Healthy Eating for Successful Living in Older Adults TM

1. �Healthy Eating for Successful Living in Older Adults�TM 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 adult�s 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 The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation. The workshop is conducted over six sessions, meeting weekly for two and one half-hours per session. A restaurant outing to test knowledge and skills is included as a seventh session. Peer leaders are trained to facilitate the weekly meetings using a scripted curriculum. A Registered Dietitian/Nutritionist serves as a resource to both peer leaders and participants to answer specific nutrition questions as needed. Classes are small in number; maintaining the enrollment between 8 and 12 per workshop facilitates active group participation.

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/Nutritionist, 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 Week #1 Food Guide Pyramid, Dietary Guidelines, Water, and Exercise Week #2 Grains, Fruits, Vegetables, and Exercise 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 Month later Healthy Eating Luncheon Week #1 Food Guide Pyramid, Dietary Guidelines, Water, and Exercise Week #2 Grains, Fruits, Vegetables, and Exercise 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 Month later Healthy Eating Luncheon

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