Fostering Healthy Aging through Evidence-Based Prevention Programs: Perspectives from the Administration for Community Living/Administration on Aging

Understanding the implementation and sustainability needs of evidence-based programs for racial and ethnic minoritized older adults in under-resourced communities with limited aging services

BACKGROUND

Evidence-based programs (EBPs) for older adults effectively improve health outcomes. However, there is a limited understanding of the unique needs of service providers as they consider adopting, implementing, and maintaining programs for older minority adults in low-income communities with limited aging services.

METHODS

We conducted semi-structured interviews with key informants of community-based organizations (CBOs) to understand implementation and sustainability needs of CBOs within four racial and ethnically diverse Los Angeles County geographic areas. We performed thematic analysis of interview transcripts.

RESULTS

Interviews were conducted with representatives from 25 senior-serving agencies providing aging-related EBPs. CBO representatives reported implementing EBPs in 8 domains: Falls Prevention (68%), Mental Health (64%), Caregiver Health (48%), Chronic Disease Management (48%), Diabetes Management (36%), Arthritis Management (28%), Physical Activity (24%), and Multiple Conditions Management (8%). Themes are presented using the six domains of the Bass and Judge framework for factors impacting successful and sustained EBP implementation. CBOs in low-income and diverse communities described unique challenges with tailoring interventions based on local community context (literacy, language), cultural context, and locally available resources (technology, safe community spaces, transportation) and faced resource-intensive administrative burdens through staff turnover, data collection, sustainable funding, and networking.

CONCLUSIONS

Serving racial and ethnic communities has unique challenges that require tailored approaches and additional resources to ensure equitable access to EBPs for all communities. We describe suggestions for enhancing the effective adoption of EBPs among service agencies in under-resourced and diverse aging communities serving populations with aging-related health disparities.

Aging Adults' Preferences for Wellness Program Activities and Delivery Characteristics: A Cross-Sectional Survey

BACKGROUND

Lifestyle wellness programs help prevent and manage chronic diseases, yet few are designed for aging adults.

PURPOSE

Identify characteristics associated with aging adults' preferences for wellness program activities and delivery characteristics.

SUBJECTS/METHODS

Cross-sectional, self-administered survey of a convenience sample of 386 adults aged ≥55 years. Logistic regression models identified characteristics influencing preferences.

RESULTS

Current healthy behaviors, gender, and age influenced many preferences, while BMI, multiple chronic conditions, self-rated general health status, and quality of life did not.

DISCUSSION

Incorporating aging adults' preferences for wellness programs will help design appealing and engaging programs.

Effects of Sequential Participation in Evidence-Based Health and Wellness Programs Among Older Adults

Background and Objectives

Evidence suggests participation in evidence-based programs by older adults is effective, yet most studies focus on participation in a single evidence-based program, leaving repeated participation insufficiently understood. We aimed to compare participation in multiple evidence-based programs (repeaters) versus a single evidence-based program (nonrepeaters).

Research Design and Methods

Secondary data analysis was conducted on pre–post longitudinal data targeting older adults participating in evidence-based program(s) in Texas (2013–2016). Surveys included sociodemographic and health-related indicators (e.g., self-rated health, health behaviors, and falls-risks). Mixed-effects models examined pre–post changes in health-related indicators.

Results

Of the 734 study-eligible participants, 145 (20%) participated in two or more evidence-based programs. The participants’ average age was 74 years, and the majority was female (80%), non-Hispanic White (79%), or lived in urban or large rural cities/towns (79%). At baseline, repeaters reported less depressive symptomology (p = .049), fewer chronic conditions (p = .048), and less concern of falling (p = .030) than nonrepeaters. Repeaters had better workshop attendance and completion rates (p < .001). Compared to nonrepeaters, repeaters showed significantly-better improvements in communication with physicians (p = .013).

Discussion and Implications

Study findings suggest potential benefits of participation in multiple evidence-based program workshops, but repeaters may have different health profiles than nonrepeaters in natural settings. Future evaluations should consider participants’ past participations in evidence-based programs. Further research is needed to build more comprehensive evidence about the incremental benefits of participation in multiple evidence-based programs.

Reaching diverse participants utilizing a diverse delivery infrastructure: a replication study

This replication study examines participant recruitment and program adoption aspects of disease self-management programs by delivery site types. Data were analyzed from 58,526 adults collected during a national dissemination of the Stanford suite of chronic disease self-management education programs spanning 45 states, the District of Columbia, and Puerto Rico. Participant data were analyzed using multinomial logistic regression to generate profiles by delivery site type. Profiles were created for the five leading delivery site types, which included senior centers or area agencies on aging, residential facilities, healthcare organizations, community or multi-purpose centers, and faith-based organizations. Significant variation in neighborhood characteristics (e.g., rurality, median household income, percent of the population age 65 years and older, percent of the population i.e., non-Hispanic white) and participant characteristics (e.g., age, sex, ethnicity, race, rurality) were observed by delivery site type. Study findings confirm that these evidence-based programs are capable of reaching large numbers of diverse participants through the aging services network. Given the importance of participant reach and program adoption to the success of translational research dissemination initiatives, these findings can assist program deliverers to create strategic plans to engage community partners to diversify their participant base.