EvidenceBased Health Promotion for Older Adults

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Evidence-Based Health Promotionfor 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

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Overview of the Presentation

• Modifiable Risk Factors Among Older Adults
• AoAs Evidence-Based Prevention Program
• Frameworks for Evidence-based Programming

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Modifiable Risk Factors Among Older Adults
http//www.cdc.gov/aging
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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
• physical health
• mental health
• ability to do their usual activities
• Increase in unhealthy days
• 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?State1
  Measure5Category1

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Health Status of Older Adults

• 88 - at least one chronic condition
• 50 - at least two chronic conditions
• 34 experience some activity limitation
• 26 assess health as fair or poor
• 41 of older African Americans
• 40 of older Hispanics

CDC-MIAH 2004 CDC/NCHS Health US, 2002
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Leading Causes of Death, Age 65 (2001)

• Heart Disease 32
• Cancer 22
• Stroke 8
• Chronic Respiratory 6
• Flu/Pneumonia 3
• Diabetes 3
• Alzheimers 3

CDC-MIAH 2004 CDC/NCHS Health US, 2002
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Underlying Risk Factors The Actual Causes of
Death

• Behavior of deaths, 2000
• Smoking 19
• Poor diet nutrition/ 14 Physical
  inactivity
• Alcohol 5
• Infections, pneumonia 4
• 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
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Benefits to Older AdultsReviewed in A New
Vision of Aging

• Longer life
• Reduced disability
• Later onset
• Fewer years of disability prior to death
• Fewer falls
• Improved mental health
• Positive effect on depressive symptoms
• Possible delays in loss of cognitive function
• Lower health care costs
• http//www.cfah.org/programs/aging

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Threats to Health and Well-being Among Seniors

• 73 age 65 - 74 report no regular physical
  activity
• 81 age 75 report no regular physical activity
• 61 - unhealthy weight
• 33 - fall each year
• 35 - no flu shot in past 12 months
• 45 - no pneumococcal vaccine
• 20 - prescribed unsuitable medications
• www.cdc.gov/nchs

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AoAs Prevention Program FY 2006

• 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
• Replicable in community-based settings

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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?se
ctionid15ElementID97
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Guiding Principles

• Make Prevention a Priority
• Start with the Science Evidence
• Work for Equity and Social Justice
• Foster Interdependence
• Aging network
• Health care
• Public health
• Long term care
• Mental health
• Research
• James Marks, MD

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Social Ecologic Model of Healthy Aging
McLeroy et al., 1988, Health Educ Q Sallis et
al., 1998, Am J Prev Med
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What the Social-Ecological Perspectives Says

• 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.

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Profiles of Evidence-based Models
http//www.cfah.org/programs/aging
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Science Not Shared Interventions that Work

• 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.

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Doing What Works

• 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?

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(P)RE-AIM Framework www.re-aim.org
PPartners and Planning RReach EEffectiveness A
Adoption IImplementation MMaintenance
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The Challenge the Opportunity

• 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.

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Center for Healthy Aging

• Increase the quality and accessibility of health
  programming for older adults
• National Resource Center on Evidence-based
  Prevention
• Evidence-based Model Health Programs
• Falls Free National Falls Prevention Action Plan
• Moving Out Best Practices in Physical Activity
• MD Link Connecting Physicians to Model Health
  Programs
• New Connections Partnerships between PH and
  Aging
• Get Connected Partnerships between MH and Aging