This study is an examination of protective and risk factors associated with weekly physical activity and number of falls among oldest-old participants enrolled in A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model. Poisson mixed regression models were used to assess potential protective (falls efficacy and self-rated health) and risk (pain, fatigue, and health interference) factors for weekly physical activity and number of falls from baseline to post-intervention after controlling for sex, race/ethnicity, age, education, living alone, and number of chronic conditions. Weekly physical activity and number of falls improved significantly from baseline to post-intervention. Falls efficacy scores and self-rated health (as protectors) as well as fatigue, health interference scores, and pain (as risk factors) at baseline were significantly related to weekly physical activity and number of falls among oldest-old participants. Findings indicate that program elements of AMOB/VLL are effective in improving physical activity and reduce falls among the oldest-old population.

Sleep is increasingly important in public health because sleep problems are associated with multiple negative health and quality-of-life outcomes, especially among those with chronic conditions. While evidence-based self-management programs have been widely studied, little is known about their specific impacts on sleep. Using data from the National Study of Chronic Disease Self-Management Program (n = 1168), improvements in sleep problems were observed for all subgroups except men. More sleep problem reductions were observed among younger participants compared with their older counterparts. This study confirmed the value of self-management programs for ameliorating sleep problems across diverse participant groups.

The Fit & Strong! program is an evidence-based, multi-component program promoting physical activity among older adults, particularly those suffering from lower-extremity osteoarthritis. The primary purpose of the study is to examine if the Fit & Strong! program translated into a lay-leader model can produce comparable outcomes to the original program taught by physical therapists and/or certified exercise instructors. A single-group, pre-post study design was employed, and data were collected at the baseline (n = 136 participants) and the intervention conclusion (n = 71) with both baseline and post-intervention data. The measurements included socio-demographic information, health- and behavior-related information, and health-related quality of life. Various statistical tests were used for the program impact analysis and examination of the association between participant characteristics and program completion. As in the original study, there were statistically significant (p < 0.05) improvements in self-efficacy for exercise, aerobic capacity, joint stiffness, level of energy, and amount and intensity of physical activities. The odds of completing the program were significantly lower for the participants from rural areas and those having multiple chronic conditions. Successful adaptation of the Fit & Strong! program to a lay-leader model can increase the likelihood of program dissemination by broadening the selection pool of instructors and, hence, reducing the potential issue of resource limitation. However, high program attrition rates (54.1%) emphasize the importance of adopting evidence-based strategies for improving the retention of the participants from rural areas and those with multiple chronic conditions.

Using the national dissemination of Chronic Disease Self-Management Education (CDSME) programs, the purposes of this study were to (1) document intervention attendance rates as related to the number of participants enrolled in the workshop and (2) compare the relationship between workshop attendance and workshop size by delivery site rurality and type. Data were analyzed from the first 100,000 middle-aged and older adults who participated in CDSME workshops spanning 45 states, Puerto Rico, and the District of Columbia as part of the American Recovery and Reinvestment Act of 2009 Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. Descriptive statistics are reported for all participants, then separately by each delivery site type. Ratios between the number of workshop participants and the number of workshop sessions attended were calculated and graphed based on the rurality of delivery and separately for the leading five delivery site types. Associations between the number of workshop participants and the number of sessions attended differed by delivery site rurality and type. Findings have implications for participant retention and workshop delivery costs, which can assist program deliverers to strategically plan implementation efforts in their areas.

Background

Functional decline is a primary risk factor for institutionalization and mortality among older adults. Although community-based fall risk reduction programs have been widely disseminated, little is known about their impact on gait speed, a key indicator of functional performance. Changes in functional performance between baseline and post-intervention were examined by means of timed up and go (TUG), a standardized functional assessment test administered to participants enrolled in A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model, an evidence-based fall risk reduction program.

Methods

This study included 71 participants enrolled in an AMOB/VLL program in the Brazos Valley and South Plain regions of Texas. Paired t-tests were employed to assess program effects on gait speed at baseline and post-intervention for all participants and by subgroups of age, sex, living status, delivery sites, and self-rated health. The Bonferroni correction was applied to adjust inflated Type I error rate associated with performing multiple t-tests, for which p-values <0.0042 (i.e., 0.5/12 comparisons) were deemed statistically significant.

Results

Overall, gait speed of enrolled participants improved from baseline to post-intervention (t = 3.22, p = 0.002). Significant changes in TUG scores were observed among participants who lived with others (t = 4.45, p < 0.001), rated their health as excellent, very good, or good (t = 3.05, p = 0.003), and attended program workshops at senior centers (t = 3.52, p = 0.003).

Conclusion

Findings suggest community-based fall risk reduction programs can improve gait speed for older adults. More translational research is needed to understand factors related to the effectiveness of fall risk reduction programs in various populations and settings.

Background

It is estimated one in two adults age 80 and over fall each year, resulting in substantial morbidity and mortality rates among this oldest-old population. The Otago Exercise program (OEP) is an evidence-based fall prevention program shown to reduce falls by 35% among high-risk older adults. The OEP was designed to be delivered in the home by physical therapists. This model has encountered multiple implementation challenges in the United States health-care system, which has resulted in the development and testing of innovative models to support a broader reach and dissemination of this program.

Methods

The Northwest Senior and Disability Services is an Area Agency on Aging (AAA) serving a five-county region in Oregon. This AAA developed a model where a Certified Occupational Therapy Assistant (COTA) and exercise physiologist delivered the OEP with a physical therapist available to consult on all cases. Physical function assessments and self-reported perceptions about physical function were collected at baseline and 6 months.

Results

Baseline measures were collected on 239 participants enrolled in the OEP, and 62 participants at 6 months. Those who completed 6 months of the OEP demonstrated significant improvements in all physical function assessments and self-perceived functional improvements. A subset of this group that demonstrated improvements in the ability to rise from a chair also reported significantly fewer falls during the 6-month intervention.

Conclusion

Innovative models in which the OEP exercise sessions are delivered by non-physical therapists appear to be effective in improving physical performance measures and decreasing fall risk over a 6-month period. Because these models do not require a physical therapist, they may require fewer resources to implement. These findings have implications to inform implementation and dissemination strategies to bring the OEP to scale.

Background

The Otago Exercise Program (OEP) is an evidence-based fall prevention program delivered by a physical therapist in 6 visits over a year. Despite documented effectiveness, there has been limited adoption of the OEP by physical therapists in the United States. To facilitate dissemination, 2 models have been developed: (1) the US OEP provided by a physical therapist or physical therapist assistant in the home or outpatient setting and (2) the community OEP provided by a non–physical therapist and a physical therapist consultant. It is unknown whether such modifications result in similar outcomes.

Objective

The aims of this study were to identify the components of these 2 models, to compare participant characteristics for those components reached by each model, and to examine outcome changes by model and between models.

Design

This was a translational cohort study with physical therapists implementing the US OEP and trained providers implementing the community OEP.

Methods

Data for physical performance, sociodemographic characteristics, and self-perception of function were collected at baseline and at 8 weeks.

Results

Participants in the community OEP were significantly younger and reported more falls compared with those in US OEP. Both sites reported significant improvements in most physical and self-reported measures of function, with larger effect sizes reported by the community OEP for the Timed “Up & Go” Test. There was no significant difference in improvements in outcome measures between sites.

Limitations

This was an evaluation of a translational research project with limited control over delivery processes. The sample was 96% white, which may limit application to a more diverse population.

Conclusion

Alternative, less expensive implementation models of the OEP can achieve results similar to those achieved with traditional methods, especially improvements in Timed “Up & Go” Test scores. The data suggest that the action of doing the exercises may be the essential element of the OEP, providing opportunities to develop and test new delivery models to ensure that the best outcomes are achieved by participants.

Objective

This study examined the applicability of the Stanford Chronic Disease Self-Management Program (CDSMP) for cancer survivors and compared outcomes among cancer survivors and participants with other chronic diseases (non-cancer survivors).

Methods

Participants were older adults (n = 1170) enrolled in the National Study of CDSMP. Detailed information about physical and psychosocial health status and health and healthcare behaviors was collected from participants (n = 116 cancer survivors and n = 1054 non-cancer survivors) via self-report before CDSMP participation and at 6-month and 12-month follow-ups. Linear and generalized linear mixed models were used to assess baseline-to-6-month and baseline-to-12-month changes.

Results

Among cancer survivors, general health, depression, and sleep significantly improved from baseline to 6 months. These significant changes were sustained at 12 months. Communication with physician, medication compliance, pain, days in poor physical health, days in poor mental health, and days kept from usual activities and physical activity also improved significantly from baseline to 12 months. Among non-cancer survivors, all outcomes except medication compliance and stress improved significantly from baseline to 6 months. At 12 months, medication compliance also improved significantly.

Conclusions

Findings suggest that participation in CDSMP, an evidence-based chronic disease self-management intervention not specifically tailored for cancer survivorship, may significantly improve physical and psychosocial health status and key health and healthcare behaviors among cancer survivors. Additional research is needed to elucidate cancer survivors' unique needs and examine the benefits of tailored versions of CDSMP. Nevertheless, CDSMP, available at scale nationally and internationally, is a promising intervention for cancer survivors and should be considered a valuable component of survivorship care.

Purpose. The aim of this exploratory study was to assess the efficacy of the "Wisdom, Power, Control" diabetes self-management education (DSME) program with regard to diabetes knowledge, self-efficacy, self-care, distress level, and A1C in an African-American population. Methods. A prospective, quasi-experimental, repeated-measure design was employed to measure these outcomes. Study participants were assessed at baseline, 6 weeks post-intervention, and at a 3-month A1C follow-up. Results. A total of 103 participants were recruited from the intervention counties, and 14 were identified from the control counties. At the post-test, participants in the intervention group reported a significantly higher level of diabetes knowledge (Δ = 9.2%, P <0.0001), higher self-efficacy (Δ = 0.60, P <0.0001), more self-care behaviors (Δ = 0.48, P <0.0001), lower distress level (Δ = -0.15, P = 0.05), and higher health status (Δ = 0.49, P = <0.0001). About 56% of the intervention group completed all six classes, and 25% attended five classes. Conclusions. Findings from this study demonstrate the initial success of translating a culturally adapted DSME program into rural African-American communities. The study highlights important lessons learned in the process of implementing this type of program in a real-world setting with a minority population.

Background

Among the most studied evidence-based programs, the Chronic Disease Self-Management Program (CDSMP) has been shown to help participants improve their health behaviors, health outcomes, and reduce healthcare utilization. However, there is a lack of information on how CDSMP, when nationally disseminated, impacts healthcare utilization and averts healthcare costs. The purposes of this study were to: 1) document reductions in healthcare utilization among national CDSMP participants; 2) calculate potential cost savings associated with emergency room (ER) visits and hospitalizations; and 3) extrapolate the cost savings estimation to the American adults.

Methods

The national study of CDSMP surveyed 1,170 community-dwelling CDSMP participants at baseline, 6 months, and 12 months from 22 organizations in 17 states. The procedure used to estimate potential cost savings included: 1) examining the pattern of healthcare utilization among CDSMP participants from self-reported healthcare utilization assessed at baseline, 6 months, and 12 months; 2) calculating age-adjusted average costs for persons using the 2010 Medical Expenditure Panel Survey; 3) calculating costs saved from reductions in healthcare utilization; 4) estimating per participant program costs; 5) computing potential cost savings by deducting program costs from estimated healthcare savings; and 6) extrapolating savings to national populations using Census data combined with national health statistics.

Results

Findings from analyses showed significant reductions in ER visits (5%) at both the 6-month and 12-month assessments as well as hospitalizations (3%) at 6 months among national CDSMP participants. This equates to potential net savings of $364 per participant and a national savings of $3.3 billion if 5% of adults with one or more chronic conditions were reached.

Conclusions

Findings emphasize the value of public health tertiary prevention interventions and the need for policies to support widespread adoption of CDSMP.