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

Organised by: Co-Sponsored: Malaysian Healthy Ageing Society

Health Promotion Programs in Hawaii Kathryn L. Braun, DrPH University of Hawaii kbraun@hawaii.edu

Active Aging Consortium Asia Pacific (ACAP) Mongolia Canada S. Korea USA Nepal Japan China Hong Kong Hawaii Malaysia Indonesia Singapore Australia

ACAP Mission Benefits • To provide a forum in • No dues! (no staff) Asia Pacific for the • Website. sharing of • Listserve – Research • Conferences and – Policy ideas conference participation – Best practices for Active Aging • Conferences • Exchange

Good news: Life expectancy in Hawaii is increasing. 85 Hawaii U.S. 80 79 80 78 74 77 75 75 72 74 70 Life 70 71 70 expectancy 68 63 65 in years 60 62 60 54 55 50 54 50 45 46 44 40 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Source: Hawaii Health Information Corporation. Health Trends in Hawaii .

Bad News: Prevalence of diabetes, HTN, & unhealthy weight are increasing, too. 11% - 18% 1995-6 2006-7 Diabetes 38%-59% Hypertension 32%-48% Overweight 0 10 20 30 40 50 60 Source: Hawaii` DOH. Behavioral Risk Factor Surveillance System., age 65+ 1995-2007.

Disability delayed 7 years in people who have good BMI, exercise, and don’t smoke (Vita et al, NEJM, 1998) High-risk elders are disabled at younger ages 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.

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 older 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 of 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 • Educational style – Led by 2 trained leaders – Once a week for 6 weeks – Based in motivational • Session interviewing – Short lecture – Feedback/ Problem solving • Brainstorming • Building self-efficacy • Group support – Action planning – Closing

Every week, participants must develop an “action plan.” By next week, I will buy • Something YOU want to do walking shoes. • Reasonable and behavior-specific By next week, I will walk around the block with • High confidence that you can do it my friend after dinner • Buddy system for support and one night. problem- solving 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

Balance Cardio Flexibility Strengthening

HHAP Partnership – 64 Organizations 2003 2004 2005 2006 2007-2008 2009- present Preparation Training & support Implement Expand & & strategic of pilot projects & Sustain: • Enhance planning grant writing • Enhance Fitness Fitness • CDSMP • CDSMP Secure funding

Our Partners and Their Roles Our Program Partners and Their Roles Implementation Partner Coordination Recruitment/ Eval. & Support Advertising 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 60% 80 53% 78 48% 50% 43% 43% 75 39% 40% 32% 30% 70 29% 30% 70 26% 25% 25% 24% 18% 20% 65 8% 10% 60 0% age 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) 180 4 3.5 Before 160 3 6-month 140 3 2.5 120 2 100 2 80 1.5 60 1 40 1 0.5 20 0 0 0 strengh aerobic Physician ER Hospital pain fatique ShrtB ex ex Minutes per week Scored 1-10; a higher score is worse Times in the past 6-month

EF: Pre-Post Results 14 12 10 8 Pre 6 Post 4 2 0 Chair Stand (reps) Arm Curl (reps) Up-and-Go (sec) N=256 (K&BI)

EF: Pre-Post Results 0.2 4 0.18 3.5 # of days/wk spent in ex for at 0.16 3 0.14 2.5 0.12 least 30 min or more Pre 0.1 2 Post 0.08 1.5 0.06 1 0.04 0.02 0.5 0 0 Falls Exercise 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 on 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.