1. 1 Research on Lifestyle Redesign: An Occupational Science Approach to Combating Health Concerns of the 21 st Century Health Collaborative Retreat October 21, 2004

2. 2 Occupational Science New Social Science Studies the relationship of occupation to health Study of the human as an occupational being: person engaged in his or her world of activity

3. 3 What do we mean by occupation?

4. 4 Definition of Occupation Activities that can be named in the lexicon of the culture: Physical activities Social activities Spiritual activities

5. 5 II Health Promotion in the Elderly

6. 6 The is upon us…

7. 7 Our focus must shift from Quantity of Life to Quality of Life

8. 8 Outstanding Quality of Life in Old AgeIS a Realistic Outcome

9. 9 Successful Aging “Growing old with good health, strength, and vitality” Rowe, Kahn. Successful Aging. 1998;23.

10. 10 Usual Aging Elders who are functioning well, but are at heightened risk for age- associated disease or disability Rowe, Kahn. Successful Aging. 1998;23.

11. 11 III The USC Well Elderly Study

12. 12 The USC Well Elderly Study was funded by National Institutes of Health National Institute on Aging (NIA) Agency for Health Care Policy and Research (AHCPR) National Center for Medical Rehabilitation Research (NCMRR) American Occupational Therapy Foundation Lumex, Inc. RGK Foundation Smith & Nephew Roylan

13. 13 Florence Clark, PhD, OTRUSC Occupational Therapy Ruth Zemke, PhD, OTRUSC Occupational Therapy Jeanne Jackson, PhD, OTRUSC Occupational Therapy Michael Carlson, PhDSocial Psychology, USC Occupational Therapy Loren G. Lipson, MDGeriatric Medicine, USC Keck School of Medicine Stanley P. Azen, PhDPreventive Medicine, Biostatistics, USC Department of Biometry Joel W. Hay, PhDPharmaceutical Policy & Economics, USC Pharmaceutical Economics Barbara Cherry, PhDCognitive Psychology, USC Occupational Therapy Deborah Mandel, MA, OTRUSC Occupational Therapy Karen Josephson, MDGeriatric Medicine, USC Keck School of Medicine The USC Well Elderly Study Group

14. 14 Health Well-Being Occupation

15. 15 Purpose/Goal of Research Prevent Illness Maintain Independence Efficacy Cost-Effectiveness

16. 16 Target Population Independent Seniors Low-Income Multi-Ethnic

17. 17 Design: Randomized Clinical Trial Three Experimental Conditions Occupational Therapy- 122 Social Group Control- 120 No Treatment Control- 119 361

18. 18 Design: Measures Physical Health Cognition Functional Status Psychosocial Well-Being General Health

19. 19 Design : Timeline 6 Months No Contact 9 Month Program 2 hr/week Small groups 15 Months Utilization of Health Services Post Test Questionnaires Pre Test Physical Exam Questionnaires Follow Up Physical Exam Questionnaires

20. 20 USC Well Elderly Study RAND SF-36 6% 16% 14% 12% 10% 8% 4% 2% 0% 2% 4% 6% 8% Vitality General Health Absence of Health-Based Role Limitations Social Functioning Occupational Therapy Subjects Control Subjects General Mental Health Absence of Bodily Pain Physical Functioning Absence of Emotion-Based Role Limitations

21. 21 LR: 6-Month Follow-up RAND SF-36 OT improvementinitial6mo No Health-based Role Limitations14%14% No Emotional-based Role Limitations10%11% Physical Functioning9%9% Vitality8%8% General Mental Health6%7% Social Functioning6%6% Absence of Bodily Pain6%5% General Health4%4% Clark et al. J Gerontology. Psychological Sciences and Social Sciences, 2001.

22. 22 LR: Cost Effectiveness Estimate of medical costs avoided as a result of occupational therapy intervention in relation to health related quality of life. Hay, et al, (2002)

23. 23 Results Program Costs OT = $548 per subject Post intervention health care costs OT = $967 Active Control = $1,726 Passive Control = $2,593 Cost per QALY (OT) = $10,660

24. 24 IV Health Mediating Effects of the Well Elderly Program # 1RO1 AG 021108-01A2, NIH $2,280,668

25. 25 Investigative Team Principal Investigator: Florence A. Clark, Ph.D., USC Department of Occupational Science & Occupational Therapy Co-Investigators: Stanley Azen, Ph.D., USC Department of Biometry, Keck School of Medicine Carolyn Ervin, USC Department of Biometry, Keck School of Medicine Michael Goran, USC Preventive Medicine, Physiology Joel Hay, USC Pharmaceutical Economics Howard Hodis, USC, Molecular Pharmacology/Toxicology Leslie Lytle, University of Minnesota, Epidemiology Virginia Quinn, Kaiser Permanente, Southern California Kim Reynolds, USC Preventive Medicine

26. 26 Aim To replicate our previous results on the positive effects of the lifestyle redesign intervention To examine the mediating mechanisms responsible for its positive effects

27. 27 Design N=440: Ethnically diverse elders Randomized semi-crossover design Intervention: Six months lifestyle redesign

28. 28 Measures (Assessed 4 – 5 times over an 18 – 24 month interval) Healthy Activity Coping Social Support Perceived Control Stress Related Biomarkers Perceived Physical Health Psychological Well-being Cognitive Functioning

29. 29 Conceptual model of positive effects of activity-based interventions for elders Intervention Potential Mediators: Subsidiary Analyses * Social Network * Domain-Specific Perceived Stress * Religious Coping * Mental Disengagement * Behavioral Disengagement * Acceptance * Volunteer Activity Healthy Activity Active Coping Social Support Perceived Control Positive Reinterpretation-Based Coping Reduced Stress- Related Biomarkers Perceived Physical Health Psychosocial Well-Being Cognitive Functioning

30. 30 VI Weight Loss Randomized Clinical Trial

31. 31 Customized Lifestyle Re-Engineering and Obesity: An RCT Principal Investigator: Florence A. Clark, Ph.D., USC Department of Occupational Science & Occupational Therapy Co-Investigators: Stan Azen, Ph.D. Michael Goran, Ph.D. Joel Hay, Ph.D. Howard Hodis, M.D. Kim Reynolds, Ph.D. Virginia Quinn, Ph.D. Leslie Lytle, Ph.D.

32. 32 Mediational Model for the Proposed Study Customized Lifestyle Re-Engineering Intervention-Based Knowledge Facilitative Social Support Increased Perceived Self- Efficacy Personalized Daily Lifestyle Change Improved Diet