1. HEALTHY AGING AT YOUR LIBRARY: CONNECTING OLDER ADULTS TO HEALTH INFORMATION Karen Vargas, Consumer Health Outreach Coordinator National Network of Libraries of Medicine, South Central Region

2. Agenda  Older adults and health  Health information access and utilization  Evaluation of health resources  Training and programs  Recommended resources

3. Aging in America

4. According to the CDC: http://www.cdc.gov/aging/

5. The country is getting older  The number of people age 65 and older is expected to grow from 39 million in 2008 to 72 million in 2030.  The first boomers reached 65 this year! (2011)  Life expectancy in the US is 78 years of age.

6. Alzheimer’s Disease  Right now, as many as 4.5 million Americans have Alzheimer’s Disease  The number of people with AD doubles for every 5-year interval beyond age 65.

7. Mental Health  20% of adults over 55 have mental illness  Suicide rate for persons 85 years and older is twice the national rate  6 percent of Americans ages 65 and older in a given year or approximately 2 million individuals in this age group have a diagnosable depressive illness

8. Causes of Death  Heart Disease - #1 cause of death adults over age 65  Cancer - #2 cause of death adults over age 65  Lung cancer most prevalent  Other prevalent: colorectal, prostate and breast (all decreasing)

9. Changes to causes of death Alzheimer's Association Generation Alzheimer's: the Defining Disease of the Baby Boomers http://www.alz.org/boomers/http://www.alz.org/boomers/

10. Birds do it, bees do it… Top 5 reasons to talk about seniors sexual health  The majority of older Americans are sexually active  15% of new cases of HIV are people over 50  Most older adults have not discussed sex with their doctors  If we can have this conversation today, it’s that much easier to handle it when it comes up at the reference desk  #1 reason: VIAGRA

11. Access and Utilization

12. Access + Utilization = Health Literacy  Health Literacy:  “The degree to which individuals have the capacity to obtain, process and understand basic health information and services need to make appropriate health decisions.” (Healthy People 2010)  ACP Foundation Video:  http://foundation.acponline.org/hl/hlvideo.htm http://foundation.acponline.org/hl/hlvideo.htm

13. How is it different from “literacy?”  People of all literacy levels can have low health literacy  However, “limited literacy skills are a stronger predictor of an individual's health status than age, income, employment status, education level, and racial or ethnic group.” Ask Me 3™ http://www.npsf.org/askme3/ http://www.npsf.org/askme3/

14. Below basic literacy levels make health literacy even harder Partnership for Clear Health Communication http://www.npsf.org/pchc/health-literacy.php

15. Why is an understanding of Health Literacy important for older adults?  Adults age 63 and older have lower health literacy scores than all other age groups  Only 3% of older adults surveyed had proficient health literacy skills The 2003 National Assessment of Adult Literacy http://nces.ed.gov/naal/ http://nces.ed.gov/naal/

16. Additional factors affecting understanding of health information  Vision and hearing changes  Cognitive changes  Additional Disabilities U.S. Department of Health and Human Services, Quick Guide to Health Literacy of Older Adults http://www.health.gov/communication/literacy/olderadults/literacy.htm http://www.health.gov/communication/literacy/olderadults/literacy.htm

17. And to make things worse...  Multiple conditions  Many, many medications  Talking to doctors  Internet comfort levels

18. Talking to Doctors: The New World Order  Before 1972,doctors told patients what they wanted patients to know, and what they wanted patients to do.  1972 – AHA Patient Bill of Rights  “The patient has the right and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information about his or her diagnosis, treatment, and prognosis.”

19. Better knowledge = better outcomes  Ask Me 3™ http://www.npsf.org/askme3/http://www.npsf.org/askme3/ 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

20. Your health depends on the questions you ask  Questions are the Answer http://www.ahrq.gov/questionsaretheanswer/ http://www.ahrq.gov/questionsaretheanswer/  Build your own personalized list of questions, including: When will I get the results? How do you spell the name of that drug? Can I stop taking my medicine if I feel better?

21. Older Adults and the Internet

22. Older Adults & the Internet  Demographics of Internet Users, May 2011 Pew Internet and American Life Project http://pewinternet.org

23. 80 is the new 60  The number of older adults using the Internet increases as computer users join the ranks of older adults. “Seniors” are not just one generation.  Seniors who are online are as likely as younger users to go online on a typical day.  66% of seniors that use the Internet have looked for health information online.

24. However, most seniors…  live lives far removed from the Internet  know few people who use email or surf the Web  cannot imagine why they would spend money and time learning how to use a computer  are more likely than any other age group to be living with some kind of disability which could hinder their capacity to get to a computer training center Fox, Susannah. “Older Americans and the Internet.” Pew Internet & American Life Project. 25 March 2004.

25. Medicare Part D If 58% of adults over 65 are NOT using the Internet, how are they choosing among the 70-plus discount drug care programs online through the Medicare Web site?

26. If not the Internet, where do seniors find health information?  Health care providers  Family  Friends  Workshops/Presentations  Print resources Pew Internet & American Life Project and Health Information Seeking Behaviors of Older Adults: Results from an Interdisciplinary IMLS-funded Research Project, presentation at 2008 Medical Library Association by Mary Stansbury, Library and Information Science, University of Denver and Ruth Ludwick, College of Nursing, Kent State University.

27. How do seniors use the Internet?  Many older adults who use the Internet don’t know how to evaluate the information they find  Some either trust information found on the Internet too much or not at all  Wired seniors outpace younger Internet users on only one health topic: Medicare and Medicaid Fox, Susannah. “Older Americans and the Internet.” Pew Internet & American Life Project. 25 March 2004.

28. What about Boomers?  In 1 year, boomers will begin to age into the 65+ demographic  Younger baby boomers are most likely to have searched online for prescription drug information  Health seeking online is one of the only areas that boomers dominate over other generations  Higher Internet skills

29. Evaluation of Health Resources  Not a real drug. Not a real disorder. A spoof.

30. ABCs (+U) of Evaluation  Accuracy  Authority  Bias  Currency  Coverage  Usability

31. Evaluate Resources for Usability  Font size  Glare-free background color/paper  Clear organization  “White” space  Short sentences  Jargon-free, definitions of medical terms included  Information in short segments  Meaningful images

32. Web Usability  Additional Features for the Web  Mouse-free controls  No flashing images or distractions  High contrast  No “watermarks”  Step-by-step navigation  Read-out-loud features  Highlighted text (hyperlinks) in dark color (other than blue) Click HERE to Win!!!!!

33. Exercise 1: Usability Evaluation  Take a look at the following websites and evaluate their usability:  http://www.healthandage.com/ http://www.healthandage.com/  http://familydoctor.org/ http://familydoctor.org/  http://nihseniorhealth.gov/ http://nihseniorhealth.gov/  http://www.oic.it/wgc2011/ http://www.oic.it/wgc2011/  http://www.wellzone.org/ http://www.wellzone.org/  http://www.aarp.org/health/ http://www.aarp.org/health/

34. Library Programs

35. SHARING: Program Ideas  What programs for senior health information are offered by your library?  What programs are you thinking about offering?  What problems do you encounter with programming for seniors?  What solutions have you found?

36. Program Ideas  Wii!  Exercise  Relationships/dating  Sexual Health  Drug information  Managing Medications  Medicare  Choosing nursing homes/assisted living  Memory issues/keeping mind active  Local resources

37. Program Ideas  Caregiving  End of Life planning  Advanced Directives  Hospice  Evaluating health information  Health Fraud  Legal issues  Alternative medicines  Dancing

38. Collaborate!  You can’t do it alone.  Senior organizations:  Area Agencies on Aging  Disease specific organizations (Alzheimer's Assoc.)  Neighborhood senior centers  Jewish Community Centers  Hospitals and Clinics  University Health Science Libraries  American Society on Aging  National Council on Aging

39. How do I find partners?  NN/LM Membership Directory  http://nnlm.gov/members/adv.html http://nnlm.gov/members/adv.html  2-1-1 Texas  https://www.211texas.org/211/ https://www.211texas.org/211/

40. Some information about Medicare  http://www.medicare.gov http://www.medicare.gov  1-800-MEDICARE (1-800-633-4227)  Health insurance for people age 65 or older (or with certain disabilities)  Part A: Hospital  Part B: Medical  Part C: Advantage Plans (HMOs and PPOs)  Part D: Prescription Drug Coverage

41. How can libraries help with Medicare?  Libraries can:  distribute Medicare publications  host outreach and education events  assist patrons in accessing Medicare.gov  To learn about how to participate in the CMS National Medicare Training Program: http://www.cms.hhs.gov/NationalMedicareTraining Program/ http://www.cms.hhs.gov/NationalMedicareTraining Program/

42. Teaching Health Information on the Internet

43. Why We Teach Health on the Internet to Older Adults  Bridge Digital Divide  Increase confidence  Increase knowledge of health conditions and healthy lifestyles  Help people know how to talk to doctors  Increase skills in evaluating health information resources

44. SHARING: Tips for Online Training  What tips do you have for training seniors with online health information or online information in general?

45. Teaching Observations  Seniors are very hungry for health information  Seniors are eager to learn  Learning a new technology may be anxiety producing  Transportation can be a problem

46. Teaching Tips  Provide hands-on practice and repetition  Use health topics they are interested in (HBP)  Provide regular access to computers  Teach small groups, low teacher/student ratio

47. Teaching Resources  Beanworks: Computers, Older Adults, and Libraries  http://beanworks.wordpress.com/computers-older- adults-and-libraries/ http://beanworks.wordpress.com/computers-older- adults-and-libraries/  Carol Bean, Palm Beach County Library  Includes mousing tutorials  Helpful articles  Other training materials

48. Teaching Resources  NIHSeniorHealth: Helping Older Adults Search for Health Information Online: A Toolkit for Trainers  http://nihseniorhealth.gov/toolkit/toolkit.html http://nihseniorhealth.gov/toolkit/toolkit.html

49. Exercise 2: Train the Trainer  Working with a partner,  Take a few minutes to review the NIHSeniorHealth training module in your packet  Talk with a partner  Present interesting features to class For trainers? For students (seniors)?

50. Teaching Resources  MLA Senior Seminars: Power Points and handouts for training http://www.mlanet.org/resources/consumr_index.ht ml#senior http://www.mlanet.org/resources/consumr_index.ht ml#senior  Reliable Sources of Health Information  Your Medicine: Play it Safe  Medicine Record Form  Buying Prescription Medicine Online: A Consumer Safety Guide

51. HEALTH RESOURCES

52. NIHSeniorHealth  http://nihseniorhealth.gov http://nihseniorhealth.gov  Health information for older adults  Partnership of National Institute on Aging and National Library of Medicine  Information comes from National Institutes of Health  Senior-friendly features (large text, sound, contrast)  Information in bite-sized pieces

53. MedlinePlus  http://medlineplus.gov http://medlineplus.gov  Links to reliable, understandable health websites  Health Topics for Seniors  Easy-to-read articles  Slideshows that have sound and contrast  Medical dictionary  Medical encyclopedia with large illustrations  Links to local services  English, Spanish and other languages  No Advertisements!

54. NIH MedlinePlus Magazine

55. National Institute on Aging  http://www.nia.nih.gov http://www.nia.nih.gov  Free publications (English and Spanish)  Alzheimer’s Disease Education and Referral Center (ADEAR)  Database of more than 300 national organizations that provide help to older adults.

56. CDC Healthy Aging  http://cdc.gov/aging/ http://cdc.gov/aging/  Health Topics  Data and Statistics  Reports  Focus on Prevention

57. DHHS HealthCare.gov

58. USA.gov Senior Citizens’ Resources  http://www.usa.gov/Topics/Seniors.shtml http://www.usa.gov/Topics/Seniors.shtml Serbia photo by HelpAge International on Flickr.com

59. Exercise 3: Reference Exercises  On your own or with a partner, answer the reference questions in your handouts.

60. Questions? Karen Vargas karen.vargas@exch.library.tmc.edu National Network of Libraries of Medicine 800-338-7657 Developed by NN/LM SCR staff. This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN- 276-2011-00007-C with the Houston Academy of Medicine-Texas Medical Center Library.