An Overview of Programs and Initiatives Sponsored by DHHS to Promote Healthy Aging: A Background Paper for the Blueprint on Aging for the 21st Century Technical Advisory Group (TAG) Meeting. APPENDIX A: Programs Designed to Translate Health Promotion and Disease Prevention Research into Practice and their Sponsors


Healthy Aging Project

Sponsors. The Centers for Medicare and Medicaid Services and Agency for Healthcare Research and Quality (AHRQ) jointly developed the Healthy Aging Project in collaboration with NIA, AoA, CDC, and the National Heart, Lung, and Blood Institute.

Background & Purpose. To identify, test, and disseminate evidence-based approaches to promote health and prevention functional decline in older adults.1 This project was designed to complement other DHHS initiatives, such as Healthy People 2010, and the U.S. Preventive Services Task Force. The Healthy Aging Project aims to review the available research science to identify what approaches are most effective for promoting health and preventing disease in older populations.

According to CMS, many health promotion and disease prevention programs have been shown to reduce risk factors and lower health care costs, but until now, these programs have not been evaluated for effectiveness in the Medicare population.2

Description. This project was launched in 1998 and is planned as a 5-year, $3.7-million project to identify and test interventions to reduce behavioral risk factors in the managed care and fee-for-service settings. Specifically, the Healthy Aging Project will examine whether health promotion interventions have a measurable impact on behavior change, health status, functional status, and quality of life, use of services, consumer satisfaction, or cost of care. An additional objective of the project is to identify ways to promote the use of Medicare clinical preventive services, such as flu shots, colorectal cancer screening, and mammograms.

CMS has contracted with RAND to produce reports that analyze the evidence on how to improve the delivery of Medicare clinical preventive and screening benefits and explore how behavioral risk factor reduction interventions, such as smoking cessation, might be implemented by the Medicare program. To date, three evidence reports have been completed. These include Interventions that Increase the Utilization of Medicare-Funded Preventive Services for Persons Aged 65 and Older, Interventions to Promote Smoking Cessation in the Medicare Population, and Health Risk Appraisals and Medicare. Reports that are currently being produced focus on the areas of chronic disease self-management, physical activity, and falls prevention.

The first evidence report, Interventions that Increase the Utilization of Medicare-Funded Preventive Services for Persons Aged 65 and Older, is a guide for providers and health care systems seeking to improve the use of influenza immunizations, pneumococcal vaccinations, mammography, Pap tests, and colon cancer screening. A major finding of this report is that organizational changes in health care delivery systems are effective in improving the delivery of preventive services. As a result of this report, CMS and CDC are collaborating on an organizational change project to increase influenza immunization rates. This project, entitled the Standing Orders Project, is being implemented by Medicare's quality improvement contractors, the Quality Improvement Organizations (QIOs).

The overall goal of the Standing Orders Project is to reduce the burden of vaccine-preventable diseases by improving influenza and pneumococcal vaccination coverage levels in LTC facilities. Immunization standing orders programs are policies and protocols that authorize nurses and pharmacists to administer vaccinations according to an approved protocol without the need for a physician's examination. Nine intervention states and five control states are currently piloting this initiative, and results are expected in late 2002.3

An evidence report on smoking cessation--Interventions to Promote Smoking Cessation in the Medicare Population--resulted from a systematic review of the scientific literature and identifies which interventions are most effective for older smokers. One of the findings was that multiple methods, including individual, group and telephone counseling, were effective in promoting smoking cessation. An additional finding was that patients whose physicians were trained in smoking cessation had higher cessation rates than those who visited untrained physicians. Another important result was that financial incentives, specifically health insurance coverage for counseling and pharmacotherapy, resulted in increased numbers of quitters.4

As a result of this evidence report, CMS, CDC, AoA, and the National Cancer Institute (NCI) collaborated on a demonstration project to test the effectiveness of Medicare smoking cessation benefits in seven states. The Medicare Stop Smoking Program is designed to compare the impact of offering three different types of benefits for smoking cessation services on quit rates. The three benefits being tested are reimbursement for provider counseling only, a quit smoking phone line with pharmacotherapy coverage, and usual care. Recruitment of smokers began in fall 2002, and the study is planned for completion in 2004. It is anticipated that the results of this demonstration project will be used to identify a potential new Medicare smoking cessation benefit.4

Similarly, in an effort to evaluate the potential effectiveness of health risk appraisal (HRA) as a health promotion tool and to provide evidence-based recommendations regarding the use of HRA in health promotion programs for older adults, those involved with the Healthy Aging Project recently commissioned a report--Health Risk Appraisals and Medicare. For the purpose of this report, HRA was defined as "a systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and possibly offers interventions to promote health, sustain function, and prevent disease."5

One key finding from this report was that effective HRA programs demonstrated beneficial effects on behavior, in particular on physical activity. (One caveat was noted, however, namely that there were few studies evaluating this approach, and they were of varying quality.) Another key finding was that HRA programs could have positive effects on physiological variables, such as blood pressure and weight, and on general health status. However, in order to be effective over time, the authors of this report found that HRA needed to be followed with specific interventions.

The report suggested that interventions combining HRA feedback with available health promotion programs would be most likely to be successful. Finally, the authors recommended that CMS conduct a Medicare demonstration to test the efficacy and cost-effectiveness of administering the HRA questionnaire with tailored feedback and regular follow-up in improving or maintaining the health of older persons.5

In response to the evidence report Health Risk Appraisals and Medicare, the Senior Risk Reduction Program Demonstration Project was enacted. CMS is taking the lead role in developing the Senior Risk Reduction Program, with the aim of "testing comprehensive and systematic approaches to identifying health risks and empowering Medicare beneficiaries to improve their health."6 This demonstration is designed to use an HRA to assess individual health risks such as smoking, lack of physical activity, poor nutrition, and avoidance of clinical preventive and screening services.

Results of the HRA will then be used to produce tailored information and recommendations on an ongoing basis. An ancillary aim of this project is to investigate the utility of novel, state-of-the-art message-tailoring methods, such as tailored interventions delivered via the Internet. The project also aims to act as a resource guide, connecting people to available programs and services in their communities. The Senior Risk Reduction Program is currently in the design stage, which is scheduled to last from September 2002 to November 2003.

The National Blueprint: Increasing Physical Activity Among Adults Aged 50 and Older

Sponsors. AARP, the American College of Sports Medicine, the American Geriatrics Society, CDC, NIA, and the Robert Wood Johnson Foundation, with contributions from 43 other organizations.

Background & Purpose. The aim of the National Blueprint is to use the clear evidence regarding the effectiveness of interventions to promote physical activity to support national action in this area. A major goal of the National Blueprint is to identify the principal barriers to physical activity among older adults and to outline strategies for increasing physical activity levels throughout the entire population. The National Blueprint report was developed as a guide for organizations, associations, and agencies to plan strategies to help people aged 50 and older increase their physical activity. The document was designed to extend the work begun by a technical expert working group that had previously met to discuss physical activity and mid-life among older adults.

Description. The National Blueprint report highlights several recommendations for overcoming barriers to physical activity among older adults, such as identifying the impact that activity-friendly communities can have on the quality of life for older adults and promoting such communities, designing health-impact assessments to help communities measure how well they serve the needs of their aging citizens, establishing tax incentives for employers who offer physical activity opportunities to their employees, requiring more training for health professionals on physical activity in older populations, and providing incentives to states and communities that increase physical activities among older adults.7

HealthierUS Initiative

Sponsor. HealthierUS is a White House initiative launched with the President's Executive Order 13266--Activities to Promote Personal Fitness on June 20, 2002. The Executive Order establishes a Personal Fitness Interagency Working Group, headed by DHHS, to provide a government-wide perspective on the efforts of federal agencies to improve the health and fitness of the American people and make recommendations for strengthening these activities.

The departments and agencies represented by the Personal Fitness Interagency Working Group include DHHS, the Department of Agriculture, Department of Interior, Department of Education, the Environmental Protection Agency, the Office of National Drug Control Policy, the Department of Defense, the Department of Labor, General Services Administration, and Veteran's Affairs.8

Background & Purpose. The goal of the HealthierUS initiative is to empower all Americans with the knowledge, motivation, and skills they need to make healthy choices and to improve government policies and services to help provide the American people with an environment that supports healthy choices. In addition, the initiative aims to increase collaboration among the federal government, states, communities, and the private sector to ensure that the American people receive health promotion and disease prevention services that are effective and efficient.8

Description. The Personal Fitness Interagency Working Group has prepared one White House report cataloging federal programs related to physical activity, nutrition, preventive screenings, and health promotion. Three subcommittees are currently at work on three interagency memorandums of understanding dealing with (1) employee health promotion, (2) public affairs, and (3) program coordination. Additionally, a HealthierUS website has been launched to bring together for the public the variety of government online resources related to personal fitness and health.9

Screen for Life: National Colorectal Cancer Action Campaign

Sponsor. CDC and CMS, with technical assistance provided by NCI.

Background & Purpose. Screen for Life: National Colorectal Cancer Action Campaign is a national campaign utilizing a multimedia approach to inform men and women aged 50 years and older about the importance of having regular colorectal cancer tests.10 The initiative was developed largely in response to the finding that colorectal screening rates were not significantly increasing despite the dissemination of research clearly showing their health benefits. This multiyear campaign was enacted in 1999.

The Screen for Life campaign's objectives are to inform the public about the benefits of colorectal cancer screening, motivate the target audience to talk with their health care providers to establish a colorectal cancer screening program, and promote Medicare's covered colorectal cancer screening benefits. To accomplish these objectives, the campaign developed multimedia materials to educate the public about the importance of screening.

Description. Campaign messages and materials were developed based upon an extensive review of existing communication and behavioral science literature and formative research, including information gathered from over 100 focus groups of men and women aged 50 years and older.

Prevention Research Centers

Sponsor. CDC.

Background & Purpose. First authorized by Congress in 1984, the CDC Prevention Research Centers are designed to involve community members, academic researchers, and public health agencies in study projects that attempt to find innovative ways of promoting health and preventing disease. There are currently 26 Prevention Research Centers associated with schools of public health, medicine, or osteopathy in the United States.

Each of the centers conducts research on underserved populations as well as special interest projects defined by the CDC and other agencies of DHHS. According to CDC, the Prevention Research Centers "serve as a national resource for developing effective prevention strategies and applying those strategies at the community level."11

Description. There are currently two Prevention Research Centers focusing on healthy aging, one at the University of Washington and the other at the University of Pittsburgh. Helping Seniors Stay Healthy and Active, a research program being conducted by the University of Washington in Seattle, involves the testing of strategies designed to help seniors (at senior centers, in managed care programs, and in other settings) to remain healthy and independent.

This project is designed to simultaneously produce scientific findings and provide meaningful benefits to the participating seniors. For instance, an ongoing intervention aimed at reducing minor depression is improving participants' physical and mental health while elucidating the most effective approaches, including counseling, social activities, and group exercise programs.

Promoting Health and Preventing Disease Among Older Adults at the University of Pittsburgh is a relatively new project, begun in 2001. The primary research question that will be guiding this center's work is "how can use of preventive care be increased among adults over 65 years of age?"

CDC Collaborations to Address Healthy Aging

In addition to funding research at the Prevention Research Centers, CDC is collaborating with numerous agencies and private partners to address healthy aging. For example, in collaboration with the School of Public Health at the University of Illinois-Chicago, CDC is sponsoring an Evidence-Based Review of Physical Activity Benefits for Older Adults with the purpose of reviewing and updating the scientific evidence on physical activity and older adults.12 Several other CDC-sponsored Prevention Research Center activities are highlighted below.

The Healthy Aging Network (HAN)

Sponsors. The CDC Prevention Research Centers' Healthy Aging Network (HAN) is a collaboration between CDC and seven of the funded Prevention Research Centers: University of Washington (lead center), University of North Carolina-Chapel Hill, University of South Carolina, University of Pittsburgh, University of California-Berkeley, University of Colorado, and the University of Illinois-Chicago.12

Purpose. HAN is designed to promote healthy aging and community-based prevention research focusing on older adult issues.

Description. The HAN has launched two national demonstration projects with a focus on physical activity. Members are currently collaborating on an in-depth, evidence-based review and statement of the role of public health in addressing physical activity for older adult populations. The HAN is also in the process of designing and implementing a HAN-wide survey of programmatic and environmental community-based physical activity opportunities for older adults across seven national sites, while collaborating with national organizations to identify best practices for physical activity programming. Additionally, HAN members are consulting with federal and state organizations working to establish local-level infrastructure for healthy aging.

Growing Stronger: Strength Training for Older Adults

Sponsors. CDC is funding and collaborating with the Tufts University Center for Physical Fitness.

Purpose. To develop, use, and evaluate low-cost training materials and programs that provide older adults with greater opportunities to strength train.

Description. Upon completion of the evaluation, the project will disseminate the materials and programs to health and aging agencies to promote resistance training in the home or in community settings.12

Training and Encouragement for Senior Activity (TESA) Project

Sponsors. The American Association for Active Lifestyles and Fitness (AAALF) and the National Senior Games Association (NSGA), with funding from CDC.

Purpose. The TESA project focuses on promoting physical activity for seniors. The project targets older adults who are contemplating participating in a physical activity program, but do not already do so.

Description. The project provides information on physical activity guidelines and provides strategies and encouragement for potential participants through a series of free, half-day workshops. The workshops cover issues such as motivation and goal-setting; muscular, aerobic, and flexibility training; nutrition; and safety. The Partners for Active Lifestyles (PALs) program complements the TESA workshops by pairing up currently active seniors with new workshop participants.13

The Older Adults Media Project

Sponsors. CDC has formed a partnership with the American Society on Aging (ASA), in cooperation with the Journalists Exchange on Aging (JEOA).

Purpose. The project's goals are threefold: (1) to highlight critical public health problems and to promote CDC's activities to prevent or remedy them, (2) to foster greater public awareness of national health issues that face the rapidly aging U.S. population, and (3) to inform members of the news and information media about key public health topics and issues.

Description. Activities conducted during the initial year included both a presentation about CDC's initiatives to protect the health of older people and an online computer-reporting workshop demonstrating CDC's surveillance systems at the Joint Conference of ASA and the National Council on the Aging (NCOA) in April 2002. The project also provided subsequent media outreach to journalists in the form of a media kit with in-depth background papers on the special topics presented. Topics covered last year included diabetes, falls prevention, and disability. During the current year, the topics of interest have included the West Nile virus, adult immunizations, diethylstilbestrol (DES), and physical activity for older adults. The project will culminate with a panel presentation at the 2003 ASA/NCOA joint conference.12

Spyglass on Aging: Tools for Journalists Covering Seniors

Sponsor. CDC's National Center for Chronic Disease Prevention and Health Promotion, Health Care and Aging Studies Branch.

Background & Purpose. This activity was designed to inform members of the news and information media about key issues and resources for reporting on health issues facing a rapidly aging U.S. population.

Description. Two workshops were provided for journalists at a joint conference of ASA and NCOA in March 2002, which led to the publication of several articles in local and national newspapers on topics presented by the CDC.14

U.S.A. on the Move: Steps to Healthy Aging

Sponsors. AoA and the National Policy and Resource Center on Nutrition and Aging at Florida International University.

Background & Purpose. U.S.A. on the Move: Steps to Healthy Aging is a two-part pilot project developed in response to the President's HealthierUS Initiative. It is designed to improve nutrition and physical activity among older adults.15

Description. The Steps to Healthy aging project is divided into two parts: Eating Better and Moving More. Eating Better is designed to promote healthier eating among older adults. Operating at the state level, this program collects healthy recipes and tips from participants in the Older Americans Nutrition Program. AoA and The National Policy and Resource Center will publish these recipes and tips in a Guide to Eating Better for wide distribution.

Moving More is modeled after Colorado on the Move,TM a statewide lifestyle initiative designed to improve health through increased physical activity. The Moving More project aims to increase walking among older adults and uses step counters to inspire adults to walk more. The National Policy and Resource Center will be collecting step data and input from state nutritionists and administrators over an 8-week period and will use the data to customize program goals. There is also a pilot step program operating at a senior center in Florida that will be reviewed for effectiveness. These activities will also result in a publication called a Guide to Moving More.

The Aging States Project

Sponsors. This project is sponsored by the Association of State and Territorial Chronic Disease Program Directors (ASTCDPD) and the National Association of State Units on Aging (NASUA), with support from the CDC and AoA.

Background & Purpose. The Aging States Project, initiated in 2001, is designed to identify ways in which public health and aging services can collaborate to better meet the needs of older adults. The project aims to systematically compile information on health-related needs, activities, and partnerships related to older adults.

Description. National health and aging organizations have joined together with federal and state government partners to integrate the expertise and capacity of both networks for the benefit of older persons.16 This project will result in the identification of opportunities for closer collaboration and the development of health promotion strategies that will assist older people today and in the future.16 The final product will be a compilation of health promotion and disease prevention activities currently in the field and a listing of recommendations for additional opportunities for collaboration between public health and aging services agencies in the future.17

NIA Behavioral Medicine and Interventions Program

Sponsor. NIA administers the Behavioral and Social Research Program.

Background & Purpose. The program "supports research, training, and the development of research resources and methodologies to produce a scientific knowledge base for maximizing active life and health expectancy."18

Description. The studies conducted within NIA's Behavioral and Social Research program examine the interrelationships among aging, health, and behavior processes. Topics of interest include both the individual processes of aging and behavior, and the role of the sociocultural environment on the development and maintenance of numerous health and illness behaviors. The Behavioral Medicine and Interventions unit currently funds research on disease recognition, coping, and management, including the physiological consequences of life stresses and burdens; and social, behavioral, and environmental interventions for health promotion, disease prevention, and disability postponement.18

Bilingual/Bicultural Service Demonstration Grant Program

Sponsor. DHHS Office of Minority Health.

Background & Purpose. To reduce barriers between providers and clients with limited English proficiency and to improve access to quality health care.

Description. The grants provide support to improve and expand the capacity and ability of health care providers and other health care professionals to deliver culturally competent health services to minority populations. Funded projects also serve to increase the minority populations' knowledge and understanding of managed care and its implications. Funded projects offer unique and appropriate activities to meet the needs of the target community. In 2002-2003, 12 projects specifically focus on older adults.19

Community Programs to Improve Minority Health Grants Program

Sponsor. DHHS Office of Minority Health.

Background & Purpose. To address at least one of the following primary health topics: cancer, cardiovascular disease, chemical dependency, diabetes, homicide, suicide and unintentional injuries, infant mortality, and HIV/AIDS. Individual projects are also asked to address issues such as access to health care, health professions personnel development, improved data collection analysis, and cultural competency.

Description. These DHHS-funded grants are administered by minority community-based organizations with established coalitions. In 2002, 12 coalitions specifically focused on older adult populations.19

Health Disparities in Minority Health Grants Program

Sponsor. DHHS Office of Minority Health.

Background & Purpose. To address health disparities in minority communities by funding activities by community-based, faith-based, and tribal organizations to reduce health risk behaviors and to improve access to health care.

Description. Three of the funded projects currently address the needs of older adults.19

Older Americans Act, Title IV Demonstration Projects

Sponsor. AoA.

Background & Purpose. To sponsor health promotion and disease prevention programs targeting older people of color.

Description. Currently, AoA funds five projects with the National Minority Aging Organizations that represent each of the four major populations of color: African-Americans, Hispanic-Americans, Asian Americans/Pacific Islanders, and Native Americans.16 The five grantees are Asociacion Nacional Pro Personas Mayores (California); National Caucus and Center for the Black Aged, Inc. (Ohio and Washington, DC); National Hispanic Council on Aging (TX and Washington, DC); National Asian Pacific Center on Aging (Seattle, WA); National Indian Council on Aging (New Mexico).

Project activities are being conducted in both urban and rural areas to provide health information at the community level on managing diabetes, preventing stroke and cardiovascular disease, preventing cancer, and promoting the use of immunizations.16 Of these five projects, the Asociacion Nacional includes a unique component that focuses on life cycle planning and health promotion.

Project REACH for the Elderly

Sponsor. AoA.

Background & Purpose. AoA is currently partnering with CDC to co-manage Project REACH for the Elderly (Racial and Ethnic Approaches to Community Health). Project REACH is now in Phase II, the third year of a 5-year project period.16 During Phase I, four local community coalitions were awarded planning grants to develop community action plans. Now, during Phase II, these four grantees are in the beginning stages of implementing unique health promotion and disease prevention strategies to reach older individuals of color.

Description. The four projects are Boston Public Health Commission (African descent) (Massachusetts); Latino Education Project (Hispanic) (Texas); Special Services for Groups, Inc. (Asian/Pacific Islanders) (California); and National Indian Council on Aging (American Indians) (New Mexico). Project REACH's health promotion strategies are focused on managing diabetes, preventing stroke and cardiovascular disease, preventing cancer, and promoting the use of immunizations.16

Project REACH is unique for its collaboration between two federal agencies to assist local communities in narrowing the gap in health disparities.16 This multiphase initiative is developing health promotion information that can be tailored and used by various populations. AoA and CDC believe that by cooperating on this initiative, a structured mechanism will be in place for local communities to build upon for future activities.

Surgeon General's Report on Osteoporosis and Bone Health

Sponsor. DHHS Surgeon General's Office.

Background & Purpose. To promote the development of strategies to increase bone health and reduce the impact of skeletal diseases. (Planned release: 2004)

Description. The report will include information on the prevention and control of diseases of the skeletal system and assess the current level of scientific consensus on issues related to the prevention and treatment of skeletal diseases. Ultimately, the document will serve as a guide to the development of health promotion programs aimed at improving bone health at the individual, community, county, state, and federal levels.19

Women Living Long and Living Well (WLLLW) Project

Sponsor. DHHS Office of Women's Health.

Background & Purpose. WLLLW aims (1) to promote women's health research and education and (2) to provide guidance to health promotion and health services providers about community needs and priorities and the health promotion approaches most likely to succeed at the community level. Although older women are not specifically being targeted for this initiative, women in all stages of life have been encouraged to participate.19

The project will report on women's health needs, identify gaps and priorities, and develop a framework that focuses on the two primary goals of the Healthy People 2010 national health agenda--improving the quality and years of life and eliminating health disparities.

Description. To develop the framework, the project synthesizes information provided from a series of focus groups and listening sessions conducted nationwide. To achieve the two primary goals, three pathways have been proposed: (1) improving chances for independent living through better access to, and coordination of, health care, services, and messages; (2) building networks of providers and communities to integrate prevention and treatment as well as mental and physical health care; and (3) enhancing the knowledge base through gender-based research and multidisciplinary collaboration. For each of the three pathways, cultural relevance, evaluation, and rapid implementation of the findings are key elements.

Participants in the listening sessions developed an understanding of the need for a holistic approach to women's health. Early education and self-esteem development were seen as key to the development and maintenance of positive health practices.

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