1 live healthy georgia, seniors taking charge!!! statewide community intervention 2006

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Live Healthy Georgia, Seniors Taking Charge!!!

Statewide Community Intervention

2006

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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



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

%



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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 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)


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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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Fruit and Vegetable

Bingo to Make Learning Fun

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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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Messages“Six Daily Do’s” Help set Daily Goals for

Diabetes Self-Management

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Diabetes Bingo to Help

Remember Diabetes Self-Management

Skills

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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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• Health Belief Model:– Susceptibility and severity – Perceived benefits – Perceived barriers – Cues to action – Self-efficacy

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• 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


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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)


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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


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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


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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

(%)

32

Results

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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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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

%

37

Results

38

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 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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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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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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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

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500

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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

1 live healthy georgia, seniors taking charge!!! statewide community intervention 2006

Documents

th slide

ga slide

vegetables slide

positive slide

population http

live healthy georgia

ne georgia

state aging trends http