1. Live Healthy Georgia, Seniors Taking Charge!!!
Statewide Community Intervention
2006

2. National Aging Trends In 2003 35.9 million older adults
12.4 % of the population
By 2030
75.1 million older adults
20% of population

3. National and State Aging Trends

4. State Aging Trends In 2004 9.6% of GA is 65+ GA ranks 12th in nation
By 2030 GA will have
1,907,837 older adults
15.9% of its population

5. Nutrition and Health Status of Older Georgians
Georgia ranks very low in:
Physically unhealthy days (38th)
Number of days during the previous month when older adults reported their physical health was not good
No leisure time physical activity (38th)
Daily activities including walking, gardening, etc.
Older adults who are eating 5 or more fruits and vegetables daily (45th)

6. Nutrition and Health Status of Older Georgians (cont.)
Georgia also ranks low in:
Complete tooth loss (44th)
Only addresses total loss, not partial loss or disease
Percentage of older adults who are obese (38th)
BMI greater than or equal to 30 kg/m2
Percent who are up to date on preventative services (43rd for women and 41st for men)
Percentage of older adults who have had their cholesterol checked in the past 5 years (81.2 %, 44th)

7. Governor’s Live Healthy Georgia Campaign

8. Key Messages http://www.livehealthygeorgia.org/
Get checked
Be smoke free
Be active
Eat healthy
Be positive

9. Georgia State Unit on Aging & Area Agencies on Aging Promote Healthy Aging
Meals served: > 30,000 people
Wellness activities: > 17,000 people
Nutrition
Physical activity
Diabetes self-management
Goal is to promote independence
Nursing homes cost > $50,000/yr in GA

10. Target Population Population in need Low SES Many chronic diseases
Poor nutrition
Low physical activity
Captive audience
Peer groups
Infrastructure and facilities

11. Live Healthy Georgia – Seniors Taking Charge!
Seniors Taking Charge of Diabetes! (8 lessons)
Serving up Fruits, Vegetables and Physical Activity Everyday! (8 lessons)

12. Needs Assessment AoA and State funding
Governor’s Long Term Care Initiative
Live Healthy Georgia
Better disease prevention & management More independence Less LTC  Less costs
What disease(s) to focus on?
Examples in :
Community Intervention Study
Diabetes
Fruits and Vegetables

13. Diabetes is Prevalent in Senior Centers
18% nationally, 1996
30% in NE Georgia, (n = 174)
Stephens et al., 2006

14. Diabetes Self-Management Interventions in Senior Centers
In North Georgia Senior Centers, a DSM intervention (n = 91) significantly (P < 0.05):
Increased compliance with healthy eating plan, spacing carbohydrates, physical activity, testing blood sugar, and foot care
Decreased A1c by 1.4% in those with A1c > 8%
Decreases in A1c mainly associated with increases in physical activity
Burnett, 2003, Redmond, 2004

15. Educational objectives:
Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Partners:
Division of Aging Services (Sudha Reddy), Area Agencies on Aging, University of Georgia, Diabetes Association of Atlanta, Diabetes Technologies, Inc., Public Health, Senior Centers
Educational objectives:
Improve knowledge and behaviors related to fruits, vegetables, physical activity, physical function, and diabetes self-management
Intervention sites:
40 Georgia senior centers

16. Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Program materials:
16 weeks, 1 lesson per week at senior centers
8 lessons “Serving Up Fruits, Vegetables and Physical Activity Everyday!”
8 lessons “Seniors Taking Charge of Diabetes!”
Reviewed by experts
Menus, recipes, handouts, games
All lessons include physical activity
Step counter
Walking
Chair exercises (NIA)

17. Topics – Fruits and Vegetables
Serving Up Fruits, Vegetables, and Physical Activity Everyday
Staying Healthy with Fruits, Vegetables, and Physical Activity
Easy Colorful Snacks
Canned and Frozen Fruits and Vegetables
Serve up Healthy Fruits and Vegetables for Breakfast
Loading Up Lunch with Healthy Fruits and Vegetables
Serving Up Healthy Fruits and Vegetables for the Evening Meal
Eating Healthy Fruits and Vegetables Away from Home

18. Fruit and Vegetable Bingo to Make Learning Fun

19. Topics - Diabetes Six Daily Do’s for Diabetes
Be Physically Active Everyday
Check Your Feet
Taking Medications and Testing Blood Sugar
Eat Healthy – Plan Your Portions and Plates
Eat Healthy – Meal Timing and Carbohydrate Counting
Eat Healthy – Take Down Fat, Cholesterol, and Sodium
Get Checked for Your A, B, Cs

20. Messages “Six Daily Do’s” Help set Daily Goals for Diabetes Self-Management

21. Diabetes Bingo to Help Remember Diabetes Self-Management Skills

22. Messages Fruits and Vegetables
7 to 10 a day the color way
2 to 3 at every meal – it’s a real healthy deal
Fruits and vegetables for snacks – keep you healthy to the max
Inspiration for messages:
USDHHS & USDA, Dietary Guidelines for Americans, 2005
Wade, 2003

23. Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Health Belief Model:
Susceptibility and severity
Perceived benefits
Perceived barriers
Cues to action
Self-efficacy

24. Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Training the educators:
Diverse backgrounds
Work with other community partners
Provided with all materials and available online:
Statewide training
Onsite training
Technical assistance by phone and

25. Program implementation:
Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Program implementation:
16 weeks, 1 lesson per week at senior centers
Lessons about 1 hour
Diabetes self-management and/or nutrition
Physical activity

26. Participants: Design:
Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Participants:
815 enrolled in the “study”
240+ with self-reported diabetes
(depends on definition)
600+ others
1,000+ more not in the “study”
Design:
Informed consent, pre-test (60 minutes)
Intervention (16 lessons x up to 60 minutes)
Post-test (30 minutes)

27. Pre- and Post-tests: Power Analyses:
Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Pre- and Post-tests:
Fruits, vegetables meals and snacks (frequency)
Physical function (Guralnik et al., 1996)
Diabetes self-management (Toobert et al., 2000)
Blood A1c (Diabetes Association of Atlanta)
Power Analyses:
n of 136 needed to show 15% change
n of 25 to 30 with A1c > 8% needed to show that 1% decrease in A1c is statistically significant

28. Barriers and Challenges
Live Healthy Georgia - Seniors Taking Charge Statewide Community Intervention
Barriers and Challenges
Public health and A1c measures, physician order
Solved by Diabetes Association of Atlanta
Diversity in educators
Address by training and ongoing consultation
Continued stress on importance of outcome measures
Very patient and skilled data management specialist
Diversity in participants
Address by flexible educational materials
Physician clearance for physical activity
Still working on this

29. Timeline 7/04: Discussions about ‘bigger initiatives”
1/05: Serious discussions, proposal writing
5/05: Governor signs legislation
7/05: IRB submitted (10/05 finalized)
8/05: DAS/UGA contracts finalized
8-10/05: Materials development, A1c
10/05: Statewide training
11-12/05: Pre-tests
01-04/06: Intervention
05-06/06: Post-tests
07-09/06: Data analysis and report writing

30. Results

31. Results

32. Results

33. Results

34. Results

35. Senior Center Participant
“Thank you for the time you’ve spent with us. The sessions have helped me to focus more on what I need to improve on – not only for my weight, but also for my diabetes.”
Senior Center Participant
“The people with diabetes really enjoyed the lessons. It was general in a sense, but they soon realized that they didn’t know as much as they should about managing diabetes. It really helped them. Also, everyone loved the fruit and vegetable Bingo game.”
AAA Wellness Coordinator
“This program has helped me move without pain. I am exercising more and eating healthier. I am not on a bunch of medications. I am thankful for my family and I take life one day at a time. I recently found out I have diabetes and these lessons have helped so much.”

36. Results

37. Results

38. Results

39. “I think the consistency of the lessons from week to week kept the participants motivated and interested.  The format of the lessons, along with the handouts made it easy for the educators to present the lessons with little preparation time."
AAA Wellness Coordinator
“I participated in the Live Healthy Georgia - Seniors Taking Charge study and lost 8 pounds and am down 2 clothing sizes. Stay active - don't sit down with folded hands. Be on the move!”
Senior Center Participant
“The Center has helped me to become more healthy.  I take vitamins and eat well.  My doctor is proud of how well I take care of myself.”

40. Website for Live Healthy Georgia- Seniors Taking Charge. www
Website for Live Healthy Georgia- Seniors Taking Charge!
Goals:
Promote healthy aging and healthy living
Authoritative source of information to age well and live well
Practical information to promote healthy aging
Target Audience:
Consumers: Georgians age 50+
Families and caretakers/caregivers
Health professionals who work with older adults

41. Website for Live Healthy Georgia- Seniors Taking Charge. www
Website for Live Healthy Georgia- Seniors Taking Charge!
Partners:
Division of Aging Services
University of Georgia
Benefits:
Translates “Live Healthy Georgia” messages for older adults and their families
Provides information on healthy living, disease risk management, and links to community resources

42. Website for Live Healthy Georgia- Seniors Taking Charge. www
Website for Live Healthy Georgia- Seniors Taking Charge!
Diseases and health conditions targeted:
Alzheimer’s Disease and other dementias
Arthritis
Cancer
Diabetes
Heart disease
Mental health and depression
Obesity
Osteoporosis
Stroke

43. Website for Live Healthy Georgia- Seniors Taking Charge. www
Website for Live Healthy Georgia- Seniors Taking Charge!
Healthy Living:
Age Well
Food Safety
Dietary Supplements
Medications
Eat Healthy
Be Active
Get Checked
Be Smoke Free
Be Positive

44. Results

45. Summary Georgia is aging! Dietary Guidelines challenging to meet
Community Intervention
Diabetes self-management
Fruits, vegetables
Physical activity, step counters
Challenges
Results show program benefits participants
Website:
Reinforce healthy living messages for those 50+ and their families and caregivers