AoA is pleased to celebrate healthy aging by highlighting evidence-based
prevention and wellness projects being conducted in communities across the Nation.
Please select the program below to learn more:
September 20, 2008
Making Brighter Days in Maine with Healthy IDEAS
Healthy IDEAS is a program that helps older adults cope with and often relieve the symptoms of depression. It is an evidenced-based program, developed at Baylor College of Medicine’s Huffington Center on Aging in collaboration with the Care for Elders partnership. (For more information, please see: www.careforelders.org/healthyideas .) The effects of depression can be broad and debilitating, so Healthy IDEAS can be a godsend. The Maine Healthy IDEAS program has had particular success. It is administrated by Elder Independence of Maine, a division of one of Maine’s area agencies on aging,
This story of one case manager is typical: “I see one client who is a wheel-chair bound 77-year-old woman, and requires a mechanical lift. She agreed to try Healthy IDEAS, but did not think it would benefit her due to her mobility limitations, one-sided paralysis and poor vision. However, after completing the process, this client changed her routine from sleeping in a recliner all day to becoming active. Her activities included performing exercises with a stationary pedal for leg strengthening three to five times per week, and knitting with a one-handed loom twice a week. She began to look forward to getting an electric wheelchair so she could go outside and enjoy her garden.”
Healthy IDEAS in Maine represents more than a sorely needed intervention for older individuals. It serves as a new service delivery model. All 80 clients who screened in were participants in a Medicaid home and community-based waiver program (HCB). It permits states to offer long-term care to clients in their homes, as long as they are eligible for Medicaid-covered nursing home care.
All clients have an Elder Independence of Maine case manager. These case managers have undergone training to offer the Healthy IDEAS intervention. The training includes how to conduct screening, teach older adults about the signs of depression, provide linkages to health or mental health care, and perform behavior activation. If every state adopted the same system for delivering Healthy IDEAS, thousands of case managers would be trained, and significantly more older and disabled people would have access to this helpful program.
Because the case managers in Maine were not mental health professionals, they naturally felt some anxiety about delivering an intervention for depression. However, within four months of implementing Healthy IDEAS, they were reporting much higher confidence levels. The catalyst proved to be giving them adequate, ongoing training and coaching, and the support of an agency administration committed at every level to the program.
Maine’s experience highlighted some important considerations for starting similar Healthy IDEAS programs elsewhere. Champions were important to getting everyone on board, from staff to community partners. Staff preparation and planning were also critical. For case managers, in particular, one principle in Healthy IDEAS helped relieve any anxieties they may have had about the intervention: Perfection is not the goal. Learning is.
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September 18, 2008
Cultivating Health in the Garden State
Many older adults face the challenge of managing one—and often several—chronic medical conditions, such as, high blood pressure, heart disease, arthritis, diabetes, hearing problems, and depression. All of which can be costly and debilitating.
The Chronic Disease Self-Management Program (CDSMP), developed at Stanford University, has proven extremely effective at enabling people to take more control of their own health. It has become the centerpiece of AoA’s 27 state grant programs. CDSMP uses peer-led education to help individuals cope with symptoms, manage medications, make behavioral lifestyle changes, and obtain medical care.
Unfortunately, health initiatives like CDSMP don’t always reach the people who could benefit the most from them. Often they are not available to older adults in communities that experience higher than average rates of chronic disease. That’s why in September 2007, two units within the New Jersey Department of Health and Senior Services—the Division of Aging and Community Services (DACS) and the Office of Minority and Multicultural Health (OMMH)—joined forces to make CDSMP more broadly available. Through the OMMH partnership, seven agencies based in minority communities received funding to have individuals trained as master trainers. The master trainers then implemented community workshops, and recruited and trained peer leaders.
The collaboration ignited a storm of interest, enthusiasm, and achievement. In the first year, six African Americans, 11 Latinos, and three Koreans became master trainers who were qualified to prepare volunteer peer leaders to run CDSMP. In the first six months of the effort, the funded agencies delivered 15 workshops for more than 180 older adults of color.
As one administrator put it, “Prior to the collaboration, we had very little reach into minority populations. So being able to have people from those communities deliver the program was major. We’ve seen life changing impact on individuals.” As a result, OMMH has also committed to funding seven additional agencies in 2009 to bring CDSMP to more communities.
Program participants weren’t the only ones to feel the program’s impact. Staff, master trainers, and peer leaders did as well. For example, at a recent reunion of peer leaders from the program, one participant admitted that after her training, she had gone back to her old habit of excluding vegetables from her diet. However, when she realized what she was doing, she created an action plan, as she had learned to do in her CDSMP training. Now she’s returned to healthful eating. Another leader had difficulty maintaining his exercise plan. But he reminded himself that during the training program, having a buddy had been a big help. As a result, he has now persuaded his wife, his best buddy, to exercise with him.
Another leader summed it up succinctly: “I’ve always helped others. But in this course, I learned how to help myself.”
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September 18, 2008
Promoting Evidence-Based Programs through New Networks that Link Clinical and Aging Services Partners
Evidence-based health programs such as the Chronic Disease Self Management Program (CDSMP), EnhanceFitness, and Matter of Balance can give older adults a sense of control over their lives, improve their day-to-day functioning, and help save on medical bills. Of course, the benefits of these programs can only be experienced by older adults who actually participate in them. One way to recruit more people is by encouraging local primary care clinics to refer patients to these programs, which are offered through aging services organizations. If the family doctor says it’s a good idea, older adults take that opinion seriously.
To explore the potential of clinical-community collaboration, the Administration on Aging has partnered with the Agency for Health Research and Quality, and the Centers for Disease Control to conduct two evidence-based Disability and Disease Prevention Learning Networks. Launched in 2006, these collaborations help facilitate better clinical-community connections, which in turn promote chronic disease self-management and other evidence-based programs.
Eleven states—Florida, Maine, Michigan, Rhode Island, South Carolina, Vermont, Illinois, Maryland, Massachusetts, New Jersey, and Ohio—have participated. Each state has created a unique coalition, tested a variety of outreach strategies, and using the Network has obtained peer-to-peer feedback and support.
Linking physicians and community providers isn’t always easy. Maryland’s partnership included two medical providers (Chase Brexton and the Centennial Medical Group), the Howard County Office on Aging, and the Maryland Departments of Aging and of Health and Mental Hygiene. Initial outreach found that area doctors needed convincing that CDSMP workshops, which were held at local senior centers, were worthwhile both for them and their patients.
Physicians needed to see the evidence base for the intervention and have assurance that if they made referrals, they would not be violating HIPAA patient-privacy rules. This learning led to an intensive “academic detailing” approach, in which physician champions took information and promotional materials about CDSMP directly to their peers, much in the same way as pharmaceutical representatives communicate with doctors about new products.
“The academic detailing allowed us to get in the door,” says Starr Sowers, Manager of the Health and Wellness Division at the Howard County (Maryland) Office on Aging.“
In addition to telling them about the Chronic Disease Self Management Program, we were able to tell them about the services and the programs of the Office on Aging. This created a win-win situation for us, the clients, and the physicians. We're hoping to use this approach with other physician practices throughout the county.”
In Illinois, the partnership was similarly diverse, including the Cook County Area Agency on Aging (AgeOptions), a clinical partner (Rush University Medical Center), a local community organization (the White Crane Wellness Center) and the Illinois Departments of Aging and of Public Health. This team focused on approaching “close-in” medical practices at Rush. A physician champion led the outreach, along with the aging service providers, making personal, peer-to-peer contacts with other physicians. Associated materials addressed doctors’ concerns about the program. Thus far, 10 physicians in six health systems are making these referrals, and the clinical partners themselves have jumped in to provide financial support to run more CDSMP workshops.
“We have really been able to leverage the resources of all partners involved,” said Dana Bright, Community Health Coordinator at Rush. She also noted that having the infrastructure in place to make CDSMP available and doctors, who championed the program to their peers, were also key.
AgeOptions Health and Diversity Coordinator Maria D. Oquendo-Scharneck agreed. “We have been fortunate to have Rush as a partner in implementing CDSMP for the past two-and-half years. Their commitment to self-management, aging, and healthcare has been extraordinary.”
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September 17, 2008
Island Hopping (and Skipping and Walking) Enhance Fitness in Hawaii
Regular physical exercise can enhance health at any age. It reduces the risk for age-related illnesses such as heart disease,
high blood pressure, osteoporosis and diabetes. Just as importantly, it improves balance,
flexibility, endurance and strength.
EnhanceFitness, an evidence-based physical activity program developed through a partnership of the University of Washington, Senior Services of Seattle/King County, and the Group Health Cooperative, brings the benefits of exercise to people over age 60, both active and frail.
The program is currently offered at 270 sites around the country. The Administration on Aging (AoA) is currently funding EnhanceFitness through grants in nine states, including Hawaii. Participants in Kaua’i, Hawaii, where the program has been running since July, 2007, are already experiencing positive results. One 90-year-old female class member told the local media that she had regained enough stamina to begin dancing again at an annual Buddhist festival.
Many other participants are enjoying benefits. Regular follow-up check-ups at four-month intervals show that the 86 Kauaians now in the program have improved their agility and balance, as well as their upper and lower body strength. In fact, they have become significantly stronger compared with other sites across the country, even though their mean age was five years older.
Classes take place at the Waimea, Kekaha, and Koloa Neighborhood centers. Efforts are also now underway to expand to the Kekaha Neighborhood Center and Hanapepe Armory. One master trainer oversees the entire program for the island and ensures that local trainers closely follow the core EnhanceFitness protocols. Using these guidelines ensures that participants get all the benefits of the program.
EnhanceFitness’s implementation in Kaua’i is part of the statewide Healthy Aging Project (HAP), which began in 2003. AoA began supporting HAP in 2006. HAP’s broad purpose is to improve the health status of older adults through improved nutrition and increased physical activity. On Kaua’i, HAP represents a dynamic and diverse collaboration among the County of Kaua’i Agency on Elderly Affairs, Kaua’i Economic Opportunity, Inc., the Kauai District Health Office, the County Department of Parks and Recreation and 50+ Lifelong Fitness. With funding from Oahu’s Child and Family Services, the program is also offered in two sites on that island with plans to increase this number.
Beyond these collaborations and the statistics, participants have expressed their heartfelt appreciation for the program. “I can climb into the tub…and breathe,” said one older adult. Another said simply, “I am more energetic.”
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September 16, 2008
Partnerships for More Responsible Self-Care in California
Alice De Franco has been leading health workshops for older adults for the past 11 years. Her life experience has equipped her well for the job. She’s a retired 77 year-old registered nurse who copes with diabetes and a heart condition on her own. Today, she’s putting her teaching and life experience to work as she coaches evidence-based practices in Healthier Living, California’s iteration of the chronic disease self-management program.
Healthier Living comprises a series of six two-and-a-half hour workshops, held over six weeks. Alice and one other leader with a chronic disease run the sessions. They cover medication management, physical exercise, loneliness and depression, physician communication, and other issues that older adults with chronic conditions are likely to face. The program not only improves symptom management and self-confidence among participants, but can lower a patient’s annual health care costs according to a study completed by Stanford researchers at Kaiser Permanente in California.
Local groups are taking notice as AoA and others promote the chronic disease self management program around the country. California, in particular, has engaged a variety of partners to create regional networks and make the program more broadly available. These groups include the California Association of Physicians Groups (CAPG), whose members are directing patients to Healthier Living programs. Health systems, private hospitals and county hospitals, which have a financial and community interest in the health of older adults, have been tapped to support or provide the program. Area Agencies on Aging and housing providers are delivering Healthier Living programs at senior and community centers. California has even brought community colleges into the initiative, providing state funds so that older adults can take the workshop at local campuses near their homes.
Never one to rest on her laurels, Alice De Franco is contributing to this expansion effort by helping to offer Healthier Living in several settings in South Orange County. Building on work begun at the end of 2006, California hopes by next year to have nearly 1,500 older adults participating in Healthier Living and another 4,500 participating in other evidence-based programs, including Matter of Balance (fall prevention), Health Moves (exercise), and the Medication Management Improvement System (reducing poly-pharmacy).
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September 15, 2008
Matter of Balance Helps Older Texans Stand Tall
Falls are a major public health issue. Currently, more than one-third of adults age 65 and older, and one in two over the age of 80, fall each year. Among older adults, falls are the leading cause of injury deaths and the most common cause of injuries and hospital admissions for trauma. Of those who fall, 20 to 30 percent suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death.
In response the Administration on Aging (AoA), in partnership with national experts, has supported the testing and dissemination of evidence-based falls prevention programs like Matter of Balance (MOB). MOB is an eight-session workshop adapted by MaineHealth from a program designed at Boston University. Through the AoA’s Evidence-based Disease Prevention Program, several states are making the workshop available. Texas has made MOB a central part of its statewide Falls Prevention Coalition, sponsored by the Texas Association of Area Agencies on Aging (T4A) and the Texas Department of Aging and Disability Services.
“This is an exiting and critically needed effort,” said Carol Zernial, Director of the Area Agency of Bexar County and the Vice President of the T4A. “We have built significant, state-wide momentum to get this program on the ground.”
Since October 2007, the Coalition, which includes the state’s 27 area agencies on aging (AAAs), has trained 55 volunteer coaches. The coaches, in turn, have conducted 96 MOB workshops, reaching more than 1,100 older Texans. By year two of the program, these AAAs already represent 220 of the 247 Texas’s counties. The program, which is being evaluated by Dr. Marcia Ory of the Texas A&M Health Science Center School of Rural Public Health, relies on proven strategies to reduce people’s fear of falling and improve their balance. It gives older people what they need to stand tall.
Just listen to one older Texan: “[Since taking the class,] I’ve been watching how I really do things in the house and outside. It really gave me food for thought on how to help myself ….Thank you all for making me aware of my surroundings and also physically helping me with the exercises that have helped me a lot. God bless the instructors! They are awesome.”
Furthermore, MOB produces measurable results. On average, Texas workshop participants report significant improvements in:
- •The number of healthy days in their lives
- •Their confidence in being able to prevent and protect themselves from falls
- •Their health status and its impact on their activities of daily living (ADLs)
“This class,” said another Texas participant, “helped me see as an older person I can improve my environment and that I can do exercises that make me more agile. This is a very helpful and enjoyable class that every senior citizen needs to take!”
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