Week 8: The Concept of Healthy Aging

Question 1

Health (WHO)

Answer 1

“A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

Question 2

Healthy Aging definition

Answer 2

“the process of developing and maintaining the functional ability that enables wellbeing in older age”
- life with FULL CAPACITY, not just without disease

Question 3

What constitutes remaining physically/socially/mentally healthy?
(BBL? Call Me.)

Answer 3

• Be mobile
• Build and maintain relationships
• Learn, grow, and make decisions
• Contribute to society
• Meet basic needs

Question 4

What is a large proportion of differences in capacity in older age is due to?

Answer 4

cumulative (life course) impacts of advantage and disadvantage across people’s lives

Question 5

T or F: Healthy aging starts in old age

Answer 5

F: starts @birth

Question 6

4 key considerations in healthy aging
(DINQ)

Answer 6

1. DIFFERENCES in capacity = due to the cumulative life course impacts (+ , -) across people’s lives
   - relationships w environment (shaped by SDH)
2. INTERVENTION is possible
   - big picture
   - identify harmful factors & target
3. NO typical older person
   - goal = improve functional ability of all
4. QOL is focus of improvement, not only lengthening life

Question 7

Rank the following on individual, societal, and policymaker levels
- Healthy Aging
- Successful Aging
- Aging Well

Answer 7

Successful Aging: Individual Health
Healthy Aging: Society
Aging Well: policymakers

Question 8

Successful aging = low _________ & high _________

Answer 8

• Low chance of chronic conditions and disability
• High mental, physical, and social functioning

Question 9

Indicators of healthy aging
(Frank Pls Stop Pressuring Carl)

Answer 9

Functioning and disability
Physical activity
Social engagement and contribution
Prevalence of chronic diseases and multi-morbidity
Cognitive capability

Question 10

what is aging in place

Answer 10

a policy to keep established social connection, continuous use of resources, no need to (many) additional direct individual-based interventions
- Older adults strive to live in their family home unless forced to move

Question 11

T or F: aging in place includes adaptations needed as situations (health, financial, family) change

Answer 11

T: ex. redesigning bathrooms and kitchens

Question 12

what order does design/evaluation of an intervention occur in
- effectiveness studies
- efficacy studies
- dissemination & implementation studies
- determinant studies

Answer 12

1. determinant studies
   (lack of walkable places = determinant of inactivity)
2. efficacy studies
   (experiment to see walkable places influence activity)
3. effectiveness studies
   (are walkable places rly helpful @population level?)
4. dissemination & implementation studies
   a. translation to policy
   b. adaption to various populations

Question 13

Why don’t some interventions work?

Answer 13

1. evidence = wrong
2. implementation = wrong
3. modifications = wrong
   - “experts” thinking they’re better than science

Question 14

Characteristics of a good intervention

Answer 14

1. Clear and specific goals
2. Focuses on a particular sub-population of elderly
3. Intervention is clearly defined
4. Outcome is measurable

Question 15

Core principles of social/behavioral aspects on aging that have implications on aging interventions
(HAAT)

Answer 15

1. Heterogeneity of the older population
   
   • variability in health & function, experiences & exposures
2. Aging as a life course phenomenon
   
   • No single chronological marker of old age
3. Aging and the social context
   
   • How one grows old depends what country they’re in
     (industrialized, prosperous)
   • unique age cohorts have common defining experiences
4. The potential for intervention
   
   • “never too late” to make changes that can influence
     ones life trajectory

Question 16

Almeida County Study’s 5 practices generally associated with longer/healthier lives

Answer 16

1. Avoiding smoking
2. Exercising regularly
3. Maintaining a healthy body weight
4. Sleeping between 7-8 hours nightly
5. Limiting consumption of alcoholic drinks

Question 17

T or F: healthy aging interventions aim at lengthening remaining years of life

Answer 17

F: Quality of remaining years of life

Question 18

What is one of the most salient risk factors for health and longevity, linked to onset and progression of most chronic conditions

Answer 18

Physical Activity

Question 19

Why are elderly (on average) the least physically active of any age group

Answer 19

stereotypes that exercise is harmful, has fewer benefits, they’re unwilling or unable to change lifestyle habits

Question 20

Essential elements needed for successful programs

Answer 20

• Social support
• Self-efficacy
• Active choices
• Health contracts
• Regular performance feedback
• Positive reinforcement

Question 21

There is an importance of SDH for understanding variance in health across populations/settings, what is a key risk factor?

Answer 21

ZIP code

Question 22

Walking environment @macro and micro/meso levels

Answer 22

Macro level: principles associated with population benefits
- supporting mixed land use
- creating walkable neighborhoods
- attractive communities with sense of pride
- variety of transportation options

Micro/Meso level: modifiable environmental designs to influence neighborhood walkability
- Access to services, aesthetics, traffic hazards, crime
- Safety + cohesion = major factor in walkability

Question 23

what 2 things are associated with walking for exercise

Answer 23

Functional capacity & environmental demands

Question 24

Research has turned towards ____ studies to identify the impact of interventions

Answer 24

efficacy

Question 25

Continuum in research translation

Answer 25

problem identification and risk factor correlation → testing/creating interventions → dissemination and scalability → sustainability of intervention effort

Question 26

4 fundamental Qs guiding research translation based on existing evidence

Answer 26

1. Types & levels of lifestyle behaviors related to the problem of interest? 2. Health benefits/consequences of these lifestyle behaviors ? 3. Interventions have been created/ tested that have been proven to work? Criteria used to evaluate their success? 4. Factors most effective in ensuring successful translation and broader dissemination of programs with demonstrated efficacy and effectiveness?

Question 27

The _____ movement is used to promote/deliver/embed evidence-based programs in communities (USA)

Answer 27

Evidence-based

Question 28

What 2 factors are being introduced as critical, making the biopsychosocial model no longer sufficient?

Answer 28

genetics & environment

Question 29

what is the silo approach

Answer 29

researchers tend to specialize on one component, not collaborating with each other

Question 30

Evidence-based programs have 2 components @macro level: therapeutic element & the delivery mechanism, explain

Answer 30

Therapeutic elements: focus on behavioral risk factors (exercise, diet, stress reduction, smoking cessation) Delivery mechanism: means by which elderly are motivated to implement/maintain appropriate health practices

Question 31

______ of interventions is necessary to disseminate known benefits to new populations/settings - Make necessary modifications to content/format to meet new objectives while maintaining essential elements from original program needed for success

Answer 31

Translation

Question 32

Successfully translated intervention =

Answer 32

capable of achieving same outcomes as original intervention while also yielding new information

Question 33

what is precision health

Answer 33

have therapeutic elements but are tailored to better align with needs/beliefs/values of target population

Question 34

Treatment fidelity

Answer 34

degree that an intervention is delivered in the way it was originally intended - ensures intervention outcomes observed are a result of the intervention model and its implementation

Question 35

Lack of fidelity

Answer 35

= effectiveness is questionable, outcomes may be due to external factors

Question 36

Program drift - how this can happen in a + or - way

Answer 36

slight modifications (intentional or unintentional) that result in less than perfect replication and program delivery - Occurs when intervention is delivered over a period of time or in multiple settings (+) when program developers attempt to scale up their dissemination efforts (-) health professional facilitates and modifies content because they "know better" than program manual

Question 37

scalability

Answer 37

Increasing # of people served by a program (scaling up)

Question 38

Only a certain # of individuals can be served by a given intervention given specified budget - strategies to enhance scalability?

Answer 38

1. Reduce/eliminate content deemed unnecessary for program success, retaining only essential elements 2. Change participant by having each individual have a certain demographic characteristic, health status, or reside within a geographic location - Help ensures those who will benefit most will be enrolled while others are not actively recruited

Question 39

Community-based participatory research (CBPR)

Answer 39

= strong strategy for planning initial program and long-term sustainability - Way of engaging community organizations/stakeholders to understand context and climate of program - help identify and meet community priorities by selecting appropriate interventions

Question 40

Strategies to enhance sustainability:

Answer 40

1. Identify an innovative partner who can help advance intervention delivery within community - ex. program targeting elderly delivered in senior centers 2. leverage: funds, target populations, referrals - budget can go further when enhanced with partnerships vs subjected to additional competition - Participants should be shared and served collectively - Avoid wasting funds on duplicated services by relying on community partners

Question 41

conquer silo approach by facilitating _______ integration

Answer 41

community-clinical ex. After clinical-based intervention, patients can be referred to community-based fall-prevention programs

Question 42

Major concern with policy = whether we can can IMPLEMENT what is known to work ... how to conquer?

Answer 42

1. Design intervention with end user in mind - Community participatory approach w stakeholders involved 2. Secure funding stream to support intervention after initial testing and first-phase dissemination

Question 43

T or F: typically quick from discovery to wide-spread dissemination

Answer 43

F: Long lag time between discovery and wide-spread dissemination