1. Evidence-Based Nutrition and Health Programs: Promoting Wellness through Behavior Change Jennifer Raymond Director of Evidence-based Programs Hebrew SeniorLife

2. Agenda Challenges Facing Health Care System Meeting the Challenges with Evidence- based Community Programs Chronic Disease Self-Management Healthy Eating for Successful Living Questions?

3. Statistics Related to Chronic Disease Over 1.7 million people die of a chronic disease each year 80% of older adults have 1 chronic health condition and 50% have 2. 95% of health care spending for older adults is attributed to chronic health conditions. Four chronic diseases cause almost two-thirds of all deaths each year: heart disease, cancer, stroke and diabetes Mensah: www.nga.org/Files/ppt/0412academyMensah.ppt#18www.nga.org/Files/ppt/0412academyMensah.ppt#18 State of Aging and Health in America 2007: www.cdc.gov/agingwww.cdc.gov/aging

4. Mensah: www.nga.org/Files/ppt/0412academyMensah.ppt#18www.nga.org/Files/ppt/0412academyMensah.ppt#18 State of Aging and Health in America 2007: www.cdc.gov/aging www.cdc.gov/aging Chronic Disease – An Epidemic of Unparalleled Proportions More than 1.7 million Americans die of a chronic disease each year. 80% of older adults have at least one chronic condition; 50% at least two. 95% of health care spending for older adults is attributed to chronic health conditions. Among older adults with 2+ chronic conditions:  76% report being limited in function  17% report being frequently depressed There are disparities in the prevalence of chronic conditions and functional loss associated with income, race and ethnicity, and other factors.

5. Changing Systems for Healthy Aging Self-management, self-determination, self- advocacy Prevention & delay of sickness and impairment Evidence & outcomes & uncertainty Community-based, collaborative solutions Challenge ageism, health disparities

6. Meeting The Challenge Partnership needed between the health care system and community based organizations Need for use of evidence-based disability and disease management Translating research into community-based programs http://www4.nas.edu/onpi/webextra.nsf/web/chasm?OpenDocument

7. What is an Evidence-based Program? An evidence-based program has been demonstrated to be effective in basic research that involved the same target audience Then it has been demonstrated to be effective in dissemination in the “real world.” There are clear protocols for the training and conducting of the program so that community programs can maintain fidelity and be successful.

8. Advantages of an Evidence-based Approach Increases the likelihood of positive outcomes Safety is built in Makes it easier to justify funding Helps to establish partnerships –esp. with health care Leads to efficient use of resources Supports sustainability of programs Supports the use of common performance measures

9. Select Programs Healthy Eating for Successful Living in Older Adults Stanford University’s Chronic Disease Self-Management Program (My Life, My Health) A Matter of Balance (Falls Prevention) Fit For your Life (Physical Activity) Arthritis Foundation Exercise Program Diabetes Self-Management Program

10. CHRONIC DISEASE SELF-MANAGEMENT PROGRAM My Life My Health:

11. My Life My Health: The Stanford Model The Chronic Disease Self-Management Program (CDSMP) was developed in the early 1990s by Dr. Kate Lorig at the Stanford University Patient Education Research Center. More than 100 health organizations in more than 40 states and 15 countries including the U.S., Great Britain, Hong Kong, China, Sweden, Canada, Australia, New Zealand, Italy and Norway now offer CDSMP.

12. My Life My Health: The Stanford Model CDSMP is a 6 week workshop offered to adults living with the challenges of 1 or more persistent health conditions. Participants meet for 2 ½ hours once a week. Each workshop is lead by 2 certified Lay Leaders. Workshops use a mutually supportive model that encourages: Discussion Problem solving

13. My Life My Health: The Stanford Model Workshops cover different topics each week Dealing with difficult emotions Physical activity and exercise Power of the mind Muscle relaxation and guided imagery Pain and fatigue management Healthy eating Communication skills Medication usage Making informed treatment decisions

14. My Life My Health: The Stanford Model Participants Learn How To Create Action Plans

15. My Life My Health: Makes A Difference My Life My Health helps people regain control of their lives and do the things that matter to them. Participants feel empowered and more confident about managing their health. My Life My Health helps people feel better. Participants increase their energy level and feel relief from their pain, fatigue and other symptoms. My Life My Health connects people with others. Participants meet new people, share what they know and learn new ways to manage their health conditions.

16. My Life My Health: Makes A Difference Participant Benefits Six Months Later Increased exercise Better coping strategies and symptom management Improvement in self-rated health, disability, social and role activities and health distress Increased energy Decreased fatigue Decreased disability Fewer visits to the doctor and hospitalizations

17. My Life My Health: Makes A Difference Participant Benefits One Year Later Decreased fatigue Decreased health distress Fewer visits to the emergency room No decrease in activity or social role functions even with a slight increase in disability Improvements in energy, health status, social and role activities and self-efficacy

18. My Life My Health: Makes A Difference Participant Benefits Two Years Later No further increase in disability Decreased health distress Decreased visits to the doctor and emergency room Increased self-efficacy Participants saved between $390 and $520 each over 2 years once the cost of administering the program was subtracted from the savings associated with decreased MD visits, ER visits, etc.

19. Online Chronic Disease Self-Management

21. https://selfmanage.org/BetterHealth/SignUp

22. Healthy Eating For Successful Living in Older Adults™: An Evidence Based Nutrition Intervention

23. What is Healthy Eating™?  Evidence-based model program sponsored by the National Council on the Aging (NCOA)  Developed in Massachusetts with funding from John A. Hartford Foundation in 2005  2008 Revision currently under pilot by Hebrew SeniorLife

24. The Healthy Eating™ Workshop Weekly interactive sessions for six weeks 8 to 14 participants per class Led by two trained lay leaders following a scripted text Supported by Nutritionist or Dietitian Optional 7 th : restaurant outing

25. Main Components  Nutrition and Health Education  MyPyramid   Label Reading and Portion Control  Importance of Physical Activity  Availability of Community Resources  Behavior Change Techniques  Goal setting  Problem-solving  Self assessment  Socialization and Group Interaction

26. Participant Benefits Upon Completion of the Program …. 80% of participants changed their diet or behavior to make “healthy” food choices or include physical exercise in your daily routine 87% of participants used MyPyramid to help manage their nutrition 87% of participants used behavior change techniques (goal setting and problem-solving) to help manage their nutrition 57% of participants made exercise changes as a result of the Healthy Eating  program

27. What are Participants Saying? I think this group is one of the best things that that ever happened to me. From the first session, I started paying more attention to what I was eating. Until I did my journal, I never knew I was eating as much as I was. I thought I was eating right until I started to read the boxes (labels). I didn’t know I was having so much sodium! I could eat this every day! ( after trying a whole wheat pita with veggie dip for the first time) I learned that I don’t have to change everything. I can just try to change a little more each day.

28. Jennifer Raymond Director of Evidence-based Programs Hebrew SeniorLife 1-617-363-8319 JenniferRaymond@hsl.harvard.edu Contact Information