Community Resources for the elderly population of Greenville, North Carolina .

1. Community Resources for the elderly population of Greenville, North Carolina. Presented to Vidant Medical Center Physical Therapy Staff June 14th, 2013 Allison Rowe, SPT

2. Objectives • Learning objectives: • Following this in-service the learner will be able to describe the population of Greenville and will demonstrate an understanding of the relationship between an underserved population and their potential to not have access to various community resources. • Following this in-service the learner will be able to describe various community resources in the Greenville area. • Following this in-service the learner will demonstrate an understanding of the evidence that is available supporting community resources. • Following this in-service the learner will understand health literacy and it’s importance when providing resources to patients.

3. Overview • Population of Greenville, NC • Community resources for this population • Do these resources even work? • Tips for providing resources to our patients

4. Greenville, NC5

5. “It takes a village to age successfully”3 • National resources • Provide the structure for programming • State resources • Provide the funding • Community Resources • Provide the space and services • Providers • Deliver the programs

6. Community Resources • Mid-East Commission Area Agency on Aging (AAA) • Pitt County Council on Aging • Pitt County Community Schools and Recreation • Greenville Parks & Recreation • REAL Crisis Intervention, Inc. and Collaborators • Vidant Wellness Center • Transportation services • Pitt County Department of Social Services • Etc., etc., etc...

7. Community Resources • Mid-East Commission Area Agency on Aging (AAA) • Pitt County Council on Aging • Pitt County Community Schools and Recreation • Greenville Parks & Recreation • REAL Crisis Intervention, Inc. and Collaborators • Vidant Wellness Center • Transportation services • Pitt County Department of Social Services • Etc., etc., etc...

8. Area Agencies on Aging (AAA)3 • State Resource • First resource in the area to understand what options are there for your patients • Provides advocacy, planning, program and resource development, information brokerage, fund administration and quality assurance

9. AAA Regions: North Carolina3 http://www.ncdhhs.gov/aging/aaa.htm

10. Mid-East Commission Area Agency on Aging (AAA)6 • Serves Beaufort, Bertie, Hertford, Martin and Pitt counties to address the needs of their communities for senior and disabled populations to successfully age with choices in community based services and resources.

11. Mid-East Commission Area Agency on Aging (AAA)6 • Adult services fundable through grants: • Adult day care • Adult day health care • Care management • Congregate Nutrition • Group respite • Health Promotions & Disease prevention • Health Screenings • Home delivered meals • Skilled home (health) care • Housing and home improvement • Information and case assistance • In-home aide • Institutional respite care • Mental Health counseling • Senior companion • Senior Center operations • Transportation

12. Mid-East Commission Area Agency on Aging (AAA)6 • Long Term Care Ombudsman • Advocate for residents when their legal rights have been violated • Project C.A.R.E. • Caregiver Alternatives to Running on Empty • Caregiver Support • Family Caregiver Support Program (FCSP)

13. Mid-East Commission Area Agency on Aging (AAA)6 • Elder Abuse • What it is, warning signs, what to do and who to contact • Health Promotions • Chronic Disease Self Management Program • A Matter of Balance: Managing Concerns about Falls • Diabetes Self Management • Arthritis Foundation Exercise Program • Walk With Ease

14. Mid-East Commission Area Agency on Aging (AAA)6 • Reverse Mortgages • Demographics • Mid-East Development Corporation • Facilitates affordable housing and social services to housing • SHIIP • Senior health insurance information program • NCSMP • NC senior Medicare patrol program • STHL • Senior Tarheel Legislature

15. Pitt County Council on Aging7 • Helps to coordinate and deliver programming and resources to older adults • The Pitt County Council on Aging is a non-profit agency that is committed to improving the quality of life for older Americans through advocacy, services, life enrichment activities and friendship.

16. Pitt County Council on Aging Services7 • Senior InfoLine • Meals on Wheels • Senior Centers • Ayden • Bethel • Farmville • Fountain • Greenville • Grifton

17. Pitt County Council on Aging Services7 • Caregivers • “Powerful Tools for Caregivers Classes” • Caregiver mailing list • Medical Transportation • Seniors’ Health Insurance Information Program (S.H.I.I.P.)

18. Pitt County Council on Aging Services7 • Nutritional Supplement Program • S.P.I.C.E. for Life (Senior Safety Prevention Intervention and Community Education) • Special events, trips & resource guide

19. Pitt County Senior Center7 • Greenville location is the headquarters site • Offers a full array of services to seniors ages 60 and over targeted to meet their social, educational, physical and recreational interests. • Lunch is served to those who meet the eligibility criteria. • New calendar of events each month with date, time, program name, location and program description

20. Pitt County Community Schools & Recreation8 • Exercise Programs are held at six different sites throughout the county: • Ayden Arts and Recreation Center • Bethel Community Center • C.M. Eppes Recreation Center • Farmville Community Center • Council on Aging • Community Schools & Recreation. • Senior programs

21. Pitt County Community Schools & Recreation8 • Programs Offered: • AHOY: Add Health to Our Years • Balance Through Movement • Tai Chi from Arthritis Foundation and Arthritis Foundation Exercise Program • Low-impact Aerobics • Other programs include: Senior Games Softball, 3-on-3 Basketball, Badminton, Archery, and Horseshoes/shuffleboard.

22. Community Resources • Mid-East Commission Area Agency on Aging (AAA) • Pitt County Council on Aging • Pitt County Community Schools and Recreation • Greenville Parks & Recreation • REAL Crisis Intervention, Inc. and Collaborators • Vidant Wellness Center • Transportation services • Pitt County Department of Social Services • Etc., etc., etc...

23. Why even bother to recommend these resources?

24. Evidence!!!

25. Physical Activity4 • Has been shown to benefit a number of chronic conditions prevalent among older adults • Improve balance and reduce risk for falls • Is associated with lower risk for physical disability later in life • Among older adults, physical inactivity is a strong predictor of physical disability

26. RCT • 1,000+ people aged 70 years +, living at home • Interventions: • 1) group-based exercise • 2) home hazard management • 3) vision improvement • Main outcome measure: time to first fall Physical Activity to prevent falls?10

27. Physical Activity to prevent falls?10 • Group-based exercise was the most potent single intervention tested. • 14% reduced annual falls rate for all 3 combined

28. 163 seniors>65 at risk for falling (weakness, poor balance, and/or slow reaction time) Intervention group: supervised group exercise in community centers 1 hour/week for 1 year Targeted balance and coordination, strength, reaction time, and aerobic capacity Exercise group 40% less likely to fall Exercise group 30% less likely to have fall-related injury compared to control group Barnett 2003 -Safe Safe Stay Active2

29. Tai Chi uses 24 forms that emphasize weight shifting, postural alignment, and coordinated movements. Synchronized breathing is integrated into the movement routines. Tai Chi1

30. Tai Chi1 • 256 physically inactive, community-dwelling adults 70-92. • Participants randomized in to a 3x/week Tai Chi group or to a exercise stretching control group, each for six months. • Study showed Tai Chi participants had 55% fewer falls • Intervention gains in these measures were maintained at a 6-month post intervention follow-up in the Tai Chi group

31. Pitt County, NC9 • 14% of adults have “below basic” literacy skills • 24% of adults have “basic” literacy skills • Pitt County’s poverty rate: 22% • Unemployment rate: 10.2% • Four-year graduation rate: 57% • 20% of adults without high school diplomas

32. Health Literacy11 • According to the National Adult Literacy Survey (NALS)66% of U.S. adults age 60 and over have inadequate or marginal literacy skills • Two-thirds of 58 patients who admitted having reading difficulties had never told their spouse. Nine of them had told no one.

33. Health Literacy11 • Even practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients. • Study of 483 asthma patients found that two thirds reported graduating from high school, but only 60% could read above the sixth-grade level. • Never assume anything!

34. Tips11 • Searching the internet requires high-level literacy skills • Be aware of cultural appropriateness • Some cultures may respond to something if it is emphasized as “important” rather than “helpful”. • Use graphics and pictures if possible • Use common, simple words

35. Resources 1. FuzhongL, Harmer P, Fisher JK, Mcauley E. Tai Chi: Improving Functional Balance and Predicting Subsequent Falls in Older Persons. Med Sci Sports Exerc. (2004) 36 (12): 2046-2052. 2. Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing 2003 Jul;32(4):407-14 3. Giuliani, Carol. Accessing and Utilizing Community Resources: Establishing Continuity of Care. Lecture presented to PHYT 736: Physical Therapy for Older Adults, UNC-Chapel Hill. Spring 2013. 4. Belza B., Shumway-Cook A., Phelan E. A., Williams B., Snyder S. J. (2006). The effects of a community-based exercise program on function and health in older adults: The EnhanceFitness Program. Journal of Applied Gerontology, 25, 291-306 5. State & county QuickFacts. United States Census Berau Web site. http://quickfacts.census.gov.libproxy.lib.unc.edu/qfd/states/37/3728080.html. Updated 2013. Accessed 06/04, 2013. 6. Services for older adults. Area Agency on Aging Web site. http://www.mecaaa.org. Updated 2013. Accessed 06/03, 2013. 7. Pitt County Council on Aging Web site. http://www.pittcoa.com. Updated 2013. Accessed 06/04, 2013. 8. Community Schools & Recreation: Senior Recreation Web site. www.pittcountync.gov/csandrecreation. Updated 2013. Accessed 06/07, 2013. 9. Literacy Volunteers Pitt County Web site. http://www.pittliteracy.org/. Updated 2013. Accessed 06/06, 2013. 10. Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, et al.. (2002) Randomised factorial trial of falls prevention among older people living in their own homes. Br Med J 325, 128. 11. What is Health Literacy? Center for Health Care Strategies. www.chs.org. Accessed 06/05, 2013.

36. Questions??