Raisa Valve, Head of Development, University of Helsinki, Palmenia Centre for Continuing Education Good Aging in Lahti Region (GOAL) Regional research and development project Lifelong Physical activity, , RV

GOAL = GOod Ageing in Lahti region (international name) Ikihyvä Päijät-Häme (national name) Collaborators University of Helsinki, Palmenia and Faculty of Social Sciences National Institute for Health and Welfare Joint Authority for Päijät-Häme Social and Health Care and its 15 municipalities Lahti University of Applied Sciences

Goals To empower both professionals and population in health promotion To increase welfare, diminish morbidity, and improve quality of life among ageing, and thereby to increase attractiveness of the region

Care and service costs according to age (€ per month )

Health and social expenditures and their predicted change in Finland, 1975– ilman tuottavuutta Increasing productivity + postponing of serv.needs Increasing productivity

 Technological innovations are needed in order to improve productivity.  Social innovations are needed in order to postpone the needs for and use of services. Antti Karisto

Social innovations  All innovations are social in the sense that they come into existence through the interaction between producers and users  Doing new things, doing things in a new way  Challenging the customary way of thinking and acting  Also minor novelties may satisfy criteria of innovativeness.  Innovations are not disseminated in an uniform and mechanistic way. Antti Karisto

Societies are rapidly ageing, and there is a strong need for new innovative working practices in health promotion as well as for new kinds of alliances and co-operation in old age care. Photo by Iiris Salomaa Antti Karisto

Goals  To increase welfare, diminish morbidity, and improve quality of life among ageing, and thereby to increase attractiveness of the region  The project goals have been defined by the representatives from the hospital district, the province, municipalities, national and local research and education institutions, non-governmental organizations

Goals  To empower both the professionals and the population in health promotion  Main entry point to the municipalities is via the social and health care sector  Professionals are overburdened and need practices that will clarify responsibilities between different professionals and between patients and professionals

Three parts of GOAL 1)10-year cohort study ( )  Three birth cohorts will be followed, those born in (the baby boomers), and  needs assessment  general program evaluation 2)Community-based interventions  evidence-based  implementation studies  development of policies and practicies 3)Community Diagnoses  Combining data from cohort study, statistical reports and policy documents from each municipality.

F-0 n=2815 GOAL program design F-1 n=2415 F-2 n=205 0 F-3 Community diagnoses Interventions Evaluation 2002 N= N= N=2817 Community diagnoses Interventions F = Follow-up Community diagnoses

GOAL model GOAL group Municipal administration Community-based interventions Lifestyle counseling T2DM Evaluation and cohort study Promotion of functional capability in elderly Interventions support each other ideologically, structurally and methodologically Sensitivity to emerging intervention needs

Lifestyle counselling process Where, How, Who

Intention formationAction Planning IntentionPlanningInitiative Maintenance Recovery Perceived self-efficacy Outcome expectancies Risk perception Disengagement Action Barriers and resources Theory-base I: The Health Action Process Approach Schwarzer, R., Fuchs, R. (1996). Self-efficacy and health behaviors. In M. Conner & P. Norman (eds.): Predicting health behaviour: Research and practice with social cognition models (pp ). Buckingham, UK: Open University Press.

Community-based intervention : Intervention on promotion of functional capability in elderly LOCAL HEALTH CARE CENTER THIRD SECTOR ORGANIZATION KEY WORDS  TO CREATE A SYSTEMATIC MODEL  CO-OPERATION WITH THE PUBLIC AND THE THIRD SECTOR  DOING THINGS IN A NEW WAY  PREVENTIVE ACTION  HOLISTIC HEALTH Group-based interventions Contents Physical exercise progam Nutrition Social networks At an early stage identify those who are in a risk of losing their functional capacity ≥ 70 years of age Directed to the group-based intervention Directed to the local health care center (follow-up measurements and marking the results

Research setting study participant recruitment over 70 years of age, no severe dementia, mental illness, cancer treatment or other ”fatal” disease, Short functional capacity test (Guralnik,SPPB) (home care personnel) more comprehensive tests (the Berg, TOIMIVA) (physiotherapist) interview (researcher) group-based (GB) at the gym home- based (HB) GB+ goal settingHB+goal settinginformation group Short functional capacity test (Guralnik,SPPB) (home care personnel) more comprehensive tests (the Berg, TOIMIVA) (physiotherapist) interview (researcher) follow-up 3 mo 9 mo 15 mo Short functional capacity test (Guralnik,SPPB) (home care personnel) more comprehensive tests (the Berg, TOIMIVA) (physiotherapist) interview (researcher) strenght and balance training

SPPB -test 1. balance a) semi-tandem b) the side-by-side c) Tandem

Funding - Municipalities Academy of Finland The Social Insurance Institution of Finland Ministry of Social affairs and Health, National Health Project

To conclude about GOAL  Initial focus was on population level  Emphasis shifted towards development of social and health care services as primary targets  Sensitivity to emerging intervention needs  Interventions support each other ideologically, structurally and methodologically  Doing new things, doing in a new way  Group-based lifestyle counseling  How to measure and promote functional capacity in a systematic way  Several national and international publications  GOAL could be seen as a research and developmental resource in Paijat-Hame 