National Association of Chronic Disease DirectorsNational Association of Chronic Disease Directors

General Member CallGeneral Member Call

March 28March 28thth, 2013, 2013

“Integrating Efforts to Support Livable Communities Across the Lifespan”

Division of Population Health

National Center for Chronic Disease Prevention and Health Promotion

About Today’s Call

Highlights importance of integrating mobility and livable communities into public health activities

Provides information about activities of the CDC’s Healthy Aging Program (HAP) and AARP

Stimulates dialogue among call participants, HAP and AARP

Informs HAP and AARP efforts to support future work that promotes the health and well-being of older adults

Supports CDC/NCCDPHP Domain #2: Environmental Approaches

Introductions

Lynda Anderson, PhDDirector, Healthy Aging ProgramApplied Research and Translation Branch

Amy Levner, AARP

Introductions

Cheryl Schott, MPHConsultant, Michigan Public Health Institute

Amy Slonim, PhD CDC-AARP Liaison

Webinar Dialogue Objectives

Describe the shifting demographics in the US population

Share overviews of priorities, activities and resources of CDC Healthy Aging Program and AARP Livable Communities

Engage in dialogue about state and local public health opportunities to integrate older adults issues in work with communities, state and local elected officials and partners

Tell Us Few Things About Yourself

Check the box that best represents your professional affiliation:

• -- State and local public health

• -- Aging Services

• -- Academia

• -- Federal government

• -- Other

*

Lynda Anderson, PhDDirector, Healthy Aging ProgramApplied Research and Translation Branch

CDC’s Healthy Aging ProgramWork on Mobility

Transformative Demographic Shifts

The number of older adults are growing faster than any other age groupBy 2015, there will be more people over age 65 than those aged 15 or younger

By 2030, 20% of the U.S. population will be 65 years of age or older

Adults age 65 or older are twice as likely to be living in poverty as they were a decade ago

* Anderson LA et al. The public's perceptions about cognitive health and dementia among the United States population: a national review. Gerontologist 2009;49(51):S3-11.

CDC’s Healthy Aging ProgramWork on Mobility

Objectives

Provide a brief history and rationale for current work in mobility and older adults

Summarize the findings from the mobility and older adults concept mapping work and resulting framework

Discuss next steps

Mobility

Optimal mobility* is defined “as being able to safely and reliably go where you want to go, when you want to go, and how you want to reach your designation, and is key a component of healthy aging.”

* Modified from the CDC-HAN Mobility Workgroup and Satariano et al. (2012) AJPH

Concept Mapping Applied to Mobility

Engages stakeholders

Applies multi-dimensional scaling and cluster analysis

Creates visual maps of relationships among ideas

Provides a foundation for prioritizing action items

Steps in Concept Mapping

Planning: Develop a focused question and identify participants

Idea Generation: Experts and interested community members invited to respond to focused question

Data Collection: Participants sort and rate the results of the idea generation

Analysis: Creates visual maps of relationships among ideas

Interpretation and Use: Develop conceptual framework and identify priorities

Develop a Focused Question

“One specific action that can lead to positive change in mobility for older adults in the U.S. is…”“One specific action that can lead to positive change in mobility for older adults in the U.S. is…”

Specific Aim: To engage stakeholders to create a framework that will contribute to promoting mobility in community-dwelling older adults as a coordinated response across agencies and organizations.

Specific Aim: To engage stakeholders to create a framework that will contribute to promoting mobility in community-dwelling older adults as a coordinated response across agencies and organizations.

Sort and Rate Ideas

Each idea was rated for potential impact and

achievability

Each idea was rated for potential impact and

achievability

12

34

5

12

34

5

3Scan a multit

ude of

information and decide

what is im

portant.12

34

5

12

34

5

12

34

5

12

34

5

12

34

5

1Manage tim

e effectively

2Manage resources effectively.

3Scan a multitu

de of

information and decide

what is im

portant.

4Decide how to manage multip

le tasks.

5Organize the work when

directions are not specific.

1Manage tim

e effectively

Rating Sheet

102 ideas were sorted into

groups

102 ideas were sorted into

groups

Work quickly and effectively

under pressure

49

Organize the work when

directions are not specific.

39

Decide how to manage multiple

tasks.20 Manage resources

effectively.4

Conceptual Framework: Mobility and Older Adults

Housing andAccessibility

Policy

CoordinatedAction

Community Supports

Training

Research to Practice

Transportation

Built Environmentand Safety

Independenceand Engagement

Independence and EngagementIdentify one or more communities to serve as environmental models or as examples of mobility-sensitive or friendly communities.

Engage community volunteers in conducting walkability audits. Actively encourage recognition of and planning for older adults to continue to be active in the years when mobility will be limited.

Make available a variety of evidence-based physical activity and fall prevention/education programs, both in-home and in community based settings, that can be scaled for different locales or communities.

Identify and support physical activity programs that can accommodate people aging with disabilities.

Support the use of programs for exercise to maintain strength and improve balance.

Encourage the use of available health self-management tools, like online, buddy systems, in person support and information, group support and so on.

Identify and promote critical programs related to driving and older adults, including persons with cognitive and physical limitations.

Encourage ways to promote intergenerational physical activity and connection to family, friends and community to provide social supports.

Encourage shops or large retail or entertainment locations to provide and support mobility options for their customers.

Repurpose locations like community centers so they can better serve the needs of adults and persons with disabilities.

Coordinated ActionInclude mobility and older adults in coordinated chronic disease prevention and health promotion state plans.

Engage older adults, though interactive participatory methods, in voicing their strengths and priorities in promoting mobility. Implement a certification process for age-friendly communities.

Partner with state coalitions on fall prevention to identify community safety activities that may be useful for local communities.

Encourage states to develop, implement and evaluate their own physical activity plans modeled after the National Physical Activity Plan.

Public awareness campaigns about the benefit of physical activity for older adults that include a call to participation and action for older adults.

Identify and support a guide for smaller towns that want to adopt a bike/ped master plan for their town.

Work with schools and others to seek opportunities for intergenerational connections, like reciprocal tutoring and volunteering.

Develop a comprehensive, multi-faceted approach to healthy aging, coordinated across agencies, through information and assistance and care coordination.

Encourage states to develop, implement and evaluate their own fall prevention plans modeled after the National Fall Prevention Plan.

In what programmatic or functional areas are you most fully integrating the perspectives and needs of older adults?

WE WANT TO HEAR FROM YOU . . .

AARP Livable Communities:Great Places for All AgesAmy LevnerMarch 28, 2013

The Challenge

AARP Livable Communities Vision

1961 White House Council on Aging

Creating Communities for ALL Ages

aarp.org/livable

AARP Network of Age Friendly Communities

AARP State Work

Kingsport, TN

AARP State work

WE WANT TO HEAR FROM YOU . . .

Do you include the perspective of older adults in your chronic disease efforts around mobility?

Healthy Aging Mobility Scan:An Assessment of State Mobility Work

Cheryl Schott, MPHCheryl Schott, MPH

Consultant, Michigan Public Health InstituteConsultant, Michigan Public Health Institute

National Association of Chronic Disease DirectorsNational Association of Chronic Disease Directors

General Member CallGeneral Member Call

March 28March 28thth, 2013, 2013

Scope of Work/Methods

Reviewed ten state health department websites:

Searched: 1) A-Z index/site maps, 2) Homepages, 3) Website search engine

Particular attention given to physical activity, walking, obesity prevention, arthritis, disability, fall prevention, transportation, and healthy/livable communities programs

Relevant URL’s and sub-links, summary of findings, and key documents were recorded on a search log and document review form

• Arkansas• California• Florida• Kansas• Michigan

• New York• North Carolina• Texas• Vermont• Washington State

Findings

All states reviewed are actively involved in policy and environmental efforts to promote healthy communities

Strategies include:

Changes to the built environment

Adopting Complete Streets policies

Improving public transportation

Promoting access and safety

Developing joint-use agreement

Older adults are recognized as a special population in several states’ plans and reports

Inclusion of strategies specific to the aging population varies

Examples: Older Adults

Built Environment

Healthy Kansas Community Assessment and Planning Tool includes considerations for older adults and people with disabilities such as:

wheelchair access

resting space for pedestrians

visual/sound signals at cross-walks

assistance with snow/ice removal

in-door walking programs

Photo credit: Dan Burden, www.pedbikeimages.org

Walkable Communities

California Walkable Neighborhoods for Seniors project provides workshops on how to make communities more walkable for seniors and offers local walking groups

The Arkansas Department of Health and Arkansas Coalition for Obesity Prevention (ArCop) has partnered with AARP to conduct Active Living Workshops and walkability assessments as part of their Growing Healthy Communities initiative

Photo credits: Luciano Rizzi and Dan Burden, www.pedbikeimages.org

Examples: Older Adults

Supports community efforts to conduct assessments and initiate improvements to make communities more elder friendly and livable for all ages

Florida, Michigan and North Carolina are among the states with such programs

Administered by state aging departments, versus public health, although they may collaborate on certain components

Communities For A Lifetime/Aging in Place

Transportation

California Health in All Policies Task Force addresses transportation issues for the aging population

Plans to model future transit access to essential destinations

Sponsors an annual Senior Safe Mobility Summit

Provides training to healthcare professionals on assessing older adults’ functional driving skills

A few states (e.g. Kansas, Texas, Vermont) address access to health care or other services by promoting transportation assistance for those in need

Photo credit: Dan Burden, www.pedbikeimages.org

Arthritis, Disability & Fall Prevention

Most states reviewed also address mobility issues through arthritis, disability, and/or fall prevention programs

Primarily address personal mobility such as activity limitations (e.g., trouble walking, climbing stairs, activities of daily living)

Kansas Arthritis Program promotes changes to the built environment to facilitate physical and social activity among people with arthritis; disability program promotes community improvement of non-automobile travel systems (e.g., sidewalks, curb cuts, etc.) for people with disabilities

Surveillance/Data Collection

BRFSS data on activity limitations (e.g., trouble walking short distance, climbing stairs) among people with arthritis or disabilities

Fall injury and mortality data among older adults

Percent of older adults who engage in recommended amounts of physical activity

Michigan - limited data on the use of local trails and parks among older adults (collected through an evaluation of their Building Healthy Communities program)

In development - policy, environmental and built environment indicators promoting mobility

Any questions?

WE WANT TO HEAR FROM YOU . . .

What partnerships do you use to promote active communities for older adults?

WE WANT TO HEAR FROM YOU . . .

What challenges do you face when integrating mobility into new or existing programs?

WE WANT TO HEAR FROM YOU . . .

Call for Papers

Special Supplemental Issue Health Education & Behavior

Fostering Engagement and Independence: Opportunities and Challenges for an Aging Society

Guest Editors: Lynda A. Anderson, PhD and Thomas R. Prohaska, PhD

250-word abstract describing the manuscript by May 20, 2013

Submit to Debbie Gordon Messer at heathy.aging.heb@gmail.com

Email follow-up to be sent with additional information

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

For more information about the Healthy Aging Program: Visit www.cdc.gov/agingTelephone: 770 488-5360

Division of Population Health

National Center for Chronic Disease Prevention and Health Promotion