1
|
Wright DS, Zhou B, Wright CX, Axtell RS, Mangi A, Safdar B. Association Between Exercise Program Participation and Hospitalization of Older Adults. Am J Prev Med 2024:S0749-3797(24)00295-2. [PMID: 39218409 DOI: 10.1016/j.amepre.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Government and insurance sponsored exercise programs have demonstrated decreased hospitalizations, but it is unclear if this is the case for self-referred programs. METHODS In this retrospective cohort study from 2013 to 2020, older adults who participated for at least three months at a community-based exercise center (participants) were compared with those who did not (nonparticipants). Each completed a baseline physical assessment and periodic reassessments thereafter. These data were paired with regional hospital data and a national mortality database. Statistical analysis and modeling were performed from 2020 to 2023. Survival to all-cause hospitalization was assessed with a priori subgroup comparison by gender and cox proportional hazard modeling by age, gender, and comorbidities. RESULTS The cohort included 718 adults, mean age 69.5 years (SD 8.4), with 411 (57.2%) participants and 307 nonparticipants. Mean follow-up was 26.7 months. Participants had similar baseline measures of fitness (p>0.05) but were more likely to be retired and less likely to have diabetes or prior stroke than nonparticipants. Sustained participation was associated with a reduced rate of all-cause hospitalization (9.0% vs. 12.7%, p=0.02), even when adjusted (HR 0.54; 95% CI 0.34, 0.87, p=0.01). This decrease was noted only in women (p=0.03) but not in men (p=0.49), gender was nonsignificant after adjustment for comorbidities (p=0.15). CONCLUSIONS Exercise program participation was independently associated with decreased risk of all-cause hospitalization, with possible differential effects by gender. Further randomized trials of the benefits of personalized exercise programs are warranted to assess sex- and gender-specific effects.
Collapse
Affiliation(s)
- Donald S Wright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Bin Zhou
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Catherine X Wright
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert S Axtell
- Department of Health and Movement Science, Southern Connecticut State University, New Haven, Connecticut
| | - Abeel Mangi
- Department of Cardiac Surgery, Nuvance Health System, Poughkeepsie, New York
| | - Basmah Safdar
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
| |
Collapse
|
2
|
Howland J, Peterson EW. The critical role of primary care health care professionals in referring older adults to community-based fall prevention programs. Front Public Health 2024; 12:1377972. [PMID: 38544734 PMCID: PMC10965610 DOI: 10.3389/fpubh.2024.1377972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/04/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Jonathan Howland
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Elizabeth W. Peterson
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
| |
Collapse
|
3
|
Coyle P, Tripken J, Perera S, Juarez GA, Spencer-Brown L, Cameron K, Brach JS. Dissemination and implementation of evidence-based programs for people with chronic disease: the impact of the COVID-19 pandemic. Front Public Health 2024; 11:1276387. [PMID: 38274541 PMCID: PMC10808618 DOI: 10.3389/fpubh.2023.1276387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we describe the implementation of evidence-based chronic disease self-management education (CDSME) programs by the Administration for Community Living CDSME Grantees during 2016-2022 and we also explore the impact of the COVID-19 pandemic on implementation. Methods Grantees collected data before and after the implementation of the CDSME programs and contributed to the national data repository. Data components included workshop information, participant information, and organizational data. Results The cohort consisted of 175,973 individuals who participated in 34 CDSME programs across 45 states. Participants had a mean ± SD age of 66.1 ± 14.8 years, were primarily female (65.9%) and had a mean ± SD of 2.6 ± 2.3 chronic conditions. Compared to the pre-COVID-19 strata, those who participated during COVID-19 were on average 1.5 years younger and had slightly less comorbidities. For individuals who had pre and post program self-reported health, 65.3% stayed the same, 24.4% improved, and 10.3% worsened (p < 0.001) after participating in CDSME programs. Conclusion CDSME offers a variety of programs across a broad geographic area to a diverse set of older adults in the US, underscoring the expansive reach of this public health initiative. COVID-19 appears to have shifted participant reach toward a slightly younger and healthier population. Finally, these programs appear to be effective in improving participants' self-rated health. However, these results should be interpreted with caution, given limitations due to missing data and the observational nature of this study design.
Collapse
Affiliation(s)
- Peter Coyle
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer Tripken
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Subashan Perera
- Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gardenia A. Juarez
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Kathleen Cameron
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
4
|
Chandrashekhar A, Thakur HP. Efficacy of Government-Sponsored Community Health Programs for Older Adults: A Systematic Review of Published Evaluation Studies. Public Health Rev 2022; 43:1604473. [PMID: 36211228 PMCID: PMC9537370 DOI: 10.3389/phrs.2022.1604473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/02/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: Population aging is an ongoing challenge for global health policy and is expected to have an increasing impact on developing economies in years to come. A variety of community health programs have been developed to deliver health services to older adults, and evaluating these programs is crucial to improving service delivery and avoiding barriers to implementation. This systematic review examines published evaluation research relating to public and community health programs aimed at older adults throughout the world. Methods: A literature search using standardized criteria yielded 58 published articles evaluating 46 specific programs in 14 countries. Results: Service models involving sponsorship of comprehensive facilities providing centralized access to multiple types of health services were generally evaluated the most positively, with care coordination programs appearing to have generally more modest success, and educational programs having limited effectiveness. Lack of sufficient funding was a commonly-cited barrier to successful program implementations. Conclusion: It is important to include program evaluation as a component of future community and public health interventions aimed at aging populations to better understand how to improve these programs.
Collapse
|
5
|
Oliveira A, Vale W, da Silveira A, de Carvalho L, Lattari E, Pancoti B, Maranhão Neto G. Frequency of leisure-time physical activity and pulse pressure in the Brazilian population: a population-based study. Public Health 2022; 209:39-45. [DOI: 10.1016/j.puhe.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/16/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
|
6
|
Díaz-Benito VJ, Barriopedro Moro MI, Clemente Remón ÁL, Santacruz Lozano JA, Hervás Pérez JP, Vanderhaegen F. Effects of worksite exercise intervention (PRODET®) on well-being at work and capability in performing work-related sedentary tasks: A pilot study. Work 2022; 72:909-920. [DOI: 10.3233/wor-205340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Companies have tried to carry out interventions in order to mitigate the risks associated with losses in productivity and the health of employees. OBJECTIVE: This intervention trial evaluated the effect of a supervised exercise intervention based on aerobic capacity and strength on well-being at work and capability in performing work tasks. METHODOLOGY: The sample was composed of 67 participants (N = 67, mean age 34.31 years) and investigated a 12-week group physical exercise program in the workplace, two days per week for 50 minutes, which was supervised and based on aerobic endurance and strength. The 67 subjects were working-age office workers, deemed sedentary and randomized into an intervention (N = 40) or control (N = 27) group. Among them, 33 were men (N = 33; 49.25%) and 34 were women (N = 34, 50.75%). Outcomes were assessed pre- and post-test in both groups. The Mann-Whitney U and Chi-Square tests were performed to compare the characteristics of the intervention and control group. η2 = z/(n-1) was calculated as effect size rates. RESULTS: The program showed statistically significant effects on strength endurance (P = 0.020, η2 = 0.08), the loss of fat percentage (P = 0.015, η2 = 0.09), lower limb power (P = 0.020, η2 = 0.08) and QoL (P = 0.0001, η2 = 0.39 for the physical health outcome, and P = 0.0001, η2 = 0.35 for the outcome of total scores of mental health). CONCLUSIONS: The intervention had an impact on the endurance, fat percentage loss and QoL of the workers whose occupations were based on sedentary tasks.
Collapse
Affiliation(s)
- Vıctor Jiménez Díaz-Benito
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Marıa Isabel Barriopedro Moro
- Applied Psychosocial Research Group, Physical Activity and Sports Sciences, Technical University of Madrid, Madrid, Spain
| | - Ángel Luis Clemente Remón
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | | | - Juan Pablo Hervás Pérez
- Department of Physiotherapy, Faculty of Health, Camilo Jos\'{e} Cela University, Madrid, Spain
| | - Frederic Vanderhaegen
- LAMIH, UMR CNRS 8201, Polytechnic University of Hauts-de-France, Valenciennes, France
- INSA Hauts-de-France, Valenciennes, France
| |
Collapse
|
7
|
Association between Age-Friendliness of Communities and Frailty among Older Adults: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127528. [PMID: 35742777 PMCID: PMC9224492 DOI: 10.3390/ijerph19127528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/07/2023]
Abstract
An age-friendly environment is one of the measures of healthy aging. However, there is scarce evidence of the relationship between the age-friendliness of communities (AFC) and frailty status among Chinese older adults. This study aims to examine this relationship using a multilevel analysis with the data of a cross-sectional study conducted among 10,958 older adults living in 43 communities in four cities in China. The validated Age-friendly Community Evaluation Scale and Chinese frailty screening-10 Scale (CFS-10) were used to measure AFC and Frailty. Multilevel regression analyses were performed to examine the relationship between the AFC in two assessments of individual- and community-level and frailty status. After controlling for individual-level socio-demographic, health status, and lifestyle variables, compared with older adults in the lowest quartile of the individual-level perception of AFC, the frailty odds ratios for those in the top three quartiles were 0.69 (95% confidence interval [CI]: 0.56–0.83), 0.75 (95% CI: 0.61–0.91), and 0.56 (95% CI: 0.48–0.74). However, there was no association between the community-level AFC and frailty. A higher level of age-friendliness in the community is associated with lower frailty odds. Therefore, building age-friendly communities may be an important measure to prevent frailty among Chinese older adults.
Collapse
|
8
|
Vincenzo JL, Hergott C, Schrodt L, Perera S, Tripken J, Shubert TE, Brach JS. Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs. Front Public Health 2021; 9:672366. [PMID: 34249840 PMCID: PMC8267879 DOI: 10.3389/fpubh.2021.672366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: Physical therapists (PTs) are integral team members in fall prevention in clinical settings; however, few studies have investigated PTs' engagement in pro-bono community-based falls prevention. Therefore, we aimed to describe the characteristics of PTs and physical therapist assistants (PTAs) in the United States who conduct community-based fall screenings, the reach of screenings, their knowledge and utilization of the Centers for Disease Control and Prevention's fall-risk screening toolkit (STEADI, Stopping Elderly Accidents, Deaths, and Injuries), and therapists' knowledge and referrals to evidence-based programs (EBPs) and community resources. Methods: A cross-sectional survey distributed to a convenience sample of PTs/PTAs in the United States through news-blasts, and social media. Results: Four hundred and forty-four therapists who worked with older adults completed the survey. Approximately 40% of the respondents (n = 180) conduct screenings, most frequently annually. People who screen tend to be PTs with >20 years of experience, work in outpatient/wellness or academia, and be involved in the least amount of direct patient care. The majority (n = 344, 77.5%) of survey respondents were somewhat to very familiar with the STEADI, and ~84% (n = 114) of respondents who were very familiar with the STEADI (n = 136) use the toolkit to conduct community-based, pro-bono fall risk screenings. Twenty-six percent (n = 14) out of the 53 PTAs who responded to the survey conduct falls screenings in the community. Of the PTs/PTAs who conduct community-based fall screenings (n = 180), ~ 75% (n = 136) are aware of and refer older adults to EBPs. Over half also refer to Silver Sneakers and/or senior centers. Discussion: PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community. Data helps inform community organizations that most PTs who engage in community-based fall risk screening utilize the STEADI toolkit and refer to community-based programs. Community organizations seeking PT partners to engage in fall risk screenings and promote referrals to local resources or EBPs will likely have the most success collaborating with local physical therapy education programs or physical therapy clinic managers.
Collapse
Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, United States
| | - Colleen Hergott
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
| | - Lori Schrodt
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC, United States
| | - Subashan Perera
- Department of Physical Therapy, University of Pittsburg, Pittsburg, PA, United States
| | - Jennifer Tripken
- Center for Healthy Aging, National Council on Aging, Washington, DC, United States
| | - Tiffany E Shubert
- University of North Carolina Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburg, Pittsburg, PA, United States
| |
Collapse
|
9
|
Coughlan D, Saint-Maurice PF, Carlson SA, Fulton J, Matthews CE. Leisure time physical activity throughout adulthood is associated with lower medicare costs: evidence from the linked NIH-AARP diet and health study cohort. BMJ Open Sport Exerc Med 2021; 7:e001038. [PMID: 33768963 PMCID: PMC7938970 DOI: 10.1136/bmjsem-2021-001038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/12/2023] Open
Abstract
Background There is limited information about the association between long-term leisure time physical activity (LTPA) participation and healthcare costs. The purpose of this study was to investigate the association between LTPA over adulthood with later life healthcare costs in the USA. Methods Using Medicare claims data (between 1999 and 2008) linked to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, we examined associations between nine trajectories of physical activity participation throughout adulthood with Medicare costs. Results Compared with adults who were consistently inactive from adolescence into middle age, average annual healthcare costs were significantly lower for maintainers, adults who maintained moderate (–US$1350 (95% CI: –US$2009 to –US$690) or −15.9% (95% CI: −23.6% to −8.1%)) or high physical activity levels (–US$1200 (95% CI: –US$1777 to –US$622) or −14.1% (95% CI: −20.9% to −7.3%)) and increasers, adults who increased physical activity levels in early adulthood (–US$1874 (95% CI: US$2691 to –US$1057) or −22.0% (95% CI: −31.6% to −12.4%)) or in middle age (–US$824 (95% CI: –US$1580 to –US$69 or −9.7% (95% CI −18.6% to −0.8%)). For the four trajectories where physical activity decreased, the only significant difference was for adults who increased physical activity levels during early adulthood with a decline in middle age (–US$861 (95% CI:–US$1678 to –US$45) or −10.1% (95% CI: −19.7% to −0.5%)). Conclusion Our analyses suggest the healthcare cost burden in later life could be reduced through promotion efforts supporting physical activity participation throughout adulthood.
Collapse
Affiliation(s)
- Diarmuid Coughlan
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Surveillance Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Pedro F Saint-Maurice
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Susan A Carlson
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Fulton
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| |
Collapse
|
10
|
Coyle PC, Perera S, Albert SM, Freburger JK, VanSwearingen JM, Brach JS. Potential long-term impact of "On The Move" group-exercise program on falls and healthcare utilization in older adults: an exploratory analysis of a randomized controlled trial. BMC Geriatr 2020; 20:105. [PMID: 32178633 PMCID: PMC7075006 DOI: 10.1186/s12877-020-1506-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background Wellness program participation may reduce the risk of falling, emergency department-use, and hospitalization among older adults. “On the Move” (OTM), a community-based group exercise program focused on the timing and coordination of walking, improved mobility in older adults, but its impact on falls, emergency department-use, and hospitalizations remains unclear. The aim of this preliminary study was to investigate the potential long-term effects that OTM may have on downstream, tertiary outcomes. Methods We conducted a secondary analysis of a cluster-randomized, single-blind intervention trial, which compared two community-based, group exercise programs: OTM and a seated exercise program on strength, endurance, and flexibility (i.e. ‘usual-care’). Program classes met for 50 min/session, 2 sessions/week, for 12 weeks. Older adults (≥65 years), with the ability to ambulate independently at ≥0.60 m/s were recruited. Self-reported incidence of falls, emergency department visitation, and hospitalization were assessed using automated monthly phone calls for the year following intervention completion. Participants with ≥1 completed phone call were included in the analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated (reference = usual-care). Results Participants (n = 248) were similar on baseline characteristics and number of monthly phone calls completed. Participants in the seated exercise program attended an average of 2.9 more classes (p = .017). Of note, all results were not statistically significant (i.e. 95% CI overlapped a null value of 1.0). However, point estimates suggest OTM participation resulted in a decreased incidence rate of hospitalization compared to usual-care (IRR = 0.88; 95% CI = 0.59–1.32), and the estimates strengthened when controlling for between-group differences in attendance (adjusted IRR = 0.82; 95% CI = 0.56–1.21). Falls and emergency department visit incidence rates were initially greater for OTM participants, but decreased after controlling for attendance (adjusted IRR = 1.08; 95% CI = 0.72–1.62 and adjusted IRR = 0.96; 95% CI = 0.55–1.66, respectively). Conclusion Compared to a community-based seated group exercise program, participation in OTM may result in a reduced risk of hospitalization. When OTM is adhered to, the risk for falling and hospitalizations are attenuated. However, definitive conclusions cannot be made. Nevertheless, it appears that a larger randomized trial, designed to specifically evaluate the impact of OTM on these downstream health outcomes is warranted. Trial registration Clinical trials.gov (NCT01986647; prospectively registered on November 18, 2013).
Collapse
Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE, USA. .,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Subashan Perera
- Department of Medicine (Division of Geriatric Medicine), University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
11
|
Lobelo F, Muth ND, Hanson S, Nemeth BA. Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics 2020; 145:peds.2019-3992. [PMID: 32094289 DOI: 10.1542/peds.2019-3992] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.
Collapse
Affiliation(s)
| | - Natalie D Muth
- Children's Primary Care Medical Group, Carlsbad, California; and
| | - Sara Hanson
- Nutrition and Health Sciences Program, Laney Graduate School and Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Blaise A Nemeth
- American Family Children's Hospital and School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | | | | |
Collapse
|
12
|
Smith KC, Losina E, Messier SP, Hunter DJ, Chen AT, Katz JN, Paltiel AD. Budget Impact of Funding an Intensive Diet and Exercise Program for Overweight and Obese Patients With Knee Osteoarthritis. ACR Open Rheumatol 2020; 2:26-36. [PMID: 31943972 PMCID: PMC6957917 DOI: 10.1002/acr2.11090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Diet and exercise (D+E) for knee osteoarthritis (OA) is effective and cost‐effective. However, cost‐effectiveness does not imply affordability; the impact of knee OA–specific D+E programs on insurer budgets is unknown. Methods We estimated changes in undiscounted medical expenditures (2016 US dollars) with and without a D+E program. We accounted for both additional program outlays and potential savings from reduced use of other knee OA treatments and from reduced incidence of comorbidities. We adopted the perspective of a representative commercial insurance plan covering 200 000 individuals aged 25 to 64 years and a representative Medicare Advantage plan covering 200 000 Medicare‐eligible individuals aged 65 years and older. We used the Osteoarthritis Policy Model, a validated microsimulation model of knee OA, to model D+E efficacy (measured by pain and weight reduction), adherence, and price based on the Intensive Diet and Exercise for Arthritis (IDEA) trial. In sensitivity analyses, we varied time horizon, D+E efficacy, and D+E price. Results Over 3 years, the D+E program increased spending by $752 200 ($0.10 per member per month [PMPM]) in the commercial plan and by $6.0 million ($0.84 PMPM) in the Medicare plan. Over 3 years, the D+E program reduced opioid use by 6% and 5% and reduced total knee replacements by 5% and 4% in the commercial and Medicare plans, respectively. Expenses were higher in the Medicare plan because it had more patients with knee OA than the commercial plan. Conclusion Although there is no established threshold to define affordability, a D+E program for knee OA would likely produce expenditures comparable with outlays for other health‐promotion interventions.
Collapse
Affiliation(s)
- Karen C. Smith
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe)Brigham and Women's HospitalBostonMassachusetts
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe)Brigham and Women's HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Stephen P. Messier
- J.B. Snow Biomechanics LaboratoryWake Forest UniversityWinston‐SalemNorth Carolina
| | | | - Angela T. Chen
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe)Brigham and Women's HospitalBostonMassachusetts
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe)Brigham and Women's HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | | |
Collapse
|
13
|
Schousboe JT, Vo TN, Kats AM, Langsetmo L, Diem SJ, Taylor BC, Strotmeyer ES, Ensrud KE. Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity. J Am Geriatr Soc 2019; 67:1596-1603. [PMID: 30903701 DOI: 10.1111/jgs.15881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity. DESIGN Prospective cohort study (Study of Osteoporotic Fractures [SOF]). SETTING Four US sites. PARTICIPANTS A total of 2508 community-dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data. MEASUREMENTS At Y10, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0-5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data. RESULTS Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0-1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2-5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self-reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14-1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99-1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms). CONCLUSION Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596-1603, 2019.
Collapse
Affiliation(s)
- John T Schousboe
- Department of Rheumatology, Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Tien N Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Allyson M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Susan J Diem
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| | - Brent C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| |
Collapse
|
14
|
Lobelo F, Rohm Young D, Sallis R, Garber MD, Billinger SA, Duperly J, Hutber A, Pate RR, Thomas RJ, Widlansky ME, McConnell MV, Joy EA. Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e495-e522. [DOI: 10.1161/cir.0000000000000559] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association’s My Life Check - Life’s Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association’s 2020 Impact Goals.
Collapse
|
15
|
Pratt SI, Jerome GJ, Schneider KL, Craft LL, Buman MP, Stoutenberg M, Daumit GL, Bartels SJ, Goodrich DE. Increasing US health plan coverage for exercise programming in community mental health settings for people with serious mental illness: a position statement from the Society of Behavior Medicine and the American College of Sports Medicine. Transl Behav Med 2017; 6:478-81. [PMID: 27146275 DOI: 10.1007/s13142-016-0407-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adults with serious mental illness die more than 10 years earlier than the average American. Premature mortality is due to the high prevalence of preventable diseases including cardiovascular disease and diabetes. Poor lifestyle behaviors including lack of exercise and physical inactivity contribute to the epidemic levels of obesity, diabetes, and cardiovascular disease observed among adults with serious mental illness. Not surprisingly, people with serious mental illness are among the most costly consumers of health services due to increased visits for poorly managed mental and physical health. Recent studies have demonstrated that exercise interventions based on community mental health settings can significantly improve physical and mental health in people with serious mental illness. However, current funding regulations limit the ability of community mental health settings to offer exercise programming services to people with serious mental illness. Policy efforts are needed to improve the dissemination and sustainability of exercise programs for people with serious mental illness.
Collapse
Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 105 Pleasant Street, Main Building, Dartmouth College, Concord, NH, 03301, USA.
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Mark Stoutenberg
- American College of Sports Medicine, Indianapolis, IN, USA.,Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 105 Pleasant Street, Main Building, Dartmouth College, Concord, NH, 03301, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
| |
Collapse
|
16
|
Cowper PA, Peterson MJ, Pieper CF, Sloane RJ, Hall KS, McConnell ES, Bosworth HB, Ekelund CC, Pearson MP, Morey MC. Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial. J Am Geriatr Soc 2017; 65:533-539. [PMID: 28152170 PMCID: PMC5357188 DOI: 10.1111/jgs.14567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans. DESIGN Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost. SETTING Veterans Affairs Medical Center, Durham, North Carolina. PARTICIPANTS Male veterans aged ≥70 years (n = 398). INTERVENTION An experienced health counselor provided baseline in-person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly. MEASUREMENTS Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated. RESULTS The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention, versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed. CONCLUSION Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.
Collapse
Affiliation(s)
- Patricia A Cowper
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Matthew J Peterson
- Departments of Community Health and Geriatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Carl F Pieper
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Richard J Sloane
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Katherine S Hall
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Eleanor S McConnell
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Hayden B Bosworth
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
- Health Services Research and Development Service, VA Medical Center, Durham, NC
| | - Carola C Ekelund
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Megan P Pearson
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Miriam C Morey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| |
Collapse
|
17
|
García-Albéniz X, Hsu J, Bretthauer M, Hernán MA. Effectiveness of Screening Colonoscopy to Prevent Colorectal Cancer Among Medicare Beneficiaries Aged 70 to 79 Years: A Prospective Observational Study. Ann Intern Med 2017; 166:18-26. [PMID: 27669524 PMCID: PMC5417337 DOI: 10.7326/m16-0758] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND No randomized, controlled trials of screening colonoscopy have been completed, and ongoing trials exclude persons aged 75 years or older. The Medicare program, however, reimburses screening colonoscopy without an upper age limit. OBJECTIVE To evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years. DESIGN Large-scale, population-based, prospective study. The observational data were used to emulate a target trial with 2 groups: colonoscopy screening and no screening. SETTING United States. PARTICIPANTS 1 355 692 Medicare beneficiaries (2004 to 2012) aged 70 to 79 years at average risk for CRC who used Medicare preventive services and had no previous diagnostic or surveillance colonoscopies in the past 5 years. MEASUREMENTS 8-year risk for CRC and 30-day risk for adverse events. RESULTS In beneficiaries aged 70 to 74 years, the 8-year risk for CRC was 2.19% (95% CI, 2.00% to 2.37%) in the screening colonoscopy group and 2.62% (CI, 2.56% to 2.67%) in the no-screening group (absolute risk difference, -0.42% [CI, -0.24% to -0.63%]). Among those aged 75 to 79 years, the 8-year risk for CRC was 2.84% (CI, 2.54% to 3.13%) in the screening colonoscopy group and 2.97% (CI, 2.92% to 3.03%) in the no-screening group (risk difference, -0.14% [CI, -0.41 to 0.16]). The excess 30-day risk for any adverse event in the colonoscopy group was 5.6 events per 1000 individuals (CI, 4.4 to 6.8) in the 70- to 74-year age group and 10.3 per 1000 (CI, 8.6 to 11.1) in the 75- to 79-year age group. LIMITATION CRC-specific mortality was not available, but CRC incidence and stage were studied at diagnosis. CONCLUSION Screening colonoscopy may have had a modest benefit in preventing CRC in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries. The risk for adverse events was low but greater among older persons. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- Xabier García-Albéniz
- From Harvard T.H. Chan School of Public Health, Massachusetts General Hospital, Harvard Medical School, and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts; and University of Oslo and Oslo University Hospital, Oslo, Norway
| | - John Hsu
- From Harvard T.H. Chan School of Public Health, Massachusetts General Hospital, Harvard Medical School, and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts; and University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Michael Bretthauer
- From Harvard T.H. Chan School of Public Health, Massachusetts General Hospital, Harvard Medical School, and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts; and University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Miguel A Hernán
- From Harvard T.H. Chan School of Public Health, Massachusetts General Hospital, Harvard Medical School, and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts; and University of Oslo and Oslo University Hospital, Oslo, Norway
| |
Collapse
|
18
|
Murphy SL, Robinson-Lane SG, Niemiec SLS. Knee and Hip Osteoarthritis Management: A Review of Current and Emerging Non-Pharmacological Approaches. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2016. [DOI: 10.1007/s40674-016-0054-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
19
|
Ács P, Stocker M, Füge K, Paár D, Oláh A, Kovács A. Economic and public health benefits: The result of increased regular physical activity. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
Macera CA, Cavanaugh A, Bellettiere J. State of the Art Review: Physical Activity and Older Adults. Am J Lifestyle Med 2016; 11:42-57. [PMID: 30202313 DOI: 10.1177/1559827615571897] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/18/2014] [Accepted: 01/12/2015] [Indexed: 12/31/2022] Open
Abstract
Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.
Collapse
Affiliation(s)
- Caroline A Macera
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
| | - Alyson Cavanaugh
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
| | - John Bellettiere
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
| |
Collapse
|
21
|
Anderson C, Seff LR, Batra A, Bhatt C, Palmer RC. Recruiting and Engaging Older Men in Evidence-Based Health Promotion Programs: Perspectives on Barriers and Strategies. J Aging Res 2016; 2016:8981435. [PMID: 27366330 PMCID: PMC4913010 DOI: 10.1155/2016/8981435] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 12/01/2022] Open
Abstract
Evidence-based health promotion programs are effective at reducing health risks and healthcare costs among older adults, but few men participate in the programs. This mixed methods study aimed to gain insight into the barriers to recruiting and engaging older men in evidence-based health promotion programs offered by the Healthy Aging Regional Collaborative of South Florida (HARC). Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate the findings. Themes among barriers to male participation included women outnumbering men in the implementation sites and programs, conflict between male gender roles and the programs, and preference for other activities. Themes among strategies included public support of programs by male community leaders, program advertisements featuring males, and adapting program content. Survey results supported themes identified in the focus group. Nearly 78% of the survey respondents agreed that the perception of exercise programs as feminine was a barrier and over 90% of the survey respondents believed program advertisements featuring men would increase male participation. Findings indicate that health promotion programs and recruiting strategies need to be tailored to the unique needs and preferences of older men to improve participation.
Collapse
Affiliation(s)
| | - Laura R. Seff
- Florida International University, Miami, FL 33199, USA
| | - Anamika Batra
- Florida International University, Miami, FL 33199, USA
| | - Chintan Bhatt
- Florida International University, Miami, FL 33199, USA
| | | |
Collapse
|
22
|
Bachmann JM, DeFina LF, Franzini L, Gao A, Leonard DS, Cooper KH, Berry JD, Willis BL. Cardiorespiratory Fitness in Middle Age and Health Care Costs in Later Life. J Am Coll Cardiol 2015; 66:1876-85. [DOI: 10.1016/j.jacc.2015.08.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 10/22/2022]
|
23
|
Abstract
This study examines the expected and experienced benefits among participants in Enhance®Fitness (EF), an evidence-based group physical activity program for older adults. We also describe the implications for program dissemination (reach, implementation, and maintenance) within the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Twenty semistructured interviews were conducted with EF participants enrolled from 2005 to 2012. Interviews were digitally recorded, professionally transcribed, and analyzed using a deductive approach. Participants were motivated to join EF for expected physical benefits and the social environment of a group-based class. Actualized benefits of participation included physical, social, functional, and improved self-image/sense of well-being. Participants valued the practical application of class exercises to daily activities that support independent living, such as lifting objects and completing household chores. Organizations looking to implement EF or improve existing EF classes can improve program reach, implementation, and maintenance by incorporating participants’ expressed motivations and valued benefits in program marketing and by improving organizational support to meet participant needs. EF class instructors can tailor their classes to engage participants based on their motivations. Understanding participants’ motivations and valued benefits can improve EF dissemination by meeting participant needs with tailored class offerings and organizational needs informed by participant insights that aid program sustainability.
Collapse
|
24
|
Towne SD, Smith ML, Ahn S, Altpeter M, Belza B, Kulinski KP, Ory MG. National dissemination of multiple evidence-based disease prevention programs: reach to vulnerable older adults. Front Public Health 2015; 2:156. [PMID: 25964901 PMCID: PMC4410420 DOI: 10.3389/fpubh.2014.00156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/08/2014] [Indexed: 12/21/2022] Open
Abstract
Older adults, who are racial/ethnic minorities, report multiple chronic conditions, reside in medically underserved rural areas, or have low incomes carry a high burden of chronic illness but traditionally lack access to disease prevention programs. The Chronic Disease Self-Management Program (CDSMP), A Matter of Balance/Volunteer Lay Leader (AMOB/VLL), and EnhanceFitness (EF) are widely disseminated evidence-based programs (EBP), but the extent to which they are simultaneously delivered in communities to reach vulnerable populations has not been documented. We conducted cross-sectional analyses of three EBP disseminated within 27 states throughout the United States (US) (2006-2009) as part of the Administration on Aging (AoA) Evidence-Based Disease and Disability Prevention Initiative, which received co-funding from the Atlantic Philanthropies. This study measures the extent to which CDSMP, AMOB/VLL, and EF reached vulnerable older adults. It also examines characteristics of communities offering one of these programs relative to those simultaneously offering two or all three programs. Minority/ethnic participants represented 38% for CDSMP, 26% for AMOB/VLL, and 43% for EF. Rural participation was 18% for CDSMP, 17% for AMOB/VLL, and 25% for EF. Those with comorbidities included 63.2% for CDSMP, 58.7% for AMOB/VLL, and 63.6% for EF while approximately one-quarter of participants had incomes under $15,000 for all programs. Rural areas and health professional shortage areas (HPSA) tended to deliver fewer EBP relative to urban areas and non-HPSA. These EBP attract diverse older adult participants. Findings highlight the capability of communities to serve potentially vulnerable older adults by offering multiple EBP. Because each program addresses unique issues facing this older population, further research is needed to better understand how communities can introduce, embed, and sustain multiple EBP to ensure widespread access and utilization, especially to traditionally underserved subgroups.
Collapse
Affiliation(s)
- Samuel D Towne
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health , College Station, TX , USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA
| | - SangNam Ahn
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health , College Station, TX , USA ; Division of Health Systems Management and Policy, School of Public Health, The University of Memphis , Memphis, TN , USA
| | - Mary Altpeter
- University of North Carolina at Chapel Hill , Chapel Hill, NC , USA
| | - Basia Belza
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington , Seattle, WA , USA
| | | | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health , College Station, TX , USA
| |
Collapse
|
25
|
Snyder SJ, Thompson M, Denison P. EnhanceFitness: A 20-Year Dissemination History. Front Public Health 2015; 2:270. [PMID: 25964937 PMCID: PMC4410340 DOI: 10.3389/fpubh.2014.00270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 11/21/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | - Paige Denison
- Partners in Care Foundation , San Fernando, CA , USA
| |
Collapse
|
26
|
Belza B, Petrescu-Prahova M, Kohn M, Miyawaki CE, Farren L, Kline G, Heston AH. Adoption of Evidence-Based Health Promotion Programs: Perspectives of Early Adopters of Enhance(®)Fitness in YMCA-Affiliated Sites. Front Public Health 2015; 2:164. [PMID: 25964904 PMCID: PMC4410415 DOI: 10.3389/fpubh.2014.00164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 09/12/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose To identify facilitators and barriers among early adopters of Enhance®Fitness (EF), in Young Men’s Christian Association-affiliated (Y-affiliated) sites from the perspective of program staff. EF is an evidence-based group exercise program for seniors. Methods This qualitative study used semi-structured phone interviews with 15 staff members representing 14 Y-affiliated sites. Interviews were digitally recorded, transcribed, and analyzed using qualitative content analysis informed by the RE-AIM framework. Findings Staff were, on average, 48.7 years old (SD 13.5) and had been involved with EF for 5.2 years (SD 3.1). Key themes related to facilitating adoption of EF were: match with the Y mission, support from different organizational levels, match between the target population need and EF, initial and on-going financial support, presence of champions, novelty of EF, an invitation to partner with a community-based organization to offer EF, and program-specific characteristics of EF. Key themes related to barriers interfering with EF adoption included competing organizational programs and space limitations, limited resources and expertise, and costs of offering the program. Implications Our findings identify the types of organizational support needed for adoption of evidence-based health promotion programs like EF. Recommendations for practice, research, and policy based on the findings, including assessing organizational readiness, researching late adopters, and developing revenue streams, may help facilitate program adoption. Packaging and sharing these practical recommendations could help community-based agencies and nationally networked organizations facilitate adoption of EF and other evidence-based programs.
Collapse
Affiliation(s)
- Basia Belza
- Health Promotion Research Center, University of Washington , Seattle, WA , USA ; School of Nursing, University of Washington , Seattle, WA , USA
| | | | - Marlana Kohn
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | - Christina E Miyawaki
- Health Promotion Research Center, University of Washington , Seattle, WA , USA ; School of Social Work, University of Washington , Seattle, WA , USA
| | - Laura Farren
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | - Grace Kline
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | | |
Collapse
|
27
|
Petrescu-Prahova M, Belza B, Kohn M, Miyawaki C. Implementation and Maintenance of a Community-Based Older Adult Physical Activity Program. THE GERONTOLOGIST 2015; 56:677-86. [PMID: 26035891 DOI: 10.1093/geront/gnv024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/22/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY We examine facilitators and barriers to the implementation and maintenance of Enhance®Fitness (EF), a group exercise program for older adults, at early-adopter YMCA-affiliated sites, and summarize strategies employed by EF instructors and staff to overcome challenges. DESIGN AND METHODS This qualitative study used semi-structured phone interviews with 32 instructors, staff members, and master trainers from 24 different YMCA-affiliated sites. Interviews were digitally recorded, transcribed, and analyzed with a focus on the implementation and maintenance components of the RE-AIM framework. RESULTS We identified a series of factors affecting the implementation and maintenance of EF at YMCA-affiliated sites, which can be categorized into program-specific (such as instructor training, the structure of the program, reporting requirements, and insurance coverage), and organizational (such as organizational support and infrastructure for program delivery, champions, and funding to cover the costs of program delivery). Strategies used to overcome challenges associated with these factors include identifying parts of the program that can be adapted, hiring staff and instructors that understand and support the program, and educating staff and instructors about the importance of evidence-based programs and of data collection for program evaluation. IMPLICATIONS Assessing the readiness of organizations for program delivery and the match between program goals and the needs of organizations and participants would help facilitate the successful implementation and maintenance of physical activity programs in community settings.
Collapse
Affiliation(s)
| | - Basia Belza
- Health Promotion Research Center, University of Washington, Seattle
| | - Marlana Kohn
- Health Promotion Research Center, University of Washington, Seattle
| | | |
Collapse
|
28
|
Evaluation of the duplication of staging CT scans for localized colon cancer in a Medicare population. Med Care 2014; 52:963-8. [PMID: 25226545 DOI: 10.1097/mlr.0000000000000231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND To quantify and characterize duplicated tests performed during the staging of localized colon cancer in the Medicare population. METHODS We used the SEER-Medicare linked database to select patients diagnosed with localized colon cancer between the years 1996 and 2009. We considered a patient as adequately staged after having received a colonoscopy, an abdominal computed tomography (CT) scan, and a pelvic CT scan. Abdominal and pelvic CT scans performed between complete staging and first cancer-directed treatment, if not ordered due to an acute condition, were considered duplicates. We characterized the institutions providing the tests and evaluated the association with survival using a weighted pooled logistic regression adjusted by baseline and time-varying confounders. RESULTS Of 36,291 patients with a complete staging, 2680 (7.4%) had at least 1 duplicated test. Patients receiving a duplicate had a higher comorbidity score, were more symptomatic, and had more visits to the emergency department and clinical evaluations. They also were treated with surgery less frequently and had worse survival (hazard ratio 1.22, 95% confidence interval, 1.16-1.28). The type of institution involved in the staging (nonprofit/government centers, proprietary centers, free-standing facilities) was not associated with receiving duplicated tests. CONCLUSIONS We found a low frequency of duplicated abdominal or pelvic CT scans in the staging of colon cancer in the Medicare population.
Collapse
|
29
|
Participant Variation by Delivery Site Type in an Evidence-Based Physical Activity Program. J Aging Phys Act 2014; 23:401-8. [PMID: 25134641 DOI: 10.1123/japa.2013-0252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study examined participant demographic and physical function characteristics from EnhanceFitness, an evidence-based physical activity program for older adults. The sample consisted of 19,964 older adults. Participant data included self-reported health and demographic variables, and results for three physical function tests: chair stand, arm curls, and timed up-and-go. Linear regression models compared physical function test results among eight program site types. Participants were, on average, 72 years old, predominantly female, and reported having one chronic condition. Residential site participants' physical function test results were significantly poorer on chair stand and timed up-and-go measures at baseline, and timed up-and-go at a four-month follow-up compared with the reference group (senior centers) after controlling for demographic variables and site clustering. Evidence-based health-promotion programs offered in community settings should assess demographic, health, and physical function characteristics to best serve participants' specific needs, and offer classes tailored to participant function and ability while maintaining program fidelity.
Collapse
|
30
|
Lobelo F, Stoutenberg M, Hutber A. The Exercise is Medicine Global Health Initiative: a 2014 update. Br J Sports Med 2014; 48:1627-33. [PMID: 24759911 DOI: 10.1136/bjsports-2013-093080] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A third of the world's population does not engage in recommended levels of physical activity (PA), leading to substantial health and economic burdens. The healthcare sector offers a variety of resources that can help counsel, refer and deliver PA promotion programmes for purposes of primordial, primary, secondary and tertiary prevention. Substantial evidence already exists in support of multipronged PA counselling, prescription and referral strategies, in particular those linking healthcare and community-based resources. METHODS The Exercise is Medicine (EIM) initiative was introduced in 2007 to advance the implementation of evidence-based strategies to elevate the status of PA in healthcare. In this article, we describe the evolution and global expansion of the EIM initiative, its components, their implementation, an evaluation framework and future initiative activities. RESULTS Until now, EIM has a presence in 39 countries with EIM Regional Centers established in North America, Latin America, Europe, Africa, Southeast Asia, China and Australasia. The EIM Global Health Initiative is transitioning from its initial phase of infrastructure and awareness building to a phase of programme implementation, with an emphasis in low-to-middle income countries, where 80% of deaths due to non-communicable diseases already occur, but where a large gap in research and implementation of PA strategies exists. CONCLUSIONS Broad implementation of PA counselling and referral systems, as clinical practice standard of care, has the potential to improve PA at the population level by complementing and leveraging other efforts and to contribute to achieving global targets for the reduction of inactivity and related morbidity and mortality.
Collapse
Affiliation(s)
- Felipe Lobelo
- Exercise is Medicine Research Center, American College of Sports Medicine, Indianapolis, Indiana, USA
| | - Mark Stoutenberg
- American College of Sports Medicine, Indianapolis, Indiana, USA Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Adrian Hutber
- American College of Sports Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
31
|
Farooqui MA, Tan YT, Bilger M, Finkelstein EA. Effects of financial incentives on motivating physical activity among older adults: results from a discrete choice experiment. BMC Public Health 2014; 14:141. [PMID: 24512102 PMCID: PMC3933254 DOI: 10.1186/1471-2458-14-141] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 02/04/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is extensive evidence that regular physical activity confers numerous health benefits. Despite this, high rates of physical inactivity prevail among older adults. This study aimed to ascertain if incentives could be effective in motivating physical activity through improving uptake of walking programs, either with or without an enrolment fee to cover corresponding costs. METHODS A discrete-choice conjoint survey was fielded to a national sample of older adults in Singapore. Each respondent was given ten pairs of hypothetical walking programs and asked to choose the option they preferred. Each option varied along several dimensions, including the level and type (cash, voucher, or health savings credit) of incentive and an enrolment fee. For each option, they were asked how likely they would be to join their preferred program. A random utility model (RUM) was used to analyze the responses. RESULTS Results suggest that a free 6-month program with a $500 cash incentive would generate enrolment rates of 58.5%; charging $50 to enroll lowers this to 55.7%. In terms of incentive type, cash payments were the most preferred incentive but not significantly different from supermarket vouchers. Both were preferred to health savings credits and sporting goods vouchers. Concerns of adverse selection were minimal because those who were inactive represented at least 72% of new participants for any offered program(s) and were the majority. CONCLUSIONS Study results demonstrate the potential for even modest incentives to increase program uptake among inactive older adults. Moreover, although cash was the most preferred option, supermarket vouchers, which could potentially be purchased at a discount, were a close alternative. Results also suggest that an enrolment fee is a viable option to offset the costs of incentives as it has only minimal impact on participation.
Collapse
Affiliation(s)
| | | | | | - Eric A Finkelstein
- Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
| |
Collapse
|
32
|
Page TF, Batra A, Ghouse MM, Palmer RC. Implementation cost analysis of a community-based exercise program for seniors in South Florida. Health Promot Pract 2014; 15:585-91. [PMID: 24440919 DOI: 10.1177/1524839913518221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the study was to measure the costs of implementing the EnhanceFitness program to elderly residents of South Florida. The Health Foundation of South Florida's Healthy Aging Regional Collaborative implemented EnhanceFitness as part of their initiative to make evidence-based healthy aging programs available to South Florida seniors. Cost data were collected from agencies participating in the delivery of EnhanceFitness classes in South Florida. Cost questionnaires were e-mailed to program coordinators from agencies participating in the delivery of EnhanceFitness classes. Program coordinators worked with accounting staff to complete the questionnaires. Questionnaires were returned via e-mail. Costs were presented from the perspective of participating agencies. Total costs were divided by the number of classes being offered by each agency to determine cost per class per month. Average monthly costs per class were $1,713 during the first year of implementation and $873 during the second year of implementation. The cost measurements, combined with information from the literature on cost savings attributable to EnhanceFitness participation, suggest that EnhanceFitness has the potential to generate a net societal cost savings among program participants. The results are useful for community agencies considering implementing EnhanceFitness for their populations.
Collapse
|
33
|
Hamar B, Coberley CR, Pope JE, Rula EY. Impact of a senior fitness program on measures of physical and emotional health and functioning. Popul Health Manag 2013; 16:364-72. [PMID: 23560492 DOI: 10.1089/pop.2012.0111] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The SilverSneakers fitness program is a health plan benefit for Medicare beneficiaries that provides older adults with fitness center membership, customized group exercise classes, and a supportive social environment that promotes socialization among participants. This study evaluated the impact of the SilverSneakers program on physical and emotional health and activities of daily living (ADLs). A quasi-experimental retrospective analysis compared annual survey responses from SilverSneakers members (treatment N=5586) to a matched national random sample of Medicare Advantage organization beneficiaries (comparison N=22,344) in Cohort 10 of the Medicare Health Outcomes Survey. Matching was performed based on 6 demographic and 6 disease status variables. Survey responses from 2007 and 2009 were evaluated using categorical and logistic regression analysis. The treatment group showed significantly better physical and emotional health and lower impairment in both 2007 and 2009, less impairment for 4 of 6 ADLs in 2007, and all 6 in 2009, and a higher average number of days of good health within the prior month for both years. Three-year longitudinal analyses indicated a significantly more favorable survey response trend for the treatment group for nearly all measures of health and ADLs. Members who exercised less frequently had poorer health and functioning. Overall, participation in the SilverSneakers program was associated with more favorable overall physical and social/emotional health status and fewer activity impairments, suggesting that the provision of senior-oriented group fitness programs may be a valuable approach to improve quality of life and reduce the burden associated with declining health and functioning as older adults age.
Collapse
Affiliation(s)
- Brent Hamar
- Center for Health Research, Healthways, Inc. , Franklin, Tennessee
| | | | | | | |
Collapse
|
34
|
Physical Activity and Health Service Utilization Among Older People. J Am Med Dir Assoc 2013; 14:125-9. [DOI: 10.1016/j.jamda.2012.10.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/20/2022]
|
35
|
Best Practice Physical Activity Programs for Older Adults and ADL/IADL Performance. TOPICS IN GERIATRIC REHABILITATION 2013. [DOI: 10.1097/tgr.0b013e3182780813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
36
|
Doba N, Tokuda Y, Goldstein NE, Kushiro T, Hinohara S. A pilot trial to predict frailty syndrome: the Japanese Health Research Volunteer Study. Exp Gerontol 2012; 47:638-43. [PMID: 22664579 DOI: 10.1016/j.exger.2012.05.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/19/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
Most definitions of frailty utilize US populations in their development. The concept of frailty has not been well studied in Japan, which has the largest percentage of older patients (per capita) in the world. We created a 5-year prospective cohort study of community-dwelling older Japanese adults. Participants were not frail at baseline, based on our definition adapted from the Canadian Study for Health and Aging Clinical Frailty Scale. Participants underwent a comprehensive geriatric assessment (CGA) at baseline, and final assessments were either in person or via mailed survey. We enrolled 407 individuals (184 men, mean age 78 ± 4 years; 223 women, mean age 77 ± 4 years). Sixty-five participants met criteria for frailty by the end of the study. In univariate analyses, eighteen separate parameters were associated with frailty, some of which included: age, gender, handgrip, timed walk, systolic blood pressure, pulse pressure, cognitive status, living alone, and hearing deficits. In multivariate analyses, the following elements remained associated with frailty: timed walk, pulse pressure, cognition deficits and hearing deficits. We established cut-off points for timed walk (5m/3s) and pulse pressure (60 mmHg). We then created a simple additive score for these four factors (present = 1; absent = 0). A score of 0 had a 93% negative predictive value for frailty while a score of 4 had a 70% positive predictive value. While further study is needed, this work creates an easy-to-administer tool that may be generalizable to other populations.
Collapse
Affiliation(s)
- Nobutaka Doba
- Division of Research and Education, Life Planning Center Foundation, Sasakawa Kinen Kaikan, Eleventh Floor, 12-12, Mita 3-chome, Minato-ku, Tokyo, 108-0073, Japan.
| | | | | | | | | |
Collapse
|
37
|
Wolfenstetter SB, Wenig CM. Costing of physical activity programmes in primary prevention: a review of the literature. HEALTH ECONOMICS REVIEW 2011; 1:17. [PMID: 22827967 PMCID: PMC3402935 DOI: 10.1186/2191-1991-1-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/26/2011] [Indexed: 05/07/2023]
Abstract
This literature review aims to analyse the costing methodology in economic analyses of primary preventive physical activity programmes. It demonstrates the usability of a recently published theoretical framework in practice, and may serve as a guide for future economic evaluation studies and for decision making.A comprehensive literature search was conducted to identify all relevant studies published before December 2009. All studies were analysed regarding their key economic findings and their costing methodology.In summary, 18 international economic analyses of primary preventive physical activity programmes were identified. Many of these studies conclude that the investigated intervention provides good value for money compared with alternatives (no intervention, usual care or different programme) or is even cost-saving. Although most studies did provide a description of the cost of the intervention programme, methodological details were often not displayed, and savings resulting from the health effects of the intervention were not always included sufficiently.This review shows the different costing methodologies used in the current health economic literature and compares them with a theoretical framework. The high variability regarding the costs assessment and the lack of transparency concerning the methods limits the comparability of the results, which points out the need for a handy minimal dataset of cost assessment.
Collapse
Affiliation(s)
- Silke B Wolfenstetter
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Christina M Wenig
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Institute of Health Economics and Health Care Management and Munich Center of Health Sciences, Ludwigstr. 28 RG, 80539 Munich, Germany
| |
Collapse
|
38
|
Sari N. Exercise, physical activity and healthcare utilization: A review of literature for older adults. Maturitas 2011; 70:285-9. [PMID: 21924847 DOI: 10.1016/j.maturitas.2011.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/22/2011] [Indexed: 11/29/2022]
Abstract
The impacts of exercise and physical activity on healthcare utilization of older adults have been studied using either (1) clinical trials or retrospective cohort studies focusing on older people who participated in various exercise intervention programs, or (2) survey data. This review focuses on both streams of studies, which cover the topic for adults aged 65 and older. The paper reviews the literature on physical activity and its implications for healthcare system, and discusses potential directions for future research by highlighting the limitations of the existing studies. Although there are significant variations in samples and methods used, both streams of reviewed literature provide evidence that physical activity leads to lower utilization of healthcare services. Given differences in methods and samples in these studies, estimated effect of physical activity on healthcare utilization shows significant variation from one study to another. These results, therefore, cannot be generalized to justify population wide exercise intervention programs for older adults. Additional studies are needed to provide more robust estimates for the effects of exercise, and to examine the feasibility of population wide policies that aim to encourage participation of older adults in physical activity.
Collapse
Affiliation(s)
- Nazmi Sari
- University of Saskatchewan, Department of Economics & SPHERU, 9 Campus Drive, Saskatoon SK S7N 5A5, Canada.
| |
Collapse
|
39
|
Rosenberg DE, Bombardier CH, Hoffman JM, Belza B. Physical activity among persons aging with mobility disabilities: shaping a research agenda. J Aging Res 2011; 2011:708510. [PMID: 21748010 PMCID: PMC3124953 DOI: 10.4061/2011/708510] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/17/2011] [Indexed: 11/20/2022] Open
Abstract
With the aging of the baby boomer population and their accompanying burden of disease, future disability rates are expected to increase. This paper summarizes the state of the evidence regarding physical activity and aging for individuals with mobility disability and proposes a healthy aging research agenda for this population. Using a previously published framework, we present evidence in order to compile research recommendations in four areas focusing on older adults with mobility disability: (1) prevalence of physical activity, (2) health benefits of physical activity, (3) correlates of physical activity participation, and, (4) promising physical activity intervention strategies. Overall, findings show a dearth of research examining physical activity health benefits, correlates (demographic, psychological, social, and built environment), and interventions among persons aging with mobility disability. Further research is warranted.
Collapse
Affiliation(s)
- Dori E. Rosenberg
- Harborview Medical Center, Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Charles H. Bombardier
- Harborview Medical Center, Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, WA 98195, USA
- School of Public Health, University of Washington, Seattle, WA 98195, USA
- Coordinating Center, CDC Healthy Aging Research Network, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
40
|
Coberley C, Rula EY, Pope JE. Effectiveness of health and wellness initiatives for seniors. Popul Health Manag 2011; 14 Suppl 1:S45-50. [PMID: 21323620 DOI: 10.1089/pop.2010.0072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Given the increasing prevalence of obesity and lifestyle-related chronic diseases in the United States and abroad, senior wellness initiatives have emerged as a means to stem the troubling trends that threaten the well-being and the economy of many nations. Seniors are an important demographic for such programs because this age group is growing, both as a proportion of the overall population and as a contributor to health care cost escalation. The goal of senior wellness programs is to improve the overall health of seniors through a variety of approaches, including increased physical activity, better nutrition, smoking cessation, and support of other healthy behaviors. Outcome metrics of particular interest are the effects of participation in these programs on health care utilization and expenditures. This review describes several studies that demonstrate reduced inpatient admissions and health care costs, as well as improved health-related quality of life as a direct result of participation in large-scale senior wellness programs. Programs that effectively engage seniors in, and change behavior as a direct result of, participation provide strong evidence that health improvements and decreased health care expenditures can be achieved. However, solutions to the challenges of broader enrollment and sustained participation in these programs would increase the impact of their outcomes and health-related benefits.
Collapse
Affiliation(s)
- Carter Coberley
- Center for Health Research, Healthways, Inc., Franklin, Tennessee 37067, USA
| | | | | |
Collapse
|
41
|
|
42
|
Williams B, Diehr P, LoGerfo J. Evaluating a preventive services index to adjust for healthy behaviors in observational studies of older adults. Prev Chronic Dis 2010; 7:A110. [PMID: 20712937 PMCID: PMC2938404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Analysis of outcome measures from nonrandomized, observational studies of people participating or not participating in health programs may be suspect because of selection bias. For example, fitness programs may preferentially enroll people who are already committed to healthy lifestyles, including use of preventive services. Some of our earlier studies have attempted to account for this potential bias by including an ad hoc preventive services index created from the patient's number of earlier clinical preventive services, to adjust for health-seeking behaviors. However, this index has not been validated. We formally evaluated the performance of this preventive services index by comparing it with its component parts and with an alternative index derived from principal component analysis by using the weighted sums of the principal components. METHODS We used data from a cohort of 38,046 older adults. We used the following variables from the administrative database of a health maintenance organization to create this index: fecal occult blood test, flexible sigmoidoscopy, screening mammogram, prostate cancer screening, influenza vaccination, pneumococcal vaccination, and preventive care office visits. RESULTS The preventive services index was positively correlated with each of the following components: colon cancer screening (r = .752), screening mammogram (r = .559), prostate cancer screening (r = .592), influenza vaccination (r = .844), pneumococcal vaccination (r = .487), and preventive care office visits (r = .737). An alternative preventive services index, created by using principal component analysis, had similar performance. CONCLUSION A preventive services index created by using administrative data has good face validity and construct validity and can be used to partially adjust for selection bias in observational studies of cost and use outcomes.
Collapse
Affiliation(s)
- Barbara Williams
- Health Promotion Research Center, School of Public Health, University of Washington
| | - Paula Diehr
- University of Washington, Seattle, Washington
| | | |
Collapse
|
43
|
Abstract
Economical burden for the individuals and for the national budgets of chronic cardio-vasculo-metabolic diseases is high and is rapidly increasing. Costs of treatments and prevention are very different in countries of diverse culture, ethnicity, social-economical situations, but prevention with healthy foods and with adequate physical activity are cheaper than medicines anywhere in the world. A great couple of studies approved cost-effectiveness of interventions directed to the change of life style factors. Cheaper is to influence the whole, yet healthy population, but interventions on people with high risk are more target-specific and usually more expensive. Enhanced physical activity (minimum 30 minutes five times per week with low-medium intensity, plus resistance exercises for maintain the muscle mass and force, plus stretching and calisthenics to maintain joints motility) can be promoted by few hundred-few ten hundred euros or dollars. Price of gain in Quality/Disability-Adjusted Life Years expressed as Incremental Cost Effectiveness/Utility Ratio is known, estimated or modelled, and offers a good value of money.
Collapse
Affiliation(s)
- Péter Apor
- Semmelweis Egyetem Testnevelés és Sporttudományi Kara, Budapest, Apor-Med Bt. p.apor.md@freemail
| |
Collapse
|
44
|
Brady TJ, Jernick SL, Hootman JM, Sniezek JE. Public health interventions for arthritis: expanding the toolbox of evidence-based interventions. J Womens Health (Larchmt) 2010; 18:1905-17. [PMID: 20044851 DOI: 10.1089/jwh.2009.1571] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Since 1999, the Centers for Disease Control and Prevention's (CDC) Arthritis Program has worked to improve the quality of life for people with arthritis, in part by funding state health departments to disseminate physical activity (PA) and self-management education (SME) interventions. Initially, only one SME and two PA interventions were considered evidence-based and appropriate for people with arthritis. The purposes of this article are to describe the processes and criteria used to screen new or existing intervention programs and report the results of that screening, including an updated list of recommended intervention programs. METHODS A series of three sets of screening criteria was created in consultation with subject matter experts: arthritis appropriateness, adequacy of the evidence base, and implementability as a public health intervention. Screening interventions were categorized as Recommended, Promising Practices, Watch List, Future Possibility, or Unlikely to Meet criteria based on how well the intervention met the screening criteria. RESULTS A total of 15 packaged PA interventions and six SME interventions were screened. Three PA and three SME interventions met all three sets of criteria and were added to the list of recommended public health interventions for use by CDC-funded state arthritis programs. An additional two SME interventions are developing the infrastructure for public health dissemination and were categorized as Promising Practices, and six PA interventions have evaluations underway and are on the Watch List. CONCLUSIONS The CDC Arthritis Program identified arthritis-appropriate interventions that can be used effectively and efficiently in public health settings to improve the quality of life of people with arthritis. The screening criteria used offer a guide to intervention developers on necessary characteristics of interventions for use in public health settings. The expanded menu of interventions is beneficial to clinical care and public health professionals and, ultimately, to people with arthritis.
Collapse
Affiliation(s)
- Teresa J Brady
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | | | | | |
Collapse
|
45
|
Mayer C, Williams B, Wagner EH, LoGerfo JP, Cheadle A, Phelan EA. Health care costs and participation in a community-based health promotion program for older adults. Prev Chronic Dis 2010; 7:A38. [PMID: 20158966 PMCID: PMC2831792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION EnhanceWellness (EW) is a community-based health promotion program that helps prevent disabilities and improves health and functioning in older adults. A previous randomized controlled trial demonstrated a decrease in inpatient use for EW participants but did not evaluate health care costs. We assessed the effect of EW participation on health care costs. METHODS We performed a retrospective cohort study in King County, Washington. Enrollees in Group Health Cooperative (GHC), a mixed-model health maintenance organization, who were aged 65 years or older and who participated in EW from 1998 through 2005 were matched 1:3 by age and sex to GHC enrollees who did not participate in EW. We matched 218 EW participants by age and sex to 654 nonparticipants. Participants were evaluated for 1 year after the date they began the program. The primary outcome was total health care costs; secondary outcomes were inpatient costs, primary care costs, percentage of hospitalizations, and number of hospital days. We compared postintervention outcomes between EW participants and nonparticipants by using linear regression. Results were adjusted for prior year costs (or health care use), comorbidity, and preventive health care-seeking behaviors. RESULTS Mean age of participants and nonparticipants was 79 years, and 72% of participants and nonparticipants were female. Adjusted total costs in the year following the index date were $582 lower among EW participants than nonparticipants, but this difference was not significant. CONCLUSION Although EW participation demonstrated health benefits, participation does not appear to result in significant health care cost savings among people receiving health care through a health maintenance organization.
Collapse
Affiliation(s)
- Charles Mayer
- University of Washington Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington Department of Family Medicine, Seattle
| | | | | | - James P. LoGerfo
- University of Washington Departments of Medicine and Global Health, Seattle, Washington
| | - Allen Cheadle
- University of Washington Health Promotion Research Center, Seattle, Washington
| | - Elizabeth A. Phelan
- University of Washington Health Promotion Research Center and University of Washington, Seattle, Washington
| |
Collapse
|
46
|
Pai CW, Mullin J, Payne GM, Love J, O'Connell G, Edington DW. Factors Associated with Incidental Sickness Absence among Employees in One Health Care System. Am J Health Promot 2009; 24:37-48. [DOI: 10.4278/ajhp.081117-quan-286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Assess the association of taking incidental sickness absence with health risks and health status. Design. Observational. Setting. One Midwest health care system. Subjects. Individuals who were employed for 2 years (2006–2007) and had completed at least one health risk appraisal (HRA) in 2007 (N = 3790). Measures. Outcomes were any incidental sickness absence and absence duration in 2007 measured by an absence tracking system. Health risks and health status were estimated by HRAs. Program participation was captured using 7-year HRA data and 5-year wellness data. Analysis. Multivariate, binary logistic regression for the probability of taking any absence day among the overall population as well as four demographic subgroups; proportional odds model for the probability of taking more absence days. Results. Different patterns were observed in association with taking incidental sickness absence among age and gender subgroups. Among the overall population, three health risks (smoking overweight, and use of medication for relaxation) were positively associated with taking absence (at least p <. 05 for all three health risks). Participation in a wellness program for more years was also associated with a less likelihood of taking absence (odds ratio, .72; p = .002). Results from the proportional odds model were consistent with results from the binary logistic regression. Conclusion. Sickness absence is an important productivity concern of employers. Employers may implement early interventions to focus on preventable causes. Special interventions may target absence-causing risks such as smoking behavior and excess body weight. Study limitation includes a lack of measures for psychosocial work environment.
Collapse
Affiliation(s)
- Chih-Wen Pai
- Chih-Wen Pai, PhD, and Dee W. Edington, PhD, are with the Health Management Research Center, University of Michigan, Ann Arbor. John Mullin, PhD; Gina M. Payne, PhD; Jeaneeta Love, RN, MBA; and Gayle O'Connell, MS, are with Saint Luke's Health System, Kansas City, Missouri
| | - John Mullin
- Chih-Wen Pai, PhD, and Dee W. Edington, PhD, are with the Health Management Research Center, University of Michigan, Ann Arbor. John Mullin, PhD; Gina M. Payne, PhD; Jeaneeta Love, RN, MBA; and Gayle O'Connell, MS, are with Saint Luke's Health System, Kansas City, Missouri
| | - Gina M. Payne
- Chih-Wen Pai, PhD, and Dee W. Edington, PhD, are with the Health Management Research Center, University of Michigan, Ann Arbor. John Mullin, PhD; Gina M. Payne, PhD; Jeaneeta Love, RN, MBA; and Gayle O'Connell, MS, are with Saint Luke's Health System, Kansas City, Missouri
| | - Jeaneeta Love
- Chih-Wen Pai, PhD, and Dee W. Edington, PhD, are with the Health Management Research Center, University of Michigan, Ann Arbor. John Mullin, PhD; Gina M. Payne, PhD; Jeaneeta Love, RN, MBA; and Gayle O'Connell, MS, are with Saint Luke's Health System, Kansas City, Missouri
| | - Gayle O'Connell
- Chih-Wen Pai, PhD, and Dee W. Edington, PhD, are with the Health Management Research Center, University of Michigan, Ann Arbor. John Mullin, PhD; Gina M. Payne, PhD; Jeaneeta Love, RN, MBA; and Gayle O'Connell, MS, are with Saint Luke's Health System, Kansas City, Missouri
| | - Dee W. Edington
- Chih-Wen Pai, PhD, and Dee W. Edington, PhD, are with the Health Management Research Center, University of Michigan, Ann Arbor. John Mullin, PhD; Gina M. Payne, PhD; Jeaneeta Love, RN, MBA; and Gayle O'Connell, MS, are with Saint Luke's Health System, Kansas City, Missouri
| |
Collapse
|