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Improving the lives of older Americans Healthy Aging: Why Does it Matter? How Do We Get There? Nancy Whitelaw, PhD Senior Vice President, Healthy Aging.

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Presentation on theme: "Improving the lives of older Americans Healthy Aging: Why Does it Matter? How Do We Get There? Nancy Whitelaw, PhD Senior Vice President, Healthy Aging."— Presentation transcript:

1 Improving the lives of older Americans Healthy Aging: Why Does it Matter? How Do We Get There? Nancy Whitelaw, PhD Senior Vice President, Healthy Aging National Council on Aging September, 2008

2 © Copyright NCOA Overview Health Promotion & Impact on Health and Well- being of Older Adults Models and Principles Promotion is a systems change strategy, not just a service. Evidence-based Prevention Movement National Attention – More is Needed

3 © Copyright NCOA What Is Healthy Aging? Healthy Aging Research Network Holistic Definition The development and maintenance of optimal physical, mental and social well-being and function in older adults. Key contributors to healthy aging: Physical environments and communities are safe, and support the adoption and maintenance by individuals of attitudes and behaviors known to promote health and well-being; Effective use of community programs and health services to prevent or minimize the impact of acute and chronic disease on function.

4 © Copyright NCOA Source: K. Davis, C. Schoen, S. Guterman, T. Shih, S. C. Schoenbaum, and I. Weinbaum, Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?, The Commonwealth Fund, January 2007, updated with 2007 OECD data Average Spending on Health (per capita)

5 © Copyright NCOA 5 Source: Congressional Budget Office, June 2008 A Joint Proposal of NASUA and n4a Spending as Percent of Gross Domestic Product

6 © Copyright NCOA Our nation spends more on health care than any other country in the world. Mensah: Life Expectancy by Health Care Spending

7 © Copyright NCOA Genetic Predisposition 30% Access to Medical Care 10% Determinants of Health – Proportions of Premature Mortality Behavior 40% Social Circumstances 15% Environmental Exposures 5% Source: McGinnis JM, Russo PG, Knickman, JR. Health Affairs, April Premature mortality: Years of Potential Life Lost (YPLL) subtracts the age a person dies from their life expectancy.

8 © Copyright NCOA Misalignment in Spending Undermines Optimal Health Health Behaviors Genetics Access to Care Social & Environment Access to Care Health Behaviors Other 10% 20% 30% 40% $1.2 Trillion 88% 8% 4% Sources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute of the Future, 2000.

9 © Copyright NCOA National Vital Statistics System, National Center for Health Statistics, CDC 190.5– – – –354.9 United States Total Cardiovascular Disease Deaths, 1999 (per 100,000 population)

10 © Copyright NCOA Byers et al. Prev Med, 1998 Variation in Heart Disease Rates, Why? 200% difference between high and low states Nearly 2/3 of the difference in death rates is explained by differences in modifiable risks Tobacco Physical inactivity Overweight High blood pressure High cholesterol Diabetes

11 © Copyright NCOA Disability Increases with Age, But at Much Higher Rates Among the Obese* *Data based on 1996 National Health Interview Survey Sources: National Business Group on Health; Rand Corp. Age Group , per 10,000 people Obese Non-Obese

12 © Copyright NCOA Disability by Age and Health Risk Progression of disability delayed approximately 7 years in low risk vs. high risk. Study of University of Pennsylvania Alumni Risk based upon BMI, smoking, exercise Note: A disability index of 0.1 = minimal disability. Vita et al. NEJM, 1998.

13 © Copyright NCOA 73% age report no regular physical activity 81% age 75+ report no regular physical activity 61% unhealthy weight 33% fall each year 15%-20% clinically significant depression 35% no flu shot in past 12 months 45% no pneumococcal vaccine 20% prescribed unsuitable medications Threats to Health and Well-Being Among Seniors

14 © Copyright NCOA Health Promotion Works for Older Adults 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

15 © Copyright NCOA Confronting our Challenges Ageism in health promotion and disease prevention Great disparities based upon race, ethnicity, income, location Science not shared – growing body of evidence of interventions that can positively impact health, disability and quality of life Untapped assets of 29,000 organizations currently reaching 7-10 million older adults Fragmented systems and services across aging, medical care, mental health and public health

16 © Copyright NCOA Changing Direction – Guiding Principles Primacy for Prevention Dependence on Science Quest for Equity and Social Justice Interdependence of Essential Partners Health care Public health Mental health Aging and long-term care Employers Environmental design *James Marks, MD, MPH when Director, National Center for Chronic Disease Prevention and Health Promotion, CDC

17 © Copyright NCOA Evidence of a problem does NOT change behavior. " spite of the multitude of evidence that physical activity improves health status, prevents a number of negative health outcomes, and improves quality of life in individuals across the age spectrum, leisure time and structured physical activity levels have changed very little over the last few decades, especially in older persons. No matter how strong the evidence that physical activity delays disability, this information by itself has not been effective in modifying individual behavior." Luigi Ferrucci, NIA in JG:MS:2006:

18 © Copyright NCOA Individual Interpersonal Organizational Community Public Policy McLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med Social Ecologic Model of Healthy Aging

19 © Copyright NCOA Health and well-being 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. Make the right choice the easy choice. What the Social-Ecological Perspectives Says

20 © Copyright NCOA The Innovation Challenge

21 © Copyright NCOA National movement to address to the epidemic of chronic diseases through prevention and risk factor reduction programs in community settings Multiple federal, state and local agencies Public, philanthropic and corporate partners Reaching diverse older adults in convenient, accessible community settings Evidence-Based Prevention Movement: Leveraging and Strengthening the Community

22 © Copyright NCOA US Administration on Aging & Aging Services Network 2003 Community Grantees: $8,400,000/$12,000, State Grants: $21,000,000/$28,000,000 Hispanic Elders Project Evidence-based Intervention Grants - Alzheimers Disease and Related Disorders: $8,000,000 Evidence-based prevention and promotion into the Older Americans Act States encourage/mandate evidence-based programming for Area Agencies and they in turn for service delivery organizations National Investments – Modest but Effective

23 © Copyright NCOA More Investments Centers for Disease Control and Prevention Medicare QIO 9 th Scope of Work Medicaid Proposed: Kerry–Grassley S Empowered At Home Act State Waiver Program Improvements in Case Management (e.g., Meds Mgt; Healthy IDEAS) Substance Abuse and Mental Health Services Adm. AHRQ, HRSA and other DHHS Philanthropy

24 © Copyright NCOA Evidence-Based Prevention 1. Evidence about the health issue that supports the statement, Something should be done. 2. Evidence about a tested intervention or model that supports the statement,This should be done. 3. Evidence about the design, context and attractiveness of the program that supports the statement, How this should be done. * Bronson and others A process of planning, implementing, and evaluating programs adapted from tested models or interventions in order to address health issues in an ecological context

25 © Copyright NCOA Evidence-based interventions Improved organizational capacity Broad-based coalitions and networks Population-focus Strategic partnerships Effective, targeted advocacy Multi-Component Strategy to Achieve Impact

26 © Copyright NCOA Science Not Shared – Interventions That Work CHRONIC DISEASE SELF-MANAGEMENT PROGRAM Lorig KR et al. (1999) Medical Care. ENHANCE FITNESS: Wallace, JI et al. (1998) Journal of Gerontology. ENHANCE WELLNESS: Leveille et al. (1998) Journal of American Geriatrics Society MATTER OF BALANCE: Tennsdedt, S et al. (1998) Journal of Gerontology. PEARLS: Ciechanowski, P et al. (2004) Journal of the American Medical Association. Healthy IDEAS: Quijano, L et al. (2007) Journal of Applied Gerontology And others …

27 © Copyright NCOA Community Resources - Aging Service Settings Area agencies on aging / local offices on aging Case management programs Senior centers Social service organizations Meal programs Senior congregate housing Adult day services Faith-based service organizations Churches, congregations Community centers, cultural centers Personal residence

28 © Copyright NCOA The Value Added by Community Resources Key characteristics of community settings: 29,000+ organizations nationwide Reach 10 million seniors, especially low-income, frail and minorities Staff and volunteers are trusted intermediaries Agencies deliver cost-effective programs Agencies involve older people as part of the solution Key strengths of community settings Outreach, screening, assessment, education Support for self-efficacy and self-care Peer support Regular, positive reinforcement Attention to social and cultural context

29 © Copyright NCOA Evidence-Based Disease Prevention Grants Metropolitan Area Projects of HHS Hispanic Elders Health Initiative MA AK Hawaii MT ID WA CO WY NV CA NMAZ MN KS TX IA WI IL KY TN OH MI ALMS AR LA GA FL SC WVVA NC MD DE PA NJ OR UT SD ND MO OK NE NY ME VT NH CT Guam Northern Marianas IN Funded by or Working with NCOA RI State Projects Funded by AoA Local Projects on Linkages between Aging Services and Health Care Providers for Evidence-based Programming

30 © Copyright NCOA 15 State Grantees – Early Reach and Adoption 7000 Participants 55% age % living alone 25% male 35% racial or ethnic minority 500 Organizations 75 host/lead organizations 400 program sites Area agencies on aging / local offices on aging Social service and case management agencies Senior centers and senior housing Adult day services Faith-based service organizations, churches, congregations Community centers, cultural centers

31 © Copyright NCOA Hawaii – 10:45 Monday Chronic Disease Self-Management Workshops 29 workshops at 21 sites on 4 islands 314 participants Mean age % Hawaiian, 28% Filipino, 18% Japanese, 17% White Enhance Fitness 6 sites on 2 islands 141 participants Mean age 77

32 © Copyright NCOA Front Line Systems Changes NYC Department for the Aging – evidence-based programming in developing wellness centers Texas Association of Area Agencies on Aging – cross state collaboration for diffusion of Matter of Balance WI embeds evidence-based health promotion in $30 million state funding of aging resource centers NJ Office of Minority and Multi-Cultural Health targets prevention and aging for grants program CA embedding prevention programming via courses in the community colleges MASSHealth targeted for senior health promotion WA funds initial development of comprehensive fall prevention strategy ME incorporate Healthy IDEAS into Medicaid care management

33 © Copyright NCOA 33A Joint Proposal of NASUA and n4a Project 2020: Building on the Promise of Home and Community-Based Services Led by n4a and NASUA (National Association of State Units on Aging) Language in 2006 Reauthorization of Older Americans Act Seeking appropriations to match the authorizing language Using the past five years worth of tested and proven best practices

34 © Copyright NCOA ComponentService Person-Centered Access to Information Provides assistance, access, counseling and awareness of long-term care services and supports Evidence-Based Disease Prevention and Health Promotion Targets scientifically proven interventions to reduce chronic disease and disability to affected elderly individuals Enhanced Nursing Home Diversion Services Provides consumer directed community care to individuals at high risk of institutionalization 34A Joint Proposal of NASUA and n4a Components of the Project 2020 Proposal

35 © Copyright NCOA ComponentEligibility Criteria Estimated Number of Recipients (5 years) Estimated Number of Recipients (10 years) Person-Centered Access to Information Anyone interested in Long-Term Care 40 million105 million Evidence-Based Disease Prevention and Health Promotion Individuals 60 or older or who are at risk of falls, have chronic illness, etc. 1.2 million3.9 million Enhanced Nursing Home Diversion Services 300 percent of SSI with assets not in excess of $25, ,000164,000 A Joint Proposal of NASUA and n4a 35 Proposed Number of Participants

36 © Copyright NCOA Call to Act Prevention is essential to improving health and reducing disability among older adults. The social-ecological approach is the solution. Community organizations have a significant opportunity NOW. Individual Interpersonal Organizational Community Public Policy

37 © Copyright NCOA

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