Transcript Research on Lifestyle Redesign: An Occupational Science Approach to Combating Health Concerns of the 21st Century Health Collaborative Retreat October 21, 2004

Research on Lifestyle Redesign: An
Occupational Science Approach to
Combating Health Concerns of the 21st
Century
Health Collaborative Retreat
October 21, 2004
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Occupational Science
New Social Science
Studies the relationship of occupation to
health
Study of the human as an occupational
being: person engaged in his or her
world of activity
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What do we mean by
occupation?
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Definition of Occupation
Activities that can be named in the lexicon
of the culture:
Physical activities
Social activities
Spiritual activities
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II
Health Promotion in the
Elderly
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The
is upon us…
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Our focus must shift
from
Quantity of Life
to
Quality of Life
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Outstanding Quality of Life
in Old Age
IS
a Realistic Outcome
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Successful Aging
“Growing old with good health,
strength, and vitality”
Rowe, Kahn. Successful Aging. 1998;23.
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Usual Aging
Elders who are functioning well,
but are at heightened risk for ageassociated disease or disability
Rowe, Kahn. Successful Aging. 1998;23.
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III
The USC Well Elderly Study
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The USC Well Elderly Study was funded
by
National Institutes of Health
National Institute on Aging (NIA)
Agency for Health Care Policy and Research (AHCPR)
National Center for Medical Rehabilitation Research (NCMRR)
American Occupational Therapy Foundation
Lumex, Inc.
RGK Foundation
Smith & Nephew Roylan
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The USC Well Elderly Study Group
Florence Clark, PhD, OTR
Ruth Zemke, PhD, OTR
Jeanne Jackson, PhD, OTR
Michael Carlson, PhD
Loren G. Lipson, MD
Stanley P. Azen, PhD
Joel W. Hay, PhD
Barbara Cherry, PhD
Deborah Mandel, MA, OTR
Karen Josephson, MD
USC Occupational Therapy
USC Occupational Therapy
USC Occupational Therapy
Social Psychology, USC Occupational
Therapy
Geriatric Medicine, USC Keck School of
Medicine
Preventive Medicine, Biostatistics, USC
Department of Biometry
Pharmaceutical Policy & Economics, USC
Pharmaceutical Economics
Cognitive Psychology, USC Occupational
Therapy
USC Occupational Therapy
Geriatric Medicine, USC Keck School of
Medicine
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Health
Well-Being
Occupation
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Purpose/Goal of Research
Prevent Illness
Maintain Independence
Efficacy
Cost-Effectiveness
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Target Population
Independent
Seniors
Low-Income
Multi-Ethnic
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Design:
Randomized Clinical Trial
Three Experimental Conditions
 Occupational
 Social
 No
Therapy
- 122
Group Control
- 120
Treatment Control
- 119
361
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Design: Measures
Physical Health
Cognition
Functional Status
Psychosocial Well-Being
General Health
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Design : Timeline
9 Month Program
6 Months
2 hr/week Small groups
No Contact
Pre Test
Physical Exam
Questionnaires
Post Test
Questionnaires
Follow Up
Physical Exam
Questionnaires
15 Months
Utilization of Health Services
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USC Well Elderly Study
RAND SF-36
8%
6%
Occupational Therapy Subjects
4%
Control Subjects
2%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Vitality
General
Health
Absence of
Health-Based
Role Limitations
Social
Functioning
General Mental
Health
Absence of
Bodily Pain
Physical
Functioning
Absence of
Emotion-Based
Role Limitations
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LR: 6-Month Follow-up
RAND SF-36
OT improvement








initial 6mo
No Health-based Role Limitations 14%
No Emotional-based Role Limitations
Physical Functioning
Vitality
General Mental Health
Social Functioning
Absence of Bodily Pain
General Health
14%
10%
9%
8%
6%
6%
6%
4%
11%
9%
8%
7%
6%
5%
4%
Clark et al. J Gerontology. Psychological Sciences and Social Sciences, 2001.
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LR: Cost Effectiveness
Estimate of medical costs avoided as a
result of occupational therapy
intervention in relation to
health related quality of life.
Hay, et al, (2002)
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Results
Program Costs

OT = $548 per subject
Post intervention health care costs
OT = $967
 Active Control = $1,726
 Passive Control = $2,593
 Cost per QALY (OT) = $10,660

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IV
Health Mediating Effects of
the Well Elderly Program
# 1RO1 AG 021108-01A2, NIH
$2,280,668
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Investigative Team
Principal Investigator: Florence A. Clark, Ph.D., USC Department of
Occupational Science & Occupational Therapy
Co-Investigators:
Stanley Azen, Ph.D., USC Department of Biometry, Keck School of
Medicine
Carolyn Ervin, USC Department of Biometry, Keck School of
Medicine
Michael Goran, USC Preventive Medicine, Physiology
Joel Hay, USC Pharmaceutical Economics
Howard Hodis, USC, Molecular Pharmacology/Toxicology
Leslie Lytle, University of Minnesota, Epidemiology
Virginia Quinn, Kaiser Permanente, Southern California
Kim Reynolds, USC Preventive Medicine
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Aim
To replicate our previous results on the
positive effects of the lifestyle redesign
intervention
To examine the mediating mechanisms
responsible for its positive effects
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Design
N=440: Ethnically diverse elders
Randomized semi-crossover design
Intervention: Six months lifestyle
redesign
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Measures
(Assessed 4 – 5 times over an 18 – 24 month interval)
Healthy Activity
Coping
Social Support
Perceived Control
Stress Related Biomarkers
Perceived Physical Health
Psychological Well-being
Cognitive Functioning
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Conceptual model of positive effects of activity-based interventions
for elders
Healthy Activity
Intervention
Reduced StressRelated Biomarkers
Active Coping
Social Support
Potential Mediators:
Subsidiary Analyses
* Social Network
* Domain-Specific
Perceived Stress
* Religious Coping
* Mental
Disengagement
* Behavioral
Disengagement
* Acceptance
* Volunteer Activity
Perceived Control
Perceived Physical Health
Psychosocial Well-Being
Cognitive Functioning
Positive Reinterpretation-Based
Coping
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VI
Weight Loss Randomized
Clinical Trial
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Customized Lifestyle Re-Engineering
and Obesity: An RCT
Principal Investigator: Florence A. Clark, Ph.D., USC
Department of Occupational Science & Occupational
Therapy
Co-Investigators:
Stan Azen, Ph.D.
Michael Goran, Ph.D.
Joel Hay, Ph.D.
Howard Hodis, M.D.
Kim Reynolds, Ph.D.
Virginia Quinn, Ph.D.
Leslie Lytle, Ph.D.
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Mediational Model for the
Proposed Study
Intervention-Based
Knowledge
Customized Lifestyle
Re-Engineering
Facilitative Social
Support
Increased Perceived SelfEfficacy
Improved Diet
Personalized Daily
Lifestyle Change
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