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 www.healthyagingprograms.org http://www.aoa.gov/prof/evidence/evidence.asp

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

Modifiable Risk Factors Among Older Adults http://www.cdc.gov/aging

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 45-54 years old had consistently greater deterioration than younger or older adults. http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Measure=5&Category=1 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 1996. 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 45-54 years old had consistently greater increases than younger or older adults. BRFSS data

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

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

Underlying Risk Factors – “The Actual Causes of Death” Behavior % of deaths, 2000 Smoking 19% Poor diet & nutrition/ 14% Physical inactivity Alcohol 5% 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

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 http://www.cfah.org/programs/aging

Threats to Health and Well-being Among Seniors 73% age 65 - 74 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 www.cdc.gov/nchs

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

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. http://www.healthyagingprograms.org/content.asp?sectionid=15&ElementID=97

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

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

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.

Profiles of Evidence-based Models http://www.cfah.org/programs/aging

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.

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?

(P)RE-AIM Framework www.re-aim.org P=Partners and Planning R=Reach E=Effectiveness A=Adoption I=Implementation M=Maintenance

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.

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