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Evidence-Based Disability and Disease Prevention for Elders
Health Promotion and Disease Prevention Campaigns
Pamela Piering, Director, Aging and Disability Services, Human Services Department, City of Seattle, Seattle, WA.
James P. LoGerfo, M.D., M.P.H., Professor, Medicine and Health Services, Health Promotion Research Center, School of Public Health and Community Medicine, University of Washington, Seattle, WA.
Academic-community partnerships work together to develop, test, disseminate, and institutionalize programs that improve the lives of seniors. Such partnerships are an essential component of a national strategy promoting healthy aging in seniors.
What Kinds of Academic and Community Partnerships Have Resulted in Successful Initiatives?
The Centers for Disease Control and Prevention (CDC) fund Prevention Research Centers (PRCs) to conduct participatory, community-based research to prevent disease and promote health. The PRCs use rigorous scientific methods to design, test, and disseminate feasible and effective strategies to improve personal and community health.
The Healthy Aging Research Network consists of nine PRCs located throughout the country. The mission of the Healthy Aging Research Network is to better understand the determinants of healthy aging in older adult populations; to identify interventions that promote healthy aging; and to assist in the translation of such research into sustainable community-based programs throughout the nation.
The University of Washington's PRC supports healthy aging initiatives which are widely implemented in a variety of organizations and healthcare settings throughout the Pacific Northwest, including:
PEARLS: Program to Encourage Active, Rewarding Lives for Seniors
The University of Washington PRC is collaborating with community agencies in the Seattle area on the PEARLS research project for older adults focused on reducing minor depression and resulting disability. The PEARLS study is testing an intervention for relatively home-bound seniors with moderate depression. The intervention is conducted in the home of subjects in eight sessions over a 19-week period. This intervention seeks to improve depression outcomes through a structured program of problem-solving therapy and pleasurable events scheduling. The PEARLS intervention also includes clinical supervision by a psychiatrist. PEARLS is designed to be deliverable by staff typically available in an Area Agency on Aging or in senior centers.
The Senior Center Disability Prevention Study
The Senior Center Disability Prevention Study conducted in 1994 included a nurse visit to conduct a risk factor review, develop a health plan, and promote an exercise program. The study also developed a nutrition tip sheet and a self-administered home safety evaluation. A group exercise program focused on improving balance, strength, aerobic condition, and flexibility. A nurse followed-up by phone with each participant at two, four, and sixteen weeks after program completion. The study found statistically significant improvements in physical function, mental health, and reduction of bodily pain.
Health Enhancement Program (HEP)
The Health Enhancement Project (HEP) Research Study was a randomized control trial based at a senior center. The study was conducted by the University of Washington, Group Health Cooperative of Puget Sound, PacifiCare, and Senior Services of Northshore Senior Center. HEP is a health mentor program with seniors helping seniors. Peer volunteers act as role models to extend the work of professionals.
The study showed that hospital days decreased by 72 percent, psychoactive medication use decreased by 36 percent, and participants had higher levels of physical activity and better functioning in daily living activities. The study also looked at outcomes for participating mentors. Twenty-eight percent of mentors increased exercise, 50 percent increased self-management techniques, and 22 percent of mentors' social activity and physical function scores increased.
Currently researchers are conducting research into replication. The goal is to widen elders' access to a low-cost, high quality, and truly comprehensive system of health promotion programs. In 1997 the programs operated at five sites in one county. In 2004 there were 27 programs in six states. Leadership at each site embraces the concept of participant centered health programs.
Lifetime Fitness Program
The Lifetime Fitness Project (LFP) is an example of implementing an evidence-based individual approach to health promotion. Lifetime Fitness exists as a partnership of the University of Washington Health Promotion Research Center, Senior Services of Seattle/King County, and the Group Health Cooperative. The program emphasizes moderate intensity activities and can be transitioned to a self-maintained program at home. It is safe for physically unfit seniors including the "near frail." It is also self sustaining.
LFP is a one-hour, three-times-a-week, group exercise program that combines walking, strength training using cuff weights, stretching, balance exercises, and warm-up and cool-down activities. Outcomes include:
- Improved physical function, social function, and fitness.
- Reduced pain, fatigue, and depression.
- Reduced medical expenditures.
Regression analysis suggests a $7.50 saving for each session attended.
Translating the LFP research into practice has involved developing a business model, the preparation of instructor manuals and participant manuals, and the development of an evaluation plan. Training programs on how to teach classes and conduct outcomes testing were set up for instructors. A collection and analysis system for outcome data was created, and a home for the program was established at Senior Services of Seattle. An electronic LISTSERV™ was created for exercise leaders to share questions and issues and includes regular updates to incorporate new research findings.