Malaysian Healthy Ageing Society Health Promotion Programs in Hawaii - - PowerPoint PPT Presentation

Organised by:

Malaysian Healthy Ageing Society

Co-Sponsored:

Health Promotion Programs in Hawaii

Kathryn L. Braun, DrPH University of Hawaii kbraun@hawaii.edu

Active Aging Consortium Asia Pacific (ACAP)

Japan

• S. Korea

China Hawaii Indonesia Singapore Mongolia Malaysia Canada Nepal USA Hong Kong Australia

ACAP

Mission

• To provide a forum in

Asia Pacific for the sharing of

– Research – Policy ideas – Best practices for Active Aging

• Conferences
• Exchange

Benefits

• No dues! (no staff)
• Website.
• Listserve
• Conferences and

conference participation

Good news: Life expectancy in Hawaii is increasing.

44 46 54 62 70 72 74 78 79 80 50 54 60 63 68 70 71 74 75 77 40 45 50 55 60 65 70 75 80 85 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Hawaii U.S.

Life expectancy in years

Source: Hawaii Health Information Corporation. Health Trends in Hawaii.

Bad News: Prevalence of diabetes, HTN, & unhealthy weight are increasing, too.

10 20 30 40 50 60 Overweight Hypertension Diabetes

11% - 18% 32%-48%

Source: Hawaii` DOH. Behavioral Risk Factor Surveillance System., age 65+ 1995-2007.

2006-7 1995-6

38%-59%

Disability delayed 7 years in people who have good BMI, exercise, and don’t smoke (Vita et al, NEJM, 1998)

Study of University of Pennsylvania Alumni, Vita et al. NEJM, 1998 Risk based upon BMI, smoking, exercise Note: A disability index of 0.1 = minimal disability.

High-risk elders are disabled at younger ages

Health Promotion

• Research has validated benefits of health

promotion among elders. (U.S. Administration on Aging, 2009). Examples of direct benefits:

• Improve lifestyle
• Improve self-management
• Improve independence
• Reduce falls and injury

Purpose: To describe two health promotions programs implemented for

• lder adults in our state.

Chronic Disease Self Management Program (CDSMP)

• Stanford University Patient Ed Center (Kate Lorig)

– To empower people with chronic diseases to take control

• f their health

– To gain knowledge of self-management – To improve skills and increase healthful behaviors

Stanford trains Hawaii Master Trainers, August 2008

CDSMP = 6 small-group meetings

• Session

– Short lecture – Feedback/ Problem solving

• Brainstorming
• Building self-efficacy
• Group support

– Action planning – Closing

• Educational style

– Led by 2 trained leaders – Once a week for 6 weeks – Based in motivational interviewing

Every week, participants must develop an “action plan.”

• Something YOU want to do
• Reasonable and behavior-specific
• High confidence that you can do it
• Buddy system for support and

problem- solving

By next week, I will buy walking shoes. By next week, I will walk around the block with my friend after dinner

• ne night.

By next week, I will walk after dinner most week nights. By next week, I will walk after dinner on week nights, and walk to the beach and back (1 mile) on Saturdays.

EnhanceFitness Program Overview

• Developed by Senior Services in Seattle

and University of Washington

• Purpose:

To improve the health of older adults through stretching, low-impact aerobics, and strength training

EnhanceFitness

• Group exercise program

– Led by nationally certified instructors – On-going classes three times a week

Senior Services trains Hawaii Master Trainers, June 2007

Cardio Balance Flexibility Strengthening

2003 2004 2005 2006 2007-2008 2009- present Preparation & strategic planning Training & support

• f pilot projects &

grant writing Secure funding Implement

• Enhance

Fitness

• CDSMP

Expand & Sustain:

• Enhance Fitness
• CDSMP

HHAP Partnership – 64 Organizations

Our Partners and Their Roles

Our Program Partners and Their Roles

Partner

Coordination & Support Recruitment/ Advertising

Implementation

Eval.

Executive Office on Aging (SUA) DOH Community Health Div.

• Univ. of Hawaii Center on

Aging Research & Education Area Agencies on Aging ALU LIKE, Inc. (Title VI Provider) Local Service Providers (e.g.) Senior Service Providers Community Health Centers Nutrition/Meals on Wheels Health Care Providers

Key Steps and Checks

• Build and support champions in organizations

willing to implement programs

• Provide excellent training for local leaders
• Monitor fidelity of delivery
• Evaluate outcomes to see if seniors are

benefiting as expected

• Report information back to your group,

funders, and policy makers

Reach

EnhanceFitness CDSMP Providers 4 22 Sites 12 45 Leaders 19 90

Demographics

70 78 60 65 70 75 80 age 29% 25% 30% 25% 53% 43% 32% 26% 18% 8% 48% 43% 39% 24% 0% 10% 20% 30% 40% 50% 60%

CDSMP (N=1483) EnhanceFitness (N=340)

CDSMP: Reporting More Exercise, Fewer Symptoms, and Fewer Health Care Utilization

(n=709 at 6-month post-program follow-up)

20 40 60 80 100 120 140 160 180 strengh ex aerobic ex 1 2 3 4 pain fatique ShrtB 0.5 1 1.5 2 2.5 3 3.5

Before 6-month

Minutes per week Scored 1-10; a higher score is worse Times in the past 6-month

Physician ER Hospital

EF: Pre-Post Results

2 4 6 8 10 12 14 Chair Stand (reps) Arm Curl (reps) Up-and-Go (sec) Pre Post N=256 (K&BI)

EF: Pre-Post Results

0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16 0.18 0.2 Falls Pre Post 0.5 1 1.5 2 2.5 3 3.5 4 Exercise # of days/wk spent in ex for at least 30 min or more N=256 (K&BI)

Dissemination

• Presentations to HHAP and policy makers
• Local “success stories”
• Presentations at conferences
• Publications
• Tomioka M, Sugihara N, Braun KL. Replicating the EnhanceFitness physical activity

program in Hawai`i’s multicultural population: 2007-2010. Preventing Chronic

• Disease. 2012;9:110155. DOI: http://dx.doi.org/10.5888/pcd9.110155.
• Tomioka M, Braun KL, Compton M, Tanoue L. Adapting Stanford’s Chronic Disease

Self-Management Program to Hawaii’s multicultural populations. The

• Gerontologist. 2012;52 121-132. doi: 10.1093/geront/gnr054.
• Sugihara N, Watanabe M, Tomioka M, Braun KL, Pang L. Saving money through

exercise: Estimating the investment-to-return ratio of an elderly exercise program

• n Kaua‘i. Hawai‘i Medical Journal. 2011;70:116-120.

Implications

• To institutionalize new health promotion

programs:

– Engage policy makers and funders, as well as program providers. – Train and monitor providers to assure that the programs are delivered with fidelity. – Check that health outcomes of participants are positive. – Publicize your findings.

This is NOT the end

Importance of the Environment

• Blue Zones – Areas of the

world with exceptional longevity

– Okinawa – Loma Linda – Sardinia

• In general, long-living

individuals are NOT

– Marathon runners – Strict vegetarians or vegans

What is the secret?

• A lifestyle that

includes

– Physical activity – Diet high in plants – Social networks – Ways to relieve stress and promote meaning

Pathways around lake, and pathways from neighborhoods to town

Application at the Community Level Albert Lea, Minnesota

Modifications to stores restaurants, and school food polices

Results

• After one year:

– Residents trimmed a collective 12,000 pounds off waistlines – Dropped healthcare costs of city workers by some 40%.

Implications

Individuals behavior changes are important BUT Environmental and policy changes can help make the “right” choices the “easy” choices.