1. Evidence-Based Health Promotion for Older Adults
Nancy A. Whitelaw, Ph.D.
Director, Center for Healthy Aging
National Council on Aging
4th State Units on Aging Nutritionists & Administrators Conference
August, 2006

2. Overview of the Presentation
Modifiable Risk Factors Among Older Adults
AoA’s Evidence-Based Prevention Program
Frameworks for Evidence-based Programming

3. Modifiable Risk Factors Among Older Adults

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 health
mental health
ability to do their usual activities
Increase in “unhealthy days”
5.2 to 6.1 days
Adults 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 condition
50% - at least two chronic conditions
34% experience some activity limitation
26% assess health as fair or poor
41% of older African Americans
40% of older Hispanics
Increasingly, 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, 2000
Smoking 19%
Poor diet & nutrition/ 14% Physical inactivity
Alcohol %
Infections, pneumonia 4%
Racial, ethnic, economic ? disparities
McGinnis 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 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

9. Threats to Health and Well-being Among Seniors
73% age report no regular physical activity
81% age 75+ report no regular physical activity
61% - unhealthy weight
33% - fall each year
35% - no flu shot in past 12 months
45% - no pneumococcal vaccine
20% - 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 disability
Accelerate the translation of HHS-funded research (from NIH, CDC, AHRQ and others) into practice
Public-Private Collaboration with AoA and Atlantic Philanthropies
Criteria for selecting programs to implement:
Based upon rigorously conducted research (randomized trial) and published
Developed and tested with older adults
Replicable 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 Justice
Foster Interdependence
Aging network
Health care
Public health
Long term care
Mental health
Research
* James Marks, MD

13. Social Ecologic Model of Healthy Aging
Individual
Interpersonal
Organizational
Community
Public Policy
McLeroy 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.

15. Profiles of Evidence-based Models

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 Works
Evidence 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 Planning
R=Reach
E=Effectiveness
A=Adoption
I=Implementation
M=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 adults
National Resource Center on Evidence-based Prevention
Evidence-based Model Health Programs
Falls Free: National Falls Prevention Action Plan
Moving Out: Best Practices in Physical Activity
MD Link: Connecting Physicians to Model Health Programs
New Connections: Partnerships between PH and Aging
Get Connected: Partnerships between MH and Aging