Making A Commitment To Healthy Aging

Document Sample
Making A Commitment To Healthy Aging Powered By Docstoc
					Improving the lives of older Americans


                                           Making a Commitment
                                                to Healthy Aging

                                                     Nancy Whitelaw, PhD
                                                 National Council on Aging
                                         Gerontological Society of America
                                                          November, 2008
Healthy aging is a systems change strategy,
not simply a program or service.




                                      © 2008. Copyright NCOA
What Is Healthy Aging?
   The development and maintenance of optimal
    physical, mental and social well-being and function
    in older adults.
   Physical environments and communities are safe
    and they support the adoption and maintenance by
    individuals, families and groups of attitudes and
    behaviors known to promote wellness and well-
    being.
   Community programs and health services are
    effectively used to prevent or minimize the impact
    of acute and chronic disease on function.
    Adapted from the Healthy Aging Research Network

                                                      © 2008. Copyright NCOA
Overview of the Healthy Aging Movement
   Foster widespread adoption of evidence-based
    “health promotion programs” through sites that are
    convenient and engaging for older adults.
   Leverage and build organizational capacity at state,
    regional and local levels to support health
    promotion and use of research in practice.
   Support Administration on Aging and other public
    and private initiatives to foster evidence-based
    health promotion for older adults.
   Engage a variety of sectors - aging, public health,
    mental health, long-term care, health care,
    education, philanthropy and more to create lasting
    policy and systems changes.

                                           © 2008. Copyright NCOA
Ann Speaks About Health & the Program




                               © 2008. Copyright NCOA
What is Evidence-Based Health Promotion?
A process of planning, implementing, and evaluating
programs adapted from tested models or interventions in
order to address health issues in an ecological context.
1.   Evidence about the health issue that
     supports the statement, “Something should       Doing things
     be done.”                                       that result
2.   Evidence about a tested intervention or         in improved
     model that supports the statement, “This        health and
     should be done.”                                function
3.   Evidence about the design, context and
     attractiveness of the program that supports
     the statement, “How this should be done.”
Adapted from Bronson and others

                                                   © 2008. Copyright NCOA
Chronic Disease –
An Epidemic of Unparalleled Proportions
   More than 1.7 million Americans die of a chronic
    disease each year.
   80% of older adults have at least one chronic
    condition; 50% at least two.
   Among older adults with 2+ chronic conditions:
     • 76% report being limited in function
     • 17% report being frequently depressed
   There are disparities in the prevalence of chronic
    conditions and functional loss associated with
    income, race and ethnicity, and other factors.
Mensah: www.nga.org/Files/ppt/0412academyMensah.ppt#18
State of Aging and Health in America 2007: www.cdc.gov/aging


                                                               © 2008. Copyright NCOA
Average Spending on Health (per capita)
                          7000
                                               United States
                                               Germany
                                               Canada
                          6000                 France
                                               Australia
                                               United Kingdom
                          5000



                          4000



                          3000



                          2000



                          1000



                              0
                              80
                              82

                              84
                              86
                              88

                              90
                              92

                              94
                              96

                              98
                              00

                              02
                              04
                           19
                           19

                           19
                           19
                           19

                           19
                           19

                           19
                           19

                           19
                           20

                           20
                           20
  Source: K. Davis, C. Schoen, S. Guterman, T. Shih, S. C. Schoenbaum, and I. Weinbaum, Slowing the Growth of U.S. Health Care
  Expenditures: What Are the Options?, The Commonwealth Fund, January 2007, updated with 2007 OECD data

                                                                                                   © 2008. Copyright NCOA
  Leading Causes of Death Age 65+
   “Medical Diagnoses”
    Heart Disease                 32%
    Cancer                        22%
    Stroke                         8%
    Chronic respiratory            6%
    Flu/Pneumonia                  3%
    Diabetes                       3%
    Alzheimer’s                    3%

State of Aging and Health 2007 www.cdc.gov/aging; CDC/NCHS Health US, 2002


                                                         © 2008. Copyright NCOA
Underlying Risk Factors –
“The Actual Causes of Death”

Behavior                               % of deaths, 2000
 • Smoking                                   18%
 • Poor diet & nutrition/                    17%
   Physical inactivity
 • Alcohol                                       4%
 • Infections, pneumonia                         3%


  McGinnis & Foege, JAMA, 1993; Mokdad et al, JAMA, 2004




                                                      © 2008. Copyright NCOA
Threats to Health and Well-being Age 65+
   78%         age 65+ report no regular physical activity
   61%         unhealthy weight
   33%         fall each year
   15%-20%     clinically-relevant depressive symptoms
   9%          cigarette smokers
   36%         no flu shot in past 12 months
   43%         no pneumococcal vaccine ever
   25%-30%     inappropriate medication use
www.cdc.gov/nchs; Older Americans 2008



                                                © 2008. Copyright NCOA
Health Promotion Works for Older Adults
   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

www.cfah.org/programs/aging.cfm


                                                   © 2008. Copyright NCOA
US Federal “Health & Aging” Spending, 2007

     In Billions
     $450
     $400
     $350
     $300
     $250
     $200
     $150
     $100
      $50
       $0
            Medicare Medicaid   AoA   CDC HP
                      Aged

                                          © 2008. Copyright NCOA
Change is Needed!




                    © 2008. Copyright NCOA
Guiding Values for Healthy Aging
   Person-centered; self-directed; respectful; dignified
   Engaging, interactive, supportive
   Convenient, community-based, culturally
    appropriate
   Health promoting
     •   99% of chronic care is self care
   Science-based; results-focused
   Far-reaching, widely relevant
   Systems changing



                                            © 2008. Copyright NCOA
Healthy Aging Systems Model




                              © 2008. Copyright NCOA
Evidence-based Program: Results are Replicable




                                  © 2008. Copyright NCOA
Desirable Characteristics of Programs
   Rigorous science; peer-reviewed publication
   Health-related outcomes
     • Health and functional status
     • Depressive symptoms
     • Health behaviors
     • Efficacy, self-management skills
     • Health services utilization
   Suitable for non-clinical settings and personnel
   Fit with diffusion and RE-AIM frameworks
   Attractive to participants and adopting agencies
   Training, tool kits, technical assistance
                                           © 2008. Copyright NCOA
Intervention Programs That Work
   CHRONIC DISEASE SELF-MANAGEMENT PROGRAM Lorig
    KR et al. (1999) Medical Care.
   ENHANCE FITNESS: Wallace, JI et al. (1998) Journal of
    Gerontology.
   ENHANCE WELLNESS: Leveille et al. (1998) Journal of
    American Geriatrics Society
   MATTER OF BALANCE: Tennsdedt, S et al. (1998)
    Journal of Gerontology.
   PEARLS: Ciechanowski, P et al. (2004) Journal of the
    American Medical Association.
   Healthy IDEAS: Quijano, L et al. (2007) Journal of
    Applied Gerontology
   And 11 others ….

                                             © 2008. Copyright NCOA
Programs Being Diffused
   Person/Group; Home/Community; Peer-led
    /professionally-led
     • Stanford Chronic Disease Self-Management Program
         50 states
     • Enhance Fitness
         27 states
     • Matter of Balance
         25 states – 24 within past 3 years
     • Healthy IDEAS
         10 states – 9 within the past 2 years
     • And others ….


                                           © 2008. Copyright NCOA
Engagement & Support: Personal and Social




                                © 2008. Copyright NCOA
    Social Cognitive Theory
   Self-management skills are learned and behavior is
    self-directed.
   Person-centered definition of the problem and person-
    selected targets for improvement.
   Motivation and confidence in managing one’s
    conditions dictate success.
   The social environment supports or impedes progress.
   Successful self-management includes:
     •   Monitoring and responding to changes in symptoms,
         emotions and function
     •   Goal setting, action plans and peer support
     •   Review, feedback and problem-solving
                                               © 2008. Copyright NCOA
Who Participates ≈ 20,000 Participants
   Age
     • 49%     Under 74
     • 34%     75-85
     • 18%     85+
   Race/Ethnicity
     • 74%      White – not Hispanic
     • 11%      African American
     • 8%       Hispanic
     • 7%       Asian, Native American; Pacific Islander
 76% Female
 49% living alone
   50% High school graduate or less education
                                                  © 2008. Copyright NCOA
How Engaged Are Participants?
   Chronic Disease Self-Management Program
     •   75% complete at least 4 of 6 sessions
     •   Range across states: 54% - 98%
   Matter of Balance Program
     •   81% complete at least 5 of 8 sessions
     •   Range across states: 79% – 83%
   Enhance Fitness
     •   63% average percent of available classes attended
     •   Range across states: 50% – 72%




                                                 © 2008. Copyright NCOA
Bernice Speaks About Engagement




                                  © 2008. Copyright NCOA
Organizational Capacity: Collaboration & Results




                                    © 2008. Copyright NCOA
Capacity Building in States 31 States

   AK
                           WA                                                                                   VT    ME
                                     MT
                                               ND
                                                              MN
                      OR                                                                                                    NH
                                ID                                           WI                                 NY               MA
                                               SD
                                                                                                                           RI
                                     WY                                                 MI
                                                                                                                      CT
                                                                                                           PA          NJ
                                                                   IA
                                               NE
        Hawaii             NV                                                                OH                      DE
                                                                              IL       IN
                                          CO                                                          WV VA          MD
                 CA                                 KS                                      KY
                                                                    MO
                                                                                                       NC
                                                                                   TN
                                                         OK
                                AZ    NM                            AR                                SC
                                                                                                 GA
                                                                                  MS    AL

                                                    TX                  LA
                                                                                                      FL




                                                                                        © 2008. Copyright NCOA
Organizational Capacity
   Partnerships State Offices on Aging and Public Health
   Regional leadership organizations
     •   Area Agencies on Aging
     •   Health care organizations
     •   Educational institutions
     •   Social service organizations
   Local program sites – 855 sites
     • Senior centers and community centers
     • Residential settings
     • Clinics
     • Social service organizations
     • Faith-based organizations
                                              © 2008. Copyright NCOA
    Challenges for Program Sites
       How difficult to introduce evidence-based program?
         •   6%    Very difficult
         •   16%   Difficult                   “Once you get
                                               them through the
         •   46%   Somewhat difficult          door they are
         •   40%   Not very difficult          believers. All take
       Most difficult aspects                 something home
         •   72%   Recruiting participants     that I believe
                                               sticks.”
         •   44%   Retaining participants
         •   35%   Recruiting lay leaders
         •   31%   Making sure staff have time to teach course
    Based upon partial and preliminary data
.
                                                     © 2008. Copyright NCOA
Rewards for Program Sites
   Most rewarding aspects of offering evidence-based
    program
     • 68%     Clear health benefit to participants
     • 44%     Achieve organization’s mission
     • 38%     Establish new partnerships
     • 31%     Positive reactions by participants

    “These have been the most important new programs
    that we have offered through the AAA. The connection
    between health organizations and aging has been
    important in establishing new partnerships, securing
    new funds, and getting greater visibility in the
    community and the state for our organization.”

                                                  © 2008. Copyright NCOA
Finance & Sectors: More is Better!




                                     © 2008. Copyright NCOA
Partnerships and Collaborations
   Public, Private, National, Regional, Local
     •   Aging
     •   Public health
     •   Mental health
     •   Long-term care
     •   Health care
     •   Housing
     •   Education
     •   Employment
     •   Philanthropy
   Practice Change Fellows
   Investment exceeds $50,000,000

                                            © 2008. Copyright NCOA
Research: Evidence & Culture of Inquiry




                                 © 2008. Copyright NCOA
Pursue Evidence &
Foster a Culture of Collaborative Inquiry
   Intervention/Efficacy Studies
     •   Robust models; theoretically-based
     •   Community settings – leveraging current assets
     •   Ongoing training and technical assistance
   Evaluation and Effectiveness Studies
     • Collaborative approaches
     • Replicate findings from original intervention
     • Feed a national strategy
   Process and Qualitative Studies
     •   Partnering, fidelity, organizational impact, meaning
   Continuous Quality Improvement

                                                © 2008. Copyright NCOA
Advocacy: Silos of Opportunities




                                   © 2008. Copyright NCOA
Aging? Chronic Care? Prevention? Health Reform?
    Older Americans Act
      •   Done: “Evidence-based prevention and promotion” into the
          Older Americans Act
      •   Project 2020 Appropriations Initiative
    Medicaid
      •   Kerry–Grassley S. 3327 Empowered At Home Act
      •   Various State-specific targets
    Medicare
      •   Advocate for:
            vulnerable and disadvantaged seniors
            person-centered supports for self-management
            collaboration with community organizations
      •   Diabetes Self-management Training
      •   Senior Risk Reduction Demonstration
      •   Fall risk evaluation and management
    Safety of Seniors Act

                                                      © 2008. Copyright NCOA
The Road Ahead & A Call to Action




                                © 2008. Copyright NCOA
Challenges Abound
   Who cares about evidence?
   What are successful strategies for science to
    influence policy?
   Who is willing to invest in development and
    application of science and research to policy,
    program development and practice?
   How do we change the paradigm that equates
    health and medicine?
   How do we change ageist attitudes around
    promoting health and self-determination?


                                            © 2008. Copyright NCOA
Promising Opportunities
   Expanded engagement and ownership by older adults
     •   Champions for the cause
     •   National corps of peer facilitators/instructors
     •   Grass roots organizing to effective advocacy
   Expand program options, including online
   Improve interface with clinical care
   Strengthen messaging and marketing
   Organize networks and improve processes
   Diversify funding streams
   Impact policy


                                                 © 2008. Copyright NCOA
Making A Commitment to Healthy Aging

"It is necessary to carve
from the whole vast
spectrum of human
needs one small band
that the heart and mind
together tell you is the
area in which you can
make your best
contribution.”

John A. Hartford
Foundation


                                © 2008. Copyright NCOA

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:10/28/2011
language:English
pages:40
xiaohuicaicai xiaohuicaicai
About