# Presentation: 547866

## ADMINISTRATION ON AGING'SEVIDENCE-BASED PREVENTION INITIATIVE

**Nancy A. Whitelaw, Ph.D.**
- Director, Center for Healthy Aging
- The National Council on the Aging
- _www.healthyagingprograms.org_
- October, 2005

## Chronic Conditions Among Persons 70+

-  CDC/NCHS Health US, 1999

## Leading Causes of Death, Age 65+ (2001)

- 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

## 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

**Notes:**
McGinnis and Foege (1993) examined the behavioral factors that represent the “actual causes” of death in the United States.  For each of these factors, organizations in the aging services network are working together to reduce risk.  Addressing these risks is a central contribution to health outcomes that the aging services network could make.

Studies have found that health care costs for persons with these underlying risk factors can be 50% higher than for those with good health habits.

Social isolation increases the risk for cognitive decline and mortality

## Threats to Health and Well-being Among Seniors

- 35% age 65 – 74 report no physical activity
- 46% age 75+ report no physical activity
- 24% - obese
- 18% - have diabetes
- 33% - fall each year
- Each of these numbers is higher for minority and/or disadvantaged older adults.

## Guiding Principles*

- Make Prevention a Priority
- Start with the Science
- Work for Equity and Social Justice
- Foster Interdependence
- Aging network
- Health care
- Public health
- * James Marks, MD

## Social Ecologic Model of Healthy Aging

- McLeroy et al., 1988, *Health Educ Q*; Sallis et al., 1998, *Am J Prev Med*

## What the Social-Ecological Perspective 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.

## Why aging service organizations?

- Outreach
- Screening, assessment
- Health education; health promotion
- Attention to social and cultural context
- Peer support
- Supportive services
- Accessible, affordable programs

## Challenges for the Future

- Old question:  Does what we are doing work?
- New question:  Can we do what is known to work?
- What do we know works?
- How well do we know it and understand it?
- About whom do we know it?

## Doing What Works

- Evidence of problem: *The burden is great.*
- Evidence of effective interventions: *The science is convincing.*
- Core features of an effective program: *Fidelity is possible with diverse populations and diverse organizations.*
- Requirements for successful implementation _[www.re-aim.org](http://www.re-aim.org/)__ _
- Reach
- Effectiveness
- Adoption
- Implementation
- Maintenance

## AoA Initiative - Evidence-Based Programs

- Disease self-management (5)
- Diabetes
- Heart disease
- Depression
- Chronic Disease Self-Management Program (2)
- Physical activity (4)
- Falls prevention (2)
- Nutrition (2)
- Medication management (1)

## 14 AoA Demonstration Sites

- East:  Portland, Maine; Hartford; Albany; Philadelphia
- Southeast – South Central: Miami; Houston; San Antonio
- Central: Western Michigan
- Western: Los Angeles; Portland OR; Seattle

## Crosscutting Themes

- Self efficacy, active learning and self care
- Social context (family, intergenerational programs, caregiver needs)
- Peer support, role models, peer leaders
- Cultural competence
- Regular, positive reinforcement
- Connections to health care
- Outcomes focus - social, mental, physical, functional

## Local Partners 

- Community aging service providers
- Area Agencies on Aging
- Hospital, health system, physicians, health plan
- Consumers
- Research centers, universities
- County/City Social Services
- State Unit on Aging
- Health Departments
- Local foundations
- Others

## Reach into Diverse Communities

- Total participants – 2700
- 1/3 African American
- 1/4 Latino
- Other minorities
- 1/10 non-English speaking
- Varies by site
- Philadelphia – 100% African American (N=368)
- Miami  – 100% Latino (N=215)

## NCOA’s Center for Healthy Aging and AoA’s National Resource Center

- Collaborate with diverse organizations to contribute to a broad-based national movement.
- Identify, translate and disseminate evidence on what works – scientific studies and best practices.
- Promote community organizations as essential agents for improving the health of older adults.
- Advocate for greater support for strong and effective community programs.
- Provide clearinghouse and technical assistance.

## Center for Healthy Aging

- Increase the quality and accessibility of health programming at community agencies serving 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

## Harvest Health, PhiladelphiaStanford Self-Management Course

**To learn more - Poster Sessions #13 and #19**