OASIS Health Programs: improving health equity through evidence-based approaches to healthy aging

1. Building Health Equity in the St Louis Region Missouri Health Equity Collaborative Regional Meeting, October 19, 2012 OASIS Health Programs: improving health equity through evidence-based approaches to healthy aging Peter L. Holtgrave, MA, MPH James Teufel, MPH, PhD

2. What is OASIS? A three-fold approach to successful aging

3. 700 partners, 35,000 participants annually OASIS reaches adults 50+ in 40 cities

4. Statistics of the US Aging Population

5. Statistics of the US Aging Population US National Center for Health Statistics

6. Health and Aging in the US • 80% of older adults have one chronic condition and 50% have at least two • 70% of all deaths (1.7 million annually) are due to chronic disease • Infectious diseases and injuries also take a disproportionate toll on older adults • 1 of 3 adults, aged 65+, fall each year • leading cause of injury-related death for this age group

7. Local arts & humanities classes Technology training National humanities programs Programs support the mind, body and spirit Lifelong learning Health promotion • Active Start • Chronic disease management • Matter of balance • Tai Chi, Yoga, Zumba etc Community involvement evidence- andresearch-based programs • Intergenerational Tutoring • CATCH Healthy Habits • Instructors and peer leaders • Program planning and support

8. Evidence-Based Health Programs Active Start

9. Active Start • Winner, US Department of Health and Human Services Innovation in Prevention Award • Evidence- & community-based behavior change and fitness program • Facilitated by trained older adult lay leaders for sedentary older adult participants • 20 to 24 weeks, 1x/week, 1-hour/session • Combines 2 programs: 1. Active Living Every Day [behavior change] 2. ExerStart (added week 5+) [physical fitness]

10. Active Living Every Day • A 12 or 20 week behavior change class • Designed by Cooper Institute • Funded by Robert Wood Johnson Foundation • American Public Health Association’s “Award of Excellence in Program Innovation”

11. Active Living Every Day • Pilot Program Locations: • OASIS centers in Pittsburgh and St. Louis • Program Design: • Weekly, 1-hour group meetings • Participants develop strategies to: • incorporate physical activity into their routine in realistic ways • stay active, including when difficult life situations arise • Approach • Set goals, identify barriers, establish social support systems

12. ExerStart • Low-intensity exercise program for sedentary adults • Adapted by Center for Successful Aging • California State University – Fullerton • Jessie Jones, PhD • Older Adult Participants: • Class students: learn in-class exercises, practiced at home • Trained volunteer-facilitators/class leaders

13. ExerStart • Course design: 43 exercises • Focus: aerobic strength, flexibility, and balance • Session design: (45 minutes) start Increase flexibility & balance Increase endurance Increase strength

14. Active Start Outcome Measures • Pre- and Post-program surveys • Senior Fitness Test1 • Measures physical capacity of older adults to perform usual, everyday activities • Chair Stand Test (lower-body strength) • Arm Curl Test (upper-body strength) • 2-Minute Step Test (aerobic endurance) • Chair Sit and Reach Test (lower-body flexibility) • Back Scratch Test (upper-body flexibility) • 8-Ft Up and Go Test (agility and balance) 1Rikli & Jones, 1999

15. Active Start Outcomes1 • Behavioral change support group + fitness classes = significant improvements in physical performance • strength, flexibility, and balance • 93% of participants in the intervention group completed the 24-week study • Supports that community-based physical activity programs benefit sedentary, ethnically diverse older adults 1Yan, et al., 2009

16. Evidence-Based Health Programs Chronic Disease Self-Management Program (CDSMP)

17. CDSMP • Lay led education program developed by the Stanford University Patient Education Research Center • Recognized by US Administration on Aging and the US Centers for Disease Control and Prevention • Purpose: increase confidence and motivation needed to manage challenges of living with chronic health conditions

18. CDSMP • Participants: • Older adults with chronic health conditions • hypertension, arthritis, heart disease, stroke, lung disease, diabetes, others • Model: • Provides information and teaches practical skills on managing chronic health problems • Design: • 6 sessions, 1x/week for 2 ½ hours each • Facilitated by two trained lay leaders, one or both with a chronic condition • Participant caregivers can attend

19. CDSMP • Approach: • Focus on problems common to individuals suffering from chronic diseases • Controlling symptoms through: • Relaxation techniques • Dietary changes • Sleep and fatigue management • Correct medication use • Exercise • Communication with health providers

20. CDSMP • Skill development: • Coping strategies • Action planning • Giving feedback • Behavior modeling • Decision-making and problem-solving techniques

21. CDSMP Outcomes • After 1st Year: • Significant improvements in energy, health status, social and role activities and self-efficacy. • Less fatigue or health distress • Fewer visits to the emergency room • No decline in activity or role functions • even with slight increase in disability after 1 year Lorig et al. (2001a), Stanford University

22. CDSMP Outcomes • After 2 years: • No further increase in disability • Reduced health distress • Fewer visits to physicians and emergency rooms • Increased self-efficacy = reduction in health care use Lorig et al. (2001a), Stanford University

23. Evidence-Based Health Programs Better Choices, Better Health

24. Better Choices, Better Health • Developed by National Council on Aging (NCOA) and Stanford University • Kate Lorig, RN, DrPH • Internet version of CDSMP • Convenient option for those comfortable with web-based learning • Purpose: Build confidence and develop self-management skills to address problems associated with chronic conditions

25. Better Choices, Better Health • Design: • Pair of trained facilitators (at least one with a chronic health problem) lead 6-week web-based workshop • Participants: • Had MD-diagnosed chronic condition: heart disease, lung disease, type 2 diabetes • Process: • Log contributions (Email, message boards) 3+ times/week (c. 1-2 hours) for 6 weeks • Not required to log-in at same time

26. Better Choices, Better Health • Topics: • Making informed treatment decisions • Appropriate use of medications • Communicating effectively with family, friends, and health professionals • Healthy eating • Disease-related problem solving • Activities: • Action planning • Sharing experiences • Building mutual support

27. Better Choices, Better HealthOutcomes • Randomized, controlled trial1: • Significant improvement in health status & self-efficacy • Improvement in health distress, fatigue, pain, shortness of breath, and illness intrusiveness • Longitudinal study2: • Significant improvement in symptoms, health behaviors, self-efficacy, health-care system satisfaction • Lessened need for hospital and doctor visits • net cost saving in first year 1Lorig, Ritter, et al (2006); 2Lorir, Ritter, et al (2008)

28. Evidence-based IntergenerationalHealth Programs Active Generations and CATCH Healthy Habits

29. Intergenerational, evidence-based physical activity and nutrition programs Funding Robert Wood Johnson Foundation (2006) WellPoint Foundation (2007-2012) Adaptation of Coordinated Approach to Child Health (CATCH) Outcomes-driven Award-winning Active Generations (2006-2010) &CATCH Healthy Habits (2010-2012)

30. Address childhood and older adult obesity and improve overall health and wellness Increase physical activity and encourage active living Increase knowledge about nutrition to encourage healthy eating Foster positive relationships between young people and adults, age 50-plus Objectives

31. Program Design Nutrition Lessons Snack Lessons Physical Activities

32. Program Design

33. CATCH Healthy Habits 18 Cities across 14 States

34. 400+ Organizational Partners

35. Example Titles Team Member (everyone!) Pioneer(joined in first year) Talent Scout/Coach (recruitment/screen/train volunteers) Food Scout/Culinary Steward (purchase food for healthy snacks) Community Connector (partnership development) Outcome Czar (evaluation, data collection /entry) Professional Storyteller (marketing, publicity) Documentary Artist (takes photos, shoots videos) Volunteer Leader (program administration, volunteer supervision) Volunteer Roles

36. Pilot Program Child Results (2006-2010; N=760) • Statistically significant health impacts: • Eating 3+ vegetable servings daily • Eating no vegetable daily • Understanding min. fruit and vegetable consumption • Understanding link between nutrition and disease • Self-efficacy engaging in PA 3-5 times per week • Self-efficacy running or biking • Self-efficacy exercising at a steady pace • Decrease daily TV watching • Play no video games daily

37. CATCH Healthy Habits Child Results (June 2011-September 2012) • Survey-based improvements • Days physically active after school • Decrease screen time • Food label reading • Eating 3+ fruits a day • Eating 2+ fruits a day • SOFIT Observations • 61% MVPA (vs. 50% CATCH) • SMART tool • 26,500 volunteer hours • $484,000 value SOFIT Coding Sheet SMART tool

38. Future Directions • Diabetes Self-Management Program (DSMP) • Community-level policy and environment change through intergenerational approaches • Generations for a Healthy Community

39. OASIS Evidence- and Research-based Programs Questions and Discussion 33

40. Thank you James Teufel, MPH, PhD National Health Director Email: jteufel@oasisnet.org Phone: 314-862-2933 ext. 237 Peter L. Holtgrave, MA, MPH National Health Manager Email: pholtgrave@oasisnet.org Phone: 314-862-2933 ext. 230