Across the States: Profiles for Long-term Care 2002 ³Maine Behavioral Risk Factor Surveillance System 2002

  38. Falls and the Older Adult • Each year one of every three adults age 65 or older falls¹ • Falls are the leading cause of injury hospitalization in Maine² • 1/3 to 1/2 of older adults acknowledge fear of falls • Fear of falling is associated with: • depression • decreased mobility and social activity • increased frailty • increased risk for falls as a result of deconditioning ¹Analysis of unintentional fall injuries 2004 ²Healthy Maine 2010

  39. Depression and the Older Adult • The rate of depressive symptoms among persons receiving long-term care in Maine is twice the national average¹ • 40% of the aged 60 and older population in residential care or home care have a diagnosis of depression² ¹ QI data from the national CMS website for the first quarter for 2005 ² MDS,MDS-RCA, and MeCare data

  40. Strategic Partners • Maine’s Department of Health and Human Services, Office of Elder Services • Maine Center for Disease Control and Prevention • Partnership for Healthy Aging/MaineHealth • Area Agencies on Aging

  41. 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* * Bronson and others

  42. Philosophy AParticipant-Centered Approach • Personal choice and responsibility for change • Active participation with peers • Emphasis on behavior • Self-efficacy /Self-management • Cognitive restructuring- thinking about things in a different way

  43. Advantages of an Evidenced- Based Approach • Increases the likelihood of positive outcomes • Makes it easier to justify funding • Helps to establish partnerships –esp. with healthcare • Leads to efficient use of resources • Facilitates the spread of programs • Facilitates the use of common performance measures • Supports continuous quality improvement

  44. Benefits to 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

  45. Living Well - Chronic Disease Self-Management Program Evidence-based, peer led, group program • People with different diseases participate in same group • Meet 2 ½ hours per week for 6 weeks • Built on principals of self-efficacy and self-management Participants learn about: • Symptom management, exercise, nutrition, problem solving, communications, advance directives • Skills and build confidence to deal with the medical management, role management, and emotional management of their chronic conditions • Problem solving skills, how to generate short-term action plan, and how to act on problems

  46. Living Well Outcomes Health Outcomes at 6 Months • Improved self-rated health • Decreased disability, pain, shortness of breath • Improved functioning, decreased social and role activities limitations • Increased energy / decreased fatigue • Decreased distress with health state • Fewer days in hospital • Trend toward fewer outpatient and ER visits • Cost savings • Lorig KR, Sobel DS, Stewart AL, Brown Jr BW, Ritter PL, González VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing utilization and costs: A randomized trial. Medical Care, 37(1):5-14, 1999. • Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Bandura A, González VM, Laurent DD, Holman HR. Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care, 39(11),1217-1223, 2001.

  47. A Matter of Balance Benefits 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. During 8 two-hour classes, participants learn to: • View falls and fear of falling as controllable • Set realistic goals for increasing activity • Change their environment to reduce fall risk factors • Promote exercise to increase strength and balance

  48. A Matter of Balance: Managing Concerns about Falls 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 • translated into Volunteer Lay Leader Model AoA Grant #90AM2780 Tennsdedt, S., Howland, J., Lachman, M., Peterson, E., Kasten, L. & Jette, A. (1998). A randomized, controlled trail of a group intervention to reduce fear of falling and associated activity restriction in older adults. Journal of Gerontology, Psychological Sciences, 54B (6), P384-P392.

  49. A MOB/VLL Outcomes Participant Outcomes at 6 months Improvement in: • Falls Efficacy • Falls Management • Falls Control • Exercise level • Decrease in Monthly Falls Class Evaluation Results • 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 “I am already noticing a difference in my physical being. I am sure I am a little more mobile than I had been and plan to continue these exercises. Hopefully I’ll be jumping over the moon soon.” “I seem to be more aware of every situation for my safety. I now `stop, look and listen’ to my surroundings.”

  50. Designed for older adults with chronic conditions at risk for hospitalization. Creates a team with: Participant Registered Nurse Social Worker Primary Care Physician Health Mentor Seeks to improve health and functioning and reduce unnecessary medical care with: A health screening and action plan Ongoing personal encouragement and feedback Problem solving, health education and regular monitoring Support and links to community services

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