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

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

CDC-MIAH 2004; CDC/NCHS Health US, 2002

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

Leading Causes of Death, Age 65+ (2001)

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

“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 AdultsReviewed 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” medicationswww.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

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

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.

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.

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

Profiles of Evidence-based Models

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

Reach

How do I reach the targeted

population?

How do I know my intervention

is effective?

How do I develop organizational

support to deliver my intervention?

How do I ensure the intervention

is delivered properly?

How do I incorporate the intervention so it is delivered over the long-term?

P=Partners and PlanningR=ReachE=EffectivenessA=AdoptionI=ImplementationM=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