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Healthy Eating for Successful Living in Older AdultsTM

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Title: Healthy Eating for Successful Living in Older AdultsTM


1
Healthy Eating for Successful Living in Older
AdultsTM
  • NCOA Model Programs Project Boston Team
  • National Council on Aging/American Society on
    Aging Joint conference
  • Mar 15, 2006
  • Anaheim California

2
NCOA Model Programs Project
  • Developed, tested and disseminated four
    evidence-based model health programs
  • Models designed to improve health of older adults
    and be readily implemented by community-based
    aging services organizations
  • Utilized regional advisory panels
  • Four model programs
  • Physical Activity-Los Angeles, CA
  • Depression-Houston, TX
  • Diabetes Self Management-Portland, OR
  • Nutrition-Boston, MA

3
Key Concepts Incorporated into the Model Program
Design
  • Linkages among community agencies and primary
    health care and/or mental health providers
  • Evidence-based effective approaches to behavior
    change included
  • Promoting older adults central role in managing
    his/her health
  • Recognizing the importance of promotion and
    prevention

4
Key Concepts Incorporated into the Model Program
Design
  • Evidence-based effective approaches to behavior
    change included
  • Providing older adult with the skills of goal
    setting, action planning and problem solving
  • Providing ample opportunity to practice these new
    behaviors
  • Encouraging peer support
  • Talking about health promotion, not illness and
    disability

5
Advantages of Evidence-based Approach
  • Increases likelihood of successful outcomes when
    agencies move away from decision-making that
    relies too heavily on history, anecdotes and
    pressure from policy makers
  • Enhances the ability to use common health
    indicators and match health programs to needs
  • Makes it easier to defend or expand an existing
    program
  • Provides hard data to advocate for new programs
  • Generates new knowledge about what works and
    how to do it that can help others

6
The Nutritional Model Program Healthy Eating
for Successful Living in Older Adults
7
The Team
  • Joseph Carlin MS,MA,RD, FADA
  • Regional Nutrition Specialist, Administration on
    Aging
  • Shirley Chao MS, RD, LD/N
  • Director of Nutritional Services,
  • MA Executive Office of Elder Affairs
  • Rosanne DiStefano, MUA
  • Executive Director
  • Elder Services of Merrimack Valley
  • Marta Frank MS
  • Executive Director,
  • Boston Home Care
  • Ruth Palombo PhD, RD
  • Assistant Professor of Public Health and Family
    Medicine
  • Tufts University
  • Margie Doyle MBA
  • Program Director, Lahey Clinic
  • Chris Economos PhD
  • Jean Mayer USDA Human Nutrition
  • Tufts University
  • Robert Schreiber, MD
  • Team Leader

8
Why Nutrition Chosen?
  • It is critically important in aging population
  • Epidemic of arteriosclerosis vascular disease,
    diabetes and osteoporosis
  • There is clear evidence documenting the
    effectiveness of sound nutritional strategies in
    preventing progression or prevention of disease
    in diabetes, hypertension, CAD, cancer

9
Essential Elements for Successful Behavior Change
  • Goal Setting
  • Problem Solving
  • Action-planning
  • On-going support
  • Monitoring

10
Goals of Healthy Eating for Successful Living
  • Designed to increase knowledge about enhancing
    heart and bone health through healthy diet
    choices and physical activity
  • Adapt to culturally diverse populations
  • Foster improvement in nutrition life-style to all
    seniors through peer-led behavioral change
  • Participants learn how to set reasonable goals
    and solve problems related to common nutrition
    self-management issues, what community resources
    are available and how to use them

11
The Nutrition Program
  • Six sessions meet weekly for 21/2 hours
  • A restaurant outing to test knowledge and skills
    is included as a seventh session
  • Focus on heart and bone health
  • Peer leaders are trained to facilitate using
    scripted curriculum
  • Registered Dietitian/ Nutritionist serves as a
    resource
  • Classes are small 8-12 facilitating active group
    participation

12
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13
Main Components of the Program
  • Self-assessment and management of dietary
    patterns by each participant
  • Goal setting, problem solving, and group support
  • Education, relying on both group interaction and
    the expertise of a Registered Dietitian/Nutritioni
    st, when needed
  • Behavior change strategies

14
Target Populations
  • Over age 60 cognitively intact
  • Mobile, ability to attend programs
  • Held in community based site
  • Senior or community centers, congregate housing,
    religious centers and community dining center.
  • Need to have access to food or have someone who
    will be able to provide food

15
Framework of the Intervention
  • Uses My Pyramid as the central framework to help
    participants create a nutritional lifestyle that
    meets individual needs
  • Sessions are highly participatory with distinct
    components
  • Education
  • Hands-on activities
  • Support
  • Resource connections

16
Outline of the Sessions
  • Week 1 My Pyramid, Dietary Guidelines,
    Water and Exercise
  • Week 2 Grains, Fruits, Vegetables and Water
  • Week 3 Meat , Eggs, Legumes, Milk and Exercise
  • Week 4 Milk, Sweets, Fats, and Exercise
  • Week 5 Label Reading and Grocery Shopping
  • Week 6 Putting It all Together
  • Meal preparation or cooking
    demonstration
  • Week 7 Restaurant Dining

17
Peer Leader Role
  • Not experts in nutrition or health
  • Participate in two days of training to learn how
    to use a detailed script, behavioral change and
    group dynamic strategies to guide the process
  • Play a key role in some of the hands-on activities

18
Nutritionist Role
  • Serves as a consultant to the peer leaders and to
    the participants
  • Participates in the program sessions as needed to
    help with patient information needs

19
Community Nutrition Sites
  • Kit Clark Senior Services Boston 46
    participants
  • Vietnamese (17), Cape Verdean (14)
  •  Montachusett Opportunity Council Fitchburg
  • 37 participants
  • Hispanic (6)
  • Andover Senior Center Andover
  • 57 participants
  • Mostly Caucasian

20
Diverse Populations Adaptations
  • Peer Leaders of same culture for the groups
  • Challenges
  • Translating Information
  • Adapting food choices for ethnic preferences
  • Journaling
  • Literacy

21
Measurement Tool
  • Participant satisfaction survey after each
    session
  • Brief final survey of participant self-reported
    changes in achieving personal goals and changes
    in eating habits
  • Change in knowledge, cooking and shopping
    behaviors, dietary intake

22
Findings
  • Distinctly different dietary habits in accordance
    with ethnic backgrounds and demographics
  • Issues in Vietnamese and Cape Verdean ability to
    use participant manuals
  • Participants empowered and able to apply new new
    knowledge and skills
  • Program was well-received by participants from
    diverse cultural backgrounds

23
Reunion Data 1 Year Follow-upAndover
  • 56 out of 57 participants attended the reunion
  • Reading labels (almost everyone)
  • Watching portion size
  • Increased fluid intake
  • Decreased fats and sugars
  • More whole grains, fiber, fruit and vegetables
  • Increased self awareness of intake

24
Proposed Changes
  • Conduct monthly follow up support groups
  • Develop new modules for follow-up sessions
  • Streamline survey tools and record keeping
  • Provide information on calories
  • Enhance physical activity component
  • Translate model program into Spanish for expanded
    dissemination

25
Next Steps
  • Expand evaluation for include outcome measures
  • Work with Executive Office of Elder Affairs to
    identify additional sites, e.g. HUD housing
    sites, SCOs, and train personnel to implement
    program
  • Conduct additional trainings for interested new
    Massachusetts sites
  • Orchard Cove
  • Burlington and Wilmington Senior Centers
  • Pepperhill and Shirley Senior Centers
  • Elder Services of Merrimack Valley

26
Next Steps
  • Secure funding for testing model using a proposal
    with outcome measures
  • HSL Center effort involving Adrienne Rosenberg,
    Sue Nonemaker, Richard Jones, Rob Schreiber,
    Philanthropy
  • Translating Model into Spanish with opportunity
    to disseminate in Latin America (El Salvador)
    through PAO
  • Collage Consortium

27
For more information, please contact Anne-Reet
Ilves Annunziata, PhD RD LDN Project
Director Healthy Eating Program annereet_at_yahoo.com
Shirley Chao, MS RD LDN Director of
Nutrition Massachusetts Executive Office of Elder
Affairs 617-222-7469 Shirley.chao_at_state.ma.us
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