Thomas R. Prohaska March 8, 2011

1. Centers for Disease Control and PreventionHealthy Aging Research Network Semi-Annual MeetingInternational Classification of Functioning, Disability and Health Thomas R. Prohaska March 8, 2011

2. Objectives • Brief history of HAN from physical activity to mobility interest group • Present examples Mobility Workgroup: Easter Seals Project on Non-Emergency Medical Transportation and JAR Special Issue on Mobility • Promoting science • Leveraging resources • Building capacity • Present International Classification of Functioning, Disability and Health in the context of mobility disability

3. Physical Activity to Mobility • 2001 HAN formed, physical activity first topic of focus • 2004 NCOA National Best Practice • 2004-5 Characteristics of PA programs for older adults Results of Multi-site survey • 2004 HAN Audit tool development • 2005 HAN walking study • 2006 Position Paper on PA Public Health and Aging • 2007 HAN Physical Activity Conference • 2009 Promoting Environment and Policy Change to Support Healthy Aging • 2010 HAN presentation and focus on Mobility

4. National Center on Senior TransportationEaster Seals Project Action Non-Emergency Medical Transportation Assessing the Interaction between Health and Transportation Access

5. Background • Ability to access health is important to maintaining the health and well-being of older adults • Lack of access to nonemergency medical transportation (NEMT) is a critical barrier to the management of chronic illness and disabilities. • Findings from the National Health Interview Survey noted that approximately 3.6 million adults living in the community fail to obtain health care due to a lack of transportation and that these individuals are more likely to be older, minority, and female.

6. Background • These individuals are also more likely to report multiple medical conditions and related mobility disability. • These impairments can include lower extremity, sensory, neurological, cognitive, and mental health impairments that make it difficult for older adults to perform activities involved in successful transportation to medical appointments. • Research is needed to understand the role of transportation on the health and well being of older adults, especially in the context of improving access to non-emergency medical care.

7. To determine the role of transportation in obtaining access to non-emergency medical care. To examine the role of transportation access on health and health care use of community residing older adults. Objectives

8. National Center on Senior Transportation Easter Seals Project Action American Medical Association LogistiCare Centers for Disease Control Health Aging research Network (CDC-HAN) Partners

9. CDC HAN Partners • University of Illinois at Chicago • Thomas Prohaska, Sue Hughes, Chaya Cary • University of California Berkeley • William Satariano, David Ragland, Kara MacLeod • Texas A & M University • Marcia Ory, Matthew Smith

10. Interview principle stakeholders to gain an understanding of their efforts to date. Implement and document a literature review Review and assess the provided (LogistiCare) database to address proposed objectives Proposed Activities

11. Guideline Question for Analyses • What types of clients/patients use what types and levels of transportation services for non-emergency medical services? • What are the documented benefits of access (and consequences of non-access) to NEMT ?

12. Next Steps • Continue to conduct literature review and annotations • Engage CDC-HAN group in manuscript development • Convene advisory committee to provide direction and review • Working with partners, AMA, Easter Seals, continue to develop proposed analyses of LogistiCare data and incorporate National Death Index data into analyses • Pilot analyses • Complete all proposed project activities • Disseminate findings into research practice and policy applications

13. Journal of Aging Research: Special Issue: Mobility and Aging: Transference to Transportation • Call for manuscripts, original research and review articles that advances understanding on how to prevent or minimize the impact of mobility loss in older populations • Emphasized WHO’ International Classification of Functioning, Disability and Health (ICF) • “We invite manuscripts that approach mobility at any ecological level from the individual to policy as well as those ranging from basic science application to community practice.”

14. HAN Guest EditorsMobility and Aging: Transference to Transportation • University of Illinois Chicago Thomas Prohaska, Susan Hughes • University of Washington Basia Belza • University of South Carolina Steven Hooker • Centers for Disease Control and Prevention Healthy Aging Program Lynda Anderson

15. Status of Special Issue • Over 20 manuscripts were received • Reviews are in progress • Elicitation of manuscripts has closed • Editorial by editors on ICF

16. International Classification of Functioning, Disability and Health ICF • “ICF” is framework for health and disability and the domains influencing functioning, disability and health • Multipurpose classification of health (rather than just illness) and health related domains • Biopsychosocial model in that it integrates biological individual and social perspectives • Disability and functioning are viewed as outcomes of Health conditions and contextual factors

17. International Classification of Functioning, Disability and Health ICF • “ICF” is framework for health and disability and the domains influencing functioning, disability and health • Multipurpose classification of health (rather than just illness) and health related domains • Biopsychosocial model in that it integrates biological individual and social perspectives • Disability and functioning are viewed as outcomes of Health conditions and contextual factors

18. ICF Compatible with HAN Perspective to Healthy Aging Healthy aging is the development and maintenance of optimal physical, mental and social well-being and function in older adults. It is most easily achieved when physical environments and communities are safe and support the adoption and maintenance of attitudes and behaviors known to promote health and well-being; and by the effective use of health services and community programs to prevent or minimize the impact of acute and chronic disease on function.

20. ICF Performance and Capacity • Distinction between Performance and Capacity • Performance functioning in current environment • Capacity functioning at highest provable level • Distinction seems to be between what is observed and what is possible given their state of health. • Example- ADL assessment of ability • 1. Without informal care assistance or assistive devices (disability) and • 2. With care assistance and devices. 1=functional status, 2= disability

21. ICF Performance and Capacity • Distinction between Performance and Capacity • Performance functioning in current environment • Capacity functioning at highest provable level • Distinction seems to be between what is observed and what is possible given their state of health. • Example- ADL assessment of ability 1. without informal care assistance or assistive devices (disability) and 2. with care assistance and devices. 1=functional status, 2= disability

22. ICF and HAN Mobility • Easter Seals Transportation Project • With NEMT as the primary activity/participation, project examines environmental and personal factors and health conditions • Potential to influence policy, practice and research • JAR Special Issue on Mobility • JAR editorial opportunity to set the stage for promoting broadly defined measures of mobility in the context of ICF • EPC Environmental & Policy Change • EPC website and modules promote optimal environments and maximizing resources for healthy aging including mobility

23. Possible Next Steps ICF and HAN Mobility • Map HAN activities related to mobility to identify strengths and weaknesses of strategies to data and how they fit in the ICF framework • Determine the utility of mobility related projects in terms of informing: policy development, research, public health practice • Consider the linkages between ICF and the HAN Logic Model