NANCY WELLMAN National Resource Center on Nutrition, Physical Activity & Aging Florida International University 4 th State Units on Aging Nutritionists & Administrators Conference August 2006

Steps to Healthy Aging

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Integrated Program to improve Nutrition & Physical Activity in Older Adults

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Part of National Campaigns

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USDHHS

HealthierUS

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AoA

You Can!

www.aoa.gov/youcan

Steps to Healthy Aging GUIDEBOOK

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Health benefits Setting up a program

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Designed for congregate dining sites & senior centers Lesson plans for 12 weeks

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Ready-to use Tips & Tasks sheets to take home

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To motivate & measure progress

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Matches nutrition education with today’s food issues for

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Older Americans

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Aging Network

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Encourages better food choices & motivates by daily practice

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Charts progress

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Celebrates success

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More fruits & vegetables More calcium-rich foods More fiber & whole grains Less portion distortion

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Uses simple food check-offs

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Helps older adults increase physical activity

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Aims to add steps throughout day to achieve realistic step goal

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Helps older adults value physical activity

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Increases daily step goal realistically & individually Includes walking tips Encourages fluids Uses step counters Records steps daily to track progress

About the STEP COUNTERS

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Easy to use 1 button reset Large display Accuracy tested Safety leash Alligator clip Value

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$26 ~$9 + S/H Order online: http://nutritionandaging.fiu.edu

Wearing your STEP COUNTER

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Wear it directly above your knee. Make sure it’s close & flat to your body.

It must be vertical with cover closed for accurate counts.

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Attach safety leash to belt loop or button hole; use alligator clip to secure counter. At end of each day, write down displayed number — your total steps for day.

To start a new day, press yellow reset button to set counter to zero.

Start wearing your counter anytime during day. Wearing it for even part of day motivates you to walk more.

EVIDENCE … OUTCOMES

WHY COLLECT DATA?

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Document local program effectiveness & timeliness Add effective programming that attracts more clients Justify increased funding for more services Increase marketability with real-life data on older adults Quality & performance improvement Share successes & challenges

RESEARCH: WHAT IS NEEDED?

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Easy-to-use methods & measures Effect of nutrition & physical activity on

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Diet quality & choices

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Health status

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Functional status

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Fitness, strength, balance

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Quality of life

Multi-Site Demonstration

PURPOSE

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Encourage current participants to take simple steps for better health.

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Collect national data & monitor outcomes from diverse populations & program types.

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Build evidence base regarding Program's effectiveness

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Help local programs generate funding & PR opportunities

Multi-Site Demonstration

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106 applications from community programs nationwide

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10 chosen: Program size, Participants served, Geographic location, Ability to report data

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$10,000 grants awarded 2-Day Orientation Workshop: June 2004; Baltimore

Workshop: Data Collection

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Group revised data collection forms to better suit needs of their clients

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Practiced some measures

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Safety Issues: basic safety, movement safety

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Stretches

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Timed Up & Go

Workshop: Barriers

Roundtable discussion of strategies to combat barriers

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Implementation Consistency

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Data Collection Consistency

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For Older Adults to:

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Make Eating Changes

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Increase Physical Activity

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Complete Weekly Tasks

Interactive Approach

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Worked together to develop tools

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Piloted forms & revised

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Kept in touch via listserv & regular conference calls

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Flexible with timelines

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Hurricanes

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Slow start

GRANTEES

10

Grantees

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Active Aging Meadville, PA Alameda County AAA Oakland, CA Citizen Potawatomi Nation, Shawnee, OK Detroit AAA Detroit, MI Township Senior Citizens Activity Ctr, E St Louis, IL

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Hillsborough County Tampa, FL Kit Clark Sr Services Dorchester, MA SE Wisconsin AAA Brookfield, WI Valley Program for Aging Services, Waynesboro, VA Senior Services of Snohomish County, Mukilteo, WA http://nutritionandaging.fiu.edu/You_Can/Mini_Grantees.asp

OUTCOMES

999 Older Adult Participants

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620 “Completers”

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>60 yr + Native Americans

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59% Caucasian

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25% African American

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4% Hispanic

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7% Asian 6% Native American

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82% Women; 18% Men Age: 74.6

+7.5 yr; Oldest: 101

Variable Age Health conditions Assistive devices Completers N 596 Mean + SD (range) 74.6 + 7.5 (53-101) Non Completers N 227 Mean + SD (range) 73.6 + 7.6 (56-95) 615 615 2.1 + 1.9 (0-11) 237 0.4 + 0.8 237 (0-6) 2.4 + 2.2 (0-15) 0.4 + 1.0 (0-5) ADLs IADLs NSI Checklist 578 580 401 0.14

+ 0.6 182 (0-6) 0.4

+ 1.2 184 (0-8) 3.0

+ 2.6 (0-19) 132 0.22

+ 0.8 (0-6) 0.6

+ 1.5 (0-9) 4.1

+ 3.2 (0-15)

Chronic Conditions

High Blood Pressure Diabetes Heart Disease Asthma Impaired Hearing Impaired Eyesight Arthritis Osteoporosis Participants 47% 19% 14% 6% 12% 15% 39% 11%

OA Population*

50% 18%

♂

37%

♂

7%

♂ 50% ♂ 16% ♂

31%

♂ 20% ♂ 14% ♀ 27% ♀ 9% ♀ 33% ♀ 19% ♀ 39% ♀ 46% ♀**

*Older Americans 2004: Key indicators of Well-Being **NHANES III

Impaired Walking

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12% Use canes 8% Knee replacement 4% Use walkers 3% Hip replacement

Self Reported Health Status

increase 3 increase 2 increase 1 no change decrease 1 decrease 2 0 10 20 30 40 50 Percentage of participants 60 70

Significant Outcomes Summary

NUTRITION

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Daily Intakes

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Fruits & vegetables

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Calcium-rich foods

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Fiber-rich foods

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Fluids Stage of Change PHYSICAL ACTIVITY

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35%

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# daily steps

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Pace, stairs climbed, blocks walked, days active

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Risk of falling --

Timed Up & Go

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Stage of Change

STAGES of CHANGE

Pre Contemplation No intention to change behavior in immediate future Contemplation Aware problem exists but not committed to taking Action yet Preparation Intend to take action in next month Action Modify behavior Maintenance Consolidate gains attained during Action stage

Participant Review

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Achieved self-set goal: 92% Recommend Program: 99% Agreed program helped them

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Eat Better

93%

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Move More 90%

Participant Feedback

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Right from day one, I knew this program was going to be a winner! Every session was full of good information on eating & exercise.

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Tips & Tasks to Eat Better & Move More are excellent--new ideas & confirmed old ones.

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Great! I increased my fiber & calcium. I learned how many steps it takes to make a mile. I am going to walk 2 miles everyday.

Follow-up Project

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Data analysis

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What factors impact site participant retention

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Time of day

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Before or after meal

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Site staff incentive

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$$$$$

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Am J Public Health: in press

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Wellman, Kamp, Kirk Sanchez, Johnson

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Part 2: New Guidebook

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Closer look at Dietary Guidelines Resistance training

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Eat Better & Move More for Homebound

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Specially designed for needs & abilities of frail, homebound older adult

National Resource Center on Nutrition, Physical Activity & Aging

http:// nutritionandaging.fiu.edu

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