Administration On Aging Research Articles

Advancing Community-Based Falls Prevention Programs for Older Adults-The Work of the Administration for Community Living/Administration on Aging.

The mission of the Administration for Community Living (ACL) is to maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers. In direct alignment with this mission is ACL’s support of evidence-based falls prevention programs in communities throughout the United States. Since 2014, the Administration on Aging (AoA), part of ACL, has invested nearly $14 million in entities such as state agencies, nonprofits, and universities to expand access to proven community-based falls prevention programs. The initiatives supported by ACL/AoA bring to bear two primary goals—(1) to significantly increase the number of older adults and older adults with disabilities at risk for falls who participate in evidence-based community programs to reduce falls and falls risks; and (2) to implement innovative funding arrangements, including contracts, partnerships, and collaborations with one or more sustainability partners to support these programs during and beyond the grant period. Support from ACL/AoA has significantly increased the availability of evidence-based falls prevention programs in funded communities, as well as enhanced the network’s sustainable delivery infrastructure to promote continued access to these critical programs beyond the scope of grant funding. This article highlights the successful rollout of ACL/AoA’s falls prevention initiative.

Animal assisted therapy for elderly residents of a skilled nursing facility

There is a growing population of those with dementia and other cognitive impairments that affect the quality of life. This is attributed to advances in science, technology and medicine leading to reductions in maternal mortality, infectious and parasitic diseases, occupational safety measures, and improvements in nutrition and education of the global population. According to the Administration on Aging (AoA), an agency of the U.S. Department of Health and Human Services in 2000, approximately 605 million people were 60 years or older. By 2050, that number is expected to be close to 2 billion. Animal assisted therapy (AAT) has been used as a therapeutic activity among the elderly to help improve well being and quality of life, but there has been limited research to demonstrate its effectiveness among those with dementia. The purpose of this study was to compare the effectiveness of AAT versus human interaction only on social behaviors and engagement among elderly patients with dementia in long-term care facility. Following random assignment to groups, the participants experienced two visits per week over a two-week time period of either animal therapy visits or human interaction visits. One week with no activities then followed then with alternate animal therapy and human interaction visits. The human interaction visits consisted of conversation and reading from and looking at pictures in a newspaper. During animal visits, participants were encouraged to touch, pet, brush, and talk to the dogs. In this study, AAT increased positive social behaviors resulting in fewer incidents requiring staff intervention. AAT coincides with current goals in long-term care settings - improving and enhancing socialization behaviors among older adults with dementia.

Nourishing Boomers and Beyond Reaches 50-Plus Year Olds with Health-Related Information

Objective: ‘‘Nourishing Boomers and Beyond’’ aims to improve participants’ dietary choices and physical activity, improve health literacy and use of technology, and build audience for Extension programs. Target Audience: Adults ages 50 and older participated in the program. Theory, Prior Research, Rationale: Informed by social cognitive theory, the curriculum uses education and environmental support to promote behavior change. Description: According to theU.S. Administration onAging (2013), thenumber of adults aged 65 andolderwill double to more than 70 million by 2030, which will place increasing demands on the nation’s healthcare system. Using traditional face-to-face classes by Extension field staff supplemented with technology-based delivery of healthrelated information, the 10 monthly lessons are based on body systems (muscles, heart, bones, brain, eyes, etc.). The program includes a website www.ndsu.edu/boomers with a monthly theme, a daily Facebook page post, Pinterest pins, online modules, and a monthly e-newsletter. Evaluation: Surveysand technology tools areused todetermineprogrameffectiveness.Of thosewhocompleted thesurvey for ‘‘Nourish Your Eyes’’ (n1⁄4275), 48% had participated in the ‘‘nourishyourmuscles’’ class and55%hadparticipated in the ‘‘nourish your heart’’ class. About 98% indicated they learned something new, 95% planned to make a lifestyle change and 63% planned to try an eye-healthy food they had never tried previously. About 32% of the attendees used Facebook. Technology results were analyzed usingGoogle Analytics. To date, the number of web page views has reached 18,682, with 1,468 ongoing users. Conclusions and Implications: Face-to-face education supplemented with technology-based information has promoted knowledge gain and behavior change. Funding: USDA, Grant #2013-46100-21467.

Community-based wellness and prevention programs: the role of medicare.

Community-based wellness and prevention programs: the role of medicare.

EnhanceFitness: A 20-Year Dissemination History.

EnhanceFitness: A 20-Year Dissemination History.

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

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

Improving Lives through Evidence-Based Health Promotion Programs: A National Priority.

Improving Lives through Evidence-Based Health Promotion Programs: A National Priority.

National dissemination of multiple evidence-based disease prevention programs: reach to vulnerable older adults.

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.

Research, practice, and policy perspectives on evidence-based programing for older adults.

Demographers warn us of the “gray tsunami” approaching our global doorstep (1). Researchers are called upon to document the extent to which the growing burden of chronic conditions impacts America’s aging population and examine the uptake and effectiveness of different intervention approaches for improving the health and well-being of older adults across settings and populations (2). Working in conjunction with researchers, practitioners are asked to develop, adopt, and adapt innovative evidence-based health promotion and disease management programing that can be broadly implemented, disseminated, and sustained as appropriate in community and clinical settings (3, 4). Building on a growing research base and inventory of treatment options, policy makers are charged with identifying and supporting needed care and services that can meet the Triple Aims of health reform (i.e., better health, better health care, and better value) (5, 6). This Research Topic on evidence-based programing for older adults reflects decades of progress by researchers, practitioners, aging service providers, and policy makers working together to understand how to help older adults achieve optimal health and well-being. Such efforts have transformed successful aging from a theoretical concept into an achievable goal (7, 8). The scientific roots of this Research Topic are many, but our (Ory and Smith) personal interest began with the evaluation of the Administration on Aging (AoA)’s national disease prevention initiatives introduced in the 2000s, which will be described in length later in this volume (9–11). With our colleagues in the Centers for Disease Control and Prevention (CDC)-funded Healthy Aging Research Network (12, 13), we began documenting the national roll-out of evidence-based programs for older adults.Wewere concernedwithmany issues: (1)whowere themajor stakeholders in this national effort?; (2) what programs were being offered and who they were reaching?; (3) what could we say about the fidelity, dissemination, and sustainability of different programs?; (4) what was known about the impact of different programs in different populations and settings?; and (5) what were the best strategies for advancing the evidence-based movement? As we explored these questions, we realized the need to look beyond single silos or perspectives to understand how researchers, program developers, and policy makers could work together more closely. Such collaborations are essential to develop, promote, and support evidence-based programing that reflects stakeholders’ perspectives and increases the likelihood of being embedded into existing structures. Ideally, evidence-based programs reflect a translation of testable research theories into key intervention elements that resonate with program adopters and intended participants.

Will Rest for the Weary Wear Everybody Out?

Will Rest for the Weary Wear Everybody Out?

The Impact of a National Strategy to Increase Physical Activity Among Older Adults on National Organizations

This study was designed to evaluate the impact of the National Blueprint (NB) on the policies, programs, and organizational culture of selected national organizations. The theoretical model selected to assess the impact of the NB on organizational behavior was Burke's system theory of organizational change. Three organizations, AARP, the American College of Sports Medicine (ACSM), and the Administration on Aging (AoA), were selected for the study. Two individuals in each of these organizations were selected for interview. Semistructured interviews and document reviews were used in the data-collection process. Findings showed that the publication and establishment of the NB resulted in changes in the operating procedures of AARP, ACSM, and AoA. The results were broadly consistent with Burke's system theory of organizational change. The publication of the NB was shown to affect the behavior of organizational leaders, organizational culture, policies, programs, and individual and organizational performance. The new information generated has increased our understanding of the impact of health campaigns on organizational behavior.

Administration on Aging

Administration on Aging

National Leadership Summit Promotes Consumer-Driven Options in LTC

National Leadership Summit Promotes Consumer-Driven Options in LTC

States Join HHS Campaign for LTC Planning

WASHINGTON — The U.S. Department of Health and Human Services recently announced a partnership with six states in a campaign to build awareness about the importance of planning for long-term care. The “Own Your Future” campaign will operate in Georgia, Massachusetts, Michigan, Nebraska, South Dakota, and Texas. The six these states are joining others where pilot programs have operated, including Arkansas, Idaho, Kansas, Maryland, Nevada, New Jersey, Rhode Island, Virginia, and Washington. Governors of the participating states will send letters to all households with residents between the ages of 45 and 65 to offer them a free long-term care planning kit. The kit includes information about Medicare and Medicaid, and about ways to plan and to assess long-term care insurance options. Nearly one-third of the kit is devoted to information on long-term care insurance, although other financing vehicles such as trusts, annuities, and reverse mortgages are briefly mentioned. The kit also addresses legal documents such as living wills and durable powers of attorney for health care, and gives details on what long-term care resources the community has to offer. The program is an effort of the Centers for Medicare and Medicaid Services (CMS), the Administration on Aging (AOA), and the Office of the Assistant Secretary for Planning and Evaluation. The educational campaign also has been undertaken in partnership with the National Governors Association. “Increased planning for long-term care is likely to increase people's ability to remain at home with better use of their own resources, and may also reduce pressures on public programs,” according to Assistant Secretary for Aging Josefina G. Carbonell. CMS will contribute $3 million to fund the National Clearinghouse for Long-Term Care Information, which supports expansion of the awareness campaign in additional states. It also has developed a Web site (www.ltcaware.info) to increase access to long-term care information.

Nursing Home Complaints

Long Term Care Ombudsman Complaint data from one state's 261 nursing homes are examined in the study. We assessed differences between male and female groups, including chiefly residents, but also ombudsmen, the residents' relatives or friends, administrators, legal representatives, and others regarding types and rates of complaints as reported in the Administration on Aging (AoA) major categories of: Resident Care, Resident Rights, Administration, Quality of Life and Complaints Not Against Facility. Proportionately, male residents lodged more complaints than females. Further, males complained more than females about Resident Rights violations and filed more Complaints Not Against Facility. Females lodged significantly more complaints about Care, Quality of Life and Administration. Thas males were more likely to report technical, impersonal, and legalistic issues, than females, who were more likely to express concerns about personal care and socio-emotional-environmental issues. Results yielded further evidence of gender differences in the patterns of resident complaints. Nursing home social workers are highlighted as agents in changing embedded stereotypes about residents and complaints.

The Value of a Gerontology Certificate

The Frank J. Manning Certificate Program in Gerontology at the University of Massachusetts Boston was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. The program was designed to implement concepts associated with productive aging theory and traditionally has targeted learners age 60 and older. Alumni representing classes from 1980 to 2001 were surveyed by phone to learn if the original program objectives still have relevance today and to document how alumni have utilized knowledge and skills attained in the program. Almost 80% (364) of surviving alumni completed interviews. Specifically, alumni were asked about their volunteer experiences, employment, and advocacy efforts within the aging network of programs and services, as well as the impact of their training on their own aging. About 3/4 of the alumni had volunteered with elders since completing the program, while 1/4 worked in the aging network. Additional outcomes support the notion of life-long learning with many alumni continuing their education beyond the certificate program. In addition, many alumni reported utilizing knowledge and skills in care-giving for family members and friends. This study will help document the value of certificate-level training in Gerontology for its students and for the communities they serve.

Aging: A Feminist Issue

Aging:A Feminist Issue Leni Marshall (bio) When Barbara Macdonald spoke on a plenary at the 1985 NWSA convention, she was angry! A pioneer in feminist aging studies, Macdonald described a four-year fight to get the topic of aging included in a plenary session. She took feminists to task when she asked, "Has it never occurred to those of you in Women's Studies, as you ignore the meaning and the politics of the lives of women beyond our reproductive years, that this is male thinking? Has it never occurred to you as you build feminist theory that ageism is a central feminist issue?" (21). Twenty years later, aging studies remains an emergent topic for scholars outside Women's Studies. Within NWSA, the topic's progress can be measured by two recent events. First, the NWSA governing council unanimously decided to focus an entire plenary on aging studies. Marilyn Hughes Gaston, Margaret Gullette, and Kathleen Woodward were selected to speak at the 2005 convention. Then, the NWSA Journal agreed to devote a special issue to aging studies. With these actions, the organizations' leadership has acknowledged the importance of aging studies, and its centrality to Women's Studies. As Women's Studies develops, it occurs to more and more of us that aging and ageism are important feminist issues. This is good news not only for those of us working in the field of aging studies, but also for those of us who are aging—that is, all of us. Each of us has confronted, or will eventually have to confront, the physical, psychological, social, and other changes that happen with time; all of us who live will eventually belong to the "Othered" category that is old age. Each day, more and more of us realize the eventuality of belonging to the "Othered" category that is old age. In the United States, 10,000 people turn 50 each day (Akers 2001). The U.S. Administration on Aging (AoA) data show that, in the year 2000, 12.4 percent of the U.S. population was over the age of 65. By 2030, the raw numbers will double, bringing the percentage to a projected 20 percent. People of color, who made up 17.2 percent of the over-65 population in 2002, are projected to be 26.4 percent of that population by 2030 (Administration on Aging 2003). The statistics can be overwhelming, but they are worth knowing. The AoA uses the term "elderly" to denote people over age 65; I could argue the term, but I co-opt it for the sake of brevity. Almost 17 percent of the elderly were near (6.4 percent) or below (10.4 percent) the poverty line: 8.3 percent of elderly whites, 23.8 percent of elderly blacks, and 21.4 percent of elderly Hispanics live below the poverty line (Administration on Aging 2003). That 10.4 percent is more than three and a half million people. Elderly people living alone are more likely to be poor than those living with families. Forty-one [End Page vii] percent of elderly women live alone (versus 18 percent for men). Elderly Hispanic women living alone had the highest poverty rate: 47.1 percent. More than half of the non-institutionalized elderly have some form of disability (Administration on Aging 2003). These data make it abundantly clear: aging is a feminist issue, one that women's studies scholars need to incorporate into their analyses. In a country in which the demographic bulge of aging continues to expand, the limited size and influence of aging studies' academic repertoire frustrates scholars of aging as much as those texts' contents illuminate and inspire. Since the 1973 publication of Simone de Beauvoir's The Coming of Age, reviewers have greeted feminist books on aging with words that emphasize the importance of the topic—and that reflect the larger social amnesia. A few examples: The Coming of Age was hailed as a text that "confronts a subject of universal public anguish and universal public silence" ("Five Significant Books" 1972). The back cover of Barbara Macdonald and Cynthia Rich's own text, Look Me in the Eye: Women, Aging, and Ageism (1983), shows...

Integrating Curriculum and Practice with Students and their Field Supervisors: Reflections on Spirituality and the Aging (Rosa) Model

Knowledge and sensitivity about diverse aging populations is a rapidly emerging area of interest in higher education. The next decades will see dramatic increases in the number of older adults in the United States (Administration on Aging (AOA), 2000). Recognizing and utilizing spiritual and religious traditions holds special significance when preparing students to serve older adult populations, as these are potential sources of strength, coping, and social support (Seeber, 1990). This paper describes the rationale and strategy for designing, implementing, and teaching students in the social science and health care fields to increase skills, expand knowledge, and deepen sensitivities about spirituality and religion when serving older adults and their families. The authors developed and delivered a teaching module for social work practicum students and their field instructors entitled Reflections on Spirituality and Aging (ROSA). This module may be adapted to other disciplines, (e.g., political science, criminal justice, nursing, public health, and education). The discussion includes an overview of the ROSA content and process as well as qualitative evaluation data of the module. Suggestions and considerations for use of this module in educational settings are provided.

Improving nutrition for American seniors: A new look at the Older Americans Act

When you think of 1965, what legislation comes to mind? For most of us who work in health care or nutrition policy, it is the Medicare law. However, the Older Americans Act (OAA) was also enacted that year. This landmark legislation paved the way for the establishment of the largest, longest-standing coordinated program of community and home-based preventive nutrition and related services to the nation’s elderly population. The OAA was first enacted out of concern for the health and well-being of America’s seniors, and it established the US Administration on Aging (AoA) with the intent of expanding opportunities for improving the health and enriching the lives of American citizens as they reach their elderly years. The OAA was last amended and reauthorized in 2000 and expires on October 1, 2005.

Texas Tech University Health Sciences Center School of Medicine.

Texas Tech University Health Sciences Center School of Medicine.