Transcript Live Healthy Georgia-Community Intervention Study 2005-2006

Live Healthy Georgia, Seniors
Taking Charge!!!
Statewide Community Intervention
2006
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National Aging Trends
Population of Older Adults in the US
80
Millions
• In 2003
– 35.9 million older
adults
– 12.4 % of the
population
• By 2030
– 75.1 million older
adults
– 20% of population
60
40
20
0
2003
2030
Year
http://www.aoa.gov/prof/Statistics/2004Pop/Stterr2004_files/sheet004.asp
http://wonder.cdc.gov/WONDER/help/populations/population-projections/PressTab5.xls
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National and State Aging Trends
Older Adult Population Estimates in Georgia
600
Thousands
500
400
300
200
100
0
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Age Range
http://www.aoa.gov/prof/Statistics/2004Pop/Stterr2004_files/sheet004.asp
http://wonder.cdc.gov/WONDER/help/populations/population-projections/PressTab5.xls
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State Aging Trends
• In 2004
– 9.6% of GA is 65+
– GA ranks 12th in
nation
• By 2030 GA will have
– 1,907,837 older
adults
– 15.9% of its
population
Percentage of Older Adults in GA
18
16
14
12
10
%
8
6
4
2
0
2004
http://www.aoa.gov/prof/Statistics/2004Pop/Stterr2004_files/sheet004.asp
http://wonder.cdc.gov/WONDER/help/populations/population-projections/PressTab5.xls
2030
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Nutrition and Health Status of
Older Georgians
• Georgia ranks very low in:
– Physically unhealthy days (38th)
• Number of days during the previous month when older
adults reported their physical health was not good
– No leisure time physical activity (38th)
• Daily activities including walking, gardening, etc.
– Older adults who are eating 5 or more fruits and
vegetables daily (45th)
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Nutrition and Health Status of
Older Georgians (cont.)
• Georgia also ranks low in:
– Complete tooth loss (44th)
• Only addresses total loss, not partial loss or disease
– Percentage of older adults who are obese (38th)
• BMI greater than or equal to 30 kg/m2
– Percent who are up to date on preventative services
(43rd for women and 41st for men)
– Percentage of older adults who have had their
cholesterol checked in the past 5 years (81.2 %, 44th)
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Governor’s Live Healthy
Georgia Campaign
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Key Messages
http://www.livehealthygeorgia.org/
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Get checked
Be smoke free
Be active
Eat healthy
Be positive
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Georgia State Unit on Aging &
Area Agencies on Aging
Promote Healthy Aging
• Meals served: > 30,000 people
• Wellness activities: > 17,000 people
– Nutrition
– Physical activity
– Diabetes self-management
• Goal is to promote independence
– Nursing homes cost > $50,000/yr in GA
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Target Population
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Population in need
Low SES
Many chronic diseases
Poor nutrition
Low physical activity
Captive audience
Peer groups
Infrastructure and facilities
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Live Healthy Georgia – Seniors Taking Charge!
– Seniors Taking Charge of Diabetes! (8 lessons)
– Serving up Fruits, Vegetables and Physical Activity
Everyday! (8 lessons)
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Needs Assessment
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AoA and State funding
Governor’s Long Term Care Initiative
Live Healthy Georgia
Better disease prevention & management More
independence Less LTC  Less costs
What disease(s) to focus on?
Examples in 2005-2006:
– Community Intervention Study
• Diabetes
• Fruits and Vegetables
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Diabetes is Prevalent in Senior Centers
Poor Physical Function
50
40
30
Diabetes
%
• 18% nationally, 1996
• 30% in NE Georgia,
2004-2005 (n = 174)
No Diabetes
20
10
0
SPPB = 5 or less (p=0.12)
Cardiovascular Risk Factors
Nutrition Risk
80
60
Diabetes
% 40
No Diabetes
20
0
Obesity
(p<0.05)
Hypertension
(p<0.10)
Heart
Disease
(p=0.17)
Circulatory
Problems
(p=0.06)
100
80
60
%
40
20
0
Diabetes
No Diabetes
M oderate to
High Risk
(NSI = 3 or
more,
p<0.05)
Illness or
Condition
that
Interferes
with Eating
(p<0.01)
3 or M ore
Prescription
or OTC
M edications
Daily
(p<0.05)
Stephens et al., 2006
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Diabetes Self-Management
Interventions in Senior Centers
• In North Georgia Senior Centers, a DSM
intervention (n = 91) significantly (P < 0.05):
– Increased compliance with healthy eating plan,
spacing carbohydrates, physical activity, testing
blood sugar, and foot care
– Decreased A1c by 1.4% in those with A1c > 8%
• Decreases in A1c mainly associated with
increases in physical activity
Burnett, 2003, Redmond, 2004
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
• Partners:
– Division of Aging Services (Sudha Reddy), Area
Agencies on Aging, University of Georgia, Diabetes
Association of Atlanta, Diabetes Technologies, Inc.,
Public Health, Senior Centers
• Educational objectives:
– Improve knowledge and behaviors related to fruits,
vegetables, physical activity, physical function, and
diabetes self-management
• Intervention sites:
– 40 Georgia senior centers
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
Program materials:
• 16 weeks, 1 lesson per week at senior centers
– 8 lessons “Serving Up Fruits, Vegetables and Physical
Activity Everyday!”
– 8 lessons “Seniors Taking Charge of Diabetes!”
– Reviewed by experts
– Menus, recipes, handouts, games
– All lessons include physical activity
• Step counter
• Walking
• Chair exercises (NIA)
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Topics – Fruits and Vegetables
1.
2.
3.
4.
5.
6.
7.
8.
Serving Up Fruits, Vegetables, and Physical Activity Everyday
Staying Healthy with Fruits, Vegetables, and Physical Activity
Easy Colorful Snacks
Canned and Frozen Fruits and Vegetables
Serve up Healthy Fruits and Vegetables for Breakfast
Loading Up Lunch with Healthy Fruits and Vegetables
Serving Up Healthy Fruits and Vegetables for the Evening Meal
Eating Healthy Fruits and Vegetables Away from Home
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Fruit and
Vegetable
Bingo to Make
Learning Fun
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Topics - Diabetes
1.
2.
3.
4.
5.
6.
7.
8.
Six Daily Do’s for Diabetes
Be Physically Active Everyday
Check Your Feet
Taking Medications and Testing Blood Sugar
Eat Healthy – Plan Your Portions and Plates
Eat Healthy – Meal Timing and Carbohydrate Counting
Eat Healthy – Take Down Fat, Cholesterol, and Sodium
Get Checked for Your A, B, Cs
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Messages
“Six Daily Do’s” Help set Daily Goals for
Diabetes Self-Management
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Diabetes Bingo
to Help
Remember
Diabetes SelfManagement
Skills
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Messages
Fruits and Vegetables
• 7 to 10 a day the color way
• 2 to 3 at every meal – it’s a real healthy deal
• Fruits and vegetables for snacks – keep you
healthy to the max
• Inspiration for messages:
– USDHHS & USDA, Dietary Guidelines for
Americans, 2005
– Wade, 2003
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
• Health Belief Model:
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Susceptibility and severity
Perceived benefits
Perceived barriers
Cues to action
Self-efficacy
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
• Training the educators:
– Diverse backgrounds
– Work with other community partners
– Provided with all materials and available online:
www.livewellagewell.info/study/materials.htm
– Statewide training
– Onsite training
– Technical assistance by phone and email
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
Program implementation:
• 16 weeks, 1 lesson per week at senior centers
• Lessons about 1 hour
– Diabetes self-management and/or nutrition
– Physical activity
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
• Participants:
– 815 enrolled in the “study”
• 240+ with self-reported diabetes
(depends on definition)
• 600+ others
– 1,000+ more not in the “study”
• Design:
– Informed consent, pre-test (60 minutes)
– Intervention (16 lessons x up to 60 minutes)
– Post-test (30 minutes)
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
• Pre- and Post-tests:
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Fruits, vegetables meals and snacks (frequency)
Physical function (Guralnik et al., 1996)
Diabetes self-management (Toobert et al., 2000)
Blood A1c (Diabetes Association of Atlanta)
• Power Analyses:
– n of 136 needed to show 15% change
– n of 25 to 30 with A1c > 8% needed to show that
1% decrease in A1c is statistically significant
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Live Healthy Georgia - Seniors Taking Charge
Statewide Community Intervention
• Barriers and Challenges
– Public health and A1c measures, physician order
• Solved by Diabetes Association of Atlanta
– Diversity in educators
• Address by training and ongoing consultation
• Continued stress on importance of outcome measures
• Very patient and skilled data management specialist
– Diversity in participants
• Address by flexible educational materials
– Physician clearance for physical activity
• Still working on this
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Timeline
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7/04:
1/05:
5/05:
7/05:
8/05:
8-10/05:
10/05:
11-12/05:
01-04/06:
05-06/06:
07-09/06:
Discussions about ‘bigger initiatives”
Serious discussions, proposal writing
Governor signs legislation
IRB submitted (10/05 finalized)
DAS/UGA contracts finalized
Materials development, A1c
Statewide training
Pre-tests
Intervention
Post-tests
Data analysis and report writing
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Results
Figure 1. High Prevalence of Chronic Health Problems in Older Adults in
Georgia's Wellness Programs
80
74
71
High blood
pressure
Arthritis
60
41
% 40
25
45
30
20
0
Poor physical Heart disease
function
At risk for
diabetes
Diabetes
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Results
Figure 2. Poor Diabetes Control Shows Need for More Diabetes
Self-management Skills
Prevalence (%)
40
30
30
23
18
20
10
0
A1c: 7% to <8%
(poor)
A1c: 8% or more
(very poor)
Blood sugar: 180 or
higher (poor)
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Results
Figure 3. Community Intervention Improves Diabetes
Self-management Shown
by Decreasing A1c
0
-0.27
-0.5
A1c
Decrease
%
-1
-1.12
-1.5
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Results
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Results
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“Thank you for the time you’ve spent with us. The sessions
have helped me to focus more on what I need to improve on – not
only for my weight, but also for my diabetes.”
Senior Center Participant
“The people with diabetes really enjoyed the lessons. It was
general in a sense, but they soon realized that they didn’t know as
much as they should about managing diabetes. It really helped
them. Also, everyone loved the fruit and vegetable Bingo game.”
AAA Wellness Coordinator
“This program has helped me move without pain. I am
exercising more and eating healthier. I am not on a bunch of
medications. I am thankful for my family and I take life one day at a
time. I recently found out I have diabetes and these lessons have
helped so much.”
Senior Center Participant
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Results
Figure 5. Nutrition, Physical Activity, and
Physical Function Need Improvement in
Older Adults in Georgia's Wellness
Programs
40
30
28
31
25
% 20
10
0
5 or more
fruits and
vegetables
daily
Active 7 days Poor physical
per week
function
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Results
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Results
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“I think the consistency of the lessons from week to week kept
the participants motivated and interested. The format of the
lessons, along with the handouts made it easy for the educators
to present the lessons with little preparation time."
AAA Wellness Coordinator
“I participated in the Live Healthy Georgia - Seniors Taking
Charge study and lost 8 pounds and am down 2 clothing sizes.
Stay active - don't sit down with folded hands. Be on the move!”
Senior Center Participant
“The Center has helped me to become more healthy. I take
vitamins and eat well. My doctor is proud of how well I take
care of myself.”
Senior Center Participant
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Website for Live Healthy GeorgiaSeniors Taking Charge!
www.livewellagewell.info
Goals:
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Promote healthy aging and healthy living
Authoritative source of information to age well and live
well
Practical information to promote healthy aging
Target Audience:
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Consumers: Georgians age 50+
Families and caretakers/caregivers
Health professionals who work with older adults
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Website for Live Healthy GeorgiaSeniors Taking Charge!
www.livewellagewell.info
Partners:
• Division of Aging Services
• University of Georgia
Benefits:
• Translates “Live Healthy Georgia” messages
for older adults and their families
• Provides information on healthy living, disease
risk management, and links to community
resources
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Website for Live Healthy GeorgiaSeniors Taking Charge!
www.livewellagewell.info
Diseases and health conditions targeted:
• Alzheimer’s Disease and other dementias
• Arthritis
• Cancer
• Diabetes
• Heart disease
• Mental health and depression
• Obesity
• Osteoporosis
• Stroke
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Website for Live Healthy GeorgiaSeniors Taking Charge!
www.livewellagewell.info
Healthy Living:
• Age Well
• Food Safety
• Dietary Supplements
• Medications
• Eat Healthy
• Be Active
• Get Checked
• Be Smoke Free
• Be Positive
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Results
Figure 6. Website Usage Summary
3500
3000
2500
Unique visitors
2000
Number of unique visits
1500
Pages visited
1000
500
0
Jan Feb Mar Apr May Jun
Jul Aug
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Summary
• Georgia is aging!
• Dietary Guidelines challenging to meet
• Community Intervention
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Diabetes self-management
Fruits, vegetables
Physical activity, step counters
Challenges
Results show program benefits participants
www.livewellagewell.info/study/materials.htm
• Website: www.livewellagewell.info
– Reinforce healthy living messages for those 50+ and their families
and caregivers
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