“Integrating Efforts to Support Livable Communities Across the Lifespan”

1. “Integrating Efforts to Support Livable Communities Across the Lifespan” National Association of Chronic Disease Directors General Member Call March 28th, 2013 Division of Population Health National Center for Chronic Disease Prevention and Health Promotion

2. About Today’s Call • Highlights importance of integrating mobility and livable communities into public health activities • Provides information about activities of the CDC’s Healthy Aging Program (HAP) and AARP • Stimulates dialogue among call participants, HAP and AARP • Informs HAP and AARP efforts to support future work that promotes the health and well-being of older adults • Supports CDC/NCCDPHP Domain #2: Environmental Approaches

3. Introductions Lynda Anderson, PhD Director, Healthy Aging ProgramApplied Research and Translation Branch Amy Levner, AARP

4. Introductions Cheryl Schott, MPHConsultant, Michigan Public Health Institute Amy Slonim, PhD CDC-AARP Liaison

5. Webinar Dialogue Objectives • Describe the shifting demographics in the US population • Share overviews of priorities, activities and resources of CDC Healthy Aging Program and AARP Livable Communities • Engage in dialogue about state and local public health opportunities to integrate older adults issues in work with communities, state and local elected officials and partners

6. Tell Us Few Things About Yourself Check the box that best represents your professional affiliation: • -- State and local public health • -- Aging Services • -- Academia • -- Federal government • -- Other *

7. CDC’s Healthy Aging ProgramWork on Mobility Lynda Anderson, PhD Director, Healthy Aging ProgramApplied Research and Translation Branch

8. Transformative Demographic Shifts • The number of older adults are growing faster than any other age group • By 2015, there will be more people over age 65 than those aged 15 or younger • By 2030, 20% of the U.S. population will be 65 years of age or older • Adults age 65 or older are twice as likely to be living in poverty as they were a decade ago * Anderson LA et al. The public's perceptions about cognitive health and dementia among the United States population: a national review. Gerontologist 2009;49(51):S3-11.

9. CDC’s Healthy Aging ProgramWork on Mobility Objectives • Provide a brief history and rationale for current work in mobility and older adults • Summarize the findings from the mobility and older adults concept mapping work and resulting framework • Discuss next steps

10. Mobility Optimal mobility* is defined “as being able to safely and reliably go where you want to go, when you want to go, and how you want to reach your designation, and is key a component of healthy aging.” * Modified from the CDC-HAN Mobility Workgroup and Satariano et al. (2012) AJPH

11. Concept Mapping Applied to Mobility • Engages stakeholders • Applies multi-dimensional scaling and cluster analysis • Creates visual maps of relationships among ideas • Provides a foundation for prioritizing action items

12. Steps in Concept Mapping Planning: Develop a focused question and identify participants Idea Generation: Experts and interested community members invited to respond to focused question Data Collection: Participants sort and rate the results of the idea generation • Analysis: Creates visual maps of relationships among ideas Interpretation and Use: Develop conceptual framework and identify priorities

13. Develop a Focused Question • Specific Aim: To engage stakeholders to create a framework that will contribute to promoting mobility in community-dwelling older adults as a coordinated response across agencies and organizations. “One specific action that can lead to positive change in mobility for older adults in the U.S. is…”

14. Decide how to manage multiple tasks. 20 Manage resources effectively. 4 Work quickly and effectively under pressure 49 Organize the work when directions are not specific. 39 Rating Sheet 1 Manage time effectively 2 Manage resources effectively. 3 Scan a multitude of information and decide what is important. 4 Decide how to manage multiple tasks. 1 2 3 4 5 5 Organize the work when directions are not specific. 1 2 3 4 5 1 2 3 4 5 1 Manage time effectively 3 Scan a multitude of information and decide what is important. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Sort and Rate Ideas 102 ideas were sorted into groups Each idea was rated for potential impact and achievability

15. Conceptual Framework: Mobility and Older Adults Research to Practice Training Independence and Engagement Coordinated Action Community Supports Built Environment and Safety Housing and Accessibility Transportation Policy

16. Independence and Engagement Identify one or more communities to serve as environmental models or as examples of mobility-sensitive or friendly communities. Engage community volunteers in conducting walkability audits. Actively encourage recognition of and planning for older adults to continue to be active in the years when mobility will be limited. Make available a variety of evidence-based physical activity and fall prevention/education programs, both in-home and in community based settings, that can be scaled for different locales or communities. Identify and support physical activity programs that can accommodate people aging with disabilities. Support the use of programs for exercise to maintain strength and improve balance. Encourage the use of available health self-management tools, like online, buddy systems, in person support and information, group support and so on. Identify and promote critical programs related to driving and older adults, including persons with cognitive and physical limitations. Encourage ways to promote intergenerational physical activity and connection to family, friends and community to provide social supports. Encourage shops or large retail or entertainment locations to provide and support mobility options for their customers. Repurpose locations like community centers so they can better serve the needs of adults and persons with disabilities.

17. Coordinated Action Include mobility and older adults in coordinated chronic disease prevention and health promotion state plans. Engage older adults, though interactive participatory methods, in voicing their strengths and priorities in promoting mobility. Implement a certification process for age-friendly communities. Partner with state coalitions on fall prevention to identify community safety activities that may be useful for local communities. Encourage states to develop, implement and evaluate their own physical activity plans modeled after the National Physical Activity Plan. Public awareness campaigns about the benefit of physical activity for older adults that include a call to participation and action for older adults. Identify and support a guide for smaller towns that want to adopt a bike/ped master plan for their town. Work with schools and others to seek opportunities for intergenerational connections, like reciprocal tutoring and volunteering. Develop a comprehensive, multi-faceted approach to healthy aging, coordinated across agencies, through information and assistance and care coordination. Encourage states to develop, implement and evaluate their own fall prevention plans modeled after the National Fall Prevention Plan.

18. WE WANT TO HEAR FROM YOU . . . In what programmatic or functional areas are you most fully integrating the perspectives and needs of older adults?

19. AARP Livable Communities: Great Places for All Ages Amy Levner March 28, 2013

20. The Challenge

21. AARP Livable Communities Vision

22. 1961 White House Council on Aging

23. Creating Communities for ALL Ages

24. aarp.org/livable

26. AARP Network of Age Friendly Communities

27. AARP State Work Kingsport, TN

28. AARP State work

29. WE WANT TO HEAR FROM YOU . . . Do you include the perspective of older adults in your chronic disease efforts around mobility?

30. Healthy Aging Mobility Scan:An Assessment of State Mobility Work Cheryl Schott, MPH Consultant, Michigan Public Health Institute National Association of Chronic Disease Directors General Member Call March 28th, 2013

31. Scope of Work/Methods • Reviewed ten state health department websites: • Searched: 1) A-Z index/site maps, 2) Homepages, 3) Website search engine • Particular attention given to physical activity, walking, obesity prevention, arthritis, disability, fall prevention, transportation, and healthy/livable communities programs • Relevant URL’s and sub-links, summary of findings, and key documents were recorded on a search log and document review form • Arkansas • California • Florida • Kansas • Michigan • New York • North Carolina • Texas • Vermont • Washington State

32. Findings • All states reviewed are actively involved in policy and environmental efforts to promote healthy communities • Strategies include: • Changes to the built environment • Adopting Complete Streets policies • Improving public transportation • Promoting access and safety • Developing joint-use agreement • Older adults are recognized as a special population in several states’ plans and reports • Inclusion of strategies specific to the aging population varies

33. Examples: Older Adults • Built Environment • Healthy Kansas Community Assessment and Planning Tool includes considerations for older adults and people with disabilities such as: • wheelchair access • resting space for pedestrians • visual/sound signals at cross-walks • assistance with snow/ice removal • in-door walking programs Photo credit: Dan Burden, www.pedbikeimages.org

34. Examples: Older Adults • Walkable Communities • California Walkable Neighborhoods for Seniors project provides workshops on how to make communities more walkable for seniors and offers local walking groups • The Arkansas Department of Health and Arkansas Coalition for Obesity Prevention (ArCop) has partnered with AARP to conduct Active Living Workshops and walkability assessments as part of their Growing Healthy Communities initiative Photo credits: Luciano Rizzi and Dan Burden, www.pedbikeimages.org

35. Communities For A Lifetime/Aging in Place • Supports community efforts to conduct assessments and initiate improvements to make communities more elder friendly and livable for all ages • Florida, Michigan and North Carolina are among the states with such programs • Administered by state aging departments, versus public health, although they may collaborate on certain components

36. Transportation • California Health in All Policies Task Force addresses transportation issues for the aging population • Plans to model future transit access to essential destinations • Sponsors an annual Senior Safe Mobility Summit • Provides training to healthcare professionals on assessing older adults’ functional driving skills • A few states (e.g. Kansas, Texas, Vermont) address access to health care or other services by promoting transportation assistance for those in need Photo credit: Dan Burden, www.pedbikeimages.org

37. Arthritis, Disability & Fall Prevention • Most states reviewed also address mobility issues through arthritis, disability, and/or fall prevention programs • Primarily address personal mobility such as activity limitations (e.g., trouble walking, climbing stairs, activities of daily living) • Kansas Arthritis Program promotes changes to the built environment to facilitate physical and social activity among people with arthritis; disability program promotes community improvement of non-automobile travel systems (e.g., sidewalks, curb cuts, etc.) for people with disabilities

38. Surveillance/Data Collection • BRFSS data on activity limitations (e.g., trouble walking short distance, climbing stairs) among people with arthritis or disabilities • Fall injury and mortality data among older adults • Percent of older adults who engage in recommended amounts of physical activity • Michigan - limited data on the use of local trails and parks among older adults (collected through an evaluation of their Building Healthy Communities program) • In development - policy, environmental and built environment indicators promoting mobility

39. WE WANT TO HEAR FROM YOU . . . Any questions?

40. WE WANT TO HEAR FROM YOU . . . What partnerships do you use to promote active communities for older adults?

41. WE WANT TO HEAR FROM YOU . . . What challenges do you face when integrating mobility into new or existing programs?

42. Call for Papers • Special Supplemental Issue Health Education & Behavior • Fostering Engagement and Independence: Opportunities and Challenges for an Aging Society • Guest Editors: Lynda A. Anderson, PhD and Thomas R. Prohaska, PhD • 250-word abstract describing the manuscript by May 20, 2013 • Submit to Debbie Gordon Messer at heathy.aging.heb@gmail.com • Email follow-up to be sent with additional information

43. For more information about the Healthy Aging Program: Visit www.cdc.gov/aging Telephone: 770 488-5360 Division of Population Health National Center for Chronic Disease Prevention and Health Promotion