health & wellness - easterseals new jersey · 2019-02-26 · health & wellness be well!...

HEALTH & WELLNESS

Be Well! & Thrive™ is a leader in health and wellness programs for individuals with

special needs and their families.

Designed to provide tools for our participants, their caregivers, and our staff to make

healthy lifestyle choices.

A Program of

Health Awareness Guide

Laura O’Reilly, R.N. with James Richardson.

Be Well! & Thrive™ is a registered trademark of Easter Seals New Jersey. All program content and branded materials are the intellectual property of Easter Seals New Jersey.

©2011, ©2014, © 2015 Easterseals New Jersey

A program of Easterseals New Jersey

Contents

I. A Culture of Health and Wellness Page 1

II. Lifestyle Factors and Health

III. Preventive Care Page 6

IV. Standard Precautions and Hand Hygiene Page 13

V. Smoking and Tobacco Page 15 VI. A Balanced Life Page 17 VII. Health and Safety Page 19

VIII. Nutrition Page 21

VIIII. Physical Fitness Page 33 IX. Healthy Living Links Page 35

Health Awareness Guide 1

I A Culture of Health and Wellness

Recently, the widespread rise in obesity, and consequential decline in overall health has received nationwide attention.

According the U.S. Centers for Disease Control and Prevention treating people with chronic diseases accounts for 86% of our nation’s health care costs, and half of all American Adults have at least one chronic condition.

Older adults are among the fastest growing age groups, and a larger share of people 65 and older is staying in or returning to the labor force. Age related changes increase the risk of obesity and chronic illness making it more challenging to balance the demands of life and work.

The U.S. Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities is “built on the need to promote accessible, comprehensive health care that enables persons with disabilities to have a full life in the community with integrated services, consistent with the President’s New Freedom Initiative. Persons with disabilities must have accessible, available and appropriate health care and wellness promotion services. They need to know how to—and to be able to—protect, preserve and improve their health in the same ways as everyone else. This Call to Action encourages health care providers to see and treat the whole person, not just the disability; educators to teach about disability; a public to see an individual’s abilities, not just his or her disability; and a community to ensure accessible health care and wellness services for persons with disabilities.(U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities. US Department of Health and Human Services, Office of the Surgeon General, 2005)

According to the American Journal of Preventive Medicine, 42% of American individuals with disabilities are obese; more than 13% higher than people without disabilities. Accordingly, people with disabilities have greater incidences of chronic illnesses like diabetes, hypertension, high cholesterol, and other related health complications.

Easterseals New Jersey’s Be Well! & Thrive Health and Wellness Programs are designed to guide our participants, caregivers, and our staff towards healthy lifestyle changes, and provide information and resources to prevent or lessen the severity of chronic disease. The program has empowered a great many of our participants and has already yielded tangible results.

Wellness is not simply the absence of disease. It affects the quality of a person’s life and that person’s ability to live to the fullest extent of his or her potential. Lifestyle, or how you live your life, is defined as a way of life or style of living that reflects the attitudes and values of a person or group.

Encouraging people to look at their eating and physical fitness habits is important in being able to understand why they choose the foods they do, and what barriers stand in their way of being

2 Health Awareness Guide

physically active. Our program encourages even small changes in attitudes toward food, and increases in the consumption of a variety of fruits and vegetables, and water. Changes small as these can reduce calories and in the long run contribute to some weight loss, decrease sugar intake, improve hydration status and strengthen the immune system. The more people know about nutrition and their body, and the value of exercise, the better they will be able to plan fitness activities and create meals that are enjoyable and meet their needs.

For those at risk for diseases such as diabetes, heart disease and obesity related illness due to excessive calorie intake and other factors, interventions include weight loss and health promotion strategies through improved nutrition and hydration, and increased physical activity, stress management, preventive care, and a balance of rest and activity. Your lifestyle choices have a huge impact on your health no matter what age you are. What you do on a regular basis will determine how you feel. If your usual diet is nutritious and your usual schedule includes physical activity, you are reducing the risk for many chronic illnesses and improving your health and quality of life.

Though some diseases are related to genetics and other factors, and may not be preventable, many chronic illnesses can be managed with nutrition, physical activity, stress management and preventive care.


II Lifestyle Factors and Health

Note: This manual is not intended to teach medical care or be used to diagnose illness. These conditions are highlighted as examples of how positive lifestyle changes can reduce the risk for certain diseases.

By recognizing health threats, a person better understands the steps to take that may reduce the risks for chronic illness and other illness, and help avoid the leading causes of death. Positive lifestyle changes can lessen some of the risks.

A risk factor is anything that affects your chance of getting a disease. Different diseases have different risk factors. Some risk factors, like smoking, eating an unhealthy diet, or not exercising, can be changed. Other risk factors, like a person’s age or family history, can’t be changed.

It is important that all people and their caregivers and guardians discuss screenings and healthy lifestyle strategies with a primary healthcare provider.

Diabetes

Diabetes is the condition in which the body does not properly process food for use as energy. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugars to build up in your blood. This is why many people refer to diabetes as “sugar.”

Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States.

Type 1 diabetes, previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, may account for 5 percent to 10 percent of all diagnosed cases of diabetes. Risk factors are less well defined for Type 1 diabetes than for Type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes.

Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90 percent to 95 percent of all diagnosed cases of diabetes. Risk factors for Type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.

Treatment for Type 2 diabetes Treatment typically includes diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40 percent of people with type 2 diabetes require insulin injections.


There are things that those at risk can do to prevent or delay type 2 diabetes.

Making healthy lifestyle changes that include improved nutrition and increased physical activity helps to control the level of sugar in the blood.

Physical activity also has a positive effect on blood pressure and blood fat and can lower the risk for heart attack and stroke.

Hypertension

High blood pressure is known as hypertension. When uncontrolled, high blood pressure can lead to a heart attack and stroke.

One health benefit of exercise is the lowering of the resting arterial pressure. Since exercise is effective in lowering blood pressure in people who already have hypertension, some individuals with high blood pressure may have a reduced need for antihypertensive medications.

Regular visits with a health care professional are the best way to keep informed.

Cholesterol

Cholesterol is a waxy, fat like substance. Since fat can’t mix with water (blood is made mostly of water) cholesterol carries fat through the blood vessels. It is essential to have some cholesterol. It forms bile acids that help us digest fats, helps to build cell membranes and helps us to produce certain hormones.

There are two different types of cholesterol.

The “good” type is High Density Lipoproteins (HDL) which carry cholesterol away from the arteries and to the liver for disposal. It is believed that HDL removes excess plaque from the arteries, protecting against heart attack.

The “bad” type is Low Density Lipoproteins (LDL) which circulate throughout the body making their fat available to all cells. When there is too much cholesterol in the blood, some excess is deposited in artery walls and leads to heart disease.

Most people can raise their HDL (good cholesterol) levels by exercising and lowering their weight with diet and exercise. Many people can lower LDL levels (bad cholesterol) levels by exercising and avoiding foods high in cholesterol. However there are times when diet and exercise alone may not lower cholesterol. Discuss this with your healthcare provider so you can decide together on the best treatment plan.

A blood test will tell how high your cholesterol is and, for those who are at risk, a healthcare provider will advise on medications, as well as diet and lifestyle changes.


Early detection and treatment of Familial Hyperlipidemia (FD) – a common genetic disorder which causes elevated levels of LDL - Low Density Lipoproteins (bad cholesterol) can help reduce the risk for coronary heart disease and death in persons with the disorder.

Heart Disease

Having close relatives with heart disease can increase the risk for heart disease with age. Review your family health history with your healthcare provider to understand risk for heart disease. This can impact screening recommendations. Physical activity may help to prevent heart disease by improving cardiovascular endurance, promoting weight management, decreasing waist circumference, and reducing stress.

Coronary Artery Disease

Coronary Artery Disease is a disease of the heart’s arteries. According to The Harvard Medical School Family Health Guide, 1999, it is the most common cause of death in the United States and in the developed nations of the world. The most common form of Coronary Artery Disease is artherosclerosis, a buildup of fatty deposits inside the arteries. It narrows the vessels and slows the flow of blood. A healthy artery is free of blockage and brings blood to organs and tissues of the body.

Many people have this disease without showing any symptoms. However, they may show symptoms in the future. These symptoms can be chest pain, cardiac arrest, heart attack and congestive heart failure. Regular screenings can help to detect Coronary artery disease.

Some people are born with a genetically determined condition; others develop the disease as a result of their lifestyle.

Some known risk factors are:

• Tobacco use- The risk decreases rapidly when you quit smoking.• High cholesterol- Your doctor will tell you how low your cholesterol should be, and if you need to take cholesterol lowering drugs. Less than 200 mg/dL is the desired level for total cholesterol.• Physical inactivity- Regular exercise can decrease the risk of heart attack. • Obesity- Being more than twenty pounds overweight increases the risk of diseases which can lead to coronary artery disease.

Regular exercise is recommended for people after they have had treatment for Coronary Artery Disease, and some folks bounce back to be stronger and healthier than before!


IIIPreventive Care

Regular Check-Ups are Important

Source: CDC.Gov

Regular health exams and tests can help find problems before they start. They also can help find problems early, when your chances for treatment and cure are better. By getting the right health services, screenings, and treatments, you are taking steps that help your chances for living a longer, healthier life. Your age, health, family history, lifestyle choices (i.e., what you eat, how active you are, whether you smoke), and other important factors impact what and how often you need healthcare.

Most Health Plans Cover Annual Physical Examinations and Preventive Screenings.

Check with your insurance carrier and health care provider to confirm coverage.

Health Screenings Screenings are tests that look for diseases before you have symptoms. Screening tests can find diseases early, when they’re easier to treat. You can get some screenings in your doctor’s office. Others need special equipment, so you may need to go to a different office or clinic.

Some conditions that doctors commonly screen for include:

• Breast cancer and cervical cancer in women • Colorectal cancer • Diabetes • High blood pressure • High cholesterol • Osteoporosis • Overweight and obesity • Prostate cancer in men


Which tests you need depends on your age, your sex, your family history, and whether you have risk factors for certain diseases. After a screening test, ask when you will get the results and whom to talk to about them. (Source: National Institute of Health, U.S. National Library of Medicine). Routine health and dental checkups and preventive screenings are important to help prevent, detect and treat illness in the earliest stages. Many may find these procedures uncomfortable and confusing. Breast cancer, prostate and colorectal cancer screenings and blood tests are all part of routine adult health care. Fear and anxiety and can often be a deterrent to getting regular screenings. Discuss your concerns with your healthcare provider and nurse, and work together on a pan to help you to overcome fears.

Access for Screenings for Individuals with Disabilities

Discuss Disability-Related Concerns

Discussing your disability related concerns with your healthcare provider can increase awareness and sensitivity and reduce barriers that prevent many people with disabilities from obtaining early cancer and disease detection services.

A team approach consisting of the individual with a disability, the caregiver, primary healthcare provider, and radiologists and staff at the diagnostic center may give the individual confidence and reduce stress and trauma associated with uncomfortable medical procedures.

Thyroid Screenings

According to the American Thyroid Association, an estimated 27 million Americans have overactive or underactive thyroid glands, but more than half remain undiagnosed. Women are also more likely than men to develop thyroid disease. Additionally, people with diabetes and/or their siblings are 15 to 20% more likely to develop thyroid disease.

The thyroid gland is a butterfly-shaped gland located in the neck. It produces the thyroid hormone that helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

If the thyroid gland is underactive or overactive, it can have a slew of negative effects. Some classic features of poor thyroid function include tiredness, over-weight and general sluggishness. In addition, the person may feel the cold, experience constipation, have dry skin, sparse hair and a rather hoarse voice.


3 WAYS TO HELP PREVENT THYROID DISORDER

• Talk to your doctor about your risk factors and thyroid testing • Stop Smoking! Cigarette smoke has various toxins that are especially dangerous to the thyroid • A healthy diet, exercise, proper nutrition, adequate sleep and stress reduction can all minimize the chance of developing thyroid disease

Find more tips and valuable information on thyroid health at www.thyroid.org.

Colorectal Cancer

Although a leading cause of cancer death for both men and women, if detected early, colorectal cancer can be more easily and successfully treated.

There are often no signs or symptoms of colorectal cancer. Younger adults can develop colorectal cancer, but people over age 50 are at highest risk for colorectal cancer. The best way to prevent colorectal cancer is to get screened regularly starting at age 50.

Other risk factors include smoking, having a personal history or having a family history of colorectal cancer, having a personal history of inflammatory bowel disease, being overweight or obese, physical inactivity and heavy alcohol use.

Everyone can take these healthy steps to help prevent colorectal cancer:

• Get screened starting at age 50 • Quit smoking and stay away from secondhand smoke • Get active and eat healthy


Certain types of diets can increase colorectal cancer risk. A diet that is high in red meats (such as beef, pork, lamb, or liver) and processed meats (such as hot dogs and some luncheon meats) can increase your risk for colorectal cancer.

Certain types of diets can lower colorectal cancer risk. Diets high in vegetables, fruits, and whole grains have been linked with a lower risk of colorectal cancer, but fiber supplements have not been shown to help.

Oral Care

Oral health is essential to general health and well-being. It is an important part of a daily self-care regimen and is essential to our ability to chew, swallow, talk and use facial expressions. Oral infections can lead to systemic diseases that affect the entire body.

The American Dental Association recommends scheduling regular dental checkups, eating a balanced diet, and limiting snacks which may reduce your risk of developing tooth decay and gum disease. Professional cleanings are the only way to remove tartar, which traps plaque bacteria along the gum line.

Regular flossing and brushing help to keep the gums healthy to prevent gingivitis (inflammation of the gums), periodontal disease (disease of the gums), and prevent cavities (an infection that causes destruction of the teeth).


Know Your Numbers

Knowing more about your health status can help you reduce your risk of costly health problems, and better manage any conditions you might have.

By knowing your numbers, you can take action to make positive changes that will help to reduce the risk of, and control chronic health conditions. When your provider takes your blood pressure, or gives you a copy of your lab report do you know what the numbers mean? Understanding what the numbers are and what you can do to improve those numbers puts you in charge of your health!

Some of the numbers that are important for you to know are:

Blood Pressure – This is one of the strongest markers for heart disease risk. It is measured as two numbers. Systolic pressure is the first number and is the pressure when the heart is contracting. Diastolic is the second number and is the pressure when the heart is at rest between beats. Normal blood pressure is 120 / 80 or below.

Cholesterol Levels – Too much bad cholesterol can lead to a hardening of your arteries. This can put you at risk for a heart attack or stroke. When it comes to cholesterol, there are two important numbers you should know. LDL, is the bad cholesterol, and should be below 100 mg/dL, and lower is better. HDL, is good cholesterol, and should be above 40 mg/dL. Your total cholesterol (TC) level should be below 200 mg/dL.

Blood Sugar – A blood sugar test is commonly used to diagnose the presence of diabetes. A fasting blood sugar (taken when you haven’t eaten for 12 hours) should be below 100 mg/dL.

BMI – is calculated from two other numbers that you probably know – your weight and height. Your BMI Is not always the most accurate test of body fat, because people with a lot of muscle mass may have a high body mass index. Typically, a body mass index less than 25 is considered healthy.

Body Fat – Checking your body Composition (Fat/Muscle/Water) helps to determine if you are overweight. This measurement determines how much fat (%) is on your body. Body fat norms differ between men and women.

Waist circumference – A high waist circumference indicates a greater level of abdominal fat which is associated with an increased risk for type 2 diabetes, high cholesterol, high blood pressure and heart disease. According to the United States Department of Health and Human Services women with


a waist circumference of more than 35 inches, and men with a waist circumference of more than 40 inches are at increased disease risk.

Some of health risks are inherited. But the majority of chronic disease risk is in the lifestyle you lead - specifically linked to smoking, poor diet and an inactive lifestyle. These are things you can change!

When reviewing lab results with your healthcare provider ask what the “numbers” mean and what you can do to maintain or improve those numbers.

Body Mass Index (BMI)


Body Composition (Body Fat)


IV Standard Precautions and Hand Hygiene

Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources. In the healthcare setting professionals use many types of precautions including Personal Protective Equipment (PPE) to protect themselves, their patients, and the public from infection. PPE includes gowns, gloves, respiratory masks and goggles. There is a proper technique to put on, remove, and dispose of PPE to further contain pathogens and prevent the spread of infection diseases.

Hand hygiene is a major component of standard precautions that everyone can use every day at home and in the community to help to prevent transmission of pathogens.

Preventing the Spread of Germs Everyday and During Cold and Flu Season

Flu viruses are thought to spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. A person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes, or nose.

The U.S. Centers for Disease Control and Prevention (CDC) recommends an annual seasonal flu vaccine (either the flu shot or the nasal-spray flu vaccine) as the best way to reduce the chances that you will get seasonal flu and spread it to others. When more people get vaccinated against the flu, less flu can spread through that community.

To learn more about the flu vaccine, and find out where to get a flu shot contact your healthcare provider or use the U.S. Department of Health and Human Services Flu.gov Flu Vaccine Finder to find a flu clinic near you. www.flu.gov/prevention-vaccination.

Some Natural ways to prevent colds and flu:

• Wash your hands often with soap and water, or an alcohol based hand rub- especially after you cough or sneeze. • Don’t cover your coughs and sneezes with your hands- use a tissue and dispose of it immediately, or cough or sneeze into your elbow. • Don’t touch your face- cold and flu viruses enter through the eyes, nose and mouth.


• Drink lots of fluids- water flushes your system, washing out the toxins as it rehydrates you. A typical, healthy adult needs eight 8-ounce glasses of fluids each day. • Try to avoid close contact with sick people. • While sick limit contact with others as much as possible to keep from infecting them. • Try to stay home if you are sick until at least 24 hours after you no longer have a fever, without the use of fever reducing medication. • Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill.

There is no guarantee against getting colds or the flu, but practicing healthy lifestyle habits can help to keep your immune system strong and improve the function of every part of your body.

Proper Handwashing Technique can reduce the spread of germs

Time Required: 30 seconds

Here’s How:

1. Turn on the tap until the water is warm but not too hot. 2. Rub hands together to get a nice, soapy lather. 3. Wash your palms, the back of their hands, their fingers and under your nails. 4. Sing “Happy Birthday” or count for 15-20 seconds. 5. Dry your hands on a paper towel (or if you are at home, on a clean hand towel). 6. If you are in a public bathroom, get into the habit of turning off the faucet with the paper towel when you are done. 7. When exiting a public or school restroom, use the same paper towel on the handle of the bathroom door to open it and to throw out the paper towel after exiting.

When using gloves to protect yourself and others from germs while performing a task, change the gloves between tasks and remove after use, before touching non-contaminated items and surfaces. Perform hand hygiene immediately after removing the gloves.


V Smoking and Tobacco

Source: American Cancer Society

According to the U.S. Centers for Disease Control and Prevention Cigarette smoking is the leading preventable cause of death in the United States. Cigarette smoking causes more than 480,000 deaths each year in the United States. This is nearly one in five deaths.

A smoking addiction is a dependence on cigarettes. It is common knowledge that smoking is harmful and addictive, but few people realize just how risky and addictive it is.

Exposure to secondhand smoke from burning tobacco products causes disease and premature death among nonsmokers. Even brief exposure to second hand smoke can cause harm. Studies have shown that smokefree laws that prohibit smoking in public places like bars and restaurants help improve the health of workers and the general population. Some of these improvements in health outcomes, such as reductions in hospital admissions for heart attacks, begin to be realized shortly after the laws take effect. (Source: U.S. Centers for Disease Control and Prevention.)

Easterseals New Jersey’s Tobacco Free Policy

As stated on Page 42 of Employee Handbook, Easterseals New Jersey is a tobacco-free workplace:

“We maintain a tobacco-free working environment, in keeping with our desire to provide a safe and healthful work environment, and consistent with state and local law. Smoking or the use of other tobacco products anywhere in the workplace, at any time, is strictly prohibited. This policy applies equally to all employees and visitors, and applies to electronic vapor cigarettes as well as traditional tobacco cigarettes, or other sorts of smoking devices.”

Employees who wish to smoke or use other tobacco products can do so outside the building during breaks, meal periods, or before or after work, provided they are not blocking or standing in entranceways such that those wishing to enter or leave the building need to experience the smoke or tobacco use in doing so. Employees are expected to limit all breaks during working hours, and smoke breaks are no exception. Smokers should also ensure that their breath, hair and clothing do not smell of smoke when they return to work. All cigarettes or other lighted tobacco products should be extinguished completely and disposed of in the proper receptacles.”

Easterseals New Jersey employees are asked to be positive role models for the individuals served in our programs. The No-Smoking Policy includes not smoking with, or in the presence of consumers, even if you are not on Easterseals New Jersey property.


“Quitting smoking is easy. I’ve done it a thousand times.” Mark Twain

Help Quitting is Available

Smoking is a physical addiction that it is difficult to give up. Without help most smokers fail despite trying many times. How and when you stop is a personal matter. Pressure from others is not often helpful, and you will only stop when you have decided you are ready to. There is help available when you are ready to quit. Discuss options for smoking cessation with your primary physician.

Help is available for New Jersey residents from New Jersey Quitline, a program that is supported by the NJ Department of Health, Office of Tobacco Control. Telephone coaching support and a supply of nicotine patches are offered free of charge.

1-866-NJSTOPShttp://njquitline.org

Assistance is also available at:

The American Lung Association http://www.lung.org/

The American Cancer Society http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/index


VIA Balanced Life

We all have an instinctive stress response that releases hormones into our bloodstream when we are faced with danger. These hormones cause instant mental and physical change in us, giving added strength and endurance so we can adapt to the stressor. In today’s world we live at such a pace that many of us activate the body’s stress response all the time- at work, at school, interacting with peers, and driving in traffic.

The Body’s Stress ResponseWhen you perceive a threat, your nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol. These hormones rouse the body for emergency action.

What happens to your body?Your heart pounds faster, muscles tighten, blood pressure rises, breath quickens, and your senses become sharper.

These physical changes increase your strength and stamina, speed your reaction time, and enhance your focus – preparing you to either fight or flee from the danger at hand.

Stress is a normal physical response to events that make you feel threatened or upset your balance in some way. When you sense danger – whether it’s real or imagined – the body’s defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction, or the stress response.

The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life – giving you extra strength to defend yourself, for example, or stimulating you to slam on the brakes to prevent an auto accident.

The body’s stress response also helps you rise to meet daily challenges. It keeps you on your toes during a presentation at work, and moves you to study when you’d rather be relaxing.


But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, and your quality of life.

Managing Stress

It’s important to learn how to recognize when your stress levels are out of control. The most dangerous thing about stress is how easily it can creep up on you. You get used to it. It starts to feel familiar, even normal. You don’t notice how much it’s affecting you, even as it takes a heavy toll.

Most people don’t give themselves quiet time to de-stress, decompress, and breathe slowly and deeply to relax the body and regulate the heart rate after a stressful event. With no release, your stress hormones keep on working, which adds to tension and anxiety, difficulty concentrating, and essentially affecting your overall well-being, and possibly your immune system.

Taking time out to stretch or do yoga, breathe quietly, and do creative positive visualization help to improve mood and coping skills.

Sleep A good night’s sleep is important for good health and weight maintenance. Are you getting enough sleep? Now is a good time to think about it and making changes that will get you the restorative sleep you need at night to have healthy and productive days. Insufficient sleep causes the brain to operate less effectively, impairing our memory and problem solving abilities. Fatigue leads to anxiety and stress, which can contribute to a vicious cycle of insomnia. Our reflexes and physical responses can be affected. Muscle endurance drops, weight gain occurs due to an increase in appetite, and the immune system may become compromised.

Some common signs that indicate a lack of sleep are:

• Irritability • Fatigue • Feelings of Depression

If you are not getting enough sleep, you are sapped of energy and do not have the drive to exercise. A sensible diet and workout plan are the keys to a fit body, but new studies are showing that sleeping habits also play a role in the success of weight loss programs.


VIIHealth and Safety

Preventing Falls Reduces the Risk for Injuries and Fractures

A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. It is a loss of balance which results in uncontrolled contact with a surface or object. Some falls result in injuries, and can cause pain and suffering and impact quality of life.

According to the National Council on Aging falling is not an inevitable result of aging. Through evidence-based interventions, practical lifestyle adjustments, the number of falls among older adults can be substantially reduced.

6 Tips to Help to Prevent Falls • Find a good balance and exercise program which is taught by a qualified exercise professional: Look to build balance, strength, and flexibility. Contact your local Area Agency on Aging for referrals. Find a program you like and take a friend.

• Talk to your health care provider: Ask for an assessment of your risk of falling. Share your history of recent falls.

• Regularly review your medications with your doctor or pharmacist: Make sure side effects aren’t increasing your risk of falling. Take medications only as prescribed.

• Get your vision and hearing checked annually and up-date your eyeglasses: Your eyes and ears are key to keeping you on your feet.

• Keep your home safe: Remove tripping hazards, increase lighting, make stairs safe, and install grab bars in key areas.

• Talk to your family members: Enlist their support in taking simple steps to stay safe. Falls are not just an issue affecting only seniors.

• Wear comfortable proper fitting shoes with good support.


Being Prepared for an Emergency in Your Community

Disasters can strike quickly and without warning, forcing people to leave or be confined in their home. Make plans to protect yourself in the event of an emergency. It is also important that first responders know how to evacuate people with health concerns and disabilities safely and quickly.

Emergency Preparedness tips from the CDC Website

• Develop a back-up plan. Inform caregivers, friends, family, neighbors or others who might be able to help during an emergency.

• Stock up on food, water, and any necessary prescription medications, medical supplies or equipment. Have enough to last at least a week.

• Make a list of emergency contact information and keep it handy.

• Keep a charged car battery at home. It can power electric wheelchairs and other motorized medical equipment if there is an electricity outage.

• Learn about alternate transportation and routes.

• Understand the responsibilities and limitations of a “first responder” (for example, members of your local fire department of law enforcement office) during a disaster.

More information is available at: http://www.cdc.gov/Features/EmergencyPreparedness/

Get to Know Your Local Health Department

Since many towns share services your health department may be in a neighboring town. Contact your city or town municipal center to locate your local office of public health and get on the mailing list for health fairs, preventive screening events and flu shot clinics, and receive information on how to stay healthy and get access to quality health care.

If you have a health issue, disability, or special need:

Let your local health officer and public health nurse know if you or a person you live with has special health needs so they can be prepared to assist you in the event of a weather related or other emergency.


VIIINutrition

Eating a Healthy Diet

Nutrition and Meal Planning

You are What You Eat!

While daily activities may be challenging for some, it is important to know that all people can be healthy, productive and contributing members to society!

Though some face various barriers as a result of their disability (lack of knowledge or independent choice, physical limitations, medications that lead to weight gain), research has shown that even small lifestyle changes can make dramatic differences.

A healthy, productive and active lifestyle can be maintained and improved with proper nutrition. A balanced diet helps to maintain a healthy weight and provides your body with energy and nutrients that lead to present and future health.

Professional Help is Available

There is not one nutrition plan that will work for everyone. Age, height, weight and gender are just a few factors that determine nutrition needs. Other aspects such as physical activity, special needs, family health history and present health conditions require further specialization. Dietitians take all of these things into consideration and are able to create a personalized plan that aligns with your specific health needs and goals. If you are having difficulty making healthy nutrition choices or managing your weight, discuss nutrition options with your healthcare provider to create a plan to help you to succeed.

Food Allergies Parents, caregivers, educators, and community members can all play a part in helping adults and children with food allergies stay safe. The Food Allergy & Anaphylaxis Management Act (included under the FDA’s Food Safety Modernization Act), was signed into law on Jan. 4, 2011. The law required the U.S. Secretary of Health and Human Services to develop and make available to schools a voluntary policy to manage the risk of food allergy and anaphylaxis in schools. FARE, the National Association of School Nurses and other groups collaborated with the CDC on the development of these guidelines. For more information visit http://www.cdc.gov/healthyyouth/foodallergies Discuss food and other allergy concerns with your healthcare provider.


Build a Healthy Plate

Before you eat, think about what goes on your plate or in your cup or bowl. Foods like vegetables, fruits, whole grains, low-fat dairy products, and lean protein foods contain the nutrients you need without too many calories. Try some of these options.

• Make half your plate fruits and vegetables. • Switch to skim or 1% milk. • Make at least half your grains whole. • Vary your protein food choices. • Keep your food safe to eat - learn more at www.FoodSafety.gov Special Conditions Require Special Diets

Keep in mind that if a person has high blood pressure, heart disease or other conditions, healthy diet recommendations may be different. Individuals should always follow the guidelines of his or her physician.

Hydration

Tips for Staying Hydrated:

Generally if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or light yellow urine a day, your fluid intake is probably adequate. If you’re concerned about your fluid intake or have health issues, check with your doctor or a registered dietitian. He or she can help you determine the amount of water that’s right for you.

To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. It’s also a good idea to:

Drink a glass of water or other calorie-free or low-calorie beverage with each meal and between each meal.

Drink water before, during and after exercise.

Beyond the tap: Other sources of water

Although it’s a great idea to keep water within reach at all times, you don’t need to rely only on what you drink to meet your fluid needs.

Stock up on Healthy Food

What you buy from the grocery store and put in your refrigerator and cupboard is the foundation for your at-home meal preparation.

Bring home nutritious food from the market- if you buy it, you are more likely to eat it!

Tip: Always wash your fruits and vegetables with drinkable water before eating.


Tips for Preparing Healthy Meals

1. Cook once and eat twice. When cooking dinner plan for leftovers. They make great lunches or quick dinners another night.

2. Have a cooking marathon. Use a few hours of downtime or have a set schedule to prepare several meals for the week. 3. Save for later. For perfect and convenient meals at a later date, store leftover meal portions in the freezer or refrigerator.

4. Freezer Fresh. Frozen vegetables make easy additions for quick meals. Just add to your favorite protein and season.

5. Fresh bread. Breads store well in the refrigerator or freezer. Simply remove servings as needed. 6. Beware of preservatives and artificial ingredients. Avoid prepared frozen foods with sauces and creams. Instead add your own favorite herbs and spices to reduce calories, fats and unnecessary chemicals.

7. Buy in bulk. Purchase grains, beans, nuts and seeds in bulk to save money. Purchase bulk meat, chicken or fish and wrap individually before freezing for convenience and cost savings.

8. Keep fruit longer. If fruit seems to be ripening before you have time to eat it just freeze (peel or slice before freezing). Use later for smoothies or desserts.

9. Tasty variation. Roasting vegetables brings out natural sweetness. It’s a tasty variation and adds great flavor to any dish.

10. Expand your taste buds. Try new vegetables over a period of time to develop acquired tastes.

For cooking ideas and recipes visit these resources: www.choosemyplate.gov www.eatright.org www.readyseteat.com


Foods

Grains, Fruits, Vegetables

Meat, Fish, Poultry, Beans

Nuts, Seeds

Pretzels & Popcorn, Baked Chips

Peanut Butter, Hard Cheese

Salad Dressing, Oil & Vinegar, Mayonnaise, Butter

Equivalent Measurement

1 cup

3 ounces

1 ounce

1 ounce

1 ounce

1 teaspoon

Hand Symbols:

Fist

Palm

Handful

Two Handfuls

Thumb

Tip of Thumb


VegetablesFresh or Frozen

Leafy Greens:Spinach, Kale, Collards, Swiss chard, Beet Greens, Escarole, Lettuce (Red Leaf, Romaine, Green Leaf), etc.

Root Vegetables: Beets, Carrots, Parsnips, Turnips, Rutabaga, Sweet Potatoes, etc.

Gourds:Eggplant, zucchini, Spaghetti Squash, Acorn Squash, Yellow Squash, etc.

Others:Peppers, broccoli, Cauliflower, Brussel Sprouts, Green Beans, Peas, Cucumbers, celery, etc.

FruitFresh or Frozen

Apples, Bananas, Grapes, Grapefruit, Mango, Pears, Peaches, Papaya, Pineapple, Figs, Dates,

Berries: Blueberry, Strawberry, Raspberry, Goji Berry, Blackberry, etc.

Dried Unsweetened:Raisins, Cranberries, Figs, Berries, Bananas,Mango, Apple, Papaya, Apricots

Whole Grains

Oats (Oatmeal), Whole Grain Pasta, Brown Rice, Wild Rice, Quinoa, Millet, Barley, Bulgur, Corn, Spelt

Whole Grain Cereals (unsweetened)

Whole Grain Breads: Rye, Wheat, Pumpernickel, Spelt, etc.

Whole Grain Flour Products: Tortillas, Rolls, Pitas, Bagels, etc.

Proteins

Beans: Black, Kidney, Chick Peas, Pink, Red, Black Eye Peas, Pigeon, Lentils, etc.

Poultry (3-4 oz.): Chicken, Turkey, Cornish Hens

Fish: Salmon, Tuna, Tilapia, etc.

Raw Nuts (1-2 oz.): Almonds, Walnuts, Cashews, Pistachios, etc.

Raw Seeds (1-2 oz.): Pumpkin, Sunflower, Chia, Flaxseeds, etc.

Dairy or Alternatives

Skim or 1% Milk, Soy Milk, Almond Milk

Low-fat Half & Half

Reduced fat Cheeses (block, shredded, slices.): Provolone, Muenster, Cheddar, Swiss, Colby Jack, etc.

Soy based cheeses (shredded, block, slices)

Light Cream Cheese, Neuchâtel

Cottage Cheese

Ricotta Cheese

Yogurts: Traditional, Greek, Soy Based,

Herbs & Spices

Salt, Pepper, Chili Powder, Cayenne, Red Pepper Flakes, Cumin, Coriander

Italian Seasoning, Oregano, Parsley, Basil, Dill,

Garlic Powder, Onion Powder, Celery Powder, etc.

Condiments

Light Mayonnaise

Mustard: Yellow, Brown, DijonLow sodium Ketchup

Low Sodium Soy Sauce, Worcestershire Sauce,

Assorted Vinegars: Red Wine, Balsamic, Apple Cider, etc.

Low Sodium Pickles, Olives, Roasted Red Peppers, etc.

Cooking OilsOlive Oil, Canola Oil, Cooking Spray

SweetenersHoney, Maple Syrup, Agave Nectar, Brown Rice Syrup


Reading Nutrition Labels Puts You in Charge of Your Diet

Many people don’t eat the right foods because they do not know enough about nutrition. A balanced diet provides us with adequate amounts of fats, proteins, and carbohydrates, and vitamins, iron, calcium and other minerals that nourish the body. Under Food and Drug Administration regulations, any foods for which a nutrition claim is made, or that has added nutrients, must carry nutrition information on the label. A product must list all ingredients in order of decreasing amounts. Products must list food additives, artificial flavors and colors.

If you cannot pronounce the name of an ingredient, which is often the case, find out what it is. Knowing what you are putting into your body puts you in charge of your diet and your health. Once you are in the habit of reading labels, it can be done quickly and efficiently while you are shopping.

The U.S. Food and Drug Administration is proposing to update the Nutrition Facts label found on most food packages in the United States. The Nutrition Facts label, introduced 20 years ago, helps consumers make informed food choices and maintain healthy dietary practices.

To learn more about food labels visit the U.S. Food and Drug Administration website: http://www.fda.gov/food/ingredientspackaginglabeling/labelingnutrition/default.htm


The Brain / Gut Connection

There is a direct relationship between what you eat, the health of your digestive system (“Gut Health”) and brain health and mental performance. Healthy bacteria (flora) in the gut improves brain function by supporting the neurotransmitters in the brain.

How Does Nutrition Help?

Plant-based diet helps to improve gut flora. Apart from brain health, heathy flora helps to improve digestive disorders (which lead to decreased nutrients to the brain and body) and decreases the risk for colon cancer.

Photo Source: Blog.PremarkHS.com

1. Gut Brain a. Increase in good bacteria (flora) in the gut improves brain function b. Supports neurotransmitters: Dopamine, serotonin and GABA ; functions of each c. Tryptophan – amino acid; benefits and sources; effect on brain health

2. Food Sources for Optimal Brain Health a. Diet impacts brain function b. Increase beneficial foods c. Benefits of vegetable based eating d. Probiotic food sources increase healthy bacteria 3. Stress and Brain Health a. Activation of corticotropin/cortisol receptors b. Foods impact the effects of stress c. Effects on brain function as relates to appetite/weight gain d. Omega-3’s ; healthy fats

4. Sleep and Brain Function a. Benefits of sleep b. Impacts of sleep deprivation


Fact Sheet from U.S. Department of Health and Human Services and National Institutes of Health discusses myths and provides facts and tips about weight loss, nutrition, and physical activity. This information may help you make healthy changes in your daily habits.

Weight-loss and Diet Myths

Myth: Fad diets will help me lose weight and keep it off.

Fact: Fad diets are not the best way to lose weight and keep it off. These diets often promise quick weight loss if you strictly reduce what you eat or avoid some types of foods. Some of these diets may help you lose weight at first. But these diets are hard to follow. Most people quickly get tired of them and regain any lost weight.

Fad diets may be unhealthy. They may not provide all of the nutrients your body needs. Also, losing more than 3 pounds a week after the first few weeks may increase your chances of developing gallstones (solid matter in the gallbladder that can cause pain). Being on a diet of fewer than 800 calories a day for a long time may lead to serious heart problems.

Healthy habits may help you lose weight.

- Make healthy food choices. Half of your plate should be fruits and veggies. - Eat small portions. Use a smaller plate, weigh portions on a scale, or check the Nutrition Facts label for details about serving sizes.

- Build exercise into your daily life. Garden, go for family walks, play a pickup game of sports, start a dance club with your friends, swim, take the stairs, or walk to the grocery store or work.

Combined, these habits may be a safe, healthy way to lose weight and keep it off.

TIP: Research suggests that safe weight loss involves combining a reduced-calorie diet with physical activity to lose 1/2 to 2 pounds a week (after the first few weeks of weight loss). Make healthy food choices. Eat small portions. Build exercise into your daily life. Combined, these habits may be a healthy way to lose weight and keep it off. These habits may also lower your chances of developing heart disease, high blood pressure, and type 2 diabetes.

The U.S. Food and Drug Administration (FDA) Nutrition Facts label appears on most packaged foods. It tells you how many calories and servings are in a box or can. The serving size varies from product to product.

A portion is how much food you choose to eat at one time, whether in a restaurant, from a package, or at home. Sometimes the serving size and portion size match; sometimes they do not.


You can use the Nutrition Facts label

- to track your calorie intake and number of servings

- to make healthy food choices by serving smaller portions and selecting items lower in fats, salt, and sugar and higher in fiber and vitamins

For more guidance on reading food labels, check out the web page How to Use and Understand the Nutrition Facts Label listed under Resources.

Myth: “Low-fat” or “fat-free” means no calories.

Fact: A serving of low-fat or fat-free food may be lower in calories than a serving of the full-fat product. But many processed low-fat or fat-free foods have just as many calories as the full-fat versions of the same foods—or even more calories. These foods may contain added flour, salt, starch, or sugar to improve flavor and texture after fat is removed. These items add calories.

Myth: Fast foods are always an unhealthy choice. You should not eat them when dieting.Fact: Many fast foods are unhealthy and may affect weight gain. However, if you do eat fast food, choose menu options with care. Both at home and away, choose healthy foods that are nutrient rich, low in calories, and small in portion size.

TIP: To choose healthy, low-calorie options, check the nutrition facts. These are often offered on the menu or on restaurant websites. And know that the nutrition facts often do not include sauces and extras. Try these tips:

- Avoid “value” combo meals, which tend to have more calories than you need in one meal.

- Choose fresh fruit items or nonfat yogurt for dessert.

- Limit your use of toppings that are high in fat and calories, like bacon, cheese, regular mayonnaise, salad dressings, and tartar sauce.

- Pick steamed or baked items over fried ones.

- Sip on water or fat-free milk instead of soda.

Myth: If I skip meals, I can lose weight.

Fact: Skipping meals may make you feel hungrier and lead you to eat more than you normally would at your next meal. In particular, studies show a link between skipping breakfast and obesity. People who skip breakfast tend to be heavier than people who eat a healthy breakfast.


TIP: Choose meals and snacks that include a variety of healthy foods. Try these examples:

- For a quick breakfast, make oatmeal with low-fat milk, topped with fresh berries. Or eat a slice of whole-wheat toast with fruit spread.

- Pack a healthy lunch each night, so you won’t be tempted to rush out of the house in the morning without one.

- For healthy nibbles, pack a small low-fat yogurt, a couple of whole-wheat crackers with peanut butter, or veggies with hummus.

Myth: Eating healthy food costs too much.

Fact: Eating better does not have to cost a lot of money. Many people think that fresh foods are healthier than canned or frozen ones. For example, some people think that spinach is better for you raw than frozen or canned. However, canned or frozen fruits and veggies provide as many nutrients as fresh ones, at a lower cost. Healthy options include low-salt canned veggies and fruit canned in its own juice or water-packed. Remember to rinse canned veggies to remove excess salt. Also, some canned seafood, like tuna, is easy to keep on the shelf, healthy, and low-cost. And canned, dried, or frozen beans, lentils, and peas are also healthy sources of protein that are easy on the wallet.

TIP: Check the nutrition facts on canned, dried, and frozen items. Look for items that are high in calcium, fiber, potassium, protein, and vitamin D. Also check for items that are low in added sugars, saturated fat, and sodium. For more tips, see Smart Shopping for Veggies and Fruits and Healthy Eating on a Budget, both on the MyPlate website (see the Resources section)

Myth: Nuts are fattening. I shouldn’t eat them if I want to lose weight.

Fact: While it is true that nuts are high in calories and fat, in small amounts nuts can be part of a healthy program to lose weight. Most nuts contain healthy fats. Nuts are also good sources of fiber, minerals, protein, and vitamins.

TIP: Enjoy small portions of nuts. One-half ounce of mixed nuts (about 1 tablespoon) has about 84 calories.

Myth: Eating meat is bad for my health and makes it harder to lose weight.

Fact: Eating lean meat in small amounts can be part of a healthy plan to lose weight. Chicken, fish, pork, and red meat contain some cholesterol and saturated fat. But they also contain healthy nutrients like iron, protein, and zinc.

TIP: Choose cuts of meat that are lower in fat, and trim off all the fat you can see. Meats that are lower in fat include chicken breast, pork loin and beef round steak,


flank steak, and extra lean ground beef. Also, watch portion size. Try to eat meat or poultry in portions of 3 ounces or less. Three ounces is about the size of a deck of cards.

Myth: Dairy products are fattening and unhealthy.

Fact: Fat-free and low-fat cheese, milk, and yogurt are just as healthy as whole-milk dairy products, and they are lower in fat and calories. Dairy products offer protein to build muscles and help organs work well, and calcium to strengthen bones. Most milk and some yogurts have extra vitamin D added to help your body use calcium. Most Americans don’t get enough calcium and vitamin D. Dairy is an easy way to get more of these nutrients.

TIP: Based on Government guidelines, you should try to have 3 cups a day of fat-free or low-fat milk or milk products. This can include soy beverages fortified with vitamins. If you can’t digest lactose (the sugar found in dairy products), choose lactose-free or low-lactose dairy products or other foods and drinks that have calcium and vitamin D:

- Calcium: soy-based drinks or tofu made with calcium sulfate; canned salmon; dark leafy greens like collards or kale

- Vitamin D: cereals or soy-based drinks

Myth: “Going vegetarian” will help me lose weight and be healthier.

Fact: Research shows that people who follow a vegetarian eating plan, on average, eat fewer calories and less fat than non-vegetarians. Some research has found that vegetarian-style eating patterns are associated with lower levels of obesity, lower blood pressure, and a reduced risk of heart disease.


Reducing Sodium in Your Diet

It is estimated that if Americans cut their average sodium intake by more than half – to an average of 1,500 milligrams a day – there would be a nearly 26 percent decrease in high blood pressure and a savings of more than $26 billion in healthcare costs over just a year.


VIIIIPhysical Fitness

One of the best things we can do for ourselves and those who are in our care is limit the amount of time we and they spend doing non educational, non-creative, sedentary activities. Participate in recreation activities that you enjoy and stay in motion! Indoor and outdoor chores, gardening and simply walking keeps you physically active to keep fit.

Make Physical Activity a Way of Life. Physical activity does not always have to be in the form of a formal exercise program. Increasing your movement in the course of your activities of daily living may help to keep you physically fit.

Walk the Walk! How many steps do you walk each day? Wearing a pedometer is an easy way to track your steps each day. Start by wearing the pedometer every day for one week. Put it on when you get up in the morning and wear it until bed time. Record your daily steps in a log or notebook and by the end of the week you will know your average daily steps. You might be surprised how many (or how few) steps you take each day. It takes just over 2,000 steps to walk one mile, and 10,000 steps is close to 5 miles.

Whatever activity you choose, start slowly by doing 5 minutes a day and add on more time until you are exercising for 30 minutes a day, five days a week. Here are some suggestions:

• While watching TV, walk or dance around the room, march in place, or do some sit-ups and leg lifts.

• Take a class at a local gym or recreation center with a qualified fitness professional.

• Stay motivated by walking or exercising with a family member or friend.

• Gently stretch after exercising. Perform slow movements and stretch only as far as you feel comfortable. Do not overstretch or do bouncing movements.

Have fun and keep at it! The reward for physical activity is a healthier life.

Those with gait and balance issues should use appropriate assistive devices and be supervised.

When selecting a fitness program it is recommended that training sessions and exercise classes are taught by qualified professionals, preferably those with special needs exercise credentials.

For a variety of reasons, including medications and conditions such as diabetes, not all people needs should participate in vigorous exercise.


Furthermore, an exercise program may help mobility and well-being if it is designed to achieve the following results:

• Increase strength and flexibility • Improve cardiovascular endurance • Improve posture and spine health • Improve balance and gait • Improve proprioception • Reduce the risk for falls • Enhance one’s ability to perform activities of daily living

How Regular Exercise can Help Manage and Prevent Disease:

• Reduce risk of heart disease • Reduce blood pressure • Reduce total cholesterol • Reduce risk of developing some cancers • Reduce risk of developing diabetes • Build bone density and reduce risk for osteoporosis and fractures • Enhance well-being by reducing depression and increasing energy • Reduce weight in overweight people • Maintain a healthy body weight and body fat percentage


IXHealthy Living Links

Useful links with additional information on how to make healthy choices to achieve optimal health and wellness:

Academy of Nutrition and Dietetics http://www.eatright.org/

Choose My Plate.Gov. An interactive website that offers personalized eating plans, interactive tools to help you plan and assess food choices.http://www.choosemyplate.gov/

American Dietetic Association www.eatright.org

Brain Health Resource and Brain Health Articles http://www.totalhealthmagazine.com/items/articles/brain-health.html

Brain Foods: the effects of nutrients on brain functionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805706/

Eat Smart for a Healthier Brainhttp://www.webmd.com/diet/eat-smart-healthier-brainhttp://www.pcrm.org/health/diets/ffl/newsletter/gut-flora-diet-and-health

HealthyPeople.gov http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=29

MyPyramid Tracker. An online dietary and physical activity assessment tool that provides information on your diet quality, physical activity status, related nutrition messages, and links to nutrient and physical activity information. http://www.mypyramidtracker.gov/

National Council on Aging and National Council on Aging https://www.ncoa.org/ ncoa.org/FallsPrevention.

National Institute for Health, U.S. National Library of Medicine https://www.nlm.nih.gov/medlineplus/healthscreening.html

New Jersey Department of Human Services Division of Aging Services http://www.state.nj.us/humanservices/doas/home/

State of New Jersey Dept. of Health and Senior Services Office of Nutrition and Fitness http://www.nj.gov/health/fhs/shapingnj/index.shtml

U.S. Centers for Disease Control and Prevention Developmental Disabilities http://www.cdc.gov/ncbddd/developmentaldisabilities/index.html

U.S. Department of Agriculture U.S. Department of Health and Human Services www.dietaryguidelines.gov

United States Department of Agriculture Center For Nutrition Policy and Promotion http://www.cnpp.usda.gov/Publications/MyPlate/DG2010Brochure.pdf


Sources

American Cancer Society Guide to Quitting Smoking www.cancer.org

American Journal of Preventive Medicine, Volume 45, Issue 1 (83-90) July 2013 American Cancer Society www.cancer.org

American Diabetes Association. www.diabetes.org

American Lung Association http://www.lung.org/

American Thyroid Association. www.thyroid.org.

Hsieh, K., Heller, T. and Miller, A. B. (2001), Risk factors for injuries and falls among adults with developmental disabilities.

Journal of Intellectual Disability Research, 45: 76–82. doi: 10.1111/j.1365-2788.2001.00277.x

mayoclinic.com/hydration

New Jersey Quitline http://njquitline.org/ National Council on Aging; http://www.ncbi.nlm.nih.gov/pubmed/11168779;

Oral Health Disability.gov

U.S. CDC. Nobody Left Behind (NLB): Disaster Preparedness for Persons with Mobility Impairments http://www.cdc.gov/Features/EmergencyPreparedness/

U.S. Department of Health and Human Services flu.gov

U.S. Department of Labor Bureau of Labor Statistics

U.S. Centers for Disease Control and Prevention

http://www.cdc.gov/cancer/breast/basic_info/index.htm

http://www.cdc.gov/Features/BreastCancerDisabilities/

U.S. Centers for Disease Control and Prevention;

http://www.cdc.gov/flu/about/disease/high_risk.htm; Harvard Health Publications;

WomensHealth.gov

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