Healthy Living: Self-Management of Chronic Conditions Stanford University’s CDSMP Presented By: Mary Ellen Beaurain Pima Council on Aging 8467 E. Broadway Tucson, AZ 85710 520-790-0504 mebeaurain@gmail.com In partnership with the Arizona Living Well Institute Insert your own contact information and logo instead of Mary Ellen & PCOA’s information 1. Introduce self - include something personal in your introduction that relates to chronic conditions if possible. 2. I’m here today to talk about the possibilities for Healthy Living even for those of us who have chronic conditions or are living with someone who has a chronic condition. As we age, unfortunately, chronic illnesses often accompany the aging process. Increasingly more attention is being given to programs that help people learn to manage their chronic conditions so that they can feel more in control and ultimately feel better. The Healthy Living:Self Management of Chronic Conditions program that I’m going to talk about today has shown remarkable success in helping individuals. It was even recently endorsed by the Surgeon General. 3.The program was developed at Stanford University’s Patient Education Center many years ago. It is offered all over the country and in Arizona, through the partnership with the Arizona Living Well Institute, workshops are now being offered all over the state. 4. I’d like to start my presentation with a brief look at how big this concern is, then explore a little about the impact of chronic conditions and how it can affect the quality of our lives, and then most of the time today will be spent on talking about the Healthy Living program to manage their chronic health conditions and how it works. Part or all of this work first appeared in the 2006 Chronic Disease Self-Management Leader’s Manual and is derived or adapted from the Chronic Disease Self-Management Program and is copyrighted by The Board of Trusteesof the Leland Stanford Junior University.

Somefacts about chronic health conditions Over 50% of Americans in their forties or older have at least one chronic condition More than 85% of adults 65 or older have at least one chronic condition Many adults have 3 or more chronic conditions Arizona Living Well Institute

State of the State One out of four households in AZ includes a resident who is 65 years or older. Source - US Census Bureau. US Population Projections In 2008, 71% of Arizonians 65 years or older reported having at least one chronic condition. Of the same group, 20% reported having three or more chronic diseases. Source - Arizona Health Survey, 2008 Report on Aging in Arizona, Arizona Department of Health Services – 2010. Co-Authors: Reva Litt, MPH and Ramona Rusinak, RN, PhD Arizona Living Well Institute

Chronic Health Conditions Are: Illnesses that are prolonged in duration Do not resolve spontaneously Are rarely cured completely Examples include heart disease, cancer, stroke, lung disease, diabetes, and arthritis Review what chronic health conditions are and watch for any comments or need for clarification on this. Then depending on time and audience you can do an interactive exercise before moving to the next slide to bring out the next point: • Ask the group to volunteer answers to the question “What problems do you have because of your chronic health condition (or problems caused by living with someone with a chronic health condition). (Allow time for 5-6 responses. If no one reports any symptoms, attempt to bring the conversation around to the subject of symptoms. For example, if a problem is limitation of an activity, you might ask them what is causing that limitation. If no one reports any symptoms, i.e. depression, fatigue, stress, etc., you should ask for a show of hands of how many have experienced these symptoms.) • Write the responses from the group on the board or flip chart. (If no flip chart or board is available write them down and repeat back to the group when brainstorm has finished). • Point out that even though members of the group may have different chronic conditions, many of their concerns are the same. Arizona Living Well Institute

Some symptoms of chronic conditions Fatigue and loss of energy Limitations & frustrations Trouble breathing Pain May experience depression Uncertainty about future When reviewing these points, you might add on the final point on “uncertainty about future” words like anxiety/stress Arizona Living Well Institute

The Symptom Cycle Referring back to the list of problems generated earlier or the previous slide : 1) Point out that often pain and fatigue seems to be one of the most common problems experienced by people with chronic health problems. 2) As you may already have experienced, one symptom can then lead to a series of other problems, which often creates more symptoms. It becomes a symptom cycle. 3) Let me give you an example of how the symptom cycle works. Arthritis causes you pain because of inflammation or bone rubbing against bone. In response, to protect the hurting joint, you tighten the muscles in that affected area. As these are tightened for a long time, the muscles also begin to cause pain (ask them to make a fist or outstretch their hand and hold for a few minutes: as the time passes, they'll notice that it starts to ache). As your pain mounts, you become stressed and more tense, wondering if the pain will ever get better. You might even cut back on activities. This, in turn, causes weak muscles and emotions such as worry, anger, fear, frustration, and even depression. Stress, difficult emotions and lack of exercise can cause shortness of breath and fatigue, making the pain worse and completing the vicious cycle. 5) This vicious cycle can happen with any health problem, not just arthritis, and the cycle can start anywhere – depression, for example, can start the whole cycle, or fatigue. 6) How many of you have experienced aspects of this cycle (ask for a show of hands)? How many of you believe people can influence this cycle by using certain methods or techniques (ask for a show of hands)? 7) You can break this vicious cycle! There are a variety of ways to do this using physical exercises, mental exercises and more. Arizona Living Well Institute

What you can do! Learn to BREAK the cycle and manage your symptoms Learn techniques that can help cope with your conditions Gain insights and wisdom from others Being with others who have similar challenges can be a powerful motivator - you are not alone! Sign up for a Healthy Living workshop Remember, because there is no known cure for many of the chronic health problems, self-management or learning techniques that you can use to break the symptom cycle and ease your symptoms is very important. Arizona Living Well Institute

What is Healthy Living? In AZ, CDSMP known as Healthy Living: Self-Management of Chronic Conditions Workshops (Healthy Living) 6 week workshop, meeting once a week for 2 ½ hours Developed by Stanford Patient Education Research Center For people with chronic health conditions & their caregivers Facilitated by two trained leaders Between 10-16 participants Offered in community settings Remember to mention: -Kate Lorig -A family member, friend, or caregiver is also encouraged to attend -”Peer leaders” are usually not health professionals, best if leaders have chronic conditions themselves -Class size is important for discussion purposes -Community settings = Senior centers, churches, community centers, senior living communities, etc. Arizona Living Well Institute

Topics Covered Making an action plan Using your mind to manage symptoms Feedback/problem solving  Managing difficult emotions Fitness/exercise Better breathing  Working with health care professionals Working with health care system  Arizona Living Well Institute

Workshop Design Introduces tools needed in day-by-day life with chronic conditions Practices using self-management skills - participants choose what to work on Highly interactive, not a lecture course Focuses on goal setting Share experiences, emphasizes mutual support ON final bullet, you might mention that they are very supportive although not support groups alone. Arizona Living Well Institute

What Else Do I Need to Know? Healthy Living workshops complement other programs - they do not interfere with them Workshops increase participant’s ability to manage their health To be most effective, participation in all sessions is very important Arizona Living Well Institute

What does it do? Self-Management NOT Health Education Purpose of self-management is to help people gain self confidence in their ability to: - control their symptoms - control how their health problems affect their lives Health education- inform/increase knowledge, change behaviors Self-management- Helps participant to: manage life with Disease, increase skills/self confidence, problem solve and make decisions It is what you call an Evidence Based program: Stanford did a year randomized study…. outcomes 5 year randomized study, 1000 people Outcomes? Arizona Living Well Institute

Outcomes Increased physical activity Enhanced partnerships with physicians Improved social/role activities Improved self-reported general health Better psychological well-being Improved health-status Increased energy/reduced fatigue For more information on CDSMP outcomes, Review of Findings on Chronic Disease Self-Management Program (CDSMP) Outcomes:Physical, Emotional & Health-Related Quality of Life, Healthcare Utilization and Costs, http://patienteducation.stanford.edu/research/Review_Findings_CDSMP_Outcomes1%208%2008.pdf And even 0.8 fewer days in the hospital In summary, they showed more confidence in their ability to manage their conditions Arizona Living Well Institute

Participants Comments I have been inspired through this program. I look forward to my time alone just relaxing and meditating. This has reduced my stress. I have become more confident and positive and plan to do achievable goals. I would recommend this class for anyone who wants a lifestyle change for themselves. You learn to control your circumstances. Arizona Living Well Institute

Registration Process Upcoming Healthy Living Workshops in your area: To register: Schedule of current statewide workshops on the Institute’s website www.azlivingwellinstitute.org Arizona Living Well Institute

Director of AZ Living Well Institute Questions? Mary Ellen Beaurain Pima Council on Aging (520) 790-0504 mebeaurain@pcoa.org www.pcoa.org/arizona-living-well/ Insert your own contact information and logo above the Institute contact information. I would like to thank all of you for coming. Give out information about upcoming programs. Stay around for a few minutes to answer any questions. Melanie Mitros, PhD Director of AZ Living Well Institute (480) 982-3118 or (877) 982-3118 Mmitros@azlivingwellinstitute.org www.azlivingwellinstitute.org Arizona Living Well Institute