Presentation on theme: "Evidence-Based Health Promotion for Older Adults"— Presentation transcript:
1 Evidence-Based Health Promotion for Older Adults Nancy A. Whitelaw, Ph.D.Director, Center for Healthy AgingNational Council on Aging4th State Units on Aging Nutritionists & Administrators ConferenceAugust, 2006
2 Overview of the Presentation Modifiable Risk Factors Among Older AdultsAoA’s Evidence-Based Prevention ProgramFrameworks for Evidence-based Programming
4 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 healthmental healthability to do their usual activitiesIncrease in “unhealthy days”5.2 to 6.1 daysAdults years old had consistently greater deterioration than younger or older adults.according to a recent study from the Centers for Disease Control and Prevention. Adults’ average physically unhealthy days per month increased from 3.0 in 1993 to 3.5 days in 2001, mentally unhealthy days from 2.9 to 3.4 days, and activity limitation days from 1.6 to 2.0 days. Overall unhealthy days--a summary measure of population health--increased from 5.2 to 6.0 days. Most of these increases occurred in the years since The percentage of U.S. adults rating their health as fair or poor also increased from 13.4% in 1993 to 15.5% in 2001.The study also found:Adults years old had consistently greater increases than younger or older adults.BRFSS data
5 Health Status of Older Adults 88% - at least one chronic condition50% - at least two chronic conditions34% experience some activity limitation26% assess health as fair or poor41% of older African Americans40% of older HispanicsIncreasingly, community-based organizations are being seen as having an important role to play in improving health outcomes for older people. Persons with fair or poor health, serious chronic disease, and/or IADL limitations, and minority groups are often targeted for health-related services. But health-related interventions can benefit all elderly persons.CDC-MIAH 2004; CDC/NCHS Health US, 2002
6 Leading Causes of Death, Age 65+ (2001) Heart Disease 32%Cancer 22%Stroke 8%Chronic Respiratory 6%Flu/Pneumonia 3%Diabetes 3%Alzheimer’s 3%CDC-MIAH 2004; CDC/NCHS Health US, 2002
7 Underlying Risk Factors – “The Actual Causes of Death” Behavior % of deaths, 2000Smoking 19%Poor diet & nutrition/ 14% Physical inactivityAlcohol %Infections, pneumonia 4%Racial, ethnic, economic ? disparitiesMcGinnis and Foege (1993) examined the behavioral factors that represent the “actual causes” of death in the United States. For each of these factors, organizations in the aging services network are working together to reduce risk. Addressing these risks is a central contribution to health outcomes that the aging services network could make.Studies have found that health care costs for persons with these underlying risk factors can be 50% higher than for those with good health habits.Social isolation increases the risk for cognitive decline and mortality“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
8 Benefits to Older Adults Reviewed in “A New Vision of Aging” Longer lifeReduced disabilityLater onsetFewer years of disability prior to deathFewer fallsImproved mental healthPositive effect on depressive symptomsPossible delays in loss of cognitive functionLower health care costs
9 Threats to Health and Well-being Among Seniors 73% age report no regular physical activity81% age 75+ report no regular physical activity61% - unhealthy weight33% - fall each year35% - no flu shot in past 12 months45% - no pneumococcal vaccine20% - prescribed “unsuitable” medications
10 AoA’s 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 disabilityAccelerate the translation of HHS-funded research (from NIH, CDC, AHRQ and others) into practicePublic-Private Collaboration with AoA and Atlantic PhilanthropiesCriteria for selecting programs to implement:Based upon rigorously conducted research (randomized trial) and publishedDeveloped and tested with older adultsReplicable in community-based settings
11 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.
12 Guiding Principles* Make Prevention a Priority Start with the Science – “Evidence”Work for Equity and Social JusticeFoster InterdependenceAging networkHealth carePublic healthLong term careMental healthResearch* James Marks, MD
13 Social Ecologic Model of Healthy Aging IndividualInterpersonalOrganizationalCommunityPublic PolicyMcLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med
14 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.
16 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.
17 Doing What WorksEvidence 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?
18 (P)RE-AIM Framework www.re-aim.org P=Partners and PlanningR=ReachE=EffectivenessA=AdoptionI=ImplementationM=Maintenance
19 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.
20 Center for Healthy Aging Increase the quality and accessibility of health programming for older adultsNational Resource Center on Evidence-based PreventionEvidence-based Model Health ProgramsFalls Free: National Falls Prevention Action PlanMoving Out: Best Practices in Physical ActivityMD Link: Connecting Physicians to Model Health ProgramsNew Connections: Partnerships between PH and AgingGet Connected: Partnerships between MH and Aging