Transcript Evidence-Based Health Promotion for Older Adults

Evidence-Based Health Promotion
for Older Adults
Nancy A. Whitelaw, Ph.D.
Director, Center for Healthy Aging
National Council on Aging
4th State Units on Aging Nutritionists & Administrators Conference
August, 2006
www.healthyagingprograms.org
http://www.aoa.gov/prof/evidence/evidence.asp
Overview of the Presentation
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Modifiable Risk Factors Among Older Adults
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AoA’s Evidence-Based Prevention Program
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Frameworks for Evidence-based Programming
Modifiable Risk Factors Among Older Adults
http://www.cdc.gov/aging
Chronic diseases account for 7 of every 10 deaths;
affect the quality of life of 90 million Americans.
1993 vs. 2001: US adults reported:
Deterioration in:
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physical health
mental health
ability to do their usual activities
Increase in “unhealthy days”
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5.2 to 6.1 days
Adults 45-54 years old had consistently greater
deterioration than younger or older adults.
http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Measure=5&Category=1
Health Status of Older Adults
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88% - at least one chronic condition
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50% - at least two chronic conditions
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34% experience some activity limitation
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26% assess health as fair or poor
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41% of older African Americans
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40% of older Hispanics
CDC-MIAH 2004; CDC/NCHS Health US, 2002
Leading Causes of Death, Age 65+ (2001)
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Heart Disease
32%
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Cancer
22%
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Stroke
8%
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Chronic Respiratory
6%
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Flu/Pneumonia
3%
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Diabetes
3%
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Alzheimer’s
3%
CDC-MIAH 2004; CDC/NCHS Health US, 2002
Underlying Risk Factors –
“The Actual Causes of Death”
Behavior
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% of deaths, 2000
Smoking
19%
Poor diet & nutrition/
Physical inactivity
14%
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Alcohol
5%
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Infections, pneumonia
4%
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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
Benefits to Older Adults
Reviewed in “A New Vision of Aging”
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Longer life
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Reduced disability
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Later onset
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Fewer years of disability prior to death
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Fewer falls
Improved mental health
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Positive effect on depressive symptoms
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Possible delays in loss of cognitive function
Lower health care costs
http://www.cfah.org/programs/aging
Threats to Health and Well-being Among
Seniors
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73% age 65 - 74 report no regular physical activity
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81% age 75+ report no regular physical activity
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61% - unhealthy weight
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33% - fall each year
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35% - no flu shot in past 12 months
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45% - no pneumococcal vaccine
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20% - prescribed “unsuitable” medications
www.cdc.gov/nchs
AoA’s Prevention Program FY 2006
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Assist States to implement and sustain evidence-based
programs that have proven effective in helping older
adults to reduce their risk of chronic disease and disability
Accelerate the translation of HHS-funded research (from
NIH, CDC, AHRQ and others) into practice
Public-Private Collaboration with AoA and Atlantic
Philanthropies
Criteria for selecting programs to implement:
► Based upon rigorously conducted research (randomized
trial) and published
► Developed and tested with older adults
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Replicable in community-based settings
Frameworks for Evidence-based Programming
Definition: A process of
planning, implementing, and
evaluating programs adapted
from tested models or
interventions in order to
address health issues in an
ecological context.
http://www.healthyagingprograms.org/content.asp?sectionid=15&ElementID=97
Guiding Principles*
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Make Prevention a Priority
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Start with the Science – “Evidence”
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Work for Equity and Social Justice
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Foster Interdependence
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Aging network
Health care
Public health
Long term care
Mental health
Research
* James Marks, MD
Social Ecologic Model of Healthy Aging
Public Policy
Community
Organizational
Interpersonal
Individual
McLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med
What the Social-Ecological Perspectives Says
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The health and well-being of older adults will be
improved only if we work from a broad perspective.
Comprehensive planning and partnerships at all
levels are required.
Harassing individuals about their bad habits has very
little impact.
Changes at the individual level will come with
improvements at the organizational, community and
policy levels.
Profiles of Evidence-based Models
http://www.cfah.org/programs/aging
Science Not Shared –
Interventions that Work
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Chronic Disease Self-management Program: Lorig
et al. (1999) Medical Care.
PEARLS: Ciechanowski et al. (2004) Journal of the
American Medical Association.
Multifactorial Intervention: Tinetti ME et al. (1994)
New England Journal of Medicine.
Matter Of Balance: Tennsdedt, S et al. (1998)
Journal of Gerontology.
Enhance Fitness: Wallace, JI et al. (1998) Journal
of Gerontology.
Doing What Works
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Evidence of problem: The burden is great. Something
should be done.
Evidence of effective interventions: The science is
convincing that “this” should be done.
Core features of an effective program: Fidelity is
possible – there is evidence about how “this” should be
done.
Key question: Can we do what is known to work?
(P)RE-AIM Framework
www.re-aim.org
Reach
e
Ma
inte
nan
c
pl
em
en
ta
tio
n
How do I know
my intervention
is effective?
How do I develop
organizational
support to deliver
my intervention?
ss
ne
Im
How do I ensure
the intervention
is delivered
properly?
e
tiv
How do I
incorporate the
intervention so it
is delivered over
the long-term?
ec
Eff
How do I reach the
targeted
population?
p
o
d
A
n
it o
P=Partners and Planning
R=Reach
E=Effectiveness
A=Adoption
I=Implementation
M=Maintenance
The Challenge & the Opportunity
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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.
Center for Healthy Aging
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Increase the quality and accessibility of health
programming for older adults
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National Resource Center on Evidence-based Prevention
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Evidence-based Model Health Programs
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Falls Free: National Falls Prevention Action Plan
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Moving Out: Best Practices in Physical Activity
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MD Link: Connecting Physicians to Model Health Programs
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New Connections: Partnerships between PH and Aging
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Get Connected: Partnerships between MH and Aging