Presentation on theme: "Healthy Aging: Why Does it Matter? How Do We Get There?"— Presentation transcript:
1 Healthy Aging: Why Does it Matter? How Do We Get There? Nancy Whitelaw, PhDSenior Vice President, Healthy AgingNational Council on AgingSeptember, 2008
2 OverviewHealth Promotion & Impact on Health and Well-being of Older AdultsModels and PrinciplesPromotion is a systems change strategy, not just a service.Evidence-based Prevention MovementNational Attention – More is Needed
3 What Is Healthy Aging?Healthy Aging Research Network Holistic DefinitionThe 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 Average Spending on Health (per capita) 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
5 Spending as Percent of Gross Domestic Product Source: Congressional Budget Office, June 2008A Joint Proposal of NASUA and n4a5
6 Life Expectancy by Health Care Spending Our nation spends more on health care than any other country in the world.Mensah:
7 Determinants of Health – Proportions of Premature Mortality Genetic Predisposition30%Social Circumstances 15%Environmental Exposures 5%Access to Medical Care10%Behavior40%Source: McGinnis JM, Russo PG, Knickman, JR. Health Affairs, April 2002.Premature mortality: Years of Potential Life Lost (YPLL) subtracts the age a person dies from their life expectancy.
8 Misalignment in Spending Undermines Optimal Health $1.2 TrillionHealth Behaviors4%Other40%Health Behaviors8%30%Genetics88%Access to CareSocial &Environment20%10%Access to CareSources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute of the Future, 2000.
9 Total Cardiovascular Disease Deaths, 1999 (per 100,000 population) 190.5–230.8231.1–250.0255.5–284.8285.1–354.9United States - 172National Vital Statistics System, National Center for Health Statistics, CDC
10 Variation in Heart Disease Rates, Why? 200% difference between high and low statesNearly 2/3 of the difference in death rates is explained by differences in modifiable risksTobaccoPhysical inactivityOverweightHigh blood pressureHigh cholesterolDiabetesByers et al. Prev Med, 1998
11 Disability Increases with Age, But at Much Higher Rates Among the Obese* *Data based on 1996 National Health Interview SurveySources: National Business Group on Health; Rand Corp.Age Group18-2930-3940-4950-5960-691,200900600300per 10,000 peopleObeseNon-Obese
12 Disability by Age and Health Risk Progression of disability delayed approximately 7 years in low risk vs. high risk.Study of University of Pennsylvania AlumniRisk based upon BMI, smoking, exerciseNote: A disability index of 0.1 = minimal disability.Vita et al. NEJM, 1998.
13 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 year15%-20% clinically significant depression35% no flu shot in past 12 months45% no pneumococcal vaccine20% prescribed “unsuitable” medications
14 Health Promotion Works for Older Adults 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
15 Confronting our Challenges Ageism in health promotion and disease preventionGreat disparities based upon race, ethnicity, income, locationScience not shared – growing body of evidence of interventions that can positively impact health, disability and quality of lifeUntapped assets of 29,000 organizations currently reaching 7-10 million older adultsFragmented systems and services across aging, medical care, mental health and public health
16 Changing Direction – Guiding Principles Primacy for PreventionDependence on ScienceQuest for Equity and Social JusticeInterdependence of Essential PartnersHealth carePublic healthMental healthAging and long-term careEmployersEnvironmental design*James Marks, MD, MPH when Director, National Center for Chronic Disease Prevention and Health Promotion, CDC
17 Evidence of a problem does NOT change behavior. "...in 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 Social Ecologic Model of Healthy Aging IndividualInterpersonalOrganizationalCommunityPublic PolicyMcLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med
19 What the Social-Ecological Perspectives Says 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.
21 Evidence-Based Prevention Movement: Leveraging and Strengthening the Community National movement to address to the epidemic of chronic diseases through prevention and risk factor reduction programs in community settingsMultiple federal, state and local agenciesPublic, philanthropic and corporate partnersReaching diverse older adults in convenient, accessible community settings
22 National Investments – Modest but Effective US Administration on Aging & Aging Services Network2003 Community Grantees: $8,400,000/$12,000,000State Grants: $21,000,000/$28,000,000Hispanic Elders ProjectEvidence-based Intervention Grants - Alzheimer’s Disease and Related Disorders: $8,000,000“Evidence-based prevention and promotion” into the Older Americans ActStates encourage/mandate evidence-based programming for Area Agencies and they in turn for service delivery organizations
23 More Investments Centers for Disease Control and Prevention Medicare QIO 9th Scope of WorkMedicaidProposed: Kerry–Grassley S Empowered At Home ActState Waiver Program Improvements in Case Management (e.g., Meds Mgt; Healthy IDEAS)Substance Abuse and Mental Health Services Adm.AHRQ, HRSA and other DHHSPhilanthropy
24 Evidence-Based Prevention A process of planning, implementing, and evaluating programs adapted from tested models or interventions in order to address health issues in an ecological contextEvidence about the health issue that supports the statement, “Something should be done.”Evidence about a tested intervention or model that supports the statement, “This should be done.”Evidence about the design, context and attractiveness of the program that supports the statement, “How this should be done.”* Bronson and others
25 Multi-Component Strategy to Achieve Impact Evidence-based interventionsImproved organizational capacityBroad-based coalitions and networksPopulation-focusStrategic partnershipsEffective, targeted advocacy
26 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 SocietyMATTER 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 GerontologyAnd others …
27 Community Resources - Aging Service Settings Area agencies on aging / local offices on agingCase management programsSenior centersSocial service organizationsMeal programsSenior congregate housingAdult day servicesFaith-based service organizationsChurches, congregationsCommunity centers, cultural centersPersonal residence
28 The Value Added by Community Resources Key characteristics of community settings:29,000+ organizations nationwideReach 10 million seniors, especially low-income, frail and minoritiesStaff and volunteers are trusted intermediariesAgencies deliver cost-effective programsAgencies involve older people as part of the solutionKey strengths of community settingsOutreach, screening, assessment, educationSupport for self-efficacy and self-carePeer supportRegular, positive reinforcementAttention to social and cultural context
29 Evidence-Based Disease Prevention Grants AKWAVTMEMTNDMNORNHIDWINYMASDWYMIRICTPANJIANEHawaiiNVOHDEILINUTCOWVVAMDKSKYCAMOGuamNorthernMarianasNCTNOKAZNMARSCGAMSALTXLAFLMetropolitan Area Projects of HHS Hispanic Elders Health InitiativeFunded by or Working with NCOALocal Projects on Linkages between Aging Services and Health Care Providers for Evidence-based ProgrammingState Projects Funded by AoA
30 15 State Grantees – Early Reach and Adoption 7000 Participants55% age 75+50% living alone25% male35% racial or ethnic “minority”500 Organizations75 host/lead organizations400 program sitesArea agencies on aging / local offices on agingSocial service and case management agenciesSenior centers and senior housingAdult day servicesFaith-based service organizations, churches, congregationsCommunity centers, cultural centers
31 Hawaii – 10:45 Monday Chronic Disease Self-Management Workshops 29 workshops at 21 sites on 4 islands314 participantsMean age 72.547% Hawaiian, 28% Filipino,18% Japanese, 17% WhiteEnhance Fitness6 sites on 2 islands141 participantsMean age 77
32 Front Line Systems Changes NYC Department for the Aging – evidence-based programming in developing wellness centersTexas Association of Area Agencies on Aging – cross state collaboration for diffusion of Matter of BalanceWI embeds evidence-based health promotion in $30 million state funding of aging resource centersNJ Office of Minority and Multi-Cultural Health targets prevention and aging for grants programCA embedding prevention programming via courses in the community collegesMASSHealth targeted for senior health promotionWA funds initial development of comprehensive fall prevention strategyME incorporate Healthy IDEAS into Medicaid care management
33 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 ActSeeking appropriations to match the authorizing languageUsing the past five years’ worth of tested and proven best practicesJointly presented the concept to the ASA/NCOA conference the last week in March.A Joint Proposal of NASUA and n4a3333
34 Components of the Project 2020 Proposal ServicePerson-Centered Access to InformationProvides assistance, access, counseling and awareness of long-term care services and supportsEvidence-Based Disease Prevention and Health PromotionTargets scientifically proven interventions to reduce chronic disease and disability to affected elderly individualsEnhanced Nursing Home Diversion ServicesProvides consumer directed community care to individuals at high risk of institutionalizationA Joint Proposal of NASUA and n4aA Joint Proposal of NASUA and n4a34
35 Proposed Number of Participants ComponentEligibility CriteriaEstimated Number of Recipients(5 years)(10 years)Person-Centered Access to InformationAnyone interested in Long-Term Care40 million105 millionEvidence-Based Disease Prevention and Health PromotionIndividuals 60 or older or who are at risk of falls, have chronic illness, etc.1.2 million3.9 millionEnhanced Nursing Home Diversion Services300 percent of SSI with assets not in excess of $25,000118,000164,000A Joint Proposal of NASUA and n4a3535
36 Call to ActPrevention 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.IndividualInterpersonalOrganizationalCommunityPublic Policy