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Livable and Senior Friendly Communities and Healthy Aging in North Carolina

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Title: Livable and Senior Friendly Communities and Healthy Aging in North Carolina


1
Livable and Senior Friendly Communities and
Healthy Aging in North Carolina
  • We can make a difference!!

Audrey Edmisten May 2008
2
Overview
  • The Changing Face of Aging in North Carolina A
    Demographic Profile
  • Livable and Senior-Friendly Communities
  • Healthy Aging in North Carolina

3
Actual and Projected Population Age 65 and
Better, North Carolina, 1900 to 2030
1900 1910 1920 1930 1940 1950 1960 1970 1980 199
0 2000 2010 2020 2030
4
Shifting Demographics
The boomers are coming!!
Age Group 18-64
Age Group 0-17
Age Group 65
5
Did you know??
  • by 2030, 75 counties are projected to have more
    persons age 60 and older than age 17 and under!

6
Percent of Population Age 65 in North Carolina,
2000
7
Percent of Population Age 65 in North Carolina,
2030
Based on July 2006 population projections
8
An Extreme County Example
Brunswick Age 60 NC Age 60
Source NC State Data Center
http//demog.state.nc.us/
9
The Population of NC is Getting Older
  • Older adults are North Carolina's fastest growing
    segment of the population.
  • Reasons include decreasing birth rates, improved
    life expectancies, migration, and better health

10
NC ranked third nationally with a net migration
number of 34,290 among older adults (60) in the
five-year period between 1995 and 2000. Along
with other Sunbelt states (Florida, South
Carolina, Texas, Tennessee, Georgia, and
Virginia) North Carolina is a popular destination
for people of all ages, including seniors.
In-migration of Older Adults to NC
11
Longer Life Expectancy
12
More Older Women than Older Men
Percent of NC population by Gender and Age (2000)
All Ages
Age 65
Age 85
Male40.1
Male25.9
Male49.0
Female51.0
Female59.9
Female74.1
Source of data U.S. Census Bureau, Census 2000
Summary File 1, Matrices P13 and PCT12.Prepared
by the UNC Institute on Aging Last updated
September 2001
13
Profile of the Boomers
  • Born 1946-1964
  • 1.63 million Google hits
  • Baby Boomers have a higher level of education
    than any generation before them
  • Estimated annual spending power is 2.5 Trillion

14
Life Experience and Perspective
  • Strong Self-Image (They do not now and never
    will consider themselves senior citizens.)
  • Numerous time constraints
  • Actively employed longer than previous
    generations
  • Caregiving responsibilities

15
Life Experience and Perspective (Continued)
  • Willing to pay for desired and high-quality goods
    and services
  • Technologically proficient
  • Possess the sophistication to drive and navigate
    the system
  • Desire to expand knowledge and experience base

16
Life Experience and Perspective (Continued)
  • Likely to respond to programs that provide
    intellectual stimulation, physical challenges, a
    creative outlet and enhanced life experience

17
What the Data Tells Us about Older North
Carolinians
  • The population is aging and the older adult
    population is the fastest growing sector
  • The majority of NC counties are experiencing
    increases in the proportion of their older adult
    populations
  • Older adults are becoming more racially and
    ethnically diverse racial differences exist in
    perceptions of health status

18
What the Data Tells Us About Older North
Carolinians (continued)
  • Gender, race and income differences compound
    health problems
  • As compared to the US average, the NC older adult
    population is less educated, has lower incomes,
    is more likely to be disabled, yet is also more
    likely to be working
  • The growth of the older adult population will
    place increased demand for health promotion,
    support services, greater need for long term care
    solutions, and higher expenditures for health
    care and services

19
What the Data Tells Us About North Carolinas
Service Capacity
  • NC is meeting national standards for selected
    preventive care
  • BUT
  • NC is not meeting the national standards for oral
    health care, proper nutrition and physical
    activity levels
  • NC is ranked 42nd or worse in the percent of
    older adults who are disabled, obese or report
    physically unhealthy days
  • NC does not have an adequate health services
    workforce

20
Division of Aging and Adult Services
  • Mission to promote independence and enhance the
    dignity of N C's older adults, persons with
    disabilities, and their families through a
    community-based system of opportunities . . .
  • Adult Day Services
  • Care Management
  • Nutrition Services (Congregate, Home Delivered
    Meals)
  • Respite Care
  • In-Home Aide
  • Information and Case Management
  • Senior Center Operations
  • Transportation
  • Housing and Home Improvement
  • Other Services (Health Promotion, Ombudsman Adult
    Protective Services, State Prescription Drug
    Program, . . .)

21
Building Livable and Senior-Friendly Communities
One Piece at a Time
22
NCs Livable and Senior-Friendly Community
Framework
Physical Accessible Environment
Public Accountability and Responsiveness
Healthy Aging
Access and Choice in Services and Supports
Economic Security
Social and Cultural Opportunity
Technology
Safety and Security
23
Vision
  • A livable and seniorfriendly community
  • Promotes social and economic security for all
    citizens
  • Celebrates seniors contributions to the
    community
  • Inspires intergenerational relations
  • Encourages community planners to involve seniors
    and consider their needs and interests
  • Affirms senior efforts to live independently and
    builds responsive systems of long-term services
    and supports for people of all ages
  • Acknowledges important role that families,
    friends, and neighbors play in the lives of
    seniors, and enhances their capacity for caring.

24
Livable and Senior-FriendlyCommunity Components
  • Physical and Accessible Environment
  • Healthy Aging
  • Economic Security
  • Technology
  • Safety and Security
  • Social and Cultural Opportunity
  • Access and Choice in Services and Supports
  • Public Accountability and Responsiveness

25
LSFC Components Physical and Accessible
Environment
  • Schools of Architecture
  • City Regional Planning
  • Geography
  • Public Administration
  • School of Government
  • Schools of Business
  • Highway Safety Research Center
  • School of Public Health
  • Schools of Recreation/Recreational Therapy
  • Schools of Social Work
  • Environmental Sciences Engineering
  • Transportation
  • Air/water quality
  • Housing/utilities
  • Land use
  • Noise control
  • Road safety
  • Recreational facilities
  • Shopping
  • Zoning
  • Neighborhood organizations
  • Center for Universal Design

26
LSFC ComponentsHealthy Aging
  • Health Dept
  • Adult immunization
  • Dental health
  • Leisure
  • Nutrition
  • Mental health
  • Medicare/Medicaid acceptance
  • Medications
  • Preventive care
  • Primary care
  • Rehabilitation
  • Vision/hearing care
  • Wellness/fitness
  • Schools/Departments of Medicine, Nursing, Public
    Health, Allied Health, Psychology, Dentistry,
    Pharmacy, Hospital Administration, Exercise
    Sport Science, etc.
  • Schools of Education
  • NC Cooperative Extension Service
  • Hospitals

27
LSFC ComponentsEconomic Security
  • Job training
  • Age discrimination
  • Financial planning
  • Health and long-term care cost
  • Health insurance
  • Income
  • Job opportunities
  • Job retooling
  • Senior-friendly businesses
  • Tax credits/exemptions
  • Schools/Departments of Economics, Public Health,
    Public Administration, Business, Education,
    Political Science, Gerontology, Journalism Mass
    Communications, Social Work, etc.
  • Community Colleges
  • NC Cooperative Extensive Service
  • School of Government

28
Potential Winners in a Boomer Market
  • Home-renovation and building stores (with onsite
    instruction)
  • Improvements to the ergonomic fit of the
    environment
  • Specialty diagnosis and treatment centers
  • Boomer arcades, including Senior video-gaming
  • Reputable financial, job, and health counselors
  • Progressive colleges and universities
  • Rating servicesperformance scorecards
  • Accommodating employers
  • Innovative travel services
  • Mature dating services
  • Livable and Senior-friendly Communities

29
LSFC ComponentsTechnology
  • Internet access
  • Assistive/Adaptive devices
  • Distance learning
  • Medical alert
  • Tele-medicine
  • Telephone/cell phone access
  • Community Colleges
  • Schools/Departments of Economics, Public Health,
    Public Administration, Business, Education,
    Medicine, Nursing, Allied Health, Gerontology,
    Information and Library Science, Journalism
    Mass Communications, Social Work, etc.

30
LSFC ComponentsSafety and Security
  • Driver safety
  • Abuse/neglect
  • Domestic violence
  • Emergency response
  • Fire safety
  • Fraud/exploitation
  • Outreach
  • Schools/Departments of Public Health, Public
    Administration, Business, Education, Medicine,
    Nursing, Gerontology, Journalism Mass
    Communications, Social Work, etc.
  • Community Colleges
  • NC Highway Safety Research Center
  • NC Justice Academy

31
LSFC ComponentsSocial and Cultural Opportunity
  • Volunteerism
  • Community sensitivity
  • Media
  • Intergenerational relations
  • Libraries
  • Lifelong learning
  • Spiritual growth
  • Racial/ethnic/linguistic diversity
  • Cultural/social programs
  • The Arts
  • Schools/Departments of Information and Library
    Science, Public Administration, Education,
    Gerontology, Journalism Mass Communications,
    Art, Music, Philosophy, Religious Studies,
    Sociology, Social Work, Dramatic Art, Creative
    Writing, Anthropology, Recreation Leisure
    Studies, etc.
  • Community Colleges

32
Healthy AgingWhats so urgent about health
promotion prevention in aging?
A call for action
33
The Population of NC is Getting Older
  • Older adults are North Carolina's fastest growing
    segment of the population.
  • Reasons include decreasing birth rates, improved
    life expectancies, migration, and better health.

34
NC Leading Causes of Death
Source NC Center for Health Statistics (2003).
Leading Causes of Death 2002
35
Poor Lifestyle Choices
36
How do we use our time?
37
(No Transcript)
38
The State of Aging and Health in America, 2004
  • National Report Card on 15 indicators in the CDC
    Behavioral Risk Factor Surveillance System
    (BRFSS)
  • health status, health behaviors, preventive care,
    and injuries of persons age 65

The Merck Institute of Aging Health
www.miahonline.org
www.cdc.gov/aging
39
Aging in North Carolina
  • North Carolina has one of the fastest growing
    older adult populations in the U.S., and is
    ranked 10th in the number of older adults
  • By 2030, 75 counties with have more people gt 60
    than lt 17
  • 33 of older adults rate their health as fair or
    poor
  • 44 report arthritis
  • 27 report hypertension
  • 12.5 report diabetes
  • North Carolinians rank
  • 33/50 in obesity rates
  • 48th/50 in recommended physical activity levels
  • 49th/50 in nutritious eating habits

40
Chronic diseases account for 75 of the 1.4
trillion we spend on health care
Mensah www.nga.org/Files/ppt/0412academyMensah.pp
t21 Heffler et al. Health Affairs, March/April
2002.
41
How is the allocated?
42
Is it worth the effort?
  • You bet!

43
The Body
Only 30 of physical aging is attributable to
genetic heritage!
  • Poor diet obesity
  • Physical inactivity
  • Social isolation
  • Smoking other poor health habits

44
Better Late than Never
  • Risks reduced
  • even in late life
  • Benefits significant
  • despite age

Its never too late to start its always too
early to stop!
45
Avoid bad habits...
46
Good Nutrition
  • Long and Healthy Living
  • Improves Health
  • Maintains Functionality
  • Prolongs Independence
  • Benefits Quality Of Life
  • Saves
  • healthcare industry
  • taxpayers individuals

47
2005 Dietary Guidelines for Americans
  • Key Recommendations
  • Adequate Nutrients within Calorie Needs
  • Weight Management
  • Physical Activity
  • Food Groups to Encourage
  • Fats
  • Carbohydrates
  • Sodium and Potassium
  • Alcoholic Beverages
  • Food Safety

48
Physical Activity
  • Increases
  • Bone strength
  • Physical work capacity
  • Flexibility
  • Muscular strength
  • Improves
  • Glucose regulation
  • Sleep patterns anxiety
  • Sense of well-being
  • Cognitive functioning

49
Physical Activity
  • Decreases
  • Blood pressure
  • Cholesterol levels
  • Osteoporosis
  • Depression, stress, anxiety
  • Risk of heart disease, colon cancer, diabetes

50
The Mind
  • Debilitating changes not inevitable
  • Brain central nervous system have great
    plasticity
  • Evidence that older younger adults use
    different pathways for same task
  • Compensatory strategies helpful 

51
The Spirit
  • Engagement in life
  • Meaningful activities, roles relationships
  • Occupational engagement, as distinct from
    exercise social activity

52
Social Connectedness
among the most important predictors of health
and independence as we agealmost as strong as
not smoking or being overweight Kawachi
  • Less mental decline
  • More active lives
  • Protective effects
  • cardiovascular disease (Berkman)
  • Concrete social support

53
The race is afootso lets get to it!!
54
Promoting Healthy Aging in NC
  • Livable and Senior-Friendly Communities
  • Community Partnerships, Collaborations and
    Resources
  • Evidence-Based Health Promotion Programs

55
Livable Communities and Long Range Planning
  • Municipal, county and regional planners are
    developing plans to meet the long range needs of
    our aging population
  • The concept of Livable and Senior Friendly
    Communities is taking hold in many areas

56
Partnerships/Collaborations
  • Partnerships with employers to provide fitness
    time for older workers
  • Flexible/expanded days and hours of programming
    to allow for weekend and evening activities
  • Parks and nature trails that allow for hiking,
    biking, cycling and artistic endeavors

57
Partnerships/Collaborations
  • Growth of team sports basketball, softball, ice
    hockey, volleyball, soccer
  • Challenges of outdoor and extreme sports, i.e.
    whitewater rafting, kayaking, bungee jumping,
    in-line skating, ropes courses
  • Adventure travel groups
  • Enhanced, more stimulating exercise programs such
    as tai chi, yoga, Pilates, kick boxing, including
    options for online registration and access
    through downloads and/or streaming video

58
Partnerships/Collaborations NC Senior Games
  • wellness and prevention program - a model for the
    nation, with
  • 54 Local Games serving all 100 counties 60,000
    participants statewide
  • Overall growth in team sports, track events,
    bocce, bowling, SilverArts
  • Diminishing participation in events such as
    shuffleboard, croquet, horseshoes
  • Interest in new events, i.e. javelin, high jump,
    volleyball

59
Senior Games Participant Satisfaction Survey
with the Year-Round Program2006 n444
  • 96 of respondents would recommend participation
    in Senior Games to friends and family
  • Once they became involved in Senior Games, 85
    have never considered quitting.

60
Senior Games Survey Results
  • Over 90 of respondents used Senior Games to keep
    active
  • Improved health, increased self-esteem were cited
    as greatest benefits of Senior Games
  • Fitness 82 Very Important or Important
  • Improving Health 77 Very Important or
    Important
  • Competition 80 Very Important or Important

61
Partnerships/Collaborations NC Healthy Aging
Roadmap Creating Sustainable Partnerships For
Efficient And Effective Health Promotion For
Older Adults
62
What is the Roadmap?
  • A user-friendly guide for community providers
  • A data resource providing
  • Health information specific to your county
  • An easy to use guide to access additional
    information
  • A program resource providing
  • A state-wide inventory of health promotion
    programming
  • A county by county listing of evidence-based
    health promotion programming and other types of
    programming

63
Roadmap for Healthy AgingProducts
  • Memorandum of Agreement
  • North Carolina Survey of Older Adult Health
    Promotion Programs
  • Development of North Carolina Older Adult Health
    Data Matrix

64
The North Carolina Healthy Aging Coalition
  • Formed in 2005 25 organizations
  • Building state, regional local partnerships
  • Promoting evidence-based health promotion
    prevention
  • Fostering the independence well-being of aging
    North Carolinians

Were all in this together
65
Best Practices Evidence-Based Programs
  • Best Practices are processes, practices, or
    systems widely recognized as improving the
    performance and efficiency of organizations in a
    target area, such as health promotion.

66
Evidence-Based Programming NCOAs 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.
  • 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.

67
Questions And Evidence-Based Programs
  • Old question
  • Does what we are doing work?
  • New question
  • Can we do what is known to work?
  • What do we know works?
  • How well do we know it and understand it?
  • About whom do we know it?

68
Why Evidence-Based Programs?
  • Older adults are largely ignored by health
    promotion/prevention initiatives and funding.
  • Recognize the importance of promotion and
    prevention for older adults make it a priority.
  • Add evidence-based programming to current
    expertise of the aging network.
  • Replicate evidence-based models by carefully
    adapting them to your community.
  • Not all programming can be evidence-based!!

69
Advantages to Implementing Evidence-Based
Programs
  • Increases the likelihood of positive outcomes
  • Makes it easier to justify funding
  • Helps to establish partnerships esp. with
    health care providers
  • Leads to efficient use of resources
  • Facilitates the spread of programs
  • Facilitates the use of common performance
    measures
  • Supports continuous quality improvement

70
Disadvantages of Evidence-Based Programs
  • Feels like standardization
  • Difficult to build community support everyone
    wants home grown
  • Tools and processes are unfamiliar
  • Research studies are difficult to read and
    interpret
  • Requires partnerships - some communities may not
    have partners that can help
  • IT IS HARD sort of

71
  • Examples of evidence-based programs
  • that have been successfully implemented in NC
  • Arthritis Foundation Exercise Program (AFEP)
  • Chronic Disease Self-Management Program

72
Evidence-based physical activity programs
  • Arthritis Foundation Exercise Program
  • Arthritis Foundation Aquatic Program
  • www.arthritis.org

73
What is arthritis?
Blounts disease
  • Arthritis joint inflammation
  • More than 100 diseases including
  • Osteoarthritis
  • Rheumatoid arthritis
  • Gout
  • Lupus
  • Gout
  • Fibromyalgia
  • Juvenile arthritis

Dupuytrens contracture
Immune Complex disease
Sickle cell arthropathy
Gauchers disease
Scleroderma
Bursitis
Tendinitis
Raynauds phenomenon
Lyme disease
Osteoporosis
Psoriatic arthritis
Hip dysplasia
Cogans Syndrome
Carpel Tunnel
Duchennes Muscular Dystrophy
74
Why is arthritis a concern?
  • In NC 27 of all adults have arthritis
  • ½ of those in NC w/ arthritis are 65
  • Over ½ a million North Carolinians report
    limitations in daily activities due to arthritis
  • Dealing with the pain and limitations caused by
    arthritis complicates other chronic conditions

75
Arthritis Foundation Exercise Program (AFEP)
(formerly People with Arthritis Can Exercise or
PACE)
  • A community-based recreational exercise program.
  • Trained AEFP instructors cover a variety of
    range-of-motion, endurance-building, and
    strengthening activities relaxation techniques
    and health education topics.
  • All of the exercises can be modified to meet
    participant needs.
  • Classes typically meet two or three times per
    week.

76
AFEP Benefits
  • Improved functional ability
  • Decreased depression
  • Increased confidence in ones ability to exercise

77
Living Healthy
  • Chronic Disease Self-Management Program

78
CDSMP Background
  • Evidence-Based Health Promotion
  • Developed at Stanford University

79
This just in!
  • Improved health behaviors
  • Exercise, cognitive symptom management, coping,
    communication with physician
  • Improved health status
  • Self-reported health, fatigue, disability, health
    distress
  • Decreased days in the hospital

80
Underlying Assumptions
  • Similar symptoms and concerns
  • Coping with disease AND the impact
  • of disease on lives and emotions
  • Lay people with chronic conditions, can be
    effective leaders
  • Process is just as important as content

81
Self Efficacy
  • Goal setting, making an action plan, feedback
    sharing
  • Modeling
  • Reinterpreting symptoms
  • Persuasion

82
CDSMP in North Carolina Living Healthy
  • 3-year demonstration grant from AoA
  • Currently in 7 Regions A, B, F, I, J, L, P
  • Regional Coordinators in each area
  • Working to target hard-to-reach, underserved
    adults 60 and offer the program in a wide
    variety of settings.
  • Current partners
  • DPH - Extension - UNC IoA
  • CCNC - AARP - Many others!

83
North Carolina CDSMP Project Map
Winston-Salem
Raleigh
Northampton
Alleghany
Gates
Warren
Currituck
Ashe
Stokes
Surry
Camden
Caswell
Rockingham
Vance
Person
Hertford
Granville
Pasquotank
Watauga
Halifax
Wilkes
Perquimans
Yadkin
Chowan
Forsyth
Guilford
Bertie
Franklin
Orange
Alamance
Avery
Durham
Mitchell
Caldwell
Nash
Edgecombe
Davie
Alexander
Yancey
Madison
Washington
Martin
Iredell
Tyrrell
Wake
Davidson
Dare
Chatham
Randolph
Burke
Wilson
McDowell
Catawba
Rowan
Buncombe
Pitt
Beaufort
Haywood
Johnston
Hyde
Swain
Greene
Lee
Lincoln
Rutherford
Cabarrus
Harnett
Cleveland
Henderson
Wayne
Graham
Montgomery
Jackson
Stanly
Moore
Gaston
Mecklenburg
Polk
Craven
Lenoir
Transylvania
Macon
Cherokee
Pamlico
Cumberland
Clay
Hoke
Jones
Richmond
Anson
Sampson
Union
Duplin
Scot land
Carteret
Onslow
Robeson
Asheville
Bladen
Charlotte
Pender
Columbus
New Hanover
Brunswick
84
Nuts Bolts
  • The workshop consists of
  • Six, 2 ½ hour sessions
  • Each session has 4-8 different activities
  • Specified time limits for each activity
  • Scripted, activities must be taught in a certain
    order with stated methods
  • Each pair of leaders makes charts

85
Join the Fun!
  • Partnership
  • staff time
  • co-sponsor
  • resource sharing
  • client referral process
  • promotional support
  • Etc.

86
Want to Learn More?
  • Using the Evidence Base to Promote Healthy
    AgingIssue Brief 1
  • www.healthyagingprograms.org/content.asp?sectioni
    d15ElementID97
  • A New Vision of Aging Helping Older Adults Make
    Healthier Choices
  • www.healthyagingprograms.org/content.asp?sectioni
    d75ElementID304
  • NC Division of Aging and Adult Services
  • http//www.ncdhhs.gov/aging/mission.htm
  • Administration on Aging
  • www.aoa.gov/prof/evidence/evidence.asp
  • Centers for Disease Control and Prevention
  • www.cdc.gov/aging/index.htm
  • Agency for Healthcare Research and Quality
  • www.ahrq.gov/news/ulp/diselder/ulpdiseld.htm
  • CDCs Healthy Aging Research Network
  • depts.washington.edu/harn

87
Summary
  • The power of our aging population will only
    continue to grow in the coming years
  • Wellness, fitness and recreational activities are
    crucial to the lifestyle of the Baby Boom
    generation
  • Intense, pro-active collaboration and cooperation
    remain integral for our success!

88
Audrey.edmisten_at_ncmail.net NC Division of Aging
and Adult Services
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