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Research on Lifestyle Redesign An Occupational Science Approach (PowerPoint)

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					Research on Lifestyle Redesign: An Occupational Science Approach to Combating Health Concerns of the 21st Century

Health Collaborative Retreat
October 21, 2004
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Occupational Science
New Social Science
Studies the relationship of occupation to health Study of the human as an occupational being: person engaged in his or her world of activity
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What do we mean by occupation?

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Definition of Occupation
Activities that can be named in the lexicon of the culture: Physical activities Social activities Spiritual activities

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II Health Promotion in the Elderly

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The

is upon us…

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Our focus must shift from

Quantity of Life to Quality of Life
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Outstanding Quality of Life in Old Age

IS
a Realistic Outcome
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Successful Aging
“Growing old with good health, strength, and vitality”

Rowe, Kahn. Successful Aging. 1998;23. 9

Usual Aging
Elders who are functioning well, but are at heightened risk for ageassociated disease or disability

Rowe, Kahn. Successful Aging. 1998;23. 10

III The USC Well Elderly Study

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The USC Well Elderly Study was funded by
National Institutes of Health National Institute on Aging (NIA) Agency for Health Care Policy and Research (AHCPR) National Center for Medical Rehabilitation Research (NCMRR)
American Occupational Therapy Foundation Lumex, Inc. RGK Foundation Smith & Nephew Roylan

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The USC Well Elderly Study Group
Florence Clark, PhD, OTR Ruth Zemke, PhD, OTR Jeanne Jackson, PhD, OTR Michael Carlson, PhD Loren G. Lipson, MD Stanley P. Azen, PhD Joel W. Hay, PhD Barbara Cherry, PhD Deborah Mandel, MA, OTR Karen Josephson, MD USC Occupational Therapy USC Occupational Therapy USC Occupational Therapy Social Psychology, USC Occupational Therapy Geriatric Medicine, USC Keck School of Medicine Preventive Medicine, Biostatistics, USC Department of Biometry Pharmaceutical Policy & Economics, USC Pharmaceutical Economics Cognitive Psychology, USC Occupational Therapy USC Occupational Therapy Geriatric Medicine, USC Keck School of Medicine
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Health Well-Being Occupation

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Purpose/Goal of Research
Prevent Illness Maintain Independence Efficacy Cost-Effectiveness

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Target Population
Independent Seniors Low-Income Multi-Ethnic
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Design:

Randomized Clinical Trial
Three Experimental Conditions
 Occupational  Social  No

Therapy

- 122 - 120 - 119

Group Control

Treatment Control

361
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Design: Measures
Physical Health Cognition Functional Status Psychosocial Well-Being General Health

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Design : Timeline
9 Month Program
2 hr/week Small groups

6 Months
No Contact

Pre Test
Physical Exam Questionnaires

Post Test

Questionnaires

Follow Up
Physical Exam Questionnaires

15 Months
Utilization of Health Services

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USC Well Elderly Study
RAND SF-36
8% 6% 4% 2% 0% 2% 4% 6% 8% 10% 12% 14% 16%
Vitality General Health

Occupational Therapy Subjects Control Subjects

Absence of Health-Based Role Limitations

Social Functioning

General Mental Health

Absence of Bodily Pain

Physical Functioning

Absence of Emotion-Based Role Limitations

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LR: 6-Month Follow-up
RAND SF-36
OT improvement
       

initial 6mo
14% 10% 9% 8% 6% 6% 6% 4% 11% 9% 8% 7% 6% 5% 4%

No Health-based Role Limitations 14% No Emotional-based Role Limitations Physical Functioning Vitality General Mental Health Social Functioning Absence of Bodily Pain General Health

Clark et al. J Gerontology. Psychological Sciences and Social Sciences, 2001.

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LR: Cost Effectiveness
Estimate of medical costs avoided as a result of occupational therapy intervention in relation to health related quality of life.
Hay, et al, (2002)

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Results
Program Costs


OT = $548 per subject

Post intervention health care costs
OT = $967  Active Control = $1,726  Passive Control = $2,593  Cost per QALY (OT) = $10,660


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IV Health Mediating Effects of the Well Elderly Program
# 1RO1 AG 021108-01A2, NIH $2,280,668

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Investigative Team
Principal Investigator: Florence A. Clark, Ph.D., USC Department of Occupational Science & Occupational Therapy Co-Investigators:

Stanley Azen, Ph.D., USC Department of Biometry, Keck School of Medicine
Carolyn Ervin, USC Department of Biometry, Keck School of Medicine

Michael Goran, USC Preventive Medicine, Physiology
Joel Hay, USC Pharmaceutical Economics Howard Hodis, USC, Molecular Pharmacology/Toxicology Leslie Lytle, University of Minnesota, Epidemiology Virginia Quinn, Kaiser Permanente, Southern California Kim Reynolds, USC Preventive Medicine
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Aim
To replicate our previous results on the positive effects of the lifestyle redesign intervention
To examine the mediating mechanisms responsible for its positive effects

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Design
N=440: Ethnically diverse elders
Randomized semi-crossover design Intervention: Six months lifestyle redesign

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Measures
(Assessed 4 – 5 times over an 18 – 24 month interval)

Healthy Activity Coping Social Support Perceived Control Stress Related Biomarkers Perceived Physical Health Psychological Well-being Cognitive Functioning
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Conceptual model of positive effects of activity-based interventions for elders

Healthy Activity

Reduced StressRelated Biomarkers

Intervention
Potential Mediators: Subsidiary Analyses * Social Network * Domain-Specific Perceived Stress * Religious Coping * Mental Disengagement * Behavioral Disengagement * Acceptance * Volunteer Activity

Active Coping Social Support Perceived Control Perceived Physical Health

Psychosocial Well-Being
Cognitive Functioning Positive Reinterpretation-Based Coping

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VI Weight Loss Randomized Clinical Trial

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Customized Lifestyle Re-Engineering and Obesity: An RCT
Principal Investigator: Florence A. Clark, Ph.D., USC Department of Occupational Science & Occupational Therapy Co-Investigators: Stan Azen, Ph.D. Michael Goran, Ph.D. Joel Hay, Ph.D. Howard Hodis, M.D. Kim Reynolds, Ph.D. Virginia Quinn, Ph.D. Leslie Lytle, Ph.D.

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Mediational Model for the Proposed Study
Intervention-Based Knowledge Facilitative Social Support Increased Perceived SelfEfficacy Personalized Daily Lifestyle Change
Improved Diet

Customized Lifestyle Re-Engineering

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