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Research on Lifestyle Redesign: An Occupational Science Approach to Combating Health Concerns of the 21st Century

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

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Title: Research on Lifestyle Redesign: An Occupational Science Approach to Combating Health Concerns of the 21st Century


1
Research on Lifestyle Redesign An Occupational
Science Approach to Combating Health Concerns of
the 21st Century
  • Health Collaborative Retreat October 21, 2004

2
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

3
What do we mean by occupation?
4
Definition of Occupation
  • Activities that can be named in the lexicon of
    the culture
  • Physical activities
  • Social activities
  • Spiritual activities

5
IIHealth Promotion in the Elderly
6
  • The
  • is upon us

Longevity Revolution
7
  • Our focus must shift
  • from
  • Quantity of Life
  • to
  • Quality of Life

8
  • Outstanding Quality of Life
  • in Old Age
  • IS
  • a Realistic Outcome

9
Successful Aging
  • Growing old with good health, strength, and
    vitality

Rowe, Kahn. Successful Aging. 199823.
10
Usual Aging
  • Elders who are functioning well,but are at
    heightened risk for age- associated disease or
    disability

Rowe, Kahn. Successful Aging. 199823.
11
IIIThe USC Well Elderly Study
12
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

13
The USC Well Elderly Study Group
  • Florence Clark, PhD, OTR USC Occupational Therapy
  • Ruth Zemke, PhD, OTR USC Occupational Therapy
  • Jeanne Jackson, PhD, OTR USC Occupational Therapy
  • Michael Carlson, PhD Social Psychology, USC
    Occupational Therapy
  • Loren G. Lipson, MD Geriatric Medicine, USC Keck
    School of Medicine
  • Stanley P. Azen, PhD Preventive Medicine,
    Biostatistics, USC Department of Biometry
  • Joel W. Hay, PhD Pharmaceutical Policy
    Economics, USC Pharmaceutical Economics
  • Barbara Cherry, PhD Cognitive Psychology, USC
    Occupational Therapy
  • Deborah Mandel, MA, OTR USC Occupational Therapy
  • Karen Josephson, MD Geriatric Medicine, USC Keck
    School of Medicine

14
HealthWell-BeingOccupation
15
Purpose/Goal of Research
  • Prevent Illness
  • Maintain Independence
  • Efficacy
  • Cost-Effectiveness

16
Target Population
  • Independent Seniors
  • Low-Income
  • Multi-Ethnic

17
Design Randomized Clinical Trial
  • Three Experimental Conditions
  • Occupational Therapy - 122
  • Social Group Control - 120
  • No Treatment Control - 119
  • 361

18
Design Measures
  • Physical Health
  • Cognition
  • Functional Status
  • Psychosocial Well-Being
  • General Health

19
Design Timeline
6 Months No Contact
9 Month Program 2 hr/week Small groups
15 Months Utilization of Health Services
20
USC Well Elderly StudyRAND SF-36
8
Occupational Therapy Subjects
6
Control Subjects
4
2
0
2
4
6
8
10
12
14
16
Absence of Health-Based Role Limitations
Vitality
General Health
Social Functioning
21
LR 6-Month Follow-up RAND SF-36
  • OT improvement initial 6mo
  • No Health-based Role Limitations 14 14
  • No Emotional-based Role Limitations 10 11
  • Physical Functioning 9 9
  • Vitality 8 8
  • General Mental Health 6 7
  • Social Functioning 6 6
  • Absence of Bodily Pain 6 5
  • General Health 4 4
  • Clark et al. J Gerontology. Psychological
    Sciences and Social Sciences, 2001.

22
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)

23
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

24
IVHealth Mediating Effects of the Well Elderly
Program
  • 1RO1 AG 021108-01A2, NIH
  • 2,280,668

25
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
26
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

27
Design
  • N440 Ethnically diverse elders
  • Randomized semi-crossover design
  • Intervention Six months lifestyle redesign

28
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

29
  • Conceptual model of positive effects of
    activity-based interventions for elders

Reduced Stress- Related Biomarkers
Healthy Activity Active Coping Social
Support Perceived Control
Intervention
Perceived Physical Health Psychosocial
Well-Being Cognitive Functioning
Potential Mediators Subsidiary Analyses
Social Network Domain-Specific Perceived
Stress Religious Coping Mental
Disengagement Behavioral Disengagement
Acceptance Volunteer Activity  
Positive Reinterpretation-Based Coping
30
VIWeight Loss Randomized Clinical Trial
31
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.

32
Mediational Model for the Proposed Study
Intervention-Based Knowledge
Facilitative Social Support
Customized Lifestyle Re-Engineering
Improved Diet
Increased Perceived Self-Efficacy
Personalized Daily Lifestyle Change
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