1 live healthy georgia, seniors taking charge!!! statewide community intervention 2006
TRANSCRIPT
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National Aging Trends
• In 2003
– 35.9 million older adults
– 12.4 % of the population
• By 2030
– 75.1 million older adults
– 20% of population
Population of Older Adults in the US
0
20
40
60
80
2003 2030
Year
Mil
lion
s
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
http://www.aoa.gov/prof/Statistics/2004Pop/Stterr2004_files/sheet004.asp
http://wonder.cdc.gov/WONDER/help/populations/population-projections/PressTab5.xls
Older Adult Population Estimates in Georgia
0
100
200
300
400
500
600
50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age Range
Tho
usan
ds
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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
02468
1012141618
2004 2030
%
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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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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Key Messageshttp://www.livehealthygeorgia.org/• Get checked
• Be smoke free
• Be active
• Eat healthy
• Be positive
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Georgia State Unit on Aging & Area Agencies on AgingPromote 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
• 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• 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
• 18% nationally, 1996
• 30% in NE Georgia, 2004-2005 (n = 174)
Cardiovascular Risk Factors
0
20
40
60
80
Obesity(p<0.05)
Hypertension(p<0.10)
HeartDisease
(p=0.17)
CirculatoryProblems(p=0.06)
%Diabetes
No Diabetes
Poor Physical Function
0
10
20
30
40
50
SPPB = 5 or less (p=0.12)
%
Diabetes
No Diabetes
Nutrition Risk
020406080
100
Moderate toHigh Risk (NSI = 3 or
more,p<0.05)
Illness orCondition
thatInterferes
with Eating(p<0.01)
3 or MorePrescription
or OTCMedications
Daily(p<0.05)
%Diabetes
No Diabetes
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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• 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
Live Healthy Georgia - Seniors Taking ChargeStatewide Community Intervention
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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)
Live Healthy Georgia - Seniors Taking ChargeStatewide Community Intervention
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Topics – Fruits and Vegetables
1. Serving Up Fruits, Vegetables, and Physical Activity Everyday2. Staying Healthy with Fruits, Vegetables, and Physical Activity3. Easy Colorful Snacks4. Canned and Frozen Fruits and Vegetables5. Serve up Healthy Fruits and Vegetables for Breakfast 6. Loading Up Lunch with Healthy Fruits and Vegetables7. Serving Up Healthy Fruits and Vegetables for the Evening
Meal8. Eating Healthy Fruits and Vegetables Away from Home
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Topics - Diabetes
1. Six Daily Do’s for Diabetes2. Be Physically Active Everyday3. Check Your Feet4. Taking Medications and Testing Blood Sugar5. Eat Healthy – Plan Your Portions and Plates6. Eat Healthy – Meal Timing and Carbohydrate Counting7. Eat Healthy – Take Down Fat, Cholesterol, and Sodium8. Get Checked for Your A, B, Cs
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MessagesFruits 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 ChargeStatewide Community Intervention
• Health Belief Model:– Susceptibility and severity – Perceived benefits – Perceived barriers – Cues to action – Self-efficacy
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Live Healthy Georgia - Seniors Taking ChargeStatewide 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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Program implementation:• 16 weeks, 1 lesson per week at senior centers• Lessons about 1 hour
– Diabetes self-management and/or nutrition– Physical activity
Live Healthy Georgia - Seniors Taking ChargeStatewide Community Intervention
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• 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)
Live Healthy Georgia - Seniors Taking ChargeStatewide Community Intervention
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• Pre- and Post-tests: – 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
Live Healthy Georgia - Seniors Taking ChargeStatewide Community Intervention
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• 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
Live Healthy Georgia - Seniors Taking ChargeStatewide Community Intervention
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Timeline• 7/04: Discussions about ‘bigger initiatives”• 1/05: Serious discussions, proposal writing• 5/05: Governor signs legislation• 7/05: IRB submitted (10/05 finalized)• 8/05: DAS/UGA contracts finalized• 8-10/05: Materials development, A1c• 10/05: Statewide training• 11-12/05: Pre-tests• 01-04/06: Intervention• 05-06/06: Post-tests• 07-09/06: Data analysis and report writing
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ResultsFigure 1. High Prevalence of Chronic Health Problems in Older Adults in
Georgia's Wellness Programs
2530
41 45
74 71
0
20
40
60
80
Poor physicalfunction
Heart disease At risk fordiabetes
Diabetes High bloodpressure
Arthritis
%
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ResultsFigure 2. Poor Diabetes Control Shows Need for More Diabetes
Self-management Skills
2318
30
0
10
20
30
40
A1c: 7% to <8% (poor)
A1c: 8% or more (very poor)
Blood sugar: 180 orhigher (poor)
Pre
vale
nce
(%)
35
“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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ResultsFigure 5. Nutrition, Physical Activity, and Physical Function Need Improvement in
Older Adults in Georgia's Wellness Programs
2831
25
0
10
20
30
40
5 or morefruits andvegetables
daily
Active 7 daysper week
Poor physicalfunction
%
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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 Georgia- Seniors Taking Charge! www.livewellagewell.info
Goals:• Promote healthy aging and healthy living• Authoritative source of information to age well and live
well • Practical information to promote healthy aging
Target Audience:• Consumers: Georgians age 50+• Families and caretakers/caregivers• Health professionals who work with older adults
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Website for Live Healthy Georgia- Seniors 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 Georgia- Seniors 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 Georgia- Seniors 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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ResultsFigure 6. Website Usage Summary
0
500
1000
1500
2000
2500
3000
3500
Jan Feb Mar Apr May Jun Jul Aug
Unique visitors
Number of unique visits
Pages visited
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Summary• Georgia is aging!• Dietary Guidelines challenging to meet• Community Intervention
– 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