Health, Prevention, and Wellness Program
The Purpose of the Program
Older Americans are disproportionately affected by chronic diseases and conditions, such as arthritis, diabetes and heart disease, as well as by disabilities that result from injuries such as falls. More than one-third of adults 65 or older fall each year. Twenty-one percent of the population age 60 and older – 10.3 million people – have diabetes. Seven of every 10 Americans who die each year, or more than 1.7 million people, die of a chronic disease. The need for programs that enable older adults to learn and practice healthy behaviors is critical.
Through collaboration with Health and Human Services Agencies, the National Council on Aging (NCOA), and philanthropic organizations, AoA has created national partnerships that have addressed the need for community-based health, prevention, and wellness programs. These evidence-based programs have been proven to increase self-efficacy, decrease health service utilization, and enable participants to adopt healthy self-management behaviors. The Administration on Aging’s Health, Prevention, and Wellness Program:
- Focuses on the utilization of evidence-based self-management programs;
- Implements and maintains self-management classes within the comfort of participants’ community, using traditional non-clinical settings such as Area Agencies on Aging or senior centers; and
- Enables participants to modify existing health self-management behaviors through group interaction and reinforcement.
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Evidence-Based Disease and Disability Prevention Program
The primary goals of the Evidence-Based Disease and Disability Prevention Program are to: a) empower older persons to adopt healthy behaviors, improve health status, and manage chronic conditions better, and b) enable aging networks to have the capacity to deliver evidence-based programs. Additional information can be found on Evidence-Based Prevention Program Fact Sheet
During 2006-2007, AoA initiated its state-based EBDDP grant program. Through both public and private partnerships, 27 states have deployed evidence-based interventions whose primary focus is to help enable adults to maintain their health, wellness, and independence.
AoA has required each state to implement the Stanford University Chronic Disease Self-Management Program (CDSMP). In addition, each state participating in this grant program was required to select and implement one or more other evidence-based programs in the following subject areas:
- Physical Activity - Programs such as Enhance Wellness, Tai Chai or Healthy Moves, which emphasize low-impact aerobic activity, minimal strength training and stretching;
- Fall Prevention - Programs such as Matter of Balance and Stepping On, which emphasize strength training and behavioral modification to help prevent falls and the fear of falling;
- Nutrition and Diet – Programs such as Healthy Eating, which teach older adults the value of eating healthy foods, as well as maintaining an active lifestyle; and
- Depression and/or Substance Abuse – PEARLS or Healthy IDEAS, which involve the screening and referral of older adults who are currently experiencing or at risk of depression.
AoA has funded NCOA to assist the Aging Services Network, federal partners and philanthropic funders in the implementation of self-management programs, as well as to help to ensure their fidelity to the original interventions. In addition, AHRQ and other national partners are planning substantial training efforts to strengthen the capacity of both public and private sector organizations to accelerate the development and implementation of evidence-based prevention programs for older adults.
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Hispanic Elders Project
In 2007, AHRQ, AoA, CDC, CMS, and HRSA created the Hispanic Elders Project. The metropolitan areas of Chicago, Ill., Houston, Texas; Los Angeles, Calif., McAllen, Texas; Miami, Fla.; New York, NY; San Antonio, Texas; and San Diego, Calif., were selected to take part in a pilot project launched to help communities work together to develop coordinated strategies for improving Hispanic elders' access to important benefits, including the new Medicare prescription drug and prevention benefits as well as low-cost evidence-based prevention programs, such as Stanford University’s Chronic Disease Self-Management Program.
Each community team has developed and implemented a plan for addressing one or more health disparities. Many of the communities have identified diabetes as a primary issue of concern for their population. Hispanic elders have a higher incidence of certain chronic diseases such as diabetes, heart disease and arthritis, than the rest of the U.S. population. Twenty-one percent of Hispanic elders have diabetes compared to 14.3% of non-Hispanic whites. Hispanic elders are much more likely to be hospitalized for diabetes due to poor diabetes control, and they are far less likely to receive pneumonia or flu shots or participate in cancer screening services.
This initiative is based on findings from the National Healthcare Disparities Report 2006 prepared by AHRQ. This report finds that persistent and growing health disparities exist among Hispanic/Latino elders compared to the majority, non-Hispanic white older adult population.
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Diabetes Self Management Training Initiative
There exists an increasingly critical need to provide Diabetes Self-Management Training (DSMT) to older adults. On a national level, 18% of all Medicare beneficiaries, or approximately 7 million older adults have diabetes. These individuals account for nearly 32% of all Medicare expenditures. Additionally, of the 200,000 individuals who enroll in Medicare each month, 40,000 have diabetes. As only approximately 3200 sites exist nationally which provide an American Diabetes Association (ADA) or American Association of Diabetes Educators (AADE) recognized DSMT program, it is obvious that in this instance, supply does not equal demand.
In partnership with the ADA, AADE, and Stanford University’s Patient Education Research Center, the Administration on Aging is working to implement Stanford’s DSMT Program in 14 community-based settings in an effort to provide outreach, education, and treatment to minority older adults who have been diagnosed with diabetes. While enabling Medicare beneficiaries to access their Medicare Part B prevention benefits, this collaborative will work to significantly reduce utilization outcomes among older adults engaged in the Stanford DSMT Program, while improving specific clinical measures associated with diabetes within targeted elder Hispanic and African American communities.
Community-based, peer-led DSMT programs have the opportunity to positively affect the lives of millions of Medicare beneficiaries who would normally lack access to such programs, or may feel uncomfortable participating in programs which take place within clinical environments. Through increasing access to DSMT programs by using existing Medicare benefits, millions of elderly will learn and adopt essential diabetes self-management techniques which will improve their lives.
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Resources and Useful Links
The documents below provide additional background information on the EBDDPP.
There are a number of specific programs that AoA and its partners identified as meeting their criteria of being evidence-based and suitable for older adults. The following programs have training materials, tool kits and/or manuals readily available and have been successfully replicated by the aging network.
- Stanford University Chronic Disease Self-Management Program
- Enhance Wellness
- Active Choices
- Enhance Fitness
- Matter of Balance
- Strong for Life
- Healthy IDEAS:
Additional programs, presentations and data, as well as other references regarding states and sites that have successfully implemented EBDDPP can be found on NCOA’s website, at http://www.healthyagingprograms.org/
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