Aging Well: What Works for Older Persons in the Community - PowerPoint PPT Presentation

Loading...

PPT – Aging Well: What Works for Older Persons in the Community PowerPoint presentation | free to download - id: 404c31-MzJkM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Aging Well: What Works for Older Persons in the Community

Description:

One only needs to consider the importance of falls and broken hips in the elderly to ... improve nutrition, ... and evaluating programs adapted from tested ... – PowerPoint PPT presentation

Number of Views:783
Avg rating:3.0/5.0
Slides: 69
Provided by: JoA447
Learn more at: http://wvsioa.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Aging Well: What Works for Older Persons in the Community


1
Aging Well What Works for Older Persons in the
Community
BEATRICE RUTH BURGESS MEMORIAL LECTURE JoAnn
Damron-Rodriguez, LSCW, PhD University of
California, Los Angeles
33rd Summer Institute on Aging Living Well,
Staying Well, Aging Well West Virginia
University June 8, 2011
2
Mountain Mama, Bring Me Home
1918 to present
3
Youth is a Gift of Nature Age is a Work of Art
  • Chinese Proverb

4
Overview of Our Considerations
  • Future of Aging
  • Preparing Practitioners
  • Challenges to Wellness
  • Promoting Wellness
  • Programs that Work for Wellness

5
I. Considering The Future of Aging
6
OUR AGING WORLD CHANGING THE SHAPE OF THE
AMERICAN POPULATION
  • THE FUTURE OLDER POPULATION WILL
  • BE MORE EDUCATED AND DIVERSE
  • BE CHALLENGED TO MANAGE CHRONIC ILLNESS
  • DEMAND SERVICE CHOICES
  • HAVE FEWER FAMILY CAREGIVERS

7
Boomers Living Longer
  • Greater expectancy of a long life
  • Due to advances in public health, health care and
    healthier lifestyles
  • 1900 47 years
  • 2011 78 years
  • West Virginia Aging
  • 3rd highest in USA
  • Over 15

When Im 64 How Boomers Will Change Health Care
, American Hospital Association, May 2007
8
Cohort view of the world shaped by
Swing Generation (G.I. Generation)
1900-1926 Silent Generation 1927-1945 Baby
Boomers 1946-1964 Baby Bust (Gen X) 1965-1976
Echo Boomers (Gen Y) 1977-1994
9
Ageism
  • Relates to considering one group of people as
    essentially different from themselves
  • Similar to racism and sexism.
  • Names and terms to designate the other
  • Differentiate illness from aging
  • We incorporate these beliefs into who we are
  • Robert Butler, M.D., Pulitzer Prize Winner

10
Do Ageist Attitudes Hurt You?
  • Older individuals apply negative age stereotypes
    to themselves, they have
  • a greater cardiovascular response to stress
  • and worse health behaviors, such as higher
    tobacco use (Levy, Slade, Kunkel, Kasl, 2002).
  • these outcomes have been linked to the risk of
    cardiovascular events (Levy, Hausdorff,Hencke,
    Wei, 2000 Levy Myers, 2004)
  • When younger people hold negative stereotypes
    earlier in life they have consequences for health
    in later life.
  • greater likelihood of experiencing
    cardiovascular events up to 38 years later than
    individuals with more positive age stereotypes.
    (Levy, Zonderman, Slad Ferrucci, 2009)

11
An Active Aging Framework
  • Active aging
  • Emphasis on autonomy/choice with aging
  • A model of viewing aging as a positive experience
    of continued growth and participation in family,
    community, and societal activities, even when
    accompanied by decline in some capacities

12
FIGURE 1.1 The Determinants of Active
Aging SOURCE World Health Organization, Active
ageing A policy framework (WHO 2002). Reprinted
by permission of the World Health Organization.
13
Rowe and Kahns Successful Aging Model
Source Marshall, V.M. Altpeter, M. (2005).
Cultivating social work leadership in health
promotion and aging Strategies for active aging
interventions. Health Social Work, 30(2),
135-144.
14
II. Considering The Preparation of
Practitioners for the Future Aging Workforce
15
Retooling for an Aging America Building the
Health Care Workforce Institute of Medicine,
2008 www.nap.edu.
  • The health needs of the older population need to
    be addressed comprehensively
  • Services need to be provided efficiently
  • Older persons need to be active partners in
    their own care.

16
Three-Pronged Approach to Building Capacity
Enhance geriatric competence of general workforce
in common problems Increase recruitment and
retention of geriatric specialists and
caregivers Implement innovative models of care
17
Learning Objectives based on the Hartford
Geriatric Social Work Nursing Competencies
  • Use educational strategies to provide older
    persons and their families with information
    related to wellness and disease management
  • 2. Include older adults in planning and designing
    programs.
  • 3. Promote use of research (including
    evidence-based practice) to evaluate and enhance
    the effectiveness of social work practice and
    aging related services.

18
  • 4. Advocate with and for older adults and their
    families for building age-friendly community
    capacity and enhance the contribution of older
    persons.
  • 5. Address the cultural, spiritual, and ethnic
    values and beliefs of older adults and families
    including rural distinctiveness.

19
Geriatric Social Work Competency Scale II
  • Please use the scale below to thoughtfully rate
    your current skill
  • 0 Not skilled at all (I have no experience with
    this skill)
  • 1 Beginning skill (I have to consciously work
    at this skill)
  • 2 Moderate skill (This skill is becoming more
    integrated in my practice)
  • 3 Advanced skill (This skill is done with
    confidence and is an integral part of my
    practice)
  • 4 Expert skill (I complete this skill with
    sufficient mastery to teach others)
  • 0 1
    2 3
    4
  • Not skilled Beginning skill Moderate skill
    Advanced skill Expert skill

20
Geriatric Social Work Defined
  • Enhance the developmental, problem solving, and
    coping capacities of older people and their
    families
  • Promote the effective and humane operating of
    systems that provide resources and services to
    older people and their families
  • 3) Link older people with systems that provide
    them with resources, services and opportunities
    and
  • 4) Contribute to the development and
    improvement of social policies that support
    persons throughout the lifespan.
  • Source Berkman, Dobrof, Damron-Rodriguez
    White (1997)

21
Geriatric Social Work Addressing Key Issues of
Older Persons and Their Families in Todays
Delivery System

Consumer Direction (Choice, Quality and
Satisfaction) Family Caregiving (Family
Caregiver Acts) Community Care (HCBS, Olmstead
Decision) Addressing Diversity ( Ethnic Elders)
22
II. Considering The Challenges to Wellness for
Older Persons
23
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
24
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

25
Threats to Health and Well-being Among Older
Adults
  • 35 age 65 - 74 report no physical activity
  • 46 age 75 report no physical activity
  • 24 - obese
  • 33 - fall each year
  • 34 - no flu shot
  • 45 - no pneumococcal vaccine
  • 20 - prescribed unsuitable medications

26
Chronic diseases account for 75 of the 1.4
trillion we spend on health care
  • 95 of health care spending for older adults
    attributed to chronic conditions

Mensah www.nga.org/Files/ppt/0412academyMensah.pp
t21 Heffler et al. Health Affairs, March/April
2002.
27
Whats the health and health care picture for
Boomers?
  • By 2030
  • More than 6 of every 10 will be managing more
    than one chronic condition
  • 14 million (1 out of 4) will be living with
    diabetes
  • gt21 million (1 out of 3) will be considered obese
  • Their health care will cost Medicare 34 more
    than others
  • 26 million (1 out of 2) will have arthritis
  • Knee replacement surgeries will increase 800 by
    2030

When Im 64 How Boomers Will Change Health Care
, American Hospital Association, May 2007
28
Threats to Health Among )lder Adults
  • 73 age 65 - 74 report no regular physical
    activity
  • 81 age 75 report no regular physical activity
  • 61 - unhealthy weight
  • 35 - fall each year
  • 20 - clinically significant depression age
    group at highest risk for suicide
  • 32 - no flu shot in past 12 months
  • 35 - never had pneumococcal vaccine
  • 20 - prescribed unsuitable medications
  • Also at greatest risk for fire-related injuries,
    and traumatic brain injury (age 75)

modifiable
  • Sources State of Aging and Health, 2007
    www.cdc.gov/nchs www.cdc.gov/ncipc/olderadults.ht
    m

29
RURAL ELDERS VS. URBAN43 of 55 West Virginia
Counties Rural
  • Higher proportion older persons (20 vs. 15)
  • More likely to be poor
  • Only 8 of 410 counties in Appalachia equal to
    national income average or above
  • More likely to have less education
  • More likely to own their home
  • More likely to report health as fair or poor

30
Rural Health
  • Score lower (than urban and suburban)on 21 of 23
    major health indicators
  • Smoke more
  • WV rank 46
  • Exercise less
  • WV rank 32
  • Eat less nutritional diets
  • WV rank 46
  • Centers for Disease Control and Prevention (CDC)
  • cdcinfo_at_cdc.gov

31
Boomers are provide a substantial amount of
caregiving
  • Many serve as caregivers
  • gt70 have at least one living parent
  • 25 million live with an aging parent
  • 13 million provide parental caregiving

When Im 64 How Boomers Will Change Health Care
, American Hospital Association, May 2007
32
Health Risks Associated with Caregiving
  • Increased stress and chronic stress
  • Comprise in in physiological functioning (e.g.,
    decrements in immunity)
  • Less likely to engage in preventive behaviors
  • Increased risk for serious illness
  • An independent risk factor for mortality

Schulz, R. Beach, S.R. (2009). Caregiving as a
Risk Factor for Mortality The Caregiver Health
Study. JAMA, 282(23), 2215 2219.
33
IV. Considering Wellness Promotion As A
Primary Focus of Aging Practice and Services
34
Focus on the Positive Side of Aging
  • Much emphases on the negative aspects of aging
  • Public health perspective focus on strengths to
    compensate for deficits

35
Health Promotion
  • At the individual level
  • People gain the skills to maintain and improve
    their health by adopting beneficial health
    behaviors
  • Draw on social supports
  • Learn to change or cope with their environments
  • At the community level
  • Improve those environments through increased
    access to health care
  • Adequate housing and transportation
  • Safe neighborhoods

36
West Virginia Cultural Strengths
  • Rural Beatitudes
  • Healing in the Hills
  • Mountain State Geriatric Education Center
  • WVU Center on Aging
  • Hilda R. Heady, MSW
  • Blessed are the rural for they are self-reliant
    and true collaborators.
  • Blessed are the rural for they value family and
    friendly folks.
  • Blessed are the rural for they value
    individualism, modesty and independence.
  • Blessed are the rural for they all deserve a good
    life and quality health care.

37
What is a Health Behavior?
  • Actions and habits that relate to
  • PRIMARY
  • Health promotion and prevention
  • SECONDARY
  • Health maintenance and restoration
  • TERTIARY
  • Health treatment

38
What Theory Can Guide Us to Change Health
Behaviors?
  • Social Cognitive Theory
  • Emphasizes personal factors (e.g., beliefs)
  • Physical and social environmental factors
  • Strong emphasis on self-efficacy
  • Occurs in social context
  • Formal health care providers
  • Informal social network members
  • Physical environment

39
Self-Efficacy
  • Key construct in social cognitive theory
  • (Bandura, 1977)
  • Confidence in accomplishing a specific action
  • Enhances or impedes motivation to act
  • Remember only 30 of physical and cognitive aging
    is attributable to genetic heritage.
  • We influence the rest..

40
Social Cognitive Theory Applied to Chronic
Illness
  • Illness management skills are learned and
    behavior is self-directed
  • Motivation and self-confidence (self-efficacy)
    are important determinants of patients
    performance
  • Social environment can either help or hinder
  • Monitoring and responding to changes in disease
    state improves adaptation

41
Definition of Self-Management of Chronic Illness
(CI)
  • Self-care behaviors that individuals do
  • In order to keep the illness under control
  • To minimize its impact on physical health and
    functioning
  • To cope with the psychosocial components and/or
    impact of the illness
  • Most prevalent chronic illnesses entail a
    significant self-management component

42
SOCIAL COGNITIVE MANAGEMENT PRINCIPLES APPLIED
TO CHRONIC ILLNESS MANAGEMENT

Assess and Specify Problem/Target Behavior
Provide Follow Up Collaboratively Support Set
Goal(s), Identify
Barriers Motivators
Provide Personalized Coping Skills as Needed
Source Glasgow, R.E., Wagner, E.H., Kaplan,
R.M., et al., 1999, page 163
43
V. Considering and Applying What Works in
Promoting Wellness
44
Evidence-based Health Promotion
  • Is a process of planning, implementing, and
    evaluating programs adapted from tested models or
    interventions
  • Uses an public health (population) perspective
  • Emphasizes both prevention and treatment
  • Uses an ecological approach
  • A special thank you to Mary Altpeter, PhD,
    University of North Carolina, Institute on Aging
    and The National Council on Aging

45
The socioecological framework for levels of
focus
46
Evidence-Based Change!
  • Credit to
  • Administration on Aging
  • Centers for Disease Control and Prevention
  • AHRQ , NIH, SAMHSA and other federal agencies
  • John A. Hartford Foundation
  • Atlantic Philanthropies
  • Retirement Research Foundation
  • Archstone Foundation
  • Regional Foundations
  • States, localities, regional and community-based
    organizations

47
Stanford Universitys Chronic Disease
Self-Management Programs (CDSMP)
CDSMP is available in Arabic, Bengali, Chinese,
Dutch, French, German, Hindi, Italian, Japanese,
Korean, Norwegian, Punjabi, Somali, Tamil,
Turkish, Vietnamese and Welsh (Russian and
Tagalog coming soon)
48
The EBHP Movement
  • 2001 Demonstration projects (4)
  • 2003 Model projects (14) served 5,000 people
  • Programs included CDSMP, Falls, Depression,
    Physical Activity, Medication Management, and
    Nutrition
  • Documented fidelity and focus on evaluation
  • Produced replication reports
  • 2006 Choices for Independence moves into 24
    states
  • 2007 Challenge grants (4 more states)
  • 2010 AoA ARRA Projects 48 states/territories

49
Crosscutting Themes of Evidence-based Health
Promotion Programs
  • Individual level
  • Use of effective self management
  • Assessment, goal setting, action planning,
    problem solving, follow-up
  • Social and familial context
  • Use of peer support, peer health mentors,
    professional support, role modeling, sharing and
    feedback, reinforcement
  • Cultural context
  • Saliency, appeal and adaptation to community
    norms, language, customs, beliefs

Adapted from Nancy Whitelaw presentation, AHRQ
Conference, 2006
50
Challenges of Evidence-Based Health Promotion
  • Requires knowing where to find and how to
    understand/judge the evidence
  • Feels like standardization of programs rather
    than site-specific tailoring
  • Tools and processes are unfamiliar
  • Difficult to build community support many
    prefer home grown to off the shelf

Adapted from Nancy Whitelaw, Director, NCOA
Center on Healthy Aging
51
Advantages of Evidence-Based Health Promotion
  • Increase the likelihood of positive outcomes
  • Lead to efficient use of resources
  • Facilitate the spread of programs
  • Facilitate the use of common performance measures
  • Support continuous quality improvement
  • Make it easier to justify funding
  • Help to establish partnerships esp. with health
    care

Adapted from Nancy Whitelaw, Director, NCOA
Center on Healthy Aging
52
Doing What Works
  • Evidence of problem
  • The burden is great.
  • Evidence of effective interventions
  • The science is convincing.
  • Effectiveness of EBHPPrograms
  • Work with diverse populations and diverse
    organizations

53
Taking Science to the People 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.

54
Health Promotion and Disease Prevention Programs
Work for Older Adults
  • Longer life
  • Reduced disability
  • Later onset
  • Fewer years of disability
  • Fewer falls
  • Improved mental health
  • Less depression symptoms
  • More social connectedness
  • Delays in loss of cognitive function
  • Lower health care costs

Its never too late to start its always too
early to stop!
55
Some Evidence-based Health Promotion Programs for
Older Adults
  • DEPRESSION MANAGEMENT
  • Healthy IDEAS
  • PEARLS 
  • FALL RISK REDUCTION
  • Matter of Balance
  • NUTRITION
  • Healthy Eating  
  • DRUG AND ALCOHOL
  • Brief Interventions for Alcohol Misuse
  • Medication Management Improvement System (MMIS)
  • PHYSICAL ACTIVITY
  • PROGRAMS
  • Arthritis Exercise
  • Enhanced Fitness
  • Enhanced Wellness
  • Fit and Strong
  • Healthy Moves
  • Stepping On
  • Tai Chi
  • Active Living Every Day

56
Community EBHP Rolled Out Nationally
Chronic Disease Self-Management Program A Matter of Balance
EnhanceFitness Tai Chi Moving for Better Balance
Healthy IDEAS
57
Common program elements
  • make the new behavior as easy to do as possible
  • help participants develop individualized action
    plans or routines
  • provide structured reinforcement to monitor (and
    celebrate!) progress
  • provide support through group and facility-based
    programming
  • use peers to help reinforce desired behavior

57
Thanks to Dr. Rachel Seymour for permission to
use and adapt slide.
58
CDSMP Features
  • 6-week online or group workshops led by a pair of
    trained lay leaders
  • Standardized curriculum and interactive process
    goal-setting, practice and problem solving
  • Workshop topics based on needs assessment, e.g.
  • Exercise and Nutrition
  • Medication Usage
  • Stress Management
  • Talking with health providers
  • Dealing with emotions and depression

59
CDSMP Outcomes 1 year later
  • Improved
  • self-efficacy
  • health status
  • fatigue level
  • Reduction in
  • health distress
  • visits to physicians and emergency departments
  • days in the hospital
  • hospitalizations
  • Cost savings per participant are projected
    between 390 - 750
  • Lorig, Ritter, et al., 2001 Sobel, Lorig
    Hobbs, 2002

60
Healthy Aging Systems Model
Policy
Multisector Collaboration
Research
Organizational Networks
Evidence-based Programs
61
National level approaches CDC policy framework
for change
  • 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
  • Community sector
  • James Marks, MD

62
Evidence-Based Program Implementation Site Types
63
63
64
West Virginia Recovery Act Chronic Disease
Self-Management Program Diabetes Self-Management
Program
The State of Aging and Health In America in
America Report CDC (2007) Number of Unhealthy
Days in Past Month West Virginia 7.2 50th in
nation
Joseph Barker Joseph.l.barker_at_wv.gov
65
WHAT ARE THE RE-AIM ELEMENTS?
RE-AIM
66
Staying Current Healthy Aging Community
(requires registration)
67
Resources You Can Use
www.healthyagingprograms.org
68
The Prevention Imperative
A difference, to be a difference, must make a
difference. Anonymous quote Aging Wellness Works!
Prevention its for EVERYONE!
About PowerShow.com